Journal of pediatric surgery最新文献_第10页

A pediatric Brain Injury Guideline allows safe management of traumatic brain injuries by trauma surgeons 小儿脑损伤指南允许创伤外科医生对创伤性脑损伤进行安全管理

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-24 DOI: 10.1016/j.jpedsurg.2024.07.029

Allison G. McNickle MD FACS, Dina Bailey BSN RN CSTR, Mais Yacoub MD, Shirong Chang MD FACS, Douglas R. Fraser MD FACS

{"title":"A pediatric Brain Injury Guideline allows safe management of traumatic brain injuries by trauma surgeons","authors":"Allison G. McNickle MD FACS, Dina Bailey BSN RN CSTR, Mais Yacoub MD, Shirong Chang MD FACS, Douglas R. Fraser MD FACS","doi":"10.1016/j.jpedsurg.2024.07.029","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.029","url":null,"abstract":"We implemented a pediatric Brain Injury Guideline (pBIG) to stratify traumatic brain injuries (TBI) and allow management of less severe cases without repeat CT imaging or neurosurgical consultation. Injuries were classified as mild (pBIG1), moderate (pBIG2), severe (pBIG3) or isolated skull fractures (ISF) based on neurologic status, size and number of bleeds. We hypothesize that pediatric TBIs can be safely managed with this guideline. Isolated TBIs (<18 years) were queried from the Pediatric Trauma Registry after pBIG implementation from July 2021-March 2023. Datasets included age, injury specifics, repeat head CTs, neurosurgical consultations and interventions. Analysis was performed with Stata, with significance set at p<0.05. A total of 139 children with a median age of 2.8 years were included. Skull fractures (113, 81%) and subdural hematomas (54, 39%) were the most common injuries. Repeat head CTs were obtained in 44 (32%) and neurosurgical consultation in 89 (64%). Overall guideline compliance was 83.5%, with best performance in the pBIG3 category (96%). One pBIG1 patient had increasing symptoms requiring upgrade, neurosurgical consultation and repeat head CT, but no intervention. Five children (3.6%; 4 isolated skull fractures, 1 pBIG3) had post-discharge ED visits and 1 (0.7%, ISF) had a post-discharge CT. Three (2.2%) children, all in the pBIG3 group, died from their TBIs. Adherence to the algorithm was 83.5%, with the lowest compliance in the moderate TBI (pBIG2) category. This group had a high rate of neurosurgical consultation suggesting uneasiness with independent management of moderate injuries when compared to minor TBIs or isolated skull fractures. Outcomes with the use of the pBIG algorithm were otherwise acceptable. Level IV, Therapeutic/Care Management","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772357","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}

引用次数: 0

Outcomes Of Children With Short Bowel Syndrome: Experiences In A Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades 短肠综合征患儿的疗效：多学科肠道康复小组二十年来的经验

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-24 DOI: 10.1016/j.jpedsurg.2024.07.031

Jaime Tsz-wing Tsang MBBS, Adrian Chi-heng Fung MBBS, Stephen Cheuk-lam Lau MBBS, Kenneth Kak-yuen Wong PhD

{"title":"Outcomes Of Children With Short Bowel Syndrome: Experiences In A Multidisciplinary Intestinal Rehabilitation Unit Over Two Decades","authors":"Jaime Tsz-wing Tsang MBBS, Adrian Chi-heng Fung MBBS, Stephen Cheuk-lam Lau MBBS, Kenneth Kak-yuen Wong PhD","doi":"10.1016/j.jpedsurg.2024.07.031","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.031","url":null,"abstract":"Short bowel syndrome (SBS) is a rare but serious form of organ failure, and patients with SBS depend on total parenteral nutrition (PN) to maintain growth and development. The present study aimed to evaluate the experiences and outcomes of children with SBS managed by a multidisciplinary intestinal rehabilitation programme in a tertiary paediatric centre. A retrospective single-centre analysis of all paediatric patients with a clinical diagnosis of SBS between 2001 and 2022 was performed. Clinical outcomes and their predictors were extracted and analysed. Of the 64 children included in the study, 43 (67%) had extensive necrotising enterocolitis. The median bowel length was 45 cm (interquartile range (IQR) = 18–65) and 18.9% (IQR = 10–28.5) of the expected length based on age. Over a mean follow-up period of 8.9 years, 57 patients (89%) survived, and 50 (78%) weaned off PN. The presence of intestinal failure-associated liver disease (IFALD) (OR = 6.375, = 0.02) and patients managed before the introduction of fish oil-based PN in 2007 (OR = 5.895, = 0.001) were significant predictors of mortality. There was an overall improvement in survival over time ( = 0.003). Ultrashort bowel length was not associated with significantly higher mortality (OR = 1.1, = 0.65) but was a poor prognostic factor for weaning off PN (OR = 3.57, p = 0.004). Among all patients who weaned off PN, two had bowel lengthening procedures and one received a glucagon-like peptide 2 (GLP-2) analogue. A multidisciplinary intestinal rehabilitation programme offers a comprehensive approach for patients with SBS and has been shown to be effective with favourable outcomes. Improvements in the choice of PN and the development of new treatment strategies potentially improved the survival and enteral autonomy of SBS patients. III","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772360","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}

引用次数: 0

Finnish pediatric surgery hub – From centralization to collective learning and sharing of expertise 芬兰小儿外科中心--从集中到集体学习和共享专业知识

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-24 DOI: 10.1016/j.jpedsurg.2024.07.027

Mikko P. Pakarinen, Topi Luoto, Susanna Nuutinen, Arimatias Raitio, Esko Tahkola, Antti Koivusalo

{"title":"Finnish pediatric surgery hub – From centralization to collective learning and sharing of expertise","authors":"Mikko P. Pakarinen, Topi Luoto, Susanna Nuutinen, Arimatias Raitio, Esko Tahkola, Antti Koivusalo","doi":"10.1016/j.jpedsurg.2024.07.027","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.027","url":null,"abstract":"Continuous surgical developments, growing awareness of patient representatives and limited health-care resources are pushing for innovative approaches to ensure equal high-quality pediatric surgical care. We aimed to describe early experiences and assess surgical safety of a novel nationwide pediatric surgery collaborative initiative. In 2021, general pediatric surgeons representing all five independent university hospitals performing neonatal surgery in Finland initiated national collaboration, the Finnish pediatric surgery hub (FPSH), for sharing of surgical expertise and collective learning. For each case addressed by FPSH, place of care and surgical team were decided individually, and when deemed necessary, operations were performed in cooperation. Operations performed during 2021-2023 and associated early (<30 days) postoperative complications were analyzed according to Clavien-Madadi classification. Of the total 40 surgeries managed co-operatively by FPSH, 30 (75%) took place in local university hospitals and 10 in Helsinki University Hospital. There were 34 (85%) elective and 6 urgent cases, which were operated within median 1 (range, 1-3) days. Most frequent underlying diagnoses included anorectal malformations, esophageal atresia and Hirschsprung disease. Overall, 12 (30%) had any early postoperative complications, all Clavien-Madadi grade IIIB or lower, and five patients (13%) were reoperated. Rate or grade of complications was not associated with place of care. In addition to regular virtual case meetings, national care protocols and research projects were introduced. These preliminary findings suggest that our national collaborative initiative, FPSH, not only provided practical and safe framework for sharing of surgical expertise but also for collective learning. III","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772358","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}

引用次数: 0

A phase 3, randomized, active-controlled, single-blind clinical trial to evaluate the efficacy of Fibrin Sealant Grifols in achieving hemostasis in pediatric surgery 3 期随机、主动对照、单盲临床试验：评估纤维蛋白密封剂 Grifols 在小儿外科手术中止血的疗效

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-23 DOI: 10.1016/j.jpedsurg.2024.07.024

Laura Balanescu, Djordje Gajdobranski, Aleksandar Sretenović, Krasimira Kalinova, Péter Vajda, the Fibrin Sealant Pediatric Surgery Study Group, Isodoro Wiener, Zoltan Jenovari, Maja Mikickovic, Krasimir Kamenov, Simeon Simeonov, Borislav Ninov, Khalid Sharif, Andjelka Slavkovic, Sabine Irtan, Michael K. James, Jordi Bozzo, Kim Hanna, Montse Querolt, Sandra Camprubí, Elsa Mondou

{"title":"A phase 3, randomized, active-controlled, single-blind clinical trial to evaluate the efficacy of Fibrin Sealant Grifols in achieving hemostasis in pediatric surgery","authors":"Laura Balanescu, Djordje Gajdobranski, Aleksandar Sretenović, Krasimira Kalinova, Péter Vajda, the Fibrin Sealant Pediatric Surgery Study Group, Isodoro Wiener, Zoltan Jenovari, Maja Mikickovic, Krasimir Kamenov, Simeon Simeonov, Borislav Ninov, Khalid Sharif, Andjelka Slavkovic, Sabine Irtan, Michael K. James, Jordi Bozzo, Kim Hanna, Montse Querolt, Sandra Camprubí, Elsa Mondou","doi":"10.1016/j.jpedsurg.2024.07.024","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.024","url":null,"abstract":"In this study, two fibrin sealant products, Fibrin Sealant Grifols (FS Grifols 80mg/mL fibrinogen; 500 IU/mL thrombin) and Evicel (fibrinogen 55-85 mg/ml; thrombin 800-1200 IU/mL) were studied for efficacy in achieving hemostasis at a targeted bleeding site (TBS) on parenchymous or soft tissue in pediatric surgeries. This phase 3, single-blind, active comparator, non-inferiority trial compared the number of patients achieving hemostasis at a TBS at four (T - primary endpoint), seven (T) and 10 (T) minutes after application, Safety and tolerability were assessed by recording adverse events during and after procedures. Eligible patients were <18 years old undergoing elective, open, non-cardiac thoracic, abdominal or pelvic surgeries. Preterm (<37 weeks gestation) and newborn (0-27 days) were eligible. At T, 98.7% of FS Grifols group (n= 91) and 95.4% of the Evicel group (n = 87) achieved hemostasis . All patients with residual bleeding at T were undergoing soft tissue surgery. All patients achieved hemostasis by T. At T, all patients achieved hemostasis except one (FS Grifols (no observation recorded). There were no incidents of persistent bleeding. FS Grifols was safe and effective at achieving hemostasis in pediatric patients having parenchymous or soft tissue surgeries. The efficacy of FS Grifols was non-inferior to Evicel. I","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772361","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}

引用次数: 0

Clinical Characteristics and Outcomes of Neonatal Hepatoblastoma: a single center study 新生儿肝母细胞瘤的临床特征和预后：一项单中心研究

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-23 DOI: 10.1016/j.jpedsurg.2024.07.025

Jiquan Zhou, Liyuan Yang, Tingyi Fu, Hongxiang Gao, Yuhua Shan, Jing Wang, Lei Zhang, Chenjie Xie, Jingyan Tang, Yijin Gao, Minzhi Yin, Ji Ma, Qiuhui Pan, Min Xu, Song Gu

{"title":"Clinical Characteristics and Outcomes of Neonatal Hepatoblastoma: a single center study","authors":"Jiquan Zhou, Liyuan Yang, Tingyi Fu, Hongxiang Gao, Yuhua Shan, Jing Wang, Lei Zhang, Chenjie Xie, Jingyan Tang, Yijin Gao, Minzhi Yin, Ji Ma, Qiuhui Pan, Min Xu, Song Gu","doi":"10.1016/j.jpedsurg.2024.07.025","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.025","url":null,"abstract":"Hepatoblastoma (HB) diagnosed within one month following birth qualifies for a diagnosis of neonatal HB, whose prognosis is reportedly controversial, and its treatment is challenging. This study discussed the diagnosis, treatment, and outcomes of neonatal HB at a single center so as to enhance its overall management in the future. The clinical information of babies diagnosed with neonatal HB at our center from August 2009 to September 2023 were retrospectively analyzed for demographics, clinical features, therapy, and outcomes. The outcomes were estimated by the Kaplan-Meier analysis method. The study comprised 79 patients aged less than one year old, among which 14 had neonatal HB whereas 65 were non-neonatal HB patients. No differences were found between groups regarding gender, birth weight, delivery details, parental age, clinical signs, or treatment strategies. Neonatal HB patients were more likely to have PRETEXT I-II, smaller tumor size, congenital diseases, and lower risk tumor grade (p<0.05). Additionally, the AFP levels of all neonatal HB patients were greater than 10,000 ng/ml (p=0.009) and they had higher levels of ferritin (p=0.003) and hemoglobin (p=0.021), but lower levels of serum total proteins (p=0.001). The three-year survival rate (100% vs 90.8%) and three-year event-free survival rate (100% vs 86.2%) in the neonatal HB group were higher than the non-neonatal HB group. Neonatal HB patients have unique clinical features and can achieve an excellent prognosis following combined treatment with surgery and chemotherapy. Tumor resection, when carefully performed, was safe even in babies younger than one months old. Further and long-term studies are needed from a larger neonatal HB population. Level III","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772359","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}

引用次数: 0

Association of operative approach with postoperative outcomes in neonates undergoing surgical repair of esophageal atresia and tracheoesophageal fistula 接受食管闭锁和气管食管瘘手术修复的新生儿的手术方式与术后效果的关系

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-23 DOI: 10.1016/j.jpedsurg.2024.07.026

Paulo Castro BS, Fari Fall MD MA, Devon Pace MD MPH, Shale J. Mack BS, David H. Rothstein MD MS, Courtney L. Devin MD, Emily Sagalow MD, Allison F. Linden MD MPH, Matthew Boelig MD, Lindsey Asti PhD MPH, Loren Berman MD

{"title":"Association of operative approach with postoperative outcomes in neonates undergoing surgical repair of esophageal atresia and tracheoesophageal fistula","authors":"Paulo Castro BS, Fari Fall MD MA, Devon Pace MD MPH, Shale J. Mack BS, David H. Rothstein MD MS, Courtney L. Devin MD, Emily Sagalow MD, Allison F. Linden MD MPH, Matthew Boelig MD, Lindsey Asti PhD MPH, Loren Berman MD","doi":"10.1016/j.jpedsurg.2024.07.026","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.07.026","url":null,"abstract":"Minimally invasive surgery (MIS) is gaining traction as a first-line approach to repair congenital anomalies. This study aims to evaluate outcomes for neonates undergoing open versus MIS repairs for esophageal atresia/tracheoesophageal fistula (EA/TEF). In this retrospective study, neonates undergoing EA/TEF repair from 2013-2020 were identified using the National Surgical Quality Improvement Program-Pediatric database. Proportions of operative approach (open vs. MIS) over time were analyzed. A propensity score-matched analysis using preoperative characteristics was performed and outcomes were compared including composite morbidity and reintervention rates (overall, major [thoracoscopy, thoracotomy], and minor [chest/feeding tube placement, endoscopy]) between operative approaches. Pearson’s chi-square or Fisher’s exact tests were used as appropriate. We identified 1,738 neonates who underwent EA/TEF repair. MIS utilization increased over time. Pre-match, neonates undergoing open repair were more likely to be premature, lower weight, ventilator dependent, and have cardiac risk factors with higher severity. Post-match, the groups were similar and included 340 neonates per group. MIS repair was associated with longer median operative time (209 vs. 174 minutes, p<0.001) and increased overall post-operative intervention rates (7.6% vs. 2.9%, p=0.01). There were no differences in composite morbidity (24.4% vs. 25.0%, p=0.86) outside of reintervention. MIS approach for neonates with EA/TEF appears to be associated with a higher rate of reinterventions. Further studies evaluating MIS approaches for the repair of EA/TEF are needed to better define short- and long-term outcomes. Retrospective comparative study Level III","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141772363","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}

引用次数: 0

Revision of the VACTERL Acronym for the Screening of Gynecologic/Genitourinary Anomalies in Patients with Anorectal Malformations 修订用于筛查肛门直肠畸形患者妇科/泌尿生殖系统异常的 VACTERL 缩写词

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-23 DOI: 10.1016/j.jpedsurg.2024.07.023

Kristina Arion MD FRCSC, Ibukunoluwa Araoye MD MS, Andrea Lo MD FRCSC, Paul Beaudry MD FRCSC, Sarah McQuillan MD FRCSC

引用次数: 0

Pectus bar dislocation: Comparison between three different stabilization techniques adopted in a single centre 胸骨脱位一个中心采用的三种不同稳定技术的比较

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-22 DOI: 10.1016/j.jpedsurg.2024.07.022

Francesco Donati MD, Michele Torre MD

引用次数: 0

Announcements of Future Meetings 未来会议公告

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-16 DOI: 10.1016/S0022-3468(24)00382-8

引用次数: 0

Commentary- Bridging the Gap: The Impact of Bowel Management Programs on Daily Life in Pediatric Colorectal Disease 缩小差距：肠道管理计划对小儿结直肠疾病患者日常生活的影响》（Bridging the Gap: The Impact of Bowel Management Programs on Daily Life in Pediatric Colorectal Disease）。

IF 2.4 2区医学

Journal of pediatric surgery Pub Date : 2024-07-14 DOI: 10.1016/j.jpedsurg.2024.07.009

{"title":"Commentary- Bridging the Gap: The Impact of Bowel Management Programs on Daily Life in Pediatric Colorectal Disease","authors":"","doi":"10.1016/j.jpedsurg.2024.07.009","DOIUrl":"10.1016/j.jpedsurg.2024.07.009","url":null,"abstract":"<div><h3>Background</h3><p>This commentary discusses the social impact of bowel management programs (BMPs) on children with colorectal diseases, including anorectal malformations (ARM), Hirschsprung disease (HD), functional constipation (FC), and spina bifida. Previous studies focused on functional outcomes, but this study bridges the gap to daily life experiences.</p></div><div><h3>Methods</h3><p>The study examined children's experiences in BMPs, focusing on school participation, vacation ability, and overall patient experience. Cleanliness, defined as fewer than one stool soiling episode per week, was achieved by 70% of participants.</p></div><div><h3>Results</h3><p>Positive patient experiences were linked to achieving stool cleanliness, regardless of the management method. Invasive methods like enemas did not negatively affect experiences if cleanliness was maintained. Validated patient-reported experience measures (PREMs) and patient-reported outcomes measures (PROMs) were used, though the median age of 8.9 years posed limitations.</p></div><div><h3>Conclusion</h3><p>The commentary highlights the significance of stool cleanliness in improving patient experiences and supports the effectiveness of various BMP methods. Future research should include longitudinal follow-ups to assess BMP durability and gather data from older children.</p></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875068","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}

引用次数: 0