Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Meconium Obstruction in Very Low Birth Weight Infants

극소저출생체중아에서 태변에 의한 장폐색에 관한 연구

  • Hong, Ki-Bae (Department of Pediatrics, College of Medicine, Dankook University) ;
  • Seong, In-Chang (Department of Pediatrics, College of Medicine, Dankook University) ;
  • Lee, Kun-Song (Department of Pediatrics, College of Medicine, Dankook University) ;
  • Chang, Young-Pyo (Department of Pediatrics, College of Medicine, Dankook University) ;
  • Song, Hee-Seung (Department of Pediatrics, College of Medicine, Dankook University)
  • 홍기배 (단국대학교 의과대학 소아청소년과학교실) ;
  • 성인창 (단국대학교 의과대학 소아청소년과학교실) ;
  • 이건송 (단국대학교 의과대학 소아청소년과학교실) ;
  • 장영표 (단국대학교 의과대학 소아청소년과학교실) ;
  • 송희승 (단국대학교 의과대학 소아청소년과학교실)
  • Received : 2010.08.07
  • Accepted : 2010.09.10
  • Published : 2011.03.30
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Abstract

Purpose: Mecnoium obstruction in very low birth weight infants (VLBWI), which delays enteral feeding and is one of the major causes of bowel obstruction, can be diagnosed and treated with hyperosmolar water-soluble contrast enema. The purpose of this study was to observe the clinical findings of meconium obstruction, the improvement of small bowel obstruction after contrast enema, and the complications related to the enema. Methods: Hypersolmolar water-soluble contrast enemas were performed in 14 VLBWIs with meconium obstruction. Clinical findings, radiologic findings, feeding intolerance, effectiveness, and complications of enemas were observed. Also, clinical findings related to meconium obstruction were compared with 18 VLBWIs without meconium obstruction. Results: 1) Fourteen VLBWIs with meconium obstruction had significantly lower 5 minutes Apgar scores than 18 VLBWIs without meconium obstruction (p<0.05). Moreover, the day of last meconium passing, and the day of the first trial and full enteral feeding were delayed significantly. 2) A total of 18 enemas were performed in the 14 infants. The contrast medium passed the ileocecal valve and reached the terminal ileus in 12 enemas. Of the 12 enemas, 11 were successful, but 1 infant underwent an ileotomy, even though the contrast medium reached the terminal ileum. 3) Intestinal obstruction was not relieved in three of five infants, in whom the contrast medium failed to pass the ileocecal valve. Obstruction was relieved after repeated enemas in which the contrast medium reached the terminal ileum. 4) No complications associated with water-soluble contrast enemas were observed. Conclusion: Hyperosmolar water-soluble contrast enema is considered to be safe and therapeutic for meconium obstruction in VLBWIs.

목 적: 극소저출생체중아 태변 장폐색은 장관 영양을 지연시키고 장폐색을 유발하는 주요 원인 중 하나로 고삼투압 수용성 조영제 관장이 진단과 치료의 유용성에 대한 원칙은 아직 논란 중이다. 본 연구는 태변 장폐색을 보인 극소저출생체중아의 임상 소견을 관찰하고, 고삼투압 수용성 조영 관장 후 장폐색 증상 호전, 장관영양의 진행, 합병증 등을 관찰하고자 하였다. 방 법: 극소저출생체중아 중에 태변 장폐색으로 고삼투압 수용성 조영제 관장을 시행한 14명의 임상 소견과 방사선 소견, 장관 영양의 진행, 고삼투압 수용성 조영제 관장 치료 후 호전 여부, 고삼투압 수용성 조영제 관장과 연관된 합병증 등을 관찰하였다. 이들의 주요임상 소견을 장폐색 증상 없이 수유 진행이 가능하였던 극소저출생체중아 18명과 비교 하였다. 결 과: 1) 태변 장폐색을 보인 극소저출생체중아에서 태변 장폐색이 없었던 극소저출생체중아에 비해 낮은 5분 Apgar 점수를 보였다(p<0.05). 또한, 출생 후 마지막 태변 배출시기(일), 첫 수유 시작 시기(일), 전 장관 영양 도달 시기(일)들도 의미 있게 지연되었다(p<0.05). 2) 고삼투압 수용성 조영제 관장은 14명에서 18 회를 시행하였다. 18회 중 12회에서 조영제가 회장 말단에 도달하였으며 이 중 11회에서 관장 후 다량의 태변 배출과 함께 장폐색 증상의 호전이 있었으나, 1예는 호전이 없어 회장절개술로 태변을 제거하였다. 3) 조영제가 회장 말단에 도달 못한 5명 중 3명에서 증상의 호전이 없어 조영제 관장을 재시행 하여 조영제가 회장말단에 도달하였고 장폐색 증상이 호전되었다. 4) 고삽투압 수용성 조영제 관장과 연관된 특별한 합병증은 없었다. 결 론: 극소저출생체중아 태변 장폐색에서 고삼투압수용성 조영제 관장은 비교적 안전하게 시행할 수 있는 치료 방법이었다.

Keywords

References

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  1. Meconium-related Ileus in Extremely Low-birth Weight Newborn Infants Meconium-related Ileus in ELBWI vol.20, pp.1, 2011, https://doi.org/10.5385/nm.2013.20.1.121
  2. Efficacy of Ultrasound-guided Contrast Enema on Meconium Plug Syndrome in Preterm Infants vol.27, pp.1, 2011, https://doi.org/10.14734/kjp.2016.27.1.28