Prophylactic antibiotics in umbilical artery catheterization in the newborn

Over a period of 30 months, umbilical artery catheters were inserted in 229 infants. The main complications were haemorrhage, infection, and obstruction of a blood vessel. The incidence of infection was not affected by the use of prophylactic antibiotics. Vascular obstruction was more common in small infants, and in those in whom a catheter was reintroduced in the same blood vessel.     

Prophylactic antibiotic use in pediatric burn units.

Prophylactic antibiotic use in childhood burns is controversial. The efficiency of antibiotic prophylaxis in 77 pediatric burn patients was evaluated. Forty-seven patients received prophylactic antibiotics (Group AP), while 30 patients received no prophylaxis (Group NP). Age, wound depth, day of admission, mechanism of burn injury, type of dressings were similar for both groups (p > 0.05). Wound infection rates were 21.3 % in Group AP and 16.7 % in Group NP (p > 0.05). S. aureus, Enterobacter spp., P. aeruginosa, and E. coli were the most common microorganisms. Patients with wound colonization and infection had a larger burned total body surface area (BTBSA) in both groups (p < 0.01). Eight patients had clinical sepsis. All but one of the septic patients were from Group AP. Associated infections of the upper and lower respiratory tract (16), urinary tract (7), and otitis media (2) were more common in Group AP. One patient died from sepsis in Group AP. Hospital stays were longer in Group AP (21.7 +/- 16.4 vs. 13.5 +/- 10 days; p < 0.05). Antibiotic prophylaxis in childhood burns does not reduce the rate of wound infection. Age, wound depth and BTBSA are not critical variables for prophylaxis. Reinforcing the use of culture-specific antibiotics for more beneficial and cost-effective results in the treatment of childhood burns is recommended.     

Prophylactic oesophageal calibration in oesophageal atresia surgery

Anastomotic structure is the most common complication following surgery for oesophageal atresia. The management of this problem provides a continuing challenge to paediatric surgeons. In an effort to reduce the rate as well as the morbidity and mortality associated with oesophageal stricture formation, a regime of routine postoperative prophylactic oesophageal calibration has been undertaken in Princess Margaret Hospital for Children over the last 12 years. Retrospective review of the results of this treatment modality shows low stricture (1.8%) and morbidity rates associated with the procedure. Correspondence to: P. A. King     

Prophylactic antibiotics for children with recurrent urinary tract infections

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made.     

Prophylactic oral antibiotics for low-risk dog bite wounds.

The use of prophylactic antibiotics in the initial treatment of noninfected dog bite wounds is controversial. All patients with noninfected dog bite wounds who presented to our emergency department (ED) over a two-year period were considered for entry into a randomized prospective study. Patients were excluded from the study if they had any high-risk criteria for infection: puncture wounds, hand or foot wounds, wounds greater than 12 hours old, a history of immunocompromising disorders, or the use of immunosuppressive drugs. Patients in the antibiotic group (n = 89) were treated with local wound care and given either dicloxacillin, cephalexin, or erythromycin orally for seven days. Patients in the control group (n = 96) received local wound care only. All patients had their wounds irrigated with a 1% povidone-iodine solution and debrided and sutured if clinically indicated. All patients were subsequently reevaluated for clinical signs of wound infection. The groups were similar in age, sex, time of delay in seeking treatment, anatomic sites of wounds, depths and types of wounds, and number of wounds requiring suturing. The wound infection rates for the antibiotic and control groups were 1.1 and 5.1%, respectively. This difference was not significant (P = 0.212). There were 36 wounds in the antibiotic group and 37 wounds in the control group that were full thickness. The infection rates for these wounds were 2.8 and 13.5%, respectively. This was not statistically significant (P = 0.132). This study suggests that prophylactic oral antibiotics in low-risk dog bite wounds are not indicated.     

Telemedicine in pediatric surgery

Telemedicine is a new academic specialty at the crossroads of medical informatics whose potential is still largely untapped by pediatric surgeons. Telemedicine aims to alleviate travel concerns associated with the delivery of health care, to bring expert pediatric surgeons to areas where currently none exist, and to improve coordination between pediatric surgeons, transcending all barriers. Today, it is possible to transmit all digitized data – roentgenograms, echocardiograms, radiologic images, intraoperative photographs, histologic images, etc., and to consult specific experts in the subspecialties of childcare. It is possible to train and guide surgical trainees by experts without their physical presence. In the future, telemedicine will constitute an integral part of the health care of children and the training of pediatric surgeons. Accepted: 11 August 2000     

Prophylactic antibiotics for colostomy closure in children: short versus long course

A prospective, randomized clinical study was performed to compare the results of 1-day versus 7-day administration of the same prophylactic antibiotics to 30 consecutive patients undergoing colostomy closure. The antibiotics used were cotrimoxazole (8 mg/kg per day trimethoprim) and ornidazole (20 mg/kg per day), which were this department's standard prophylactic agents for colorectal surgery. Patients, in the first group received cotrimoxazole i. m. 1 h before the operation and ornidazole by i. v. infusion starting after induction of anesthesia. The same dosages of both drugs were repeated once 12 h after the initial dose. In the second group (7 days), both agents were started orally 48 h before the operation. The preoperative doses were given as in the short-course group and were continued in this fashion until the end of the 5th postoperative day. Mechanical cleansing of the bowel and the operative procedure were standardized for all patients. Intraluminal swab cultures were obtained during the operation; only aerobic cultures could be studied. Patients were closely monitored for septic complications during the post-operative period. Study groups were similar regarding age, sex, nutritional status, and micro-organisms isolated from the bowel. Wound infections confined to the subcutaneous tissue occurred in 2 patients, 1 in each group (6.6%). No intraperitoneal infection, anastomotic leakage/dehiscence, or wound dehiscence was encountered. While susceptibilities to antibiotics other than cotrimoxazole were similar in both groups, cotrimoxazole-resistant micro-organisms were found more often in the long-course group (P <0.05). Because we found no difference in the rate of infectious complications between groups, we recommend the use of short-term parenteral antibiotic prophylaxis for colostomy closure in children. Such an approach saves nursing time, reduces costs, and prevents the formation of bacterial resistance.     

小儿外科病人的肠内营养支持

目的 探讨小儿外科病人实施肠内营养的优越性和可行性。方法 87例小儿外科住院病人分别经口、鼻胃管及空肠造瘘管予以小儿安素,自然过渡到正常饮食。对比肠内营养前后患儿的体重、身高、上臂肌围、三角肌皮褶厚度、血红蛋白、血球压积及血清总蛋白,通过前后比较就肠内营养对患儿的营养状态、肠道功能的影响作前瞻性随机化研究。结果 受试患儿身高、体重、上臂肌围、三角肌皮褶厚度于2周后开始增加,8周后明显增加。长期测量血红蛋白、血球压积及血清总蛋白均有所增加。结论 小儿外科病人施行肠内营养是可行的,能避免负氮平衡,改善机体的营养状态。     

Cataract surgery in pediatric uveitis

Uveitis in children is associated with several sight-threatening ocular complications, including the formation of cataracts. The surgical management of uveitic cataracts in children is both challenging and controversial and, unlike in adult uveitic cataracts, surgery has historically been associated with poor visual outcomes. Juvenile idiopathic arthritis-associated uveitis in particular poses unique therapeutic challenges and the issue of correction of aphakia in these patients remains a contentious one. The growing use of immunotherapies and, where needed, targeted biologic agents in childhood uveitis increases our potential to implant lenses and predict outcomes. The authors review the available evidence base for the treatment of these children.     

Risk management in pediatric surgery

Purpose  To present the experience documented over 1 year of analysis and quality control on surgical complications and organizational accidents. Methods  All children admitted during the study period at our Institution were included in the analysis, which consisted of four phases: (1) definition and standardization of perioperative diagnostic and therapeutic tracks; (2) staff education; (3) documentation and data implementation, and (4) “Morbidity and Mortality” audit. Results  Over a 1-year study period, 3,116 children were admitted to our Institution: 2,222 out of 3,116 (71.3%) children underwent a surgical procedure. A total number of 184 complications were recorded in 149 patients. One hundred and seventy-one (92.9%) complications occurred following a surgical procedure. Fifty-six out of 149 complicated patients (37.6%) required a re-operation. Thirty-five out of 184 (19%) complications were classified as organizational. Infection represented the most common complication. All cases of anastomotic dehiscence and perforation, bowel obstruction, and stoma malfunction required reintervention. None of the postoperative bleedings required a second surgical procedure. Conclusion  Although a proper statistical comparison with literature complication rates is not feasible, our experience confirms the importance of quality-control audit in health care systems. Prolonged observation, long-term follow up, and comparison with previous results will represent our future goal.