Outcomes and Evidence-based Practice Committee Literature Reviews
The Outcomes and Evidence-based Practice Committee has identified the following literature reviews to help identify best-practice and appropriate standards for clinical management of pediatric surgical disease.
If you have questions, contact Robert Ricca.
The APSA Outcomes and Evidence-based Practice Committee
View the current members of this committee.
Earn MOC CME from the Literature Reviews
Continuing medical education maintenance of certification self-assessment credit is now available for the Cancer, Critical Care, Ethics, Outcomes and Trauma literature reviews.
- ExPERT subscribers: log onto ExPERT, go to Pre-Created courses, look for "Articles" under course type and select the desired course. Remember to use Chrome or Safari.
- Not a subscriber yet? Subscribe to ExPERT and start earning MOC CME*.
*Subscriptions purchased prior to October 1 expire December 31. Subscriptions purchased October 1 or later expire December 31.
Visual abstracts offer a quick snapshot of the articles. Follow APSA on Facebook and Twitter.
Controlled Trial of Two Incremental Milk-Feeding Rates in Preterm Infants
Dorling et al. N Engl J Med. 2019 Oct 10;381(15):1434-1443.
What is known on this subject?
Observational studies have shown a higher risk of necrotizing enterocolitis with the rapid advancement of feeding volumes in premature and/or low birthweight infants although slower advances may increase the risk of line sepsis.
What this study adds:
This is a multicenter, parallel group, randomized, controlled trial of 2793 infants who were less than 32 weeks or weighed less than 1500g at birth, no known severe congenital anomalies or reasons to be untraceable for follow-up and receiving less than 30 mL/kg/d of milk. They were randomized to either faster (advancements by daily increments of 30 mL/kg) or slower (advancements by daily increments of 18 mL/kg). Individual units were allowed to stop or alter the rate of increase if clinically indicated.
A modified intention-to-treat analysis revealed that the faster group reached full volumes at median of seven days versus 10 days in slower group; no significant difference in survival without moderate or severe neurodevelopmental disability at 24 months corrected for gestational age, individual components of composite outcome, late onset sepsis, Bell’s stage 2-3 necrotizing enterocolitis, death during hospitalization, weight and head circumference standard deviation scores at discharge, duration of intensive care unit stay and duration of hospital stay. After adjusting for collaborating hospital, single versus multiple birth, gestational age at birth and birthweight less than 10th percentile, there was a significantly greater risk of moderate or severe motor impairment in the faster increment group. There was a weak interaction of type of milk with feeding increment (i.e lower survival without moderate/severe neurodevelopmental disability in formula fed fast-increment group vs formula fed slow-increment group), but since only 2.8% were fed formula alone, the authors feel this may be a chance finding.
Poisson Probability of Failing to Meet Minimal Case Volumes in Pediatric Surgery Fellowships
Lucas DJ et al. Ann Surg. 2019 Aug 13.
What is known on this subject?
The number of pediatric surgery fellowship programs has expanded. The ACGME has established minimum required case requirements that are monitored at the program level. The ABS is proposing minimum required case requirements for individuals seeking board certification.
What this study adds:
Using 2008 to 2018 ACGME data for graduating pediatric surgery fellows, the authors compared median case volumes to minimum ACGME defined categories. The probability of a fellow at the median program to fail to meet category minimums was calculated using Poisson regression and then compared across years using linear regression. The analysis was repeated using minimum complex ABS-defined categories. The ACGME categories on which fellows were most likely to fall short were: Hirschsprung’s/pull through, biliary atresia and choledochal cyst. The cumulative probability of a fellow in the median program failing to meet ACGME criteria for one or more categories was 16.6%. There was no significant change in this annual probability over the last 10 years. The ABS categories on which fellows were most likely to fall short were: trauma/critical care, head and neck/endocrine/genitourinary/anorectal malformation. The cumulative probability of a fellow in the median program failing to meet the ABS minimums was 44.1%. There was no significant change in this annual probability over the last 10 years. If these ABS volumes are enforced, many graduating fellows will not be board eligible.
Another article you may find interesting:
Does Peritoneal Lavage Influence the Rate of Complications Following Pediatric Laparoscopic Appendicectomy with Complicated Appendicitis? A Prospective Randomized Clinical Trial
Nataraja RM, et al. J Pediatr Surg. 2019 Aug 30.
Esophagitis in Pediatric Esophageal Atresia: Acid May Not Always Be the Issue
Yasuda JL, Clark SJ, Staffa SJ, Blansky B, Ngo PD, Hamilton TE, Smithers CJ, Jennings R, Manfredi MA
J Pediatr Gastroenterol Nutr. 2019 Aug;69(2):163-170.
What is known on this subject?
Children with esophageal atresia are frequently found to have esophagitis. Estimates of prevalence of in this patient population show that 25 to 90 percent of children with EA will have esophagitis. Many of these children are treated with long term acid-suppressive therapy or anti-reflux surgery in line with ESPGHAN-NASPGHAN guidelines. Long-term data on effectiveness of therapy in this patient population is lacking.
What this study adds
Three hundred ten patients with a diagnosis of esophageal atresia (33.5% of whom had long gap EA) were retrospectively evaluated. These patients were treated at a tertiary care center and underwent at least one upper endoscopy with biopsy over a 2 year period. A total of 576 endoscopies were performed. Endoscopy was preceded by acid suppressive therapy in 86.9% of the procedures. Fundoplication had been performed in over 25% of the patients. Twenty seven patients had gross erosive esophagitis on endoscopic biopsy during this time period. Histologic eosinophilia was seen in 56.8% of patients undergoing endoscopic biopsy. Two patients were found to have Barret’s esophagitis. The authors note that acid suppression therapy was the only significant factor associated with reduced odds of abnormal esophageal biopsy. The authors did not see a significant change in esophagitis following fundoplication. Given the prevalence of esophagitis, even in children on acid suppressive therapy, the authors recommend continued surveillance endoscopy even in children receiving acid suppressive therapy.
Other articles you may find interesting:
A Novel Streamlined Trauma Response Team Training Improves Imaging Efficiency for Pediatric Blunt Abdominal Trauma Patients
Nti BK, Laniewicz M, Skaggs T, Cross K, Fallat ME, Rominger A
J Pediatr Surg. 2019 Sep;54(9):1854-1860.
Defining Barriers and Facilitators to Advancement for Women in Academic Surgery
Thompson-Burdine JA, Telem DA, Waljee JF, Newman EA, Coleman DM, Stoll HI, Sandhu G
JAMA Netw Open. 2019 Aug 2;2(8):e1910228.
State Gun Laws and Pediatric Firearm-Related Mortality
Pediatrics. 2019 Aug;144(2). pii: e20183283. doi: 10.1542/peds.2018-3283. Epub 2019 Jul 15
What is known about this subject?
Firearms are the second leading cause of pediatric death in the United States. There has been recent increased interest in legislation to help lower pediatric firearm-related mortality. One proposed approach is universal background checks. This study examined firearm-related pediatric mortality in states that require universal background checks versus those with less strict gun laws.
What this study adds:
Pediatric firearm-related mortality was lower in states with stricter gun laws. In addition, states with universal background checks in effect for more than 5 years had a significantly lower pediatric firearm-related mortality rate. This research provides more evidence for a national discussion regarding prevention of pediatric firearm-related mortality.
Click here to view the Visual Abstract.
Other articles you may find interesting:
Predictors of the Performance of Early Antireflux Surgery in Esophageal Atresia
Francois et al. J Pediatr. 2019 Aug;211:120-125.e1. doi: 10.1016/j.jpeds.2019.03.045. Epub 2019 May 6
Survival and Scoliosis Following Resection of Chest Wall Tumors in Children and Adolescents – A Single-center Retrospective Analysis
Saltsman et al. Ann Surg. 2019 Jul 25. doi: 10.1097/SLA.0000000000003495. [Epub ahead of print]
Firearm Legislation Stringency and Firearm-Related Fatalities among Children in the US
Madhavan et al. J Am Coll Surg 2019 Aug;229(2):150-157.
What is known on this subject: Firearm injuries are the second leading cause of pediatric deaths in the United States. Due to the rising incidence and frequency of child firearm related deaths, some states have enacted child access prevention laws in order to prevent firearms from children and youth. This study examined firearm child access prevention laws between states to determine their effectiveness in reducing pediatric fatalities.
What this study adds: Fewer pediatric related fatalities were identified in states with stricter firearm legislation and child access prevention laws. Stricter firearm legislation was also associated with a decreased pediatric firearm suicide rate. This research speaks to the national conversation about how to address and decrease firearm related deaths, especially in the pediatric population.
Other articles you may find interesting:
The Role of Oral Antibiotic Preparation in Elective Colorectal Surgery: A Meta-Analysis
Rollins et al., Ann Surg. 2019 Jul; 270(1):43-58. PMID: 30570543
Five-Year Outcomes of Gastric Bypass in Adolescents as Compared with Adults
Inge et al. N Engl J Med. 2019 May 30;380(22):2136-2145.
What is known about this subject: Bariatric surgery can be safe and efficacious in adolescents and adults and results in significant weight loss and improvement in weight-associated comorbidities when other treatments have failed. Roux-en-Y gastric bypass (RYGB) is increasingly considered for the treatment of adolescents with severe obesity and it is unclear whether long term outcomes differ between adolescents and adults.
What this study adds: The health effects of Roux-en-Y gastric bypass were compared between adolescents and adults enrolled in the Teen–Longitudinal Assessment of Bariatric Surgery (Teen–LABS) and the Longitudinal Assessment of Bariatric Surgery (LABS) studies. Weight loss after RYGB was similar in magnitude for adolescents and adults five years after surgery. Adolescents had remission of type 2 diabetes and of hypertension more often than adults but differences in hypertriglyceridemia and high-density lipoprotein (HDL) cholesterol levels were not statistically different.
This study builds on previous findings of durable weight loss after gastric bypass in adolescents. This study suggests that young patients undergoing RYGB may have better potential for recovery of islet cell secretory capacity and that the histologic remodeling and increased vascular stiffness due to obesity-related hypertension may be more readily reversed in adolescents.
Further research and long-term follow-up is needed to understand if the increased reversal of the complications in adolescents may be attributed to a shorter duration of exposure to the harmful effects of obesity. Consideration of early bariatric surgery may be warranted in severely obese adolescents who develop type 2 diabetes and hypertension.
Other articles you may find interesting:
Factors that Predict the Need for Early Surgeon Presence in the Setting of Pediatric Trauma
McGaha et al. J Pediatr Surg. 2019 May 16. PMID 31153589
Identification of New Wilms Tumour Predisposition Genes: An Exome Sequencing Study
Mahamdallie et al. Lancet Child Adolesc Health. 2019 May;3(5):322-331. PMID 30885698
Predicting Intestinal Adaptation in Pediatric Intestinal Failure. A Retrospective Cohort Study.
Belza C. Ann Surg. 2019 May;269(5):988-993.
What is known on this subject: Short bowel syndrome results from resection of a large amount of small intestine - usually in the neonatal period - secondary to a variety of diagnoses. Intestinal failure, which is the inability of the intestine to absorb enough nutrients to sustain growth and life, is most often secondary to short bowel syndrome in pediatric patients. These patients often require prolonged parenteral nutrition and there remains high rates of morbidity and mortality. Recent studies have shown that implementation of novel lipid strategies as well as formal multidisciplinary intestinal rehabilitation programs can have positive impacts on outcomes.
What this study adds: The authors of this study looked at a large contemporary group of intestinal failure patients to evaluate factors that were related to attainment of intestinal autonomy and specifically assess the relationship of residual bowel length. A high proportion (70%) of patients achieved autonomy. Longer residual bowel length and the presence of the ileocecal valve was correlated with a higher chance of achieving autonomy, as well as was. The number of episodes of sepsis were negatively correlated with achieving enteral autonomy. The authors conclude that in a contemporary cohort managed by a multidisciplinary team, residual bowel length remains an important factor in the prediction of enteral autonomy and that continued avoidance of central line associated sepsis is necessary.
Management of Pediatric Gastroesophageal Reflux Disease
Barfield E. JAMA Pediatr. 2019 Mar 18. doi: 10.1001/jamapediatrics.2019.0170. [Epub ahead of print] PMID: 30882857
What is known on the subject: Gastroesophageal reflux is common in infants and children. Gastroesophageal reflux disease (GERD) occurs when the reflux leads to worrisome symptoms or complications. Symptoms in infancy can be vague. The diagnosis of GERD has increased rapidly.
What this study adds: NASPGHAN and ESPGHAN have updated their clinical guideline from 2009. The process followed the Institute of Medicine standards for development and use of evidence. Separate algorithms were developed for those younger and older than 12 months of age. Major recommendations were to avoid imaging and diagnostic studies in infants and children (barium, EGD, manometry). They recommended against positioning in sleeping infants (i.e. head of bed raised) and to avoid PPI or H2 blockers for regurgitation in otherwise healthy infants without extraesophageal symptoms. In older children and adolescents, a four- to eight-week trial of therapy is suggested followed by weaning. They note that 39/49 recommendations were made on the basis of expert opinion given the lack of robust data. They acknowledge that there is clearly a need for further studies to determine optimal medical therapy.
Other articles you may find interesting:
Effect of New Fellowship Programs on Resident Case Volume in Pediatric Surgery
Potts JR J Am Coll Surg. 2019 Mar 21. [Epub ahead of print] PMID: 30905854
Association of In Vitro Fertilization With Childhood Cancer in the United States
Spector LG JAMA Pediatric. 2019 Apr 1. [Epub ahead of print] PMID: 30933244
Molecular Genetic Anatomy and Risk Profile of Hirschsprung’s Disease
Tilghman JM, N Engl J Med. 2019 Apr;380(15):1421-1432 PMID: 30970187
Wounding Patterns Based on Firearm Type in Civilian Public Mass Shootings in the United States
Sarani et al. J Am Coll Surg. 2019 Mar. 228(3). 228-234. PMID: 30529633
Family Firearm Ownership and Firearm-Related Mortality Among Young Children: 1976-2016
Prickett et al. Pediatrics. 2019;143(2):e20181171 PMID: 30835244
Antibiotic Treatment and Appendectomy for Uncomplicated Acute Appendicitis in Adults and Children: A Systematic Review and Meta-analysis
Podda et al. Ann Surg. 2019 Jan 31. [Epub ahead of print]
For many years, appendectomy has been the mainstay of therapy for acute appendicitis. More recently, antibiotic therapy alone for acute, uncomplicated appendicitis has become an alternative treatment. While some previous studies have promoted antibiotic therapy as a safe approach for uncomplicated appendicitis there is still limited data on the effectiveness and safety of nonoperative management of uncomplicated appendicitis.
What this study adds: This study is a meta-analysis of 20 studies with evidence on the nonoperative management of uncomplicated appendicitis in adults and children. The study included 3,618 patients with appendicitis, with 1743 patients treated with antibiotic therapy (AT) and 1875 patients treated with surgery (ST). Complication-free treatment was higher for the ST group as opposed to the AT group (82% vs.67%). Treatment efficacy (based on one-year follow-up) was 93% in the ST group and 73% in the AT group. There was a trend toward a higher perforation rate in the patients who failed AT (22% versus those who underwent initial ST 13% (p=0.07)). However, the rate of postintervention adverse events was significantly lower in the AT group in adults (AT 6.6% vs. ST 14.5%) but this difference was not significant in children (AT 9.6% vs. ST 12.5%). The costs for AT were approximately $1,000 less than the ST group even when accounting for antibiotic therapy failure and subsequent surgery.
Although there is a lower efficacy rate than surgery, antibiotic therapy for uncomplicated appendicitis may be a safe option for the majority of patients wishing to avoid appendectomy. Further studies are required to determine the optimal management and to understand the long-term outcomes for patients with uncomplicated appendicitis.
*Click here to view the Visual Abstract.
Does Retrieval Bag Use During Laparoscopic Appendectomy Reduce Postoperative Infection?
Fields et al. Surgery. 2018 Dec 24. [Epub ahead of print]
Laparoscopy is used for the majority of appendectomies in the United States. Patients who undergo laparoscopic appendectomy are still at risk for infectious complications. There is little data on how operative technique affects the infection rate following laparoscopic appendectomy.
What this study adds: Using the NSQIP Procedure Targeted Appendectomy 2016 database, the authors investigated whether the use of a retrieval bag for removal of the appendix during a laparoscopic appendectomy is associated with the risk of infectious complications. In this study, 10,578 patients underwent laparoscopic appendectomy with a retrieval bag and 897 patients without. On multivariate analysis, use of a retrieval bag was an independent predictor of decreased intra-abdominal infection (OR: 0.6, 95% CI: 0.42-0.95, p=0.03). Other predictors of increased likelihood of intra-abdominal infection included diabetes, preoperative sepsis, complicated appendicitis and male sex. The authors recommend the use of retrieval bags for all laparoscopic appendectomies.
*Click here to view the Visual Abstract.
Other articles you may find interesting:
Transition of care: A Growing Concern in Adult Patients Born with Colorectal Anomalies
Acker et al. Pediatr Surg Int. 2019. 35:233-237. Epub 2018 Nov 3. PMID: 30392127
Alonso EM, et al, J of Pediatrics 202:179-85, 2018.
What’s known: The use of steroids following hepatoportoenterostomy (HPE) for biliary atresia is controversial. The START trial, a multicentered randomized control trial with 70 patients in each study arm compared high dose steroid therapy following HPE to placebo. 58.6% of patients in the steroid group achieved a total bilirubin less than 1.5 mg/dL compared to 48.6% in the placebo group (not statistically significant) although a small clinical benefit could not be excluded. The trial also showed that steroid treatment was associated with an earlier onset of serious adverse events in children with biliary atresia although complications were equivalent in both groups.
What this article adds: This article is a continuation of the START trial and investigates the impact of steroids in the growth of the children involved in the trial. The study showed that steroid therapy following HPE is associated with impaired length, weight and head circumference growth trajectories for at least six months following HPE - especially for infants with successful bile drainage. Ultimately, there was some catch up growth for the infants but it is not known whether the delayed growth in the first six months will have a long term impact on growth of this patient population.
Overton HN, et al. JACS 227:411-418, 2018
What’s known: The Department of Health and Human Services reports that over two million people in the United States have an opioid problem and more than 11 million people have misused prescription opioids resulting in over 17,000 deaths in 2017. As a result, there is continued interest in optimizing the use of opioids following surgical procedures.
What this article adds: This study used a three-step modified Delphi method involving a multidisciplinary expert panel of surgeons, pain specialists, outpatient surgical nurse practitioners, surgical residents, patients and pharmacists to develop consensus ranges for outpatient opioids after 20 common procedures in eight surgical specialties. The study noted that patients who had a procedure consistently voted for lower opioid amounts than the surgeons who performed the operation indicating that inclusion of patients in postoperative pain regimens is likely to decrease the amount of opioids prescribed. The article also noted that many patients do not want opioids at all and prefer acetaminophen and nonsteroidal anti-inflammatory drugs for postoperative analgesia.
Other articles you may find interesting:
Neuvonen MI, et al. J Ped Gastr Nutr 67:594-600, 2018. PMID: 29652728
Brock PR, et al. N Engl J Med 378:2376-2385, 2018. PMID: 29924955\
Endoscopic Electrocautery Incisional Therapy as a Treatment for Refractory Benign Pediatric Esophageal Strictures
Manfredi MA, et al. JPGN 2018;67(4):464-8
The traditional treatment for esophageal strictures is balloon or bougie dilatation. There is no agreed upon definition for refractory esophageal strictures in children.
A refractory esophageal stricture is defined as inability to achieve an age appropriate esophageal lumen with five dilatations within five months or requiring seven or more dilatations without time frame.
In a retrospective review, 61% of children with refractory anastomotic strictures were successfully treated with endoscopic electrocautery incisional therapy requiring less than seven dilatations and no stricture resection at two years after treatment. The esophageal leak rate was 5.3% overall with 3% contained and 2.3% noncontained. Although none of the patients required surgery, all of the noncontained leaks were treated with advanced endoscopic therapy.
*Click here to view the Visual Abstract.
Other articles you may find interesting:
Population-Based Validation of a Clinical Prediction Model for Congenital Diaphragmatic Hernias
Bent DP, et al. J Pediatrics 2018;201:160-5.
Comparing Percutaneous to Open Access for Extracorporeal Membrane Oxygenation in Pediatric Respiratory Failure
Cairo SB, et al. Pediatric Critical Care Medicine 2018;19(10):981-91.
Remnant Small Bowel Length in Pediatric Short Bowel Syndrome and the Correlation with Intestinal Dysbiosis and Linear Growth
Engelstad et al. J Am Coll Surg. 2018 Oct;227(4):439-449.
Short bowel syndrome places patients at risk for malnutrition, dehydration and bacterial overgrowth. Little is known about the effects of the remnant small bowel length on the intestinal microflora.This study evaluated the gut microbiome in patients with pediatric short bowel syndrome. The gut microbiome was compared between patients with less and more than 35 cm of remaining small bowel and a normal control population. The group with shorter bowel length had more pathogenic Proteobacteria (Shigella/Escherichia) than those with longer bowel lengths. These patients also required more parenteral nutrition, had stunted linear growth and a higher body mass index. The study results suggested that enteral adaptation resulted in normalization of the gut microbiome.
*Click here to view the Visual Abstract.
Other articles you might find interesting:
Repeat Head CT for Expectant Management of Traumatic Epidural Hematoma
Flaherty et al. Pediatrics. 2018 Sep;142(3).
Outpatient Opioid Prescriptions for Children and Opioid-Related Adverse Events
Chung CP, et al. Pediatrics. 2018 Aug;142(2). Epub 2018 Jul 16.
There is continued discussion regarding the use of opioid analgesics in the United States. The majority of current literatures has focused on use in adult patients. Little is known about opioid prescriptions for acute, self-limited conditions in children. This retrospective cohort study evaluated outpatient opioid prescriptions in Tennessee Medicaid patients aged two to 17 years. Fifteen percent of children filled outpatient opioid prescriptions for acute, self-limited conditions. The most common indications for opioid prescriptions were dental procedures, outpatient surgical procedures, trauma and infections. There were 437 opioid related adverse events with 71.2% of these events occurring without deviation from the prescribed regimen. Adverse events occurred in older children and in higher opioid doses.
Heterotaxy Syndrome and Intestinal Rotation Abnormalities
Ryerson LM, et al. Pediatrics. 2018 Aug;142(2).
Infants with heterotaxy syndrome have abnormal lateralization of organs along the right-left body axis. Intestinal rotation abnormalities are commonly associated with heterotaxy syndrome. Continued debate exists as to the best management of an asymptomatic patient with heterotaxy syndrome and an intestinal rotational abnormality.
A multi-institutional prospective observational study was performed evaluating children with heterotaxy syndrome. Thirty-eight infants were included, of which 21 patients were found to have an associated intestinal rotational abnormality on examination using upper gastrointestinal imaging. Eight infants were evaluated due to concerning symptoms with an average age of 46 days (5 to 171 days). Three symptomatic and four asymptomatic patients underwent Ladd procedure. No child was found to have midgut volvulus.
It is common to find intestinal rotational abnormalities in children with heterotaxy syndrome. Symptoms usually presented by six months of age. Expectant management of the asymptomatic patient is reasonable because no infant managed as such developed midgut volvulus at a median follow-up of 1.6 years.
Lower Distending Pressure Improves Respiratory Mechanics in Congenital Diaphragmatic Hernia Complicated by Persistent Pulmonary Hypertension
Guevorkian D, et al. J Pediatr. 200:38-43, 2018
Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis
Evans et al. JAMA 320:358-367, 2018.
Contemporary clinical practice guidelines recommend prompted recognition of sepsis and initiation of treatment. New York state mandates the initiation of blood cultures, broad spectrum antibiotics and a 20 mL/kg intravenous fluid bolus in pediatric patients with sepsis within one hour of diagnosis.
A statewide cohort study of patients younger than 18 years with sepsis and septic shock were reviewed. A total of 1179 patients were identified. The entire sepsis bundle was completed within one hour in 294 patients. Antibiotics were administered to 798 patients, blood cultures were obtained in 740 patients and a fluid bolus was completed in 548 patients. Completion of the entire bundle within one hour was associated with a lower risk adjusted odds of in hospital mortality. Completion of each individual element, however, was not predictive of decreased in-hospital mortality.
The New York State mandate on sepsis bundle has a positive effect on the management of pediatric patients with sepsis and septic shock.
Attitudes Surrounding the Management of Neonates with Severe Necrotizing Enterocolitis
Pet et al. J Pediatr 199:186-193, 2018.
Association Between Early Postoperative Acetaminophen Exposure and Acute Kidney Injury in Pediatric Patients Undergoing Cardiac Surgery
Van Driest et al. JAMA Pediatr 172:655-663, 2018.
Association of Exposure to Formula in the Hospital and Subsequent Infant Feeding Practices With Gut Microbiota and Risk of Overweight in the First Year of Life
Forbes et al. JAMA Pediatr. 2018 Jul 2;172(7):e181161.
Restrictive versus Liberal Fluid Therapy for Major Abdominal Surgery
Myles et al. N Engl J Med. 2018 Jun 14;378(24):2263-2274. PMID: 29742967
Review Shows that Implementing a Nationwide Protocol for Congenital Diaphragmatic Hernia was a Key Factor in Reducing Mortality and Morbidity
Storme L et al. Acta Paediatr. 2018 Jul;107(7):1131-1139.
Association of Preprocedural Fasting With Outcomes of Emergency Department Sedation in Children
Bhatt M, et al. JAMA Pediatr 2018 May 7. PMID:29800944
Preprocedural fasting guidelines have been established by consensus opinion to decrease the risk of adverse and serious adverse events, particularly pulmonary aspiration, during procedural sedation. In this large study, almost half of children did not meet ASA fasting guidelines for solids whereas 5% did not meet ASA fasting guidelines for liquids. No adverse events were characterized as clinically apparent pulmonary aspiration. There was no difference in the length of fasting duration among those who did or did not experience an adverse event, serious adverse event or vomiting. Furthermore, after adjusting for age, sex, sedation medication and procedure type, the odds ratio of an adverse event occurring did not change with additional hours of fasting duration. In summary, this large, prospective study did not show an association between pre-procedure fasting duration and the development of an adverse event, particularly pulmonary aspiration. Implications of this study may help guide protocols to decrease the duration of preprocedural fasting in the emergency department.
Ramifications of the Children’s Surgery Verification Program for Patients and Hospitals
Baxter KJ, et al. JACS 2018 226: 917-924. PMID:29458092
Data exists to show that for complex procedures and medical conditions, high volume medical centers have improved outcomes compared to low volume centers. With this in mind, the American College of Surgeons developed the Children’s Surgery Verification (CSV) program which has categorized medical institutions as Levels I through III based on their ability to provide high level care to pediatric surgery patients. The goal of this study was to evaluate the effects of the CSV on neonates undergoing one of five complex procedures using data available through the Kids’ Inpatient Database (KID). Outcomes analyzed included the need for children to relocate to a Level I center, the distance required to do so, as well as the crude and adjusted mortality comparing Level I to Level II/III centers. Almost 8,000 neonates with one of five qualifying diagnoses (necrotizing enterocolitis, patent ductus arteriosus (PDA), esophageal atresia, diaphragmatic hernia, gastroschisis/omphalocele) were identified in the 2009 version of the KID. In this cohort, 34.6% of neonates would have required transport to a Level I center. Based on zip code calculations the majority of neonates (72.5%) would have had to travel fewer than 20 miles to the closest Level I facility (range of zero to 384.3 miles). Regarding mortality, the adjusted odds ratio of death was significantly lower at Level I facilities compared to Level II/III facilities; this was particularly true for those with gastroschisis/omphalocele or a PDA. In an unadjusted analysis it was estimated that 32 neonates would need to be transferred to a Level I center to prevent a single death.
Other articles you may find interesting:
Opioid Use After Discharge in Postoperative Patients
Feinberg AE, et al. Ann Surgery 2018 267:1056-1062. PMID:29215370
Aggressive Surgical Management of Congenital Diaphragmatic Hernia: Worth the Effort?
Harting, et al. Ann Surg. 2018 May;267(5):977-982. PMID: 28134682
Approximately 20% of children born with congenital diaphragmatic hernia (CDH) do not undergo repair. Using the CDH study group database this group noted, unsurprisingly, that unrepaired patients had worse APGAR scores and were more likely to have a concomitant anomaly when compared to repaired patients. Specific reasons for nonrepair included presence of an anomaly, intraventricular hemorrhage, hypoxia and parental request. After considerable risk adjustment, high volume centers that had lower rates of nonrepair (i.e. aggressive managers) were noted to have an additional 2.7 survivors per 100 patients treated. This study suggests that marginal survival gains continue to accrue for patients provided maximal therapy.
Concurrent Surgery and the Role of the Pediatric Attending Surgeon: Comparing Parents’ and Surgeons’ Expectations
Choe, et al. J Am Coll Surg. 2018 Apr 12. PMID: 29655618
This study surveyed parents, surgeons and trainees regarding the concurrent delivery of surgical care for children – when two operations occur simultaneously under the auspices of a single attending. The authors noted that parents overwhelmingly expected surgeons to be present throughout the entire operative process (sign in to sign out). While attending surgeons agreed that they necessarily be present during critical components of a procedure, they frequently responded being comfortable not being present during other operative time points. This study highlights the importance of a clear and transparent informed consent process regarding surgical team members and operative processes.
Other articles you might find interesting:
A Checklist to Elevate the Science of Surgical Database Research
Haider, et al. JAMA Surg. 2018 Apr 4. PMID: 29617525
Healthcare Utilization and Comorbidities Associated with Anorectal Malformations in the United States
Kovacic K, Matta SR, Kovacic K, Calkins C, Yan K, Sood MR.
J Pediatr 2018; March; 194: 142-6
Summary: Anorectal Malformations (ARMs) are a broad spectrum of anomalies that involve the anorectal and genitourinary tract with an incidence of 1-2 per 5000 live births. Previous studies have found that 50-70% of patients with ARMs have other congenital abnormalities. This large nationally representative study of 2396 patients with ARMs from the Kids Inpatient Database examines the significant morbidities and increased healthcare expenditures associated with patients having congenital anomalies in addition to their ARM. This study found that 80% of patients had congenital anomalies other than ARMs; urogenital malformations (38.5%), other GI anomalies (35.3 %), cardiac anomalies (21.2%), and genetic disorders (14.1%) being the most common. The study also highlights the direct relationship between the numbers of congenital anomalies and both length of stay and hospital charges.
Outcomes in Children Undergoing Surgery in Congenital Pulmonary Airway Malformations in the First Year of Life
Dukleska K, Teeple EA, Cowan SW, Vinocour CD, Berman L.
J AM Coll Surg 2018 March; 226 (3): 287-293
Summary: Congenital Pulmonary Airway Malformations (CPAMs) are anomalies encompassing infants born with abnormal lung tissue, blood vessels, or airways. Symptomatic CPAM lesions are typically large and require immediate treatment after birth, or even prenatally. There are no established guidelines, however, for the treatment of asymptomatic CPAMs. This study evaluated 541 patients (20.7% neonates and 79.3% non-neonates) undergoing surgery for CPAMs using the National Surgical Quality Improvement Program and analyzed their outcomes. In the uncontrolled analysis, compared to surgery on older patients neonatal surgery was associated with increased peri-operative comorbidities and worse post-operative outcomes. Multivariate analysis, however, showed that only pre-operative symptoms were independently associated with increased morbidity, and that CPAM surgery on asymptomatic neonates had no difference in overall morbidity when compared to CPAM surgery on older infants.
Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)
Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F, Gupta S, Langendam M, Staiano A, Thapar N, Tipnis N, Tabbers M.
J Pediatr Gastroenterol Nutr 2018 March 66(3): 516-554
Summary: Gastroesophageal Reflux (GER) and Gastroesophageal Reflux Disease (GERD) are one of the most frequently discussed and treated gastroenteric disease processes in children. This latest guideline from NASPGHAN and ESPGHAN evaluates studies through June 1 2015 and forms recommendations for the diagnosis and management of GER and GERD in infants and children based on this literature review and expert opinion. The latest recommendations: 1) focus on reducing acid suppression; 2) shift away from attributing respiratory/laryngeal symptoms to GER; 3) add algorithms for typical symptoms in both infants and older children to differentiate between GERD versus functional diagnoses; and 4) add a recommendation for change of formula to a protein hydrolysate or amino acid formula before acid suppression in infants.
Factors Associated with Outcomes and Costs After Pediatric Laparoscopic Cholecystectomy
Akhtar-Danesh G, Doumouras A, Bos C, Flageole H, Hong, D.
JAMA Surgery. 2018 Jan 17.
Summary: Pediatric Cholelithiasis is increasing in prevalence along with childhood obesity and is no longer predominantly attributable to hemolytic diseases. Correspondingly, rates of laparoscopic cholecystectomy have increased. In this retrospective, population-based study of all Canadian pediatric patients undergoing laparoscopic cholecystectomy from 2008 – 2015, the researchers demonstrated an association between patient indication for operation, patient comorbidities, surgeon volume with cost and post-operative morbidity. Although indication and comorditites cannot be changed, the authors suggest that surgeon volume rather than specialty training (general surgery vs. pediatric surgery) may be more important when considering referrals for pediatric cholecystectomy.
Radiation Exposure and Attributable Cancer Risk in Patients with Esophageal Atresia
Yousef Y, Baird R.
J Pediatr Gastroenterol Nutr. 2018 Feb;66(2):234-238.
Summary: Radiation exposure of patients with esophageal atresia is significant. A single-institution, retrospective study of 53 esophageal patients with a mean follow-up of 5.7 years allowed the calculation of effective dose of radiation exposure. Additionally, using pre-existing normative data, the median and maximum increases in mortality risk were found to range from 130 to 1575-fold higher in this patient population. The authors suggest that eliminating unnecessary studies and restricting exposure during essential studies should be emphasized during the care of esophageal atresia patients both during their initial admission as well as outpatient follow up. Measurement by patient specific direct dosimeters may draw the attention of caregivers to cumulative exposure over the patient’s lifetime.
Intraoperative Clonidine for Prevention of Postoperative Agitation in Children Anaesthetized with Sevoflurane (PREVENT AGITATION): a Randomized, Placebo-controlled, Double-blind Trial
Ydemann M, Nielson BN, Henneberg S, Jakobsen JC, Wetterslev J, Lauritsen T, Steen N, Edstrom B, Afshari A. Lancet Child Adolesc Health 2018; 2:15-24.
Summary: Postoperative agitation continues to be a common problem in children. Although there is data regarding use of alpha-2-receptor agonists to treat postoperative agitation, information is limited in children especially regarding optimal dosing. Children ages 1-5 years were enrolled in this randomized, placedbo-controlled, double-blind trial in three hospitals in Denmark with the goal of reducing postoperative agitation while assessing the potential benefits and harms of clonidine in this patient population. The authors enrolled 379 children (191 in the treatment group and 188 in the placebo group) and were able to analyze data for 187 and 183 patients respectively. Analysis showed that clonidine reduced the risk of postoperative agitation in boys (relative risk 0.43, 95% CI 0.30-0.61; p<0.0001) without increasing the need for interventions for hypotension or bradycardia. An increased recovery time was also noted as were secondary benefits of reduced opioid administration, increased time to first analgesic administration, and decreased postoperative nausea and vomiting.
Diagnosis and Management of Congenital Diaphragmatic Hernia: a Clinical Practice Guideline
Canadian Congenital Diaphragmatic Hernia Collaborative.
CMAJ. 2018 Jan 29;190(4):E103-E112
Summary: Congenital Diaphragmatic Hernia (CDH) occurs in ~1:3300 live births and is accompanied by both short- and long-term morbidity and mortality. A defining attribute of CDH is its requirement for integrated multidisciplinary care across three distinct phases: prenatal, perinatal/postnatal and childhood/adolescent. This report from the Canadian CDH Collaborative contains evidence-based guidelines to standardize CDH care. The guidelines were developed by a multidisciplinary panel of experts (maternal-fetal medicine, pediatric surgery, pediatric anesthesia, neonatal intensive care, neonatal follow-up, pediatric intensive care and pediatric cardiology) using a modified Delphi consensus framework. The guideline encompasses prenatal diagnosis, ventilation strategies, hemodynamic support, echocardiography usage, management of pulmonary hypertension, use of extracorporeal life support, surgical approaches, and long-term follow-up.
Association of Same-Day Discharge With Hospital Readmission After Appendectomy in Pediatric Patients
Cairo SB, Raval MV, Browne M, Meyers H, Rothstein DH.
JAMA Surg. 2017 Dec 1;152(12):1106-1112
Summary: Appendicitis is the most common indication for urgent surgery in children in the US. Multiple studies in the adult population have demonstrated safety of same-day discharge (SDD) following multiple types of operations (including appendectomy) and small series have suggested this concept applies to children as well. In this study, the authors utilized the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) to evaluate outcomes in children that were discharged from the hospital on the same day as undergoing appendectomy for non-perforated/non-complicated appendicitis versus those discharged 1-2 days postoperatively. They found no differences in odds for 30-day readmission or wound complication rates. This suggests that, in selected patients, SDD is a safe alternative to overnight admission after appendectomy.
Persistent Opioid Use Among Pediatric Patients After Surgery
Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, Brummett CM, Waljee JF.
Pediatrics. 2018 Jan;141(1). pii: e20172439
Summary: The “opioid crisis” is a major public health problem in the US, with rapidly rising hospitalization and mortality rates from prescription and non-prescription opioid mis/use. However, opioids are an important adjunct in analgesia for acute pain following surgery and very little is known about opioid use in the post-operative pediatric patient population. In this study, the authors used a national data set of employer-based insurance claims to evaluate prolonged opioid refills in the 13-21-year-old patient population. They found that ~60% of patients received an opioid prescription post-operatively and ~5% demonstrated persistent opioid use (>90 days postoperative), with variation based on type of surgery, age, gender and other factors. The authors suggest these data may assist in developing methods to minimize opioid exposure in those patients at highest risk for subsequent misuse.
Antibiotic Stewardship in the Newborn Surgical Patient: A Quality Improvement Project in the Neonatal Intensive Care Unit.
Walker S, Datta A, Massoumi RL, Gross ER, Uhing M, Arca MJ.
What is known on this subject:
• No consensus exists regarding perioperative antibiotic usage in neonatal patients.
• Wide variability exists in perioperative and postnatal antibiotic therapy nationally.
What this study adds:
• Elimination of postnatal antibiotics in surgical neonates without signs and symptoms of infections or perinatal risk factors for sepsis was not associated with increased rates of surgical site infections or hospital acquired infections.
• Limiting perioperative antibiotics to less than 72 hours was not associated with increased rates of surgical site infections or hospital acquired infections.
• Antibiotic stewardship with the implementation of antibiotic usage guidelines in surgical neonates was associated with a decrease in median antibiotic days.
Combination Analgesia for Neonatal Circumcision: A Randomized Controlled Trial.
Sharara-Chami R, Lakissian Z, Charafeddine L, Milad N, El-Hout Y.
Pediatrics 2017;140(6): e20171935.
What is known on this subject:
• Circumcision is often performed without analgesia or only a local anesthetic cream
• Penile nerve blocks have been shown to be more effective than cream analgesia or sucrose alone.
What this study adds:
• In a 4-arm double-blinded randomized controlled trial, penile ring block combined with oral sucrose and EMLA cream was the most effective analgesia during neonatal circumcision.
• No adverse effects were reported with ring block.
Diagnostic Performance of Magnetic Resonance Enterography for Detection of Active Inflammation in Children and Adolescents With Inflammatory Bowel Disease: A Systematic Review and Diagnostic Meta-analysis.
Yoon HM, Suh CH, Kim JR, Lee JS, Jung AY, Kim KM, Cho YA.
JAMA Pediatr. 2017;171(12):1208-1216
What is known on this subject:
• Magnetic resonance enterography has the advantage of being a noninvasive, radiation-free imaging modality that can evaluate extraintestinal disease.
• The diagnostic performance of magnetic resonance enterography for detection of active inflammation in children and adolescents with inflammatory bowel disease has not been systematically evaluated.
What this study adds:
• Systematic review and meta-analysis of 18 articles including 687 patients found a sensitivity of 83% and a specificity of 93% for magnetic resonance enterography using histopathology as the reference standard in pediatric and adolescent inflammatory bowel disease patients.
• There was substantial heterogeneity (I2 > 65%) across the included studies and scanner manufacturer was a statistically significant and clinically meaningful cause of heterogeneity in meta-regression analysis.
Extended Versus Narrow-Spectrum Antibiotics in the Management of Uncomplicated Appendicitis in Children: A Propensity-Matched Comparative Effectiveness Study
Cameron DB, Melvin P, Graham DA, Glass CC, Serres SK, Kronman MP, Saito JM, Rangel SJ.
Ann Surg. 2017 Jun 26. doi: 10.1097/SLA.0000000000002349
Question: In children with uncomplicated appendicitis, is extended spectrum antibiotics necessary to improve outcomes?
Findings: A total of 1389 patients were included using PHIS and NSQIP-P data. This was a retrospective database study that did not find a difference in outcomes for surgical site infection comparing extended spectrum (piperacillin/tazobactam) and narrow spectrum (cefoxitin or ceftriaxone + metronidazole) antibiotics.
Meaning: Cefoxitin or Ceftriaxone + metronidazole provides adequate antibiotic coverage for uncomplicated appendicitis.
Hats Off: A Study of Different Operating Room Headgear Assessed by Environmental Quality Indicators
Markel TA, Gormley T, Greeley D, Ostojic J, Wise A, Rajala J, Bharadwaj R, Wagner J.
J Am Coll Surg. 2017
Question: Are there differences in particulate and bacterial contamination from commonly used operating room head gear?
Findings: Disposable bouffant hats have significantly higher microbial shed at the sterile field compared to disposable skull caps and cloth skull caps. Disposable bouffant hats were significantly more permeable than either disposable or cloth skull caps.
Meaning: Disposable style hats should not be considered superior to skull caps in preventing airborne contamination.
The Effect of Level of Care on Gastroschisis Outcomes
Apfeld JC, Kastenberg ZJ, Sylvester KG, Lee HC.
J Pediatr. 2017 Nov;190:79-84
Question: Is there a relationship between level of care in NICUs and outcomes?
Findings: Outcomes were evaluated for 1588 newborns with gastroschisis using data collected by the California Perinatal Care Collaborative. Outcomes were evaluated by NICU level of care. The adjusted odds of death was higher for infants cared for in level II A/B NICUs (OR 6.66), level IIIA NICUs (OR 5.95), or IIIB NICUs (OR 5.85) when compared to level IIIC NICUs. Overall in-hospital mortality was 2.5 %, it was 1% for level IIIC NICUs.
Meaning: This study found significantly higher odds of death for patients cared for in lower level NICUs compared to level IIIC NICUs.
Hukkinen M, Kerola A, Lohi J, Heikkilä P, Merras-Salmio L, Jahnukainen T, Koivusalo A, Jalanko H, Pakarinen MP.
J Am Coll Surg. 2017 Sep 25. pii: S1072-7515(17)31971-3
What is Known:
• Hospitals with low caseloads may have inferior outcomes compared to more experienced centers, prompting centralization of biliary atresia treatment in the United Kingdom and Finland.
• Portoenterostomy success rates are influenced by liver histological features at time of portoenterostomy, including degrees of fibrosis and ductal reaction.
What this study adds:
• BA outcomes improved significantly after centralization and standardized management within Finland.
• Resolution of cholestasis and reduction of high-grade portal inflammation postoperatively predict slower fibrosis progression and improved native liver survival.
• Persisting ductal reaction parallels progressive native liver fibrosis despite clearance of jaundice.
The Cumulative Burden of Surviving Childhood Cancer: an Initial Report from the St. Jude Lifetime Cohort Study (SJLIFE)
Bhakta N, Liu Q, Ness KK, Baassiri M, Eissa H, Yeo F, Chemaitilly W, Ehrhardt MJ, Bass J, Bishop MW, Shelton K, Lu L, Huang S, Li Z, Caron E, Lanctot J, Howell C, Folse T, Joshi V, Green DM, Mulrooney DA, Armstrong GT, Krull KR, Brinkman TM, Khan RB, Srivastava DK, Hudson MM, Yasui Y, Robison LL.
Lancet. 2017 Sep 7. pii: S0140-6736(17)31610-0.
What Is Known:
• 10-year survival for pediatric cancer is now > 80% and late mortality is decreasing for long-term survivors.
• Because of their curative treatment-related exposures, survivors of childhood cancer are at increased risk for a broad range of chronic health conditions.
What This Study Adds:
• For survivors of childhood cancer, the cumulative incidence of chronic health conditions at age 50 years was 99.9%, compared to 9.2% in healthy community controls.
• Second neoplasms, spinal disorders and pulmonary disease were major contributors to the excess total cumulative health burden.
• The cumulative burden of chronic health conditions at age 50 years was highest in survivors of CNS malignancies and lowest in survivors of germ cell tumors.
• Older age at diagnosis, treatment era, and higher doses of brain and chest radiation are significantly associated with a greater cumulative burden and severity of chronic health conditions.
Bhatt M, Johnson DW2, Chan J, Taljaard M, Barrowman N, Farion KJ, Ali S, Beno S, Dixon A, McTimoney CM, Dubrovsky AS1, Sourial N, Roback MG; Sedation Safety Study Group of Pediatric Emergency Research Canada (PERC).
JAMA Pediatr. 2017 Oct 1;171(10):957-964.
What is Known:
• Procedural sedation, defined as the administration of medications to minimize pain and awareness, is standard practice in pediatric emergency departments worldwide to facilitate procedures.
• Serious adverse events (i.e. apnea, bradycardia, laryngospasm, pulmonary aspiration, neurologic injury and death) associated with procedural sedation occur infrequently and are thereby difficult to characterize.
What this Study Adds:
• Administration of ketamine hydrochloride as a single agent for sedation had the best outcomes.
• The addition of propofol or fentanyl citrate to ketamine increased the rates of serious adverse events and significant interventions.
Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤1500 g.
Semberova J, Sirc J, Miletin J, Kucera J, Berka I, Sebkova S, O'Sullivan S, Franklin O, Stranak Z.
Pediatrics. 2017 Aug;140(2). pii: e20164258. doi: 10.1542/peds.2016-4258. Epub 2017 Jul 12.
Summary: The management of patent ductus arteriosus (PDA) in very low birth weight infants remains controversial. The presence of a PDA has been associated with multiple complications; however, causality in these relationships has not been established to date. Furthermore, literature on medical and surgical treatment of PDA has not shown definitive long-term benefits. This has led to wide practice variation between institutions. Spontaneous PDA closure has been documented in a significant number of infants. Semberova et al. performed a retrospective review of VLBW patients born at two level-3 NICU’s. The primary outcome was documentation of time of closure of the PDA in patients who did not receive medical or surgical treatment. Secondary outcome was a demographic comparison between those with spontaneous closure and those patients in whom the PDA did not close. Eighty-five percent of non-treated patients achieved spontaneous closure. The conclusion of this study was that the likelihood of spontaneous closure of a PDA in VLBW infants is extremely high. Rates of spontaneous closure are inversely related to gestational age and birthweight. Further studies are required to compare a non-management approach to medical and surgical management to determine the true benefit of a practice that allows for spontaneous closure of PDA.
Variation in Preoperative Testing and Antireflux Surgery in Infants.
Short HL, Braykov NP, Bost JE, Raval MV.
Pediatrics. 2017 Jul 28. pii: e20170536. doi: 10.1542/peds.2017-0536. [Epub ahead of print]
Summary: Gastroesophageal reflux disease (GERD) affects approximately 7% of infants in the first year of life. First line management is medical treatment with feeding modifications and pharmacotherapy. Antireflux surgery may be required when medical management fails; however, there are no current established guidelines for determining necessity of surgery. Short et al. performed a multicenter retrospective review using the Pediatric Health Information Systems database evaluating infants less than one year of age with a diagnosis of GERD. Primary outcome was the receipt of anti-reflux surgery within 12 months after index admission date. Relevant clinical studies were also recorded. There was a wide variation, by institution, in both the diagnosis of GERD and the utilization of anti-reflux surgery. The conclusion of the study was that there was a notable variation in the overall utilization of anti-reflux surgery and in the surgical and diagnostic approach to GERD. Fewer than 4% of infants with GERD undergo diagnostic testing. Less than 22.8% of patients who undergo anti-reflux surgery had preoperative diagnostic testing. The authors noted that this variation merits development of consensus guidelines for the management of GERD in infants.
Effect of American College of Surgeons Trauma Center Designation on Outcomes: Measurable Benefit at the Extremes of Age and Injury.
Grossman MD, Yelon JA, Szydiak L.
J Am Coll Surg. 2017 Aug;225(2):194-199. doi: 10.1016/j.jamcollsurg.2017.04.034. Epub 2017 Jun 9.
Summary: The American College of Surgeons Committee on Trauma (ACS-COT) has provided verification of trauma centers since 1987. Recent data has shown that there was more variability in adverse outcomes with non-ACS level II centers. Grossman et al. sought to determine if there was a difference in outcomes in both pediatric and elderly outcomes when treated at an ACS verified center versus a non-verified center. The authors performed a 1-year retrospective review of the National Sample Program of the National Trauma Databank. Primary outcome was to determine the effect of verification on mortality and major complications. For pediatric and elderly patients, complications were more likely in non-ACS verified centers. There was no difference in mortality in pediatric and elderly patients treated at non-ACS versus ACS centers. The authors concluded that there was a measurable benefit in complications observed in patients at the extremes of age when treated at an ACS verified center versus a non-verified center. Further studies are required to determine which standards, requirements or clinical characteristics make the most difference with regard to outcome when creating basic structural standards across a national trauma system.
Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis.
Georgiou R, Eaton S, et al.
Pediatrics. 2017 March;139(3):1-9.
PMID: 28213607 (Level 2)
Summary: A meta-analysis of 10 articles involving 413 children who received non-operative (antibiotics only) management of pediatric simple appendicitis. Non-operative management of appendicitis was shown to be 97% effective (95% confidence interval [CI] 96% to 99%), meaning discharge without operation. Recurrent appendicitis occurred in 14%, but overall appendectomy rate in the non-operatively managed patients was 18% (95% CI 77% to 87%). Complication rates were similar between operatively and non-operatively managed patients. Based on these data, the authors recommend that non-operative management of appendicitis should be reserved for those patients in the setting of a trial. Routine non-operative management was not recommended.
Comparison of Antibiotic Therapy and Appendectomy for Acute Uncomplicated Appendicitis in Children: A Meta-analysis.
Huang L, Yin Y, et al.
JAMA Pediatr. 2017 May;171(5):426-34.
PMID: 28346589 (Level 2)
Summary: A meta-analysis of 5 prospective trials comparing operative to non-operative (antibiotics only) management of pediatric simple appendicitis, which included 404 patients aged 5-15 years. Four of these trials were nonrandomized and the one randomized study was a pilot study (not fully powered). Overall, 90.5% of patients were successfully treated with antibiotics and discharged, with 9.5% progressing to appendectomy prior to discharge. Within 1 year, 26.8% of antibiotics-only patients underwent appendectomy due to recurrent appendicitis, symptoms, or parent preference. Patients with an appendicolith on imaging had a higher rate of recurrent appendicitis than did patients without an appendicolith (10 of 30 [33.3%] vs 17 of 138 [12.3%]). The complication rate in the antibiotic-only group was equivalent to the operative group (perforation, abscess, gangrene, and/or postoperative complications). Determination of conclusive measures of risk will require the completion of full prospective randomized trials.
Antibiotics Versus Surgical Therapy for Uncomplicated Appendicitis: Systematic Review and Meta-analysis of Controlled Trials (PROSPERO 2015)
Harnos JC, Zelienka I, at al.
Annals of Surgery. 2017 May;265(5):889-900. PMID: 27759621 (Level 2)
Summary: A meta-analysis of the adult literature including four trials and four cohort studies totaling 2551 patients comparing operative to non-operative management (NOM) of uncomplicated appendicitis. The paper comes out strongly against non-operative management, with 26.5% of patients having appendectomy within 1 year, along with a higher rate of adverse events and complicated appendicitis in the non-operative arm. Length of stay was longer for NOM in the randomized trials, but that may have been due to study design. Follow-up time is limited to 1 year. The authors state that antibiotics may prevent some patients from appendectomies, but surgery represents the definitive, one-time only treatment with a well-known risk profile, and "the long-term impact of antibiotic treatment on patient quality of life and health care costs is unknown”.
Pediatric Intestinal Failure
N Engl J Med. 2017 Aug 17; 377(7):666-675
Association of Same-Day Discharge With Hospital Readmission After Appendectomy in Pediatric Patients
Cairo SB, Raval MV, Browne M, Meyers H, Rothstein DH.
JAMA Surg 2017, July 5th [Epub ahead of print].
Congenital Diaphragmatic Hernia and Growth to 12 Years
Leeuwen L, Mous DS, van Rosmalen J, Olieman JF, Andriessen L, Gischler SJ, Joosten KFM, Wijnen RMH, Tibboel D, IJsselstijn H, Spoel M.
Pediatrics. 2017 Aug;140(2). pii: e20163659
Transfusion Requirement in Burn Care Evaluation (TRIBE): A Multicenter Randomized Prsopective Trial of Blood Transfusion in Major Burn Injury.
Palmieri TL, Holmes JH 4th, Arnoldo B, Peck M, Potenza B, Cochran A, King BT, Dominic W, Cartotto R, Bhavsar D, Kemalyan N, Tredget E, Stapelberg F, Mozingo D, Friedman B, Greenhalgh DG, Taylor SL, Pollock BH.
Ann Surg. 2017 Jul 10. [Epub ahead of print]
Effects of Intraoperative Liberal Fluid on Postoperative Nausea and Vomiting in Children - A Randomized Controlled Trial
Ashok V, Bala I, Bhala I, Bharti N, Jain D, Samujh R.
Paediatr Anaesth. 2017 Aug;27(8):810-815. Epub 2017 Jun 6.
Intravenous Versus Oral Antibiotics for the Prevention of Treatment Failure in Children With Complicated Appendicitis: Has the Abandonment of Peripherally Inserted Catheters Been Justified?
Rangel SJ, Anderson BR, Srivastava R, Shah SS, Ishimine P, Localio R, Luan X, Anandalwar S, Keren R. Pediatric Research in Inpatient Settings (PRIS) Network
Ann Surg. 2017 Aug;266(2):361-368.
Centers of Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017
Berrios-Torres SI, Umscheid CA, Bratzler DW, et al.
JAMA Surg. 2017 May 3. doi: 10.1001/jamasurg.2017.0904. [Epub ahead of print]
Proposed Clinical Pathway for Non-operative Management of High-Grade Pediatric Pancreatic Injuries Based on a Multicenter Analysis: A Pediatric Trauma Society Collaborative
Naik-Mathuria BJ, Rosenfeld EH, Vogel A, et al.
J Trauma Acute Care Surg. 2017 Oct;83(4):589-596. doi: 10.1097/TA.0000000000001576. [Epub ahead of print]
Focused Assessment with Sonography for Trauma (FAST) in Children Following Blunt Abdominal Trauma: A Multi- Institutional Analysis
Sutureless vs Sutured Gastroschisis Closure: A Prospective Randomized Trial
Calder BW, Vogel AM, Zhang J, et al.
J Trauma Acute Care Surg. 2017 Aug;83(2):218-224. doi: 10.1097/TA.0000000000001546. [Epub ahead of print]
Bruzoni M, Jaramillo JD, Dunlap JL, Abrajano C, Stack SW, Hintz SR, Hernandez-Boussard T, Dutta S.
J Am Coll Surg. 2017 Mar.pii:S1072-7515(17)30228-4.
Association of Patent Ductus Arteriosus Ligation With Death or Neurodevelopmental Impairment Among Extremely Preterm Infants
Weisz DE, Mirea L, Rosenberg E, Jang M, Ly L, Church PT, Kelly E, Kim SJ, Jain A, McNamara PJ, Shah PS.
JAMA Pediatr. 2017 Mar;171(5):443-449.
Survival and Neurodevelopmental Outcomes among Periviable Infants
Younge N, Goldstein RF, Benn CM, Hintz SR, Patel RM, Smith PB, Bell EF, Rysavy MA, Duncan AF, Vohr BR, Das A, Goldberg RN, Higgins RD, Cotton CM; Eunice Kenndey Shriver National Institute of Child Health and Human Development Research Network.
N Engl J Med. 2017 Feb;376(7):617-628.
Should Extracorporal Membrane Oxygenation Be Offered? An International Survey
Kuo KW, Barbaro RP, Gadepalli SK, Davis MM, Bartlett RH, Odetola FO.
J Pediatr. 2017 Mar;182:107-113.
Development of a Gestation Age-Specific Case Definition for Neonatal Necrotizing Enterocolitis
Battersby C, Longford N, Costeloe K, Modi N; UK Neonatal Collaborative Necrotising Enterocolitis Study Group.
JAMA Pediatr. 2017 Mar;171(3):256-263.
Respiratory Morbidity in Infants Born with Congenital Lung Malformation
Delestrain C, Khen-Dunlop N, Hadchouel A, Cros P, Ducoin H, Fayon M, Gibertini I, Labbe A, Labouret G, Lebras MN, Lezmi G, Madhi F, Thouvenin G, Thumerelle C, Delacourt C.
Pediatrics. 2017 Mar;139(3).
Clinical Outcome and Biological Predictors of Relapse after Nephrectomy only for Very Low Risk Wilms Tumor
Fernandez, CV, Perlman EJ, Mullen EA, et al.
Ann Surg 2017;265:835-40
PMID: 27811504 PMCID: PMC5145762
Tight Glycemic Control in Critically Ill Children
Agus MSD, Wypij D, Hirshberg EL, et al.
PMID: 28118549 DOI: 10.1056/NEJMoa1612348
Clinical Relevance of the Nonvisualized Appendix on Ultrasonography of the Abdomen in Children
Nah SA, Ong SS, Lim WX, et al.
J Pediatr 2017;182:164-9
PMID: 28010937 DOI: 10.1016/j.jpeds.2016.11.062
Future Supply of Pediatric Surgeons: Analytical Study of the Current and Projected Supply of Pediatric Surgeons in the Context of a Rapidly Changing Process for Specialty and Subspecialty Training
Ricketts TC, Adamson WT, Fraher EP, Knapton A, Geiger JD, Abdullah F, Klein MD.
Ann Surg. 2017 Mar; 265(3):609-615.
Diagnosing Surgical Site Infection Using Wound Photography: A Scenario-Based Study
Sanger PC, Simianu VV, Gaskill CE, Armstrong CA, Hartzler AL, Lordon RJ, Lober WB, Evans HL.
J Am Coll Surg. 2017 Jan;224(1):8-15.e1.
Neuropsychological Follow-Up After Neonatal ECMO
Schiller RM, Madderom MJ, Reuser JJ, Steiner K, Gischler SJ, Tibboel D, van Heijst AF, IJsselstijn H.
Pediatrics. 2016 Nov;138(5).
Association of Anesthesia and Surgery during Childhood with Long-term Academic Performance
Glatz P, Sandin RH, Pederson NK, Bonamy AK, Eriksson LI, Granath F.
JAMA Pediatr. 2017 Jan 2;171(1):e163470.
Responsible Innovation in Children’s Surgical Care
Section on Surgery; Committee on Bioethics; American Pediatric Surgical Association New Technology Committee.
Pediatrics. 2017 Jan;139(1).
Management of Sepsis and Septic Shock
Oral Paracetamol versus Oral Ibuprofen in the Management of Patent Ducts Arteriosis in Preterm Infants: A Randomized Controlled Trial
Howell MD and Davis AM.
JAMA Pediatr. 2017 Jan 19. Epub.
Oncel MY, Yurttutan S, Erdeve O, Uras N, Altug N, Oguz SS, Canpolat FE, Dilmen, U.
J Pediatr. 2014 Mar;164:510-514.
Complications of Endoscopic Retrograde Cholangiopancreatography in Pediatric Patients; A Systemic Literature Review and Meta-Analysis
Usatin D, Fernandes M, Allen IE, Perito ER, Ostroff J, Heyman MB
J Pediatr. 2016 Dec;179:160-165.
Quantifying the Burden of Interhospital Cost Variation in Pediatric Surgery: Implications for the Prioritization of Comparative Effectiveness Research
Cameron DB, Graham DA, Milliren CE, Glass CC, Feng C, Sidhwa F, Thangarajah H, Hall M, Rangel SJ.
JAMA Pediatr. 2016 Dec 12:e163926.
Prevalence of Barrett Esophagus in Adolescents and Young Adults with Esophageal Atresia
Schneider A, Gottrand F, Bellaiche M, Becmeur F, Lachaux A, Bridoux-Henno L, Michel JL, Faure C, Phillipe P, Vandenplas Y, Dupont C, Breton A, Gaudin J, Lamireau T, Muyshont L, Podevin G, Viola S, Bertrand V, Caldari D, Colinet S, Wanty C, Sauleau E, Leteurtre E, Michaud L.
Ann Surg. 2016 Dec;264(6):1004-1008.
Congenital Diaphragmatic Hernia Defect Size and Infant Morbidity at Discharge
Putnam LR, Harting MT, Tsao K, Morini F, Yoder BA, Luco M, Lally PA, Lally KP, Congenital Diaphragmatic Hernia Study Group
Pediatrics. 2016 Nov;138(5):1-10.
PMID: epub ahead of print
Is Screening of Intestinal Foregut Anatomy in Heterotaxy Patients Really Necessary?: A Systematic Review in Search of the Evidence
Cullis PS, Siminas S, Losty PD.
Ann Surg. 2016 Dec;264(6):1156-1161.
Evaluation of Variability in Inhaled Nitric Oxide Use and Pulmonary Hypertension with Congenital Diaphragmatic Hernia
Putnam LR, Tsao K, Morini F, Lally PA, Miller CC, Lally KP, Harting MT; Congenital Diaphragmatic Hernia Study Group.
JAMA Pediatr. 2016 Oct 10.doi: 10.1001/jamapediatrics.2016.2023.
Association of Preoperative Anemia with Postoperative Mortality in Neonates
Goobie SM, Faraoni D, Zurakowski D, DiNardo JA.
JAMA Pediatr. 2106 Sep 1;170(9):855-62.
Ovarian Torsion in Children: Management and Outcomes
Geimanaite L, Trainavicious K.
J Pediatr Surg. 2013 Sep;48(9):1946-53.
Current Trends in the Surgical Treatment of Pediatric Ovarian Torsion: We can do better
Campbell BT, Austin DM, Kahn O, McCann MC, Lerer TJ, Lee K, Thaker S, Herbst KW, Rader CM.
J Pediatr Surg. 2015 Aug;50(8):1374-7.
Ovarian Torsion in Children: Is Oophorectomy Necessary?
Aziz D, Davis V, Allen L, Langer JC.
J Pediatr Surg. 2004 May;39(5):750-3.
Survival and Surgical Interventions for Children With Trisomy 13 and 18
Nelson KE, Rosella LC, Mahant S, Guttmann A.
JAMA. 2016 Jul 26;316(4):420-8. doi: 10.1001/jama.2016.9819.
Long-term outcomes after pediatric splenectomy
Luoto TT, Pakarinen MP, Koivusalo A.
Surgery. 2016 Jun;159(6):1583-90. doi: 10.1016/j.surg.2015.12.014. Epub 2016 Jan 30.
Limiting chest computed tomography in the evaluation of pediatric thoracic trauma
Golden J, Isani M, Bowling J, Zagory J, Goodhue CJ, Burke RV, Upperman JS, Gayer CP.
J Trauma Acute Care Surg. 2016 Aug;81(2):271-7. doi: 10.1097/TA.0000000000001110.
Effect of Donor Milk on Severe Infections and Mortality in Very Low Birth Weight Infants: The Early Nutrition Study Randomized Clinical Trial
Corpeleijn WE, de Waard M, Christmann V, van Goudoever JB, Janson-van der Weide MC, Kooi EM, Koper JF, Kouwenhoven SM, Lafeber HN, Mank E, van Toledo L, Vermeulen MJ, van Vliet I, van Zoeren-Grobben D.
JAMA Pediatr 2016;170(7):654-61.
Computed Tomography Evaluation of Esophagogastric Necrosis After Caustic Ingestion
Chirica M, Resche-Rigon M, Zagdanski AM, Bruzzi M, Bouda D, Roland E, Sabatier F, Bouhidel F, Bonnet F, Munoz-Bongrand N, Marc Gornet J, Sarfati E, Cattan P.
Ann Surg. 2016 Jul;264(1):107-13.
National Variability and Appropriateness of Surgical Antibiotic Prophylaxis in US Children’s Hospitals
Sandora TJ, Fung M, Melvin P, Graham DA, Rangel SJ.
JAMA Pediatr. 2016 Jun 1;170(6):570-6. doi: 10.1001/jamapediatrics.2016.0019.
Delaying Appendectomy Does Not Lead to Higher Rates of Surgical Site Infections
Boomer LA, Cooper JN, Anandalwar S, Fallon SC, Ostlie D, Leys CM, Rangel S, Mattei P, Sharp SW, St Peter SD, Rodriguez JR, Kenney B, Besner GE, Deans KJ, Minneci PC.
Ann Surg. 2016 Jul;264(1):164-8. doi: 10.1097/SLA.0000000000001396.
Predictors of Increasing Injury Severity Across Suspected Recurrent Episodes of Non-Accidental Trauma: A Retrospective Cohort
Thackeray J, Minneci PC, Cooper JN, Groner JI, Deans KJ.
BMC Pediatr. 2016 Jan 16;16:8. doi: 10.1186/s12887-016-0540-y.
Effect of a Clinical Practice Guideline for Pediatric Complicated Appendicitis
Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease: Controlled Outcomes up to Adulthood
Willis ZI, Duggan EM, Bucher BT, Pietsch JB, Milovancev M, Wharton W, Gillon J, Lovvorn H, O’Neill JA, Di Pentima MC, Blakely M. Effect of a Clinical Practice Guideline for Pediatric Complicated Appendicitis.
JAMA Surg. 2016 May 18;151(5):e160194.
Should Children with Suspected Nonaccidental Injury Be Admitted to a Surgical Service?
Magoteaux S, Gilbert M, Langlais CS, Garcia-Filion P, Notrica DM. Should Children with Suspected Nonaccidental Injury Be Admitted to a Surgical Service?
J Am Coll Surg 2016;222:838e 843.
Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants
Talavera MM, Bixler G, Cozzi C, et al. Quality Improvement Initiative to Reduce the Necrotizing Enterocolitis Rate in Premature Infants.
Early Versus Late Parenteral Nutrition in Critically Ill Children
Fivez T, Kerklaan D, Mesotten D, Verbruggen S, Wouters PJ, Vanhorebreek I, Debaveye Y, Vlasselaers D, Desmet L, Casaer MO, Garcia Guerra G, Hanot J, Joffe A, Tibboel D, Jooston K, Van der Berghe G.
N Engl J Med 2016 Mar;374(12):1111-1122. Epub 2016 Mar 15
Development of Guidelines for Skeletal Survey in Young Children with Intracranial Hemorrhage
Paine CW, Scribano PV, Wood JN.
Pediatrics 2016 Apr;137(4):1-8.
Conventional Ventilation Versus High-frequency Oscillatory Ventilation for Congenital Diaphragmatic Hernia: A Randomized Clinical Trial (The VICI - Trial)
Snoek KG, Capolupo I, van Rosmalan J, Hout Lde J, Vijfhuize S, Greenough A, Wijnen RM, Tibboel D, Reiss IK, CDH EURO Consortium.
Ann Surg 2016;263(5):867-874.
Neuvonen MI, Kyrklund K, Rintala RJ, Pakarinen MP.
Ann Surg. 2016 Mar 8. [Epub ahead of print]
Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants
Patel RM, Knezevic A, Shenvi N, Hinkes M, Keene S, Roback JD, Easley KA, Josephson CD.
JAMA. 2016 Mar 1;315(9):889-97. doi: 10.1001/jama.2016.1204.
Hospital Costs for Neonates and Children Supported with Extracorporeal Membrane Oxygenation
Faraoni D, Nasr VG, DiNardo JA, Thagarajan.
J Pediatr 2016;169:69-75
Optimal Timing of Appendectomy in the Pediatric Population
Gurien LA, Wyrick DL, Smith SD, Dassinger MS.
Journal of Surgical Research 2016;202:126-131
no PMID yet
Postoperative Timing of Computed Tomography Scans for Abscess in Pediatric Appendicitis
Nielsen JW, Kurtovic KJ, Kenney BD, Diefenbach KA.
Journal of Surgical Research 2016;200:1-7
Feeding Post-pyloromyotomy: A Meta-Analysis
Sullivan KJ, Chan W, Vincent J, Iqbal M, Wayne C, Nasr A, Canadian Association of Paediatric Surgeons Evidence-Based Resource.
Pediatrics. 2016 Jan;137(1):1-11.
Racial Disparities in Pain Mangament of Children With Appendicitis in Emergency Rooms
Goyal MK, Kupperman N, Cleary SD, Teach SJ, Chamberlain JM.
JAMA Pediatr. 2015 Nov;169(11):996-1002.
Effect of Liver Transplant on Long-term Disease-Free Survival in Children with Hepatoblastoma and Hepatocellular Cancer
Pham TA, Gallo AM, Concepcion W, Esquivel CO, Bonham CA.
JAMA Surg. 2015 Dec;150(12):1150-8.
Pediatric Emergency Appendectomy and 30-Day Postoperative Outcomes in District General Hospitals and Specialist Pediatric Surgical Centers in England, April 2001 to March 2012: Retrospective Cohort Study.
Giuliani S, Cecil EV, Apelt N, Sharland M, Saxena S.
Ann Surg. 2016;263:184-190.
Critical Elements for the Pediatric Perioperative Anesthesia Environment
Section on Anesthesiology and Pain Medicine.
Pediatrics. 2015 Dec;136(6):1200-1205.
Nonoperative management of blunt liver and spleen injury in children: Evaluation of the ATOMAC guideline using GRADE
Notrica DM, Eubanks JW 3rd, Tuggle DW, Maxson RT, Letton RW, Garcia NM, Alder AC, Lawson KA, St Peter SD, Megison S, Garcia-Fillon P.
J Trauma Acute Care Surg. 2015 Oct;79(4):683-693.
Neurodevelopment Outcome at 2 years of Age after General Anesthesia and Awake-Regional Anesthesia in Infancy (GAS): an international multicentre, randomised controlled trial
Davidson AJ, DIsma N, de Graaf JC, Withington DE, Dorris L, Bell G, Stargatt R, Bellinger DC, Schuster T, Amup SJ, Hardy P, Hunt RW, Takagi MJ, Giribaldi G, Hartmann PL, Morton NS, von Ungern Sternberg BS, Locatelli BG, Wilton N, Lynn A, Thomas JJ, Polaner D, Bagshaw O, Szmuk P, Absalom AR, Frawley G, Berde C, Ormond GD, Marmor J, McCann ME, GAS consortium.
Lancet 2015 Oct 23. Epub ahead of print.
Weight Loss and Health Status 3 Years after Bariatric Surgery in Adolescents
Inge TH, Courcoulas AP, Jenkins TM, Michalsky MP, Helmrath MA, Brandt ML, Harmon CM, Zeller MH, Chen MK, Xanthakos SA, Horlick M, Buncer CR, Teen-LABS Consortium.
N Engl J Med. 2015 Nov 6. Epub ahead of print.
Trimethoprim-Sulfamethoxazole Therapy Reduces Failure and Recurrence in Methicillin-Resistant Staphylococcus aureus Skin Abscesses After Surgical Drainage
Holmes L, Ma C, Qiao H, Drabik C, Hurley C, Jones D, Judkiewicz S and Faden H.
J Pediatr. 2016 Feb;169:128-34.e1. doi: 10.1016/j.jpeds.2015.10.044. Epub 2015 Nov 11.
Does the American College of Surgeons NSQIP-Pediatric accurately represent overall patient outcomes?
Gross ER, Christensen M, Schultz JA, Cassidy LD, Anderson Y, Arca MA.
J Am Coll Surg. 2015 Oct;221(4):828-36. doi: 10.1016/j.jamcollsurg.2015.07.014. Epub 2015 Jul 20.
Intravascular Complications of Central Venous Catheterization by Insertion Site
Parienti JJ, Mongardon N, Magarbane B, Mira JP, Kalfon P, Gros A, Marque S, Thuong M, Pottier V, Ramakers M, Savary B, Seguin A, Valette X, Terzi N, Sauneuf B, Cattoir V, Mermel LA, du Cheyron D.
N Engl J Med. 2015 Sep 24;373(13):1220-9. doi: 10.1056/NEJMoa1500964.
Same Hospital Readmission Rates as a measure of Pediatric Quality Care
Kahn A, Nalamura MM, Zaslavsky AM, Jang J, Beery J, G, Feng.
JAMA Pediatr. 2015 Oct 1;169(10):905-12. doi: 10.1001/jamapediatrics.2015.1129.
Effect of Reduction in the Use of Computed Tomography on Clinical Outcomes of Appendicitis
Bachur RG, Levy JA, Callahan MJ, Rangel SJ, Monuteaux MC.
JAMA Pediatr. 2015 Aug 1;169(8):755-60. doi: 10.1001/jamapediatrics.2015.0479.
Randomized Controlled Trial of Laparoscopic and Open Nissen Fundoplication in Children
Fyhn TJ, Knatten CK, Edwin B, Schistad O, Aabakken L, Kjosbakken H, Pripp AH, Emblem R, Bjørnland K.
Ann Surg. 2015 Jun;261(6):1061-7. doi: 10.1097/SLA.0000000000001045.
Early Detection of Necrotizing Enterocolitis by Fecal Volatile Organic Compounds Analysis
de Meij TG, van der Schee MP, Berkhout DJ, van de Velde ME, Jansen AE, Kramer BW, van Weissenbruch MM, van Kaam AH, Andriessen P, van Goudoever JB, Niemarkt HJ, de Boer NK.
J Pediatr. 2015 Sep;167(3):562-567.e1. doi: 10.1016/j.jpeds.2015.05.044. Epub 2015 Jul 15.
Antibiotic Prophylaxis to Prevent Surgical Infections in Children: A Prospective Cohort Study
Khoshbin A, So JP, Aleen IA, Stephens D, Matlow AG, Wright JG.
Ann Surg 2015;262(2):397-402. Appendix http://links.lww.com/SLA/A826
Comparison of Isotonic and Hypotonic Intravenous Maintenance Fluids: A Randomized Clinical Trial
Friedman JN, Beck CE, DeGroot J, Geary DF, Sklansky DJ, Freedman SB.
JAMA Pedaitr 2015;169(5):445-451. doi: 10.1001/jamapediatrics.2014.3809.
Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study
Khan FA, Squires RH, Litman HJ, Balint J, Carter BA, Fisher JG, Horslen SP, Jaksic T, Kocoshis S, Martinez JA, Mercer D, Rhee S, Rudolph JA, Soden J, Sudan D, Superina RA, Teitetbaum DH, Venick R, Wales PW, Duggan C, Pediatric Intestinal Failure Consortium.
J Peds 2015;167(1):29-34.
Neonatal morphine exposure in very preterm infants-cerebral development and outcomes
Steinhorn R, McPherson C, Anderson PJ, Neil J, Doyle LW, Inder T
J Pediatr. 2015 May;166(5):1200-1207.e4. doi: 10.1016/j.jpeds.2015.02.012.
Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial
Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Grönroos JM
JAMA, 2015 Jun 16;313(23):2340-8. doi: 10.1001/jama.2015.6154.
Presentation and clinical outcomes of Choledochal Cysts in children and adults: a multi-institutional analysis
Soares KC1, Kim Y1, Spolverato G1, Maithel S2, Bauer TW3, Marques H4, Sobral M4, Knoblich M5, Tran T6, Aldrighetti L7, Jabbour N8, Poultsides GA6, Gamblin TC9, Pawlik TM1.
JAMA Surg. 2015 Jun 1;150(6):577-84. doi: 10.1001/jamasurg.2015.0226.
Outcomes and costs of surgical treatments of necrotizing enterocolitis
Stey A, Barnert ES, Tseng CH, Keeler E, Needleman J, Leng M, Kelley-Quon LI, Shew SB.
Pediatrics. 2015 May;135(5):e1190-7. doi: 10.1542/peds.2014-1058. Epub 2015 Apr 13.
Between-hospital variation in treatment and outcomes in extremely preterm infants
Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, Vohr BR, Carlo WA, Shankaran S, Walsh MC, Tyson JE, Cotten CM, Smith PB, Murray JC, Colaizy TT, Brumbaugh JE, Higgins RD; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
N Engl J Med. 2015 May 7;372(19):1801-11. doi: 10.1056/NEJMoa1410689.
Urokinase versus VATS for treatment of empyema: a randomized multicenter clinical trial
Marhuenda C, Barceló C, Fuentes I, Guillén G, Cano I, López M, Hernández F, Pérez-Yarza EG, Matute JA, García-Casillas MA, Alvarez V, Moreno-Galdó A.
Pediatrics. 2014 Nov;134(5):e1301-7. doi: 10.1542/peds.2013-3935.
Stool color card screening for early detection of biliary atresia and long-term native liver survival: a 19-year cohort study in Japan
Yan-Hong Gu, MD, MSc, PhD, Koji Yokoyama, MD, Koichi Mizuta, MD, PhD, Takashi Tsuchioka, MD, PhD, Toyoichiro Kudo, MD, PhD, Hideyuki Sasaki, MD, PhD, Masaki Nio, MD, PhD, Julian Tang, PhD, Takayoshi Ohkubo, MD, PhD, and Akira Matsui, MD, DMSci
J Pediatr. 2015 Apr;166(4):897-902.e1. doi: 10.1016/j.jpeds.2014.12.063. Epub 2015 Feb 11.
Brain Oxygenation During Laparoscopic Correction of Hypertrophic Pyloric Stenosis
Stefaan H.A.J. Tytgat, MD, Lisanne J. Stolwijk, MD, Kristin Keunen, MD, Dan M.J. Milstein, PhD, Petra M.A. Lemmers, MD, PhD, and David C. van der Zee, MD, PhD
J Laparoendosc Adv Surg Tech A. 2015 Apr;25(4):352-7. doi: 10.1089/lap.2014.0592. Epub 2015 Mar 13.
Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections
Loren G. Miller, MD, MPH, Robert S. Daum, MD, CM, C. Buddy Creech, MD, MPH, David Young, MD, Michele D. Downing, RN, MSN, Samantha J. Eells, MPH., Stephanie Pettibone, BS, Rebecca J. Hoagland, MS, and Henry F. Chambers, MD, for the DMID 07-0051 Team*
N Engl J Med. 2015 Mar 19;372(12):1093-103. doi: 10.1056/NEJMoa1403789.
Anesthetic neurotoxicity--clinical implications of animal models
Rappaport BA, Suresh S, Hertz S, Evers AS, Orser BA.
N Engl J Med. 2015 Feb 26;372(9):796-7. doi: 10.1056/NEJMp1414786.
PMID:25714157[PubMed - indexed for MEDLINE]
Cognitive and behavioral outcomes after early exposure to anesthesia and surgery
Flick RP, Katusic SK, Colligan RC, Wilder RT, Voigt RG, Olson MD, Sprung J, Weaver AL, Schroeder DR, Warner DO.
Pediatrics. 2011 Nov;128(5):e1053-61. doi: 10.1542/peds.2011-0351. Epub 2011 Oct 3. Erratum in: Pediatrics. 2012 Mar;129(3):595.
PMID:21969289[PubMed - indexed for MEDLINE]
Very low birth weight is an independent risk factor for emergency surgery in premature infants with inguinal hernia
de Goede B, Verhelst J, van Kempen BJ, Baartmans MG, Langeveld HR, Halm JA, Kazemier G, Lange JF, Wijnen RM.
J Am Coll Surg. 2015 Mar;220(3):347-52. doi: 10.1016/j.jamcollsurg.2014.11.023. Epub 2014 Dec 3.
PMID:25532618[PubMed - in process]
Effect of deregionalized care on mortality in very low-birth-weight infants with necrotizing enterocolitis
Kastenberg ZJ, Lee HC, Profit J, Gould JB, Sylvester KG
JAMA Pediatr. 2015 Jan 1;169(1):26-32. doi: 10.1001/jamapediatrics.2014.2085.
Effect of an enhanced medical home on serious illness and cost of care among high-risk children with chronic illness: a randomized clinical trial
Mosquera RA, Avritscher EB, Samuels CL, Harris TS, Pedroza C, Evans P, Navarro F, Wootton SH, Pacheco S, Clifton G, Moody S, Franzini L, Zupencic J, Tyson JE.
JAMA. 2014 Dec 24-31;312(24):2640-8. doi: 10.1001/jama.2014.16419.
Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: A Pilot Randomized Controlled Trial
Svensson JF, Patkova B, Almström M, Naji H, Hall NJ, Eaton S, Pierro A, Wester T.
Ann Surg. 2014 Jul 28. [Epub ahead of print]
PMID: 25072441 [PubMed - as supplied by publisher]
Outcomes of Full-term Infants with Bilious Vomiting: Observational Study of a Retrieved Cohort
Mohinuddin S, Sakhuja P, Bermundo B, Ratnavel N, Kempley S, Ward HC, Sinha A.
Arch Dis Child. 2015 Jan;100(1):14-7. doi: 10.1136/archdischild-2013-305724. Epub 2014 Sep 9.
PMID: 25204734 [PubMed - in process]
Propranolol for Infantile Haemangiomas: Single Centre Experience of 250 Cases and Pproposed Therapeutic Protocol
Solman L, Murabit A, Gnarra M, Harper JI, Syed SB, Glover M.
Arch Dis Child. 2014 Dec;99(12):1132-6. doi: 10.1136/archdischild-2014-306514. Epub 2014 Aug 14.
PMID: 25123404 [PubMed - in process]
Consequences of the affordable care act for sick newborns
Profit J, Wise PH, Lee HC.
Pediatrics. 2014 Nov;134(5):e1284-6. doi: 10.1542/peds.2014-0470. Epub 2014 Oct 13. No abstract available.
PMID:25311609 [PubMed - in process]
A statewide collaborative to reduce pediatric surgical site infections
Toltzis P, O'Riordan M, Cunningham DJ, Ryckman FC, Bracke TM, Olivea J, Lyren A.
Pediatrics. 2014 Oct;134(4):e1174-80. doi: 10.1542/peds.2014-0097. Epub 2014 Sep 8.
PMID:2520179 [PubMed - in process]
Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants
Kelleher J, Salas AA, Bhat R, Ambalavanan N, Saha S, Stoll BJ, Bell EF, Walsh MC, Laptook AR, Sánchez PJ, Shankaran S, VanMeurs KP, Hale EC, Newman NS, Ball MB, Das A, Higgins RD, Peralta-Carcelen M, Carlo WA; GDB Subcommittee, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.
Pediatrics. 2014 Nov;134(5):e1369-77. doi: 10.1542/peds.2014-0183. Epub 2014 Oct 27.
PMID:2534931[PubMed - in process]
Medical status of 219 children with biliary atresia surviving long-term with their native livers: results from a north american multicenter consortium.
Ng VL, Haber BH, Magee JC, Miethke A, Murray KF, Michail S, Karpen SJ, Kerkar N, Molleston JP, Romero R, Rosenthal P, Schwarz KB, Shneider BL, Turmelle YP, Alonso EM, Sherker AH, Sokol RJ; Childhood Liver Disease Research and Education Network (CHiLDREN).
J Pediatr. 2014 Sep;165(3):539-546.e2. doi: 10.1016/j.jpeds.2014.05.038. Epub 2014 Jul 9.
PMID:25015575[PubMed - in process]
Antibiotic Prophylaxis to Prevent Surgical Site Infections in Children: A Prospective Cohort Study.
Khoshbin A, So JP, Aleem IS, Stephens D, Matlow AG, Wright JG; for The SickKids Surgical Site Infection Task Force.
Ann Surg. 2014 Sep 19. [Epub ahead of print]
PMID:25243561[PubMed - as supplied by publisher]
Cancer incidence rates and trends among children and adolescents in the United States, 2001-2009.
Siegel DA, King J, Tai E, Buchanan N, Ajani UA, Li J.
Pediatrics. 2014 Oct;134(4):e945-55. doi: 10.1542/peds.2013-3926. Epub 2014 Sep 8.
PMID:25201796[PubMed - in process]
A clinical prediction rule for the severity of congenital diaphragmatic hernias in newborns
Brindle ME, Cook EF, Tibboel D, Lally PA, Lally KP; Congenital Diaphragmatic Hernia Study Group.
Pediatrics. 2014 Aug;134(2):e413-9. doi: 10.1542/peds.2013-3367. Epub 2014 Jul 14.
PMID:25022745 [PubMed - in process]
Regionalization of the surgical care of children: a risk-adjusted comparison of hospital surgical outcomes by geographic areas
Salazar JH, Goldstein SD, Yang J, Douaiher J, Al-Omar K, Michailidou M, Aboagye J, Abdullah F.
Surgery. 2014 Aug;156(2):467-74. doi: 10.1016/j.surg.2014.04.003. Epub 2014 Jun 19.
PMID:24953271 [PubMed - in process]
Feasibility of a nonoperative management strategy for uncomplicated acute appendicitis in children
Minneci PC, Sulkowski JP, Nacion KM, Mahida JB, Cooper JN, Moss RL, Deans KJ.
J Am Coll Surg. 2014 Aug;219(2):272-9. doi: 10.1016/j.jamcollsurg.2014.02.031. Epub 2014 Apr 13.
PMID:24951281 [PubMed - indexed for MEDLINE]
Prophylactic Use of Lactobacillus acidophilus/Bidifobacterium infantis: Probiotics and Outcome in Very Low Birth Weight Infants
Härtel C, Pagel J, Rupp J, Bendiks M, Guthmann F, Rieger-Fackeldey E, Heckmann M, Franz A, Schiffmann JH, Zimmermann B, Hepping N, von der Wense A, Wieg C, Herting E, Göpel W; German Neonatal Network.
J Pediatr. 2014 Aug;165(2):285-289.e1. doi: 10.1016/j.jpeds.2014.04.029. Epub 2014 May 29.
PMID: 24880888 [PubMed - in process]
Randomized Controlled Trial of Early Enteral Fat Supplement and Fish Oil to Promote Intestinal Adaptation in Premature Infants with an Enterostomy
Yang Q1, Ayers K2, Welch CD3, O'Shea TM3.
J Pediatr. 2014 Aug;165(2):274-279.e1. doi: 10.1016/j.jpeds.2014.02.002. Epub 2014 Mar 12.
PMID: 24630347 [PubMed - in process]
Hypotonic Versus Isotonic Fluids in Hospitalized Children: a Systematic Review and Meta-Analysis
Foster BA1, Tom D2, Hill V3.
J Pediatr. 2014 Jul;165(1):163-169.e2. doi: 10.1016/j.jpeds.2014.01.040. Epub 2014 Feb 28.
PMID: 24582105 [PubMed - in process]
Safety of short, in-hospital delays before surgery for acute appendicitis: multicentre cohort study, systematic review, and meta-analysis
United Kingdom National Surgical Research Collaborative, Bhangu A.
Ann Surg. 2014 May;259(5):894-903. doi: 10.1097/SLA.0000000000000492. Review.
PMID: 24509193 [PubMed - indexed for MEDLINE]
High Doses of Methylprednisolone in the Management of Caustic Esophageal Burns
Usta M, Erkan T, Cokugras FC, Urganci N, Onal Z, Gulcan M, Kutlu T.
Pediatrics. 2014 May 26. pii: peds.2013-3331. [Epub ahead of print]
PMID: 24864182 [PubMed - as supplied by publisher]
Cohort study of probiotics in a North American neonatal intensive care unit
Janvier A, Malo J, Barrington KJ.
J Pediatr. 2014 May;164(5):980-5. doi: 10.1016/j.jpeds.2013.11.025. Epub 2014 Jan 7.
PMID: 24411521 [PubMed - indexed for MEDLINE]
Use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia: the START randomized clinical trial
Bezerra JA, Spino C, Magee JC, Shneider BL, Rosenthal P, Wang KS, Erlichman J, Haber B, Hertel PM, Karpen SJ, Kerkar N, Loomes KM, Molleston JP, Murray KF, Romero R, Schwarz KB, Shepherd R, Suchy FJ, Turmelle YP, Whitington PF, Moore J, Sherker AH, Robuck PR, Sokol RJ; Childhood Liver Disease Research and Education Network (ChiLDREN).
JAMA. 2014 May 7;311(17):1750-9. doi: 10.1001/jama.2014.2623.
PMID: 24794368 [PubMed - indexed for MEDLINE]
Conservative management of antenatally diagnosed cystic lung malformations
Ng C, Stanwell J, Burge DM, Stanton MP.
Arch Dis Child. 2014 May;99(5):432-7. doi: 10.1136/archdischild-2013-304048. Epub 2014 Jan 9.
PMID: 24406806 [PubMed - in process]
Effect of abdominal insufflation for laparoscopy on intracranial pressure
Kamine TH, Papavassiliou E, Schneider BE.
JAMA Surg. 2014 Apr;149(4):380-2. doi: 10.1001/jamasurg.2013.3024
PMID: 24522521 [PubMed - in process]
A Noise-Reduction Program in a Pediatric Operation Theatre Is Associated With Surgeon's Benefits and a Reduced Rate of Complications: A Prospective Controlled Clinical Trial
Engelmann CR, Neis JP, Kirschbaum C, Grote G, Ure BM.
Ann Surg. 2014 May;259(5):1025-33. doi: 10.1097/SLA.0000000000000253.
PMID:24394594 [PubMed - in process]
PDA Ligation and Health Outcomes: A Meta-analysis
Weisz DE, More K, McNamara PJ, Shah PS.
Pediatrics. 2014 Apr;133(4):e1024-46. doi: 10.1542/peds.2013-3431. Epub 2014 Mar 17.
PMID:24639268 [PubMed - in process]
Ultrasonography/MRI Versus CT for Diagnosing Appendicitis
Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, Oh PS, Behr G, Chen S, Lampl B, Middlesworth W, Kandel J, Ruzal-Shapiro C.
Pediatrics. 2014 Apr;133(4):586-93. doi: 10.1542/peds.2013-2128. Epub 2014 Mar 3.
PMID:24590746 [PubMed - in process]
Extracorporeal life support in patients with congenital diaphragmatic hernia: how long should we treat?
Kays DW, Islam S, Richards DS, Larson SD, Perkins JM, Talbert JL.
J Am Coll Surg. 2014 Apr;218(4):808-17. doi: 10.1016/j.jamcollsurg.2013.12.047. Epub 2014 Feb 7.
PMID:24655875[PubMed - in process]
Influence of in-house attending presence on trauma outcomes and hospital efficiency
Cox JA, Bernard AC, Bottiggi AJ, Chang PK, Talley CL, Tucker B, Davenport DL, Kearney PA.
J Am Coll Surg. 2014 Apr;218(4):734-8. doi: 10.1016/j.jamcollsurg.2013.12.027. Epub 2013 Dec 28.
PMID:24508425[PubMed - in process]
Comparative effectiveness of skin antiseptic agents in reducing surgical site infections: a report from the washington state surgical care and outcomes assessment program
Hakkarainen TW, Dellinger EP, Evans HL, Farjah F, Farrokhi E, Steele SR, Thirlby R, Flum DR; Surgical Care and Outcomes Assessment Program Collaborative.
J Am Coll Surg. 2014 Mar;218(3):336-44. doi: 10.1016/j.jamcollsurg.2013.11.018. Epub 2013 Nov 27.
PMID:24364925[PubMed - in process]
Referral to Pediatric Surgical Specialists
Surgical Advisory Panel
Pediatrics. 2014 Feb;133(2):350-6. doi: 10.1542/peds.2013-3820. Epub 2014 Jan 27.
Operative vs Nonoperative Management for Blunt Pancreatic Transection in Children: Multi-Institutional Outcomes
Iqbal CW1, St Peter SD2, Tsao K3, Cullinane DC4, Gourlay DM5, Ponsky TA6, Wulkan ML7, Adibe OO8; Pancreatic Trauma in Children (PATCH) Study Group.
J Am Coll Surg. 2014 Feb;218(2):157-62. doi: 10.1016/j.jamcollsurg.2013.10.012. Epub 2013 Oct 25.
Functional outcomes and complications after restorative proctocolectomy and ileal pouch anal anastomosis in the pediatric population
Ozdemir Y1, Kiran RP1, Erem HH1, Aytac E1, Gorgun E1, Magnuson D2, Remzi FH3.
J Am Coll Surg. 2014 Mar;218(3):328-35. doi: 10.1016/j.jamcollsurg.2013.11.019. Epub 2013 Nov 26.
Blunt cerebrovascular injury in children: underreported or underrecognized?: A multicenter ATOMAC study
Azarakhsh N, Grimes S, Notrica DM, Raines A, Garcia NM, Tuggle DW, Maxson RT, Alder AC, Recicar J, Garcia-Filion P, Greenwell C, Lawson KA, Wan JY, Eubanks JW 3rd.
J Trauma Acute Care Surg. 2013 Dec;75(6):1006-11; discussion 1011-2. doi: 10.1097/TA.0b013e31829d3526.
PMID: 24256674 [PubMed - indexed for MEDLINE]
Thoracoscopic vs Open Lobectomy in Infants and Young Children with Congenital Lung Malformations
Kunisaki SM, Powelson IA, Haydar B, Bowshier BC, Jarboe MD, Mychaliska GB, Geiger JD, Hirschl RB.
J Am Coll Surg. 2014 Feb;218(2):261-70. doi: 10.1016/j.jamcollsurg.2013.10.010. Epub 2013 Oct 24.
PMID: 24315887 [PubMed - in process]
Use of white blood cell count and negative appendectomy rate
Bates MF, Khander A, Steigman SA, Tracy TF Jr, Luks FI.
Pediatrics. 2014 Jan;133(1):e39-44. doi: 10.1542/peds.2013-2418. Epub 2013 Dec 30.
PMID: 24379236 [PubMed - in process]