Induction of early meconium evacuation promotes feeding tolerance in very low birth weight infants.
BACKGROUND
A delay in reaching full enteral feeding is linked to poorer outcome in preterm neonates. Meconium retention has been viewed as a cause of bowel dysfunction in very low birth weight infants (VLBWI). Thus, adequate evacuation of meconium could help to promote feeding tolerance.


OBJECTIVE
Our goal was to determine the effect of the induction of early meconium evacuation on feeding tolerance in VLBWI.


METHODS
An observational study involving two subsequent periods was performed in inborn infants with birth weights of <1,500 g, before (control) and after (study) the induction of early meconium evacuation by routine glycerin enema. The total duration of these periods was from January 2003 to December 2005. To evaluate feeding tolerance, we measured time to achieve full enteral feeding. Complications such as sepsis and necrotizing enterocolitis were compared.


RESULTS
The study group achieved full enteral feeding significantly faster than the control group (hazard ratio (HR) = 2.9; 95% confidence interval (CI) = 1.8-4.8), and this effect was more definite in infants with a birth weight of <1,000 g (HR = 4.6; 95% CI = 1.9-11.1). The study group passed first meconium faster than the control group (median = 1.4 vs. 3.7 days; p < 0.001). Sepsis, especially as determined by positive culture in central venouscatheter, was significantly reduced in the study group (7.7 vs. 27.8%; p = 0.02).


CONCLUSIONS
The induction of early meconium evacuation had a significantly positive effect on feeding tolerance and sepsis prevention in VLBWI.
Shim
So-Yeon
SY
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Kim
Han-Suk
HS
Kim
Do-Hyun
DH
Kim
Ee-Kyung
EK
Son
Dong Woo
DW
Kim
Beyong Il
BI
Choi
Jung-Hwan
JH
D004733:Enema / Q000009:adverse effects / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology; D005990:Glycerol / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn / Q000378:metabolism*; D019102:Infant, Very Low Birth Weight / Q000378:metabolism*; D008470:Meconium / Q000378:metabolism*; D016896:Treatment Outcome
D005990:Glycerol