The first bowel movement that a newborn with cystic fibrosis passes is called meconium ileus. It is normally very thick and sticky and usually passes in the first 12-24 hours after birth.1,2
Meconium ileus and cystic fibrosis
The meconium in newborns with cystic fibrosis (CF) is thicker and stickier than usual and this may block a part of the small intestine called the ileum. Thus, meconium ileus is a bowel obstruction in newborns. It is estimated that 80 to 90% of infants with meconium ileus have cystic fibrosis.1,2
In its 2017 Annual Data Report, the Cystic Fibrosis Foundation reports that meconium ileus is the first symptom that points to CF in 13.1% of babies eventually found to have CF. Of those, 13.8% of those babies had a severe enough blockage that it caused bowel perforation.3
How is it diagnosed?
Babies with meconium ileus may not pass the first stool for several days, vomit, and have a swollen belly. In some cases, a prenatal ultrasound may reveal that the baby’s intestines are blocked. After birth, if meconium ileus is suspected, the child’s doctor will order an X-ray of the abdomen. X-rays may show a blockage, larger than normal small intestines, and smaller than usual colon because nothing is passing through.
What is the treatment for meconium ileus?
If meconium ileus is suspected, doctors will prescribe an enema that contains medicines to help break up the meconium. During this period, the baby will be fed and given the medicine through an intravenous line (IV). A small nasogastric tube (NG) will be placed in the infant’s nose to help remove excess air and fluid in the stomach.1
If the X-ray reveals a perforation or twisted intestines, or if the enema doesn’t work, immediate surgery is needed. This surgery is called a bowel resection.
Surgery for meconium ileus
Only 13.8% of babies with meconium ileus need surgery for bowel obstruction or perforation.3 In bowel resection surgery, a piece of the small intestine is brought out to the surface of the skin to create an ileostomy. This is temporary. The bowel is reconnected later. Infants that have this surgery are cared for afterward in the Newborn Intensive Care Unit (NICU) until they are ready to go home.1