P182 Are we missing anorectal malformations?. (June 2019)

• Record Type: Journal Article
• Authors: Finnegan, Jennifer; Corcoran, John David
• Is Part Of: Archives of disease in childhood. Volume 104:Supplement 3(2019)
• Page Start: A231
• Page End: A231
• Publication Date: 2019-06
• Subjects: Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2019-epa.537
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Background: Anorectal malformations (ARM) have an incidence of 1:2, 500. ARM such as imperforate anus are commonly overlooked on newborn examination. 21% of cases in Ireland are late diagnoses1 . Delayed diagnosis is associated with significant morbidity and mortality. The inability of the infant to pass meconium can lead to perforation of the small bowel requiring emergency surgery and colostomy formation2 . The Faculty of Pediatrics advises thorough perineal examination as part of routine newborn examination2, the Rotunda guidelines on Newborn Examination also state that infants require physical examination shortly after birth3 . Two cases of imperforate anus were diagnosed in our hospital within a 6 month period in 2018. One case was a delayed diagnosis at 27 hours of age when the infant was reviewed for failure to pass meconium. Aims: To identify if newborn examination is being completed and documented at time of delivery. To identify if examination of the anus specifically is being documented. To establish if mode of delivery impacts on whether initial examination is completed. Methods: A concurrent review of electronic healthcare (EHR) record of all babies on the postnatal wards was conducted over a 48 hour period in February 2019. Microsoft Excel was used to collate data. Results: Of 71 records reviewed, 44 patients had a complete examination including documentation of a patent anus using a template on the EHR. 27 patients (38%) did not. In two cases examination was performed and documented in free-text. In both cases, examination of the anus was not recorded. 33 patients were delivered by caesarean section, of these 67% had initial examination documented. 28 babies were born vaginally, 50% had examination documented. Of 10 babies born by assisted vaginal delivery, 80% had an examination documented. Conclusion: 38% of patients did not have an early newborn examination performed. The use of an electronic template increases the likelihood that complete examination will be carried out. Mode of delivery affects the likelihood of initial examination being completed, with babies born by instrumental or caesarean delivery more likely to have an early newborn examination than those born vaginally. Recommendations: It is recommended that the template for newborn examination on the EHR is utilised to reduce the risk of overlooking any part of the examination. Results will be disseminated to stakeholders with reminder of the importance of early newborn examination. The audit cycle will be repeated in 3 months with the aim of improving compliance.