Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
권호 표지
DOI QR코드

DOI QR Code

Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus

  • Shin, Jaeho (Division of Pediatric Surgery, Department of Surgery, Busan Paik Hospital, Inje University College of Medicine) ;
  • Jeon, Ga Won (Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine)
  • Received : 2017.10.21
  • Accepted : 2018.01.21
  • Published : 2018.02.28
⟨ Previous Next ⟩

Abstract

Purpose: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. Methods: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight <1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. Results: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9-34.3 weeks) and 893 g (range, 610-1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3-11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was $2.8{\pm}1.5hours$ (range, 1-6 hours). The time until radiographic improvement was $2.8{\pm}3.4days$ (range, 1-14 days) after the procedure. Conclusion: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.

Keywords

References

  1. Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg 2004;39:731-7. https://doi.org/10.1016/j.jpedsurg.2004.01.027
  2. Clatworthy HW, Jr., Howard WH, Lloyd J. The meconium plug syndrome. Surgery 1956;39:131-42.
  3. Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, et al. Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int 2011;53:887-91. https://doi.org/10.1111/j.1442-200X.2011.03381.x
  4. Shinohara T, Tsuda M, Koyama N. Management of meconiumrelated ileus in very low-birthweight infants. Pediatr Int 2007;49:641-4. https://doi.org/10.1111/j.1442-200X.2007.02457.x
  5. Kubota A, Imura K, Yagi M, Kawahara H, Mushiake S, Nakayama M, et al. Functional ileus in neonates: Hirschsprung's diseaseallied disorders versus meconium-related ileus. Eur J Pediatr Surg 1999;9:392-5. https://doi.org/10.1055/s-2008-1072290
  6. Greenholz SK, Perez C, Wesley JR, Marr CC. Meconium obstruction in markedly premature infant. J Pediatr Surg 1996;31:117-20. https://doi.org/10.1016/S0022-3468(96)90332-2
  7. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg 1969;4:190-7. https://doi.org/10.1016/0022-3468(69)90390-X
  8. Ein SH, Shandling B, Reilly BJ, Stephens CA. Bowel perforation with nonoperative treatment of meconium ileus. J Pediatr Surg 1987;22:146-7. https://doi.org/10.1016/S0022-3468(87)80434-7
  9. Chang PY, Huang FY, Yeh ML, Sheu JC, Chen BF, Chen CC. Meconium ileus-like condition in Chinese neonates. J Pediatr Surg 1992;27:1217-9. https://doi.org/10.1016/0022-3468(92)90791-5
  10. Dimmitt RA, Moss RL. Meconium diseases in infants with very low birth weight. Semin Pediatr Surg 2000;9:79-83. https://doi.org/10.1016/S1055-8586(00)70020-5
  11. Vinograd I, Mogle P, Peleg O, Alpan G, Lernau OZ. Meconium disease in premature infants with very low birth weight. J Pediatr 1983;103:963-6. https://doi.org/10.1016/S0022-3476(83)80732-X
  12. Milla PJ. Development of intestinal structure and function in neonatal gastroenterology. In: Tanner MS, Stocks RJ, editors. Neonatal gastroenterology: contemporary issues. Newcastle upon Tyne(UK): Intercept, 1984;1-20.
  13. Wolinski J, Slupecka-Ziemilska M, Boryczka M, Grzesiak P, Kwiatkowski J, Kotarba G. Small intestine motility development in newborn mammals. Dev Period Med 2016;20:53-60.
  14. Yoo SY, Jung SH, Eom M, Kim IH, Han A. Delayed maturation of interstitial cells of Cajal in meconium obstruction. J Pediatr Surg 2002;37:1758-61. https://doi.org/10.1053/jpsu.2002.36715
  15. Toyosaka A, Tomimoto Y, Nose K, Seki Y, Okamoto E. Immaturity of the myenteric plexus is the aetiology of meconium ileus without mucoviscidosis: a histopathologic study. Clin Auton Res 1994;4:175-84. https://doi.org/10.1007/BF01826183
  16. Ziegler MM. Meconium ileus. Curr Probl Surg 1994;31:731-77.
  17. Del Pin CA, Czyrko C, Ziegler MM, Scanlin TF, Bishop HC. Management and survival of meconium ileus. A 30-year review. Ann Surg 1992;215:179-85. https://doi.org/10.1097/00000658-199202000-00014
  18. Garza-Cox S, Keeney SE, Angel CA, Thompson LL, Swischuk LE. Meconium obstruction in the very low birth weight premature infant. Pediatrics 2004;114:285-90. https://doi.org/10.1542/peds.114.1.285
  19. Blott M, Greenough A, Gamsu HR, Nicolaides K, Campbell S. Antenatal factors associated with obstruction of the gastrointestinal tract by meconium. Br Med J (Clin Res Ed) 1988;296:250. https://doi.org/10.1136/bmj.296.6617.250
  20. Yu HY, Shin JE, Eun HS, Lee SM, Park MS, Lee MJ, et al. Meconium-related ileus in extremely low-birth weight newborn infants. Neonatal Med 2013;20:121-8. https://doi.org/10.5385/nm.2013.20.1.121
  21. Krasna IH, Rosenfeld D, Salerno P. Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. J Pediatr Surg 1996;31: 855-8. https://doi.org/10.1016/S0022-3468(96)90153-0
  22. Maneksha FR, Betta J, Zawin M, Poppers PJ. Intraoperative hypoxia and hypotension caused by gastrografin-induced hypovolemia. Anesthesiology 1984;61:454-6. https://doi.org/10.1097/00000542-198410000-00015
  23. Rowe MI, Furst AJ, Altman DH, Poole CA. The neonatal response to gastrografin enema. Pediatrics 1971;48:29-35.
  24. Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: fctors that affect treatment success. Eur J Radiol 2015;84:2024-31. https://doi.org/10.1016/j.ejrad.2015.06.006
  25. Hatanaka A, Nakahara S, Takeyama E, Iwanaka T, Ishida K. Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth. Surg Today 2014;44:2269-74. https://doi.org/10.1007/s00595-013-0824-x
  26. Fuchs JR, Langer JC. Long-term outcome after neonatal meconium obstruction. Pediatrics 1998;101:E7.
  27. Koshinaga T, Inoue M, Ohashi K, Sugito K, Ikeda T, Tomita R. Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates. Pediatr Int 2011;53:338-44. https://doi.org/10.1111/j.1442-200X.2010.03231.x
  28. Kao SC, Franken EA, Jr. Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology. Pediatr Radiol 1995;25:97-100. https://doi.org/10.1007/BF02010315