Meconium-Related Obstruction: Contemporary Experience in a Multi-Institutional Consortium.

Purpose: Neonatal bowel obstruction secondary to inspissated meconium has been historically associated with cystic fibrosis. Increasingly, meconium-related obstruction (MRO) has been observed in preterm infants. We conducted a multicenter mixed-methods study to better characterize the contemporary experience with MRO.

Methods: A retrospective cohort study of infants with MRO was performed at seven children's hospitals from 2018-2022. Chi-squared tests, Kruskal-Wallis tests, and logistic regression were used to assess the association of cystic fibrosis, Hirschsprung disease, and prematurity with treatment strategies and clinical outcomes of MRO. Providers were surveyed regarding their management of MRO of prematurity.

Results: We identified 105 infants treated for MRO, including 54 (51%) with MRO of prematurity, 16 (15%) with Hirschsprung disease, 6 (6%) with cystic fibrosis, and 29 (28%) with MRO of the term infant. Overall, 32% (n=34) received glycerin suppositories, 25% (n=26) rectal irrigation, 79% (n=83) contrast enemas, and 6% (n=6) retrograde or antegrade N-acetylcysteine. Twenty-seven (26%) infants required surgery for MRO, of whom 21 (78%) had MRO of prematurity. For infants with MRO of prematurity, a one-week increase in gestational age was associated with a 23% decrease in the odds of requiring surgery (OR=0.77; 95%CI=0.64-0.93). Survey responses from 42 providers suggested limited institutional treatment algorithms for MRO.

Conclusion: In this multi-institutional study, most cases of MRO were associated with prematurity. Extent of prematurity was associated with a higher likelihood of requiring surgery. Results from this contemporary cohort study and survey provide a framework for developing a prevention and treatment algorithm for MRO of prematurity.