CLINICAL RISK FACTORS OF HIRSCHSPRUNG-ASSOCIATED ENTEROCOLITIS IN
THE NEWBORN
Huimin Xia, Liankang Wu,
Zhiqiang Zhu, Hongwen Xu, Shuiqiong Li, Jiaxiong Xie
Department of Pediatric
Surgery, Guangzhou Children Hospital, Guangzhou, China
Background/Purpose: Enterocolitis continues
to be the major cause of morbidity and mortality in newborn with
Hirschsprung's disease. The exact etiology of Hirschsprung's-associated
enterocolitis is not known.This study was therefore identified risk factors
associated with hirschsprng of
newborn
Methods: 147 newborn with HD treated from
1995 through 2000 at our Hospital were assessed. Risk factors were examined
in following items: patient factors (gender, age at diagnosis, age and
weight at pull-through), technical factors (type of repair, number of
stages, location of transition zone, previous EC),
Results: In 107 patients, the
incidence of EC was 34.44%(n=31). The extent of aganglionosis in the all
newborn with EC was as follows:common type restricted to the rectosigmoid
or descending colon (n =19 ,61.29 %); long segment (n = 9,29.03%); total
colon (n=3,9.68%),unknown length because of death without autopsy (n
=10,32.4%) . The median age at operation was 19.1 day .Surgical procedures
used for short and common-segment disease were Soave with colostomy (n =
96), for long-segment disease
were Martin (n = 3), and ileostomy only in = 2). and the others were not
classified because of death before curative surgery. Enterocolitis (EC) was
the most common cause of death (five cases) The risk of EC was no
significantly increased by gender, age at diagnosis, age and weight The
presence of EC significantly increased the number of hospital admissions,
mean length of stay, and total treatment cost.
Conclusion: HEC can be characterized
as abdominal distension and explosive diarrhea associated with the
intestinal cutoff sign and the occurrence of explosive diarrhea in any
newborn with HD is suggestive of HEC, even in the absence of systemic
symptoms, and should be treated to avoid the morbidity and potential
mortality of HEC. The most effective method of prophylaxis and treatment of
enterocolitis is decompression of a stretched colon with the aid of the
irrigation technique.