Neonatal Intestinal Obstruction Research Articles

Posterior Urethral Valve associated with Meconium Ileus: A Case Report

Association of posterior urethral valve with neonatal intestinal obstruction is rare; rarer still is its association with meconium ileus. A 1-day-old male presented with features of neonatal intestinal obstruction. Gastrografin enemas confirmed microcolon and were therapeutic. Later, the neonate developed overflow incontinence and deranged renal functions; micturating cystourethrogram confirmed posterior urethral valve. Cystoscopic valve fulguration was performed after stabilization; outcome was favourable.

Assessment of Nursing knowledge and Practices in Caring of Neonatal Intestinal Obstruction

Background: Intestinal obstructions are the most common surgical emergencies in the neonatal period. Nurses play an important role in caring of neonates with intestinal obstructions includes pre-operative care and post-operative care. This study aimed to: Assess nurses' knowledge and practices in caring for neonates with intestinal obstruction. Setting: This study was conducted at the Neonatal Intensive Care Units (NICUs) in El-Kasr Al-Ainy University Hospital and El-Hussein University Hospital. Design: A descriptive design was used. Sample: A purposive sample of 86 nurses included in the study working at the previously mentioned setting. Tools: The first tool is a predesigned questionnaire sheet to assess nurses' knowledge about neonates with intestinal obstruction; the second tool was observational check list to assess nurses' practices for neonates with intestinal obstruction. Results: Revealed that less than two thirds of the studied nurses had unsatisfactory level of knowledge regarding neonatal intestinal obstruction. While less than three quarters of the studied nurses had incompetent level of practices regarding care of neonates with intestinal obstruction. Conclusion: This study concluded that the majority of the studied nurses had unsatisfactory level of knowledge. While most of the studied nurses had incompetent level of practices regarding neonatal intestinal obstruction. There were statistically significance relation between total level of the studied nurses' knowledge and their practice. Recommendations: Collaboration and continuing education of the pediatric nurses staff in the NICUs are vital to improve their knowledge and practices about care provided for neonates with intestinal obstruction.

Oral Water-Soluble Contrast Agent as the Definitive Treatment of Uncomplicated Adhesive Bowel Obstruction in Infants and Neonates

Oral Water-Soluble Contrast Agent as the Definitive Treatment of Uncomplicated Adhesive Bowel Obstruction in Infants and Neonates

Cystic fibrosis in black African children in South Africa: a case control study

BackgroundCystic fibrosis (CF) is described more commonly in Caucasian populations in whom p.Phe508del is the most common mutation. There is a paucity of data of CF in black African children. The aim of this study was to describe and compare the presentation and outcomes of black African children with CF to those with p.Phe508del genotype. MethodsA retrospective case-controlled study was conducted from January 2000 – March 2018 of children with CF attending two CF centres in South Africa. Presentation, genotype, nutrition and pulmonary function outcomes of black African children were compared to matched controls with the p.Phe508del mutation. ResultsThirty-four black African children (cases) with median age of diagnosis (5.5 months, IQR 2.0-15.0) were matched to 34 controls. Among cases, 3120+1G->A CFTR mutation was most commonly identified; homozygous n=22 (64.7%) and heterozygous=7(20.5%). Compared to controls, cases at diagnosis were more malnourished and fewer presented with neonatal bowel obstruction [cases n=2 (5.9%) vs. controls n=10 (29.4%); p = 0.03]. Nutrition and pulmonary function (FEV1 in children ≥ 6 years) outcomes and changes over time from ages 3-16 years were similar in both groups; median FEV1 z-score at age 6,10 and 14 years was -0.9 (±1.5), -1.8 (±2.0) and -1.8 (±1.9) respectively for all patients. Deaths were recorded in three cases (8.8%) and one control (2.9%) (p = 0.6). ConclusionBlack African children with CF were more malnourished at diagnosis, and fewer presented with neonatal bowel obstruction. Cases and controls had comparable nutritional, pulmonary function and early mortality outcomes.

Jejunal Atresia Associated With Intramural Calcification in a Newborn

Abstract Objectives Jejunal atresia and associated intramural calcification are a rare phenomenon, only few cases have been reported. Jejunal atresia is an antenatal developmental defect causing intestinal obstruction in newborns. In most of the cases, the condition is diagnosed by fetal ultrasound during the period of third trimester. We are reporting a case of neonatal jejunal atresia associated with intramural calcification and extensive foreign body reaction. Methods A baby girl was born at a gestational age of 36 weeks, 4 days through spontaneous vaginal delivery with a weight of 2.99 kg. The significant maternal history was gestational diabetes. The baby was diagnosed with jejunal atresia by antenatal ultrasound and received gastric suction immediately after delivery. About 200 mL of dark green fluid was suctioned from the stomach. Postnatal x-ray demonstrated significant distension of bowel loops and stomach. The baby underwent exploratory laparotomy with congenital atresia repair. Morphologically, the proximal portion of jejunum was dilated and small portion of distal segment of jejunum appeared to have type IIIB atresia. The atretic portion was examined grossly and processed as paraffin-embedded tissue for microscopic examination. Results The atretic segment was about 1 cm long, the serosal surface demonstrated foci of hemorrhage, and the wall was thickened. Microscopically, the atretic segment and adjacent area showed chronic inflammation, extensive foreign body type giant cell reaction, and abundant intramural calcification. Conclusion Some hypothesize that intramural calcification in conjunction with foreign body giant cell reaction associated with multifactorial events including vascular insults during the prenatal period. However, there are no studies directed to elucidate the precise pathogenesis of this combination of findings in the intramural location.

Neonatal Intestinal Obstruction Management: Ten Years Experience in Combined Military Hospital, Dhaka

Introduction: Neonatal intestinal obstruction is the commonest surgical emergency in neonatal period. The outcome in neonatal intestinal obstruction has improved dramatically due to the improvements in diagnostic facilities and neonatal intensive care, and surgical advances.
 Objective: To detect the pattern of neonatal intestinal obstruction, to find out their cause and outcome after management.
 Materials and Methods: This was a 10 years retrospective review of all children aged 28 days and below, managed for intestinal obstruction between March 2006 and February 2016 at the Pediatric Surgical Division of Combined Military Hospital, Dhaka. Patients who were presented with septic shock, pneumonia, very low birth weight and extreme prematurity, Anorectal malformation were excluded from the study.
 Result: Out of 196 patients, male patients were 135(68.87%), female 61(31.12%) and male to female ratio was 2.2:1. Most common cause of intestinal obstruction was Intestinal atresia 55(28.08%) followed by Hirschsprung disease 45(22.93%), Meconium ileus 43(21%), Malrotation of gut 23(11.73%), duodenal atresia 12 (6.12%), gastroschisis 10(5.10%) and other case 8(4.01%). Majority of neonates 158(80.61%) presented within 1st week of life and survival rate was 83.16%. Mortality in preterm was much higher 19(70.35%) than in term newborns 21(12.42%).
 Conclusion: Dedicated delicate neonatal surgical care, early diagnosis and intervention are the crucial factors in improving operative outcome in neonatal surgery.
 Journal of Armed Forces Medical College Bangladesh Vol.14(1) 2018: 24-28

Outcomes of Both Complex and Isolated Cases of Infants With Large Stomach on Fetal Ultrasound [33D

INTRODUCTION: A sonographically large fetal stomach has resulted in gastrointestinal obstruction, per case reports, and is often followed with serial ultrasounds. We hypothesize that a LS is predictive of neonatal bowel obstruction. METHODS: We performed retrospective cohort study of all prenatal sonographic cases with a large stomach visualized between 1/1/02-6/1/16. Inclusion criteria required a liveborn delivery within the Johns Hopkins health system. We excluded pregnancy loss/termination cases and cases delivered outside JHHS. We defined a large stomach as an increased measurement in 2 or greater dimensions based on a normogram. Cases were classified as isolated or complex based on additional US findings at initial presentation. We collected demographics, sonographic findings and postnatal outcomes. Approval was obtained by the Johns Hopkins IRB. RESULTS: We identified 340 fetuses with large stomach. Two hundred thirty three met inclusion criteria, including 160 isolated and 73 complex. Of the 160 isolated cases, none resulted in gastrointestinal obstruction. Those with isolated findings were significantly less likely to deliver preterm (n=24, 15.0% vs n=31, 42.5%, p<0.001). Isolated cases were less likely to be complicated by polyhydramnios (n=13, 8.1% vs. n=18, 24.7%, p<0.001), NICU admittance (n=30, 18.8% vs n=70, 95.9%, P<0.001) or neonatal procedure (n=1, 0.63% vs. n=60, 82.2, p<0.001). CONCLUSION: While a sonographically large fetal stomach has been reported to result in gastrointestinal obstruction, the rate may be lower than previously hypothesized. We found that <1% of large fetal stomachs resulted in obstruction. When isolated, a large stomach is not a sole indication for ultrasounds and postnatal imaging.

Molecular Genetic Anatomy and Risk Profile of Hirschsprung’s Disease

BackgroundHirschsprung’s disease, or congenital aganglionosis, is a developmental disorder of the enteric nervous system and is the most common cause of intestinal obstruction in neonates and infants. The disease has more than 80% heritability, including significant associations with rare and common sequence variants in genes related to the enteric nervous system, as well as with monogenic and chromosomal syndromes.MethodsWe genotyped and exome-sequenced samples from 190 patients with Hirschsprung’s disease to quantify the genetic burden in patients with this condition. DNA sequence variants, large copy-number variants, and karyotype variants in probands were considered to be pathogenic when they were significantly associated with Hirschsprung’s disease or another neurodevelopmental disorder. Novel genes were confirmed by functional studies in the mouse and human embryonic gut and in zebrafish embryos.ResultsThe presence of five or more variants in four noncoding elements defined a widespread risk of Hirschsprung’s disease (48.4% of patients and 17.1% of controls; odds ratio, 4.54; 95% confidence interval [CI], 3.19 to 6.46). Rare coding variants in 24 genes that play roles in enteric neural-crest cell fate, 7 of which were novel, were also common (34.7% of patients and 5.0% of controls) and conferred a much greater risk than noncoding variants (odds ratio, 10.02; 95% CI, 6.45 to 15.58). Large copy-number variants, which were present in fewer patients (11.4%, as compared with 0.2% of controls), conferred the highest risk (odds ratio, 63.07; 95% CI, 36.75 to 108.25). At least one identifiable genetic risk factor was found in 72.1% of the patients, and at least 48.4% of patients had a structural or regulatory deficiency in the gene encoding receptor tyrosine kinase (RET). For individual patients, the estimated risk of Hirschsprung’s disease ranged from 5.33 cases per 100,000 live births (approximately 1 per 18,800) to 8.38 per 1000 live births (approximately 1 per 120).ConclusionsAmong the patients in our study, Hirschsprung’s disease arose from common noncoding variants, rare coding variants, and copy-number variants affecting genes involved in enteric neural-crest cell fate that exacerbate the widespread genetic susceptibility associated with RET. For individual patients, the genotype-specific odds ratios varied by a factor of approximately 67, which provides a basis for risk stratification and genetic counseling. (Funded by the National Institutes of Health.)

Intussusception in preterm neonate

Abstract Introduction While necrotizing enterocolitis (NEC) is more commonly encountered in premature infants in the neonatal intensive care unit, intussusception is extremely rare and usually forgotten in differential diagnosis. This is because both diseases share common clinical findings including abdominal distension, bilious gastric residuals and bloody stool. Presentation of case A 33-gestational week-male baby was referred on 23rd postnatal day with bleeding per rectum, intolerance to feed and absolute constipation 2 days earlier. He was misdiagnosed as necrotizing enterocolitis and received conservative treatment. Later, because of deterioration of general condition, he was explored and an intussusception was found. Resection and anastamosis were done and the child was discharged on the 11th day postoperative. Conclusion Although extremely rare, intussusception should be included in the differential diagnosis of neonatal intestinal obstruction, even in the preterms as delayed diagnosis will further result in gangrene and perforation as well as deterioration of the baby's general condition.

A transition to discipline curriculum for pediatric surgery trainees: Evaluation of a pediatric surgery boot camp from 2017 to 2018

IntroductionBoot camps seek to impart knowledge and skills for individuals entering new roles. We sought to evaluate knowledge, skills, and confidence of in-coming pediatric surgery trainees with a 2.5-day pediatric surgery boot camp. MethodsA curriculum included key aspects of pediatric surgery delivered during interactive lectures, small group discussions, and simulation. With REB approval, participant demographics were collected. Pre- and posttests assessed knowledge and trainee confidence. Comparative statistics and multivariate analysis of variance (MANOVA) were performed. ResultsBetween 2017 and 2018, 16 individuals from North American pediatric surgery training programs participated in two boot camps. Ten had North American general surgery training, and eleven had no pediatric surgery exposure ≥1 year prior. All participants expressed increased confidence with course material after boot camp [F(18,11) = 3.137;p < 0.05]. Performance improved significantly (pre- vs. posttests, 47.0% vs. 62.4%; p < 0.05). MANOVA between faculty and trainees demonstrated agreement on the value of individual sessions [F(15,3) = 0.642;p = 0.76]. Neonatal bowel obstruction, gastrostomy tube complications, esophageal atresia, pain management, and informed consent were rated most useful. ConclusionTrainees and teaching faculty considered the boot camp valuable. Trainees demonstrated significant improvements in core knowledge and confidence. The initial pediatric surgery boot camp experience shows promise in facilitating the transition to discipline for new trainees. Study typeProspective treatment study. Level of evidenceIV.

Neonatal Intestinal Obstruction Due to Intussusception: A Case Report and Review of Literature

Intussusception is a very rare cause of neonatal intestinal obstruction, particularly in preterm neonates. This rarity may lead to a significant delay in diagnosis. We present a case report of ileo-ileal intussusception occurring in a preterm neonate. Intussusception should be suspected in any neonate suffering from intestinal obstruction. Performing an abdominal ultrasound may confirm the diagnosis.

Management of Meconium Ileus: 5 years' experience at Dhaka Shishu (Children) Hospital

Background : Meconium ileus (MI) is one of the common cause of intestinal obstruction in neonate. It can be present with various complications (about 50%) like volvulus, atresia, and gangrene of the gut, perforation and meconium cyst.&#x0D; Objective : This study aimed to compare various surgical procedures used in the treatment of meconium ileus and to assess their efficacy regarding survival and complications in our center.&#x0D; Methods : This retrospective study was done to all cases of meconium ileus admitted in the Department of neonatal surgery of Dhaka Shishu (Children) Hospital during the past 5 years (2011 to2016). The medical records of all patients with meconium ileus were studied. The surgical procedures were Mikulicz procedure, Bishop-Koop procedure done in case of complicated cases and Mikulicz procedure, Bishop-Koop and T tube ileostomy done in uncomplicated cases. Outcomes were compared between complicated and uncomplicated group and between the surgical procedures.&#x0D; Results : Total patients were 224. Among them 8 were excluded due to incomplete data. The mean age was 3.23 days. Twenty four neonates were preterm. Fifty-two percent were uncomplicatedMI and 48.15% were complicated. Among 112 uncomplicated cases, Mikulicz procedure done in 33 cases, Bishop-Koop procedure done in 37 cases and rest were treated by T tube ileostomy procedures. Among 104 cases of complicated meconium ileus, Mikulicz procedure done in 75 cases and 42 cases were treated by Bishop-Koop stoma. Predominant complications in Mikulicz procedures were high output fistula (67.6%), sepsis (34.84%) and skin excoriation (58.33%), while in Bishop-Koop procedure were sepsis (59.25%), anastomotic leak and reoperation (25.75%). In T tube ileostomy, complications were intra-peritoneal leak with reoperation and sepsis (9.52%). Twenty five (11.6%) stoma prolapse were found in Mikulicz ileostomy. The overall mortality of meconium ileus was 36.6%, in simple MI 23 out of 112 and in complicated MI 56 out of 104. This difference was significant.&#x0D; Conclusion : Considering the study result we concluded that complications occur more frequently in Mikulicz procedure and it is significantly associated with mortality, Bishop- Koop ileostomy can be considered but anastomotic leak is still an important complication of this procedure. In uncomplicated cases T tube ileostomy found as the best option.&#x0D; Northern International Medical College Journal Vol.10(1) Jul 2018: 326-329

Neonatal Intestinal Obstruction: A 5 Year Experience in a Tertiary Hospital in Enugu, Nigeria

Background: Neonatal intestinal obstruction is one of the most common surgical emergencies in a newborn requiring the services of a pediatric surgeon. This study reports the etiology, sex incidence, age of presentation, management and outcome of neonatal intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of neonates who presented, at Enugu State University Teaching Hospital, with intestinal obstruction over a 5-year period. Result: Thirty five neonates were recruited into the study. There were 24 (68.6%) males and 11 (31.4%) females. Five patients (14.3%) were delivered before term (preterm) while thirty patients (85.7%) were delivered at term. Most of the patients (54.3%) presented after 72 hours from onset of symptoms. Abdominal distension was the most common symptomatology recorded in our patients. Necrotizing enterocolitis was the most common etiology in our patients accounting for 17 neonates (48.6%). This was followed by anorectal malformation 5 (14.3%), obstructed hernia 4 (11.4%), intestinal atresia 4 (11.4%), Hirschsprung’s disease 3 (8.6%), meconium plug 2 (5.7%). Colostomy formation was the most common surgical procedure performed. Twenty percent of our patients developed post-operative complication and mortality was 22.9%. Conclusion: Necrotizing enterocolitis is the most common cause of neonatal intestinal obstruction in the current study. With the mortality of 22.9%, the outcome in our patients is still poor and requires some improvements.

Spectrum of Paediatric Intestinal Obstruction in a Tertiary Hospital in Enugu, Nigeria

Background: Paediatric intestinal obstruction is a common surgical emergency and is associated with lots of morbidity and mortality especially in developing countries. Paediatric intestinal obstruction differs from adult intestinal obstruction in terms of aetiology, presentation, management and outcome. This study reports the demography, diagnosis, management and outcome of paediatric intestinal obstruction in pediatric surgical unit of a tertiary hospital in Enugu, Nigeria. Methodology: This was a retrospective study of paediatric patients who presented with intestinal obstruction to the paediatric surgical unit of Enugu State University Teaching Hospital (ESUTH) Enugu, South East Nigeria. Children above one month of age but below 15 years, who presented with symptoms and signs of intestinal obstruction, were recruited for the study. Intestinal obstruction in neonates was excluded from this study. The study period was for one year, from January 1st 2018 to December 31st 2018. Result: During the period of the study 45 cases, 30 (66.7%) males and 15 (33.3%) females were managed. The mean age of the patients was 52.2 months. Abdominal pain was the most common presenting symptom and intussusception was the most common cause of intestinal obstruction. Forty two patients (93.3%) did well and were discharged. Two patients (4.4%) died while one patient (2.2%) was discharged against medical advice. Conclusion: Intussusception was the most common cause of intestinal obstruction in the current study. The mortality of 4.4% recorded in this study can be improved upon.

The Study of Intestinal Obstruction in Neonates and their Outcome Excluding Anorectal Malformation

The Study of Intestinal Obstruction in Neonates and their Outcome Excluding Anorectal Malformation

Clinical Presentation and Management of Neonatal Intestinal Obstruction

AimsTo find out etiological aspect and outcome of neonatal intestinal obstruction.nbspMaterial and MethodsThis prospective study was conducted over a period of 3 years from February 2016 to January 2019. 60 cases presented with neonatal intestinal obstruction were included in the study. Neonates of Multiple anomalies Necrotising enterocolitis anorectal malformation and esophageal atresia were excluded from the study. Plain x-ray abdomen and Ultrasound scan were done in all cases to rule out renal and other anomalies. Contrast radiography was performed in selected cases. All cases underwent their respective operations depending upon diagnoses.nbspResultsAmong 60 cases 28 neonates had bowel atresia 3 meconium ileus 9 malrotation 15 HD and 5 Meckelrsquos diverticulum. There were 43 males and 17 females M F- 2.51. Median weight for patients with intestinal atresia and meconium ileus was 2 Kg 1.3-3 kg. Median weight was 2.5 kg for malrotation and Meckelrsquos diverticulum and for Hirschsprung disease HDnbsp it was 2.5 kg 1.6-2.9 kg.Babies with atresia and meconium ileus presented earlier compared to those with HD and other conditions with obstruction presented late. Median age of presentation for intestinal atresia malrotation and HD was 2 days 10 days and 18 days respectively. Median age of presentation for Meckelrsquos diverticulum was 16 days. Most atresia patients 25 89.3 were premature as compared to only four premature patients in other group 31 12.5.Bilious vomiting abdominal distention and failure to pass meconium or stool were the most prominent features of presentation in most cases. Septicaemia 53.3 was most common complication followed by wound infection 16.6 pneumonitis 8.3 and anastomotic leak 5. 1 case of jejunal atresia and 2 cases of ileal atresia were reexplored due to anastomotic leak.12 20 cases had mortality due to septicaemia and prematurity.nbspConclusionnbspIntestinal atresia was most common cause of neonatal intestinal obstruction in our study and septicaemia was most common cause of morbidity and mortality. Early diagnosis including prenatal diagnosis and planned delivery in a fully equipped pediatric surgical centre is recommended for better outcome.

Paediatric Abdominal Surgical Emergencies in Enugu, South East Nigeria: Any Change in Pattern and Outcome

Background: Paediatric abdominal surgical emergencies (PASE) constitute a significant workload of the paediatric surgeon. The objective of this study was to characterize the pattern of PASE in a tertiary hospital in Enugu and determine any change in pattern and outcome. Methodology: This was a retrospective study of children aged 1 day to 16 years who presented with abdominal surgical emergencies to Enugu State University Teaching Hospital (ESUTH), Enugu. Result: There were 152 patients recruited for the study. There were 122 males and 30 females. The mean age at presentation was 6 years while the mean duration of symptoms before presentation to the hospital was 3.5 days. Thirty eight (25%) patients presented within 48 hours of the onset of their symptoms while 114 patients (75%) presented after 48 hours. The emergencies were intussusception 56 (36.8%), typhoid intestinal perforation 30 (19.7%), obstructed hernia 20 (13.2%), appendicitis 17 (11.2%), abdominal trauma 10 (6.6%), neonatal intestinal obstruction 6 (4%), ruptured appendix 6 (3.9%), Hirschsprung’s disease 4 (2.6%), adhesive bowel obstruction 2 (1.3%), and Gastroschisis 1 (0.7%). The mean hospital stay was 6.7 days. Thirty four patients (22.4%) who had surgery developed post-operative complication. The most common complication was surgical site infection and this occurred most in patients who had typhoid intestinal perforation (P = 0.017). There were 12 (7.9%) deaths. Conclusion: In this series, intussusception was the most common paediatric abdominal surgical emergency seen in Enugu unlike in the past when it used to be typhoid intestinal perforation. Mortality was less in the current study. This illustrates a change in pattern and outcome.

Neonatal Intestinal Obstruction Due to Enteric Duplication: Report of Three Cases and an Analysis of Case Reports in the Japanese Literature

Neonatal Intestinal Obstruction Due to Enteric Duplication: Report of Three Cases and an Analysis of Case Reports in the Japanese Literature

Outcome of Management of Neonatal Intestinal Obstruction at a Tertiary Center in Nigeria.

Background:Intestinal obstruction in a newborn remains a significant emergency in pediatric surgery. Clinical presentation is often subtle with sudden deterioration of their clinical states. Clinical outcome in the developing countries is poor owing to a variety of factors.Objective:The objective of this study is to identify the factors affecting the management outcome in our environment.Patients and Methods:Data on clinical presentation, management, and outcome of all neonates managed for intestinal obstruction over a 13-year period at a tertiary center in Nigeria were retrospectively reviewed. Analysis of factors affecting the management outcome was also performed.Results:One hundred and seventeen neonates comprising 85 (72.7%) boys and 32 (27.3%) girls were managed for intestinal obstruction. The age at presentation ranged from 0 to 29 days, with a mean of 6.86 ± 8.4 days. Seventy-five (64.1%) patients presented within a week of onset of symptoms and 42 (35.9%) patients later. Eighty-five patients (72.6%) presented with symptoms from birth. The most common causes of intestinal obstruction included anorectal malformation in 62 (53%) neonates and Hirschsprung's disease in 16 (13.7%) neonates. Other causes included obstructed inguinoscrotal hernias, duodenal atresia, jejunoileal atresia, malrotation, and annular pancreas. Eleven patients died with a mortality rate of 9.4%. The age at presentation (P = 0.001) and the presence of postoperative complications (P = 0.009) were significantly related to the duration of hospital stay. Furthermore, the presence of postoperative complications (P = 0.012) was significantly associated with postoperative mortality.Conclusion:Early presentation and postoperative complications significantly affected the morbidity and mortality associated with the management of neonates with intestinal obstruction.

Milk curd obstruction: An increasingly common rarity?

Introduction: Milk curd obstruction is a rare, yet important cause of neonatal bowel obstruction that has been seldom reported in the literature. The presentation has evolved over time: Initially being seen in formula-fed term babies, to now being more prevalent in premature babies that require milk fortification. We present a case series of four patients treated for the condition at our institution and report that there may be additional contributing factors that have not been previously described. Method: Case notes of four patients that were diagnosed with milk curd obstruction over a one-year period were retrospectively analysed. Data collected included: gender, gestational age at birth, birth weight, pre-existing gastro-intestinal pathology, previous surgeries, feeding regimens used as well as the management and outcomes of milk curd obstruction. Results: All patients included in the series were premature, with three being classified as extremely low birth weight (ELBW). All babies received fortified expressed breast milk feeds. Three patients were treated for necrotising enterocolitis (NEC) prior to being diagnosed with milk curd obstruction. Two patients had undergone surgery for abdominal pathology ahead of their diagnosis. Three of the four babies required operative management for milk curd obstruction, whilst one was successfully managed conservatively. There were no mortalities. Conclusion: Previous gastrointestinal pathology as well as previous surgery may be associated with the development of milk curd obstruction. Milk curd obstruction is becoming an increasingly significant cause of neonatal bowel obstruction and further research and investigation is required to establish patterns of causation.