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Optimum therapeutic strategy for meconium-related ileus in very-low-birth-weight infants
Yasuyuki Mitani1, Akio Kubota1, Taro Goda1
1Second Department of Surgery, Wakayama Medical University, 811-1, Kimiidera, Wakayama-shi, Wakayama 641-8510, Japan.
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 h 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.
Insights
The optimal treatment for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs) involves early diagnosis with Gastrografin enema (GaE). Early surgery following GaE significantly reduces complications and hospital stay for VLBW infants with MRI.
Area of Science:
- Neonatal surgery
- Pediatric gastroenterology
- Infant critical care
Background:
- Meconium-related ileus (MRI) poses significant challenges in very-low-birth-weight infants (VLBWs).
- Optimal therapeutic strategies for MRI in VLBWs remain undefined, necessitating further investigation.
Purpose of the Study:
- To determine the most effective therapeutic strategy for meconium-related ileus (MRI) in very-low-birth-weight infants (VLBWs).
Main Methods:
- Retrospective review of 42 VLBW infants diagnosed with MRI between 2009 and 2019.
- Classification into two groups based on Gastrografin enema (GaE) findings: Group A (regurgitation) and Group B (no regurgitation).
- Laparotomy criteria included intestinal perforation or failure to relieve abdominal distention after two GaE rounds.
Main Results:
- All 21 infants in Group A experienced successful meconium excretion post-GaE, with no need for laparotomy.
- 12 infants (57%) in Group B required laparotomy, and 6 (29%) showed signs of free air on X-ray.
- Median hospital stay was significantly shorter in Group A (89 days) compared to Group B (136.5 days).
Conclusions:
- Early therapeutic diagnosis using Gastrografin enema (GaE) is crucial for managing MRI in VLBWs.
- Prompt surgical intervention following GaE appears to be the optimal strategy, reducing complications and improving outcomes.
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