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Constipation in Preemies

By Helen Harrison

Gastro-intestinal motility has been shown to be slower for preemie neonates than for full-term infants (Berseth. "Gastrointestinal motility in the neonate" Clinics in Perinatology, 1996;23:179-190). And there is evidence that constipation remains a problem among preemies after the NICU, especially preemies whowere extremely premature, had a difficult NICU course, and have on-going developmental problems.

My own feeling, hearing how frequently this problem has been described on the list, is that it may also be related to *transient* problems with poor muscle tone. The poor gastro-intestinal motility that results in gastro-esophageal reflux and, possibly, in constipation may simply be another manifestation of the tone problems seen in about 2/3 of babies born weighing less than 1500 g during the first two years of life. There is also some evidence that NEC (and damage to the intestines from ischemia -- poor circulation) may play a role. Also babies who are preemies are more likely to be formula fed and to receive iron supplementation, all of which makes constipation more likely.

A recent study on chronic constipation (into adolescence) among extremely low birth weight children was just published in Pediatric Research April 1998;43:100A.. It is part of Maureen Hack's research on children and teens born weighing less than 750 grams. It does provide evidence for constipation being more prevalent in preemies. Here it is:

"Constipation is a Problem Among Former <750 Gram Birthweight (ELBW [extremely low birth weight] Children" by Cunningham, Taylor, Klein, Minich and Hack, Rainbow Babies & Children's Hospital, Cleveland, OH

"When interviewed at [the time their child was] 10 years of age, 19/58 (33%) of parents of ELBW children (mean bwt. 664 gm., mean gest. age 26 weeks) born 1982-86, reported constipation to be a problem compared to 6/53 (11%) of children with birthweights 750 - 1499 gm and 3/49 (6%) normal birthweight controls (p< .001). Constipation was defined as difficulty in passing hard, dry stools. To determine the etiology we compared neonatal and neurodevelopmental outcomes of the constipated to non-constipated ELBW children.."

"Thus constipated ELBW [adolescents] were of lower gestational age at birth, had more neonatal problems including NEC, and had higher rates of neurologic abnormality (4 cerebral palsy, 1 blind, 1 deaf) and subnormal IQ than non-constipated ELBW. Further history obtained from 15 of 19 parents of the constipated ELBW at age 12 years revealed that for 13 of the 15 children constipation began prior to age 6 months. Four children were severely retarded and not toilet trained and 8 of the remaining 11 were still having soiling accidents. Among 15 non-constipated ELBW matched by race and sex, only 1 was not toilet trained and 4 were still having soiling accidents at age 12 years. Constipation among ELBW is probably associated with neurodevelopmental impairment but could also be secondary to neonatal ischemic injury."


My own feeling from interviewing parents and reading the preemie-child list is that constipation -- like transient dystonia (increased tone in the legs seen in preemies during the first two years) -- is common early on, but tends to get better with age. The children in whom it is chronic and severe (lasting into adolescence or adulthood) often have on-going developmental problems.

Helen Harrison is the well known author of The Premature Baby Book, often referred to as the "Bible of Prematurity" by older preemie parents. These observations are excerted with permission from posts to the prematurity parents support internet mailing lists on prematurity: Preemie-child and Preemie-L.

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