Postoperative Period In Children Research Articles

Perioperative use of erythrocyte-containing blood components in children during the first months of life

BACKGROUND: Anemia can be diagnosed before surgery, occur during surgical treatment, and develop and worsen in the postoperative period in children with surgical diseases. Anemia is associated with increased morbidity, severe complications, and even death after surgical treatment. AIM: This study aimed to determine the frequency and indications for transfusion of red blood cell-containing components in the perioperative period in children in the first months of life. MATERIALS AND METHODS: This cohort study included 187 children from the G.N. Speransky Children’s Hospital No. 9. The hemoglobin, hematocrit, and red blood cell levels were studied as well as the volume of intraoperative blood loss, hemodynamic parameters, the presence of hemorrhagic syndrome, and the use of adrenomimetics in the perioperative period. The stage of the perioperative (pre, intra, or post) period at which the transfusion of erythrocyte-containing components was conducted was recorded. Statistical data analysis was performed using the statistical computing environment R 4.3.0. RESULTS: The average age of the children at the time of surgery was 41 (16.5–63) days [5.9 (2.4–9) weeks]. Sixty-four (34.2%) children were in their first month of life, 72 (38.5%) in their second month, and 51 (27.3%) in their third month, and 76 (40.6%) children were premature. The surgeries were emergent and urgent in 102 (54.5%) children and planned in 85 (45.5). The hemoglobin, hematocrit, and erythrocyte levels at which erythrocyte-containing components were transfused were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively. The volume of erythrocyte-containing components was 54.0 (32.9–74.4) ml (10–30 ml/kg/child’s body weight). The need for and duration of artificial pulmonary ventilation in the postoperative period were 31 (72.1%) cases and 48.5 (22.5–190) hours, respectively, in contrast to children who did not receive transfusions of red blood cell-containing components—57 (39.6%) cases and 40 (22–96) hours. The indication for transfusion was anemia of varying degrees; however, 74.4% of children received adrenergic agonists simultaneously with transfusion to stabilize hemodynamics: dopamine monotherapy in 23 (74.2%) and combinations of dopamine and norepinephrine in 8 (25.8%) at 10 (8–12) mcg/kg/min and 0.2 (0.15–0.4) mcg/kg/min, respectively. CONCLUSION: The frequency of use of red blood cell-containing components was 23%. Threshold values for transfusion of erythrocyte-containing components Hb, Ht, and erythrocytes were 82 (77–90) g/l, 25% (22%–28%), and 2.8 (2.3–3.0) × 1012/l, respectively.

THE POSSIBILITY OF PREDICTING LEFT VENTRICULAR DYSFUNCTION IN THE EARLY POSTOPERATIVE PERIOD IN CHILDREN WITH VENTRICULAR SEPTAL DEFECT

Highlights The article reflects data of an original study on the diagnosis of early postoperative dysfunction in children under 1 year of age after correction of a ventricular septal defect. The relationship between troponin I and conventional echocardiographic parameters, left ventricular longitudinal strain (S, % LV), and parameters reflecting central hemodynamics was assessed. The predictive ability of S, % LV in predicting a decrease in cardiac index after surgery was revealed. AbstractAim. To evaluate the possibility of predicting left ventricular (LV) dysfunction in the early postoperative period in children with ventricular septal defect (VSD).Methods. The study included 204 children under 1 year of age with non-restrictive perimembranous VSD. All parameters were evaluated before surgery, 6 hours, 24 hours and 10 days after surgery. 125 healthy children were enrolled as the control group.Results. 6 hours after surgery, there was a statistically significant decrease in LV ejection fraction (EF) (Me 55 [K3 60–K1 45] %, p = 0.0001), stroke index (SI) of LV outflow tract (LVOT) (12, 07 [16.38–8.24] mL/m2, p = 0.0001), and cardiac index (CI) (1.52 [2.08–1.07] L/min/m2, p = 0.0001). Arterial elasticity (AE) increased (21.4 [32.4–15.79] mm Hg/mL, p = 0.002), indicating a significant increase in afterload. Arterial compliance (AC) decreased (0.058 [0.081-0.038] mL/mm Hg, p = 0.0001), whereas ventricular-arterial coupling (VAC) value significantly increased (2 [2.54–1.67], p = 0.009). There was a dependence between LVOT SI and age (Rs = 0.45, p = 0.03), a moderate relationship between LVOT SI and VAC (Rs = –0.59, p = 0.001), a pronounced relationship between LVOT SI and AC (Rs = 0, 93, p = 0.02), pronounced relationship between LVOT SI and AE (Rs = –0.94, p = 0.03), moderate correlation between VAC and SI (Rs = –0.44, p = 0.04), weak relationship between VAC and patient age (Rs = –0.28, p = 0.03). Longitudinal deformity before surgery (b = 0.028; F = 3.9; p = 0.006) and VSD size (b = -0.08; F = 3.4; p = 0.029) were significantly associated with LV SI dynamics 6 hours after surgery. Dependence equation was as follows: 2.8 – 0.08 * VSD + 0.028 * S. A predictive ability to reduce CI 6 hours after surgery was revealed: longitudinal strain (S), % with a threshold “–” 14.3% (sensitivity 96.2%, specificity 81.6%, AUC 0.92, p<0, 00001) and VSD diameter with a threshold of 8 mm (sensitivity 75%, specificity 52%, AUC 0.69, p<0.0001).Conclusion. In the early postoperative period, there is a decrease in systolic and LV pump function. High AE rates are associated with a decrease in AC and an increase in VAC. Preoperative predictors of SI decrease are as follows: S, %> “–” 14.3 and VSD size > 8 mm.

Тонзилектомія в дітей: терапевтичні можливості в оптимізації результатів хірургічного втручання

Tonsillectomy is one of the most common surgical interventions. The search for effective medical measures to optimize the course of regeneration processes in a postoperative wound is urgent. Purpose - to evaluate the effect of the complex homeopathic preparation Tonsilotren on the reparative processes of the postoperative period in children who underwent tonsillectomy. Materials and methods. The test group of 70 patients with chronic tonsillitis and 30 patients of the control group aged from 6 to 17 years were under observed and compared. All patients in the test group received Tonsilotren 7 days before surgery and for 2 weeks after surgical tonsillectomy. The examination of the ENT doctor was carried out during 5 visits: 1 visit before the operation, 2-5 visits - corresponded to the period from 1 to 14 days of the postoperative period. The results of observation were evaluated according to the following indicators: hyperemia of the mucous membrane of the faucial pillars, swelling of the mucous membrane of the faucial pillars, fibrinous pellicle in the postoperative wound, epithelization of the postoperative wound, bleeding from the postoperative wound, blood clots in the postoperative wound, scarring of the faucial pillars, pain intensity to VAS scale during swallowing and eating solid food, side effects, tolerability of the Tonsilotren medicine, complications of the disease, the need and duration of use of analgesics. Results. Prescribing of the Tonsilotren medicine to patients with chronic tonsillitis during and after surgical treatment (tonsillectomy) significantly increases the effectiveness of the treatment, namely: it helps to reduce the intensity of pain during swallowing and eating solid food, hyperemia and swelling of the mucous membrane of the faucial pillars, acceleration of epithelization of the postoperative wound, reduces scaring of faucial pillars (p<0.05). Epithelization of the postoperative wound with an area of more than 75% of its surface was observed in 24 (34.3%) patients on the 10th day and in 68 (97.1%) patients on the 14th day after the operation in the test group, while this indicator occurred in the control group only in 13 (43.3%) children on the 14th day after surgery. During observation, no side effects of the Tonsilotren medicine and adverse events were detected, which confirms the safety of its use. Conclusions. Course use of the Tonsilotren medicine in children in preparation for tonsillectomy and in the postoperative period demonstrates better effectiveness compared to standard treatment in terms of indicators of postoperative wound healing, rates of epithelization, absence of scarring and blood clots, and less pronounced pain syndrome. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Evaluation of the effectiveness of ozone therapy in the early postoperative period in children with appendicular peritonitis

The article examines the effectiveness of the use of ozone therapy in the complex treatment of children with appendicular peritonitis at the stage of the early postoperative period in relation to the correction of laboratory indicators of endotoxin aggression and relief of the main clinical symptoms. 60 children operated on for widespread appendicular peritonitis were examined. The main group consisted of 30 children who received a course of ozone therapy in addition to standard complex therapy at the stage of the early postoperative period. Only standard therapy was performed in patients of the comparison group. The control group consisted of 30 healthy children of the same age. Among the patients of the control group, in most cases, its physiological level was established - in 93.3%. The average value of lipopolysaccharides in the group was 0.6±0.1 EU/ml. In turn, among the patients of the main group and the comparison group, all children (100%) showed the development of endotoxin aggression. So, in the main group, the initial average value of lipolysaccharides was 2.6 ± 0.2 EU/ml, and in the comparison group - 2.50.2 EU/ml. 2 weeks after the surgical intervention in patients of the main group, the increased level of lipolysaccharides remained only in 20.0% of children. At the same time, the average value of the indicator was 0.8±0.1 EU/ml. Among the patients of the comparison group, on the 14th day of the postoperative period, 50.0% of children retained an elevated level of lipopolysaccharides, and the average value of the indicator was 1.50.1 EU/ml. It is proved that the use of ozone therapy according to the proposed method at the stage of the early postoperative period in the complex treatment of children with widespread appendicular peritonitis makes it possible to reduce laboratory indicators of endotoxin aggression in a shorter time and accelerate the regression of clinical symptoms.

Analgesic effect of ropivacaine combined with dexmedetomidine in the postoperative period in children undergoing ultrasound-guided single-shot sacral epidural block: A systematic review and meta-analysis.

This study aims to evaluate the efficacy of dexmedetomidine as an adjuvant to ropivacaine in prolonging postoperative analgesia and reducing pain scores in children undergoing surgery. Five online databases were searched for RCTs on postoperative analgesia of pediatric patients undergoing ultrasound-guided single-shot sacral epidural block with dexmedetomidine as an adjuvant to ropivacaine up to January 2, 2023. Pain score and sedation score at 2, 4, 8, 12, and 24 h after the operation, the time of first receiving additional analgesic drugs, and the number of postoperative adverse effects were selected to compare the efficacy and safety of combined treatment with ropivacaine alone for pediatrics. The standard mean difference (SMD) or odds ratio (OR) and the corresponding 95% confidence interval (95%CI) were calculated by using a random-effects model. A total of 295 articles were retrieved, but only 20 records were included in this meta-analysis. The results showed that dexmedetomidine combined with ropivacaine for sacral epidural block in children undergoing ultrasound-guided single-shot sacral epidural block had a more prolonged analgesia effect (SMD = 3.47, 95%CI: 2.80, 4.14). There were lower analgesia scores at 2 h(T1), 4 h(T2), 8 h(T3), 12 h(T4), and 24 h(T5) in postoperative period (T1 : SMD = -1.02, 95%CI: -1.31, -0.72; T2 : SMD = -1.02, 95%CI: -1.32, -0.72; T3 : SMD = -0.84, 95%CI: -1.12, -0.56; T4 : SMD = -0.61, 95%CI: -1.03, -0.20; T5 : SMD = -1.03, 95%CI: -1.28, -0.78). And the incidence of adverse effects was similar between the two groups (OR = 0.84, 95%CI: 0.59, 1.18). The results of this review and meta-analysis support that dexmedetomidine, as an adjuvant to ropivacaine, can improve postoperative analgesia of surgery and significantly prolong the analgesic time in children, with a similar incidence rate of adverse symptoms when compared with ropivacaine alone.

Study of the polymorphism of the ADRB2 molecular structure and its influence on the development of chronic postsurgical pain in children

Introduction. Pain is a signal to any aggression that leads to cellular damage and requires a defensive response. Uncontrolled acute perioperative visceral pain can lead to the development of pain chronicity. By studying the characteristics of chronic pain, some scientists have identified relationships with single-nucleotide polymorphisms of the beta2-adrenergic receptor (ADRB2) gene. Purpose - to study the dependence of pain expression in the postoperative period in children on the polymorphism of the molecular structure of the ADRB2 receptor. Materials and methods. The study involved 42 children (20 boys and 22 girls) aged 7 to 18 years who were treated in the surgical department in 2020-2022 for acute appendicitis and peritonitis. Results. Based on the results of examining all the subjects under study, 13 children had the Arg16Gly polymorphism, 15 children had the Arg16Gly polymorphic variant, and 14 children were diagnosed with the homomorphic Gly16Gly polymorphism in the ADRB2. The data obtained confirmed the trend of the preliminary analysis and proved better body response to pain relief and reduced pain intensity in individuals with the Arg16Arg variant of the ADRB2. Analysis of the dependence between the polymorphism of the ADRB2 molecular structure and Visual Analogue Scale (VAS) scores in children in the postoperative period proved that the presence of Arg in the receptor phenotype had a strong negative correlation with the VAS score on discharge day (r=-0.822, p<0.001), while the presence of Gly in the receptor phenotype had a strong positive correlation with the Visual Analogue Scale score on discharge day (r=0.814, p<0.001). In regression analysis, the presence of Gly in the receptor phenotype was associated with a 1.917-fold increase in the VAS score at hospital discharge (OR: 1.917; 95% CI: 1.448-2.385; р<0.001). Conclusions. The presence of the homomorphic Arg16Arg variant of the ADRB2 in children who underwent anterior abdominal wall surgery was accompanied by rapid response to analgesics. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Post-operative dysnatremia is associated with adverse early outcomes after surgery for congenital heart disease.

Dysnatremia is a common disorder in critically ill surgical children. The study's aim is to determine the prevalence of dysnatremia and its association with outcomes after surgery for congenital heart disease (CHD). This is a single-center retrospective cohort study of children <18 years of age undergoing surgery for CHD between January 2012 and December 2014. Multivariable logistic regression analysis was used to evaluate the relationship between dysnatremia and outcomes during the perioperative period. A total of 1345 encounters met the inclusion criteria. The prevalence of pre- and post-operative dysnatremia were 10.2% and 47.1%, respectively. Hyponatremia occurred in 19.1%, hypernatremia in 25.6%. Hypernatremia at 24, 48, and 72 h post-operative was associated with increased hospital mortality (odds ratios (OR) [95% confidence intervals (CI)] 3.08 [1.16-8.17], p = 0.024; 4.35 [1.58-12], p = 0.0045; 4.14 [1.32-12.97], p = 0.0148, respectively. Hypernatremia was associated with adverse neurological events 3.39 [1.12-10.23], p = 0.0302 at 48 h post-operative. Hyponatremia was not associated with any adverse outcome in our secondary analysis. Post-operative dysnatremia is a common finding in this heterogeneous cohort of pediatric cardiac-surgical patients. Hypernatremia was more prevalent than hyponatremia and was associated with adverse early post-operative outcomes. Our study has shown that dysnatremia was highly prevalent in children after congenital heart surgery with hypernatremia associated with adverse outcomes including mortality. It is important to understand fluid and sodium regulation in the post-operative period in children with congenital heart disease to better address fluid overload and associated electrolyte imbalances and acute kidney injury. While clinicians are generally very aware of the importance of hyponatremia in critically ill children, similar attention should be given to hypernatremia in this population.

Correction of hypoalbuminemia after cardiac surgery in children: What level needs to be maintained?

Research hypothesis. Maintenance of the target albumin level of less than 25 g/l in the postoperative period in children under 1 year of age does not affect the results of treatment.Materials and methods. A prospective randomized study included 70 patients after open cardiac surgery from January 2020 to June 2021. Two groups of 35 people were formed. Patients of the main group were transfused with albumin at its level below 25 g/l, the control group – less than 25 g/l. The median age at the time of surgery was 1.0 month in patients of both groups (p = 0.860), the median weight was 3.6 kg (3.0; 5.2) and 3.8 kg (3.1; 5.0) in patients of the main and control groups, respectively (p = 0.900).Results. At the preoperative stage, as well as in intraoperative parameters reflecting the complexity of the operation (Aristotle score, time of cardiopulmonary bypass and aortic clamping, delayed chest closure), the groups did not differ. On the 3rd and 4th days of the postoperative period, the level of albumin in patients of the main group was significantly lower (p = 0.027 and p = 0.034). Albumin transfusion in the ICU was more often performed in patients of the control group (p = 0.031). We did not find significant differences (time of inotropes use, artificial lung ventilation, stay in the intensive care unit, lethality).Conclusions. There were no significant differences in mortality between groups with different target levels of albumin. Also, no differences were found that could affect the outcome of the disease. Based on our study, it is impossible to draw conclusions about the course of the postoperative period in children with an albumin level of 25 g/l and below, since such an albumin level was not registered.

Epidemiology of severe bleeding in children following cardiac surgery involving cardiopulmonary bypass: use of Bleeding Assessment Scale for critically Ill Children (BASIC).

To describe the epidemiology of severe bleeding in the immediate post-operative period in children who undergo cardiopulmonary bypass surgery using the Bleeding Assessment Scale for critically Ill Children (BASIC). Retrospective cohort study in a paediatric ICU from 2015 to 2020. 356 children were enrolled; 59% were male with median (IQR) age 2.1 (0.5-8) years. Fifty-seven patients (16%) had severe bleeding in the first 24 hours post-operatively. Severe bleeding was observed more frequently in younger and smaller children with longer bypass and cross-clamp times (p-values <0.001), in addition to higher surgical complexity (p = 0.048). Those with severe bleeding received significantly more red blood cells, platelets, plasma, and cryoprecipitate in the paediatric ICU following surgery (all p-values <0.001). No laboratory values obtained on paediatric ICU admission were able to predict severe post-operative bleeding. Those with severe bleeding had significantly less paediatric ICU-free days (p = 0.010) and mechanical ventilation-free days (p = 0.013) as compared to those without severe bleeding. Applying the BASIC definition to our cohort, severe bleeding occurred in 16% of children in the first day following cardiopulmonary bypass. Severe bleeding was associated with worse clinical outcomes. Standard laboratory assays do not predict bleeding warranting further study of available laboratory tests.

Efficiency of intravenous infusion of ketamine and lidocaine as part of multimodal analgesia in the postoperative period in children

BACKGROUND: The improvement of multimodal anesthesia schemes is of clinical interest because of the possibility of reducing the doses of narcotic analgesics and the earlier mobilization of patients postoperatively.&#x0D; AIM: To evaluate the efficiency of intravenous infusion of ketamine and lidocaine as adjuvants for multimodal analgesia in children aged 1 year after cardiac surgery.&#x0D; MATERIALS AND METHODS: A prospective single-center study included 122 children aged 1 year, who divided into three groups: group 1, postoperative pain management included a combination of fentanyl and ketamine (n = 40); group 2 (n = 41), lidocaine infusion in combination with fentanyl; group 3 (n = 41), standard analgesia (fentanyl). The median ages at the time of surgery were 4.0, 4.5, and 4.0 months in groups 1, 2, and 3, respectively. Anatomical, demographic, clinical, and laboratory parameters were analyzed before surgery and early after surgery.&#x0D; RESULTS: The pain intensity according to the Neonatal Infant Pain Scale did not differ among the groups at any stage of the study. The average dose of fentanyl was twice as high in group 3 at 1.6 mcg/kg/h compared with 0.5 mcg/kg/h in group 1 and 0.6 mcg/kg/h in group 2. Group 2 had a shorter duration of mechanical ventilation in an intergroup comparison. The side effects of lidocaine were not recorded, and hypersalivation was noted in 35% of the patients who were treated with ketamine.&#x0D; CONCLUSIONS: Ketamine infusion as an adjuvant to multimodal analgesia provides an adequate analgesic effect without a significant effect on hemodynamics and allows a reduction in the dose of opioids. The intravenous infusion of lidocaine as a component of multimodal analgesia after cardiac surgery in children has an additional opioid-sparing effect and reduces the mechanical ventilation time. The use of lidocaine at a dose of 1 mg/kg/h is not accompanied by side effects.

Intravenous lidocaine infusion in children

BACKGROUND: The problem of adequate analgesia in the early postoperative period is not relevant at present, both in our country and abroad because 50% of children experience pain after surgical interventions despite the ongoing therapy. Inadequate ideal method for assessing the pain syndrome severity, age restrictions with several drugs, and difficult communication with young children, as well as drug selection, lead to inadequate detection in pediatric practice.&#x0D; AIM: This study aimed to evaluate the effectiveness and safety of intravenous infusion of lidocaine in the early postoperative period in children operated on the abdominal cavity organs.&#x0D; MATERIALS AND METHODS: This study included 119 children who were randomized into 3 groups, in which intravenous lidocaine infusion, prolonged epidural blockade, or systemic fentanyl analgesia were used for pain relief after abdominal surgery. Hemodynamic parameters, respiratory system, pain intensity, resolution time of intestinal paresis, cortisol, glucose and lidocaine levels in blood plasma, and complications were monitored and compared intergroup.&#x0D; RESULTS: Lidocaine infusion had no effects on the hemodynamics and respiratory system in children. Cortisol level was markedly decreased through the day to baseline (32065 nmol/l). Early recovery of peristalsis corresponded to 233.75 h postoperatively. The pain syndrome intensity during the observation period did not exceed 2 points. The maximum level of free lidocaine in blood plasma was 2.811.31 g/ml, and the time spent in the intensive care unit (ICU) was 4810 h.&#x0D; CONCLUSION: Intravenous infusion of lidocaine after abdominal surgery in children is a safe method that provides effective pain relief, restores peristalsis early, and reduces the length of ICU stay.

Ефективність та безпечність пролонгованої внутрішньовенної інфузії лідокаїну для післяопераційного знеболювання та відновлення після оперативних втручань у дітей віком 8-17 років

Postoperative pain control in pediatric practice is an important issue not only for patients but also for the health care system overall. The results of meta-analyses and a large number of studies have shown that intravenous infusions of lidocaine significantly improve the quality of postoperative analgesia and help reduce the consumption of narcotic analgesics after various surgical procedures in adult patients. This technique is rarely reported in the pediatric population due to insufficient data on its efficacy and safety. The purpose - to evaluate the efficacy and safety of perioperative continuous intravenous infusion of lidocaine as a component of multimodal analgesia in children aged 8 years and older to improve pain control and quick recovery after surgery. Materials and methods. The prospective controlled study included 74 (50 boys, 24 girls) children who underwent surgical procedures under general anesthesia. The age of the patients was from eight to 18 years. Patients were divided into two groups: the (study) Group 1 (n=28) included children who received intravenous lidocaine as a component of multimodal analgesia in the perioperative period, and the second (control) group (n=46) included children who were not administered lidocaine. Pain intensity, duration of the postoperative narcotic analgesics administration and their dosage, the time for recovery of intestinal motility, the transition period to full enteral nutrition, the length of hospital stay, and the nature of postoperative complications were evaluated. Data analysis was performed using the statistical package “SPSS 20” (SPSS Inc.) version 21.0.0 for Windows. Results. The results of our study demonstrated that pain intensity, as well as total postoperative morphine requirement, were significantly lower in the lidocaine group compared to the control group during the 48-hour follow-up period (p&lt;0.05). Additional morphine analgesia on postoperative day 1 was documented in 5 (17.9%) patients in the lidocaine group and 19 (41.3%) patients in the control group. Intestinal motility was restored within 3.79±1.81 hours postoperatively in the study group and was significantly shorter compared to the control group. In the postoperative period, there was a significantly lower frequency of postoperative nausea in patients in the study group. Side effects of lidocaine infusion were not registered. Conclusions. Prolonged perioperative infusion of lidocaine as a component of multimodal analgesia helps to reduce the consumption of narcotic analgesics and significantly improves the quality of pain syndrome treatment in the postoperative period in children. Due to the earlier restoration of bowel motility, lidocaine infusion may be useful for rapid postoperative rehabilitation programs. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

What is the postoperative nutrition intake in children with congenital heart disease? A single-center analysis in China

BackgroundIt is common that inadequate nutritional intake happens in patients with congenital heart disease (CHD), which can adversely affect the prognosis of patients. However, the details and reasons are not clear enough so far. Therefore, the primary aim of this study was to investigate the current nutritional requirements and energy intake on days 1–7 in the cardiac intensive care unit after surgery. Our secondary aim was to investigate potential factors that hinder nutritional supply and to compare the resting energy expenditure (REE) based on two methods, the Fick method and the Schofield equation.MethodsUsing retrospective analysis, we collected data from postoperative children with CHD at a children's hospital in Shanghai, China. We used the Fick method to calculate the REE, and compare the results with the actual enteral nutrition intake. Meanwhile, we recorded the initiation time of enteral nutrition, feeding intolerance, unfinished milk volume, etc. Then the correlation between the results of the Fick method and the equation method was calculated.ResultsA total of 49 patients were included, with a median age of 22 months (IQR 4.9, 57.3), and a median Aristotle basic complexity score of 8 (IQR 6.0, 9.8). The time interval for surgical intervention within 7 days after operation was 4 (IQR 2.5, 6). No statistical difference in REE on postoperative days 1–7. The average enteral nutrition energy provided 64.6 (33.6, 79.6)% of the REE, which showed a significant decrease on postoperative day 4, and then reached its lowest on postoperative day 5. The protein supply was 0.7 ± 0.3 kcal/kg/d. In addition, the REE calculated by the Fick method was moderately correlated with that estimated by the equation (r = 0.467, P = 0.001).ConclusionsThe energy and protein supply in the acute postoperative period in children with CHD is inadequate. Fluid restriction and fasting may be the main causes. In addition, there is a moderate correlation between the REE calculated by the Fick method and that estimated by the equation.

Intravenous infusion of lidocaine as a component of multimodal analgesia in children under one year of age after cardiac surgery

BACKGROUND: The use of lidocaine in the scheme of multimodal anesthesia in order to reduce doses of opioids in comparison with traditional anesthesia and the possibility of influencing various links in the pathogenesis of pain is a promising direction in modern cardioanesthesiology.&#x0D; AIM: This study evaluates the effectiveness of intravenous infusion of lidocaine as a component of multimodal analgesia and its effect on the postoperative period in children under one year of age after surgical correction of congenital heart defects.&#x0D; MATERIALS AND METHODS: The prospective comparative study included 81 cardiac surgery patients aged 0 to 1 year. All patients underwent open cardiac surgery by a cardiopulmonary bypass from January 2019 to April 2021. The patients were divided into two groups: the first (n = 40) included patients receiving intravenous lidocaine as a component of multimodal analgesia in the postoperative period, and the second, control (n = 41) patients who were not prescribed lidocaine.&#x0D; RESULTS: : In patients receiving lidocaine infusion, the need for opioids was significantly lower (p 0.001), which is also associated with a shorter mechanical ventilation time (p = 0.03). The cortisol levels and most laboratory parameters (the concentration of glucose, lactate, albumin, C-reactive protein, and the level of leukocytes and lymphocytes) in the two patient groups did not differ. Clinical indicators reflecting intestinal paresis development (the appearance of peristalsis, the onset of enteral nutrition, the rate of its increase, and the time when the patient receives the total amount of food only enterally) also did not differ between the groups. No side effects of lidocaine infusion were reported. There were no deceased patients in any of the study groups.&#x0D; CONCLUSIONS: Intravenous infusion of lidocaine as a component of multimodal analgesia after heart surgery in children has an additional opioid-saving effect and shortens the mechanical ventilation time. It is not accompanied by the development of side effects and does not affect the restoration of gastrointestinal functions.

Лапароскопічне лікування пахових гриж у дітей

Вступ. Операції з приводу пахових гриж є найбільш частими хірургічними втручаннями в дитячій хірургії, частота яких більше ніж 30 % від усіх планових операцій у дітей. Незважаючи на поширеність захворювання в дитячій популяції, кількість порівняльних досліджень відкритого та лапароскопічного підходів до лікування пахової грижі в дітей обмежена. Метою нашої роботи було оцінити результати лапароскопічних хірургічних втручань при пахових грижах у дітей.Матеріали та методи. Під нашим спостереженням перебували 458 дітей із паховими грижами в період 2011–2015 рр. Усі діти були прооперовані в плановому порядку. У 120 з усіх дітей використовували модифіковану методику, що полягала в проведенні гидравлічної препаровки парієтальної очеревини в ділянці внутрішнього кільця пахового каналу за допомогою попереднього введення в очеревину 0,25% розчину новокаїну. З метою об’єктивної оцінки кровотоку яєчка в післяопераційному періоді в дітей із паховою грижею проводили ультразвукову діагностику з допплерівським картуванням.Результати та обговорення. При аналізі отриманих даних виявлено, що однопортових операцій було виконано 369 (80 %). У 89 дітей проведено мультипортові операції. Дослідження кровотоку в яєчках у дітей першої групи вірогідно показали, що у 26,6 % із них було зниження кровотоку в яєчку з боку прооперованої грижі. У пацієнтів другої групи в післяопераційному періоді не виявлено значущих відхилень від норми. При спостереженні протягом 1 року після операції кількість пізніх післяопераційних ускладнень у пацієнтів була невеликою. Тільки у 12 (2,6 %) дітей першої групи відзначений рецидив грижі, в 11 (2,4 %) — водянка яєчка.Висновки. 1. Переважна більшість оперованих дітей була віком до 2 років. 2. Метод лапароскопічної герніорафії з гідропрепаровкою супроводжується більш низькою частотою рецидивів. 3. Така технологія є прийнятною для відтворення в умовах будь-якого дитячого хірургічного або урологічного відділення і може вважатися методом вибору при лікуванні дітей із паховою грижею.

Обґрунтування використання регіональної аналгезії для знеболювання в ранньому післяопераційному періоді у дітей з онкопатологією

Дослідження проведені у 62 дітей віком 14,2 ± 4,2 року, прооперованих з приводу пухлин черевної порожнини — 24 (38,7 %) дитини, пухлин заочеревинного простору — 38 (41,3 %) дітей. Комплексне вивчення реакцій больової поведінки, фізіологічних показників і лабораторних стресових тестів показало, що використання схеми комбінованої регіональної анестезії бупівакаїном 0,375% та безперервною внутрішньовенною інфузією фентанілу в дозі 10 мкг/кг/год для післяопераційного знеболювання призводить до ефективної аналгезії після травматичних онкологічних оперативних втручань. Мультимодальна аналгезія — регіональна анестезія та безперервна внутрішньовенна інфузія опіоїдних анальгетиків покращує показники центральної та мезентеріальної гемодинаміки і, можливо, знижує ризик розвитку ускладнень у післяопераційному періоді та призводить до зменшення проявів гіпералгезії, а використання парацетамолу як додаткового знеболювання призводить до адекватного знеболювання та не впливає на розвиток гіпералгезії на відміну від наркотичних анальгетиків.

Postoperative agitation syndrome in young children with perinatal damage to the central nervous system

One of the complications of the postoperative period in children is postanesthetic agitation, a significant emotional and uncontrollable worry, clouding of consciousness, feeling of anxiety and fear, inappropriate behavior, irritability, inconsolable crying, aggressive and negative attitude towards parents and medical staff. Postoperative agitation is very important for clinicians and hospitals, it has a risk of harming a patient, staying longer in the ward after anesthesia, and increasing the period of postoperative recovery. The frequency of postoperative agitation depends on age group. Most often agitation occurs in young children. There is evidence that agitation can also be due to the immature nervous system and a consequence of pathological conditions of the central nervous system (asthenoneurotic syndrome, encephalopathy, hyperactivity syndrome, perinatal posthypoxic and organic brain lesions, history of prematurity, epilepsy, psychophysical and speech delay, etc.). That is why the goal of our research was to study the patterns of clinical manifestations of postoperative agitation syndrome in children with prenatal damage to the central nervous system. The work was performed based on the analysis of the postoperative period in 109 young children: 59 patients with acquired hydrocephalus, who underwent ventriculoperitoneal shunting, and 50 children without neurological disorders in whom reconstructive surgeries were carried out. Depending on the type anesthetic management, each group was divided into two subgroups: children, who received inhalation anesthesia with sevoflurane, and those, who received total intravenous anesthesia using propofol. In the postoperative period, the behavior of children was assessed on a Pediatric Anesthesia Emergence Delirium scale 30 minutes after anesthesia was completed. Criterion for the development of agitation was the presence of excitement in a child with a score of ≥ 10 points. Study showed that young children with perinatal damage to the central nervous system and children whose anesthetic provision is carried out using sevoflurane are the most vulnerable to the development of agitation syndrome. Agitation in such children is more pronounced and longer. These cases require prediction, detection and active surveillance.

Analysis of early postoperative period in children with Down syndrome and congenital heart disease

<h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить частоту и структуру врожденных пороков сердца (ВПС) у детей с синдромом Дауна, проанализировать течение раннего послеоперационного периода у этих пациентов. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> Выполнен ретроспективный анализ электронной базы данных пациентов в возрасте 0—17 лет. <h3>РЕЗУЛЬТАТЫ</h3> Стационарное лечение по поводу ВПС проводили 6634 детям, из них 301 ребенок был с синдромом Дауна. В среднем соотношение мужского и женского полов составило 1,11. Анализ позволил выявить изолированный ВПС у 106 (35,2%) детей и комбинированные пороки у 195 (64,8%). В 96% случаев отмечали септальные ВПС бледного типа с артериовенозным шунтом. Синдром Дауна был диагностирован у 55% детей при рождении и у 45% — после 1-го месяца жизни. У 10% детей ВПС был верифицирован пренатально, у 90% — после рождения. При поступлении в стационар тяжесть состояния пациентов была обусловлена сердечной недостаточностью. В 91,4% случаев послеоперационный период протекал благоприятно. В 8,6% случаев он осложнился пневмонией, сепсисом и острой сердечно-сосудистой недостаточностью. <h3>ВЫВОД</h3> Результаты ретроспективного анализа частоты и структуры ВПС у детей с синдромом Дауна, находящихся на лечении в Федеральном центре сердечно-сосудистой хирургии (Астрахань), могут быть использованы при планировании объемов специализированной помощи детям с ВПС.

Динамічна оцінка поширеності та глікемічного контролю цукрового діабету I типу в дитячій популяції

Glycated hemoglobin (HbAc1) remains one of the most valuable methods of glycemic control among patients with diabetes mellitus (DM). Its target level in children and adolescents is ≤7% according to the recommendations of ISPAD (2018) and ≤7.5% – ADA (2020), but the presence of complications and labile course of type I diabetes mellitus (T1DM) in children and adolescents requires an individual approach to achieve optimal glycemic control. The level of glycated hemoglobin determines the risk of concomitant purulent-inflammatory diseases (PID) and the restoration of systemic homeostasis after the surgery. High HbAc1 levels during the last 90 days before the surgery significantly increase the length of hospital stay among adult patients. Currently, there are no published data on the level of glycemic control in children with T1DM in Vinnytsia region, which is extremely important in assessing the risk of complications and treatment outcomes of this population in a surgical department. Purpose – to analysis and assessment of the prevalence of T1DM and glycemic control among children with T1DM in Vinnytsia region in 2013, 2016 and 2017. Materials and methods. We carried a retrospective study to assess the prevalence of T1DM among the pediatric population of Vinnytsia region through the period from 2013 to 2017 by analyzing the reports of the Vinnytsia Regional Clinical Endocrinology Center and demographic data of the Main Department of Statistics in Vinnytsia Region, case histories of patients treated at Vinnytsia Regional Children’s Hospital. Number of patients with T1DM in 2013 was – 321, in 2016–358, in 2017–399 patients. The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from parents to conduct the research. HbAc1 was used to assess glycemic control. The value of HbAc1 ≤7.5% was considered as optimal, &gt;7.5–9.0% – suboptimal, &gt;9.1% – poor. Patients with no HbAc1 available were excluded from further study. Fisher’s exact test was used to compare the groups. P-value ˂0.05 was considered statistically significant. Results. During the study period, there was an increase in the prevalence of T1DM in the pediatric population. Particularly, in 2013 this indicator was equal to – 1.08‰, in 2016 – 1.23‰, and in 2017 – 1.37‰ (p=0.1266; p=0.0015, compared to 2017, respectively), which corresponds to the estimated global trends. The primary incidence of T1DM in Vinnytsia region was: 0.017% in 2013, 0.015% in 2016, 0.022% in 2017, with the peak of the manifestation at the age of 6 and 10. Average indicators of glycemic control based on HbA1c were at the level of 8.73±1.82% in 2013, 8.60±1.52% in 2016, 8.85±1.88% in 2017, respectively. In 2013 glycemic control was assessed as optimal in 27.5% (88/319) of children, suboptimal – 37.5% (120/319), poor – 35% (111/319). In 2016 the number of patients with optimal HbAc1 decreased to 25% (83/336), suboptimal level was found in 41% (139/336), poor – in 34% (114/336), respectively. In 2017 the optimal level of HbAc1 was recorded in only 21% (68/329), suboptimal – in 41% (135/329), poor – in 38% (126/329), respectively. There is an increase in the number of patients with poor glycemic control and HbA1c exceeding 11% in 2017 (42/329) compared to the corresponding indicator in 2016 (24/336), p=0.0191. Clinical manifestations of poor glycemic control in the study population were acute complications (ketosis, ketoacidosis), which were accompanied by abdominal pain, nausea and vomiting and required treatment in the intensive care unit. Purulent-inflammatory diseases (PID) of the abdominal cavity in children with T1DM were accompanied by a combination of clinical and laboratory data of decompensation of T1DM, a significant increase in WBC and diffuse abdominal pain. Macroscopic and pathomorphological characteristics of the appendix and peritoneum corresponded to destructive forms of PID in the presence of a short period from the disease onset. The course of the postoperative period in children with PID of the abdominal cavity in the setting of T1DM was labile and required insulin correction. Conclusions. The prevalence of T1DM among children in Vinnytsia region is growing (1.08‰ – in 2013, in 1.37‰ – in 2017; p=0.0015). Glycemic control in this population is within suboptimal limits (&gt;7.5–9.0%) during the period from 2013 to 2017. As of 2017, more than a third of pediatric patients (38%) have poor glycemic control. The number of patients with HbA1c &gt;11% significantly increased in 2017 compared to 2016 (p=0.0191). The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: type I diabetes mellitus, glycemic control, glycated hemoglobin, children.

МЕДИКАМЕНТОЗНАЯ КОРРЕКЦИЯ ПОСЛЕОПЕРАЦИОННОГО ПЕРИОДА У ДЕТЕЙ ПОСЛЕ АНТИСТРАБИЧЕСКИХ ХИРУРГИЧЕСКИХ ВМЕШАТЕЛЬСТВ

Изучалась эффективность использования глазных капель Eye-t 2%, содержащих Эктоин, на течение воспалительной реакции и косметические исходы послеоперационного периода у детей, получавших хирургическое лечение по поводу косоглазия. Под наблюдением находилось 234 ребенка в возрасте от 2-х до 18-ти лет. В послеоперационном периоде к стандартной терапии у пациентов основной группы применялись капли Eye-t 2% с частотой 3 раза в день.Статистически достоверно было показано, что использование капель Eye-t 2% в послеоперационной схеме лечения детей с косоглазием позволяет сократить время реабилитации, ускорить стихание воспалительных явлений и значительно улучшить отдаленные косметические результаты. Препарат легко переносится детьми и не имеет побочных эффектов.