Journal List > Korean J Pediatr Gastroenterol Nutr > v.14(1) > 1043529

Korean J Pediatr Gastroenterol Nutr. 2011 Mar;14(1):52-58. Korean.
Published online March 31, 2011.  https://doi.org/10.5223/kjpgn.2011.14.1.52
Copyright © 2011 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Meconium Obstruction in Very Low Birth Weight Infants
Ki Bae Hong, M.D., In Chang Seong, M.D., Kun Song Lee, M.D., Young Pyo Chang, M.D., and Hee Seung Song, R.N.
Department of Pediatrics, College of Medicine, Dankook University, Cheonan, Korean.

Corresponding author (Email: ychang@dankook.ac.kr )
Received August 07, 2010; Revised September 10, 2010; Accepted September 10, 2010.

Abstract

Purpose

Mecnoium obstruction in very low birth weight infants (VLBWI), which delays enteral feeding and is one of the major causes of bowel obstruction, can be diagnosed and treated with hyperosmolar water-soluble contrast enema. The purpose of this study was to observe the clinical findings of meconium obstruction, the improvement of small bowel obstruction after contrast enema, and the complications related to the enema.

Methods

Hypersolmolar water-soluble contrast enemas were performed in 14 VLBWIs with meconium obstruction. Clinical findings, radiologic findings, feeding intolerance, effectiveness, and complications of enemas were observed. Also, clinical findings related to meconium obstruction were compared with 18 VLBWIs without meconium obstruction.

Results

1) Fourteen VLBWIs with meconium obstruction had significantly lower 5 minutes Apgar scores than 18 VLBWIs without meconium obstruction (p<0.05). Moreover, the day of last meconium passing, and the day of the first trial and full enteral feeding were delayed significantly. 2) A total of 18 enemas were performed in the 14 infants. The contrast medium passed the ileocecal valve and reached the terminal ileus in 12 enemas. Of the 12 enemas, 11 were successful, but 1 infant underwent an ileotomy, even though the contrast medium reached the terminal ileum. 3) Intestinal obstruction was not relieved in three of five infants, in whom the contrast medium failed to pass the ileocecal valve. Obstruction was relieved after repeated enemas in which the contrast medium reached the terminal ileum. 4) No complications associated with water-soluble contrast enemas were observed.

Conclusion

Hyperosmolar water-soluble contrast enema is considered to be safe and therapeutic for meconium obstruction in VLBWIs.

Keywords: Infant; Low birth weight; Contrast media; Enema; Meconium; Ileus

Tables


Table 1
Comparison of Perinatal and Neonatal Characteristics between Infants with and without Meconium Obstruction
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Table 2
Comparison of Meconium Passage and Feeding between Infants with and without Meconium Obstruction
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Table 3
Radiologic Findings on a Contrast Study of Meconium Obstruction in Very Low Birth Weight Infants
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Table 4
Findings Related to Hyperosmolar Water-soluble Contrast Enema
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References
1. Shinohara T, Tsuda M, Koyama N. Management of meconium-related ileus in very low-birthweight infants. Pediatr Int 2007;49:641–644.
2. Durkin EF, Shaaban A. Commonly encountered surgical problems in the fetus and neonate. Pediatr Clin North Am 2009;56:647–669.
3. Garza-Cox S, Keeney SE, Angel CA, Thompson LL, Swischuk LE. Meconium obstruction in the very low birth weight premature infant. Pediatrics 2004;114:285–290.
4. 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;39:731–737.
5. Haiden N, Jilma B, Gerhold B, Klebermass K, Prusa AR, Kuhle S, et al. Small volume enemas do not accelerate meconium evacuation in very low birth weight infants. J Pediatr Gastroenterol Nutr 2007;44:270–273.
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;37:760–764.
7. Winfield RD, Beierle EA. Pediatric surgical issues in meconium disease and cystic fibrosis. Surg Clin North Am 2006;86:317–327.
8. Siegel MJ, Shackelford GD, McAlister WH. Neonatal meconium blockage in the ileum and proximal colon. Radiology 1979;132:79–82.
9. Krasna IH, Rosenfeld D, Salerno P. Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. J Pediatr Surg 1996;31:855–858.
10. Jawaheer J, Khalil B, Plummer T, Bianchi A, Morecroft J, Rakoczy G, et al. Primary resection and anastomosis for complicated meconium ileus: a safe procedure? Pediatr Surg Int 2007;23:1091–1093.
11. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg 1969;4:190–197.
12. 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.
13. 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;90:409–411.
14. Caniano DA, Beaver BL. Meconium ileus: a fifteen-year experience with forty-two neonates. Surgery 1987;102:699–703.
15. Amodio J, Berdon W, Abramson S, Stolar C. Microcolon of prematurity: a form of functional obstruction. AJR Am J Roentgenol 1986;146:239–244.
16. Kenny SE, Vanderwinden JM, Rintala RJ, Connell MG, Lloyd DA, Vanderhaegen JJ, et al. Delayed maturation of the interstitial cells of Cajal: a new diagnosis for transient neonatal pseudoobstruction. Report of two cases. J Pediatr Surg 1998;33:94–98.
17. Goo HW, Kim KS, Kim AR, Pi SY, Yoon CH. Sonography-guided Gastrografin Enema for Meconium Plug Syndrome in Premature Newborns: Preliminary Results. J Korean Radiol Soc 2004;50:281–288.
18. Park HS, Kim TH, Kim HY, Park JH. Three cases of meconium plug syndrome. Korean J Pediatr Gastroenterol Nutr 2006;009:249–255.