title: Glycerin enemas and suppositories in premature infants: a meta-analysis.
abstract: OBJECTIVE
  Premature infants are often given glycerin enemas or suppositories to facilitate meconium evacuation and transition to enteral feeding. The purpose of this study was to assess the available evidence for this treatment strategy.
  
  
  METHODS
  We conducted a systematic search of Medline, Embase, Central, and trial registries for randomized controlled trials of premature infants treated with glycerin enemas or suppositories. Data were extracted in duplicate and meta-analyzed using a random effects model.
  
  
  RESULTS
  We identified 185 premature infants treated prophylactically with glycerin enemas in one trial (n = 81) and suppositories in two other trials (n = 104). All infants were less than 32 weeks gestation and had no congenital malformations. Treatment was associated with earlier initiation of stooling in one trial (2 vs 4 days, P = .02) and a trend towards earlier meconium evacuation in another (6.5 vs 9 days, P = .11). Meta-analysis demonstrated no effect on transition to enteral feeding (0.7 days faster, P = .43) or mortality (P = 0.50). There were no reports of rectal bleeding or perforation but there was a trend towards increased risk of necrotizing enterocolitis with glycerin enemas or suppositories (risk ratio = 2.72, P = .13). These three trials are underpowered and affected by one or more major methodological issues. As a result, the quality of evidence is low to very low. Three other trials are underway.
  
  
  CONCLUSIONS
  The evidence for the use glycerin enemas or suppositories in premature infants in inconclusive. Meta-analyzed data suggest that treatment may be associated with increased risk of necrotizing enterocolitis. Careful monitoring of ongoing trials is required.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Clinician Investigator Program.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: Division of Pediatric Surgery, Alberta Children's Hospital, Calgary, Alberta, Canada.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.affiliation: CanChild Center for Childhood Disability Research, Department of Pediatrics, and.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Rosenbaum
authors.affiliation: Department of Pediatrics, and.
authors.forename: Connie
authors.initials: C
authors.lastname: Williams
authors.affiliation: Divisions of Pediatric Surgery, Western University, London, Ontario, Canada; and.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Jones
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Division of Pediatric Surgery, McMaster University, Hamilton, Ontario, Canada; waltonj@mcmaster.ca.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Walton
mesh_terms: D004733:Enema; D005990:Glycerol / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008470:Meconium; D013488:Suppositories
chemical_list: D013488:Suppositories; D005990:Glycerol