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"Pulling the plug"--management of meconium plug syndrome in neonates
Alex G Cuenca1, Anam S Ali, David W Kays
1Department of Surgery, Division of Pediatric Surgery, University of Florida, Gainesville, Florida 32610, USA.
Background:
The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung's disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes.
Methods:
Using the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998-2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed.
Results:
Approximately 30% of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97% success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 ± 1.8 versus 8.6 ± 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94% of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16% of the cases, and Hirschsprung's disease was only found in 3.2% of patients.
Conclusions:
Patients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung's disease with MPS, our experience suggests otherwise.
Insights
Meconium plug syndrome (MPS) in infants typically resolves spontaneously or with a contrast barium enema, showing excellent outcomes. This study found no strong association between MPS, Hirschsprung
Area of Science:
- Neonatal care
- Pediatric gastroenterology
- Clinical outcomes research
Background:
- Meconium plug syndrome (MPS) significance is unclear.
- Potential associations with Hirschsprung's disease and magnesium tocolysis have been suggested.
- This study aimed to clarify these associations and review patient outcomes.
Purpose of the Study:
- To investigate potential associations between meconium plug syndrome (MPS) and Hirschsprung's disease or magnesium tocolysis.
- To review the clinical course and outcomes of infants diagnosed with MPS.
- To evaluate the effectiveness of different treatment modalities for MPS.
Main Methods:
- Retrospective chart review of infants diagnosed with meconium obstruction (ICD-9 code) between 1998-2008.
- Exclusion of 7 cases of meconium ileus, resulting in 61 cases of MPS.
- Analysis of hospital course, outcomes, gestational age, and treatments received.
Main Results:
- Approximately 30% of MPS cases resolved spontaneously.
- Contrast barium enema achieved 97% success in treated cases, including 94% in preterm infants (<36 weeks).
- Hirschsprung's disease was found in only 3.2% of patients, and magnesium tocolysis in 16%, challenging previous associations.
Conclusions:
- Infants with meconium plug syndrome (MPS) demonstrate excellent outcomes, irrespective of gestational age.
- Contrast barium enema is an effective initial diagnostic and treatment option for MPS.
- The study's findings do not support a strong link between MPS, magnesium tocolysis, and Hirschsprung's disease.
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