MECONIUM PLUG SYNDROME IN THE NEWBORN

meconium plug syndrome in the newborn :
Some newborns present with bowel obstruction from plugs of meconium isolated to the colon. Most of these newborns are otherwise healthy babies, but all should undergo a contrast enema, which almost always is diagnostic (no pathology) as well as therapeutic (successful in loosening the meconium plug and resolving the obstruction). A plug of meconium isolated to the colon is usually unrelated to cystic fibrosis.

Conditions that predispose to dysmotility of the neonatal bowel, such as maternal preeclampsia, maternal diabetes mellitus, maternal administration of magnesium sulfate, prematurity, sepsis, and hypothyroidism, may be responsible for the formation of the meconium plug. In each of these conditions, the colon distal to the obstruction is narrowed and small in caliber.

Because of the frequent association between maternal diabetes mellitus and colonic obstruction with a small left colon, this association is termed small left colon syndrome. As with meconium ileus, a nonoperative approach with administration of enemas is favored to relieve the obstruction. The enemas can also serve to dilate the small-caliber distal colon.

A need for laparotomy to evacuate the meconium suggests a diagnosis other than simple meconium plug syndrome. Hirschsprung disease can be associated with meconium plug syndrome in 4% of patients; therefore, a suction rectal biopsy may be indicated.