NEONATAL INTESTINAL PSEUDOOBSTRUCTION DUE TO IMMATURITY

Background. A chronic intestinal pseudo-obstruction is sometimes seen in premature neonates who are fed early and subsequently suffer from d igestive intolerance for several weeks. Patients. Seven premature babi es (mean gestational age: 30.5 weeks, mean birthweight: 950 g) suffere d from abdominal distension and failure to pass stools at a mean age o f 2.5 days (extremes: 1 to 6 days); 2 of them also had vomiting. X-ray examination showed dilated loops of bowel throughout the abdomen with out obstructive changes; barium or Gastrografin(R) studies demonstrate d inertia of the colon without obstructive changes or abrupt changes i n caliber. Histological examination of enteric nerve cells in 2 cases showed normal maturation. Parenteral nutrition was necessary in all pa tients for 30 to 78 days (mean: 47), followed by continuous enteral fe eding for 24 to 48 days (mean: 37). Septicemia complicated parenteral nutrition in 4 babies and was responsible for the death of 1 of them. Normal evacuation of stools occurred between day 27 and day 91 (mean d ay 46) allowing normal enteral feeding. All 6 patients, now aged 2.5 t o 8 years (mean 3.5 years) are in good health, and have no digestive p roblems. Conclusions. Immaturity of intestinal motility may occur in s ome premature neonates suffering from intestinal ileus. Parenteral nut rition may be necessary for several weeks, but spontaneous recovery is usual. This transient intestinal pseudo-obstruction of premature babi es is different from the classical chronic pseudo-obstruction for whic h surgery is often needed.