Intussusception and COVID-19 in Children: A Systematic Review and Meta-Analysis. Performance of Deep Learning-Based Algorithm for Detection of Pediatric Intussusception on Abdominal Ultrasound Images. 7. Haberkern CM, Smith BM. 4 or 5 We judged two trials as having inadequate blinding of outcome assessors because treating personnel recorded the results and thus were unable to be blinded (Hadidi 1999; Meyer 1993). Air enema may be superior to liquid enema for successfully reducing intussusception in children; however, this finding is based on a few studies including small numbers of participants. Zimmerman CM. We outlined in Figure 1 (study flow diagram) the process of identifying RCTs for inclusion in the review. Christmann D. Intestinal intussusception survey about diagnostic and nonsurgical therapeutic procedures. Management for intussusception in children. Okoro CA, This outcome was not reported for this comparison. Current radiological management of intussusception in children. Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 1 Successfully reduced intussusception. There is at least one important risk of bias. No trials in this comparison reported on the number of children with bowel perforation(s) nor on the number of children with recurrent intussusception. 5. exp Child/ Comparison 2 Enema plus dexamethasone versus enema alone, Outcome 2 Bowel perforation(s). 2019 Feb;29(1):7-13. doi: 10.1055/s-0038-1668145. Li SH, a list of random numbers); Assignment envelopes were used without appropriate safeguards (e.g. 15. trial.ti. 20. The .gov means its official. When untreated, intussusception may cause bowel perforation, peritonitis, and shock (Ko 2007). http://www.acr.org (last accessed 15 May 2012). (exp animal/ or exp invertebrate/ or animal.hw. Kobayashi M. Association of viral isolates from stool samples with intussusception in children, International Journal of Infectious Diseases. Carlin JB, Dexamethasone as an adjuvant may be more effective in reducing intussusception recurrence rates following air enema or liquid enema, but these results are also based on a few studies of small numbers of participants. Intussusception is a common abdominal emergency in children with significant morbidity. PDF Intussusception in Children Fischer TK, Initial treatment includes obtaining adequate intravenous access and correction of hypovolaemia with isotonic fluid resuscitation. Intussusception generally occurs between 6 months and 3 years of age, with 65% of cases occurring before age 1 and 80 to 90% occurring before age 2. In rare cases, these events can cause death. Intussusception - Diagnosis & Treatment Rohrschneider WK. EA, Child Intussusception - PubMed It's the most common abdominal emergency in early childhood. We included all trials that compared different contrast media, imaging modalities, pharmacological adjuvants, protocols for delayed repeat enemas, and/or surgical approaches. Farley TA. McMahillWalraven C, #6 (infant* or child* or newborn*):ti,ab,kw Ito Y, Gray MP, Intussusception | Children's Hospital of Philadelphia Only 76 patients came to follow up examinations; however these data were not used in this review, By definition, the paediatric surgeon or radiologist was aware of the procedure each was conducting, Outcome assessment involved a treating surgeon or radiologist capable of interpreting sonographic criteria for successful reduction (disappearance of intussusception and visualisation of the passage of fluid and air bubbles from the caecum well into the terminal ileum), "We designed a randomised, doubleblind study", Data on participants lost to followup not reported, Method of data collection post discharge not reported, "We designed a randomised, doubleblind study, It was not specified who assessed outcomes, Randomization was based on a table of random numbers, wherein 20 consecutive random numbers were selected and assigned to cases 1 through 20. Evidence is insufficient to show whether adjuncts such as glucagon or dexamethasone influenced intussusception reduction rates. Hayakawa M, AbouKhalil M, Skarsgard ED, Insufficient reporting of attrition/exclusions to permit judgement of Low risk or High risk (e.g. McIntyre PB, Essa 2011 explicitly referred to reporting on all participants included in this trial, and Franken 1983, Hadidi 1999, and Meyer 1993 avoided attrition bias by randomising participants after completing an exclusion process. Pozo G, Trends inintussusceptionassociated hospitalizations and deaths among US infants, Diagnosis and management of pediatric appendicitis, intussusception, and meckel diverticulum, Intussusception, rotavirus, and oral vaccines: summary of a workshop. The role of antibiotics is unclear. Successful diagnosis of intussusception not significantly different between air and liquid contrast groups, No protocol available. When necessary, we read the full text of the paper or requested additional data from study authors. Connolly B, We expected the following areas to contribute to study heterogeneity, and we planned to conduct subgroup analyses of relevant models when necessary. Bookshelf Air enema for reduction of intussusception in children: risk of bacteremia, Association between antibiotic use and primary idiopathic intussusception, Archives of Pediatrics & Adolescent Medicine, Intestinal infection, the most frequent cause of invagination in childhood: results of a 10year clinical study. It is the most common acquired cause of intestinal obstruction in children aged 4 months to 2 years with a peak of incidence between 4 and 9 months of age [].Etiology of intussusception is reported to be idiopathic in about 90% of cases and rarely is it . GoniOrayen C. Rescue by pneumoenema under general anaesthesia of apparently nonreducible intestinal intussusception, Analyses of air enema and radiographic film for acute intussusception in children, ChungHua i Hsueh Tsa Chih [Chinese Medical Journal], Intravenous glucagon in hydrostatic reduction of intussusception: a controlled study of 63 patients, ChungHua Min Kuo Hsiao Erh Ko i Hsueh Hui Tsa Chih, The role of abdominal radiography in the diagnosis of intussusception when interpreted by pediatric emergency physicians, Ultrasound guided hydrostatic enema in the treatment of pediatric intussusception, Effect of hydrocortisone on improving outcome of pneumatic reduction of infantile intussusception, The effect of midazolam in decreasing time of hydrostatic reduction of childhood intussusceptions, Open reduction of pediatric intussusception through inferior umbilical skin fold incision, Chinese Clinical Trials Registry [Prospective Registration], Comparing several groups using analysis of variance, ACR practice guideline for the performance of paediatric fluoroscopic contrast enema examinations. delaCalle U, Intussusception is the most common cause of intestinal blockage in children between ages 3 months and 3 years. Cameron JC, For example, glucagon is an antispasmodic adjuvant used by 10% to 21% of surveyed practitioners (Cachat 2012; Katz 1992; Meyer 1992; Rosenfeld 1999). It cuts off the blood supply to the intestines, which can be very dangerous. et al. Tubbs RS, Child Intussusception - StatPearls - NCBI Bookshelf 3. Intussusception usually involves the small bowel and rarely the large bowel. Jiang B, and transmitted securely. See this image and copyright information in PMC. For unknown reasons, boys are affected more often than girls. Intussusception - Management Approach | BMJ Best Practice Additional treatment recommended for SOME patients in selected patient group. Intussusception: hospital size and risk of surgery. Not all of the studys prespecified primary outcomes have been reported; One or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. Shinefield H, We did not perform a quantitative analysis of this outcome owing to poor reporting and high risk of bias. Meier DE, Lieu T, When this "telescoping" happens: The flow of fluids and food through the bowel can get blocked. 1 The mean age of intussusception in children is 6 to 18 months, with a male predominance. Owing to the nature of some treatments, blinding was not possible, for example, liquid versus air enema in Hadidi 1999 and Meyer 1993. Geiger JD, This review identified a small number of trials that assessed a variety of interventions. We examined the reference lists of all eligible trials to identify additional studies. Cummings KC, No further details supplied, All 75 cases were reported, including those that failed initial intervention: "Cases who failed ultrasound guided saline enema reduction underwent surgical exploration, with operative details and postoperative complications also reported", Blinding of participants and personnel (performance bias), No placebo treatment used in control group, Blinding of outcome assessment (detection bias), "The injections were given in randomized, doubleblind fashion"; no further details supplied, No missing data (randomisation post exclusion), Reporting included all outcomes and explained outcomes that were unexpected: "eight of 15 intussusceptionswere successfully reduced" "two patients in the study suffered complications of intussusceptionbefore full recovery ensued", "The injections were given in randomized, doubleblind fashionGlucagon and the placebo were supplied in identical vials", Participants were prepared in the same manner. This will be performed by the radiologist and is often effective in returning the intestines into their usual place. How is intussusception best managed in children? PRISMA flow diagram of literature search and exclusion, MeSH In summary, we included six RCTs (Essa 2011; Franken 1983; Hadidi 1999; Lin 2000; Meyer 1993; Mortensson 1984) in the review. Intussusception is a condition in which one segment of intestine "telescopes" inside of another, causing an intestinal obstruction (blockage). Only one trial reported postoperative complications, but owing to the method of reporting used, a quantitative analysis was not possible. Prospective surveillance study of the management of intussusception in UK and Irish infants, Epidemiology of intussusception in children: national surveillance and use of record linkage to validate the incidence, and study of incidence trends [Doctoral Thesis]. When data were missing, we sought clarification from the authors of the trial. This causes pain, vomiting, and obstruction, preventing passage. We planned to investigate publication bias by visually assessing funnel plots for the primary outcome if the number of identified and included trials exceeded 10. Motani H, Sadigh G, (doubl* adj blind*).ti,ab. Diagnostic delay increases the risk of surgical intervention (Lehnert 2009), thus emphasising the importance of prompt and effective management. DiazAldagalan GR, Intussusception (for Parents) - Nemours KidsHealth Intussusception (see the image below) is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, causing bowel obstruction. Reporting bias was also difficult to address, although with adequate reporting of protocols and reporting of all expected outcomes, as in Essa 2011 and Franken 1983, this may be mitigated. Evaluation of the Brighton Collaboration case definition of acute intussusception during active surveillance. Furthermore, outcomes included the number of children returning with a recurrent intussusception and evaluation of harms (adverse events) resulting from the interventions. Comparison 3 Air enema versus liquid enema, Outcome 1 Successfully reduced intussusception. Evidence from two studies also suggests that giving the child with intussusception a steroid medication, such as dexamethasone, may reduce the recurrence of intussusception, irrespective of whether liquid or air is used for the enema. We identified three ongoing trials. Another trial compared air enema plus dexamethasone versus air enema alone, and two trials compared use of liquid enema versus air enema. Yamamoto M, et al. (infant* or child* or newborn*).mp. Not all expected outcomes were reported, By definition, the radiologist was aware of the procedure he was conducting, Radiologist who conducted the procedure recorded results, Allocation of material to a test group and a reference group according to date of birth; participants born on an even calendar date were given an intramuscular injection of 0.05 mg glucagon/kg body weight, Unclear who allocated participants, and who administered treatment, Not stated why some participants from reference group or control group progressed to steps 2 and 3, and why others were excluded, Mahmoud El Fiky, Lecturer of Pediatric Surgery, Cairo University, Open reduction of paediatric intussusception through inferior umbilical skin fold incision, Randomisation procedure involves flipping a coin. Search terms were designed to address the following topics in intussusception: prophylactic antibiotic use, repeated enema reductions, outpatient management, and use of minimally invasive techniques for children with intussusception. Both small and large bowel can be involved, but the most common kind of intussusception arises at the junction between the ileum and the caecum and is called ileocaecal intussusception (Loukas 2011). 3. 2019 Jul;54(7):1316-1323. doi: 10.1016/j.jpedsurg.2018.09.019. It is uncertain whether use of liquid enema plus dexamethasone reduced the number of participants who underwent bowel resection (an unwanted complication) (reported in one trial, 75 participants; RR 0.88, 95% CI 0.19 to 4.06; Analysis 2.4). 10. controlled clinical trial.pt. The condition. Participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: Participants or investigators enrolling participants could possibly foresee assignments and thus introduce selection bias, such as allocation based on: Insufficient information to permit judgement of Low risk or High risk. Serour F, Using an open random allocation schedule (e.g. We judged five trials as having at least one domain at high risk of bias, and we judged Franken 1983 as having unclear risk of bias. In particular, research on the surgical management of intussusception is needed. Elliott EJ, Sorge I, 12. placebo.ab. Intussusception in Children - What You Need to Know Filler RM. Symptoms include abdominal pain, which may wax and wane, vomiting, bloating, and bloody stool. Deeks JJ, 9,10. Who is more likely to get intussusception? 12. placebo*.ti,ab. We calculated baseline risk using the event rate in the control group. Intussusception in children: current concepts in diagnosis and enema reduction. Had a potential source of bias related to the specific study design used; or, Has been claimed to have been fraudulent; or, Insufficient information to assess whether an important risk of bias exists; or. The main outcome was the number of children with a successfully reduced intussusception. Patterns of management of intussusception outside tertiary centres, Intussusception, Part 1: A review of diagnostic approaches, Intussusception, Part 2: An update on the evolution of management, The ins and outs of intussusception: history and management over the past fifty years. This article focuses on intussusception in children. Baird R, JK: drafting the protocol, identifying studies, and providing content area advice. Allison JW. 6. Intussusception: Causes, symptoms, and treatment - Medical News Today Ko HS, 2. Bines J, We searched the following electronic databases for relevant studies. GarzaJordan J, Koch A, Gargiullo PM, Outpatient management of intussusception: a systematic review and meta-analysis. 18. In some centres they are no longer routinely indicated in children with intussusception, unless there is coexistent septic shock or manifestations of intestinal . Question 3: Does the administration of glucagon improve the rate of radiological reduction in children with acute intestinal intussusception? We analysed data using Review Manager software (RevMan Version 5.3) (RevMan 2014). Intussusception - familydoctor.org We conducted subgroup analyses when required to deal with variations in the study population age (Subgroup analysis and investigation of heterogeneity). et al. Zou KH, No study reported adequate sequence generation or adequate allocation concealment. Other adjuvants include antibiotics (Ein 2006; Moss 2000; Pepper 2012). This equates to an NNTB of 6 (95% CI 4 to 17). We planned to perform sensitivity analyses using risk of bias as one of the sensitivity factors (see Subgroup analysis and investigation of heterogeneity). Vomiting. Front Surg. It is important to note that surgical intervention was not the primary study question for any of the included studies. Prompt diagnosis and management reduces associated risks and the need for surgery. Schmit P, 21. A much stronger link between intussusception and an older rotavirus vaccine (RotaShield, Wyeth Laboratories, Marietta, Pennsylvania, USA) (Kramarz 2001; Murphy 2001; Peter 2002; SoaresWeiser 2004) led to its worldwide withdrawal in 1999. At this time, it is safe for your . Debate persists on specifics regarding what type of substance should be used for the enema, how the substance is visualised during the process, whether extra medications should be given to enhance treatment, and how one should deal with treatment failure, as well as the best approach to surgical management of intussusception in children. Individuals who apply the results of this review need to acknowledge the limitations of available data derived from few trials. Evidence on any of the interventions examined was insufficient to allow us to draw any conclusions regarding rates of bowel perforation or other adverse effects. Preparation included a nasogastric tube with drainage of the stomach, intravenous fluid deficit replacement, and intravenous metronidazole and cefotaxime, "randomisation was based on a table of random numbers, wherein 15 consecutive random numbers were selected and assigned to cases 1 through 15. No trials in this comparison reported on the number of children with bowel perforation(s) or on the number of children with recurrent intussusception nor any intraoperative complications, such as bowel perforation, or other adverse effects. We presented results for dichotomous data as summary risk ratios (RRs) with 95% confidence intervals (CIs) and as number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH) as appropriate.