“Pulling the plug”—Management of meconium plug syndrome in neonates

• Published in: The Journal of surgical research Vol. 175; no. 2; pp. e43 - e46
• Main Authors: Cuenca, Alex G., MD, Ali, Anam S., BS, Kays, David W., MD, Islam, Saleem, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.06.2012
• Subjects: Barium Sulfate; Cystic Fibrosis - complications; Cystic Fibrosis - diagnosis; Cystic Fibrosis - epidemiology; Enema; Female; Hirchsprung’s disease; Hirschsprung Disease - complications; Hirschsprung Disease - diagnosis; Hirschsprung Disease - epidemiology; Humans; Ileal Diseases - etiology; Ileal Diseases - therapy; Incidence; Infant, Newborn; Intestinal Obstruction - etiology; Intestinal Obstruction - therapy; Left colon syndrome; Male; Meconium; Meconium ileus; Meconium plug syndrome; Retrospective Studies; Surgery; Syndrome; Treatment Outcome; Left colon syndrome; Hirchsprung’s disease; Meconium plug syndrome; Meconium ileus
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2012.01.029

Abstract Background The significance of meconium plug syndrome (MPS) is unclear but has been associated with Hirschsprung’s 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 ± 1.8 versus 8.6 ± 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’s 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’s disease with MPS, our experience suggests otherwise.