Optimum therapeutic strategy for meconium-related ileus in very-low-birth-weight infants
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Read the article on jpedsurg.org ↗Article · Mar 2021 · 1 min read
In brief
In brief
Study of 42 VLBW infants with meconium-related ileus demonstrates that successful Gastrografin regurgitation into dilated bowel predicts conservative management success, while failure to achieve regurgitation correlates with 57% laparotomy rate and higher perforation risk. Early diagnostic enema followed by prompt surgical intervention when indicated optimizes outcomes in this high-risk population.
Written by the GCMD Library team from the article.
Abstract
Background/Purpose
: Therapeutic strategy for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs) has not been established. This study aims to clarify the optimum therapeutic strategy for MRI in VLBWs.
Methods
: MRI was defined as delayed meconium excretion and microcolon on contrast enema with Gastrografin (diatrizoate acid). Forty-two infants with MRI were treated at our institution between 2009 and 2019, and are reviewed here. They were classified into two groups: in group A (n=21), Gastrografin regurgitated into the dilated intestine during the first or second round of Gastrografin enema (GaE), while in group B (N=21), Gastrografin did not regurgitate. Laparotomy was indicated if the intestine was perforated, or if abdominal distention was not relieved by two rounds of GaE.
Results
: In group A, meconium was excreted in all cases within 24 hours after GaE, and no cases required laparotomy. In group B, twelve cases (57%) underwent laparotomy (P < 0.01), six cases in this group (29%), showed free air on X-ray images (P < 0.01). The median hospital stay in groups A and B were 89.0 and 136.5 days, respectively (P < 0.05). Overall mortality was 2.4%.
Conclusions
: Early therapeutic diagnosis by GaE followed by early surgery is suggested as the optimum strategy for MRI in VLBWs.