THE BURDEN OF NON OPERATIVE MANAGEMENT OF CHILDREN WITH PNEUMATOSIS INTESTINALIS BEYOND THE NEONATAL PERIOD: AN OPPORTUNITY FOR DECREASING RESOURCE UTILIZATION?
Brianna L. Spencer*, Bryan Aaron, Sydni Imel, Ronald B. Hirschl, Samir Gadepalli
Surgery, University of Michigan Michigan Medicine, Ann Arbor, MI
Background: Pneumatosis intestinalis (PI), when found in the neonatal period is concerning for necrotizing enterocolitis (NEC). Unfortunately, management of PI outside the neonatal period remains unclear. We sought to identify comorbidities associated with PI and resources used in the treatment of the disease.
Methods: We conducted a single institution retrospective chart review of pediatric patients (6months -18 years) with a diagnosis of pneumatosis, excluding by age (<6 months and >18 years) or with a prior or current diagnosis of NEC. We collected demographics (age, gender, race, insurance), comorbidities (congenital anomalies, genetic defects, immunosuppression) and hospital course(s) with need for operation as primary outcome. Secondary outcomes included readmission and number of total parenteral nutrition (TPN) days. We defined insurance as private or public (Medicare/Medicaid). Serial imaging was defined as one or more X-rays or other imaging within 24 hours on consecutive days from diagnosis. Descriptive statistics were used.
Results: Of the 66 patients (median age 7y IQR 10, 65% male, 71% white, 53% private insurance), 40/66 (60%) were gastrostomy tube dependent, and 60/66 (90%) had comorbidities: congenital anomaly 36/60 (60%), genetic defect 10/60 (17%), or immunosuppression 14/60 (23%). All patients had imaging as part of a workup for abdominal symptoms and were made NPO at the time of diagnosis (median NPO 8d IQR 5), with 60/66 (86%) requiring TPN, 63/66 (95%) patients receiving antibiotics. 12/66 (18%) were readmitted at least once with a similar diagnosis but none required the OR at a maximum of 4 years from initial diagnosis. 3/66 (5%) patients were made NPO from diagnosis did not receive antibiotics and did not go to the OR for pneumatosis. Resource utilization included length of stay (median 32d IQR 56), serial imaging (median 3d IQR 2), and antibiotic use (median 7d IQR 4), without differences in gender, race, or insurance. Only 5/66 (8%) required an operation (median 0d IQR 1.5): 4 had free air, 2 had laparoscopy without further intervention, 3 had perforation with pneumatosis and required bowel resection. All operations were performed within 3 days of PI diagnosis.
Conclusions: In children with PI past the neonatal period, associated comorbidities were common. With operative need identified early in the disease course, further studies are needed to determine if we can reduce resource utilization.
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