Management strategies for functional intestinal obstruction of prematurity

Authors

  • Olugbenga Awolaran Department of Paediatric Surgery, Royal Alexandra Childrens Hospital, Brighton
  • Jigna Sheth Department of Paediatric Surgery, Royal Alexandra Children’s Hospital, Brighton, United Kingdom

DOI:

https://doi.org/10.47338/jns.v10.926

Keywords:

Functional intestinal obstruction, Premature infants, Management

Abstract

Functional intestinal obstruction of prematurity (FIOP) is characterised by a partial or complete failure of meconium evacuation due to hypomotility of the immature bowel and this presents with features of intestinal obstruction typically within the first 2 weeks of life. It contributes significantly to the morbidity and mortality of extremely and very low birth weight preterm infants. This disorder has been described using many terminologies and there is controversy amidst clinicians as to the optimal approach to its management.

This review summarises the characteristic clinical and radiologic findings to aid timely diagnosis and initiation of prompt treatment. Available evidence on different treatment options and their limitations is reviewed and practical stepwise management is described. In most cases, FIOP can be successfully managed conservatively with proactive management and monitoring.

Overall outcomes are favourable and normal long-term gastrointestinal function is commonly experienced. Evidence for investigations to exclude cystic fibrosis and Hirschsprung’s disease in preterm infants with FIOP is evaluated and a link with focal intestinal perforation is highlighted.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Greenholz SK, Perez C, Wesley JR, Marr CC. Meconium obstruction in markedly premature infants. J Pediatr Surg. 1996; 31:117-20.

Kubota A, Shiraishi J, Kawahara H, Okuyama H, Yoneda A, Nakai H, et al. Meconium-related ileus in extremely low-birthweight neonates: etiological considerations from histology and radiology. Pediatr Int. 2011; 53:887-91.

Siddiqui MMF, Drewett M, Burge DM. Meconium obstruction of prematurity. Arch Dis Child Fetal Neonatal Ed. 2012; 97:147-50.

Miserez M, Barten S, Geboes K, Naulaers G, Devlieger H, Pennickx F. Surgical therapy and histological abnormalities in functional isolated small bowel obstruction and idiopathic gastrointestinal perforation in the very low birth weight infant. World J Surg. 2003; 27:350–5.

Koshinaga T, Gotoh H, Sugito K, Ikeda T, Hagiwara N, Tomita R. Spontaneous localized intestinal perforation and intestinal dilatation in very-low-birthweight infants. Acta Paediatr. 2006; 95:1381-8.

Dimmitt RA, Moss RL. Meconium diseases in infants with very low birth weight. Semin Pediatr Surg. 2000; 9:79-83.

Kim YJ, Kim EK, Kim ES, Kim HS, Choi JH, Cheon JE, et al. Recognition, diagnosis and treatment of meconium obstruction in extremely low birth weight infants. Neonatol. 2012; 101:172-8.

Okuyama H, Ohfuji S, Hayakawa M, Urushihara N, Yokoi A, Take H, et al. Risk factors for surgical intestinal disorders in VLBW infants: Case-control study. Pediatr Int. 2016; 58:34-9.

Kadigolu Simsek G, Arayici S, Buyuktiryaki M, Okur N, Kanmaz Kutman G, Suna Oguz S. Oral N-acetyl cysteine for meconium ileus of preterm infants. Gynecol Obstet Reprod Med. 2019; 25:169-73.

Weaver LT, Lucas A. Development of bowel habits in preterm infants. Arch Dis Child. 1993; 68:317-20.

Paradiso VF, Briganti V, Oriolo L, Coletta R, Calisti A. Meconium obstruction in absence of cystic fibrosis in low birth weight infants: an emerging challenge from increasing survival. Ital J Pediatr. 2011; 14:37-55.

Emil S, Nguyen T, Sills J, Padilla G. Meconium obstruction in extremely low-birth-weight neonates: guidelines for diagnosis and management. J Pediatr Surg. 2004; 39:731-7.

Cho HH, Cheon JE, Choi YH, Lee SM, Kim WS, Kim IO, et al. Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success. Eur J Radiol. 2015; 84:2024-31.

Koshinaga T, Inoue M, Ohashi K, Sugito K, Ikeda T, Tomita R. Therapeutic strategies of meconium obstruction of the small bowel in very-low-birthweight neonates. Pediatr Int. 2011; 53:338-44.

Noblett HR. Treatment of uncomplicated meconium ileus by Gastrografin enema: a preliminary report. J Pediatr Surg. 1969; 4:190-7.

Gastrografin. Drugs.com (November 2019). Available from: https://www.drugs.com/pro/gastrografin.html. Accessed on 04/10/2020.

Nakaoka T, Shiokawa C, Nishihara M, Tamai H, Funato M, Uemura S. Iopamidol enema treatment for meconium obstruction of prematurity in extremely low-birth-weight infants: a safe and effective method. Pediatr Surg Int. 2009; 25:273-6.

Raith W, Resch B, Pichler G, Zotter H, Urlesberger B, Mueller W. Delayed meconium passage in small vs. appropriate for gestational age preterm infants: management and short-term outcome. Iran J Pediatr. 2013; 23:8-12.

Langer JC, Paes BM, Gray S. Hypernatremia associated with N-acetylcysteine therapy for meconium ileus in a premature infant. CMAJ. 1990; 143:202-3.

Cooke A, Deshpande AV, Wong CK, Cohen R. Hepatic derangement following N-Acetylcysteine enemas in an infant with cystic fibrosis. J Paediatr Child Health. 2008; 44:673-5.

Kahn DJ, Gregorisch S, Whitehouse JS, Fisher PD. Delayed diagnosis of spontaneous intestinal perforation among very low birth weight neonates: A single center experience. J Perinatol. 2019; 39:1509-20.

Okuyama H, Kubota A, Oue T, Kuroda S, Ikegami R, Kamiyama M. A comparison of the clinical presentation and outcome of focal intestinal perforation and necrotizing enterocolitis in very-low-birth-weight neonates. Pediatr Surg Int. 2002; 18:704-6.

Tatekawa Y, Muraji T, Imai Y, Nishijima E, Tsugawa C. The mechanism of focal intestinal perforations in neonates with low birth weight. Pediatr Surg Int. 1999; 15:549-52.

Fisher JG, Jones BA, Gutierrez IM, Hull MA, Kang KH, Kenny M, et al. Mortality associated with laparotomy-confirmed neonatal spontaneous intestinal perforation: a prospective 5-year multicenter analysis. J Pediatr Surg. 2014; 49:1215-9.

Kubota A, Yamanaka H, Okuyama H, Shiraishi J, Kawahara H, Hasegawa T, et al. Focal intestinal perforation in extremely-low-birth-weight neonates: etiological consideration from histological findings. Pediatr Surg Int. 2007; 23:997-1000.

Sharp NE, Pettiford-Cunningham J, Shah SR, Thomas P, Juang D, St Peter SD, et al. The prevalence of Hirschsprung disease in premature infants after suction rectal biopsy. J Surg Res. 2013; 184:374-7.

Downey EC, Hughes E, Putnam AR, Baskin HJ, Rollins MD. Hirschsprung disease in the premature newborn: a population based study and 40-year single center experience. J Pediatr Surg. 2015; 50:123-5.

Baxter KJ, Bhatia AM. Hirschsprung's disease in the preterm infant: implications for diagnosis and outcome. Am Surg. 2013; 79:734-8.

Published

2021-02-20

How to Cite

1.
Awolaran O, Sheth J. Management strategies for functional intestinal obstruction of prematurity. J Neonatal Surg [Internet]. 2021Feb.20 [cited 2021Sep.25];10:12. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/926