A Score Based on Plain Abdominal Radiographs for Separating Meconium Plug Syndrome, Meconium Ileus and Hirschsprung's Disease in the Neonate

 

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%.