Management of meconium‐related ileus in very low‐birthweight infants

Shinohara, Takaaki; Tsuda, Mineyuki; Koyama, Norihisa

doi:10.1111/j.1442-200x.2007.02457.x

Cited by 31 publications

(27 citation statements)

References 16 publications

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“…Altogether, the whole gut transit time is increased in preterm compared with term infants (28). This reduced GI motor activity is then responsible for gastric stasis (36) and prolonged ileus (39) and is also probably involved in the pathogenesis of digestive complications observed in preterm infants such as necrotizing enterocolitis (26) and spontaneous intestinal perforation (5). In addition, severe GI motility dysfunctions observed in populations of preterm infants can prevent enteral feeding, leading to a prolonged parenteral nutrition and associated morbidity (16,40).…”

mentioning

confidence: 98%

Butyrate enemas enhance both cholinergic and nitrergic phenotype of myenteric neurons and neuromuscular transmission in newborn rat colon

Suply

Vries

Soret

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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Postnatal changes in the enteric nervous system (ENS) are involved in the establishment of colonic motility. In adult rats, butyrate induced neuroplastic changes in the ENS, leading to enhanced colonic motility. Whether butyrate can induce similar changes during the postnatal period remains unknown. Enemas (Na-butyrate) were performed daily in rat pups between postnatal day (PND) 7 and PND 17. Effects of butyrate were evaluated on morphological and histological parameters in the distal colon at PND 21. The neurochemical phenotype of colonic submucosal and myenteric neurons was analyzed using antibodies against Hu, choline acetyltransferase (ChAT), and neuronal nitric oxide synthase (nNOS). Colonic motility and neuromuscular transmission was assessed in vivo and ex vivo. Butyrate (2.5 mM) enemas had no impact on pup growth and histological parameters compared with control. Butyrate did not modify the number of Hu-immunoreactive (IR) neurons per ganglia. A significant increase in the proportion (per Hu-IR neurons) of nNOS-IR myenteric and submucosal neurons and ChAT-IR myenteric neurons was observed in the distal colon after butyrate enemas compared with control. In addition, butyrate induced a significant increase in both nitrergic and cholinergic components of the neuromuscular transmission compared with control. Finally, butyrate increased distal colonic transit time compared with control. We concluded that butyrate enemas induced neuroplastic changes in myenteric and submucosal neurons, leading to changes in gastrointestinal functions. Our results support exploration of butyrate as potential therapy for motility disorders in preterm infants with delayed maturation of the ENS.

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mentioning

confidence: 98%

Butyrate enemas enhance both cholinergic and nitrergic phenotype of myenteric neurons and neuromuscular transmission in newborn rat colon

Suply

Vries

Soret

et al. 2012

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…Spontaneous meconium evacuation is prolonged in premature infants and meconium retention seems to be associated with a delay in establishing enteral feeds [4,5]. The deep intestinal segments are obstructed by meconium with a consequent delay in establishing full feeds [6,7,8,9,10,11]. …”

Section: Introductionmentioning

confidence: 99%

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

et al. 2017

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Background: Meconium retention is associated with feeding intolerance. Trials using glycerol and Gastrografin to expedite the evacuation of meconium have failed to generate clinically valid results for efficacy and safety. Objective: We assessed the feasibility of aggressive meconium evacuation with saline rectal washout (RW) in very-low-birth-weight infants to reduce the time it took them to reach full enteral feeds. Methods: We conducted an open-label, pilot, randomized controlled trial (RCT) (birth weight stratified, i.e., to 750-999 g and 1,000-1,500 g) of early aggressive meconium evacuation with twice-daily normal saline RW compared to conventional management with glycerin suppositories (GS), until full enteral feeds (110 mL/kg/day) were reached. Primary outcome was time to reach full enteral feeds. Safety, process, and secondary efficacy outcomes were also evaluated. Results: Sixty-one infants were randomized, 28 to RW and 33 to GS. The process and feasibility outcomes were met. RW was found to be safe; none of the RW-randomized infants developed necrotizing enterocolitis (≥ stage II) or complications secondary to RW. Evidence of efficacy was supported: in the 750-999 g stratum (n = 15), the median time to full enteral feeds was shorter with RW (11.0 days, 95% CI: 10.4-11.6) than with GS (15.6 days, 95% CI: 13.0-18.2) by a reduction of 4.6 days (p = 0.027). In the 1,000-1,500 g stratum (n = 46), there was no evidence of benefit: RW 10.2 days (95% CI 8.3-12.1) and GS 10.1 days (95% CI 9.3-10.9, p = 0.304). Conclusion: Our protocol was feasible and an adequately powered RCT is required to confirm the findings of this trial.

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“…In the nonoperative management of MI, if evacuation is incomplete or if the first attempt at Gastrografin evacuation does not reflux contrast into dilated bowel, a second enema may be necessary. Reflux of the enema into the terminal ileum is critical for the bowel obstruction to be relieved [34]. Serial Gastrografin enemas can be performed at 12-to 24-hour intervals if necessary.…”

Section: Nonoperative Managementmentioning

confidence: 99%

A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon

Carlyle

Borowitz

Glick

2012

Journal of Pediatric Surgery

124

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Management of meconium‐related ileus in very low‐birthweight infants

Abstract: Although administration of water-soluble contrast enemas can be effective for meconium-related ileus, reflux into the terminal ileum is essential for bowel obstruction to improve, so it is desirable to perform the procedure under fluoroscopic guidance.

Cited by 31 publications

References 16 publications

Butyrate enemas enhance both cholinergic and nitrergic phenotype of myenteric neurons and neuromuscular transmission in newborn rat colon

Butyrate enemas enhance both cholinergic and nitrergic phenotype of myenteric neurons and neuromuscular transmission in newborn rat colon

Saline Enemas versus Glycerin Suppositories to Promote Enteral Feeding in Premature Infants: A Pilot Randomized Controlled Trial

A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon

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