on Constipation and Prematurity
By Helen Harrison
Dr. Maureen Hack is the only person I have known to consider chronic
constipation as a preemie follow-up issue, but it makes sense that
she has. Neurological problems (such as CP) change the muscle tone in
various ways throughout the body. High tone in the arms and legs
may coexist with low tone in the mouth and digestive tract. This
low tone may lead to problems with swallowing, gagging, reflux, digestion,
and constipation (sometimes with concurrent diarrhea).
The after effects of NEC are other possibilities. This too can cause a
variety of long-term bowel problems.
Here is a study on constipation in preemies that was presented by Cunningham,
Taylor, Klein, Minich, and Hack, at the 1998 Society for Pediatric
Research Meeting. This is from Dr. Maureen Hack's group at Case Western
Reserve (Rainbow Babies and Children's Hospital) in Cleveland, Ohio.
"Constipation is a Problem Among Former <750 Gram Birthweight
When interviewed and evaluated at 10 years of age, 19 out of 58 (33%)
of the parents of ELBW children (mean birthweight 664 grams, mean gestational
age 26 weeks, born between 1982-86) reported constipation to be problem
compared to 6/53 (11%) of children with a birthweight of 750 g - 1499
g and 3/49 (6%) of normal birthweight controls. Constipation was
defined as difficulty passing hard dry stools. To determine the
cause, we compared neonatal and neurodevelopmental outcomes of the constipated
to non-constipated children Group differences are summarized below.
|Average gestational age
|Neonatal Risk Score (Hobel)
|IQ < 70
Thus constipated ELBW were of lower gestational age at birth and had more
neonatal problems including NEC, and had higher rates of neurologic abnormality
(4 cerebral palsy, one blind, one deaf) and were more likely to have IQs
below 70 than non-constipated ELBW. Further history obtained from
15 of 19 parents of the constipated ELBW children at age 12 years revealed
that for 13 of the 15 children constipation began prior to 6 months of age.
Four children were severely retarded and were not toilet trained and 8 of
the remaining 11 were still having soiling accidents. Among 11 non-constipated
ELBW matched by race and sex, only one was not toilet trained and 4 were
still having soiling accidents at age 12 years. Conclusions: Constipation
among ELBW children is probably associated with neurodevelopmental impairment,
but could also be secondary to neonatal ischemic (lack of proper circulation)
I suppose the ischemic injury they have in mind is intestinal damage as
a result of NEC.
Source: Cunningham et al. "Constipation is a Problem Among Former <750
gram Birthweight ELBW Children" Pediatric Research 1998;100A
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.