Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates.
BACKGROUND
Meconium obstruction without cystic fibrosis in low-birthweight neonates is a distinct clinical entity. We aimed to determine what therapeutic strategies work best in very-low-birthweight neonates with meconium obstruction of the small bowel under varied clinical conditions caused by the associated diseases of prematurity.


METHODS
Medical records of very-low-birthweight neonates with meconium obstruction of the small bowel treated from 1998 to 2008 were retrospectively reviewed. Pre- and postnatal data, treatments, and clinical outcomes were assessed.


RESULTS
Nine patients with perinatal complications were identified. Mean gestational age and birthweight were 26.9 weeks and 863 g, respectively. Abdominal distension developed from 1 to 7 days of life. Five patients were initially treated with Gastrografin enema, three of whom had successful outcomes. Two hemodynamically unstable patients failed to respond to Gastrografin treatment; they ultimately died of sepsis. The remaining four without Gastrografin treatment underwent enterostomy to resolve the obstructions with good results.


CONCLUSIONS
Gastrografin and surgical treatments should be appropriately selected based on the underlying pathologies of meconium obstruction of the small bowel. Therapeutic Gastrografin enema is effective, safe and repeatable; however, it is not recommended for hemodynamically unstable patients. Surgical intervention is reserved for those who develop rapid abdominal distension that risks perforation.
Koshinaga
Tsugumichi
T
Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan. tkoshina@med.nihon-u.ac.jp
Inoue
Mikiya
M
Ohashi
Kensuke
K
Sugito
Kiminobu
K
Ikeda
Taro
T
Tomita
Ryouichi
R
D003287:Contrast Media; D003937:Diagnosis, Differential; D003974:Diatrizoate Meglumine; D013505:Digestive System Surgical Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000601:surgery*; D008297:Male; D008470:Meconium; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal / Q000379:methods / Q000592:standards*
D003287:Contrast Media; D003974:Diatrizoate Meglumine