Clinical Predictors and Outcomes for Recurrent Pneumatosis Intestinalis in Children: A Case Control Study
Allison De Groot Ta1,2, Michael Farrell1,2, Jonathan R Dillman3,4
1Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center.
Insights
Recurrent pneumatosis intestinalis (PI) in children is predicted by small bowel involvement, while colonic PI is protective. Outcomes were similar for single and recurrent PI episodes.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Clinical Outcomes Research
Background:
- Pneumatosis intestinalis (PI) involves intestinal wall air collections, potentially indicating serious conditions.
- Recurrent PI episodes are documented, but risk factors remain poorly understood.
Purpose of the Study:
- Identify predictors of recurrent pneumatosis intestinalis in pediatric patients.
- Evaluate the long-term outcomes for children experiencing recurrent PI.
Main Methods:
- Retrospective case-control study of 46 pediatric patients (6 months-18 years) with imaging-confirmed PI over 30 months.
- Recurrence defined as new PI findings post-resolution or a 1-month interval between episodes.
- Logistic regression used for univariate and multivariable analyses (P < 0.05).
Main Results:
- Recurrent PI occurred in 37% of patients (17/46).
- Small bowel PI predicted recurrence (OR 1.6; 95% CI 1.01, 2.4), while colonic PI was protective (OR 0.6; 95% CI 0.4, 0.87).
- Cerebral palsy and small bowel PI predicted surgical intervention (OR 17 and OR 19, respectively).
Conclusions:
- Bowel segment location is a key predictor of PI recurrence in children.
- Clinical outcomes did not significantly differ between single-episode and recurrent PI groups.
Introduction:
Pneumatosis intestinalis (PI) is air collections within the wall of the intestine that can be associated with life threatening conditions. Recurrent episodes of PI have been reported; however, little is known about risks for recurrent disease. This study aims to identify predictors of recurrent PI and evaluate long-term outcomes in patients with recurrent PI.
Methods:
This retrospective case-control study evaluated patients, ages 6 months to 18 years, with imaging evidence of PI over a 30-month period. Images were analyzed by consensus to confirm PI. Recurrent PI was defined as new findings of PI after resolution by imaging and/or at least 1-month interval between episodes of PI. Univariate and multivariable analyses were performed using logistic regression, with significance set to P < 0.05.
Results:
Forty-six children were included. Recurrent PI occurred in 17 (37%) patients, with a total of 39 episodes. Predictors of recurrent PI all related to the segment of bowel involved with small bowel PI predictive of recurrent PI (odds ratio [OR] 1.6; 95% confidence interval [CI] 1.01, 2.4) and colonic PI protective (OR 0.6; 95% CI 0.4, 0.87) after adjusting for age. Predictors for surgical intervention included cerebral palsy (OR 17; 95% CI 1.7, 167) and PI involving small bowel (OR 19; 95% 3.1, 114).
Conclusion:
Location of PI is predictive of recurrence. Clinical outcomes were similar between groups with single episode and recurrent PI.
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