Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management.
BACKGROUND
Guidelines for diagnosis and therapy of meconium obstruction in extremely low birth weight neonates are still not well established.


METHODS
All low-birth-weight infants presenting with meconium obstruction over a 5-year period were reviewed retrospectively. Patients with meconium plug syndrome or cystic fibrosis were excluded.


RESULTS
Seven patients were identified. Average birth weight and gestational age were 874 g and 27.7 weeks, respectively. All were products of high-risk pregnancies, and 6 (86%) were delivered by cesarean section. All patients presented with distended abdomens without peritonitis. Abdominal films showed multiple distended intestinal loops without air-fluid levels in all cases. Three patients (43%) had contrast enemas, all showing microcolon. Nonoperative therapy, consisting of rectal irrigations and N-acetylcysteine per orogastric tube, succeeded in 3 patients who were obstructed for less than 10 days and failed in 1 patient obstructed for 12 days. Four patients, all obstructed for more than 10 days, underwent enterotomy and lavage (2), bowel resection and ileostomy (1), and initial peritoneal drainage for perforation followed by bowel resection (1). All patients survived with intact bowel function.


CONCLUSIONS
Extremely low-birth-weight infants with meconium obstruction can be diagnosed based on their typical clinical and plain radiographic characteristics, without need for a contrast enema. Nonoperative treatment is successful early in the course of the obstruction. In the absence of an intestinal complication, simple enterotomy and meconium evacuation effectively treats long-standing obstruction.
Emil
Sherif
S
Division of Pediatric Surgery, University of California, Irvine Medical Center, Orange 92868, USA.
Nguyen
Thang
T
Sills
Jack
J
Padilla
Guadalupe
G
D000465:Algorithms; D004733:Enema; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D019102:Infant, Very Low Birth Weight; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008470:Meconium; D011859:Radiography; D012189:Retrospective Studies