Duration of meconium passage in preterm and term infants

Bekkali, N; Hamers, S.; Schipperus, Martin R.; Reitsma, J. B.; Valerio, P G; Toledo, Letty van; Benninga, Marc A.

doi:10.1136/adc.2008.138024

Cited by 70 publications

(56 citation statements)

References 19 publications

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“…The neonatal gut also seems to be more susceptible to intestinal ischaemia/reperfusion injury than the adult gut [34], and the activity of carbohydrate digestive enzymes is significantly lower in the preterm intestine than term intestine [35]. Gut motility is also different in preterm and term infants [36]. Another potentially important difference between preterm and term infants is that of maternal separation.…”

Section: Pathogenesismentioning

confidence: 99%

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

2017

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Despite decades of research on necrotizing enterocolitis, we still do not fully understand the pathogenesis of the disease, or how to prevent or how to treat it. However, as a result of recent significant advances in the microbiology, molecular biology, and cell biology of the intestine of preterm infants and infants with necrotizing enterocolitis, there is some hope that research into this devastating disease will yield some important translation into effective prevention, more rapid diagnosis, and novel therapies.

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Section: Pathogenesismentioning

confidence: 99%

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

2017

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“…More than 90% of term neonates, and <10% of children with HD, pass meconium in the first 24 hours of life (13,14). Thus, HD must be suspected in any full-term infant who does not pass meconium in the first 24 hours of life and in the premature infants who have excessively delayed the passage of meconium (7-8 days) (14). Failure of the distal bowel to relax and allow the passage of stool leads to functional obstruction and to secondary dilatation of the bowel proximal to the aganglionic segment.…”

Section: Clinical Presentationmentioning

confidence: 99%

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Schäppi

Staiano

Milla

et al. 2013

J. pediatr. gastroenterol. nutr.

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Objective: Primary gastrointestinal neuropathies are a heterogeneous group of enteric nervous system (ENS) disorders that continue to cause difficulties in diagnosis and histological interpretation. Recently, an international working group published guidelines for histological techniques and reporting, along with a classification of gastrointestinal neuromuscular pathology. The aim of this article was to review and summarize the key issues for pediatric gastroenterologists on the diagnostic workup of congenital ENS disorders. In addition, we provide further commentary on the continuing controversies in the field. Results: Although the diagnostic criteria for Hirschsprung disease are well established, those for other forms of dysganglionosis remain ill-defined. Appropriate tissue sampling, handling, and expert interpretation are crucial to maximize diagnostic accuracy and reduce interobserver variability. The absence of validated age-related normal values for neuronal density, along with the lack of correlation between clinical and histological findings, result in significant diagnostic uncertainties while diagnosing quantitative aberrations such as hypoganglionosis or ultrashort Hirschsprung disease. Intestinal neuronal dysplasia remains a histological description of unclear significance. Conclusions:The evaluation of cellular quantitative or qualitative abnormalities of the ENS for clinical diagnosis remains complex. Such analysis should be carried out in laboratories that have the necessary expertise and access to their own validated reference values.

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“…Spontaneous meconium evacuation is prolonged in premature infants and meconium retention seems to be associated with a delay in establishing enteral feeds [4,5]. The deep intestinal segments are obstructed by meconium with a consequent delay in establishing full feeds [6,7,8,9,10,11].…”

Section: Introductionmentioning

confidence: 99%

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

et al. 2017

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Background: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. Objective: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. Methods: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. Results: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). Conclusion: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

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Duration of meconium passage in preterm and term infants

Abstract: PoM was not only delayed but also prolonged in preterm infants. Duration of PoM was associated with GA, birth weight and morphine therapy.

Cited by 70 publications

References 19 publications

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

Current Research on the Epidemiology, Pathogenesis, and Management of Necrotizing Enterocolitis

A Practical Guide for the Diagnosis of Primary Enteric Nervous System Disorders

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

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