Gross Maximilian, Hummler Helmut, Haase Bianca, Quante Mirja, Wiechers Cornelia, Poets Christian F
Department of Neonatology, University Children's Hospital Tuebingen, 72076 Tuebingen, Germany.
Children (Basel). 2022 Jul 27;9(8):1122. doi: 10.3390/children9081122.
Meconium passage is often delayed in preterm infants. Faster meconium passage appears to shorten the time to full enteral feeds, while severely delayed meconium passage may indicate meconium obstruction. Neonatologists often intervene to promote meconium passage, assuming that benefits outweigh potential risks such as necrotizing enterocolitis (NEC). We performed an anonymous online survey on different approaches to facilitate meconium passage among tertiary neonatal intensive care units (NICUs) in Germany between February 2022 and April 2022. We collected information on enteral nutrition, gastrointestinal complications, and interventions to promote meconium passage. We received 102 completed questionnaires (response rate 64.6%). All responders used interventions to promote meconium passage, including enemas (92.0%), orally applied contrast agents (61.8%), polyethylene glycol (PEG) (46.1%), acetylcysteine (19.6%), glycerin suppositories (11.0%), and maltodextrin (8.8%). There was substantial heterogeneity among NICUs regarding frequency, composition, and mode of administration. We found no differences in NEC incidence between users and nonusers of glycerin enemas, high or low osmolar contrast agents, or PEG. There is wide variability in interventions used to promote meconium passage in German NICUs, with little or no evidence for their efficacy and safety. Within this study design, we could not identify an increased risk of NEC with any intervention reported.
早产儿的胎粪排出往往会延迟。更快的胎粪排出似乎能缩短完全肠内喂养的时间，而严重延迟的胎粪排出可能表明存在胎粪梗阻。新生儿科医生常常进行干预以促进胎粪排出，认为益处大于坏死性小肠结肠炎（NEC）等潜在风险。我们在2022年2月至2022年4月期间对德国三级新生儿重症监护病房（NICU）促进胎粪排出的不同方法进行了一项匿名在线调查。我们收集了有关肠内营养、胃肠道并发症以及促进胎粪排出的干预措施的信息。我们收到了102份完整问卷（回复率64.6%）。所有回复者都使用了促进胎粪排出的干预措施，包括灌肠（92.0%）、口服造影剂（61.8%）、聚乙二醇（PEG）（46.1%）、乙酰半胱氨酸（19.6%）、甘油栓（11.0%）和麦芽糊精（8.8%）。各新生儿重症监护病房在频率、成分和给药方式方面存在很大差异。我们发现使用或未使用甘油灌肠剂、高渗或低渗造影剂或PEG的患者之间NEC发病率没有差异。德国新生儿重症监护病房用于促进胎粪排出的干预措施差异很大，几乎没有或没有关于其疗效和安全性的证据。在本研究设计中，我们无法确定所报告的任何干预措施会增加NEC的风险。
