Should we look for Hirschsprung disease in all children with meconium plug syndrome?
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Read the article on jpedsurg.org ↗Article · Mar 2019 · 1 min read
In brief
In brief
Multi-institutional study reveals significant variation in rectal biopsy utilization for meconium plug syndrome, with biopsy rates ranging 0-80% despite similar Hirschsprung disease prevalence (40.5% in biopsied patients). Early biopsy increased timely HD diagnosis by 35% per additional case, suggesting standardized screening protocols could reduce delayed diagnoses.
Written by the GCMD Library team from the article.
Background
Meconium plug syndrome (MPS) is associated with Hirschsprung disease (HD) in 13–38% of cases. This study sought to assess institutional variation in utilization of rectal biopsy in children with MPS and the likelihood of diagnosing HD in this population.
Methods
Patients with MPS on contrast enema in the first 30 days of life from the Pediatric Health Information System database in 2016–2017 were included. Institutional rates of rectal biopsies performed during the initial admission were calculated and then used to predict institutional rates of early HD diagnoses using Poisson regression.
Results
Of 373 newborns with MPS, 106 (28.4%) underwent early rectal biopsy, of whom 43 (40.5%) had HD. Fifty-seven (15.3%) were ultimately diagnosed with HD. Eight (14%) of these patients had a delayed diagnosis. HD rates between institutions did not differ significantly (range 0–50%, p=0.52), but usage of early rectal biopsy did (range 0–80%, p=0.03). Each additional early biopsy increased the early HD diagnosis rate by 35% (β=0.30, 95% CI 0.15–0.45, p