The Effect of an Osmotic Contrast Agent on Complete Meconium Evacuation in Preterm Infants

Haiden, Nadja; Norooz, F; Klebermass-Schrehof, Katrin; Horak, Anna Sophie; Jilma, Bernd; Berger, Angelika; Repa, Andreas

doi:10.1542/peds.2011-3634

Cited by 35 publications

(57 citation statements)

References 18 publications

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“…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.…”

Section: Resultsmentioning

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: Resultsmentioning

confidence: 99%

“…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.…”

Section: Resultsmentioning

confidence: 99%

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

2016

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“…otro estudio evaluando el uso sistemático de supositorio de glicerina, con 54 casos randomizados, no muestra diferencias significativas pero una tendencia de mejor tolerancia en el grupo tratado 14 . La preocupación por estimular la eliminación de meconio y mejorar el aporte enteral persiste y un reciente estudio probó el aporte enteral de Gastrografin ® diluido 15 , que es una medida previamente utilizada para tratar un taponamiento meconial en prematuros extremos 10 . Este estudio aportó Gastrografin ® oral 9 ml por kilo en dilución 1:3, en las primeras 24 h de vida a menores de 1.500 g o 32 semanas.…”

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“…Este estudio aportó Gastrografin ® oral 9 ml por kilo en dilución 1:3, en las primeras 24 h de vida a menores de 1.500 g o 32 semanas. aunque hubo poca diferencia en el pasaje de meconio, tanto la tolerancia alimentaria como la duración de la hospitalización en cuidado intensivo, mejoraron significativamente en el grupo tratado; pero, aumentó el riesgo de ecn, lo que puede relacionarse con la alta osmolaridad del Gastrografin ® diluido (717 m mosm /L) 15 .…”

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Evacuación del meconiointestinal para mejorar tolerancia alimentaria en prematuro de muy bajo peso (protocolo Emita)

et al. 2014

Rev. chil. pediatr.

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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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The Effect of an Osmotic Contrast Agent on Complete Meconium Evacuation in Preterm Infants

Cited by 35 publications

References 18 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

Evacuación del meconiointestinal para mejorar tolerancia alimentaria en prematuro de muy bajo peso (protocolo Emita)

Breast Milk Enema and Meconium Evacuation Among Preterm Infants

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