Enemas, suppositories and rectal stimulation are not effective in accelerating enteral feeding or meconium evacuation in low‐birthweight infants: a systematic review

Kamphorst, Kim; Sietsma, Ydelette; Brouwer, Annemieke J.; Rood, Paul; Hoogen, Agnes van den

doi:10.1111/apa.13540

Cited by 11 publications

(11 citation statements)

References 30 publications

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“…Currently, many methods exist to promote meconium evacuation [13][14][15][16], with the most popular being the use of enemas. Commonly used enemas include saline, glycerin solution, and glycerin suppositories.…”

Section: Introductionmentioning

confidence: 99%

Clinical effects of breast milk enema on meconium evacuation in premature infants: study protocol for a randomized controlled trial

Zheng

Gai

Gao

et al. 2021

Trials

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Background Delayed meconium evacuation is an important cause of intestinal dysfunction in preterm infants. There are many methods to induce defecation in preterm infants: however, the effects are controversial. Finding a new intervention method to promote meconium evacuation in premature infants is necessary. Therefore, in the proposed study, the effectiveness of breast milk enema on complete meconium evacuation and time to achieve full enteral feeding will be investigated in preterm infants. Methods/design The study is a randomized, open-label, parallel-group, and single-center clinical trial. A total of 294 preterm infants will be recruited and stratified based on gestational age. Then, the infants will be assigned in a randomized block design to the intervention and control groups with a 1:1 ratio. Preterm infants in the control and intervention groups will receive saline enema and breast milk enema, respectively. The primary outcomes will be the time to achieve complete meconium evacuation from birth and time to achieve full enteral feeding from birth in preterm infants. The secondary outcomes will include hospitalization days, body weight at discharge, duration of total parenteral nutrition, cholestasis, and adverse events. Discussion The results of this trial will determine whether breast milk enema shortens the time to complete meconium evacuation and the time to achieve full enteral feeding in extremely preterm and preterm infants. Furthermore, the study results may provide a new, safe, inexpensive, and easy-to-use intervention to effectively evacuate meconium in preterm infants. Trial registration ISRCTN Registry ISRCTN17847514. Registered on September 14, 2019

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Section: Introductionmentioning

confidence: 99%

Clinical effects of breast milk enema on meconium evacuation in premature infants: study protocol for a randomized controlled trial

Zheng

Gai

Gao

et al. 2021

Trials

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“…There are approximately 15 million premature infants were born before 37 weeks every year around the world [1]. However, due to various immature systems, most premature infants are prone to gastrointestinal dysfunction, and have the higher incidence of feeding intolerance.…”

Section: Introductionmentioning

confidence: 99%

Effect of Abdominal Massage on Feeding Intolerance of Premature Infants

Jin¹,

He²,

Zhang³

et al. 2020

AJNS

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Aim: To evaluate the improvement of feeding intolerance to premature infants by abdominal massage. Method: From January 2018 to January 2020, the basic data of 72 premature infants in the NICU of our hospital were collected by retrospective method, which was divided into an experimental group and control group, 36 cases ineach group. The infants in the experimental group received such intervention of abdominal massage with daily fixed time and fixed frequency, and the control group without abdominal massage. The gestational age, birth weight, sex was not statistically significant in the two groups. The outcome indexes of the two groups were evaluated including the length of stay, the weight beginning oral feeding, the weight reaching total oral feeding, the weight at discharge, transition time, time to recover to birth weight, the daily weight gain, gastric residue. Results: Data analysis by SPSS24.0 showed that the weight beginning oral feeding (P = 0.012), weight reaching total oral feeding (P = 0.014) and the mean times of gastric residue in the experimental group was statistically significant. But there was no significant difference in the length of stay, the weight at discharge, transition time, time to recover to birth weight, and the daily weight gain. Conclusion: Intervention of abdominal massage might promote the weight gain and improve the feeding intolerance in premature infants.

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“…While meconium passage is often delayed and prolonged in very preterm infants [ 1 ], early meconium evacuation is associated with a shortened time to full enteral feeding, reduced central venous line use and hospital stay [ 2 , 3 , 4 , 5 ]. Therefore, various interventions have been studied to promote meconium evacuation in preterm infants, including enemas, suppositories, rectal stimulation, and enteral application of a contrast agent [ 5 , 6 , 7 , 8 , 9 ]. Although some of these interventions shortened the time to full enteral feeds [ 5 , 10 ], the overall evidence for routinely promoting meconium evacuation to facilitate feeding tolerance and accelerate meconium passage in preterm infants is limited [ 6 , 9 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, various interventions have been studied to promote meconium evacuation in preterm infants, including enemas, suppositories, rectal stimulation, and enteral application of a contrast agent [ 5 , 6 , 7 , 8 , 9 ]. Although some of these interventions shortened the time to full enteral feeds [ 5 , 10 ], the overall evidence for routinely promoting meconium evacuation to facilitate feeding tolerance and accelerate meconium passage in preterm infants is limited [ 6 , 9 , 11 ]. In addition, conflicting data exist regarding the association of enemas and enteral administration of contrast agents with necrotizing enterocolitis (NEC) [ 5 , 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Interventions for Promoting Meconium Passage in Very Preterm Infants—A Survey of Current Practice at Tertiary Neonatal Centers in Germany

et al. 2022

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Meconium passage is often delayed in preterm infants. Faster meconium passage appears to shorten the time to full enteral feeds, while severely delayed meconium passage may indicate meconium obstruction. Neonatologists often intervene to promote meconium passage, assuming that benefits outweigh potential risks such as necrotizing enterocolitis (NEC). We performed an anonymous online survey on different approaches to facilitate meconium passage among tertiary neonatal intensive care units (NICUs) in Germany between February 2022 and April 2022. We collected information on enteral nutrition, gastrointestinal complications, and interventions to promote meconium passage. We received 102 completed questionnaires (response rate 64.6%). All responders used interventions to promote meconium passage, including enemas (92.0%), orally applied contrast agents (61.8%), polyethylene glycol (PEG) (46.1%), acetylcysteine (19.6%), glycerin suppositories (11.0%), and maltodextrin (8.8%). There was substantial heterogeneity among NICUs regarding frequency, composition, and mode of administration. We found no differences in NEC incidence between users and nonusers of glycerin enemas, high or low osmolar contrast agents, or PEG. There is wide variability in interventions used to promote meconium passage in German NICUs, with little or no evidence for their efficacy and safety. Within this study design, we could not identify an increased risk of NEC with any intervention reported.

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Enemas, suppositories and rectal stimulation are not effective in accelerating enteral feeding or meconium evacuation in low‐birthweight infants: a systematic review

Cited by 11 publications

References 30 publications

Clinical effects of breast milk enema on meconium evacuation in premature infants: study protocol for a randomized controlled trial

Clinical effects of breast milk enema on meconium evacuation in premature infants: study protocol for a randomized controlled trial

Effect of Abdominal Massage on Feeding Intolerance of Premature Infants

Interventions for Promoting Meconium Passage in Very Preterm Infants—A Survey of Current Practice at Tertiary Neonatal Centers in Germany

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