Journal of pediatric surgery
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According to currently accepted diagnostic criteria, ultrasonography confirms hypertrophic pyloric stenosis (HPS) when the pyloric muscle thickness (MT) is greater than 4 mm and the pyloric channel length (CL) is greater than 15 mm. Hypertrophic pyloric stenosis frequently presents in newborns younger than 21 days; yet, the diagnostic criteria in this younger population remain poorly defined. We, therefore, sought to define the diagnostic criteria for HPS in newborns younger than 21 days. ⋯ These findings suggest that current guidelines to diagnose HPS do not accurately diagnose HPS in children younger than 3 weeks, and these findings raise the need to evaluate the decision analysis algorithm using prospective studies.
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Controversy persists regarding the optimal management for adolescent pilonidal disease. We reviewed the outcome of wide local excision (WLE) vs unroofing and marsupialization (UM) for pilonidal disease. ⋯ Unroofing and marsupialization for primary pilonidal disease has a shorter time to heal and carries a lower complication and reoperative rate compared to WLE.
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The purpose of this study was to identify preoperative predictors of adverse outcomes in infants undergoing surgical ligation of patent ductus arteriosus (PDA). ⋯ The PDA ligation can be accomplished safely; however, some neonates have prolonged recovery. Lower gestational age and low peak velocity (<2.6 m/s) at the PDA shunt correlate with lengthened ventilator requirement after surgery.
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Multicenter Study
Mortality prediction in congenital diaphragmatic hernia.
A validated risk stratification tool for congenital diaphragmatic hernia (CDH) is required for accurate outcomes analyses. Existing mortality-predictive models include those of the CDH Study Group (CDHSG) based on birth weight and 5-minute Apgar score, the Canadian Neonatal Network (CNN) based on gestational age and admission score in Score for Neonatal Acute Physiology version II, and the Wilford Hall/Santa Rosa clinical prediction formula (WHSR(PF)) derived from blood gas measurements. The purpose of this study was to evaluate the calibration and discrimination of these predictive models using the Canadian Pediatric Surgical Network dataset. ⋯ Predictive outcome models are essential for risk-adjusted outcome analysis of CDH. The ideal predictive equation should prove robust across CDH datasets.
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Comparative Study
Quality-of-life outcomes after surgical correction of pectus excavatum: a comparison of the Ravitch and Nuss procedures.
The purpose of this study was to compare clinical and health-related quality-of-life (HRQL) outcomes within a group of patients treated for pectus excavatum (PE). ⋯ Patients undergoing surgery for PE by either Nuss or Ravitch procedure have similar clinical and HRQL outcomes, but as a group have poorer HRQL scores than age-matched population norms.