University Hospital Southampton NHS Foundation Trust

Meconium Ileus

Meconium Ileus (MI) is a condition where the content of the baby's bowel (meconium) is extremely sticky and causes the bowel to be blocked at birth. In most cases the bowel itself is complete and intact but it is just the inside that is blocked.

In some cases there has been a twist of the bowel before birth, which has caused the bowel to be blind ending (an atresia). Most babies with meconium ileus (90%) have Cystic Fibrosis (CF) and it is this that has caused the sticky meconium. Meconium ileus is a rare condition affecting only 1 in 25,000 babies.

What happens at the delivery?

Most babies with MI are only diagnosed after birth but occasionally it is detected on an ultrasound scan before delivery. In such cases it should be possible for you to deliver your baby in the normal way unless there are other reasons for requiring Caesarean Section. We would recommend, however, that your baby be delivered at the Princess Anne Hospital.

What are the symptoms of Meconium Ileus?

There is normally a delay in your baby passing meconium (black sticky stool normally passed within 24 hours of delivery) and your baby may also be reluctant to feed and may vomit a green fluid called bile which would normally pass through the bowel.

Your baby may be uncomfortable because of constipation and trapped air in the bowel and the abdomen (tummy) will become distended. Some babies present at delivery with a distended abdomen and may be unwell due to infection around the bowel.

What is the treatment?

  • Milk feeds will be stopped
  • A tube will be passed through your baby’s nose into the stomach to drain away the bile (green fluid) that collects here. This reduces the risk of your baby vomiting and reduces discomfort.
  • Your baby will be given fluid through a drip sited in a vein
  • Antibiotics may be started to treat any infection

 

The effects of Meconium Ileus vary from baby to baby. In some babies it is possible to dissolve the sticky meconium by injecting a fluid via a soft tube into the baby’s bottom (enema) during the course of an x-ray. This may need to be repeated within a few hours to completely clear the bowel.

In some babies there may be associated complications which means that an operation is necessary. Occasionally it is necessary to bring the bowel out onto the surface (a stoma) as a temporary treatment for a few weeks.

Once the bowel obstruction is relieved a blood test will be done to see if your baby has cystic fibrosis. It takes several days for the results to be known. In the mean time your baby will be given a special medicine both by mouth and bottom to reduce the risk of blockage recurring.

How is Meconium Ileus diagnosed?

The diagnosis is usually suggested on x-rays of the abdomen.

What is Cystic Fibrosis?

This is a fairly common genetic condition.

Babies who have CF may have very sticky poo causing plugs. Exactly how CF affects the individual child in other ways varies greatly. Children with CF can have frequent chest infections, this is because they have thick mucus in their lungs which they may find difficult to cough up. They may also have problems with digestion and have to take medicine with food.

It is difficult to predict how the condition will progress but early treatment is believed to be beneficial to the long term outlook of the individual child.

Can I feed my baby?

Milk feeds will be started slowly over the first few days. This may be your own breast milk or a formula feed.

Fine granules of Creon, a medicine to help your baby absorb feeds, may need to be given by mouth. This is because babies with CF usually lack the natural gut juices (enzymes) that are needed to digest milk and food. If you baby has CF it is likely that your baby will need this treatment for life.

It is likely your baby will need to be in hospital for 2 to 3 weeks while feeds are established. During this time, if CF is confirmed, a specialist cystic fibrosis team of doctors and nurses will become involved in planning your baby's care and giving you detailed information about the condition. If you wish to meet this team before the diagnosis is confirmed this can be arranged. 

Long-term surgical care

If your baby has a stoma this will be closed a few weeks or months after your baby has gone home. Following an operation there is always a small risk of future obstruction occurring.

If your baby has a bilious vomit or a distended abdomen medical advice should be sought.

What is the after care for Meconium Ileus?

Following discharge from the ward, there will be regular check-ups in order to monitor your baby's progress. These may be organised at your local hospital if you live outside Southampton.

Parent to parent link

Many parents who have experienced this same condition with their baby have indicated that they would be willing to speak to other parents. If you would like to speak to another family please contact us.

Disclaimer

University Hospital Southampton NHS Foundation Trust produce guidelines as an aid to good clinical practice. They represent recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented by the patient and the diagnostic or treatment options available. The guidelines issued are not intended to be prescriptive directions defining a single course of management and departure from the local guidelines should be fully documented in the patient's case notes at the time the relevant decision is taken.