Bedside ultrasound-guided contrast enema for preterm infants with suspected meconium plug syndrome: a 10-year single-center experience

Abstract

Objectives: To evaluate the safety and efficacy of bedside ultrasound-guided contrast enema (US-enema) in the neonatal intensive care unit (NICU) and to assess factors associated with its outcome.

Materials and methods: This retrospective study included preterm NICU babies who underwent US-enema for suspected meconium plug syndrome between 2014 and 2023. Patient characteristics, procedure-related factors, necrotizing enterocolitis (NEC) grades on US, presence of microcolon, and outcomes were reviewed. Group comparison and correlation analyses were performed.

Results: Eighty-two patients (mean gestational age at birth, 27.1 ± 2.5 weeks; mean birth weight, 872.0 ± 378.5 g; 45 males) with 128 sessions of US-enema were enrolled. Forty patients had no NEC, 32 had grade 1 NEC, and 10 had grade 2 NEC. Enema was repeated in 37 patients (45.1%), up to four times. The mean age at initial US-enema was 17.3 days. US-enema was successful in 68.3% (56/82) of patients. There were three events (3/128, 2.3%) of bowel perforation during enema, all had microcolon (p = 0.02), and two cases (2/82, 2.4%) of bowel-related mortality. Patients with enema success had higher gestational age at birth (27.6 vs. 25.9 weeks; p = 0.006), were older at initial enema (19.3 vs. 13.0 days; p = 0.02), and showed microcolon less frequently (12.5% (7/56) vs. 61.5% (16/26); p < 0.001) than those with enema failure.

Conclusion: US-enema is safe and effective for preterm NICU babies with suspected meconium plug syndrome. Higher gestational age at birth and older age at enema without microcolon were associated with successful enema.

Key points: Question Bedside ultrasound-guided contrast enema (US-enema) is considered an effective technique for preterm neonates with meconium plug syndrome, but data on outcome-related factors are limited. Findings US-enema successfully treated 68.3% of patients, with a 2.3% rate of bowel perforation. Higher gestational/postnatal age and absence of microcolon were associated with successful enemas. Clinical relevance US-enema is an effective and safe technique for meconium plug syndrome with a low risk of complications. Preterm neonates with higher gestational age at birth, older age at the time of enema, and without microcolon showed better treatment responses.