Stool Pattern in Normal Full Term Neonates

Abstract

SUMMARY T o date, little is known about normal bowel habits in the first years of life. The necessity for more prospectively obtained data concerning infants and young children is mandatory, not only to define normal bowel habits but also to recognize abnormal bowel habits such as constipation. Since the Rome III criteria lack clear definitions for constipation in infants, clinical experience is often the reason to start laxative treatment. This is a longitudinal study to describe the stool patterns of normal full term neonates. Infants were followed from one week afterbirth till the third month of life. Meconium, the first stool excreted, is a dark viscous substance composed of different minerals. More than 98% of term born infants passes their first stool, meconium, within 48 hours after birth. There was no significant difference in type of feeding and time of first meconium passage. In the present study, a mean stool frequency in the first month was 3.88 and decreased to 2.58 by the third month. We could confirm that breastfed infants have higher defecation frequencies than formula-fed infants in the first 3 months. Stool consistency was found to be correlated with age. In our study stool consistency was significantly softer in breastfed infants as compared with formula-fed and mixed feeding infants. In breastfed infants main stool consistency was soft and watery or loose stool decreased significantly with time. In artificial and mixed feeding infants stool consistency changed from watery to hard with increasing age (p=0.0001). None of those infants who had hard stool met the Rome III criteria for constipation. We found that breastfed infants have predominantly yellow-coloured stools, while yellow and green are customary colours, even with formula and mixed feeding in the first month. Initial laxative treatment at 1st month was (10.8%) increase to (18.0%) at 3rd month for many reasons such as low defecation frequency, hard stools, small amounts of stools, and straining, and also for abdominal distension. Infantile colic is a widespread clinical condition in infancy in our study Constant crying occur in (40.0%) of infants in first month and (38.0%) in third month. We found no significance different in type of feeding and infantile colic. The main limitation of this study is that stool pattern was assessed by questionnaire, while some other studies have obtained more objective assessments using stool samples. However the consistency of our results with other studies is reassuring and suggests that questionnaires have given reliable data. Our results contribute to data regarding bowel habit in infants, and we aim to be beneficial for understanding the normal physiology of bowel habits of infants in the first three months of life.