Acquisition of full enteral feeds may depend on stooling pattern in very premature infants

Objective: The objective of this study was to determine whether acquisition of normal stooling pattern is associated with full enteral feeding and growth. Study design: This is a prospective observational study of infants with a gestational age of <28 weeks (n=121). All infants admitted to our unit during the study period were managed using the same protocol for rectal stimulation and enemas: we used rectal stimulation if abdominal distension and no defecation occurred in the previous 24 h; enema administration was practiced if abdominal distension persists and no defecation had occurred after rectal stimulation. Age of normal bowel habit (T-NBH) is defined as days when two stools passed each day without enemas or stimulation for three consecutive days. Full enteral feeding is measured by time to receive 120 mL/kg/day (T-120). Multivariable linear regression estimated the contribution of T-NBH on T-120 and the effect of tolerance on growth. Results: T-NBH was 16 days (12, 24 days) and T-120 was 16 days (12, 24 days). T-120 decreased with earlier normal bowel habit (r=0.625, P<0.0001). Change in weight z-score between 36 weeks postmenstrual age and birth was less pronounced with earlier full enteral feeding (r=-0.446, P<0.0001). Conclusion: Normalization of bowel habit is an important determinant of full enteral feeding of very immature infants. Earlier full enteral feeding is associated with less postnatal growth failure.