Bowel regimen medication use and its effect on bowel movements in a pediatric intensive care unit: A retrospective study.

Background: Constipation affects up to 50% of critically ill children and is associated with poor clinical outcomes. The best approach to promote bowel movements in critically ill children is not known.

Methods: We performed a retrospective study including children admitted for >24 h to an intensive care unit who received enteral nutrition (EN). Demographic and clinical characteristics, ordered and administered bowel regimen medications (categorized into enteral softener/osmotic, enteral/intravenous stimulant agents, and rectal softener/osmotic agents), and number of bowel movements were collected for the first 4 days of EN. A multistate model analysis, controlling for severity of illness, assessed the probability of having a bowel movement based on exposure to the categories of medications.

Results: We included 121 patients, median age 53 months (<1 month, 118 months) and 45% female. A medication was ordered for 77 of 121 (64%) patients and administered in 59 of 77 (77%). Enteral softener/osmotic agents were ordered in 64%-90% and rectal agents in 38%-56% of instances. The multistate model analysis identified a greater probability of having a bowel movement after receiving a rectal agent for 1 or 2 days compared with other agents. The most common reason for an ordered medication not being administered was an "as needed" order status.

Conclusion: Rectal agents, the least ordered/administered medication category, were the most effective. Ordering medications in an "as needed" order status reduced the rate of administration. These findings suggest practical changes that may improve the prevention and management of constipation in pediatric critical illness.