Prediction of Intestinal Perforation by Daily Radiographic Findings in Very Low Birth Weight Infants With Meconium Ileus

• Published in: Journal of pediatric surgery 2024-11, Vol.60 (2), p.162076, Article 162076
• Main Authors: Katsumata, Yoshio, Terui, Keita, Takenouchi, Ayako, Komatsu, Shugo, Kawaguchi, Yunosuke, Nishimura, Katsuhiro, Mise, Naoko, Matsuura, Gen, Endo, Mamiko, Osone, Yoshiteru, Sonoda, Yuko, Yoshida, Kazushi, Hishiki, Tomoro
• Format: Article
• Language: English
• Subjects: Diatrizoate meglumine; Enema; Intestinal perforation; Meconium ileus; Very low birth weight; X-rays
• ISSN: 0022-3468; 1531-5037; 1531-5037
• DOI: 10.1016/j.jpedsurg.2024.162076

This study aimed to develop a prediction model for intestinal perforation from meconium ileus (MI) based on findings from plain X-ray images. Very low birth weight (VLBW) infants with MI hospitalized in two tertiary centers between 2011 and 2022 were included in this study. We retrospectively reviewed clinical parameters and assessed plain X-ray images from 0 to 5 days of age. The standardized transverse diameter of intestinal gas (STDI) was calculated by dividing the largest diameter of the intestinal gas by the distance from the upper edge of L1 to the lower edge of L4. We then compared the STDI of patients with and without intestinal perforation. Among 81 VLBW infants with MI, intestinal perforation occurred in 6 (7 %). Among known risk factors, significant differences were observed between the two groups regarding pregnancy-induced hypertension (p = 0.03), weeks of gestation (p < 0.01), birthweight (p = 0.02), and indomethacin administration (p < 0.01). The mortality rate was higher in the perforation group (33 %) than in the non-perforation group (3 %) (p = 0.021). There were significant differences between the perforated and non-perforated groups regarding STDI except at 0 days of age. The positive and negative predictive cut-off values of STDI were respectively 0.08 and 0.93 on day 0, 0.30 and 1.00 on day 1, 0.33 and 0.97 on day 2, 0.33 and 1.00 on day 3, 0.29 and 1.00 on day 4, and 0.33 and 0.98 on day 5, respectively. Our novel prediction model, using STDI, predicted intestinal perforation in VLBW infants with MI. Level Ⅲ •What is currently known about this topic?The indications for surgery for non-perforated cases of meconium ileus have not been established.•What new information is contained in this article?The standardized transverse diameter of intestinal gas on daily abdominal X-ray images may be able to predict intestinal perforation of very low birth weight infants with meconium ileus.