Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations

Srinivas, Shruthi; Gasior, Alessandra; Driesbach, Sarah; DeBacco, Natalie; Pruitt, Liese C. C.; Trimble, Casey; Zahora, Pooja; Mueller, Claudia M.; Wood, Richard J.

doi:10.3390/children11040494

Open AccessEditor’s ChoiceArticle

Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations

by

Shruthi Srinivas

^1,2

,

Alessandra Gasior

¹,

Sarah Driesbach

¹

,

Natalie DeBacco

¹,

Liese C. C. Pruitt

^1,2

,

Casey Trimble

¹,

Pooja Zahora

¹,

Claudia M. Mueller

³ and

Richard J. Wood

^1,2,*

¹

Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children’s Hospital, 611 E. Livingston Ave., Columbus, OH 43205, USA

²

Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH 43205, USA

³

Department of Pediatric Surgery, Stanford Children’s Hospital, Stanford, CA 94304, USA

^*

Author to whom correspondence should be addressed.

Children 2024, 11(4), 494; https://doi.org/10.3390/children11040494

Submission received: 19 March 2024 / Revised: 8 April 2024 / Accepted: 19 April 2024 / Published: 20 April 2024

(This article belongs to the Special Issue Recent Advances in Pediatric Colorectal Surgery)

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Abstract

Neonates with a new diagnosis of anorectal malformation (ARM) present a unique challenge to the clinical team. ARM is strongly associated with additional midline malformations, such as those observed in the VACTERL sequence, including vertebral, cardiac, and renal malformations. Timely assessment is necessary to identify anomalies requiring intervention and to prevent undue stress and delayed treatment. We utilized a multidisciplinary team to develop an algorithm guiding the midline workup of patients newly diagnosed with ARM. Patients were included if born in or transferred to our neonatal intensive care unit (NICU), or if seen in clinic within one month of life. Complete imaging was defined as an echocardiogram, renal ultrasound, and spinal magnetic resonance imaging or ultrasound within the first month of life. We compared three periods: prior to implementation (2010–2014), adoption period (2015), and delayed implementation (2022); p ≤ 0.05 was considered significant. Rates of complete imaging significantly improved from pre-implementation to delayed implementation (65.2% vs. 50.0% vs. 97.0%, p = 0.0003); the most growth was observed in spinal imaging (71.0% vs. 90.0% vs. 100.0%, p = 0.001). While there were no differences in the rates of identified anomalies, there were fewer missed diagnoses with the algorithm (10.0% vs. 47.6%, p = 0.05). We demonstrate that the implementation of a standardized algorithm can significantly increase appropriate screening for anomalies associated with a new diagnosis of ARM and can decrease delayed diagnosis. Further qualitative studies will help to refine and optimize the algorithm moving forward.

Keywords: neonatal intensive care unit; imperforate anus; cloacal malformation; diagnostic algorithm

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MDPI and ACS Style

Srinivas, S.; Gasior, A.; Driesbach, S.; DeBacco, N.; Pruitt, L.C.C.; Trimble, C.; Zahora, P.; Mueller, C.M.; Wood, R.J. Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations. Children 2024, 11, 494. https://doi.org/10.3390/children11040494

AMA Style

Srinivas S, Gasior A, Driesbach S, DeBacco N, Pruitt LCC, Trimble C, Zahora P, Mueller CM, Wood RJ. Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations. Children. 2024; 11(4):494. https://doi.org/10.3390/children11040494

Chicago/Turabian Style

Srinivas, Shruthi, Alessandra Gasior, Sarah Driesbach, Natalie DeBacco, Liese C. C. Pruitt, Casey Trimble, Pooja Zahora, Claudia M. Mueller, and Richard J. Wood. 2024. "Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations" Children 11, no. 4: 494. https://doi.org/10.3390/children11040494

APA Style

Srinivas, S., Gasior, A., Driesbach, S., DeBacco, N., Pruitt, L. C. C., Trimble, C., Zahora, P., Mueller, C. M., & Wood, R. J. (2024). Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations. Children, 11(4), 494. https://doi.org/10.3390/children11040494

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Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations

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