title: Glycerin suppositories used prophylactically in premature infants (SUPP) trial: a study protocol for a pilot randomized controlled trial.
abstract: BACKGROUND
  Feeding is a significant challenge for premature infants in the neonatal intensive care unit (NICU). These patients are often treated with glycerin suppositories to stimulate the passage of meconium and prevent feeding intolerance. Unfortunately, the evidence for this practice is inconclusive.
  
  
  METHODS
  This protocol is for an external pilot study that will assess the feasibility of a superiority, placebo-controlled, parallel-design, multicenter randomized controlled trial. Participants are premature infants treated in a level 3 NICU with a gestational age 24 to 32 weeks and/or birth weight of 500 to 1500 g. Thirty participants will be recruited as part of this external pilot study. Participants will be randomized to glycerin suppository (250 mg) or placebo starting 48 to 72 h after birth and continuing once daily until meconium evacuation is complete or for a maximum of 12 days. The placebo consists of a 250-mg glycerin suppository placed in the diaper rather than the rectum. Study treatments are administered by the charge nurse on duty who is not otherwise involved in patient care. All other clinicians and research personnel will remain blinded. Outcomes for the pilot study are percentage of eligible participants randomized, percentage of infants reaching full enteral feeds, cost, and treatment-related adverse events (rectal bleeding, rectal perforation, and anal fissure).
  
  
  CONCLUSIONS
  This external pilot study will assess the feasibility of a multicenter randomized controlled trial of glycerin suppositories in premature infants. The subsequent multicenter trial will have sufficient power to determine whether this treatment strategy is associated with decreased time to full enteral feeds.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02153606.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada ; Clinician Investigator Program, Postgraduate Medical Education, McMaster University, MDCL Rm 3101, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Livingston
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada ; Division of Pediatric Surgery, University of Puerto Rico School of Medicine, University of Puerto Rico-Medical Sciences Campus, San Juan, 00921 Puerto Rico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Zequeira
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada ; Division of Pediatric Surgery, Department of Surgery, McMaster University, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.
authors.forename: Henrietta
authors.initials: H
authors.lastname: Blinder
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada ; Division of Pediatric Surgery, Department of Surgery, McMaster University, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.affiliation: Division of Neonatology, Department of Pediatrics, McMaster University, Health Sciences Centre Room 4F5, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.
authors.forename: Connie
authors.initials: C
authors.lastname: Williams
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, McMaster Children's Hospital, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada ; Division of Pediatric Surgery, Department of Surgery, McMaster University, Health Sciences Centre Room 4E3, 1280 Main Street West, Hamilton, Ontario L8S 4K1 Canada.
authors.forename: J Mark
authors.initials: JM
authors.lastname: Walton
keywords: Feeding intolerance; Necrotizing enterocolitis; Newborn; Prematurity; Suppository