Journal of pediatric surgery最新文献

英文中文

Ovotesticular Disorders of Sexual Development: Diagnostic, Therapeutic, and Evolutionary Aspects

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-23 DOI: 10.1016/j.jpedsurg.2025.162187

Ndèye Aby Ndoye , Lissoune Cissé , Chérif Mouhamed Moustapha Dial , Abdou Magib Gaye , Abibatou El Fecky Agne , Hatem Elfeki , Youssouph Diedhiou , Faty Balla Lo , Ndèye Fatou Seck , Aloïse Sagna , Oumar Ndour , Gabriel Ngom

Introduction

Disorders of sexual development (DSDs) have various etiologies. Our study aims to describe the diagnostic, therapeutic, and evolutionary aspects of ovotesticular disorders of sexual development (OT-DSDs).

Patients and methods

We conducted a retrospective, descriptive study in the pediatric surgery department of the Albert Royer National Children's Hospital Center in Dakar. From January 2019 to December 2023, sixteen children diagnosed and followed for OT-DSD were included in the study. The patient's ages ranged from 3 days to 14 years, with a mean age of three years. We studied the assigned gender, genetic sex, clinical presentation, imaging findings, treatment, and morbidity.

Results

The assigned gender was female in ten patients (62 %), male in five (32 %) and undetermined for one patient. Among those raised as male, two showed signs of female puberty. Nine patients (56 %) presented with an ambiguous phenotype. All of our patients had a 46, XX karyotype. The diagnosis included unilateral ovotesticular DSD in ten cases (63 %), lateral in five cases (31 %), and bilateral in one case (6 %). Three patients were reassigned to the female gender, and two maintained their male assigned gender. Partial gonadectomy was performed in 56 % of the cases. Genitoplasty was performed in nine patients, seven of whom underwent feminizing procedures (78 %). Postoperative morbidity included one case of vaginal stenosis (11 %).

Conclusion

Disorders of sex development can be diagnosed late, with patients typically having a 46, XX karyotype. The most common form is unilateral, involving an ovotestis and an ovary. Partial gonadectomy is possible even without intraoperative histological examination.

Type of study

Retrospective case series.

Level of evidence

IV.

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引用次数: 0

Utilizing Preoperative Rectus Sheath Blocks to Decrease Opioid Administration During Pediatric Umbilical Hernia Repair

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-23 DOI: 10.1016/j.jpedsurg.2025.162179

Derek J. Krinock , Benjamin Moore , Stephen M. Bowman , Jesus Apuya , Lindsey L. Wolf , Melvin S. Dassinger

Introduction

Regional anesthetic blocks are an adjunct to decrease pediatric opioid utilization and improve perioperative pain control. We compared opioid use in patients who underwent umbilical hernia repair (UHR) with or without preoperative bilateral rectus sheath block (BRSB).

Methods

We conducted a single-center retrospective cohort study evaluating opioid use in patients <18 years who underwent an UHR. Two time periods were compared. From 1/1/2019-7/31/2020, BRSB was not routinely performed. From 1/1/2022-7/31/2023, BRSB was routinely performed with UHR. Patient demographics, intra- and postoperative medications, BRSB procedure and follow-up data were collected. Descriptive statistics and bivariate analysis were performed to compare the two groups.

Results

Of 256 patients, mean age was 5.1 years (SD = 2.4) and 55 % were female. Decreased amounts of intraoperative (No BRSB: 0.13 versus BRSB: 0.04, p < 0.001) and post-anesthesia (No BRSB: 0.04 versus BRSB: 0.02, p = 0.005) intravenous opioids (MME/kg) were given following BRSB (Table). Of 132 patients who received a BRSB, 121 (92 %) had telephone follow-up. Ninety-seven percent (n = 117) reported adequate postoperative pain control with the BRSB lasting for a median of 9 h (IQR 6–12).

Conclusion

Children who underwent an UHR with BRSB received decreased intraoperative and postoperative opioid amounts. Nearly all patients who received a BRSB reported adequate postoperative pain control. Preoperative regional anesthetic blocks can be used to decrease opioid use in the perioperative period with satisfactory pain control.

Level of Evidence

Level III.

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引用次数: 0

Letter to the Editor in Response to: Retrospective Review of Management of Antenatally Diagnosed Ovarian Cysts at the Hospital for Sick Children.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-22 DOI: 10.1016/j.jpedsurg.2025.162180

Bade Toker Kurtmen

引用次数: 0

Child- and Proxy-reported Differences in Patient-reported Outcome and Experience Measures in Pediatric Surgery: Systematic Review and Meta-analysis.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.jpedsurg.2025.162172

Zanib Nafees, Siena O'Neill, Alexandra Dimmer, Elena Guadagno, Julia Ferreira, Nancy Mayo, Dan Poenaru

Purpose: Pediatric health outcomes are often assessed using proxy reports, which may not fully capture children's experiences. Children with surgical conditions face unique, changing healthcare journeys, making accurate representation challenging. This review compares child-reported health status and treatment experiences from Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) with parent reports.

Methods: A systematic search, designed by a librarian and adhering to PRISMA guidelines, was conducted across eight databases up to July 2023, targeting studies using PROMs and PREMs in pediatric surgery to capture both child and parent perspectives. Two reviewers independently screened abstracts, with conflicts resolved by senior authors. The Mixed Methods Appraisal Tool (MMAT) was used for quality assessment. A meta-analysis was also performed on Pediatric Quality of Life Inventory (PedsQL™) outcomes.

Results: Of 5415 screened studies, 53 met inclusion criteria: 50 used PROMs, two used PREMs, and one used both. PedsQL™ appeared in 30 studies, with 16 other quality of life measures used less frequently. Twenty-two studies with PedsQL™ data from 6691 child-parent pairs were included in the meta-analysis. The pooled effect size between child- and parent-reported PedsQL™ scores was 0.98 (95 % CI: [-0.81, 2.77]), with high heterogeneity (I² = 89 %).

Conclusion: This review revealed substantial variability but minimal systematic differences between child and parent reports, highlighting the need for future research to understand this variability and improve integration of child and parent perspectives in pediatric health assessments.

Level of evidence: I, Systematic Review or meta-analysis of RCTs (randomized control trials).

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引用次数: 0

Conservative Management of Pediatric Patients With Appendicolith Appendicitis Versus Non-appendicolith Appendicitis: A Systematic Review and Meta-analysis

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.jpedsurg.2025.162175

Fatemeh Akbarpoor , Karen Blanco , Barbara Bombassaro Masiero , Rasha Rowaiaee , Victor Gonçalves Soares , Ocílio Ribeiro Gonçalves , Mohammed Amaan Khokar , Hussein Naji

Introduction

Up to one-third of pediatric patients with acute appendicitis present with radiological evidence of appendicoliths. However, whether appendicolith presence influences prognosis under conservative management compared to non-appendicolith appendicitis remains uncertain.

Methods

We systematically searched PubMed, Cochrane, Embase, and Web of Science databases for studies comparing pediatric appendicolith and non-appendicolith appendicitis managed conservatively with antibiotics, fluids, and percutaneous drainage. Outcomes included the initial success of conservative management and recurrence rates. A random-effects model was applied for all analyses.

Results

Twelve observational studies with 814 patients were included. Of these, 282 (35 %) had appendicoliths, and 532 (65 %) did not. The average age ranged from 2 to 11 years, with follow-up between 1 week and 2 years. Overall, there is no significant difference in the initial success of conservative management was observed between the two groups (OR 0.70; 95 % CI 0.28–1.78; p = 0.46). Subgroup analysis revealed lower success rates for appendicolith-associated simple appendicitis (OR 0.42; 95 % CI 0.21–0.84; p = 0.01), but no difference in complicated appendicitis (OR 1.01; 95 % CI 0.24–4.31; p = 0.99). Recurrence rates were significantly higher in appendicolith appendicitis across both groups (OR 2.75; 95 % CI 1.05–7.20; p = 0.04).

Conclusion

Appendicolith presence reduces conservative management success in simple appendicitis, supporting early appendectomy. Although appendicoliths do not predict treatment failure in complicated appendicitis, interval appendectomy may be advisable due to the higher recurrence risk in both groups.

Type of Study

Meta-analysis and systematic review.

Level of Evidence

Level I.

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引用次数: 0

Crime Victim Compensation: We Can Do Better for Our Children.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.jpedsurg.2025.162173

Phillip M Dowzicky, Clarice Robinson, Rachel Nordgren, Marion Henry, Carmelle Romain, Kylie Callier, Joy Ayemoba, Fatima Bouftas, Myles Francis, Carla Galvan, Franklin Cosey-Gay, Tanya L Zakrison, Charlotte Kvasnovsky

Background: Interpersonal injury disproportionately impacts marginalized communities. Crime Victim Compensation (CVC) was developed in Canada and the United States to help individuals and their families following violent injury. In Illinois, the CVC program offers up to $27,000 per claim to assist with mental health, relocation, and burial expenses. Pediatric claimants are inherently vulnerable and may need assistance filing claims. We aimed to study disparities in CVC claim outcomes for Illinois children.

Methods: We filed a Freedom of Information Act claim with the Office of the Illinois Secretary of State from 2012 to 2021. We used descriptive statistics to analyze CVC claim requests in children ages 17 and under.

Results: On average, 3677 claims were filed annually, 13.2 % for youths (Table 1). The most common crimes for which compensation was requested were assault/battery (47.1 %) and homicide (20.8 %). 39.7 % of claims were awarded, 53.6 % were denied, 3.4 % remained open, and 3.3 % were closed without payment. Claims for homicides were the most likely to be awarded, at 69.4 % overall and 70.7 % of youth claimants. The median award following homicide was $7500 (IQR 5460-7500) and similar in children (P = 0.11). The median award following assault/battery was $1564 (IQR 638-4179), although less for children $900 (250-2749, P < 0.0001). Children were less likely to be awarded after filing a claim (P < 0.0001) and were awarded less money for successful claims (P < 0.0001).

Conclusion: CVC was created to support injured persons, however, most claims in Illinois are rejected with children being even less likely to benefit. Further action is needed to increase the proportion of successful claims.

Level of evidence: IV.

{"title":"Crime Victim Compensation: We Can Do Better for Our Children.","authors":"Phillip M Dowzicky, Clarice Robinson, Rachel Nordgren, Marion Henry, Carmelle Romain, Kylie Callier, Joy Ayemoba, Fatima Bouftas, Myles Francis, Carla Galvan, Franklin Cosey-Gay, Tanya L Zakrison, Charlotte Kvasnovsky","doi":"10.1016/j.jpedsurg.2025.162173","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162173","url":null,"abstract":"<p><strong>Background: </strong>Interpersonal injury disproportionately impacts marginalized communities. Crime Victim Compensation (CVC) was developed in Canada and the United States to help individuals and their families following violent injury. In Illinois, the CVC program offers up to $27,000 per claim to assist with mental health, relocation, and burial expenses. Pediatric claimants are inherently vulnerable and may need assistance filing claims. We aimed to study disparities in CVC claim outcomes for Illinois children.</p><p><strong>Methods: </strong>We filed a Freedom of Information Act claim with the Office of the Illinois Secretary of State from 2012 to 2021. We used descriptive statistics to analyze CVC claim requests in children ages 17 and under.</p><p><strong>Results: </strong>On average, 3677 claims were filed annually, 13.2 % for youths (Table 1). The most common crimes for which compensation was requested were assault/battery (47.1 %) and homicide (20.8 %). 39.7 % of claims were awarded, 53.6 % were denied, 3.4 % remained open, and 3.3 % were closed without payment. Claims for homicides were the most likely to be awarded, at 69.4 % overall and 70.7 % of youth claimants. The median award following homicide was $7500 (IQR 5460-7500) and similar in children (P = 0.11). The median award following assault/battery was $1564 (IQR 638-4179), although less for children $900 (250-2749, P < 0.0001). Children were less likely to be awarded after filing a claim (P < 0.0001) and were awarded less money for successful claims (P < 0.0001).</p><p><strong>Conclusion: </strong>CVC was created to support injured persons, however, most claims in Illinois are rejected with children being even less likely to benefit. Further action is needed to increase the proportion of successful claims.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162173"},"PeriodicalIF":2.4,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066354","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

Invited Commentary on Moturu, et al.: Identifying Quality Improvement Targets After Pediatric Gastrostomy Tube Insertion: A NSQIP-Pediatric Pilot Study.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-20 DOI: 10.1016/j.jpedsurg.2025.162181

Brian Bucher, Natasha Corbitt

引用次数: 0

Pediatric Surgical Outreach: An Underutilized Resource for Increasing Children's Surgical Capacity in Canada.

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-19 DOI: 10.1016/j.jpedsurg.2025.162174

Amanpreet Brar, Kenneth W Gow, Erik D Skarsgard

Background: Wait times for children's hospital-based surgical services are at unprecedented levels. Opportunities to increase most children's hospital-based service capacity are sparse, and community-based services are a potential patient-centered alternative. The aim of this study was to understand the current state of pediatric surgical outreach in Canada as an option to address these challenges.

Methods: An electronic survey was sent to all (n = 18) Canadian children's hospital surgical leaders inquiring about "outreach services" defined as inpatient/outpatient services provided by pediatric surgeons outside of children's hospitals. Descriptive analysis of outreach included facility type/location (by postal code), nature and frequency of service, and participation of other specialties.

Results: 18 survey respondents (100 %) reported that pediatric surgical outreach services were available in 7 out of 10 provinces, but only 8/18 (44 %) of Canadian children's hospitals. Services include: i) inpatient coverage at 2 sites in 2 provinces; ii) outpatient surgery at 6 sites in 3 provinces (median distance 69 km, range 6-1881 km from home children's hospital); and iii) outpatient ambulatory clinics at 19 sites in 4 provinces (median distance 18 km, range 4-1448 km from home children's hospital). Median frequencies of outreach surgical slates and clinics were 1 per week and 1 per month, respectively.

Conclusion: Less than half of Canadian children's hospitals have developed outreach programs as a strategy to increase capacity for children's surgical services. To promote improved surgical care for all Canadian children, efforts targeting expansion of outreach capacity could increase access for geographically remote children.

Type of study: Cross sectional Retrospective Survey.

Level of evidence: Level IV.

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引用次数: 0

Addressing Health Inequities: Understanding the Relationship Between Social Determinants of Health and Necrotizing Enterocolitis

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-18 DOI: 10.1016/j.jpedsurg.2025.162176

Kailah Young , Kristen N. Kaiser , Emma Holler , Troy A. Markel

Introduction

Necrotizing enterocolitis (NEC) is a severe illness with high mortality. Traditional risk factors are prematurity and neonatal stress. Maternal risk factors have also been postulated but are often overlooked. We aimed to define parental and patient factors associated with NEC and their impact on outcomes.

Methods

Infants under 1 year old diagnosed with NEC were identified via the Pediatric Health Information System database between 2012 and 2022. The Childhood Opportunity Index (COI) was used to represent each family's household educational, environmental, and socioeconomic conditions. The COI was split into low, middle, and high levels and analyzed across demographics and mortality. Multivariable regression was used to determine the association between COI and in-hospital mortality, adjusting for gestational age, gender, race, primary payor, urban flag, and geographic region.

Results

Overall, 10,768 patients with a median gestational age of 29 weeks (IQR 25-34), and a median birthweight of 1,010 g (IQR 660-1,880 g) met inclusion criteria. The cohort was majority male (57 %), and White (46 %), and overall, had a mortality rate of 18 %. Low COI was associated with longer length of stay (56 vs. 53 days) and increased mortality (19 % vs. 15 %) when compared to high COI. On adjusted analysis, high COI was associated with decreased odds of death by time of discharge (OR 0.75, 95 % CI 0.65–0.86, p < 0.001) when compared to low COI.

Conclusion

NEC is a disease that disproportionately affects socially disadvantaged infants. The mortality rates of NEC are linked to parental social determinants of health, highlighting this unique population to target for risk assessment and additional prenatal resources.

Type of Study

Cross Sectional Study.

Level of Evidence

III.

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引用次数: 0

Cardiopulmonary Impact of the Minimally Invasive Repair of Pectus Excavatum in Pediatric patients: A Prospective Pilot Study

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery

Pub Date : 2025-01-17 DOI: 10.1016/j.jpedsurg.2025.162177

R. Scott Eldredge , Arash Sabati , Brielle Ochoa , Vijay Viswanath , Emily Khoury , Kristin Rassam , Daniel J. Ostlie , Justin Lee , Lisa McMahon , David M. Notrica , Benjamin E. Padilla

Introduction

The physiologic benefits of the minimally invasive repair of pectus excavatum (MIRPE) on cardiopulmonary function are poorly understood in pediatrics. We sought to examine the effects of MIRPE on exercise response during cardiopulmonary exercise testing (CPET).

Methods

A prospective-pilot study was conduct of patients ≤18 years who presented for pectus bar removal. All patients had CPET prior to MIRPE and following bar removal. Paired sample T tests were used to compare pre- and post-MIRPE CPET results.

Results

Twenty-five patients completed post-MIRPE CPET (72 % male, median age 18.6 [IQR:17.5–19.8]). The median Haller and correction indices were 4.5 and 29.4 %, respectively. There was significant increase in O2Pulse, (10.3 vs 12.1 mL/beat, p = 0.004), and percent predicted O2Pulse (79.5% vs 84.4 %, p = 0.046) following MIRPE/bar removal. The peak-VO2/kg and did not change significantly following MIRPE/bar removal; however, peak-VO2 (ml/min) increased. Patients with decreased activity levels at time of bar removal compared to pre-MIRPE had decreased peak-VO2/kg and predicted peak-VO2/kg.

Conclusion

Following MIRPE, patients experience increased in O2Pulse, which is a surrogate measure of stroke volume response to exercise and may reflect relief of cardiac compression. Cardiopulmonary function is multifactorial and despite improvement in stroke volume, other factors may impact exercise capacity (VO2) following MIRPE.

Study Type

Treatment Study.

Level of Evidence

IV.

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引用次数: 0

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