A score based on findings seen on plain radiographs of the abdomen can be used to evaluate a neonate having difficulty in evacuating meconium. This can be used to determine if the neonate has meconium plus syndrome, meconium ileus or neonatal Hirschsprung's disease. The authors are from the Erasmus University in Rotterdam, the Netherlands.
Radiographic parameters used:
(1) dilatation of bowel loops
(2) varying loop calibre
(3) fluid levels
(4) colonic gas
Parameter |
Finding |
Points |
dilatation of bowel loops (DBL) |
absent |
0 |
|
present |
1 |
varying loop calibre (VLC) |
absent |
0 |
|
present |
1 |
fluid levels (FL) |
absent |
0 |
|
present |
1 |
colonic gas (CO) |
absent |
0 |
|
present |
1 |
meconium plug syndrome score =
= (12 * (points for dilatation of bowel loops)) + (points for colon gas) + 3
meconium ileus score =
= (11 * (points for dilatation of bowel loops)) + (12 * (points for varying loop calibre)) + (3 * (points for fluid levels))
neonatal Hirschsprung's disease score =
= (6 * (points for dilatation of bowel loops)) + (10 * (points for fluid levels)) + (5 * (points for colon gas)) + 1
Interpretation:
• minimum meconium plug syndrome score: 3
• maximum meconium plug syndrome score: 16
• other possible scores for meconium plug syndrome score: 4, 15
• minimum meconium ileus score: 0
• maximum meconium ileus score: 26
• possible scores for meconium ileus score: 3, 11, 12, 15
• minimum points for neonatal Hirschsprung's disease score: 1
• maximum points for neonatal Hirschsprung's disease score: 22
• possible scores for neonatal Hirschsprung's disease score: 6, 7, 11, 12, 16, 17
• The score with the maximum number of points in a patient is taken to be the probable diagnosis.
Additional testing to confirm diagnosis:
(1) Hirschsprung's disease: rectal biopsy
(2) meconium ileus: sweat testing or other test for cystic fibrosis; evidence of meconium impaction causing small bowel obstruction
(3) meconium plug syndrome: improvement after klysma or Gastrografin enema
Performance:
• The overall diagnostic accuracy was 89%.
Specialty: Pedatrics
ICD-10: ,