Neonatal meconium-related obstruction: Establishing a research strategy to evaluate an evolving disease

Purpose

The link between prematurity and meconium-related obstruction is understudied. We sought to describe the contemporary spectrum of meconium-related obstruction and to validate the use of ICD-10 codes for the study of this family of diseases.

Methods

This retrospective cohort study included neonates within our health system treated for a radiographically or intraoperatively confirmed meconium-related obstruction from January 2018 to December 2022. We stratified obstructions by type (meconium ileus vs meconium plug syndrome) and need for intervention (contrast enema vs surgery). We evaluated the association of prematurity, cystic fibrosis, and Hirschsprung's disease with disease severity using t-tests, ANOVA, and chi-squared tests. We secondarily evaluated the accuracy of ICD-10 codes at identifying meconium-related obstructions using sensitivity, specificity, and predictive values.

Results

Over five years, 18 infants were treated for meconium-related obstruction. This included five patients (28%) with meconium ileus and 13 (72%) with meconium plug syndrome. Twelve neonates (67%) were preterm, including all five (100%) treated for meconium ileus, none of whom had cystic fibrosis or Hirschsprung's disease. Among infants with meconium plug syndrome, one (8%) had cystic fibrosis and two (15%) had Hirschsprung's disease. Eight (44%) patients required a contrast enema, 5 (28%) multiple contrast enemas, and 5 (28%) surgery. Increasing prematurity was associated with worse disease severity (p<0.001). Diagnosis code P76.0 identified all cases of meconium-related obstruction (sensitivity=100%; specificity=95%).

Conclusions

Most meconium-related obstructions were related to prematurity and not cystic fibrosis or Hirschsprung's disease. The use of ICD-10 code P76.0 is a promising research strategy for this evolving condition.

Level of evidence

Level III – retrospective comparative study