25 yrs primi mothers 50 hr old son has not passed stool

Mother is anxious

Should we be concerned?

She delivered as term


The time when the first meconium stool passes has been used as a marker for normal gastrointestinal functioning and a delay can occur because of gestational immaturity, a severe illness, a bowel obstruction or other causes.

An infant with a complete obstruction can pass meconium because the meconium was formed in utero distal to obstruction or a mucous stool (intestinal secretions can occur distal to the obstruction).

If delayed passage of meconium occurs,  consider prematurity, distal intestinal obstruction, or Hirschsprung disease (observed in 90% of infants).

If meconium has never been passed, consider imperforate anus or some degree of distal bowel obstruction.

If meconium has been passed and stooling has occurred and then slowed down or stopped completely,  consider small bowel obstruction.

Differential diagnosis. 

The differential diagnosis of failure to pass a stool includes constipation, secondary to prematurity, and bowel obstruction, among many other causes. The main concern is being able to recognize a bowel obstruction.


This occurs in infants who have already passed a stool and then fail to pass one. Infants have a mean of 4 stools per day during the first week of life; this gradually decreases to a mean average of 1.7 stools per day at age 2 years. Some breastfed infants have only 1 stool a day during the first few days of life, but as the mothers’ milk comes in, the frequency increases, and they tend to have more frequent stools in the first 3 months of life than standard formula-fed infants.

B. Prematurity/very low birthweight infants.

Delayed passage of meconium is common in premature and VLBW infants. Immaturity of the colon, increased viscosity of meconium, and delayed first feeding are all associated with delayed passage in these infants. These infants also have a higher risk of respiratory distress syndrome, mechanical ventilation, patent ductus arteriosus, and uteroplacental insufficiency, which also contribute to delayed passage. These infants usually do not have abdominal distension or bilious nasogastric aspirates. Delayed meconium passage in VLBW infants can be a predisposing factor for bowel perforation (mortality rate of 50%). Prophylactic administration of glycerin laxatives in VLBW infants resulted in improved stool passage over the first 48 hours of life but did not shorten the time to full feeding or decrease time to discharge (Cochrane review, September 2015).

Bowel obstruction  has an incidence of 1 in 2000 live births.

1. Large bowel obstruction  usually presents with abdominal distension and no stools. This can be secondary to a meconium plug, Hirschsprung disease, anorectal malformations, small left colon syndrome, and colonic atresia.

Small bowel obstruction  usually presents with bilious vomiting with or without abdominal distension, and meconium can be passed, but it usually progresses to decreased or no stools. This can be secondary to meconium ileus, meconium obstruction of prematurity, small bowel atresias, meconium peritonitis secondary to perforation, or malrotation and midgut volvulus.




About Dr. Jayaprakash

Asst. Prof. of Pediatrics, ICH. Institute of Child Health. Gov. Medical College Kottayam. Kerala, India.

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