Contrast agent ‘not recommended’ in premature neonates

Premature neonates who are given oral Gastrografin immediately after birth do not pass meconium more quickly than others, study findings suggest.

Moreover, although the osmotic contrast agent does appear to increase stool frequency during the first week of life, which, in turn, can improve feeding and shorten hospital stay, it may also increase the risk for necrotizing enterocolitis among premature neonates.

Therefore, Nadja Haiden (Medical University of Vienna, Austria) and team say: "The prophylactic use of Gastrografin cannot currently be recommended without further clinical trials."

The study, published in Pediatrics, involved 78 premature neonates with a birth weight of less than 1500 g and a gestational age of less than 32 weeks.

Of these neonates, 39 were randomly allocated to receive a Gastrografin and water (1:3 ratio) solution via nasogastric (NG) tube within 1 day of birth and 39 were given water only (placebo) via NG tube.

All feeds were given at 3-hour intervals and discontinued on completion of meconium passage.

No significant inter-group difference was observed in time to completion of meconium passage, which took a median 7.0 and 8.0 days among Gastrografin and placebo babies, respectively.

Time to full enteral feeding, however, was 7.5 days shorter among neonates allocated to intervention than placebo, which the authors say suggests that Gastrografin enhances gastrointestinal mobility.

As a result, neonates in the Gastrografin group were discharged from the hospital 17 days earlier than placebo neonates.

However, a higher incidence of necrotizing enterocolitis was observed in the intervention group (21%) than the placebo group (8%).

No other serious adverse events were associated with Gastrografin administration.

And, although nausea and vomiting are reported to be frequent side effects of enteral Gastrografin administration, these problems were observed only in infants with a birth weight between 500 and 650 g, note Haiden et al.

They suggest that small premature neonates may be at higher risk for Gastrografin-related nausea and vomiting because of increased sensitivity to high feeding volumes.

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