title: Randomized controlled trial of prophylactic rectal stimulation and enemas on stooling patterns in extremely low birth weight infants.
abstract: OBJECTIVE
  We hypothesized that rectal stimulation and small volume enemas would accelerate normalization of stooling patterns in extremely low birth weight infants.
  
  
  METHODS
  In a randomized controlled trial, infants with a gestational age 28 weeks received one of the following: twice daily rectal stimulation and/or enemas until two stools were passed daily, without enemas or stimulation, for three consecutive days. Intervention only occurred when symptoms, abdominal distension and no defecation, occurred in the previous 24 h. Enema administration occurred if abdominal distension persisted without defecation occurring after rectal stimulation. Multivariable linear regression was used to determine the contribution of a patent ductus arteriosus (PDA) on normalization of stooling patterns and feeding tolerance.
  
  
  RESULTS
  Rectal stimulation and/or small volume enemas did not accelerate the median (quartile range) time normalization of stooling patterns, 13 (11-20) days in control group and 16 (12-25.5) days in intervention group. A higher frequency of PDA occurred in the intervention than the non-intervention group. Infants with a persistent PDA had a longer duration of parenteral nutrition, worse feeding tolerance and more days to achieve normal stooling patterns. In multivariable regression analysis, a PDA, not repeated rectal stimulation and/or enemas, was significantly related to stooling and feeding tolerance.
  
  
  CONCLUSIONS
  Twice daily administration of rectal stimulation and/or enemas did not normalize stooling patterns (fecal frequency). A PDA is an important determinant of acquisition of normal stooling patterns and feeding tolerance of very immature newborns.
authors.affiliation: 1] Department of Neonatology, La Paz University Hospital, Autonoma University of Madrid, Madrid, Spain [2] Instituto de Salud Carlos III, Red de Salud Materno Infantil y Desarrollo-SAMID, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Sáenz de Pipaón Marcos
authors.forename: M
authors.initials: M
authors.lastname: Teresa Montes Bueno
authors.forename: B
authors.initials: B
authors.lastname: Sanjosé
authors.forename: M
authors.initials: M
authors.lastname: Gil
authors.forename: I
authors.initials: I
authors.lastname: Parada
authors.forename: P
authors.initials: P
authors.lastname: Amo
mesh_terms: D003248:Constipation / Q000628:therapy*; D003672:Defecation / Q000502:physiology*; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology; D004733:Enema; D005260:Female; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D010812:Physical Stimulation; D012007:Rectum / Q000502:physiology*; D012044:Regression Analysis