Meconium Ileal Obstruction and Functional Immaturity of the Intestine (MIOFI) in Extremely Premature neonates: A Case Series 

Lisieux Eyer de Jesus, Tania Cristina Lund, Claudia Tavares Regadas, Luiza Coutinho Porto, Bruno Henrique de Oliveira, Raquel Roxo Bruno, Samuel Dekermacher

Department of Pediatric Surgery, Hospital Federal dos Servidores do Estado, Brazilian Ministry of Health, Rio de Janeiro, Brazil

Keywords

Acute abdomen

Intestinal obstruction

Meconium disorders

Neonatal emergency

Premature newborn

Abstract

Introduction: Thick meconium induced ileal obstruction due to functional immaturity of the intestine (MIOFI) is a rare and frequently unrecognized condition that is typically seen in extremely low birth-weight (ELBW) and low birth-weight (LBW) premature babies. Its prognosis depends on early recognition and treatment. This retrospective study was performed to analyze the spectrum of babies with MIOFI and their outcome.

Methods: A retrospective review of neonates presenting to two referral hospitals with MIOFI during the first semester of 2024 was performed.

Results: During the study period 3 neonates presented with MIOFI. All of them were product of complicated pregnancies. Two of them were of ELBW. All the babies passed minimal amount of meconium prior to the onset of MIOFI symptoms. Two of them had severe abdominal distension without air-fluid levels and 1 presented with gasless abdomen. Only one was operated upon, with a mistaken clinical diagnosis of long-segment aganglionic megacolon; the other two were treated conservatively. All the 3 babies showed normal intestinal function during follow-up. 

Conclusions: MIOFI presents as neonatal intestinal obstruction affecting the distal ileum. Diffuse abdominal distention and respiratory distress are common symptoms. MIOFI responds well to water-soluble contrast enemas, with elimination of meconium plugs and mucus, followed by normalization of intestinal transit.