RESUMEN
BACKGROUND: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. OBJECTIVE: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. METHODS: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. RESULTS: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). CONCLUSION: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.
Asunto(s)
Nutrición Enteral , Glicerol/administración & dosificación , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Obstrucción Intestinal/terapia , Meconio , Cloruro de Sodio/administración & dosificación , Irrigación Terapéutica/métodos , Adulto , Peso al Nacer , Enema , Nutrición Enteral/efectos adversos , Estudios de Factibilidad , Femenino , Edad Gestacional , Glicerol/efectos adversos , Humanos , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Obstrucción Intestinal/etiología , Obstrucción Intestinal/fisiopatología , Masculino , Proyectos Piloto , Singapur , Cloruro de Sodio/efectos adversos , Supositorios , Irrigación Terapéutica/efectos adversos , Factores de Tiempo , Resultado del TratamientoRESUMEN
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