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 simple), the remainder underwent contrast enema. Twelve, (12/33 (36%) with simple MI) achieved decompression. 8/12 (67%) who decompressed had >1 enema vs 3/20 (15%) with simple MI who had laparotomy after enema. The number of enemas per infant (1-4), contrast agents and their concentration, were highly variable. Enterostomy was formed at 24/44(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 laparotomy 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.





Polls results
1

On a scale of 1 to 10, rate how much this article will change your clinical practice?

NO change
BIG change
0% Article relates to my practice (0/0)
0% Article does not relate to my practice (0/0)
0% Undecided (0/0)
2

Will this article lead to more cost-effective healthcare?

0% Yes (0/0)
0% No (0/0)
0% Undecided (0/0)
3

Was this article biased? (commercial or personal)

0% Yes (0/0)
0% No (0/0)
0% Undecided (0/0)
4

What level of evidence do you think this article is?

0% Level 1 (0/0)
0% Level 2 (0/0)
0% Level 3 (0/0)
0% Level 4 (0/0)
0% Level 5 (0/0)