Journal of pediatric surgery
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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.
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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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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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Comparative Study
Long-term outcome of Boix-Ochoa and Nissen fundoplication in normal and neurologically impaired children.
The aim of this study was to compare the results of Boix-Ochoa and Nissen fundoplication performed in the authors' department in normal and neurologically impaired children. ⋯ Antireflux surgery is beneficial in children with significant gastroesophageal reflux, irrespective of their neurological status, although complications are more common in the neurologically impaired group. Nissen fundoplication is more effective and has fewer complications.
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Infection will complicate the care of a significant number of injured adults. Trauma is the leading cause of mortality in the pediatric population, yet little information is available regarding the incidence of infection in this group. This study evaluates infectious complications in the critically injured child. ⋯ Infection is a significant source of morbidity in the critically injured child. Nosocomial infections predominate, and a majority of these are device related, emphasizing the need for continued vigilance toward prevention in this high-risk group.