Do Glycerine Laxatives Have a Role in the Neonatal Intensive Care Unit? A Systematic Review

Abstract

Background: Glycerine laxatives are often prescribed in the neonatal population. Indications for its use include: meconium evacuation to promote feeding tolerance and prevent hyperbilirubinemia. To-date, the literature regarding its effectiveness has not been systematically reviewed. Objective: To assess the effectiveness and safety of glycerine laxatives (suppositories or enemas) on feeding intolerance and hyperbilirubinemia in neonates. Design/Methods: MEDLINE, EMBASE, Cochrane Library, Scopus and Web of science were searched for randomized/quasi-randomized controlled trials and observational studies. Quality assessment and data extraction were performed by two authors (VS, NC). When appropriate, data were analyzed using Rev Man 5.0 and meta-analysis performed using a fixed effects model. Results are presented as mean difference (MD) or relative risk (RR)/odds ratio (OR) with 95% confidence interval (CI). Results: Of the 5 eligbile studies, 2 studies [RCT (N=1) and observational study (N=1)] evaluated meconium evacuation and feeding tolerance in VLBW infants and 3 RCTs evaluated effect on hyperbilirubinemia in term infants. Outcome data for VLBW infants are presented below [Figure]. (Table presented) Haiden et al showed no difference in the time to pass first meconium or establishing full enteral feeds while Shim et al showed that the time to first meconium passage and full enteral feeding was statistically significantly shorter and the rate of sepsis lower in the glycerine enema group. The use of glycerine suppository (N=2 studies) and enema (N=1 study) had no effect on serum bilirubin in the first 2 to 7 days of life. There was heterogeneity in the timing and frequency of use of glycerine laxatives in the included studies. No difference in adverse events were reported. Conclusions: There is inconclusive evidence regarding the effectiveness of glycerine laxatives for prevention of feeding intolerance in VLBW infants and further evaluation is needed. Glycerine laxatives cannot be recommended for prevention of hyperbilirubinemia