title: Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth.
abstract: OBJECTIVE
  The majority of bowel obstructions in extremely low birth weight (ELBW) neonates are meconium-related ileus (MRI). ELBW neonates with bowel obstruction may recover by conservative treatment, but some do not. Considering the high surgical morbidity rates, unnecessary surgery should be avoided. We sought to identify a reasonable treatment strategy under these conditions.
  
  
  METHODS
  ELBW neonates who started to have bowel obstruction with an unclear cause within 14 days of age were enrolled. The study period was from January 2009 to August 2011. The enrolled patients had daily Gastrografin(®) enemas until 14 days of age or until the obstruction resolved. If the obstruction lasted beyond around 14 days of age, the patient underwent surgical intervention. The clinical data of the patients were collected and analyzed.
  
  
  RESULTS
  Fourteen patients were enrolled. Twelve patients had MRI, which resolved within 14 days without surgery. Two patients with persistent obstruction underwent surgery, and they were found to have Hirschsprung's disease and ileal volvulus, respectively.
  
  
  CONCLUSIONS
  For ELBW neonates with bowel obstruction of unclear etiology, the early and frequent administration of a Gastrografin(®) enema is reasonable. Surgery should be considered if the obstruction lasts beyond approximately 14 days after birth.
authors.affiliation: Department of Pediatric Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya, Tokyo, 1508935, Japan, hatanakaa-psu@h.u-tokyo.ac.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Hatanaka
authors.forename: Saori
authors.initials: S
authors.lastname: Nakahara
authors.forename: Eriko
authors.initials: E
authors.lastname: Takeyama
authors.forename: Tadashi
authors.initials: T
authors.lastname: Iwanaka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Ishida
mesh_terms: D000367:Age Factors; D003974:Diatrizoate Meglumine / Q000008:administration & dosage; D013505:Digestive System Surgical Procedures / Q000379:methods; D004733:Enema; D005260:Female; D006627:Hirschsprung Disease / Q000628:therapy*; D006801:Humans; D045823:Ileus / Q000209:etiology / Q000628:therapy*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D008470:Meconium; D016896:Treatment Outcome
chemical_list: D003974:Diatrizoate Meglumine