Park Brian L, Tunc Emine, Qu Pingping, Klein Eileen, Solari Patrick
Emergency Department, University of California San Diego, San Diego, USA.
Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, USA.
Cureus. 2025 Apr 24;17(4):e82919. doi: 10.7759/cureus.82919. eCollection 2025 Apr.
Constipation is a common complaint in the pediatric emergency department (PED). Management often includes an enema administered in the PED, especially for children with significant discomfort or those who have failed outpatient therapy with oral bowel motility agents. Enema administration can be anxiety-provoking and may cause children to further withhold stool. Midazolam, a rapid-acting benzodiazepine, is sometimes given prior to an enema for anxiolysis. This study evaluated the effect of intranasal midazolam on the success rate of bowel movement after an enema for the management of constipation in the pediatric emergency department (PED).
Retrospective cohort study at a single, academic, quaternary-care hospital. Patients 2 to 10 years of age receiving at least one enema for management of constipation from May 1, 2016, through April 30, 2021, were included. Exclusion criteria include neurodevelopmental disorders, prior abdominal surgeries, or administration of any non-intranasal midazolam anxiolytic agents. The primary outcome was the success of bowel movement in the emergency department (ED). Secondary outcomes included ED length-of-stay (LOS), enema-to-discharge time, number of enemas administered, and admission rates.
Intranasal midazolam was administered in 214 (27%) out of 795 encounters. There was no difference in rates of successful bowel movements between the midazolam and no-midazolam groups (83.6% vs. 84.2%, respectively). When stratified by age in multivariate regression analysis, the rate of bowel movement success was higher in preschool-aged children receiving midazolam (ARR 1.09; CI 1.01-1.18, p=0.032). Midazolam was associated with longer ED LOS (271 min vs. 235 min, p=0.004), longer enema-to-discharge time (121 min vs. 93 min, p < 0.001), more frequent administration of multiple enemas (14% vs. 7%, p=0.021), and higher admission rates (7% vs. 2%, p=0.002).
Intranasal midazolam prior to enema administration was not associated with an overall higher rate of successful bowel movement in the PED. Pre-school-aged children showed a small improvement in bowel movement success with midazolam. Midazolam administration was associated with worse secondary outcomes, but there are likely other confounding factors such as severity of illness. Intranasal midazolam may provide benefits to preschool-aged children, but a prospective study is needed to confirm this finding.
便秘是儿科急诊科（PED）常见的主诉。治疗通常包括在PED进行灌肠，特别是对于有明显不适的儿童或门诊口服促胃肠动力药物治疗失败的儿童。灌肠可能会引起焦虑，还可能导致儿童进一步抑制排便。咪达唑仑是一种速效苯二氮䓬类药物，有时在灌肠前使用以缓解焦虑。本研究评估了鼻内给予咪达唑仑对儿科急诊科（PED）灌肠治疗便秘后排便成功率的影响。
在一家单一的学术性四级医疗医院进行回顾性队列研究。纳入2016年5月1日至2021年4月30日期间接受至少一次灌肠治疗便秘的2至10岁患者。排除标准包括神经发育障碍、既往腹部手术史或使用过任何非鼻内给予的咪达唑仑类抗焦虑药物。主要结局是急诊科（ED）排便成功。次要结局包括ED住院时间（LOS）、灌肠至出院时间、灌肠次数和住院率。
795次就诊中有214次（27%）给予了鼻内咪达唑仑。咪达唑仑组和未使用咪达唑仑组的排便成功率无差异（分别为83.6%和84.2%）。在多变量回归分析中按年龄分层时，接受咪达唑仑的学龄前儿童排便成功率更高（绝对风险率1.09；可信区间1.01 - 1.18，p = 0.032）。咪达唑仑与更长的ED LOS（271分钟对235分钟，p = 0.004）、更长的灌肠至出院时间（121分钟对93分钟，p < 0.001）、更频繁地多次灌肠（14%对7%，p = 0.021）以及更高的住院率（7%对2%，p = 0.002）相关。
灌肠前给予鼻内咪达唑仑与PED总体上更高的排便成功率无关。学龄前儿童使用咪达唑仑后排便成功率有小幅提高。使用咪达唑仑与更差的次要结局相关，但可能还有其他混杂因素，如疾病严重程度。鼻内咪达唑仑可能对学龄前儿童有益，但需要前瞻性研究来证实这一发现。
