NICU Consult: Mucous Fistula refeeding in Infants with Short Bowel syndrome

A variety of congenital and acquired conditions of the gastrointestinal tract result is short bowel syndrome in infants. These include intestinal atresias, complicated meconium ileus, and necrotizing enterocolitis. Since the late 1990's it has been demonstrated in the literature that stimulation of the mucosal surface of the intestinal tract results in improved outcomes in terms of gut function. It is thought that refeeding helps with intestinal adaptation leading to improved peristalsis and mucosal growth. This technique requires a patent distal intestinal limb, however this limb is often of small caliber due to disuse. Refeeding of the proximal stomal effluent into the distal limb of the intestine via the mucous fistula often proves to be challenging for the nursing staff. Challenges include maintenance of catheter placement in the mucous fistula, accurate measurement of input of refeed contents into the distal limb, and protection of the peristomal skin. A small catheter is placed into the mucous fistula through a slit in the ostomy bag and a feeding pump helps to maintain a slow continuous feeding volume. This presentation will describe a creative technique to secure the refeeding catheter so successful and accurate refeeding of the distal limb can occur. Successful refeeding ofthe distal limb in the infant with short bowel syndrome contributes to gut adaptation and prepares the infant for successful ostomy takedown and contributes to postive patient outcomes.