Translocation of bacteria due to direct mucosal damage caused by Gastrografin. An experimental study in newborn rats

The effect of an osmotic contrast agent on complete meconium evacuation in preterm infants

OBJECTIVE

To determine whether enteral application of the osmotic contrast agent Gastrografin accelerates complete meconium excretion and improves feeding tolerance in very low birth weight infants.

METHODS

This study was a stratified, randomized, placebo-controlled trial in premature infants with a birth weight <1500 g and a gestational age <32 weeks who received 3 mL/kg Gastrografin diluted 1:3 with water within their first 24 hours of life, or placebo.

RESULTS

Passage of last meconium occurred after a median of 7 days (95% confidence interval: 6-9 days, n = 39) in the intervention group and after 8 days (95% confidence interval: 7-10 days, n = 39) in the control group (P = .61); however, Gastrografin application was associated with a 7.5-day shorter time to full enteral feedings, a 24-day shorter stay in the NICU, and a 17-day reduction in the overall hospital stay in the intervention group compared with the control group. A numerically higher incidence of necrotizing enterocolitis (21%) was observed in the intervention group, however.

CONCLUSIONS

Gastrografin application did not accelerate meconium evacuation, but the higher stool frequency during the first week of life had a beneficial effect on the time to full enteral feedings and later hospital stay; however, it may increase the necrotizing enterocolitis risk. Further investigations are needed with modified protocols, and the prophylactic use of Gastrografin cannot currently be recommended without further clinical trials.

Allergic reactions to oral iodinated contrast agents: reactions to oral contrast

Allergic reactions can occur with virtually all substances used in medicine. Recently there has been increasing recognition that iodinated oral contrast agents (oral contrast) used in radiology are also capable of inducing an allergic response. Fortunately these are rarely life-threatening. This paper discusses three cases of mild reactions to oral iodinated contrast (all for computed tomography (CT) scans). The Australian experience of these agents is also reviewed.