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Glycerin enemas and suppositories in premature infants: a meta-analysis
Michael H Livingston1, Anna C Shawyer2, Peter L Rosenbaum3
1McMaster Pediatric Surgery Research Collaborative, Clinician Investigator Program.
Insights
Glycerin enemas or suppositories for premature infants show inconclusive evidence for meconium evacuation. The treatment may increase the risk of necrotizing enterocolitis, warranting careful monitoring of ongoing trials.
Area of Science:
- Neonatal care
- Gastroenterology
- Clinical evidence synthesis
Background:
- Premature infants often receive glycerin enemas or suppositories to aid meconium evacuation.
- This intervention aims to facilitate the transition to enteral feeding in neonates.
Purpose of the Study:
- To systematically assess the existing evidence on the efficacy and safety of glycerin enemas or suppositories in premature infants.
- To evaluate the impact of this treatment on meconium evacuation and enteral feeding transition.
Main Methods:
- A systematic search was conducted across major databases (Medline, Embase, Central) and trial registries.
- Randomized controlled trials involving premature infants treated with glycerin interventions were included.
- Data were extracted and meta-analyzed using a random effects model.
Main Results:
- Three trials involving 185 premature infants (gestation < 32 weeks) were analyzed.
- A trend towards earlier stooling was observed in one trial, but no significant effect on enteral feeding transition or mortality was found.
- A trend towards an increased risk of necrotizing enterocolitis was noted (RR 2.72, P = .13), with low to very low-quality evidence.
Conclusions:
- Current evidence on glycerin enemas or suppositories for premature infants is inconclusive.
- Meta-analysis suggests a potential increased risk of necrotizing enterocolitis.
- Ongoing trials require careful monitoring to clarify the safety and efficacy of this intervention.
Background And 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.
