Ultrasound-guided contrast enema for meconium obstruction in very low birth weight infants: Factors that affect treatment success

• We assessed the factors those might affect the therapeutic results of US-guided water-soluble contrast enema in very low birth weight preterm infants with meconium obstruction.
• 33 very low birth weight preterm infants underwent the bedside procedure for meconium obstruction.
• Patient, maternal and procedural factors were evaluated.
• Retrial of contrast injection during the procedure and contrast reflux into the distal small bowel were related to the success of the procedure.

IntroductionThis study aimed to assess the therapeutic results of ultrasound (US)-guided water-soluble contrast enema in very low birth weight (VLBW) preterm infants (<1,500 g) with meconium obstruction and to study factors that affect therapeutic results.MethodsThis study included a total of 33 consecutive VLBW infants with clinically diagnosed meconium obstruction underwent US-guided water-soluble contrast enema, from April 2007 to March 2014. Patients were classified into two groups based on to procedure outcome: the success group (evacuation of the meconium plug resolution followed by improved bowel distention within 2 days of the procedure, without additional interventions), and the failure group (the contrast enema failed to relieve the obstruction, or other procedure-related complications occurred). Patient- and mother-related clinical factors and procedure-related factors were compared between both groups.ResultsOverall success rate was 54.5%, with 18 successful (M:F = 10:8), and 15 failure (M:F = 7:8) cases. When compared with the failure group, the success group patients showed statistically significant older gestational age (29+1 vs. 27 weeks; p = 0.028), larger birth weight (1023.1 g vs. 790.3 g; p = 0.048), and higher body weight on the day of the procedure (1036.2 g vs. 801.6 g, p = 0.049). However, no statistically significant differences were seen between other patient and maternal factors. Among the procedure-related factors, retrial of contrast injection during the procedure was associated with significantly higher success than the single trial (p = 0.027). The presence of refluxed contrast into the distal ileum was the statistically significant predictor for success of the procedure (p = 0.038). There were three cases of bowel perforation (9.1% per person).ConclusionUS-guided water-soluble contrast enema in VLBW infants with meconium obstruction showed a 54.5% success rate and a 9.1% perforation rate per person. Among the procedure-related factors, retrial of contrast injection during the procedure and the presence of refluxed contrast into the distal ileum were related to the success of the procedure.