Health
‘It’s abnormal for newborns not to pass stool within 48 hours’
Janet Ogundepo
Newborn and child health experts have asserted that it is abnormal and a medical red flag for a newborn not to pass stool within the first 24 to 48 hours of birth, stating that such a condition requires immediate professional evaluation to rule out and treat potentially life-threatening conditions.
The seasoned paediatricians told PUNCH Healthwise in separate interviews that a newborn must pass the first black stool, called meconium, and further described as a very thick tar-like substance, shortly after birth.
They stressed that the normal timeline is that up to 90 per cent of healthy newborns pass meconium within the first 24 hours of life and that by 48 hours, virtually all healthy newborns born at nine months must have passed their first stool.
Failure to pass this stool, the experts stated, could indicate underlying congenital conditions including imperforate anus, intestinal obstruction, Hirschsprung’s disease, and systemic illnesses, all of which required urgent specialist evaluation and in many cases surgical intervention.
The paediatricians warned that waiting up to a week before seeking medical care was dangerous and could result in intestinal perforation, life-threatening sepsis, enterocolitis, and the death of the baby, as the newborn’s delicate intestines could not withstand prolonged obstruction.
They also strongly condemned the use of home remedies, oils, concoctions, and rectal insertions to stimulate stooling in newborns, describing such practices as extremely dangerous and capable of causing fatal lipoid aspiration pneumonia, bowel perforation, and masking underlying diagnoses that required surgery.
PUNCH Healthwise reports that some mothers give newborns, who are unable to pass stool, castor oil, baby oil or water as remedies for constipation and to help them defecate.
In an exclusive interview with PUNCH Healthwise, a paediatric surgeon and Professor of Surgery at Bayero University, Kano, and Aminu Kano Teaching Hospital, Aminu Mohammad said newborns were the most delicate human beings because of the enormous physiological transition they underwent at birth.
He further noted that “it is highly abnormal and a medical red flag for a newborn not to pass stool within the stipulated period.”
Mohammad, who is also Chair of the Department of Surgery at Bayero University Kano, explained that meconium was the “first black stool a newborn passes out, which is usually the residue from while the baby is inside. It is not what the baby has eaten that the baby passed as opposed to stool.
“It is called meconium in medical language, which is a very thick, tar-like substance that should be passed shortly after birth. The normal timeline is that up to 90 per cent of the healthy newborn pass meconium within the first 24 hours of life. By 48 hours, virtually all healthy term newborns, meaning those born at nine months, must have passed their first stool.”
He stated that newborns who haven’t passed meconium after 48 hours of birth are in a medical emergency and need immediate consultation with a paediatrician or to take the baby to the emergency department.
The paediatric surgeon warned that any suggestion of waiting a full week before seeking help was risky, saying, “That one-week mark is very risky for anybody to wait for. Waiting a full week is not just delayed; it’s a sign of a serious underlying condition. Delayed passage is officially considered when a baby does not stool within 48 hours. A delay beyond this point requires immediate medical evaluation.”
The researcher on Congenital Paediatric Oncology and Infections cautioned against attempting to stimulate a newborn’s bowel movement at home with concoctions, oils or objects inserted into the rectum, warning that such practices could worsen an underlying condition.
He said, “Parents should not attempt to treat this at home with remedies like rectal stimulation, as this can mask a serious diagnosis and delay proper treatment. This practice is extremely dangerous and must be strongly discouraged.
“Giving oils like castor oil or mineral oil orally to an infant can cause them to inhale the oil into their lungs, leading to a serious and potentially fatal type of pneumonia. Also, bowel injury: Enemas or suppositories can easily injure the delicate mucous membrane of a newborn’s rectum.
“These remedies might produce a stool, giving a false sense of security while a life-threatening condition like Hirschsprung’s disease or an intestinal obstruction continues undiagnosed and worsens. Also, oils can interfere with normal digestion, causing diarrhoea, cramping, or allergic reactions.”
Mohammad further noted that the condition is not always avoidable because many of its causes occur before birth and are linked to congenital abnormalities.
He, however, stated that its complications can be prevented through early recognition and prompt medical treatment.
The professor of paediatrics said, “Most of the causes of failure to pass meconium originate from before the child is born. So it is not an acquired condition that can be relieved by some of these remedies. Some of the causes could be what we call anatomical or structural, meaning that such babies, if carefully examined, may not have an anus open, what we call an imperforate anus.
“Therefore, when the buttocks of the baby are examined, they may find no opening, or the opening is in an abnormal place. Such babies cannot pass meconium as expected. There is also what we call intestinal atresia or stenosis, whereby the intestine is not connected; it is disjointed inside the abdomen. So whatever you do, you cannot relieve it by giving the newborn anything by mouth or from the anus. Such cases may require surgery.”
The immediate past National President of the Medical and Dental Consultants Association of Nigeria further said that functional causes were equally serious, adding, “Sometimes it might be functional or what we call motility problems. There are patients who have abnormal innervation of the intestine, like those that have what we call Hirschsprung’s disease.
“This is a condition whereby the coordinating junction between the two nerves is absent, which we call ganglion cells. So therefore, the message will come from the brain for the intestine to open, to pass stool, but because of the absence of that integrating cell, it will not allow it to pass.”
Mohammad said other possible causes included very thick and sticky meconium, systemic illnesses such as poor thyroid function, and certain medications administered to mothers around labour.
He warned that leaving an intestinal obstruction untreated could lead to bowel perforation, sepsis and death.
The paediatric surgeon urged parents to seek urgent medical attention if a newborn failed to pass stool within 24 to 48 hours, especially when this was accompanied by green vomiting, abdominal distension, refusal to feed, weakness or blood in the stool.
Mohammad noted that affected babies would require physical examination and, where necessary, diagnostic investigations to establish the cause of the delayed passage of stool.
Speaking with PUNCH Healthwise, a Professor of Paediatrics and Neonatology at Ahmadu Bello University, Zaria, Kaduna State, Professor Isa Abdulkadir, said most healthy term newborns were expected to pass their first stool within the first few days of life and that failure to do so warranted medical evaluation.
Abdulkadir, a Consultant Paediatrician and Neonatologist at the Ahmadu Bello University Teaching Hospital and a member of the African Neonatal Nutrition Network, said the failure to pass meconium could be a sign of an underlying problem with the baby.
He said, “Normally, we expect newborns to pass what we call meconium, which is the first stool they pass. It is expected that at least within the first few days, most of the term babies will have passed that first stool. If that is not obtained, we need to evaluate; it could be a problem. Particularly, if these are term babies and they are feeding and suckling well, we expect 80 to 90 per cent of them to pass this stool within the first two to three days. But if that doesn’t occur, we need to worry.”
Abdulkadir, a member of the Nigerian Society of Neonatal Medicine, said that for babies who failed to pass stool, specialist review must be immediate.
He said, “They need to see a physician who needs to review because it could indicate some problem that the baby has been delivered with, that the baby has some issues with the normal motions of the intestine and then subsequent passing of stool. The parents should see a paediatrician and, if possible, a neonatologist who will take a deep look at the baby and try to sort out the reason why the baby has not passed stool.”
The neonatologist said that while many causes of delayed meconium passage were congenital anomalies and unrelated to anything the mother did during pregnancy, feeding practices after birth were also an important factor in supporting normal bowel function.
Continuing, he said, “The act of bowel motion at birth also depends on other factors like how early the baby is nourished on oral feeds, what the baby is nourished on, and the digestibility of what the baby has been fed. One of the things that could encourage and ease more bowel movements once delivery has taken place is the mother avoiding feeding any other thing to the baby except human breast milk, meaning the mother’s own milk. That is the natural, digestible and conducive food for the baby. We encourage that the baby should be exclusively fed as soon as the baby is delivered, within the first 30 minutes to one hour of birth.”
Abdulkadir said the worst-case scenario of untreated failure to pass stool could be fatal, but stressed that it was largely preventable through good antenatal care, delivery in certified health facilities and under the supervision of trained healthcare professionals and sustained expert support for breastfeeding.
He said, “From antenatal, mothers need to go to antenatal care and receive quality antenatal care under an approved and certified care provider. And part of the antenatal care services should include education on feeding methods and what to feed their babies when they do deliver.
“When they deliver, they should deliver in certified health institutions under the supervision of a skilled doctor. Part of the care also is to help them establish lactation and support them to initiate sustained exclusive breastfeeding. This baby should be seen within the first week of delivery to assess how the baby is feeling, whether feeding has been established, and whether the right information is given to the mother. These are all standard postnatal care measures that are put in place.”
He urged parents to report any deviation from expected newborn behaviour to a specialist immediately, regardless of how minor it might seem.
He said, “The key thing is people should understand that babies are not adults. The care is delicate and needs to be provided by experts who are trained, certified and licensed to provide this care. Every deviation from what we consider to be normal needs to be properly looked into and assessed.
“For any mother who sees anything abnormal from what is expected from other babies, the first thing is to report to a paediatrician or a neonatologist, who will determine whether this is something that has to do with feeding and support her to reestablish the pathway for normal quality feeds, or whether this is a disease condition that needs to be addressed and the appropriate sub-speciality needs to be involved.”
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