Eur J Pediatr Surg
DOI: 10.1055/s-0039-1687868
Original Article
Georg Thieme Verlag KG Stuttgart · New York

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

1  Department of Paediatric and Neonatal Surgery, Royal Manchester Children’s Hospital, Manchester, United Kingdom
,
Joseph R. Davidson
2  Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom
,
Simon Eaton
2  Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom
,
Riccardo Coletta
3  Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Italy
,
Andre Cardoso Almeida
1  Department of Paediatric and Neonatal Surgery, Royal Manchester Children’s Hospital, Manchester, United Kingdom
,
Anna-May Long
4  National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
,
Marian Knight
4  National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
,
Kate M. Cross
5  Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
,
Taieb Chouikh
6  Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
,
Barbara Daniela Iacobelli
7  Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Research Hospital, Rome, Italy
,
Sabine Sarnacki
6  Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
,
Pietro Bagolan
7  Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Research Hospital, Rome, Italy
,
Celia Cretolle
6  Department of Pediatric Surgery, Hôpitaluniversitaire Necker Enfants Malades, Paris, Île-de-France, France
,
Sotirios Siminas
1  Department of Paediatric and Neonatal Surgery, Royal Manchester Children’s Hospital, Manchester, United Kingdom
,
Joe I. Curry
5  Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
,
Antonino Morabito
3  Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Italy
,
Paolo De Coppi
2  Stem Cells and Regenerative Medicine, Developmental Biology and Cancer Programme, University College London Institute of Child Health, London, United Kingdom
5  Department of Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
› Author Affiliations
Further Information

Publication History

05 December 2018

09 March 2019

Publication Date:
30 April 2019 (eFirst)

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.

Note

All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.


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