Journal of pediatric surgery最新文献

{"title":"Geospatial Analysis of Pediatric Burns Reveals Opportunities for Injury Prevention.","authors":"Walter A Ramsey, Justin Stoler, Christopher R Haggerty, Carlos T Huerta, Rebecca A Saberi, Christopher F O'Neil, Luciana Tito Bustillos, Eduardo A Perez, Juan E Sola, Shevonne S Satahoo, Carl I Schulman, Chad M Thorson","doi":"10.1016/j.jpedsurg.2024.161963","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161963","url":null,"abstract":"<p><strong>Background: </strong>Geospatial analysis is useful for identifying hot spots for preventable injuries and for informing prevention efforts. We hypothesize that specific populations of children in South Florida are at increased risk of burn injury.</p><p><strong>Methods: </strong>We used a regional burn center registry to geocode burn cases treated from July 2013 to December 2022 for patients <18 years. Spatial analysis was utilized to identify high-density areas and potential spatial clusters of patients living in Palm Beach, Broward, and Miami-Dade Counties. Sociodemographic factors, burn etiology, and physiologic characteristics were analyzed using geospatial and statistical analyses.</p><p><strong>Results: </strong>689 patients (58% male, median age 2 [1-8] years) were identified. The annual incidence of burns was 5.5 per 100,000 children. There was no seasonal variation in injury patterns. Most patients were Black (51%) and non-Hispanic (73%). Scald burns (72%) represented the most common etiology, followed by flame (10%) and contact with hot objects (9%). Most patients (58%) required inpatient admission. Scald and contact burns occurred in younger patients compared to other mechanisms (median [IQR] age: 2 [1-6] vs. 8 [4-12] years, p < 0.001). Race, ethnicity, and insurance status were not associated with inpatient admission (all p > 0.05). Overall, there was a higher rate of pediatric burn injuries affecting Black residents, with a paucity of injuries in predominately high-income areas.</p><p><strong>Conclusions: </strong>A disproportionate amount of pediatric burn injuries occur in low-income and predominantly Black neighborhoods. Additionally, scald and contact burns are a target for injury prevention in South Florida. These data may inform public health implementation to reduce morbidity in vulnerable populations.</p><p><strong>Level of evidence: </strong>Level III.</p><p><strong>Type of study: </strong>Retrospective comparative study.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor in Response to: Congenital Diaphragmatic Hernia Repair on ECMO and the Risk of Bleeding.","authors":"Amnuay Kleebayoon, Viroj Wiwanitkit","doi":"10.1016/j.jpedsurg.2024.161968","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161968","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Distraction Enterogenesis Induces Desert Hedgehog in the Lengthened Murine Colon.","authors":"Siavash Shariatzadeh, Arshia Tofang Sazi, James C Y Dunn","doi":"10.1016/j.jpedsurg.2024.161960","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161960","url":null,"abstract":"<p><strong>Background: </strong>Distraction enterogenesis lengthens the intestine through applied mechanical stress. The Hedgehog pathway (Hh) is responsible for intestinal tract development and directing the multi-layer patterning of the intestinal lumen. This study investigates the alteration in the principal components of this pathway in spring-mediated colonic lengthening.</p><p><strong>Methods: </strong>Samples from the murine cecal lengthening model were used to study Hh alteration during the cecal lengthening process. Primary components of this pathway were analyzed using RT-qPCR and immunostaining after 7 and 14 days of force application. The spring-mediated lengthened segments were compared to untreated control segments within each animal.</p><p><strong>Results: </strong>The spring-treated segments showed a 50% increase in length. There was a significant increase in the expression of the Desert Hedgehog ligand as opposed to the Sonic Hedgehog and Indian Hedgehog ligands. Additionally, the downstream targets of the pathway, Gli1, Gli2, and Gli3, were significantly overexpressed. The highest alterations in these components occurred at the earlier time point, after 7 days.</p><p><strong>Conclusions: </strong>These findings highlight the contribution of the conserved Hedgehog developmental pathway during mechanical force-induced cecal lengthening, primarily through the Desert Hedgehog ligand. These data suggest that the Desert Hedgehog pathway may serve as therapeutic targets for intestinal regeneration.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best Practices for Vessel Management in Pediatric Extracorporeal Membrane Oxygenation Cannulation, Decannulation, and Follow-up: A Narrative Review.","authors":"Katherine M McDermott, Mohammed Moursi, Sandra Tomita, David H Rothstein","doi":"10.1016/j.jpedsurg.2024.161961","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161961","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) to support neonates and children with cardiopulmonary failure was first described in the 1970s, since which time its use has expanded to an increasingly complex and heterogenous pediatric population. Despite preserved survival outcomes, complications of ECMO use, including iatrogenic vascular injury, are common. Here, we provide a brief overview of the epidemiology of pediatric ECMO and associated vascular complications; describe common peripheral cannulation equipment and techniques, trends in cannulation and decannulation strategies, and respective incidence of vascular complications; and review existing evidence for best practices in cannula site selection, cannulation technique, decannulation strategies, and management of vascular complications, with the goal of providing a comprehensive review for interventionalists involved in the care of pediatric ECMO patients. Areas of wide practice variation in vessel management-application of vessel-sparing cervical venoarterial cannulation, the use of distal perfusion catheters in femoral arterial cannulation, and best practices for percutaneous single-lumen venovenous cannulation, as examples-areas of focus for future research, and the potential role of vascular surgeons and other subspecialty proceduralists in the care of pediatric ECMO patients are highlighted. LEVEL OF EVIDENCE: V.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Gastrointestinal Quality of Life After Congenital Duodenal Obstruction Repair: A Nationwide Long-term Follow-up Study\".","authors":"Martin Alavi Treider, Henrik Røkkum, Thorstein Sæter, Kristin Bjørnland","doi":"10.1016/j.jpedsurg.2024.161938","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161938","url":null,"abstract":"<p><strong>Background: </strong>Congenital duodenal obstruction (CDO) is one of the most common gastrointestinal congenital anomalies. Still, patient-reported long-term results are limited. The aims of this study were to evaluate the long-term gastrointestinal quality of life (QoL), generic QoL, patient-reported scar appearance, and reinterventions after CDO repair.</p><p><strong>Methods: </strong>Patients who underwent surgery for CDO in Norway from 1995 to 2020 were invited to answer the validated questionnaires PedsQL and PedsQL gastrointestinal symptom scale and a study-specific questionnaire on general health and scar assessment. Parent-proxy reports were used for patients <12 years and patients with cognitive impairment. Scores were compared with an American and Norwegian control group for gastrointestinal and generic QoL, respectively.</p><p><strong>Results: </strong>Of 186 eligible patients, eight were deceased, 25 had unretrievable contact information, and 79 did not respond. There were no significant differences between included (n = 74) and not included (n = 112) patients regarding baseline data. The mean follow-up time was 13.3 (SD = 6.6) years. Patients with CDO had significantly lower overall gastrointestinal QoL than controls (85.9 versus 90.0, p = 0.010). The most common symptoms were gas/bloating, constipation, food/drink limits, and reflux. Generic QoL was similar between the CDO population and controls (84.4 versus 85.3, p = 0.530). Twenty-one (28 %) patients had some degree of pain and/or concern related to the surgical scar. Nine (12 %) patients had reoperations related to the CDO repair; four due to adhesive small bowel obstruction.</p><p><strong>Conclusion: </strong>A notable portion of patients report troublesome gastrointestinal symptoms and cosmetic concerns regarding their surgical scar after CDO repair. Even so, generic QoL was good.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comments on Fendereski et al., Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision.","authors":"Guy Cox, Brian J Morris","doi":"10.1016/j.jpedsurg.2024.161908","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161908","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial.","authors":"Mustafa Azizoglu, Sergey Klyuev, Tahsin Onat Kamci, Mehmet Hanifi Okur","doi":"10.1016/j.jpedsurg.2024.161934","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161934","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD).</p><p><strong>Methods: </strong>A single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0-18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6-8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656).</p><p><strong>Results: </strong>The CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039).</p><p><strong>Conclusion: </strong>The autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children.</p><p><strong>Type of the study: </strong>Randomized controlled trial.</p><p><strong>Level of evidence: </strong>Level I.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Surgery-first Approach to Pediatric Choledocholithiasis.","authors":"Sindhu V Mannava, Alan P Ladd","doi":"10.1016/j.jpedsurg.2024.161936","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161936","url":null,"abstract":"<p><strong>Background: </strong>In choledocholithiasis, the obstructed common bile duct (CBD) requires clearance either via endoscopic retrograde cholangiopancreatography (ERCP) or intraoperative cholangiogram (IOC) and common bile duct exploration (CBDE) during cholecystectomy. We hypothesized that patients with primary cholecystectomy (PC) and IOC/CBDE will have improved clinical outcomes when compared to primary ERCP (PE) patients.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of pediatric choledocholithiasis patients who underwent treatment at our institution between 2019 and 2023. We compared clinical and cost outcomes between PC and PE cohorts and assessed protocol compliance.</p><p><strong>Results: </strong>We analyzed 36 PC patients and 40 PE patients. Among PC patients, 52.7% underwent postoperative ERCP of which 47.4% were negative for CBD stone. Duct-clearing procedure varied between PC and PE groups, respectively, in terms of ERCP (36.1% vs. 65%), IOC/CBDE (36.1% vs. 2.5%), and spontaneous clearance (27.8 vs. 32.5%) (p < 0.001). One-third of PC patients had CBD clearance via IOC and flush and 16.7% had successful IOC/CBDE. PC patients had longer median combined surgical/procedural anesthesia duration (186 vs. 170.5 min, p = 0.318). There were no significant differences between PC and PE patients in terms of cost of surgery/procedures or overall admission.</p><p><strong>Conclusion: </strong>Most PC patients achieved duct clearance via IOC and spontaneous means. PC has the potential to enable earlier cholecystectomy and avoid postoperative ERCP altogether. In the setting of failed CBDE, combining a PC strategy with non-interventional monitoring may eliminate unnecessary postoperative ERCPs. Future studies should assess outcomes associated with an amended surgery-first protocol in a larger cohort.</p><p><strong>Level of evidence: </strong>II.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Announcement of Future Meetings","authors":"","doi":"10.1016/j.jpedsurg.2024.161872","DOIUrl":"10.1016/j.jpedsurg.2024.161872","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0022346824007668/pdfft?md5=82354cf768177f4b1db4f8a8cd80084f&pid=1-s2.0-S0022346824007668-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142172751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Surgical Margin in Wide Local Excision of Pediatric Melanoma - An Argument for a More Conservative Approach.","authors":"Anthony V Basta, Connor D Fritz, Yi-Ju Chiang, Neha Malik, Lily Koscielniak, Lauren Mayon, Cynthia E Herzog, Mary T Austin","doi":"10.1016/j.jpedsurg.2024.161897","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161897","url":null,"abstract":"<p><strong>Background: </strong>Pediatric melanoma is the most common skin cancer in children. Achieving surgical margins recommended by the National Comprehensive Cancer Network (NCCN) for wide local excision (WLE) is challenging in children with less body domain. This study investigated whether surgical margin impacted postoperative clinical outcomes following WLE for melanoma in children and adolescents.</p><p><strong>Methods: </strong>All patients ≤21 years undergoing WLE between 2007 and 2023 were analyzed. Patients were categorized in groups of surgical margin <2 cm vs. ≥2 cm. The chi-square test/Fisher's exact test and Mann-Whitney U test were used to analyze categorical and continuous variables between groups. Multivariate logistic regression was used to determine the association of age and tumor location with surgical margin group and whether NCCN guidelines for WLE were met.</p><p><strong>Results: </strong>Of the 59 patients included, 61% had WLE with <2 cm margins. Head/neck melanomas were less likely to have margins ≥2 cm (OR = 0.121, 95% CI 0.022-0.648, p = 0.014) and margins that met the NCCN guidelines (OR = 0.002, 95% CI 0.003-0.215, p < 0.001) when compared to trunk/extremity primaries. There was no difference in the rate of postoperative complications or need for intervention for complications between patients with margins <2 cm and those with ≥2 cm. No patients experienced local recurrence with a median follow-up of 52 months (IQR: 16 to 93).</p><p><strong>Conclusion: </strong>Pediatric head/neck melanomas undergoing WLE were likelier to have narrow margins <2 cm and less likely to meet NCCN criteria. Narrow margins may achieve excellent results for pediatric melanoma patients.</p><p><strong>Type of study: </strong>This is a treatment study.</p><p><strong>Levels of evidence: </strong>This is a Level III retrospective comparative study.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}