Abstract
<title>Abstract</title> <p>Purpose Intestinal neuronal dysplasia (IND) is a congenital enteric neuropathy characterized by abnormalities of the enteric nervous system, most commonly involving hyperplasia of the submucosal plexus and the presence of giant ganglia. This study aimed to characterize the clinical features of IND, evaluate postoperative enterocolitis (POEC), and develop a machine learning (ML)-based model for POEC prediction. Methods Patients diagnosed with IND who underwent pull-through surgery at our institution between 2005 and 2025 were retrospectively reviewed. Clinical characteristics and postoperative outcomes were analyzed. Five feature selection strategies and five machine learning algorithms were combined to construct and evaluate 101 predictive models using out-of-fold area under the receiver operating characteristic curve (AUC). Results A total of 84 patients were included in the study. Male patients predominated (57.1%), and 44.0% were underweight. Constipation was the most common presenting symptom (67.9%). Pathological comorbidities identified 30 (35.7%) patients with pure IND and 54 (64.3%) with mixed IND. Statistical analysis demonstrated that lower BMIZ values were associated with mixed IND and female sex in our cohort, whereas the interval from symptom onset to surgery was inversely associated with initial symptom severity. A machine learning model for predicting postoperative enterocolitis (POEC) was subsequently developed, in which BMIZ consistently emerged as a key predictive feature, suggesting its potential value for individualized postoperative risk assessment. Conclusion In this study, we characterized the clinical and pathological features of children with isolated intestinal neuronal dysplasia over a 20-year period. Patients were predominantly male, frequently presented with constipation, and most exhibited mixed IND rather than pure IND. Nutritional impairment was common, with female patients and those with mixed IND showing lower BMIZ values. Machine learning analyses consistently identified BMIZ as a potential predictive feature associated with postoperative enterocolitis, highlighting the potential role of nutritional status in postoperative risk stratification.</p>