Hot New Topics from The Journal Of Pediatric Surgery: Update Course 2017
With Dr. David Rothstein · hosted by Dr. Todd Ponsky · StayCurrentMD
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Pneumomediastinum in trauma is not predictive of injury unless there is a wide mediastinum
A high percentage of spontaneous pneumomediastinum patients had comorbidity of asthma
Historical data about post-operative apnea in pyloric stenosis was based on anesthetics not used in 5 decades
Most esophageal atresia anastomotic leaks will resolve spontaneously with observation if the child is stable
Complete disruption of EA anastomosis within 2-3 days should be re-operated, unlike small leaks
The low closure rate in the glycopyrrolate study's control group (29%) may reflect short follow-up period rather than true failure to close
Neonatologists are concerned that glycopyrrolate may cause mucus plugs in EA patients
In patients with spontaneous pneumomediastinum, esophagrams never showed any leak or injury in a 16-year retrospective review
55% of spontaneous pneumomediastinum patients had CT scans and none showed positive findings
In traumatic pneumomediastinum, esophagrams never showed findings in patients who looked clinically well
For pyloric stenosis with chloride <85, give three 20 cc/kg normal saline boluses before rechecking labs
For pyloric stenosis with chloride ≤97, give two 20 cc/kg normal saline boluses before rechecking labs
For pyloric stenosis with chloride >97 but bicarbonate <33, give one 20 cc/kg normal saline bolus
The pyloric stenosis resuscitation study used 20 cc/kg boluses of normal saline, not 10 cc/kg
Midwest Pediatric Surgery Consortium review of 400+ EA patients found trans-anastomotic tube associated with increased stricture and complication risk
Great Ormond Street does not leave nasogastric tubes or chest tubes after EA repair and routinely feeds on day 2-3 without contrast study, with great results for 20 years
In glycopyrrolate RCT for EA leaks, chest tube output was 124 mL in treatment group vs 370 mL in placebo group
Leak resolution in glycopyrrolate RCT was achieved in 76% of treatment group vs 29% of placebo group
Oral feeding after EA leak was achieved in 71% of glycopyrrolate group vs 14% of placebo group