Meconium peritonitis: prenatal diagnosis, postnatal management and outcome

Chan, Kelvin; Tang, May; Tse, H. Y.; Tang, Rebecca; Tam, Paul K. H.

doi:10.1002/pd.1221

Cited by 72 publications

(43 citation statements)

References 23 publications

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“…Few reports in the past have shown a strong correlation between antenatal US features of MP and its postnatal outcome [20][21][22][23] . Kamata et al [15] classified MP into three types: type I with massive ascites, type II with giant MPC, and type III with intraperitoneal calcifications with or without small pseudocyst.…”

Section: Discussionmentioning

confidence: 99%

Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Ping

Rajadurai²,

Saffari³

et al. 2016

Fetal Diagn Ther

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Objective: To identify the fetal and neonatal imaging characteristics of meconium peritonitis (MP) and their clinical outcome. We also studied the role of prenatal ultrasound (US) in antenatal diagnosis and its use in predicting the need for surgical intervention postnatally. Material and Methods: We conducted a retrospective analysis of a cohort of 18 infants with MP from April 2004 to March 2014. Results: Prenatal US detected MP-related abnormalities in 15/18 (83.3%) fetuses. The median gestational age at initial diagnosis of MP was 24 weeks (range 19-31). Fetal ascites (93.3%) was the most common prenatal US finding. Of the 18 infants, 12 (66.7%) required surgical intervention. The overall survival rate was 94.4%. All infants with a prenatal US scan showing meconium pseudocyst or bowel dilatation required surgical intervention postnatally. Discussion: A combination of ascites, intraperitoneal calcification, and echogenic bowel on fetal US raises a high suspicion of MP. Surgical intervention is indicated in the presence of meconium pseudocyst on fetal or postnatal US scan. Antenatal US has high specificity (100%) but low sensitivity (22.2%) in detecting meconium pseudocyst. A favorable outcome can be expected with early antenatal diagnosis and timely surgical intervention in a tertiary hospital.

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Section: Discussionmentioning

confidence: 99%

Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Ping

Rajadurai²,

Saffari³

et al. 2016

Fetal Diagn Ther

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“…In the absence of radiological signs that characterise complex meconium peritonitis, the prognosis is very good [14,15]: in all other forms of prenatal meconium peritonitis, but the cystic form, emergency surgery is not required.…”

Section: Discussionmentioning

confidence: 98%

Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery

et al. 2008

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Prenatal ultrasound (US) diagnosis and postnatal outcome are reviewed in three babies with the complex form of meconium peritonitis (MP), the cystic type. Perinatal management is discussed. Large intra-abdominal cysts with signs of calcifications were detected during the second mid-trimester. Meconium ascites and polyhydramnios appeared between 32 and 35 weeks of gestation. Signs of anaemia were assessed on median cerebral artery peak systolic velocity. Sudden appearance of hydrops and anaemia required preterm delivery, neonatal resuscitation and urgent abdominal drainage. Postnatal US imaging confirmed prenatal sonographic evidence. Abdominal X-ray showed calcifications and no free abdominal air. Intestinal diversion was performed in two patients on their first day of life and evolution was uneventful. Hospital death occurred in one baby, who was submitted to delayed surgery due to unstable hemodynamic conditions. Distal ileal perforation walled off by pseudocysts was detected in all cases. One baby was found to be affected by cystic fibrosis. Ileal intussusception was described in the non-surviving infant. The cystic type of MP may have a potentially rapid lethal course and the onset of foetal anaemia and polyhydramnios is a bad prognostic factor. Severe evolution in hydrops and foetal distress may occur at any moment suggesting the persistence of a leakage or re-rupture of the cysts with new meconium spillage into the abdomen. Prenatal detection of ascites, polyhydramnios and pseudocysts requires a strict follow-up, and timing of delivery has to be planned in a tertiary centre. Postnatal radiological imaging does not offer further information over prenatal imaging and surgical decision should not be influenced by the absence of abdominal free air. Urgent abdominal drainage at birth, followed by intestinal diversion of persistent intestinal perforation on the first day of life, may prevent bacterial colonisation and improve prognosis.

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“…Recently, antenatal diagnosis and progress in treatment have decreased the mortality rate [7,8], but the morbidity rate is still high because the severe inflammatory response may continue after birth and cause complications [2]. FIRS is a relatively novel concept, but it is now becoming widely accepted by neonatologists and obstetricians [1], and it is closely related to the presence of cytokines such as IL-6 and IL-8 [9,10].…”

Section: Discussionmentioning

confidence: 99%

Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis

et al. 2011

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Interleukin 6 and interleukin 8 play important roles in the inflammatory response syndrome associated with meconium peritonitis, and drainage of cystic fluid did not completely suppress this inflammation. To lessen the high morbidity of meconium peritonitis, efforts should be made to suppress the inflammatory response using new treatment strategies, such as administration of steroids or anti-cytokine therapy to supplement cystic drainage.

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Meconium peritonitis: prenatal diagnosis, postnatal management and outcome

Cited by 72 publications

References 23 publications

Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Meconium Peritonitis: Correlation of Antenatal Diagnosis and Postnatal Outcome - An Institutional Experience over 10 Years

Prenatal detection of the cystic form of meconium peritonitis: no issues for delayed postnatal surgery

Interleukin 6 and interleukin 8 play important roles in systemic inflammatory response syndrome of meconium peritonitis

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