Treatment of Delayed Meconium Passage in Preterm Infants: A Systematic Review of Timing and Effect
Related Experiment Video
Updated: Oct 31, 2026
Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Delphine M M Winters1, Viola Christmann1, Marije Hogeveen1
1Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, the Netherlands.
Aim:
Meconium passage is often delayed in preterm infants and assumed to be related to delayed adaptation to enteral nutrition, meconium-related ileus, necrotizing enterocolitis, intestinal perforation and sepsis. While a definition for indication of treatment is lacking, strategies can be divided between a prophylactic approach: treatment is initiated within the first 48 h after birth irrespective of clinical symptoms, or a therapeutic approach: treatment is not initiated for at least 48 h after birth, and only indicated if clinical symptoms develop. This study systematically reviewed the efficacy and safety of prophylactic versus therapeutic treatments and compared various laxatives, with a focus on treatment-related side effects.
Methods:
Literature search was conducted in four databases up to 19 July 2025. Participants included preterm infants; studies were limited to rectal strategies and excluded pathological intestinal obstructions. The review was conducted according to standards for systematic reviews and registered prior to commencement.
Results:
Six studies with moderate to high risk of bias were included (956 infants). The studies showed inconsistent findings regarding the timing of meconium passage and varying side effects of the treatments.
Conclusion:
No evidence-based recommendations can be made regarding timing of treatment or laxative type.