Risk factors of meconium-related ileus in very low birth weight infants: patients-control study (original) (raw)
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Pediatrics International, 2011
Background: A nationwide survey on neonatal surgery conducted by the Japanese Society of Pediatric Surgeons has demonstrated that the mortality of neonatal intestinal perforation has risen over the past 15 years. The incidence of intestinal perforation in extremely low-birthweight (ELBW) neonates has been increasing as more ELBW neonates survive and as the live-birth rate of ELBW has increased. In contrast to necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP), the pathogenesis of meconium-related ileus, defined as functional bowel obstruction characterized by delayed meconium excretion and microcolon, remains unclarified. Methods: The histology of 13 ELBW neonates with intestinal perforation secondary to meconium-related ileus was reviewed, and the radiology of 33 cases of meconium-related ileus diagnosed on contrast enema was reviewed. Specimens obtained from 16 ELBW neonates without gastrointestinal disease served as age-matched controls for histological assessment. Results: The size of the ganglion cell nucleus in meconium-related ileus and in control subjects was 47.3 1 22.0 mm 2 and 37.8 1 11.6 mm 2 , respectively, which was not significantly different. In all cases of meconium-related ileus, contrast enema demonstrated a microcolon or small-sized colon, with a gradual caliber change in the ileum and filling defects due to meconium in the ileum or colon, showing not-identical locations of caliber changes and filling defects. Conclusion: Morphological immaturity of ganglia was not suggested to be the pathogenesis of meconium-related ileus. Impaction of inspissated meconium is not the cause of obstruction, but the result of excessive water absorption in the hypoperistaltic bowel before birth, although the underlying mechanism responsible for the fetal hypoperistalsis remains unclear.
Fetal MRI in management of complicated meconium ileus: Prenatal and surgical imaging
Prenatal diagnosis, 2018
To review fetal MRI cases surgically proven to have meconium ileus (MI) and obstruction, describe the common fetal MRI findings that distinguish cases of complicated MI, and to compare these findings with surgical images and perinatal outcomes. We performed a retrospective review of all fetal MRI examinations and the corresponding medical record from our tertiary care children's hospital over an 18-month period. Postnatal management and outcomes were reviewed for these patients, and those patients with surgical or postmortem diagnosis of complicated MI were included in the study. Our analysis revealed 7 cases. In this cohort, 3 imaging features of the fetal bowel were repeatedly seen: gradient appearance of intraluminal bowel contents, abnormally localized meconium signal, and collapsed appearance of the colon on MRI. Surgical diagnoses confirmed MI. All live-born infants underwent surgical repair. Fetal MRI should be included in the diagnostic algorithm of any pregnancy where f...
Neonatal Medicine, 2018
Purpose: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasoundguided Gastrografin enema at bedside for preterm infants with meconium-related ileus. Methods: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight <1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. Results: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9-34.3 weeks) and 893 g (range, 610-1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3-11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1-6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1-14 days) after the procedure. Conclusion: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
Italian Journal of Pediatrics, 2011
Background Meconium abnormalities are characterized by a wide spectrum of severity, from the meconium plug syndrome to the complicated meconium ileus associated with cystic fibrosis. Meconium Related Ileus in absence of Cystic Fibrosis includes a combination of highly viscid meconium and poor intestinal motility, low grade obstruction, benign systemic and abdominal examination, distended loops without air fluid levels. Associated risk factors are severe prematurity and low birth weight, Caesarean delivery, Maternal MgSO4 therapy, maternal diabetes. In the last 20 yrs a new specific type of these meconium related obstructions has been described in premature neonates with low birth weight. Its incidence has shown to increase while its management continues to be challenging and controversial for the risk of complicated obstruction and perforation. Materials and methods Among 55 newborns admitted between 1992-2008 with Meconium Related Ileus as final diagnosis, data about Low Birth Weig...
Evaluation of Impact of Perinatal Factors on Time to First Meconium Passage in Nigerian Neonates
Malawi medical journal, 2019
Background Delayed meconium passage is usually a signal to congenital distal bowel dysfunction. Timing of meconium passage may vary depending on race, sex and several perinatal factors. Understanding the timing and associated perinatal factors in any given population will help in prompt diagnosis and adequate management of cases in that population. Objectives: To determine the timing of first meconium passage amongst Nigerian neonates, and evaluate the impact of various associated perinatal factors. Materials and Methods A cross-sectional study using interviewer-administered questionnaires to obtain data from mothers of apparently normal infants attending the postnatal clinic of the
Background: Meconium abnormalities are characterized by a wide spectrum of severity, from the meconium plug syndrome to the complicated meconium ileus associated with cystic fibrosis. Meconium Related Ileus in absence of Cystic Fibrosis includes a combination of highly viscid meconium and poor intestinal motility, low grade obstruction, benign systemic and abdominal examination, distended loops without air fluid levels. Associated risk factors are severe prematurity and low birth weight, Caesarean delivery, Maternal MgSO4 therapy, maternal diabetes. In the last 20 yrs a new specific type of these meconium related obstructions has been described in premature neonates with low birth weight.
Oral N - Acetyl Cysteine for Meconium Ileus of Preterm Infants
Gynecology Obstetrics & Reproductive Medicine, 2019
OBJECTIVE: Meconium ileus of preterm infant is a kind of intestinal obstruction. There is no standard medical treatment of meconium ileus of preterm infant. STUDY DESIGN: During the study period, preterm infants under 1250 g and have clinical signs of meconium obstruction were retrospectively included in the study. In the first two days, rectal saline and metoclopramide started and if not respond these infants assigned to receive oral or rectal n-acetyl cysteine and control group remained to receive a saline enema. RESULTS: One hundred and twenty-one infants were included in the study. Thirty-four of them received oral n-acetyl cysteine (group 1) and fifty-two had treated with rectal n-acetyl cysteine (group 2), thirty-five of them served as a control group (group 3). The mean gestational ages were 28, 28, 27 weeks and birthweights were 942, 1010, 965 grams for group 1 & 2 & 3 respectively. There was a difference between groups for reaching full enteral feedings (13±2, 13±3, 15±3, group 1 & 2 & 3 respectively, p=0.001). CONCLUSION: According to this study, it can be stated that orally administered n-acetyl cysteine is tolerable and as effective as rectal n-acetyl cysteine when used for MIPI.
The Time of First Passage of Meconium in Inborn Neonates in Baghdad Teaching Hospital- Medical City
2011
The first passage of stool after birth (meconium), is delayed in preterm neonates compared to term neonates. Ninety-nine percent of term infants and 76% of premature infants pass a stool in the first 24 hours of life. Ninety-nine percent of premature infants pass a stool by 48 hours. To explain the effect of some factors on the time of first passage of meconium(POM) in neonates. Between January and March 2009, all neonates born in Baghdad teaching Hospital-medical city-Baghdad, with gestational age (GA) of 28-42 weeks and without metabolic, congenital or gastrointestinal diseases, were included. Neonates were divided into four groups: A. GA ≤ 30 weeks, B GA 31-34 weeks, C GA 35-36 weeks, D GA ≥ 37 weeks(term). Neonates were followed for first POM. A total of 222 neonates (115 males); 12, 22, 29 and 159 neonates in group A, B, C and D respectively were included. With decreasing gestation, a trend was found for delayed first POM (P 2.5 kg. The time of first POM was associated with typ...