Outcomes at five to eight years of age for children with Hirschsprung's disease

Abstract

Objective: This study describes core outcomes of Hirschsprung's disease (HD) in a UK-wide cohort of primary school-aged children.

Design: A prospective cohort study conducted from 1 October 2010 to 30 September 2012. Outcomes data were collected from parents and clinicians when children were 5-8 years of age, and combined with data collected at birth, and 28 days and 1 year post diagnosis.

Setting: All 28 UK and Irish paediatric surgical centres.

Participants: Children with histologically proven HD diagnosed at <6 months of age.

Main outcome measures: NETS^1HD core outcomes.

Results: Data were returned for 239 (78%) of 305 children. Twelve children (5%) died prior to 5 years of age.Of the 227 surviving children, 30 (13%) had a stoma and 21 (9%) were incontinent of urine. Of the 197 children without a stoma, 155 (79%) maintained bowel movements without enemas/washouts, while 124 (63%) reported faecal incontinence. Of the 214 surviving children who had undergone a pull-through operation, 95 (44%) underwent ≥1 unplanned reoperation. 89 unplanned reoperations (27%) were major/complex.Of the 83 children with returned PedsQL scores, 37 (49%) had quality of life scores, and 31 (42%) had psychological well-being scores, that were ≥1 SD lower than the reference population mean for children without HD.

Conclusion: This study gives a realistic picture of population outcomes of HD in primary school-aged children in the UK/Ireland. The high rates of faecal incontinence, unplanned procedures and low quality of life scores are sobering. Ensuring clinicians address the bladder, bowel and psychological problems experienced by children should be a priority.

Keywords: epidemiology; gastroenterology.

Figure 1

Data return for the NETS^2HD study. BAPS-CASS, British Association of Paediatric Surgeons Congenital Anomalies Surveillance System.

Figure 2

Proportion of children reporting key outcomes at 5–8 years of age.