Meconium-related ileum in preterm and low birth weight children

Background: Surgical intestinal Disorders (SiD) represent a group of neonatal diseases with high morbidity and mortality, especially in the preterm child. The term SiD includes three Pathologies: Necrotizing Enterocolitis (NEC), Focal intestinal Perforation (FiP) and Meconium-related ileum (Mri); the latter one includes Meconium Plug Syndrome (MPS), Meconium Disease (MD) and Small Left Colon Syndrome. This is a critical retrospective review of our cases. The purpose of this study is to share our experience to the scientific community. Methods: This is a retrospective study conducted at the Department of Paediatric Surgery at the azienda Ospedaliera universitaria Senese. We identified patients from a prospectively kept database. We selected patients with MRI seen in the last 18 years (1999-2017) who underwent surgery. Exclusion Criteria: birth weight >1000 g and gestational age >37 weeks, diagnosis of cystic fibrosis and conservatively treatment (enema). Results: Of the 26 patients with MRI: 5 patients had MPS, 4 a Small Left Colon Syndrome and 17 were included in the Meconium Disease group (MD). The latter one comprehends 8 patients with Meconium Peritonitis and 9 patients with Meconium Ileus (MI). The mean gestational age of these patients was 28 weeks (25 - 32 weeks) and the mean birth weight was 888 g (490 - 1700 g). All patients underwent laparotomy and ileostomy. Conclusions: The analysis of our case studies supports the existence of a new pathological entity: Mri. Known pathologies, such as the meconium ileus, have thus acquired different characteristics, which should be considered in the clinical management of these patients and in the surgical management in term of timing and type of surgery.