Breast Milk Enema Helps Preterm Infants Pass Meconium

A breast milk enema resulted in faster meconium evacuation and a shorter time to enteral feeding compared with a saline enema, a randomized clinical trial in a Chinese hospital showed.

Among 286 preterm infants, those who received the breast milk enema achieved complete meconium evacuation 2.2 days faster than those who received normal saline (95% CI −3.2 to −1.2 days), Liqiang Zheng, MD, PhD, of the Shanghai Jiao Tong University School of Medicine in China, and colleagues reported in JAMA Network Open.

Additionally, the preterm infants in the breast-milk group achieved full enteral feeding more quickly than those who received saline (-4.6 days, 95% CI −8.0 to −1.2 days), the second primary outcome of the study, they reported.

This group also had a shorter duration of total parenteral nutrition (-4.6 days, 95% CI −8.6 to −1.0 days), though there were "no clinically notable differences in any other secondary or safety outcomes between the two groups," including duration of hospitalization and weight at discharge, the authors reported.

"In this randomized clinical trial testing the effects of breast milk enema on meconium evacuation, breast milk reduced the time to achieve complete meconium evacuation and achieve full enteral feeding for preterm infants with a gestational age of 23 to 30 weeks," they concluded.

They added that their study is the first "to use breast milk as an enema agent, representing a novel approach."

Meconium is an infant's first stool, which contains the fetal intestinal lining, mucous, and amniotic fluid. A delay in meconium excretion "prolongs the total parenteral nutrition and hospital stay and increases the risk of infection," Zheng and colleagues wrote.

Previous research has indicated that abdominal massage, prophylactic rectal stimulation, oral contrast, and enemas can promote meconium evacuation. However, some studies have questioned the efficacy and safety glycerin enemas and contrast agents, which led the team to "doubt the safety of glycerin and contrast agents for the enemas of premature infants" and to look for a novel enema to promote meconium evacuation.

For their study, the researchers randomized infants born in the neonatal ward of Shengjing Hospital of China Medical University at 23 to 30 weeks' gestation from September 1, 2019 through September 30, 2022 to breast milk enemas (n=141) or normal saline enemas (n=145) 48 hours after birth.

Mean maternal age was about 32, mean gestational age was 198.8 days, and there were slightly more male infants (58%). Time to complete meconium evacuation and achieve full eternal feeding were the two primary outcomes; secondary outcomes included length of hospitalization, weight at discharge, and duration of total parenteral nutrition.

Limitations included that the authors did not conduct stratified analysis based on birth weight and that, as a single-center study, the results are not as generalizable as a multicenter study, which they recommend be conducted in the future.

Courtney Gutman, MD, a neonatologist at the University of Tennessee Health Science Center in Knoxville, who was not involved in the study, told MedPage Today that the most valuable finding from this study was that breast milk was "a safe alternative to a contrast enema if that is needed for significant dysmotility of prematurity, or delayed stooling."

She also noted that breast milk is generally one of the best medications available in the neonatal intensive care unit and this finding may have interesting research applications in the future.

While Gutman didn't have concerns about the study's methods, she did have some reservations.

"This paper is based on a claim that meconium retention is the basis for dysmotility of prematurity. Early preterm GI [gastrointestinal] motility is really a very complex process that is multifactorial and I have not seen much information to definitively say meconium is a cause," Gutman said.

She also pointed out that while the safety analysis mentioned four colorectal and anal injuries among infants who received a breast milk enema, no further information was given about when or why the injuries occurred. If they occurred at enema insertion, it "would make me very reluctant to use enema versus glycerin suppository or time."

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