Pediatric Surgery Research Articles

Are we informing our patients correctly? Evaluation of perioperative counselling for paediatric intestinal stoma formation: a national study.

Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. UK paediatric surgery centres were invited to recruit patients aged 6-16years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.

Yuri Yu. Sokolov is 60 years old!

On May 27, 2024, Yuri Yu. Sokolov, Doctor of Medical Sciences, Professor, Member of the Editorial Board of journal “Russian Journal of Pediatric Surgery” celebrates his 60-year jubilee. The leading area of his scientific interest is minimally invasive surgery of malformations in the thoracic and abdominal cavities in children. Prof. Sokolov has conducted on-site master classes on pediatric endosurgery more than 50 times in various Russian cities and neighboring foreign countries. He was the first in Russia to perform laparoscopic (in 2005) and robot-assisted (in 2021) extirpation of a cyst in the common bile duct in a child.

Postoperative EEG abnormalities in relation to neurodevelopmental outcomes after pediatric cardiac surgery.

We had reported that postoperative EEG background including sleep-wake cycle (SWC) and discharge (seizures, spikes/sharp waves) abnormalities were significantly correlated with adverse early outcomes in children after cardiac surgery. We aimed to analyze the relations between these EEG abnormalities and neurodevelopmental outcomes at about2 years after cardiac surgery. We enrolled 121 patients undergoing cardiac surgery at 3.3 months (0.03 ~ 28 months). EEG abnormalities described above during the first postoperative 48 h were evaluated. Griffiths Mental Development Scales-Chinese was used to evaluate the quotients of overall development and 5 subscales of the child's locomotor, language, personal-social, eye-hand coordination and performance skills at 16 ~ 31 months of age. EEG background abnormalities occurred in 59/121 (48.8%) patients and 33 (55.9%) unrecovered to normal by 48 h. Abnormal SWC occurred in 15 (12.4%) patients and 7 (5.8%) unrecovered to normal by 48 h. EEG seizures occurred in 11 (9.1%) patients with frontal lobe seizures in 4. Spikes/sharp waves occurred in 100 (82.6%). EEG background abnormalities, number of spikes/sharp waves and frontal lobe seizures were significantly associated with neurodevelopmental impairment at about 1 ~ 2 year after surgery (Ps ≤ 0.05). Most parameters of EEG abnormalities were significantly associated with neurodevelopmental impairment after cardiac surgery. Neurodevelopmental impairment in children with congenital heart disease remain poorly understood. Previous studies had reported that either EEG seizures or background abnormalities were associated with worse neurodevelopmental outcomes. Our present study showed that all the EEG background and discharge abnormalities including EEG background, seizures and spikes/sharp waves in the early postoperative period were significantly associated with neurodevelopmental impairment at about 1 ~ 2 years after cardiac surgery. Comprehensive evaluation of early postoperative EEG may provide further insights about postoperative brain injury, its relation with neurodevelopmental impairment, and guide to improve clinical management.

External validation of a clinical mathematical model estimating post-operative urine output following cardiac surgery in children

BackgroundThis study aims to externally validate a clinical mathematical model designed to predict urine output (UOP) during the initial post-operative period in pediatric patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).MethodsChildren aged 0–18 years admitted to the pediatric cardiac intensive care unit at Cleveland Clinic Children’s from April 2018 to April 2023, who underwent cardiac surgery with CPB were included. Patients were excluded if they had pre-operative kidney failure requiring kidney replacement therapy (KRT), re-operation or extracorporeal membrane oxygenation or KRT requirement within the first 32 post-operative hours or had indwelling urinary catheter for fewer than the initial 32 post-operative hours, or had vasoactive-inotrope score of 0, or those with missing data in the electronic health records.ResultsA total of 213 encounters were analyzed; median age (days): 172 (IQR 25–75th%: 51–1655), weight (kg): 6.1 (IQR 25–75th%: 3.8–15.5), median UOP ml/kg/hr in the first 32 post-operative hours: 2.59 (IQR 25–75th%: 1.93–3.26) and post-operative 30-day mortality: 1, (0.4%). The mathematical model achieved the following metrics in the entire dataset: mean absolute error (95th% Confidence Interval (CI)): 0.70 (0.67–0.73), median absolute error (95th% CI): 0.54 (0.52–0.56), mean squared error (95th% CI): 0.97 (0.89–1.05), root mean squared error (95th% CI): 0.99 (0.95–1.03) and R2 Score (95th% CI): 0.29 (0.24–0.34).ConclusionsThis study provides encouraging external validation results of a mathematical model predicting post-operative UOP in pediatric cardiac surgery patients. Further multicenter studies must explore its broader applicability.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

The Complex Interplay of Variables in Extubation Decision-Making Following Pediatric Cardiac Surgery: A Narrative Review.

Pediatric cardiac surgery poses significant challenges in developing countries, where a considerable number of children require intervention for congenital heart disease (CHD). The utilization of endotracheal intubation and anesthesia is pivotal in conducting surgical or angiography procedures on patients with CHD exhibiting diverse anatomical and hemodynamic characteristics. The decision to extubate pediatric patients following cardiac surgery remains a crucial element of postoperative care. This article explores the complexities surrounding extubation decision-making in this population, emphasizing the critical role of surgical, physiological, and postoperative factors. Various preoperative and intraoperative factors influence the timing of extubation. Early extubation is increasingly prevalent, offering benefits like reduced length of stay and minimized drug exposure. Multidisciplinary collaboration and protocol-driven strategies contribute to improved extubation outcomes, emphasizing the need for a comprehensive approach in pediatric cardiac surgery. Future research can focus on the implementation and efficacy of standardized extubation procedures involving collaboration among healthcare experts.

Use of biobehavioral interventions in children undergoing surgery and associated patient-reported outcomes

Background: Biobehavioral interventions including relaxation, distraction, and mindfulness meditation exercises have been shown to decrease perioperative stress, anxiety, and pain. Our aims were to 1) quantify pediatric surgical patient-reported pre-operative exposure to and post-operative use of biobehavioral interventions; 2) understand barriers and facilitators to incorporation of biobehavioral interventions into clinical practice; and 3) evaluate associated patient-reported outcomes. Methods: We conducted an embedded mixed-methods study with a quantitative focus. Data were collected as part of the 18-hospital ENhanced Recovery In CHildren Undergoing Surgery (ENRICH-US) clinical trial for children, ages 10–18 years, undergoing elective gastrointestinal surgery. Patients/caregivers were surveyed about preoperative exposure to and postoperative use of biobehavioral interventions. Four semi-structured group interviews with 20 pediatric surgery providers were conducted. Outcomes included pain-related functional disability, health-related quality of life (HRQoL), and perioperative nervousness. Results: 41 % (n = 67) of 164 enrolled patients/caregivers reported preoperative exposure to and 71 % (n = 117) reported postoperative use of a biobehavioral intervention(s). Barriers to incorporation of biobehavioral interventions included lack of standardized workflows, clinician knowledge, and resources. Potential facilitators included media and peer-counseling. After adjusting for individual and hospital characteristics, those who reported using a biobehavioral intervention(s) were 70 % less likely to report worsened postoperative nervousness (95 % CI 0.10–0.91; p = 0.03). Reported use of a biobehavioral intervention(s) was not found to be associated with pain-related functional disability or HRQoL. Conclusions: Use of a biobehavioral intervention(s) may stabilize postoperative nervousness of children undergoing surgery. There is a need for redesign of clinical workflows and clinician training to facilitate integration of biobehavioral interventions.

The effect of BIS-guided anaesthesia on the incidence of postoperative nausea and vomiting in children: a prospective randomized double-blind study

BackgroundPostoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients.Study objectiveEvaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV.DesignProspective, randomized, double-blind study.SettingA single center study in university hospital in Czech republic, from June 2021 to November 2022.PatientsA total of 163 children, aged 3–8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included.InterventionsIn the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS.Main outcome measureThe primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery.ResultsThe use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27–0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20–0.54); p = 0.01, respectively].ConclusionsBIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy.Trial registrationClinicaltrials.gov identifier: NCT04466579.

Evaluation of the level of information of pediatricians about the diagnosis and management of cryptorchidism

ObjectiveEvaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism. MethodA cross-sectional observational study was conducted using a form via the "Google Forms" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21. Results728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism. ConclusionIt is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery.

Paediatric post-grommets surgery review: Audiology-led clinic

BackgroundOtitis media (OM) has a high prevalence in childhood, and grommet insertion is the most common surgical treatment for OM. The public health system in Australia faces considerable strains, including high demand for Ear, Nose and Throat (ENT) specialists. Extending the scope of practice for audiologists to manage post-operative care for children receiving grommets has the potential to alleviate this burden. MethodsThis non-randomised, cross-sectional study investigated the efficacy and feasibility of an audiology-led clinic for managing paediatric patients after grommet insertion at a tertiary teaching hospital in Western Australia. Senior audiologists reviewed children at 6 weeks and 10 months post-operatively, escalating care to an ENT specialist if abnormalities were observed. Children with normal hearing and patent grommets were reviewed and discharged by the audiologist. ResultsA total of 93 children were included (mean age 5.18 ± 2.25 years, range 1.59–11.46 years). At the 6-week review, 72/93 (77 %) presented with in-situ grommets and normal hearing, while 21/93 (22 %) were escalated for immediate ENT care. At the 10-month review, 54/72 (75 %) were discharged without further ENT intervention, and 18/72 (25 %) required additional ENT investigation. ConclusionThis study demonstrated that an audiology-led follow-up clinic for post-grommet insertion is a viable option, providing efficient, high-quality care. Two-thirds of paediatric patients did not require ENT input or review post-operatively. The results support interdisciplinary models of care, which could help address challenges faced by overburdened ENT services.

Limitations and complications of robotic urological surgery in younger children: debunking old beliefs.

Even though certain technical limitations associated with the small size of the patients were taken for granted in the advent of pediatric robotic surgery, we could now be facing a paradigm shift challenging these old beliefs. A retrospective study of patients undergoing Da-Vinci-Xi(IS4000)-assisted urological surgery from May 2022 to October 2023 was carried out. Patients were divided into two groups -Group A <15 kg and Group B ≥15 kg. Operating times, hospital stay, and intra- and postoperative complications were compared. 17 patients (9 in Group A, 8 in Group B) underwent surgery. Median age was 29months (A) and 109 months (B) (p<0.001). Median weight was 12.0 kg (A) and 31.5 kg (p<0.001). Operating time was 162 min (A) and 130 min (p=0.203). Console time was 99 min (A) and 70 min (B) (p=0.065). Mean hospital stay was 2 days (A) and 3 days (B) (p=0.41). No differences were found in terms of intraoperative (p=0.453) or postoperative (p=0.485) complications. Even though operating on younger children seemed more complicated than on older ones in the advent of robotic surgery, the results in our series were similar. The fact patients under 12 months of age were not included means larger studies are required to prove this.

Effects of Fibrinogen Concentrate Supplementation on Postoperative Bleeding in Infants Undergoing Complex Cardiac Surgery.

The use of allogeneic blood products to restore hemostasis during pediatric cardiac surgery is associated with major risks. Consequently, there has been a growing interest in new patient blood management strategies, such as those based on the use of fibrinogen concentrate (FC). Accumulating evidence has shown FC supplementation to be safe and effective. Nevertheless, no guidelines are available on using FC in the pediatric setting, and few objective evaluations have been provided in clinical practice. The endpoint of this monocenterretrospective study was the hemostatic effect of additional FC in infants undergoing complex cardiac surgery with cardiopulmonary bypassto manage persistent clinically relevant bleeding. After weaning from cardiopulmonary bypass and after protamine administration, patients were transfused with conventional allogeneic products such as packed red blood cells, fresh frozen plasma (FFP), and platelets. In the case of redo surgery, according to the institutional protocol, patients also received tranexamic acid. In case of clinically persistent relevant bleeding, according to the anesthesiologist's judgment and thromboelastography, patients received FC supplementation (group with FC) or further FFP transfusions without receiving FC supplementation (group without FC). The primary endpoint was the hemostatic effects of FC. Secondary endpoints were the functional hypofibrinogenemia threshold value (expressed as maximum amplitude fibrinogen, MA-Fib) and postoperative MA-Fib, fibrinogenemia, intraoperative transfusions, and adverse events (AEs). In total, 139 patients who underwent cardiac surgery with CPB and aged less than 2 years were enrolled: 70 patients received allogeneic blood products and FC supplementation (group FC); 69 patients received allogeneic products without FC supplementation (group without FC). Patients that received FC supplementation were characterized by a significantly longer time of extracorporeal circulation (p < 0.001) and aortic cross-clamping (p < 0.001), a significantly lower minimum temperature (p = 0.011), increased use of concentrated prothrombin complex (p = 0.016) and tranexamic acid (p = 0.010), and a significantly higher amount of packed red blood cells, platelets (p < 0.001) and fresh frozen plasma (p = 0.03). Postoperative bleeding and severe bleeding were not statistically different between patients treated with FC and those not treated with FC supplementation (p = 0.786 and p = 0.695, respectively); after adjustment, a trend toward reduced bleeding can be observed with FC (p = 0.064). Overall, 88% of patients with severe bleeding had MA-Fib < 10 mm; a moderate association between severe bleeding and MA-Fib (odds ratio 1.7, 95% CI 0.5-6.5, p = 0.425) was found. Increased MA-Fib and postoperative fibrinogen were higher in the FC group (p = 0.003 and p < 0.001, respectively) than in FFP. AEs in the FC group were comparable to those observed in less complicated surgeries. Our results suggest a potential role of FC in complex surgery in maintaining postoperative bleeding at a level comparable to less complicated surgical procedures and favoring the increase in postoperative MA-Fib and fibrinogen.

Celsior® vs. St Thomas® cardioplegia: analysis of myocardial protection and clinical safety in neonates.

To compare the effectiveness and safety of Celsior® crystalloid solution to St Thomas® solution as cardioplegia in pediatric arterial switch surgery. A retrospective study was conducted on 180 patients who underwent arterial switch operation (ASO) between 2005 and 2019. The patients were divided into two groups: the St Thomas group receiving St Thomas solution and the Celsior® group receiving Celsior® solution. The study aimed to assess myocardial protection while evaluating clinical outcomes of patients between groups. Baseline characteristics not different between groups. The postoperative troponin release trends and blood lactate levels were not different between groups. However, the Celsior® group had a significant lower incidence of delayed sternal closure (9.7% vs. 19.5%; p = 0.09) and mechanical circulatory support (ECMO) (4.9% vs. 24.7%; p < 0.001) compared to the St Thomas group. The length of stay in the intensive care unit (ICU) was significantly shorter in the Celsior® group (4.6 ± 3.36 days vs. 8.72 ± 5.08 days, respectively; p < 0.001). There was no significant difference in 30-day mortality between the two groups (2.9% vs. 2.6%; p = 0.147). The study suggests that Celsior® solution is effective and safe for myocardial protection in pediatric arterial switch surgery. It may offer potential benefits such as reduced need for delayed sternal closure and ECMO support, as well as shorter ICU stay. However, the study has limitations including its retrospective design and the use of different cardioplegic solutions during different time periods. Further prospective randomized trials are needed for confirmation. ClinicalTrials.gov, ID: NCT04616222.

Pediatric Anatomy of the Sternocleidomastoid Muscle on Magnetic Resonance Imaging Views.

This study aimed to investigate morphologic features of the sternocleidomastoid muscle (SCM) in children for pediatric head-neck surgeries. Magnetic resonance imaging images of 84 (46 males/38 females) pediatric patients aged ages 1 to 18 years (mean age: 9.38 ± 4.46y) constituted the study universe. The size of SCM (including its height, width, and angulation) was measured, and the origin types of SCM were noted. All patients had SCM bilaterally. The origin variation of SCM was observed in 22 sides (13.10%). The authors observed type 1 in 146 sides (86.90%), type 2a in 15 sides (8.90%), type 3 in 2 sides (1.20%), type 4 in 1 side (0.60%), and type 5 in 4 sides (2.40%). The absence and presence of SCM variation were not affected by sex (P = 0.370) and side (P = 0.360). All measured parameters were similar in right and left sides, and also in males and females, except from the angle between the junction of the sternal and clavicular heads of SCM. The angle was greater in males than females (P = 0.004). All measured parameters increased with advancing age (between 1 and 18y; P < 0.05). The authors' SCM-related data may be useful for clinicians to estimate the size origin variations of SCM in children.

Does bilateral Wilms’ tumor involving the collecting system in children have a worse prognosis?

BackgroundThe literature on nephron-sparing surgery (NSS) in children with bilateral Wilms’ tumors (BWT) involving the collection system is mostly comprised of case reports. The present study aimed to summarize the clinical characteristics, treatments, and prognosis of children with BWT involving the collecting system admitted to our pediatric surgery center compared with those whose tumors did not involve the collecting system. A secondary aim was to discuss how to preserve more kidney parenchyma and prevent long-term renal failure under the premise of preventing tumor recurrence.MethodsPatients with BWT admitted to our pediatric surgery center between January 2008 and June 2022 were reviewed. All included patients were grouped according to the relationship between the tumor and collecting system according to the intraoperative findings. Group I included children with tumor infiltrating the collecting system, group II included children with tumor growing into the collecting system, and group III included children whose tumor did not involve the collecting system. The clinical features, treatments and prognosis of the patients were analyzed.ResultsSeventy patients were enrolled, including 20 patients with 25 sides of tumors infiltrating the collecting system in group I,10 patients with 13 sides of tumors growing into the collecting system in group II, and 40 patients in group III. There was no significant difference in patients age and gender between group I and group II. In total, 20 patients in group I and 9 patients in group II had partial response (PR) after neoadjuvant chemotherapy. In group I, 22 of 25 sides of tumors underwent NSS; in group II, 11 of 13 sides of tumors underwent NSS. During an average follow-up of 47 months, in group I, 6/20 patients relapsed and 2/20 patients died; in group II, 3/10 patients relapsed and 1/10 patient died. There was no significant difference in 4-year overall survival (OS) rate among groups I, II and III (86.36% vs. 85.71%vs. 91.40%, P = 0.902).ConclusionsTo preserve renal parenchyma, NSS is feasible for children with BWT involving the collecting system. There was no significant difference in postoperative long-term OS between patients with BWT involving the collecting system and not involving the collecting system.

Association between the MTHFR (rs1801133) gene variation and serum trace elements levels (Copper and Zinc) in individuals diagnosed with neural tube defects

Background and AimsNeural tube defects (NTDs) occur when the neural tube fails to close within 28 days of human embryonic development. This results in central nervous system disorders like anencephaly, spina bifida, and encephalocele. Early diagnosis and treatment are crucial to minimize their impact on an individual’s health and well-being. The present study aims to define the association between prenatal exposure to trace elements (Cu and Zn) and the single nucleotide polymorphism (SNP) of the MTHFR gene involved in folate metabolism pathways in neural tube defects in children and their mothers. Material and MethodsA cross-sectional study involving 331 participants (90 NTD cases, 88 healthy mothers, 85 NTD children, and 68 healthy children) from antenatal check-ups in Obstetrics and Gynaecology and Pediatric Surgery for Neural Tube Defects in the Outpatient Department (OPD) and Inpatient Department (IPD). Assessed Cu and Zn concentrations and their associations. Genomic DNA was extracted, and real-time PCR was used to determine genotypes. Atomic absorption spectrophotometry measured trace elements. Statistical analyses included Chi-Square tests, odds ratios, and Mann-Whitney U tests. ResultsSignificant associations were found between MTHFR C677T genotypes and NTD risk in mothers (p = 0.0491) and children (p = 0.0297). Allelic frequency analysis indicated a T allele association with NTD risk in children (p = 0.0107). Recessive models showed significant associations in mothers (p = 0.0169) and children (p = 0.1678). Cu levels differed significantly between NTD cases and controls (p < 0.0001), with MTHFR genotypes influencing Cu levels. Zinc levels also varied significantly (p < 0.0001). ConclusionThis study reveals complex associations between MTHFR C677T genotypes, trace element concentrations, and NTD risk in mothers and children. This targeted approach allows healthcare providers to identify at-risk pregnancies early, enabling personalised interventions like folic acid supplementation and counselling to moderate neural tube defect (NTD) risk in a future pregnancy.

OUTCOMES OF NEONATAL SURGERIES WITHOUT NICU IN LMIC

Dealing with neonatal surgery, which nearly invariably entails emergency neonatal surgical scenarios, is the most challenging and complex problem in pediatrics and pediatric surgery. Congenital abnormalities are the most common reason for emergency neonatal surgery. Pakistan and other low and middle-income countries (LMICs) account for over ninety percent of these abnormalities. Objective: Our goal is to examine the factors contributing to the high mortality rate in neonatal surgery among those individuals who didn't have access to the NICU. This will inform our recommendations for the worldwide community and the need for NICU care post-operatively. Method: This prospective research was carried out in PIMS hospital from December 2022 to December 2023. Our center has a 15-bed NICU facility, which is almost negligible compared to the patient load of our center. Two hundred patients who underwent surgery during the study were enrolled in our study. Demographic and clinical data were gathered using a questionnaire, and SPSS 25 was used for analysis. Results: Throughout the study period, 33 of 200 neonates died, resulting in a 16.5% mortality rate. Over 53% of these cases were preterm. The research had a minimum gestation age of 29 weeks and a mean gestational age of 35.54 ± 3.56 weeks. The mean newborn's weight had been 2.41 ± 0.52 kg (range: 1.22–3.5 kg). There were more male babies (67.5%) than females. Anorectal malformation was found in four infants who died following surgery. Gastroschisis was discovered in five infants who died after surgery. Sepsis was the most common cause of death following neonatal surgery, amounting to 84.84% of total deaths. Cardiogenic shock was the reason for expiry in 9.09% of the cases, and 6.06% of the cases had respiratory failure as the cause of death. Gastroschisis and esophageal atresia were associated with the most significant mortality. Conclusions: In underdeveloped nations like Pakistan, surgical infants account for a sizable fraction of the total neonatal death rate, most of which may be avoided with proper perioperative and NICU care. Nevertheless, the national health strategy does not give neonatal surgery the priority it deserves. NICUs should be established countrywide to enhance patient care and decrease the overall mortality rate of pediatric surgery.

Intraparenchymal Indocyanine Green Use Improves Nodal Yield During Minimally Invasive Tumor Nephrectomy in Children.

Introduction: Correctly identifying positive lymph nodes associated with pediatric renal tumors is key to guiding management. Recommended targets for lymph node sampling are commonly missed during tumor nephrectomy, particularly if minimally invasive surgery (MIS) is performed. Indocyanine green (ICG) is used for lymph node mapping in adult oncology with excellent efficacy and safety profile. Materials and Methods: A prospective study was undertaken at a single-quaternary-level pediatric surgery center. All patients undergoing MIS radical or partial nephrectomy for renal tumors 2016-2023 were included. Patients managed from 2020 onwards received intra-parenchymal ICG prior to lymph node sampling. Main Results: Twenty-five patients underwent MIS nephrectomy at mean age 2 years 10 months. Eighteen patients were pre-ICG and 7 received ICG. ICG administration successfully demonstrated fluorescent nodes in all patients. Median number of nodes sampled was three pre-ICG and seven with ICG (P = 0.009). Forty-six nodes were sampled across 7 ICG patients-33 fluorescent, 10 non-fluorescent, and 3 identified histologically. Three nodes overall contained active disease, two pre-ICG and one fluorescent node with ICG. Neither operative time (180 pre-ICG versus 161 minutes ICG, P = 0.7) nor length of stay (72 versus 84 hours, P = 0.3) were significantly affected by ICG administration. There were no adverse events associated with ICG use. Conclusions: ICG is safe and effective at identifying nodes in MIS resection of pediatric renal tumors with the potential to increase the number of nodes sampled. Further research is needed, specifically a randomized control trial with extended follow-up.

Postoperative Intensive Care Requirements of Pediatric Surgery Patients

Postoperative Intensive Care Requirements of Pediatric Surgery Patients

Diaphragmatic paralysis after pediatric cardiac surgery: Associated implications and outcomes

Diaphragmatic paralysis after pediatric cardiac surgery: Associated implications and outcomes

Analysis of Risk Factors of Difficult Weaning from Mechanical Ventilation after Pediatric Cardiac Surgery: A Single Center Prospective Study

Abstract Background Weaning from mechanical ventilation (MV( and timing of extubation are crucial components in the postoperative management of cardiac surgery as altered respiratory mechanics and positive pressure ventilation may have significant influence on hemodynamics. Aim: To evaluate risk factors for failure of weaning from mechanical ventilation after pediatric cardiac surgery and to assess the frequency of phrenic nerve injury. Methodology This Cohort study included medical records of 101 children admitted consecutively to Pediatric post-cardiac surgery ICU in Academy of Cardiovascular surgery in Ain Shams university Hospitals between April, 2020 and April, 2021, who had undergone heart surgery. The patients were divided into two groups : - successefully weaned group. - Difficult to wean group. Diaphragmatic ultrasound was done for every difficult weaning patient to assess diaphragmatic paralysis. Result: Age (P &amp;lt; 0.001), Weight (P &amp;lt; 0.001), volum intake (P &amp;lt; 0.001), systolic blood pressure (P = 0.017), Diastolic blood pressure (P = 0.004), were significantly lower in patients who showed difficult weaning compared to patients with successful weaning. Furthermore operation time (P &amp;lt; 0.001), use of noradrenaline (P = 0.019), use of adrenaline ( P = 0.017), use of Milirinon ( P = 0.003), respiratory rate ( P = 0.003), inotropic support (P = 0.001), positive fluid balance (P &amp;lt; 0.001), heart failure, renal failure, Pulmonary complications, need of pace maker, sepsis ( P &amp;lt; 0.001), diaphragmatic paralysis ( P &amp;lt; 0.001), transposition of great arteries operations ( P = 0.009), were significantly higher in patients who showed difficult weaning compared to patients with successful weaning. While use of dobutamine, discharge with open chest, reoperation, transfusion &amp;gt; 50 ml / kg, urine output, reoperation bleeding and any operation other than atrial septal defect, transposition of great arteries all did not affect weaning difficulty. Conclusion younger age, operation time, as well as sepsis were the best predictors for difficulty of weaning.