Journal of pediatric surgery最新文献

{"title":"Prehospital Reverse Shock Index Times Glasgow Coma Scale as a Predictor for Trauma Intervention in Paediatric Trauma Patients.","authors":"Nicholas J Dante, Ryan J Salvatore, Nicolas L Carayannopoulos, Sathyaprasad C Burjonrappa","doi":"10.1016/j.jpedsurg.2024.162018","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162018","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have identified the reverse shock index x Glasgow Coma Scale (rSIG) as a tool for predicting the need for trauma intervention in pediatric patients. This study sought to investigate the utility of prehospital rSIG as a triage tool to predict the need for trauma-center level of care in a large pediatric cohort.</p><p><strong>Methods: </strong>Data from the American College of Surgeons National Trauma Data Bank (NTDB) (2018-2020) were used. Patients aged 1-18 with valid values for prehospital systolic blood pressure (EMS SBP), prehospital heart rate (EMS HR), and EMS total GCS, were included. Prehospital rSIG was calculated as (EMS SBP/EMS HR) x EMS total GCS. Abnormal values for rSIG were defined as: ≤13.1, ≤16.5, and ≤20.1 for patients aged 1-6, 7-12, and 13-18, respectively. Injury severity was determined by Injury Severity Score (ISS). ISS 1-8 represented minor injury, 9-15 moderate injury, and 16 severe injury. Rates of hemorrhage control surgery, embolization, transfusion at 4 hours, mechanical ventilation, ICU stay 3 days, and mortality was compared between patients with abnormal vs. normal prehospital rSIG.</p><p><strong>Results: </strong>120,941 patients were included in the analysis; 60269 (49.8 %) had an abnormal prehospital rSIG. Patients with abnormal prehospital rSIG had significantly higher rates of 1 trauma intervention (23.3 % vs 8.3 %, p < 0.0001) and mortality (2.7 % vs 0.1 %, p < 0.0001). When stratified by injury severity, rates of 1 trauma intervention were significantly higher for patients with abnormal prehospital rSIG in minor (2.8 % vs. 1.5 %, p < 0.0001), moderate (18.9 % vs 10.5 %, p < 0.0001), and severe injury (69.8 % vs 43.1 %).</p><p><strong>Conclusion: </strong>Prehospital rSIG appears to be an independent predictor of both trauma intervention and mortality, regardless of injury severity, in the pediatric trauma population. Use of prehospital rSIG may prove useful in triage situations, particularly mass casualty incidents, to determine need for trauma-center care.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162018"},"PeriodicalIF":2.4,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569039","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":"Vacuum Bell Therapy for Pectus Excavatum: Long-term Experience at a Single Center.","authors":"Shelby Aughtman, Charles Hehman, Letitia Janssen, Jamie Golden, Michael J Goretsky, Robert J Obermeyer","doi":"10.1016/j.jpedsurg.2024.162020","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162020","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate factors associated with excellent correction in pectus excavatum patients undergoing vacuum bell therapy (VBT).</p><p><strong>Methods: </strong>A single-institution retrospective chart review was performed November 2012-April 2023 to assess corrections of patients who underwent VBT. Patient demographics, presentation, and results were collected. Excellent correction was defined as complete correction or >100 % improved from an average standard chest depth of 0.51 cm. Data are reported using odds ratio & confidence intervals; and paired t-test comparison. A p-value of <0.05 was regarded as significant.</p><p><strong>Results: </strong>VBT was utilized in 431 patients with 278 patients included and 153 excluded due to loss of follow-up or incomplete data. Of those included, 89 % were male. There were 31 patients with excellent corrections (11 %) and 247 non-excellent corrections. Initial chest depth < 1.5 cm and chest wall flexibility remain important predictors of positive outcome (p=0.008 and < 0.001, respectively). Excellent correction was statistically more likely in patients aged 8 to 12.9 (OR = 2.2, p = 0.039). Surgical correction following VBT was performed in only 15.5 % (42 of 278) of our patients, none of which were in the group with an excellent correction.</p><p><strong>Conclusion: </strong>Excellent correction for pectus excavatum via VBT was achieved in a small proportion of patients, with improved outcomes in those initiating therapy at a younger age, with a mild defect, and with increased chest wall flexibility. These data may be used to help determine those more likely to achieve complete correction from a nonsurgical approach and guide decisions towards treatment methods.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162020"},"PeriodicalIF":2.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564229","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":"A Multidisciplinary Assessment of Standard Low Dose Versus Ultra-low Dose Chest CT Scans for Pectus Excavatum Imaging.","authors":"Charles Hehman, Shelby Aughtman, Michael Goretsky, Jamie Golden, Jennifer Rush, Neil Vachhani, John Conery, Turaj Vazifedan, Ricardo Rendel, Robert Obermeyer","doi":"10.1016/j.jpedsurg.2024.162026","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162026","url":null,"abstract":"<p><strong>Aim: </strong>Evaluation of ultra-low dose chest CT imaging for the assessment of pectus excavatum severity as determined by pediatric radiologists and pediatric surgeons using Haller (HI) and Correction indices (CI).</p><p><strong>Methods: </strong>A single institution, prospective evaluation of patients being evaluated for pectus excavatum were scanned with a standard low-dose chest CT protocol (CARE) followed by a consecutive ultra-low dose CT scan (ULTRA). 3 surgeons and 4 radiologists were instructed to determine HI and CI in each series. The Intraclass Correlation Coefficient (ICC) was used to calculate the agreement level between CARE and ULTRA. Bland-Altman (BA) and scatter plots were also performed to determine bias of each approach.</p><p><strong>Results: </strong>32 patients had CARE and ULTRA consecutively. The ICC for HI demonstrated good reliability with a value of 0.89 and excellent reliability for CI with a value of 0.91. The reliability for HI was greater in the surgeon group (0.89) compared to the radiologist group (0.88). The reliability for CI was greater in the radiologist group (0.92) compared to the surgeon group (0.90). The Bland Altman plots for the HI and CI demonstrate no consistent bias for CARE or ULTRA approach when evaluating HI and CI.</p><p><strong>Conclusion: </strong>Ultra-low dose CT scan imaging compared to standard low-dose CT appears to be a reliable alternative for evaluating PE severity as assessed by HI and CI. This work supports the evaluation and potential development of a standardized CT imaging protocol capable of reducing radiation exposure without sacrificing imaging for PE patients.</p><p><strong>Level of evidence: 2: </strong></p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162026"},"PeriodicalIF":2.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564213","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":"Continuous Incisional Infusion of Local Anaesthetic (CIILA) Reduces Postoperative Opioid Usage in Children.","authors":"Natalie Vallant, Eleftheria Xilas, Manasvi Upadhyaya","doi":"10.1016/j.jpedsurg.2024.162025","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162025","url":null,"abstract":"<p><strong>Aim: </strong>Adequate post-operative pain relief is associated with shorter recovery time and higher patient satisfaction. Universally, opioids have been the mainstay but are associated with many adverse effects. We aimed to assess the safety and effectiveness of Continuous Incisional Infusion of Local Anaesthetic (CIILA) for postoperative pain relief in the paediatric population.</p><p><strong>Methods: </strong>After Trust approval for the use of CIILA was obtained, data were collected prospectively from 2019 to 2022. Patients who had previously undergone laparotomy were used as historical controls. Morphine usage, pain scores and complications were documented. Median (IQR) were quoted throughout and comparison between groups performed using a Mann-Whitney U test. p < 0.05 was accepted as significant.</p><p><strong>Results: </strong>76 cases with CIILA were included (laparotomies n = 43, renal transplants n = 33), 58 children who underwent laparotomy served as control group. Age at surgery was 9.0 years (IQR: 2.3-13.1) and 6.1 years (IQR: 2.9-10.6), respectively; p = 0.23). Total morphine usage and number of bolus doses (<48 h) were significantly less in the CIILA group [23 (IQR: 2.6-261.6) vs. 460 (IQR: 265.0-566.0) mcg/kg total, and 0.4 (IQR: 0.4-10.0) vs. 10 (IQR: 10.0-10.0) mcg/kg bolus dose respectively, both p < 0001)]. Reported pain scores were similar in both groups [1.0 (IQR: 1.0-7.0) vs 0.0 (IQR: 0.0-0.5); p = 0.13)]. Length of stay was significantly shorter in the CIILA group [(4.5 days (IQR: 3.5-6.0) vs 6.0 days (IQR: 4.0-8.0); p = 0.02)]. There were no toxicity issues nor any local infection complications reported in the CIILA group.</p><p><strong>Conclusion: </strong>The use of CIILA is safe, and was associated with lower morphine consumption postoperatively. We suggest that CIILA should be more widely used in the paediatric population.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162025"},"PeriodicalIF":2.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142729877","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":"Predictors of Conservative Management Failure in Pediatric Renal Trauma: National Trauma Database Insights.","authors":"Mann Patel, Taylor Glassman, Sathyaprasad Burjonrappa","doi":"10.1016/j.jpedsurg.2024.162024","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162024","url":null,"abstract":"<p><strong>Aim of the study: </strong>This study aimed to evaluate contemporary management strategies of pediatric renal trauma, focusing on the failure of conservative management and identifying its predictors.</p><p><strong>Methods: </strong>The National Trauma Database (2018-2021) was queried for pediatric patients (≤18 years) with renal injury, identified via AIS codes aligned with the AAST kidney injury grading system. Urological surgical procedures were identified via ICD-10 Procedure Codes. Patients were categorized into immediate surgical management (within 4 h), conservative management (no surgery), and failed conservative management (surgery after 4 h). Demographics, injury characteristics, and clinical data were analyzed using descriptive and univariate statistical analyses (Wilcoxon Rank Sum, Chi-square, Odds Ratios).</p><p><strong>Results: </strong>Of 7266 pediatric renal trauma patients, most were white (63.4 %) males (69.1 %), aged 12-18 (76.6 %), suffering from unintentional blunt trauma (86.9 %). Most (n = 6610, 95 %) received conservative management; however, 4.5 % (n = 298) failed. Common surgical interventions included ureteral stent placement (n = 200, 59 %), renal IR procedures (n = 44, 13 %), and nephrectomy (n = 33, 9.7 %). Nephrectomy rates at low AAST kidney injury grades (I-II) were higher with upfront surgical management (n = 7, 3.5 %) than with failed conservative management (n = 0). Predictors of failed conservative management included higher Injury Severity Score (ISS) and higher AAST kidney injury grades (III-V) (p < 0.05).</p><p><strong>Conclusion: </strong>Conservative management failed in 4.5 % of paediatric renal trauma cases, associated with higher AAST kidney injury grade and ISS. Upfront surgical management correlated with a higher nephrectomy rate at lower injury grades compared to failed conservative management. Refinement of pediatric trauma protocols is needed for optimal care.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162024"},"PeriodicalIF":2.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546071","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":"Role of Emerging Urinary Biomarkers in Predicting Progressive Deterioration of Kidney Function in Congenital Anomalies of Kidney and Urinary Tract: Trefoil Family Factor 3, Alpha Soluble Klotho and Urinary Microalbuminuria.","authors":"Ayushi Vig, Manish Pathak, Shailja Sharma, Avinash Jadhav, Shubhalaxmi Nayak, Arvind Sinha","doi":"10.1016/j.jpedsurg.2024.162019","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162019","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is an irreversible fate of many CAKUT (Congenital Abnormalities of the Kidneys and Urinary Tract) patients. Biomarkers involved in the disease progression are raised early in the disease process and aid in identifying the individuals at risk of progressive renal function decline.</p><p><strong>Aims: </strong>To determine and compare the initial levels of urinary biomarkers in patients of CAKUT with asymptomatic controls and to correlate the same with progression of renal disease.</p><p><strong>Results: </strong>This study includes 66 children with CAKUT and 22 healthy controls. Initial levels of three urinary Biomarkers: Trefoil family factor 3 (TFF3), Alpha soluble Klotho and Albumin-to-creatinine ratio (ACR) was recorded. Kidney function was assessed initially and at the end of 1 y follow up. Progressive deterioration of renal disease was noted in 26 (fall in GFR by >10 ml/min/m²). Median levels of urinary TFF3, alpha soluble Klotho and ACR was higher in patients with CAKUT (263, 18, 56 mcg/gCr) as compared to controls (15, 5, 6 mcg/gCr) and was further higher in patients having a progressive kidney disease (586, 40, 182 mcg/gCr). The cut-off value of the TEF3 to diagnose progressive renal disease was 178 mcg/g Cr with sensitivity and specificity of 95 % and 96 %, respectively. Using a cut-off of 29 mg/g Cr for ACR, sensitivity and specificity were 97 and 96 %, respectively. Urinary soluble Klotho was a relatively poor urinary biomarker with sensitivity and specificity of only 70 and 78 %, respectively, at a cut-off value of 18 mcg/g Cr.</p><p><strong>Conclusion: </strong>TFF3 and ACR are useful biomarkers which can be included in the biomarker panel to identify patients having a progressive renal disease and are at a risk of developing CKD.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162019"},"PeriodicalIF":2.4,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546073","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":"The Transition of Patients with an ACE: Referral Pathway and Outcomes.","authors":"Anna Cv Harris, Yvette Perston, Anil Bagul","doi":"10.1016/j.jpedsurg.2024.162021","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162021","url":null,"abstract":"<p><strong>Aims: </strong>Transition of paediatric patients is challenging. This study aimed to assess the transition pathway for patients who underwent an ACE procedure as a child and to understand ongoing support requirements.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients on the Pelvic Floor Clinical Specialist Nurse's (PFCNS) database from a tertiary adult hospital. Patients receiving their ACE as an adult or patients who did not attend any outpatient appointments (OPAs) were excluded. Data was gathered on complications, additional procedures and outcomes.</p><p><strong>Results: </strong>Sixty-three patients met the inclusion criteria. The median age at referral to an appropriate team was 18 years but the median age of referral to the PFCNS was 23 years. Only 7(11 %) were referred to the PFCNS by Paediatric Services. Patients experienced a variety of problems including change in equipment (n = 38, 60 %), change in washout regime (n = 28, 44 %), ACE leakage (n = 15, 24 %), stenosis (n = 15, 24 %) and ineffective washouts (n = 11, 17 %). Of those where data was available, there was a median of 7 PFCNS and 2.5 Colorectal Consultant (CC) OPAs per patient. Surgical intervention was common including procedures to the ACE (n = 8, 13 %), excision of ACE (n = 5, 7.9 %) manual evacuation (n = 5, 7.9 %) and formation of a stoma (n = 1%). 35 (56 %) were still using their ACE with a median time since transition of 11 years.</p><p><strong>Conclusion: </strong>Patients with an ACE need considerable ongoing support yet few are appropriately transitioned. There needs to be a clear transition pathway for these patients to the PFCNS and if appropriate a CC.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162021"},"PeriodicalIF":2.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622854","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":"Outcomes of Management of Anterior Anus in Girls in Glasgow, UK.","authors":"Sesi Hotonu, Anna Annett, Alison Campbell, Timothy Bradnock, Gregor Walker","doi":"10.1016/j.jpedsurg.2024.162023","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.162023","url":null,"abstract":"<p><strong>Background: </strong>Anterior anus is considered part of the spectrum of anorectal malformations in girls and has been associated with childhood constipation. However, limited literature exists on outcomes and associated malformations.</p><p><strong>Methods: </strong>All girls <6 months referred to our centre with suspected anterior anus between January 2015 and December 2022 were identified. Data collected included patient demographics, presence of anomalies, operative management, laxative use and continence. Results are described using descriptive statistics and percentages.</p><p><strong>Results: </strong>147 girls were referred with suspected anterior anus of which 95 were confirmed to have an anterior anus. Median age of first assessment was 3 (0-13) months. Median follow up was 24 (1-94) months. 21 (22.1 %) had clinical concern of partial absence of normal circumferential anal corrugation. 10 (10.5%) girls underwent examination under anaesthesia; 4 patients underwent anoplasty with covering colostomy. Laxatives were prescribed in 31 (32.6%) girls. Of the 53 patients followed up to age 4 years and older, 51 (96.2%) achieved continence. On renal ultrasonography significant hydroureteronephrosis was detected in one patient. No significant spinal anomalies were detected on imaging. Two patients had ventricular-septal defects were identified. All significant anomalies were in patients with an ectopic anus/ perineal fistula.</p><p><strong>Conclusion: </strong>This represents the largest reported series of girls with anterior anus. The incidence of identified associated malformations was low. Furthermore, laxative use and continence outcomes are similar to the general infant/childhood population. Screening and routine follow-up should be reserved for individual cases where there is clinical concern.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162023"},"PeriodicalIF":2.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502513","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":"The Impact of Deep Learning on Determining the Necessity of Bronchoscopy in Pediatric Foreign Body Aspiration: Can Negative Bronchoscopy Rates Be Reduced?","authors":"Nurcan Çoşkun ,&nbsp;Meryem Yalçınkaya ,&nbsp;Emre Demir","doi":"10.1016/j.jpedsurg.2024.162014","DOIUrl":"10.1016/j.jpedsurg.2024.162014","url":null,"abstract":"<div><h3>Introduction</h3><div>This study aimed to evaluate the role of deep learning methods in diagnosing foreign body aspiration (FBA) to reduce the frequency of negative bronchoscopy and minimize potential complications.</div></div><div><h3>Methods</h3><div>We retrospectively analysed data and radiographs from 47 pediatric patients who presented to our hospital with suspected FBA between 2019 and 2023. A control group of 63 healthy children provided a total of 110 PA CXR images, which were analysed using both convolutional neural network (CNN)-based deep learning methods and multiple logistic regression (MLR).</div></div><div><h3>Results</h3><div>CNN-deep learning method correctly predicted 16 out of 17 bronchoscopy-positive images, while the MLR model correctly predicted 13. The CNN method misclassified one positive image as negative and two negative images as positive. The MLR model misclassified four positive images as negative and two negative images as positive. The sensitivity of the CNN predictor was 94.1 %, specificity was 97.8 %, accuracy was 97.3 %, and the F1 score was 0.914. The sensitivity of the MLR predictor was 76.5 %, specificity was 97.8 %, accuracy was 94.5 %, and the F1 score was 0.812.</div></div><div><h3>Conclusion</h3><div>The CNN-deep learning method demonstrated high accuracy in determining the necessity for bronchoscopy in children with suspected FBA, significantly reducing the rate of negative bronchoscopies. This reduction may contribute to fewer unnecessary bronchoscopy procedures and complications. However, considering the risk of missing a positive case, this method should be used in conjunction with clinical evaluations. To overcome the limitations of our study, future research with larger multi-center datasets is needed to validate and enhance the findings.</div></div><div><h3>Type of study</h3><div>Original article.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162014"},"PeriodicalIF":2.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530064","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":"Perioperative Antibiotic Use in Pediatric Solid Tumor Resection: A Two-center Retrospective Cohort Study","authors":"Huma Faiz Halepota ,&nbsp;Emily Zeng ,&nbsp;Suraj Sarvode Mothi ,&nbsp;Tarek M. Zaghloul ,&nbsp;Daniel B. Gehle ,&nbsp;Ijeoma Nwachukwu ,&nbsp;Mary Beth Houston ,&nbsp;Matthew Joseph Lynn ,&nbsp;Emile Crouzen ,&nbsp;Bhanumathi Lakshminarayanan ,&nbsp;Andrew Jackson Murphy","doi":"10.1016/j.jpedsurg.2024.162008","DOIUrl":"10.1016/j.jpedsurg.2024.162008","url":null,"abstract":"<div><h3>Purpose</h3><div>There is no consensus on the perioperative use of antibiotics in pediatric solid tumor resection. This study collected data from two pediatric centers that utilize perioperative antibiotics to varying degrees in pediatric solid tumor patients to investigate the occurrence of postoperative sepsis and infectious complications.</div></div><div><h3>Methods</h3><div>A two-institution, retrospective cohort study was performed. Charts of children who underwent solid tumor resection between July 2018–June 2021 were reviewed. Patient characteristics, diagnosis, operative data, perioperative antibiotic use, and postoperative infection/sepsis were analyzed within 30 days of surgery. The primary outcome was surgical site infection (SSI) or systemic sepsis within 30 days of surgery. Fisher's tests were performed to evaluate differences.</div></div><div><h3>Results</h3><div>250 patients underwent tumor resection between July 2018 and June 2021 at both centers. The median age was 4 years [Range: 0.02–26.1]. Seventy-five percent (N = 188) received perioperative antibiotics prophylaxis (AP), while 25 % of patients did not receive AP (N = 62). Only one patient in the AP group (0.5 %) developed postoperative sepsis, while 12 patients (19.4 %) in the non-AP group developed sepsis (p &lt; 0.0001). There were 3 SSI in the AP group and none in the non-AP group (p = 1.0).</div></div><div><h3>Conclusions</h3><div>The administration of AP in children undergoing solid tumor resection is associated with a reduced rate of postoperative sepsis but no difference in SSI. This could possibly be related to bacterial translocation during surgery and the seeding of indwelling central venous access catheters. Our results support the standardized use of AP in this population.</div></div><div><h3>Type of Study</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162008"},"PeriodicalIF":2.4,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546076","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}