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1.
Joseph C. Fusco Juan L. Calisto Barbara A. Gaines Marcus M. Malek 《Journal of pediatric surgery》2018,53(1):118-120
Introduction
Transanastomatic feeding tube (TAT) use in the repair of tracheoesophageal fistulas (TEF) with or without esophageal atresia (EA) and EA with or without TEF allows for earlier enteral feedings, however, may predispose to esophageal stricture.Methods
We review our institutional experience with esophageal atresia repair over a 15-year period from 2000 to 2015 and report on our observed complication rate with emphasis on the surgical approach and use of TATs.Results
We identified 110 TEF repairs. Ninety-six were Type C, 7 were Type A, 4 were Type D, and 3 were Type E (H-Type). TATs were used in 74% of patients. The stricture rate with the TAT approached 56% versus 17% without a TAT (p < 0.0005). There was no difference in leak rate (p = 0.27). Ninety-four TEF repairs were performed via open thoracotomy, and 16 were initially approached thoracoscopically. Six out of 16 that were started thoracoscopically were completed with the minimally invasive approach. Whether the case was started thoracoscopically, completed thoracoscopically, or performed open made no difference in the rate of stricture or anastomotic leak, but we did observe an increase in musculoskeletal complications in the open thoracotomy group (28% vs. 0).Conclusion
Our data suggests that the use of TATs does not protect against anastomotic leak, but may increase stricture rate. Further, the thoracoscopic group showed no difference in the leak or stricture rate and demonstrated less musculoskeletal complications. Confirmation of these findings will require a prospective study.Level of evidence
III. 相似文献2.
Katherine J. Baxter Lauren M. Baxter April M. Landry Mark L. Wulkan Amina M. Bhatia 《Journal of pediatric surgery》2018,53(9):1655-1659
Background
Long-term dysphagia occurs in up to 50% of repaired esophageal atresia and tracheoesophageal fistula (EA/TEF) patients. The underlying factors are unclear and may include stricture, esophageal dysmotility, or associated anomalies. Our purpose was to determine whether structural airway abnormalities (SAA) are associated with dysphagia in EA/TEF.Methods
We conducted a retrospective chart review of children who underwent EA/TEF repair in our hospital system from 2007 to 2016. Children with identified SAA (oropharyngeal abnormalities, laryngeal clefts, laryngomalacia, vocal cord paralysis, and tracheomalacia) were compared to those without airway abnormalities. Dysphagia outcomes were determined by the need for tube feeding and the modified pediatric Functional Oral Intake Scale (FOIS) at 1 year.Results
SAA was diagnosed in 55/145 (37.9%) patients with EA/TEF. Oropharyngeal aspiration was more common in children with SAA (58.3% vs. 36.4%, p = 0.028). Children with SAA were more likely to require tube feeding both at discharge (79.6% vs. 48.3%, p < 0.001) and at 1 year (52.7% vs. 13.6%, p < 0.001) and had lower mean FOIS (4.18 vs. 6.21, p < 0.001). In the logistic regression model adjusting for gestational age, long gap EA, and esophageal stricture, the presence of SAA remained a significant risk factor for dysphagia (OR 4.17 (95% CI 1.58–11.03)).Conclusion
SAA are common in children with EA/TEF and are associated with dysphagia, even after accounting for gestational age, esophageal gap and stricture. This study highlights the need for a multidisciplinary approach, including early laryngoscopy and bronchoscopy, in the evaluation of the EA/TEF child with dysphagia.Level of evidence
Level II retrospective prognostic study 相似文献3.
Michaela Dellenmark-Blom Linus Jönsson Vladimir Gatzinsky Kate Abrahamsson 《Journal of pediatric surgery》2018,53(10):1970-1975
Background/purpose
In a sparsely investigated field, we aimed to evaluate the use of special preschool/school support among children with repaired esophageal atresia (EA) and/or tracheoesophageal fistula (TEF), the predicting clinical factors for this support, and level of school absence.Methods
Data on 119 EA/TEF children 2–17 years old were collected through medical records and questionnaires (response rate 95%). Logistical regression analysis identified clinical predictors of special preschool/school support in the population without genetic disorders (n = 105). Nominal hypothesis testing was performed using Fisher's exact test (p < 0.05).Results
Of the 119 children, 35.3% received special preschool/school support; 26.8% educational support, 21.8% support with nutritional intake issues and 13.4% received both types of support. Educational support was independently predicted by birth weight < 2500 g (p = 0.026) and associated anomalies (p = 0.049), nutritional intake support by gastrostomy insertion (p = 0.0028), and both types of supports by major revisional surgery (p = 0.0081). School absence ≥ 1 month/year, present in 25.5% of the children, was more frequently reported in children receiving preschool/school support, in preschoolers and in those with persistent respiratory problems (p < 0.05).Conclusions
Special preschool/school support is provided for approximately one-third of EA/TEF children. In EA/TEF children without genetic disorders, use of this support is predicted by congenital and surgical factors, and related to frequent school absence. 相似文献4.
Wegdan Mawlana Paul Zamiara Hilary Lane Margaret Marcon Eveline Lapidus-Krol Priscilla PL Chiu Aideen M Moore 《Journal of pediatric surgery》2018,53(9):1651-1654
Background
Esophageal atresia with or without tracheoesophageal fistula (EA/TEF) is a complex disorder, and most outcome data are confined to mortality and feeding-related morbidities. Our objective was to examine mortality, growth and neurodevelopmental outcomes in a large recent cohort of infants with EA/TEF.Methods
Single center study of EA/TEF infants referred from January 2000 to December 2015. Data collected included associated defects, neonatal morbidity and mortality and growth and neurodevelopmental outcomes at age 12–36 months. Multiple regression analysis was used to determine variables associated with adverse outcome.Results
Of the 253 infants identified, 102 infants (40%) were preterm. Overall mortality was 8.3%, the majority from major cardiac malformations (p < 0.001) Neurodevelopmental assessments (n = 182) showed that 76% were within normal, while some delay was seen in 24%, most often in expressive and receptive language. Nine infants had hearing impairment and 5 had visual impairment. Gastrostomy tubes were required in 47 patients and 15% continued to have weight growth velocities less than the 10th centile. A number of specialist interventions were required, Speech/Language being frequent.Conclusion
Mortality in EA/TEF is primarily related to concomitant anomalies, especially cardiac. Multidisciplinary follow up is important for early identification and intervention for growth failure and developmental delay.Type of study
Retrospective studyLevel of evidence
Level II 相似文献5.
Mackenzie C. Lees Ioana Bratu Maryna Yaskina Michael van Manen 《Journal of pediatric surgery》2018,53(5):929-932
Purpose
The purpose of this study was to explore oral feeding outcomes in infants born with type-C esophageal atresia and tracheoesophageal fistula (EA/TEF).Methods
A retrospective cohort study of all infants born between January 2005 and December 2015 undergoing surgery for type-C EA/TEF at the University of Alberta Hospital was performed.Results
Fifty-seven infants were identified, of which 61.4% were exclusively orally feeding at discharge home. Variables anticipated to predict oral feeding were explored. Only 46% of babies with a structural cardiac anomaly had exclusive oral feeding compared to 79% without cardiac anomaly, p = 0.055. Logistic regression identified the presence of structural cardiac anomaly and corrected gestational age at discharge as significant negative predictor variables for exclusive oral feeding at discharge home. Additional regression analyses found early transanastomotic feeding to be a significant positive predictor for the discontinuation of PN.Conclusion
We report the rate of oral feeding at discharge for infants born with type-C EA/TEF and identify predictor variables. This information is important for health care professionals and the families of children born with EA/TEF, because a significant number will go home with supplemental nutrition by gavage tube or other routes.Level of Evidence
Level 2. 相似文献6.
Steven S. Rothenberg 《Journal of pediatric surgery》2018,53(1):121-125
Purpose
This study evaluates the results of thoracoscopic management of complex, non-type C, EA and TEF in infants.Methods
From March 2000 to February 2017, 23 patients were treated for Type A N = 13, Type B N = 4, and Type E N = 6. Patients diagnosed with EA had G-tube feeds for a period of 4–9 weeks. All procedures were performed thoracoscopically. EA gaps were between 4 and 7 1/2 vertebral bodies.Results
All surgeries were completed thoracoscopically. Average operative time was 95 min for Type A, 115 min for Type B, and 50 min for Type E. Two patients with long gaps had small leaks which resolved with conservative management. One patient with an H-type was re-intubated causing a partial disruption of the tracheal repair. This required thoracoscopic re-exploration with repair and placement of an intercostal muscle flap. No patient has any clinical evidence of fused ribs, chest wall asymmetry, shoulder girdle weakness, or winged scapula.Conclusion
Thoracoscopic repair of complex EA and TEF is safe and effective. The excellent visualization of the thoracic inlet allows for extensive mobilization creating sufficient length for long gaps and safely managing high fistulas. This may limit injury to adjacent structures and avoid a neck incision and chest wall deformity.Level of evidence
IV. 相似文献7.
8.
Sarah Tracy Terry L. Buchmiller Offir Ben-Ishay Carol E. Barnewolt Susan A. Connolly David Zurakowski Andrew Phelps Judy A. Estroff 《Journal of pediatric surgery》2018,53(6):1137-1141
Background/Purpose
Although advances have been made in the prenatal diagnosis of esophageal atresia (EA), most neonates are not identified until after birth. The distended hypopharynx (DHP) has been suggested as a novel prenatal sign for EA. We assess its diagnostic accuracy and predictive value on ultrasound (US) and magnetic resonance imaging (MRI), both alone and in combination with the esophageal pouch (EP) and secondary signs of EA (polyhydramnios and a small or absent fetal stomach).Methods
We retrospectively reviewed fetal US and MRI reports and medical records of 88 pregnant women evaluated for possible EA from 2000 to 2016. Seventy-five had postnatal follow-up that confirmed or disproved the diagnosis of EA and were included in our analysis.Results
Seventy-five women had 107 study visits (range 1–4). DHP and/or EP were seen on US and/or MRI in 36% of patients, and 78% of those patients had EA. DHP was 24% more sensitive for EA than EP, while EP was 30% more specific. After 28 weeks of gestation, DHP had a predictive accuracy for EA of 0.929 (P = 0.001).Conclusions
DHP is a sensitive additional prenatal sign of EA. More accurate diagnosis of EA allows for improved counseling regarding delivery, postnatal evaluation, and surgical correction.Type of Study
Diagnostic.Level of Evidence
Level II. 相似文献9.
William C. Kethman Chad M. Thorson Tiffany J. Sinclair William E. Berquist Stephanie D. Chao James K. Wall 《Journal of pediatric surgery》2018,53(8):1532-1536
Background
Achalasia is a primary esophageal motility disorder characterized by aperistalsis of the esophagus and failed relaxation of the lower esophageal sphincter that presents rarely in childhood. The peroral endoscopic myotomy (POEM) procedure is an emerging treatment for achalasia in adults that has recently been introduced into pediatric surgical practice.Methods
This is a prospective case series of all children referred to Stanford University Lucile Packard Children's Hospital with manometry-confirmed achalasia who underwent a POEM procedure from 2014 to 2016.Results
We enrolled 10 subjects ranging in age from 7 to 17 years (M = 13.4). The mean pre- and 1-month post-procedure Eckardt scores were 7 (SD = 2.5) and 2.4 (SD = 2) (p < 0.001), respectively. The median procedure time for the entire cohort was 142 min (range 60–259 min) with ongoing improvement with increased experience (R2 = 0.6, p = 0.008). There were no major adverse events.Conclusion
The POEM procedure can be successfully completed in children for the treatment of achalasia with demonstrated short-term post-operative improvement in symptoms. The adoption of advanced endoscopic techniques by pediatric surgeons may enable development of unique intraluminal approaches to congenital anomalies and other childhood diseases.Level of evidence
Treatment Study – Level IV 相似文献10.
Jake D Foster Nigel J Hall S Charles Keys David M Burge 《Journal of pediatric surgery》2018,53(11):2331-2335
Background
Many pediatric surgeons have limited experience of esophageal replacement. This study reports outcomes of esophageal replacement by gastric transposition performed by a single UK-based pediatric surgeon.Methods
Consecutive patients were identified who underwent esophageal replacement by gastric transposition over a 28?year period. Clinical and demographic data were collected. Weight-for-age Z-scores were calculated for esophageal atresia patients.Results
Nineteen patients were identified. Indication in the majority was long-gap esophageal atresia (n?=?17; 10 with tracheoesophageal fistula). At surgery, median age was 8.5?months (range 2–55); median weight was 7.4?kg (range 4.0–17.4?kg). A right-sided thoracotomy or transhiatal approach was used. Median postoperative length of stay was 17.5?days (range 7–130); median intensive care stay was three days (range 1–63). There were no deaths. Anastomotic leak rate at 30?days was 10.5% (n?=?2). One patient required early stricture dilatation. Median weight-for-age Z-score increased from ? 2.17 at one year of age to ? 1.86, ? 1.70 and ? 1.93 at 5, 10 and 15?years.Conclusions
Esophageal replacement by gastric transposition offers a potentially life-changing treatment; however, it is associated with significant morbidity. The majority of patients eventually achieve full oral feeding and maintenance of weight gain trajectory. A right-sided approach to the esophagus is feasible.Type of Study
Treatment Study.Level of Evidence
IV. 相似文献11.
Colin Muncie Michael Morris Barry Berch David Sawaya Christopher Blewett 《Journal of pediatric surgery》2018,53(1):126-129
Purpose
The safety and effectiveness of a stapled intestinal anastomosis in adults, children, and infants is well documented. However, in neonates it is not well validated. We hypothesized that premature infants who received a stapled bowel anastomosis utilizing endoscopic staplers had similar outcomes compared to patients with a handsewn anastomosis.Methods
A retrospective study was performed reviewing premature infants who underwent an intestinal anastomosis over a 4-year period. Patients greater than 36 weeks gestational age at birth or a weight greater than 5 kg at surgery were excluded. Patient demographics, type of intestinal anastomosis, and anastomotic related complications within 3 months were collected and analyzed.Results
Sixty-five patients underwent 71 operations involving an intestinal anastomosis: 33 cases were handsewn, and 38 cases were stapled. Groups were noted to have differences in age, weight, and diagnosis. Complications including leak and anastomotic stricture did not differ between groups. Reports of blood per rectum after surgery were more common in the stapled group (24% versus 6%, p = 0.0522), but this did not reach statistical significance.Conclusion
There were no significant differences in anastomotic complications when comparing the handsewn and stapled intestinal anastomosis techniques in premature infants weighting less than 5 kg.Type of study
Treatment Study.Level of evidence
III. 相似文献12.
Suna Sun Weihua Pan Wenjie Wu Yiming Gong Jia Shi Jun Wang 《Journal of pediatric surgery》2018,53(8):1584-1587
Objectives
The treatment of long gap esophageal atresia (LGEA) is one of the most challenging congenital malformations in neonatal surgery. A preoperative bougienage stretching technique for elongation of the two segments of esophagus is applied to achieve utilizing the native esophagus to establish esophageal continuity by open or thoracoscopic approach.Methods
From January 2015 to May 2017, 12 neonates who suffered from LGEA were admitted to our department. They were divided into 2 groups (A and B) according to their admission time. They all accepted bougienage stretching technique before esophageal anastomosis.Results
Initially the lengths of esophageal gap in 12 infants ranged from 4 to 7.5 vertebral bodies (M = 5.8 ± 1.1). The gap lengths became –1 to 2.5 vertebral bodies after bougienage stretching technique and tension-free anastomosis were performed successfully for all 12 cases: Group A (n = 5) by thoracotomy and group B (n = 7) by thoracoscopic approach. 12 cases have been followed up for 1–25 months (M = 12.4 ± 8.5) after definitive surgery.Conclusions
Bougienage stretching technique for LGEA is feasible with satisfactory clinical results. Thoracoscopic approach is a good choice for primary anastomosis in LGEA.Levels of evidence
Treatment Study Level IV 相似文献13.
Chase A. Arbra Andra Oprisan Dulaney A. Wilson Rita M. Ryan Aaron P. Lesher 《Journal of pediatric surgery》2018,53(6):1187-1191
Background
For infants with necrotizing enterocolitis (NEC) treated nonoperatively, no consensus exists on the optimal fasting period prior to reintroducing feeds after NEC. We report our experience with early (< 7 days) and late (≥ 7 days) refeeding in this population.Methods
A chart review of infants with NEC born between 2006 and 2016 was performed. Data elements include demographics, comorbidities, day of diagnosis, Bell's stage, recurrence, strictures, length of stay and mortality, and were grouped into early and late refeeding. T-tests were used for means and chi-squared tests for distribution of proportions. Linear and logistic regressions were used to further evaluate the association of length of stay, stricture, recurrence, and death with time to refeeding.Results
Of 228 NEC patients, 149(65%) were treated nonoperatively (Bell Stages I, IIA, IIB, IIIA). Eleven patients were excluded owing to never restarting feeds, largely secondary to early death. The early (n = 40) and late refeeding (n = 98) groups were not significantly different with regard to mean gestational age at birth, race, birth weight, day of life at NEC diagnosis, or cardiac disease. NEC Stage was significantly different (p < 0.001). The late group had significantly more Stage IIB patients (p = .02), and the early group had more stage I patients (p = < 0.01). After adjusting for Bell's stage, the odds of NEC recurrence, death, and the composite outcome of recurrence or stricture or death were not significantly different between early and late groups.Conclusions
No standardized guidelines exist for restarting enteral nutrition following medical NEC. In patients managed nonoperatively, early reintroduction of feeding was not significantly associated with increased NEC recurrence, mortality, or stricture.Level of evidence
Treatment Study – Level III. 相似文献14.
Tiffany J. Zens Andrew P. Rogers Erica L. Riedesel Charles M. Leys Daniel J. Ostlie Michael A. Woods Kara G. Gill 《Journal of pediatric surgery》2018,53(6):1168-1174
Introduction
Contrast-enhanced CT remains the first-line imaging for evaluating postoperative abscess (POA) after appendicitis. Given concerns of ionizing radiation use in children, we began utilizing quick MRI to evaluate POA and summarize our findings in this study.Materials and Methods
Children imaged with quick MRI from 2015 to 2017 were compared to children evaluated with CT from 2012 to 2014 using an age and weight matched case–control model. Radiation exposure, size and number of abscesses, length of exam, drain placement, and patient outcomes were compared.Results
There was no difference in age or weight (p > 0.60) between children evaluated with quick MRI (n = 16) and CT (n = 16). Mean imaging time was longer (18.2 ± 8.5 min) for MRI (p < 0.001), but there was no difference in time from imaging order to drain placement (p = 0.969). No children required sedation or had non-diagnostic imaging. There were no differences in abscess volume (p = 0.346) or drain placement (p = 0.332). Thirty-day follow-up showed no difference in readmissions (p = 0.551) and no missed abscesses. Quick MRI reduced imaging charges to $1871 from $5650 with CT.Conclusion
Quick MRI demonstrated equivalent outcomes to CT in terms of POA detection, drain placement, and 30-day complications suggesting that MRI provides an equally effective, less expensive, and non-radiation modality for the identification of POA.Type of Study
Retrospective Case–Control Study.Level of Evidence
Level III. 相似文献15.
Background
The Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirements state that faculty must establish and maintain an environment of inquiry and scholarship. Bibliometrics, the statistical analysis of written publications, assesses scientific productivity and impact. The goal of this study was to understand the state of scholarship at Pediatric Surgery training programs.Methods
Following IRB approval, Scopus was used to generate bibliometric profiles for US Pediatric Surgery training programs and faculty. Statistical analyses were performed.Results
Information was obtained for 430 surgeons (105 female) from 48 US training programs. The mean lifetime h-index/surgeon for programs was 14.4 +/? 4.7 (6 programs above 1 SD, 9 programs below 1 SD). The mean 5-year h-index/surgeon for programs was 3.92 +/? 1.5 (7 programs above 1 SD, 8 programs below 1 SD). Programs accredited after 2000 had a lower lifetime h-index than those accredited before 2000 (p = 0.0378). Female surgeons had a lower lifetime h-index (p < 0.0001), 5-year h-index (p = 0.0049), and m-quotient (p < 0.0001) compared to males. Mean lifetime h-index increased with academic rank (p < 0.0001), with no gender differences beyond the assistant professor rank (p = NS).Conclusion
Variability was identified based on institution, gender, and rank. This information can be used for benchmarking the academic productivity of faculty and programs and as an adjunct in promotion/tenure decisions.Type of Study
Original Research.Level of Evidence
n/a. 相似文献16.
Kohei Otake Keiichi Uchida Michiko Kubo Akira Yamamoto Yuka Nagano Ryo Uratani Kiyoshi Hashimoto Kohei Matsushita Mikihiro Inoue Hirofumi Sawada Masato Kusunoki 《Journal of pediatric surgery》2018,53(3):499-502
Background/purpose
The purpose of this study was to explore clinical characteristics and primary surgical diagnoses associated with in-hospital death in pediatric surgical patients admitted to the neonatal intensive care unit (NICU) of a tertiary hospital.Methods
This retrospective study includes all patients admitted to our NICU for pediatric surgical diseases between January 2001 and December 2015. Univariate and multivariate binary logistic regression were performed to assess independent factors associated with in-hospital death.Results
A total of 440 cases were included and 334 (83.5%) patients underwent one or more surgeries. Thirty six patients (8.2%) died while hospitalized in the NICU. The 5 most common surgical diagnoses were intestinal atresia/stenosis, anorectal malformation, congenital diaphragmatic hernia (CDH), esophageal atresia, and urinary system disorder. Necrotizing enterocolitis (NEC) had the highest mortality rate. Using logistic regression, in-hospital death was predicted by extremely low birth weight (ELBW) (odds ratio (OR) = 6.594; P = 0.006), CDH (OR = 13.954; P < 0.001), and NEC (OR = 8.991; P = 0.049).Conclusions
This study describes CDH, NEC, and ELBW are independent predictive factors associated with in-hospital death of pediatric surgical patients in our NICU. Novel approaches for those conditions are required to improve the survival.Type of study
PrognosticLevels of evidence
II. 相似文献17.
Yangyang R. Yu Jennifer L. Carpenter Annalyn S. DeMello Sundeep G. Keswani Darrell L. Cass Oluyinka O. Olutoye Adam M. Vogel James A. Thomas Cole Burgman Caraciolo J. Fernandes Timothy C. Lee 《Journal of pediatric surgery》2018,53(5):1060-1064
Purpose
This study assesses the impact of extracorporeal membrane oxygenation (ECMO) associated morbidities on long-term quality of life (QOL) outcomes.Methods
A single center, retrospective review of neonatal and pediatric non-cardiac ECMO survivors from 1/2005–7/2016 was performed. The 2012 Pediatric Quality of Life Inventory? (PedsQL?) survey was administered. Clinical outcomes and QOL scores between groups were compared.Results
Of 74 patients eligible, 64% (35 NICU, 12 PICU) completed the survey. Mean time since ECMO was 5.5 ± 3 years. ECMO duration for venoarterial (VA) and venovenous (VV) were similar (median 9 vs. 7.5 days, p = 0.09). VA ECMO had higher overall complication rate (64% vs. 36%, p = 0.06) and higher neurologic complication rate (52% vs. 9%, p = 0.002). ECMO mode and ICU type did not impact QOL. However, patients with neurologic complications (n = 15) showed a trend towards lower overall QOL (63/100 ± 20 vs. 74/100 ± 18, p = 0.06) compared to patients without neurologic complications. A subset analysis of patients with ischemic or hemorrhagic intracranial injuries (n = 13) had significantly lower overall QOL (59/100 ± 19 vs. 75/100 ± 18, p = 0.01) compared to patients without intracranial injuries.Conclusion
Neurologic complication following ECMO is common, associated with VA mode, and negatively impacts long-term QOL. Given these associations, when clinically feasible, VV ECMO may be considered as first line ECMO therapy.Type of study
Retrospective review.Level of evidence
II 相似文献18.
Ferdynand Hebal Hayley T. Sparks Karen L. Rychlik Meredith Bone Sifrance Tran Katherine A. Barsness 《Journal of pediatric surgery》2018,53(4):794-797
Background/purpose
Arterial catheter complications are a common problem in a pediatric critical care setting, but reported complication rates and risk factors associated with peripheral arterial catheter complications vary. We conducted a retrospective cohort study to identify risk factors in a pediatric patient population.Methods
We performed a detailed abstraction of provider notes in the electronic medical records of inpatients ≤ 18 years of age who underwent arterial line placement between January 1, 2008 and January 1, 2013 at a university-affiliated standalone pediatric hospital. Inpatient records were assessed for complications associated with arterial catheterization and risk factors inherent to arterial catheter insertion.Results
Two hundred twenty-eight children were identified, of whom 75 (33%) had a total of 106 arterial catheter complications. Complications included line malfunctions (59%, n = 63), bleeding (16%, n = 17), multiple complications (11%, n = 12), infiltration (8%, n = 9), and hematoma (4%, n = 4). Line malfunction was reported in all patients with multiple complications. Independent predictors of complications associated with arterial catheterization were the presence of more than one provider during the insertion (p = 0.007) and insertion attempts at multiple sites (p = 0.036).Conclusions
Our analysis suggests the need for a prospective study to comprehensively assess provider-related risk factors associated with arterial catheter complications in children.Level of evidence
IV 相似文献19.
Raymond Zhun Ming Lim Terance Lee Justin Yau Zane Ng Kia Fatt Quek Nyazirah Abdul Wahab Shahrul Lokman Amansah V Muthu Alhagi M Vellusamy Chin Fang Ngim 《Journal of pediatric surgery》2018,53(11):2312-2317
Background/purpose
Although ultrasound-guided hydrostatic reduction (USGHR) is increasingly used in managing pediatric intussusception, there is limited literature concerning its use in Malaysia. We aim to examine the experience and factors associated with the effectiveness of USGHR using water.Methods
This is a single-center retrospective observational study in a Malaysian tertiary referral center. Children with intussusception admitted between year 2012 and 2016 were included and medical records reviewed. Factors associated with success or failure of USGHR were identified using multivariable logistic regression.Results
Of the 172 cases included, 151 cases (87.8%) underwent USGHR, of whom 129 cases were successfully reduced (success rate of 85.4%). One perforation (0.7%) was reported. Age more than 3 years old (aOR = 7.16; 95% CI = 1.07–47.94; p = 0.042), anemia (aOR = 10.12; 95% CI = 1.12–91.35; p = 0.039), thrombocytosis (aOR = 11.21; 95% CI = 2.06–64.33; p = 0.005) and ultrasound findings of free fluid (aOR = 9.39; 95% CI = 1.62–54.38; p = 0.012) and left-sided intussusception (aOR = 8.18;95% CI = 1.22–54.90, p = 0.031) were independently associated with USGHR irreducibility. Symptom duration, blood in stool, vomiting and other clinical presentations, however, showed no association.Conclusions
USGHR with water is effective in the non-operative management of pediatric intussusception. Prolonged symptom duration need not necessarily preclude USGHR. The findings of anemia and thrombocytosis as independent predictors of USGHR irreducibility deserve further study.Type of study
Treatment studyLevel of evidence
III 相似文献20.
Joana Barbosa Sequeira Ana Coelho Ana Sofia Marinho Berta Bonet Fátima Carvalho João Moreira-Pinto 《Journal of pediatric surgery》2018,53(10):2003-2007