Journal of Pediatric Surgery Article Review: October 2023
With Dr. Pablo Laje & Dr. Tom Wiley & Dr. Madina Chakraborty & Dr. Elizabeth Speck · hosted by Dr. Cecilia Jigena & Dr. Em Goddy · 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
There are no randomized controlled trials on prophylactic acid suppression after esophageal atresia repair
In a meta-analysis of 1,395 patients, 753 received acid suppression medication but it did not increase the odds of having an esophageal stricture
There was no evidence to associate prophylactic acid suppression with protection from stricture formation after esophageal atresia repair
There was a tendency toward higher incidence of strictures with anti-acid medication
The use of anti-acid medication is not without cost and is not as innocent as once thought
A large prospective study demonstrated that even children with sizable pneumothorax can be safely observed
Not all patients with pneumothorax have an active leak
Cross-sectional imaging should not be done on children to help make clinical decisions about spontaneous pneumothorax
If air reaccumulates after observation, the patient has an ongoing air leak and warrants an operation
Data support doing some pleural-based management rather than just staple lobectomy for spontaneous pneumothorax
Studies are not available to demonstrate one pleural-based procedure is better than another
For the asymptomatic contralateral side in children with pneumothorax, do not do anything unless it develops symptoms
For recurrent pneumothorax, whatever was done before, do something more
In a study of 110 CPAM patients, the asymptomatic group had shorter operating times, shorter post-operative mechanical ventilation, shorter chest tube durations, and shorter hospital stays
The CPAM study excluded patients who underwent thoracotomy, including only thoracoscopic resections
No significant differences were found in secondary outcomes including gastroesophageal reflux disease, anastomotic leak, and esophagitis between infants receiving prophylactic acid suppression and those who did not
Potential risks of long-term acid suppression therapy include dysbiosis, necrotizing enterocolitis, and increased neonatal infection rates, particularly relevant in preterm and low birth weight infants
Factors associated with symptomatic CPAM lesions include age older than 4 years, postnatal diagnosis, and maximum cyst diameter bigger than 39.9 millimeters
The CPAM study did not enroll patients who accepted conservative treatment
The CPAM study had insufficient sample size and was from a single center