# Defining the Natural History and Drivers of Surgical Referral of Pediatric Umbilical Hernias to Reduce Unnecessary Surgery

> **NIH NIH F32** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $1

## Abstract

Project Summary/Abstract
 The objectives of the proposed study are: 1) to define the rate of spontaneous closure over time for
asymptomatic umbilical hernias (UHs) in children, and 2) to characterize the drivers of early surgical referral for
asymptomatic UHs by primary care providers (PCPs). UHs are common in children and most will
spontaneously close by 4-5 years of age. Repair is generally recommended after this age based on the risk of
enlargement and development of symptoms. Based on these observations, the American Academy of
Pediatrics (AAP) recommends delaying surgical referral and repair until 4-5 years of age to allow for
spontaneous closure. Despite these guidelines, many children with asymptomatic UHs are referred for early
surgery (i.e. at 3 years of age or younger), with 30% ultimately undergoing repair. Available data indicate that
early repair is not benign, and may be associated with potentially preventable caregiver anxiety, lost days away
from work and school, increased health care costs, increased hospital revisits, recurrence, and potentially
unnecessary surgery. Early referral is an obligatory step in the “exposure” to early surgery.
 We hypothesize that the lack of compliance with AAP referral guidelines is driven by lack of sound
epidemiologic data. Although there is general consensus that spontaneous closure after age 5 is unlikely, the
rate of spontaneous closure between 3 and 5 years of age is not well characterized. In our prior survey of
pediatric surgeons, the most common reason for variability in preferred age at repair was differences among
surgeons in the perceived rate of spontaneous closure between 3 and 5 years of age. It is our hypothesis that
similar PCP beliefs drive early referral for surgical repair. To address the existing knowledge gap, we will use
large database analysis with natural language processing and mixed methods techniques to define the rate of
spontaneous resolution of asymptomatic UH and reasons for early PCP referral, respectively. This project aims
to elucidate the natural history of UH and drivers of surgical referral to reduce the burden of unnecessary
referrals and surgeries on patients, caregivers, and the healthcare system.
 The fellowship will take place in the Boston Children’s Hospital (BCH) under the sponsorship of Dr.
Shawn Rangel as part of the Health Services Research (HSR) Fellowship. BCH is affiliated with Harvard
Medical School and provides unparalleled opportunities for collaboration across Harvard schools, hospitals,
and research sites. The three main areas of fellowship development are 1) technical skills to design and
execute health outcomes research, 2) leadership and soft skills necessary to run a research laboratory, and 3)
policy skills to strategically drive evidence-based clinical care. These goals will be supported by the sponsor
and collaborators in natural language processing, biostatistical methods, electronic medical record database
management, and mixed method...

## Key facts

- **NIH application ID:** 10314578
- **Project number:** 1F32HD106687-01
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Katherine He
- **Activity code:** F32 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $1
- **Award type:** 1
- **Project period:** 2022-02-01 → —

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10314578

## Citation

> US National Institutes of Health, RePORTER application 10314578, Defining the Natural History and Drivers of Surgical Referral of Pediatric Umbilical Hernias to Reduce Unnecessary Surgery (1F32HD106687-01). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10314578. Licensed CC0.

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