Early management of meconium ileus in infants with cystic fibrosis: A prospective population cohort study

Background: Contemporary early outcome data of meconium Ileus (MI) in cystic fibrosis (CF) are lacking on a population level. We describe these and explore factors associated with successful non-operative management. Methods: A prospective population-cohort study using an established surveillance system (BAPS-CASS) was conducted October 2012-September 2014. Live-born infants with bowel-obstruction from inspissated meconium in the terminal ileum and CF were reported. Data are described as median (interquartile range, IQR). Results: 56 infants were identified. 14/56(25%) had primary laparotomy (13/23 complicated MI, 1/33 sim-ple), the remainder underwent contrast enema. Twelve, (12/33 (36%) with simple MI) achieved decom-pression. 8/12 (67%) who decompressed had > 1 enema vs 3/20 (15%) with simple MI who had laparo-tomy after enema. The number of enemas per infant (1-4), contrast agents and their concentration, were highly variable. Enterostomy was formed at 24/4 4(55%) of laparotomies. In infants with simple MI, time to full enteral feeds was 6 (2-10) days in those decompressing with enema vs 15 (9-19) days with la-parotomy after enema. Case fatality was 4% (95% CI 0.4-12%). Two infants, both preterm died, both in the second month after birth. Conclusions: Infants with simple MI achieving successful enema decompression were more likely to have had repeat enemas than those who proceeded to laparotomy. Successful non-operative management was associated with a shorter time to full feeds. The early management of infants with MI is highly variable and not standardised across the UK and Ireland. (c) 2021 Published by Elsevier Inc.