Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management |
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Authors: | Emil Sherif Nguyen Thang Sills Jack Padilla Guadalupe |
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Affiliation: | a Division of Pediatric Surgery, University of California, Irvine Medical Center, Orange, CA, USA b Division of Newborn Medicine, University of California, Irvine Medical Center, Orange, CA, USA c Department of Pediatric Surgery, Miller Children’s Hospital, Long Beach, CA, USA d Department of Neonatology, Miller Children’s Hospital, Long Beach, CA, USA |
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Abstract: | BackgroundGuidelines for diagnosis and therapy of meconium obstruction in extremely low birth weight neonates are still not well established.MethodsAll 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.ResultsSeven 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 cesarian 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.ConclusionsExtremely 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. |
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Keywords: | Meconium intestinal obstruction low-birth-weight neonates |
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