MECONIUM OBSTRUCTION IN THE MARKEDLY PREMATURE-INFANT

Markedly premature infants may: present with intestinal obstruction an d perforation secondary to inspissated meconium in the absence of cyst ic fibrosis. Between 1990 and 1994, 13 patients were treated for intes tinal obstruction secondary to inspissated meconium. The average birth weight was 760 g. Prenatal and postnatal risk factors were identified , and included intrauterine growth retardation, maternal hypertension, prolonged administration of tocolytics, patent ductus arteriosus, hya line membrane disease, and intraventricular hemorrhage. Stooling wa's absent or infrequent during the first 2 weeks of life. Surgical presen tation consisted of distension and/or perforation between days 2 and 1 7 of life. Twelve patients required operative intervention. Findings i nvariably included one or more obstructing meconium plugs with proxima l distension and frequent necrosis of the dilated segments. Surgical o ptions consisted of resection or enterotomy, accompanied by primary cl osure or by distal irrigation and exteriorization. Irrigation led to i atrogenic bowel injury in two patients. One patient was managed succes sfully with oral and rectal gastrograffin and oral acetylcysteine. Ten patients were discharged, all of whom had normal stooling patterns an d tested negatively for cystic fibrosis. Three patients died, two from the primary disease. The markedly premature infant is at risk for obs truction and eventual perforation secondary to meconium plugs, presuma bly formed in conjunction with intestinal dysmotility. Prompt diagnosi s and timely intervention require a high index of suspicion, attention to stooling patterns and abdominal examinations, and screening radiog raphs when indicated. Copyright (C) 1996 by W.B. Saunders Company.