Mena N Patricia, León Del P Jorge, Sandino P Daniela, Ralmolfo B Pamela, Sabatelli Debora, Llanos M Adolfo, Milet L Beatriz
Rev Chil Pediatr. 2014 Jun;85(3):304-11. doi: 10.4067/S0370-41062014000300006.
It has been reported that feeding tolerance in preterm infants is associated with an early passage of meconium. Prospective, randomized or historical control studies that stimulate meconium evacuation have reported varied results. This study was intented to evaluate the use of enemas to speed up meconium evacuation, facilitating feeding tolerance.
A controlled multicenter randomized trial that evaluated the use of physiological saline enemas with glycerol (0.8 ml glycerol + 3 ml saline or 1 ml glycerol + 5 ml saline depending on babies weighing less or more than 800 g at birth, respectively) versus simulation. This procedure was performed in the first 96 hours of life in infants with birth weight between 500 and 1,250 g. Maternal (preterm delivery, clinical chorioamnionitis, gestational hypertension, administration of magnesium sulfate and prenatal corticosteroids, fetal Doppler altered, type of delivery, gender, weight and gestational age, assessment of Apgar and need for assisted ventilation and oxygenotherapy) and nutritional history (age when feeding volumes of 100 ml/kg/day and full enteral feeding were reached, age to remove meconium, number of days on parenteral nutrition, weight at 28 days, weekly volumes of breast milk and preterm formula) were described.
No significant differences were obtained regarding the age to reach full enteral intake or 100 ml/kg/day were found among the 101 patients in the study. Also, no differences in the following secondary variables are observed: number of episodes of late sepsis with or without positive blood culture, hyperbilirubinemia, necrotizing enterocolitis and intraventricular hemorrhage.
The routine use of saline enemas and glycerin in this study does not alter the enteral feeding tolerance in very low birth weight preterm infants.
据报道，早产儿的喂养耐受性与胎粪的早期排出有关。刺激胎粪排出的前瞻性、随机或历史对照研究报告的结果各不相同。本研究旨在评估使用灌肠剂加速胎粪排出，促进喂养耐受性。
一项对照多中心随机试验，评估使用含甘油的生理盐水灌肠剂（根据出生时体重小于或大于800 g的婴儿，分别为0.8 ml甘油 + 3 ml生理盐水或1 ml甘油 + 5 ml生理盐水）与模拟操作的效果。该操作在出生体重500至1250 g的婴儿出生后的前96小时内进行。描述了母亲的情况（早产、临床绒毛膜羊膜炎、妊娠高血压、硫酸镁和产前皮质类固醇的使用、胎儿多普勒检查异常、分娩方式、性别、体重和胎龄、阿氏评分评估以及辅助通气和氧疗需求）和营养史（达到100 ml/kg/天喂养量和完全肠内喂养的年龄、排出胎粪的年龄、肠外营养天数、28天时的体重、每周母乳和早产配方奶量）。
该研究中的101例患者在达到完全肠内摄入量或100 ml/kg/天的年龄方面未发现显著差异。此外，在以下次要变量中也未观察到差异：有或无血培养阳性的晚期败血症发作次数、高胆红素血症、坏死性小肠结肠炎和脑室内出血。
本研究中生理盐水灌肠剂和甘油的常规使用并未改变极低出生体重早产儿的肠内喂养耐受性。
