Ann Surg Treat Res.  2015 Sep;89(3):151-157. 10.4174/astr.2015.89.3.151.

Meconium-related ileus in very low birth weight and extremely low birth weight infants: immediate and one-year postoperative outcomes

Affiliations
  • 1Division of Pediatric Surgery, Department of Surgery, Pusan National University School of Medicine, Yangsan, Korea. choyh70@pusan.ac.kr
  • 2Department of Pediatrics, Pusan National University School of Medicine, Yangsan, Korea.
  • 3Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.

Abstract

PURPOSE
One of the major causes of bowel obstruction in extremely premature infants is a meconium obstruction. However, there are many challenges not only in the recognition and diagnosis, but also in the management of meconium obstruction. This study aimed to find perioperative clinical features and determine the postoperative course of meconium-related ileus in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.
METHODS
We retrospectively reviewed the clinical data of premature infants (n = 11, VLBW infnats; n = 16, ELBW infants) with a meconium-related ileus who underwent operation for intractable ileus between January 2009 and May 2013.
RESULTS
The average duration of conservative management was longer and postnatal age was older in ELBW infants than VLBW infants: 19.9 days vs. 11.5 days and 34.9 days vs. 19.2 days. The immediate postoperative course (day that beginning feeding and full feeding) was not significantly different based on birth weight, but the ELBW infants had slightly higher mortality. At 12 months of corrected age after operation, both average body weight and average height was below 10th percentile for growth in most infants (61.1%).
CONCLUSION
There was a slightly high mortality in the ELBW infants, but two groups did not experience significant differences in the immediate postoperative course of meconium-related ileus. Nevertheless, considering their growth patterns, it is necessary to do a close follow-up and more aggressive nutritional management to achieve optimal growth and development in both patient groups.

Keyword

Meconium; Ileus; Very low birth weight infant; Extremely low birth weight infant; Growth

MeSH Terms

Birth Weight
Body Weight
Diagnosis
Growth and Development
Humans
Ileus*
Infant*
Infant, Extremely Low Birth Weight
Infant, Extremely Premature
Infant, Low Birth Weight*
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight*
Meconium
Mortality
Retrospective Studies

Figure

  • Fig. 1 Abdominal radiography shows gaseous distention of the small bowel loop without air-fluid level in A, B.

  • Fig. 2 Contrast enema shows normal-sized colon (A) or microcolon (B) with multiple filling defects.

  • Fig. 3 Operative finding also shows a gaseous distention of small intestinal loop and collapsed distal ileum filled with sticky meconium causing obstruction.

  • Fig. 4 Sticky, mucoid meconium removed from intestine and an impacted meconium looking like a hard, thick strand in inlet.

  • Fig. 5 The percentile of growth: body weight at corrected age of 12 months. VLBW, very low birth weight; ELBW, extremely low birth weight.

  • Fig. 6 The percentile of growth: height at corrected age of 12 months. VLBW, very low birth weight; ELBW, extremely low birth weight.


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