Social Determinants of Health and Hirschsprung-associated Enterocolitis

Knaus, Maria E.; Pendola, Gabriella; Srinivas, Shruthi; Wood, Richard J.; Halaweish, Ihab

doi:10.1016/j.jpedsurg.2022.09.039

Cited by 6 publications

(3 citation statements)

References 40 publications

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“…Additionally, socioeconomic risk factors for the development of HAEC have been identified. In a study of 100 children awaiting surgical correction for HSCR, the authors found that patients that used public transportation for clinic visits, had one or more missed appointments, had any reported safety concerns, had parents or guardians who were not married, lived with people other than their immediate family, or had mothers who reported drug use or lack of prenatal care were found to have a higher likelihood of developing HAEC[ 29 ].…”

Section: Hirschsprung’s Disease Associated Enterocolitismentioning

confidence: 99%

Hirschsprung's disease associated enterocolitis: A comprehensive review

Es¹,

Rodriguez²,

Arbizu³

2023

World J Clin Pediatr

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Hirschsprung’s disease (HSCR) is a congenital disorder characterized by failure of the neural crest cells to migrate and populate the distal bowel during gestation affecting different lengths of intestine leading to a distal functional obstruction. Surgical treatment is needed to correct HSCR once the diagnosis is confirmed by demonstrating the absence of ganglion cells or aganglionosis of the affected bowel segment. Hirschsprung’s disease associated enterocolitis (HAEC) is an inflammatory complication associated with HSCR that can present either in the pre- or postoperative period and associated with increased morbidity and mortality. The pathogenesis of HAEC remains poorly understood, but intestinal dysmotility, dysbiosis and impaired mucosal defense and intestinal barrier function appear to play a significant role. There is no clear definition for HAEC, but the diagnosis is primarily clinical, and treatment is guided based on severity. Here, we aim to provide a comprehensive review of the clinical presentation, etiology, pathophysiology, and current therapeutic options for HAEC.

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Section: Hirschsprung’s Disease Associated Enterocolitismentioning

confidence: 99%

Hirschsprung's disease associated enterocolitis: A comprehensive review

Es¹,

Rodriguez²,

Arbizu³

2023

World J Clin Pediatr

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“…10,11 Our study is the first to demonstrate the role of SDOH in success following BMP in children with ARM. 5,8 Antegrade continence enema (ACE) procedures, including appendicostomies or cecostomiess are generally reserved for patients with noncompliance or nonadherence to rectal enemas, as they allow for more functional independence. [12][13][14][15] This study shows that older children who underwent ACE procedures had improved outcomes.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…7 A recent study demonstrated a correlation between specific SDOH elements, such as involvement with Child Protective Services (CPS), maternal drug use, and missed clinic appointments with the development of Hirschsprung-associated enterocolitis in children with Hirschsprung's disease. 8 Prior studies in ARM have linked failure in BMPs to nonadherence and failure to identify the appropriate individualized regimen, but no study has examined the association between BMP failure and SDOH. The goal of this study was to investigate the association between SDOH and outcomes following BMP in patients with ARM.…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Health Are Associated with Failed Bowel Management for Children with Anorectal Malformations

Srinivas,

Knaus,

Campbell

et al. 2024

Eur J Pediatr Surg

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Introduction Children with anorectal malformations (ARMs) benefit from bowel management programs (BMPs) to manage constipation or fecal incontinence. We aimed to understand the role of social determinants of health (SDOH) in outcomes following BMPs in this population. Materials and Methods A single-institution, IRB-approved, retrospective review was performed in children with ARM who underwent BMP from 2014-2021. Clinical, surgical, and SDOH data were collected. Children were stratified as clean or not clean per Rome IV criteria at the completion of BMP. Descriptive statistics were computed. Categorical variables were analyzed via Fisher’s exact tests and continuous variables with Mood’s median tests. Results There were 239 patients identified who underwent BMP, with median age of 6.62 years [IQR: 4.78 – 9.83]. Of these, 81 (34%) were not clean after completing BMP. Children with prior history of antegrade enema procedures had more failure. Children who held public insurance, lived within driving distance, had unmarried parents, lived with extended family, and lacked formal support systems had a significant association with BMP failure (p<0.05 for all). Type of ARM, age at repair, type of repair, age at BMP, and type of BMP regimen were not significantly associated with failure. Conclusions There is a significant correlation of failure of BMPs with several SDOH elements in patients with ARM. Attention to SDOH may help identify high-risk patients in whom additional care may lead improved outcomes following BMP.

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