Efficacy of Ultrasound-guided Contrast Enema on Meconium Plug Syndrome in Preterm Infants

Byoung Kook Lee; Hye Rim Kim; Ji Young Kim; Chang Won Choi; Beyong Il Kim

doi:10.14734/kjp.2016.27.1.28

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Lee, Kim, Kim, Choi, and Kim: Efficacy of Ultrasound-guided Contrast Enema on Meconium Plug Syndrome in Preterm Infants

Original Article

Korean J Perinatol 2016;27(1):28-35.

Published online: 19 March 2016

DOI: https://doi.org/10.14734/kjp.2016.27.1.28

Efficacy of Ultrasound-guided Contrast Enema on Meconium Plug Syndrome in Preterm Infants

Byoung Kook Lee, M.D.¹, Hye Rim Kim, M.D.¹, Ji Young Kim, M.D.², Chang Won Choi, M.D.^1,, Beyong Il Kim, M.D.¹

¹Department of Pediatrics and, Seongnam, Korea

²Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea

Correspondence to: Chang Won Choi, M.D. Department of Pediatrics, Seoul National University Bundang Hospital, Gumi-dong 300, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Korea Tel: +82-31-787-7286, Fax: +82-31-787-4054 E-mail: choicw1029@gmail.com

Received 2 February 2016 Revised 23 February 2016 Accepted 26 February 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

This study aims to compare the effectiveness and safety of ultrasound-guided contrast enema comparing with exploratory laparotomy for meconium plug syndrome in preterm infants.

Methods:

Fifty-three preterm infants who were diagnosed with meconium plug syndrome among the neonates admitted to the Neonatal Intensive Care Unit of the Seoul National University Bundang Hospital from March 2008 to August 2015 were analyzed retrospectively. Four-teen infants among the 53 infants were excluded and Thirty-nine infants were analyzed. That time were divided into Period I and Period II. There was no pediatric radiologist and we couldn’t try contrast enema in Period I. Pediatric radiologist was appointed and ultrasound guided contrast enema has been available in Period II.

Result:

There were no specific differences of demographic characters between both Periods. Invasive procedure including contrast enema was increased in Period II than Period I (81% vs. 42%; P<0.05) and there were more exploratory laparotomy in Period I than in Period II (42% vs. 7%; P<0.05). Complications after treatment of meconium plug syndrome were more frequent in exploratory laparotomy groups than in ultrasound-guided contrast enema (57% vs. 0%; P<0.05) and total parenteral nutrition days were longer in laparotomy groups than in contrast enema groups (61±30 days vs. 31±13 days; P<0.05).

Conclusion:

We suggest that ultrasound-guided contrast enema with hyperosmolar water-soluble contrast is more therapeutic and safe therapy than exploratory laparotomy for meconium plug syndrome.

Keywords: Meconium, Contrast enema, Premature infant

REFERENCES

1). Haram-Mourabet S., Harper R G., Wapnir RA. Mineral composition of meconium: effect of prematurity. J Am Coll Nutr. 1988. 17:356–60.

2). Weaver LT., Lucas A. Development of bowel habit in preterm infants. Arch Dis Child. 1993. 68:317–20.

3). Emil S., Nguyen T., Sills J., Padilla G. Meconium obstruction in extremely low birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg. 2004. 39:731–7.

4). Dimmitt RA., Moss RL. Meconium diseases in infants with very low birth weight. Semin Pediatr Surg. 2000. 9:79–83.

5). Loening-Baucke V., Kimura K. Failure to pass meconium: diagnosing neonatal intestinal obstruction. Am Fam Physician. 1999. 60:2043–50.

6). Burke MS., Ragi JM., Karamanoukian HL., Kotter M., Brisseau GF., Borowitz DS, et al. New strategies in nonoperative management of meconium ileus. J Pediatr Surg. 2002. 37:760–4.

7). Hong KB., Seong IC., Lee KS., Chang YP., Song HS. Meconium Obstruction in Very Low Birth Weight Infants. Korean J Pediatr Gastroenterol Nutr. 2011. 14:52–8.

8). Lubchenco LO., Hansman C., Dressler M., Boyd E. Intrauterine growth as estimated from liveborn birth-weight data at 24 to 42 weeks of gestation. Pediatrics. 1963. 32:793–800.

9). Jobe AH., Bancalari E. Bronchopulmonary dysplasia. Am J Resp Crit Care Med. 2001. 163:1723–9.

10). Bell MJ., Ternberg JL., Feigin RD., Keating JP., Marshall R., Barton L, et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg. 1978. 187:1–7.

11). Clatworthy HW., Howard WH., Lloyd J. The meconium plug syndrome. Surgery. 1956. 39:131–42.

12). Yoo SY., Jung SH., Eom M., Kim IH., Han A. Delayed maturation of interstitial cells of Cajal in meconium obstruction. J Pediatr Surg. 2002. 37:1758–61.

13). Greenholz SK., Perez C., Wesley JR., Marr CC. Meconium obstruction in the markedly premature infant. J Pediatr Surg. 1996. 31:117–20.

14). Sokal MM., Koenigsberger MR., Rose JS., Berdon WE., Santuli TV. Neonatal hypermagnesemia and the meconium-plug syndrome. N Engl J Med. 1972. 286:823–5.

15). Hutchinson HT., Nichols MM., Kuhn CR., Vasicka A. Effects of magnesium sulfate on uterine contraction, intrauterine fetus and infant. Am J Obstet Gyneco. 1964. 88:747–58.

16). Yi GC., Kang KJ., Kim EH., Kim CS., Lee SL. Clinical features and Outcomes of Meconium Intestinal Obstruction in Preterm Infants. Korean J Perinatol. 2012. 23:242–9.

17). Fenton TR., Lyon AW., Rose MS. Cord blood calcium, phosphate, magnesium, and alkaline phosphatase gestational age-specific reference intervals for preterm infants. BMC Pediatr. 2011. 11:76.

18). Stewart DR., Nixon GW., Johnson DG., Condon VR. Neonatal small left colon syndrome. Ann Surg. 1977. 186:741–5.

19). Philippart AI., Reed JO., Georgeson KE. Neonatal small left colon syndrome: intramural not intraluminal obstruction. J Pediatr Surg. 1975. 10:733–40.

20). Mihatsch WA., Franz AR., Lindner W., Pohlandt F. Meconium passage in extremely low birthweight infants and its relation to very early enteral nutrition. Acta Paediatr. 2001. 90:409–11.

21). Flidel-Rimon O., Friedman S., Lev E., Juster-Reicher A., Amitay M., Shinwell ES. Early enteral feeding and nosocomial sepsis in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2004. 89:F289–92.

22). Shim SY., Kim HS., Kim DH., Kim EK., Son DW., Kim BI, et al. Induction of early meconium evacuation promotes feeding tolerance in very low birth weight infants. Neonatology. 2007. 92:67–72.

23). Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg. 1969. 4:190–7.

24). Shaw A. Safety of N-acetylcystein in treatment of meconium obstruction of the newborn. J Pediatr Surg. 1969. 4:119–25.

25). Cho HH., Cheon JE., Choi YH., Lee SM., Kim WS., Kim IO, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. Eur J Radiol. 2015. 84:2024–31.

26). Yu HY., Shin JE., Eun HS., Lee SM., Park SM., Lee MJ, et al. Meconium-related ileus in extremely low-birth weight newborn infants meconium-related ileus in ELBWI. Neonatal Med. 2013. 20:121–8.

Fig. 1

Schematic review of study population.

Table 1.

Characters of Demographics between Period I and Period II

	Period I (n=12)	Period II (n=27)	P value
Birth weight, g (range)	1,052±328 (620-1,615)	834±234 (430-1,280)	0.02∗
GA, weeks (range)	27±2 (24-31)	29±4 (24-35)	0.29
Male gender, n (%)	8 (67)	11 (41)	0.18
Cesarean section, n (%)	0 (0)	23 (85)	0.29
Preeclampsia/Eclampsia, n (%)	2 (17)	9 (33)	0.45
Maternal MgSO₄ use, n (%)	5 (33)	14 (52)	0.73
Serum Mg levels, mg/dL (range)	2.5±0.8 (1.8-3.8)	2.7±1 (1.7-4.7)	0.67
Gestational diabetics, n (%)	1 (9)	2 (7)	1.00
Histologic chorioamnionitis, n (%)	5 (42)	10 (37)	0.74
Prenatal steroid use, n (%)	3 (25)	8 (30)	1.00
APGAR score
1 minute	5±2	4±2	0.48
5 minute	7±1	6±2	0.54
Small for gestational age, n (%)	4 (33)	10 (37)	1.00
RDS, n (%)	10 (83)	23 (85)	0.79
Hypothyroidism, n (%)	3 (25)	8 (30)	1.00

Data are presented as Mean±SD or number (%). ∗P<0.05 Abbreviations: GA, gestational age; MgSO₄, magnesium sulfate; Mg, magnesium; RDS, respiratory distress syndrome.

Table 2.

Comparison of Clinical Outcomes between Period I and Period II

Outcomes	Period I (n=12)	Period II (n=27)	P value
Invasive procedure, n (%)	5 (42)	22 (81)	0.02∗
Complication of invasive procedure, n (%)	2 (16)	2 (8)	0.57
Duration of hospital stay, d (range)	80±35 (31-135)	105±97 (44-570)	0.40
Introduction of oral feedings, days of life (range)	4±3 (1-12)	5±7 (1-40)	0.51
Full enteral feedings, days of life (range)	31±23 (11-78)	26±14 (11-56)	0.54
Duration of NPO, d (range)	10±12 (3-45)	7±8 (0-19)	0.35
Duration of TPN use, d (range)	35±23 (9-90)	35±21 (11-105)	0.98
Duration of mechanical ventilation, d (range)	12±19(0-67)	21±26 (0-76)	0.29
Operation for meconium obstruction, n (%)	5 (42)	2 (7)	0.02∗

Data are presented as Mean±SD or number (%). ∗P<0.05 Abbreviations: NPO, nothing per os; TPN, total parenteral nutrition.

Table 3.

Comparison of Clinical Characters between Contrast Enema Groups and Exploratory Laparotomy Groups

Parameters	Contrast enema (n=20)	Laparotomy (n=7)	P value
GA, weeks (range)	28±2 (25-31)	27±4 (23-34)	0.74
Birth weight, g (range)	826±229 (430-1180)	909±374 (430-1600)	0.50
Male gender, n (%)	7 (35)	4 (57)	0.39
Preeclampsia/Eclampsia, n (%)	8 (40)	0 (0)	0.07
Small for gestational age, n (%)	9 (45)	2 (29)	0.66
Histologic chorioamnionitis, n (%)	6 (30)	3 (43)	0.65
Serum Mg levels, mg/dL	2.8±1 (1.8-4.7)	2.8±0.8 (1.8-3.8)	0.88
Duration of hospital stay, d	105±112 (57-570)	100±39 (34-145)	0.90
Introduction of enteral feeding, d	3±2 (1-8)	10±14 (1-40)	0.25
Full enteral feedings, day of life	25±12 (13-54)	42±27 (12-65)	0.16
Duration of NPO, d (range)	6±5 (0-39)	20±16 (5-45)	0.06
Duration of TPN use, d (range)	31±13 (17-69)	61±30 (23-105)	0.04^‡
Duration of MV, d (range)	15±22 (0-63)	31±30 (0-67)	0.16
Complication after CE or laparotomy, n (%)	0 (0)	4 (57)	0.02∗

Data are presented as Mean±SD or number (%). ∗P<0.05 Abbreviations: GA, gestational age; Mg, magnesium; NPO, nothing per os; TPN, total parenteral nutrition; MV, mechanical ventilation; CE, ultrasound-guided contrast enema.

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