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Congenital duodenal obstruction in the UK: a population-based study
  1. George Stephen Bethell1,
  2. Anna-May Long2,3,
  3. Marian Knight2,
  4. Nigel J Hall1
  5. On behalf of BAPS-CASS
    1. 1 University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
    2. 2 National Perinatal Epidemiology Unit, Nuffield Department of Population Health, Oxford, UK
    3. 3 Department of Paediatric Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Cambridgeshire, UK
    1. Correspondence to Nigel J Hall, University Surgery Unit, Mailpoint 816, Southampton General Hospital, Southampton SO16 6YD, UK; n.j.hall{at}soton.ac.uk

    Abstract

    Objective Congenital duodenal obstruction (CDO) comprising duodenal atresia or stenosis is a rare congenital anomaly requiring surgical correction in early life. Identification of variation in surgical and postoperative practice in previous studies has been limited by small sample sizes. This study aimed to prospectively estimate the incidence of CDO in the UK, and report current management strategies and short-term outcomes.

    Design Prospective population-based, observational study for 12 months from March 2016.

    Setting Specialist neonatal surgical units in the UK.

    Main outcome measures Incidence of CDO, associated anomalies and short-term outcomes.

    Results In total, 110 cases were identified and data forms were returned for 103 infants giving an estimated incidence of 1.22 cases per 10 000 (95% CI 1.01 to 1.49) live births. Overall, 59% of cases were suspected antenatally and associated anomalies were seen in 69%. Operative repair was carried out mostly by duodenoduodenostomy (76%) followed by duodenojejunostomy (15%). Postoperative feeding practice varied with 42% having a trans-anastomotic tube placed and 88% receiving parenteral nutrition. Re-operation rate related to the initial procedure was 3% within 28 days. Two infants died within 28 days of operation from unrelated causes.

    Conclusion This population-based study of CDO has shown that the majority of infants have associated anomalies. There is variation in postoperative feeding strategies which represent opportunities to explore the effects of these on outcome and potentially standardise approach. Short-term outcomes are generally good.

    • neonatology
    • paediatric surgery
    • epidemiology
    • congenital Abnorm

    This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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    Footnotes

    • Contributors GSB wrote the statistical analysis plan, cleaned and analysed the data, and drafted and revised the manuscript. A-ML designed the study protocol and data collection forms, monitored data collection and revised the manuscript. MK designed the study protocol and data collection forms, monitored data collection and revised the manuscript. NJH designed the study protocol and data collection forms, monitored data collection, revised the statistical analysis plan, oversaw analysis of the data and revised the manuscript. All other named collaborators were involved in data collection and submission at individual surgical centres.

    • Funding This project was funded through a National Institute for Health Research (NIHR) Professorship award to MK (NIHR-RP-011-032). GSB is funded by the National Institute of Heath Research Academic Clinical Fellow programme.

    • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

    • Competing interests None declared.

    • Ethics approval The study was carried out according to a predefined protocol and received ethical approval from the National Research Ethics Service South Central—Oxford A committee 12/SC/0416.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data sharing is governed by the National Perinatal Epidemiology Unit Data Sharing Policy, which can be obtained from marian.knight@npeu.ox.ac.uk.

    • Collaborators Abigail Jones, Queen’s Medical Centre; Adil Aslam, Addenbrooke’s Hospital; Alan Mortell, The Children’s University Hospital; Amanda McCabe, Edinburgh Royal Hospital for Sick Children; Andrew Ross, Chelsea and Westminster Hospital; Anna Harris, Edinburgh Royal Hospital for Sick Children; Anne Lawson, Royal Victoria Infirmary; Arun Kelay, King’s College Hospital; Aruna Abhyankar, University Hospital of Wales; Ashok Rajimwale, Leicester Royal Infirmary; Atif Saeed, Addenbrooke’s Hospital; Bala Eradi, Leicester Royal Infirmary; Baqer Sharif, Birmingham Children’s Hospital; Brian MacCormack, Royal Belfast Hospital for Sick Children; Caroline Pardy, St George’s Hospital; Catherine Ridd, The Great North Children’s Hospital; Ceri Jones, John Radcliffe Hospital and Southampton General Hospital; Chris Driver, Royal Aberdeen Children’s Hospital; Chris Parsons, Royal London Hospital; Chun-Sui Kwok, John Radcliffe Hospital; Clare Rees, Great Ormond Street Hospital for Sick Children; Clare Skerritt, Evelina Children’s Hospital; Dan Aronson, University Hospital of Wales; David Marshall, Royal Belfast Hospital for Sick Children; Dawn Deacy, The Children’s University Hospital; Debasish Banerjee, Norfolk and Norwich University Hospital; Diane De Caluwe, Chelsea and Westminster Hospital; Dorothy Kufeji, Evelina Children’s Hospital; Eleri Cusick, Bristol Royal Hospital for Children; Elizabeth O’Connor, The Great North Children’s Hospital; Georgina Bough, Addenbrooke’s Hospital; Govind Murthi, Sheffield Children’s Hospital; Hetal Patel, Glasgow Royal Hospital for Sick Children; Ian Jones, University Hospital of Wales; Ian Sugarman, Leeds General Infirmary; Ike Njere, St George’s Hospital; Ingo Jester, Birmingham Children’s Hospital; Jonathan Durell, Southampton General Hospital; Kevin Cao, Royal Alexandra Children’s Hospital; Khalid Elmalik, Leicester Royal Infirmary; Lucinda Tullie, Southampton General Hospital; Madhavi Kakade, Leicester Royal Infirmary; Maryam Haneef, Alder Hey Children’s Hospital; Melania Matcovici, The Children’s University Hospital; Michael Dawrant, Leeds General Infirmary; Michelle Horridue, Sheffield Children’s Hospital; Miguel Soares-Oliveira, Addenbrooke’s Hospital; Miriam Doyle, The Children’s University Hospital; Mohamed Shalaby, Bristol Royal Hospital for Children; Morven Allan, King’s College Hospital; Oliver Burdall, Norfolk and Norwich University Hospital; Paul Charlesworth, Royal London Hospital; Paul Johnson, John Radcliffe Hospital; Richard Hill, Leicester Royal Infirmary; Rosie Cresner, Chelsea and Westminster Hospital; Ross Craigie, Royal Manchester Children’s Hospital; Samir Gupta, Great Ormond Street Hospital for Sick Children; Sandeep Motiwale, Queen’s Medical Centre; Sanja Besarovic, Hull Royal Infirmary; Saravanakumar Paramalingam, Royal Alexandra Children’s Hospital; Sean Marven, Sheffield Children’s Hospital; Shailesh Patel, King’s College Hospital; Shazia Sharif, Royal London Hospital; Shehryer Naqvi, Royal Alexandra Children’s Hospital; Simon Clarke, Chelsea and Westminster Hospital; Simon Kenny, Alder Hey Children’s Hospital; Stefano Giuliani, St George’s Hospital; Susan Payne, Sheffield Children’s Hospital; Thanos Tyraskis, King’s College Hospital; Thomas Tsang, Norfolk and Norwich University Hospital; Tim Bradnock, Glasgow Royal Hospital for Sick Children; William Calvert, Alder Hey Children’s Hospital; Yatin Patel, Royal Aberdeen Children’s Hospital.

    • Presented at 65th British Association of Paediatric Surgeons Annual International Congress, Liverpool. July 2018. Oral presentation.

    • Patient consent for publication Not required.

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