Times of First Void and First Stool in 500 Newborns

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Times

of

First Void

and

First

Stool

in 500

Newborns

David A. Clark, M.D.

From theDepartmentof Pediatrics, Rainbow Babiesand Children's Hospital, Cleveland

ABSTRACT. The times of the first stool and the first void were recordedfor 500 infants. Thepopulation studied was definedinterms ofgestationalage,maternalpremedication, and modeofdelivery. The results arepresented in tabular form by time segments with term, preterm, and postterm infants treated separately. Pediatrics 60:457-459, 1977,

STOOL, VOID.

Thetimesofpassage of the first stool andurine are hallmarks of the

well-being

of the newborn

infant. Delayed micturition may be the first clue

to urinary tract pathology. Failure to pass meconium may be one of the early signs of

intestinal obstruction or an anatomic

abnormal-ity.

In 1955, Sherry and Kramer' compiled data on

500 full-term newborn infants (defined as weighing more than 2,500 g). In 1957, they observed 200 preterm infants (defined as weigh-ing less than 2,500 g).2 Their data are referred to

in several textbooks3'4 and in 1972 in aarticle by Moore and Galvez5 which discussed various

causes ofdelayed micturition inthe newborn. In

1972, Pynnonen et al.6 reported the time of the first and second urinations in 319 newborn infants and were unable to find an association between delayed micturition in males and the male preponderance for urinary tract infections in the newborn.

The available normative data were gathered from populations of infants without regard for gestational age. The purpose of this study is to present data on the times of the first void and the first stool with respect to gestational age, maternal premedication, and mode ofdelivery.

METHODS

Five hundred consecutive newborn infants

were included in this study. These infants were

born in North Carolina Memorial Hospital,

Chapel

Hill, between January 1 and June

18,

1976. A pediatric house officer was present at each delivery and assigned the Apgarscore. The

infants were cared for in either the newborn ,nurseryorthe intensive care-observationnursery.

The times of the first stool and first void were

recordedbynursesinthedeliverysuite, newborn

and intensive care nurseries, and also by the

pediatric house staff.

One hundred thirty-seven of the mothers receivedanalgesia by takingmeperidine (Demer-ol) hydrochloride ora combination ofmeperidine

hydrochloride and promethazine hydrochloride (Phenergan). Nineteen percent of the deliveries

were by cesarean section. There was meconium staining of the amniotic fluid with 39 infants. (Meconium-stained amniotic fluid was not

counted as the first stool.) With each birth, the

umbilical cord was clamped within the first minute of life.

There were 252 boys and 248 girls studied.

Eighty-six infants were admitted to the intensive care nursery, 40 remained there less than 48

hours, and 46 infants received parenteral fluid

Received January27; revisionaccepted forpublicationApril 4, 1977.

ADDRESS FOR REPRINTS: Department of Pediatrics, Rainbow Babies and Children's Hospital, 2103 Adelbert Road, Cleveland, OH44106.

PEDIATRICS Vol. 60 No. 4 October 1977 457

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TABLE I

GESTATIONAL AGE ASSESSMENT

GestationalAge No. ofInf(ants (wck) <32 3 32-33 11 34-35 28 36-37 38 38-42 395

>42 25

therapy. Of the infants admitted to the intensive care nursery,7were infants of diabetic mothers, 8 had neonatal asphyxia, 17 were diagnosed as having classical respiratory distress syndrome, and 5 infantswerehypotensive. Hypotension was corrected by administering 5% albumin solution orwhole blood. Atotal of440of the infants were fed in the first four hours after birth.

A gestational age examination was performed oneachinfantbyatleasttwophysiciansusingthe

criteria of Dtubowitz et al.7 The gestational age

assessment is summarized in Table I. Of the 46

infants requiring more than 48 hours of special-ized care, 42 were preterm infants. The gesta-tional ages of the seven infants of diabetic motherswere34, 35, 36, 37,37, 37, and 40 weeks. Sizingwasalso doneusingthecriteria ofUsheret al." Thirty-six of the 500 infants were small for gestational age; eight of the 80 preterm infants were small for gestational age.

RESULTS

The data are summarized in Table II and III with respect to gestational age. All infants had voided by 24 hours, with a tendency for the

preterm infants to void early and the postterm

infants to void later. Infants of diabetic mothers tended to void early andfrequently.

All but seven infants had stooled by 36 houirs. Six of theseveninfantsstoolingfirst after 36houirs werepreterm infants with a gestational ageof35

weeksorless. The only newborn to stool after 48 hourswas a very ill infant with a gestational age

of 29 weeks who had not been fed; she first stooled at 59 houirs after birth. Newborn infants with low Apgar scores tended to pass their first meconium early in all three groups.

TABLE II

TIME OF FIRST VOID IN 5()( INFANTS

39.5FuIll-Tenrm Infaintts 80Preterml Infants

r A e, - A,

,\o. of Cilltilul(itivev So. of Clitt 111(itive

Infaints % Infant.s N

51 12.9 17 21.2

151 158 35 0 51.1 91.1 100.0 50 12 1 0 83.7 98.7 100.0

25Postterm Infaint.s

No. of Cunm lulative

Infants % 3 4 14 4 0 12.0 38.0 84.0 10(.0 ... TABLE III

TIME OF FIRST STOOL IN500 INFANTS

395 FIll-Termi Infaints

A,

INo. of Cumtitulaitive

Infants %

80Preternm Infants

No. of Cuiniiulative

Infants %

25Posttenrm Itnfantits K- -5' o. of CGumuIJlatite

Infants % 66 169 125 29 6* 0 16.7 59.5 91.1 98.5 100.0 4 22 25 10 18t

5.0 8 32.0

32.5

63.8

76.3 98.8 100.0

458 FIRST VOID AND FIRST STOOL

flours In delivery room 1-8 9-16 17-24 >24 Houirs Indelivery room 1-8 9-16 17-24 24-48 >48 9 3 0 0 68.0 88.0 100.( .. ..

*At 25, 26, 27, 28, 33, and37hotIrS.

tFivestooled morethan 36 hours after birthat 38, 39, 40, 42, and 47hotIrs. lAt 59 hours.

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Infants born by cesarean section and infants born to mothers who received analgesics did not differfrom the general population in the times of first urination and stool passage. The 36 infants who were small for gestational age also did not differ from thegeneral population in the times of first void and stool.

DISCUSSION

In theirstudies, Sherry andKramer1 2 and also Pynnonen et al.1 reported that 7% of full-term infants and 9.5% of preterm infants voided "nor-mally" more than 24 hours after birth. Three "normal" infantsvoided after 48hours.1 Allof the 500 infants in this study voided within 24 hours after birth. The last to void was a full-term healthy infant who first voided at 23 hours.

Urine formation is dependent on the total volume of body water, blood volume (partly determined by the time of cord clamping), and renal perfusion. It may be enhanced by adminis-tration of parenteral fluids or by early feeding. The excretion of urine implies continuity of the urinary tract. No single factor could be credited for the passage of the first urine before 24 hours in all of the newborns in this study.

Failure of any newborn to void by 24 hours should prompt thephysiciantocheck the infant's hematocrit value and blood pressure. If these are

normal, consideration should be given to other causes ofanuria as described in detail by Moore

and Galvez.5

Infants having a

gestational

age of more than

35 weeks should stool by 36 hours and all infants should probably stool by 48 hours. Discussion of the method of workup for suspected gastrointes-tinal obstruction is beyond the scope of this article andcan be found instandard textbooks on the subject of pediatrics.

REFERENCES

1. Sherry SN, Kramer I: The time of passage of the first stooland first urine by thenewborninfant. J Pediatr 46:158, 1955.

2. Kramer I, Sherry SN: The time of passage of the first stool andurine by the premature infant. J Pediatr 51:373, 1957.

3. Behrman RE: Neonatology: Diseases of the Fetus and Infant. St Louis, CV Mosby Co, 1973, p 490. 4. RoyerP:Pediatricnephrology,inSchafferA(ed):Major

Problems in Clinical Pediatrics. Philadelphia, WB

SaundersCo, 1974, vol 11, p 116.

5. Moore ES, Galvez MB: Delayed micturition in the newborn period. J Pediatr80:867, 1972.

6. Pynnonen AL, Kouvalainen K, Jaykka S: Time of the firsturinations inmale and female newborns. Acta

Paediatr Scand61:303, 1972.

7. DubowitzL, Dubowitz V, Goldberg C: Clinical assess-ment of gestational age in the newborn infant. J Pediatr 77:1, 1970.

.8. Usher R, McLean F: Intrauterine growth of live-born

caucasian infants at sea level. J Pediatr 74:901, 1969.

ACKNOWLEDGMENT

Ithank the nurses of the delivery suite,newborn nursery, andintensivecare nurseryand alsothepediatric house staff ofNorth CarolinaMemorial Hospital, Chapel Hill, for their cooperationinthisstudy. Aspecialthanks goes to Dr.E. N. Kraybill forhis encouragementand guidance.