Diagnosis and treatments in simple meconium ileus in neonates:ten_year experience in a single center / 中华实用儿科临床杂志

ABSTRACT

Objective To improve the accuracy of the diagnosis and decrease the unnecessary surgical explo_ration in neonates with simple meconium ileus(SmI)by analyzing clinical characteristics of SmI. Methods Forty_five neonates identified as SmI from January 2008 to may 2018 had been collected,and the data of pregnancy,birth weight,treatments,hospital stay and results of follow_up were included. The patients were divided into 2 groupssurgi_cal group and non_surgical group. The surgical group underwent enterostomy at the end of ileum,meanwhile,the intes_tinal wall was biopsied for checking the existence of ganglion cells. All the neonates in the surgical group underwent sto_ma closure in 3 to 6 months postoperatively. The non_surgical group received fasting,intravenous nutritional support, enema with amiotol diluted into 1 1 or injected into the stomach by the gastric tube. They all received enema with warm salt(9 g/L)1_2 times per day. Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition( TPN). The 45 neonates were also divided into earlier group(from January 2008 to may 2013)and later group(from June 2013 to may 2018) according to the time of diagnosis. The relationships between the SmI treatment choice and the pregnancy,birth weight and time of diagnosis were analyzed. Results No cystic fibrosis lesions were found in 45 neonates,of which 21 and 24 neonates were in non_surgical group and surgical group,respectively. In the operation,the intestine presented similar anatomy to the total Hirschsprung＇s disease. However,the ganglion was observed not only in the stricture,transitional and dilated zone of ileum,but also in the colon. There were no significant differences in the pregnancy and birth weight in both groups(P>0. 05),but there was significant difference in the duration of hospitalization[(21. 19 ± 5. 13)d υs. (12. 29 ± 3. 85)d,P=0. 000]. There were complications in those patients who had undergone enterostomy,including wound infection(2 cases),prolapse of stoma(2 cases),water and electrolyte disorders(2 cases),malnutrition(21 cases). After the stoma closure,no signs of ganglion cell dysplasia were found in follow_up. In non_surgical group, there were 20 pre_term reonates and 1 full_term neonate,respectively. In surgical group,there were 22 pre_term reonates and 2 full_term neonate,respectively. Neither pregnancy nor birth weight was related to the choice of treat_ment(P>0. 05 ),but the time when to be admitted was highly related to the choice of treatment( P <0. 05 ). Conclusions It is not rare for the occurrence of SmI in neonates in China,especially in preterm neonates. Amiotol may have effects not only on diagnosis but also on treatment of SmI,which can be applied repeatedly. Non_surgical treat_ment can help most of the neonates with SmI to avoid surgical exploration. Enhancing apprehension about the SmI may have great advantages to decrease the rate of unnecessary laparotomy.