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Predictive risk factors for meconium-related ileus requiring surgical intervention in very low birth weight infants
Yoshinobu Tsuno1, Takeshi Kumagai1, Mitsuhiko Riko1
1Department of Pediatrics, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
Background:
Meconium-related ileus (MRI) is a serious morbidity in very low birth weight infants (VLBWI). MRI can lead to intestinal perforation, which has a poor prognosis. Treatment may involve medical or surgical approaches. Our aim was to identify the risk factors predicting surgery in VLBWI with MRI, which are not well studied. We also compared clinical factors between VLBWI treated medically versus surgically.
Methods:
We identified VLBWI with MRI who were admitted to our institution between January 2014 and December 2022. Infants were divided into those who underwent surgery and those who received conservative medical therapy. We compared various clinical factors between the groups. In each group, we calculated the ratio of maximum dilatational diameter of the intestinal tract to the maximum abdominal transverse diameter on abdominal X-rays at different time points; we called this ratio the "MRI index". Using receiver operating characteristic curve analysis, we determined the MRI index cutoff value to predict surgery.
Results:
We evaluated 34 VLBWI with MRI; 9 underwent surgery and 25 responded to conservative medical therapy. The MRI index on day 0 and the maximum MRI index in the surgical group were significantly higher than those in the medical group (p = 0.036 and p < 0.001, respectively). The MRI index cutoff value to predict surgery was 0.205 (area under the curve: 0.900, sensitivity: 0.92, specificity: 0.78). Compared with the medical group, the surgical group required significantly longer to achieve enteral feeding at 100 ml/kg/day, had a longer duration of hospital stay (p = 0.003 and p = 0.038, respectively) and a significantly higher incidence of sepsis (p = 0.042).
Conclusion:
VLBWI with an MRI index ≥0.205 have a significantly high risk of requiring surgery.
Insights
Meconium-related ileus (MRI) in very low birth weight infants (VLBWI) often requires surgery. An MRI index of 0.205 or higher on X-ray accurately predicts the need for surgical intervention in these infants.
Area of Science:
- Neonatalogy
- Pediatric Surgery
- Gastroenterology
Background:
- Meconium-related ileus (MRI) is a significant cause of morbidity in very low birth weight infants (VLBWI).
- Untreated MRI can lead to intestinal perforation and carries a poor prognosis.
- Current treatment strategies include medical and surgical interventions, but risk factors for surgery are not well-defined.
Purpose of the Study:
- To identify risk factors predicting the need for surgery in VLBWI diagnosed with MRI.
- To compare clinical characteristics between VLBWI treated medically versus surgically for MRI.
Main Methods:
- A retrospective review of VLBWI with MRI admitted between January 2014 and December 2022.
- Infants were categorized into medical therapy and surgical groups.
- The "MRI index" (ratio of maximal intestinal diameter to maximal abdominal transverse diameter) was calculated from X-rays at various time points. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive cutoff value for surgery.
Main Results:
- Of 34 VLBWI with MRI, 9 underwent surgery and 25 received conservative medical therapy.
- The surgical group exhibited significantly higher MRI index values on day 0 and maximal MRI index compared to the medical group (p=0.036 and p<0.001).
- An MRI index cutoff of 0.205 predicted surgery with 92% sensitivity and 78% specificity (AUC=0.900). The surgical group also had longer time to enteral feeding, longer hospital stays, and higher sepsis incidence.
Conclusions:
- An MRI index of ≥0.205 is a significant predictor of the need for surgical intervention in VLBWI with meconium-related ileus.
- This index can aid in early identification and management decisions for high-risk infants.
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