morphine and Infant--Premature--Diseases

Meconium obstruction of prematurity is an entity primarily affecting very low birthweight or extremely low birthweight babies causing low intestinal obstruction. Its presence may at best delay establishment of enteral feeding and compromise nutrition and at worst lead to mechanical obstruction requiring surgery or to intestinal perforation. There are considerable challenges in the recognition, diagnosis and management of this condition. Awareness of the disease and understanding of its pathogenesis may lead to early detection of affected babies and allow proactive measures to decrease the associated morbidity and mortality.

Topics: Early Diagnosis; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Meconium

Intrapartum asphyxia is defined as metabolic acidemia measured at birth with pH less than 7.00 and base deficit greater or equal to 12 mmol/l. Neonatal complications of intrapartum asphyxia include multiorgan failure and neonatal encephalopathy. Most severe consequences are death and neurological or sensorial impairment. Cause of permanent neurological impairment can be attributed to intrapartum asphyxia if three criteria are met: intrapartum history of a threatening event with acute fetal heart rate deterioration, biological markers of asphyxia, neonatal encephalopathy. Moderate to severe neonatal encephalopathy in asphyxiated term infants is associated with a high risk of cerebral palsy (especially quadriplegic or dyskinetic type) and/or cognitive disorders. Prognosis of neonatal encephalopathy can be accurately assessed by MR imaging.

Topics: Acidosis; Apgar Score; Biomarkers; Brain Diseases; Cerebral Palsy; Female; Fetal Blood; Fetal Hypoxia; Heart Rate, Fetal; Humans; Hydrogen-Ion Concentration; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lactic Acid; Magnetic Resonance Imaging; Meconium; Multiple Organ Failure; Nervous System Diseases; Pregnancy; Ultrasonography

Retained meconium resulting in intestinal obstruction in infants with very low birth weight (VLBW) may cause significant morbidity and even mortality. Immature intestinal neuromuscular function, abnormal meconium composition, and maternal magnesium sulfate therapy results in delay of first meconium passage. This "normal" passage of first meconium may not occur until 1 week of life or later. A spectrum of conditions results from this delayed passage. At the most serious end of this continuum is intestinal obstruction. These patients present with abdominal distension, emesis, and reduced stool frequency. Early diagnosis of this condition using plain abdominal radiographs and contrast enemas where appropriate is imperative. Contrast enemas may be both diagnostic and therapeutic. Most patients do not need surgical intervention. Operation is indicated when enemas fail to relieve the obstruction or perforation occurs. Prompt diagnosis and appropriate management results in a good outcome. Meconium obstruction in VLBW infants does not appear to be associated with cystic fibrosis or Hirschsprung's disease.

Topics: Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Meconium

Topics: Bronchopulmonary Dysplasia; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Inhalation; Male; Meconium; Respiratory Distress Syndrome, Newborn; Respiratory Tract Diseases; Respiratory Tract Infections

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

To determine whether longitudinal measurements of fecal S100A12, a fecal marker of intestinal inflammation, can identify very low birth weight infants at risk for necrotizing enterocolitis (NEC).. This prospective study included 145 preterm infants with birth weight <1500 g. Meconium and stool samples (n = 843) were collected prospectively on alternate days for 4 weeks, and fecal S100A12 and calprotectin were measured by enzyme-linked immunosorbent assay.. Eighteen patients (12.4%) developed NEC. Gestational age and birth weight were significantly lower in the patients with NEC compared with unaffected reference infants. Fecal S100A12 levels were significantly higher in patients with severe NEC at onset of disease and also, in contrast to fecal calprotectin, at 4-10 days before onset of NEC compared with unaffected reference infants (ideal cutoff value, 65 μg/kg; sensitivity, 0.76; specificity, 0.56).. Fecal S100A12 level may be a helpful marker for predicting disease severity and early risk assessment for subsequent development of NEC. However, the use of fecal S100A12 as a predictive biomarker for NEC in very low birth weight infants may be limited due to a high interindividual and intraindividual variability in S100A12 fecal excretion.

Topics: Biomarkers; Cohort Studies; Enterocolitis, Necrotizing; Enzyme-Linked Immunosorbent Assay; Feces; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Leukocyte L1 Antigen Complex; Male; Meconium; Prospective Studies; Risk Assessment; ROC Curve; S100 Proteins; S100A12 Protein; Sensitivity and Specificity; Severity of Illness Index

We hypothesized that small volume enemas accelerate meconium evacuation in very low birth weight (VLBW) infants. In a randomized controlled trial, VLBW infants (n = 81) received either repeated daily small volume enemas if complete spontaneous meconium passage failed within 24 h or no intervention. Small volume enemas did not accelerate complete meconium evacuation, which occurred after 6.0 to 9.6 (95% CI) d in the intervention group and after 7.7 to 11.0 (95% CI) d in the control group. No adverse events were observed. Daily administration of small volume enemas had no effect on total meconium evacuation defined by the time of last meconium passage.

Topics: Defecation; Enema; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Meconium; Time Factors

Early-onset neonatal sepsis (EONS) remains one of the leading causes of morbidity and mortality related to premature birth, and its diagnosis remains difficult. Our goal was to evaluate the intestinal microbiota of the first meconium of preterm newborns and ascertain whether it is associated with clinical EONS.. In a controlled, prospective cohort study, samples of the first meconium of premature infants with a gestational age (GA) ≤32 weeks was obtained at Hospital de Clínicas de Porto Alegre and DNA was isolated from the samples. 16S rDNA based microbiota composition of preterm infants with a clinical diagnosis of EONS was compared to that of a control group.. 40 (48%) premature infants with clinical diagnosis of EONS and 44 (52%) without EONS were included in the analysis. The most abundant phylum detected in both groups,. These findings suggest that the first-meconium microbiota is different in preterm neonates with and without clinical EONS.

Topics: Female; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meconium; Microbiota; Neonatal Sepsis; Pregnancy; Premature Birth; Prospective Studies; Sepsis

Topics: Humans; Ileostomy; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium; Parenteral Nutrition; Treatment Outcome

Topics: Adult; Cytomegalovirus Infections; Digestive System Abnormalities; Female; Gestational Age; Humans; Infant, Premature, Diseases; Intestinal Volvulus; Meconium; Peritonitis; Respiratory System Abnormalities; Ultrasonography, Prenatal

In the last century, meconium peritonitis(MP)was once a highly fatal gastrointestinal. disease With the development of fetal radiological technology, abnormal signs, such as pseudocysts, can. be detected during the fetal period so that more patients can be diagnosed prenatally and receive surgery. in the early stage of life. The survival rate of MP has increased up to 80% in recent years. According to. a review of the treatment and outcomes of patients diagnosed with MP, we evaluated the influence of. early operation on survival rate and discussed the risk factors of prognosis.. We collected 79 cases of patients diagnosed with MP who were treated in our department. from October 2001 to December 2017. They were divided into 2 groups. Patients in group A were born. in our hospital. Patients in group B were born in a local hospital with suspicion of MP and then transferred. to our department.. The birth weight (BW) and gestational age (GA) of patients were higher in group A than in. group B. There was no significant difference in the proportion of premature and low birth weight (LBW). patients between the two groups (p = 0.422, p = 0.970). Their age at the time of surgery was younger in. group A than in group B (1.4 ± 2.0 vs. 6.9 ± 14.9, p < 0.001). The overall survival rate of group A was higher. than that of group B (95.0% vs. 79.5%, p = 0.038). The prognosis of premature patients was worse than. that of full-term infants for both groups (p = 0.012).. Prematurity is a significant risk factor related to death for MP patients. The survival rate. of MP patients can be improved by early operation during the neonatal period.

Topics: Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Perforation; Magnetic Resonance Imaging; Male; Meconium; Peritonitis; Prenatal Diagnosis; Prognosis; Retrospective Studies; Survival Rate; Time-to-Treatment; Ultrasonography, Prenatal

To identify peripartum events that may predict the development of short-term neurologic morbidity and mortality among acidemic neonates.. Retrospective case-control study conducted at a single-teaching hospital on data from January 2010 to December 2015. The study cohort group included all acidemic neonates (cord artery pH ≤ 7.1) born at ≥ 34 weeks. Primary outcome was a composite including any of the following: neonatal encephalopathy, convulsions, intra-ventricular hemorrhage, or neonatal death. The study cohort was divided to the cases group, i.e., acidemic neonates who had any component of the primary outcome, and a control group, i.e., acidemic neonates who did not experience any component of the primary outcome.. Of all 24,311 neonates born ≥ 34 weeks during the study period, 568 (2.3%) had a cord artery pH ≤ 7.1 and composed the cohort study group. Twenty-one (3.7%) neonates composed the cases group. Multivariate logistic regression analysis revealed that cases were significantly more likely to have experienced placental abruption (OR 18.78; 95% CI 5.57-63.26), born ≤ 2500 g (OR 13.58; 95% CI 3.70-49.90), have meconium (OR 3.80; 95% CI 1.20-11.98) and cord entanglement (OR 5.99; 95% CI 1.79-20.06). The probability for developing the composite outcome rose from 3.7% with isolated acidemia to 97% among neonates who had all these peripartum events combined with intrapartum fetal heart rate tracing category 2 or 3.. Neonatal acidemia carries a favorable outcome in the vast majority of cases. In association with particular antenatal and intrapartum events, the short-term outcome may be unfavorable.

Topics: Abruptio Placentae; Acidosis; Case-Control Studies; Cohort Studies; Female; Fetal Blood; Humans; Hydrogen-Ion Concentration; Infant; Infant Mortality; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Parturition; Peripartum Period; Pregnancy; Retrospective Studies; Seizures

Identification of factors that influence the neonatal gut microbiome is urgently needed to guide clinical practices that support growth of healthy preterm infants. Here, we examined the influence of nutrition and common practices on the gut microbiota and growth in a cohort of preterm infants.. With weekly gut microbiota samples spanning postmenstrual age (PMA) 24 to 46 weeks, we developed two models to test associations between the microbiota, nutrition and growth: a categorical model with three successive microbiota phases (P1, P2, and P3) and a model with two periods (early and late PMA) defined by microbiota composition and PMA, respectively. The more significant associations with phase led us to use a phase-based framework for the majority of our analyses. Phase transitions were characterized by rapid shifts in the microbiota, with transition out of P1 occurring nearly simultaneously with the change from meconium to normal stool. The rate of phase progression was positively associated with gestational age at birth, and delayed transition to a P3 microbiota was associated with growth failure. We found distinct bacterial metabolic functions in P1-3 and significant associations between nutrition, microbiota phase, and infant growth.. The phase-dependent impact of nutrition on infant growth along with phase-specific metabolic functions suggests a pioneering potential for improving growth outcomes by tailoring nutrient intake to microbiota phase.

Topics: Bacteria; Breast Feeding; Cohort Studies; DNA, Bacterial; Feces; Female; Gastrointestinal Microbiome; Gestational Age; Humans; Infant; Infant Health; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meconium; Nutritional Status; RNA, Ribosomal, 16S; Sequence Analysis, DNA

Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants.. A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children's Hospital, was conducted.. The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death.. Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.

Topics: Case-Control Studies; Enterocolitis, Necrotizing; Female; Gestational Age; Heart Defects, Congenital; Humans; Ileus; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Intestinal Perforation; Male; Meconium; Retrospective Studies; Risk Factors

Citrulline is a non-protein amino acid synthesized in the enterocytes of the small bowel. Recent studies have reported that plasma citrulline levels correlate with functional enterocyte mass.. This study aimed to determine the normal dried blood spot (DBS) citrulline levels and to determine the existence of a correlation between citrulline levels and meconium obstruction of prematurity (MOP).. A retrospective cohort study was performed involving 285 infants born at less than 32weeks gestation who were admitted to the neonatal intensive care unit between Oct 2009 and Aug 2014.. We analyzed the DBS citrulline levels, which are routinely measured via newborn screening at 7days following birth, using liquid chromatography-MS/MS. We investigated the relationship between DBS citrulline levels and clinical parameters such as gestational age (GA), body measurements at birth, gender, or the presence or absence of either necrotizing enterocolitis or MOP.. A total of 229 infants with a median GA of 29.6weeks and a median birth weight of 1160g were included. DBS citrulline levels were not associated with GA, body measurements at birth or gender. DBS citrulline levels were significantly decreased when patients presented with MOP (p=0.037).. Early DBS citrulline levels were not associated with either GA or body measurements at birth but were reduced among preterm infants with MOP compared with the control infants. These results may be indicative of abnormal fetal intestinal development and reduced functional enterocyte mass among preterm infants with MOP.

Topics: Citrulline; Enterocolitis, Necrotizing; Enterocytes; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium; Neonatal Screening; Retrospective Studies

In term newborns meconium ileus is frequently associated with cystic fibrosis. Reports on meconium ileus in preterm infants being diagnosed with cystic fibrosis early after birth are very scarce. Associations between genotype and phenotype in cystic fibrosis and its particular comorbidities have been reported.. Two extremely preterm twin infants (26 weeks of gestation) born from a Malaysian mother and a Caucasian father were presented with typical signs of meconium ileus. Despite immediate surgery both displayed a unique and finally lethal course. Mutation analysis revealed a novel, probably pathogenic cystic fibrosis mutation, p.Cys524Tyr. The novel mutation might explain the severity of disease next to typical sequelae of prematurity.. Preterm neonates with meconium ileus have to be evaluated for cystic fibrosis beyond ethnical boundaries, but may take devastating clinical courses despite early treatment. The novel, potentially pathogenic CF mutation p.Cys524Tyr might be associated with severe meconium ileus in neonates. Disease-modifying loci are important targets for intestinal comorbidity of cystic fibrosis.

Topics: Cystic Fibrosis; Cystic Fibrosis Transmembrane Conductance Regulator; Diseases in Twins; Fatal Outcome; Humans; Ileus; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meconium; Mutation

Topics: Female; Humans; Infant, Premature; Infant, Premature, Diseases; Meconium; Meconium Aspiration Syndrome; Nurse's Role; Nursing Methodology Research; Obstetric Labor Complications; Perinatal Care; Pregnancy

To investigate the relationship of delivery type, maternal anesthesia, feeding modalities, and first feeding and meconium passage times with early bilirubin levels of healthy infants.. Cord, 24 hours' and 48 hours' total bilirubin levels were measured in 388 study infants.. Infants born with cesarean section were fed later and more often had mixed feeding. First meconium passage was delayed with general anesthesia. Cord, 24 and 48 hours' bilirubin levels were not correlated with first feeding time, meconium passage time, mode of delivery, existence and type of anesthesia, and feeding modalities. Being in high intermediate risk zone at 72 hours of Bhutani's nomogram was only related to first feeding time and high cord bilirubin level. Late preterm infants were more frequently born with cesarean section and offered supplementary formula. Therefore, first meconium passage times and bilirubin levels were similar in the late preterm and term infants.. Type of delivery or anesthesia, late prematurity, feeding modalities, and first meconium passage time were not related to early bilirubin levels in healthy neonates, but delayed first feeding and high cord bilirubin levels were related to be in higher risk zone for later hyperbilirubinemia.

Topics: Anesthesia; Bilirubin; Breast Feeding; Cesarean Section; Female; Fetal Blood; Humans; Hyperbilirubinemia; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Meconium; Pregnancy

Topics: Abdominal Neoplasms; Diagnosis, Differential; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Atresia; Meconium; Peritonitis

Neonatal sepsis due to intestinal bacterial translocation is a major cause of morbidity and mortality. Understanding microbial colonisation of the gut in prematurity may predict risk of sepsis to guide future strategies to manipulate the microbiome.. Prospective longitudinal study of premature infants. Stool samples were obtained weekly. DNA was extracted and the V6 hypervariable region of 16S rRNA was amplified followed by high throughput pyrosequencing, comparing subjects with and without sepsis.. Six neonates were 24-27 weeks gestation at birth and had 18 samples analysed. Two subjects had no sepsis during the study period, two developed late-onset culture-positive sepsis and two had culture-negative systemic inflammation. 324 350 sequences were obtained. The meconium was not sterile and had predominance of Lactobacillus, Staphylococcus and Enterobacteriales. Overall, infants who developed sepsis began life with low microbial diversity, and acquired a predominance of Staphylococcus, while healthy infants had more diversity and predominance of Clostridium, Klebsiella and Veillonella.. In very low birth weight infants, the authors found that meconium is not sterile and is less diverse from birth in infants who will develop late-onset sepsis. Empiric, prolonged antibiotics profoundly decrease microbial diversity and promote a microbiota that is associated not only with neonatal sepsis, but the predominant pathogen previously identified in the microbiome. Our data suggest that there may be a 'healthy microbiome' present in extremely premature neonates that may ameliorate risk of sepsis. More research is needed to determine whether altered antibiotics, probiotics or other novel therapies can re-establish a healthy microbiome in neonates.

Topics: Anti-Bacterial Agents; Bacterial Translocation; Base Sequence; Colony Count, Microbial; Enterobacteriaceae; Gastrointestinal Tract; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Longitudinal Studies; Meconium; Molecular Sequence Data; Risk Factors; RNA, Messenger; Sepsis; Staphylococcus

Meconium abnormalities are characterized by a wide spectrum of severity, from the meconium plug syndrome to the complicated meconium ileus associated with cystic fibrosis. Meconium Related Ileus in absence of Cystic Fibrosis includes a combination of highly viscid meconium and poor intestinal motility, low grade obstruction, benign systemic and abdominal examination, distended loops without air fluid levels. Associated risk factors are severe prematurity and low birth weight, Caesarean delivery, Maternal MgSO4 therapy, maternal diabetes. In the last 20 yrs a new specific type of these meconium related obstructions has been described in premature neonates with low birth weight. Its incidence has shown to increase while its management continues to be challenging and controversial for the risk of complicated obstruction and perforation.. Among 55 newborns admitted between 1992-2008 with Meconium Related Ileus as final diagnosis, data about Low Birth Weight infants (LBW < 1500 g) were extracted and compared to those of patients ≥ 1500 g. Hischsprung's Diseases and Cystic Fibrosis were excluded by rectal biopsy and genetic probe before discharge. A softening enema with Gastrografin was the first option whenever overt perforation was not present. Temporary stoma or trans appendiceal bowel irrigation were elected after unsuccessful enema while prompt surgical exploration was performed in perforated cases. NEC was excluded in all operated cases. Data collected were perinatal history and neonatal clinical data, radiological signs, clinical course and complications, management and outcome.. 30 cases with BW ≥ 1500 g had an M/F ratio 16/14, Mean B.W. 3052 g, Mean G.A. 37 w Caesarean section rate 40%. There were 10 meconium plug syndrome, 4 small left colon syndromes, and 16 meconium ileus without Cystic Fibrosis. Five cases were born at our institution (inborn) versus 25 referred after a mean of 2, 4 Days (1-7) after birth in another Hospital (outborn). They were managed, after a Gastrografin enema with 90% success rate, by 1 temporary Ileostomy and 2 trans appendiceal irrigation. 25 cases with BW< 1500 g (LBW) had M/F ratio 11/14, Mean B.W. 818 g, Mean G.A. 27 w, Caesarean section rate 70%, assisted ventilation 16/25. There were 8 inborn and 17 outborn. Gastrografin enema was successful in 6 out 8 inborn infants only, all referred within one week from birth. There were 12 perforations mainly among late referred LBW outborn.. Meconium Related Ileus without Cystic Fibrosis responds to conservative management and softening enema in most of mature infants. In LBW clinical course is initially benign but as any long standing bowel obstruction management may present particular challenges. Clinical and plain radiographic criteria are reliable for making diagnosis and testing for Cystic Fibrosis may not be indicated. Enema may be resolutive when performed in a proper environment. Perforated cases may be confused with NEC which is excluded by clinical history, no signs of sepsis, lab signs missing, abdominal signs missing, typical radiological signs missing. The higher complication rate is recorded among cases delivered and initially managed in Neonatal Units without co-located Surgical Facilities. Early diagnosis and aggressive medical therapy may lead to higher success rate and help avoiding surgical interventions. Surgical therapy in uncomplicated cases, unresponsive to medical management, should be minimally aggressive.

Topics: Cystic Fibrosis; Female; Follow-Up Studies; Humans; Ileus; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Italy; Male; Meconium; Prognosis; Retrospective Studies; Survival Rate

Newborn surgery for meconium peritonitis (MP) is sometimes very difficult owing to severe adhesions and bleeding. The aim of this study was to reveal the benefit of primary anastomosis (PA) for MP by comparing PA with multistep operations (MO).. We retrospectively reviewed 38 patients with MP who underwent surgery in our institution from 1983 to 2009. From 1983 to 2000, we essentially used MO. After 2001, we used PA with the exception of 1 patient. We performed MO on 20 patients (group A) and PA on 18 patients (group B).. Mortality was 4 in 20 in group A and 1 in 18 in group B. Three patients in group A and 2 in group B required reoperation because of complications. After 2001, 14 of 16 patients underwent PA. Of the 2 patients for whom PA could not be performed, one was postresuscitation from cardiopulmonary arrest and the other was an extremely low-birth-weight infant. The only mortality among the patients who underwent PA occurred in a very low-birth-weight infant who died from intraoperative hepatic hemorrhage.. PA can be performed for almost all patients with MP except for extremely low-birth-weight infants.

Topics: Anastomosis, Surgical; Contraindications; Cysts; Disease Management; Drainage; Humans; Ileostomy; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Atresia; Intestinal Perforation; Intestinal Volvulus; Intussusception; Jejunostomy; Meconium; Peritonitis; Postoperative Complications; Reoperation; Retrospective Studies; Ultrasonography, Prenatal

Delayed meconium passage, typical of premature newborns, is a predisposing condition for bowel perforation with a significant risk of morbidity and mortality.. A retrospective study was undertaken to verify the entity of the disease, assess the average time to meconium passage in a neonatal population of very low birth weight (VLBW) infants, and identify associated risk factors.. The time of first stool passage was studied in 110 VLBW infants (weighing less than 1500 g at birth). Their perinatal features, clinical course, and treatment were reviewed and studied retrospectively.. Delayed meconium passage was recorded in 81% of this group. Patent ductus arteriosus, mechanical ventilation and uteroplacental insufficiency were significantly associated with delayed passage. An inverse relationship between gestational age, birth weight and meconium passage was found. Bowel perforation occurred in 4.5% of this neonatal population with a mortality of 50%.. In very low birth weight infants delay in the passage of the first stool is common. Perforation in these patients may represent a fatal event, and procedures such as daily rectal enemas, which can prevent this complication, must be applied.

Topics: Defecation; Female; Follow-Up Studies; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Male; Meconium; Retrospective Studies

To use high throughput techniques to analyze intestinal microbial ecology in premature neonates, who are highly susceptible to perturbations of the luminal environment associated with necrotizing enterocolitis (NEC) and late-onset sepsis.. With non-culture-based techniques, we evaluated intestinal microbiota shortly after birth and during hospitalization in 23 neonates born at 23 to 32 weeks gestational age. Microbiota compositions were compared in 6 preterm infants in whom NEC, signs of systemic inflammation, or both developed with matched control subjects by using 16S ribosomal RNA pyrosequencing.. Microbial DNA was detected in meconium, suggesting an intrauterine origin. Differences in diversity were detected in infants whose mothers intended to breast feed (P = .03), babies born to mothers with chorioamnionitis (P = .06), and in babies born at <30 weeks gestation (P = .03). A 16S ribosomal RNA sequence analysis detected Citrobacter-like sequences only in cases with NEC (3 of 4) and an increased frequency of Enterococcus-like sequences in cases and Klebsiella in control subjects (P = .06). The overall microbiota profiles in cases with NEC were not distinguishable from that in control subjects.. Microbial DNA in meconium of premature infants suggests prenatal influences.

Topics: DNA, Bacterial; Enterocolitis, Necrotizing; Feces; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meconium; Polymerase Chain Reaction; RNA, Ribosomal, 16S

Ochrobactrum anthropi is a non-fermenting gram-negative rod that was identified as a pathogenic microorganism during the past decade. O. anthropi is extensively distributed in the environment, and has been found in hospital and environmental water sources. O. anthropi infection is rare in childhood. We report a case of O. anthropi bacteremia in a preterm infant with a peritoneal lavage catheter and meconium peritonitis.

Topics: Adult; Bacteremia; Catheters, Indwelling; Fatal Outcome; Female; Gram-Negative Bacterial Infections; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Perforation; Meconium; Ochrobactrum anthropi; Peritoneal Lavage; Peritonitis; Pregnancy

Meconium obstruction of prematurity (MO) often occurs in extremely low-birth weight (ELBW) infants, and its treatment is quite a challenge for neonatologists. We attempted to establish a method of primary treatment for MO of prematurity in ELBW infants.. An iopamidol enema with 50 cm H(2)O static pressure was performed as the primary treatment. This procedure is safe and effective and we recommend this as the first treatment for MO in ELBW infants.. The procedure was performed 50 times in 23 infants and no complications occurred. Out of 23 patients, 20 (88%) improved, but the other 3 did not. In the failure group, the procedure was performed on a significantly later date and the mortality rate was higher (12.5 vs. 67%).. This procedure is safe and effective. We recommend this as the first treatment for MO in ELBW infants.

Topics: Contrast Media; Enema; Female; Humans; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Obstruction; Iopamidol; Male; Meconium; Retrospective Studies; Treatment Outcome

To determine the incidence of in utero meconium passage and the rate of associated complications among VLBW infants.. Retrospective review of medical records and prospective evaluation of placental samples from 431 VLBW infants who survived >24 h. Cases with histologic evidence of meconium were re-examined and hemosiderin excluded by a negative iron stain. Statistical analysis included chi2, logistic regression, Student's t-test and Kruskal-Wallis.. The 70 infants (16.2%) who had placental evidence of in utero meconium passage were younger, weighed less, and more likely to be delivered by C-section (P = 0.006), intubated in the delivery room (P = 0.02), receive chest compressions (P = 0.003), require volume resuscitation (P = 0.001) and develop grade III-IV intraventricular hemorrhages (P = 0.011) than were control infants.. Microscopic evaluation of the placental membranes reveals that the in utero passage of meconium occurs in about 16% of premature infants and is associated with adverse perinatal outcomes, including the need for resuscitation at delivery and an increased risk for grade III-IV intraventricular hemorrhages.

Topics: Amniotic Fluid; Biomarkers; Biopsy, Needle; Female; Follow-Up Studies; Gestational Age; Humans; Immunohistochemistry; Infant Mortality; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Male; Meconium; Perinatal Care; Placenta; Placental Circulation; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Probability; Prospective Studies; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Tissue Culture Techniques

Two preterm infants with non-immune hydrops fetalis associated with meconium peritonitis are reported. The first presented with a cystic abdominal mass and the second had positive parvovirus B19 serology. The association of meconium peritonitis with hydrops fetalis was through different mechanisms in each patient.

Topics: Adult; Calcinosis; Fatal Outcome; Female; Humans; Hydrops Fetalis; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Male; Meconium; Parvoviridae Infections; Parvovirus B19, Human; Peritonitis; Radiography

Guidelines for diagnosis and therapy of meconium obstruction in extremely low birth weight neonates are still not well established.. All low-birth-weight infants presenting with meconium obstruction over a 5-year period were reviewed retrospectively. Patients with meconium plug syndrome or cystic fibrosis were excluded.. Seven patients were identified. Average birth weight and gestational age were 874 g and 27.7 weeks, respectively. All were products of high-risk pregnancies, and 6 (86%) were delivered by cesarean section. All patients presented with distended abdomens without peritonitis. Abdominal films showed multiple distended intestinal loops without air-fluid levels in all cases. Three patients (43%) had contrast enemas, all showing microcolon. Nonoperative therapy, consisting of rectal irrigations and N-acetylcysteine per orogastric tube, succeeded in 3 patients who were obstructed for less than 10 days and failed in 1 patient obstructed for 12 days. Four patients, all obstructed for more than 10 days, underwent enterotomy and lavage (2), bowel resection and ileostomy (1), and initial peritoneal drainage for perforation followed by bowel resection (1). All patients survived with intact bowel function.. Extremely low-birth-weight infants with meconium obstruction can be diagnosed based on their typical clinical and plain radiographic characteristics, without need for a contrast enema. Nonoperative treatment is successful early in the course of the obstruction. In the absence of an intestinal complication, simple enterotomy and meconium evacuation effectively treats long-standing obstruction.

Topics: Algorithms; Enema; Humans; Ileal Diseases; Ileum; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Obstruction; Meconium; Radiography; Retrospective Studies

The incidence of preterm meconium staining of the amniotic fluid (MSAF) is uncertain. It may be an indicator of possible listeriosis. It is unclear how great this risk is or whether preterm MSAF is a risk factor for adverse neonatal outcome.. To investigate the incidence of preterm MSAF, the incidence of associated maternal and neonatal infection, and the outcomes of the infants at discharge.. Retrospective case-control study.. Infants < 33 weeks gestation with preterm MSAF born in the Simpson Memorial Maternity Pavilion, Edinburgh between 1 January 1994 and 2 January 2001 were matched with the next infant of the same sex and gestation with clear liquor. Maternal and infant characteristics, culture results, placental histology, and clinical outcomes were compared.. Preterm MSAF was observed in 45/1054 (4.3%) infants below 33 weeks gestation. No maternal or infant listeriosis was identified in cases or controls. There was no significant difference in birth weight, Apgar score, or first pH between cases and controls. Preterm MSAF was associated with prolonged rupture of the membranes (odds ratio (OR) 3.34, 95% confidence interval (CI) 1.07 to 10.49), but not maternal hypertension, sepsis, or chorioamnionitis. Severe (grade 3/4) intraventricular haemorrhage was significantly more common in infants with preterm MSAF (OR 2.03, 95% CI 1.62 to 2.53). There was no significant difference in mortality. Early onset sepsis was observed in two cases and three controls.. Preterm meconium staining of the amniotic fluid may be associated with increased risk of intraventricular haemorrhage. It does not appear to be a useful indicator of listeriosis.

Topics: Amniotic Fluid; Birth Weight; Cerebral Hemorrhage; Chronic Disease; Epidemiologic Methods; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Leukomalacia, Periventricular; Lung Diseases; Male; Meconium; Pregnancy; Pregnancy Complications, Infectious; Prognosis; Scotland; Twins

Meconium obstruction of prematurity is a distinct clinical condition that occurs in very low birth weight infants, predisposing them to intestinal perforation and a prolonged hospitalization if not diagnosed and treated promptly. We report a series of 21 infants, including 2 detailed case reports, whose clinical course is indicative of meconium obstruction of prematurity. Specific risk factors are identified along with descriptions of clinical and radiologic findings, disease course, treatment, and outcome. Meconium obstruction of prematurity was more common in infants with a maternal history of pregnancy-induced or chronic hypertension, suggesting the possibility of decreased intestinal perfusion prenatally. Inspissated meconium was located most frequently in the distal ileum, making this disease process difficult to treat. Gastrografin enemas were safe, diagnostic, and therapeutic. Delay in diagnosis and treatment was associated with perforation and delay in institution of enteral feeds.

Topics: Diagnostic Errors; Enema; Humans; Ileus; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Small for Gestational Age; Infant, Very Low Birth Weight; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Radiography; Risk Factors

Topics: Angiography; Catheterization; Equipment Design; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intubation, Intratracheal; Meconium; Peritonitis; Surface Properties

a) assessment of the relationship between ileus of premature infants and the development of intestinal perforation in premature infants, b) suggestions of an optimal therapeutic procedure. In the study children (n = 50) are included a) with intestinal perforation in conjunction with impaired excretion of meconium (n = 22), b) with an ileus state based on obstruction of the ileum by a viscous meconium treated either surgically or conservatively (n = 28). Surgical treatment involved: a) establishment of a double ileostomy (n = 28), b) insertion of a T drain into the terminal ileum (n = 8), c) removal of meconium from the gut and its primary closure (n = 2). Conservative treatment in 11 children involved irrigography with an liquid contrast substance under X-ray control. The group of children with perforation was compared with the group of children without perforation, risk factors were evaluated by statistical methods. The necessity of ventilation (P = 0.051) and gestation age (P = 0.006) proved to be statistically significant risk factors for the development of perforation. Survival was not influenced by perforation. All 11 children treated conservatively survived, of 39 operated children 26 survived (66.7%). An early start of conservative treatment of ileus of premature infants reduces markedly the risk of intestinal perforation and can thus influence the survival of low birth weight neonates.

Topics: Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meconium; Risk Factors

A 3-day-old premature infant with meconium peritonitis, periventricular leukomalacia, and pulmonary hypertension died with respiratory insufficiency. An autopsy disclosed intravascular squamous cells in the lungs, brain, liver, pancreas, and kidneys. Numerous pulmonary capillaries and arterioles were occluded by squamous cells, accounting for pulmonary hypertension. Brain parenchyma surrounding occluded cerebral vessels showed infarct and gliosis. A mediastinal lymph node filled with squamous cells alluded to the mechanism by which these cells from the peritoneal cavity likely entered the bloodstream--namely, via diaphragmatic pores connecting with lymphatics. Thus, disseminated intravascular meconium rarely may complicate meconium peritonitis and have devastating consequences.

Topics: Embolism; Fatal Outcome; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Peritonitis; Pregnancy; Pregnancy Complications; Vascular Diseases

Between May 1994 and June 1995, nine newborns underwent surgery due to mechanical ileus or intrauterine perforation of the small bowel. Three were very-low-birth-weight infants weighing between 520 and 1,200 g. Surgery was performed in the first 2 days of life and split ileo- or jejunostomas were implanted. Early oral nutrition was initiated. To avoid non-use of the distal bowel and short-bowel syndrome, the aboral stoma was irrigated a few days later with the proximal feces. A new technique was applied to transport the chyle continuously from the oral to the aboral stoma: the stool was collected in an especially constructed stoma bag and transported distally by a roller pump. No major complications were seen. The general outcome was excellent in all cases, and reanastomosis under optimal bowel conditions was achieved in all patients without further problems.

Topics: Feces; Humans; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intestinal Atresia; Intestinal Obstruction; Meconium; Short Bowel Syndrome

To estimate the risk for cerebral palsy in preterm infants in relation to the presence of meconium in the amniotic fluid (AF).. A cohort study was conducted of 404 consecutive preterm infants delivered between 24 and 33 weeks' gestation at a single institution. Sociodemographic and clinical data were collected at birth. The diagnosis of cerebral palsy was made at 2 years' corrected age. Politomous logistic regression models were used to evaluate the odds for cerebral palsy while adjusting for potential confounders.. The overall prevalence of cerebral palsy among survivors was 11.6% (40/345). The cerebral palsy rate was 41.2% (7/17) among infants who were meconium-stained at birth and 10% (33/328) among those who were not (P = .006 by Fisher exact test). After adjustment for potential confounders (gestational age and fetal gender), the odds ratio of cerebral palsy among infants delivered to women with meconium-stained AF was 6.9 (95% confidence interval 2.32, 20.81, P = .001) relative to those delivered to women with clear AF.. The results of the present study support the view that the presence of meconium in the AF is a gestational age-independent risk factor for cerebral palsy among preterm infants.

Topics: Amniotic Fluid; Cerebral Palsy; Cohort Studies; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Logistic Models; Meconium; Prevalence; Risk Factors; Socioeconomic Factors

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

The time for passage of the first stool and urine was studied in 111 infants who weighed less than 1500 g at birth. Delayed passage of the first stool (greater than 24 h) was noted in 25 (22.5%) infants of this group, including 7 cases (6.3%) in whom the delay was greater than 48 h (4 on the 3rd day, 2 on the 4th day, 1 on the 6th day of life, respectively). Three (2.7%) cases had delayed passage of the first urine (at 25, 25, and 45 h of life, respectively). Significant differences between the two groups with delayed and nondelayed passage of the first stool were noted in both the gestational age and in the time of the first enteral feeding. In very low birth weight infants, delay in the passage of the first stool is a common occurrence. This delay is probably due to physiological immaturity of the motor mechanisms of the gut, and lack of triggering effect of enteral feeds on gut hormones. As far as passage of the first urine was concerned, there were no significant perinatal factors found between the delayed and nondelayed groups.

Topics: Defecation; Enteral Nutrition; Female; Gestational Age; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Male; Meconium; Reference Values; Time Factors; Urination

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

A case of a premature infant with meconium peritonitis and intraperitoneal calcifications is described. The course of illness was mild and recovery complete. No evidence of congenital intestinal obstruction or cystic fibrosis was found.

Topics: Calcinosis; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Meconium; Peritonitis; Radiography

Topics: Acetylcysteine; Female; Humans; Hypernatremia; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Meconium

Topics: Adult; Cystic Fibrosis; Diseases in Twins; Enterostomy; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Pregnancy; Radiography

Topics: Contrast Media; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestines; Meconium; Radiography

Antenatal appendicular perforation leading to localized meconium peritonitis and intestinal obstruction is reported in a premature neonate. The baby was successfully treated by a limited ileocaecal resection.

Topics: Appendicitis; Female; Fetal Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Meconium; Peritonitis; Pregnancy; Rupture, Spontaneous

An autopsy case of meconium peritonitis is described. This baby was born at 24 weeks of gestation. The pathological findings were generalized peritonitis and this inflammation spread to the umbilical cord. It can be thought that the cause of premature labor may be in part some inflammatory process.

Topics: Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Peritonitis; Pregnancy; Umbilical Cord

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

Neonatal intussusception in premature infants is uncommon and may mimic other abdominal disorders. We present a case of intussusception in a very low birthweight neonate. Presenting signs initially suggested necrotizing enterocolitis and meconium disease, and the diagnosis was confirmed at laparotomy.

Topics: Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intussusception; Male; Meconium; Radiography

Intraluminal meconium calcification of unknown mechanism is reported in three neonates who did not have distal intestinal obstruction. The condition was benign in all three cases and did not require surgical intervention. This new form of intra-abdominal calcification should be differentiated from other forms that invariably are due to surgical disorders.

Topics: Calcinosis; Colonic Diseases; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intestinal Diseases; Male; Meconium; Radiography

Topics: Diatrizoate Meglumine; Enema; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium; Radiography

Topics: Cystic Fibrosis; Diagnosis, Differential; Hirschsprung Disease; Humans; Ileal Diseases; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium

Patients with perinatal asphyxia from a total population of 15,216 births were studied prospectively. A total of 76 newborn infants achieved the criteria for inclusion. These were distributed in three populations: 53 (73%) without acute renal failure (ARF); 17 (22%) with ARF of prerenal type; 6, (8%) with ARF of renal type. Incidence of several perinatal factors were compared (gestational age, birth weight, meconial amniotic fluid, cord and/or placental disturbances, type of delivery, APGAR Score, and resuscitation). Authors observed that in the group of preterm infants, ARF is present, always was of renal type. In the population with ARF of renal type perinatal asphyxia was clinically worse: greatest frequency of meconial amniotic fluid (p less than 0,025) and worse response to resuscitation with a lower increment in the APGAR Score between one and five minutes (p less than 0.005).

Topics: Acute Kidney Injury; Amniotic Fluid; Apgar Score; Asphyxia Neonatorum; Birth Weight; Gestational Age; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Prospective Studies

Topics: Apgar Score; Female; Fetal Growth Retardation; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Pneumonia, Aspiration; Pregnancy; Resuscitation

Meconium diseases in infancy cannot be neatly separated into discrete categories of meconium plug syndrome, meconium ileus, and meconium peritonitis; nor can the therapy of each condition. A patient with any of the three may or may not have cystic fibrosis. All babies with any form of meconium obstruction or atresia must have a sweat chloride test to confirm or rule out this diagnosis. Repeated gastrografin enemas can decrease the need for operative intervention in all babies with meconium plug syndrome and in selected babies with meconium ileus. Babies with meconium diseases can now be managed with a low perinatal mortality.

Topics: Barium Sulfate; Cystic Fibrosis; Female; Hirschsprung Disease; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Male; Meconium; Peritonitis; Retrospective Studies

Topics: Abdomen; Cysts; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Ultrasonography

Severe hypoxia unresponsive to maximum ventilatory support occurs both in idiopathic respiratory distress syndrome and meconium aspiration. We recently encountered a 980 g female infant with respiratory distress syndrome and 3 300 g female infant with meconium aspiration and persistant fetal circulation whose clinical course necessitated the use of tolazoline and dopamine to reduce pulmonary and to stabilize systemic pressures. The infant with respiratory distress syndrome responded with a PaO2 increase of 2.7 kPa while the infant with persistant fetal circulation and meconium aspiration showed a 51.6 kPa rise. Combined pharmacologic therapy may have a role in improving oxygenation status in severely hypoxemic infants receiving maximum support.

Topics: Dopamine; Female; Humans; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Lung; Meconium; Pneumonia, Aspiration; Respiratory Distress Syndrome, Newborn; Tolazoline; Vascular Resistance; Vasoconstriction

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: Germany, West; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Postoperative Complications

Hypoxia in newborn infants is becoming much easier to prevent, detect and treat. Nevertheless the successful management of potentially hypoxic fetuses and newborn infants remains the major challenge to all physicians concerned with perinatal care. What is at stake is not only that sick infants should survive, but equally or more importantly that the survivors should be normal children. Recent follow-up studies show that this aim can, with few exceptions, now be achieved (Stewart and Reynolds, 1974; Davies and Stewart, 1975; Durbin et al, 1976).

Topics: Apnea; Asphyxia Neonatorum; Blood Circulation; Humans; Hyaline Membrane Disease; Hypoxia; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Lung Diseases; Meconium; Pneumothorax; Pulmonary Edema; Pulmonary Surfactants; Respiration; Vitamin K Deficiency Bleeding

Topics: Birth Weight; Cystic Fibrosis; Humans; Immunodiffusion; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Immunoglobulins; Infant, Newborn; Infant, Premature, Diseases; Meconium; Time Factors

Topics: Colonic Diseases, Functional; Diagnosis, Differential; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Megacolon; Pregnancy; Pregnancy in Diabetics; Radiography

Topics: Cross Infection; Germany, East; Humans; Infant, Newborn; Infant, Premature, Diseases; Klebsiella Infections; Meconium

Topics: Drainage; Humans; Hyaline Membrane Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Inhalation; Meconium; Methods; Pneumothorax; Respiration, Artificial

Topics: Catheterization; Colon; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Infusions, Parenteral; Intestinal Perforation; Labor Presentation; Laparotomy; Meconium; Pregnancy; Twins

Topics: Diatrizoate; Enema; Fluoroscopy; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Methods; Pneumonia

Topics: Autopsy; Central Nervous System; Cerebrospinal Fluid; Germany, East; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Listeria monocytogenes; Listeriosis; Meconium; Meningitis, Listeria; Organ Specificity

Topics: Humans; Infant, Newborn; Infant, Premature, Diseases; Meconium; Pneumonia, Aspiration

Topics: Adult; Animals; Female; Gelatin; Glucose; Glycine; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Absorption; Intestinal Obstruction; Meconium; Milk; Pregnancy; Radiography; Xylose

Topics: Asphyxia Neonatorum; Humans; Hyaline Membrane Disease; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Pneumonia; Pneumothorax; Respiratory System Abnormalities; Respiratory Tract Diseases

Topics: Calcinosis; Genital Diseases, Male; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Meconium; Peritonitis; Scrotum

Topics: Barium Sulfate; Biopsy; Chymotrypsin; Diagnosis, Differential; Feces; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Intestine, Small; Male; Meconium; Megacolon; Radiography; Trypsin

Topics: Agglutination Tests; Animals; Anti-Bacterial Agents; Diagnosis, Differential; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Listeria monocytogenes; Listeriosis; Meconium; Meningitis, Listeria; Meningoencephalitis; Pregnancy; Sepsis; Zoonoses

Topics: Abdomen, Acute; Child, Preschool; Cystic Fibrosis; Duodenal Diseases; Esophagus; Female; Hirschsprung Disease; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Intestinal Perforation; Male; Meckel Diverticulum; Meconium; Posture; Pyloric Stenosis; Radiography

Topics: Animals; Diagnosis, Differential; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Listeria monocytogenes; Listeriosis; Meconium; Pregnancy; Pregnancy Complications, Infectious; Zoonoses

Topics: Calcinosis; Cystic Fibrosis; Humans; Ileostomy; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Radiography

Topics: Diagnosis, Differential; Humans; Ileus; Infant, Newborn; Infant, Premature, Diseases; Intestinal Obstruction; Meconium; Megacolon; Radiography; Surgical Procedures, Operative

Topics: Cystic Fibrosis; Diseases in Twins; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Intestinal Atresia; Intestine, Small; Male; Meconium; Peritonitis

Topics: Fetal Diseases; Granuloma; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Intestinal Perforation; Meckel Diverticulum; Meconium; Pathology; Peritonitis

Topics: Fetal Diseases; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Meconium; Peritonitis; Radiography; Surgical Procedures, Operative

Topics: Child; Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Meconium; Peritonitis

Topics: Child; Fetal Diseases; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Meconium; Peritonitis

Topics: Child; Humans; Ileus; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Infant, Premature, Diseases; Intestinal Obstruction; Meconium