Reconizing Meconium Plug Syndrome

Inspissated, sticky, immobile meconiumcauses this transient form of distalcolonic or rectal obstruction in newborns.The incidence has been estimatedat 1 in 500 to 1000 live births.The condition is thought to resultfrom dehydration of the meconium.Meconium plug syndrome is associatedwith prematurity, toxemia ofpregnancy, maternal use of phenothiazinesor tricyclic antidepressants,hypotonia, hypermagnesemia, hypothyroidism,and sepsis. Most affectedinfants are otherwise healthy. Approximately15% have cystic fibrosis,small left colon syndrome, orHirschsprung disease.Clinical manifestations includesignificant abdominal distention andfailure to pass meconium. Plain abdominalradiographs demonstrate multipleloops of distended bowel, often withair-fluid levels. The results of a bariumenema reveal an enlarged rectum withmeconium in the colon. Followingthe enema, large pieces of inspissatedmeconium plugs are usually passedand the obstruction is completely relieved.If the obstruction recurs, cysticfibrosis and Hirschsprung diseasemust be considered in the differentialdiagnosis.