Plain film diagnosis in meconium plug syndrome, meconium ileus and neonatal Hirschsprung's disease. A scoring system.

Abdominal plain films of 133 neonates, with 82 cases of meconium plug syndrome (MPS), 27 cases of meconium ileus (MI) and 24 cases of neonatal Hirschsprung's disease (HD), were reviewed to assess the value of such radiographs for diagnosis. The radiographs were examined according to a list of 11 parameters. By using multivariate discriminant analysis, it appeared that 4 parameters i.e. dilatation of bowel loops, varying loop calibre, fluid levels and colonic gas were most important in discriminating among the three disorders. For each parameter the weight (in points) was derived. To classify patients, three group-scores had to be calculated: the group-score with the largest value indicated the most likely disorder. So in 99%, 88% and 63% of MPS, HD and MI, respectively, an accurate diagnosis could be predicted. The overall diagnostic accuracy was 89%. Such a diagnosis can be a sound basis for further investigation.