title: Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success.
abstract: BACKGROUND
  This study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.
  
  
  METHODS
  This study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.
  
  
  RESULTS
  Overall success rate was 54.5%, with 18 successful (M:F=10:8), and 15 failure (M:F=7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29(+1) vs. 27 weeks; p=0.028), larger birth weight (1023.1g vs. 790.3g; p=0.048), and higher body weight on the day of the procedure (1036.2g vs. 801.6g, p=0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p=0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p=0.038). There were three cases of bowel perforation (9.1% per person).
  
  
  CONCLUSIONS
  US-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
authors.forename: Hyun-Hae
authors.initials: HH
authors.lastname: Cho
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea. Electronic address: cheonje@snu.ac.kr.
authors.forename: Jung-Eun
authors.initials: JE
authors.lastname: Cheon
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea.
authors.forename: Young Hun
authors.initials: YH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
authors.forename: So Mi
authors.initials: SM
authors.lastname: Lee
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
authors.forename: Woo Sun
authors.initials: WS
authors.lastname: Kim
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul 110-799, South Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea.
authors.forename: In-One
authors.initials: IO
authors.lastname: Kim
authors.affiliation: Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Su-Mi
authors.initials: SM
authors.lastname: Shin
authors.affiliation: Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Ee-Kyung
authors.initials: EK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Han-Suk
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 110-744, South Korea.
authors.forename: Sun Kyoung
authors.initials: SK
authors.lastname: You
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use; D001724:Birth Weight; D002400:Cathartics / Q000627:therapeutic use*; D003287:Contrast Media / Q000627:therapeutic use*; D003974:Diatrizoate Meglumine / Q000627:therapeutic use; D004733:Enema / Q000379:methods*; D005100:Expectorants / Q000627:therapeutic use; D005260:Female; D005865:Gestational Age; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000628:therapy*; D007416:Intestinal Perforation / Q000209:etiology; D007483:Iothalamic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008470:Meconium / Q000000981:diagnostic imaging; D011859:Radiography; D019233:Retreatment; D012965:Sodium Chloride / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D002400:Cathartics; D003287:Contrast Media; D005100:Expectorants; D007483:Iothalamic Acid; D003974:Diatrizoate Meglumine; D012965:Sodium Chloride; C002587:ioxitalamic acid; D000111:Acetylcysteine
keywords: Contrast enema; Meconium obstruction; Neonate; Preterm; Ultrasonography; Very low birth weight infant