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关键词： 小儿外科   新生儿疾病   Surgery   儿科学   漏斗胸   胃肠疾病   路易斯安那州   事务管理  

摘要： 《Journal of Pediatric Surgery》2020年第6期开篇汇总2019年10月在路易斯安那州新奥尔良举办的第69届美国儿科学年会(American Academy of Pediatrics, AAP)外科分会情况,开场即针对下一代小儿外科医师的培训计划即从确定专业、早期职业生涯发展到成为有造诣的执业高手进行了热烈讨论。会议内容重点在小儿外科相关基础研究和临床研究,涉及新生儿疾病、胃肠疾病、临床医患事务管理、漏斗胸、肿瘤和实验研究等,以专题讨论、大会发言、简述壁报和壁报展示的形式进行交流。此次会议共收到43篇文章,JPS杂志第6期由从中择优选取的25篇(58%)文章和7篇自由来稿的关于手术技术的文章组成。

关键词： 支原体肺炎   中西医结合疗法   中医儿科学  

摘要： 目的探讨中西医结合治疗小儿支原体肺炎的临床效果.方法选取山西省儿童医院于2018年10月—2018年12月收治的小儿支原体肺炎确诊患儿共60例,肺炎支原体DNA均为阳性.根据治疗方法的不同随机将患者分为对照治疗组30例和中西医结合治疗组30例.对照治疗组使用阿奇霉素进行治疗,结合治疗组使用阿奇霉素并结合实际病情给予不同的中药口服治疗.对比2组患儿的治疗效果、住院时间、症状消失时间、中医主要症状积分、不良反应发生率和炎症因子水平.结果结合治疗组退热时间、咳嗽及啰音消失时间、住院时间都短于对照治疗组;治疗3周后,结合治疗组的患儿的咯痰、咳嗽及发热症状的积分低于对照治疗组;结合治疗组患儿治疗后的IL-6、TNF-α水平也低于对照治疗组;以上差异均有统计学意义(P<0.05).结论中西医结合对于小儿支原体肺炎的治疗效果优于单纯的西医治疗,具有缓解临床症状、减轻炎症反应的特点,具有更高的安全性.

关键词： Antimicrobial stewardship   Children   Paediatrics   Programme implementation  

摘要： A survey was conducted in UK regional children's hospitals with paediatric intensive care and paediatric infectious disease (PID) departments to describe the characteristics of paediatric antimicrobial stewardship (PAS) programmes. A structured questionnaire was sent to PAS coordinators. 'Audit and feedback' was implemented in 13 out of 17 centres. Microbiology-led services were more likely to implement antimicrobial restriction (75% vs 33% in PID-led services), to focus on broad-spectrum antibiotics, and to review patients with positive blood cultures. PID-led services were more likely to identify patients from e-prescribing or drug charts and review all antimicrobials. A PAS network has been established. Crown Copyright (C) 2020 Published by Elsevier Ltd on behalf of The Healthcare Infection Society. All rights reserved.

关键词： Muscle   Bone   Paediatric   Strength  

摘要： Post-puberty, bone mass displays clear sex-specific patterns. However, research has suggested that a sexual dimorphism in bone mass is evident in younger children and is likely attributable to differences in lean mass. Thus, we aimed to determine whether the association with both overall muscle mass and/or muscle strength was different between the sexes in a paediatric population. Participants were recruited as part of the Vitamin D in Pregnancy Study, Australia. There were 209/402 (52.3%) children at the 11-year follow-up, and 172 had complete data. Children were assessed for bone mineral content (BMC), bone mineral density (BMD) and lean mass by DXA (Lunar). Handgrip strength (kg) was measured using a dynamometer (JAMAR). Linear regression models were adjusted for height, weight, age and pubertal stage. In adjusted models, including both muscle strength and lean mass, the observed association differed between boys and girls. At the spine in boys, BMC and BMD were associated with muscle strength (beta 0.34 [95%CI 0.09-0.59] and 0.008 [95%CI 0.003-0.014];respectively) but not total muscle mass. However, muscle mass was associated with BMC and BMD at the total body (less head). In girls, spine BMC and BMD were associated with total lean mass (beta 0.95 [95%CI 0.61-1.3] and beta 0.01 [95%CI 0.005-0.02], respectively), with a similar pattern of association with total body (less head) measures. Muscle mass and strength appear to have sexually dimorphic effects on bone mass in school-aged children. These findings should be replicated in longitudinal studies.

关键词： Best Practice   Tariff   Trauma call   Paediatric trauma   Remuneration   Trauma network   Reimbursement policy   Major trauma   Epidemiological overview  

摘要： Introduction: The Best Practice Tariff (BPT) in major trauma awards Major Trauma Centres (MTCs) a financial incentive when predefined standards of care are met. However, no tailored criteria exist with regards to the reimbursement policy in paediatric major trauma. In this study, we aim to examine the utility of the paediatric Major Trauma BPT and identify predictors of additional resource utilisation. Materials and methods: This cohort study encompassed all paediatric major trauma calls (N = 682) presenting to a designated combined adult and paediatric MTC between July 2014 and June 2017. Patient demographics, admission pattern, injury parameters, length of stay (LOS) and the need for operative management were collected. Patients approved for the BPT uplift payment (BPT group) were compared with the cohort of children not qualifying (non-BPT group). Results: Overall, less than a quarter (23.2%) of the trauma population qualified for the BPT. The proportion of patients requiring operative intervention and CT scanning in the BPT group was significantly higher (p<0.001). These children also attained a higher ISS (median, 13.5 vs. 0, p<0.001) and required longer hospitalisation. Following a Receiver Operator Characteristic (ROC) curve analysis, a cut off ISS score > 8 demonstrated an excellent predictive value in identifying children qualifying for BPT (true positive and false positive rates: 90% and 10.7%). However, a subgroup analysis including the more severely injured children (ISS >8) not qualifying for the uplift payment revealed that equally substantial resource went into their management - 42.9% needed surgical intervention and 57.1% a CT scan. Discussion: This study demonstrated that BPT in paediatric major trauma is a valuable reimbursement;however, our findings also unveiled a cohort deemed ineligible for BPT despite the high costs accrued. Re-evaluation of the remuneration criteria of paediatric major trauma networks with an alternative, more inclusive reim

关键词： Paediatric   ACL   Repair   Outcome  

摘要： Purpose Anterior cruciate ligament (ACL) surgery in the paediatric population has long been a challenge. Non-operative treatment will result in persistent instability which can lead to chondral and meniscal injuries. The results of primary open ACL repair are poor. Concerns of growth plate disturbance with transphyseal techniques and issues with relatively small-diameter grafts in Tanner 1 and 2 patients, which are inadequate, have contributed to these challenges. With advancing instrumentation, there is renewed interest in ACL repair. The minimally invasive approach of arthroscopic primary ACL repair retains the native ligament. The objective and subjective outcomes at 2 years are presented. Methods Paediatric patients, less than 16 years of age, presenting acutely with complete proximal ACL ruptures underwent direct arthroscopic ACL repair, reinforced by a temporary internal brace, which was subsequently removed after 3 months. Patient-reported outcome measures including the Lysholm, Tegner and KOOS scores were collected at 6 months, 1 year and 2 years post-operatively. Results Twenty patients (age 6-16) completed data at 2 years post-operatively. There were no failures, no complications and no growth disturbance out to 2 years. The 2-year postoperative outcomes;Lysholm 95 (90-100), Tegner 7 (6-10), KOOS-Child 96.5 (88.9-100) demonstrated statistically significant improvements following surgery (p < 0.001). Objective measurements with an accelerometer did not demonstrate any significant side-to-side difference. Conclusion ACL repair for proximal ACL tears in the paediatric population demonstrates the potential for excellent outcomes at short-term follow-up. This presents an attractive alternative to ACL reconstruction when an adequate ACL remnant permits direct repair. Our results demonstrate that paediatric ACL repair is safe and effective.

关键词： Appendicectomy   Hospital-volume   Paediatric surgery   Surgeon-volume  

摘要： Introduction Acute appendicitis is a common surgical emergency in children. The majority of appendicectomies in children are performed by general surgeons, rather than specialist paediatric surgeons. Aim To assess the impact of hospital specialization, hospital volume, and surgeon volume on outcomes for children undergoing appendicectomy in Ireland. Methods NQAIS (National Quality Assurance and Improvement System) data for all appendicectomies performed on children in Ireland between January 2014 and November 2017 was examined. Hospitals were categorized as specialist paediatric centres (SPCs), high-volume general (HVGHs), moderate-volume general (MVGHs), or low-volume general (LVGHs) by annual case volume. Similarly, surgeons were categorized as high-volume (HVSs), moderate-volume (MVSs), or low-volume (LVSs) by annual volume. Data relating to patient demographics, type of surgery (open/laparoscopic/laparoscopic converted to open), length of stay (LOS), mortality, admission to critical care, and readmission rates were collected and analysed. Results About 9593 appendicectomies were performed in 21 hospitals by 134 surgeons. Patients in SPCs had lowest overall rates of laparoscopic surgery (48% v 66% (HVGHs) v 70% (MVGHs) v 57%(LVGHs), p < 0.001). In SPCs 30-day readmission rates were lower for younger children (5.3% for 5-8-year olds v 6.7% (HVGHs) v 7.3%(MVGHs) v 10.5% (LVGHs), p = 0.023). HVSs performed more laparoscopic appendicectomies on younger patients (0-4 years: 40% v 6% (MVSs) v 17%(LVSs), p < 0.001) but performed the least on older children (13-16 years: 76% v 82%(MVSs) v 82%(LVSs), p < 0.001). Conclusion Children younger than 8 years undergoing appendicectomy in HVGHs or SPCs, or by HVSs, have marginally better outcomes. In older children, marginally shorter in-hospital stays and higher laparoscopic rates are seen in those looked after outside of high-volume or specialist units. Our results show that nonspecialist centres provide an essential, and safe,

摘要： In this paper titled Atlantoaxial instability treated with free-hand C1-2 fusion in a 3-year old boy with Morquio syndrome, the authors, Eun Ji Moon, MD, Sang Joon Chong, MD, PhD and Jin Hoon Park, MD, PhD describe the case of a just 3-year Morquio old boy presenting with a 5-month history of progressive quadriparesis and severe neck pain [1]. The preoperative cervical imaging showed a compressive myelopathy at C1-2 and atlantoaxial subluxation. Atlantoaxial fixation and decompression were performed successfully with posterior C1-2 fusion using a free-hand technique. After the operation, the patient had improved neck pain and quadriparesis, and finally, he had been able to walk independently after postoperative 8 months. The authors conclude that this is the first report dealing with a paediatric Morquio patient treated just with C1-2 screwing and fusion with a free-hand technique. As far as I realize, the most important topic of this paper is the biochemical considerations on Morquio syndrome, the odontoid malformations, the surgical options and the intraoperative assistance.

关键词： Paediatric   Pediatric   Surgery   COVID-19   Pandemic   SARS-CoV-2  

摘要： Purpose The COVID-19 pandemic has placed an unprecedented test on the delivery and management of healthcare services globally. This study describes the adaptive measures taken and evolving roles of the members of the paediatric surgery division in a developing country during this period. Methods We adopted multiple adaptive strategies including changes to stratification of surgeries, out-patient services by urgency and hospital alert status, policy writing involving multidisciplinary teams, and redeployment of manpower. Modifications were made to teaching activities and skills training to observe social distancing and mitigate reduced operative learning opportunities. Roles of academic staff were expanded to include non-surgical duties. Results The planned strategies and changes to pre COVID-19 practices were successful in ensuring minimal disruption to the delivery of essential paediatric surgical services and training. Despite the lack of established guidelines and literature outlining strategies to address the impact of this pandemic on surgical services, most of the initial measures employed were consistent with that of other surgical centres. Conclusion Changes to delivery of surgical services and surgical training warrant a holistic approach and a constant re-evaluation of practices with emergence of new experiences and guidelines.