1,721,317 research outputs found
Letter to the editor re: Association of preoperative anemia with postoperative mortality in neonates
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Congenital problems of the gastrointestinal tract
No full textCongenital abnormalities of the gastrointestinal tract (GIT) are relatively common, frequently diagnosed prenatally, and often require the attention of a neonatal surgeon for surgical correction. On occasion, such abnormalities may present with life-threatening complications necessitating urgent surgical intervention to prevent catastrophic consequences. This chapter provides an overview of the most common conditions encountered and those which require intervention as a matter of urgency. Typical presenting features, clinical findings, and treatment options are discussed
Necrotising enterocolitis: better data, still many questions
No full textIn The Lancet Gastroenterology & Hepatology, Cheryl Battersby and colleagues start to fill in some of these gaps in knowledge by providing an up-to-date epidemiological picture of severe necrotising enterocolitis among babies born before a gestational age of 32 weeks in England over a 2-year period. The importance of this study is in its completeness, with data captured from 118,073 babies admitted to all 163 neonatal units in England. Consequently, reliable data are now available that will help to inform research and service delivery. As an aside, this study also serves as an excellent example of how the (electronic) capture of routinely collected data can be used effectively and efficiently for research purposes, and is a model that should undoubtedly be replicated
What is the role of enhanced recovery after surgery in children? A scoping review
No full textPurpose: Enhanced Recovery after Surgery (ERAS) pathways are standard practice in adult specialties resulting in improved outcomes. It is unclear whether ERAS principles are applicable to Paediatric Surgery. We performed a scoping review to identify the extent to which ERAS has been used in Paediatric Surgery, the nature of interventions and outcomes. Methods: Pubmed, Cochrane library, Google Scholar and Embase were searched using the terms enhanced recovery, post-operative protocol/pathway and paediatric surgery. Studies were excluded if they did not include abdominal/thoracic/urological procedures in children. Results: Nine studies were identified (2003-2014; total 1269 patients): Three case control studies, one retrospective review and five prospective implementations, no RCTs. Interventional elements identified were post-operative feeding, mobilisation protocols, morphine-sparing analgesia, reduced use of nasogastric tubes and urinary catheters. Outcomes reported included post-operative length of stay (LOS), time to oral feeding and stooling, complications and parent satisfaction. Fast-track programmes significantly reduced LOS in 6/7 studies, time to oral feeding in 3/3 studies and time to stooling in 2/3 studies. Conclusion: The use of ERAS pathways in Paediatric surgery appears very limited but such pathways may have benefits in children. Prospective studies should evaluate interventions used in adult ERAS on outcomes in the paediatric setting
Assessment and management of paediatric hydrocoele and hernia - a guide for the non specialist
No full textMortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-, middle- and high-income countries: a multicentre, international, prospective cohort study
No full textBackground: congenital anomalies are the 5th leading cause of under-5 mortality, globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care. Limited literature exists on these conditions in low- and middle-income countries (LMICs). We compared the outcomes of the seven commonest gastrointestinal congenital anomalies in low-, middle- and high-income countries (LICs, MICs, and HICs), globally, and identified factors associated with mortality.
Methods: the Global PaedSurg Research Collaboration, consisting of healthcare professionals who provide surgical care for neonates and children with congenital anomalies, performed a multicentre, international prospective cohort study of consecutive patients, under 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s Disease. Recruitment was for a minimum of 1-month between October 2018 and April 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using REDCap. Follow-up was to 30 days post-primary intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We used chi-squared to compare mortality between country income strata, and penalised regression to identify factors associated with mortality (Risk Ratio [RR], 95% Confidence Interval [CI], p value).
Findings: we included 3849 patients with 3975 study conditions (560 oesophageal atresia, 448 congenital diaphragmatic hernia, 681 intestinal atresia, 453 gastroschisis, 325 exomphalos, 991 anorectal malformation, and 517 Hirschsprung’s Disease) from 264 hospitals (89 HICs, 166 MICs, 9 LICs) in 74 countries. Mortality amongst all patients was 39·8% (37/93) in LICs, 20·4% (583/2860) in MICs, and 5·6% (50/896) in HICs (p<0·001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (90·0% [9/10] LICs, 31·9% [97/304] MICs, 1·4% [2/139] HICs, p<0·001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included: country income status (LIC [RR 2·78, CI 1·88-4·11, p<0·001], MIC [RR 2·11, CI 1·59-2·79, p<0·001] vs HIC), sepsis at presentation (RR 1·20, CI 1·04-1·40, p=0·016), higher American Society of Anesthesiologists score (ASA) at primary intervention (ASA 4-5 [RR 1·82, CI 1·40-2·35, p<0·001], ASA 3 [RR 1·58, CI 1·30-1·92, p<0·001] vs ASA 1-2), surgical safety checklist not used (RR 1·39, CI 1·02-1·90, p=0·035), and ventilation or parenteral nutrition unavailable when needed (RR 1·96, CI 1·41-2·71, p<0·001, or RR 1·35, CI 1·05-1·74, p=0·018, respectively). Administration of parenteral nutrition (RR 0·61, CI 0·47-0·79, p<0·001), and use of a peripherally inserted central catheter (RR 0·65, CI 0·5-0·86, p=0·002), or percutaneous central line (RR 0·69, CI 0·48-1·00, p=0·049) were associated with lower mortality.
Interpretation: unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-, middle- and high-income countries. Improving access to quality neonatal surgical care in LMICs is vital to achieve Sustainable Development Goal 3·2 to ‘end preventable deaths in neonates and children under five by 2030’.
Funding: Wellcome Trust (Funder Reference: 203905/Z/16/Z)
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
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