1,721,246 research outputs found
Non-operative management of appendicitis in children
No full textWhilst appendicectomy has been considered the mainstay of treatment for children with acute appendicitis for many decades there has been a great deal of recent interest in non-operative treatment (NOT) with antibiotics alone. Initial results suggest that many children with appendicitis can indeed be safely treated with NOT and can be spared the surgeon’s knife. Many as yet unanswered questions remain however before NOT can be considered a realistic and reliable alternative to the surgery. This review summaries current knowledge and understanding of the role of NOT in children with appendicitis and outlines and discusses the outstanding knowledge gaps
The evidence base for neonatal surgery
No full textThe practise of evidence based medicine means integrating the clinical expertise with the best available external clinical evidence from systematic research. There is a lack of supporting scientific evidence from rigorous trials in neonatal surgery. The indications for surgery and the type of operation performed in neonates are rarely supported by randomised controlled trials. As a consequence, the majority of the operations performed in neonates are supported by retrospective studies and surgeon preference. This review article is focussed on operations in neonates which are performed by general paediatric surgeons. Only a few randomised controlled trials have been performed in neonatal diseases such as congenital diaphragmatic hernia, necrotizing enterocolitis, pyloric stenosis and inguinal hernia. All of these trials have been based on collaboration between paediatric surgical units highlighting the importance of creating a network of centres that will promote multicentre prospective studies
Royal Australasia of Surgeons guest lecture. Necrotizing enterocolitis: prevention, treatment, and outcome
No full textNecrotizing enterocolitis (NEC) remains a very serious disease, particularly in premature infants. This review describes various aspects of the diagnosis and treatment of the disease. The pathogenesis of NEC is not completely understood, and risk factors include formula enteral feeding and bacterial involvement. Prevention of the disease is desirable, and the most robust evidence is linked to the protective effet of human milk and probiotics. The medical and surgical management has not changed significantly in the last 20 years. Insertions of peimary peritoneal drainage in comparison with laparotomy remain controversial, and this uncertainty stimulated the development of two randomized controlled trials. Neither definitely demonstrated an advantage of either periotneal drainage or laparotomy over the other. The advantage offered by a stoma compared to primary intestinal anastomosis is currently investigated in a multicenter randomized controlled trial (STAT Trial). The mortality of the disease remains high, and new therapeutic interventions are needed. Novel forms of treatment that can improve the outcome of this disease are currently under investigation. These include whole-body moderately controlled hypothermia and administration of amniotic fluid stem cell
Current research on epidemiology, pathogenesis and management of necrotizing enterocolitis
No full textDespite decades of research on necrotizing enterocolitis, we still do not fully understand the pathogenesis of the disease, how to prevent or how to treat the disease. However, as a result of recent significant advances in the microbiology, molecular biology, and cell biology of the intestine of premature infants and infants with necrotizing enterocolitis, there is some hope that research into this devastating disease will yield some important translation into effective prevention, more rapid diagnosis, and novel therapies for the disease
Outcome reporting in studies of paediatric achalasia: a systematic review
No full textObjectives: paediatric achalasia is a rare condition associated with significant morbidity. A core outcome set (COS) would standardise reporting, enable comparison of data sets, and focus research efforts; ultimately improving care for children with achalasia. We aimed to identify outcomes currently reported in studies of paediatric achalasia to inform outcomes for a COS.Methods: a systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Studies investigating children ≤18 years of age with a diagnosis of achalasia were included. Primary and secondary outcomes were recorded and assigned to OMERACT core areas. The study was pre-registered (PROSPERO: CRD42024509855).Results: sixty-two studies were included in this review, consisting of 54 retrospective and 8 prospective studies. Median cohort size was 20 patients (inter-quartile range: 13–28). Forty-eight unique outcomes were reported. The most common outcomes reported were intra-operative complications (65%, 40 studies), post-operative complications (58%, 36 studies) and length of stay (58%, 36 studies). A primary outcome was specified in 12 studies (19%), the most common was the Eckardt score (13%) in 8 studies. Studies least frequently reported outcomes in the death (21%, 13 studies) and pathophysiological manifestations (35%, 22 studies) core areas.Conclusions: the studies included in this review were predominantly small and retrospective. Of the few studies that specified a primary outcome, the majority used the Eckardt score, which is unvalidated in children. Outcomes relevant to pathophysiological manifestations, life impact and survival were under-reported. A COS for paediatric achalasia, involving key stakeholders, would ensure that patient-relevant outcomes were reported, reduce heterogeneity and facilitate meta-analysis
Growth pattern of infants with gastroschisis in the neonatal period
No full textBackground/Aim: Early postnatal growth patterns may have significant long term health effects. Although preterm infants on parenteral nutrition (PN)exhibit poor growth, growth pattern of term or near-term infants requiring PN is not well reported. We aimed to investigate this in infants born with gastroschisis. Methods: Retrospective review of all infants with gastroschisis requiring PN treated at a single centre over a 4 year period. Growth and clinical data were retrieved, and weight SDS scores for corrected gestational age calculated. Weight SDS (mean ± SD)were compared at clinically relevant timepoints and multi-level regression used to model growth trends over time. Main results: During the study period 61 infants with gastroschisis were treated; all were included. Infants were small for gestational age at birth for weight (SDS score −0.87 ± 0.85). Weight SDS decreased significantly during the first 10 days of age (mean decrease 0.81 ± 0.56; p < 0.0001)and between birth and discharge (mean decrease 0.81 ± 0.56; p < 0.0001). Despite tolerating full enteral feeds, weight SDS velocity was negative around the time of transition from parenteral to enteral feed. There was evidence of ‘catch up’ growth between 3 and 6 months of age. Conclusion: Despite nutritional support with PN, infants with gastroschisis demonstrate significant growth failure during the newborn period. Further efforts are required to understand the underlying mechanisms, improve nutritional support and to evaluate the long term consequences of postnatal growth failure in this population.</p
Age-related probability of contralateral processus vaginalis patency in children with unilateral inguinal hernia
No full textPurpose: contralateral groin exploration with closure of a patent processus vaginalis (PPV) in children with a unilateral inguinal hernia remains controversial. We aimed to generate precise, age-related probabilities of patency of the contralateral processus vaginalis (PV) in infants with a unilateral inguinal hernia to guide practice.Methods: retrospective review of all unilateral laparoscopic inguinal hernia repairs in 5 years to determine patency of contralateral PV. Using logistic binomial regression, age-adjusted odds ratio (OR), probability of contralateral PPV and number needed to explore (NNE) in order to close all PPVs were estimated.Results: data from 331 children [262 male, median 3.8 months corrected gestational age (CGA)] were analysed; 160 (48 %) had a contralateral PPV. In the regression model, CGA is linearly related to log[OR] such that for each month increase in CGA, the log[OR] of having a contralateral PPV decreased by 0.017 ± 0.006 (mean ± SEM; p = 0.005). Gender and side of hernia had no significant effect. The probability of contralateral PPV is 50 % (NNE = 2) at 8 m CGA, 33 % (NNE = 3) at 49 m and 25 % (NNE = 4) at 72 m.Conclusions: these data contribute to our knowledge of the natural history of the PV and may help guide the need for contralateral groin exploration in infants with inguinal herni
Urinary intestinal fatty acid-binding protein concentration predicts extent of disease in necrotizing enterocolitis
No full textIn this pilot study, urinary i-FABP was associated with extensive disease in infants with NEC requiring surgery. Further work, in a larger number of patients, is required to investigate the applicability of urinary i-FABP as a marker of intestinal damage and as an adjunct to current indications for surgical intervention in infants with NE
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