Growth Outcomes in CHARM (Cloaca, Hirschsprung disease, Anorectal Malformation) Patients
Abstract
OBJECTIVE: CHARM are congenital anomalies of the hindgut. Small series have suggested that children with these anomalies may be at risk for growth impairment. We sought to expand on these findings, hypothesizing that patients... [ view full abstract ]
OBJECTIVE: CHARM are congenital anomalies of the hindgut. Small series have suggested that children with these anomalies may be at risk for growth impairment. We sought to expand on these findings, hypothesizing that patients with Medicaid Insurance or African American race would be at higher risk for poor growth.
METHODS: A single-institution retrospective review of children with CHARM anomalies was performed (2009-2016). Body Mass Index (BMI) Z-scores were obtained using the 2006 World Health Organization (age 0-24 months) and 2000 Centers for Disease Control (age >2 years) growth charts and calculators. Patient factors and BMI Z-scores were analyzed with descriptive statistics and Fisher's exact test.
RESULTS: 166 patients (Cloaca n=16, HD n=71, ARM n=79) were identified. The BMI Z-score distribution for the entire CHARM cohort was lower than controls (p<.0001). HD and ARM z-scores were also lower vs. controls (p<.0007, p<.0037). Requiring more or less than the average number of surgeries did not impact Z-score (p=NS). Patients with Medicaid had lower z-scores vs. Private or Commercial insurance (p<.0001). African-American race z-score distribution was lower than controls (p<.0002), but there was no statistical difference in z-scores when comparing African-American vs. non-African-American CHARM patients (p=NS). Mean follow-up time was significantly higher in both cloaca (7.2 years, p=.0005) and HD (6.6 years, p<.0001) cohorts compared to ARM (4.6 years).
CONCLUSION: Patients born with CHARM anomalies are at risk for impaired growth. Further study is warranted to identify modifiable risk factors contributing to this impairment. Longitudinal follow-up should include interventions to mitigate these risks.
Authors
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Laura Veras
(University of Tennessee Health Science Center)
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Pranit Chotai
(Vanderbilt University Medical Center)
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Andrew Tumen
(University of Tennessee Health Science Center)
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Ash Gosain
(University of Tennessee Health Science Center)
Topic Area
Pediatric Surgery
Session
QS-Peds » Quick-Shot Presentations: Pediatric Surgery (15:00 - Thursday, 21st September, Dearth Tower Conf 1)