Laparoscopic heminephrectomy in infants and children: first 54 cases

ObjectiveHeminephrectomy in the pediatric population remains a popular open surgical procedure. We describe our experience with laparoscopic heminephrectomy using a retroperitoneoscopic approach.Materials and methodsData were collected retrospectively and prospectively on all patients undergoing laparoscopic heminephrectomy by a single surgeon using a prone retroperitoneoscopic approach. Information relating to the age, sex, laterality, duration of surgery, analgesic requirements, duration of hospital stay, postoperative complications and outcome was recorded.ResultsBetween March 2001 and August 2005 54 laparoscopic heminephrectomies were performed in 48 children (34 girls and 14 boys). The median age at surgery was 14 months (range 2–112 months). Forty-four upper and 10 lower moieties were removed. The median operative time was 105 min (range 50–150 min). There were no intraoperative complications and no conversions. There were four minor complications, comprising haematuria (n = 1) and postoperative pyrexia (n = 3). The median length of follow up was 22 months (range 3–57 months). All patients remained asymptomatic at last follow up. Ultrasound findings included presence of a visible ureteric stump (n = 7) and cysts at the resection margin of the remaining remnant (n = 17); none of these patients manifested clinical symptoms (e.g. infection, pain).ConclusionsWith advanced laparoscopic skills, laparoscopic heminephrectomy is a feasible operation for the treatment of non-functioning duplex renal units in children and infants.     

School-based control of urinary schistosomiasis on Zanzibar, Tanzania: monitoring micro-haematuria with reagent strips as a rapid urological assessment

ObjectiveTo evaluate micro-haematuria, detected by Haemastix^® reagent strips, for diagnosis of urinary schistosomiasis during a 3-year period of school-based control on Zanzibar.Patients and methodsA sub-set of school children, from a total of 135,000 who were receiving treatment for urinary schistosomiasis and soil-transmitted helminthiasis, were monitored by parasitological and questionnaire methods for Schistosoma haematobium infections: at treatment baseline in 2004 (n = 2002), follow up with re-treatment in 2005 (n = 3278) and further follow up with re-treatment in 2006 (n = 3993). Standard diagnostic scores for micro-haematuria were calculated against parasitological assessment.ResultsDiagnostic scores of Haemastix^® remained strong throughout the 3-year period. In 2006, scores were: sensitivity (SS) = 0.86 (95% CI: 0.86–0.88), specificity (SP) = 0.99 (0.98–1.00), positive predictive value (PPV) = 0.90 (0.88–0.91), negative predictive value (NPV) = 0.98 (0.98–0.99) in boys; and SS = 0.84 (0.82–0.86), SP = 0.98 (0.98–0.99), PPV = 0.77 (0.75–0.79) and NPV = 0.99 (0.99–1.00) in girls. By comparison, reported blood in urine and pain upon urination were much lower and not as informative.ConclusionAt a cost of approximately £0.20/test, further use of reagent strips for monitoring of urinary schistosomiasis during ongoing control programmes should be advocated as a rapid, cost-effective and informative disease surveillance tool.     

Ureteric stents in pyeloplasty: a help or a hindrance?

ObjectiveTo examine whether routine ureteric stenting influences outcome of pyeloplasty for pelvi-ureteric junction obstruction (PUJO).Patients and methodsA 10-year review was conducted of 105 consecutive open Anderson–Hynes dismembered pyeloplasties performed for PUJO, covering two periods: (1) pyeloplasties performed without ureteric stents (1994–1998) and (2) pyeloplasties performed with ureteric stents (1999–2003). Outcomes (expressed as means ± SEM) of unstented patients (UPs; n = 47) and stented patients (SPs; n = 58) were compared and results analysed using ANOVA and chi-square tests.ResultsFifty-five patients (53.9%) presented with antenatal hydronephrosis, whilst 47 (46.1%) presented postnatally (at mean age 88.4 ± 7.1 months) with one or more of the following: pain (n = 30, 63.8%), urinary tract infection (n = 16; 34.0%), haematuria (n = 3, 6.4%), abdominal mass (n = 3, 6.4%), acute renal failure (n = 2, 4.3%), incidental finding (n = 4, 8.5%). Pyeloplasty was performed (at mean age 58.9 ± 5.3 months) for one or more of the following: pain (n = 40, 38.1%), haematuria (n = 6, 5.7%), urinary tract infection (n = 18, 17.1%), poor initial or deteriorating function (n = 29, 27.6%), severe or deteriorating hydronephrosis (n = 41, 39.0%), calculus (n = 1, 0.95%). Recognised complications of surgery were significantly higher in UPs (5 of 47; 10.6%) than SPs (0 of 58); P = 0.016. These were leakage (n = 4, 8.5%) and obstruction by blood clot (n = 1, 2.1%). Nine SPs (15.5%) developed stent-related complications, including stent migration (n = 5, 8.6%), infection (n = 3, 5.2%) and calculus (n = 1, 1.7%). SPs had significantly shorter hospital stay (2.71 ± 0.25 days) than UPs (4.30 ± 0.38 days); P < 0.01. Preoperative renal pelvis antero-posterior diameter in SPs (3.24 ± 0.25 cm) and UPs (3.21 ± 0.28 cm) was comparable (P = 0.80). Following pyeloplasty, a significant improvement from these preoperative baselines occurred earlier in SPs (at 3.10 ± 0.46 months) than UPs (at 15.71 ± 3.05 months); P < 0.01.ConclusionStented pyeloplasty significantly reduces complications from surgery, particularly leakage, and results in shorter hospital stay and earlier resolution of hydronephrosis, but at the expense of stent-related complications which could be avoided in future by the use of external stents.     

The appendix as ureteral substitute: a report of 10 cases

BackgroundUreteric replacement in part or in total is rarely needed in children. We present our experience in using the appendix to replace the ureter.MethodsA retrospective case note review was carried out at Sheffield Children's Hospital (UK), Ekta Institute of Child Health (Raipur, Chhattisgarh, India) and Christian Medical College Hospital (Vellore, India) of all cases of ureteric substitution using the appendix.ResultsTen patients were identified, operated in 2002–2007: seven males and three females with a median age of 2.5 years (range 2.5 months to 12 years). The reasons for ureteric replacement were traumatic ureteric avulsion (n = 1), congenital ureteric stenosis (n = 5), non-drainage following previous pyeloplasty for pelvi-ureteric junction obstruction (n = 3) and ureteric stricture following reimplantation for vesico-ureteric reflux (n = 1). The appendix was used in an anti-peristaltic manner in all cases, and in one case a transureteroureterostomy was performed. At a median follow up of 16 months (1–72 months), all the patients were well except one whose kidney function had deteriorated.ConclusionsTotal or partial replacement of the ureter using the appendix, even in the first year of life, preserved renal function in nine cases. Ureteric continuity can be successfully restored in children using the appendix.     

The role of laparoscopic surgery for urinary tract reconstruction in infants weighing less than 10 kg: a comparison with open surgery

PurposeTo compare the outcome of laparoscopic urinary tract reconstruction (LUTR) in children weighing 10 kg or less with a weight-matched cohort undergoing open urinary tract reconstruction surgery (OUTR).Materials and methodsWe conducted a retrospective chart review of patients weighing 10 kg or less at the time of surgery who underwent open or laparoscopic pyeloplasty, transuretero-ureterostomy and ipsilateral uretero-ureterostomy between January 2000 and May 2007. The following information was recorded: body weight, age, sex, diagnosis, type of procedure, operative time, estimated blood loss, pre- and postoperative hemoglobin levels, length of hospitalization, length of follow up, use of drains and stents, intraoperative and postoperative analgesic requirement, need for readmission, subsequent procedures, costs, complications and reoperations.ResultsThere were 52 patients divided into two groups: LUTR (n = 23) and OUTR (n = 29). Median weight (range) and follow up was 6.2 kg (3.9–10) and 9 months and 6.5 kg (4.7–9.6) and 31 months for LUTR and OUTR, respectively. Mean operative time for LUTR (including cystoscopy and stent placement) was 237 min and for OUTR 128 min (P < 0.01). There were no differences in blood loss, intra- or postoperative analgesic requirement, results or complications. Mean hospitalization time was shorter for LUTR than OUTR (2 and 3 days, respectively). There were no differences in hospital costs between the two groups.ConclusionsLaparoscopic reconstructive surgery for congenital urological anomalies is safe and effective in small infants and can be performed with outcomes comparable to that of open surgery.     

Angiotensin-converting enzyme gene polymorphism in North-west Indian children with posterior urethral valves

PurposeTo investigate the association of angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and other risk factors with renal scarring in patients with posterior urethral valves (PUV).Materials and methodsForty consecutive patients from North-west India were treated for PUV in 1997–2004. The patients were divided into group 1 (no renal scarring, n = 12) and group 2 (renal scars present, n = 28) based on dimercato-succinic acid scans. ACE I/D polymorphism was determined by polymerase chain reaction in PUV patients and unrelated healthy controls (n = 100).ResultsMean age at presentation was 23.7 ± 37.2 months and mean follow up was 4.8 ± 1.5 years. Preoperative mean serum creatinine levels for group 1 (non-scarred) and group 2 (scarred) were 1.1 ± 1.6 mg/dl and 1.7 ± 1.6 mg/dl, respectively. One year after treatment, the serum creatinine levels had decreased to 0.6 ± 0.1 mg/dl and 0.8 ± 0.3 mg/dl in group 1 and group 2, respectively. ACE genotype distribution in children with PUV was no different from that of controls. The occurrence of D allele was significantly (p = 0.04) higher in patients of group 2. Multivariate logistic regression analysis showed that D allele had a significant impact on renal scar formation, introducing a 4.6-fold risk (odds ratio 4.6, 95% confidence interval 1.03–20.38, p = 0.04). A highly significant correlation between the occurrence of renal scarring and presence of breakthrough urinary tract infection (odds ratio = 7.5, 95% confidence interval 1.60–35.07, p = 0.006) and serum creatinine at follow up (odds ratio = 0.6, 95% confidence interval 0.47–0.81, p = 0.03) was observed. The mean values for glomerular filtration rate (GFR) after 1 year of treatment (p = 0.006) and at follow up (p = 0.027) were significantly different between the patients with II genotype and ID/DD genotype. Hypertension was observed in 13 patients and proteinuria in nine patients with no significant difference between the patients having II/I D/DD genotypes.ConclusionThe presence of D allele is associated with progression of renal scarring and reduced GFR in PUV patients.     

Spanish paediatric research in ANALES DE PEDIATRÍA: research groups and research areas (2003-2009)

IntroductionAuthorships of scientific papers are a significant milestone for researchers. Quantification of authors’ contribution in research papers makes it possible to investigate patterns of research collaboration and interactions in scientific community. The objective of this paper is to analyse scientific collaboration and to identify research groups and research areas of ANALES DE PEDIATRÍA.Material and methodsPapers published in ANALES DE PEDIATRÍA between 2003 and 2009 period were selected from Medline. An author name normalization process was carried out. Productivity and scientific collaboration indexes have been determined. Research groups have been identified through co-authorships networks analysis. Thematic areas of research and major domains of research groups have been characterised by means of quantification of Medical Subject Headings terms assigned to documents.ResultsAn analysis was made of 1,828 documents published by 4,695 authors. The collaboration index (articles) was 5.3 ± 2.3. A total of 97 research groups consisting of between 2 and 80 researchers, which add up 415 researchers have been identified. The main diseases and medical signs studied were asthma (n = 35), multiple abnormalities (n = 28), premature diseases (n = 25), sepsis (n = 24), congenital heart defects (n = 23), respiratory insufficiency (n = 22), HIV infections (n = 21), streptococcal infections (n = 20) and gastroenteritis (n = 20).ConclusionsANALES DE PEDIATRÍA is one of the most productive Spanish medical journals. Author's collaboration was similar to those observed in other Spanish clinical journals included in Journal Citation Reports. A remarkable number of paediatric research groups publishing on many topics have been identified.     

Retroperitoneoscopic adrenalectomy: an early institutional experience

ObjectiveTo review our initial experience with the retroperitoneoscopic approach, which is rapidly becoming the procedure of choice for paediatric adrenalectomy. Swift access to the vascular pedicle makes this approach ideal for adrenal surgery where haemodynamic instability is a common feature.MethodPatients were placed in a fully prone position and the locations of the 12th rib, iliac crest and paravertebral muscles were marked. A 10-mm incision was made lateral to the para-vertebral muscle, halfway between the iliac crest and costal margin. A retroperitoneal working space was created around the kidney using a homemade balloon. A 10-mm Hasson port was then inserted. A 5-mm working port was placed lateral to the tip of the 12th rib and, if necessary, a second was inserted medial to the camera port. Dissection was performed with diathermy and/or Harmonic Scalpel™ and the adrenal vessels were divided between clips. The specimen was retrieved in an endopouch through the 10-mm port.ResultsOver 16 months, six adrenalectomies were performed in five patients (three boys and two girls); two right, two left and one bilateral. Median age at surgery was 8 years. Presentation was with hypertension (n = 2), Cushing's syndrome (n = 2) and abdominal pain (n = 1). Median operative time was 154 min. A single-instrument port adrenalectomy was performed in three patients. Histopathological diagnosis included adrenal cyst (n = 1), cystic phaeochromocytoma (n = 1), adrenal cortical tumour (n = 2) and central Cushing's disease (n = 1). All were completely resected. All patients remain symptom free with a median follow up of 17 months.ConclusionThese cases represent our initial institutional experience with retroperitoneoscopic adrenalectomy. The senior reporting surgeons have already surmounted the general learning curve for laparoscopy, and this experience has proved vital to expand our repertoire with encouraging early results. This is our technique of choice as it provides a superior view of the adrenal gland and vessels, with good intraoperative haemodynamic stability.     

Comparison of three different noninvasive ventilation strategies as initial respiratory support in very low birth weight infants with respiratory distress syndrome: A retrospective study

BackgroundThere is inadequate evidence regarding which noninvasive ventilation (NIV) is superior for initial respiratory support of preterm infants with respiratory distress syndrome.ObjectivesTo compare the failure of noninvasive ventilation (NIV) and neonatal outcomes between nasal continuous positive airway pressure (NCPAP), bi-level positive airway pressure (BiPAP), and nasal intermittent positive pressure ventilation (NIPPV) as the initial respiratory support with less invasive surfactant administration (LISA) in very low birth weight (VLBW) infants.MethodsMedical records of 419 VLBW infants born at 26–30 weeks’ gestation who did not require intubation in the delivery room and were initially supported with either NCPAP (n = 221), BiPAP (n = 101), or NIPPV (n = 97) were retrospectively reviewed. The LISA approach was preferred in cases of surfactant requirement. The primary outcome was the failure of NIV within the first 72 h of life. Failure of NIV was defined as the persistence or recurrence of one or more of the following: hypoxemia, respiratory acidosis, more than one episode of apnea requiring bag and mask ventilation or more than six episodes of apnea requiring stimulation over a 6-h period. Data were analyzed using univariate and multivariate logistic regression analysis.ResultsFailure of NIV within the first 72 h of life was significantly higher in the NCPAP group (29.4%) compared with the BiPAP (12.9%) or NIPPV (12.4%) group (P < 0.001). However, the BiPAP and NIPPV groups were not different in terms of NIV failure (P = 0.91). Multivariable logistic regression analysis showed that antenatal steroid administration (OR: 0.49, 95% CI: 0.27–0.90; P = 0.02) and gestational age ˂ 28 weeks (OR: 2.03, 95% CI: 1.18–3.49; P = 0.01) were independent factors that influence failure of NIV within the first 72 h of life.ConclusionCompared with NCPAP, the use of NIPPV/BiPAP strategies for initial respiratory support can reduce the need for invasive ventilation in infants born at 26–30 weeks’ gestation.     

Laparoscopic heminephroureterectomy for duplex kidney anomalies in the pediatric population

ObjectiveDespite increasing acceptance of laparoscopy in pediatric urology, few published data are available on laparoscopic heminephroureterectomy in patients with duplex kidney anomalies. In the present study, we report our own experiences with this technique.Patients and methodsFrom August 2003 to January 2006, five laparoscopic heminephroureterectomies were performed in four girls with a mean age of 41 (9–67) months. In all cases, a non-functioning upper pole with an obstructive (n = 4) or refluxing (n = 1) megaureter was found. The upper pole was resected laparoscopically en bloc with the megaureter using three to four trocars.ResultsMean follow-up was 42.4 (±7.9) months. All procedures were performed successfully without conversion to open surgery with a mean operative time of 190 (170–210) min. Blood loss was minimal and no intraoperative complications occurred. Despite chronic inflammation in the resected specimens, the patients showed no clinical signs of infection postoperatively. The average length of hospital stay was 5.6 (4–7) days. All patients were followed using duplex sonography.ConclusionsThese data demonstrate that, even in infants, laparoscopic heminephroureterectomy is feasible and associated with minimal morbidity, a better cosmetic result and a shorter hospital stay compared to open surgery. The main disadvantage of the laparoscopic approach is a longer operative time. Laparoscopic heminephroureterectomy is a technically demanding procedure and should be performed only in specialized centers.     

Modern staged repair of bladder exstrophy: a contemporary series

ObjectiveMany changes have occurred in the treatment of bladder exstrophy over the last few years and many repairs are now offered. The purpose of this study was to evaluate long-term outcomes in a select group of patients in whom modern staged repair (MSRE) was undertaken.Patients and methodsFrom an institutionally approved database were extracted 189 patients who had undergone primary closure between 1988 and 2004. The records of 131 patients (95 males) who underwent MSRE with a modified Cantwell-Ransley repair by a single surgeon in 1988–2004 were reviewed with a minimum 5-year follow up.ResultsSixty-seven patients with a mean age of 2 months (range 6 h to 4 months) underwent primary closure, and 18 underwent osteotomy at the same time. Mean age at epispadias repair was 18 months (8–24). Mean age at bladder neck reconstruction (BNR) was 4.8 years (40–60 months) with a mean capacity of 98 cc (75–185). Analysis of bladder capacity prior to BNR revealed that patients with a mean capacity greater than 85 cc median had better outcomes. Seventy percent (n = 47) are continent day and night and voiding per urethra without augmentation or intermittent catheterization. Social continence defined as dry for more than 3 h during the day was found in 10% (n = 7). Six patients required continent diversion after failed BNR. Seven patients are completely incontinent. The mean time to daytime continence was 14 months (4–23) and the mean time to night-time continence was 23 months (11–34). No correlation was found between age at BNR and continence.ConclusionsPatients with a good bladder template who develop sufficient bladder capacity after successful primary closure and epispadias repair can achieve acceptable continence without bladder augmentation and intermittent catheterization.     

Newborn society of fetal urology grade 3 hydronephrosis is equivalent to preserved percentage differential function

PurposeIn newborn hydronephrosis (HN), the level of differential function (%df) measured by diuretic renography (DR) is used to judge the need for pyeloplasty. As DR testing is complex, we sought to determine if grading the level of HN (Society of Fetal Urology grade, SFU Gr) by a simple ultrasound correlates with percentage differential function (%df) and thereby obviates the need to perform DR.Materials and methodsBetween 1990 and 2003 our institution prospectively enrolled all cases of fetal HN who showed unilateral newborn SFU Gr HN ≥3. The cases underwent standardized testing. DR was done using the method of Well-Tempered Renography which was then followed by ultrasound (US). The US studies were performed while the hydration induced by DR was in effect. The level of %df was categorized as preserved (≥40%) or reduced (<40%). Cases were excluded if there was an additional urological abnormality (e.g. ureterocele).ResultsThere were 71 cases that met our study criteria. The SFU Gr HN was 3 (n = 33) or 4 (n = 38). Kidneys with SFU Gr 3 HN showed preserved %df (33/33,100%) (mean = 50.1 ± 3.6) significantly more often than kidneys with SFU Gr 4 HN (27/38, 71%) (mean = 42.2 ± 13.9) (RR = 1.41, 95% CI (1.15–1.72), p < 0.001).ConclusionIn newborns with a history of fetal HN, the postnatal finding of SFU Gr 3 HN uniformly correlates with preserved %df. Standardized hydration prior to US study is done to assure consistency in measurement of the SFU Gr HN. Determining the duration of the relationship between SFU Gr 3 HN and preserved %df will require prospective, longitudinal studies.     

Rapid diagnosis of respiratory distress syndrome by oral aspirate in premature newborns

ObjectiveThe stable microbubble test on gastric aspirate and on amniotic fluid has been used for the diagnosis of respiratory distress syndrome in the newborn. However, no study has performed this test on oral aspirates from premature infants. The objective of this study was to evaluate the performance of the stable microbubble test on oral aspirates from preterm newborns to predict respiratory distress syndrome.MethodThis study included infants with gestational age <34 weeks. Oral fluids were obtained immediately after birth and gastric fluids were collected within the first 30 minutes of life. The samples were frozen and tested within 72 hours.ResultsThe sample was composed of paired aspirates from 64 newborns, who were divided into two groups: respiratory distress syndrome group (n = 21) and control group (n = 43). The median (interquartile range) of the stable microbubble count in the oral samples of infants with respiratory distress syndrome was significantly lower than that of infants who did not develop respiratory symptoms: respiratory distress syndrome group = 12 (8–22) stable microbubbles/mm²; control group = 100 (48–230) microbubbles/mm² (p < 0.001). The correlation between microbubble count in gastric and oral aspirates was 0.90 (95% confidence interval = 0.85–0.95; p < 0.001). Considering a cut-off point of 25 microbubbles/mm², the sensitivity and the specificity of the stable microbubble test were 81.4% and 85.7%, respectively.ConclusionThe study suggests that the stable microbubble test performed on oral aspirate is a reliable alternative to that performed on gastric fluid for the prediction of respiratory distress syndrome in the newborn.     

Prevalence of nocturnal enuresis, risk factors, associated familial factors and urinary pathology among school children in Iran

AimTo estimate the prevalence of enuresis in school-age children in Iran and determine associated factors.Materials and methodsA total of 7562 children, aged 5–18 years, enrolled in this cross-sectional study. Using a standard questionnaire, data on demographic characteristics, and familial and physical conditions were obtained from the parents by interview. The ICD-10 definition of enuresis was used. In the case of enuretics, a detailed history was taken, and physical and ultrasonographic examinations, urinalysis and urine culture were performed.ResultsThe overall prevalence of enuresis was 6.8%. A significant relationship was found between the prevalence of enuresis and age (P = 0.001), educational level of parents (P = 0.001), number of family members (P = 0.028), positive family history of enuresis (P = 0.001), parenting methods (P = 0.001), and deep sleep (P = 0.001). Birth weight (P = 0.07), monthly income (P = 0.322), employment status of parents (P = 0.08), ethnic differences (P = 0.09), delayed development (P = 0.062), drinking (P = 0.072) or urination habit before sleep (P = 0.06), and stool incontinence (P = 0.062) were not significantly associated with enuresis. Prevalence of urinary tract pathology was 2.9% in enuretics.ConclusionsThis study provides a quantitative estimate of the prevalence and main risk factors for enuresis in Iranian children.     

Developmental change of amplitude-integrated electroencephalographic activity in preterm infants with intraventricular hemorrhage

Background

Amplitude-integrated electroencephalography (aEEG) allows continuous brain function monitoring at bedside.

Objectives

This prospective cohort study was designed to longitudinally evaluate aEEG tracings at increased postmenstrual age (PMA) in preterm infants with intraventricular hemorrhage (IVH).

Methods

Biweekly aEEG recordings were performed on preterm infants < 32 weeks gestational age from 24 to 36 weeks PMA. The tracings were evaluated according to a scoring system adapted from Burdjalov et al.

Results

We analyzed 496 aEEG recordings in 105 preterm infants. The control group consisted of 42 infants with no IVH, whereas the IVH grade I, II, III, and IV groups consisted of 38, 8, 3, and 14 infants, respectively. There were significant differences in the cycling and total maturation scores among the IVH groups at 36 weeks PMA (p = 0.010 and p = 0.006, respectively). The IVH-IV patients maintained low scores in their cycling as their PMA increased, in contrast to their continuity and amplitude scores. The risk factors affecting the aEEG maturation scores at 36 weeks PMA in the IVH-IV patients included seizure events with the administration of antiepileptic drugs and the insertion of external ventricular drains (β = − 0.679 and β = − 0.418, respectively; p = 0.003).

Conclusions

The low cycling scores persisted until 36 weeks PMA in the IVH-IV group.     

Comparison of outcomes of tubularized incised plate hypospadias repair and circumcision: a questionnaire-based survey of parents and surgeon

AimWe administered a standardized questionnaire to parents and operating surgeon to determine their opinions regarding outcomes from tubularized incised plate (TIP) hypospadias repair.MethodsLikert scale questionnaires were used to assess six outcomes: overall penile appearance, cosmesis of meatus and skin, penile size, straightness during erection, and voided stream. These were answered by consecutive parents of boys 6 weeks following TIP hypospadias repair, as well as by the surgeon. Controls were normal boys 6 weeks after elective circumcision, with their parents and the surgeon answering the same questionnaires.ResultsThere were no significant differences in responses between parents of boys undergoing TIP repair for distal (n = 50) to proximal (n = 15) hypospadias compared to parents of normal boys undergoing elective circumcision (n = 22). Surgeon impressions of cosmetic results were slightly, but significantly, more favorable than those of parents. Surgeon scores were higher for distal versus proximal hypospadias outcomes.ConclusionsOur study provides objective evidence that parents consider TIP hypospadias repair to create a normally functioning and appearing penis. Parent and surgeon opinions of cosmetic outcomes were similar, although surgeon impressions were more favorable.     

High odds for freedom from early complications after tubularized incised-plate urethroplasty in 1-year-old versus 5-year-old boys

ObjectiveWe present two parallel case series on outcome after tubularized incised-plate urethroplasty (TIP repair) for hypospadias in 1-year-old versus 5-year-old boys.Patients and methodsOver a 2-year period two groups (1 year old, n = 57 and 5 years old, n = 65) of boys were operated in parallel using the TIP repair. Main endpoints were set as incidence of fistula, meatal stenosis and foreskin dehiscence/phimosis. A logistic regression model was used to predict the odds for freedom from either ‘any complication’ or fistula in 1-year-old boys versus 5-year-old boys.ResultsFive-year-old boys had a significantly higher incidence of fistula (26% vs. 7%, P < 0.01) and ‘any complication’ (50% vs. 18%, P < 0.001) than the 1-year-old boys. The odds ratio for freedom from ‘any complication’ and fistula was 4.8:1 (P < 0.001) and 4.7:1 (P = 0.009), respectively, in favor of the 1-year-old group. Avoiding foreskin reconstruction gave increased odds for freedom of “any complicaton” (4.2:1, P = 0.034), but was an insignificant factor concerning freedom from fistula.ConclusionThese data substantiate why boys with hypospadias should be corrected early. Foreskin reconstruction increases postoperative problems but does not increase the rate of postoperative fistulae.     

Ages of sitting up and walking in preterm newborns less than 1,500 G with bronchopulmonary dysplasia

IntroductionAdverse neurological events in very low birth weight (VLBW) children with bronchopulmonary dysplasia (BPD) are more frequent than in children without. An understanding of the ages when preterm infants acquire certain motor skills will give parents more appropriate information on motor development. The objective of the present study is to estimate the influence between BPD and the age of acquisition of sitting unsupported and independent walking in VLBW children with normal neurological examination at 2 years of corrected age.Patients and methodsA longitudinal study was conducted on a cohort of 885 children with VLBW, admitted to the Hospital “12 de Octubre” between January 1991 and December 2003. Age for both skills was established by interview with parents. Means were compared with t-test and Bonferroni adjustment where appropriate.ResultsBoth motor skills were acquired later in the group with BPD (7.8 ± 2m vs. 7.1 ± 1.3m for sitting unsupported and 14.5 ± 3.8m vs. 13.4 ± 2.5m for walking) (P < .001). BPD was associated with delayed acquisition (above p90) of these skills, OR = 2.6 (1.6-4.1) for sitting and OR = 2.8 (1.6-4.8) for walking. Association was found after adjusting for gestational age (GA) and weight.ConclusiónBPD was associated with delayed acquisition of both skills in VLBW children with normal neurological examination at 2 years.     

Leishmaniose viscérale infantile : profil épidémiologique, clinique et biologique. À propos de 93 cas

IntroductionInfantile visceral leishmaniasis (LVI) is a problem of public health in Morocco. This parasitosis rages to the state of endemic and touches the infants.ObjectivesThe goal of this survey is to draw up epidemiological, clinical and biologic profile of LVI in children hospitalized in the Children Hospital of Rabat, and to prove the contribution of serology in diagnosis of this illness.Material and methodsThis retrospective study concerned all LVI cases gathered in the HER during 5 years (from 1997 to 2001). For every patient included in this study, the authors collected geographical origin, age, sex, clinical data (splenomegaly, fever, hepatomegaly, paleness), and biologic data (numeration formulates red chalk, speed of sedimentation, protein in blood and electrophoresis of the proteins). The myelogram results were also exploited as well as results of serology when they were realized.ResultsNinety-three LVI cases were listed with an age average of 3.5 ± 3 years, and a sex ratio of 1.82 (p = 0.032). Patients coming from farming surroundings or semi-urban were more numerous than those from cities: 85.5% versus 14.5% (p < 0.0001). Most of the patients suffered from splenomegaly, fever and paleness; anaemia was almost constant. In case of hyperprotidemy (43.5%; n = 27), the albumin–globulin report was always lower than 1.2. Indirect immunofluorescence was practised among 39 patients with a positive response in 84.6% of the cases. Forty patients whose serums were analyzed by indirect hemagglutination (HAI) had all a myelogram revealing the presence of protozoon, but only 57% of them showed a positive reaction in HAI.ConclusionsThese results confirm that the LVI touches children coming from underprivileged surroundings. The triad, splenomegaly, paleness and fever, is a good element of diagnostic orientation, whereas parasite revelation in bone marrow remains the best way to establish the diagnosis of this illness.     

Does gestational diabetes mellitus affect respiratory outcome in late-preterm infants?

BackgroundBoth gestational diabetes mellitus (GDM) and late-preterm delivery at 34–36 weeks' gestation are independently associated with neonatal respiratory complications, but it is unknown whether their combination increases further its risk. We therefore appraised the independent effect of GDM on the respiratory outcome of late-preterm infants.MethodsIn a retrospective cohort study, respiratory outcome of 911 infants delivered at 34–36 weeks' gestation between 1 January 2009 and 30 August 2012 from mothers with GDM (study group, n = 130) was compared with infants delivered at the same gestation by mothers without GDM (control group, n = 781).ResultsThe study group had significantly higher incidence of transient tachypnoea of newborn (TTN, p = 0.02) and air leak (p = 0.012), and required more respiratory support, including oxygen, continuous positive airway pressure (CPAP), mechanical ventilation and neonatal intensive care, with a longer length of hospital stay, but not duration on respiratory support. On logistic regression analysis, GDM is an independent risk factor for TTN (aOR = 1.5, 95% C.I.1.0–2.4), CPAP (aOR = 2.37, 95% C.I. 1.05–4.89), mechanical ventilation (aOR = 4.02 95% C.I. 1.57–10.32) and neonatal intensive care (aOR 1.83, 95% C.I. 1.05–3.87).ConclusionsOur results demonstrated an independent effect of GDM on the risk of severe respiratory complications in late-preterm infants. Additional close monitoring and timely intervention are necessary in the management of these infants.