Diagnosis and treatments in simple meconium ileus in neonates: ten-year experience in a single center
10.3760/cma.j.issn.2095-428X.2019.11.005
- VernacularTitle: 新生儿单纯性胎粪性肠梗阻临床诊治：单中心10年经验回顾
- Author:
Xiaofeng XIONG
1
;
Wei LU
1
;
Fuzhong XING
1
;
Lei YU
1
;
Yue WANG
1
;
Yuji WANG
2
;
Xuyong CHEN
3
Author Information
1. Department of Neonate Surgery, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
2. Department of Medical Record, Wuhan Children′s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430016, China
3. the Research Institute at Nationwide Children′s Hospital, Ohio State University, Columbus 43205, U.S.A
- Publication Type:Journal Article
- Keywords:
Meconium ileus;
Infant, newborn;
Treatment;
Amiotol
- From:
Chinese Journal of Applied Clinical Pediatrics
2019;34(11):818-822
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To improve the accuracy of the diagnosis and decrease the unnecessary surgical exploration in neonates with simple meconium ileus (SMI) by analyzing clinical characteristics of SMI.
Methods:Forty-five neonates identified as SMI from January 2008 to May 2018 had been collected, and the data of pregnancy, birth weight, treatments, hospital stay and results of follow-up were included.The patients were divided into 2 groups: surgical group and non-surgical group.The surgical group underwent enterostomy at the end of ileum, meanwhile, the intestinal wall was biopsied for checking the existence of ganglion cells.All the neonates in the surgical group underwent stoma closure in 3 to 6 months postoperatively.The non-surgical group received fasting, intravenous nutritional support, enema with amiotol diluted into 11 or injected into the stomach by the gastric tube.They all received enema with warm salt (9 g/L) 1-2 times per day.Once the abdominal dilation was mitigated and autonomous defecation obtained, the neonates gradually began the oral feeding and weaned from the total parenteral nutrition(TPN). The 45 neonates were also divided into earlier group (from January 2008 to May 2013) and later group (from June 2013 to May 2018) according to the time of diagnosis.The relationships between the SMI treatment choice and the pregnancy, birth weight and time of diagnosis were analyzed.
Results:No cystic fibrosis lesions were found in 45 neonates, of which 21 and 24 neonates were in non-surgical group and surgical group, respectively.In the operation, the intestine presented similar anatomy to the total Hirschsprung′s disease.However, the ganglion was observed not only in the stricture, transitional and dilated zone of ileum, but also in the colon.There were no significant differences in the pregnancy and birth weight in both groups(P>0.05), but there was significant difference in the duration of hospitalization [(21.19±5.13) d vs.(12.29±3.85) d, P=0.000]. There were complications in those patients who had undergone enterostomy, including wound infection (2 cases), prolapse of stoma (2 cases), water and electrolyte disorders (2 cases), malnutrition (21 cases). After the stoma closure, no signs of ganglion cell dysplasia were found in follow-up.In non-surgical group, there were 20 pre-term reonates and 1 full-term neonate, respectively.In surgical group, there were 22 pre-term reonates and 2 full-term neonate, respectively.Neither pregnancy nor birth weight was related to the choice of treatment (P>0.05), but the time when to be admitted was highly related to the choice of treatment (P<0.05).
Conclusions:It is not rare for the occurrence of SMI in neonates in China, especially in preterm neonates.Amiotol may have effects not only on diagnosis but also on treatment of SMI, which can be applied repeatedly.Non-surgical treatment can help most of the neonates with SMI to avoid surgical exploration.Enhancing apprehension about the SMI may have great advantages to decrease the rate of unnecessary laparotomy.
