Meconium-related Ileus in Extremely Low-Birth Weight Infants

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  • Imaji Reisuke
    Department of Pediatric Surgery, Hiroshima City Hiroshima Citizens Hospital
  • Kato Reiko
    Department of Pediatric Surgery, The University of Tokyo Hospital
  • Hashimoto Shintaro
    Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University Hospital
  • Mukai Wataru
    Department of Pediatric Surgery, Hiroshima City Hiroshima Citizens Hospital
  • Saeki Isamu
    Department of Pediatric Surgery, Hiroshima City Hiroshima Citizens Hospital
  • Akiyama Takashi
    Department of Pediatric Surgery, Hiroshima City Hiroshima Citizens Hospital

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Other Title
  • 超低出生体重児における胎便関連性腸閉塞症の検討
  • チョウテイシュッショウ タイジュウジ ニ オケル タイベン カンレンセイ チョウ ヘイソクショウ ノ ケントウ

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Abstract

Purpose: Extremely low-birth weight infant (ELBWI) have a high incidence of meconium-related ileus (MRI), which causes intestinal perforation and has a high mortality rate. However, the strategy of management and surgical indication are still debated. Here, we report our clinical experience of treating MRI in ELBWI.<br>Methods: We reviewed the medical records with clinical and radiological findings of ELBWI who presented with MRI between May 2006 and April 2013 at Hiroshima City Hospital; 154 ELBWI were admitted during this period. Eight MRI patients (5.2%) were identified. Five were boysand 3 girls. The median gestational age was 28 weeks and 4 days. The median birth weight was 649 g. Severe fetal growth retardation (FGR) was confirmed in 7 out of the 8 patients. Medical records were retrospectively reviewed in terms of pre- and postnatal clinical courses, timing of onset and operation, clinical outcomes and the cause of death.<br>Results: Three patients improved following a conservative treatment and 5 patients required surgery, 2 of which (40%) survived. Surgical interventions were performed on days 2 and 3 in the survivors, and on days 3, 5 and 12 in the nonsurvivors. The times from the appearance of intestinal dilatation to surgery were 1 and 3 days in the survivors, and 2, 5 and 7 days in the nonsurvivors.<br>Conclusions: FGR is a risk factor for MRI, and early surgical intervention may improve survival rate. Prompt diagnosis of MRI and medical treatment are essential, particularly in ELBWI with FGR. Unless patients improve medically, surgical intervention within 72 hours after onset should be considered.

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