Anorectal malformations: changes in neonatal management in the last 22 years

Abstract

Introduction and objectives. An altered perineal inspection or the delay in meconium expulsion should lead us to suspect an anorectal malformation. This study has aimed to know the incidence of these malformations and to study the obstetric and neonatal, diagnostic and therapeutic characteristics of these patients, and their complications in the last 22 years.

Material and methods. A descriptive and retrospective study including patients having a diagnosis in the neonatal period of anorectal malformations, excluding Hirschsprung’s disease, between 2000-2021. Two time periods were established to see possible changes (2000-2010 versus 2011-2021).

Results. 27 patients, 92.6% males, there being an incidence of one case per 5,895 newborns in our region. 88.9% underwent surgery with a median age of 2 days, admission being required for a median of 15 days. 95.8% received antibiotic therapy (median of 6 days), the regimen used most being the association of ampicillin, gentamicin and clindamycin; 25% required invasive mechanical ventilation (median of 1 day) and 25% sedated analgesia after the intervention. 17 patients required parenteral nutrition (mean 7.6 days). 16.7% had short-term complications (75% infectious). In the medium to long term, 37.5% required reoperation. We did not find any significant differences in the clinical or diagnostic characteristics between the two time periods analyzed.

Conclusions. Anorectal malformations are a relatively frequent cause of intestinal obstruction in the neonatal period that requires multidisciplinary treatment. We have not found differences in terms of its incidence or in its management and outcome regarding the last 22 years.