User:Obijuan1/Meconium Plug

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Meconium Plug Syndrome is a benign cause of neonatal intestinal obstruction that clears after rectal stimulation or the administration of a contrast enema. Meconium is the first stool of an infant, composed mainly of substances that are ingested in utero, including skin cells, amniotic fluid, and mucus. Although meconium plugs themselves are benign, they may indicate underlying disease.

Associated Syndromes

The initial reports from Clatworthy and Howard ^[1] described a 13% incidence of Hirschsprung's disease. Subsequent studies have also associated cystic fibrosis with meconium plug syndrome, with as many as 43% of patients with meconium plug syndrome having cystic fibrosis^[2] and a higher rate of association with Hirschsprung's disease up to 38% ^[3].

Diagnosis

Treatment

Meconium plug is a benign cause of neonatal bowel obstruction. Digital rectal stimulation or barium enema is often enough to relieve the obstruction. Given the association rate with Hirschsprung's disease and cystic fibrosis, it is recommended that children who are diagnosed with meconium plug syndrome receive rectal biopsy and CF genetic or sweat testing.

earliest stools of an infant. Unlike later feces, meconium is composed of materials ingested during the time the infant spends in the uterus: intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water. Meconium is almost sterile,^[4] unlike later feces, is viscous and sticky like tar, and has no odor. It should be completely passed by the end of the first few days of postpartum life, with the stools progressing toward yellow (digested milk). The term Meconium derives from meconium-arion, meaning "opium-like", in reference either to its tarry appearance or to Aristotle's belief that it induces sleep in the fetus.^[5]

Hirschsprung's disease presents as failure to pass meconium.

Meconium is normally stored in the infant's intestines until after birth, but sometimes it is expelled into the amniotic fluid prior to birth or during labor and delivery.

Meconium can be tested for various drugs, to check for in utero exposure. Using meconium, a Canadian research group at the Hospital for Sick Children, University of Toronto, showed that by measuring a by-product of alcohol (FAEE) they could objectively detect babies exposed to excessive maternal drinking of alcohol in pregnancy.^[6] In the USA, the results of meconium-testing run on a newborn can be turned in to child protective services and other law enforcement agencies.^[7]

Meconium ileus

The meconium sometimes becomes thickened and congested in the ileum, a condition known as meconium ileus. Meconium ileus is often the first sign of cystic fibrosis.^[8] In cystic fibrosis, the meconium can form a bituminous black-green mechanical obstruction in a segment of the ileum. Beyond this there may be a few separate grey-white globular pellets. Below this level, the bowel is a narrow and empty micro-colon. Above the level of the obstruction, there are several loops of hypertrophied bowel distended with fluid. No meconium is passed, and abdominal distension and vomiting appear soon after birth. About 20% of cases of cystic fibrosis present with meconium ileus, while approximately 20% of one series of cases of meconium ileus did not have cystic fibrosis.^[9] The presence of meconium ileus is not related to the severity of the cystic fibrosis.^[10] The obstruction can be relieved in a number of different ways.^[11]

Meconium ileus should be distinguished from meconium plug syndrome, in which a tenacious mass of mucus prevents the meconium from passing.

Other uses

In biology, meconium describes the metabolic waste product from the pupal stage of an insect that is expelled through the anal opening of the adult upon eclosion from the pupa.

References

^ Clatworthy Jr HW, Lloyd J. The meconium plug syndrome. Surgery 1956;39:131-42.
^ Olsen MM, Luck SR, Lloyd-Still J, et al. The spectrum of meconium disease in infancy. J Pediatr Surg 1982;17:479-81.
^ Burge D, Drewett M, Meconium plug obstruction. Pediatr Surg Int 2004;20:108-10
^ JIMÉNEZ, Esther, et al. Is meconium from healthy newborns actually sterile? Research in Microbiology. Vol. 159, Issue 3, pp. 187-193.
^ Health on the Net Foundation Mother and Child Glossary [1]
^ Chan D, Knie B, Boskovic R, Koren G. Placental handling of fatty acid ethyl esters: perfusion and subcellular studies. J Pharmacol ExpTher 2004; 310: 75-82.
^ G.B. v. Dearborn County Div. of Family and Children, 754 N.E.2d 1027 (Ind.Ct.App., 2001).
^ James H Hutchinson Practical Paediatric Problems 4th ed. London: Lloyd-Luke 1975 p. 314 ISBN 0-85324-114-7
^ Ali Hekmatnia Meconium Ileus [2]
^ Peter G Jones Clinical Paediatric Surgery 2nd ed. Oxford: Blackwell 1976 pp 74-5 ISBN 0-632-00089-9
^ Michael S Irish Surgical Aspects of Cystic Fibrosis and Meconium Ileus [3]

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[1] Clatworthy Jr HW, Lloyd J. The meconium plug syndrome. Surgery 1956;39:131-42.

[2] Olsen MM, Luck SR, Lloyd-Still J, et al. The spectrum of meconium disease in infancy. J Pediatr Surg 1982;17:479-81.

[3] Burge D, Drewett M, Meconium plug obstruction. Pediatr Surg Int 2004;20:108-10

[sterile-4] JIMÉNEZ, Esther, et al. Is meconium from healthy newborns actually sterile? Research in Microbiology. Vol. 159, Issue 3, pp. 187-193.

[5] Health on the Net Foundation Mother and Child Glossary [1]

[6] Chan D, Knie B, Boskovic R, Koren G. Placental handling of fatty acid ethyl esters: perfusion and subcellular studies. J Pharmacol ExpTher 2004; 310: 75-82.

[7] G.B. v. Dearborn County Div. of Family and Children, 754 N.E.2d 1027 (Ind.Ct.App., 2001).

[8] James H Hutchinson Practical Paediatric Problems 4th ed. London: Lloyd-Luke 1975 p. 314 ISBN 0-85324-114-7

[9] Ali Hekmatnia Meconium Ileus [2]

[10] Peter G Jones Clinical Paediatric Surgery 2nd ed. Oxford: Blackwell 1976 pp 74-5 ISBN 0-632-00089-9

[11] Michael S Irish Surgical Aspects of Cystic Fibrosis and Meconium Ileus [3]

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