鈥淧ulling the plug鈥濃€擬anagement of meconium plug syndrome in neonates

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• 作者：Alex G. Cuenca ; MD ; Anam S. Ali ; BS ; David W. Kays ; MD ; Saleem Islam ; MD ; MPH ; ^{Saleem.islam@surgery.ufl.edu}
• 关键词：Meconium plug syndrome ; Meconium ileus ; Left colon syndrome ; Hirchsprung&rsquo ; s disease
• 刊名：Journal of Surgical Research
• 出版年：2012
• 期刊代码：299_00224804
• 类别：med
• 出版时间：15 June, 2012
• 卷：175
• 期：2
• 页码：e43-e46
• 文件大小：165 K

摘要

Background

The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung鈥檚 disease and magnesium tocolysis. We reviewed our experience to attempt to identify any potential association with these conditions and to review our outcomes.

Methods

Using the International Classification of Diseases, Ninth revision, code for meconium obstruction, patient charts were identified during the 1998-2008 period. A total of 61 cases of MPS were found, after excluding 7 of meconium ileus. Data regarding the hospital course and outcomes were collected and analyzed.

Results

Approximately 30%of patients had spontaneous resolution of the meconium plug without any treatment. Of those patients requiring treatment, contrast barium enema was used, with 97%success. Only 2 patients required surgical intervention owing to worsening distension and subsequent peritonitis. When we stratified the patients according to gestational age of >36 and <36 wk, contrast barium enemas were performed 2.2 卤 1.8 versus 8.6 卤 7.8 d after birth (P = 0.003), respectively, and the lower gestational age patients had a longer length of stay. Contrast barium enema was still successful in 94%of patients with a gestational age of <36 wk. Magnesium tocolysis was noted in 16%of the cases, and Hirschsprung鈥檚 disease was only found in 3.2%of patients.

Conclusions

Patients with MPS have excellent outcomes, independent of gestational age. Contrast barium enema remains the initial diagnostic and treatment of choice for patients with MPS. Also, although previous reports have shown a link between magnesium tocolysis and Hirschsprung鈥檚 disease with MPS, our experience suggests otherwise.