title: Predictive value of nerve trunk size in the neonate.
abstract: OBJECTIVE
  The diagnosis of Hirschsprung's disease (HD) remains challenging. The identification of ganglion cells is difficult and acetycholine esterase (AChE) staining can be subject to a great variability, particularly in the neonatal period (<8 weeks). Nerve trunks greater than 40 µm are considered to be predictive for HD. The aim of this study was to evaluate the usefulness of measuring nerve trunk size in the newborn with HD.
  
  
  METHODS
  Out of 292 biopsies 69 could be reanalyzed by three independent researchers. 40 µm was used as cutoff point for nerve trunk size. They were subdivided into three groups: (a) diagnosis of HD certain at the first biopsy, (b) no HD and (c) diagnosis of HD remains doubtful and re-biopsy taken.
  
  
  RESULTS
  In 87 % of group A nerve trunk size was ≥ 40 µm (SD 13.8). In 84 % of group B trunk size was < 40 µm (SD 16.2). In group C only 60 % of the patients showed a positive correlation between final diagnosis and nerve trunk size.
  
  
  CONCLUSIONS
  Using 40 µm as the cutoff point gave 13 % false-negative and 16 % false-positive cases. Measurement of the nerve trunk in the neonatal period does not seem to be a reliable method for detecting HD.
authors.affiliation: Department of Surgery-Pediatric Surgery, Radboudumc, Nijmegen, The Netherlands, roxana.rassouli-kirchmeier@radboudumc.nl.
authors.forename: Roxana
authors.initials: R
authors.lastname: Rassouli-Kirchmeier
authors.forename: Maarten Janssen
authors.initials: MJ
authors.lastname: Lok
authors.forename: Benno
authors.initials: B
authors.lastname: Kusters
authors.forename: Iris
authors.initials: I
authors.lastname: Nagtegaal
authors.forename: Nils
authors.initials: N
authors.lastname: Köster
authors.forename: Herjan
authors.initials: H
authors.lastname: van der Steeg
authors.forename: Marc
authors.initials: M
authors.lastname: Wijnen
authors.forename: Ivo
authors.initials: I
authors.lastname: de Blaauw
mesh_terms: D001706:Biopsy; D003106:Colon / Q000294:innervation* / Q000473:pathology; D005724:Ganglia / Q000473:pathology*; D006627:Hirschsprung Disease / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007413:Intestinal Mucosa / Q000294:innervation* / Q000473:pathology; D009474:Neurons / Q000473:pathology*; D012007:Rectum / Q000294:innervation* / Q000473:pathology