Hydrostatic low-volume enemas in infants with birth weight ≤1000 g or gestational age ≤28 weeks: A controlled interventional study.

Objective: This study evaluated the safety and efficacy of standardized minimally invasive hydrostatic low-volume saline enemas in infants with a birth weight ≤1000 g or gestational age ≤28 weeks and delayed meconium passage.

Methods: Conducted at the Neonatology Department of Klinikum Kassel, Germany, this monocentric controlled interventional study included a historic control group and a prospective intervention group. Infants born between January 2019 and October 2022 were included. The control group received manual enemas using varied techniques, while the intervention group underwent standardized hydrostatic low-volume saline enemas at predefined intervals. Key outcomes assessed included gastrointestinal complications (necrotizing enterocolitis [NEC], focal intestinal perforation [FIP], and meconium plug syndrome [MPS]), morbidity, mortality, stool and feeding parameters, and staff evaluations.

Results: A total of 42 infants were included in the control group and 74 in the intervention group. NEC incidence was lower in the intervention group (4.1%) compared to the control group (9.5%), as was the rate of FIP (2.7% vs. 7.1%). Morbidity showed a decreasing trend in the intervention group (6.8% vs. 16.7%), and the combined morbidity and mortality rate was significantly lower (6.8% vs. 19.1%). Despite reduced stool frequency, enteral feeding tolerance improved in the intervention group.

Conclusion: An unstandardized approach to rectal interventions may increase the need for surgical interventions, whereas standardized hydrostatic low-volume saline enemas are a safe and effective alternative to conventional rectal interventions, offering improved comfort and potentially reducing intestinal morbidity in infants with a birth weight ≤1000 g or gestational age ≤28 weeks.

Trial identification number: DRKS00024191 (https://drks.de/search/de/trial/DRKS00024191).