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Activity of the internal anal sphincter during the first days of life
Insights
Anorectal manometry can diagnose Hirschsprung disease in newborns. While internal sphincter relaxation is usually present, repeated tests may be needed for accuracy in the neonatal period.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Physiology
- Surgical Diagnostics
Background:
- Hirschsprung disease diagnosis relies on internal anal sphincter manometry.
- Normal response involves internal sphincter relaxation upon rectal distension, absent in Hirschsprung disease.
Purpose of the Study:
- To assess the feasibility and reliability of anorectal manometry for diagnosing Hirschsprung disease in newborns.
- To characterize normal internal anal sphincter function during the first four days of life.
Main Methods:
- Ano-rectal manometry performed daily on 17 healthy full-term infants over the first four days of life.
- Measured resting anal pressure and internal anal sphincter response to rectal distension.
Main Results:
- Resting anal pressure was lower in neonates compared to older children.
- Internal sphincter relaxation was observed in most infants across the first four days.
- One infant showed absent relaxation on day one and two infants on days three and four.
Conclusions:
- Anorectal manometry is applicable for diagnosing Hirschsprung disease in the neonatal period.
- Repeated examinations may enhance diagnostic accuracy in newborns.
- Diagnostic reliability might be lower in neonates compared to older children.
Abstract:
Manometric recordings of the internal anal sphincter activity are frequently used in the diagnosis of Hirschprung's disease. Normally, there is a relaxation of the internal sphincter in response to a rectal distension, but this is absent in Hirschprung's disease. In order to study the normal physiology during the first days of life, 17 healthy full-term infants were examined daily with ano-rectal manometry during the first four days of life. Resting anal pressure was lower than in older children. Internal sphincter relaxation was recorded in all infants but one on the first day, in all on the second and finally in all but one on the third and fourth days. The results indicate that anorectal manometry may be used in the diagnosis of Hirschprung's disease also in the newborn period. However, repeated examinations may be necessary and the diagnostic reliability may be somewhat lower than in older children.