The treatment of choice for neonates with uncomplicated meconium ileus is:

C. Intravenous hydration and a gastrograffin enema.

 DISCUSSION: Meconium ileus is a form of intestinal obstruction that occurs in 10% to 15% of neonates with cystic fibrosis. The obstruction is related to intraluminal concretions of abnormal meconium. The treatment of choice is adequate hydration and evacuation with a hypertonic gastrograffin enema. The hyperosmolar contrast material causes an outpouring of fluids into the bowel lumen, which flushes out the obstructing meconium and negates the need for laparotomy. Observation alone is not a useful method of treatment. When gastrograffin evacuation fails, laparotomy, placement of a pursestring suture in the bowel wall, and intraluminal irrigation with saline and gastrograffin (administered through a catheter inserted through a small enterotomy within the pursestring) will often clear the obstructing meconium. This obviates the need for resection or enterostomy in most cases. Postoperatively, a sweat chloride test should be obtained to confirm the diagnosis of cystic fibrosis. Pancreatic enzyme should be given when diet is initiated.