Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management.

Creator(s)

Elizaveta Bokova, Children's Mercy Kansas CityFollow
Ninad Prasade, Children's Mercy Kansas City
Wendy E. Lewis, Children's Mercy Kansas CityFollow
Christine N. Feira, Children's Mercy Kansas CityFollow
Irene Isabel P. Lim, Children's Mercy Kansas CityFollow
Tolulope A. Oyetunji MD MPH, Children's Mercy Kansas CityFollow
Rebecca M. Rentea, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

7-2024

Identifier

DOI: 10.1016/j.jpedsurg.2024.03.012

Abstract

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.

Journal Title

Journal of pediatric surgery

Volume

59

Issue

7

First Page

1245

Last Page

1249

MeSH Keywords

Humans; Hirschsprung Disease; Infant, Newborn; Retrospective Studies; Intensive Care Units, Neonatal; Male; Female; Enterocolitis; Therapeutic Irrigation; Length of Stay; Postoperative Complications; Decompression, Surgical; Incidence

Keywords

Anorectal tube; Enterocolitis; Hirschsprung disease home rectal irrigation; Hirschsprung-associated enterocolitis; Neonate; Pull-through; Rectal irrigation; Single-stage surgery

Recommended Citation

Bokova E, Prasade N, Lewis WE, et al. Evaluation of Post-neonatal Intensive Care Unit Home Irrigations Prior to Pull-through: Implications for Hirschsprung Disease Management. J Pediatr Surg. 2024;59(7):1245-1249. doi:10.1016/j.jpedsurg.2024.03.012