Meconium-related obstruction: Contemporary experience in a multi-institutional consortium

作者：Jordan M. Rook, Jamie E. Anderson, Katelin Kramer, Caitlin Royse, Michele Evans, Erin E. West, Adnan Ismail, Yigit S. Guner, Henry Lee, Sherry Bai-Tong, Leslie Lusk, Geoanna Bautista, Hanmin Lee, Cherry Uy, Kara L. Calkins, Karen Kling, Daniel A. DeUgarte · 发表于：Journal of Pediatric Surgery · 年份：2025 · DOI：10.1016/j.jpedsurg.2025.162545 · 被引用次数：2 · 研究领域：Intestinal Malrotation and Obstruction Disorders、Congenital gastrointestinal and neural anomalies、Pediatric Urology and Nephrology Studies

PURPOSE: Neonatal bowel obstruction secondary to inspissated meconium has been historically associated with cystic fibrosis. Increasingly, meconium-related obstruction (MRO) has been observed in preterm infants. We conducted a multicenter mixed-methods study to better characterize the contemporary experience with MRO. METHODS: A retrospective cohort study of infants with MRO was performed at seven children's hospitals from 2018 to 2022. Chi-squared tests, Kruskal-Wallis tests, and logistic regression were used to assess the association of cystic fibrosis, Hirschsprung disease, and prematurity with treatment strategies and clinical outcomes of MRO. Providers were surveyed regarding their management of MRO of prematurity. RESULTS: We identified 105 infants treated for MRO, including 54 (51 %) with MRO of prematurity, 16 (15 %) with Hirschsprung disease, 6 (6 %) with cystic fibrosis, and 29 (28 %) with MRO of the term infant. Overall, 32 % (n = 34) received glycerin suppositories, 25 % (n = 26) rectal irrigation, 79 % (n = 83) contrast enemas, and 6 % (n = 6) retrograde or antegrade N-acetylcysteine. Twenty-seven (26 %) infants required surgery for MRO, of whom 21 (78 %) had MRO of prematurity. For infants with MRO of prematurity, a one-week increase in gestational age was associated with a 23 % decrease in the odds of requiring surgery (OR = 0.77; 95%CI = 0.64-0.93). Survey responses from 42 providers suggested limited institutional treatment algorithms for MRO. CONCLUSION: In ...