morphine and Abnormalities--Multiple

Enterolithiasis is an uncommon finding of intraluminal calcified meconium. Whereas extraluminal calcifications are commonly reported and usually indicate intrauterine intestinal perforation with intraperitoneal extravasation of meconium (meconium peritonitis), true intraluminal calcifications of meconium in newborns are rare.. We report a case of a newborn boy with pneumothorax and pneumoperitoneum because of a transmediastinal air leakage who unfortunately died on the fifth postnatal day after a pneumopericard. The baby had lung hypoplasia and a hypoplastic thorax. Oligohydramnion was present because of urethral agenesis and anal atresia with rectourinary fistula. Enterolithiasis was found, distributed from the transverse to the rectosigmoid colon. Enterolithiasis was not diagnosed prenatally in this boy, and any of those preexisting pathologies were therefore not assumed before birth except the suspicion for urethral valves because of oligohydramnion.. Approximately 48 cases of human neonatal enterolithiasis have been described in the medical literature. The etiology of enterolithiasis appears to be intraluminal mixture of meconium und alkaline urine--as it appears in anal atresia with enterourinary fistula. Most cases of enterolithiasis are associated with major urogenital and intestinal malformations--especially VACTERL association. With support of modern high-resolution imaging devices, enterolithiasis can be detected antenatally. We suppose that prenatal diagnosis of enterolithiasis is a warning sign of underlying pathologies.

Topics: Abnormalities, Multiple; Colonic Diseases; Critical Illness; Fatal Outcome; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature; Lithiasis; Male; Meconium; Pneumoperitoneum; Pneumothorax; Rectal Fistula; Urinary Fistula

Generalized arterial calcification of infancy (GACI) is a rare genetic disorder consisting of diffuse arterial calcification and intimal proliferation. The disease typically results in progressive arterial stenosis and frequently leads to death from myocardial ischemia by 6 months of life. Affected infants are usually diagnosed before birth or in the neonatal period with symptoms of congestive heart failure. Therapy with bisphosphonate has been used to treat the condition, but with inconsistent results. The disease is associated with mutations in ENPP1 in the majority of the cases. Here we report a unique case of GACI associated with in utero meconium peritonitis and without coding region mutations of the ENPP1 gene. GACI should be considered in the differential diagnosis in infants presenting with arterial calcifications and congenital anomalies of the gastrointestinal tract.

Topics: Abnormalities, Multiple; Adult; Aortic Diseases; Calcinosis; Clubfoot; Female; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Phosphoric Diester Hydrolases; Pyrophosphatases; Scoliosis; Ultrasonography, Prenatal

Topics: Abnormalities, Multiple; Colonic Diseases; Digestive System Abnormalities; Duodenal Obstruction; Esophageal Atresia; Female; Hernia; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestines; Jejunum; Male; Meconium; Megacolon; Mesenteric Cyst; Polyhydramnios; Pregnancy; Pylorus; Radiography; Vitelline Duct

To evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.. Multicentre randomised controlled trial.. A large urban academic hospital. Electronic fetal heart rate monitoring was not used.. Women in labour at term with moderate or thick meconium staining of the amniotic fluid.. Transcervical amnioinfusion of 500 mL saline over 30 minutes, then 500 mL at 30 drops per minute. The control group received routine care. Blinding of the intervention was not possible.. Caesarean section, meconium aspiration syndrome and perinatal mortality.. There was no difference in risk for caesarean section in the two groups (amnioinfusion 9.5% vs control 12.3%; RR 0.84, 95% CI 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1% vs 12.8%; RR 0.24, 95% CI 0.12-0.48), and there was a trend towards fewer perinatal deaths (1.2% vs 3.6%; RR 0.34, 95% CI 0.11-1.06).. Amnioinfusion is technically feasible in a developing country situation with limited intrapartum facilities. In this study amnioinfusion for meconium stained amniotic fluid was associated with striking improvements in perinatal outcome.. The presence of meconium in the amniotic fluid is associated with increased perinatal morbidity and mortality. Saline amnioinfusion during labor has been shown, in several clinical trials, to reduce the incidence of cesarean section and meconium aspiration syndrome. A randomized controlled trial conducted at Harare Maternity Hospital in Zimbabwe sought to confirm the benefits of amnioinfusion for meconium-stained amniotic fluid during labor for perinatal outcome. In the intervention group (n = 325), 500 ml of saline was transcervically amnioinfused over a 30-minute period, followed by 500 ml at 30 drops per minute for the duration of labor. The control group (n = 336) received routine obstetric care. The cesarean section rate was 9.5% in the intervention group and 12.3% in the control group (relative risk (RR), 0.84; 95% confidence interval (CI), 0.53-1.32). Meconium aspiration syndrome was significantly less frequent in the amnioinfusion group (3.1%) than the control group (12.8%) (RR, 0.24; 95% CI, 0.12-0.48). The perinatal death rate was 1.2% in the amnioinfusion group and 3.6% among controls (RR, 0.34; 95% CI, 0.11-1.06). Also recorded in the amnioinfusion group were significant reductions in the following perinatal morbidity measures: 5-minute Apgar score below 7, neonatal intensive care admissions, neonatal ventilation, and hypoxic ischemic encephalopathy. The striking improvements in perinatal outcome recorded among women in the amnioinfusion group suggest the feasibility of more widespread use of this simple procedure in developing country settings without routine electronic fetal monitoring facilities.

Topics: Abnormalities, Multiple; Adult; Amnion; Cesarean Section; Female; Fetal Death; Hospitalization; Humans; Infant, Newborn; Intensive Care, Neonatal; Meconium; Meconium Aspiration Syndrome; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Sodium Chloride; Urban Health; Zimbabwe

With the rise in genetic screening both pre- and postnatally, new variances in genes are being recognized. Some are of unknown significance, while other known genetic expressions have obvious phenotypical expressions. Transient neonatal diabetes mellitus is a result of the duplication of chromosome 6q24, but little is known about the phenotypic expression of a triplication of chromosome 6q24. This case study presents an infant with a postnatally diagnosed triplication of chromosome 6q24, meconium pseudocyst, and multiple congenital anomalies with unknown genetic significance.

Topics: Abnormalities, Multiple; Cysts; Diabetes Mellitus; Humans; Infant, Newborn; Male; Meconium

Anorectal malformations are usually diagnosed at birth, and the diagnosis is usually readily apparent in boys and girls by direct inspection of the perineal region. However, some of the less complex lesions, often referred to as 'low lesions', such as rectovestibular fistula in girls, may not be diagnosed at birth. These children are able to pass meconium, and it is only when the narrow fistula fails to pass formed stool later in infancy or childhood does the child become symptomatic. It is important to emphasise that the diagnosis of these defects should be made during neonatal predischarge examination. Such a delayed diagnosis may change their management, complicate surgical repair and may contribute to both functional and psychological problems for the patient and family.

Topics: Abnormalities, Multiple; Anal Canal; Child, Preschool; Delayed Diagnosis; Female; Humans; Meconium; Vaginal Fistula

Meconium peritonitis results from antenatal perforation of the gastrointestinal tract; it presents as gastrointestinal obstruction, intraabdominal masses, or calcification. The presentation with passage of meconium per vagina secondary to meconium peritonitis is rare. We describe the radiologic and surgical findings in a neonate who had passage of meconium per vagina secondary to ileal atresia and meconium peritonitis. Initial clinical and radiologic examination suggested rectal atresia with an associated rectovaginal fistula, although subsequently, this was not the case. Possible explanations for the passage of meconium per vagina include decompression of a meconium cyst via the left fallopian tube or direct perforation of a collection into the vagina from the peritoneal cavity.

Topics: Abnormalities, Multiple; Anastomosis, Surgical; Digestive System Abnormalities; Digestive System Surgical Procedures; Female; Follow-Up Studies; Humans; Ileum; Infant, Newborn; Intensive Care Units, Neonatal; Intestinal Perforation; Laparotomy; Meconium; Peritonitis; Pregnancy; Risk Assessment; Treatment Outcome; Ultrasonography, Prenatal; Uterus

This report describes a case of giant cystic meconium peritonitis (GCMP) associated with a cloacal anomaly. Antenatal ultrasonography and magnetic resonance imaging demonstrated persistent fetal ascites, bilateral hydronephrosis, and 3 pelvic cystic structures. The baby girl showed duplicated hydrocolpos and a single orifice of the cloaca with a long common channel inducing a urinary outflow obstruction. After constructing a diversion colostomy, a cutaneous vesicostomy was necessary to prevent recurrent urinary tract infections. These findings are consistent with a prenatal diagnosis of cloacal anomalies, thus suggesting an association with severe obstruction of lower urinary tract and meconium peritonitis. Most of reported cases of meconium peritonitis associated with the cloaca show fibroadhesive types with scattered intraperitoneal calcifications and adhesions. However, the present case showed a rare GCMP suggesting continuous urinary influx via the fallopian tubes until the later stage of intrauterine life.

Topics: Abnormalities, Multiple; Adult; Cesarean Section; Cloaca; Female; Follow-Up Studies; Humans; Hydrocolpos; Laparotomy; Magnetic Resonance Imaging; Meconium; Peritonitis; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Prenatal Diagnosis; Risk Assessment; Treatment Outcome

Extraluminal calcified meconium is found frequently by prenatal ultrasound in cases with bowel perforation and meconium peritonitis. Intraluminal intestinal meconium calcifications are rarely seen in prenatal sonography. Meconium calcifications result from a mixture of meconium and urine that indicates a connection between intestinal and urinary tract. We report a case of a male newborn prenatally diagnosed with intraluminal echogenic calcifications at 23 weeks of gestation, suggesting an anorectal malformation (ARM) with rectourinary fistula. At birth, the child presented with a complex ARM including high anal atresia with both perineal and rectourethral fistula. Furthermore, a bladder outlet obstruction due to a urethral stenosis was diagnosed. Vesicostomy was performed as an emergency procedure followed by colostomy during neonatal period. Posterior sagittal anorectoplasty was performed at the age of 4 months. Prenatal echogenic calcifications within bowel should raise the suspicion of ARM with rectourinary fistula and bladder outlet obstruction.

Topics: Abnormalities, Multiple; Anal Canal; Calcinosis; Colostomy; Humans; Infant, Newborn; Male; Meconium; Rectal Fistula; Rectum; Ultrasonography, Prenatal; Urinary Bladder Neck Obstruction; Urinary Fistula

Cloacal malformations are rare anomalies, occurring in females, and in which they demonstrate a single perineal orifice for urethra, vagina, and rectum. Prenatal ultrasonograms (US) of cloacal malformations sometimes show ascites, hydrocolpos, and hydronephrosis. We herein describe the characteristic prenatal US and magnetic resonance imaging (MRI) findings of the cloacal malformations associated with meconium peritonitis.. The pre- and postnatal records of 11 newborn patients with cloacal malformations, treated in our hospital from 1988 to 2004, were reviewed. All fetuses underwent prenatal US by experienced obstetricians, whereas in addition, fetal MRI was performed in 1 patient.. The prenatal US and/or MRI findings showed fetal ascites, a multicystic pelvic mass, oligohydramnios, and bilateral hydronephrosis in 5 of 11 patients with cloacal malformations. In these 5 cases, postnatal examinations showed associated hydrocolpos, hydrometrocolpos, and bilateral hydronephrosis; furthermore, 4 of these 5 cases also showed meconium peritonitis at laparotomy.. The prenatal US and MRI findings, showing fetal ascites, multicystic pelvic mass, bilateral hydronephrosis, and oligohydraminios are highly suggestive of the cloacal malformations associated with meconium peritonitis.

Topics: Abdomen; Abnormalities, Multiple; Cloaca; Esophageal Atresia; Female; Gestational Age; Humans; Hydrocolpos; Hydronephrosis; Infant, Newborn; Magnetic Resonance Imaging; Meconium; Peritonitis; Prenatal Diagnosis; Ultrasonography, Prenatal; Uterus; Vagina

Meconium peritonitis is a sterile chemical peritonitis caused by peritoneal seeding of meconium from an antenatal gastrointestinal perforation. We report a 32-week preterm female neonate who developed meconium peritonitis due to bowel perforation, secondary to a twisted left fallopian tube mass, which was excised and confirmed by histopathology. This association has not been reported earlier. The infant also developed transient central diabetes insipidus, a very rare condition in a preterm neonate.

Topics: Abnormalities, Multiple; Cysts; Diabetes Insipidus; Diagnosis, Differential; Fallopian Tube Diseases; Female; Humans; Infant, Newborn; Meconium; Peritonitis; Radiography; Torsion Abnormality

Cloacal malformation is a rare abnormality, characterized by direct communication between the gastrointestinal, urinary, and genital structures, resulting in a single perineal opening. Prenatal diagnosis is difficult because of nonvisualization of the communication. We report a case of prenatal diagnosis of this condition, in which the recognition of calcified meconium in the colon and urinary tract provided an important clue.

Topics: Abnormalities, Multiple; Adult; Calcinosis; Cloaca; Female; Humans; Meconium; Pregnancy; Ultrasonography, Prenatal

The objective was to evaluate the incidence of gastrointestinal abnormalities amongst those fetuses with antenatally diagnosed echogenic bowel (EB).. A retrospective review of all cases delivered from April 2002 to March 2003 with antenatally diagnosed EB was conducted. This was defined as bowel that appeared as echogenic as (if not greater than) the iliac bone on a real-time image. The postnatal outcomes with regard to gastrointestinal abnormalities, till their discharge, were noted.. Of the 13,941 patients delivered, there were 70 cases with antenatally diagnosed EB, giving an incidence of 70/13,941 or 0.50%. Of these, 6 defaulted follow-up and 1 had a mid-trimester termination of pregnancy at 21 weeks' gestation for social reasons. Of the remaining 63 cases with EB, 2 were stillbirths at 31 weeks and 35 weeks of gestation, respectively. Three fetuses (3/63 or 4.76%) were diagnosed with gastrointestinal abnormalities. Meconium plug syndrome was diagnosed postnatally in 2 cases, of which, 1 resolved with conservative management while the other required an emergency laparotomy. Intestinal atresia was diagnosed in the postmortem of one of the stillbirths. There was evidence of intrauterine growth retardation (IUGR) in both the stillbirth and the fetus that had required laparotomy. None of the 3 fetuses exhibited clinical features of aneuploidy.. As the quoted background risk for gastrointestinal pathology is 0.23%, an increased incidence (4.76%) is observed in those fetuses found to have antenatal EB. It is possible that the presence of IUGR is associated with a worse prognosis. Further prospective studies are needed to verify this association.

Topics: Abnormalities, Multiple; Adult; Female; Fetal Diseases; Fetal Growth Retardation; Humans; Incidence; Infant, Newborn; Intestinal Obstruction; Intestines; Maternal Age; Meconium; Parity; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Pregnancy, High-Risk; Prenatal Care; Prognosis; Risk Factors; Singapore; Ultrasonography, Prenatal

Topics: Abnormalities, Multiple; Colon; Humans; Infant, Newborn; Male; Meconium; Mesoderm; Neural Tube Defects; Notochord; Pancreas; Peritonitis; Radiography; Syndrome

A material of 21 cases of meconium peritonitis treated by operation from 1972-1987 is presented. In four cases, intraabdominal anomaly was suspected on the basis of antenatal ultrasonography. The mortality was 19%. 57% developed symptoms during the first 24 hours, one at the age of one month and this case history is presented. Thirteen had intestinal atresia, 14 intrauterine volvulus, 7 open perforation, 13 pseudocyst, 1 gastroscisis. 2 had cystic fibrosis. Two patients are still attending the outpatient clinic on account of minor sequelae. The remainder have been discharged.

Topics: Abnormalities, Multiple; Cysts; Female; Fetal Diseases; Humans; Infant; Infant, Newborn; Male; Meconium; Peritonitis; Pregnancy; Ultrasonography, Prenatal

Reported is the analysis of morbidity, mortality, and mode of delivery in 38 cases of ventral wall defects identified from among 128,500 consecutive live births in Maine (January 1975 to December 1982). Thirteen of the ventral wall defects were classified as gastroschisis, and only one had an additional defect not directly attributable to the ventral wall defect itself. By contrast, 16 of the 25 omphalocele cases had additional defects, including eight congenital heart lesions, four genitourinary malformations, two neural tube defects, and three trisomies. Ten cases of omphalocele and one of gastroschisis died, all as a result of independent defects or involvement of adjacent structures. Intrauterine growth retardation was prominently associated with gastroschisis. Vaginal delivery occurred in three of the six ventral wall defects diagnosed antenatally and in 28 of the 32 ventral wall defects not diagnosed until delivery. The only episode of birth trauma to ventral wall defect sac or abdominal viscera occurred during cesarean section in an undiagnosed case. The present data provide a basis for prognosis and management of antenatally diagnosed ventral wall defects and suggest that these defects are not, a priori, an indication for abdominal delivery.

Topics: Abdominal Muscles; Abnormalities, Multiple; Adolescent; Adult; Amniotic Fluid; Apgar Score; Birth Weight; Delivery, Obstetric; Female; Heart Ventricles; Hernia, Umbilical; Humans; Infant Mortality; Infant, Newborn; Maine; Male; Maternal Age; Meconium; Pregnancy; Prenatal Diagnosis

Calcified intraluminal meconium is rarely observed in newborn. Only 27 cases are related in litterature; the authors report 4 new cases and point out the role of intestinal obstruction (principaly anorectal malformations, but also atresia, meconium ileus or Hirschsprung disease). Pathogenesis is unknown, while intestinal urinary fistula is frequently described.

Topics: Abnormalities, Multiple; Calcinosis; Digestive System Abnormalities; Humans; Infant, Newborn; Intestinal Fistula; Intestinal Obstruction; Male; Meconium; Urinary Fistula; Urinary Tract

Topics: Abnormalities, Multiple; Hernia, Diaphragmatic; Humans; Infant, Newborn; Male; Meconium; Peritonitis; Pneumothorax; Radiography

Topics: Abnormalities, Multiple; Calcinosis; Female; Humans; Infant, Newborn; Intestines; Meconium; Urogenital Abnormalities; Urography

An autopsy case of bilateral renal dysplasia with other congenital malformations is reported. Malformations included severe pancreatic fibrosis with meconium ileus, situs inversus totalis, cardiovascular anomalies, and others. The only syndrome of multiple congenital malformations involving renal dysplasia which is similar to the present case is Ivemark's syndrome, though the present case lacked hepatic lesions. Apart from the pancreatic lesion, there were no abnormalities compatible with cystic fibrosis (mucoviscidosis). It was considered that meconium ileus in the present case was caused by pancreatic achylia secondary to severe pancreatic fibrosis, unrelated to cystic fibrosis, but closely allied to renal dysplasia.

Topics: Abnormalities, Multiple; Cystic Fibrosis; Diagnosis, Differential; Female; Humans; Infant, Newborn; Intestinal Obstruction; Kidney; Meconium; Pancreatic Diseases; Situs Inversus

Five cases are reported and reference is made to 3 previous similar cases of calcified intraluminal meconium in newborn males with "imperforate anus." A rectourinary fistula was found in most of the patients; none of the cases had meconium peritonitis. The calcifications may develop in areas of prolonged stasis; the possible added role of the mixture of urine and meconium in utero is raised.

Topics: Abnormalities, Multiple; Anus, Imperforate; Calculi; Humans; Infant, Newborn; Intestinal Diseases; Male; Meconium; Radiography; Rectal Fistula; Urinary Fistula

Topics: Abnormalities, Multiple; Anal Canal; Child, Preschool; Colostomy; Female; Humans; Infant; Intestinal Obstruction; Intestine, Large; Kidney; Male; Meconium; Penis; Rectal Fistula; Sacrum; Spine; Urethra; Urinary Bladder; Urogenital Abnormalities; Vagina

Topics: Abnormalities, Multiple; Age Factors; Bile; Child; Child, Preschool; Down Syndrome; Duodenal Obstruction; Duodenum; Esophageal Atresia; Female; Humans; Infant; Infant, Newborn; Meconium; Polyhydramnios; Pregnancy; Vomiting

Topics: Abdominal Muscles; Abnormalities, Multiple; Colon; Ductus Arteriosus, Patent; Female; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Intestine, Small; Meconium; Prostheses and Implants; Respiratory Insufficiency; Transposition of Great Vessels

Topics: Abdomen; Abdominal Muscles; Abnormalities, Multiple; Colonic Diseases; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium

Topics: Abnormalities, Multiple; Cystic Fibrosis; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Male; Meconium; Pancreas; Pancreatic Diseases

Topics: Abnormalities, Multiple; Amnion; Amniotic Fluid; Deglutition; Female; Fetus; Humans; Infant, Newborn; Maternal-Fetal Exchange; Meconium; Polyhydramnios; Pregnancy; Pregnancy in Diabetics; Urination