Discussion
perforation, weight gain, stoma prolapse, stoma, , bowel distension
SKIN EROSION, MINOR, CHRONIC INFLAMMATION, PREMATURE, COMPLICATIONS
This is the first prospective RCT examining the safety and efficacy of administering MFR to preterm neonates. Our study showed that MFR is beneficial for increasing the bowel diameter and growth rate. Moreover, citrulline levels tended to be higher in the MFR group than for infants in the control group, which was not statistically significant.Premature infants are capable of intestinal growth and adaptation after bowel resection [The z-score of bodyweight at the stoma formation in the normal-output MFR group was significantly lower than that of the control group; however, at the times of reanastomosis operation and three months after the reanastomosis, the z-scores of bodyweight were not significantly different, thus meaning that MFR facilitated weight gain.In the loopograms taken just before reanastomosis, colon diameters were significantly larger in the transverse, descending, and sigmoid colon of infants in the normal-output MFR group than those in the control group. Lau et al. [Histopathological findings of the distal ileum at the stoma closure showed that chronic inflammation and destruction of villous structures were more frequent in the control group than in the normal-output MFR group. Similar to our findings, Yabe et al. [Serum citrulline is a non-protein amino acid that is synthesized from glutamine and glutamine-related components within enterocytes [The amount of weight gain in premature infants naturally increases as PMA advances. Therefore, we compared the growth velocity before and after MFR after adjusting for PMA, by which the positive impact of MFR on weight gain would be verified more appropriately. Both of the daily weight and length gain were significantly larger after MFR in high-output + normal-output MFR group after adjusting for PMA.In our study, several complications had occurred. MFR was terminated in one case due to perforation during a manual stoma reduction and minor complications of stoma prolapse, bowel distension and skin erosion were reported. Haddock et al. [Several limitations of this study need to be acknowledged. Due to the vulnerability of the patient group comprising premature infants, achieving a sufficient sample size through power calculation was difficult. Nevertheless, this was the first RCT for MFR that explored the benefits and safety of MFR with a controlled protocol. Hence, it can provide the basis for further RCTs for MFR.