Abstract
BackgroundFeeding is a significant challenge for premature infants in the neonatal intensive care unit (NICU). These patients are often treated with glycerin suppositories to stimulate the passage of meconium and prevent feeding intolerance. Unfortunately, the evidence for this practice is inconclusive.Methods/designThis protocol is for an external pilot study that will assess the feasibility of a superiority, placebo-controlled, parallel-design, multicenter randomized controlled trial. Participants are premature infants treated in a level 3 NICU with a gestational age 24 to 32 weeks and/or birth weight of 500 to 1500 g. Thirty participants will be recruited as part of this external pilot study. Participants will be randomized to glycerin suppository (250 mg) or placebo starting 48 to 72 h after birth and continuing once daily until meconium evacuation is complete or for a maximum of 12 days. The placebo consists of a 250-mg glycerin suppository placed in the diaper rather than the rectum. Study treatments are administered by the charge nurse on duty who is not otherwise involved in patient care. All other clinicians and research personnel will remain blinded. Outcomes for the pilot study are percentage of eligible participants randomized, percentage of infants reaching full enteral feeds, cost, and treatment-related adverse events (rectal bleeding, rectal perforation, and anal fissure).DiscussionThis external pilot study will assess the feasibility of a multicenter randomized controlled trial of glycerin suppositories in premature infants. The subsequent multicenter trial will have sufficient power to determine whether this treatment strategy is associated with decreased time to full enteral feeds.Trial registrationClinicalTrials.gov: NCT02153606
Highlights
Feeding is a significant challenge for premature infants in the neonatal intensive care unit (NICU)
This external pilot study will assess the feasibility of a multicenter randomized controlled trial of glycerin suppositories in premature infants
The subsequent multicenter trial will have sufficient power to determine whether this treatment strategy is associated with decreased time to full enteral feeds
Summary
The evidence for the use of glycerin suppositories in premature infants is inconclusive [9, 17]. No differences were reported for any of the secondary outcomes, including duration of hospital stay, weight at discharge, days to introduction of oral feedings, feeding volume on day 14 of life, days to passage of first meconium, or days to full enteral feeding This trial was limited by the lack of blinding, possibility of selective reporting, small sample size, and frequent protocol violations. All study treatments were administered by a research nurse, and blinding was maintained for all other clinical and research personnel This trial reported no differences between treatment groups for any of the outcomes, including time to full enteral feeds, time to regain birth weight, NEC, frequency of feeds being withheld, and length of hospital stay. The multicenter trial will have sufficient power to determine whether glycerin suppositories facilitate meconium evacuation and transition to enteral feeding in premature infants.
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