Originally published by 2 Minute Medicine^® (view original article). Reused on AccessMedicine with permission.

Meconium-Related Obstruction and Clinical Outcomes in Term and Preterm Infants

1. Nearly 95% of cases of meconium-related obstruction (MRO) occur in the absence of cystic fibrosis or Hirschsprung disease

2. MRO occurred most frequently in preterm infants, who more often experienced longer hospital stays and required surgical intervention

Evidence Rating Level: 2 (Good)

Historically, the causes of most cases of meconium ileus and meconium plug syndrome have been attributed to cystic fibrosis and Hirschsprung disease, respectively. However, there is limited data reporting on the modern epidemiology of MRO. This retrospective cohort study therefore sought to investigate the incidence of MRO in infants and the underlying rates of prematurity, cystic fibrosis and Hirschsprung disease among these infants. 3,550,796 neonates (51.2% male) from the National Inpatient Sample Healthcare Cost and Utilization Project in the United States were identified. Outcomes of interest included the diagnosis of MRO associated with cystic fibrosis, Hirschsprung disease or neither, as well as associated clinical outcomes. Among the total study cohort, 1844 (0.1%) neonates were diagnosed with MRO. 41 (2.2%) of these neonates had concomitant cystic fibrosis while 60 (3.3%) had Hirschsprung disease, and 1743 (94.5%) had neither. Factors associated with a higher risk of developing MRO in neonates with MRO compared to unaffected neonates included preterm birth (634 [34.4%] vs 321 865 [9.1%]; P < .001), low birth weight (463 [25.1%] vs 229 908 [6.5%]; P < .001), and small for gestational age (150 [8.1%] vs 141 896 [4.0%]; P < .001). MRO of prematurity was associated with an increase in the length of hospitalization of 7.3 days (95% CI, 5.8-8.8 days; 48.0% relative change) and an increase in the likelihood of requiring abdominal surgery of 4.2% (95% CI, 3.1-5.4 percentage points; 1400.0% relative change). Overall, this study found that 94.5% of cases of MRO occur in the absence of cystic fibrosis or Hirschsprung disease, and that MRO occurred most commonly among preterm infants without either condition.

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