Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
Aim of the Study
2. Methods
2.1. Design
2.2. Inclusion–Exclusion Criteria
2.3. Data Extraction
2.4. Quality Assessment
2.5. Data Analysis
3. Results
3.1. Study Characteristics and Quality
3.2. Meta-Analysis of ISN in Pediatric Patients following COVID-19 Infection
3.3. Demographic and Clinical Characteristics of ISN Pediatric Patients with SARS-CoV-2 Infection
3.4. Treatment Outcome and Predictors of Mortality in Pediatric COVID-19 Patients with ISN
4. Discussion
Limitations of the Study
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Author, Year, Study Location | Study Design, Setting | Age (Months) a | Male, n (%) | Ethnicity | Comorbidities, n | Number of Patients (n = 1828) | Number of SARS-CoV-2 Patients with ISN (n = 64, 3.5%) | ISN Classification by Location AND Symptoms from ISN, n | Laboratory Findings | Imaging | Admitted to ICU, n | Mechanical Ventilation, n | ARDS, n | Treatment, n; If Failure to Pneumatic, Hydrostatic or Surgical Reduction Occurred; If ISN Was Recurrent | Assessment of Study Risk of Bias (Tool Used, Finding); Treatment Outcome |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Acharyya et al., 2022 [15], India | Retrospective case report, single center | 4 | 1 (100) | 1 Indian | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Abdominal distension 1 Blood in stool 1 Large hematoma in the serous layer of the intestine | 1 Raised procalcitonin 1 High D-dimer 1 High prothrombin time 1 High NT-proBNP | 1 Acute ISN 1 Multiple air fluid levels | 0 | 0 | 0 | 1 Surgical reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 survived |
Agarwalla and Jalan 2022 [16], India | Retrospective case report, single center | 10 | 1 (100) | 1 Indian | 1 No medical history | 1 | 1 | 1 Ileo-ileal ISN AND 1 Abdominal pain 1 Abdominal tenderness 1 Crying 1 Vomiting 1 Red currant jelly stools 1 Drowsiness 1 Low BP 1 Pallor 1 Tachycardia 1 Low oxygen saturation 1 Cold extremities 1 Peripheral pulses 1 Autonomic dysfunction 1 Irregular heartbeat 1 Ectopic beats | 1 Low Hb 1 High CRP 1 High ferritin 1 High D-dimer 1 High LDH | 1 Acute ISN | 1 | 0 | 1 | 1 Surgical reduction of the ISN 1 Dopamine 1 IV fluids 1 Oxygen supplementation 1 Inotropes 1 Antibiotics 1 Steroids 1 Anticoagulant 1 NGT feeding 1 Removal of surgical drain 1 Dressing No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Athamnah et al., 2021 [17], Jordan | Retrospective case report, single center | 2.5 | 1 (100) | 1 Arab | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Fever 1 Vomiting 1 Dehydration 1 Blood in stool 1 Abdominal distension 1 Abdominal tenderness 1 Bilious discharge from the NGT 1 Red currant jelly stools | 1 Not reported | 1 Distal small bowel obstruction and decreased gas in the colon 1 Acute ISN (target sign) | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN 1 IV fluids 1 Antibiotics No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Bazuaye-Ekwuyasi et al., 2020 [4], United States | Retrospective case report, single center | 9 | 1 (100) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Vomiting 1 Abdominal pain 1 Anorexia 1 Blood in stool 1 Dehydration | 1 Ketonuria 1 Proteinuria 1 Decreased lymphocytes | 1 Acute ISN 1 Colon cutoff sign of ISN | 0 | 0 | 0 | 1 Hydrostatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Cai et al., 2020 [5], China | Retrospective case-series, single center | 10 | 0 (0) | 1 Asian | 1 No medical history | 5 | 1 | 1 Location was not reported AND 1 Crying 1 Restlessness 1 Vomiting 1 Red currant jelly stools 1 Apathy 1 Drowsiness 1 Convulsions 1 Septic shock 1 Multiple organ dysfunction 1 Abdominal distension 1 Blood in stool 1 Coffee dreg-like gastric contents | 1 Leukopenia 1 Decreased lymphocytes 1 Thrombocytopenia 1 High CRP 1 Raised procalcitonin 1 High D-dimer 1 High prothrombin time 1 High APTT 1 High ferritin 1 High interleukin-6 1 High interleukin-10 1 Hypoalbuminemia 1 Hyponatremia 1 Hypocalcemia 1 Reduced number of CD3+, CD4+, CD8+ T lymphocytes and CD16 + CD56 natural killer cells | 1 Acute ISN 1 Large amount of abdominal dropsy 1 Necrosis of the proximal ileus of the small intestine | 1 | 1 | 1 | 1 Steroids 1 IVIG 1 Interferon 1 Antivirals 1 Antibiotics 1 Oxygen supplementation 1 CRRT 1 Plasma exchange 1 Surgical resection of necrotic intestine 1 Dopamine 1 Dobutamine No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Died |
Castellazzi et al., 2021 [18], Italy | Retrospective case report, single center | 10 | 0 (0) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Irritability 1 Anorexia 1 Crying 1 Vomiting 1 Rectal blood 1 Spiking colicky pain | 1 High CRP | 1 Acute ISN 1 Increased thickness of the intestinal wall and accompanying mesentery 1 Enlarged lymph nodes | 0 | 0 | 0 | 1 Hydrostatic reduction of the ISN 1 Antibiotics 1 IV fluids 1 Surgical reduction of the ISN 1 Laparotomy 1 Ileocecopexy Yes failure (hydrostatic, n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Díaz-Ruiz et al., 2022 [19], Peru | Retrospective case report, single center | 72 | 1 (100) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Liquid stools with mucus and no blood 1 Anorexia 1 Chills 1 Vomiting 1 Nausea | 1 High CRP 1 High leukocytes | 1 Acute ISN | 0 | 0 | 0 | 1 Surgical reduction of the ISN 1 Laparotomy 1 Appendectomy 1 Analgesics No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Du et al., 2021 [20], China | Retrospective cohort, single center | 10 | 0 (0) | 1 Asian | 1 No medical history | 182 | 1 | 1 Ileocolic ISN AND 1 Nausea 1 Vomiting 1 Multiple organ dysfunction 1 Intestinal necrosis 1 Septic shock 1 DIC | 1 High CRP 1 High LDH 1 High BUN | 1 Acute ISN | 1 | 1 | 1 | 1 Interferon 1 Antibiotics 1 Oxygen supplementation No failure (n = 1) No recurrence (n = 1) | (NOS, 7) 1 Died |
Fadgyas et al., 2022 [21], Hungary | Retrospective case report, single center | 90 | 1 (100) | 1 White (Caucasian) | 1 Left-sided renal agenesis 1 Developmental delay 1 Meningism | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal tenderness 1 Headache 1 Vomiting 1 Facial petechiae 1 Dehydration 1 Abdominal pain 1 Low BP | 1 High CRP 1 High WBCs 1 High neutrophils 1 High D-dimer 1 Raised liver enzymes 1 Raised bilirubin 1 High troponin | 1 Enlarged mesenteric lymph nodes 1 Acute ISN 1 Very dilated, fluid- and gas-filled small bowel loops 1 Meckel’s diverticulum 1 Bowel obstruction | 1 | 1 | 0 | 1 Antibiotics 1 Analgesics 1 IV fluids 1 Oxygen supplementation 1 Laparotomy 1 Surgical resection 1 Anastomosis No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
García et al., 2021 [22], Guatemala | Retrospective case report, single center | 6 | 1 (100) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Irritability 1 Vomiting 1 Red currant jelly stools 1 Pallor 1 Abdominal pain | 1 Low Hb 1 High D-dimer 1 High CRP 1 High ferritin | 1 Acute ISN 1 Dilation of intestinal loops 1 Poor gas distribution | 0 | 0 | 0 | 1 Antibiotics 1 Analgesics 1 Surgical resection 1 Oxygen supplementation 1 Total parenteral nutrition No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Guerrón and Figueroa 2021 [23], Colombia | Retrospective case report, single center | 5 | 1 (100) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Vomiting 1 Red currant jelly stools 1 Absence of bowel sounds 1 Anorexia | 1 Not reported | 1 Acute ISN 1 Significant colonic parietal thickening | 0 | 0 | 0 | 1 Hydrostatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Hyun et al., 2022 [24], United States | Retrospective case report, single center | 20 | 0 (0) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Weakness 1 Lethargy 1 Abdominal pain 1 Abdominal tenderness 1 Increased fussiness 1 Crying 1 Facial cyanosis 1 Cold extremities 1 Perception of a firm and painful mass 1 Low oxygen saturation | 1 High WBCs 1 High neutrophils 1 High monocytes 1 Hypokalemia 1 High LDH | 1 Acute ISN 1 Concentric rings of the bowel 1 Enlarged lymph nodes | 0 | 0 | 0 | 1 Analgesics 1 Oxygen supplementation 1 IV fluids 1 Hydrostatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Khan et al., 2021 [25], United States | Retrospective case report, single center | 2 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal tenderness 1 Vomiting 1 Diarrhea 1 Blood in stool 1 Abdominal distension 1 Red currant jelly stools | 1 Not reported | 1 Acute ISN 1 Enlarged lymph nodes | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Leiva et al., 2022 [26], United States | Retrospective case reports, single center | 7 and 9 | 1 (50) | 2 Whites (Caucasians) | 1 No medical history | 2 | 2 | 2 Ileocolic ISN AND 2 Abdominal pain 2 Irritability 1 Vomiting 2 Blood in stool | 1 Not reported | 2 Acute ISN 1 Hypertrophied lymph nodes | 0 | 0 | 0 | 2 Hydrostatic reductions of the ISN 2 Surgical reductions of the ISN 2 Laparotomy Yes failure (hydrostatic, n = 2) No recurrence (n = 2) | (Modified NOS, high) 2 Survived |
Makrinioti et al., 2020 [6], United Kingdom | Retrospective case reports, multicenter | 10 and 10 | 0 (0) | 1 White (Caucasian) and 1 Asian | 2 No medical history | 2 | 2 | 2 Ileocolic ISN AND 1 Crying 2 Vomiting 2 Red currant jelly stools 1 Abdominal distension 1 Absence of bowel sounds 1 Peritonitis 1 Ascites 1 Swelling of the small intestinal wall 1 Lethargy 1 DIC | 2 High CRP | 1 Acute ISN | 1 | 1 | 1 | 2 Pneumatic reductions of the ISN 1 Laparotomy 1 Defunctioning ileostomy 1 Antibiotics 1 Inotropes 1 Surgical reduction of the ISN 1 Ladd’s procedure No failure (n = 1) Yes failure (pneumatic, n = 1) No recurrence (n = 2) | (Modified NOS, high) 1 Survived 1 Died |
Martínez-Castaño et al., 2020 [27], Spain | Retrospective case report, single center | 6 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Vomiting 1 Abdominal cramps 1 Red currant jelly stools 1 Anemia | 1 Low Hb 1 High CRP 1 High WBCs | 1 Acute ISN (target sign) | 0 | 0 | 0 | 1 Hydrostatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Mercado-Martínez et al., 2021 [28], Mexico | Retrospective case reports, multicenter | 8 and 7 | 1 (50) | 2 Hispanics | 2 No medical history | 2 | 2 | 2 Ileocolic ISN AND 1 Crying 2 Vomiting 2 Red currant jelly stools 2 Irritability 1 Pallor 1 Tachycardia 1 Abdominal distension 1 Decreased peristalsis 1 Painful on deep palpation in mesogastrium 1 Perception of a firm and painful mass 2 Rectal mucus and blood | 1 High CRP 1 High D-dimer 1 Anemia 1 Low Hb | 2 Acute ISN | 0 | 0 | 0 | 2 Surgical reductions of the ISN 1 Rockey–Davis incision for manual reduction 1 Anticoagulant No failure (n = 2) No recurrence (n = 2) | (Modified NOS, high) 2 Survived |
Moazzam et al., 2020 [29], Pakistan | Retrospective case report, single center | 4 | 1 (100) | 1 Pakistani | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Crying 1 Drawing up of the legs towards the abdomen 1 Anorexia 1 Red currant jelly stools 1 Pallor 1 Irritability 1 Sausage-shaped lump 1 Anemia | 1 High D-dimer 1 Low Hb | 1 Acute ISN | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN 1 Antibiotics 1 Analgesics No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Noviello et al., 2021 [30], Italy | Retrospective case report, single center | 7 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Anorexia 1 Diarrhea 1 Vomiting 1 Sleepiness 1 Pallor 1 Lethargy 1 Dehydration 1 Red currant jelly stools | 1 High D-dimer | 1 Acute ISN 1 Alternating rings of low and high echogenicity 1 “Pseudokidney” sign | 1 | 0 | 0 | 1 Hydrostatic reduction of the ISN 1 Laparotomy 1 Surgical resection 1 Anastomosis Yes failure (hydrostatic, n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Osorno et al., 2021 [31], Colombia | Retrospective case report, single center | 8 | 1 (100) | 1 Hispanic | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Red currant jelly stools 1 Perception of a firm and painful mass 1 Metabolic acidosis 1 Peritonitis | 1 Not reported | 1 Acute ISN 1 Ischemia of distal ileum and right colon | 1 | 0 | 0 | 1 Laparotomy 1 Surgical resection 1 Ileostomy 1 Fistula No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Ponmani and Hulse 2022 [32], United Kingdom | Retrospective case report, single center | 18 | 0 (0) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Constipation 1 Abdominal pain | 1 High CRP | 1 Acute ISN 1 Doughnut-shaped mass | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 survived |
Rajalakshmi et al., 2020 [7], India | Retrospective case report, single center | 8 | 1 (100) | 1 Indian | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Red currant jelly stools 1 Vomiting 1 Lethargy 1 Dehydration 1 Perception of a firm and painful mass | 1 Low Hb 1 Low hematocrit | 1 Acute ISN | 0 | 0 | 0 | 1 IV fluids 1 Pneumatic reduction of the ISN No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Rohani et al., 2021 [33], Iran | Retrospective case report, single center | 72 | 1 (100) | 1 Persian | 1 No medical history | 1 | 1 | 1 Location was not reported AND 1 Abdominal tenderness 1 Abdominal pain 1 Vomiting 1 Diarrhea 1 Abdominal distension | 1 Leukopenia 1 Decreased lymphocytes 1 High calprotectin 1 Hypoalbuminemia 1 Hypocalcemia 1 Hypophosphatemia 1 Hypomagnesaemia 1 Raised liver enzymes | 1 Multifocal small bowel loops intussusceptum 1 Pneumatosis intestinalis in ascending colon 1 Dilatation in colon caliber 1 Necrotizing enterocolitis | 0 | 0 | 0 | 1 Oral rehydration solution 1 Ondansetron 1 Total parenteral nutrition 1 Antibiotics No failure (n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Salman et al., 2022 [34], United States | Retrospective cohort, single center | Median (IQR), 36 (3-216) | 19 (79.2) | 4 Whites (Caucasians) 6 Hispanics 1 Asian | 11 Not reported | 685 | 24 | 8 Small bowel ISN and 3 ileocolic ISN AND 7 Vomiting 5 Abdominal pain 2 Blood in stool 4 Red currant jelly stools | 11 Not reported | 11 Abnormal imaging 3 Acute ISN | 11 Not reported | 11 Not reported | 11 Not reported | 3 Pneumatic reductions of the ISN 4 Surgical reductions of the ISN No failure (n = 8) Yes failure (pneumatic, n = 3) No recurrence (n = 11) | (NOS, 7) 11 Survived |
Saxena et al., 2021 [35], United Kingdom | Retrospective case report, single center | 10 | 0 (0) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Location was not reported AND 1 Red currant jelly stools 1 Vomiting | 1 Not reported | 1 Acute ISN 1 Waugh syndrome (ISN with malrotation) | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN 1 Surgical reduction of the ISN 1 Ladd’s procedure Yes failure (pneumatic, n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Scottoni et al., 2022 [36], Italy | Retrospective case reports, multicenter | 1 and 5.5 | 1 (50) | 2 Whites (Caucasians) | 1 No medical history 1 Hyperinsulinism | 2 | 2 | 2 Ileocolic ISN AND 1 Constipation 2 Vomiting 2 Lethargy 1 Dehydration 2 Blood in stool 1 Anorexia | 2 Not reported | 2 Acute ISN 1 Enlarged lymph nodes 1 Necrosis of the terminal ileum to the splenic flexure | 1 | 1 | 1 | 1 Pneumatic reduction of the ISN 1 Laparotomy 1 Removal of lymph node 1 Hemicolectomy 1 Anastomosis 1 Noradrenaline No failure (n = 1) Yes failure (pneumatic, n = 1) No recurrence (n = 2) | (Modified NOS, high) 2 Survived |
Sorkhi et al., 2022 [37], Iran | Retrospective case report, single center | 132 | 1 (100) | 1 Persian | 1 Nephrotic syndrome 1 Long use of steroid (15 years) | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Vomiting 1 Nausea 1 Weakness 1 Anorexia 1 Myalgia 1 Pallor 1 Dehydration | 1 High leukocytes 1 Hypernatremia 1 Hypokalemia | 1 Acute ISN 1 Meckel’s diverticulum | 0 | 0 | 0 | 1 Steroids 1 Enalapril 1 Pantoprazole 1 Antibiotics 1 IV fluids 1 Hydrostatic reduction of the ISN 1 Diverticulectomy No failure (n = 1) No recurrence (n = 1) | (Modified NOS, moderate) 1 Survived |
Stephenson et al., 2021 [38], United States | Retrospective case report, single center | 6 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Abdominal pain 1 Vomiting 1 Irritability 1 Red currant jelly stools | 1 Not reported | 1 Acute ISN | 0 | 0 | 0 | 1 Pneumatic reduction of the ISN Yes failure (pneumatic, n = 1) Yes recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Sullivan et al., 2021 [39], United States | Retrospective case report, single center | 7 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileal-ileal ISN and 1 ileocolic ISN AND 1 Abdominal pain 1 Crying 1 Fist clenching 1 Grimacing | 1 Not reported | 1 Acute ISN 1 Ileocolic ISN (Target sign) | 0 | 0 | 0 | 1 Hydrostatic reduction of the ISN Yes failure (hydrostatic, n = 1) Yes recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Swyden et al., 2022 [40], United States | Retrospective case report, single center | 4 | 1 (100) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileocolic ISN AND 1 Blood in stool 1 Anorexia 1 Red currant jelly stools 1 Tachycardia 1 Lethargy 1 Metabolic acidosis | 1 Thrombocytosis 1 High leukocytes 1 Hypochloremia 1 Raised procalcitonin | 1 Acute ISN 1 Doughnut-shaped mass 1 Pneumoperitoneum | 0 | 0 | 0 | 1 IV fluids 1 Hydrostatic reduction of the ISN 1 Laparotomy Yes failure (hydrostatic, n = 1) No recurrence (n = 1) | (Modified NOS, high) 1 Survived |
Tran et al., 2022 [41], United States | Retrospective case report, single center | 8 | 0 (0) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Location was not reported AND 1 Blood in stool 1 Rash 1 Diarrhea 1 Metabolic acidosis | 1 High leukocytes 1 High CRP | 1 Acute ISN (target sign) | 0 | 0 | 0 | 1 No treatment for ISN (follow-up and bowel rest) No failure (n = 1) No recurrence (n = 1) | (Modified NOS, moderate) 1 Survived |
Vecchio et al., 2021 [42], Italy | Retrospective cohort, multicenter | 4 Not reported | 4 Not reported | 4 Whites (Caucasians) | 4 Not reported | 685 | 4 | 1 Ileal ISN and 3 ileocolic ISN AND 4 Abdominal pain 4 Vomiting 4 Red currant jelly stools | 4 Not reported | 4 Not reported | 4 Not reported | 4 Not reported | 4 Not reported | 2 Surgical reductions of the ISN 1 Removal of solid mass Failure was not reported (n = 4) Recurrence was not reported (n = 4) | (NOS, 8) 4 Not reported |
Wang et al., 2021 [43], China | Retrospective cohort, single center | 10 | 0 (0) | 1 Asian | 1 No medical history | 238 | 1 | 1 Location was not reported AND 1 Blood in stool 1 Vomiting 1 Diarrhea 1 Oliguria 1 Acute kidney injury (stage 3) | 1 Raised procalcitonin 1 High CRP 1 High interleukin-6 1 High D-dimer 1 High LDH 1 High BUN 1 High serum creatinine 1 Low estimated glomerular filtration rate 1 Proteinuria 1 Hematuria | 1 Acute ISN 1 Intestinal necrosis | 1 | 1 | 1 | 1 Surgical reduction of the ISN 1 Antibiotics 1 Antivirals 1 Steroids 1 IVIG 1 CRRT 1 Plasma exchange Yes failure (surgical, n = 1) No recurrence (n = 1) | (NOS, 7) 1 Died |
Yalçınkaya et al., 2021 [44], Turkey | Retrospective cohort, single center | 72 | 0 (0) | 1 White (Caucasian) | 1 No medical history | 1 | 1 | 1 Ileo-ileal ISN AND 1 Diarrhea 1 Abdominal tenderness 1 Abdominal pain 1 Conjunctivitis 1 Tachycardia 1 Abdominal tenderness 1 Blood in stool 1 Mitral regurgitation 1 Left ventricular systolic dysfunction | 1 High CRP 1 Raised ESR 1 Raised procalcitonin 1 High interleukin-6 1 High ferritin 1 High fibrinogen 1 Decreased lymphocytes | 1 Acute ISN 1 Fluid retention in the ileal and colonic walls | 0 | 0 | 0 | 1 IVIG 1 Steroids 1 No treatment for ISN (follow-up and bowel rest) No failure (n = 1) No recurrence (n = 1) | (NOS, 7) 1 Survived |
Variable | Findings a | |||
---|---|---|---|---|
All (n = 64) | Survived (n = 43) | Died (n = 4) | p-Value b | |
Age | ||||
Less than 1 month | 0 | 0 | 0 | 0.001 * |
1 month to less than 1 year | 32 (50) | 28 (65.1) | 4 (100) | |
1 year to less than 3 years | 4 (6.2) | 4 (9.3) | 0 | |
3 years to less than 6 years | 4 (6.2) | 4 (9.3) | 0 | |
6 years to less than 12 years | 7 (10.9) | 7 (16.3) | 0 | |
12 years to 18 years | 0 | 0 | 0 | |
Gender | ||||
Male | 41 (64.1) | 41 (95.3) | 0 | 0.000 * |
Female | 18 (28.1) | 14 (32.5) | 4 (100) | |
Ethnicity | ||||
White (Caucasian) | 25 (39.1) | 25 (58.1) | 0 | 0.000 * |
Hispanic | 13 (20.3) | 13 (30.2) | 0 | |
Asian | 5 (7.8) | 1 (2.3) | 4 (100) | |
Persian | 2 (3.1) | 2 (4.6) | 0 | |
Indian | 3 (4.7) | 3 (7) | 0 | |
Arab | 1 (1.6) | 1 (2.3) | 0 | |
Pakistani | 1 (1.6) | 1 (2.3) | 0 | |
ISN classification by location | ||||
Ileocolic | 34 (53.1) | 32 (74.4) | 2 (50) | 0.001 * |
Ileo-ileal | 4 (6.2) | 4 (9.3) | 0 | |
Location was not reported | 5 (7.8) | 3 (7) | 2 (50) | |
Imaging | ||||
Acute ISN | 37 (57.8) | 33 (76.7) | 4 (100) | 0.237 |
Enlarged lymph nodes | 6 (9.4) | 6 (13.9) | 0 | |
Target sign | 4 (6.2) | 4 (9.3) | 0 | |
Imaging findings were not reported | 4 (6.2) | 4 (9.3) | 0 | |
Intestinal necrosis | 4 (6.2) | 2 (4.6) | 2 (50) | |
Doughnut-shaped mass | 2 (3.1) | 2 (4.6) | 0 | |
Meckel’s diverticulum | 2 (3.1) | 2 (4.6) | 0 | |
Symptoms from ISN | ||||
Vomiting | 36 (56.2) | 32 (74.4) | 4 (100) | 0.179 |
Abdominal pain | 29 (45.3) | 29 (67.4) | 0 | |
Red currant jelly stools | 25 (39.1) | 23 (53.5) | 2 (50) | |
Blood in stool | 15 (23.4) | 13 (30.2) | 2 (50) | |
Anorexia | 9 (14.1) | 9 (20.9) | 0 | |
Irritability | 8 (12.5) | 8 (18.6) | 0 | |
Abdominal tenderness | 8 (12.5) | 8 (18.6) | 0 | |
Dehydration | 7 (10.9) | 7 (16.3) | 0 | |
Pallor | 6 (9.4) | 6 (13.9) | 0 | |
Crying | 8 (12.5) | 6 (13.9) | 2 (50) | |
Lethargy | 7 (10.9) | 6 (13.9) | 1 (25) | |
Abdominal distension | 7 (10.9) | 5 (11.6) | 2 (50) | |
Diarrhea | 6 (9.4) | 5 (11.6) | 1 (25) | |
Tachycardia | 4 (6.2) | 4 (9.3) | 0 | |
Perception of a firm and painful mass | 4 (6.2) | 4 (9.3) | 0 | |
Rectal mucus and blood | 3 (4.7) | 3 (7) | 0 | |
Metabolic acidosis | 3 (4.7) | 3 (7) | 0 | |
Low BP | 2 (3.1) | 2 (4.6) | 0 | |
Anemia | 2 (3.1) | 2 (4.6) | 0 | |
Weakness | 2 (3.1) | 2 (4.6) | 0 | |
Nausea | 3 (4.7) | 2 (4.6) | 1 (25) | |
Cold extremities | 2 (3.1) | 2 (4.6) | 0 | |
Constipation | 2 (3.1) | 2 (4.6) | 0 | |
DIC | 2 (3.1) | 0 | 2 (50) | |
Septic shock | 2 (3.1) | 0 | 2 (50) | |
Multiple organ dysfunction | 2 (3.1) | 0 | 2 (50) | |
Peritonitis | 2 (3.1) | 1 (2.3) | 1 (25) | |
Drowsiness | 2 (3.1) | 1 (2.3) | 1 (25) | |
Absence of bowel sounds | 2 (3.1) | 1 (2.3) | 1 (25) | |
Laboratory findings | ||||
Laboratory results were not reported | 25 (39.1) | 25 (58.1) | 0 | 0.063 |
High CRP | 14 (21.9) | 10 (23.2) | 4 (100) | |
High D-dimer | 9 (14.1) | 7 (16.3) | 2 (50) | |
Low Hb | 6 (9.4) | 6 (13.9) | 0 | |
Raised procalcitonin | 5 (7.8) | 3 (7) | 2 (50) | |
High leukocytes | 4 (6.2) | 4 (9.3) | 0 | |
Decreased lymphocytes | 4 (6.2) | 3 (7) | 1 (25) | |
High ferritin | 4 (6.2) | 3 (7) | 1 (25) | |
High LDH | 4 (6.2) | 2 (4.6) | 2 (50) | |
High WBCs | 3 (4.7) | 3 (7) | 0 | |
High interleukin-6 | 3 (4.7) | 1 (2.3) | 2 (50) | |
High neutrophils | 2 (3.1) | 2 (4.6) | 0 | |
Raised liver enzymes | 2 (3.1) | 2 (4.6) | 0 | |
Hypokalemia | 2 (3.1) | 2 (4.6) | 0 | |
High BUN | 2 (3.1) | 0 | 2 (50) | |
Proteinuria | 2 (3.1) | 1 (2.3) | 1 (25) | |
High prothrombin time | 2 (3.1) | 1 (2.3) | 1 (25) | |
Leukopenia | 2 (3.1) | 1 (2.3) | 1 (25) | |
Hypoalbuminemia | 2 (3.1) | 1 (2.3) | 1 (25) | |
Hypocalcemia | 2 (3.1) | 1 (2.3) | 1 (25) | |
Comorbidities | ||||
No medical history | 32 (50) | 28 (65.1) | 4 (100) | 0.036 * |
Not reported | 15 (23.4) | 15 (34.9) | 0 | |
Left-sided renal agenesis | 1 (1.5) | 1 (2.3) | 0 | |
Developmental delay | 1 (1.5) | 1 (2.3) | 0 | |
Meningism | 1 (1.5) | 1 (2.3) | 0 | |
Hyperinsulinism | 1 (1.5) | 1 (2.3) | 0 | |
Nephrotic syndrome | 1 (1.5) | 1 (2.3) | 0 | |
Long use of steroid (15 years) | 1 (1.5) | 1 (2.3) | 0 | |
Treatment | ||||
Surgical reduction of the ISN | 17 (26.6) | 15 (34.9) | 2 (50) | 0.051 |
Pneumatic reduction of the ISN | 13 (20.2) | 11 (25.6) | 2 (50) | |
Antibiotics | 12 (18.7) | 8 (18.6) | 4 (100) | |
Hydrostatic reduction of the ISN | 11 (17.2) | 11 (25.6) | 0 | |
Laparotomy | 10 (15.6) | 9 (20.9) | 1 (25) | |
IV fluids | 8 (12.5) | 8 (18.6) | 0 | |
Oxygen supplementation | 6 (9.4) | 4 (9.3) | 2 (50) | |
Analgesics | 5 (7.8) | 5 (11.6) | 0 | |
Surgical resection | 5 (7.8) | 4 (9.3) | 1 (25) | |
Steroids | 5 (7.8) | 3 (7) | 2 (50) | |
Anastomosis | 3 (4.7) | 3 (7) | 0 | |
Anticoagulant | 2 (3.1) | 2 (4.6) | 0 | |
Total parenteral nutrition | 2 (3.1) | 2 (4.6) | 0 | |
No. treatment for ISN (follow-up and bowel rest) | 2 (3.1) | 2 (4.6) | 0 | |
CRRT | 2 (3.1) | 0 | 2 (50) | |
Plasma exchange | 2 (3.1) | 0 | 2 (50) | |
Interferon | 2 (3.1) | 0 | 2 (50) | |
Antivirals | 2 (3.1) | 0 | 2 (50) | |
IVIG | 3 (4.7) | 1 (2.3) | 2 (50) | |
Ladd’s procedure | 2 (3.1) | 1 (2.3) | 1 (25) | |
Inotropes | 2 (3.1) | 1 (2.3) | 1 (25) | |
Dopamine | 2 (3.1) | 1 (2.3) | 1 (25) | |
ISN was recurrent | ||||
No | 45 (70.3) | 41 (95.3) | 4 (100) | 0.140 |
Yes | 2 (3.1) | 2 (4.6) | 0 | |
Failure to ISN treatment | ||||
No failure | 25 (39.1) | 23 (53.5) | 2 (50) | 0.002 * |
Pneumatic reduction (yes) | 7 (10.9) | 6 (13.9) | 1 (25) | |
Hydrostatic reduction (yes) | 6 (9.4) | 6 (13.9) | 0 | |
Surgical reduction (yes) | 1 (1.5) | 0 | 1 (25) | |
Complications and treatment outcomes | ||||
Patient was admitted to ICU | 9 (14.1) | 5 (11.6) | 4 (100) | 0.000 * |
Patient was intubated and on mechanical ventilation during the ICU stay | 6 (9.4) | 2 (4.6) | 4 (100) | 0.000 * |
Patient experienced ARDS | 6 (9.4) | 2 (4.6) | 4 (100) | 0.000 * |
Variable | Univariate Analysis OR (95% CI) for Death | Multivariate Analysis OR (95% CI) for Death | ||
---|---|---|---|---|
OR (95% CI) | p-Value | OR (95% CI) | p-Value | |
Age (1 month to <1 year) | 0.42 (0.1–0.33) | 0.04 * | 0.1 (0.13–0.25) | 0.52 |
Gender (Female) | 0.74 (0.36–0.52) | <0.001 * | 1.13 (0.31–0.79) | 0.045 * |
Location (Asia) | 0.36 (0.26–0.45) | <0.001 * | 0.38 (0.28–0.48) | <0.001 * |
ISN symptom (abdominal pain) | 0.14 (0.43–0.71) | 0.62 | 0.19 (0.13–0.3) | 0.41 |
ISN symptom (blood in stool) | 0.14 (0.41–0.7) | 0.61 | 0.32 (0.11–0.31) | 0.34 |
ISN symptom (constipation) | 0.5 (0.15–1.15) | 0.13 | 0.7 (0.22–0.45) | 0.36 |
ISN symptom (crying) | 0.13 (0.44–0.69) | 0.66 | NA | NA |
ISN symptom (diarrhea) | 0.17 (0.41–0.74) | 0.57 | NA | NA |
ISN symptom (DIC) | 1 (0.35–1.65) | 0.003 * | 1.31 (0.47–0.97) | 0.42 |
ISN symptom (drowsiness) | 0.5 (0.21–1.15) | 0.13 | 0.68 (0.2–0.41) | 0.33 |
ISN symptom (lethargy) | 0.33 (0.24–0.91) | 0.25 | NA | NA |
ISN symptom (multiple organ failure) | 1 (0.35–1.65) | 0.003 * | 1.31 (0.47–0.97) | 0.42 |
ISN symptom (nausea) | 0.33 (0.28–0.95) | 0.29 | 0.41 (0.22–0.47) | 0.43 |
ISN symptom (peritonitis) | 0.5 (0.15–1.15) | 0.13 | 0.7 (0.22–0.45) | 0.36 |
ISN symptom (red currant jelly stools) | 0.04 (0.5–0.58) | 0.88 | 0.32 (0.51–0.87) | 0.32 |
ISN symptom (vomiting) | 0.11 (0.43–0.66) | 0.68 | 0.39 (0.24–0.68) | 0.75 |
Laboratory finding (decreased lymphocytes) | 0.25 (0.77–1.27) | 0.62 | 1.01 (0.74–0.75) | 0.22 |
Laboratory finding (high bloods urea nitrogen) | 1 (0.12–2.12) | 0.08 | 0.86 (0.33–0.56) | 0.48 |
Laboratory finding (high C reactive protein) | 0.31 (0.64–1.25) | 0.52 | 0.71 (0.2–0.68) | 0.47 |
Laboratory finding (high D-dimer) | 0.22 (0.74–1.18) | 0.64 | 0.48 (0.24–0.71) | 0.55 |
Laboratory finding (high ferritin) | 0.25 (0.77–1.27) | 0.62 | 0.38 (0.27–0.4) | 0.48 |
Laboratory finding (high interleukin-6) | 0.67 (0.38–1.72) | 0.21 | 0.6 (0.38–0.74) | 0.64 |
Laboratory finding (high lactate dehydrogenase) | 0.5 (0.52–1.52) | 0.33 | NA | NA |
Laboratory finding (high prothrombin time) | 0.5 (0.62–1.62) | 0.37 | NA | NA |
Laboratory finding (hypocalcemia) | 0.5 (0.62–1.62) | 0.37 | 0.21 (0.1–0.35) | 0.49 |
Laboratory finding (leukopenia) | 0.5 (0.62–1.62) | 0.37 | NA | NA |
Laboratory finding (proteinuria) | 0.5 (0.62–1.62) | 0.37 | NA | NA |
Failure to ISN reduction (pneumatic or surgical) (yes) | 0.16 (0.06–0.27) | 0.002 * | 0.11 (0.05–0.21) | 0.036 * |
Recurrent ISN (yes) | 0.17 (0.09–0.43) | 0.21 | 0.34 (0.19–0.29) | 0.51 |
Intensive care unit admission (yes) | 0.53 (0.45–0.6) | <0.001 * | 0.71 (0.83–1.18) | 0.03 * |
Mechanically ventilated (yes) | 0.84 (0.79–0.9) | <0.001 * | 0.68 (0.51–1.41) | 0.01 * |
Suffered from ARDS (yes) | 0.75 (0.68–0.81) | <0.001 * | 0.88 (0.93–1.88) | 0.01 * |
Treatment (antibiotics = yes) | 0.31 (0.02–0.59) | 0.03 * | 0.29 (0.01–0.03) | 0.06 |
Treatment (antivirals = yes) | 1 (0.61–1.39) | <0.001 * | 0.78 (0.93–1.22) | 0.77 |
Treatment (CRRT = yes) | 1 (0.55–1.45) | <0.001 * | 0.64 (0.31–0.45) | 0.63 |
Treatment (dopamine = yes) | 0.5 (0.05–0.95) | 0.03 * | NA | NA |
Treatment (inotropes = yes) | 0.5 (0.05–0.95) | 0.03 * | NA | NA |
Treatment (interferon = yes) | 1 (0.55–1.45) | <0.001 * | 0.64 (0.31–0.45) | 0.63 |
Treatment (IVIG = yes) | 0.75 (0.39–1.11) | <0.001 * | 0.78 (0.48–1.49) | 0.27 |
Treatment (Ladd’s procedure = yes) | 0.5 (0.05–0.95) | 0.03 * | NA | NA |
Treatment (oxygen supplementation = yes) | 0.33 (0.61–1.39) | 0.04 * | 0.19 (0.17–0.34) | 0.23 |
Treatment (plasma exchange = yes) | 1 (0.55–1.45) | <0.001 * | 0.64 (0.31–0.45) | 0.63 |
Treatment (pneumatic reduction of ISN = yes) | 0.03 (0.23–0.28) | 0.83 | 0.13 (0.16–0.45) | 0.61 |
Treatment (surgical reduction of ISN = yes) | 0.09 (0.16–0.34) | 0.47 | NA | NA |
Treatment (steroids = yes) | 0.5 (0.17–0.83) | <0.001 * | 0.21 (0.14–0.58) | 0.21 |
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Alhumaid, S.; Al Alawi, Z.; Alnaim, A.A.; Al Ghamdi, M.A.; Alabdulqader, M.; Al Noaim, K.; Rabaan, A.A.; Al mutared, K.M.; Al Dossary, N.; Alsuliman, M.; et al. Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis. Children 2022, 9, 1745. https://doi.org/10.3390/children9111745
Alhumaid S, Al Alawi Z, Alnaim AA, Al Ghamdi MA, Alabdulqader M, Al Noaim K, Rabaan AA, Al mutared KM, Al Dossary N, Alsuliman M, et al. Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis. Children. 2022; 9(11):1745. https://doi.org/10.3390/children9111745
Chicago/Turabian StyleAlhumaid, Saad, Zainab Al Alawi, Abdulrahman A. Alnaim, Mohammed A. Al Ghamdi, Muneera Alabdulqader, Khalid Al Noaim, Ali A. Rabaan, Koblan M. Al mutared, Nourah Al Dossary, Murtadha Alsuliman, and et al. 2022. "Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis" Children 9, no. 11: 1745. https://doi.org/10.3390/children9111745
APA StyleAlhumaid, S., Al Alawi, Z., Alnaim, A. A., Al Ghamdi, M. A., Alabdulqader, M., Al Noaim, K., Rabaan, A. A., Al mutared, K. M., Al Dossary, N., Alsuliman, M., Almatawah, Y. A., AlOmran, A. T., Al HajjiMohammed, S. M., Alfarhan, D. R., Al Suwaiq, H. A., Al mutarid, M. M., Alkolib, M. J., Mohapatra, R. K., & Al Mutair, A. (2022). Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis. Children, 9(11), 1745. https://doi.org/10.3390/children9111745