New strategies in nonoperative management of meconium ileus

Burke, Mark S.; Ragi, Jennifer; Karamanoukian, Hratch L.; Kotter, Mark R.; Brisseau, Guy F.; Borowitz, Drucey S.; Ryan, Michael E.; Irish, Michael S.; Glick, Philip L.

doi:10.1053/jpsu.2002.32272

Cited by 73 publications

(42 citation statements)

References 4 publications

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“…Because their hyperosmolarity can be harmful to the intestines of small, preterm infants, 1 part contrast was diluted in 3 parts distilled water to achieve slightly greater osmolarity than body fluid. If the contrast enema failed to relieve the obstruction, we then tried oral 10% N-acetylcysteine administration [8] , or surgical intervention. A final diagnosis was made either based on contrast radiology or surgical findings or when the evacuation of the meconium plug was associated with the relief of bowel distension and feeding intolerance.…”

Section: Methodsmentioning

confidence: 99%

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

Kim

et al. 2011

Neonatology

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Background: Meconium obstruction (MO) of prematurity can result in increased morbidity or mortality and prolonged hospitalization if not diagnosed and treated appropriately. Objectives: The aims of our study were to identify the incidence and risk factors associated with MO and to review the treatment outcomes. Methods: A retrospective analysis was undertaken of 101 extremely low birth weight infants (ELBWIs) who were born between January 1, 2007, and April 1, 2009, at Seoul National University Hospital. Prenatal and neonatal factors were compared between the MO and control groups. The treatment outcomes were also reviewed. Results: Twenty-two (22%) patients were diagnosed as having MO. Eighteen of these patients (82%) had prenatal risk factors for MO. Respiratory distress syndrome was more prevalent in the MO group than in the control group (p = 0.001). Overall, 17 of the 22 patients (77%) were relieved with medical treatment and the rest underwent ileostomy. The times to full enteral feeding did not differ between the medically treated group and the control group. However, the surgically treated group required more time to achieve full enteral feeding, and some patients had persistent gastrointestinal problems. Conclusion: MO is not a rare condition in ELBWIs, and the majority of ELBWIs have prenatal risk factors. Medical management was effective, and medically manageable cases had good prognoses for subsequent feeding, whereas some surgically managed cases had persistent gastrointestinal problems.

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Section: Methodsmentioning

confidence: 99%

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

Kim

et al. 2011

Neonatology

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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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“…These directed hyperosmolar enemas are not without risk. Reported complications include hypovolemic shock, inflammation, perforation, and ischemic enterocolitis [13].…”

Section: Discussionmentioning

confidence: 99%