Hernia In Infants Research Articles

Umbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of giant inguinal hernias in infants and young children

ObjectiveExploration of the efficacy of treating large indirect inguinal hernias in infants and young children using umbilical double-port laparoscopy combined with extraperitoneal water injection.MethodsA retrospective analysis was conducted on 165 cases of primary unilateral large indirect inguinal hernias in infants and young children treated at our hospital from May 2018 to May 2023. Among them, 90 cases underwent umbilical double-port laparoscopic surgery combined with extraperitoneal water injection and high ligation of the hernia sac (Double-Port Group), and another 75 cases underwent conventional three-port laparoscopic high ligation of the hernia sac (Three-Port Group). The two groups were compared in terms of operation time, postoperative pain scores at 24 hours, hospital stay, incision complications, and recurrence within one year after surgery.ResultsBoth groups successfully completed the surgery without any intraoperative complications. The pain score at 24 hours postoperatively was lower in the Double-Port Group compared to the Three-Port Group, and there was no statistically significant difference in operation time, hospital stay, and incision complications between the two groups (P > 0.05). Both groups were followed up for one year postoperatively; the Three-Port Group had one recurrence that was cured after further treatment, while there were no recurrences in the Double-Port Group.ConclusionUmbilical double-port laparoscopy combined with extraperitoneal water injection for the treatment of large indirect inguinal hernias in infants and young children has the advantages of being safe and reliable, with concealed and aesthetic incisions, and rapid recovery.

Spectrum of Minimally Invasive Surgical Techniques for the Managment of Inguinal Hernias in Infants and Children

One of the most common surgical procedures in infants and children is the repair of an indirect inguinal hernia. This can be carried out by open technique or using minimally invasive surgery (MIS). Since 1998, numerous different MIS techniques have been described. Scientifically proven advantages include a shorter operation time for bilateral hernias, along with a lower risk of metachronal, contralateral hernia. Nevertheless, the proportion of inguinal hernias treated using MIS in children in this country is relatively low, at around 8% of all operations. The aim of this synopsis is to describe the different MIS techniques for inguinal hernia repair in children, including their respective advantages and disadvantages.This video compilation shows the spectrum of different techniques for laparoscopic inguinal hernia repair in children. It includes the intracorporeal suturing technique, the incision of the peritoneum, extracorporeal percutaneous techniques, and the cauterisation of the open peritoneal vaginal process in girls.Although minimally invasive inguinal hernia repair in children is technically and scientifically established, it is not yet being widely used. This video manuscript provides an overview of the various techniques, thus facilitating clinical application.

Encysted spermatic cord hydrocele: A case series

Introduction and importanceEncysted spermatic cord hydrocele is a rare anomaly characterized by obstruction of processus vaginalis closure. Clinically, it presents as a swelling in the inguinal region extending to the upper scrotum and does not communicate with the peritoneal cavity. It is often mistaken for indirect inguinal hernias, inguinal lymphadenopathy, undescended testis, and primary tumors of the cord in infants and children, making the diagnosis challenging. Case presentationWe report the cases of five male patients aged nine months to 12 years who presented with painless swelling on the right side of the scrotal region. Physical examination revealed firm masses in the right inguinal region with positive transillumination, negative cough impulse tests, and irreducibility. Inguinal and scrotal ultrasonography showed an anechoic cystic lesion with thin walls, without any signs suggestive of a hernia. Patients were diagnosed with encysted spermatic cord hydrocele and advised to undergo cyst excision. The postoperative periods were uneventful, and expected recovery was observed at one-week and one-month follow-ups. Clinical discussionEncysted spermatic cord hydroceles are rare causes of painless inguinal swelling. The medical history and clinical findings can be used to establish a diagnosis, which can be confirmed using ultrasonography. Management depends on differentiating between spermatic cord hydrocele and scrotal hydrocele and involves considering the type. Treatment options range from conservative measures to surgery, particularly for non-communicating hydroceles that persist beyond 12–18 months or enlarge in size. ConclusionEncysted hydrocele of the cord is rare and is often mistaken for indirect inguinal hernias in infants and children. This similarity makes the diagnosis challenging and necessitates vigilance from clinicians. Surgical intervention results in optimal outcomes, especially in cases where the hydrocele persists beyond 12–18 months or with size progression.

The Timing of Surgery for Congenital Diaphragmatic Hernia in Infants, on or after Weaning from Extracorporeal Membrane Oxygenation: A Meta-Analysis.

We conducted a meta-analysis of trials to determine the optimal time to conduct surgery for congenital diaphragmatic hernia (CDH) in infants, on or after weaning from extracorporeal membrane oxygenation (ECMO). We searched the PubMed, Embase, Scopus, and Cochrane Library databases to identify relevant articles published prior to May 2023 in which surgery was performed to treat CDH in infants. Data were collected, and continuous data were represented by the mean difference (MD) and 95% confidence interval (CI). Dichotomous data were represented by the odds ratio (OR) and 95% CI. Review Manager V.5.4 and Stata were used to synthesize results and to assess publication bias. The results showed that infants undergoing surgery after being weaned from ECMO had reduced mortality (OR, 2.40; 95% CI, 1.23-4.69; p = 0.01) and postoperative bleeding rates (OR, 16.20; 95% CI, 5.73-45.76; p < 0.00001) and reduced ECMO duration (MD, 3.47; 95% CI, 1.89-5.05; p < 0.0001) compared with those who underwent surgery while on ECMO. There was no statistically significant difference in hospital duration (MD, 5.48; 95% CI, -8.66 to 19.62; p = 0.45) or ventilator duration (MD, -1.93; 95% CI, -8.55 to 4.68; p = 0.57). We recommend weaning patients with CDH from ECMO before performing surgery.

Can we preserve the necrotic testis caused by incarcerated inguinal hernia in infants under 3months?

This study aims to investigate whether necrotic testis resulting from incarcerated inguinal hernias can be preserved in infants under 3months old. A retrospective analysis was conducted on data collected from infants under 3months old who had necrotic testis caused by incarcerated inguinal hernias between 2016 and 2020. They were divided into two groups: the orchiectomy group and the testicular preservation group. The control group consisted of normal male children of the same age. Data regarding bilateral testicular volume, dihydrotestosterone, inhibin B, and antisperm antibodies were collected. The study included 42 cases, with 18 patients being followed up for 6-54months after the operation. In the testicular preservation group, 2 children did not experience testicular atrophy. There was no significant difference in the volume of the contralateral testes between the testicular preservation group and the control group; however, both groups had smaller testicular volumes compared to the orchiectomy group. There was no significant difference in the levels of inhibin B between the testicular preservation group and the orchiectomy group, although both were lower than the control group. Furthermore, no significant difference was observed in the levels of dihydrotestosterone and the positivity rate of antisperm antibodies among the three groups. Preserving the necrotic testis may allow it to survive without impacting the contralateral testis. Therefore, a more conservative approach should be considered for orchiectomy when dealing with testicular necrosis caused by incarcerated inguinal hernias in infants.

Pre-germ cell neoplasia in-situ in a patient with complete androgen insensitivity syndrome

Abstract Introduction/Objective Complete androgen insensitivity syndrome is a disorder of sex development in 46, XY individuals with external female genitalia and undescended testes, often presenting with inguinal hernia in infancy and/or primary amenorrhea in adolescents. Given the increased risk for the development of germ cell neoplasms in the ectopic testis, early gonadectomy or orchidopexy may be indicated. Methods/Case Report We report a 21-year-old patient assigned female at birth (46, XY) with a history of bilateral inguinal hernia repairs (age 2) and later with lack of menarche (age 16). Additional work-up showed an elevated testosterone level (394 ng/mL) and normal luteinizing and follicle stimulating hormone values. On pelvic ultrasound, retained intraabdominal gonads were identified, but female sex organs were absent. During a gonadal relocation procedure, the gonads appeared irregular in shape with multiple cysts and small nodules, and bilateral gonadectomy was performed. Grossly, the gonads measured 4.9 and 4.3 cm with a smooth external surface and a lobulated cut surface with multiple cysts, up to 1.6 cm, containing clear, serous fluid. Histologic sections showed most seminiferous tubules were lined only by Sertoli cells with only occasional spermatogonia. Leydig cell hyperplasia and areas of ovarian-like stroma were seen. OCT4 immunostain highlighted the nuclei of individually disposed germ cells in the base of tubules (singly dispersed, non-linear pattern), raising concern for germ-cell neoplasia in-situ (GCNIS). However, the histology and staining pattern were better interpreted as diagnostic of germ cells with delayed maturation and pre-GCNIS. Additionally, OCT4 showed rare single cells within the stroma and considered to represent residual undifferentiated gonadal tissue. After gonadectomy, the patient was started on hormone replacement therapy. Results (if a Case Study enter NA) NA Conclusion This case highlights the potential pitfalls in the interpretation of OCT4 immunostain to avoid misdiagnosis of germ cell neoplasia.

Late diagnosis of congenital diaphragmatic hernia: a case report

BackgroundCongenital diaphragmatic hernia beyond the neonatal period is not uncommon. Its diagnosis in infancy and early childhood poses a challenge owing to different clinical presentation ranging from gastrointestinal to respiratory symptoms. These neonates are usually misdiagnosed as having pneumonia until radiological imaging picks up the defect during routine scan for worsening respiratory symptoms. In high-income countries, the survival rate for these patients has been reported to be high, while in Sub-Saharan Africa the survival rate is still low due to delayed diagnosis, delayed referral, and hence delayed management.Case reportWe present an African male baby from non-consanguineous parents, 6 weeks old, diagnosed with congenital diaphragmatic hernia at 6 weeks of age after failure to respond to antibiotics for suspected pneumonia. Despite attempts at management, he died at 5 weeks post surgery.ConclusionOur case emphasizes the importance of early clinical suspicion and early detection for a differential diagnosis of congenital diaphragmatic hernia in infants who present with respiratory symptoms not responding to antibiotics or recurrent pneumonia, and improving the availability of imaging in primary care facilities to diagnose such defects early and manage them accordingly.

Infantile umbilical hernia tape fixation method without compression materials.

Compression therapy using compression material is often used for umbilical hernias in infants; however, there are problems regarding its use, such as appearance and cost. In our hospital, we use the tape fixation method without compression materials. We report the effectiveness of this method, its significance in measuring the degree of hernia bulge before treatment, and parent satisfaction with the treatment. We analyzed 77 cases of umbilical hernias (41 boys and 36 girls, mean age 52.7 ± 18.3 days) that were treated with the tape fixation method at the Department of Pediatrics of our hospital. Hernia size was classified based on the height of the bulge: mild (<1 cm), moderate (1≦ and <3 cm), or severe (>3 cm). Treatment duration was compared between the groups using the Steel-Dwass test. After the treatment, a questionnaire was mailed to the parents to assess the treatment satisfaction. Seventy-three patients (94.8%) achieved closure of the hernia orifice, with no excess skin and a well-shaped umbilicus. The duration of treatment was significantly shorter, with the following order: mild (18.5 ± 8.2 days), moderate (25.0 ± 11.9 days), and severe cases (47.8 ± 11.7 days). According to the questionnaire, 97.5% of the parents were satisfied with the treatment. Our tape fixation method without compression material achieved a high closure rate and a good shape of the umbilicus. In addition, we noted that the height of the hernia bulge can be used as a guide to estimate the duration of treatment.

Successful prioritisation of inguinal herniotomies in children during the COVID-19 pandemic to minimise emergency presentations

BackgroundThe coronavirus disease 2019 (COVID-19) disrupted the delivery of elective surgery in children. We introduced guidance to mitigate this impact. By reviewing the outcomes for inguinal herniotomies, we aimed to determine if this guidance has enabled us to prevent an increase in the elective surgery wait time and therefore the need for emergency surgery for incarcerated hernias. This report aims to share our learnt lessons about responding to a crisis limiting accessibility to elective surgery.ResultsWe performed a retrospective review of all elective and emergency herniotomies performed between April 1 and September 30, 2019 (pre-COVID-19) and the same period in 2020 (post-COVID-19). We compared the data on wait time from referral to clinic review/elective surgery and incarceration rates. During the study period in 2019, 76 elective herniotomies were performed compared to 46 in 2020. We did not observe a simultaneous increase in emergency herniotomies in 2020 (27 [2020] vs 25 [2019], OR [95% CI] = 1.53 [0.79–2.9]; p = 0.2). The median time from referral to elective surgery in 2019 compared to 2020 did not differ (56 vs 59 days, respectively; p = 0.61). In 2020, 72% of children that required emergency surgery had not been previously referred to our service and the median age (interquartile range) at which they presented with an incarcerated hernia was 2.8 months (2.1–13.7 months).ConclusionBy adhering to local guidelines for resumption of elective activity, the pandemic did not result in children waiting longer to be seen by a surgeon for a suspected inguinal hernia. As a result, we did not perform more emergency herniotomies. Urgent prioritisation of hernias in infants, from birth up to 3 months old, was a beneficial strategy. Public health education on childhood hernias will improve outcomes.

Laparoscopic Multiport Inguinal Hernia Repair in a Male Infant

Inguinal hernias in infants and children may be treated with open surgery or laparoscopy. First performed in 1993 more and more pediatric surgeons in western countries use the laparoscopic technique, at least in older children. Laparoscopic repair may be performed by either intra- or extra corporeal closure of the open processus vaginalis. The intra-corporeal method uses an intracorporeal suture with the help of three ports while the extra-corporeal closure uses a suture that is passed over two needles and the knot is tied manually outside the patient without the need for an additional port. We hereby describe step by step the laparoscopic multiport inguinal hernia repair in a male infant. This includes positioning of patient and trocars, incision of the peritoneum and placement of a non-absorbable braided purse-string suture at the inner inguinal ring, and intracorporal knot tying using the laparoscopic sliding knot. Minimally invasive hernia surgery in children is a common and technically demanding operation that lends itself well to teaching residents.

Nomogram for the Estimation of Intestinal Necrosis Risk in Incarcerated Inguinal Hernia in Infants under 6 Months.

This article develops a nomogram to estimate intestinal necrosis risk in the incarcerated inguinal hernia (IIH) in infants under 6 months. A total of 273 infants who underwent an emergency operation due to IIH were investigated retrospectively. Univariate and multivariate logistic regression were used to analyze the relationship between variables and intestinal necrosis and construct a nomogram of intestinal necrosis. The discrimination and concordance of the model were verified by receiver operating characteristic (ROC) analysis and calibration curve, and the bootstrap method was used for internal validation of the model. The clinical applicability of the model was evaluated using the decision curve and the clinical impact curve. Intestinal necrosis was found in 37 of 273 infants (13.6%) in this study. The vomiting symptoms, platelet count, C-reactive protein, and neutrophil-lymphocyte ratio were independent risk factors for intestinal necrosis in IIH. We then constructed a nomogram with these four factors. ROC analysis showed that the nomogram had a good diagnostic performance, with the area under the curve (AUC), sensitivity, and specificity of 0.918 (95% confidence interval: 0.880-0.956), 97.3%, and 69.9%, respectively. The nomogram was further validated using 2,000-repetition internal bootstrap validation, and the values of AUC, sensitivity, and specificity were 0.899, 95.7%, and 50.5%, respectively. The decision curve and the clinical impact curve indicated that the predictive model has a favorable clinical application. The nomogram can be used to predict intestinal necrosis in IIH, and allow us to estimate the severity of IIH more accurately and arrange the treatment process more reasonably.

The challenges of the management of the incisional hernia in children and infants: a retrospective experience of a tertiary hospital

BackgroundIncisional hernia in children and infants represents a major complication following exploration. The condition is associated with prolonged hospital stay, readmission, and the need for another operation to treat the resulting incisional hernia. The incidence is variable worldwide. The leading causes are still indeterminate as well as the management strategy. We aimed at studying incisional hernia in children and infants at a tertiary level hospital as regards presenting symptoms, methods of management, and its impact on the quality of life of patients.ResultsA retrospective study included all infants and children presented with incisional hernia. Patients were categorized in to two groups according to the age of presentation, group A patients younger than 2 years of age and group B patients older than 2 years. All data related to the first operation in addition to data related to repair of the incisional hernia were collected in special charts. The study included 67 patients. the median age in group A was 6.5 months vs 10.5 years in group B. Urgent presentation was found in 35.4% of cases in group A vs 19.44% of cases in group B. Tissue repair was used as the definitive management in 64.5% of cases in group A and in 52.7% of cases in group B.ConclusionIncisional hernia in infants and children is a major complication. The management is associated with prolonged hospital stay, financial burden, and deep impact on the quality of life. It is to some extent difficult to predict its onset.

Congenital diaphragmatic hernias repair is feasible in peripheral hospitals

Laparoscopic repair of congenital diaphragmatic hernias can be done in suitable infants and children with good long-term results. The benefits includes lower risk of infection, less intra-abdominal adhesions and early recovery, while being a «scar-less» procedure. Materials and methods. The 3 patients included a 9-months-old infant with a late presentation of Bochdalek left diaphragmatic hernia, and 2 patients with Morgagni congenital diaphragmatic hernia - a 1-year-old infant and a 3-year-old toddler. All procedures were performed in abdominal approach using 3- and 5-mm ports, and a 5-mm 30 degrees camera. Suturing of the diaphragmatic defect was done with unabsorbed materials (Ethibond® 4.0). Results. No intra-operative complications were noted, all patients recovered quickly and uneventfully, and were discharged between 3-6 postoperative day. Follow-up period is now between 3-23 months and so far there is no evidence of recurrence. Conclusions. Laparoscopic surgery is used more and more in smaller cavities by pediatric surgeons. Laparoscopic repair of congenital diaphragmatic hernias in infants and toddlers can safely be performed in peripheral hospitals by skilled pediatric surgeons with good results. However, our follow-up period is relatively short, and because of common recurrence rate in those patients, 15-40% in different reports, both in laparoscopic and open repair, long term follow-up is required. The research was carried out in accordance with the principles of the Helsinki declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: children, laparoscopic repair, congenital diaphragmatic hernias.

Single-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle for incarcerated ovarian hernia in infants

BackgroundThe purpose of this study was to evaluate the safety and efficacy of single-site laparoscopic extraperitoneal hernia sac ligation with an epidural needle for incarcerated ovarian hernias in infants and young children.MethodsThe clinical data of 38 infants with incarcerated ovarian hernias who underwent single-site laparoscopic extradural needle extraperitoneal hernia sac ligation from January 2015 to January 2018 were retrospectively analysed.ResultsAll procedures were successfully performed using laparoscopy with no need for conversion to open surgery. The time of hospital stay was 1.30 ± 0.39 days. During hospitalization and follow-up, there were no complications, such as intestinal or bladder injury, abdominal wall vascular injury, ovarian atrophy, hernia recurrence or contralateral indirect hernia. However, three patients experienced complications, including two cases of poor healing of the umbilical incision and one case of suture granuloma.ConclusionsSingle-site laparoscopic high ligation of the extraperitoneal hernia sac with an epidural needle is a safe and feasible method for the treatment of incarcerated ovarian hernias in infants and young children. It has the advantages of minimal trauma, no scarring and good cosmetic effects.

INCARCERATED INGUINAL HERNIA IN NEWBORNS AND INFANTS

Introduction. Inguinal hernias (IG) in children are a congenital pathology of the processusvaginalis and a local manifestation of the syndrome of mesenchymal insufficiency. Incarcerated IG is the most common and dangerous complication, the risk of which is significantly higher in children during the first 3 months of life. To date, there is no perfect method of pinched IG treatment in newborns and infants. Data on the optimal timing of herniotomy in newborns and infants are also insufficient and contradictory.The aim of this study is to provide our own experience in the treatment of infants with pinched inguinal hernias.Material and methods. The material of this study is 97 newborns and infants with irreducible and incarcerated inguinal hernias. Diagnosis was based on anamnesis data, physical examination methods and ultrasound data with inguinal and scrotal Doppler. Indications for review radiography of the abdominal cavity were clinical signs of acute intestinal obstruction.Results and discussion. Analyzing the obtained results, we have found that the diagnosis of hernias in 91 (93.81%) children was based on anamnestic data, complaints of parents about the presence of bulging in the groin area and physical examination of a child. The most important condition for effective diagnosis is the thorough collection of anamnestic data to determine the duration of the acute condition in a child and its dynamics. It is important to examine a child in a horizontal and vertical position. Differential diagnosis of incarcerated IG in infants was performed with acute hydrocele, torsion of the spermatic cord, inguinal lymphadenitis, etc., which are very similar to incarcerated IG in small children.Treatment of incarcerated inguinal hernias in newborns and infants has been carried out using a combined strategy, which involved the use of conservative invagination of hernia contents (49.48% of patients) followed by delayed surgical correction and emergency surgery according to urgent indications (42.27% of infants).Among 48 children treated conservatively, non- operative manual hernia invagination (Taxis - method) was effective in 46 of them or 95.83%. We used this method in children with a strangulation period up to 12 hours in the absence of inflammation signs in the pinched area.Indications for urgent herniotomy were: strangulation period of more than 12 hours (12 children), ineffectiveness of conservative treatment for 1 hour (2 patients), intractable hernia protrusion in girls (27 patients).As for the planned surgery, we support surgical correction of inguinal hernias at the age of 6-12 months, which we consider optimal.Conclusions1. Conservative manual invagination of an incarcerated inguinal hernia in newborns and infants is used in terms of pinching the contents of the hernia lasting up to 12 hours and is effective in 95.83% of cases.2.Surgical intervention for incarcerated hernia in infants should be performed in children with a duration of pinching more than 12 hours, in cases of impossibility and / or ineffectiveness of conservative invagination for 1 hour and in girls.3. Correction of a incarcerated inguinal hernia in girls is not recommended due to the high risk of ovarian damage.

TP7.2.6 Frequency of Obstructed Inguinal Hernia in Infants

Abstract Inguinal hernia in children is the result of the failure of obliteration of processus vaginalis or weakness of the abdominal wall. The incidence of inguinal hernia ranges from 0.8-5%. It is more common in preterm babies with an incidence of up to 30%.There is disagreement concerning the management of inguinal hernia in infants worldwide with few in favor of early repair of the hernia due to fear of incarceration while some are against it. This study was conducted to determine the frequency of intestinal obstruction in infants with an inguinal hernia for the development of a proper protocol for the management of inguinal hernias. Methods A total of 112 patients were included in the study. The patient’s gender and age were recorded. The presence of hernia was confirmed clinically and by performing an ultrasound. All the relevant data was recorded in a pre-designed printed proforma. Results In this study, 112 children were included. 73% of children were in the age between 1-6 months and 27% children were in age between 7-12 months. The mean age was 5 months ±5.87. Male children were 86% and female children were 14%. An obstructed inguinal hernia was observed in 11% of children while 89% of children didn’t have obstructed inguinal hernia. Conclusion Our study concludes that the frequency of incarcerated inguinal hernia was 11% in infants mostly occurring at a younger age and in male children.

AAP Publications Reaffirmed or Retired

Policy Statement. Nondiscrimination in pediatric health care. Pediatrics. 2007;120(4):922–923. Available at: https://pediatrics.aappublications.org/content/120/4/922. Reaffirmed May 2021Policy Statement. Global climate change and children's health. Pediatrics. 2015;136(5):992–997. Available at: https://pediatrics.aappublications.org/content/136/5/992. Reaffirmed May 2021Technical Report. Global climate change and children's health. Pediatrics. 2015;136(5). Available at: https://pediatrics.aappublications.org/content/136/5/e1468. Reaffirmed May 2021Clinical Report. Assessment and management of inguinal hernia in infants. Pediatrics. 2012;130(4):768–773. Available at: https://pediatrics.aappublications.org/content/130/4/768. Reaffirmed May 2021Clinical report. Parental presence during treatment of Ebola or other highly consequential infection. Pediatrics. 2016;138(3):e20161891. Available at: https://pediatrics.aappublications.org/content/138/3/e20161891. Reaffirmed March 2021Clinical report. The use of systemic and topical fluoroquinolones. Pediatrics. 2016;138(5):e20162706. Available at: https://pediatrics.aappublications.org/content/128/4/e1034. Reaffirmed March 2021Clinical report. Infectious complications with the use of biologic response modifiers in infants and children. Pediatrics. 2016;138(2):e20161209. Available at: https://pediatrics.aappublications.org/content/early/2016/07/14/peds.2016-1209. Reaffirmed March 2021Technical report. Nontherapeutic use of antimicrobial agents in animal agriculture: implications for pediatrics. Pediatrics. 2015;136(6):e1670-e1677. Available at: https://pediatrics.aappublications.org/content/136/6/e1670. Reaffirmed June 2021Clinical report. Evaluation and referral for developmental dysplasia of the hip in infants. Pediatrics. 2016;138(6): e20163107. Available at: https://pediatrics.aappublications.org/content/138/6/e20163107. Reaffirmed June 2021Clinical Report. Parent-provider-community partnerships: optimizing outcomes for children with disabilities. Pediatrics. 2011;128(4):795–802. Available at: https://pediatrics.aappublications.org/content/128/4/795. Retired May 2021

Nonoperative management for umbilical hernia in infants using adhesive strapping.

The aim of this study was to evaluate the efficacy of adhesive strapping (AS) for umbilical hernia (UH) in infants. A retrospective review of 30 mature infants without any treatment for UH between January 2006 and December 2008 and 87 infants (42 mature and 45 premature) who were treated with AS between January 2010 and December 2014 was conducted. The rate and age of closure of UH were compared between the groups and the complications and limitations of AS were evaluated. In the observation-only group, 24 UHs spontaneously closed at a mean age of 13.5months, but a protruding umbilicus with redundant skin was present in three of 27 infants. Three infants had persistent UH, so a total of six infants, including the three with redundant skin and three with persistent UH, underwent surgery at the mean age of 30.0months. In the AS group, 72 UHs were cured at a mean age of 4.3months, which was significantly earlier than in the observation-only group (P < 0.01). Eleven infants did not continue AS because of skin irritation or discomfort. Four infants underwent repair due to persistent UH, but not for redundant skin of the umbilicus. Adhesive strapping is effective for promoting the early resolution of UH in infants and preventing the forming of redundant skin, which can reduce the need for surgical intervention. To achieve better results with AS, we recommend applying this technique before the UH grows large.

Predicting Perinatal Outcomes in Fetuses with Congenital Diaphragmatic Hernia Using Ultrasound and Magnetic Resonance Imaging

Abstract Congenital diaphragmatic hernia is a congenital fetal disease, which mainly causes pulmonary hypoplasia and pulmonary hypertension. Effective early prenatal diagnosis can detect and predict the prognosis of congenital diaphragmatic hernia in infants, thus provide a reference for prenatal counseling, early intervention, and potential choices for the child's family. Ultrasound and magnetic resonance imaging are the most commonly used methods for non-invasive examination of the fetus. This paper discusses evaluation parameters based on these two imaging modalities.

Exploratory Assessment of Levosimendan in Infants With Congenital Diaphragmatic Hernia.

Infants with congenital diaphragmatic hernia frequently suffer from cardiac dysfunction and pulmonary hypertension during the postnatal course. With the use of the inodilator levosimendan, a therapeutic approach is available in situations with catecholamine-refractory low-cardiac-output failure and severe pulmonary hypertension. Retrospective single-center cohort study. University-based, tertiary-care children's hospital neonatal ICU. Cohort of 24 infants with congenital diaphragmatic hernia and levosimendan therapy, without underlying major cardiac defect, treated at the University Children´s Hospital Bonn, Germany, between January 2017 and December 2018. None. Twenty-four infants with congenital diaphragmatic hernia were treated with levosimendan (41% of hospitalized congenital diaphragmatic hernia infants in the study period). In 88%, the congenital diaphragmatic hernia was left-sided. The median observed-to-expected lung-to-head ratio was 36%. About 60% of the infants were supported with venovenous extracorporeal membrane oxygenation and the mortality was 38% (9/24 infants). Levosimendan administration was associated with improvement of pulmonary hypertension severity (p = 0.013 and p = 0.000) and right ventricular dysfunction (p = 0.011 and p = 0.000) at 24 hours and 7 days after treatment. Similarly, the prevalence of left ventricular dysfunction decreased from 50% at baseline to 10% after 7 days (p = 0.026). A significant reduction in the peak inspiratory pressure was observed after drug application (p = 0.038) and a significant decrease of the Vasoactive-Inotropic Score was apparent (p = 0.022). A relevant arterial hypotension as a drug-related adverse event occurred in one patient. This is the first study exploring clinical and hemodynamic changes after levosimendan treatment in a cohort of infants with congenital diaphragmatic hernia. An association of levosimendan application and an improvement in pulmonary hypertension, right ventricular, and left ventricular dysfunction were observed within 7 days after drug infusion. However, due to the retrospective design of this study, the results should be interpreted carefully.