World Journal of Pediatric Surgery最新文献

{"title":"Lung-protective ventilation in the management of congenital diaphragmatic hernia.","authors":"Mike Traynor","doi":"10.1136/wjps-2024-000789","DOIUrl":"10.1136/wjps-2024-000789","url":null,"abstract":"<p><p>Prioritizing lung-protective ventilation has produced a clear mortality benefit in neonates with congenital diaphragmatic hernia (CDH). While there is a paucity of CDH-specific evidence to support any particular approach to lung-protective ventilation, a growing body of data in adults is beginning to clarify the mechanisms behind ventilator-induced lung injury and inform safer management of mechanical ventilation in general. This review summarizes the adult data and attempts to relate the findings, conceptually, to the CDH population. Critical lessons from the adult studies are that much of the damage done during conventional mechanical ventilation affects normal lung tissue and that most of this damage occurs at the low-volume and high-volume extremes of the respiratory cycle. Consequently, it is important to prevent atelectasis by using sufficient positive end-expiratory pressure while also avoiding overdistention by scaling tidal volume to the amount of functional lung tissue rather than body weight. Paralysis early in acute respiratory distress syndrome improves outcomes, possibly because consistent respiratory mechanics facilitate avoidance of both atelectasis and overdistention-a mechanism that may also apply to the CDH population. Volume-targeted conventional modes may be advantageous in CDH, but determining optimal tidal volume is challenging. Both high-frequency oscillatory ventilation and high-frequency jet ventilation have been used successfully as 'rescue modes' to avoid extracorporeal membrane oxygenation, and a prospective trial comparing the two high-frequency modalities as the primary ventilation strategy for CDH is underway.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11308893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141907857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of robot-assisted thoracoscopic surgery in the treatment of pulmonary sequestration in children.","authors":"Liang Liang, Zheng Tan, Ting Huang, Yue Gao, Jian Zhang, Jiangen Yu, Jie Xia, Qiang Shu","doi":"10.1136/wjps-2023-000748","DOIUrl":"10.1136/wjps-2023-000748","url":null,"abstract":"<p><strong>Objective: </strong>This study was performed to evaluate the efficacy of robot-assisted thoracoscopic surgery (RATS) in the treatment of pulmonary sequestration (PS) in children.</p><p><strong>Methods: </strong>All video-assisted thoracoscopic surgery (VATS) and RAST performed on patients with PS at a single center from May 2019 to July 2023 were identified. The <i>χ</i> ^<i>2</i> and Wilcoxon tests were used to compare the perioperative outcomes between VATS and RATS groups.</p><p><strong>Results: </strong>Ninety-three patients underwent RATS while 77 patients underwent VATS. In both two groups, one patient converted to thoracotomy and no surgical mortality case. The median operation time was longer for the RATS group compared with the VATS group (75 min <i>vs.</i> 60 min, <i>p</i> <0.001). A lower ratio of chest tube indwelling (61.3% <i>vs.</i> 90.9%, <i>p</i> <0.001), fewer drainage days (1.0 day <i>vs.</i> 2.0 days, <i>p</i> <0.001), and a shorter postoperative length of stay (5.0 days <i>vs.</i> 6.0 days, <i>p</i> <0.001) were found in the RATS group than that in the VATS group. No significant difference was found in the incidence of short-term postoperative complications (hydrothorax and pneumothorax) between two groups.</p><p><strong>Conclusions: </strong>RATS was safe and effective in children with PS over 6 months old and more than 7 kg. Furthermore, RATS led to better short-time postoperative outcome than VATS. Multi-institutional studies are warranted to compare differences in long-term outcomes between RATS and VATS.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11298719/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of initial assessment variables and mortality in severe pediatric traumatic brain injury.","authors":"Katherine C Bergus, Kelli N Patterson, Lindsey Asti, Josh Bricker, Tariku J Beyene, Lauren N Schulz, Dana M Schwartz, Rajan K Thakkar, Eric A Sribnick","doi":"10.1136/wjps-2023-000718","DOIUrl":"10.1136/wjps-2023-000718","url":null,"abstract":"<p><strong>Background: </strong>Predictive scales have been used to prognosticate long-term outcomes of traumatic brain injury (TBI), but gaps remain in predicting mortality using initial trauma resuscitation data. We sought to evaluate the association of clinical variables collected during the initial resuscitation of intubated pediatric severe patients with TBI with in-hospital mortality.</p><p><strong>Methods: </strong>Intubated pediatric trauma patients <18 years with severe TBI (Glasgow coma scale (GCS) score ≤8) from January 2011 to December 2020 were included. Associations between initial trauma resuscitation variables (temperature, pulse, mean arterial blood pressure, GCS score, hemoglobin, international normalized ratio (INR), platelet count, oxygen saturation, end tidal carbon dioxide, blood glucose and pupillary response) and mortality were evaluated with multivariable logistic regression.</p><p><strong>Results: </strong>Among 314 patients, median age was 5.5 years (interquartile range (IQR): 2.2-12.8), GCS score was 3 (IQR: 3-6), Head Abbreviated Injury Score (hAIS) was 4 (IQR: 3-5), and most had a severe (25-49) Injury Severity Score (ISS) (48.7%, 153/314). Overall mortality was 26.8%. GCS score, hAIS, ISS, INR, platelet count, and blood glucose were associated with in-hospital mortality (all <i>p</i><0.05). As age and GCS score increased, the odds of mortality decreased. Each 1-point increase in GCS score was associated with a 35% decrease in odds of mortality. As hAIS, INR, and blood glucose increased, the odds of mortality increased. With each 1.0 unit increase in INR, the odds of mortality increased by 1427%.</p><p><strong>Conclusions: </strong>Pediatric patients with severe TBI are at substantial risk for in-hospital mortality. Studies are needed to examine whether earlier interventions targeting specific parameters of INR and blood glucose impact mortality.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11138288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141180905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social determinants of gastrointestinal malformation mortality in Brazil: a national study.","authors":"Ayla Gerk, Amanda Rosendo, Luiza Telles, Arícia Gomes Miranda, Madeleine Carroll, Bruna Oliveira Trindade, Sarah Bueno Motter, Esther Freire, Gabriella Hyman, Julia Ferreira, Fabio Botelho, Roseanne Ferreira, David P Mooney, Joaquim Bustorff-Silva","doi":"10.1136/wjps-2023-000759","DOIUrl":"10.1136/wjps-2023-000759","url":null,"abstract":"<p><strong>Introduction: </strong>In Brazil, approximately 5% are born with a congenital disorder, potentially fatal without surgery. This study aims to evaluate the relationship between gastrointestinal congenital malformation (GICM) mortality, health indicators, and socioeconomic factors in Brazil.</p><p><strong>Methods: </strong>GICM admissions (Q39-Q45) between 2012 and 2019 were collected using national databases. Patient demographics, socioeconomic factors, clinical management, outcomes, and the healthcare workforce density were also accounted for. Pediatric Surgical Workforce density and the number of neonatal intensive care units in a region were extracted from national datasets and combined to create a clinical index termed <i>'</i>NeoSurg'. Socioeconomic variables were combined to create a socioeconomic index termed <i>'</i>SocEcon'. Simple linear regression was used to investigate if the temporal changes of both indexes were significant. The correlation between mortality and the different indicators in Brazil was evaluated using Pearson's correlation coefficient.</p><p><strong>Results: </strong>Over 8 years, Brazil recorded 12804 GICM admissions. The Southeast led with 6147 cases, followed by the Northeast (2660), South (1727), North (1427), and Midwest (843). The North and Northeast reported the highest mortality, lowest NeoSurg, and SocEcon Index rates. Nevertheless, mortality rates declined across regions from 7.7% (2012) to 3.9% (2019), a 51.7% drop. The North and Midwest experienced the most substantial reductions, at 63% and 75%, respectively. Mortality significantly correlated with the indexes in nearly all regions (<i>p</i><0.05).</p><p><strong>Conclusion: </strong>Our study highlights the correlation between social determinants of health and GICM mortality in Brazil, using two novel indexes in the pediatric population. These findings provide an opportunity to rethink and discuss new indicators that could enhance our understanding of our country and could lead to the development of necessary solutions to tackle existing challenges in Brazil and globally.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring causality with biliary atresia at different levels: two-sample Mendelian randomization study.","authors":"Shaowen Liu, Jiayinaxi Musha, Zhiru Wang, Xueting Wang, Tengfei Li, Jianghua Zhan","doi":"10.1136/wjps-2023-000754","DOIUrl":"10.1136/wjps-2023-000754","url":null,"abstract":"<p><strong>Background: </strong>In recent years, Mendelian randomization (MR) has been widely used to infer causality of related disease risk exposures. However, this strategy has not been applied to biliary atresia (BA).</p><p><strong>Methods: </strong>Genome-wide association studies (GWAS) data of 41 inflammatory cytokines, 731 immune cell traits, and 1400 metabolites were obtained from public databases as exposure factors. The outcome information was obtained from a GWAS meta-analysis of 499 children with BA and 1928 normal controls. Inverse variance weighting was the primary causality analysis. Cochran Q-test, MR-Egger intercept, MR pleiotropy residual sum and outlier, and 'leave-one-out' analyses were used for sensitivity analysis. Reverse MR, MR-Steiger, and Linkage Disequilibrium Score were used to exclude the effects of reverse causality, genetic association, and linkage disequilibrium.</p><p><strong>Results: </strong>MR results showed that a total of seven traits had potential causal relationships with BA, including three inflammatory cytokines: eotaxin (odds ratio (OR)=1.45, 95% confidence interval (CI): 1.08 to 1.95, <i>p</i> _<i>FDR</i>=0.18), G-CSF (OR=4.21, 95% CI: 1.75 to 10.13, <i>p</i> _<i>FDR</i>=0.05) and MCP-1/MCAF (OR=1.53, 95% CI: 1.12 to 2.10, <i>p</i> _<i>FDR</i>=0.14); three immune cell traits: CD8dim NKT/T cells ratio (OR=0.59, 95% CI: 0.45 to 0.77, <i>p</i> _<i>FDR</i>=0.06), CD8dim NKT counts (OR=0.58, 95% CI: 0.43 to 0.78, <i>p</i> _<i>FDR</i>=0.06), CD8dim NKT/lymphocyte ratio (OR=0.63, 95% CI: 0.49 to 0.81, <i>p</i> _<i>FDR</i>=0.06); one metabolite: X-12261 levels (OR=2.86, 95% CI: 1.73 to 4.74, <i>p</i> _<i>FDR</i>=0.06).</p><p><strong>Conclusions: </strong>In this study, eotaxin, G-CSF, MCP-1/MCAF, and X-12261 levels were shown to be risk factors for BA. However, CD8dim NKT/T cells ratio, CD8dim NKT counts, and CD8dim NKT/lymphocyte ratio were protective factors for BA. These findings provided a promising genetic basis for the etiology, diagnosis, and treatment of BA.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140910793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodynamic management of congenital diaphragmatic hernia: the role of targeted neonatal echocardiography.","authors":"Aimann Surak, Linda Mahgoub, Joseph Y Ting","doi":"10.1136/wjps-2024-000790","DOIUrl":"10.1136/wjps-2024-000790","url":null,"abstract":"<p><p>Congenital diaphragmatic hernia (CDH) is a major congenital anomaly, resulting from the herniation of abdominal contents into the thoracic cavity, thereby impeding the proper development of the lungs and pulmonary vasculature. CDH severity correlates with a spectrum of pulmonary hypoplasia, pulmonary hypertension (PHT), and cardiac dysfunction, constituting the pathophysiological triad of this complex condition. The accurate diagnosis and effective management of PHT and cardiac dysfunction is pivotal to optimizing patient outcomes. Targeted neonatal echocardiography is instrumental in delivering real-time data crucial for the bespoke, pathophysiology-targeted hemodynamic management of CDH-associated PHT.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140910874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perforation of Meckel's diverticulum in two neonates with single umbilical artery.","authors":"Lifeng Zhang, Shannan Wu, Xuefeng Miao, Yonglin Li, Xiaojian Yuan, Zhigang Gao","doi":"10.1136/wjps-2024-000770","DOIUrl":"10.1136/wjps-2024-000770","url":null,"abstract":"","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140910965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of extracorporeal life support and timing of repair in infants with congenital diaphragmatic hernia","authors":"Daniel B Gehle, Logan C Meyer, Tim Jancelewicz","doi":"10.1136/wjps-2023-000752","DOIUrl":"https://doi.org/10.1136/wjps-2023-000752","url":null,"abstract":"Extracorporeal life support (ECLS) serves as a rescue therapy for patients with congenital diaphragmatic hernia (CDH) and severe cardiopulmonary failure, and only half of these patients survive to discharge. This costly intervention has a significant complication risk and is reserved for patients with the most severe disease physiology refractory to maximal cardiopulmonary support. Some contraindications to ECLS do exist such as coagulopathy, lethal chromosomal or congenital anomaly, very preterm birth, or very low birth weight, but many of these limits are being evaluated through further research. Consensus guidelines from the past decade vary in recommendations for ECLS use in patients with CDH but this therapy appears to have a survival benefit in the most severe subset of patients. Improved outcomes have been observed for patients treated at high-volume centers. This review details the evolving literature surrounding management paradigms for timing of CDH repair for patients receiving preoperative ECLS. Most recent data support early repair following cannulation to avoid non-repair which is uniformly fatal in this population. Longer ECLS runs are associated with decreased survival, and patient physiology should guide ECLS weaning and eventual decannulation rather than limiting patients to arbitrary run lengths. Standardization of care across centers is a major focus to limit unnecessary costs and improve short-term and long-term outcomes for these complex patients. No data are available.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140617635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood opportunity and appropriate use of child safety restraints in motor vehicle collisions","authors":"Stephanie Y Chen, Iris Garcia, Shadassa Ourshalimian, Chantel Lowery, Pradip P Chaudhari, Ryan G Spurrier","doi":"10.1136/wjps-2023-000703","DOIUrl":"https://doi.org/10.1136/wjps-2023-000703","url":null,"abstract":"Objectives Safety restraints reduce injuries from motor vehicle collisions (MVCs) but are often improperly applied or not used. The Childhood Opportunity Index (COI) reflects social determinants of health and its study in pediatric trauma is limited. We hypothesized that MVC patients from low-opportunity neighborhoods are less likely to be appropriately restrained. Methods A retrospective cross-sectional study was performed on children/adolescents ≤18 years old in MVCs between January 1, 2011 and December 31, 2021. Patients were identified from the Children’s Hospital Los Angeles trauma registry. The outcome was safety restraint use (appropriately restrained, not appropriately restrained). COI levels by home zip codes were stratified as very low, low, moderate, high, and very high. Multivariable regression controlling for age identified factors associated with safety restraint use. Results Of 337 patients, 73.9% were appropriately restrained and 26.1% were not appropriately restrained. Compared with appropriately restrained patients, more not appropriately restrained patients were from low-COI (26.1% vs 20.9%), high-COI (14.8% vs 10.8%) and very high-COI (10.2% vs 3.6%) neighborhoods. Multivariable analysis demonstrated no significant associations in appropriate restraint use and COI. There was a non-significant trend that children/adolescents from moderate-COI neighborhoods were more likely than those from very low-COI neighborhoods to be appropriately restrained (OR=1.82, 95% CI 0.78, 4.28). Conclusion Injury prevention initiatives focused on safety restraints should target families of children from all neighborhood types. Level of evidence III. Data are available upon reasonable request.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term follow-up of patients with congenital diaphragmatic hernia","authors":"Nicole Cimbak, Terry L Buchmiller","doi":"10.1136/wjps-2023-000758","DOIUrl":"https://doi.org/10.1136/wjps-2023-000758","url":null,"abstract":"Neonates with congenital diaphragmatic hernia encounter a number of surgical and medical morbidities that persist into adulthood. As mortality improves for this population, these survivors warrant specialized follow-up for their unique disease-specific morbidities. Multidisciplinary congenital diaphragmatic hernia clinics are best positioned to address these complex long-term morbidities, provide long-term research outcomes, and help inform standardization of best practices in this cohort of patients. This review outlines long-term morbidities experienced by congenital diaphragmatic hernia survivors that can be addressed in a comprehensive follow-up clinic. No data are available.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140560274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}