What do candles have to do with an intensive care unit? If you assumed it’s for festive reasons, I’m afraid I must disappoint you. Before I answer your question definitively, let me first present a case.
Case Presentation
A baby, born on November 12, 2024, was brought to the hospital two weeks after birth due to severe abdominal distension (see X-ray below) and delayed meconium passage. The baby’s mother, only 16 years old, had a normal pregnancy and delivery and is breastfeeding. The doctors diagnosed the baby with Hirschsprung’s disease, a condition where the intestine doesn’t function properly. Hirschsprung's disease is a congenital disorder where nerve cells (ganglion cells) are missing in the last segment of the intestine, leading to impaired bowel movement and chronic constipation.
X-ray at Admission:
On December 10, 2024, the baby underwent surgery to repair the intestine. Furthermore, on December 13, 2024, the baby required a second operation. The doctors created an artificial bowel opening (ileostomy) to relieve the intestine.
X-ray after the 2nd Operation:
After the second surgery, the baby received two blood transfusions, was mechanically ventilated for three days, and was nourished via intravenous nutrition for five days. On December 18, 2024, a special program started, where the anal canal is gently dilated using soft candles to expand the newly created bowel opening and support its function. On December 23, 2024, the baby was successfully discharged home.
Candles in the Intensive Care Unit
Candles are used for babies with certain congenital malformations. In babies with anorectal malformation (ARM) [1], candles (rectal bougies) are used to expand and maintain the opening of the anal canal after surgery. This is particularly important because the reconstruction of the anus or rectum often leads to scar tissue, which can narrow the passage.
Regular use of the candles helps minimize scarring, preventing the narrowing of the new rectum or anal canal. It also ensures the passage remains open, allowing for smooth stool passage. Ultimately, the candles are also used to train the anus, promoting the function of the newly created anal canal. This procedure is typically done in collaboration with pediatric surgeons and parents, who are properly trained. The anal dilatation process is a commitment of the parents for a 1-year-long program. After learning several times at the hospital from our experts, the parents would have to do on their own at home.
[1] "Pediatric Surgery" von Arnold G. Coran et al.
"Pediatric Colorectal Surgery" von Alberto Peña und Andrea Bischoff
The Krickenbeck Classification and Treatment Guidelines for ARM (2005)
How are these candles made?
In the pictures, you can see how we are in the process of transforming candles into rectal bougies. The candles are molded into different sizes. We used staplers to "peel" the candles accordingly. It’s important to create candles of varying sizes, starting from a diameter of 8mm, increasing up to 14mm.
What advantages do candles have over metal bougies?
If you’re wondering why exactly candles are used, I can explain the many advantages over metal bougies. I took this information from a study.[2] Candles made of soft material (such as silicone) are gentler on the mucous membranes, more flexible, easier to use, cheaper, and reduce the risk of injury. They are more suitable for home use, while metal bougies are stiffer and typically used in clinical settings.
I hope I have successfully answered your question about why candles are used in a neonatal intensive care unit.
Best regards from Siem Reap
Luca
Comments