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Wands ZE, Cave DGW, Cromie K, Hough A, Johnson K, Mon-Williams M, Feltbower RG, Glaser AW. Early educational attainment in children with major congenital anomaly in the UK. Arch Dis Child 2024; 109:326-333. [PMID: 38262694 DOI: 10.1136/archdischild-2023-326471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe early educational attainment and special educational needs (SEN) provision in children with major congenital anomaly (CA) compared with peers. DESIGN Analysis of educational data linked to the ongoing Born in Bradford cohort study. Confounders were identified via causal inference methods and multivariable logistic regression performed. SETTING Children born in Bradford Royal Infirmary (BRI), West Yorkshire. PATIENTS All women planning to give birth at BRI and attending antenatal clinic from March 2007 to December 2010 were eligible. 12 453 women with 13 776 pregnancies (>80% of those attending) were recruited. Records of 555 children with major CA and 11 188 without were linked to primary education records. OUTCOMES Key Stage 1 (KS1) attainment at age 6-7 years in Maths, Reading, Writing and Science. SEN provision from age 4 to 7 years. RESULTS 41% of children with major CA received SEN provision (compared with 14% without), and 48% performed below expected standards in at least one KS1 domain (compared with 29% without). The adjusted odds of children with CA receiving SEN provision and failing to achieve the expected standard at KS1 were, respectively, 4.30 (95% CI 3.49 to 5.31) and 3.06 (95% CI 2.47 to 3.79) times greater than their peers. Those with genetic, heart, neurological, urinary, gastrointestinal and limb anomalies had significantly poorer academic achievement. CONCLUSIONS These novel results demonstrate that poor educational attainment extends to children with urinary, limb and gastrointestinal CAs. We demonstrate the need for collaboration between health and education services to assess and support children with major CA, so every CA survivor can maximise their potential.
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Affiliation(s)
- Zoë E Wands
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel G W Cave
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kirsten Cromie
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
| | - Amy Hough
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Kathryn Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Congenital Anomaly and Rare Disease Registration Service, London, UK
| | - Mark Mon-Williams
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Adam W Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Koo FEC, Chan MCE, King SK, Trajanovska M. The early years: hirschsprung disease and health-related quality of life. Qual Life Res 2023; 32:3327-3337. [PMID: 37474849 DOI: 10.1007/s11136-023-03482-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
PURPOSE Chronic diseases are notorious in the way that they interfere with many aspects of a child's development, and this holds true for children with Hirschsprung disease (HD). The present research aims to (1) determine whether the health-related quality of life (HRQoL) of HD children differs from healthy paediatric populations; and (2) explore the relationship between HD children's HRQoL and psychosocial outcomes of parents. METHODS Using a cross-sectional survey study design, children's HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL), while parental psychosocial outcomes were measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression short-forms, Family Management Measure (FaMM), and Parent Experience of Child Illness. Surveys were administered over telephone to parents of 48 Australian children treated for HD (87.5% male, median age 4.5 years) during the period May to November 2021. RESULTS While postoperative HRQoL of HD children was comparable to that of healthy age-matched controls, psychosocial quality of life of HD children was significantly poorer (mean difference = 3.40, CI [0.05, 6.76]). All parental outcome measures were significantly correlated with the PedsQL (r = - 0.77-0.67, p < 0.05) in expected directions, with FaMM subscales (except parent mutuality) demonstrating the most variation (R2 = 0.41-0.59). Of note, 31.3% of parents reported moderate to severe symptoms of anxiety on the PROMIS. CONCLUSION Despite overall positive results for children, parents reported elevated symptoms of anxiety. This study highlights the importance of long-term follow-up care for HD patients and their families.
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Affiliation(s)
- Fern Ee Caryn Koo
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, VIC, Australia
- Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, Australia
| | - Man Ching Esther Chan
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, VIC, Australia
| | - Sebastian K King
- Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia
- Department of Paediatric Surgery, The Royal Children's Hospital, Parkville, VIC, Australia
| | - Misel Trajanovska
- Clinical Sciences, Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
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Dellenmark-Blom M, Reilly C, Öst E, Örnö Ax S, Svensson JF, Kassa AM, Jönsson L, Abrahamsson K, Gatzinsky V, Tollne AM, Omling E, Stenström P, Engstrand Lilja H. Schooling experiences in children with long-gap esophageal atresia compared with children with esophageal atresia and primary anastomosis: a Swedish study. Orphanet J Rare Dis 2023; 18:233. [PMID: 37550744 PMCID: PMC10408199 DOI: 10.1186/s13023-023-02846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Children with long-gap esophageal atresia (LGEA) risk living with aerodigestive morbidity and mental health difficulties. No previous study has investigated their experiences of schooling, despite the importance of schools in children's development, learning and social relationships. We aimed to describe experiences of schooling in children with LGEA in Sweden in comparison with children with EA who had primary anastomosis. METHOD Children with LGEA aged 3-17 were recruited nationwide in Sweden. One parent completed a survey on their child's school-based supports (according to definitions from the Swedish National Agency for Education), school absence, school satisfaction, school functioning (PedsQL 4.0), mental health (Strength and Difficulties Questionnaire) and current symptomatology. School data were compared between 26 children with LGEA to that from 95 children with EA who had PA, a hypothesized milder affected group. Mental health level was determined using validated norms; abnormal ≥ 90 percentile. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05. RESULTS Formal school-based support was reported in 17 (65.4%) children with LGEA and concerned support with nutritional intake (60%), education (50%) and medical/special health needs (35%). The prevalence of school-based support was significantly higher compared to children with PA overall (36.8%, p = 0.013) and regarding nutritional intake support (20%, p < 0.001). In children with LGEA, school-based support was related to low birth weight (p = 0.036), young child age (p = 0.014), height ≤ -2SD for age/sex (p = 0.024) and an increased number of aerodigestive symptoms (p < 0.05). All children with LGEA who had abnormal mental health scores had school-based support, except for one child. Nine children with LGEA (36%) had school absence ≥ 1times/month the past year, more frequently because of colds/airway infections (p = 0.045) and GI-specific problems compared to PA (p = 0.003). School functioning scores were not significantly different from children with PA (p = 0.34) but correlated negatively with school-based support (< 0.001) and school absence (p = 0.002). One parent out of 26 reported their child's school satisfaction as "not good". CONCLUSIONS Children with LGEA commonly receive school-based support, reflecting multifaceted daily needs and disease severity. School absence is frequent and related to poorer school functioning. Future research focusing on academic achievement in children with EA is needed.
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Affiliation(s)
- M Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.
| | - C Reilly
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - E Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - S Örnö Ax
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - J F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - A-M Kassa
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - K Abrahamsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - A M Tollne
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Omling
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - P Stenström
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - H Engstrand Lilja
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Cowap M, Derraugh G, Shawyer AC, Balshaw R, Min SAL, Keijzer R. Educational outcomes in school age children with a history of isolated Hirschsprung disease are equivalent to their peers. J Pediatr Surg 2022; 57:851-854. [PMID: 35094837 DOI: 10.1016/j.jpedsurg.2021.12.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/29/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to assess real-world educational outcomes and developmental disorders in patients with a history of Hirschsprung disease compared to an age-matched control group. METHODS With ethics approval (H2016:014) a retrospective cohort study of all children diagnosed with Hirschsprung disease at a single centre from 1992 to 2017 was performed. A 10:1 date-of-birth matched control cohort was constructed from a population-based directory. The educational outcomes were compared using the following measures: Early Developmental Instrument, Grades 3, 7, and 8 assessments, Grade 9 completion, Grade 9 performance, and high school graduation. Fisher's exact tests were used to compare the odds of failure between cases to controls. Only children who reached 4 years of age were included. RESULTS A total of 75 cases with Hirschsprung disease patients were identified. Patients with Hirschsprung disease were at increased risk of failing to meet expectations on the Early Development Instrument. After entering elementary school, Hirschsprung patients were at no greater risk than their peers of failing to meet expectations on standardized testing or failing to graduate from high school. CONCLUSION Using real-world measures of academic success as a surrogate for neurodevelopmental status, our study demonstrates that patients with a history of Hirschsprung disease demonstrated poor neurodevelopmental performance in pre-school, but the educational achievements of patients did not differ from controls once they started school. These promising data can be used to mitigate preconceived notions that patients with Hirschsprung disease require special education, which may be isolating and psychosocially damaging.
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Affiliation(s)
- Michael Cowap
- Max Rady College of Medicine, Rady Faculty of Health Sciences, 260 Brodie Centre, 727 McDermot Ave, University of Manitoba, Winnipeg, Manitoba, Canada, R3E 3P5
| | - Gabrielle Derraugh
- Departments of Surgery and Pediatrics & Child Health, Division of Pediatric Surgery, AE402-820 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1S1
| | - Anna C Shawyer
- Departments of Surgery and Pediatrics & Child Health, Division of Pediatric Surgery, AE402-820 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1S1; Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba, Canada, R3E 3P4
| | - Rob Balshaw
- Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suyin A Lum Min
- Departments of Surgery and Pediatrics & Child Health, Division of Pediatric Surgery, AE402-820 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1S1; Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba, Canada, R3E 3P4
| | - Richard Keijzer
- Departments of Surgery and Pediatrics & Child Health, Division of Pediatric Surgery, AE402-820 Sherbrook St, Winnipeg, Manitoba, Canada, R3A 1S1; Children's Hospital Research Institute of Manitoba, 715 McDermot Ave, Winnipeg, Manitoba, Canada, R3E 3P4.
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Svetanoff WJ, Kapalu CL, Lopez JJ, Fraser JA, Briggs KB, Rentea RM. Psychosocial factors affecting quality of life in patients with anorectal malformation and Hirschsprung disease-a qualitative systematic review. J Pediatr Surg 2022; 57:387-393. [PMID: 34127258 DOI: 10.1016/j.jpedsurg.2021.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Little is known about psychosocial and behavioral factors that impact the quality of life of patient's with anorectal malformations (ARM) and Hirschsprung disease (HSCR). We aimed to highlight the psychosocial, emotional, and behavioral themes that affect these patients. METHODS A qualitative literature review of articles published between 1980 and 2019 was performed. Articles that reported quality of life (QoL) measures not directly related to bowel function and incorporated data on patients aged 0-21 years old were included. Data were separated based on distinct developmental time points. RESULTS In the neonatal period, parents relayed uncertainty about the future and feeling overwhelmed by lack of social support. Difficulties with anxiety, peer rejection, and behavioral problems were noted in primary grades, while adolescents experienced low self-confidence, poor body image, and depression. Young adults expressed hesitancy to engage in romantic relationships or sexual activity. Lack of long-term follow-up, an incomplete transition to adult healthcare, and lack of psychology services leave young adults without guidance to manage a chronic condition. CONCLUSION Multiple psychosocial stressors are present in the lives of ARM and HSCR patients. Provision of developmentally matched medical, psychological, and community-based supports for ARM and HSCR patients and their families can lead to improved QoL.
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Affiliation(s)
- Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Christina Low Kapalu
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital Kansas City, MO, United States; University of Missouri-Kansas City School of Medicine, United States
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - James A Fraser
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Kayla B Briggs
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States; University of Missouri-Kansas City School of Medicine, United States.
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Roorda D, Königs M, Eeftinck Schattenkerk L, van der Steeg L, van Heurn E, Oosterlaan J. Neurodevelopmental outcome of patients with congenital gastrointestinal malformations: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2021; 106:635-642. [PMID: 34112720 PMCID: PMC8543204 DOI: 10.1136/archdischild-2021-322158] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 12/29/2022]
Abstract
AIM Children with congenital gastrointestinal malformations may be at risk of neurodevelopmental impairment due to challenges to the developing brain, including perioperative haemodynamic changes, exposure to anaesthetics and postoperative inflammatory influences. This study aggregates existing evidence on neurodevelopmental outcome in these patients using meta-analysis. METHOD PubMed, Embase and Web of Science were searched for peer-reviewed articles published until October 2019. Out of the 5316 unique articles that were identified, 47 studies met the inclusion criteria and were included. Standardised mean differences (Cohen's d) between cognitive, motor and language outcome of patients with congenital gastrointestinal malformations and normative data (39 studies) or the studies' control group (8 studies) were aggregated across studies using random-effects meta-analysis. The value of (clinical) moderators was studied using meta-regression and diagnostic subgroups were compared. RESULTS The 47 included studies encompassed 62 cohorts, representing 2312 patients. Children with congenital gastrointestinal malformations had small-sized cognitive impairment (d=-0.435, p<0.001; 95% CI -0.567 to -0.302), medium-sized motor impairment (d=-0.610, p<0.001; 95% CI -0.769 to -0.451) and medium-sized language impairment (d=-0.670, p<0.001; 95% CI -0.914 to -0.425). Patients with short bowel syndrome had worse motor outcome. Neurodevelopmental outcome was related to the number of surgeries and length of total hospital stay, while no relations were observed with gestational age, birth weight, age and sex. INTERPRETATION This study shows that children with congenital gastrointestinal malformations exhibit impairments in neurodevelopmental outcome, highlighting the need for routine screening of neurodevelopment during follow-up.
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Affiliation(s)
- Daniëlle Roorda
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marsh Königs
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurens Eeftinck Schattenkerk
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Lideke van der Steeg
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
- Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Ernest van Heurn
- Department of Pediatric Surgery, Amsterdam Reproduction and Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Free University Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Neuroscience Group, Amsterdam Reproduction & Development Research Institute, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Wester T, Gunnarsdottir A, Skoglund C, Svenningsson A. Attention deficit hyperactivity and autism spectrum disorders in patients with anorectal malformations. Acta Paediatr 2021; 110:3131-3136. [PMID: 34498328 DOI: 10.1111/apa.16100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/07/2021] [Indexed: 12/18/2022]
Abstract
AIM To assess the risk of neurodevelopmental disorders in patients with anorectal malformations compared to controls. METHODS This was a population-based cohort study including all patients born in Sweden 1997-2012 with anorectal malformation in the Swedish National Patient Register and five matched controls per patient. Anorectal malformation was the exposure. All individuals were evaluated for the outcomes, attention deficit hyperactivity disorder or autism spectrum disorder in the National Patient Register. Data on drugs for attention deficit hyperactivity disorder were retrieved from the Swedish Prescribed Drug Register and used as proxy for attention deficit hyperactivity disorder. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Analyses were adjusted for confounders. RESULTS Five hundred and fifteen patients with anorectal malformations and 2560 controls were included. Patients with anorectal malformation had a higher risk of attention deficit hyperactivity disorder (OR 3.01 (95% CI, 1.83-4.95)) and autism spectrum disorders (OR 3.07 (95% CI, 1.62-5.79)) compared to the controls. Significantly more patients with anorectal malformation had been prescribed medication for attention deficit hyperactivity disorder compared to controls (OR 2.26 (95% CI 1.33-3.85)). CONCLUSION Patients with anorectal malformations have a higher risk of attention deficit hyperactivity disorder and autism spectrum disorders than controls.
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Affiliation(s)
- Tomas Wester
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | - Anna Gunnarsdottir
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
| | | | - Anna Svenningsson
- Department of Pediatric Surgery Karolinska University Hospital Stockholm Sweden
- Pediatric Surgery Research Unit Department of Women’s and Children’s Health Karolinska Institute Stockholm Sweden
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Quality of life and neuropsychological development at school age in Hirschsprung's disease. J Pediatr Surg 2020; 55:1481-1487. [PMID: 32063371 DOI: 10.1016/j.jpedsurg.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the quality of life and neuropsychological development of school-aged children with Hirschsprung's disease. METHODS In this observational monocentric study, a multidisciplinary team prospectively assessed quality of life, neuropsychometric development and bowel functional outcomes. This study was registered on ClinicalTrial.gov (NCT03406741). Kidscreen and VSP-A questionnaires assessed the quality of life and were compared to the reference population (Eurostat database). Intelligence, attention and executive functions, perceptual organization and memory were evaluated using the Wechsler Children's Intelligence Scale, the NEuroPSYchological assessment, and the Rey figure test. Bowel functional outcomes were obtained using the Krickenbeck score. RESULTS Fifteen patients were included, with a mean age of 10.25 years. The children's Kidscreen-assessed quality of life index was higher than the reference population (p = 0.01). The Full-Scale Intelligent Quotient was dissociated in 64% of children. The Perceptional Reasoning Index and the Processing Speed Index were observed at lower levels. There were no disturbances in executive functions. A satisfactory bowel functional outcome was noted in 46.7% of children. CONCLUSION Children with Hirschsprung's disease have been shown to have subtle decreased performances in some areas of intelligence. Performing a neuropsychological assessment upon entering elementary school could help to detect these specific learning disabilities. LEVELS OF EVIDENCE Level II, prognosis study.
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Kassa A, Dahl M, Strinnholm M, Engstrand Lilja H. Attention difficulties and physical dysfunction common in children with complex congenital malformations: a study of preschool children with VACTERL association. Acta Paediatr 2020; 109:783-789. [PMID: 30187514 PMCID: PMC7154541 DOI: 10.1111/apa.14566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 08/24/2018] [Accepted: 09/03/2018] [Indexed: 12/02/2022]
Abstract
Aim Knowledge on the neurodevelopmental and physical function in children with vertebral defects, anorectal malformations, cardiac defects, tracheo‐oesophageal fistula, renal and limb malformations (VACTERL) is scarce. We evaluated Swedish preschool children with VACTERL and identified whether they would need extra support in school. Methods From 2015 to 2017, we recruited children aged 5–7 with VACTERL association from the paediatric surgical centre at the University Children's Hospital at Uppsala. Neurodevelopmental function was assessed by age‐appropriate intelligence and visual and auditory attention tests, and the children's behaviour and attention were observed by an experienced psychologist. Physical function was evaluated through parental interviews and examinations. Data on patient characteristics, including any surgery and anaesthesia, were extracted from medical records. Results Of the 13 eligible families, 10 agreed to participate. Intelligence was within the normal range for all children, but attention difficulties were found in eight of the children, requiring adjustments at school, and two of these were later diagnosed with attention deficit hyperactivity disorder. All children had physical dysfunctions that affected their daily nutrition, bowel or bladder functions. Conclusion Attention difficulties and physical dysfunction were common in Swedish preschool children aged 5–7 with VACTERL and they would need support and adjustments when they started school.
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Affiliation(s)
- A‐M Kassa
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Section of Paediatric Surgery University Children's Hospital Uppsala Sweden
| | - M Dahl
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
| | - M Strinnholm
- Folke Bernadotte Regional Habilitation Centre University Children's Hospital Uppsala Sweden
| | - H Engstrand Lilja
- Department of Women's and Children's Health Uppsala University Uppsala Sweden
- Section of Paediatric Surgery University Children's Hospital Uppsala Sweden
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10
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No increased risk of attention deficit hyperactivity disorders in patients with Hirschsprung disease. J Pediatr Surg 2019; 54:2024-2027. [PMID: 30503197 DOI: 10.1016/j.jpedsurg.2018.10.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 12/29/2022]
Abstract
PURPOSE Hirschsprung disease (HSCR) has previously been associated with increased need of special education services despite normal intelligence. The aim of this study was to assess the risk of attention deficit hyperactivity disorders (ADHD) in individuals with HSCR in a population-based cohort. METHODS This was a nationwide, population-based cohort study. The study exposure was HSCR and the study outcome was ADHD. The cohort included all individuals with HSCR registered in the Swedish National Patient Register between 1964 and 2013 and ten age- and sex-matched controls per patient, randomly selected from the Population Register. RESULTS The cohort comprised 739 individuals with HSCR and 7390 controls. Twenty-six of the 739 individuals with HSCR and 202 of the 7390 controls were diagnosed with ADHD, Odds ratio (OR) 1.30, Confidence interval (CI) 95% 0.84-1.93, indicating no difference in risk for ADHD. The mean age at diagnosis of ADHD was not different between the groups; 18.1 years (SD 8.4) vs 16.7 years (SD 7.8), p = 0.39. Down syndrome did not affect the risk for ADHD, OR 2.26 (CI 95% 0.68-5.53). Female gender decreased the risk for ADHD, OR 0.58 (CI 95% 0.40-0.83). CONCLUSIONS There is no increased risk of ADHD in patients with Hirschsprung disease. LEVEL OF EVIDENCE Prognosis study, level of evidence: Level I.
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van der Bent A, Duggan EM, Fishman LN, Dickie BH. Reality check: What happens when patients with anorectal malformations grow up? A pilot study of medical care transition from the adult patient perspective. J Pediatr Surg 2018; 53:1722-1726. [PMID: 29605261 DOI: 10.1016/j.jpedsurg.2018.02.057] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/16/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There has been an increased focus on transition of pediatric and adolescent patients to adult centered care. For patients with rare and complex conditions, such as anorectal malformations (ARM), difficulties are compounded by the absence of structured transition protocols and lack of adult provider expertise. We sought to explore the actual experiences of adult patients with ARM and distinguish if there are factors that influence the ability to achieve satisfactory transition to adult centered medical care. METHODS Patients older than 18years with ARM were identified through a hospital database and social support networks, and invited to participate in an anonymous questionnaire. Patients were asked to describe their transition experience as well as report their demographics, and functional outcomes (bowel and bladder function). RESULTS Twenty-six surveys were completed. Comparison of those respondents (53%) who had transitioned to adult providers to those that had not yet transferred care demonstrated no difference in satisfaction with bowel and bladder function, presence of ostomy, and education level. There was a slight trend for patients with more complex malformations to seek further medical care with adult providers. Of those who transitioned, 67% reported no discussion prior to their transition and 71% received no recommendations for follow-up providers. CONCLUSIONS This pilot project suggests that a significant number of adult patients with ARM lack transition preparation and fail to find adult providers with expertise. Future studies will need to find optimal ways to address these issues. TYPE OF STUDY Survey. Retrospective Study LEVELS OF EVIDENCE: Level II.
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Affiliation(s)
- Annelotte van der Bent
- Department of Pediatric Gastroenterology, VU University Medical Center, Hemonystraat 64-3, 1074, BT, Amsterdam, The Netherlands.
| | - Eileen M Duggan
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
| | - Laurie N Fishman
- Department of Gastroenterology & Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States
| | - Belinda Hsi Dickie
- Department of Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States,.
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Abstract
Hirschsprung disease is a developmental defect of the enteric nervous system characterized by lack of enteric neurons in the distal hindgut. There are numerous reports on short-term outcomes indicating that impaired bowel function is common. Recently, several controlled studies show that bowel function outcomes are affected beyond childhood, in adolescents and adults, compared with healthy control subjects. Constipation and fecal incontinence are common. The impaired bowel function appears to have a negative impact on quality of life, although, a majority of patients have adapted to their symptoms. On the other hand, Hirschsprung disease seems to have limited impact on education and occupation in adult life. The aim of this review was to summarize current knowledge of bowel function outcome beyond childhood in patients with Hirschsprung disease.
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Affiliation(s)
- Tomas Wester
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Löf Granström
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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13
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IJsselstijn H, Gischler SJ, Wijnen RMH, Tibboel D. Assessment and significance of long-term outcomes in pediatric surgery. Semin Pediatr Surg 2017; 26:281-285. [PMID: 29110823 DOI: 10.1053/j.sempedsurg.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Treatment modalities for newborns with anatomical congenital anomalies have greatly improved over the past decades, with a concomitant increase in survival. This review will briefly discuss specific long-term outcomes to illustrate, which domains deserve to be considered in long-term follow-up of patients with anatomical congenital anomalies. Apart from having disease-specific morbidities these children are at risk for impaired neurodevelopmental problems and school failure, which may affect participation in society in later life. There is every reason to offer them long-term multidisciplinary follow-up programs. We further provide an overview of the methodology of long-term follow-up, its significance and discuss ways to improve care for newborns with anatomical congenital anomalies from childhood into adulthood. Future initiatives should focus on transition of care, risk stratification, and multicenter collaboration.
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Affiliation(s)
- Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands.
| | - Saskia J Gischler
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - René M H Wijnen
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC-Sophia Children's Hospital, Sk 1280, Wytemaweg 80, Rotterdam NL-3015 CN, The Netherlands
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14
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Tam PKH, Davenport M, Chan IHY, Numanoglu A, Hoebeke P, Diamond DA. Long-term implications and global impact of paediatric surgery. Lancet 2017; 390:1012-1014. [PMID: 28901925 DOI: 10.1016/s0140-6736(17)32341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 08/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Paul K H Tam
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong.
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, UK
| | - Ivy H Y Chan
- Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Alp Numanoglu
- Division of Paediatric Surgery, University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Piet Hoebeke
- Department of Urology, Ghent University Hospital, University of Ghent, Ghent, Belgium
| | - David A Diamond
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, USA
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15
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Granström AL, Svenningsson A, Nordenskjöld A, Wester T. Population-based study shows that Hirschsprung disease does not have a negative impact on education and income. Acta Paediatr 2016; 105:1508-1512. [PMID: 27639057 DOI: 10.1111/apa.13594] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 08/17/2016] [Accepted: 09/14/2016] [Indexed: 12/13/2022]
Abstract
AIM Hirschsprung disease is a multifactorial disease, which is mainly treated during childhood. There is a risk of impaired bowel function for a long time after surgery, and its impact on adult life has not been well studied. This study assessed whether having Hirschsprung disease affected social parameters such as educational level and income. METHODS This nationwide, population-based cohort study included all patients with Hirschsprung disease, registered in the Swedish National Patient Register from 1964 and 2013, who were each matched by age and sex to ten individuals randomly selected from the Swedish Population Register. The study outcomes were the highest educational level and individual disposable income in 2013 registered by Statistics Sweden. RESULTS The study comprised 389 patients and 3847 controls, both 76% male, with a median age of 25 years. There were no statistically significant differences in highest educational level between the groups (p = 0.327). The median individual disposable income was 142 200 (0-817 200) Swedish Krona in the patient group and 159 000 (0-3 418 900) in the control group (p = 0.615). CONCLUSION The highest educational level and the individual disposable income did not differ between patients with Hirschsprung disease and controls, indicating that the disease had a low impact on these parameters.
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Affiliation(s)
- Anna Löf Granström
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Division of Paediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Anna Svenningsson
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Division of Paediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Agneta Nordenskjöld
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Division of Paediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
- Center of Molecular Medicine; Karolinska University Hospital; Stockholm Sweden
| | - Tomas Wester
- Department of Women's and Children's Health; Karolinska Institutet; Stockholm Sweden
- Division of Paediatric Surgery; Astrid Lindgren Children's Hospital; Karolinska University Hospital; Stockholm Sweden
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16
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Wester T. Children with anorectal malformations and Hirschsprung disease need special education or remedial support at school. Acta Paediatr 2016; 105:127-8. [PMID: 26751420 DOI: 10.1111/apa.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tomas Wester
- Department of Pediatric Surgery; Karolinska University Hospital and Karolinska Institutet; Stockholm Sweden
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