Journal of pediatric surgery
-
To define patterns of care and outcome for pediatric appendectomy. ⋯ This large series, from a large number of hospitals, with multiple practitioners, can serve as a community standard for pediatric appendectomy in the 1990s.
-
Multicenter Study Comparative Study
Management of pediatric blunt splenic injury: comparison of pediatric and adult trauma surgeons.
The majority of injured children requiring hospitalization in the United States are cared for by nonpediatric surgeons. To determine whether there are differences in the management strategies (frequency of operative intervention) of pediatric and nonpediatric surgeons caring for children with blunt splenic injury, the data for children with this injury from the entire state of Vermont and the National Pediatric Trauma Registry were compared. From January 1, 1985 through December 31, 1991, 817 children (aged < 19 years) were entered into the study. ⋯ The management of children with splenic injury must take into consideration the long-term morbidity associated with splenectomy as well as the acute operative morbidity. Today, adult trauma surgeons appear to manage children with blunt splenic injury with practice standards more appropriate for adult patients. Outcome analysis must include methods of care and their long- and short-term consequences to be considered valid.
-
The management of penetrating neck injuries in adults is controversial, with a trend toward selective neck exploration. These injuries are uncommon in children, and only limited information exists regarding their management. To assess the management of these injuries in the authors' geographic region, they reviewed the records of children with injuries penetrating the platysma muscle who were treated between 1980 and 1994. ⋯ On the other hand, all neck explorations performed solely because of injury to zone II were negative. The overall morbidity and mortality rates were 31% and 7%, respectively. A more selective approach, similar to that used for adult patients, emphasizing preoperative diagnostic evaluation, is recommended to decrease the rate of negative neck explorations among children.
-
Comparative Study
Neurocognitive outcome for neonates treated with extracorporeal membrane oxygenation: are infants with congenital diaphragmatic hernia different?
The neurocognitive outcome for infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation (ECMO) is compared with that of neonates treated with ECMO for other diagnoses. The mean age at the time of the latest assessment (for the 51 survivors with adequate follow-up) was 31 months. ⋯ However, the cognitive outcome for infants with congenital diaphragmatic hernia was significantly poorer than for those without it. This was particularly true if the infant with congenital diaphragmatic hernia was a boy and his mother had limited formal education.
-
Despite improvements in the overall survival rates for critically burned children, failed resuscitation may account for 54% of deaths following burn injuries. Clinical and experimental studies have implicated failure of the right side of the heart in adults, biventricular failure in elderly patients, and inadequate resuscitation as causes of refractory burn shock. This retrospective study of resuscitation at a tertiary pediatric burn center showed that myocardial depression is a complicating factor in the treatment of the pediatric burn victim. ⋯ Cardiogenic failure is a major determinant of a failing pediatric burn resuscitation, and, contrary to the adult burn patient, the myocardial depression is predominantly left-sided. Information from pulmonary artery catheters can help direct therapy by providing indications for vasopressors and modifying fluid resuscitation.