Hey, doctor, leave those guts alone!

Intestinal function is often sluggish after preterm delivery. Establishing early enteral nutrition, the goal of all of us, is interrupted often by repeated regurgitation, or large residuals (if you measure them) or abdominal distension. There are also reported correlations between delayed meconium passage and the later development of NEC.

This has led many clinicians and investigators to look at the use of various methods to stimulate gut function, hopefully with the goal of reducing time on intravenous nutrition, and maybe even reducing NEC.

If we look at the downstream result of those methods, that is, methods to improve evacuation, do they actually promote earlier stooling, or feeding tolerance?

No.

At least that is the conclusion of a systematic review of 5 RCTs and a couple or observational studies. Kamphorst K, et al. Enemas, suppositories and rectal stimulation are not effective in accelerating enteral feeding or meconium evacuation in low birth weight infants: A systematic review. Acta Paediatrica. 2016. To prove no effect, of course, is just about impossible, but we can have reasonable confidence that there is not a clinically important effect on accelerating enteral feeding, and does not speed up the evacuation of meconium.

And there is no evidence that these interventions achieve any of the laudable goals of reducing TPN duration or reducing NEC incidence. A systematic review published last year suggested the opposite, a risk of increased NEC.

I think the best we can do improve feeding tolerance at present is the early introduction of breast milk, as periods of being npo slow down gut recovery (Maybe I should say ‘probably’, there as the evidence is limited).

And the use of probiotics. When reported as an outcome variable, probiotics have almost always improved feeding tolerance, and decreased time on TPN, which was certainly the case in our study, and is confirmed in the latest version of the Cochrane review.

About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , , , . Bookmark the permalink.

4 Responses to Hey, doctor, leave those guts alone!

  1. Tarek Sayed says:

    What about giving glycerine suppository if there is evidence of meconium plug

    • I don’t know of any evidence about what to do for a meconium plug, a glycerine suppository might be better than a gastrografin enema, but many babies don’t actually need anything at all, except time, one publication noted that 1/3 of babies passed the plug spontaneously. So if you do need to do something, maybe a glycerine suppository would help, before going to radiology.

  2. Casey Ward says:

    Hello, thank you for this fantastic blog! I am a first year fellow who is struggling to get my institute to stop routinely measuring residuals. Are there any good studies that I can use to help my case? I can’t seem to find any worth citing on Pubmed and I tried to go through several of your previous posts to see if you had commented on residuals with research. Cheers

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