Meconium-related Ileus in Extremely Low-birth Weight Newborn Infants Meconium-related Ileus in ELBWI

Abstract

Purpose: Meconium-related ileus (MRI) is one of the major causes of bowel obstruction in extremely low-birth weight newborn infants (ELBWI). Hyperosmolar water-soluble contrast (HWSC) enemas been recognized to be an effective treatment for MRI. The purpose of this study is to observe clinical findings of MRI accompanied by ELBWI and evaluate the therapeutic efficacy and complications of HWSC enemas. Methods: A total of 15 ELBWI with MRI were treated with HWSC enemas under the guidance of ultrasonography at the bedside in the NICU between 2008 and 2011. Clinical findings of 15 patients were reviewed and compared with those of 48 ELBWI without MRI administered to NICU during the same period. Radiological findings, therapeutic efficacy and complications of HWSC enemas in patients with MRI were also reviewed. Results: Patients with MRI, compared to those without MRI, showed the following significantly lower Apgar score at 1 minute, higher incidence of preeclampsia, bronchopulmonary dysplasia and sepsis, and longer duration of the first meconium passing and non-feeding per oral. Fourteen patients with MRI had resolved bowel obstruction successfully following 1-2 trials of enema. One case was not relieved following 3 trials of enema, showed no clinical improvement, and died of severe intraventricular hemorrhage and multi-organ failure at 45 days old. No complications associated with HWSC enemas were observed in all cases. Conclusion: Administration of HWSC enemas under the guidance of abdomen ultrasonography in the NICU is safe and efficacious for the rapid diagnosis and treatment of MRI even accompanied by ELBWI.

Impact of Meconium Obstruction-Related Risk Factors on Surgical Intervention in Very Low Birth Weight Infants

“…Ideally, it is recom mended that passing of the contrast agent through the dilated proximal bowel be confirmed by visualization using a radio opaque agent under fluoroscopic control. However, in clinically unstable premature infants, bedside ultrasonographyguided gastrografin enemas are safe and sufficient to diagnose and treat MO 20,21) . Surgical intervention is mandatory in patients with bowel perforation and considered for those with worsening clinical condition and showing progression of abdominal disten sion 22) .…”