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Published on: March 5, 2016
Low-risk pneumatosis intestinalis in the pediatric surgical population
Nell T Weber1,2, Sarah Ogle1, Emily H Cooper2
1Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave. Box 323, Aurora, CO, 80045, USA.
Insights
Pneumatosis intestinalis (PI) in children over age 1 without risk factors can be safely treated with 3 days of antibiotics. Outcomes were similar regardless of physician specialty or antibiotic duration, supporting shorter treatment for low-risk PI.
Area of Science:
- Pediatric Gastroenterology
- Neonatal and Pediatric Surgery
- Clinical Pediatrics
Background:
- Pneumatosis intestinalis (PI) is air in the bowel wall, with variable severity and clinical course.
- Evidence-based guidelines for managing lower-risk PI cases in children are lacking.
- This study defines and characterizes low-risk PI in pediatric patients.
Purpose of the Study:
- To describe the clinical entity of low-risk PI in children.
- To characterize the population of children who develop low-risk PI.
- To determine if management approach or outcomes differ based on physician specialty or antibiotic duration.
Main Methods:
- Retrospective review of children over 1 year old diagnosed with PI (2009-2019) at Children's Hospital Colorado.
- Exclusion of patients with cancer or bone marrow transplant history.
- Low-risk criteria: no ICU admission, vasopressor use, or urgent surgery.
Main Results:
- 72 of 91 children met low-risk criteria.
- No significant difference in complications (hemodynamic decompensation, recurrence, C. difficile, death) between antibiotic durations (≤3 days vs. >3 days).
- Outcomes did not differ between children managed by surgeons or pediatricians.
Conclusions:
- Low-risk PI is defined in children over 1 year old with no cancer/BMT history and no need for ICU, vasopressors, or urgent surgery.
- A shortened course of 3 days of antibiotic therapy and NPO appears safe for these children.
- This supports a less aggressive management strategy for select pediatric PI cases.
Background:
Pneumatosis intestinalis (PI, presence of air in bowel wall) develops in a variety of settings and due to a variety of insults which is then characterized by varying severity and clinical course. Anecdotally, many of these cases are benign with few clinical sequelae; however, we lack evidence-based guidelines to help guide management of such lower-risk cases. We aimed to describe the clinical entity of low-risk PI, characterize the population of children who develop this form of PI, determine if management approach or clinical outcomes differed depending on the managing physician's field of practice, and finally determine if a shortened course of NPO and antibiotics was safe in the population of children with low-risk PI.
Methods:
We performed a retrospective review of all children over age 1 year treated at Children's Hospital Colorado (CHCO), between 2009 and 2019 with a diagnosis of PI who did not also have a diagnosis of cancer or history of bone marrow transplant (BMT). Data including demographic variables, clinical course, and outcomes were obtained from the electronic medical record. Low-risk criteria included no need for ICU admission, vasopressor use, or urgent surgical intervention.
Results:
Ninety-one children were treated for their first episode of PI during the study period, 72 of whom met our low-risk criteria. Among the low-risk group, rates of complications including hemodynamic decompensation during treatment, PI recurrence, Clostridium difficile colitis, and death did not differ between those who received 3 days or less of antibiotics and those who received more than 3 days of antibiotics. Outcomes also did not differ between children cared for by surgeons or pediatricians.
Conclusions:
Here, we define low-risk PI as that which occurs in children over age 1 who do not have a prior diagnosis of cancer or prior BMT and who do not require ICU admission, vasopressor administration, or urgent surgical intervention. It is likely safe to treat these children with only 3 days of antibiotic therapy and NPO.
Level Of Evidence:
Level III.
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