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Meconium Evacuation for Facilitating Feed Tolerance in Preterm Neonates: A Systematic Review and Meta-Analysis

Mangesh Deshmukh1, Hari Balasubramanian, Sanjay Patole

  • 1Department of Neonatology, St. John of God Hospital, Perth, W.A., Australia.

Neonatology
|April 7, 2016
PubMed

Insights

Delayed meconium passage in preterm infants does not improve with common evacuation methods. Treatments like glycerine suppositories or enemas did not reduce time to full feeds or affect outcomes like necrotizing enterocolitis.

Area of Science:

  • Neonatal Medicine
  • Gastroenterology

Background:

  • Delayed meconium passage is a risk factor for feed intolerance in preterm neonates.
  • Effective meconium evacuation is crucial for optimizing neonatal outcomes.

Purpose of the Study:

  • To review the effects of different therapeutic agents for meconium evacuation on feed tolerance in preterm neonates.
  • To assess the impact of meconium evacuation methods on necrotizing enterocolitis and weight at discharge.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) adhering to Cochrane methodology.
  • Included preterm neonates (<32 weeks gestation and/or <1,500 g birth weight).
  • Primary outcome: time to full feeds (TFF); secondary outcomes: necrotizing enterocolitis (NEC), weight at discharge, adverse effects.

Main Results:

  • Six RCTs (n=442) involving glycerine suppositories, enemas, and oral osmotic contrast agents were analyzed.
  • No significant reduction in time to full feeds (TFF) was observed with any agent (MD -0.03, 95% CI -2.47, 2.41).
  • No differences in NEC or weight at discharge were found; one agent showed a trend towards increased NEC.

Conclusions:

  • Limited low-quality evidence suggests prophylactic meconium evacuation methods do not improve TFF in preterm neonates.
  • Further large, well-designed trials are needed to definitively assess the efficacy and safety of these interventions.
Abstract

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