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Quick Literature Updates Episode 18

Video Published 2025-03-21 Updated 2026-08-01

Timestops (3)

ERAS Society Recommendations for Pediatric Colorectal Surger…

ERAS Society Recommendations for Pediatric Colorectal Surgery

Transition from Pediatric to Adult Colorectal Care

Surgical Timing and Symptom Impact on Outcomes

Topic Overview

A rapid-fire literature update covering three recent pediatric surgery publications. The first discusses ERAS Society consensus recommendations for neonatal perioperative care, including 16 recommendations across 11 topics developed through modified Delphi technique. The second examines transition of care for adolescents with colorectal conditions, finding that coordinated transition models are lacking. The third presents a propensity-matched cohort study showing that surgical treatment of congenital pulmonary airway malformation before symptom onset is associated with shorter length of stay, ventilation time, and operative time without increased complications.

Key Takeaways

ERAS Society established 16 evidence-based recommendations for neonatal perioperative care covering team communication, fasting, and antibiotics.
Transition care for colorectal conditions should start early in adolescence, but current models lack coordination and standardization.
Asymptomatic CPAM patients operated before symptom onset had shorter LOS, ventilation time, and OR time without increased complications.
Modified Delphi consensus achieved >70% agreement on neonatal ERAS protocols, though data gaps remain for NG tubes and central lines.
Systematic review found no validated transition models for anorectal malformations and Hirschsprung patients moving to adult care.

Inside this episode

Kai, the Library's AI content creator, listened to this episode and mapped who's speaking, the chapters, key claims, and cases. Every item links to the exact moment in the recording.

AI-enriched

Who's speaking

Em Goddy — host
Lizzie Lee — guest
Alex Halpern — guest
Cecilia Jhena — guest
Speaker 5

Chapters

0:16ERAS Society Neonatal Perioperative Care Recommendations — Introduction and review of Enhanced Recovery after Surgery Society consensus recommendations for neonatal perioperative care, developed using modified Delphi technique with multidisciplinary experts.
1:56Transition of Care for Colorectal Conditions — Systematic review examining transition from pediatric to adult healthcare for patients with colorectal conditions, finding lack of coordinated transition models.
2:50Timing of Surgery for CPAM — Propensity-matched retrospective cohort study comparing outcomes of surgical treatment for congenital pulmonary airway malformation in symptomatic versus asymptomatic patients.
3:52Closing — Episode conclusion with references to full papers and subscription information.

Key claims

1:10The ERAS Society used a modified Delphi technique with a multidisciplinary group of experts to reach more than 70% consensus — Lizzie Lee
1:34The ERAS Society agreed on 16 recommendations covering 11 topics including team communication, pre-surgery fasting, temperature control, and antibiotic use — Lizzie Lee
1:43The ERAS Society did not have enough data to make recommendations about nasogastric tubes and central lines — Lizzie Lee
2:21Eight studies were found examining transition from pediatric to adult healthcare for colorectal conditions — Alex Halpern
2:24Studies agreed that transitional care should start early in adolescence — Alex Halpern
2:24Little evidence exists that transfer from pediatric to adult care is happening in a coordinated or timely fashion — Alex Halpern
2:33No models of transition care were identified for patients with anorectal malformations and Hirschsprung's disease — Alex Halpern
3:21The CPAM study included 110 patients — Cecilia Jhena
3:21Patients who underwent surgery before becoming symptomatic had shorter length of stay — Cecilia Jhena
3:21Patients who underwent surgery before becoming symptomatic had shorter mechanical ventilation after surgery — Cecilia Jhena
3:21Patients who underwent surgery before becoming symptomatic had shorter operating times — Cecilia Jhena
3:31There was no significant difference in conversion or post-operative complications between symptomatic and asymptomatic CPAM patients undergoing surgery — Cecilia Jhena
3:44It appears safer to operate on CPAM patients before they become symptomatic — Cecilia Jhena

Open questions

What are appropriate recommendations for nasogastric tube and central line use in neonatal perioperative care?
What models of transition care should be developed for adolescents with colorectal conditions moving from pediatric to adult healthcare?

This episode was analyzed and enriched by Kai, the Library's AI content creator. Every item links to the moment it comes from — click a timestamp to listen in context.

Written for:

ERAS Neonatal Guidelines, Colorectal Transition Gaps, and CPAM Timing

The essential version of this episode — what it covers, the points that matter most, and what it changes for you. Written by Kai from the episode transcript and reviewed before publishing.

For trainees · Core brief · AI-written, human-reviewed

ERAS Society Neonatal Perioperative Recommendations

The Enhanced Recovery After Surgery Society convened a multidisciplinary expert panel using a modified Delphi technique to develop consensus-based perioperative care guidelines for neonates 1:10. The group reached agreement on 16 recommendations spanning 11 topics, including team communication, preoperative fasting protocols, intraoperative temperature management, and antibiotic prophylaxis 1:34. The panel explicitly declined to issue recommendations on nasogastric tube use and central line placement, citing insufficient evidence 1:43.

Transition to Adult Care for Colorectal Conditions

A systematic review examining healthcare transition for patients with anorectal malformations and Hirschsprung disease identified only eight studies addressing this population 2:21. The available literature supports initiating transition planning early in adolescence 2:24, but reveals little evidence that transfer from pediatric to adult providers occurs in a coordinated or timely manner 2:24. No established transition care models exist specifically for patients with anorectal malformations or Hirschsprung disease 2:33. The gap between recommended practice and documented implementation suggests these patients face significant risk of care fragmentation as they age out of pediatric systems.

Surgical Timing for Congenital Pulmonary Airway Malformation

A retrospective cohort study of 110 patients with CPAM compared outcomes between those operated before symptom onset and those who developed symptoms prior to surgery 3:21. Asymptomatic patients who underwent elective resection experienced shorter hospital stays, reduced duration of postoperative mechanical ventilation, and shorter operative times 3:21 3:21 3:21. Conversion rates and postoperative complication frequencies did not differ significantly between groups 3:31. The authors conclude that operating before symptom development appears safer 3:44.

Implications for Practice

The ERAS neonatal guidelines provide actionable consensus where evidence exists, while honestly acknowledging areas requiring further study. The transition care review exposes a structural failure: we know transition should begin early, yet have neither models nor evidence of coordinated implementation for this population. The CPAM data support elective resection in asymptomatic patients, though the retrospective design cannot account for selection bias in surgical timing decisions.

Takeaways from this story

ERAS neonatal guidelines cover 16 recommendations but lack evidence for NG tube and central line decisions
No transition care models exist for anorectal malformations or Hirschsprung disease despite known need
CPAM resection before symptom onset reduces length of stay and ventilation time without increasing complications
Transition from pediatric to adult care for colorectal conditions rarely occurs in coordinated fashion

ERAS Guidelines for Neonatal Surgery, Transition Care Gaps, and CPAM Timing

The essential version of this episode — what it covers, the points that matter most, and what it changes for you. Written by Kai from the episode transcript and reviewed before publishing.

For the care team · Core brief · AI-written, human-reviewed

ERAS Society Neonatal Perioperative Recommendations

The Enhanced Recovery After Surgery Society convened a multidisciplinary expert panel and used a modified Delphi technique to reach consensus on perioperative care for newborns undergoing surgery 1:10. The group agreed on 16 recommendations spanning 11 topics, including team communication, preoperative fasting protocols, intraoperative temperature management, and antibiotic prophylaxis 1:34. Notably, the panel could not reach consensus on nasogastric tube or central line management due to insufficient evidence 1:43. These guidelines provide a standardized framework for NICU teams managing surgical neonates, though gaps remain in several common interventions.

Transition to Adult Care for Colorectal Conditions

A systematic review identified only eight studies examining healthcare transition for adolescents with anorectal malformations and Hirschsprung disease 2:21. The available literature consistently recommends starting transition planning early in adolescence 2:24, yet little evidence suggests this transfer occurs in a coordinated or timely manner 2:24. No established transition care models exist specifically for these colorectal conditions 2:33. For primary care providers and adult gastroenterologists, this means many young adults with complex colorectal anatomy arrive without structured handoff, continuity of surgical history, or established care protocols.

Surgical Timing for Congenital Pulmonary Airway Malformation

A retrospective cohort study of 110 pediatric CPAM patients compared outcomes between those operated before and after symptom onset 3:21. Asymptomatic patients who underwent elective resection had shorter hospital stays, required less postoperative mechanical ventilation, and had shorter operative times 3:21 3:21 3:21. Conversion rates and postoperative complications did not differ significantly between groups 3:31. The authors conclude that elective surgery before symptom development appears safer 3:44. For pediatricians managing incidentally discovered CPAM, this supports early surgical referral rather than watchful waiting until respiratory symptoms emerge.

Takeaways from this story

ERAS Society reached consensus on 16 neonatal perioperative recommendations but lacks evidence for NG tube and central line guidance
No transition care models exist for adolescents with anorectal malformations or Hirschsprung disease moving to adult providers
CPAM patients operated before symptom onset had shorter stays and ventilation time without increased complications

Keywords

anorectal malformations Hirschsprung's disease congenital pulmonary airway malformation CPAM neonatal surgery surgical treatment for CPAM Cincinnati Children's Hospital Medical Center Children's National Melbourne, Australia

Hashtags

#pediatricsurgery #ERAS #NICU #colorectalconditions #CPAM #surgery #JAMA #NeonatalCare #TransitionOfCare

Transcript

Hello pediatric surgery family, I'm Em Goddy from Cincinnati Children's Hospital Medical Center, and today our team is gonna deliver the articles that you should know about. As always, we have 3 papers today. 2 of them are from Journal of Pediatric Surgery, and 1 of them is from JAMA Surgery. We don't have much time, so let's start. Our first paper titled Enhanced Recovery after Surgery or ERAS Society Recommendations for Neonatal Perioperative Care by Pilkington et al. This paper is summarized by Lizzie Lee, a physician associate by profession and a member of our team here at Cincinnati Children's dedicated to creating content for pediatric surgery. The ERAS, or the Enhanced Recovery after Surgery Society, used a modified Delphi technique, which is a fancy way of saying that a multidisciplinary group of experts gathered together to reach more than a 70% consensus. Their goal was to develop recommendations that NICUs can use to take care of the newborns during and after surgery. Focusing on the needs that they have when they are undergoing different types of surgeries. So what did they come up with? They agreed on 16 recommendations covering 11 topics like team communication, pre-surgery fasting, temperature control, and antibiotic use. However, they did not have enough data to make recommendations about things like nasogastric tubes and central lines. These new guidelines will help improve care for NICU patients undergoing surgery. Great, let's hear our second paper. Transition from pediatric to adult healthcare for colorectal conditions, a systematic review by Mooreal. And this paper is summarized by Alex Halpern. He's a research fellow at Children's National and collaborates with us to produce these article reviews. The team from Melbourne, Australia performed a systematic review and meta-analysis trying to answer this question. They found 8 studies on this topic. These studies agreed that transitional care should start early in adolescence and found little evidence that this transfer is happening in a coordinated or timely fashion. No models of transition care were identified, so it seems like more work is needed to ensure that these children with anorectal malformations and Hirschbung's disease continue to receive optimal care as they grow older. Now moving to the last paper of the day, clinical symptoms affect treatment and prognosis in pediatric patients with congenital pulmonary airway malformation or CPAP, a propensity score matching retrospective cohort study by Zeng et al. This paper is summarized by Cecilia Jhena. She is one of the previous research fellows at Cincinnati Children's. This is a retrospective study that aimed to investigate the safety and efficacy of surgical treatment for asymptomatic symptoms. They had 110 patients, and what they found is that patients that underwent surgery before they became symptomatic had shorter length. Of stay, shorter mechanic ventilation after surgery, and shorter operating times with no significant difference in conversion or post-op complications. So it seems that it's safer to operate these patients before they become symptomatic. Thank you for listening. Please check the link in the description below to read each paper. We hope you liked this episode. Please follow Stay Current MD on social media, give us a rating, and subscribe to the YouTube channel. And don't forget to download the Stay Current app on the App Store or Play Store for tons of content. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.

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