共查询到20条相似文献，搜索用时 31 毫秒
1.
Shun-li Cao Hong Jiang Shi-ping Niu Xiao-hu Wang Shan Du 《Indian journal of pediatrics》2018,85(10):855-860
Objective
To summarize the available randomized controlled trials (RCTs) to evaluate the effect of taurine supplementation on growth in low birth weight infants (LBW).Methods
PubMed, EmBase, and Cochrane Library electronic databases were searched for published articles through March 2017. Analysis was done to examine the effect of taurine supplementation on growth, and sensitivity analysis was performed by removing each individual study from meta-analysis.Results
Results of 9 trials totaling 216 LBW infants in the present meta-analysis were collected and analyzed. The conclusion of included studies demonstrated that taurine supplementation significantly reduced length gain (WMD:-0.18; P?<?0.001), plasma glycine (WMD:-106.71; P?=?0.033), alanine (WMD:-229.30; P?=?0.002), leucine (WMD:-64.76; P?<?0.001), tyrosine (WMD:-118.11; P?<?0.001), histidine (WMD:-52.16; P?<?0.001), proline (WMD: -84.29; P?=?0.033), and asparagine-glutamine (WMD:-356.30; P?<?0.001). However, taurine supplementation was associated with higher levels of acidic sterols (WMD:0.61; P?=?0.024), total fatty acids (WMD:7.94; P?=?0.050), total saturated fatty acids (WMD:9.70; P?<?0.001), and unsaturated fatty acids (WMD:6.63; P?<?0.001). Finally, taurine supplementation had little or no significant effect on weight gain, head circumference gain, plasma taurine, threonine, serine, citrulline, valine, methionine, isoleucine, phenylalanine, ornithine, lysine, arginine, glutamate, hydroxyproline, aspartate, dietary cholesterol, endogenous neutral sterols, cholesterol synthesis, and medium-chain triglycerides.Conclusions
The findings suggest that although there are several significant differences in plasma indeces, no significant effect on growth in LBW infants was observed with taurine supplementation.2.
Background
Children with Kawasaki disease (KD) and pyuria have been misdiagnosed with urinary tract infection (UTI). We compared clinical and laboratory features at admission between two groups of infants under 6?months of age who showed initial pyuria, to identify the initial clues suggestive of KD.Methods
We retrospectively reviewed the medical records of children with fever who were under 6?months of age with pyuria, over a 10-year period (2007–2017). We included infants with sterile pyuria who were finally diagnosed with KD and those with UTI.Results
During the period investigated, 12 (9.9%) KD patients with sterile pyuria and 378 infants with UTI were included in this study. Older age (P?<?0.01), a longer duration of fever; total and before admission (P?<?0.01), more negative nitrite test (P?<?0.01), higher platelet count (P?=?0.04), increased C-reactive protein (CRP) (P?<?0.01) and erythrocyte sedimentation rate (ESR) (P?<?0.01), were identified as initial features of infants finally diagnosed with KD. In the receiver operating characteristic analysis, optimal cut-off values of 509?k/μL for platelet count, 60?mg/L for CRP, and 68?mm/H for ESR were selected. Patients with ESR?>?68?mm/hr had a ninefold higher odds of KD compared to those with lower ESR levels (odds ratio: 8.963, 95% confidence intervals: 1.936–41.493, P?=?0.005), whereas CRP and platelet count could not significantly increase in the odds of KD at a cut-off point.Conclusion
Persistent fever, elevated ESR, and negative urine nitrite test can serve as early clues to suspect KD in febrile infants with pyuria.3.
Objectives
To determine the effect of breastfeeding education provided to fathers on breastfeeding rates and paternal-infant attachment.Methods
117 couples with their infants with the inclusion criteria: knowledge of reading, writing and speaking Turkish; living in the Turkish Republic of North Cyprus until their infants were six months old; and infants having no health problems preventing the early initiation of breastfeeding. Participants were divided into 3 groups (2 experimental and 1 control). Breastfeeding education was provided to the mothers (20 min/d) in the first group (n=38) and to the mothers and fathers in the second group (n=39) (20 min/d/parent) until they were discharged from the hospital. This education was supplemented by a training booklet. The parents and their infants were followed until the infants were six months old. Exclusive breastfeeding rates and Paternal-Infant Attachment Scale scores at six months were main outcome measures.Results
Exclusive breastfeeding rates (56.4%, 33.3% and 12.8%; P<0.001) and mean (SD) Paternal-Infant Attachment Scale scores [89.51(7.05), 82.37 (12.80) and 73.38 (18.67); P<0.001] were highest in the group where education was provided to both mother and father.Conclusions
Providing breastfeeding education to fathers increases exclusive breastfeeding rates and strengthens paternal attachment.4.
Purpose
The purpose was to compare the resource utilization and outcomes between patients with suspected (SUSP) and confirmed (CONF) non-accidental trauma (NAT).Methods
The institutional trauma registry was reviewed for patients aged 0–18 years presenting from 2007 to 2012 with a diagnosis of suspicion for NAT. Patients with suspected and confirmed NAT were compared.Results
There were 281 patients included. CONF presented with a higher heart rate (142?±?27 vs 128?±?23 bpm, p?<?0.01), lower systolic blood pressure (100?±?18 vs 105?±?16 mm Hg, p?=?0.03), and higher Injury Severity Score (15?±?11 vs 9?±?5, p?<?0.01). SUSP received fewer consultations (1.6?±?0.7 vs 2.4?±?1.1, 95% CI ? 0.58 to ? 0.09, p?<?0.01) and had a shorter length of stay (1.6?±?1.3 vs 7.8?±?9.8 days, 95% CI ? 4.58 to ? 0.72, p?<?0.01). SUSP were more often discharged home (OR 94.22, 95% CI: 21.26–417.476, p?<?0.01). CONF had a higher mortality rate (8.2 vs 0%, p?<?0.01).Conclusions
Patients with confirmed NAT present with more severe injuries and require more hospital resources compared to patients in whom NAT is suspected and ruled out.5.
Background
Kawasaki disease (KD) is sometimes confused with urinary tract infection (UTI) because both can present with pyuria and C-reactive protein (CRP) elevation. The present study investigated the clinical and laboratory findings that can differentiate KD from UTI in febrile children with pyuria and CRP elevation.Methods
Medical records were retrospectively reviewed for children with KD and those with UTI. The clinical and laboratory findings between the KD with pyuria group (n?=?48) and the UTI group (n?=?118) were compared.Results
The KD with pyuria group had older age (P?<?0.001) and longer duration of fever (P?<?0.001) than the UTI group. In blood tests, both groups showed increased CRP level, but the value of CRP was higher in the KD with pyuria group than in the UTI group (P?<?0.001). The KD with pyuria group also showed higher values for liver enzymes than the UTI group (P?<?0.001); >?70.0% of children in the KD with pyuria group, but <?20.0% of children in the UTI group possessed elevated liver enzymes (P?<?0.001). On urinalysis, 40.7% of the UTI group had a positive nitrite test, but 0.0% of the KD with pyuria group had a positive nitrite test (P?<?0.001).Conclusions
Elevated liver enzymes are more specific to KD than to UTI, whereas a positive nitrite test is more specific to UTI than to KD. Our findings can be used as diagnostic clues to differentiate KD from UTI in febrile children with pyuria and CRP elevation.6.
Sourabh Dutta Sarvendra Singh Anish Bhattacharya Sundaram Venkataseshan Praveen Kumar 《Indian pediatrics》2017,54(2):121-124
Objective
To compare thyroid hormone levels between septicemic preterm neonates with and without shock.Methods
Preterm septicemic infants with shock constituted Group A (n=36) and those without shock constituted Group B, with groups matched (1:1) for gestation and postnatal age. Those with maternal thyroid disorders, thyrotropic medication and life expectancy <12 hours were excluded. We compared serum tri-iodothyronine (T3), thyroxine (T4) and thyroid-stimulating hormone (TSH) between the groups by univariate and multivariate (adjusting for SNAPPE-II) analysis.Results
Median (IQR) TSH was significantly lower in Group A [1.39 (0.83,3.48)] vs Group B [5.1 (2.32,7.19)] mmol/dL (P<0.001). Serum T3 and T4 were also lower in Group A (P<0.001). On multivariate analysis, none of these measures were independently associated with septic shock.Conclusions
Thyroid hormone levels do not independently predict presence of shock among septic preterms.7.
Nazan Ulgen Tekerek Basak Nur Akyildiz Baris Derya Ercal Sabahattin Muhtaroglu 《Indian journal of pediatrics》2018,85(6):426-432
Objective
To detect the most effective biomarker to confirm ventilator associated pneumonia (VAP).Methods
Fifty patients with VAP suspicious diagnosis and 30 healthy patients were recruited. Suspicion of VAP was established if patients met the modified CPIS score?≥?6 points. The confirmation of VAP was defined by the quantitative culture of nonbronchoscopic bronchoalveolar lavage (BAL) >105 CFU/ml of pathogenic microorganism. Serum samples for determination of C-reactive protein (CRP), procalcitonin (PCT), pentraxin 3 (PTX3), surfactant protein D (SPD) were collected on suspected VAP.Results
Twenty seven of 50 patients were accepted as confirmed VAP group whose nonbronchoscopic BAL cultures were positive and rest of them were accepted as unconfirmed VAP group. PTX3, PCT and SPD levels were significantly higher in confirmed VAP group, (P?=?0.021, P?=?0.007, P?<?0.001 respectively). There were no significant differences in CRP levels between the two groups (P?=?0.062). The most sensitive marker for diagnosing VAP was SPD (P?<?0.001). Receiver operating characteristic (ROC) curve for modified clinical pulmonary infection score (CPIS) to confirm VAP was evaluated (AUC 0.741?±?0.07, P?<?0.001) and the optimal cutoff value was >7 with a sensitivity of 51.85% and a specificity of 91.3%. SPD levels were significantly higher in Acinetobacter baumannii and Pseudomonas aeruginosa infected patients than culture negative patients (P?<?0.001).Conclusions
The index findings suggest that serum SPD is the most sensitive biomarker in diagnosis of VAP and it can be used as an early and organism specific marker for Acinetobacter baumannii and Pseudomonas aeruginosa.8.
Pinky Meena Aashima Dabas Dheeraj Shah Rajeev Kumar Malhotra S. V. Madhu Piyush Gupta 《Indian pediatrics》2017,54(2):105-111
Objective
To correlate the sunlight exposure in first 6 months to vitamin D status at 6 months of age in predominantly breastfed infants; and to quantify the sunlight exposure required to achieve serum 25(OH)D level >20 ng/mL, by 6 months of ageDesign
Prospective cohort.Setting
Tertiary-care hospital predominantly catering to urban poor population in Delhi.Participants
132 healthy infants, delivered at term, and predominantly breastfed were enrolled at 6-8 weeks of age. Of these, 100 infants were available for final evaluation at 6 months of age (mean (SD) follow-up: 126 (17) days).Methods
Baseline maternal vitamin D (serum 25(OH)D) levels were obtained at enrolment. The mothers were asked to maintain a daily record of duration of sunlight exposure, timing of exposure, and body surface area exposed, for the infant, on a pre-designed proforma, till the child was 6 months of age. Infant’s serum 25(OH)D was measured at 6 months of age.Main outcome measures
Cumulative Sun Index was calculated as a composite measure of overall duration/time/body surface area exposed to sunlight; and correlated with the infant serum 25(OH)D after adjusting for baseline maternal serum 25(OH)D levels, season of exposure, and skin color of the infant. Sun index for exposure in morning (before 10 am) and afternoon (10 am-3 pm) were also correlated to vitamin D status.Results
Of 100 mother-infant pairs completing the study, 90 mothers had vitamin D deficiency (serum 25(OH)D <12 ng/mL). The median duration of exposure of infants to sunlight was 17 min per week, on 6% of body surface area. Vitamin D levels of 67 (67%) infants at 6 months were less than 12 ng/mL and another 23% had insufficient levels (12-20 ng/mL). Cumulative sun index correlated positively to infant’s serum 25(OH)D level at 6 months of age (r= 0.461, P<0.001). Increment in afternoon sun index by 1 unit increased the serum 25(OH)D level by 1.07 ng/mL (95% CI 0.37, 1.78; P= 0.003). A minimum 30 minute weekly afternoon sunlight exposure, between 10 am and 3 pm, over 40% body area (infant clothed in diapers, in prone position) for at least 16 weeks, was estimated requirement to achieve sufficient vitamin D levels (>20 ng/mL) by 6 months of age.Conclusions
There is a significant positive correlation between afternoon sunlight exposure and infant’s vitamin D levels, independent of maternal vitamin D status. Randomized controlled trials are suggested to explore the effectiveness of this simple intervention to prevent or treat vitamin D deficiency in children.9.
Objective
To investigate vitamin D levels in patients with recurrent wheeze at early ages of childhood.Methods
In the present cross-sectional study, serum 25-hydroxy vitamin D [25 (OH)D], levels which is known as an indicator of vitamin D adequacy, was examined in infants with three or more wheezing attacks.Results
A total of 186 infants with recurrent wheezing were included in the study along with 118 healthy control peers. The recurrent wheezing study participants were classified into two groups according to Asthma Predictive Index (API) positivity and compared to control subjects regarding their serum vitamin D status. The API negative group had the lowest mean serum 25 (OH)D level (n = 121; 22.71 ± 10.76 ng/ml) followed by API positive group (n = 65; 24.08 ± 9.02 ng/ml) compared to healthy group (26.24 ± 11.88 ng/ml) (p < 0.05). In addition, higher vitamin D deficiency was observed in infants in API negative group (52.1 %; p < 0.01) and API positive group (38.5 %; p < 0.05) than control group (31.4 %).Conclusions
Low levels of 25 (OH)D were detected in infants with two different phenotypes of recurrent wheeze. Vitamin D deficiency may play a role in the pathogenesis of infants with recurrent wheezing.10.
Ismail Mohamed Elhawary Eman Abdel Ghany Abdel Ghany Walaa Alsharany Aboelhamed Shahinaz Gamal Eldin Ibrahim 《World journal of pediatrics : WJP》2018,14(4):350-356
Background
To determine the incidence and risk factors of post-phototherapy rebound hyperbilirubinemia because data about bilirubin rebound in neonates are lacking and few studies have concerned this condition.Methods
A prospective observational study was conducted on 500 neonates with indirect hyperbilirubinemia who were treated according to standard guidelines. Total serum bilirubin (TSB) was measured at 24–36 h after phototherapy; significant bilirubin rebound (SBR) is considered as increasing TSB that needs reinstitution of phototherapy.Results
A total of 124 (24.9%) neonates developed SBR with TSB increased by 3.4 (2.4–11.2) mg/dL after stopping phototherapy. Multiple logistic regression model revealed the following significant risk factors for rebound: low birth weight (B = 1.3, P < ?0.001, OR 3.5), suspected sepsis (B = 2.5, P < ?0.001, OR 12.6), exposure to intensive phototherapy (B = ?0.83, P = ?0.03, OR 2.3), hemolysis (B = ?1.2, P < ?0.001, OR 3.1), high discharge bilirubin level (B = ?0.3, P = ?0.001, OR 1.3), and short duration of conventional phototherapy (B = ?? 1.2, P < ?0.001, OR 0.3).Conclusions
SBR should be considered in neonates with hemolysis, low birth weight, suspected sepsis, short duration of conventional phototherapy, exposure to intensive phototherapy, and relatively high discharge TSB. These risk factors should be taken into account when planning post-phototherapy follow-up.11.
Xin-Ting Yu Avi Sadeh Hugh Simon Lam Jodi A. Mindell Albert Martin Li 《World journal of pediatrics : WJP》2017,13(5):496-502
Background
To describe the sleep patterns of children below 36 months in Hong Kong, and evaluate the associations between parental behaviors and childhood sleep/wake patterns.Methods
Parents of 1049 infants and toddlers completed an internet-based expanded version of the Brief Infant Sleep Questionnaire.Results
Total sleep duration (P<0.001), frequency (P<0.001) and duration (P<0.001) of nocturnal awakenings decreased with age, whereas the longest sleep duration (P<0.001) and nocturnal sleep duration (P<0.001) increased with age. Children who room- or bed-shared with parents had later bedtimes (P<0.001), but similar sleep duration compared with those who had a separate sleep location. Falling asleep independently was associated with longer nocturnal sleep duration (P<0.001) and less sleep awakenings (P<0.001). Full-time employment of parents was associated with shorter total sleep duration of children (P<0.001). Although breastfeeding was associated with more nocturnal awakenings (P<0.001), no association was detected between breastfeeding and shorter sleep duration in children.Conclusions
As infants and toddlers develop, their sleep consolidates. Falling asleep independently was associated with longer nocturnal sleep duration and fewer sleep awakenings, whereas sleep location was not. This is an important finding, especially for families with limited living space where parent/child room- or bed-sharing cannot be avoided.12.
Background
Gastroschisis is the most common congenital abdominal wall defect. Due to the exposure of midgut to amniotic fluid, the recovery of bowel function is often delayed. This study aimed to identify the factors associated with the successful early enteral feeding in gastroschisis and to develop further guidelines of treatment.Methods
A retrospective cohort study of gastroschisis babies from January 2006 to December 2015 was done. Exclusion criteria were incomplete data and death. Successful early enteral feeding was defined when full feeding was achieved within 21 days of life.Results
One hundred and five gastroschisis patients were divided into a successful early-feeding group (n?=?56, 53%) and a non-successful early-feeding group (n?=?49, 46%). In multivariable analysis, significant factors for successful feeding clustered by primary treatment were female (RR?=?1.38, P value <?0.001), gestational age >?36 weeks (RR?=?1.23, P value <?0.001), age at surgery less than 10 h (RR?=?1.15, P value <?0.001), postoperative extubation time <?4 days (RR?=?1.39, P value <?0.001), and age when feeding started less than 10 days (RR?=?35.69, P value?<?0.001).Conclusion
Several factors were found to be associated with successful early enteral feeding. The modifiable factors found in this study were surgery within 10 h, early postoperative extubation within 4 days, and feeding started before 10 days of life. These will guide the management of gastroschisis to achieve successful early enteral feeding.13.
Objective
To evaluate the perioperative risk factors for 30-day complications of the Kasai procedure in a large, cross-institutional, modern dataset.Study design
The 2012–2015 National Surgical Quality Improvement Program Pediatric database was used to identify patients undergoing the Kasai procedure. Patients’ characteristics were compared by perioperative blood transfusions and 30-day outcomes, including complications, reoperations, and readmissions. Multivariable logistic regression was used to identify risk factors predictive of outcomes. Propensity matching was performed for perioperative blood transfusions to evaluate its effect on outcomes.Results
190 children were included with average age of 62 days. Major cardiac risk factors were seen in 6.3%. Perioperative blood transfusions occurred in 32.1%. The 30-day post-operative complication rate was 15.8%, reoperation 6.8%, and readmission 15.3%. After multivariate analysis, perioperative blood transfusions (OR?3.94; p?<?0.01) and major cardiac risk factors (OR?7.82; p?<?0.01) were found to increase the risk of a complication. Perioperative blood transfusion (OR?4.71; p?=?0.01) was associated with an increased risk of reoperation. Readmission risk was increased by prematurity (OR?3.88; p?=?0.04) and 30-day complication event (OR?4.09; p?=?0.01). After propensity matching, perioperative blood transfusion was associated with an increase in complications (p?<?0.01) and length of stay (p?<?0.01).Conclusion
Major cardiac risk factors and perioperative blood transfusions increase the risk of post-operative complications in children undergoing the Kasai procedure. Further research is warranted in the perioperative use of blood transfusions in this population.Level of evidence
IV.14.
Janet Sharpe Mandy Way Pieter J. Koorts Mark W. Davies 《World journal of pediatrics : WJP》2018,14(5):492-497
Background
To determine whether the introduction of pasteurized donor human milk and probiotics for infants born?<?32 weeks gestational age or?<?1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis.Methods
We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donor human milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression.Results
There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P?<?0.001) and incidence of sepsis (6.2 vs. 3.5%, P?=?0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P?=?0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P?=?0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16–0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant.Conclusion
The availability of probiotics and pasteurised donor human milk is associated with a reduction in mortality in very preterm infants.15.
Purpose
The advent of laparoscopy has revolutionized surgical practice within the last 30 years. Conversion to open surgery, however, remains necessary at times, even for the most experienced laparoscopic surgeon.Methods
The kids’ inpatient database was analyzed for 2006, 2009, and 2012 for patients who underwent laparoscopic appendectomy and conversion to open (CPT 470.1 and V64.41, respectively). Variables included in multivariable analysis were determined based on those variables found to have significance on univariate analysis.Results
A total of 104,865 patients, ages 0–17 years, underwent laparoscopic appendectomy during the three study periods. Of these, 2370 (2.2%) laparoscopic surgeries were converted to open appendectomy. Multivariable logistic regression showed significantly higher rates of conversion amongst patients with peritonitis (OR 6.7, p?<?0.001) or abscess (OR 14.3, p?<?0.001), obesity (OR 2.02, p?<?0.001), age >?13 years (OR 1.53 for ages 13–15, OR 1.77 for ages 16–17, p?<?0.001 for both), or cared for at rural hospitals (OR 1.55, p?=?0.002). Rates of conversion decreased over time for children at adult hospitals and at urban hospitals, regardless of teaching status (p?<?0.001 for both).Conclusion
Risk factors for conversion from laparoscopic to open appendectomy included abscess, peritonitis, increased age, obesity, male gender, socioeconomic status and treatment at a non-pediatric-specific hospital, and the overall rate is decreasing over time.16.
Michael?R.?Arnold Blair?A.?Wormer Angela?M.?Kao David?A.?Klima Paul?D.?Colavita Graham?H.?Cosper Brant?Todd?Heniford Andrew?M.?Schulman
Purpose
To compare the effect of home intravenous (IV) versus oral antibiotic therapy on complication rates and resource utilization following appendectomy for perforated appendicitis.Methods
This was a randomized controlled trial of patients aged 4–17 with surgically treated perforated appendicitis from January 2011 to November 2013. Perforation was defined intraoperatively and divided into three grades: I—contained perforation, II—localized contamination to right gutter/pelvis, and III—diffuse contamination. Patients were randomized to complete a ten-day course of home antibiotic therapy with either IV ertapenem or oral amoxicillin–clavulanate. Thirty-day postoperative complication rates including abscess, readmission, wound infection, and charges were compared.Results
Eighty-two patients were enrolled. Forty four (54%) were randomized to the IV group and 38 (46%) to the oral group. IV patients were older (12.3?±?3.6 versus 10.1?±?3.6, p?<?0.05) with higher BMI (20.9?±?5.8 versus 17.9?±?3.5, p?<?0.05). There were no differences in gender, comorbidities, or perforation grade (I—20.4% vs. 26.3%, II—36.4% vs. 34.2%, III—43.2% vs. 39.5%, all p?>?0.05). Comparing IV to oral, there was no difference in length of stay (4.4?±?1.5 versus 4.4?±?2.0 days, p?>?0.05), postoperative abscess rate (11.6% vs. 8.1%, p?>?0.05), or readmission rate (14.0% vs. 16.2%, p?>?0.05). Hospital and outpatient charges were higher in the IV group (p?<?0.0001).Conclusion
Oral antibiotics had equivalent outcomes and incurred fewer charges than IV antibiotics following appendectomy for perforated appendicitis.17.
Juma?Obayashi Shigeyuki?Furuta Takuya?Kawaguchi Kohei?Kawaguchi Kei?Ohyama Hideki?Nagae Munechika?Wakisaka Hiroaki?Kitagawa
Background
We investigated the efficacy of broad-spectrum antibiotics for prevention of postoperative intra-abdominal abscess in pediatric acute appendicitis with our 3 risk factors:—WBC?>?16.5 (×?103/µl), CRP?>?3.1 (mg/dl) and appendix maximum short diameter on diagnostic imaging?>?11.4 mm.Methods
Four hundred twenty-two patients were reviewed. Patients with 0–1 risk factors were assessed as low-risk and those with 2–3 were high-risk. In the low-risk group, Group A (n?=?66) patients received broad-spectrum antibiotics and Group B patients (n?=?265) received narrow-spectrum monotherapy. In the high-risk group, Group C patients (n?=?63) received broad-spectrum antibiotics and Group D patients (n?=?28), narrow-spectrum antibiotics. The outcomes were the incidence of postoperative abscess and the total duration of intravenous (IV) antibiotics.Results
The incidence of intra-abdominal abscess was 6.06% in Group A versus 1.89% in Group B (p?=?0.08), and 19.05% in Group C versus 3.57% in Group D (p?=?0.06). Total IV antibiotic duration (days) were 6.12?±?2.87 in Group A versus 3.83?±?0.69 in Group B (p?<?0.01), and 7.84?±?4.57 in Group C versus 4.00?±?0.82 in Group D (p?<?0.01).Conclusion
Broad-spectrum antibiotics did not prevent postoperative intra-abdominal abscess in either low or high-risk groups.18.
Purpose
Inguinal hernias have been reported in as many as 10–30% premature neonates, making inguinal herniorrhaphy (IHR) one of the most commonly performed surgical procedures. The timing of surgery remains controversial. The purpose of this report is to compare outcomes of IHR while in the NICU (inpatient) versus repair following discharge (outpatient) to determine optimal timing.Methods
Premature neonates having undergone IHR over a 5-year period were identified and a retrospective case cohort analysis was performed.Results
263 patients underwent IHR during the 5-year study period with 115 (43.7%) having surgical repair inpatient (IP; prior to discharge) and 148 having outpatient herniorrhaphy (OP). Patients with IHR performed IP had significantly lower birth weight (p?<?0.001), gestational age (p?<?0.001), longer duration of surgery (p?=?0.01) and were more likely to have post-operative ventilator dependence following repair; however, there were no differences in the rate of recurrence (p?=?0.44) and incarceration (p?=?0.45).Conclusion
Our study demonstrated no significant differences in the rates of incarceration or recurrence, following in- or out-patient IHR. These findings suggest that IHR can potentially be offered as an outpatient procedure following hospital discharge in appropriate patients. The optimal timing of IHR in premature infants remains elusive and will likely require additional multicenter investigation.19.
20.