Randomized Controlled Trial: Impact of Glycerin Suppositories on Time to Full Feeds in Preterm Infants

Abstract

Background: Feed intolerance delays achievement of enteral feeding in preterm infants. Parenteral nutrition is associated with cholestasis and increased risk of sepsis. Glycerin suppositories have been used to promote gastrointestinal motility and feed tolerance. Objectives: To investigate whether daily glycerin suppositories (a) reduce the time to full enteral feeding in infants born at <32 weeks’ gestation, and (b) influence feed tolerance, incidence of sepsis or necrotizing enterocolitis, duration of oxygen requirement, growth or age at discharge. Methods: Design – prospective open randomized controlled trial; study population – preterm infants stratified into 2 subgroups, 24–27⁺⁶ weeks (24–27 weeks + 6 days) and 28–31⁺⁶ weeks; intervention – daily glycerin suppository for 10 days from 24 h of age, 250 mg (24–27⁺⁶ weeks subgroup) or 500 mg (two 250-mg suppositories; 28–31⁺⁶ weeks subgroup); controls – no intervention. The same feeding protocol and departmental guidelines for other aspects of neonatal intensive care were used in all subjects. Analysis was by intention to treat. Results: 54 babies were recruited (31 males), 29 randomized to receive suppositories; 48 achieved full enteral feeds. The median (range) time to full feeds was 1.6 days shorter in intervention group babies than controls, but not statistically significant: 7.4 (4.6–30.9) days versus 9.0 (4.4–13.3) days (p = 0.780; 95% confidence interval: –1.917, 2.166). No significant differences were observed in secondary outcomes. Intervention group babies passed their first stool earlier than controls (median: day 2 vs. day 4; p = 0.016). Conclusion: Regular glycerin suppositories did not reduce the time to full enteral feeds in infants born at <32 weeks’ gestation in our setting.

A Historic Cohort Study on Accelerated Advancement of Enteral Feeding Volumes in Very Premature Infants

“…In comparison with recent studies investigating similar populations of premature infants [21,22,23,24,25], the incidence of NEC observed in our cohort remained in the lower range. Because this study was retrospective and underpowered to detect clinically relevant differences in the proportion of infants with NEC, we cannot exclude a small increase in the incidence of NEC associated with more rapid EF advancement although the data could also suggest a small decrease in the cumulative incidence of NEC and FIP.…”

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

“…The observational study by Shim et al [5] (n = 83) was excluded from the final analysis. Thus, a total of 6 studies (n = 442) assessing different interventions (glycerine suppository/enema, saline enema, oral osmotic contrast agent) for meconium evacuation were eligible for inclusion in the analysis [24,25,26,27,28,29]. The characteristics of these studies are shown in table 1.…”

“…2). Four of the 6 studies had TFF as the primary outcome [24,26,27,29], and those by Haiden et al [25] and Saenz de Pipaón Marcos et al [28] had TFF as the secondary outcome. We used the method of Hozo et al [30] to derive the mean and standard deviation from the median and range reported in the original article.…”

Randomized controlled trial of prophylactic rectal stimulation and enemas on stooling patterns in extremely low birth weight infants

“…Interestingly, a recent trial showed that regular glycerin suppositories did not reduce the time to full enteral feeding in infants born at o32 weeks' gestation. 10 To our knowledge, this is the first randomized controlled trial to investigate the impact of rectal stimulation and enemas on the time to acquire a normal stooling pattern. As the intervention was implemented for both genders, our results suggest that the entire range of ELBW infants do not benefit from using a stimulation program such as we used for the improvement of stooling patterns, and that this approach may be harmful.…”