Essay on Hirschsprung’s Disease in the Newborn

• Introduction:

Hirschsprung’s disease is one of the causes of intestinal obstructions among newborns. Intestinal obstructions among newborns may also be easily confused or misdiagnosed as other conditions, which may lead to delays in treatment or wrong treatments altogether, causing mortality. Also, some symptoms of Hirschsprung’s disease, such as the failure to pass meconium are similar for many conditions, which may lead to misdiagnosis. All these reasons indicate the need for a better understanding of Hirschsprung’s disease and are also why I settled on Hirschsprung’s disease in newborns as my topic.

• Summary of the article:

Polley and Coran [1] talk about the diagnosis and treatment of Hirschsprung’s disease. Diagnosis of Hirschsprung’s disease is essential in newborn infants (under 30 days of life) due to the high mortality rate associated with this period. In their study, Polley and Coran [1] review the high levels of congenital anomalies and the significance of diagnostic barium enema in newborns diagnosed with Hirschsprung’s disease. 35 out of 99 patients studied were infants within the first 30 days of life, and clinical data were obtained based on this cohort. Among the 35 patients selected, 24 were male, while 11 patients were female. The number of infants with rectosigmoid and long-segment diseases was 22 and 13 infants, respectively. Signs of Hirschsprung’s disease included abdominal distention, constipation, and vomiting. Additionally, infants were diagnosed using the suction rectal biopsy, whereas barium enema was used to evaluate results. The findings also indicated anomalies associated with other diseases such as Down’s Syndrome. The study recommends the use of early level colostomy in the diagnosis of patients to achieve a 100% survival rate of infants. Literature reports of most clinical studies find Hirschsprung’s disease to be significant in the neonatal treatment of long-segment and intestinal diseases. In conclusion, the study asserts that it is essential to apply diagnostic procedures in treating intestinal obstruction.

• Discussion:

Polley and Coran [1] examine the presentation of Hirschsprung’s disease in 35 newborns who are 30 days old and below. Understanding the presentation of Hirschsprung’s disease is essential because it is the second-highest cause of neonatal intestinal obstruction after necrotizing enterocolitis. In their study, Polley and Coran [1] reviewed data regarding these patients that were recorded between 1 July 1974 and 31 August 1985. Polley and Coran [1] found that 22 out of the 35 newborns had standard rectosigmoid disease while 13 had the long-segment disease. Existence of the long-segment disease in 37% of the patients (13 out of 35) was an uncommon finding since most other studies, such as one conducted by Klein and Scarborough [2], found much lower percentages of patients with the long-segment disease. Also, Polley and Coran [1] found that Hirschsprung’s disease was more predominant in males compared to females. This finding is similar to assertions by Kleinhaus [4], who found similar results while surveying Hirschsprung’s disease. Polley and Coran [1] also found abdominal distention, failure to pass meconium, constipation, and vomiting as the common symptoms of Hirschsprung’s disease. It is important to note that although failure to pass meconium is mostly used as an indicator of Hirschsprung’s disease [5], it may not always be the case since more than half of the study population were able to pass meconium. Diagnosis of Hirschsprung’s disease in 23 of the newborns was made using suction rectal biopsy while the rest of the newborns were diagnosed using other related methods such as full-thickness rectal biopsy or during operation. Concerning this, Polley and Coran [1] argue that suction rectal biopsy is the most accurate method of diagnosing Hirschsprung’s disease because it does not give a false negative or false positive. Lastly, Polley and Coran [1] used leveling colostomy or enterostomy as the primary treatment method for Hirschsprung’s disease. However, Shimm and Swenson [3] argue that stressed rectal irrigations can act as a more significant treatment method compared to colostomy. Nonetheless, Polley and Coran [1] maintain that leveling colostomy is still the most superior treatment for Hirschsprung’s disease because it resulted in 0% mortality among the 35 newborns in their study.

• Conclusion:

In conclusion, studying Hirschsprung’s disease is not only important because it is a leading cause of neonatal intestinal obstruction but also because it is a leading cause of neonatal mortality. Findings by Polley and Coran [1] are valid because they were drawn from a scientific study, and majority of them are in line with findings from other previous studies. However, the treatment of Hirschsprung’s disease needs further research to determine the best method because the existing methods of treatment have all been proven to work by different scholars. Understanding Hirschsprung’s disease is essential even for people outside the medical field since it can affect any newborn and is hereditary in some cases.

References

1. Polley TZ, Coran AG. Hirschsprung’s disease in the newborn. Pediatric surgery international. 1986 Jun 1;1(2):80-3.
2. Klein RR, Scarborough RA. Hirschsprung’s disease in the newborn. The American Journal of Surgery. 1954 Jul 1;88(1):6-16.
3. Shim WK, Swenson O. Treatment of congenital megacolon in 50 infants. Pediatrics. 1966 Aug 1;38(2):185-93.
4. Kleinhaus S, Boley SJ, Sheran M, Sieber WK. Hirschsprung’s disease a survey of the members of the surgical section of the American Academy of Pediatrics. Journal of pediatric surgery. 1979 Oct 1;14(5):588-97.
5. Bradnock TJ, Knight M, Kenny S, Nair M, Walker GM. Hirschsprung’s disease in the UK and Ireland: incidence and anomalies. Archives of disease in childhood. 2017 Aug 1;102(8):722-7.