Mucous Fistula Refeeding Reduces the Time From Enterostomy Closure to Full Enteral Feeds ("MUC-FIRE" Trial)
- Conditions
- Enterostomy
- Interventions
- Other: mucous fistula refeeding
- Registration Number
- NCT03469609
- Lead Sponsor
- University of Leipzig
- Brief Summary
The primary objective of this study is to demonstrate that mucous fistula refeeding between enterostomy creation and enterostomy closure reduces the time to full enteral feeds after enterostomy closure compared to standard of care.
- Detailed Description
Enterostomies in children may be created for different reasons. During the presence of an enterostomy the regular stool transfer is interrupted as the distal part of the bowel (the part following the enterostomy) does not participate in the circulation of stool. Therefore it does not contribute to the resorption of enteral contents. As a consequence these children need additional parenteral nutrition. Due to the negative side-effects of parenteral nutrition all patients should return to enteral nutrition as soon as possible. Consequently, many pediatric surgical centers worldwide routinely perform mucous fistula refeeding (MFR) into the former unused bowel after enterostomy creation because case reports and retrospective analyses show low complication rates and faster postoperative weight gain. Several providers, however, shy away from this approach because to date there is still no high quality evidence for the benefit of this Treatment.The aim of this study is to assess the effects of mucous fistula refeeding in a randomized, prospective trial. We hypothesize that MFR between enterostomy creation and enterostomy closure reduces the time to full enteral feeds after enterostomy closure compared to the group without refilling. Moreover, the side effects of parenteral nutrition may be reduced and the postoperative hospital care of infants undergoing ostomy closure shortened.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 120
- Infants < 366 days,
- Ileostomy / Jejunostomy,
- double loop enterostomies and split enterostomies (with mucous fistula)
- Signed written informed consent obtained by parents/legal guardians and willingness of parents/legal guardians to comply with treatment and follow-up procedures of their child
- resection of ileocecal valve,
- colostomy,
- small bowel atresia,
- multiple ostomies (more than just an enterostomy and a mucous fistula),
- chromosomal abnormalities (if known at the time of randomization),
- Hirschsprung's disease,
- participation in another drug-intervention study
- Intestinal perforation due to a hemodynamic heart defect
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Perioperative mucous fistula refeeding mucous fistula refeeding Perioperative mucous fistula refeeding between enterostomy creation and enterostomy closure
- Primary Outcome Measures
Name Time Method Time to full enteral feeds (hours) week 4 to week 12 daily Time to full feeds (hours), defined as time to actual enteral intake of the age-dependent caloric requirements per day (defined as 90 or 120kcal/kg/24h) for at least 24 hours and a concomitant reduction of parenteral fluids to \<20ml/kg/24h.
1. The nutrition aim is 120 kcal/kg/24h for premature infants with a birth weight \< 1000g or premature infants with a birth weight ≥ 1000g and mother's gestation week at birth before 37+0.
2. The nutrition aim is 90 kcal/kg/24h for born mature infants, mother's gestation week at birth at least 37+0.
- Secondary Outcome Measures
Name Time Method Assessment of serious adverse events (SAEs) Week 1 to week 12 daily, follow-up (month 3, 6, 12) Adverse events will be collected by the investigator either based on the information provided spontaneously by the parents of patient or evaluated by non-suggestive questions.
Sodium resorption Week 1 to week 12 daily, follow-up (month 3) Sodium in Urine (mmol/l)
Time to first bowel movement Week 4 to week 12 daily Cleaning and changing of infants diapers will be performed according to a fixed schedule in order to uniformly document the time to first bowel movement
Number of days of postoperative total parenteral nutrition (TPN) Week 2 to week 12 daily, follow-up (month 3, 6, 12) Calculation of days of postoperative TPN starts on the day of operation and ends on the day of full enteral nutrition
Assessment of adverse events (AEs) Week 1 to week 12 daily, follow-up (month 3, 6, 12) Adverse events will be collected by the investigator either based on the information provided spontaneously by the parents of patient or evaluated by non-suggestive questions.
Laboratory parameters Week 1 to week 12 daily, follow-up (month 3) Haemoglobin (g/dl)
Thriving Week 1 to week 12 daily; follow-up (month 3, 6, 12) Measurement of body weight
Postoperative weight gain (g/d) week 4 to week 12 Weight gain during the subsequent 5 days after reaching the primary endpoint following enterostomy closure
Status of liver enzymes Week 1 to week 12 daily, follow-up (month 3) Gamma-Glutamyltransferase (GGT) , Alanine-Aminotransferase (ALT) , Aspartate-Aminotransferase (AST) (µkat/l)
Time to full volume intake per day (in hours) week 4 to week 12 daily Time to full age-dependent volume intake per day (defined as 150ml/kg/24h for premature infants and 120ml/kg/24h for mature born infants as well as corrected mature infants) (in hours).
1. The volume aim is 150 ml/kg/24h for premature infants with a birth weight \< 1000g or premature infants with a birth weight ≥ 1000g and mother's gestation week at birth before 37+0.
2. The volume aim is 120 ml/kg/24h for born mature infants, mother's gestation week at birth at least 37+0.Z-Score (standard deviation score) Week 1 to week 12 daily, follow-up (month 3, 6, 12) Measurement of weight \[weight for age, World Health Organization (WHO)\]
Laboratory parameter indicating cholestasis Week 1 to week 12 daily, follow-up (month 3) Measurement of conjugated Bilirubin (µmol/l)
Central venous line (CVL) Week 1 to week 12 duration (days) and number of CVL infections (definition of infection: Neo-Kiss Guidelines)
hospitalisation week 1 to week 12 Length of hospital stay (days)
jump in caliber week 5 Estimated ratio of the diameter of the two bowel loops which are anastomosed.
Trial Locations
- Locations (16)
Zentrum der Chirurgie, Klinik für Kinderchirurgie
🇩🇪Frankfurt, Hessen, Germany
Hamburg [University Hospital Hamburg Eppendorf/UKE & Altonaer Kinderkrankenhaus/AKK]
🇩🇪Hamburg, Germany
Universitätsklinik für Kinder- und Jugendchirurgie
🇦🇹Graz, Austria
Universitätsklinik für Kinder- und Jugendheilkunde
🇦🇹Wien, Austria
Universitätsklinik für Kinder- und Jugendmedizin Tübingen
🇩🇪Tübingen, Baden-Württemberg, Germany
Städtisches Klinikum München GmbH/ Klinikum Schwabing
🇩🇪München, Bayern, Germany
Marien Hospital Witten, Ruhr-University Bochum, Department of Pediatric Surgery
🇩🇪Witten, Nordrhein-Westfalen, Germany
Auf der Bult, Kinder- und Jugendkrankenhaus, Kinderchirurgie und Kinderurologie
🇩🇪Hannover, Niedersachsen, Germany
University of Leipzig
🇩🇪Leipzig, Sachsen, Germany
Hannover Medical School, Clinic for Pediatric Surgery
🇩🇪Hannover, Niedersachsen, Germany
Universitätsmedizin Mainz, Klinik und Poliklinik für Kinderchirurgie
🇩🇪Mainz, Rheinland-Pfalz, Germany
Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Kinderchirurgie
🇩🇪Dresden, Sachsen, Germany
University Hospital Marburg, Clinic for Pediatric Surgery
🇩🇪Marburg, Germany
University Hospital Augsburg, Clinic for Pediatric Surgery
🇩🇪Augsburg, Germany
Amsterdam University Medical Centers
🇳🇱Amsterdam, Netherlands
Erasmus University Medical Center Rotterdam
🇳🇱Rotterdam, Netherlands