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Microfluidic Model of Necrotizing Enterocolitis Incorporating Human Neonatal Intestinal Enteroids and a Dysbiotic Microbiome
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Diagnostic Pitfalls in Meconium-Related Ileus: Red Flags for Surgical Pathologies in Extremely Low Birth Weight

Kenji Santo1, Yuichi Takama1, Marie Todo1

  • 1Department of Pediatric Surgery, Osaka City General Hospital, Osaka, Japan.

Journal of Paediatrics and Child Health
|August 21, 2026
PubMed
Abstract

Insights

Enema therapy failure in extremely low birth weight infants (ELBWIs) with suspected meconium-related ileus (MRI) may indicate underlying surgical conditions. Prompt surgical consultation is advised if enemas are delayed or ineffective.

Area of Science:

  • Neonatal surgery
  • Pediatric gastroenterology
  • Infant critical care

Background:

  • Meconium-related ileus (MRI) presents diagnostic challenges in extremely low birth weight infants (ELBWIs).
  • Enema therapy is a common intervention for suspected MRI, but its efficacy can be limited by other surgical pathologies.

Purpose of the Study:

  • To evaluate the clinical presentation and outcomes of enema therapy in ELBWIs with suspected MRI.
  • To identify clinical indicators of non-MRI surgical pathologies in this population.

Main Methods:

  • Retrospective review of 31 ELBWIs (birth weight < 1000g) treated with enema therapy for suspected MRI.
  • Comparison of clinical characteristics, intervention timing, and underlying pathologies between enema success and failure groups.

Main Results:

  • Underlying non-MRI surgical pathologies were found exclusively in the enema failure group (36%).
  • Conditions included Hirschsprung disease, necrotizing enterocolitis, meconium peritonitis, and ileal stenosis.
  • Enema failure was associated with significantly lower survival rates (55% vs. 95%) and masked by delayed or repetitive enema procedures.

Conclusions:

  • Failure of enema therapy in ELBWIs with suspected MRI is a strong indicator of underlying non-MRI surgical pathology.
  • Delayed enema initiation or repeated ineffective procedures warrant reassessment for alternative surgical conditions.
  • Early surgical consultation is recommended when enema therapy fails to yield sustained improvement.
Keywords:
enema therapyextremely low birth weight infantsmeconium‐related ileusneonatesurgery

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