Risk factors of meconium-related ileus in very low birth weight infants: patients-control study

Abstract

Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the neonatal intensive care Unit of Seoul national University children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions. Infants, especially those with very low birth weight (birth weight less than 1.5 kg), may experience various medical problems, including gastrointestinal (GI) problems. Other GI diseases, including necrotizing enterocolitis (NEC), spontaneous intestinal perforation (SIP), focal intestinal perforation (FIP), and meconium-related ileus (MRI), can also occur 1. Although NEC, SIP, and FIP are mainly related to intestinal perforation, MRI is a disease associated with meconium-induced intestinal obstruction. Since the term MRI was first used by Kubota in 1999 for meconium obstruction without cystic fibrosis (CF), many cases of MRI without CF have been reported 2,3. The incidence of surgical MRI has increased recently and is similar to that of surgical NEC and FIP 1. MRI can be managed by medical treatment with a contrast enema. However, several complications, including intestinal perforation, NEC, shock, and occasionally death, have been reported following contrast enema treatment 4,5. Hiromi et al. described the risk factors of surgical intestinal disorders in VLBW infants and Masaya et al. reported them in ELBW infants 1,6. However, some studies have reported, not only the risk factors of MRI alone but also comparisons between medical and surgical MRI. The purpose of this study was to investigate the risk factors associated with MRI in VLBW infants and compare their associated factors, especially between the medical and surgical groups. Methods This study was performed on patients with bi...

Loop Ileostomy in Europe's Tiniest Male Newborn for Meconium-Related Ileus

“…According to Byun et al, male gender and ELBW are independent risk factors for developing surgical MRI. 2 Once uncorrectable thrombocytopenia, acidosis, and cardiopulmonary insufficiency associated with prolonged MRI occur, the prognosis worsens considerably.…”

“…3,4 However, if it fails and increased intraluminal pressure develops, MRI becomes a surgical challenge to avoid bacterial translocation, sepsis, perforation, or even death. 2,5,6 We report the interdisciplinary management of a newborn with a birth weight (BW) of only 273 g.…”

“…Kubota et al ar-gued that the meconium plug syndrome of the colon and the meconium disease of the distal ileum have similar origins for an ineffective peristalsis of the sticky adherent meconium due to an immaturity of the enteric nervous system, especially the pacemaker cells of Cajal and ganglia. 1,2 Keywords ► laparotomy ► loop ileostomy ► periviable fetus ► meconium-related ileus ► extremely low birth weight…”

Oclusión intestinal por enfermedad meconial asociada a hipotiroidismo y prematurez: reporte de un caso

“…La prematurez menor a las 32 semanas, presente en el 1% al 2% de los recién nacidos vivos, tiene como causa a nivel gastrointestinal la inmadurez que dificulta la motilidad intestinal, la propulsión insuficiente y el aumento de la absorción de agua, dando como resultado una composición más espesa del meconio 8,20,[27][28][29] .…”

“…Más del 75% de la EM es causada por Fibrosis Quística 4 y el íleo Meconial (IM) es la primera manifestación de la misma en un 15% -20 % de los casos 5 . En menor proporción está asociado a hipotiroidismo 6 , a Enfermedad de Hirschsprung (EH) 7 , a hijos de madres diabéticas 8 , consumidoras de psicofármacos o en aquellas que recibieron sulfato de magnesio 2 por preeclamsia, también en prematuros extremos 9 y de muy bajo peso 9,8 . En caso de hipotiroidismo, la producción inadecuada de tiroxina, disminuye la motilidad y la secreción intestinal, generándose una oclusión funcional que en ocasiones se asocia a IM 10,11 .…”