胃影葡胺灌肠治疗极低出生体重儿胎粪性肠梗阻的临床疗效及生长转归

Clinical and growth outcomes after meconium-related ileus improved with Gastrografin enema in very low birth weight infants.

机构信息

Department of Medicine, Kyungpook National University, College of Medicine, Daegu, Korea.

Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, South Korea.

出版信息

PLoS One. 2022 Aug 11;17(8):e0272915. doi: 10.1371/journal.pone.0272915. eCollection 2022.

DOI:10.1371/journal.pone.0272915

PMID:35951504

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9371358/

Abstract

BACKGROUND

Meconium-related ileus in very low birth weight infants can lead to increased morbidity or mortality and prolonged hospitalization without prompt diagnosis and treatment. This study primarily aimed to identify the incidence of and factors associated with meconium-related ileus and secondarily sought to investigate clinical and growth outcomes after water-soluble contrast media (Gastrografin) enema.

METHODS

We retrospectively reviewed medical records of very low birth weight infants born between February 2009 and March 2019 in the neonatal intensive care unit of a single medical center. Perinatal factors, clinical outcomes, and growth outcomes were compared between the group with meconium-related ileus that received Gastrografin enema and the control group.

RESULTS

Twenty-four (6.9%) patients were diagnosed with meconium-related ileus among 347 very low birth weight infants. All achieved successful evacuation of meconium with an average of 2.8 (range: 1-8) Gastrografin enema attempts without procedure-related complications. Initiation of Gastrografin enema was performed at mean 7.0 days (range: 2-16) after birth. Incidences of moderate to severe bronchopulmonary dysplasia were higher and the duration of mechanical ventilation and need for oxygen were longer in the meconium-related ileus group (P = 0.039, 0.046, 0.048, respectively). Meconium-related ileus infants took more time to start enteral feeding and the nothing per oral time was longer (P = 0.001 and 0.018, respectively). However, time to achieve full enteral feeding and Z-scores for weight and height at 37 weeks and at 6 months corrected age did not differ between the two groups.

CONCLUSIONS

Gastrografin enema in very low birth weight infants with meconium-related ileus was an effective and safe medical management. Following Gastrografin enema, very low birth weight infants with meconium-related ileus achieved similar subsequent feeding progress and similar growth levels as the control groups without meconium-related ileus.

摘要

背景

极低出生体重儿的胎粪性肠梗阻可导致发病率和死亡率增加，住院时间延长，如果不及时诊断和治疗。本研究主要目的是确定胎粪性肠梗阻的发生率和相关因素，其次是探讨水溶性造影剂（胃复安）灌肠后的临床和生长结局。

方法

我们回顾性分析了 2009 年 2 月至 2019 年 3 月在单家医疗中心新生儿重症监护病房出生的极低出生体重儿的病历。比较胎粪性肠梗阻组和对照组接受胃复安灌肠的围产期因素、临床结局和生长结局。

结果

在 347 例极低出生体重儿中，有 24 例（6.9%）被诊断为胎粪性肠梗阻。所有患儿平均经 2.8 次（范围：1-8 次）胃复安灌肠尝试后成功排出胎粪，无与操作相关的并发症。胃复安灌肠开始于出生后平均 7.0 天（范围：2-16 天）。胎粪性肠梗阻组中中重度支气管肺发育不良的发生率较高，机械通气时间和吸氧时间较长（P = 0.039、0.046、0.048）。胎粪性肠梗阻患儿开始肠内喂养的时间较长，无口喂养时间较长（P = 0.001 和 0.018）。然而，两组患儿达到完全肠内喂养的时间和 37 周及 6 个月校正年龄时体重和身高的 Z 评分无差异。