Title: PNEUMATOSIS INTESTINALIS FOLLOWING HEMATOPOIETIC STEM CELL TRANSPLANT: RISK FACTORS, CLINICAL OUTCOMES, AND INTERVENTIONS IN THE PEDIATRIC POPULATION
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: Background/Objectives Pneumatosis intestinalis (PI) is a potential life-threatening complication following hematopoietic stem cell transplant (HSCT) in children. There is limited data on PI in this patient population, no consensus on its management, and limited data on recurrent PI. Identifying the outcomes, risk factors, and management of patients diagnosed with PI following HSCT can aid in its future clinical management. Design/Methods We conducted a retrospective cohort study of patients who received a HSCT at Riley Hospital for Children from 2014-2024. Results Twenty-two of 297 patients who underwent a HSCT were diagnosed with PI (7.4%). Four patients (18%) had recurrent episodes of PI, totaling 32 episodes in the cohort. All patients with PI were continued on (53%) or started on (47%) broad spectrum antibiotics. Management varied in duration of bowel rest, length of antibiotic course, consultation with surgery and x-ray frequency. The median time to resolution was 4 days (range 1-21). Patients with recurrent PI had a median of 3 episodes (range 3-5) and median time to recurrence after previous episode was 43 days (range 8-451). Previous diagnosis of graft-versus-host disease (GVHD) or thrombotic microangiopathy (TMA) significantly increased the rate of recurrent PI (p=0.01 and p=0.03 respectively). Conclusion The pathogenesis of PI in patients who received a HSCT is multifactorial. No uniform approach to treatment of PI was followed, suggesting an opportunity to standardize care through clinical guidelines in patients following HSCT. In addition, the significance of GVHD and TMA in recurrent PI suggests focused monitoring of this patient population to prevent recurrences.
Institution: Indiana University School of Medicine
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4413244811