Veras Laura V, Chotai Pranit N, Tumen Andrew Z, Gosain Ankush
Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.
J Surg Res. 2018 Sep;229:102-107. doi: 10.1016/j.jss.2018.03.069. Epub 2018 Apr 23.
Cloaca, Hirschsprung disease, and anorectal malformations (CHARM) are congenital anomalies of the hindgut. Small series have suggested that children suffering from one of these anomalies may be at risk for growth impairment. We sought to expand on these findings in a comprehensive cohort, hypothesizing that patients with Medicaid insurance or African-American (AA) race would be at higher risk for poor growth.
Following Institutional Review Board (IRB) approval, single-institution retrospective review of children with CHARM anomalies was performed (2009-2016). Body mass index (BMI) value Z-scores were obtained using the 2006 World Health Organization (age 0-24 mo) and 2000 Centers for Disease Control (CDC) (age >2 y) growth charts and calculators (statistical analysis system). Patient factors and BMI Z-scores were analyzed with descriptive statistics and Fisher's exact test.
One hundred sixty-six patients (Cloaca n = 16, Hirschsprung disease [HD] n = 71, anorectal malformation [ARM] n = 79) were identified. The BMI Z-score distribution for the entire CHARM cohort was lower than controls (P < 0.0001). HD and ARM BMI Z-scores were also lower versus controls (P < 0.0007, P < 0.0037). Requiring more or less than the average number of surgeries did not impact BMI Z-score [P = non-significant (NS)]. Patients with Medicaid had lower Z-scores versus private or commercial insurance (P < 0.0001). AA race BMI Z-score distribution was lower than controls (P < 0.0002), but there was no statistical difference in BMI Z-scores when comparing AA versus non-AA CHARM patients (P = NS).
Patients born with CHARM anomalies are at risk for impaired growth. Furthermore study is warranted to identify modifiable risk factors contributing to this impairment. Longitudinal follow-up should include interventions to mitigate these risks.
泄殖腔、先天性巨结肠和肛门直肠畸形（CHARM）是后肠的先天性异常。小规模研究表明，患有这些异常之一的儿童可能有生长发育受损的风险。我们试图在一个综合队列中扩展这些发现，假设参加医疗补助保险的患者或非裔美国人（AA）种族的患者生长发育不良的风险更高。
在获得机构审查委员会（IRB）批准后，对患有CHARM异常的儿童进行了单机构回顾性研究（2009 - 2016年）。使用2006年世界卫生组织（0 - 24个月龄）和2000年疾病控制中心（CDC）（年龄>2岁）的生长图表和计算器（统计分析系统）获得体重指数（BMI）值Z评分。对患者因素和BMI Z评分进行描述性统计分析和Fisher精确检验。
共确定了166例患者（泄殖腔畸形n = 16，先天性巨结肠[HD] n = 71，肛门直肠畸形[ARM] n = 79）。整个CHARM队列的BMI Z评分分布低于对照组（P < 0.0001）。HD和ARM的BMI Z评分也低于对照组（P < 0.0007，P < 0.0037）。手术次数多于或少于平均次数对BMI Z评分没有影响[P = 无统计学意义（NS）]。参加医疗补助保险的患者的Z评分低于参加私人或商业保险者（P < 0.0001）。AA种族的BMI Z评分分布低于对照组（P < 0.0002），但比较AA与非AA CHARM患者的BMI Z评分时无统计学差异（P = NS）。
患有CHARM异常的患者有生长发育受损的风险。有必要进一步研究以确定导致这种损害的可改变风险因素。纵向随访应包括减轻这些风险的干预措施。
