Department of Pediatric Surgery, Seoul National University College of Medicine, Seoul, South Korea.
Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
Sci Rep. 2020 Mar 13;10(1):4674. doi: 10.1038/s41598-020-60016-3.
Very low birth weight (VLBW) neonates experience various problems, including meconium-related ileus (MRI). This study investigated the risk factors of MRI and surgical MRI in VLBW infants. VLBW neonates admitted to the Neonatal Intensive Care Unit of Seoul National University Children's Hospital from October 2002 to September 2016 were included in the study. The diagnostic criteria for MRI were a decreased frequency of defecation with intolerable feeding, vomiting, and increased gastric residue (>50%); meconium-filled bowel dilatation in an imaging study; and no evidence of necrotizing enteritis or spontaneous intestinal perforation. Medical MRIs and surgical MRIs were managed through conventional treatment and surgical intervention. Of 1543 neonates, 69 and 1474 were in the patient and control groups, respectively. The risk factors for MRI include low birth weight (BW), cesarean section delivery, fetal distress, maternal diabetes, maternal hypertension, and maternal steroid use. Low BW and fetal distress were independent risk factors for MRI. Compared to the medical MRI group (n = 44), the risk factors for surgical MRI (n = 25) included males, younger gestational age, low BW, and meconium located at the small bowel. Male gender and low BW were independent risk factors for surgical MRI. Low BW and fetal distress were independent risk factors for MRI and male gender and low BW were independent risk factors for surgical MRI. In VLBW neonates, careful attention to the risk factors for MRI could minimize or avoid surgical interventions.
极低出生体重儿（VLBW）会出现多种问题，包括胎粪性肠梗阻（MRI）。本研究旨在探讨 VLBW 儿发生 MRI 的危险因素及手术干预的相关因素。纳入 2002 年 10 月至 2016 年 9 月在首尔国立大学儿童医院新生儿重症监护病房住院的 VLBW 儿，MRI 的诊断标准为：排便减少伴无法耐受喂养、呕吐和胃潴留增加（>50%）；影像学检查显示充满胎粪的肠扩张；无坏死性小肠结肠炎或自发性肠穿孔的证据。通过常规治疗和手术干预对疑似 MRI 儿进行医学 MRI 和手术 MRI。1543 例患儿中，69 例为 MRI 组，1474 例为对照组。MRI 的危险因素包括低出生体重（BW）、剖宫产、胎儿窘迫、母亲糖尿病、母亲高血压和母亲使用类固醇。低 BW 和胎儿窘迫是 MRI 的独立危险因素。与医学 MRI 组（n = 44）相比，手术 MRI 组（n = 25）的危险因素包括男性、较小的胎龄、低 BW 和胎粪位于小肠。男性和低 BW 是手术 MRI 的独立危险因素。低 BW 和胎儿窘迫是 MRI 的独立危险因素，男性和低 BW 是手术 MRI 的独立危险因素。在 VLBW 儿中，仔细关注 MRI 的危险因素可最小化或避免手术干预。
