PASSAGE OF FIRST STOOL IN VERY LOW BIRTH WEIGHT INFANTS

Abstract

Passage of meconium (M) after 24hrs of age in term neonates is considered to be delayed and may require diagnostic and/or therapeutic intervention. However, little is known about the time of passage of first meconium and the clinical implications in premature (P) infants weighing ≤1500gms. Sixty consecutive P born between July 1985-March 1986 were studied; six of the sixty died before passing M. The mean±S.D. birth wt. was 1144±224gms, gestational age 30.6±2.24wks, Apgar score at one minute 4±2 and at five minutes 7 ± 2. Feedings were started at 4.4±2.5 days. Time of passage of meconium is shown:There was a significant correlation between time of passage of meconium and birth wt. (r = −0.489, p<0.001) and gest. age (r = −0.334, p<0.01); no significant correlation was noted with Apgar score, feeding, peak bilirubin levels, phototherapy or electrolytes. Time of passage was significantly longer in P with HMD vs Transient Tachypnea of Newborn (TTNB) (33±30 vs 16±17hrs, p<0.05). Only one P had abdominal distension and passed M plug at 47hrs of age; others had no signs of bowel obstruction. In summary, only 2/3 of P pass M by 24hrs of age and the remaining 1/3, even though delayed, do not require diagnostic workup unless associated with other signs of bowel obstruction.