Glycerin enemas and suppositories may, may not benefit premature infants

Last Updated: 2015-05-21

By Will Boggs MD

NEW YORK (Reuters Health) - Evidence remains inconclusive on whether giving premature infants glycerin enemas or suppositories helps to promote meconium evacuation and transition to enteral feeding, Canadian researchers report.

"Our study found that glycerin enemas and suppositories may help these infants have regular bowel movements, but this does not necessarily result in improved feeding," Dr. Michael H. Livingston, from McMaster University, Hamilton, Ontario, told Reuters Health by email. The interventions may even be associated with an increased risk of a necrotizing enterocolitis (NEC), he said.

"The numbers are still too small to make any definitive conclusions at this point," Dr. Livingston said. "For now, we would recommend that glycerin enemas and suppositories be used with caution in premature infants, and preferably in the context of a supervised and systematic study."

Dr. Livingston's team analyzed the results of three randomized controlled trials on the use of glycerin enemas and suppositories in premature infants.

"We were surprised to see that so few studies have been conducted on this topic," Dr. Livingston said. "The studies that we did find were small and complicated by design problems."

Altogether the trials included 185 premature infants, and the interventions consisted of prophylactic glycerin enemas or suppositories administered once daily for several days, according to the May 18 Pediatrics online report.

There appeared to be no significant effect of glycerin enemas or suppositories on the initiation of meconium evacuation, and only one trial reported a trend toward earlier completion of meconium evacuation.

Similarly, the researchers observed no differences between treatment and control groups in transition to enteral feeding in any of the three trials or in feeding tolerance in the two studies that reported it.

They found the use of glycerin enemas or suppositories to be associated with a 2.72-fold increased risk of NEC, but as Dr. Livingston noted, the difference fell short of statistical significance.

The quality of evidence was low and the risk of bias was high in all studies included in the meta-analysis.

"Just because medications are used routinely does not mean that they are effective or harm-free," Dr. Livingston concluded. "This is especially true for premature infants for whom many medications are never formally tested or approved. While many aspects of clinical practice seem to be 'tried and true,' often because they are based on good intentions or past experience, they may not do what we expect them to do."

"To determine if glycerin enemas or suppositories are effective in premature infants, we need to design a larger study involving multiple hospitals and hundreds of participants," Dr. Livingston added. "With this in mind, we decided to conduct a pilot study to establish the feasibility of a multicenter trial. Over 20 premature infants have been recruited so far and we look forward to sharing our results later this year. If the pilot study shows that it is feasible to do a larger and more rigorous study then we will then seek funding for that."

The authors reported no specific study funding and no disclosures.

SOURCE: http://bit.ly/1Fq6I6V

Pediatrics 2015.