Effectiveness of different therapy protocols in preemies with intestinal hypomotility

Intestinal hypomotility delays achievement of full enteral feeds and normalization of stooling patterns in preemies. We hypothesized that introduction of prokinetic drug in addition to enemas would improve intestinal motility. Primary outcome: time needed to achieve full enteral feeds and normal stooling pattern. Secondary outcome: day when start of minimal enteral feeding was feasible, necrotizing enterocolitis incidence, length of hospitalization and whether daily meconium evacuation is more effective than evacuation in presence of clinical symptoms only.

A randomized controlled trial was conducted from December 1^st, 2015 until December 1^st, 2016 in level III neonatal unit on 67 preterm infants ≤32 gestational weeks and intestinal hypomotility. Infants were allocated to: group 1, treated with saline enemas twice daily until normal stooling pattern was achieved; and group 2, treated with erythromycin and enemas. Infants with intestinal hypomotility, hospitalized from December 1^st, 2014 to December 1^st, 2015, were assigned to group 3, and were treated with enemas only when symptoms of abdominal distension or absence of stool for 48 hours were observed.

Total of 127 neonates was included in this study; 33 were assigned to group 1, 34 to group 2, and 60 to group 3. There was no significant difference in number of days needed to reach full enteral feeds: 25 vs. 26 days and normal stooling pattern: 18 vs. 15 between groups 1 and 2. Time needed to achieve full enteral feeds and normal stooling pattern in groups 1 and 2 were significantly shorter when compared to group 3. No difference in length of hospitalization between the groups was observed.

Erythromycin did not improve the patient outcome, although therapy protocol in group 1 and group 2 were more effective than therapy used in patients in group 3.