Predicting poor outcomes and the need for surgical treatment in neonates with meconium peritonitis

Meconium peritonitis: A 22-year review in a tertiary referral center

BACKGROUND

Meconium peritonitis (MP) is a sterile, chemical peritonitis resulting from in-utero fetal bowel perforation. Severe cases may lead to serious morbidities and mortalities.

OBJECTIVE

To review the common antenatal ultrasound abnormalities associated with MP, and identify radiological and clinical prognostic factors.

MATERIALS AND METHODS

Retrospective review of all neonates with MP from January 1997 to December 2019 treated in our hospital was performed. Antenatal ultrasound findings, clinical presentations and outcomes were analyzed.

RESULTS

Thirty-five neonates (17 males, 18 females) were included in the study. Thirty-two (91.4%) attended antenatal screening, and 27 (84.4%) of them had abnormalities identified on antenatal ultrasound. The most common abnormality was polyhydramnios (43.8%). Nineteen (54.3%) patients were inborn. Twenty (57.1%) patients were born prematurely. Laparotomy was required in 85.7% of patients. The median time to laparotomy was shorter in the inborn group [1 day (0-9 days) vs 4 days (2-34 days), p = 0.001], but the duration of post-operative hospital stay was comparable [71 days (16-423 days) vs 73.5 days (23-231 days)]. However, such duration was found to be significantly longer in the pre-term group when compared to full-term [58.5 days (16-89 days) vs 85 (21-423 days), p = 0.01]. The most common pathology was small bowel atresia and there were two mortalities.

CONCLUSION

Due to the advancement in prenatal detection, pediatric anesthesia, intensive care and surgical techniques, the morbidity and mortality of MP has much decreased. Effective multi-disciplinary antenatal counseling facilitated the perinatal management of MP and resulted in comparable prognosis and outcome in inborn and outborn neonates.