Journal of pediatric surgery
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The authors analyzed the incidence and the course of renal injuries encountered in a cohort of pediatric patients with blunt abdominal trauma. This review focuses on the early diagnostic and therapeutic approach rather than the long-term outcome and draws conclusions for an effective initial management. ⋯ Ultrasonography and urinalysis proved to be the optimal initial evaluation tool for excluding renal injury both as a screening method and for further controls. Exact classification was possible by CT scan. During the reviewed time period a shift from surgical to conservative management was notable. If lesions were G4 or G5, surgical treatment with tendency toward minimally invasive therapy always was indicated.
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Iatrogenic bronchial perforation is an uncommon complication in intubated premature infants. The authors present 2 cases of bronchial perforation caused by closed-tube endotracheal suction catheters. These presented in the first 3 days of life with pneumothorax requiring chest tube placement. ⋯ A bronchial perforation of the right lower bronchus was identified in both cases and was repaired in the second case. This represents the first report in the literature of iatrogenic bronchial perforation in premature infants by closed-tube endotracheal suctioning catheters. Bronchial perforation requires early recognition and prompt repair if successful outcome is to be obtained.
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Clinical Trial Controlled Clinical Trial
Ligation of a patent ductus arteriosus under fentanyl anesthesia improves protein metabolism in premature neonates.
Although surgical ligation effectively reverses the cardiopulmonary failure associated with patent ductus arteriosus (PDA), previous findings have suggested that such surgery itself elicits a catabolic response in premature neonates. Therefore, the authors sought to quantitatively assess whether PDA ligation under fentanyl anesthesia aggravated or improved the protein metabolism of premature neonates. ⋯ Because of decreased whole-body protein breakdown, whole-body protein turnover, skeletal muscle protein breakdown, and increased protein accrual, surgical PDA ligation under fentanyl anesthesia promptly improves the protein metabolism of premature neonates enduring the stress of a PDA.
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After in utero resection of a sacrococcygeal teratoma coupled with a transfusion of packed red blood cells, a 23-week-gestation fetus had bradycardia. Chest compressions were begun and epinephrine, atropine, and sodium bicarbonate were given, while the fetus remained bathed in warm saline. After 3 rounds of drugs, and just before withdrawing support, the fetal heart resumed beating and normal cardiac function. Based on to this case, the authors developed a resuscitation protocol for fetal surgery.