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Aggressive enema and surgery for meconium-related ileus in extremely low-birth-weight infants

Kenji Santo1, Yuichi Takama2, Marie Todo2

  • 1Department of Pediatric Surgery, Osaka City General Hospital, 2-13-22, Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan. santokenji@gmail.com.

Pediatric Surgery International
|August 17, 2025
PubMed

Insights

An aggressive treatment strategy for meconium-related ileus (MRI) in extremely low birth weight infants (ELBWIs) significantly reduced perforation rates and improved survival. This novel protocol demonstrates enhanced outcomes for neonates with MRI.

Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Intestinal obstruction management

Background:

  • Meconium-related ileus (MRI) is a significant cause of intestinal obstruction in extremely low birth weight infants (ELBWIs).
  • Traditional management approaches have varying success rates and carry risks of complications such as perforation.
  • Optimizing treatment strategies is crucial for improving outcomes in this vulnerable population.

Purpose of the Study:

  • To evaluate the effectiveness of a novel, aggressive treatment protocol for meconium-related ileus (MRI) in extremely low birth weight infants (ELBWIs).
  • To compare outcomes between infants treated with the new protocol versus a historical control group.

Main Methods:

  • Implementation of a new protocol involving early Gastrografin injection, aggressive enema therapy, and early surgery without perforation (ES) since April 2018.
  • Retrospective comparison of 91 ELBWIs with MRI, divided into an "Old" group (n=56, pre-protocol) and a "New" group (n=35, post-protocol).
  • Analysis of patient demographics, treatment details, perforation rates, surgical intervention, and survival rates.

Main Results:

  • The "New" group exhibited significantly lower perforation rates (2.9%) compared to the "Old" group (21.4%) (p=0.014).
  • While overall surgical rates were similar (14.3% vs. 21.4%), the "New" group had a higher rate of early surgery without perforation (ES) (11.8% vs. 0%) (p=0.02).
  • The "New" group demonstrated a significantly higher overall survival rate (100%) compared to the "Old" group (87.5%) (p=0.041), with all deaths in the "Old" group linked to perforation.

Conclusions:

  • The aggressive MRI treatment protocol, including early Gastrografin and enema therapy, is effective in reducing perforation rates in ELBWIs.
  • This strategy leads to improved survival outcomes for extremely low birth weight infants suffering from meconium-related ileus.
  • The findings support the adoption of this novel protocol for managing MRI in this high-risk neonatal population.
Abstract

Keywords:
EnemaExtremely low-birth-weightIleusInfantMeconiumNewborn

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