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.
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.