An estimated 15 million babies are born preterm before 37 completed weeks of gestation worldwide every year1. In the Netherlands, infants born before 32 weeks of gestation are admitted to a neonatal intensive care unit (NICU) to increase the chance of survival 2. In these preterm infants, a delay in reaching full enteral feeding is closely associated with poorer short- and long-term outcomes. A consequence of feeding intolerance is prolonged need for total parenteral nutrition (TPN). TPN administration gives an increased risk of infection, liver damage and cholestasis. These complications result in a prolonged hospital stay3,4. Therefore, the establishment of optimal enteral feeding is a priority in NICU’s worldwide3-5.
Timing of the first and last meconium stool is critical for oral feeding tolerance and proper gastrointestinal function6. In preterm infants a delayed passage of the first stool is very common 7. The more premature an infant is, the later meconium passage starts, and the longer meconium passage lasts8. Rectal stimulation and enemas are common methods to induce meconium in current practice. These interventions can have an effect on the accelerating of meconium and therefore improve feeding tolerance9. Enemas are defined as an injection of liquid into the rectum through the anus and rectal stimulation as stimulating of the rectum with specially developed cannulas, both for stimulating evacuation of the bowels10.
Especially in premature infants that have a low birth weight, the decisions regarding the initiation of feeding depend in part on the balance between the risks of complications. Preterm infants with ‘low’ birth weight are those who weigh 1500 grams or less11. Previous research shows that in low birth weight infants a higher stool frequency during the first week of life have a positive effect on the time required to full enteral feedings12. Further, that rapid meconium evacuation is an important factor for feeding tolerance during the first fourteen days of life13 and that normalization of bowel habit is an important determinant of full enteral feeding14.
Although there is evidence that rapid meconium evacuation is a key factor for feeding tolerance in low birth weight infants, a recent systematic overview about the effect of accelerating meconium excretion is missing. Therefore, this systematic review assessed the literature for the effect of rectal stimulation and enemas on accelerating meconium excretion.
The objective of this review was to present a systematic overview of the available evidence on the effectiveness of rectal stimulation and enemas on stooling patterns and feeding tolerance in low birth weight infant’s gestational age ’32 weeks. Therefore the research question of this systematic review was: What is the effect of rectal stimulation and enemas on stooling patterns and feeding tolerance in low birth weight infant’s gestational age ’32 weeks?
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