The aim of this study was to evaluate the correlation between the timing of the first and last meconium and feeding tolerance in the very early enteral nutrition of extremely low birthweight (ELBW) infants. Forty-one ELBW infants were fed following a standardized protocol (day 3-14). At 48 h of age bolus gavage feeding with milk was started (12 ml kg(-1) d(-1) increments, 12 meals per day). Gastric residuals up to 2 ml or up to 3 ml were tolerated in infants with a birthweight of < or = 750 g or > 750 g, respectively. No enemas or laxatives were given during the study. The impact of the time until the passage of the first (M-1) and last (M-last) meconium on the feeding volume on day 14 (V14) was evaluated by linear regression analysis. Data are presented as median (range). M-1 was 31 h (0.5-77 h), M-last was 6 d (1.4-22 d) and V14 was 99 (0-156) ml kg(-1). V14 increased with decreasing M-last (p < 0.001) but there was no correlation between V14 and M-1. V14 was 112 (0-156) ml kg(-1) if M-last was shorter than 6 d and 37 (0-147) ml kg(-1) if M-last was longer than 6 d.
Conclusion: Rapid meconium evacuation appeared to be a key factor for the feeding tolerance of ELBW infants during the first 14 d of life. Further studies needed to investigate whether meconium passage can be accelerated and whether acceleration of the meconium passage will improve the early feeding tolerance in ELBWW infants.