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Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates.
MedLine Citation:
PMID:  20735806     Owner:  NLM     Status:  In-Data-Review    
Background:  Meconium obstruction without cystic fibrosis in low-birthweight neonates is a distinct clinical entity. We aimed to determine what therapeutic strategies work best in very-low-birthweight neonates with meconium obstruction of the small bowel under varied clinical conditions caused by the associated diseases of prematurity. Methods:  Medical records of very-low-birthweight neonates with meconium obstruction of the small bowel treated from 1998 to 2008 were retrospectively reviewed. Pre- and postnatal data, treatments, and clinical outcomes were assessed. Results:  Nine patients with perinatal complications were identified. Mean gestational age and birthweight were 26.9 weeks and 863 g, respectively. Abdominal distension developed from 1 to 7 days of life. Five patients were initially treated with Gastrografin enema, three of whom had successful outcomes. Two hemodynamically unstable patients failed to respond to Gastrografin treatment; they ultimately died of sepsis. The remaining four without Gastrografin treatment underwent enterostomy to resolve the obstructions with good results. Conclusions:  Gastrografin and surgical treatments should be appropriately selected based on the underlying pathologies of meconium obstruction of the small bowel. Therapeutic Gastrografin enema is effective, safe and repeatable; however, it is not recommended for hemodynamically unstable patients. Surgical intervention is reserved for those who develop rapid abdominal distension that risks perforation.
Tsugumichi Koshinaga; Mikiya Inoue; Kensuke Ohashi; Kiminobu Sugito; Taro Ikeda; Ryouichi Tomita
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics international : official journal of the Japan Pediatric Society     Volume:  53     ISSN:  1442-200X     ISO Abbreviation:  Pediatr Int     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886002     Medline TA:  Pediatr Int     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  338-44     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors.Pediatrics International © 2011 Japan Pediatric Society.
Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan.
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