Predictive risk factors for meconium-related ileus requiring surgical intervention in very low birth weight infants.

Abstract

Background: Meconium-related ileus (MRI) is a serious morbidity in very low birth weight infants (VLBWI). MRI can lead to intestinal perforation, which has a poor prognosis. Treatment may involve medical or surgical approaches. Our aim was to identify the risk factors predicting surgery in VLBWI with MRI, which are not well studied. We also compared clinical factors between VLBWI treated medically versus surgically.

Methods: We identified VLBWI with MRI who were admitted to our institution between January 2014 and December 2022. Infants were divided into those who underwent surgery and those who received conservative medical therapy. We compared various clinical factors between the groups. In each group, we calculated the ratio of maximum dilatational diameter of the intestinal tract to the maximum abdominal transverse diameter on abdominal X-rays at different time points; we called this ratio the "MRI index". Using receiver operating characteristic curve analysis, we determined the MRI index cutoff value to predict surgery.

Results: We evaluated 34 VLBWI with MRI; 9 underwent surgery and 25 responded to conservative medical therapy. The MRI index on day 0 and the maximum MRI index in the surgical group were significantly higher than those in the medical group (p = 0.036 and p < 0.001, respectively). The MRI index cutoff value to predict surgery was 0.205 (area under the curve: 0.900, sensitivity: 0.92, specificity: 0.78). Compared with the medical group, the surgical group required significantly longer to achieve enteral feeding at 100 ml/kg/day, had a longer duration of hospital stay (p = 0.003 and p = 0.038, respectively) and a significantly higher incidence of sepsis (p = 0.042).

Conclusion: VLBWI with an MRI index ≥0.205 have a significantly high risk of requiring surgery.