Meconium passage in very immature preterm infants. Current evidence and own approach

Spontaneous passage of meconium in very low birthweight (VLBW) infants can last for days, which often slows advancement of enteral feeding, particularly in non-invasively ventilated infants with an extended abdomen. To what extent the advancement of enteral feeding can be promoted by enemas or suppositories has not been clearly elucidated by studies. None of the different methods of fostering stool passage has been shown to significantly reduce the time to full enteral feeding. The risks of repeated enemas, such as intestinal perforation by repeated flushing have also not been sufficiently evaluated. The use of suppositories and enemas in very preterm infants is widespread but not confirmed by evidence. The risk of isolated bowel perforation should be taken into account when considering such procedures.