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Impaired growth outcomes in children with congenital colorectal diseases
Laura V Veras1, Pranit N Chotai1, Andrew Z Tumen1
1Division of Pediatric Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee.
Insights
Children with congenital hindgut anomalies (CHARM) face impaired growth risks. Medicaid insurance is linked to lower BMI Z-scores, highlighting a need for further research into modifiable risk factors.
Area of Science:
- Pediatric Surgery
- Developmental Biology
- Clinical Genetics
Background:
- Congenital anomalies of the hindgut, including cloaca, Hirschsprung disease (HD), and anorectal malformations (ARM), collectively known as CHARM, can impact child development.
- Previous studies suggest a potential link between CHARM and growth impairment, necessitating further investigation in larger cohorts.
- This study specifically examines the influence of socioeconomic factors, such as Medicaid insurance, and race on growth outcomes in children with CHARM anomalies.
Purpose of the Study:
- To comprehensively assess growth impairment in a large cohort of patients with CHARM anomalies.
- To investigate whether patients with Medicaid insurance or of African-American (AA) race are at a higher risk for poor growth.
- To identify potential modifiable risk factors contributing to growth deficits in this population.
Main Methods:
- A retrospective review of 166 pediatric patients diagnosed with CHARM anomalies between 2009 and 2016 was conducted.
- Body Mass Index (BMI) Z-scores were calculated using standardized World Health Organization and Centers for Disease Control growth charts.
- Statistical analyses, including descriptive statistics and Fisher's exact test, were employed to compare BMI Z-scores across different patient groups and insurance types.
Main Results:
- The overall CHARM cohort exhibited significantly lower BMI Z-scores compared to control populations (P < 0.0001).
- Patients with HD and ARM also showed lower BMI Z-scores than controls (P < 0.0007 and P < 0.0037, respectively).
- Medicaid-insured patients had significantly lower BMI Z-scores than those with private or commercial insurance (P < 0.0001). While AA race was associated with lower BMI Z-scores compared to controls, no significant difference was found between AA and non-AA CHARM patients.
Conclusions:
- Children born with CHARM anomalies are at an increased risk for impaired growth.
- Medicaid insurance status is identified as a significant factor associated with lower BMI Z-scores in this cohort.
- Further research is crucial to identify and address modifiable risk factors, with longitudinal follow-up and targeted interventions recommended to mitigate growth impairment.
Background:
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.
Methods:
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.
Results:
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).
Conclusions:
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.
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