Prevention of meconium obstruction in very low birth weight preterm infants

Solaz-García, Álvaro; Segovia-Navarro, L.; Dios-Benlloch, J.L. Rodríguez de; Benavent-Taengua, L.; Castilla-Rodríguez, D.Y.; Company-Morenza, M.A.

doi:10.1016/j.enfie.2019.04.003

Cited by 5 publications

(6 citation statements)

References 20 publications

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“…Functional Intestinal Obstruction of Prematurity (FIOP) increases morbidity and mortality in preterms with very low or extremely low birth weight. [1,[3][4][5] In our series, 3 patients weighed under 1500 g.…”

Section: Discussionmentioning

confidence: 66%

“…Intestinal obstruction appears on days 10-14 of life: feeding intolerance (vomit or gastric/bilious output through OG tube) and scarce or absent meconium evacuation despite stimulation. [1,3,4,[6][7][8][9] On physical examination, we found abdominal distention and dilated intestinal loops, without signs of perforation or hemodynamic instability. The presence of the latter might suggest the presence of Necrotizing Enterocolitis (NEC).…”

Section: Discussionmentioning

confidence: 99%

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Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series

Acosta-Farina¹,

Polit-Guerrero

Aguayo-Vistin

et al. 2022

J Neonatal Surg

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Background: Functional Intestinal Obstruction of Prematurity (FIOP) is the delay or failure of meconium evacuation in premature neonates. It is associated with hypomotility in the developing intestine. It mostly presents with signs of intestinal obstruction in very low (VLBW) or extremely low birth weight (ELBW) neonates. Case Series: We present short-term results regarding the management of 8 premature newborns with FIOP treated with Awolaran O. et al [1] algorithm in a pediatric hospital, two of them required a surgical procedure due to conservative management failure. Conclusion: Early conservative management is successful in most patients with FIOP, related to symptom resolution. Surgical management should be kept for those with conservative management failure.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series

Acosta-Farina¹,

Polit-Guerrero

Aguayo-Vistin

et al. 2022

J Neonatal Surg

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“…Studies have indicated that expediting meconium elimination can enhance feeding tolerance, facilitating a quicker transition to enteral nutrition and its associated benefits. 12 Previous studies have shown many methods for promoting meconium evacuation, including abdominal massage, prophylactic rectal stimulation, oral contrast, and enema, 12,[15][16][17][18] of which enemas are the most common in clinical practice. Commonly used enemas include saline and glycerin solutions or suppositories.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies have shown many methods for promoting meconium evacuation, including abdominal massage, prophylactic rectal stimulation, oral contrast, and enema, of which enemas are the most common in clinical practice. Commonly used enemas include saline and glycerin solutions or suppositories.…”

Section: Introductionmentioning

confidence: 99%

Breast Milk Enema and Meconium Evacuation Among Preterm Infants

Zheng,

Gai,

et al. 2024

JAMA Netw Open

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ImportanceDelayed meconium evacuation and delayed achievement of full enteral feeding among premature infants are associated with poor short- and long-term outcomes. Identifying a more effective and safer enema for meconium evacuation is imperative for improving neonatal care.ObjectiveTo examine whether breast milk enemas can shorten the time to complete meconium evacuation and achievement of full enteral feeding for preterm infants.Design, Setting, and ParticipantsThis randomized, open-label, parallel-group, single-center clinical trial was conducted from September 1, 2019, to September 30, 2022, among 286 preterm infants with a gestational age of 23 to 30 weeks in the neonatal ward of the Shengjing Hospital of China Medical University in Shenyang.InterventionsPreterm infants were randomly assigned to receive either breast milk enemas or normal saline enemas 48 hours after birth.Main Outcome and MeasuresThe primary outcomes were time to complete meconium evacuation and time to achieve full enteral feeding. Secondary outcomes were duration of hospitalization, weight at discharge, and duration of total parenteral nutrition. Intention-to-treat and per-protocol analyses were conducted.ResultsIn total, 286 preterm infants (mean [SD] gestational age, 198.8 [7.9] days; 166 boys [58.0%]) were eligible and included in this study. A total of 145 infants were randomized to the normal saline group, and 141 were randomized to the breast milk group. The time to achieve complete meconium evacuation was significantly shorter in the breast milk group than in the normal saline group (–2.2 days; 95% CI, −3.2 to −1.2 days). The time to achieve full enteral feeding was also significantly shorter in the breast milk group than in the normal saline group (−4.6 days; 95% CI, −8.0 to −1.2 days). The duration of total parenteral nutrition was significantly shorter in the breast milk group than in the normal saline group (−4.6 days; 95% CI, −8.6 to −1.0 days). There were no clinically notable differences in any other secondary or safety outcomes between the 2 groups.Conclusions and RelevanceIn this randomized clinical trial testing the effects of breast milk enema on meconium evacuation, breast milk reduced the time to achieve complete meconium evacuation and achieve full enteral feeding for preterm infants with a gestational age of 23 to 30 weeks. Subgroup analyses highlight the need for tailored interventions based on gestational age considerations.Trial Registrationisrctn.org Identifier: ISRCTN17847514

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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%

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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Prevention of meconium obstruction in very low birth weight preterm infants

Cited by 5 publications

References 20 publications

Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series

Functional Intestinal Obstruction of Prematurity (FIOP): Short term management results: A case series

Breast Milk Enema and Meconium Evacuation Among Preterm 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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