Neurogenic bowel treatments and continence outcomes in children and adults with myelomeningocele

被引:16
作者
Kelly, Maryellen S. [1 ]
Wiener, John S. [1 ]
Liu, Tiebin [2 ]
Patel, Priya [3 ]
Castillo, Heidi [4 ]
Castillo, Jonathan [4 ]
Dicianno, Brad E. [5 ]
Jasien, Joan [6 ]
Peterson, Paula [7 ]
Routh, Jonathan C. [1 ]
Sawin, Kathleen [8 ,9 ]
Sherburne, Eileen [8 ,9 ]
Smith, Kathryn [10 ]
Taha, Asma [11 ,12 ]
Worley, Gordon [6 ]
机构
[1] Duke Univ, Dept Surg, Div Urol, 20 Duke Med Circle,Box 3831, Durham, NC 27710 USA
[2] Ctr Dis Control & Prevent, Natl Ctr Birth Defects & Dev Disabil, Atlanta, GA USA
[3] Oak Ridge Inst Sci & Educ ORISE, Oak Ridge, TN USA
[4] Baylor Coll Med, Dept Pediat, Houston, TX 77030 USA
[5] Univ Pittsburgh, Dept Phys Med & Rehabil, Sch Med, Pittsburgh, PA USA
[6] Duke Univ, Dept Pediat, Div Pediat Neurol, Durham, NC USA
[7] Univ Utah, Dept Pediat, Salt Lake City, UT USA
[8] Childrens Hosp Wisconsin, Dept Nursing Res, Milwaukee, WI USA
[9] Univ Wisconsin, Self Management Sci Ctr, Coll Nursing, Milwaukee, WI USA
[10] Keck Sch Med, Dept Pediat, Los Angeles, CA USA
[11] Oregon Hlth & Sci Univ, Doernbecher Childrens Hosp, Portland, OR USA
[12] Oregon Hlth & Sci Univ, Sch Nursing, Portland, OR USA
关键词
Spina bifida; neurogenic bowel; fecal incontinence; National Spina Bifida Patient Registry; QUALITY-OF-LIFE; SPINAL-CORD-INJURY; TRANSANAL IRRIGATION; FECAL INCONTINENCE; BIFIDA; DYSFUNCTION; CONSTIPATION; PREVALENCE; MANAGEMENT;
D O I
10.3233/PRM-190667
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
PURPOSE: Neurogenic bowel dysfunction (NBD) is a common comorbidity of myelomeningocele (MMC), the most common and severe form of spina bifida. The National Spina Bifida Patient Registry (NSBPR) is a research collaboration between the CDC and Spina Bifida Clinics. Fecal continence (continence) outcomes for common treatment modalities for NBD have not been described in a large sample of individuals with MMC. NSBPR patients with MMC and NBD were studied to determine variation in continence status and their ability to perform their treatment independently according to treatment modality and individual characteristics. METHODS: Continence was defined as < 1 episode of incontinence per month. Eleven common treatments were evaluated. Inclusion criteria were established diagnoses of both MMC and NBD, as well as age > 5 years ( n = 3670). Chi-square or exact statistical tests were used for bivariate analyses. Logistic regression models were used to estimate the odds of continence outcomes by age, sex, race/ethnicity, level of motor function, and insurance status. RESULTS: At total of 3670 members of the NSBPR met inclusion criteria between November 2013 and December 2017. Overall prevalence of continence was 45%. Prevalence ranged from 40-69% across different treatments. Among continent individuals, 60% achieved continence without surgery. Antegrade enemas were the most commonly used treatment and had the highest associated continence rate. Ability to carry out a treatment independently increased with age. Multivariable logistic regression showed significantly higher odds of continence among individuals aged >= 12 years, female, non-Hispanic white, and with private insurance. CONCLUSIONS: The prevalence of continence was generally low and varied between treatment modalities. Better treatment algorithms considering patient factors may result in improved outcomes.
引用
收藏
页码:685 / 693
页数:9
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