Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. Methods: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight <1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. Results: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9-34.3 weeks) and 893 g (range, 610-1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3-11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1-6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1-14 days) after the procedure. Conclusion: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
Abstract
Purpose: Meconium-related ileus is common in preterm infants. Without proper management, it can cause necrotizing enterocolitis and perforation requiring emergent operation. This study was conducted to describe the efficacy and safety of ultrasound-guided Gastrografin enema at bedside for preterm infants with meconium-related ileus. Methods: Between March 2013 and December 2014, this study enrolled preterm infants with birth weight <1,500 g, who were diagnosed with meconium-related ileus requiring ultrasound-guided Gastrografin enema refractory to glycerin or warm saline enemas. Gastrografin was infused until it passed the ileocecal valve with ultrasound guidance at bedside. Results: A total of 13 preterm infants were enrolled. Gestational age and birth weight were 28.6 weeks (range, 23.9-34.3 weeks) and 893 g (range, 610-1,440 g), respectively. Gastrografin enema was performed around postnatal day 8 (range, day 3-11). The success rate was 84.6% (11 of 13 cases). Three of these 11 infants received a second procedure, which was successful. Among 2 unsuccessful cases, one failed to pass meconium while the other required surgery due to perforation. The time required to pass meconium was 2.8±1.5 hours (range, 1-6 hours). The time until radiographic improvement was 2.8±3.4 days (range, 1-14 days) after the procedure. Conclusion: Ultrasound-guided Gastrografin enema at bedside as a first-line treatment to relieve meconium-related ileus was effective and safe for very low birth weight infants. We could avoid unnecessary emergent operation in preterm infants who have high postoperative morbidity and mortality. This could also avoid transporting small preterm infants to fluoroscopy suite.
참고문헌 (28)
- Emil S, "Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management", J Pediatr Surg, 39, pp.731~737 (2004)[DOI]
- Clatworthy HW, "The meconium plug syndrome", Surgery, 39, pp.131~142 (1956)
- Kubota A, "Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology", Pediatr Int, 53, pp.887~891 (2011)[DOI]
- Shinohara T, "Management of meconiumrelated ileus in very low-birthweight infants", Pediatr Int, 49, pp.641~644 (2007)[DOI]
- Kubota A, "Functional ileus in neonates: Hirschsprung's diseaseallied disorders versus meconium-related ileus", Eur J Pediatr Surg, 9, pp.392~395 (1999)[DOI]
- Greenholz SK, "Meconium obstruction in markedly premature infant", J Pediatr Surg, 31, pp.117~120 (1996)[DOI]
- Noblett HR, "Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report", J Pediatr Surg, 4, pp.190~197 (1969)[DOI]
- Ein SH, "Bowel perforation with nonoperative treatment of meconium ileus", J Pediatr Surg, 22, pp.146~147 (1987)[DOI]
- Chang PY, "Meconium ileus-like condition in Chinese neonates", J Pediatr Surg, 27, pp.1217~1219 (1992)[DOI]
- Dimmitt RA, "Meconium diseases in infants with very low birth weight", Semin Pediatr Surg, 9, pp.79~83 (2000)[DOI]
- Vinograd I, "Meconium disease in premature infants with very low birth weight", J Pediatr, 103, pp.963~966 (1983)[DOI]
- Milla PJ, "Neonatal gastroenterology: contemporary issues", pp.1~20 (1984), Intercept
- Wolinski J, "Small intestine motility development in newborn mammals", Dev Period Med, 20, pp.53~60 (2016)
- Yoo SY, "Delayed maturation of interstitial cells of Cajal in meconium obstruction", J Pediatr Surg, 37, pp.1758~1761 (2002)[DOI]
- Toyosaka A, "Immaturity of the myenteric plexus is the aetiology of meconium ileus without mucoviscidosis: a histopathologic study", Clin Auton Res, 4, pp.175~184 (1994)[DOI]
- Ziegler MM, "Meconium ileus", Curr Probl Surg, 31, pp.731~777 (1994)
- Del Pin CA, "Management and survival of meconium ileus. A 30-year review", Ann Surg, 215, pp.179~185 (1992)[DOI]
- Garza-Cox S, "Meconium obstruction in the very low birth weight premature infant", Pediatrics, 114, pp.285~290 (2004)[DOI]
- Blott M, "Antenatal factors associated with obstruction of the gastrointestinal tract by meconium", Br Med J (Clin Res Ed), 296, pp.250~ (1988)[DOI]
- 유하양, "초극소저체중 출생아에서 발생한 태변 연관 장폐색증", Neonatal medicine, 20(1), pp.121~128 (2013), 대한신생아학회
- Krasna IH, "Is it necrotizing enterocolitis, microcolon of prematurity, or delayed meconium plug? A dilemma in the tiny premature infant", J Pediatr Surg, 31, pp.855~858 (1996)[DOI]
- Maneksha FR, "Intraoperative hypoxia and hypotension caused by gastrografin-induced hypovolemia", Anesthesiology, 61, pp.454~456 (1984)[DOI]
- Rowe MI, "The neonatal response to gastrografin enema", Pediatrics, 48, pp.29~35 (1971)
- Cho HH, "Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: fctors that affect treatment success", Eur J Radiol, 84, pp.2024~2031 (2015)[DOI]
- Hatanaka A, "Management of extremely low birth weight neonates with bowel obstruction within 2 weeks after birth", Surg Today, 44, pp.2269~2274 (2014)[DOI]
- Fuchs JR, "Long-term outcome after neonatal meconium obstruction", Pediatrics, 101, pp.E7~ (1998)
- Koshinaga T, "Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates", Pediatr Int, 53, pp.338~344 (2011)[DOI]
- Kao SC, "Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology", Pediatr Radiol, 25, pp.97~100 (1995)[DOI]