Treatment of Delayed Meconium Passage in Preterm Infants: A Systematic Review of Timing and Effect

Aim Meconium passage is often delayed in preterm infants and assumed to be related to delayed adaptation to enteral nutrition, meconium‐related ileus, necrotizing enterocolitis, intestinal perforation and sepsis. While a definition for indication of treatment is lacking, strategies can be divided between a prophylactic approach: treatment is initiated within the first 48 h after birth irrespective of clinical symptoms, or a therapeutic approach: treatment is not initiated for at least 48 h after birth, and only indicated if clinical symptoms develop. This study systematically reviewed the efficacy and safety of prophylactic versus therapeutic treatments and compared various laxatives, with a focus on treatment‐related side effects. Methods Literature search was conducted in four databases up to 19 July 2025. Participants included preterm infants; studies were limited to rectal strategies and excluded pathological intestinal obstructions. The review was conducted according to standards for systematic reviews and registered prior to commencement. Results Six studies with moderate to high risk of bias were included (956 infants). The studies showed inconsistent findings regarding the timing of meconium passage and varying side effects of the treatments. Conclusion No evidence‐based recommendations can be made regarding timing of treatment or laxative type.