Journal of Pediatric Surgery Open最新文献

{"title":"Single institution review of operative management of giant omphalocele","authors":"Noah J. Keime ,&nbsp;Nell T. Weber ,&nbsp;Nicole Becher ,&nbsp;Noah Wilson ,&nbsp;Jose Diaz-Miron ,&nbsp;Shannon N. Acker","doi":"10.1016/j.yjpso.2024.100175","DOIUrl":"10.1016/j.yjpso.2024.100175","url":null,"abstract":"<div><h3>Purpose</h3><div>Operative management of giant omphalocele that cannot be closed primarily varies based on several factors, and there is little data to guide choice of operative approach and how this impacts long-term outcomes. We aimed to characterize whether surgical approach – staged closure during the neonatal period, or delayed closure – affects outcomes.</div></div><div><h3>Methods</h3><div>We conducted a retrospective review of children treated for giant omphalocele who did not undergo primary closure at Children's Hospital Colorado from 2010–2022. We included patients with giant omphalocele who underwent treatment at the study site. Data collected included patient characteristics, clinical course, and outcomes. Comparisons were made based on type of closure, delayed versus staged.</div></div><div><h3>Results</h3><div>We identified 24 patients; 6 delayed and 16 staged. 2 patients died prior to closure. Delayed and staged groups did not differ regarding demographics. Infants undergoing staged repair tended to have more total hospital and total ventilator days, and more post-closure ventral hernia requiring repair; short-term outcomes were otherwise comparable. There was no difference between groups in long-term outcomes, including neurodevelopmental milestones and mortality.</div></div><div><h3>Conclusions</h3><div>Long term outcomes are equivalent between staged repair and delayed repair of giant omphalocele. However, staged repair may be associated with more ventilator days, total hospital days and higher risk of ventral hernia.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic-assisted choledochal cyst excision with Roux-en-Y hepaticojejunostomy in children: A Chinese expert panel consensus statement","authors":"Shuai Li ,&nbsp;Patrick HY Chung ,&nbsp;Zhigang Gao ,&nbsp;Xiaolong Xie ,&nbsp;Hailan Zhang ,&nbsp;Guoqing Cao ,&nbsp;Yajun Chen ,&nbsp;Xufei Duan ,&nbsp;Qi Dong ,&nbsp;Huajian Gu ,&nbsp;Yige Luo ,&nbsp;Aiwu Li ,&nbsp;Shuixue Li ,&nbsp;Zhaozhu Li ,&nbsp;Junshan Lin ,&nbsp;Dengrui Liu ,&nbsp;Haijin Liu ,&nbsp;Mingwei Liu ,&nbsp;Zhenfan Qu ,&nbsp;Yi Su ,&nbsp;Shao-tao Tang","doi":"10.1016/j.yjpso.2024.100149","DOIUrl":"10.1016/j.yjpso.2024.100149","url":null,"abstract":"<div><h3>Background</h3><div>The first robotic surgery in children and adult happened in more or less that same time but the development in children subsequently lagged behind especially for complicated operations such as robotic-assisted hepaticojejunostomy for choledochal cyst (RHCC). In order to achieve a high standard for this operation, expert consensus was developed among Chinese experts with ample experience in RHCC.</div></div><div><h3>Methods</h3><div>Thirty experts from twenty-six institutions experts participated in the consensus meeting. A Screening Committee was established to performed a comprehsenive literature review on RHCC. A few specific topics have been proposed based on the review but only topics which were agreed upon were discussed during the meeting using Delphi Rounds. Lastly, formulated recommendations were proposed by the Committee and finalized in the expert consensus meeting.</div></div><div><h3>Results</h3><div>After initial screening and discussion, nine topics were selected for discusssion. Eight recommendation statements were formulated. All recommendations reached more than 80 % consensus among experts at the final Delphi Round.</div></div><div><h3>Conclusions</h3><div>The consensus statementson RHCC in children were based on available international literatures and experience from Chinese experts. These statements helpto standardize the surgical techniques and prevent surgical complications during RHCC.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100149"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142560757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous local anaesthetic wound infusion in infants undergoing thoracic or abdominal surgery: A systematic review","authors":"Jeewan Jyoti ,&nbsp;Eva Sloukova ,&nbsp;Kaye Spence ,&nbsp;Annabel Webb ,&nbsp;Albert Shun ,&nbsp;Himanshu Popat","doi":"10.1016/j.yjpso.2024.100177","DOIUrl":"10.1016/j.yjpso.2024.100177","url":null,"abstract":"<div><h3>Objective</h3><div>To determine whether continuous local anaesthetic wound infusion (CLAWI) provides more effective pain relief and decrease the need for systemic opioids compared to other analgesic agents in term or preterm newborn infants undergoing thoracic or abdominal surgery.</div></div><div><h3>Methods</h3><div>Cochrane Central Register of Controlled Trials, Medline, Embase and CINAHL were searched from database inception to August 2022. Publications were screened and their references were hand-searched to identify additional studies. This review included randomized controlled trials (RCTs), quasi-RCTs, and cluster RCTs. Two reviewers independently extracted data and examined the methodological quality of the eligible studies. A meta-analysis was performed for available outcomes.</div></div><div><h3>Results</h3><div>After screening 1202 articles, two RCTs with 98 patients were included. Meta-analysis for combined data was possible for only two outcomes: pain scores post-surgery and length of hospital stay. The random effects model for the pooled standardised mean difference of pain scores between treatment groups post-surgery was -2.54 (95 % CI:7.53, 2.46, <em>p</em> = 0.3196) and for length of stay in the NICU was -0.19 (95 % CI:0.58, 0.21, <em>p</em> = 0.3574), suggesting that CLAWI was not more effective in either providing pain relief or reducing length of stay. However, the small number of studies included, the considerable heterogeneity between the studies, and the small sample sizes of the individual studies limit the generalizability of the findings.</div></div><div><h3>Conclusion</h3><div>This review highlights the need for further, adequately powered well-designed, multicentre trials to examine the effectiveness of CLAWI in reducing postoperative pain in newborns undergoing abdominal and thoracic surgery.</div></div><div><h3>Level of evidence</h3><div>Level I - Evidence from a systematic review of all relevant randomized controlled trials</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100177"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142593525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Double J ureteral stent removal following pediatric laparoscopic pyeloplasty without cystoscopy","authors":"Edit Kecskés,&nbsp;Levente Szabó,&nbsp;Gábor Varga,&nbsp;László Sasi Szabó","doi":"10.1016/j.yjpso.2024.100178","DOIUrl":"10.1016/j.yjpso.2024.100178","url":null,"abstract":"<div><h3>Background</h3><div>Double J ureteral stents (DJUS) require anesthesia and cystoscopy for its removal. We analysed the effectivity of a noncystoscopy (NC) DJUS removal procedure in vivo described by Shao. The study aimed to determine whether this method can safely be applied in our practice.</div></div><div><h3>Methods</h3><div>We analysed the data of all pediatric patients who had noncystoscopy DJUS removal following laparoscopic pyeloplasty in our Department between January 2021- December 2023 and compared data from cystoscopic (CS) interventions in 2020. We examined the success and complication rate of the in vivo intervention and its cost-effectivity. Ex-vivo bladder models were used to study the success rates of DJUS removal under different conditions and the impact of suture positioning.</div></div><div><h3>Results</h3><div>After laparoscopic pyeloplasty 34 NC and 10 CS stent removals were performed. The mean age was 35.65 months (NC) vs. 67.6 months (CS). DJUS removal was successful after an average of 2.08 trials without perioperative complications. Intervention time was significantly shorter in NC (4.62 mins vs. 12.90 mins, p&lt;0.005). Noncystoscopic removal reduces hospital material costs (NC: ∼ 8.4 EUR vs. CS: ∼ 98 EUR). In the ex-vivo bladder model, 400 attempts were made to remove the stent. The success rate was higher in the empty model (38.5% vs. full: 32%, p = 0.21). The position of the suture did not significantly affect the success rate (37% vs. 33.5%, p= 0.53).</div></div><div><h3>Conclusions</h3><div>This innovative technique proved to be safe and effective. NC removal significantly shortens procedural time, is less burdensome for the patient and reduces hospital material costs.</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100178"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there a need for revised guidelines in the treatment of perforated appendicitis in children? A study of risk factors for prolonged hospital stay and postoperative complications","authors":"Pia Löfgren ,&nbsp;Hanna Eriksson ,&nbsp;Isak Arvidsson ,&nbsp;Erik Persson ,&nbsp;Erik Sinclair ,&nbsp;Kate Abrahamsson ,&nbsp;Sofia Sjöström","doi":"10.1016/j.yjpso.2024.100173","DOIUrl":"10.1016/j.yjpso.2024.100173","url":null,"abstract":"<div><h3>Purpose</h3><div>To study the need for revised guidelines in the treatment of children with acute perforated appendicitis (APA) by describing the clinical course of children surgically treated for APA in one county in Sweden, with focus on length of hospital stay (LOS) and risk of postoperative complications. The study also aimed to identify variation in practice, comparing a university children's hospital (UCH) to county hospitals (CH).</div></div><div><h3>Methods</h3><div>Two thousand children, &lt;16 years, who had surgery for acute appendicitis 2014–2018 in four public hospitals (1 UCH and 3 CH), were identified. Patients with perforation of the appendix, <em>n</em> = 383(19 %) were selected for study and retrospective assessment of patient records. Uni and multivariable logistic regression analyses were done to identify risk factors for prolonged length of stay (PLOS) and complications.</div></div><div><h3>Results</h3><div>The median LOS was 5.05 days (0.5–61.9), 6.79 (1.81–61.91) for the UCH (<em>n</em> = 186) and 3.65 (0.54–35.65) for CH's (<em>n</em> = 197)(<em>p</em> &lt; 0.0001). PLOS (=&gt;5 days in hospital) was seen in 147 (79 %) at UCH and 53(26.9 %) at CH's(<em>p</em> &lt; 0.0001). Intra-abdominal abscess within 30 days was identified in 36 (9.4 %) and surgical re-intervention was needed in 19 (5 %) with no differences between hospitals. The need for readmission within 30 days was higher at CH <em>n</em> = 22(11.4 %) than at UCH <em>n</em> = 4(2.2 %), (<em>p</em> = 0.0006). Multivariable analyses showed independent predictors of PLOS to be: male gender(OR 2.97 (1.68–5.23)), treatment at UCH (OR 10.24 (6.38–16.44)), CRP &gt;135 mg/l(OR per 50 units 1.42 (1.16–1.73)), prehospital delay&gt;2.5 days(OR 1.22 (1.01–1.47)), delayed time to surgery(OR per 10 h 1.74 (1.26–2.41)) extended surgery time(OR per 2 h 4.59 (1.43–14.76)) and use of urinary catheter(OR 2.99 (1.42–6.29)).</div></div><div><h3>Conclusion</h3><div>Guidelines for treatment of childhood APA, focusing on minimizing antibiotics and facilitating early discharge, would optimize care of the patients but also the economical use of resources. Most children with APA have an uncomplicated course, but factors predicting PLOS have been identified. We found a pronounced variation in practice between the UCH and CH's, without increasing the risk of postoperative complications.</div></div><div><h3>Level of evidence</h3><div>Level III</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142539173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative continuation of antibiotic prophylaxis beyond 24 h is unnecessary for abdominal surgeries in children and neonates","authors":"Hajime Takayasu ,&nbsp;Kiyoshi Tanaka ,&nbsp;Ken-ichiro Konishi ,&nbsp;Yoshimasa Uematsu ,&nbsp;Takuji Tomari ,&nbsp;Yusuke Kumamoto","doi":"10.1016/j.yjpso.2024.100179","DOIUrl":"10.1016/j.yjpso.2024.100179","url":null,"abstract":"<div><h3>Purpose</h3><div>Despite recent WHO recommendations, antibiotic prophylaxis is routinely continued for several days after surgery. We conducted a retrospective study to evaluate the safety and efficacy of antibiotic prophylaxis cessation within 24 h after abdominal surgeries</div></div><div><h3>Methods</h3><div>We retrospectively reviewed the charts of patients who underwent 3 representative gastrointestinal surgeries (1; transumbilical small bowel procedure for intestinal atresia or stenosis, 2; extrahepatic bile duct resection, and hepaticojejunostomy for congenital biliary dilatation, 3; stoma closure for intestinal perforation, anorectal malformation, or inflammatory bowel disease) at our institution between 2011 and 2023. The demographic data collected included age, preoperative hemoglobin level, albumin level, body mass index, and ASA class. Intraoperative and postoperative data were also collected. The patients were divided into 2 groups according to the duration of perioperative antibiotics (‘within 24 h’ and ‘beyond 24 h’), and the incidence of superficial incisional SSI (siSSI) was compared between the 2 groups in each procedure</div></div><div><h3>Results</h3><div>During the study period, 25 cases underwent transumbilical small bowel procedure, 23 cases underwent hepaticojejunostomy, and 45 cases underwent stoma closure. The preoperative care bundle including bowel preparation, cleansing, and operative procedures has not changed during the study period. First- and third-generation cephalosporins were administered to all the patients. All patients received their first single dose of antibiotics within 60 min before the skin incision. In particular, 14 patients who underwent small-bowel procedures received only a single dose. The SSI rates for small bowel procedures, hepaticojejunostomy, and stoma closure were 0 %, 4.4 %, and 4.4 %, respectively. No SSIs were observed in any of the procedures in the 'within 24 h' group</div></div><div><h3>Conclusion</h3><div>Based on our study, we conclude that ≤24 h of postoperative continuation of antibiotic prophylaxis is sufficient for siSSI prevention in hepaticojejunostomy and stoma closure. Additionally, single-dose antibiotic prophylaxis is adequate for neonatal small bowel procedures.</div></div><div><h3>Level of evidence</h3><div>Level</div></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100179"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Introducing a short-medium format, paediatric surgical podcast into the formal teaching resources of a medical school","authors":"Catherine A Brown ,&nbsp;Patrina Caldwell ,&nbsp;Karen M Scott ,&nbsp;John N Colgan ,&nbsp;Andrew J A Holland","doi":"10.1016/j.yjpso.2024.100172","DOIUrl":"10.1016/j.yjpso.2024.100172","url":null,"abstract":"<div><h3>Background</h3><p>Podcasts are a popular form of extracurricular education. They provide a range of benefits for listeners including an opportunity for learning whilst mobile. We aimed to assess the interest of medical students in a podcast series as a part of their formal paediatric surgery teaching resources; to determine the optimal format for such a podcast and, following their introduction, if they were considered to have a beneficial effect on student learning.</p></div><div><h3>Method</h3><p>We conducted focus groups with medical students to explore interest in a podcast series and to determine the optimal format. Our findings guided production and introduction of 5 short-format podcast episodes as an adjunct to available formal learning resources. We ran student focus groups to evaluate the podcasts until data saturation was reached. Transcripts were analysed through thematic analysis by two researchers, who used the constant comparison process to produce a coding framework, through which they identified relevant themes.</p></div><div><h3>Results</h3><p>Medical students utilised outsourced medical podcasts as an adjunct to formal medical school curricula. All students supported the introduction of a podcast series into formal teaching resources to extend paediatric surgical teaching. The preferred medical podcast format was a short, conversational style podcast that begins with a clinical case and ends with a summary. The introduction of podcasts increased student engagement in, and understanding of, podcast topics.</p></div><div><h3>Conclusion</h3><p>Medical students enthusiastically embraced paediatric surgical podcasts in their curriculum. The addition of short-medium format podcasts enhances learning and engagement. Medical schools should utilize the teaching benefits that podcasts offer.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100172"},"PeriodicalIF":0.0,"publicationDate":"2024-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000571/pdfft?md5=e29c5ca43abcc896584c87e3fdff31f1&pid=1-s2.0-S2949711624000571-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142272883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late complications following infant male circumcision using Plastibell technique: Experience from a single facility in Pakistan","authors":"Shazia Moosa ,&nbsp;Maryam Sherwani ,&nbsp;Ammar Ali Muhammad ,&nbsp;Aqil Soomro ,&nbsp;Lubna Samad","doi":"10.1016/j.yjpso.2024.100171","DOIUrl":"10.1016/j.yjpso.2024.100171","url":null,"abstract":"<div><h3>Background</h3><p>Globally, millions of circumcisions are performed annually by both medical and non-medical providers, with minor and major adverse outcomes. Short-term outcomes are well documented but there are limited reports of long-term, group-based assessments after Plastibell circumcision of infants. Through this study, we aim to assess the rate and types of late complications in the group of boys circumcised as part of Safe Circumcision Program (SCP) in Karachi, Pakistan, to document the safety of our technique and approach in the long-term.</p></div><div><h3>Methods</h3><p>This cross-sectional study was conducted on male infants circumcised via Plastibell technique as part of the SCP from June 2016 to May 2021. A sample size of 602 was calculated using OpenEpi. After obtaining consent, telephone interviews of parents/guardians were conducted by health workers using a structured questionnaire. All complications reported by parents and identified by health workers were documented, and the babies were then referred to a pediatric surgeon for review.</p></div><div><h3>Results</h3><p>Parents of 46 (7.5%) children reported a total of 81 concerns. After health worker assessment, 20 babies were referred to a specialist for in-person review and complications were documented in four (adhesion, inclusion cyst, skin bridge and meatal stenosis); thus, a late complication rate of 0.7% was recorded.</p></div><div><h3>Conclusion</h3><p>The long-term complication rate for Plastibell circumcisions performed by trained providers is less than 1% with all reported complications minor and amenable to surgical correction.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294971162400056X/pdfft?md5=db76304fbc64e18b830589c401bf144c&pid=1-s2.0-S294971162400056X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal meconium-related obstruction: Establishing a research strategy to evaluate an evolving disease","authors":"Jordan M. Rook ,&nbsp;Jay Vankawala ,&nbsp;Daniel A. DeUgarte","doi":"10.1016/j.yjpso.2024.100170","DOIUrl":"10.1016/j.yjpso.2024.100170","url":null,"abstract":"<div><h3>Purpose</h3><p>The link between prematurity and meconium-related obstruction is understudied. We sought to describe the contemporary spectrum of meconium-related obstruction and to validate the use of ICD-10 codes for the study of this family of diseases.</p></div><div><h3>Methods</h3><p>This retrospective cohort study included neonates within our health system treated for a radiographically or intraoperatively confirmed meconium-related obstruction from January 2018 to December 2022. We stratified obstructions by type (meconium ileus vs meconium plug syndrome) and need for intervention (contrast enema vs surgery). We evaluated the association of prematurity, cystic fibrosis, and Hirschsprung's disease with disease severity using t-tests, ANOVA, and chi-squared tests. We secondarily evaluated the accuracy of ICD-10 codes at identifying meconium-related obstructions using sensitivity, specificity, and predictive values.</p></div><div><h3>Results</h3><p>Over five years, 18 infants were treated for meconium-related obstruction. This included five patients (28%) with meconium ileus and 13 (72%) with meconium plug syndrome. Twelve neonates (67%) were preterm, including all five (100%) treated for meconium ileus, none of whom had cystic fibrosis or Hirschsprung's disease. Among infants with meconium plug syndrome, one (8%) had cystic fibrosis and two (15%) had Hirschsprung's disease. Eight (44%) patients required a contrast enema, 5 (28%) multiple contrast enemas, and 5 (28%) surgery. Increasing prematurity was associated with worse disease severity (p&lt;0.001). Diagnosis code P76.0 identified all cases of meconium-related obstruction (sensitivity=100%; specificity=95%).</p></div><div><h3>Conclusions</h3><p>Most meconium-related obstructions were related to prematurity and not cystic fibrosis or Hirschsprung's disease. The use of ICD-10 code P76.0 is a promising research strategy for this evolving condition.</p></div><div><h3>Level of evidence</h3><p>Level III – retrospective comparative study</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000558/pdfft?md5=e3249b4c40b1424bb9d6625249f5fe2d&pid=1-s2.0-S2949711624000558-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142095884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and implications of pediatric spinal gun shot wounds: A cross-sectional analysis using 2017-2021 TQIP data","authors":"Matthew Merckling ,&nbsp;Victor Koltenyuk ,&nbsp;David Zuckerman ,&nbsp;Brianna Hayes ,&nbsp;Aryan Rafieezadeh ,&nbsp;Bardiya Zangbar ,&nbsp;Harshadkumar Patel ,&nbsp;Rachana Tyagi","doi":"10.1016/j.yjpso.2024.100169","DOIUrl":"10.1016/j.yjpso.2024.100169","url":null,"abstract":"<div><h3>Background</h3><p>Pediatric morbidity and mortality due to gun violence has steadily risen in recent years, becoming the leading cause of death among children and teens as of 2022 per the Center for Disease Control (CDC). For patients under the age of 17 in the United States, gunshot wounds (GSWs) are the underlying cause of traumatic spinal cord injury (tSCI) in 8.3% of patients. Although prior studies have examined the broader trends of firearm-related deaths in children, investigation specifically focusing on gunshot wounds to the spine has not addressed the pediatric population.</p></div><div><h3>Methods</h3><p>The TQIP database from 2017 to 2021 was queried for patients under the age of 18 with gunshot traumas, and ICD-10 diagnosis codes were used to identify associated spinal injuries. The incidence across time and risk factors for adverse hospital outcomes were analyzed using multivariate logistic regression. Factors of interest included demographic characteristics, insurance provider, and comorbidities.</p></div><div><h3>Results</h3><p>A total of 3,155 gunshot injuries to the spine (GSIS) in the pediatric population were reported to TQIP between 2017 and 2021. Average patient age was 16 ± 2.8 years old and the majority of patients (n=1819, 57.6%) were uninsured. Assault was the intent of firearm discharge in 2,582 (81.8%) patients and unintentional injury occurred in 322 (10.2%) cases. Mortality occurred in 11.7% of GSIS, twice that of the 5.8% seen in all pediatric GSW. Those with psychiatric disorders were more likely to result in extended LOS (OR, 2.538; 95% CI, 1.638-3.932; P &lt; 0.001) and in-hospital complications (OR, 1.841; 95% CI, 1.139-2.891; P = 0.012) when analyzed with multivariate binomial logistic regression.</p></div><div><h3>Conclusion</h3><p>In this large-scale retrospective study using TQIP data, we identified trends in spine injuries sustained from gun trauma in the pediatric population. Consideration of demographics, hospital course, and outcomes as examined in this study can provide valuable insights to clinicians, public health organizations, and policy makers.</p></div>","PeriodicalId":100821,"journal":{"name":"Journal of Pediatric Surgery Open","volume":"8 ","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949711624000546/pdfft?md5=a7eccd1b20c4b35075beeb668a30bc07&pid=1-s2.0-S2949711624000546-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142137186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}