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Preoperative nutritional support in children with Hirschsprung disease: a prospective multicenter open-label
Hong-Yi Zhang1, Ke Chen1, Yanmin Zhang2
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Center of Hirschsprung Disease and Allied Disorders, Wuhan, China.
Insights
Preoperative nutritional support significantly lowers the risk of Hirschsprung-associated enterocolitis (HAEC) in children undergoing surgery. This intervention reduces HAEC incidence by over 20% in pediatric patients with Hirschsprung disease (HSCR).
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Nutrition
Background:
- Preoperative undernutrition is common in pediatric Hirschsprung disease (HSCR) patients.
- Hirschsprung-associated enterocolitis (HAEC) is a serious postoperative complication.
- The role of preoperative nutritional support in mitigating HAEC requires further investigation.
Purpose of the Study:
- To assess the efficacy of preoperative nutritional support (PNS) in reducing the incidence of postoperative HAEC.
- To compare HAEC rates between pediatric HSCR patients receiving PNS and those receiving standard medical care (SMC).
Main Methods:
- A prospective, multicenter, open-label randomized controlled trial involving 110 pediatric HSCR patients undergoing pull-through surgery.
- Patients were randomized 1:1 to either PNS (n=55) or SMC (n=55).
- The primary outcome was the incidence of HAEC at 3 months postoperatively.
Main Results:
- The incidence of HAEC was significantly lower in the PNS group (7.27%) compared to the SMC group (29.09%).
- Preoperative nutritional support resulted in an absolute risk reduction of 21.82% for HAEC (p=0.003).
- No adverse events were reported in the PNS group.
Conclusions:
- Preoperative nutritional support is an effective strategy for reducing early HAEC incidence in pediatric HSCR patients post-pull-through surgery.
- This intervention offers a significant protective effect against a major complication of HSCR surgery.
- Optimizing preoperative nutrition should be considered in the management of pediatric HSCR patients.
Abstract:
Preoperative undernutrition is prevalent among children with Hirschsprung disease (HSCR). To evaluate whether preoperative nutritional support reduces the incidence of postoperative HSCR-associated enterocolitis (HAEC), we conducted a prospective, multicenter, open-label randomized controlled trial. The trial was initiated on January 1, 2021 and completed on October 31, 2022. It was carried out across seven tertiary hospitals in China. A total of 110 patients admitted for pull-through surgery for HSCR were enrolled. Eligible participants were randomly assigned 1:1 via a centralized web-based randomization system ( www.cbdps.com ), which generated the allocation sequence. Specifically, 55 patients were allocated to the preoperative nutritional support (PNS) group and 55 to the standard medical care (SMC) group. Surgeons and patients were not blinded to group assignment. The primary outcome was the incidence of HAEC at 3 months after surgery. At 3 months postoperatively, the incidence of HAEC in the PNS group was significantly lower compared to the SMC group. Specifically, the HAEC incidence was 7.27% (4/55) for the PNS group versus 29.09% (16/55) for the SMC group. This resulted in an absolute risk reduction of 21.82% (95% confidence interval: -35.64% to -7.99%; p = 0.003). No adverse events were documented. These results demonstrate that preoperative nutritional support substantially reduces early HAEC incidence in pediatric HSCR patients following pull-through surgery. Trial Registration: ClinicalTrials.gov NCT04598841.
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