Low-risk pneumatosis intestinalis in the pediatric surgical population
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In brief
In brief
Retrospective study of 91 children with pneumatosis intestinalis at Children's Hospital Colorado (2009-2019) identifies low-risk criteria and demonstrates that shortened antibiotic therapy (≤3 days) is safe for stable patients over age 1 without cancer/BMT history. Outcomes did not differ between surgical and pediatric management approaches.
Written by the GCMD Library team from the article.
Abstract
Background
Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician’s field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI.
Methods
We performed a retrospective review of all children over age 1 year treated at Children’s Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention.
Results
Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3 days or less of antibiotics and those who received more than 3 days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians.
Conclusions
Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3 days of antibiotic therapy and NPO.
Level of evidence
Level III.