Quick Literature Updates Episode 2

Hello, pediatric surgery family. I'm Em Tombash, a research fellow from Cincinnati Children's Hospital Medical Center. Today, our team is going to deliver the articles that you should know about. We have four papers today. First three of them are from the Journal of Pediatric Surgery, and the last one is an APSA article of interest. We don't have much time, so let's start.

Our first paper title is Congenital Lung Malformation Patients Experience Respiratory Infections After Resection, a population-based cohort study by Markle et al. And this paper is summarized by Ellen Encisco. She's a research fellow at Cincinnati Children's Hospital. In this study, the authors did a retrospective review of patients born between 1991 and 2007 with congenital lung malformations. They compared the rates of infection before and after resection with control cases.

There were 31 cases of congenital lung malformations and 310 control cases. They found that before resection, the cases of congenital lung malformations had higher rates of pneumonia but similar rates of respiratory infections and influenza to the controls. After resection, the cases of malformations had higher rates of pneumonia, respiratory infections, and influenza compared to the controls.

So the authors concluded that resection does not reduce the rates of later lung infections, and this should be taken into consideration when counseling families about operative versus conservative management. This is a controversial topic, so let us know what you think in the comments below. Perfect. Moving to the next one.

Our second paper is Acid Suppression Duration Does Not Alter Anastomotic Stricture Rates After Oesophageal Atresia with Distal Tracheoesophageal Fistula Repair, a Prospective Multi-Institutional Cohort Study by Bowder et al. This paper is summarized by Rod Gerardo. He's a general surgery resident at Wright State University and a former research fellow at Cincinnati Children's Hospital.

In this prospective multi-institutional cohort study, the researchers looked at infants who were undergoing a primary repair of an esophageal atresia from 2016 to 2020. Specifically, they wanted to know if acid suppression was associated with the development of an esophageal stricture postoperatively. Out of the 156 patients who underwent an esophageal atresia repair, about half of them developed a stricture.

Turns out acid suppression was not associated with a reduction in initial stricture formation. But you know what was associated with strictures? Trans-anastomotic feeding tubes. Great! Let's keep moving.

Third paper of the day is Optimizing Skin Antisepsis for Neonatal Surgery, a Quality Improvement Initiative by Carr et al. This paper is summarized by Cecilia Gigena. She's also a research fellow at Cincinnati Children's Hospital. After a literature review, they come up with a protocol using isopropylaclorexidine for neonatal surgery in patients older than 34 weeks gestational age and that weighed more than 1500 grams. They apply this protocol in 50 patients.

After that, they assess the skin of them with a special tool. They found that none of the patients developed any adverse skin prep outcomes, and 8% of them developed SSI compared to 14% of a previous cohort using Povidine Iodine. It seems that CHC is finally getting approved for using in the OR for neonatal surgery.

And here's our last paper. It's an APSA article of interest from Injury Journal. Nationwide Use of REBOA in Adolescent Trauma Patients. An Analysis of the AAST Order Registry by Theodorou et al. This paper is summarized by Brittany Levy. She's a research fellow at Cincinnati Children's Hospital as well. REBOA stands for resuscitative endovascular balloon occlusion of the aorta.

It's a minimally invasive method of hemorrhage control where a sheath is introduced into the aorta via femoral arterial access and it's inflated to occlude the arterial flow in either zone 1, 2, or 3 of the thoracic or abdominal aorta.

The REBOA has been gaining popularity for trauma and non-trauma indications in adult centers and so these authors queried the American Association for the Surgery of Trauma, the AAST, REBOA Registry for Pediatric Patients to see how or if it's being used in pediatrics. And so here's the deal. Over seven years' time, there were only 11 patients in the registry that were less than 18 years old that had a REBOA placed, all of which were adolescents and they had a median age of 17.

The REBOA did improve hemodynamics in this population, but still only 30% survived. So overall, REBOA hasn't made it into prime time for pediatric trauma yet and that might be due to a few reasons. The technology might need some modifications for pediatric use and we might need a better identification strategy to know what patients would benefit from REBOA intervention at all.

Check the link in the description below to read each paper. We hope you liked this episode. Please follow us on social media, give us a rating and subscribe to our YouTube channel. And don't forget to download our StayCurrent app on App Store or Play Store for more content. Thank you for listening.