Smelt is the first stool of a baby and is usually excreted within 24 hours after birth. It is sticky, chewy, dark green to almost black, and usually quite profuse. The expulsion of meconium is one of the reasons for the loss of birth weight in a child, which often worries parents. Premature meconium excretion causes green amniotic fluid. What does the lack of meconium after birth show?

Smółka - what is it?

Smelts begin to build up in the baby's intestines at 4-5. month of fetal life. Meconium owes its dark color to the anaerobic transformation of bile. Your newborn's stools may remain black for about 3 days. Over the following days, the stools turn brownish green with distinct clumps of milk. The color and texture of the stools will change as your baby grows.

The number of bowel movements in a newborn largely depends on how the baby is fed. If your baby is breastfed, you may have a bowel movement every time you feed. Usually, however, the stool is quite sparse, runny, and soaks into the nappy quickly.

The time it takes to expel meconium is important for further medical treatment and for ensuring your baby is properly cared for. Therefore, it is often recommended that young and inexperienced mums write down the time and appearance of their first stool.

What does meconium consist of?

The meconium consists mainly of:

  • amniotic fluid
  • smudge
  • exfoliated epithelium of the digestive tract
  • digestive enzymes
  • bilirubin
  • biliwerdyna
  • cholesterol

Removing meconium too early

It is unfavorable to expel meconium too early, that is, before the baby is born into the world. In this situation, green amniotic fluid is formed. The risk of a child developing aspiration pneumonia increases. Meconium in the amniotic fluid is usually found in pregnancies of 42 weeks or more.

What does no meconium mean?

Lack of stools in the first 24 hours of a newborn's life prompts doctors to carry out very thorough tests that will exclude or confirm the presence of a congenital defect in the baby.

If the child has not released meconium in the first days of life, it may be a sign of a serious medical condition, e.g. cystic fibrosis.

When meconium does not appear within 24 hoursafter birth, gastrointestinal obstruction may be suspected. Most often, however, it is about two diseases, Hirschsprung's disease and meconium obstruction.

Hirschsprung disease

It is a disease of the large intestine, and more precisely its final segment, i.e. the colon. The essence of the disease is that in children with this disease, nerve cells have not developed, and their lack makes the faecal mass unable to move properly. In a milder form of the disease, the first problems may appear in a child who is already several months old. The disease can also develop in adults.

According to medical statistics, Hirschsprung's disease is found once in 100,000 births. It has a genetic background and often runs in families. It is diagnosed much more often in boys than in girls. Children who have congenital heart disease or Down's syndrome are primarily at risk.

In older children or adults, the most characteristic symptoms of the disease are problems with defecation - diarrhea, constipation and vomiting. Sometimes the disease causes serious damage to the intestines, which is why it is so important to make an early diagnosis. In newborns with Hirschsprung's disease, the following is usually observed:

  • inability to have a bowel movement on the first or second day of life
  • swollen belly, gas or gas
  • diarrhea
  • vomiting which may contain a green or brown substance

Older children develop abdominal swelling, constipation, difficulty gaining weight, vomiting, and gas. Children with suspected Hirschsprung disease are given an enema with a special contrast agent and then an X-ray is taken. If the child is sick, where there are no nerve cells, the intestine will be visibly constricted.

In some cases it may be necessary to collect material for histopathological examination. For example, manometry is performed in older children. The test involves inserting a special balloon through the anus to check whether it will allow the muscles of the anus to relax. If not, then Hirschsprung's disease may be suspected.

The best results are achieved by surgical treatment, which consists in removing a fragment with no nerve cells and connecting the intestine. If the sick person is in a serious condition, the first thing to do is to remove the sick section and create a stoma. Only when the patient's condition stabilizes, the next stage of the procedure, i.e. intestinal anastomosis, is performed.

Meconium obstruction

Another cause of the lack of meconium in a child in the first 24 hours of life may be an obstructionmeconium, which is very often considered the first symptom of cystic fibrosis. This symptom occurs in 5-20% of all newborns with cystic fibrosis.

Lack of meconium in such cases is caused by a lack of pancreatic enzymes. The consequence of this is that the meconium cannot dissolve, it turns into sticky lumps that clog the intestinal lumen. The disease can be confirmed during the ultrasound examination of the fetus. Apart from the lack of meconium, children with meconium obstruction also develop vomiting and abdominal distension.

Blockage of the intestinal lumen can lead to twisting, entrapment or atresia of the intestine. There may also be intestinal perforation and meconium peritonitis. The appearance of a meconium obstruction is not used to assess the severity of cystic fibrosis.

About the authorAnna Jarosz A journalist who has been involved in popularizing he alth education for over 40 years. Winner of many competitions for journalists dealing with medicine and he alth. She received, among others The "Golden OTIS" Trust Award in the "Media and He alth" category, St. Kamil awarded on the occasion of the World Day of the Sick, twice the "Crystal Pen" in the national competition for journalists promoting he alth, and many awards and distinctions in competitions for the "Medical Journalist of the Year" organized by the Polish Association of Journalists for He alth.

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