Neonatal Med.  2021 Feb;28(1):22-28. 10.5385/nm.2021.28.1.22.

Oral Administration of Nonionic Water-Soluble Contrast Media to Treat Meconium Obstruction in Premature Infants: A Preliminary Study

• Hong HS
• Kim SS
• Park GY

• KMID: 2513355
• DOI: http://doi.org/10.5385/nm.2021.28.1.22

Abstract

Purpose
Meconium obstruction of prematurity (MOP) predisposes premature infants to intestinal perforation and prolonged hospitalization if not diagnosed and treated promptly. A standard contrast enema is less effective to treat infants with distal ileal obstructions because the contrast may not reach the obstructed areas. In an effort to avoid risky surgery, we administered oral contrast media to seven clinically diagnosed patients with MOP whose obstructions were not relieved via conventional sonography-guided contrast enema. We retrospectively evaluated whether oral nonionic water-soluble contrast media relieves MOP.
Methods
Seven of 67 premature infants with MOP were administered oral contrast media from June 2015 to January 2019. Patients were followed-up radiographically for bowel distention and evacuation of contrast media after oral administration. We recorded radiographic improvements, meconium evacuation, time to first feeding after oral contrast media administration, maternal history, and neonatal clinical factors.
Results
We evaluated five male and two female infants. The median gestational ages and body weights at birth were 27⁺⁵ weeks and 890 g, respectively. Radiography in five infants revealed multiple distended intestinal loops without air-fluid interfaces. Two infants had gasless abdomens, in which only stomach gas was visible. Oral contrast media (median, 2.5 mL) were administered at a median age of 7 days; five infants (5/7, 71.4%) responded to this treatment. The remaining two infants, who had ileal stenosis and hypoganglionosis, were surgically managed. Five infants (5/7, 71.4%) had maternal risk factors, and two (28.6%) were small for gestational age.
Conclusion
Nonionic oral water-soluble contrast medium can serve as a valuable adjunct treatment in premature infants with meconium obstruction.

Keyword

Meconium; Intestinal obstruction; Contrast media; Infant, premature

Figure

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  Figure 1. A male infant with a birth weight of 1,490 g was born at 29+3 weeks via emergency cesarean section. He exhibited abdominal distention from the 3rd day after birth. He received daily glycerine enemas and a contrast enema on day 7. The abdominal distention persisted. (A) An abdominal radiograph taken after the contrast enema revealed dilated bowel loops with residual contrast in the colon. (B) Oral omnipaque (10 mL) was given via a gavage tube on day 8 (30+5 gestational weeks, weight 1,440 g). Within 1 day, he passed the meconium and commenced enteral feeding. (C) Two days after oral contrast medium administration, the bowel gas pattern became normal.

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  Figure 2. A male infant with a birth weight of 560 g was born at 23+3 weeks via emergency cesarean section. He was not small for gestational age and had no maternal risk factors. After passage of some meconium following a glycerine enema (A), no bowel gas was evident (only stomach gas was present). A degree of abdominal distention, poor meconium passage, and a clinical meconium-associated obstruction were suspected. (B) Approximately 2.5 mL of contrast medium was administrated via a gavage tube on day 13 of life (25 gestational weeks, weight 500 g). (C) A 24-hour follow-up radiograph shows contrast medium into the bowel loops (D) contrast medium was completely evacuated by day 7 after administration, and a follow-up radiograph revealed a normal bowel gas pattern. He passed meconium 2 days after the oral contrast media. Enteral feeding commenced on that day.

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