Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants

Anabrees, Jasim; Shah, Vibhuti; AlOsaimi, Ahlam; AlFaleh, Khalid

doi:10.1002/14651858.cd010464.pub2

Cited by 14 publications

(14 citation statements)

References 22 publications

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“…Our findings are in line with previous systematic reviews on this topic which also suggested no significant advantage of glycerine suppositories or enema for meconium evacuation to reduce feed intolerance [15,16,17]. Our review is comprehensive in that it evaluates all therapeutic agents for meconium evacuation regardless of their route of administration.…”

Section: Discussionsupporting

confidence: 90%

“…An observational study by Shim et al [5] reported benefits of meconium evacuation by glycerine enema in achieving earlier full enteral feeds (hazard ratio 2.9, 95% CI 1.8, 4.8) and reducing the incidence of line sepsis in VLBW neonates. So far all reviews on the topic of meconium evacuation in preterm neonates are limited to the use of either a glycerine suppository or enema [15,16,17]. Considering these data and the significance of optimising enteral nutrition in preterm VLBW neonates, we aimed to conduct a systematic review of studies reporting the effects of different therapeutic agents for meconium evacuation on feed tolerance in this population.…”

Section: Introductionmentioning

confidence: 99%

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Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

2016

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Background: A delayed passage of meconium is considered as a risk factor for feed intolerance in preterm neonates. Objectives: The aim of this study was to review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates. Methods: A systematic review of randomised controlled trials (RCTs) of different therapeutic agents for meconium evacuation in preterm neonates (gestation <32 weeks and/or birth weight <1,500 g) using the Cochrane systematic review methodology was undertaken. Databases including Google Scholar were searched in January 2016. The primary outcome was the time to reach full feeds (TFF; ≥120 ml/kg feeds with stoppage of parenteral nutrition >24 h). Secondary outcomes included necrotising enterocolitis (NEC), weight at discharge and adverse effects. The results were summarised as per the GRADE guidelines. Results: Six RCTs (2 each of glycerine suppository and enema, 1 normal saline enema and 1 oral osmotic contrast agent; n = 442) with a low or unclear risk of bias were included. The pooled estimate (random effects model) showed no reduction in TFF [mean difference (MD) -0.03, 95% CI -2.47, 2.41, p = 0.98; level of evidence: low]. No differences in NEC [risk ratio (RR) 1.71, 95% CI 0.63, 4.65, p = 0.30; level of evidence: low] and weight at discharge (MD -0.08, 95% CI -0.30, 0.15, p = 0.50; level of evidence: low) were found. The trial assessing oral osmotic contrast agents reported a trend towards a higher incidence of NEC ≥ stage II. There were no other adverse effects. Conclusion: Limited low-quality evidence indicates that prophylactic glycerine suppository, small volume glycerine/normal saline enema or oral osmotic contrast agents to evacuate meconium did not reduce TFF in preterm neonates. Large, well-designed trials are essential to study this clinically significant issue.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

2016

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“…Despite the limited search results, we were still able to include seven high‐quality studies. Furthermore, we included four more studies in this review than the previous Cochrane review and meta‐analysis , such as an RCT published in Spanish. This allowed us to reach strong conclusions about the effect of glycerine suppositories and recommendations for future research.…”

Section: Discussionmentioning

confidence: 99%

“…These interventions can have an effect on the acceleration of meconium and thereby improve feeding tolerance, according to an observational study from Korea . However, a Cochrane review on the effectiveness of glycerine laxatives for the prevention or treatment of feeding intolerance in very low‐birthweight (VLBW) infants did not recommend giving infants prophylactic glycerine laxatives, as these interventions did not influence the time until full enteral feeding was reached . A meta‐analysis concluded that there was inconclusive evidence for the use of glycerine enemas or suppositories in premature infants .…”

Section: Introductionmentioning

confidence: 99%

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

Kamphorst¹,

Sietsma²,

Brouwer

et al. 2016

Acta Paediatrica

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“…Of these infants, 373 (57.6%) were eligible ( Figure 2): 54% were born between 28 and 32 weeks, 14.5% before 28 weeks and 31.5% after 32 weeks. The median [IQR 25−75 ] values for birth weight, length and HC were, respectively, 1540 [1,160-1,968] g, 41 [36][37][38][39][40][41][42][43][44] cm, and 28.5 [26-30.5] cm. The characteristics of the population are indicated in Table 1.…”

Section: Population Characteristicsmentioning

confidence: 99%

Reference Values for Abdominal Circumference in Premature Infants

et al. 2020

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Objectives: Abdominal distention is a common indicator of feeding intolerance in premature newborns. In the absence of a precise definition, abdominal distention and its degree are highly subjective. The aim of this study was to construct references and smoothed percentiles for abdominal circumference (AC) and AC to head circumference (HC) ratio (AC/HC) in infants born between 24 weeks and 34 weeks of gestational age. Methods: ACs and HCs were collected weekly in eutrophic premature infants without congenital abdominal or cerebral malformation. AC and HC charts were modeled using the LMS method, excluding measures associated with abdominal distention at clinical examination or intracranial abnormality at cerebral ultrasounds. Changes in AC and AC/HC over time were studied by repeated-measures analysis using mixed-effects linear models. Results: A total of 1,605 measurements were made in 373 newborns with a mean gestational age of 31 [29-33] weeks and mean birth weight of 1,540 [1,160-1,968] g. Of these measurements, 1,220 were performed in normal conditions. Gestational age, postnatal age, singleton status, and respiratory support were significantly associated with AC and AC/HC. LMS curves were generated according to gestational age groups and postnatal age, with coherent profiles. AC/HC was 0.91 [0.86-0.95] in absence of abdominal distention. It was higher in cases of abdominal distention (0.95 [0.89-1.00], p < 0.001) and necrotizing enterocolitis (0.98 [0.93-1.07], p < 0.001). Conclusions: References constructed for AC and AC/HC might be used to assess feeding tolerance in premature infants. AC/HC was more relevant than AC to rationalize the diagnosis of abdominal distention.

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Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants

Abstract: Humans 26 Glycerin laxatives for prevention or treatment of feeding intolerance in very low birth weight infants (Review)

Cited by 14 publications

References 22 publications

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

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

Reference Values for Abdominal Circumference in Premature Infants

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