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

Introduction This 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. Methods This 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. Results Overall 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). Conclusion US-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.