Clinical trial NCT04837963: Does Hirschsprung Disease Increase the Risk of Febrile Urinary Tract Infection in Children
Official title: Does Hirschsprung Disease Increase the Risk of Febrile Urinary Tract Infection in Children ? A Case-control Study
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Hirschsprung Disease
Febrile Urinary Tract Infection (Disorder)
Keywords: Pediatric Surgery
Case Control study
Lead sponsor: University Hospital, Montpellier
Sponsor class: OTHER
First posted: 2021-04-08
Enrollment: 630
Sex: ALL
Maximum age (years): 18
Standard ages: CHILD
ADULT
Accepts healthy volunteers: no
Observational model: CASE_CONTROL
Time perspective: RETROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Cases were patients who underwent surgical treatment of an HD confirmed on histopathologic exam. Controls were children who underwent an appendicetomy for acute appendicitis without history of HD, ano rectal malformation or any other colic disease.. Two controls were matched for age and sex, at least included for each case

Brief summary: Febrile urinary tract infection (FUTIs) are the most common bacterial infections in children under the age of 2 years. They represent 7% of children presenting with fever without a source. In case of recurrent or undertreated FUTIs there is a risk for kidney function with the threat of chronic renal failure \[7\]. They are more often isolated but some FUTIs may reveal an underlying and facilitating condition. Beside the well-known congenital anomalies of the kidneys and urinary tract such as reflux or obstructions, others risk factors for FUTI are reported. Age less than 1 year, uncircumcised males, poor fluid intake, bladder bowel dysfunction (BBD) including dysfunctional voiding pattern and constipation increase the risk of FUTI. The prevalence of BBD in children with FUTIs is far higher than in the general population. Recommendations emphasize on an efficient treatment of BBD in the first-line management of recurring FUTIs and it has been proven to be efficient (ref).

One of the BBD may include Hirschsprung's Disease (HD). HD is the first congenital malformation of the enteric nervous system with a reported prevalence of 1 in 5000 live birth. It's characterized by an aganglionosis and subsequent dysmotility affect by always the anal canal, most commonly there is a rectosigmoid form (74-80%), and less commonly involves a long segment of colon (12-22%) or a total colonic aganglionosis with ileal involvement upto 50 cm proximal to ileocecal junction (4-13%). The treatment is based on the resection of dysfunctional segment of colon with an anastomosis between the normally innervated bowel to the anus, while preserving normal sphincter function. But significant bowel dysfunction may persist postoperatively. 20% of the children present a fecal incontinence, and 14% a constipation in long-term studies. Bladder dysfunction and associated urological anomalies are also reported in these patients. All of that may facilitate the occurrence of febrile urinary tract infections (FUTI) in patients with HD. Unfortunately, few studies focused on this specific population.

The objective of this study was to find out whether children with HD are more prone to develop FUTIs than controls and which patient with HD are more at risk to develop UTIs.


Eligibility criteria: Inclusion criteria:

Patients :

- surgical treatment of an HD confirmed on histopathologic exam.

Controls :

- appendicetomy for acute appendicitis without history of HD, ano rectal malformation or any other colic disease

Exclusion criteria:

* patients with HD but not yet operated
* patient with a stoma at the time of the study
* patient with chronic intestinal pseudo obstruction without HD

Primary outcomes:
measure: Compare the risk of febril urinary tract infection
timeFrame: Day 1
Secondary outcomes:
measure: Compare the age at the time of febrile urinary tract infection
timeFrame: Day 1
measure: Febrile urinary tract infection risk factor
timeFrame: Day 1
Other outcomes:
Locations:
city: Montpellier
country: France
facility: University hospital of Montpellier
Study officials:
affiliation: University Hospital, Montpellier
name: Nicolas KALFA
role: STUDY_DIRECTOR
References: