TOP 27 - Evaluation of Outcomes with Routine Glycerin Enema Administration for Extremely Low Birthweight Infants at High Risk of Meconium-Related Ileus

Publication Number: 2778.TOP 27

Brandon D. Tucker, BayCare Health System, Tampa, FL, United States; Seriah Groen-Hoeksema, Baycare, Odessa, FL, United States; Jenelle Ferry, St. Joseph's Children's Hospital, Tampa, FL, United States

Background: Meconium-related ileus (MRI) is an emerging and significant gastrointestinal complication in extremely low birthweight (ELBW, < 1000 g) infants, characterized by delayed passage of meconium and functional intestinal obstruction. The pathogenesis and optimal management of MRI remain poorly understood. Failure to resolve early obstruction can contribute to feeding intolerance, prolonged parenteral nutrition, and an increased risk of spontaneous intestinal perforation (SIP), a severe neonatal surgical emergency associated with increased morbidity and mortality. Glycerin enemas have been proposed to stimulate intestinal motility, promote stooling, and potentially reduce the risk of MRI and SIP in ELBW infants.

Objective: To evaluate whether implementation of a standardized protocol for routine glycerin enema administration in ELBW infants who have not spontaneously stooled within 48–72 hours of life reduces the occurrence of MRI and SIP.

Design/Methods: A single-center prospective observational study was conducted in a large Level 4 neonatal intensive care unit. Infants with birth weight < 1000 g who survived to feeding implementation and beyond 1 week of life were included. IRB approval was obtained. The pre-intervention cohort consisted of 70 infants born in the 13 months before protocol implementation, between January 2023 and February 2024. The post-intervention cohort included 64 infants born between May 2024 and May 2025, with pause of data collection for a period of 3 months to allow for complete protocol implementation. The post-intervention cohort care followed a standardized protocol for early evaluation of MRI and routine administration of glycerin enemas if no spontaneous stool occurred by 48–72 hours of life. Feeding advancements for both groups followed a previously established standardized feeding pathway and did not change during the study period. Measured outcomes included time to consistent stooling (spontaneous stooling without glycerin for 48 hours), feeding intolerance (feeds held >24 hours due to gastrointestinal causes), days to full feeds (150 mL/kg/day), days of TPN use, and presence of SIP. Study population will be reported with continuous variables reported as mean +- SD and categorical variables as percentages. Non-parametric data will be analyzed with Mann-Whitney and categorical data analyzed with chi-square testing. Data analysis to be complete January 2026.