IS IT NECROTIZING ENTEROCOLITIS, MICROCOLON OF PREMATURITY, OR DELAYED MECONIUM PLUG - A DILEMMA IN THE TINY PREMATURE-INFANT

Failure of a small premature newborn to adequately evacuate meconium f or days or weeks has been attributed to ''probable necrotizing enteroc olitis (NEC)'' or ''microcolon of prematurity.'' The authors present a n unusual type of ''meconium plug syndrome'' with the same clinical pi cture, seen in tiny premature babies (500 to 1,500 g), which required a contrast enema or Gastrografin upper gastrointestinal (UGI) series t o evacuate the plugs. The obstruction resolved. Twenty babies (480 to 1,500 g) presented with the same clinical picture without any x-ray su ggestion of NEC; contrast enemas were performed because of the suspici on of meconium plug syndrome. All 20 had extensive meconium plugs that were evacuated by the enema or by a Gastrografin UGI series. Most of them improved after the plugs were passed. These infants differ from t ypical full-term babies with meconium plug syndrome in a number of way s: (1) many of the mothers were on magnesium sulfate (MgSO4) or had ec lampsia; (2) the plugs were diagnosed late rather than shortly after b irth; and (3) the plugs were significant, extending to the right colon . The authors believe that when a tiny premature baby has findings con sistent with meconium plug syndrome, the baby should be transported to radiology, for a Gastrografin enema, despite the difficulties involve d. Delay postpones the start of feedings, and increases the number of radiographic studies. Copyright (C) 1996 by W.B. Saunders Company