Journal of pediatric surgery
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The management of penetrating neck injuries in adults is controversial, with a trend toward selective neck exploration. These injuries are uncommon in children, and only limited information exists regarding their management. To assess the management of these injuries in the authors' geographic region, they reviewed the records of children with injuries penetrating the platysma muscle who were treated between 1980 and 1994. ⋯ On the other hand, all neck explorations performed solely because of injury to zone II were negative. The overall morbidity and mortality rates were 31% and 7%, respectively. A more selective approach, similar to that used for adult patients, emphasizing preoperative diagnostic evaluation, is recommended to decrease the rate of negative neck explorations among children.
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Comparative Study
Neurocognitive outcome for neonates treated with extracorporeal membrane oxygenation: are infants with congenital diaphragmatic hernia different?
The neurocognitive outcome for infants with congenital diaphragmatic hernia treated with extracorporeal membrane oxygenation (ECMO) is compared with that of neonates treated with ECMO for other diagnoses. The mean age at the time of the latest assessment (for the 51 survivors with adequate follow-up) was 31 months. ⋯ However, the cognitive outcome for infants with congenital diaphragmatic hernia was significantly poorer than for those without it. This was particularly true if the infant with congenital diaphragmatic hernia was a boy and his mother had limited formal education.
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Despite improvements in the overall survival rates for critically burned children, failed resuscitation may account for 54% of deaths following burn injuries. Clinical and experimental studies have implicated failure of the right side of the heart in adults, biventricular failure in elderly patients, and inadequate resuscitation as causes of refractory burn shock. This retrospective study of resuscitation at a tertiary pediatric burn center showed that myocardial depression is a complicating factor in the treatment of the pediatric burn victim. ⋯ Cardiogenic failure is a major determinant of a failing pediatric burn resuscitation, and, contrary to the adult burn patient, the myocardial depression is predominantly left-sided. Information from pulmonary artery catheters can help direct therapy by providing indications for vasopressors and modifying fluid resuscitation.
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Case Reports
Devascularization and staged resection of giant sacrococcygeal teratoma in the premature infant.
Sacrococcygeal teratoma identified in utero is associated with 50% fetal demise, which is caused by hyperdynamic cardiac failure, hemorrhage, and polyhydramnios-induced preterm labor. A premature infant (26 weeks' gestation) with prenatally diagnosed sacrococcygeal teratoma was managed successfully with initial devascularization to control the hyperdynamic state, followed by staged resection.
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Blunt and penetrating neck injuries are an infrequent cause of morbidity and mortality in the pediatric population. Although less common than penetrating injuries, blunt pediatric neck injuries are more often life-threatening because of associated laryngotracheal disruption. The authors reviewed their experience with pediatric neck injuries over the past 5 years. ⋯ There were no deaths in this group. The authors conclude that all patients with blunt neck trauma should undergo emergent and meticulous DL & B. Visualization of laryngotracheal disruption mandates immediate neck exploration and primary repair.