Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus.

Shin,  Jaeho; Jeon,  Ga Won

doi:2018.25.1.37

Neonatal Med > Volume 25(1); 2018 > Article

Original Article

Neonatal Medicine 2018;25(1):37-43.
DOI: https://doi.org/10.5385/nm.2018.25.1.37 Published online February 28, 2018.

Successful Ultrasound-Guided Gastrografin Enema for Very Low Birth Weight Infants with Meconium-Related Ileus.

Jaeho Shin, Ga Won Jeon

¹Division of Pediatric Surgery, Department of Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea.
²Department of Pediatrics, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea. iamgawon@hanmail.net

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.

Key Words: Gastrografin, Intestinal obstruction; Meconium; Preterm infant; Very low birth weight infant