Journal of Pediatric Surgery Article Review: September 2023
With Dr. Sahab Delaville & Dr. Red Holcomb & Dr. Jason Smithers · hosted by Dr. Cecilia Jigena & Dr. E 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
47% of pectus arcuatum patients required X-ray or CT scan for diagnosis
Pectus arcuatum is a bony deformity caused by a premature obliteration of the sternal sutures, resulting in a short sternum bent on itself
35% of pectus arcuatum cases had associated malformations like Noonan syndrome, scoliosis, or cardiopathy
25% of pectus arcuatum patients had skeletal malformation in their family
Bracing does not work for pectus arcuatum treatment
Pectus arcuatum treatment requires surgery that includes a sternotomy
Patients diagnosed with pectus arcuatum need cardiac ultrasound to look for cardiac malformation and evaluation for scoliosis
Early CDH repair on ECMO was defined as during the first 48 hours after ECMO cannulation
Bleeding risk for CDH repair on ECMO was approximately 1% if operated in less than 24 hours
Bleeding risk for CDH repair on ECMO was 5-6% at 48 hours
Bleeding risk for CDH repair on ECMO jumped to approximately 15% after 48 hours
Some patients who only get CDH repair off ECMO die because they never came off ECMO
The key after CDH repair is to get lung growth in such a way that the contralateral lung grows the most and not the ipsilateral lung
ERAS protocols significantly reduce intraoperative fluids needed by pediatric colorectal surgery patients
ERAS protocols significantly reduce postoperative opiate use in pediatric colorectal surgery
Time to first oral intake was less in pediatric colorectal surgery patients with ERAS protocols
Time for complete nutrition was less in pediatric colorectal surgery patients with ERAS protocols
ERAS protocols have a beneficial role in accelerating rehabilitation and shortening length of hospitalization
Every surgeon will have adversity in practice with patients where despite best efforts there is not a good result
Physician mental health and suicide is discussed more now versus 10 years ago, but still should be discussed more openly
Duration of ECMO support was shorter in the early CDH repair group
Survival was not statistically different between early and delayed CDH repair groups on ECMO
Physician suicide is characterized by tragically high rates of suicide among doctors compared to the general population
High levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide
Stigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders