Abstracts
1997 Digestive Disease Week

Long-term outcome in children with neonatal meconium obstruction.

J Fuchs, JC Langer. Washington University, St. Louis, MO.

Background: It is unclear whether neonates with cystic fibrosis (CF) who present with meconium ileus (MI) have a different long term outcome than those presenting later in childhood. We compared long term outcome in neonates with MI, children who had CF without MI, and neonates who had meconium plug syndrome (MPS) without CF.

Methods: 35 CF patients presented with MI from 1966-92 (grp 1). Also studied were 35 age and sex-matched CF patients without MI (grp 2), and 12 presenting with MPS during the same period (grp 3). Pulmonary, GI, and functional status, and surgical complications were recorded.

Results: Mean followup was 12.6 ± 6, 12.6 ± 6, and 9.3 ± 4 yrs in groups 1, 2, and 3. Patients without CF (grp 3) had better growth, GI, pulmonary and functional status. Although grp 1 was diagnosed earlier, there was no difference between grps 1 and 2 with respect to hepato-biliary, nutritional, functional or respiratory status. MI was associated with a slightly higher risk of meconium ileus equivalent (20% vs 6%). Late adhesive bowel obstruction or blind loop syndrome were seen in 39% of children with MI; there were no late surgical complications in grps 2 or 3. More late surgical complications were seen after complicated than uncomplicated MI (57% vs 17%), and those treated by resection or enterostomy had more complications than those undergoing enterotomy and lavage (33% vs 0%).

Conclusions: Long term outcome is similar in CF patients with and without MI, except for a slightly higher incidence of meconium ileus equivalent, and a higher rate of surgical complications which is greatest in those with complicated MI and those undergoing resection or enterostomy. Non-CF patients with MPS have an excellent long term prognosis. These data will be useful in counselling the families of infants who present with neonatal meconium obstruction.