Journal of pediatric surgery
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Overnight observation for apneic events is standard practice in former preterm infants. However, the literature supporting current protocols is dated. Therefore, we retrospectively evaluated the post-anesthetic risks in these patients. ⋯ Conservative guidelines for overnight observation after inguinal hernia repair could be set for patients born before 37 weeks gestation who are under 50 weeks PCA.
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Multicenter Study Comparative Study
Does age affect the outcomes and management of pediatric appendicitis?
Although it is recognized that younger children have higher appendiceal perforation rates, little is known about the effect of age on postoperative morbidity. The purpose of this study was to determine whether age affects the outcome and management of pediatric appendicitis. ⋯ Although older children had a higher risk of abscess drainage, younger children were more likely to have perforated appendicitis, be readmitted, and have longer LOH. Management of appendicitis differed according to age. Laparoscopic appendectomy was more frequently performed in older children, whereas the youngest children were more likely to be treated nonoperatively.
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The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. ⋯ For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
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Little is known about potentially modifiable risk factors associated with infectious complications (IC) acquired during extracorporeal life support (ECLS). ⋯ Strategies to reduce IC while on ECLS should be aimed at prevention of complications and treatment of pre-existing infections. Future studies should address whether broader spectrum antibiotic prophylaxis and/or empiric coverage for suspected sepsis is indicated in ECLS patients.
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Bi-caval dual lumen venovenous extracorporeal membrane oxygenation (VV-ECMO) as a nonoperative approach to postintubation tracheal injury has not been described. We report the case of a 7-year-old boy who sustained a postintubation tracheal injury, developed acute respiratory distress syndrome from aspiration and viral pneumonitis, and was supported on bi-caval dual lumen VV-ECMO for 16 days until the trachea healed without surgical repair. Before ECMO decannulation, high-frequency percussive ventilation using a volumetric diffusive respiration ventilator was used for lung recruitment and airway clearance without disruption of the healed trachea. The use of ECMO to allow for lower mean airway pressure during initial healing and high-frequency percussive ventilation for lung recruitment and secretion clearance is a promising strategy to allow nonoperative tracheal injury repair in critically ill patients with multiple comorbidities.