Pediatric Surgical Admissions Research Articles

Effect of COVID-19 Pandemic on Admission Pattern to Pediatric Surgery Division at King Fahad University Hospital and Subsequent Quality of Presentation in Cases: A Comparative Study and Single-Center Experience.

The coronavirus disease 2019 (COVID-19) pandemic has affected healthcare systems worldwide, with mandatory quarantine and isolation measures being implemented to curb the spread of the virus. These measures have potentially led to delayed or complicated presentations of non-COVID-19 cases, including pediatric surgical cases. This study aims to evaluate pediatric surgical admission patterns, analyze the incidence of surgical diagnoses, and assess the severity of presentation during the COVID-19 period compared to the pre-COVID-19 period. This retrospective observational study was conducted at a university hospital in the eastern region of Saudi Arabia to assess the effect of the pandemic on pediatric surgery admissions patterns and severity of presentation duringthe COVID-19 period (March 2, 2020, to March 1, 2022) and pre-COVID-19 period (March 1, 2018, to March 1, 2020). Of the 903 pediatric surgical admissions, 366 (40.5%) presented during the COVID-19 period. The admission rate per month decreased by 6.9 during COVID-19 compared to pre-COVID-19 (mean [SD]: 21.5 [9.3] vs. 14.6 [8.2], p = 0.01). The most common admission diagnoses were appendicitis (17.5%) and inguinal hernia (15.8%). There was a 15% increase in the percentage of emergency admissions (54.4% vs. 47.3%, p = 0.037) during COVID-19 compared to pre-COVID-19. Of note, the percentage of patients admitted with acute appendicitis increased by 35.9% (20.8% vs. 15.3%, p = 0.03). Furthermore, the emergency admissions for patients with inguinal hernia doubled (26.6% vs. 12.7%, p = 0.035). No significant difference in ICU admissions, hospital length of stay, and routine discharge were observed. In conclusion, the COVID-19 pandemic correlated with a significant decrease in overall admissions and an increase in emergency admissions, including those for appendicitis and inguinal hernia. The increase in complicated conditions was not significant. There was no significant difference in ICU admissions and hospital length of stay. Future studies involving multiple centers are necessary to validate these findings.

The impact of the COVID-19 pandemic on presentation of surgical disease in paediatric patients at a tertiary centre in Cape Town, South Africa.

Children are less susceptible to infection with SARS-CoV-2 and subsequent severe disease, yet especially vulnerable to the indirect effects of the pandemic. A constrained healthcare service, combined with the societal and behavioural changes observed during the pandemic, is likely to have altered the presentation of paediatric surgical disease. The objective was to investigate the impact of the COVID-19 pandemic on the volume of paediatric surgical admissions, the severity of disease and the type of surgical pathology treated at our centre. A retrospective cohort study compared paediatric surgical admissions in an eleven-month period before COVID-19 to the same period during the pandemic. Comparisons in volume and diagnoses were based on the number of admissions. Predetermined criteria for severity of disease using triage scores, intraoperative findings and intensive care admissions were compared. A total of 1 810 admissions were recorded, 1061 in the pre-COVID group and 749 during COVID. Emergency admissions reduced by 9.2%, most notably due to a reduction in trauma, caustic ingestions and constipation. There was an increase in incarcerated inguinal hernias and helminth-related pathologies. Significantly more intussusceptions failed pneumatic reduction requiring surgical intervention with bowel resection. There was a two-fold increase in patients requiring emergency intensive care. Paediatric surgical volumes at our centre decreased during the COVID-19 pandemic. There was evidence of more advanced disease on presentation of inguinal hernias and intussusception and a generalised increased demand for emergency ICU admission.

Presentation management and outcome of phlegmonous and inflammed appendicitis in children in Ethiopia: retrospective review

BackgroundAcute appendicitis is the leading cause of emergency pediatric surgical admissions in the world. The diagnosis is may be difficult and is often dependent on clinical parameters. This study was aimed at reviewing the clinical presentations, the management and outcomes in children with inflamed and phlegmonous appendicitis with reference to the operative findings.MethodsThe records of 211 children 5 to 15 years of age who were operated for acute appendicitis with intra operative findings of inflamed or phlegmonous appendicitis who met inclusion criteria were entered and analyzed using SPSS (IBM) V.26. Descriptive and regression tests were done with p < 0.05 considered statistically significant.ResultsOf 211 children with inflamed and phlegmonous appendicitis, the M: F was 1.48:1 with a median age of 11 years. 58.3% of them presented within 24 h with the commonest symptoms being right lower abdominal pain, anorexia, and vomiting (96.2%,96.2%, 85.3%,) respectively. 96.7% of them had right lower abdominal tenderness. 73% had neutrophils ≥ 75%, and of 171 patients who had abdominal ultrasound scan, 97.7% showed appendiceal diameter ≥ 6 mm. Intraoperatively 56.4% of them were found to have phlegmonous appendicitis. In a retrospective Pediatric Appendiceal Score, only 52.6% of patients fall into the high-risk category, who could be confirmed on preoperative clinical assessment. Postoperatively 90% of them discharged improved with a mean hospital stay of 2.26(SD = 0.9) days. There was no association between the sex of the child and the intraoperative finding of inflamed or phlegmonous appendicitis (p = 0.77).ConclusionPediatric appendicitis affects more male children in their second decade of life. Most had phlegmonous appendicitis and presented within 24 h. Duration of illness has little effect on the progress of appendicitis. Surgical management is safe for inflamed and phlegmonous appendicitis with a reasonable hospital stay and a low rate of complications.

The understated issue of caregiver anxiety for pediatric surgical hospital admissions: opening the blindfolds

Hospitalization is a nerve-wrecking experience for patients and their families (Lam et al. in Int J Nurs Stud 43:535-545, 2006). The financial burden of hospitalization is the prime perpetrator, however, multiple other factors also contribute significantly to the underlying problem which can be eliminated by efforts of the doctors and other healthcare workers and by modifying the hospital policies (Bassett et al. in J Hosp Med 15:652-658, 2020). We can reduce the number of outpatient visits and switch to telemedicine for rescheduling the cases. The pre-anaesthetic clearance and all the relevant investigations can be done on a single OPD visit thereby reducing the requirement of repeated commutes to the hospital. The free of charge category of the hospital can be extended to the patient requiring prolonged hospital stay or for solid tumor patients who require repeated hospital admissions for chemotherapy. Association with child welfare Non-government organizations (NGO's) can also solve major monetary issues for parents of patients suffering from complex congenital anomalies and solid tumors. The pre-operative NPO period can be shortened to 2-4h, antibiotic use can be completely avoided or minimized in clean elective cases, children living in the same city requiring dressing/catheter removal after a few days (e.g. hypospadias, posterior sagittal anorectoplasty) can be discharged and called for a OPD visit after 5-7days if the parents are willing to take care of the child at home. Patients undergoing minor elective surgeries can be followed up on telemedicine visits only. Parents of patients suffering from complex congenital anomalies should be referred to a clinical psychologist and receive periodic counseling sessions. A child psychologist should also be included in the management of cases which have social stigma attached as bladder exstrophy, anorectal malformations, spina bifida requiring lifelong follow-up and bowel washes or repeated clean intermittent catheterisation. Anxiety assessment questionnaires must be incorporated in the management of chronic patients and high-risk parents must be identified (Tiedeman in J Pediatr Nurs 12:110-119, 1997). We hereby propose adoption of family centric approach during the management of a patient as this may minimize the overall burden of the hospitalization of the family. Hospital admission of a child leads to a myriad responses in the parents. Thus, we conducted a hospital-based cross-sectional study to determine the prevalence of anxiety and depression among the primary caregivers of hospitalized children and the factors causing it. Parents of 228 children admitted in the pediatric surgery ward at a tertiary care hospital were interviewed using the HADS-A and Hamilton Anxiety Questionnaire to assess the prevalence of anxiety and depression during hospital admission. They were also subjected to a questionnaire comprising of 52 questions spread over 5 segments-demographic details, monetary burden, effect on siblings and other family members, practical problems faced, and surgery-specific concerns. Thirty percent of the parents had severe anxiety and 20% developed depression due to the hospitalization of their child. We tested the association of this depression and anxiety against 56 variables in this study. Exorbitant loan amounts (ra -0.449, rd-0.557), repeated commute to the hospital (ra -0.274, rd -0.231), monetary burden (ra -0.193, rd -0.186), repetitive sampling (ra -0.248, rd -0.203), prolonged absence from work (ra -0.440, rd -0.424) were found to be the chief perpetrators of this anxiety and depression. The burden of anxiety and depression in the primary caregivers of pediatric surgical patients is enormous. Identification of the implicating factors is essential. Simple reforms such as reduction in the number of OPD visits, extension of free of charge category, association with non-governmental organizations and involvement of a clinical psychologist can significantly meliorate the hospital journey of both the patients and their parents. (rd-correlation coefficient of for depression, ra-correlation coefficient of for anxiety).

The spectrum and outcome of paediatric emergency surgical admissions - a regional hospital analysis

BACKGROUND: Improving emergency surgical care for children requires information on the causes of admissions and the variables affecting outcome. There is a lack of such data in the South African context. METHODS: This retrospective study was conducted from January 2016 to December 2017. Data was collected on all children (&lt; 12 years of age) requiring admission with emergency surgical conditions. Infrastructure and staffing ratios were determined prior to data collection. Information was sourced from admission and discharge books, patient files and theatre registers. Variables of age, sex, referral source, diagnosis, length of stay, surgical treatment and outcome including death were collected. RESULTS: Four hundred and thirty-five of the 1 048 children (42%) admitted were in the 0-2-year age group. Trauma (258), sepsis (564) and burns (226) were the main causes. The median hospital stay was 3 days (IQR 2-5), however, for burns patients, the median stay was 4 days (IQR 2-9). Surgery was performed on 279 (27%) admissions. Eight (0.8%) died, six of which were due to burns. Clinical status prior to death was poorly documented. A dedicated high care unit and burns isolation rooms were lacking. Surgeon/population and child/nurse ratios were respectively 1.48/100 000 and 7-12/1. CONCLUSION: This study found that the emergency paediatric surgical burden is significant. Sepsis and trauma combined are the leading cause of emergency admissions. Burns had the highest mortality. Although mortality was low, improvements of staff to patient ratios and the institution of an early warning system could reduce mortality.

Helping midwives support families who require non-therapeutic infant male circumcision

In the UK, the majority of non-therapeutic infant male circumcisions for religious or cultural reasons are performed by private providers in community settings. There have been reports of unsafe practices by some unregulated private providers. The implementation of a voluntary quality assurance process in one region in northwest England has been associated with a decrease in paediatric surgical admissions of infant boys admitted following complications of circumcision in the community. Voluntary quality assurance is a feasible option to implement quality improvement for services outside clinical governance systems. The quality assurance process provides a valuable resource for midwives to signpost families to safely practising providers, potentially reducing the risk of harm to children resulting from families using unqualified providers and safeguarding infant boys from harm becuase of poor practice.

Audit of paediatric surgical intensive care unit admissions in north Jordan

An audit was carried out over a 12-month period at a district general hospital in the north of Jordan. The study aimed to establish the reasons for and outcome of paediatric intensive care unit admissions. Of the 854 admissions, 107 were paediatric surgical cases. The causes of trauma were: road traffic accident (42 cases), burns (35) and falls (18). The remaining 12 cases were either post-operative admissions (7 cases) or acute admissions (5 cases). A total of 31 patients died and 8 children were left with significant disability or brain death. We conclude that trauma is a significant cause of disability, morbidity and mortality in children in our area. Society as a whole needs to look at the causes of childhood trauma and identify ways of reducing it.

Study of the characteristics and burden of pediatric trauma in low resource settings.

Objectives: Purpose of the study is to identify the characteristics and burden of pediatric trauma in a hospital with limited resources and to compare the results with published literature and to formulate the effective injury prevention strategies. Study Design: Prospective, Descriptive, Cross-sectional study. Setting: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2019 to December 2019. Material &amp; Methods: A total of 871 patients aged 12 years and below with a history of trauma were included. The patients were categorized into four age groups, 0-2 years, 3-5 years, 6-8 years, and 9-12 years. Data collected included, age, gender, area (rural/urban), type of injury, mechanism of injury, regional pattern of injury, any intervention required and final outcome. The data were compared in different age groups and both sexes. Results: Out of total 2609 admissions, 871(33.38%) patients were of trauma and burn. 699(80.3%) trauma patients and 172(19.7%) burn patients. The males were 595(67.9%) and females comprised 276(32.1%). Age ranged from 05 days to 12 years (mean5.07years). By age groups, distribution of patients was, 0-2years 201(23.1%), 3-5years 340(39.0%), 6-8years 213(24.5%), and 9-12years 117(13.4%). Blunt trauma was most common type of injury 688(95.56%) and penetrating trauma was 31(4.43%). Most common mechanisms of injury were, vehicle related incidents 380(54.4%) and fall 238(34.0%). The majority of injuries 432(61.8%), were seen in head, neck and face region. Scald was most common type of burn and seen in 125(14.4%) patients. Conclusion: This study clearly shows that pediatric injuries and burn contribute a substantial proportion of all pediatric surgical admissions. Pediatric trauma including burn is a significant burden on health care system. Vehicle related incidents, fall injuries and scald burns are most common type of injuries.

Prevalence and Pattern of Birth Defects among Pediatric Surgical Patients: A 12-Year Analysis in a Tertiary-level Government Hospital in Bangladesh

Aims: Birth defects are structural or functional abnormalities which occur during the intrauterine life but can be identified at birth or a later age. Birth defects are major public health concerns and the World Health organization (WHO) is supporting countries for earlier diagnosis and better treatment of these conditions. The aim of the study was to assess the hospital-based prevalence and types of birth defects among the surgical children from a part of the world where these are underreported.&#x0D; Materials and Methods: We retrospectively analyzed patients of birth defects admitted in the Department of Pediatric Surgery, Chattogram Medical College Hospital, Bangladesh for a period of 12 years (2008-2019). Data were extracted from annual admission reports, annual audits, mortality and morbidity audits, death registers and computerize data base. Yearly distribution of birth defects, type of defects and their systemic distribution and mortality were analyzed.&#x0D; Results: Among a total of 30,301 admitted patients 30.72% (9307 patients) had birth defects. The most common system involved with birth defects was gastrointestinal (GI) system, 30.61% followed by genitourinary (GU), 29.15% system. Congenital inguinal hernia (17.50%) was the most common disease, followed by hypospadias (14.54%) and anorectal malformation (ARM); 13.98%. Mortality from birth defects were 53.25% of all mortalities. ARM was the most common cause of death (23%), followed by gastroschisis (16%) and intestinal atresia (11%). Highest mortality rates were in tracheo-esophageal fistula/esophageal atresia (TEF/EA)- 83.33%, gastroschisis-80.92%; intestinal atresia-42.53%; omphalocele-32.48%; and congenital diaphragmatic hernia (CDH)- 27.78%.&#x0D; Conclusion: Pattern of birth defects and outcome varied from other countries. The prevalence is 31% among pediatric surgical admissions. Some conditions have extremely high mortality rates and need better management.

Pattern of Pediatric Surgical Admissions in a Combined Military Hospital

Introduction: Pediatric surgical admissions are daily practice at peripheral hospital. To design strategy for appropriate diagnosis and management of pediatric surgical patient reported to combined military hospital (CMH) Bogura, Bangladesh.&#x0D; Objectives: To find out the pattern of pediatric surgical admission cases and factors affecting their outcomes.&#x0D; Methods: This case series analysis was conducted from November 2016 to October 2017 at CMH, Bogura. Total 175 patients admitted during this period out of them13 children excluded from study due to parent’s refusal for intervention or discharged against medical advice. In this study total 162 admitted children’s data were analyzed.&#x0D; Results: The study showed emergency cases were predominating 74.69% and elective cases were less common 25.30%. Mortality recorded exclusively in children admitted on emergency basis 6 children (3.70%). Congenital anomaly of GIT was found the leading causes of death in this study 4 (2.46%) children.&#x0D; Conclusion: Many emergency and elective pediatric surgical patients can be managed at peripheral Hospital with acceptable outcomes except the neonate.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.14 (2) 2018: 109-112

Burden of emergency pediatric surgical procedures on surgical capacity in Uganda: a new metric for health system performance

BackgroundThe significant burden of emergency operations in low- and middle-income countries can overwhelm surgical capacity leading to a backlog of elective surgical cases. The purpose of this investigation was to determine the burden of emergency procedures on pediatric surgical capacity in Uganda and to determine health metrics that capture surgical backlog and effective coverage of children’s surgical disease in low- and middle-income countries. MethodsWe reviewed 2 independent and prospectively collected databases on pediatric surgical admissions at Mulago National Referral Hospital and Mbarara Regional Referral Hospital in Uganda. Pediatric surgical patients admitted at either hospital between October 2015 to June 2017 were included. Our primary outcome was the distribution of surgical acuity and associated mortality. ResultsA combined total of 1,930 patients were treated at the two hospitals, and 1,110 surgical procedures were performed. There were 571 emergency cases (51.6%), 108 urgent cases (9.7%), and 429 elective cases (38.6%). Overall mortality correlated with surgical acuity. Emergency intestinal diversions for colorectal congenital malformations (anorectal malformations and Hirschsprung’s disease) to elective definitive repair was 3:1. Additionally, 30% of inguinal hernias were incarcerated or strangulated at time of repair. ConclusionEmergency and urgent operations utilize the majority of operative resources for pediatric surgery groups in low- and middle-income countries, leading to a backlog of complex congenital procedures. We propose the ratio of emergency diversion to elective repair of colorectal congenital malformations and the ratio of emergency to elective repair of inguinal hernias as effective health metrics to track this backlog. Surgical capacity for pediatric conditions should be increased in Uganda to prevent a backlog of elective cases.

Postoperative Inhaled Nitric Oxide Does Not Decrease Length of Stay in Pediatric Cardiac Surgery Admissions.

Pulmonary hypertension is one of the most challenging complications in congenital heart surgery. The purpose of this study was to characterize inhaled nitric oxide administration in children with and without pulmonary hypertension who underwent congenital heart surgery and to describe the effect of nitric oxide administration on admission outcomes. This is a cross-sectional study utilizing data from the Pediatric Health Information System (PHIS) and PHIS + databases from 2004 to 2015. Pediatric patients with a congenital heart disease diagnosis were included and divided into groups with pulmonary hypertension that received and not received inhaled nitric oxide and patients without diagnosis of pulmonary hypertension who received and did not receive inhaled nitric oxide. For all admissions, the following were captured: age of admission, gender, year of admission, length of stay, billed charges, inpatient mortality, the presence of specific congenital malformations of the heart, specific cardiac surgeries, and comorbidities. Comparisons between groups were completed using a Mann-Whitney-U test and Fisher's exact test. Outcomes evaluation was completed using univariate and regression analyses. A total of 40,194 pediatric cardiac surgical admissions without pulmonary hypertension were identified. Of these, 726 (1.8%) received inhaled nitric oxide. Regression analyses demonstrated that inhaled nitric oxide was independently associated with increased length of stay, billed charges, and inpatient mortality. A total of 1678 pediatric cardiac surgical admissions with pulmonary hypertension were identified. Of these, 195 (11.6%) received inhaled nitric oxide. Regression analyses demonstrated that inhaled nitric oxide was independently associated with a significant increase in length of stay and billed charges. There was no statistically significant association between inhaled nitric oxide and decrease mortality. Administration of inhaled nitric oxide after pediatric cardiac surgery increases length of stay and billed charges while not providing improved inpatient mortality. In fact, administration of inhaled nitric oxide was associated with increased mortality in those without pulmonary hypertension while not impacting mortality in any way in those with pulmonary hypertension.

Epidemiology and mortality of pediatric surgical conditions: insights from a tertiary center in Uganda.

The burden of pediatric surgical disease is largely unknown in low- and middle-income countries such as Uganda where access to care is limited. Implementation of a locally led database in January 2012 at a Ugandan tertiary referral hospital, and review of 3465 prospectively collected pediatric surgical admissions from January 2012 to August 2016. 2090 children (60.3%) underwent surgery during admission. 59% were male and 41% female. 28.6% of admissions were in neonates and 50.4% were in children less than 1 year old. Congenital anomalies including Hirschsprung's, anorectal malformations, intestinal atresias, omphalocele, and gastroschisis were the most common diagnoses (38.6%) followed by infections (15.0%) and tumors (8.6%). Mortality rates were substantially higher than those of high-income countries; for example, gastroschisis and intussusception had mortality rates of 90.1% and 19.7%, respectively. Post-operative mortality was highest in the congenital anomalies group (15.0%). There is a high burden of infant congenital anomalies with higher mortality rates compared to high-income countries. The unit performs primarily specialized procedures appropriate for a tertiary center. We hope that these data will facilitate evaluation of ongoing quality improvement and capacity-building initiatives.

Incidence and risk factors for important early morbidities associated with pediatric cardiac surgery in a UK population

ObjectiveGiven excellent 30-day survival for pediatric cardiac surgery, other outcome measures are important. We aimed to study important early postoperative morbidities selected by stakeholders following a rigorous and evidenced-based process, with a view to identifying potential risk factors. MethodsThe incidence of selected morbidities was prospectively measured for 3090 consecutive pediatric cardiac surgical admissions in 5 UK centers between October 2015 and June 2017. The relationship between the candidate risk factors and the incidence of morbidities was explored using multiple regressions. Patient survival, a secondary outcome, was checked at 6 months. ResultsA total of 675 (21.8%) procedure episodes led to at least 1 of the following: acute neurologic event, unplanned reoperation, feeding problems, renal replacement therapy, major adverse events, extracorporeal life support, necrotizing enterocolitis, surgical infection, or prolonged pleural effusion. The highest adjusted odds ratio of morbidity was in neonates compared with children, 5.26 (95% confidence interval, 3.90-7.06), and complex heart diseases (eg, hypoplastic left heart), 2.14 (95% confidence interval, 1.41-3.24) compared with low complexity (eg, atrial septal defect, P < .001 for all). Patients with any selected morbidity had a 6-month survival of 88.2% (95% confidence interval, 85.4-90.6) compared with 99.3% (95% confidence interval, 98.9-99.6) with no defined morbidity (P < .001). ConclusionsEvaluation of postoperative morbidity provides important information over and above 30-day survival and should become a focus for audit and quality improvement. Our results have been used to initiate UK-based audit for 5 of these 9 morbidities, co-develop software for local monitoring of these morbidities, and parent information about these morbidities.

Patterns and outcomes of paediatric trauma at a tertiary teaching hospital in Kenya.

IntroductionTrauma continues to be a major cause of morbidity and mortality especially in the paediatric population of low- and middle-income countries such as Kenya. The aim of this study was to establish the profile and outcomes of admitted paediatric trauma cases at the Aga Khan University Hospital, Nairobi.MethodsThis retrospective, descriptive study involved a 12-month chart review (January 2016–December 2016). A total of 218 records were identified of which 144 were reviewed.ResultsMost injuries were amongst boys (65.3%) and the very young (mean age 6), occurred in private residences (42.4% homes, 25.7% residential institutions), were typically caused by falls (56.3%) or penetrating trauma (13.2%), mostly resulted in extremity fractures (45.8% closed, 4.9% open) and burn or head injuries (in infants and small children), and got very little or no pre-hospital care (51.4% no care). Additionally, children with burns, brain injuries, or poly-trauma had the longest hospital stays and highest rates of mortality. A more detailed description of the patterns and outcomes seen are included in the study.DiscussionPaediatric injuries remain a major public health problem and contribute a substantial proportion of all paediatric surgical admissions at the Aga Khan University Hospital in Nairobi. Based on the patterns and outcomes seen in this study, we therefore recommend for Nairobi (and possibly Kenya) to establish greater supervision and safety measures for children; targeting safety interventions at all children but particularly at boys, the very young, at home and in residential buildings; building pre-hospital emergency care that can accommodate children; and equipping paediatric trauma hospitals to especially handle bony fractures, burns, head injuries, and poly-traumas. A bespoke trauma registry would benefit the hospital, and likely the country as a whole.

Clinical Epidemiology of Paediatric Surgical Admissions and Mortality – A Single Centre Retrospective Study Over last 15 Years

Clinical Epidemiology of Paediatric Surgical Admissions and Mortality – A Single Centre Retrospective Study Over last 15 Years

Trends and Outcomes of Emergency Pediatric Surgical Admissions from a Tertiary Hospital in Ethiopia.

Pediatric surgical emergency condition is a broad spectrum of surgical pathologies/disorders occurring in pediatric age group requiring proper emergency surgical care as the only option of management to salvage life, avoid/minimize disability or palliation. The objective of this study is to analyze the pattern and outcome of pediatric surgical emergencies managed at Tikur Anbesa Hospital and the factors associated with outcome. Retrospective analysis of medical records of patients was conducted to assess the pattern, outcome and factors associated with outcome of pediatric surgical emergencies admitted and managed at Tikur Anbesa Specialized Hospital, from January 1, 2015 to December 31, 2015. Data was checked for completeness and entered into SPSS version 20 for statistical analysis. A total of 454 patients' medical records were analyzed. The presentation was after 5 days of illness in 182(40%), and >3 days in 243(53.4%), while only 89(19.6%) of them come within 24 hours of the illness. The etiologies were abdominal/gastrointestinal emergencies 210(46.3%), foreign body in aero digestive system in 133(29.3%), urogenital surgical emergencies in 27(5.9%). The other causes include superficial and deep tissue abscess collections in 22(4.8%), trauma /injury related cases in 24(5.3%) and others in 38(8.4%) respectively while congenital malformations were only 57(12.6%) of the cases. Finally, 439(96.7%) were discharged cured or improved without major disabilities documented, while 9(2%) died. Delayed presentation, unstable condition on arrival, younger age group and the nature of underlying pathology could have contributed for the death, but this needs further study.

Epidemiology of childhood intussusception in Bangladesh: Findings from an active national hospital based surveillance system, 2012–2016

IntroductionRotavirus vaccines have significantly decreased the burden of diarrheal diseases in countries that have introduced them into their immunization programs. In some studies, there has been a small association between rotavirus vaccines and intussusception in post-marketing surveillance, highlighting the importance of tracking incidence before and after vaccine introduction. The objective of this study was to describe the epidemiology of intussusception among Bangladeshi children pre-vaccine introduction. MethodsWe conducted active, hospital-based surveillance for intussusception at 7 tertiary care hospitals with pediatric surgical facilities during July 2012 to September 2016. Hospitalized children under 2years of age were identified according to Brighton Collaboration level 1 criteria for intussusception. The frequency and proportion of intussusception among overall surgical admissions, as well as the demographic and clinical information of the cases is described. ResultsOverall 153 cases of intussusception among children <2years-old were identified at participating sites over the enrolment period, confirmed by Level 1 Brighton criteria. These cases represented 2% of all surgical admissions under 2years of age. One hundred twelve cases (73%) were male; the median age was 7months; and the median duration of hospitalization was 7days. One hundred forty-six (95%) children with intussusception required surgery, and 11 (7%) died. ConclusionsConfirmed cases of intussusception represented nearly 2% of pediatric surgical admissions at tertiary referral centers in Bangladesh during the study period and 7% of children with intussusception died. Given the high burden of rotavirus disease in Bangladesh, vaccine introduction is warranted, however, further studies after introduction of rotavirus vaccine are necessary to determine any association between vaccine and intussusception in this setting.

Impact of Viral Respiratory Pathogens on Outcomes After Pediatric Cardiac Surgery.

Viral respiratory infection is commonly considered a relative contraindication to elective cardiac surgery. We aimed to determine the frequency and outcomes of symptomatic viral respiratory infection in pediatric cardiac surgical patients. Retrospective cohort study of children undergoing cardiac surgery. Symptomatic children were tested using a multiplex Polymerase Chain Reaction (respiratory virus polymerase chain reaction) panel capturing nine respiratory viruses. Tests performed between 72 prior to and 48 hours after PICU admission were included. Mortality, length of stay in PICU, and intubation duration were investigated as outcomes. Tertiary PICU providing state-wide pediatric cardiac services. Children less than 18 years admitted January 1, 2008 to November 29, 2014 for cardiac surgery. Respiratory virus polymerase chain reaction was positive in 73 (4.2%) of 1,737 pediatric cardiac surgical admissions, including 13 children with multiple viruses detected. Commonly detected viruses included rhino/enterovirus (48%), adenovirus (32%), parainfluenza virus 3 (10%), and respiratory syncytial virus (3%). Pediatric Index of Mortality 2, Aristotle scores, and cardiopulmonary bypass times were similar between virus positive and negative/untested cohorts. Respiratory virus polymerase chain reaction positive patients had a median 2.0 days greater PICU length of stay (p < 0.001) and longer intubation duration (p < 0.001). Multivariate analysis adjusting for age, Aristotle score, cardiopulmonary bypass duration, and need for preoperative PICU admission confirmed that virus positive patients had significantly greater intubation duration and PICU length of stay (p < 0.001). Virus positive patients were more likely to require PICU admission greater than 4 days (odds ratio, 3.5; 95% CI, 1.9-6.2) and more likely to require intubation greater than 48 hours (odds ratio, 2.5; 95% CI, 1.4-4.7). There was no difference in mortality. No association was found between coinfection and outcomes. Pediatric cardiac surgical patients with a respiratory virus detected at PICU admission had prolonged postoperative recovery with increased length of stay and duration of intubation. Our results suggest that postponing cardiac surgery in children with symptomatic viral respiratory infection is appropriate, unless the benefits of early surgery outweigh the risk of prolonged ventilation and PICU stay.

Biliary Atresia – An Easily Missed Cause of Jaundice amongst Children in Uganda

Back ground: Biliary atresia is characterized by biliary obstruction, it has an incidence of 1:15000 and presents with jaundice, acholic stools / dark urine and hepatomegaly. This disease rapidly leads to liver cirrhosis and liver failure if untreated surgically. The main objective was to establish the epidemiology of patients presenting with biliary atresia and immediate surgical outcome. Methods: A review of a prospective data base for pediatric surgical admissions from January 2012 to December 2015 was made and examined all the entries for children admitted with biliary atresia. Results: In this study 46 patients were recruited with an age range at admission of 2 weeks to 3.5 years and a peak age of 2 months. During the four years, 14 Patients had portoenterostomy done and of these 5 died within 7 days after surgery. Thirty two (32) patients were not operated, 18 of them died and 13 were still alive by the close of 2015. Conclusion: A big number of children with biliary atresia presented late with decompensated liver functions having lost time in peripheral health facilities being managed for medical jaundice.Key words: Biliary atresia, Uganda, Jaundice