1 00:00:00,000 --> 00:00:16,560 Hello, pediatric surgery family. 2 00:00:16,560 --> 00:00:21,500 I'm Em Tombash, a research fellow from Cincinnati Children's Hospital Medical Center. 3 00:00:21,500 --> 00:00:31,520 Today, our team is going to deliver the articles that you should know about. 4 00:00:31,520 --> 00:00:33,240 We have four papers today. 5 00:00:33,240 --> 00:00:37,320 First three of them are from the Journal of Pediatric Surgery, and the last one is an 6 00:00:37,320 --> 00:00:38,640 APSA article of interest. 7 00:00:38,640 --> 00:00:45,320 We don't have much time, so let's start. 8 00:00:45,320 --> 00:00:50,720 Our first paper title is Congenital Lung Malformation Patients Experience Respiratory Infections 9 00:00:50,720 --> 00:00:56,000 After Resection, a population-based cohort study by Markle et al. 10 00:00:56,000 --> 00:00:58,440 And this paper is summarized by Ellen Encisco. 11 00:00:58,440 --> 00:01:03,880 She's a research fellow at Cincinnati Children's Hospital. 12 00:01:03,880 --> 00:01:09,080 In this study, the authors did a retrospective review of patients born between 1991 and 2007 13 00:01:09,080 --> 00:01:10,920 with congenital lung malformations. 14 00:01:10,920 --> 00:01:14,840 They compared the rates of infection before and after resection with control cases. 15 00:01:14,840 --> 00:01:19,600 There were 31 cases of congenital lung malformations and 310 control cases. 16 00:01:19,600 --> 00:01:23,760 They found that before resection, the cases of congenital lung malformations had higher 17 00:01:23,760 --> 00:01:29,060 rates of pneumonia but similar rates of respiratory infections and influenza to the controls. 18 00:01:29,060 --> 00:01:32,960 After resection, the cases of malformations had higher rates of pneumonia, respiratory 19 00:01:32,960 --> 00:01:35,800 infections, and influenza compared to the controls. 20 00:01:35,800 --> 00:01:40,660 So the authors concluded that resection does not reduce the rates of later lung infections, 21 00:01:40,660 --> 00:01:44,420 and this should be taken into consideration when counseling families about operative versus 22 00:01:44,420 --> 00:01:46,160 conservative management. 23 00:01:46,160 --> 00:01:50,160 This is a controversial topic, so let us know what you think in the comments below. 24 00:01:50,160 --> 00:01:51,160 Perfect. 25 00:01:51,160 --> 00:01:52,520 Moving to the next one. 26 00:01:52,520 --> 00:01:58,000 Our second paper is Acid Suppression Duration Does Not Alter Anastomotic Stricture Rates 27 00:01:58,000 --> 00:02:03,880 After Oesophageal Atresia with Distal Tracheoesophageal Fistula Repair, a Prospective Multi-Institutional 28 00:02:03,880 --> 00:02:06,520 Cohort Study by Bowder et al. 29 00:02:06,520 --> 00:02:08,920 This paper is summarized by Rod Gerardo. 30 00:02:08,920 --> 00:02:12,880 He's a general surgery resident at Wright State University and a former research fellow at 31 00:02:12,880 --> 00:02:14,520 Cincinnati Children's Hospital. 32 00:02:14,520 --> 00:02:19,440 In this prospective multi-institutional cohort study, the researchers looked at infants who 33 00:02:19,440 --> 00:02:24,200 were undergoing a primary repair of an esophageal atresia from 2016 to 2020. 34 00:02:24,200 --> 00:02:29,280 Specifically, they wanted to know if acid suppression was associated with the development 35 00:02:29,280 --> 00:02:32,100 of an esophageal stricture postoperatively. 36 00:02:32,100 --> 00:02:37,000 Out of the 156 patients who underwent an esophageal atresia repair, about half of them developed 37 00:02:37,000 --> 00:02:38,000 a stricture. 38 00:02:38,000 --> 00:02:44,000 Turns out acid suppression was not associated with a reduction in initial stricture formation. 39 00:02:44,000 --> 00:02:48,120 But you know what was associated with strictures? 40 00:02:48,120 --> 00:02:50,600 Trans-anastomotic feeding tubes. 41 00:02:50,600 --> 00:02:51,600 Great! 42 00:02:51,600 --> 00:02:52,600 Let's keep moving. 43 00:02:52,600 --> 00:02:57,680 Third paper of the day is Optimizing Skin Antisepsis for Neonatal Surgery, a Quality 44 00:02:57,680 --> 00:03:00,840 Improvement Initiative by Carr et al. 45 00:03:00,840 --> 00:03:03,440 This paper is summarized by Cecilia Gigena. 46 00:03:03,440 --> 00:03:06,720 She's also a research fellow at Cincinnati Children's Hospital. 47 00:03:06,720 --> 00:03:12,400 After a literature review, they come up with a protocol using isopropylaclorexidine for 48 00:03:12,400 --> 00:03:19,640 neonatal surgery in patients older than 34 weeks gestational age and that weighed more 49 00:03:19,640 --> 00:03:22,120 than 1500 grams. 50 00:03:22,120 --> 00:03:25,600 They apply this protocol in 50 patients. 51 00:03:25,600 --> 00:03:30,800 After that, they assess the skin of them with a special tool. 52 00:03:30,800 --> 00:03:37,640 They found that none of the patients developed any adverse skin prep outcomes, and 8% of 53 00:03:37,640 --> 00:03:44,560 them developed SSI compared to 14% of a previous cohort using Povidine Iodine. 54 00:03:44,560 --> 00:03:51,880 It seems that CHC is finally getting approved for using in the OR for neonatal surgery. 55 00:03:51,880 --> 00:03:53,640 And here's our last paper. 56 00:03:53,640 --> 00:03:57,040 It's an APSA article of interest from Injury Journal. 57 00:03:57,040 --> 00:04:00,040 Nationwide Use of REBOA in Adolescent Trauma Patients. 58 00:04:00,040 --> 00:04:04,720 An Analysis of the AAST Order Registry by Theodorou et al. 59 00:04:04,720 --> 00:04:07,160 This paper is summarized by Brittany Levy. 60 00:04:07,160 --> 00:04:10,400 She's a research fellow at Cincinnati Children's Hospital as well. 61 00:04:10,400 --> 00:04:15,280 REBOA stands for resuscitative endovascular balloon occlusion of the aorta. 62 00:04:15,280 --> 00:04:19,840 It's a minimally invasive method of hemorrhage control where a sheath is introduced into 63 00:04:19,840 --> 00:04:24,840 the aorta via femoral arterial access and it's inflated to occlude the arterial flow 64 00:04:24,840 --> 00:04:29,280 in either zone 1, 2, or 3 of the thoracic or abdominal aorta. 65 00:04:29,280 --> 00:04:34,200 The REBOA has been gaining popularity for trauma and non-trauma indications in adult 66 00:04:34,200 --> 00:04:40,120 centers and so these authors queried the American Association for the Surgery of Trauma, the 67 00:04:40,120 --> 00:04:47,560 AAST, REBOA Registry for Pediatric Patients to see how or if it's being used in pediatrics. 68 00:04:47,560 --> 00:04:49,160 And so here's the deal. 69 00:04:49,160 --> 00:04:53,200 Over seven years' time, there were only 11 patients in the registry that were less than 70 00:04:53,200 --> 00:04:58,040 18 years old that had a REBOA placed, all of which were adolescents and they had a median 71 00:04:58,040 --> 00:04:59,040 age of 17. 72 00:04:59,040 --> 00:05:06,200 The REBOA did improve hemodynamics in this population, but still only 30% survived. 73 00:05:06,200 --> 00:05:12,720 So overall, REBOA hasn't made it into prime time for pediatric trauma yet and that might 74 00:05:12,720 --> 00:05:14,280 be due to a few reasons. 75 00:05:14,280 --> 00:05:19,000 The technology might need some modifications for pediatric use and we might need a better 76 00:05:19,000 --> 00:05:25,360 identification strategy to know what patients would benefit from REBOA intervention at all. 77 00:05:25,360 --> 00:05:28,000 Check the link in the description below to read each paper. 78 00:05:28,000 --> 00:05:30,360 We hope you liked this episode. 79 00:05:30,360 --> 00:05:35,120 Please follow us on social media, give us a rating and subscribe to our YouTube channel. 80 00:05:35,120 --> 00:05:39,480 And don't forget to download our StayCurrent app on App Store or Play Store for more content. 81 00:05:39,480 --> 00:05:59,880 Thank you for listening.