Journal of pediatric surgery
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Comparative Study
Early postoperative alterations in infant energy use increase the risk of overfeeding.
Energy needs in infants are decreased after surgery because of growth inhibition (resulting from catabolic stress metabolism), decreased insensible losses, and inactivity. Using standardized formulas that account for growth, activity, and insensible losses during this stress period can lead to overfeeding in excess of 200% of the actual measured requirement. Overfeeding during this acute injury period can result in increased CO2 production from lipogenesis. This study determined the effects of a reduced rate of mixed caloric repletion on infant energy use during the early postoperative period. ⋯ Lipogenesis with increased CO2 production is substantial, even at reduced caloric delivery rates that exceeded MEE by only 50%, during the early postoperative acute metabolic stress period in infants. These data suggest that caloric requirements during stress are likely equal to or only minimally in excess of actual MEE. Intersubject variability, especially in more severely stressed infants, underscores the importance of serial measurements of energy expenditure to enable precise caloric delivery and avoid overfeeding. In the absence of calorimetric measurement, the data suggest that PBMR (predicted basal metabolic rate) should be used to estimate caloric delivery until CRP values are < or = 2.0 mg/dL.
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Little data exist on the type of infections patients acquire during extracorporeal life support. Through a retrospective analysis of 109 patients who underwent 115 episodes of venoarterial extracorporeal life support, it was determined that nosocomial infections developed in 18 patients (16%). Patients with nosocomial infections were supported for longer periods of time (230 versus 140 hours; P < .05) and were more likely to have an open chest (P = .02) than those who did not have infectious complications. ⋯ Patients with blood or wound fungal infections had a higher case-fatality rate than those patients with bacterial complications (P = .03). Because it is unlikely that the duration of extracorporeal life support can be shortened significantly, the authors recommend an increased level of awareness of nosocomial infections in patients on prolonged extracorporeal life support. Further research is needed to assess the effects of antifungal prophylaxis or immune modulation to prevent nosocomial infections.
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Pulmonary blastoma is a very rare malignant primary lung neoplasm, especially in the pediatric population. No more than 50 cases have been described in children, with none if these children diagnosed before the age of 1 month. Speculation regarding its congenital nature has been made. Although is has a uniformly poor prognosis, the case presented is that of congenital pulmonary blastoma as a unique cause of fatal respiratory distress in a neonate.
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Over the last 10 years, in the operating rooms of Maternity and Children Hospital, Jeddah, more than 3,200 surgical incisions of skin made for minor surgical operations were closed without suturing by using tissue adhesive Histoacryl Blue. In addition to this, in the emergency rooms over 2,600 small lacerations of skin on various parts of the body were also repaired by the same technique. The method has certain distinct advantages over conventional suturing. The success rate was very high.