Retrospective Surveillance for Intussusception in Children Aged Less Than Five Years in a South Indian Tertiary-Care Hospital

Article excerpt

INTRODUCTION

Intussusception is the most common cause of acute intestinal obstruction in infants and young children (1), with approximately two-thirds of all intussusceptions in children occurring among infants aged less than one year. Some cases of intussusception resolve spontaneously and, if treated early, most can be reduced by oenema or surgery, and if untreated, most have fatal outcomes (2). Anatomic conditions triggering intussusception are discovered in less than 15% of cases. Viruses, such as adenovirus and enterovirus, have been associated with some cases (3).

Mortality caused by intussusception in infants and children is now uncommon in developed countries due to better access to healthcare facilities. In contrast, intussusception-associated mortality remains high in some developing countries (1). A recent and extensive review by the World Health Organization (WHO) on intussusception concluded that, in developed countries, the baseline incidence of intussusception is between 0.5 and 4.3 cases per 1,000 livebirths or 0.7-1.2 cases per 1,000 children aged less than one year (4). Accurate estimates of the incidence of intussusception are not available for most developing countries (1).

In recent years, intussusception has attracted additional attention of the paediatric medical and public-health community because of its association observed in the United States with the first-licensed rotavirus vaccine--the rhesus-human reassortant rotavirus tetravalent (RRV-TV) vaccine (5,6)--and the ensuing recommendations for its suspension nine months after its introduction (7). These events raised serious questions about the further development of other rotavirus candidates.

Rotavirus is the most common cause of severe diarrhoea among infants and young children (8), resulting in approximately 600,000 to 850,000 deaths annually worldwide (1). In India, rotavirus-associated acute gastroenteritis accounts for 5-70% of all hospitalizations. About 20-30% of total hospitalizations are due to rotavirus-associated diarrhoea in early childhood (9). As a result of substantial morbidity and mortality worldwide caused by rotavirus, the WHO and Global Alliance for Vaccines and Immunization (GAVI) have identified rotavirus vaccines as a priority for development (10) and subsequent introduction (11).

Although clinical studies have demonstrated the next generation of rotavirus vaccines to be safe (12), baseline knowledge of the clinical presentation, treatment outcomes, and epidemiology of intussusception in infants and children in India, prior to the introduction of vaccine, is critically important because it will better inform interpretation of data on intussusception collected after these vaccines become available (4).

This study outlines the clinical presentation, detection, seasonality, management, and outcome of intussusception in young children aged less than five years in Vellore, India.

MATERIALS AND METHODS

This retrospective hospital-based study to review cases of intussusception was carried out at the Christian Medical College (CMC) Hospital, Vellore, India. The CMC, Vellore, occupies a prominent place among healthcare institutions in India. It is a 2,234-bed multispeciality, tertiary-care teaching hospital, which consists of a vital, diverse, and interdenominational community (13). The protocol received appropriate institutional ethical review.

Surveillance to identify cases of intussusception was planned for three complete years. However, the investigators included four subjects beyond the defined surveillance period, and therefore, the study period was extended up to June 2004. During 1 January 2001-30 June 2004, cases of intussusception were identified among hospitalized children aged less than five years.

A case was identified in a two-step process: Possible cases of intussusception were first identified by searching radiology, pathology and computerized discharge-records of hospital for the diagnoses based on the International Classification of Diseases, Ninth and Tenth Revision, Clinical modification codes for intussusception (ICD-9 CM), and intestinal obstruction (ICD-10 CM). …