Abstract
Functional intestinal obstruction of prematurity (FIOP) is characterised by a partial or complete failure of meconium evacuation due to hypomotility of the immature bowel and this presents with features of intestinal obstruction typically within the first 2 weeks of life. It contributes significantly to the morbidity and mortality of extremely and very low birth weight preterm infants. This disorder has been described using many terminologies and there is controversy amidst clinicians as to the optimal approach to its management. This review summarises the characteristic clinical and radiologic findings to aid timely diagnosis and initiation of prompt treatment. Available evidence on different treatment options and their limitations is reviewed and practical stepwise management is described. In most cases, FIOP can be successfully managed conservatively with proactive management and monitoring. Overall outcomes are favourable and normal long-term gastrointestinal function is commonly experienced. Evidence for investigations to exclude cystic fibrosis and Hirschsprung’s disease in preterm infants with FIOP is evaluated and a link with focal intestinal perforation is highlighted.
Highlights
Advances in neonatal intensive care have led to increased survival of very low birth weight (VLBW) and extremely low birth weight (ELBW) premature infants
Meconium-related ileus, meconium ileus of prematurity, meconium disease, meconium obstruction of prematurity, premature gut syndrome, microcolon of prematurity, functional isolated bowel obstruction, and functional intestinal obstruction in premature infants are some of the terms used.[1,2,3,4,5,6]
After necrotising enterocolitis (NEC) and focal intestinal perforation (FIP), functional intestinal obstruction has been shown as the third commonest indication for laparotomy in VLBW premature neonates.[8]
Summary
Advances in neonatal intensive care have led to increased survival of very low birth weight (VLBW) and extremely low birth weight (ELBW) premature infants. A degree of this disorder of motility is seen in a significant proportion of premature neonates as up to 25 – 30% do not pass meconium within the first 48hrs of life.[3,10] The VLBW (
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