ABSTRACT
PURPOSE: This study investigated the risks of development and surgical complications of meconium obstruction (MO) in very low birth weight (VLBW) infants. METHODS: We performed a retrospective medical record review of VLBW infants admitted to the neonatal intensive care unit of Haeundae Paik hospital and diagnosed with MO of prematurity (MOP) between March 2010 and August 2013. RESULTS: Of 267 VLBW infants admitted to the neonatal intensive care unit, 28 were diagnosed with MOP. Perinatal factors including maternal pregnancy-induced hypertension and small for gestational age were associated with MOP development (P<0.05). Over two-thirds of VLBW infants with MOP were successfully treated with a gastrografin enema. The remaining eight VLBW infants required surgery. Although small for gestational age was more frequent in the medical treatment group, specific risk factors associated with MOP development did not affect the need for surgical intervention. CONCLUSION: MOP is common in VLBW infants, as most VLBW infants have risk factors for MOP. Identifying risk factors permits early diagnosis and initiation of appropriate medical treatment, reducing the necessity for surgery. However, the presence of specific risk factors does not increase risk of surgical complications.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Pregnancy , Diatrizoate Meglumine , Early Diagnosis , Enema , Gestational Age , Hypertension, Pregnancy-Induced , Infant, Very Low Birth Weight , Intensive Care, Neonatal , Meconium , Medical Records , Retrospective Studies , Risk FactorsABSTRACT
Many infants with congenital hypothyroidism have few or no clinical manifestations at birth. In preterm infants, discovering related signs and symptoms of congenital hypothyroidism is even more difficult, despite the higher incidence of transient thyroid function abnormalities. Therefore, these patients need to be closely monitored during the early neonatal period. We report a case of a very low birth weight infant presenting with meconium obstruction concurrent with congenital hypothyroidism in the early neonatal period. Unless diagnosed and treated appropriately, meconium obstruction of prematurity may lead to feeding intolerance, intestinal perforation, necrotizing enterocolitis, and sepsis. It is important for medical caregivers to understand that meconium obstruction can be an early sign of congenital hypothyroidism in preterm infants with abdominal distension.
Subject(s)
Humans , Infant , Infant, Newborn , Caregivers , Congenital Hypothyroidism , Enterocolitis, Necrotizing , Incidence , Infant, Premature , Infant, Very Low Birth Weight , Intestinal Perforation , Meconium , Parturition , Sepsis , Thyroid GlandABSTRACT
Meconium obstruction (MO) in neonates arises from highly viscid meconium and the poor motility of the premature gut. Recently the incidence of the MO in neonates has been increasing, but, the diagnosis and treatment of this disease have not yet been clarified. Between March 2004 and April 2010, 24 neonates were treated for MO at Severance Children's Hospital. Their clinical characteristics and treatment were reviewed retrospectively. Twenty neonates were diagnosed with MO and 4 neonates were diagnosed with Hirschsprung's disease (HD). The mean birth weight and gestational age of the 20 neonates with MO were 1.45+/-0.90kg and 31.1+/-4.6 weeks, respectively. Thirteen neonates (65%) diagnosed with MO weighed less than 1.5kg and 10 neonates (50%) weighed less than 1kg. Half of the neonates with MO were treated by non-operative methods and the other half were treated by operative methods. Compared with the group that weighed over 1.5kg, the group that weighed less than 1.5kg were more frequently operated upon (61.5% vs. 28.5%), and contrast enemas were performed later and more frequently. Also the group that weighed less than 1.5kg had a higher mortality rate (15.4% vs. 0%). Three of the four neonates with HD were diagnosed with long-segment aganglionosis. In conclusion, MO occurred in very low birth weight neonates more often and must be differentiated from HD. Also, MO in very low birth weight neonates should be treated with special attention due to more a complicated clinical course.
Subject(s)
Humans , Infant, Newborn , Birth Weight , Enema , Gestational Age , Hirschsprung Disease , Incidence , Infant, Very Low Birth Weight , Meconium , Retrospective StudiesABSTRACT
Ileal obstruction by meconium in premature and low birth weight infants is an unique clinical entity, and it is differentiated from other types of meconium obstruction not associated with cystic fibrosis. Markedly premature infants may present with intestinal obstruction symptoms resembling those of necrotizing enterocolitis, and perforation secondary to inspissated meconium. Between 2001 and 2006, two extremely low birth weight infants were treated for intestinal obstruction secondary to inspissated meconium. They were successfully treated with gastrografin enemas. Prompt diagnosis and appropriate management resulted in a beneficial patient outcome.