Delayed meconium passage and feed intolerance in neonates with birth weight

Abstract

BackgroundOptimal feeding strategy in preterm neonates is unclear. These neonates are at high risk of feed intolerance (FI) and necrotizing enterocolitis (NEC). Considering this risk, introduction of enteral feeding in these neonates is usually delayed. Delayed passage of meconium has been considered as risk factor for FI. We planned this study with an objective to compare incidence of FI and NEC in neonates who passed meconium early vs those who had delayed passage of meconium. MethodsData of all neonates <1250g birth weight (BW) admitted between a period of January 2011 and December 2014 were retrieved from the case records. Demographic details, stooling pattern, and neonatal outcomes including FI, NEC, sepsis and mortality, and time to full feed were noted. Neonates were categorized in two groups based on timing of first meconium: those who passed meconium within 48 hours, “early meconium” and those passed meconium after 48 hours, “delayed meconium”. Outcomes in two groups were compared. ResultsIncidence of FI was 32.5% in early meconium group vs 57.1% in delayed meconium group, adjusted OR (95% CI): 0.37 (0.18, 0.75). Neonates in early meconium group had lesser duration of IV alimentation and reached full enteral feed (180ml/kg/day) earlier. Incidence of NEC, sepsis, and mortality was comparable. ConclusionEarly passage of meconium is associated with better feed tolerance, reduced duration of IV alimentation, and earlier establishment of full enteral feed in preterm neonates. Large randomized trials are warranted to evaluate impact of facilitated/scheduled evacuation of meconium on outcomes of preterm neonates.