Journal of pediatric surgery
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Comparative Study
Prosthetic patches for congenital diaphragmatic hernia repair: Surgisis vs Gore-Tex.
The sequelae of congenital diaphragmatic hernia (CDH) continue well beyond the perinatal period. Up to 50% of these patients have subsequent recurrent herniation or small bowel obstruction (SBO). A recent trend has been toward the use of bioactive prosthetic materials. We reviewed different patch closure techniques used for CDH repair at our institution and their association with these sequelae. ⋯ The rates of recurrent herniation and SBO after neonatal prosthetic patch repair of CDH were similar regardless of the prosthetic material used (Surgisis or Gore-Tex).
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In conjunction with the obesity epidemic in adults, we are starting to see an increase of obesity in children and adolescents. Obesity has been identified as risk factor for poor outcomes in adult trauma patients, but has not been investigated adequately in younger patients. The purpose of this study was to investigate the impact of obesity on the outcomes of a severely injured population of children and adolescents. ⋯ Despite similar admission characteristics and less severe head injuries, obese children and adolescents have more complications and require longer ICU stays than their lean counterparts.
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Increased utilization of computed tomography (CT) has led to a rise in the diagnosis of pulmonary contusion. Its clinical significance, in the absence of findings on chest radiograph (CXR), has not been defined. This study examines the clinical course of patients with CT-only diagnosis of pulmonary contusion and compares it with that of patients with CXR-proven pulmonary contusion. ⋯ The finding of pulmonary contusion by CT alone does not increase patient morbidity and appears to be of limited clinical significance.
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To design effective pediatric trauma care delivery systems, it is important to correlate site of care with corresponding outcomes. Using a multistate administrative database, we describe recent patient allocation and outcomes in pediatric injury. ⋯ Younger and more seriously injured children have improved outcomes in children's hospitals. Appropriate triage may improve outcomes in pediatric trauma.
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Care of pediatric traumatic brain injury (TBI) has placed emphasis on maximizing cerebral perfusion to prevent ischemia and reperfusion injury. A subset of patients with TBI will continue to have refractory intracranial pressure (ICP) elevation despite aggressive therapy including ventriculostomy, pentobarbital coma, hypertonic saline, and diuretics. Decompressive craniectomy (DC) is a controversial treatment of severe TBI. It is our hypothesis that DC can enhance survival and minimize secondary brain injury in this patient subset. ⋯ Although this is a small sample, DC should be considered in patients with TBI with refractory elevated ICP. Long-term follow-up of this patient population should consist of neuropsychiatric evaluation in conjunction with measurement of social function.