Variations in the Detection of Anorectal Anomalies at Birth among European Cities

Bashar Aldeiri, Joseph R Davidson, Simon Eaton, Riccardo Coletta, Andre Cardoso Almeida, Anna-May Long, Marian Knight, Kate M Cross, Taieb Chouikh, Barbara Daniela Iacobelli, Sabine Sarnacki, Pietro Bagolan, Celia Cretolle, Sotirios Siminas, Joe I Curry, Antonino Morabito, Paolo De Coppi

Research output: Contribution to journalArticle

Abstract

AIM:  The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers.

MATERIALS AND METHODS:  All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics.

RESULTS:  Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth.

CONCLUSION:  Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.

Fingerprint

Parturition
Delayed Diagnosis
European Union
Birthing Centers
Perineum
Anorectal Malformations
Physical Examination
Fistula
Demography
United Kingdom

Cite this

Variations in the Detection of Anorectal Anomalies at Birth among European Cities. / Aldeiri, Bashar; Davidson, Joseph R; Eaton, Simon; Coletta, Riccardo; Cardoso Almeida, Andre; Long, Anna-May; Knight, Marian; Cross, Kate M; Chouikh, Taieb; Iacobelli, Barbara Daniela; Sarnacki, Sabine; Bagolan, Pietro; Cretolle, Celia; Siminas, Sotirios; Curry, Joe I; Morabito, Antonino; De Coppi, Paolo.

In: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie, 30.04.2019.

Research output: Contribution to journalArticle

Aldeiri, B, Davidson, JR, Eaton, S, Coletta, R, Cardoso Almeida, A, Long, A-M, Knight, M, Cross, KM, Chouikh, T, Iacobelli, BD, Sarnacki, S, Bagolan, P, Cretolle, C, Siminas, S, Curry, JI, Morabito, A & De Coppi, P 2019, 'Variations in the Detection of Anorectal Anomalies at Birth among European Cities', European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. https://doi.org/10.1055/s-0039-1687868
Aldeiri, Bashar ; Davidson, Joseph R ; Eaton, Simon ; Coletta, Riccardo ; Cardoso Almeida, Andre ; Long, Anna-May ; Knight, Marian ; Cross, Kate M ; Chouikh, Taieb ; Iacobelli, Barbara Daniela ; Sarnacki, Sabine ; Bagolan, Pietro ; Cretolle, Celia ; Siminas, Sotirios ; Curry, Joe I ; Morabito, Antonino ; De Coppi, Paolo. / Variations in the Detection of Anorectal Anomalies at Birth among European Cities. In: European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie. 2019.
@article{3cbe4c83e8984d79a9479fd81e52cb44,
title = "Variations in the Detection of Anorectal Anomalies at Birth among European Cities",
abstract = "AIM:  The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13{\%}. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers.MATERIALS AND METHODS:  All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics.RESULTS:  Across the four centers, 117/1,350, 8.7{\%} were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5{\%}) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8{\%}) compared with those in the European Union (43/935, 4.6{\%}) (p < 0.00001), and this was independent of individual center and year of birth.CONCLUSION:  Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.",
author = "Bashar Aldeiri and Davidson, {Joseph R} and Simon Eaton and Riccardo Coletta and {Cardoso Almeida}, Andre and Anna-May Long and Marian Knight and Cross, {Kate M} and Taieb Chouikh and Iacobelli, {Barbara Daniela} and Sabine Sarnacki and Pietro Bagolan and Celia Cretolle and Sotirios Siminas and Curry, {Joe I} and Antonino Morabito and {De Coppi}, Paolo",
note = "Georg Thieme Verlag KG Stuttgart · New York.",
year = "2019",
month = "4",
day = "30",
doi = "10.1055/s-0039-1687868",
language = "English",
journal = "European Journal of Pediatric Surgery",
issn = "0939-7248",
publisher = "Thieme Medical Publishers",

}

TY - JOUR

T1 - Variations in the Detection of Anorectal Anomalies at Birth among European Cities

AU - Aldeiri, Bashar

AU - Davidson, Joseph R

AU - Eaton, Simon

AU - Coletta, Riccardo

AU - Cardoso Almeida, Andre

AU - Long, Anna-May

AU - Knight, Marian

AU - Cross, Kate M

AU - Chouikh, Taieb

AU - Iacobelli, Barbara Daniela

AU - Sarnacki, Sabine

AU - Bagolan, Pietro

AU - Cretolle, Celia

AU - Siminas, Sotirios

AU - Curry, Joe I

AU - Morabito, Antonino

AU - De Coppi, Paolo

N1 - Georg Thieme Verlag KG Stuttgart · New York.

PY - 2019/4/30

Y1 - 2019/4/30

N2 - AIM:  The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers.MATERIALS AND METHODS:  All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics.RESULTS:  Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth.CONCLUSION:  Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.

AB - AIM:  The diagnosis of anorectal malformations (ARMs) is made at birth by perineal examination of the newborn, yet small series reported late diagnosis in almost 13%. No large series to date have looked into the magnitude of missed ARM cases in the neonatal period across Europe. This study aimed to define the rate of missed ARM at birth across four United Kingdom and European Union centers.MATERIALS AND METHODS:  All ARM cases treated at two United Kingdom tertiary centers in the past 15 years were compared with two tertiary European centers. Demographic and relevant clinical data were collected. Late diagnosis was defined as any diagnosis made after discharge from the birth unit. Factors associated with late diagnosis were explored with descriptive statistics.RESULTS:  Across the four centers, 117/1,350, 8.7% were sent home from the birth unit without recognizing the anorectal anomaly. Missed cases showed a slight female predominance (1.3:1), and the majority (113/117, 96.5%) were of the low anomaly with a fistula to the perineum. The rate of missed ARM cases was significantly higher in the United Kingdom centers combined (74/415, 17.8%) compared with those in the European Union (43/935, 4.6%) (p < 0.00001), and this was independent of individual center and year of birth.CONCLUSION:  Significant variation exists between the United Kingdom and other European countries in the detection of ARM at birth. We recommend raising the awareness of accurate perineal examination at the time of newborn physical examination. We feel this highlights an urgent need for a national initiative to assess and address the timely diagnosis of ARM in the United Kingdom.

U2 - 10.1055/s-0039-1687868

DO - 10.1055/s-0039-1687868

M3 - Article

C2 - 31039595

JO - European Journal of Pediatric Surgery

JF - European Journal of Pediatric Surgery

SN - 0939-7248

ER -