For enemas, solutions of acetylcysteine should not exceed 4% to avoid mucosal injury and hypernatraemic dehydration.
Monitor electrolytes and liver function tests particularly with repeated administration.
There are insufficient data to determine the safety and efficacy of acetylcysteine via nasogastric tube or enema for meconium ileus of prematurity and gastric and intestinal milk curd obstruction (lactobezoar) in preterm infants, particularly in respect to other approaches and agents. [LOE IV, GOR D]
Acetylcysteine T-tube ileostomy irrigation has been used for infants with meconium ileus associated with cystic fibrosis. [LOE IV GOR D]
The ESPGHAN Cystic Fibrosis Working Group recommend that use of acetylcysteine administered orally has been superseded by diatrizoic acid (Gastrografin) in children with an acute episode of distal intestinal obstruction [12]. Oral osmotic laxatives containing polyethylene glycol (PEG) or lactulose are recommended alternatives when needed for prophylaxis against DIOS. [12] [LOE IV GOR D]
There are no published reports of use of acetylcysteine for irrigation of the upper pouch in infants with oesophageal atresia.
Irrigation of upper oesophageal pouch in tracheo-oesophageal fistula – no reported evidence. For refractory cases with thick secretions not responding to sodium chloride 0.9% irrigation – subject to surgeon’s approval – 5 mL/hour of acetylcysteine 4% through Replogle tube.
| 