Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management.
Autor: | Bokova E; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA., Prasade N; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA., Lewis WE; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA., Feira CN; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA., Lim IIP; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA., Oyetunji TA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA., Rentea RM; Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Electronic address: rrentea@cmh.edu. |
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Jazyk: | angličtina |
Zdroj: | Journal of pediatric surgery [J Pediatr Surg] 2024 Jul; Vol. 59 (7), pp. 1245-1249. Date of Electronic Publication: 2024 Mar 14. |
DOI: | 10.1016/j.jpedsurg.2024.03.012 |
Abstrakt: | Background: Pull-through procedures for Hirschsprung disease (HD) can be performed during the Neonatal Intensive Care Unit (NICU) stay or delayed until discharge following home irrigations. This study assesses the safety of a delayed pull-through as an alternative to neonatal reconstruction in infants with successful abdomen decompression with home irrigations based on Hirschsprung-associated enterocolitis (HAEC) development. Methods: A single-institution retrospective review of neonates with HD who underwent delayed or neonatal pull-through from July 2018-July 2022. Endpoints included post-pull-through HAEC incidence, recurrence at an 18-month follow-up, time to the first HAEC episode, NICU length of stay (LOS), and HAEC-related LOS. Results: Twenty-four neonates were included. Eighteen were discharged from the NICU with home irrigations. Of these, 3 (28%) developed enterocolitis preoperatively, 12 (67%) underwent a delayed pull-through. NICU LOS in the delayed cohort was 3 times shorter than in the neonatal (6 vs. 18 days, p < 0.01). The incidence of enterocolitis (82% vs. 80%), time to the first episode (43 vs. 57 days), and HAEC-related LOS (median of 3 days) were similar. Conclusions: Delayed HD pull-through is a viable neonatal reconstruction alternative that reduces NICU stay without increasing the risk of postoperative HAEC development. Type of Study: Original Research Article. Level of Evidence: III. (Copyright © 2024 Elsevier Inc. All rights reserved.) |
Databáze: | MEDLINE |
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