Published online November 1, 2004
PEDIATRICS Vol. 114 No. 5 November 2004, pp. 1367 (doi:10.1542/peds.2004-1504)

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Meconium Obstruction in the Very Low Birth Weight Premature Infant

Sherif Emil, MD, CM, FACS, FAAP, FRCSC
Division of Pediatric Surgery
College of Medicine
University of California
Irvine Medical Center
Orange, CA 92868

To the Editor.

I congratulate Garza-Cox et al for their article "Meconium Obstruction in the Very Low Birth Weight Premature Infant," which appeared in the July issue of Pediatrics.¹ This syndrome is still not well understood by many neonatologists and pediatric surgeons, often leading to undertreatment and overtreatment of these fragile newborns.

As a pediatric surgeon who often evaluates these infants for surgical intervention, I have been particularly interested in this syndrome, the incidence of which seems to be increasing steadily. We recently reported a smaller series with many of the same conclusions in the article by Garza-Cox et al.²

I wish to add 2 points regarding diagnosis and management of this syndrome that were not emphasized in the article. First, the syndrome can be diagnosed reliably at its onset based on typical risk factors, a typical clinical picture, and abdominal films showing uniformly dilated bowel loops without air-fluid levels. The absence of air-fluid levels differentiates this type of obstruction from intestinal atresias or other causes of complete mechanical obstruction. A contrast enema is not essential for diagnosis.

Second, pro-grade N-acetylcysteine (1–5 mL of 10% solution) given through an orogastric tube has a high chance of success if used early in the course of the obstruction.² We have continued to use this therapeutic modality with excellent results.

I agree with the authors that persistent obstruction can lead to perforation. We have also reported a case of meconium-induced intussusception.² These sequelae of what is initially a benign clinical picture should prompt early recognition and treatment of meconium obstruction of prematurity.

REFERENCES

1. Garza-Cox S, Keeney SE, Angel CA, Thompson LL, Swischuk LE. Meconium obstruction in the very low birth weight premature infant. Pediatrics. 2004;114 :285 –290[Abstract/Free Full Text]
2. 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 –737[Medline]

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PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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Meconium Obstruction in the Very Low Birth Weight Premature Infant: In Reply

Susan Keeney and Leonard Swischuk
Pediatrics 2004 114: 1367-1368. [Extract] [Full Text]  

This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Related articles in Pediatrics Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Emil, S. Search for Related Content PubMed PubMed Citation Articles by Emil, S. Related Collections Premature & Newborn Social Bookmarking                         What's this?