After anoplasty for anorectal malformations: Issues continue in adolescence and adulthood

Chen, J.C.; Gasior, Alessandra C

doi:10.1016/j.scrs.2023.100989

Cited by 1 publication

(1 citation statement)

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“…In addition, these first few days represent an important time in which to begin developing a therapeutic relationship with caregivers [6]. This relationship will likely extend beyond the immediate timeframe and may last for years as the child progresses through the stages of life with an ARM, including surgical interventions, bowel management programs, discussions of fertility and reproductive potential, and eventual transfer to adult care [7].…”

Section: Introductionmentioning

confidence: 99%

Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations

Srinivas,

Gasior,

Driesbach

et al. 2024

Children

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Neonates with a new diagnosis of anorectal malformation (ARM) present a unique challenge to the clinical team. ARM is strongly associated with additional midline malformations, such as those observed in the VACTERL sequence, including vertebral, cardiac, and renal malformations. Timely assessment is necessary to identify anomalies requiring intervention and to prevent undue stress and delayed treatment. We utilized a multidisciplinary team to develop an algorithm guiding the midline workup of patients newly diagnosed with ARM. Patients were included if born in or transferred to our neonatal intensive care unit (NICU), or if seen in clinic within one month of life. Complete imaging was defined as an echocardiogram, renal ultrasound, and spinal magnetic resonance imaging or ultrasound within the first month of life. We compared three periods: prior to implementation (2010–2014), adoption period (2015), and delayed implementation (2022); p ≤ 0.05 was considered significant. Rates of complete imaging significantly improved from pre-implementation to delayed implementation (65.2% vs. 50.0% vs. 97.0%, p = 0.0003); the most growth was observed in spinal imaging (71.0% vs. 90.0% vs. 100.0%, p = 0.001). While there were no differences in the rates of identified anomalies, there were fewer missed diagnoses with the algorithm (10.0% vs. 47.6%, p = 0.05). We demonstrate that the implementation of a standardized algorithm can significantly increase appropriate screening for anomalies associated with a new diagnosis of ARM and can decrease delayed diagnosis. Further qualitative studies will help to refine and optimize the algorithm moving forward.

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Section: Introductionmentioning

confidence: 99%