Low evidence for glycerin use in preterm infants

1. When comparing glycerin suppository or enemas to placebo in premature infants, there was no significant difference in terms of mortality, initiation of enteral feeding, or rectal bleeding.

2. There was a non-significant trend towards increasing rates of necrotizing enterocolitis (NEC) in infants receiving glycerin suppository or enema compared to placebo.

Evidence Rating Level: 2 (Good)

Study Rundown: Glycerin suppositories and enemas are frequently used in premature infants in the neonatal intensive care unit setting; these are given to help evacuate meconium, with the intention that such a clean out may better facilitate enteral feeding. This meta analysis examined 3 randomized control trials comparing either glycerin suppository or enema to placebo. Results indicated no significant differences between the treatment groups in terms of mortality, initiation of enteral feeding, or rectal bleeding. There was, however, a non-significant trend towards increased NEC in those receiving the glycerin treatment compared to placebo. This meta analysis was significantly limited given inconsistent methodology amongst trials, moderate risk of bias, and small sample sizes. Three further trials are pending regarding the use of rectal glycerin in premature infants. While these trials will likely help elucidate any possible benefits, the current evidence for the use of glycerin enemas or suppositories in premature infants is deemed low.

Click to read the study, published today in Pediatrics

Relevant Reading: Meconium passage in extremely low birthweight infants and its relation to very early enteral nutrition

In-Depth [meta analysis]: This meta analysis examined 3 randomized control trials, which included a total of 185 premature infants less than 32 weeks gestational age. One trial (n = 81) compared glycerin enemas to no intervention; the other 2 trials (n = 104) compared glycerin suppositories to either no intervention (n = 54) or a sham procedure of opening and closing diaper (n = 50). Infants were given glycerin treatments starting between 12-48 hours of life and continued until either stool had transitioned or for a set 10-13 day timeframe. While individual trial results varied, the meta analysis suggested no significant differences between glycerin use and placebo with regards to mortality (P = 0.50) or initiation of enteral feeding (P = 0.43). Rectal bleeding was not seen in either group. Overall data suggested a trend towards increased NEC (RR 2.72, P = 0.13), but this may be convoluted given inconsistent methodology and risk for bias in incorporated studies.

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