Pub Date : 2024-01-01DOI: 10.1136/wjps-2023-000687
Mona Takalo, Tarja Iber, Reija Autio, Topi Luoto
Purpose Various complications are associated with percutaneous endoscopic gastrostomy (PEG) procedures in children. The push technique is being increasingly used, but its complications are insufficiently characterized. We aimed to assess all complications related to PEG procedures and compare the safety of the pull and push techniques. Methods Retrospective review of consecutive pediatric patients who underwent PEG between 2002 and 2020. Results In total, 216 children underwent 217 PEG procedures. The push technique was used in 138 (64%) cases, and the pull technique in 79 (36%) cases. The median follow-up time was 6.1 (0.1–18.3) years. The complication rate was high (57%) and patients experienced complications years after the procedure. Overall, 51% and 67% of patients experienced complications in the push and pull groups, respectively. The rates of minor and major complications were higher in the pull group than in the push group (63% vs 48%, p =0.028; and 11% vs 6%, p =0.140, respectively). Reoperation was also more common in the pull group (17% vs 7%, p =0.020). Conclusions The overall complication rate of PEG procedures is high. Fortunately, most complications are mild and do not require reoperations. The increasing push technique appears to be safer than the traditional pull technique. Significant long-term morbidity is related to gastrostomies in children. Data may be obtained from a third party and are not publicly available. Data were collected from the medical records of Tampere University Hospital.
{"title":"Complications after pediatric percutaneous endoscopic gastrostomy: comparison of the push and pull technique","authors":"Mona Takalo, Tarja Iber, Reija Autio, Topi Luoto","doi":"10.1136/wjps-2023-000687","DOIUrl":"https://doi.org/10.1136/wjps-2023-000687","url":null,"abstract":"Purpose Various complications are associated with percutaneous endoscopic gastrostomy (PEG) procedures in children. The push technique is being increasingly used, but its complications are insufficiently characterized. We aimed to assess all complications related to PEG procedures and compare the safety of the pull and push techniques. Methods Retrospective review of consecutive pediatric patients who underwent PEG between 2002 and 2020. Results In total, 216 children underwent 217 PEG procedures. The push technique was used in 138 (64%) cases, and the pull technique in 79 (36%) cases. The median follow-up time was 6.1 (0.1–18.3) years. The complication rate was high (57%) and patients experienced complications years after the procedure. Overall, 51% and 67% of patients experienced complications in the push and pull groups, respectively. The rates of minor and major complications were higher in the pull group than in the push group (63% vs 48%, p =0.028; and 11% vs 6%, p =0.140, respectively). Reoperation was also more common in the pull group (17% vs 7%, p =0.020). Conclusions The overall complication rate of PEG procedures is high. Fortunately, most complications are mild and do not require reoperations. The increasing push technique appears to be safer than the traditional pull technique. Significant long-term morbidity is related to gastrostomies in children. Data may be obtained from a third party and are not publicly available. Data were collected from the medical records of Tampere University Hospital.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139585402","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}
Pub Date : 2024-01-01DOI: 10.1136/wjps-2023-000700
Maria Fazal, Charbel Chidiac, Raheel Ahmad, Oussama Issa, Erica Hodgman, Alejandro V Garcia
Introduction As fire pits grow in popularity, so do the associated burn injuries. Our study examines pediatric fire pit burns characteristics to raise awareness and promote safety precautions. Methods We conducted a retrospective review of pediatric patients (≤21 years) with firepit burns at a tertiary care hospital from 2016 to 2021. Results Eighty-four patients were identified, of whom 70.2% were male, with a median age of 62 months. The median percent total body surface area burned was 2% (interquartile range (IQR)=1–4). Thirty-five (41.7%) patients were admitted and 7 (8.3%) underwent grafting. Neck and trunk burns had the highest grafting rates (66% and 33%, respectively). The hands (41.7%) and the lower extremities (27.4%) were the most frequently burned body areas. The leading causes of burns were ashes/hot coals (34.5%), flames (31.0%), and direct contact (25.0%), often resulting from falling into the fire (59.5%) or running or playing in activities near it (26.2%). Thirty-five (41.7%) were admitted for inpatient management, while 49 (58.3%) were treated as outpatient. Eleven (13.2%) underwent at least one reconstructive surgery, 7 (8.4%) had at least one rehabilitation visit, and 65 (77.4%) had follow-up clinic visits. The median length of stay was 2 days (IQR=1.0–3.5). The peak months for burns were from August through October ( n =40, 46.0%), with an increase observed from 10 cases in 2016 to 20 cases in 2020. Conclusions Given the significant proportion of firepit burns resulting from unsafe fire behaviors, it is crucial that caretakers are aware of proper firepit safety precautions. Level of evidence III. No data are available.
{"title":"Characteristics and trends of pediatric firepit burns: insights for prevention and safety","authors":"Maria Fazal, Charbel Chidiac, Raheel Ahmad, Oussama Issa, Erica Hodgman, Alejandro V Garcia","doi":"10.1136/wjps-2023-000700","DOIUrl":"https://doi.org/10.1136/wjps-2023-000700","url":null,"abstract":"Introduction As fire pits grow in popularity, so do the associated burn injuries. Our study examines pediatric fire pit burns characteristics to raise awareness and promote safety precautions. Methods We conducted a retrospective review of pediatric patients (≤21 years) with firepit burns at a tertiary care hospital from 2016 to 2021. Results Eighty-four patients were identified, of whom 70.2% were male, with a median age of 62 months. The median percent total body surface area burned was 2% (interquartile range (IQR)=1–4). Thirty-five (41.7%) patients were admitted and 7 (8.3%) underwent grafting. Neck and trunk burns had the highest grafting rates (66% and 33%, respectively). The hands (41.7%) and the lower extremities (27.4%) were the most frequently burned body areas. The leading causes of burns were ashes/hot coals (34.5%), flames (31.0%), and direct contact (25.0%), often resulting from falling into the fire (59.5%) or running or playing in activities near it (26.2%). Thirty-five (41.7%) were admitted for inpatient management, while 49 (58.3%) were treated as outpatient. Eleven (13.2%) underwent at least one reconstructive surgery, 7 (8.4%) had at least one rehabilitation visit, and 65 (77.4%) had follow-up clinic visits. The median length of stay was 2 days (IQR=1.0–3.5). The peak months for burns were from August through October ( n =40, 46.0%), with an increase observed from 10 cases in 2016 to 20 cases in 2020. Conclusions Given the significant proportion of firepit burns resulting from unsafe fire behaviors, it is crucial that caretakers are aware of proper firepit safety precautions. Level of evidence III. No data are available.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139645531","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}
Anorectal malformation (ARM) is a frequently occurring surgical condition in neonates, with a prevalence of 1 in 4000 live births.1 In boys with this anomaly, the rectum and urinary tract share a common wall for some distance, often ending up in fistulous communication. The goals of definite reconstruction are to separate the rectum from the urinary tract without injuring the urethra and mobilizing the rectum to the perineum within the muscle complex. Separating the rectum and the urinary tract is the most critical part of this operation and is associated with a significant risk of urinary tract injury.2–5 The original procedure described by Peña and Devries involves multiple stay sutures on the rectal mucosa just above the fistula, lifting the mucosa and continuing a submucosal dissection up to the prostate, where the entire thickness of the intestine can be separated from the urinary tract.6 These stay sutures have the inherent risk of incorporating the urethra within and thereby injuring the urethra. Moreover, this submucosal dissection is delicate and requires master’s expertise to avoid urethral injury, which frequently occurs in boys with relatively benign lower malformation. However, a relatively significant space separates the rectum and the urinary tract proximal to the common sharing wall (figure 1). By first mobilizing the rectum proximally in an antegrade fashion and lifting it from the urinary tract with a loop, the posterior wall of the urethra, prostate, and bladder is easily visible. This also establishes a clear boundary between the rectum and urinary tract, making it possible to resect the fistula precisely without needing a traction suture . Figure 1 Distal loopogram showing retrovesical space. We reviewed the medical records of patients who underwent posterior sagittal anorectoplasty (PSARP) for ARM between March 2021 and March 2023. The minimum follow-up was 3 months. Demographic and …
{"title":"Complete separation of the urinary tract from proximal rectum during PSARP surgery: our experience with the noveltechnique","authors":"Md Samiul Hasan, Md Nazmul Islam, Refoyez Mahmud, Umama Huq, Ashrarur Rahman","doi":"10.1136/wjps-2023-000688","DOIUrl":"https://doi.org/10.1136/wjps-2023-000688","url":null,"abstract":"Anorectal malformation (ARM) is a frequently occurring surgical condition in neonates, with a prevalence of 1 in 4000 live births.1 In boys with this anomaly, the rectum and urinary tract share a common wall for some distance, often ending up in fistulous communication. The goals of definite reconstruction are to separate the rectum from the urinary tract without injuring the urethra and mobilizing the rectum to the perineum within the muscle complex. Separating the rectum and the urinary tract is the most critical part of this operation and is associated with a significant risk of urinary tract injury.2–5 The original procedure described by Peña and Devries involves multiple stay sutures on the rectal mucosa just above the fistula, lifting the mucosa and continuing a submucosal dissection up to the prostate, where the entire thickness of the intestine can be separated from the urinary tract.6 These stay sutures have the inherent risk of incorporating the urethra within and thereby injuring the urethra. Moreover, this submucosal dissection is delicate and requires master’s expertise to avoid urethral injury, which frequently occurs in boys with relatively benign lower malformation. However, a relatively significant space separates the rectum and the urinary tract proximal to the common sharing wall (figure 1). By first mobilizing the rectum proximally in an antegrade fashion and lifting it from the urinary tract with a loop, the posterior wall of the urethra, prostate, and bladder is easily visible. This also establishes a clear boundary between the rectum and urinary tract, making it possible to resect the fistula precisely without needing a traction suture . Figure 1 Distal loopogram showing retrovesical space. We reviewed the medical records of patients who underwent posterior sagittal anorectoplasty (PSARP) for ARM between March 2021 and March 2023. The minimum follow-up was 3 months. Demographic and …","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139423368","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}
Background Following on from an earlier study published in 2008 about left pulmonary artery (LPA) flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia (CDH) and the ratio of LPA to right pulmonary artery (RPA) diameters being a simple and reliable indicator for commencing nitric oxide (NO) therapy, the ratio of LPA:RPA diameters (PA ratio or PAR) was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH better. Methods Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to survival. Data obtained retrospectively for subject demographics, clinical course, LPA/RPA diameters, and PAR were compared between survivors and non-survivors. The value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic (ROC) curve analysis. Results Of 65 subjects, there were 54 survivors (82.3%) and 11 non-survivors (17.7%); 7 of 11 non-survivors died before surgical repair could be performed. Mean PAR for survivors (0.851±0.152) was significantly higher than for non-survivors (0.672±0.108) ( p =0.0003). Mean PAR for non-survivors was not affected by surgical repair. Characteristics of survivors were: LPA ≥2 mm (n=52 of 54; mean PAR=0.866±0.146) and RPA ≥3 mm (n=46 of 54; mean PAR=0.857±0.152). Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean PAR. ROC curve cut-off for PAR was 0.762. Subjects with high PAR (≥0.762) required high-frequency oscillatory ventilation/NO less than subjects with low PAR (<0.762) ( p =0.0244 and p =0.0485, respectively) and subjects with high PAR stabilized significantly earlier than subjects with low PAR (1.71±0.68 days vs 3.20±0.87 days) ( p <0.0001). Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH. Data are available upon reasonable request.
背景 2008 年发表的一项早期研究指出，连续超声心动图测量的左肺动脉（LPA）血流对左侧先天性膈疝（CDH）的预后有很强的预示作用，而 LPA 与右肺动脉（RPA）直径之比则是开始一氧化氮（NO）治疗的简单而可靠的指标。方法 招募 2007 年至 2020 年期间在一家儿科外科中心接受治疗的孤立性左侧 CDH 受试者，并根据存活率进行分类。比较了存活者和非存活者之间在受试者人口统计学、临床过程、LPA/RPA 直径和 PAR 方面的回顾性数据。用接收器操作特征曲线（ROC）分析了PAR对CDH患者PA直径数据预后的优化价值。结果 65名受试者中有54名存活者（82.3%）和11名非存活者（17.7%）；11名非存活者中有7名在手术修复前死亡。幸存者的平均 PAR（0.851±0.152）明显高于非幸存者（0.672±0.108）（P =0.0003）。非幸存者的平均 PAR 不受手术修复的影响。幸存者的特征如下LPA ≥2 mm（54 人中有 52 人；平均 PAR=0.866±0.146）和 RPA ≥3 mm（54 人中有 46 人；平均 PAR=0.857±0.152）。LPA 和 RPA 直径与幸存者相似的非幸存者的平均 PAR 明显较低。PAR 的 ROC 曲线临界值为 0.762。PAR 高（≥0.762）的受试者比 PAR 低（<0.762）的受试者需要的高频振荡通气/NO 更少（分别为 p =0.0244 和 p =0.0485），PAR 高的受试者比 PAR 低的受试者明显更早稳定（1.71±0.68 天 vs 3.20±0.87 天）（p <0.0001）。结论 PAR 似乎与 CDH 的临床预后密切相关，有助于规划 CDH 心肺不稳定的管理。如有合理要求，可提供相关数据。
{"title":"Pulmonary artery diameter ratio as a prognostic indicator of congenital diaphragmatic hernia","authors":"Yuichiro Miyake, Hiroyuki Koga, Shuko Nojiri, Shunsuke Yamada, Takanori Ochi, Go Miyano, Geoffrey J Lane, Atsuyuki Yamataka, Tadaharu Okazaki","doi":"10.1136/wjps-2023-000686","DOIUrl":"https://doi.org/10.1136/wjps-2023-000686","url":null,"abstract":"Background Following on from an earlier study published in 2008 about left pulmonary artery (LPA) flow measured on serial echocardiography being strongly prognostic in left-sided congenital diaphragmatic hernia (CDH) and the ratio of LPA to right pulmonary artery (RPA) diameters being a simple and reliable indicator for commencing nitric oxide (NO) therapy, the ratio of LPA:RPA diameters (PA ratio or PAR) was hypothesized to possibly reflect cardiopulmonary stresses accompanying CDH better. Methods Subjects with isolated left-sided CDH treated between 2007 and 2020 at a single pediatric surgical center were recruited and classified according to survival. Data obtained retrospectively for subject demographics, clinical course, LPA/RPA diameters, and PAR were compared between survivors and non-survivors. The value of PAR for optimizing the prognostic value of PA diameter data in CDH were analyzed with receiver operating characteristic (ROC) curve analysis. Results Of 65 subjects, there were 54 survivors (82.3%) and 11 non-survivors (17.7%); 7 of 11 non-survivors died before surgical repair could be performed. Mean PAR for survivors (0.851±0.152) was significantly higher than for non-survivors (0.672±0.108) ( p =0.0003). Mean PAR for non-survivors was not affected by surgical repair. Characteristics of survivors were: LPA ≥2 mm (n=52 of 54; mean PAR=0.866±0.146) and RPA ≥3 mm (n=46 of 54; mean PAR=0.857±0.152). Non-survivors with similar LPA and RPA diameters to survivors had significantly lower mean PAR. ROC curve cut-off for PAR was 0.762. Subjects with high PAR (≥0.762) required high-frequency oscillatory ventilation/NO less than subjects with low PAR (<0.762) ( p =0.0244 and p =0.0485, respectively) and subjects with high PAR stabilized significantly earlier than subjects with low PAR (1.71±0.68 days vs 3.20±0.87 days) ( p <0.0001). Conclusions PAR would appear to be strongly correlated with clinical outcome in CDH and be useful for planning management of cardiopulmonary instability in CDH. Data are available upon reasonable request.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139645643","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}
Pub Date : 2024-01-01DOI: 10.1136/wjps-2023-000697
Phillip J Hsu, Sangchul Yoon, Kee B Park
Background Sixty-five percent of children worldwide lack access to surgical care, the majority of whom live in low-income and middle-income countries (LMICs). Developing surgical infrastructure requires information on surgical need; however, this information is often limited in LMICs. North Korea (Democratic People’s Republic of Korea, DPRK) has a low amount of publicly available data. Here, we analyzed available modeled data to understand the causes of pediatric deaths due to conditions treatable with surgery in DPRK. Methods We used World Bank data and models from the Institute for Health Metrics and Evaluation to identify causes of pediatric deaths affecting pediatric patients (age <20 years). We compared mortality of disease between DPRK and countries with similar economic status. Results Between 1990 and 2019, the number of overall pediatric deaths has decreased. In 2019, 32.2% of all pediatric deaths in DPRK were caused by surgical conditions. The leading categories of surgical conditions were injuries (53.9%), congenital conditions (34.2%), tumors (8.8%), and abdominal conditions (3.2%). DPRK has a lower relative rate of pediatric deaths compared with other LMICs with similar gross domestic product per capita. However, it has a higher relative rate of pediatric deaths due to conditions requiring treatment with surgery. Transport injuries contribute significantly to the high rate of pediatric deaths in DPRK. Conclusions Although DPRK may be allocating overall resources toward pediatric healthcare more efficiently than economic peers, DPRK may benefit from improvement in pediatric surgical capacity. Improved availability of data and close international collaboration could be potential solutions to bridge this gap. Data are available in a public, open access repository.
{"title":"Understanding pediatric surgical needs in North Korea: a modeling analysis","authors":"Phillip J Hsu, Sangchul Yoon, Kee B Park","doi":"10.1136/wjps-2023-000697","DOIUrl":"https://doi.org/10.1136/wjps-2023-000697","url":null,"abstract":"Background Sixty-five percent of children worldwide lack access to surgical care, the majority of whom live in low-income and middle-income countries (LMICs). Developing surgical infrastructure requires information on surgical need; however, this information is often limited in LMICs. North Korea (Democratic People’s Republic of Korea, DPRK) has a low amount of publicly available data. Here, we analyzed available modeled data to understand the causes of pediatric deaths due to conditions treatable with surgery in DPRK. Methods We used World Bank data and models from the Institute for Health Metrics and Evaluation to identify causes of pediatric deaths affecting pediatric patients (age <20 years). We compared mortality of disease between DPRK and countries with similar economic status. Results Between 1990 and 2019, the number of overall pediatric deaths has decreased. In 2019, 32.2% of all pediatric deaths in DPRK were caused by surgical conditions. The leading categories of surgical conditions were injuries (53.9%), congenital conditions (34.2%), tumors (8.8%), and abdominal conditions (3.2%). DPRK has a lower relative rate of pediatric deaths compared with other LMICs with similar gross domestic product per capita. However, it has a higher relative rate of pediatric deaths due to conditions requiring treatment with surgery. Transport injuries contribute significantly to the high rate of pediatric deaths in DPRK. Conclusions Although DPRK may be allocating overall resources toward pediatric healthcare more efficiently than economic peers, DPRK may benefit from improvement in pediatric surgical capacity. Improved availability of data and close international collaboration could be potential solutions to bridge this gap. Data are available in a public, open access repository.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139657705","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}
Pub Date : 2023-11-21eCollection Date: 2023-01-01DOI: 10.1136/wjps-2023-000657
Bin Bin Cai, Dong Pi Wang
Objective: Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery.
Methods: In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs.
Results: Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery.
Conclusion: Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.
目的:术后肺部并发症(PPCs)是一项重要的质量指标，与婴儿死亡率显著升高相关。本研究的目的是确定接受非心胸外科手术的新生儿发生PPCs的危险因素。方法:在这项回顾性研究中，纳入2020年10月至2022年9月在某儿童医院接受非心胸外科手术的所有新生儿进行分析。获得人口学数据和围手术期变量。主要结局是PPCs的发生。采用单因素分析和多因素logistic回归分析探讨患者相关因素对PPCs发生的影响。结果:867例新生儿手术患者符合本研究纳入标准，其中35.3%(306/867)患者术后1周内出现肺部并发症。本研究中观察到的PPCs有51例既往肺炎加重，198例新发斑片状阴影，123例新发肺不张，10例新发气胸，6例新发胸腔积液。患者分为两组:PPCs(306例)和非PPCs(561例)。多因素逐步logistic回归分析显示PPCs的5个独立危险因素:校正胎龄(OR=0.938;95% CI 0.890 ~ 0.988)，术前肺炎(OR=2.139;95% CI 1.033 ~ 4.426)，手术时间(> 60分钟)(OR=1.699;95% CI 1.134 ~ 2.548)，术前机械通气(OR=1.857;95% CI 1.169 ~ 2.951)，术中白蛋白输注(OR=1.456;95% CI 1.041 ~ 2.036)。结论:确定新生儿PPCs的危险因素将有助于确定高危患者，并对已确定的任何可改变的危险因素进行干预。
{"title":"Risk factors for postoperative pulmonary complications in neonates: a retrospective cohort study.","authors":"Bin Bin Cai, Dong Pi Wang","doi":"10.1136/wjps-2023-000657","DOIUrl":"https://doi.org/10.1136/wjps-2023-000657","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative pulmonary complications (PPCs) are an important quality indicator and are associated with significantly increased mortality in infants. The objective of this study was to identify risk factors for PPCs in neonates undergoing non-cardiothoracic surgery.</p><p><strong>Methods: </strong>In this retrospective study, all neonates who underwent non-cardiothoracic surgery in a children's hospital from October 2020 to September 2022 were included for analysis. Demographic data and perioperative variables were obtained. The primary outcome was the occurrence of PPCs. Univariate analysis and multivariable logistic regression analysis were used to investigate the effect of patient-related factors on the occurrence of PPCs.</p><p><strong>Results: </strong>Totally, 867 neonatal surgery patients met the inclusion criteria in this study, among which 35.3% (306/867) patients experienced pulmonary complications within 1 week postoperatively. The PPCs observed in this study were 51 exacerbations of pre-existing pneumonia, 198 new patchy shadows, 123 new pulmonary atelectasis, 10 new pneumothorax, and 6 new pleural effusion. Patients were divided into two groups: PPCs (n=306) and non-PPCs (n=561). The multivariate stepwise logistic regression analysis revealed five independent risk factors for PPCs: corrected gestational age (OR=0.938; 95% CI 0.890 to 0.988), preoperative pneumonia (OR=2.139; 95% CI 1.033 to 4.426), length of surgery (> 60 min) (OR=1.699; 95% CI 1.134 to 2.548), preoperative mechanical ventilation (OR=1.857; 95% CI 1.169 to 2.951), and intraoperative albumin infusion (OR=1.456; 95% CI 1.041 to 2.036) in neonates undergoing non-cardiothoracic surgery.</p><p><strong>Conclusion: </strong>Identifying risk factors for neonatal PPCs will allow for the identification of patients who are at higher risk and intervention for any modifiable risk factors identified.</p>","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10668248/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463010","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}
Pub Date : 2023-11-17eCollection Date: 2023-01-01DOI: 10.1136/wjps-2023-000695
Na Lin, Xiong Zhao
{"title":"Unique Cobb syndrome with Kaposi hemangioendothelioma/tufted angioma as dominant phenotype: a case report.","authors":"Na Lin, Xiong Zhao","doi":"10.1136/wjps-2023-000695","DOIUrl":"https://doi.org/10.1136/wjps-2023-000695","url":null,"abstract":"","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10660422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463011","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}
Pub Date : 2023-11-02eCollection Date: 2023-01-01DOI: 10.1136/wjps-2023-000636
Jiajun Xu, Weize Xu, Jin Yu, Shanshan Shi, Qiang Shu, Zhuo Shi
{"title":"An unusual cause of cyanosis after intra-extra cardiac Fontan procedure: anastomotic leakage between conduit and inferior vena cava.","authors":"Jiajun Xu, Weize Xu, Jin Yu, Shanshan Shi, Qiang Shu, Zhuo Shi","doi":"10.1136/wjps-2023-000636","DOIUrl":"10.1136/wjps-2023-000636","url":null,"abstract":"","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10626768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71486669","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}
Objective To compare the efficacy of intravenous administration of nalbuphine at different time points for postoperative analgesia and sedation in adenotonsillectomized children. Methods Patients with obstructive sleep apnea syndrome scheduled for adenotonsillectomy were randomly divided into group A (patients received intravenous nalbuphine 0.2 mg/kg before anesthesia induction), group B (patients received intravenous nalbuphine 0.2 mg/kg 10 min before the end of surgery), and group C (patients did not receive nalbuphine injection). The time points for measuring outcomes were before anesthesia induction (T0), extubation (T1), and 0, 15, 30, or 45 min in the postanesthesia care unit (PACU) (T2–T5, respectively). Results There were 40 patients in group A, 41 patients in group B and 39 patients in group C. Patients in group B had significantly lower FLACC (Face, Legs, Activity, Cry, Consolability) pain scores at T2–T5 than those in group C (all p<0.05). Patients in group B had higher Ramsay Sedation Score at T2–T4 than those in group C (all p<0.05). The proportion of patients who received remedial analgesia in the PACU in group A (17.5%, p=0.008) and group B (9.8%, p<0.001) was significantly lower than that in group C (46.2%). Conclusion Intravenous administration of nalbuphine 10 min before the end of adenotonsillectomy in children could decrease pain intensity and increase sedation levels during the recovery period with the reduction of remedial analgesia in the PACU. Trial registration number ChiCTR2200060118.
{"title":"Impact of intravenous administration of nalbuphine at different time points for postoperative analgesia and sedation in adenotonsillectomized children: a prospective, randomized controlled trial","authors":"Hongmin Cao, Chunying Bao, Haiya Tu, Jing Gao, Jinjin Huang, Qixing Chen","doi":"10.1136/wjps-2023-000662","DOIUrl":"https://doi.org/10.1136/wjps-2023-000662","url":null,"abstract":"Objective To compare the efficacy of intravenous administration of nalbuphine at different time points for postoperative analgesia and sedation in adenotonsillectomized children. Methods Patients with obstructive sleep apnea syndrome scheduled for adenotonsillectomy were randomly divided into group A (patients received intravenous nalbuphine 0.2 mg/kg before anesthesia induction), group B (patients received intravenous nalbuphine 0.2 mg/kg 10 min before the end of surgery), and group C (patients did not receive nalbuphine injection). The time points for measuring outcomes were before anesthesia induction (T0), extubation (T1), and 0, 15, 30, or 45 min in the postanesthesia care unit (PACU) (T2–T5, respectively). Results There were 40 patients in group A, 41 patients in group B and 39 patients in group C. Patients in group B had significantly lower FLACC (Face, Legs, Activity, Cry, Consolability) pain scores at T2–T5 than those in group C (all p<0.05). Patients in group B had higher Ramsay Sedation Score at T2–T4 than those in group C (all p<0.05). The proportion of patients who received remedial analgesia in the PACU in group A (17.5%, p=0.008) and group B (9.8%, p<0.001) was significantly lower than that in group C (46.2%). Conclusion Intravenous administration of nalbuphine 10 min before the end of adenotonsillectomy in children could decrease pain intensity and increase sedation levels during the recovery period with the reduction of remedial analgesia in the PACU. Trial registration number ChiCTR2200060118.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135565204","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}
Pub Date : 2023-11-01DOI: 10.1136/wjps-2023-000645
Bo Yu, Ruiyang Zhu, Yong Fu, Bin Xu, Lulu Yu, Jing Bi
Objective To investigate the clinical significance of the inferior wall cartilage of the auditory meatus in surgical treatment of congenital first branchial cleft anomalies (CFBCAs) in children. Methods Twenty children diagnosed with CFBCAs who underwent surgery between December 2018 and June 2022 at our hospital were retrospectively analyzed and classified according to their Work lesion type. The guiding significance of the inferior wall cartilage in the surgical treatment of CFBCAs was summarized by investigating the adjacent relationships of the surgical lesions with the external auditory canal and facial nerve. Results Of the 20 patients, 16 were classified as Work type I and 4 as Work type II. The lesions were adjacent to the inferior wall cartilage of the auditory meatus in all children. Work type I lesions were located in the upper lateral aspect and were not adjacent to the facial nerve. Work type II lesions were located in the inferior-medial region of the facial nerve. The lesions were completely resected in all children. One patient experienced recurrence 3 months postoperatively because of a residual endochondral fistula. No patients developed facial paralysis or other complications. Conclusions The inferior wall cartilage of the auditory meatus may help to the identify the initial lesion of the CFBCAs and can be regarded as a guiding anatomical structure. These lesions can be completely resected. For resection of Work type II first branchial cleft lesions, the surgical incision can be narrower, and can be precisely positioned with the assistance of endoscope.
{"title":"Significance of the auditory meatus inferior wall cartilage in the surgical treatment of congenital first branchial cleft anomalies in children","authors":"Bo Yu, Ruiyang Zhu, Yong Fu, Bin Xu, Lulu Yu, Jing Bi","doi":"10.1136/wjps-2023-000645","DOIUrl":"https://doi.org/10.1136/wjps-2023-000645","url":null,"abstract":"Objective To investigate the clinical significance of the inferior wall cartilage of the auditory meatus in surgical treatment of congenital first branchial cleft anomalies (CFBCAs) in children. Methods Twenty children diagnosed with CFBCAs who underwent surgery between December 2018 and June 2022 at our hospital were retrospectively analyzed and classified according to their Work lesion type. The guiding significance of the inferior wall cartilage in the surgical treatment of CFBCAs was summarized by investigating the adjacent relationships of the surgical lesions with the external auditory canal and facial nerve. Results Of the 20 patients, 16 were classified as Work type I and 4 as Work type II. The lesions were adjacent to the inferior wall cartilage of the auditory meatus in all children. Work type I lesions were located in the upper lateral aspect and were not adjacent to the facial nerve. Work type II lesions were located in the inferior-medial region of the facial nerve. The lesions were completely resected in all children. One patient experienced recurrence 3 months postoperatively because of a residual endochondral fistula. No patients developed facial paralysis or other complications. Conclusions The inferior wall cartilage of the auditory meatus may help to the identify the initial lesion of the CFBCAs and can be regarded as a guiding anatomical structure. These lesions can be completely resected. For resection of Work type II first branchial cleft lesions, the surgical incision can be narrower, and can be precisely positioned with the assistance of endoscope.","PeriodicalId":23823,"journal":{"name":"World Journal of Pediatric Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135565738","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}
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