Neonatal Medicine

The Korean Society of Neonatology (대한신생아학회)
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Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

  • Hong, Hyun Sook (Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Kim, Sung Shin (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine) ;
  • Park, Ga Young (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
  • Received : 2020.08.27
  • Accepted : 2020.11.21
  • Published : 2021.02.28
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Abstract

Purpose: Meconium obstruction of prematurity (MOP) predisposes premature infants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clinically diagnosed patients with MOP whose obstructions were not relieved via conventional sonography-guided contrast enema. We retrospectively evaluated whether oral nonionic water-soluble contrast media relieves MOP. Methods: Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followed-up radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors. Results: We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27+5 weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without air-fluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age. Conclusion: Nonionic oral water-soluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

Keywords

Acknowledgement

This work was supported in part by the Soonchunhyang University Research Fund.

References

  1. Garza-Cox S, Keeney SE, Angel CA, Thompson LL, Swischuk LE. Meconium obstruction in the very low birth weight premature infant. Pediatrics 2004;114:285-90. https://doi.org/10.1542/peds.114.1.285
  2. Greenholz SK, Perez C, Wesley JR, Marr CC. Meconium obstruction in markedly premature infant. J Pediatr Surg 1996;31:117-20. https://doi.org/10.1016/S0022-3468(96)90332-2
  3. Vinograd I, Mogle P, Peleg O, Alpan G, Lernau OZ. Meconium disease in premature infants with very low birth weight. J Pediatr 1983;103:963-6. https://doi.org/10.1016/S0022-3476(83)80732-X
  4. Amodio J, Berdon W, Abramson S, Stolar C. Microcolon of prematurity: a form of functional obstruction. AJR Am J Roentgenol 1986;146:239-44. https://doi.org/10.2214/ajr.146.2.239
  5. Burge D, Drewett M. Meconium plug obstruction. Pediatr Surg Int 2004;20:108-10. https://doi.org/10.1007/s00383-003-1098-y
  6. Keckler SJ, St Peter SD, Spilde TL, Tsao K, Ostlie DJ, Holcomb GW 3rd, et al. Current significance of meconium plug syndrome. J Pediatr Surg 2008;43:896-8. https://doi.org/10.1016/j.jpedsurg.2007.12.035
  7. Kim YJ, Kim EK, Kim ES, Kim HS, Choi JH, Cheon JE, et al. Recognition, diagnosis and treatment of meconium obstruction in extremely low birth weight infants. Neonatology 2012;101:172-8. https://doi.org/10.1159/000330850
  8. Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, et al. Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int 2011;53:887-91. https://doi.org/10.1111/j.1442-200X.2011.03381.x
  9. Dimmitt RA, Moss RL. Meconium diseases in infants with very low birth weight. Semin Pediatr Surg 2000;9:79-83. https://doi.org/10.1016/s1055-8586(00)70020-5
  10. Krasna IH, Rosenfeld D, Salerno P. Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant. J Pediatr Surg 1996;31:855-8. https://doi.org/10.1016/S0022-3468(96)90153-0
  11. Yoo SY, Jung SH, Eom M, Kim IH, Han A. Delayed maturation of interstitial cells of Cajal in meconium obstruction. J Pediatr Surg 2002;37:1758-61. https://doi.org/10.1053/jpsu.2002.36715
  12. Chan KL, Ng SP, Chan KW, Wo YH, Tam PK. Pathogenesis of neonatal necrotizing enterocolitis: a study of the role of intraluminal pressure, age and bacterial concentration. Pediatr Surg Int 2003;19:573-7. https://doi.org/10.1007/s00383-003-0979-4
  13. Ein SH, Shandling B, Reilly BJ, Stephens CA. Bowel perforation with nonoperative treatment of meconium ileus. J Pediatr Surg 1987;22:146-7. https://doi.org/10.1016/S0022-3468(87)80434-7
  14. Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg 1969;4:190-7. https://doi.org/10.1016/0022-3468(69)90390-X
  15. Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg 2004;39:731-7. https://doi.org/10.1016/j.jpedsurg.2004.01.027
  16. Goo HW, Kim KS, Kim EA, Pi SY, Yoon CH. Sonography-guided gastrografin enema for meconium plug syndrome in premature newborns: preliminary results. J Korean Radiol Soc 2004;50:281-8. https://doi.org/10.3348/jkrs.2004.50.4.281
  17. Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: factors that affect treatment success. Eur J Radiol 2015;84:2024-31. https://doi.org/10.1016/j.ejrad.2015.06.006
  18. Carroll AG, Kavanagh RG, Ni Leidhin C, Cullinan NM, Lavelle LP, Malone DE. Comparative effectiveness of imaging modalities for the diagnosis of intestinal obstruction in neonates and infants: a critically appraised topic. Acad Radiol 2016;23:559-68. https://doi.org/10.1016/j.acra.2015.12.014
  19. Haiden N, Norooz F, Klebermass-Schrehof K, Horak AS, Jilma B, Berger A, et al. The effect of an osmotic contrast agent on complete meconium evacuation in preterm infants. Pediatrics 2012;130:e1600-6. https://doi.org/10.1542/peds.2011-3634
  20. Copeland DR, St Peter SD, Sharp SW, Islam S, Cuenca A, Tolleson JS, et al. Diminishing role of contrast enema in simple meconium ileus. J Pediatr Surg 2009;44:2130-2. https://doi.org/10.1016/j.jpedsurg.2009.06.005
  21. Karimi A, Gorter RR, Sleeboom C, Kneepkens CM, Heij HA. Issues in the management of simple and complex meconium ileus. Pediatr Surg Int 2011;27:963-8. https://doi.org/10.1007/s00383-011-2906-4
  22. Burke MS, Ragi JM, Karamanoukian HL, Kotter M, Brisseau GF, Borowitz DS, et al. New strategies in nonoperative management of meconium ileus. J Pediatr Surg 2002;37:760-4. https://doi.org/10.1053/jpsu.2002.32272
  23. Carlyle BE, Borowitz DS, Glick PL. A review of pathophysiology and management of fetuses and neonates with meconium ileus for the pediatric surgeon. J Pediatr Surg 2012;47:772-81. https://doi.org/10.1016/j.jpedsurg.2012.02.019