Breast-milk Enema Administration to Stimulate Passage of Meconium

Breast-Milk Enema Administration to Stimulate Meconium Passage in Preterm Infants

Lack of passage of meconium in preterm infants delays feeding advancement and may represent a risk factor for necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP). Usual management of meconium impaction has included glycerin suppositories and normal saline enemas. Various methods are used in routine neonatal care to promote meconium evacuation; however, there is no consensus on the agents used and the frequency of applications

Breast milk is a natural oil-in-water emulsion that can soften meconium, lubricate, and stimulate the intestinal wall, making it easier to excrete meconium. The osmotic pressure of breast milk is a benign stimulus to the digestive tract of premature infants. In addition, breast milk contains bioactive compounds that may positively influence gut motility and the microbiome and has been shown to decrease the incidence of NEC. A small-volume rectal enemas using mother's own breast milk in preterm infants born at <28 weeks' gestation with delayed passage of meconium (>48 hours of life) are feasible and safe, and may be associated with earlier meconium passage and improved early feeding outcomes without increasing the risk of necrotizing enterocolitis (NEC) or other gastrointestinal complications.

Inclusion Criteria:

• Preterm infants born at >23 and <28 weeks' gestational age born at Atrium Health Wake Forest Baptist Hospital or transferred in the first 24 hours of life.
• postnatal age >48 hours, absence of spontaneous passage of meconium by >48 hours of life
• availability of mother's own milk
• written informed consent obtained from a parent or legal guardian.

Exclusion Criteria:

• Infants with Necrotizing Enterocolitis (NEC) ≥ stage II
• spontaneous intestinal perforation (SIP)
• gastrointestinal or anorectal malformations
• infants that have developed severe hemodynamic instability or sepsis with need for vasoactive drugs
• significant hematologic abnormalities such as neutropenia or thrombocytopenia.
• Infants will also be excluded in the absence of written informed consent from a parent or legal guardian.