BOB in Ped Surg 2023 - IBEROAMERICANA Winner - Lourenzo Sbragia, MD

All right, it's my turn again. Yes. It's my turn again. All right. Here we go. So now we're going to be talking about the next society, which is Iberoamericana. Uh, so, uh, thank you all for joining this, this was the also the first year for Iberoamericana. So, so thanks for joining. And they sent us their top three papers, uh, from this year. Uh, the first is Dr. Maria Valayos, which is who's a fifth-year resident of pediatric surgery at La Paz Hospital in Madrid, Spain. And, um, she created a, a initial training model in microsurgery, uh, in the rat. And this is a pre-clinical study, which was meant to describe an initial model of training in microsurgery using rats and to look at the learning curve in that model. So that was the first paper. The second paper is Lorenzo, how do you, from the University of Sao Paulo, uh, presenting the analysis of risk factors for neonatal short intestine syndrome in two tertiary centers in Brazil. This is a retrospective study that aimed to evaluate the evolution and variables that influence the death in neonates with short bowel syndrome between 2000 and 2019. So almost a 20-year study. And the third is Dr. Maria Jose Rossell E from Nostra Seniora. I you should have done these. In Spanish. Yeah. She's from Spain too, yes. She's from Spain. Um, and, uh, they looked at urinary osmolarity, the useful parameter to assess renal function before and after surgery for obstruction of the ureteropelvic junction. They did a retrospective study from 1980 to 2021, and their aim was to determine the usefulness of basic renal function markers to assess renal function in patients with UPJ obstruction and to know the most sensitive marker for renal damage in these patients. So, we have the microsurgery in the rat model, we have the study of short bowel syndrome, uh, and, uh, in neonates, and we also have the study of, uh, UPJ obstruction, uh, and markers for that. So, why don't we take to the polls and we'll see you in a minute? The latest version of State Current allows for healthcare providers to stay up to date in medicine by aggregating the best multimedia content all in one place. Their order sets, protocols, guidelines, videos, directories, and even their favorite website links. No more having to go to the internet or a three-ring binder. Introducing State Current Spaces, a digital, sharable file box within State Current. Let us know if your hospital or society would like a space. All right, we are back. So, uh, it looks like the, uh, winner is analys analysis of risk factors for neonatal short intestine syndrome in two tertiary centers in Brazil. So, uh, let's go ahead and, uh, I know I didn't give you much warning there Carolyn, but if we could roll that video. Good morning. Good afternoon, ladies and gentlemen. Thank you for opportunity to present our paper. conflicts of interest. Short Bow syndrome is defined as the malabsorption state resulting for extensive intestinal resection. Intestinal insufficiency is characterized by the loss or decrease of intestinal absorptive capacity to maintain nutritional status exclusively through the entral. The sequel, short bowel syndrome incidence is 24 cases for thousand live births and global neonatal mortality is 37%. Our aim was to evaluate the evolution and variables that influence the death of newborns who were diagnosed with short bowel syndrome and ultra short bowel syndrome in two tertiary centers of neonatal. It was approved by our clinical. It's a court test of 18 years, 15 neonate and the data obtained by reviewing record medical. The demographic data that we studied were 13. And the criteria of inclusion were short bow syndrome less 60 cm and ultra short bow syndrome less 25 cm, no valve. And criteria exclusion or other malformations, genetic syndromes and remaining intestine more than 60. Our results, our statistical analysis compare two groups by Fisher test and Kaplan Meyer test and all this. Our results, we have 52 short bowel syndrome, 20 survive, uh, 30 short bowel and 23 ultra short bowel syndrome. diagnose 55% NEC, 20% gastrosis, 10% intestinal and 10% mid gut. The demographic results, most of them are Mayo, most submit to section, adequate for gestational age, uh, the weight is the premature to 75%. They need implantation of catheter 73% and the need of NPT 70%. Uh, when compare short bowel versus ultra short bowel, we found in full adaptation and remaining bow length had difference between groups, but there were no difference between uh, uh death uh. potential risk for values for death was TPN, uh, not able for get food adaptation and not able to get in nutrition. This is the the curve of TPN influence survival. time for adaptation survival curve. the potential predict for death was time for definitive surgery in days and weight for discharge or uh death in loss. evolution for ultra short bow syndrome was small for gestational age. the potential short bow syndrome according to diagnose NEC versus no NEC, less than 25 days of loss or survival. our general survival. Our final weight to discharge in 20 patients. Well, in conclusion, ladies and gentlemen, thank for your attention, high morbidity and mortality in neonatal uh neonatal surgery was 57% and a complicated and sure TPN during the adaptation period had a significant impact of survival. our authors and other institution. Thank you very much. All right. Okay, so that was super interesting. I really like it. Um, I mean, we know that short balance syndrome patients are really complicated and there are new therapies now going on that um, it's good to know that assess them with a good TPN that maybe in other countries that's I I don't know for Argentina, Latin America, sometimes it's quite difficult to have perfect for that. And okay, so it's they they have a um, like um, that weighed when they leave or they are not used to TPN, they may have some more complications. So to ensure that it's the best for this patient. All right. Brittany, Ellen or Tony, comments. Tony? I don't really have any comments. I couldn't um understand whether this was neonatal death or overall death, uh with a high mortality rate. It was a very high mortality rate of something like 50%. Um, so I I I I missed that part and I didn't really see what criteria in this paper would predict how patients would do. Was it purely the length of the intestine or was it complications during the neonatal period? Both was actually the length of Dave, if you have a the length of the wavel, like if you have a ultra short bowel syndrome which worse. And if you have like if you couldn't get the patient to gain weight was a predictor uh for that. Um, it not neonatal exclusive death but uh it's not a great follow up like uh included first year. Tony, did you want to follow up to that or no? No, I think it's very important. You know, the most of our patients, if they're not decided at the time, if they have total netizingitis, for example, and the decision is not continue therapy, most of our patients will survive with short gut, with ultra short gut. The question is the long-term survival. How many go on to liver transplant or intestinal transplant in the you know, in the American system. It's a it's a great point, Tony. That's the the number that matters because initial survival is not important as are they going to make it to transplant. And uh, unfortunately the author couldn't make that clear. Uh, but we that's a follow-up question that we can ask and post that, that question on on social media as well. Um, some questions from the chat and so one of them is that it was interesting, there's 33% of patients had an ostomy and how are those patients different um, from the patients who didn't get an ostomy? And then was there a protocolized or standardized um, post-op care for any of these patient groups. Right. So, we're kind of disappointed that the author couldn't come here. Um, here's what we'll do. Um, I think what we'll do is we will ask him these questions, get his answer, and then I'm going to ask Ellen, Brittany, and Cecilia to make a a summary video that's about a minute long that answers and addresses, uh, more clarity on what are we actually measuring as far as survival. Um, and and the other questions. So, um, Okay. good discussion. Thank you. Right.