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[Transient intestinal pseudo-obstruction syndrome in premature infants]
T Lamireau1, A Millon, J Sarlangue
1Service de Néonatologie et Réanimatioón Infantile, Hôpital des Enfants, Bordeaux.
Insights
Premature infants may experience transient intestinal pseudo-obstruction due to immature gut motility. This condition often resolves with supportive parenteral nutrition, allowing for eventual normal feeding and recovery.
Area of Science:
- Neonatalogy
- Gastroenterology
- Pediatric Surgery
Background:
- Chronic intestinal pseudo-obstruction can manifest in premature neonates with early feeding, leading to prolonged digestive intolerance.
- This condition presents a diagnostic challenge, mimicking obstructive causes of abdominal distension in vulnerable infants.
Observation:
- Seven premature infants (mean gestational age 30.5 weeks) presented with abdominal distension and failure to pass stools within days of birth.
- Radiological and contrast studies revealed colonic inertia without mechanical obstruction; histological examination showed normal enteric nerve cell maturation.
- All infants required prolonged parenteral nutrition (mean 47 days) followed by enteral feeding, with one mortality due to septicemia.
Findings:
- A transient form of intestinal pseudo-obstruction, likely due to immature intestinal motility, affects some premature neonates.
- Parenteral nutrition is often necessary for weeks, but spontaneous recovery is typical, with normal bowel function achieved by a mean of 46 days.
- Affected infants, followed for years, demonstrated complete recovery without long-term digestive sequelae.
Implications:
- This transient intestinal pseudo-obstruction in premature infants differs from chronic forms requiring surgical intervention.
- Conservative management with parenteral nutrition facilitates spontaneous resolution, highlighting the importance of distinguishing functional immaturity from mechanical blockage.
- Understanding this condition aids in appropriate clinical management and reassures families regarding long-term outcomes.
Background:
A chronic intestinal pseudo-obstruction is sometimes seen in premature neonates who are fed early and subsequently suffer from digestive intolerance for several weeks.
Patients:
Seven premature babies (mean gestational age: 30.5 weeks, mean birthweight: 950 g) suffered from abdominal distension and failure to pass stools at a mean age of 2.5 days (extremes: 1 to 6 days); 2 of them also had vomiting. X-ray examination showed dilated loops of bowel throughout the abdomen without obstructive changes; barium or Gastrografin studies demonstrated inertia of the colon without obstructive changes or abrupt changes in caliber. Histological examination of enteric nerve cells in 2 cases showed normal maturation. Parenteral nutrition was necessary in all patients for 30 to 78 days (mean: 47), followed by continuous enteral feeding for 24 to 48 days (mean: 37). Septicemia complicated parenteral nutrition in 4 babies and was responsible for the death of 1 of them. Normal evacuation of stools occurred between day 27 and day 91 (mean day 46) allowing normal enteral feeding. All 6 patients, now aged 2.5 to 8 years (mean 3.5 years) are in good health, and have no digestive problems.
Conclusions:
Immaturity of intestinal motility may occur in some premature neonates suffering from intestinal ileus. Parenteral nutrition may be necessary for several weeks, but spontaneous recovery is usual. This transient intestinal pseudo-obstruction of premature babies is different from the classical chronic pseudo-obstruction for which surgery is often needed.