Using three-dimensional ultrasound in predicting complex gastroschisis: A longitudinal, prospective, multicenter cohort study.

OBJECTIVE: To determine whether complex gastroschisis (ie, intestinal atresia, perforation, necrosis, or volvulus) can prenatally be distinguished from simple gastroschisis by fetal stomach volume and stomach-bladder distance, using three-dimensional (3D) ultrasound. METHODS: This multicenter prospective cohort study was conducted in the Netherlands between 2010 and 2015. Of seven university medical centers, we included the four centers that performed longitudinal 3D ultrasound measurements at a regular basis. We calculated stomach volumes (n = 223) using Sonography-based Automated Volume Count. The shortest stomach-bladder distance (n = 241) was determined using multiplanar visualization of the volume datasets. We used linear mixed modelling to evaluate the effect of gestational age and type of gastroschisis (simple or complex) on fetal stomach volume and stomach-bladder distance. RESULTS: We included 79 affected fetuses. Sixty-six (84%) had been assessed with 3D ultrasound at least once; 64 of these 66 were liveborn, nine (14%) had complex gastroschisis. With advancing gestational age, stomach volume significantly increased, and stomach-bladder distance decreased (both P < .001). The developmental changes did not differ significantly between fetuses with simple and complex gastroschisis, neither for fetal stomach volume (P = .85), nor for stomach bladder distance (P = .78). CONCLUSION: Fetal stomach volume and stomach-bladder distance, measured during pregnancy using 3D ultrasonography, do not predict complex gastroschisis.

Outcome of isolated gastroschisis; an international study, systematic review and meta-analysis.

OBJECTIVE: To determine outcome of children born with isolated gastroschisis (no extra-gastrointestinal congenital abnormalities). STUDY DESIGN: International cohort study and meta-analysis. PRIMARY OUTCOME: time to full enteral feeding (TFEF); secondary outcomes: Duration of mechanical ventilation, length of stay (LOS), mortality and differences in outcome between simple and complex gastroschisis (complex; born with bowel atresia, volvulus, perforation or necrosis). To compare the cohort study results with literature three databases were searched. Studies were eligible for inclusion if cases were born in developed countries with isolated gastroschisis after 1990, number of cases >20 and TFEF was reported. RESULTS: The cohort study included 204 liveborn cases of isolated gastroschisis. The TFEF, median duration of ventilation and LOS was, 26days (range 6-515), 2days (range 0-90) and 33days (range 11-515), respectively. Overall mortality was 10.8%. TFEF and LOS were significantly longer (P<0.0001) and mortality was fourfold higher in the complex group. Seventeen studies, amongst the current study, were included for further meta-analysis comprising a total of 1652 patients. Mean TFEF was 35.3±4.4days, length of ventilation was 5.5±2.0days, LOS was 46.4±5.2days and mortality risk was 0.06 [0.04-0.07 95%CI]. Outcome of simple and complex gastroschisis was described in five studies. TFEF, ventilation time, LOS were significant longer and mortality rate was 3.64 [1.95-6.83 95%CI] times higher in complex cases. CONCLUSIONS: These results give a good indication of the expected TFEF, ventilation time and LOS and mortality risk in children born with isolated gastroschisis, although ranges remain wide. This study shows the importance of dividing gastroschisis into simple and complex for the prediction of outcome.

[Prevention of injuries associated with horseback riding]. / Preventie van letsels in de paardensport.

Each year 9,900 equestrians present at Accident and Emergency Departments, 40% of them 10-19 year old females. The most common horse-riding injuries are to the head, brain, neck and face, torso and extremities. Because of the relatively larger head, children more often fall on their head. Wearing a helmet gives considerable protection. Despite the common use of a helmet by horseback riders, serious head injury still occurs regularly. Further research into improvement of the protective function of the helmet is indicated. The current safety vest (body protector) does not significantly reduce the risk of torso injury. Improvement of its protective function is necessary. Injury to the lower extremities is caused when they become trapped in the stirrup in a fall from or with the horse. Safety stirrups and sturdy footwear are possible preventive measures. Investment in the quality and promotion of preventive measures could reduce the frequency and severity of equestrian injuries.

Management of a Giant Omphalocele with Non-Cross-Linked Intact Porcine-Derived Acellular Dermal Matrix (Strattice) Combined with Vacuum Therapy.

The management of giant omphaloceles at our department is primarily conservative. However, management can be challenging if the omphalocele is ruptured or the sac has to be removed. We report a case in which a giant omphalocele in a newborn female patient was managed by covering the abdominal defect with non-cross-linked intact porcine-derived acellular dermal matrix (Strattice reconstructive tissue matrix, LifeCell Corp., Branchburg, New Jersey, United States) sutured to the fascia combined with vacuum therapy.

[Traumatic spinal cord injury in children; early and late effects]. / Traumatische dwarslaesies bij kinderen; vroege en late gevolgen.

Spinal cord injuries (SCIs) have physical, emotional, psychological and economic consequences for patients. Although SCIs in children are rare, they have to cope with the consequences for the rest of their lives. In this article, three children who presented at our emergency department are discussed. These children had suffered SCIs from different etiologies. Most SCIs are caused by trauma and more males than females suffer SCIs. The younger children are, the more likely they will sustain cervical SCIs, which can be attributed to several distinct anatomical differences in the juvenile spine. Depending on the level of the spine injured, multiple secondary problems can occur. In this article, we paint a picture of the complex and multidisciplinary treatment and rehabilitation of young SCI patients and emphasise the need for treatment to take place in a specialised (children's) rehabilitation unit.

[Decompression illness: minor symptoms, major consequences]. / Decompressieziekte: geringe klachten, ernstige gevolgen.

Nowadays, diving is being performed ever more frequently; it is thus important to take diving injuries into consideration in patients presenting with even minor complaints after diving. Every dive is risky and could result in decompression illness, barotrauma and/or death. We report on two cases of decompression illness: a 30-year old man, an occupational diver, and a 46-year old man, an experienced diver, who were both clinically suspected of having decompression illness and were treated with hyperbaric oxygen in a recompression chamber. Both were eventually symptom-free after several treatments. Decompression illness is caused by a reduction in ambient pressure, which results in intra- or extravascular bubbles. Symptoms vary and are dependent on the site affected: from minor pain to neurological symptoms and death. If patients are suspected of having diving injuries, we recommend contacting a centre specialised in diving and hyperbaric medicine. Recompression in a hyperbaric chamber is the definitive treatment for decompression illness and should be performed as soon as possible.

[Bicycle spoke-related injuries in children: emphasise prevention]. / Spaakverwondingen bij kinderen: benadruk preventie.

Three children, a 6-year-old boy and two girls aged 5 and 4 years, were seen at an emergency department due to distal lower-leg injuries sustained from the spokes of bicycle wheels. All three patients had been passengers on rear carrying seats of moving bicycles. Only the third bicyclist had used a special child safety seat. The second girl had drawn her foot up from underneath a strap and suffered a tibial fracture later treated with an osteosynthetic plate. The other two patients recovered after conservative casting treatment. Bicycle spoke-related injuries are sustained when the foot or lower limb makes contact with the spokes of a bicycle wheel and usually by children who are bicycle passengers. In the Netherlands, approximately 4600 children are seen at emergency departments with such injuries each year. Bicycle spoke-related accidents can cause severe damage that can result in lengthy recovery periods. Not only physical complications but also psychological ones can occur. The latter are often overlooked but do deserve proper treatment. The physician treating a spoke-related injury is in a good position to advice parents as to preventive measures, particularly on the use of special child safety seats.

The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows®.

PURPOSE: This article summarises the results of a newly developed technique that utilises Meniscus Arrows(®) for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents. METHOD: Twelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an average age of 12 years, were arthroscopically fixed with Meniscus Arrows(®), after a reduction of their fractures. This was followed by 5 weeks immobilisation in a plaster of Paris. Postoperative follow-up included radiographs, Lachmann tests on all of the children's knees and KT-1000 tests of eight out of twelve of the children's knees. The postoperative follow-up time ranged from 3 to 10 years, with patients being seen for an average of 4 years. RESULTS: All of the fractures consolidated uneventfully, and all of the patients returned unrestricted to their previous activity level. The Lachmann tests revealed no, or a non-functional, laxity in any of the patients' knees. The KT-1000 tests showed a difference between the operated side, and non-operated side, of between 3 mm in the first knee operated on and an average of 1 mm in the remaining knees. CONCLUSION: The arthroscopic fixation of tibial spine fractures using Meniscus Arrows(®) showed that this minimally invasive procedure resulted in the uneventful consolidation of all twelve of the fractures, with excellent results, and without the need for a second, hardware removal, operation. LEVEL OF EVIDENCE: Level IV.

Long-term health condition in major pediatric trauma: a pilot study.

PURPOSE: Major trauma is the leading cause of death in children of developed countries. However, little is known about its long-term health consequences in survivors. Our aim was to describe the health condition in children at long-term after major trauma. METHODS: Prospective cohort study of severely injured children (Injury Severity Score > or =16, age <16) admitted to a Dutch level I trauma center in 1999 to 2000 (N = 40). About 7 years after trauma (median, 7.3; range, 6.3-8.2 years), survivors' health condition was assessed with the following: guides to the evaluation of permanent impairment of the American Medical Association (AMA-guides), Glasgow Outcome Scales (GOS/GOSE), Vineland Adaptive Behavior Scales (VABS), Child Behavior Checklist (CBCL), and Strengths and Difficulties Questionnaire (SDQ). RESULTS: Of 40 children, 28 were followed up. Most (n = 16; 57%) had no impairments (AMA guides); minor to severe impairments were found in 12 of the respondents. About 80% (n = 22) had good recovery (GOS 5 and GOSE 7/8); the remaining had moderately disability (GOS 4 or GOSE 5/6). The mean scores on the VABS and the frequency of behavioral problems on the CBCL (24%) and the SDQ (20%) were comparable to healthy peers. CONCLUSIONS: This long-term follow-up study after major trauma revealed that most children had a health condition comparable to healthy peers; about 40% of the respondents was physically impaired or restricted in daily activities. Our experiences with different measures may be helpful to apply age-appropriate outcome measures for the clinical follow-up of children after major trauma and to design future longitudinal studies.

Long-Term Health-Related Quality of Life in Major Pediatric Trauma: A Pilot Study.

BACKGROUND: Major trauma is the leading cause of mortality and morbidity in children of developed countries. Little research has been done about the health-related quality of life (HRQL) in these children. The aim of the current research is to describe the HRQL of children in the long term after major trauma and to compare it with healthy peers. METHODS: A prospective cohort study of severely injured children (ISS ≥ 16, age < 16 years) who survived the trauma and were admitted to the emergency department of a Dutch level 1 trauma center in 1999 and 2000 (n = 40) was conducted. Between 6 and 8 years after trauma (mean 7.3, SD 0.7 years), outcome was assessed by the Pediatric Quality of Life Inventory (PedsQL 4.0), the EuroQol 5D (EQ-5D), and the EuroQol Visual Analogue Scale (EQ-VAS). RESULTS: The mean age at the time of the accident was 8.9 years (SD 4.6 years), the mean ISS was 24.9 (SD 11.1), and 25 (63%) cases were male; 28 out of 40 patients were followed up. The mean score on the PedsQL was 81.2 and this did not differ significantly from the norm value. On the EQ-5D, more health problems were reported than in a healthy reference population. The mean EQ-VAS score was 79.4 and was significantly lower than in healthy peers. The lowest scores on the PedsQL and the EQ-VAS were seen in teenagers and in respondents with spinal cord and/or severe cerebral injury. CONCLUSION: The results on HRQL in children in the long term after major trauma are inconclusive. Special attention should be given to teenagers with spinal cord or severe cerebral injury who reported the lowest HRQL.

Health-related quality-of-life measures for long-term follow-up in children after major trauma.

OBJECTIVE: Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). METHODS: The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. RESULTS: The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQ-CF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children's Quality Of Life (TACQOL), and Youth Quality of Life Instrument--Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. CONCLUSIONS: DISABKIDS, KIDSCREEN 52, and PedsQL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially.

Thoracoscopic elongation of the esophagus in long gap esophageal atresia.

Long gap esophageal atresia in which a primary anastomosis cannot be achieved remains a challenge. Elongation of the esophagus by traction on the 2 ends has been previously described. With the advent of thoracoscopic repair of esophageal atresia, there have thus far been no reports of thoracoscopic repair of long gap esophageal atresia. This paper describes the first successful repair of long gap esophageal atresia by thoracoscopic traction of the 2 esophageal ends and delayed thoracoscopic anastomosis.