Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth

Hatanaka, Akira; Nakahara, S.; Takeyama, Eriko; Iwanaka, Tadashi; Ishida, Kazuo

doi:10.1007/s00595-013-0824-x

Cited by 12 publications

(6 citation statements)

References 16 publications

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“…The reason for successful meconium evacuation, despite Gastrografin not reaching the distal ileum, in the current study is not exactly known. It is highly probable that the early initiation of therapy and the frequent interventions, which were reported in previous studies [ 13 , 17 , 19 , 29 , 40 ], played important roles; however, it is also possible that our cases had a mild form of MRI. Emil et al [ 29 ] indicated that a 10-day duration of obstruction was the limit for which the medical treatment was effective.…”

Section: Discussionmentioning

confidence: 82%

“…Eventually, this leads to extrauterine growth restrictions, and may have long-term adverse effects, including short stature and poor neurodevelopmental outcomes [ 12 ]. Reasons for delayed passage may include meconium ileus that is related to cystic fibrosis (CF), and meconium-related ileus (MRI) without CF, which occurs mainly in preterm infants [ 13 ]. Several studies have reported treatment of MRI with saline enemas, glycerin suppositories, and oral contrast agents [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants

2022

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Background Meconium-related ileus in very low birth weight infants can lead to increased morbidity or mortality and prolonged hospitalization without prompt diagnosis and treatment. This study primarily aimed to identify the incidence of and factors associated with meconium-related ileus and secondarily sought to investigate clinical and growth outcomes after water-soluble contrast media (Gastrografin) enema. Methods We retrospectively reviewed medical records of very low birth weight infants born between February 2009 and March 2019 in the neonatal intensive care unit of a single medical center. Perinatal factors, clinical outcomes, and growth outcomes were compared between the group with meconium-related ileus that received Gastrografin enema and the control group. Results Twenty-four (6.9%) patients were diagnosed with meconium-related ileus among 347 very low birth weight infants. All achieved successful evacuation of meconium with an average of 2.8 (range: 1–8) Gastrografin enema attempts without procedure-related complications. Initiation of Gastrografin enema was performed at mean 7.0 days (range: 2–16) after birth. Incidences of moderate to severe bronchopulmonary dysplasia were higher and the duration of mechanical ventilation and need for oxygen were longer in the meconium-related ileus group (P = 0.039, 0.046, 0.048, respectively). Meconium-related ileus infants took more time to start enteral feeding and the nothing per oral time was longer (P = 0.001 and 0.018, respectively). However, time to achieve full enteral feeding and Z-scores for weight and height at 37 weeks and at 6 months corrected age did not differ between the two groups. Conclusions Gastrografin enema in very low birth weight infants with meconium-related ileus was an effective and safe medical management. Following Gastrografin enema, very low birth weight infants with meconium-related ileus achieved similar subsequent feeding progress and similar growth levels as the control groups without meconium-related ileus.

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Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants

2022

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“…Ideally, it is recom mended that passing of the contrast agent through the dilated proximal bowel be confirmed by visualization using a radio opaque agent under fluoroscopic control. However, in clinically unstable premature infants, bedside ultrasonographyguided gastrografin enemas are safe and sufficient to diagnose and treat MO 20,21) . Surgical intervention is mandatory in patients with bowel perforation and considered for those with worsening clinical condition and showing progression of abdominal disten sion 22) .…”

Section: Clinical Characteristics and Risk Factors Of Vlbw Infants Wimentioning

confidence: 99%

Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants

et al. 2015

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Purpose: This study investigated the risks of development and surgical complications of meconium obstruction (MO) in very low birth weight (VLBW) infants. Methods: We performed a retrospective medical record review of VLBW infants admitted to the neonatal intensive care unit of Haeundae Paik hospital and diag nosed with MO of prematurity (MOP) between March 2010 and August 2013. Results: Of 267 VLBW infants admitted to the neonatal intensive care unit, 28 were diagnosed with MOP. Perinatal factors including maternal pregnancyinduced hyper tension and small for gestational age were associated with MOP development (P<0.05). Over twothirds of VLBW infants with MOP were successfully treated with a gas trografin enema. The remaining eight VLBW infants required surgery. Although small for gestational age was more frequent in the medical treatment group, specific risk factors associated with MOP development did not affect the need for surgical inter vention. Conclusion: MOP is common in VLBW infants, as most VLBW infants have risk factors for MOP. Identifying risk factors permits early diagnosis and initiation of appropriate medical treatment, reducing the necessity for surgery. However, the presence of specific risk factors does not increase risk of surgical complications.

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“…Meconium obstruction in prematurity results from immature or ineffective peristalsis of the fetal intestine, which develops obstructive symptoms predisposing to intestinal perforation if not diagnosed and treated promptly . Owing to the underlying prematurity, clinical decisions on when to convert to surgical treatment in extremely premature infants with meconium obstruction remain controversial . The present case had a potential high risk of intestinal perforation without surgery because repetitive contrast enema was ineffective for improving the distention of the small intestine.…”

mentioning

confidence: 84%

Early ileostomy in a 419 g infant and long‐term follow up: A case report

Hirata

Iwasaki

Shoji

et al. 2019

Pediatrics International

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Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth

Abstract: For ELBW neonates with bowel obstruction of unclear etiology, the early and frequent administration of a Gastrografin(®) enema is reasonable. Surgery should be considered if the obstruction lasts beyond approximately 14 days after birth.

Cited by 12 publications

References 16 publications

Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants

Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants

Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants

Early ileostomy in a 419 g infant and long‐term follow up: A case report

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