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

Abstract

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.

Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success

“…Many earlier studies were concerned that the high osmolality of Gastrografin ® could cause tissue dehydration and epithelial cell damage [19][20][21][22], and therefore the possibility of bowel perforation always existed in water-soluble contrast enemas [1,3,16,23]. However in this study, the procedure-related bowel perforation itself developed only in 3 cases (9.1% on per-patient basis), and the possibility of perforation seems to be relatively low as compared with the previous reports of spontaneous perforation rate in untreated MO (about 30%) [2,24].…”

“…MO was clinically suspected when the preterm infant had a problem with passing meconium and showed progressive abdominal distention and feeding intolerance despite glycerin enema [1,3]. Unlike in NEC, the patients showed a relatively good general condition without alteration of respiratory rate and heart rate, elevation of body temperature or color change of the abdominal wall.…”

“…can cause bowel distention such as congenital bowel obstruction, necrotizing enterocolitis (NEC) or hypothyroidism [3][4][5]. MO is thought to be due to the highly viscid meconium and the immature, poor motility of the bowels in preterm infants [4,6].…”

“…Whether this disease is the same or a separate entity compared to MPS is still debated [5,9,10]. However, it is undoubtedly important to discuss this disease entity due to its increasing incidence [1][2][3], along with the appropriate management needed to prevent associated complications owing to the increased intraluminal pressure that can lead to bowel ischemia and result in necrotizing enterocolitis (NEC) or sepsis [11,12].…”

“…However, glycerin enemas did not prevent all cases of MO and several cases required further interventions, such as warm saline enema, water-soluble contrast enema, oral administration of 10% N-acetylcysteine, and surgical intervention [3]. These additional interventions could be decided on within 7days after birth, if symptoms progressed despite the routine glycerin enema [3].…”