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

Cho, Hyun Hae; Cheon, Jung Eun; Choi, Young Hun; Lee, So Mi; Kim, Woo Sun; Kim, In One; Shin, Sei One; Kim, Ee Kyung; Kim, Han Suk; Choi, Jung Hwan; You, Sun Kyoung

doi:10.1016/j.ejrad.2015.06.006

Cited by 23 publications

(31 citation statements)

References 29 publications

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“…This treatment is both noninvasive and effective. Success depends on the reflux of contrast media into the distal ileum, where an inspis sated meconium is located most frequently 1,17) . GarzaCox et al 1) reported that 38% of obstruction sites were in the distal ileum and 10% in both the distal ileum and colon.…”

Section: Discussionmentioning

confidence: 99%

“…Having a lower body weight at birth or at the time of the contrast enema (SGA) reduces the success rate of contrast enema 17) . Five of the seven (71.4%) infants exhibited ma ternal risk factors, one of which had a combination of maternal GDM and preeclampsia.…”

Section: Discussionmentioning

confidence: 99%

“…patients, 9% to 50% require surgery, and 50% to 83% of obstruc tions occur in the distal ileum 1,2,17) . Standard medical therapy is less effective in such infants because the enema may not reach the ob structed area 1,7) .…”

Section: Discussionmentioning

confidence: 99%

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Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

2021

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Purpose: Meconium obstruction of prematurity (MOP) predisposes premature in fants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clini cally diagnosed patients with MOP whose obstructions were not relieved via conven tional sonographyguided contrast enema. We retrospectively evaluated whether oral nonionic watersoluble contrast media relieves MOP. Methods: Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followedup radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors. Results: We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27 +5 weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without airfluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age. Conclusion: Nonionic oral watersoluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

2021

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“…It was diagnosed if persistent or progressive gaseous bowel distension was noted on plain radiography, along with the presence of hypoechoic meconium-lled bowel loops and distended proximal bowel loops observed by sonography. [15,16] Glycerin enema was used as the rst-line therapy for a few days, and ultrasonography-guided water-soluble contrast enema was performed if the condition was not resolved. If contrast enema failed to relieve the obstruction, surgical intervention was carried out.…”

Section: Methodsmentioning

confidence: 99%

Antenatal Magnesium Sulfate Reduced Intestinal Morbidities Requiring Surgery in Preterm Infants With Extremely Low Gestational Age: A Retrospective Cohort Study

Kim¹,

Kim²,

Shin³

et al. 2020

Preprint

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Background Antenatal magnesium sulfate is widely used as a tocolytic, for maternal seizures, and for seizure prophylaxis in preeclampsia. Recent studies have suggested that antenatal magnesium sulfate use is associated with favorable neurodevelopmental outcomes in preterm infants. However, there are concerns regarding the neonatal effects of antenatal magnesium sulfate, especially regarding gastrointestinal morbidities. This study aims to explore the effects of antenatal magnesium sulfate on intestinal morbidities requiring surgery in preterm infants.Methods This was a retrospective cohort study of 181 preterm infants who were born at less than 28 weeks of gestational age. Subjects were categorized as infants exposed to antenatal magnesium sulfate and those not exposed to antenatal magnesium sulfate.Results Antenatal magnesium sulfate was associated with a lower incidence of surgical conditions of the intestine (OR 0.393, 95% CI 0.170–0.905). Multivariate analysis showed that the duration of antenatal magnesium sulfate use was associated with surgical conditions of the intestine (adjusted OR 0.766, 95% CI 0.589–0.997). In the < 26 weeks of gestational age subgroup, use of antenatal magnesium sulfate was significantly associated with decreased intestinal morbidities requiring surgery (adjusted OR 0.234, 95% CI 0.060–0.922).Conclusion Antenatal magnesium sulfate use appears to have a protective effect on intestinal morbidities requiring surgery in preterm infants in a duration-dependent manner. Association of antenatal magnesium sulfate use and decreased intestinal morbidities requiring surgery was more distinct in preterm infants < 26 weeks of gestational age.

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“…Features of NEC like intramural gas or complicated ascites are not seen. [7,13] USS for diagnostic purposes does not seem to add much beyond what is seen on plain radiographs. It could however be used as a guide for bedside contrast enema administration in cases where transfer to the radiology unit is not feasible.…”

Section: Localised Perforation Usually At the Terminal Ileummentioning

confidence: 96%

Management strategies of functional intestinal obstruction of prematurity

Awolaran

Sheth

2021

J Neonatal Surg

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Functional intestinal obstruction of prematurity (FIOP) is characterised by a partial or complete failure of meconium evacuation due to hypomotility of the immature bowel and this presents with features of intestinal obstruction typically within the first 2 weeks of life. It contributes significantly to the morbidity and mortality of extremely and very low birth weight preterm infants. This disorder has been described using many terminologies and there is controversy amidst clinicians as to the optimal approach to its management. This review summarises the characteristic clinical and radiologic findings to aid timely diagnosis and initiation of prompt treatment. Available evidence on different treatment options and their limitations is reviewed and practical stepwise management is described. In most cases, FIOP can be successfully managed conservatively with proactive management and monitoring. Overall outcomes are favourable and normal long-term gastrointestinal function is commonly experienced. Evidence for investigations to exclude cystic fibrosis and Hirschsprung’s disease in preterm infants with FIOP is evaluated and a link with focal intestinal perforation is highlighted.

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

Cited by 23 publications

References 29 publications

Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

Antenatal Magnesium Sulfate Reduced Intestinal Morbidities Requiring Surgery in Preterm Infants With Extremely Low Gestational Age: A Retrospective Cohort Study

Management strategies of functional intestinal obstruction of prematurity

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