Meconium Obstruction in the Very Low Birth Weight Premature Infant

Abstract

Meconium obstruction of prematurity is a distinct clinical condition that occurs in very low birth weight infants, predisposing them to intestinal perforation and a prolonged hospitalization if not diagnosed and treated promptly. We report a series of 21 infants, including 2 detailed case reports, whose clinical course is indicative of meconium obstruction of prematurity. Specific risk factors are identified along with descriptions of clinical and radiologic findings, disease course, treatment, and outcome. Meconium obstruction of prematurity was more common in infants with a maternal history of pregnancy-induced or chronic hypertension, suggesting the possibility of decreased intestinal perfusion prenatally. Inspissated meconium was located most frequently in the distal ileum, making this disease process difficult to treat. Gastrografin enemas were safe, diagnostic, and therapeutic. Delay in diagnosis and treatment was associated with perforation and delay in institution of enteral feeds.

Recognition, Diagnosis and Treatment of Meconium Obstruction in Extremely Low Birth Weight Infants

“…The incidence of MO has not yet been established, but its diagnosis is increasing [3,7,9] . In our study, MO occurred in 22% of ELBWIs.…”

“…Therefore, meconium obstruction (MO) of prematurity can result in increased morbidity or mortality and a prolonged hospitalization if not diagnosed and treated appropriately [3] .…”

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

“…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]. …”

Evacuación del meconiointestinal para mejorar tolerancia alimentaria en prematuro de muy bajo peso (protocolo Emita)

“…Rev chil pediatr 2014; 85 (3): 304-311 jar un segmento con menor motilidad y mayor riesgo de sobreproliferación bacteriana 7,8 . Las conductas clínicas frente a esta situación son muy variables e incluyen desde una conducta expectante, hasta la necesidad de movilizar el meconio en situaciones de distensión marcada, ya sea mediante el uso de enema con gastrograffin o laparotomía exploratoria en los casos más severos 1,2,10 . otra aproximación al problema ha sido el uso temprano de enemas con glicerina.…”

“…otro estudio evaluando el uso sistemático de supositorio de glicerina, con 54 casos randomizados, no muestra diferencias significativas pero una tendencia de mejor tolerancia en el grupo tratado 14 . La preocupación por estimular la eliminación de meconio y mejorar el aporte enteral persiste y un reciente estudio probó el aporte enteral de Gastrografin ® diluido 15 , que es una medida previamente utilizada para tratar un taponamiento meconial en prematuros extremos 10 . Este estudio aportó Gastrografin ® oral 9 ml por kilo en dilución 1:3, en las primeras 24 h de vida a menores de 1.500 g o 32 semanas.…”