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Use of Macrogol to Accelerate Feeding Advancement in Extremely Preterm Infants

Kirstin Barbara Faust1,2,3, Mariia Lupatsii4, Frederike Römer1

  • 1Department of Pediatrics, University Hospital of Lübeck, Lübeck, Germany.

Neonatology
|February 3, 2025
PubMed

Insights

Early macrogol use in extremely preterm infants significantly speeds up feeding advancement and supports gut microbiome development. This intervention shows promise for improving outcomes in vulnerable newborns.

Area of Science:

  • Neonatology
  • Pediatric Gastroenterology
  • Microbiome Research

Background:

  • Delayed enteral nutrition increases adverse outcomes in extremely preterm infants.
  • Limited evidence exists on therapies to promote meconium evacuation and gastrointestinal motility.
  • Macrogol's effect on feeding tolerance and microbiome in preterm infants requires investigation.

Purpose of the Study:

  • To determine the effect of early macrogol administration on feeding tolerance in preterm infants (<27 weeks gestation).
  • To assess macrogol's impact on gut microbiome establishment in this vulnerable population.

Main Methods:

  • Two observational cohort studies were conducted: the German-Neonatal-Network (GNN) and the Immunoregulation-of-the-Newborn (IRoN) study.
  • GNN compared NICUs with high vs. low early macrogol use.
  • IRoN assessed microbiome changes before and after macrogol implementation.

Main Results:

  • Faster advancement to full enteral feedings was observed in NICUs using macrogol (GNN: 14 vs. 16 days; IRoN: 12 vs. 16 days).
  • No increased risk for sepsis or abdominal complications was associated with macrogol use.
  • Higher abundance of Bifidobacterium longum correlated with faster feeding advancement.

Conclusions:

  • Early, off-label macrogol use may facilitate feeding advancement in highly vulnerable preterm infants.
  • The findings support the need for a randomized controlled trial to confirm macrogol's efficacy.
  • Macrogol may positively influence gut microbiome composition, aiding nutritional support.
Abstract

Keywords:
Extremely preterm infantsFeeding advancementMacrogolNutrition

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