meconium constipation
Introduction
Introduction to meconium constipation Normal newborns usually discharge meconium for the first time within 12 hours of birth, or can be extended to 12 to 24 hours, and very few begin to defecate in 24 to 48 hours. If the newborn is thickened in the mesentery and accumulates in the sigmoid colon and rectum, defecation has not started after 48 hours of birth, and there is a transient low intestinal obstruction, called meconium constipation. basic knowledge The proportion of illness: 0.002% Susceptible population: newborn Mode of infection: non-infectious Complications: intestinal obstruction, neonatal vomiting, bloating
Cause
Meconium constipation cause
(1) Causes of the disease
Mostly non-organic lesions, due to thick meconium secrets to form fecal plugs, can also occur in premature infants with low muscle tone, or newborns who have used anesthetic or magnesium sulfate before birth, can also occur in Newborns suffering from respiratory distress, craniocerebral injury, sepsis, hypothyroidism, megacolon and other diseases.
(two) pathogenesis
The composition of meconium includes: 1 gastrointestinal secretions, bile, pancreatic secretions, various digestive enzymes; 2 epithelial cells with gastrointestinal mucosal surface shedding; 3 unabsorbed mane in swallowed amniotic fluid, fetal fat, keratinization Epithelial cells, etc.; 4 calcium soap crystals formed by intestinal substances, inorganic salts, and derivatives such as fat, bile hydrochloric acid, bilirubin, meconium are dark green, sticky, not formed, no odor, due to meconium In the intestinal tract, the residence time is too long, and even dry, there is a transient low intestinal obstruction.
Prevention
Meconium constipation prevention
1. Perinatal mothers should strictly control the indications and dosages with anesthetic or magnesium sulfate.
2. Start breastfeeding as soon as possible after birth, usually breastfeeding within half an hour after birth to prevent dehydration.
3. Strengthen the care of newborns.
Complication
Meconium constipation complications Complications, intestinal obstruction, neonatal vomiting, bloating
A transient intestinal obstruction, vomiting, abdominal distension, refusal of milk and irritability.
Symptom
Meconium constipation symptoms Common symptoms Children crying uneasy refuse to eat abdominal distension fecal vomits temporary constipation pediatric constipation
The meconium discharge time is delayed to 12h~24h48h, gradually showing uneasiness, abdominal distension, refusal of milk and vomiting. The vomit can be yellow-green or fecal, the intestinal wall can be seen in the abdominal wall, and the fecal mass can be touched. Anal examination or saline enema The viscous meconium can be excreted, and the above phenomenon is relieved. For example, in some diseases, such as hypothyroidism, megacolon, respiratory distress, craniocerebral injury, sepsis, etc., there is still a primary disease. which performed.
Examine
Meconium constipation check
Non-organic lesions are triggered, routine examinations are normal, such as concurrent water and electrolyte disorders, blood sodium, potassium, chlorine, calcium, magnesium and pH should be checked.
Abdominal X-ray plain film can be seen in the small intestine and colon inflated, B-ultra visible dry knot fecal plug.
Diagnosis
Diagnosis and identification of meconium constipation
diagnosis
According to the clinical manifestations and no defecation after 48 hours of birth, the saline enema is relieved, and other intestinal organic lesions are excluded, and the diagnosis can be confirmed.
Differential diagnosis
Intestinal atresia
Intestinal atresia is characterized by complete intestinal obstruction. No matter the level of the atresia, there is no normal meconium discharge. However, in a few cases, the mucosal secretions of the distal intestinal segment and the exfoliated cell mixture are discharged. The color is slightly lighter. It is considered to be meconium, high in the duodenum and jejunum, and vomiting within 24 hours, without abdominal distension. The lower part of the jejunum and the low ileum of the ileum appear late, and the spit can be accompanied by feces. Obvious bloating, abdominal erect position flat double ball sign suggesting upper gastrointestinal obstruction, sputum enema cecum can be diagnosed in the upper abdomen.
2. Hirschsprung's disease
Congenital megacolon is the most common cause of low intestinal obstruction in neonates. It is characterized by delayed discharge of meconium, bloating, vomiting and feeding difficulties. X-ray abdominal plain films show signs of low intestinal obstruction. Rectal examination can detect rectal sphincters. The emptiness of the abdomen and the rectum of the rectum, and a large amount of meconium, the gas is discharged with the fingers, and the abdominal distension is relieved, but then the difficulty of defecation is repeated. It is currently advocated to use the rectal mucosa to attract biopsy to diagnose neonatal congenital Sexual megacolon, the diagnostic coincidence rate is higher.
3. Meconium intestinal obstruction
Meconium ileus is caused by cystic fibrosis of the pancreas. Due to excessive concentration of viscous meconium, intestinal obstruction can not be caused by the end of the ileum. This disease is extremely rare in China, and is more common in low birth weight or premature infants. History, the child begins to vomit within 1 to 2 days after birth, progressive aggravation, vomit contains bile, abdominal distension, right lower abdomen can be sputum and strong mass, no meconium discharge, rectal examination can touch dry feces The block, the anal canal and the rectum are generally small and can be mistaken for anorectal stenosis.
Abdominal plain film shows the intestine filled with meconium and expanded, but due to the thick meconium and rare liquid level, the fineness of the colon cavity of the barium enema is characteristic of it, which can be distinguished from the delayed discharge of meconium and megacolon.
