Johns Hopkins All Childrens Hospital St Petersburg, Florida, USA
Introduction: Among critically ill children, the frequency of symptomatic constipation is poorly described. We sought to estimate national constipation rates in this population and characterize prescribed prophylactic and treatment bowel regimens.
Methods: We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System database including children 0-18 years hospitalized within 48 pediatric intensive care units (PICUs) from 2017 – 2023. The primary outcome was hospital-acquired constipation defined by International Classification of Diseases, 10th revision, Clinical Modification codes not present on admission. Secondary outcomes were bowel regimen prescription rates including evacuants, bulk producing agents, lubricants, opioid antagonists, osmotics, and stimulants defined by pharmaceutical Clinical Transaction Classification codes. Descriptive data were demographics, comorbidities, indication for hospitalization (medical vs surgical), Pediatric Medical Complexity Algorithm (PMCA) category, length of stay (LOS), mortality, invasive mechanical ventilation (IMV), total parental nutrition (TPN), and prescription of sedatives and analgesics.
Results: Of 709,743 children studied, 62,408 (8.8%) had constipation (institution-specific mean ± standard deviation: 9±2.8%). Compared to those without constipation, those with were more frequently admitted for surgery (46.1% vs 32.8%), technology dependent (48% vs 27%), older (median age: 6.8 [IQR:2.3-13] vs 3.6 [IQR:0.8-11.1] years), medically complex (median PMCA category: 3 [IQR:3-3] vs. 3 [IQR:2-3]), had a longer median LOS (9 [IQR:4-20] vs 4 [IQR:2-9] days), and prescribed IMV (40.1% vs. 31.2%), TPN (14.3% vs 9.7%), benzodiazepines (64% vs 42.5%), opioids (68.4% vs 47.7%), and paralytics (45.2% vs 31.9%) (all p< 0.001). Common bowel regimens were polyethylene glycol (24.6%), senna/docusate (21.9%), and glycerin (11.9%). Those with constipation were commonly prescribed osmotics (76.8%) and stimulants (47.8%).
Conclusions: In this multicenter study, the estimated United States frequency of constipation among critically ill children was 8.8% and more common for those with medical complexity and severe clinical trajectory. Prospective study must define constipation and assess bowel regimen prophylaxis and treatment efficacy.
