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More 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 (ELBW) Children."

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.

19 children 
39 children
Average birthweight 647 grams 671 grams
Average gestational age 24.8 26.225
Neonatal Risk Score (Hobel) 146 118
NEC 16% 5%
IQ < 70 47% 31%
Neurosensory Abnormality 32% 8%

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)  injury.

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 #569

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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