Abstract
Objective
To estimate the impact of delayed presentation of anorectal malformation (ARM) in neonates and to compare the presenting characteristics and outcomes of early versus delayed presentation.
Methods
This is a prospective observational study of all neonates (age < 28 d) with ARM over 2 y. Delayed presentation was defined as presentation beyond 48 h of birth. Various presenting features and their early postoperative outcomes were compared.
Results
Nearly half (26, 48%) of the 54 neonates with ARM had delayed presentation. Early and late presenters did not differ in terms of gender, gestational age, birth weight, place of delivery, and type of ARM (p > 0.05 for all). Delayed group had lower weight at presentation (p = 0.008), higher incidence of severe abdominal distension (p = 0.05), and sepsis (p = 0.171) and required longer time for resuscitation (p = 0.007) and more inotropes (p = 0.015), preoperatively. Early postoperative outcomes including time for stoma to function, initiate feeds and time to reach full feeds were significantly delayed in late presenters. They also had more wound infections, longer hospital stay and higher mortality.
Conclusions
Delayed diagnosis of ARM is associated with significantly higher morbidity and mortality. Adequate awareness and training of health workers for early identification of ARM by careful perineal examination of all newborns at birth is the need of the hour.
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MR: Drafting the manuscript, literature search; NT: Maintaining the data, patient care, and data analysis; MB: Treating surgeon, concept, finalizing the manuscript; RPK: Critical revision, patient care; RS: Supervision and critical revision. RPK will act as the guarantor for this paper.
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Reddy, M., Tank, N., Bawa, M. et al. Anorectal Malformations: The Earlier the Diagnosis, the Better the Outcome. Indian J Pediatr 89, 536–540 (2022). https://doi.org/10.1007/s12098-021-03887-2
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DOI: https://doi.org/10.1007/s12098-021-03887-2