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Correspondence

Indian Pediatr 2014;51: 838-839

Glycerin Suppository in Preterm Neonates


I appreciate the efforts of the authors for undertaking and publishing a good quality randomized controlled trial on glycerine suppositories for promoting feed tolerance in preterm babies [1]. Through this communication, I wish to seek certain clarifications:

1. Infants assigned to control group were not given any suppository and only a sham procedure was performed. However, the details of the sham procedure is not given and I wonder whether that has got any lubricant or rectal stimulant action promoting rectal evacuation in control group as well.

2. The dose of suppository used was one gram once a day and authors have mentioned that a more frequent application (e.g.12 hourly) or higher dose may be more effective in accelerating meconium evacuation. However, the reference quoted [2] does not recommend the use of glycerine suppository for meconium obstruction in extremely low-birth-weight neonates. Moreover, Khadr, et al. [3] had used 500 mg dose for similar group of infants in a similar study. Is there a recommended dose for glycerine suppository in preterm babies for prophylactic purpose?

3. The intervention in the control arm was continued till day 14; is there any reason why daily suppositories were not continued until full enteral feeds were achieved?

Althaf Ansary
Department of Pediatrics,
Royal Alexandra Hospital, Paisley, UK,
Email: [email protected]

References

1. Shinde S, Kabra NS, Sharma SR, Avasthi BS, Ahmed J. Glycerin suppository for promoting feeding tolerance in preterm very low birthweight neonates: a randomized controlled trial. Indian Pediatr. 2014;51:367-70.

2. Khadr SN, Ibhanesebhor SE, Rennix C, Fisher HE, Manjunatha CM, Young D, et al. Randomized controlled trial: Impact of glycerin suppositories on time to full feed in preterm infants. Neonatology. 2011;100:169-76.

3. Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth weight neonates: Guidelines for diagnosis and management. J Pediatr Surg. 2004;39:731-7.

Author’s Reply

1. Interventions were performed by study nurse (two) behind the disguise of curtain. In glycerin group, suppository was administered. In control group, study nurse went behind the curtain, opened baby’s diaper and put it again. No rectal stimulation or lubricant was administered in control group.

2. We had just speculated that more frequent administration of glycerin suppository (Like 12 hourly) may be more effective. We did not find any reference recommending standard of glycerin suppository for prophylactic use in preterm neonates.

3. Individual neonates may reach full feeds at different ages. Therefore, to keep uniformity of intervention in participants we chose to continue it till day 14 and not until full enteral feeds was achieved.

Nandkishor S Kabra
Department of Neonatology,
Surya Children’s Hospital,
Santacruz West,
Mumbai, India.
Email: [email protected]


 

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