morphine and Enterocolitis--Pseudomembranous

Many different pathophysiologic conditions can affect the neonatal intestinal tract and ultimately require surgical intervention. The symptomatology is primarily that of bowel dysfunction and obstruction. A thorough understanding of these disease processes is necessary of the managing physician. With this knowledge, a systematic course of resuscitation, evaluation, and treatment can be instituted, usually with predictably gratifying results for patient, family, and physician alike.

Topics: Duodenal Obstruction; Enterocolitis, Pseudomembranous; Fluid Therapy; Hirschsprung Disease; Humans; Ileum; Infant, Newborn; Intestinal Atresia; Intestinal Diseases; Intestinal Obstruction; Jejunum; Meconium; Resuscitation

Topics: Abdomen, Acute; Abdominal Muscles; Angiography; Biliary Tract; Bladder Exstrophy; Enterocolitis, Pseudomembranous; Gastroesophageal Reflux; Gastrointestinal Diseases; Hernia, Diaphragmatic; Hernia, Umbilical; Humans; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Intestinal Atresia; Intestinal Obstruction; Meconium; Monitoring, Physiologic; Radionuclide Imaging; Ultrasonography

Topics: Birth Weight; Contrast Media; Enterocolitis, Pseudomembranous; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Mucosa; Intestinal Perforation; Intestines; Male; Meconium; Necrosis; Pneumatosis Cystoides Intestinalis; Pneumoperitoneum; Radiography

Failure of a small premature newborn to adequately evacuate meconium for days or weeks has been attributed to "probable necrotizing enterocolitis (NEC)" or "microcolon of prematurity." The authors present an unusual type of "meconium plug syndrome" with the same clinical picture, seen in tiny premature babies (500 to 1,500 g), which required a contrast enema or Gastrografin upper gastrointestinal (UGI) series to evacuate the plugs. The obstruction resolved. Twenty babies (480 to 1,500 g) presented with the same clinical picture without any x-ray suggestion of NEC; contrast enemas were performed because of the suspicion of meconium plug syndrome. All 20 had extensive meconium plugs that were evacuated by the enema or by a Gastrografin UGI series. Most of them improved after the plugs were passed. These infants differ from typical full-term babies with meconium plug syndrome in a number of ways: (1) many of the mothers were on magnesium sulfate (MgSO4) or had eclampsia; (2) the plugs were diagnosed late rather than shortly after birth; and (3) the plugs were significant, extending to the right colon. The authors believe that when a tiny premature baby has findings consistent with meconium plug syndrome, the baby should be transported to radiology, for a Gastrografin enema, despite the difficulties involved. Delay postpones the start of feedings, and increases the number of radiographic studies.

Topics: Contrast Media; Diagnosis, Differential; Diatrizoate Meglumine; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Meconium; Pregnancy; Pregnancy Complications

Neonatal gastrointestinal perforation has been associated with mortality rates of 40% to 70%. Over the past 20 years, 81 infants (46 boys and 35 girls) were treated for a gastrointestinal perforation at this institution. Perforation occurred from birth to 50 days (average, 8.2 days). Etiologies included necrotizing enterocolitis (NEC) (68%), meconium ileus (10%), and idiopathic gastric perforation (7%). Seventy-six infants underwent surgical exploration and five infants, considered too small or too sick to withstand a laparotomy, were treated with peritoneal lavage only. There were 29 deaths, an overall mortality of 36%. Ninety percent of the death occurred in patients with NEC, while all patients with gastric perforations survived. There has not been a significant improvement in survival in recent years, partly because of an increase in the proportion of NEC-related perforations. However, there is a narrowing of the mortality gap between low birth weight and normal weight infants. As the risk inherent to laparotomy in neonates is decreasing, other factors, such as the underlying etiology or the site of perforation, play a more important prognostic role.

Topics: Enterocolitis, Pseudomembranous; Female; Follow-Up Studies; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Retrospective Studies; Stomach Rupture; Survival Rate

In order to study a possible etiological relationship between Clostridium and diarrhea in children of the first half year of life and to characterize the colonization of the intestine with these bacteria, bacteriological investigations of feces were carried out in neonates and babies aged 1, 4 and 14 days and 1, 3 and 6 months. The development of the children and their health status were monitored under home conditions. It has been established that the colonization of the neonates' intestine with Clostridium including C. Difficile occurs within the early times (since the 4th day of life). Later the colonization with C. difficile becomes wavy in nature. Among 7 types of Clostridium isolated from the intestine of the children, C. difficile occurred most frequently (29.1%). The overwhelming majority of the strains of these bacteria produced toxin whose activity did no exceed 10(-1)-10(-2). The cytopathic effect was mostly demonstrable in 72 hours. No convincing evidence was obtained about the etiological importance of C. difficile in the development of diarrhea in the children placed under observation. It is likely that the latter one was due to the disturbance of intestinal biocenosis, that manifested by profound quantitative disorders (proliferation of the opportunistic aerobic flora, a dramatic reduction of the content of bifido- and lactic acid bacteria up to their complete absence). At the same time a great number of children carrying C. difficile attests to a potential development of specific diarrheas (under hospital conditions and during massive antibacterial therapy).

Topics: Bacteriological Techniques; Bifidobacterium; Clostridioides difficile; Diarrhea, Infantile; Enterocolitis, Pseudomembranous; Feces; Humans; Infant; Infant, Newborn; Lactobacillus; Meconium

Prone positioning is valuable for accurate diagnosis of intramural air in the descending colon. In the supine position, partial collapse of the descending colon can minic intramural air. Conversely, complete collapse of the descending colon eliminates the interface between intraluminal and intramural air so that the recognition of intramural air is obscured. The tendency for the descending colon to distend with gas in the prone position may reduce these false positives and negatives for intramural air.

Topics: Air; Colon; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Intestinal Obstruction; Male; Meconium; Posture; Radiography

Topics: Anus, Imperforate; Enterocolitis, Pseudomembranous; Hirschsprung Disease; Humans; Infant, Newborn; Intestinal Obstruction; Meconium

Intestinal obstruction and necrotizing enterocolitis are two of the most common surgical emergencies of the gastrointestinal tract. This article reviews the signs and symptoms of these conditions and presents guidelines for their management.

Topics: Colon; Diagnosis, Differential; Duodenal Obstruction; Emergencies; Enterocolitis, Pseudomembranous; Fluid Therapy; Humans; Ileum; Infant, Newborn; Infant, Premature, Diseases; Intestinal Atresia; Intestinal Obstruction; Jejunum; Meconium; Postoperative Complications

Out of 813 laparotomies performed for surgical problems of small bowel in infants and children, resections were necessary in 327 patients. A primary enterostomy was done in 75 cases with subsequent anastomosis. The different surgical problems, the operative findings, the various procedures adopted and the results thereof are discussed here. The greatest danger was seen to arise from the ischaemia of the bowel and from peritonitis. In doubtful conditions of small bowel two-stage operation seems advisable.

Topics: Child; Child, Preschool; Enterocolitis, Pseudomembranous; Hernia; Humans; Ileostomy; Infant; Infant, Newborn; Intestinal Diseases; Intestinal Obstruction; Meconium; Prognosis; Stomach

A prospective study, followed by a retrospective audit, was made of the radiographs and clinical features of 225 consecutive neonates with abdominal distension presenting during a period of 4 years. More than one major cause for the distension was found in a third of cases. Excluding cases of ano-rectal atresia, diagnostic difficulties were encountered in 31% of cases and, occasionally, the diagnosis was revised several times as investigations proceeded. Neuhauser's sign of 'bubbly' meconium is unreliable, being found in cases of meconium ileus, ileal atresia, Hirschsprung's disease and necrotising enterocolitis. Concomitant small-bowel atresia should be suspected in all cases of meconium ileus; intestinal malrotation should be considered in association with duodenal and intestinal atresias. In the absence of an obvious anatomical defect, it is difficult to differentiate between the various causes of functional obstruction by radiological means alone and all such infants should be referred to a specialised centre for intensive investigation and treatment. Very often, the skills of a neonatologist, paediatric surgeon and, especially, an experienced pathologist will be required in addition to those of the radiologist.

Topics: Anal Canal; Contrast Media; Enterocolitis, Pseudomembranous; Hirschsprung Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Atresia; Intestinal Obstruction; Intestine, Small; Meconium; Prospective Studies; Radiography, Abdominal; Rectum; Retrospective Studies

In 20 years the authors have met with 115 cases of meconium peritonitis (MP). The high incidence in China is shown. In all cases there were intraabdominal calcifications. There were no cases of fibrocystic disease. The authors classify 3 types: 1. Neonatal obstructive type 41 cases. 2. Free perforation with: Free pneumoperitoneum 15 cases. Localized pneumoperitoneum 23 cases. 3. No signs or symptoms, with potential intestinal obstruction 23 cases. The series shows a low incidence of atresia. The authors suggest necrotizing enterocolitis as a cause because of the high incidence of stenosis. Three prenatally diagnosed cases are discussed. All had hydramnios and fetal abdominal calcifications. Two of these were confirmed after birth. The mortality is high (42.6%). Abdominal x-ray in all cases with polyhydramnios may lead to a positive diagnosis of MP.

Topics: Abdomen; Adult; Calcinosis; China; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pneumoperitoneum; Polyhydramnios; Pregnancy; Prenatal Diagnosis

Topics: Diatrizoate; Diatrizoate Meglumine; Enema; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Meconium

Topics: Digestive System; Digestive System Abnormalities; Duodenum; Enterocolitis, Pseudomembranous; Gastrointestinal Diseases; Hernia, Umbilical; Humans; Infant, Newborn; Intestinal Obstruction; Meckel Diverticulum; Meconium; Megacolon

Three cases of premature infants with obstruction of the ileum and proximal colon in the absence of cystic fibrosis are presented. Meconium inspissation complicated low-grade bowel obstruction in 2 infants. In the third, the bowel was anatomically normal, with the tenacious meconium the apparent primary cause of obstruction. Distinguishing features of this unusual type of blockage and other meconium syndromes are also discussed. This condition may simulate necrotizing enterocolitis, requiring surgery for differentiation. It should be considered in the differential diagnosis of low small bowel or colonic obstruction in the premature infant who is several days of age.

Topics: Colonic Diseases; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Humans; Ileum; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium; Radiography

Topics: Enterocolitis, Pseudomembranous; Female; Humans; Ileum; Infant; Infant, Newborn; Intestinal Atresia; Intestinal Obstruction; Intestines; Jejunum; Male; Meconium

Topics: Diagnosis, Differential; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Intestinal Obstruction; Jejunum; Male; Meconium; Megacolon; Radiography

Topics: Appendicitis; Child; Child, Preschool; Diagnosis, Differential; Enterocolitis, Pseudomembranous; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Obstruction; Intestinal Perforation; Intussusception; Meckel Diverticulum; Meconium; Pancreatitis; Peptic Ulcer Perforation; Peritonitis; Radiography

Topics: Colostomy; Enterocolitis, Pseudomembranous; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intestinal Perforation; Jejunum; Male; Meconium; Peptic Ulcer Perforation; Peritonitis; Pneumoperitoneum; Radiography; Sepsis; Stomach