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.
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
Externí odkaz: