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

Abstract

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.

Effect of Induction of Early Meconium Evacuation using Glycerin Suppositories in Promoting Feeding Tolerance in Low Birth Weight Infants

“…However, no significant difference in the prevalence rate of NEC was observed between the users of high vs. low osmolar contrast agents. 13 In more than 90 percent cases, meconium is passed by newborns easily within 24 to 48 hours. Passage of meconium is usually observed to be delayed in case of preterm infants.…”

Clinical Dilemma Involving Treatments for Very Low-Birth-Weight Infants and the Potential Risk of Necrotizing Enterocolitis: A Narrative Literature Review

“…Conversely, a Cochrane review showed that prophylactic glycerin laxatives did not affect the incidence of NEC (any stage) [ 64 ]. A national survey by Gross et al found no difference in the incidence of NEC (stage unknown) among glycerin enema users and non-users [ 65 ]. A meta-analysis by Burchard et al also suggested that glycerin enemas have no definitive effects on NEC (stage unknown); however, they were associated with earlier meconium evacuation [ 66 ].…”

Safety of different concentrations of glycerine enema for meconium evacuation in preterm infants: study protocol for a randomised controlled trial

“…The administration of enemas or suppositories is a crucial intervention in the neonatal intensive care unit (NICU), playing a significant role in facilitating the evacuation of meconium. Enema is the most common method for prompting the expulsion of meconium 5. Enema formulations include glycerine enema solution, normal saline, acetylcysteine and others 5.…”

“… 5 Enema formulations include glycerine enema solution, normal saline, acetylcysteine and others. 5 Haiden et al used an enema of 10 mL/kg normal saline containing 0.8 g/10 mL of glycerine 6 ; Mena et al involved enemas with either 0.8 mL glycerine plus 3 mL normal saline or 1 mL glycerine plus 5 mL normal saline 7 ; Shim et al used glycerine diluted 1:4 with distilled water 8 ; Saenz de Pipaón Marcos et al used a 10 mL/kg of normal saline 9 ; Ibrahlm et al used normal saline with 10–20 mL/kg or 20–40 mL/kg for different weighing infants. 10 Glycerine enemas stimulate the evacuation of meconium by acting as an osmotic dehydrating agent, thereby elevating osmotic pressure in the intestinal tract.…”