title: Clinical impacts of delayed diagnosis of Hirschsprung's disease in newborn infants.
abstract: BACKGROUND
  Asian infants are at a higher risk of having Hirschsprung's disease (HD). Although HD is surgically correctable, serious and even lethal complications such as Hirschsprung's-associated enterocolitis (HAEC) can still occur. The aim of this study was to investigate the risk factors of HAEC, and the clinical impacts of delayed diagnosis of HD in newborn infants.
  
  
  METHODS
  By review of medical charts in a medical center in Taiwan, 51 cases of neonates with HD between 2002 and 2009 were collected. Patients were divided into two groups based on the time of initial diagnosis: Group I, diagnosis made within 1 week after birth, and Group II after 1 week. Clinical features including demographic distribution, presenting features of HD, short-term and long-term complications related to HD were compared between the two groups of patients.
  
  
  RESULTS
  There were 25 patients in Group I and 19 in Group II. Group II patients had more severe clinical signs and symptoms of HAEC than Group I patients. The incidence of preoperative HAEC was 12% in Group I and 63% in Group II (adjusted odds ratio = 12.81, confidence interval = 2.60-62.97). Patients with preoperative HAEC were more likely to develop adhesive bowel obstruction after operation (33% vs. 3%, p = 0.013) and failure to thrive (33% vs. 3%, p = 0.013). Also, patients with long-segment or total colonic aganglionosis were at risk of developing both postoperative HAEC (85% vs. 29%, p = 0.001) and failure to thrive (39% vs. 3%, p = 0.002).
  
  
  CONCLUSIONS
  In our study, we found that delayed diagnosis of HD beyond 1 week after birth significantly increases the risk of serious complications in neonatal patients. Patients with long-segment or total colonic aganglionosis have higher risk of postoperative HAEC and failure to thrive. Patients with preoperative HAEC are more likely to have adhesive bowel obstruction and failure to thrive.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University, School of Medicine, Taoyuan, Taiwan.
authors.forename: Chien-Chung
authors.initials: CC
authors.lastname: Lee
authors.forename: Reyin
authors.initials: R
authors.lastname: Lien
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chiang
authors.forename: Ming-Chou
authors.initials: MC
authors.lastname: Chian
authors.forename: Peng-Hong
authors.initials: PH
authors.lastname: Yang
authors.forename: Shih-Ming
authors.initials: SM
authors.lastname: Chu
authors.forename: Jen-Hei
authors.initials: JH
authors.lastname: Fu
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
mesh_terms: D057210:Delayed Diagnosis; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology