Membranous diaphragm presenting as esophageal atresia in a neonate.

Whenever a newborn infant presents with excessive salivation and failure to pass nasogastric tube, one of the 5 major types of esophageal atresia is suspected. We report a rare case where a newborn infant presented with features of esophageal atresia due to membranous diaphragm.

Preperitoneal approach for incarcerated inguinal hernia in children.

BACKGROUND/PURPOSE: The authors have been using abdominal extraperitoneal approach for treatment of incarcerated inguinal hernia in children for the last 2 years. The aim of this paper is to report on this experience. METHODS: Between March 1994 and July 1996, cases of infants and children presenting with incarcerated inguinal hernia were studied. Preperitoneal approach was used in all children who had incarcerated hernia that could not be reduced with gentle manipulation and did not reduce spontaneously under general anesthesia. There were 24 children with a median age of 12 months. RESULTS: Herniotomy, reduction of contents, and bowel resection were found to be much easier than the inguinal approach. There were no complications. CONCLUSIONS: Preperiotoneal approach appears to be a safe and easy technique for incarcerated inguinal hernia in children. The authors recommend that it should be used more commonly.

Gas exchange across native lungs and extracorporeal membrane in neonates and pigs during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) is a commonly used treatment modality for severe neonatal respiratory failure. The aim of the present study was to evaluate the relationship between ECMO blood flow and gas exchange across the native lungs and the extracorporeal membrane. In three healthy pigs, the ECMO flow correlated significantly with oxygen transfer (VO2) across the membrane (n = 12, r = .90, P < .001) and inversely with VO2 across the lungs (n = 12, r = -.75, p < .005). In three pigs with acute respiratory distress syndrome induced by repeated bronchoalveolar lavage, flow also significantly correlated with VO2 across the membrane (n = 9, r = .93, P < .001) and inversely with VO2 across the lungs (n = 9, r = -.97, P < .001). Eight neonates had measurements taken at different time intervals and different flow rates during ECMO. The ECMO flow correlated significantly with VO2 across the membrane (n = 45, r = .61, P < .001) and inversely with VO2 across the lungs (n = 15, r = -.54, P < .05). The relationship between carbon dioxide transfer (VCO2) and ECMO flow rates had the same trend as VO2 on all occasions. It is concluded that the ECMO flow rate is one of the main determinants of gas exchange across the lungs and the membrane.

Rectoperineal fistula in newborn boys.

Three newborn boys presented with features suggestive of classic low anorectal abnormality. However, during surgery they were found to have an intermediate anorectal abnormality and a rectoperineal fistula rather than an anocutaneous fistula. The surgical treatment of these infants is discussed.

Short bowel syndrome: metabolic and surgical management.

The management of short bowel syndrome requires long-term nutritional support and monitoring, medication, and occasionally additional surgical procedures. Constant attention is required to ensure adequate adaptation of the gut. This article reviews the normal function of the small bowel, adaptation following resection, total parenteral and enteral nutrition, and the role of adjunctive surgical procedures in the management of short bowel syndrome.

Does the fibrin coat around a central venous catheter influence catheter-related sepsis?

The purpose of this study was to determine whether the fibrin sheath that develops around an intravenous silicone catheter influences catheter-related sepsis. A rat model with a central intravenous silicone catheter was used. Staphylococcus aureus, dose 1 x 10(7) colony forming units (cfu), were injected via the tail vein, either immediately after catheter insertion (group 1, n = 23) or after the catheter had been in situ for at least 7 days (group 2, n = 22). Blood cultures were done on at 24 hours and 7 days. Animals were killed on day 7 and the catheter was removed for culture (Maki and broth) and scanning electronmicroscopy (SEM). The was no significant difference (P > .05) between the number of positive blood cultures in groups 1 and 2 at 24 hours (16 v 9) and 7 days (12 v 6). In group 1 there were significantly more positive catheter cultures by both methods (23 v 16 in group 2; P < .05) and more cfu/per centimeter catheter (group 1 mean, 520, range, 197 to 600; group 2 mean 195, range 9 to 600; P < .001). In group 1, 12 animals had catheter sepsis compared with 5 in group 2 (P = NS). On SEM a fibrinous sheath was identified on all catheters removed on day 7 but not on 5 catheters inserted and removed after 10 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum electrolytes and capillary blood gases in the management of hypertrophic pyloric stenosis.

The purpose of this study was to assess whether the concentration of serum chloride and other variables, namely serum sodium, potassium and bicarbonate, can be used to predict metabolic acid-base status in infants with hypertrophic pyloric stenosis (HPS) and to assess whether such a prediction is influenced by the state of hydration. One hundred and sixty-three infants with HPS who had at least one set of serum electrolyte and capillary blood gas estimations performed after admission were studied retrospectively. A further 25 infants who had their electrolyte and blood gases measured after at least 12 h of rehydration and correction of the serum sodium and chloride abnormalities were studied prospectively. Stepwise multiple regression analysis, using standard bicarbonate as the dependent variable, revealed serum chloride concentration to be the most powerful independent predictor of standard bicarbonate level (r = -0.69, P less than 0.0001). Other variables did not improve the correlation significantly. In the retrospective study of untreated patients, the calculation of a 90 per cent prediction interval for the model indicated that if the serum chloride level is less than 96 mmol/l, one could be 95 per cent confident (one tail) that the patient was alkalaemic. To be 95 per cent confident that the patient was not alkalaemic, the serum chloride level would have to be greater than 121 mmol/l. The prospective study found that following rehydration a serum chloride level greater than or equal to 106 mmol/l more accurately predicted absence of alkalaemia. We conclude that predictability of acid-base status from measurement of serum chloride depends on the state of hydration of the patient.

Necrotizing enterocolitis following operation in the neonatal period.

Over a 16-year period, 33 newborn infants developed necrotizing enterocolitis (NEC) following some form of operation (accounting for 19 per cent of all neonates with NEC), including repair of myelomeningocele, intestinal atresia, gastroschisis and congenital diaphragmatic hernia. The neonates with postoperative NEC had a median birth-weight of 3.05 (range 1.0-4.4) kg, and median gestational age of 40 (range 27-41) weeks. Twenty patients were treated non-operatively. The remaining 13 required operation for complications of NEC. Twenty-three patients are alive and have been followed for a median of 66 (range 3-168) months. If a neonate deteriorates following any operation NEC must be included in the differential diagnosis.

Preoperative stabilisation in congenital diaphragmatic hernia.

Between January 1983 and November 1986, 26 newborn infants with congenital diaphragmatic hernia were treated by early operation at a mean of 7 hours of age. A further 23 infants admitted between December 1986 and December 1989 were stabilised for a mean period of 40 hours before operation. There was no significant difference in survival between the two groups. Delayed operation is not detrimental to infants with congenital diaphragmatic hernia.

Effect of sepsis and surgery on trace minerals.

The purpose of this study was to evaluate effect of infection and surgery on serum iron, zinc, and the copper simultaneously. Twenty patients who had emergency abdominal surgery for acute inflammatory conditions, and 15 controls who had elective abdominal surgery were studied. Preoperatively, serum iron levels were significantly decreased in the septic group compared to controls (p less than 0.001). Following surgery and removal of the septic focus, serum iron, ferritin, and zinc levels increased, while serum transferrin levels decreased significantly. Serum copper levels did not show any significant difference. It is concluded that serum iron, transferrin, ferritin, and zinc levels are affected profoundly by septic and the surgical stress.

Richter's hernia in the neonate.

Three neonates with small bowel obstruction seen recently at Royal Aberdeen Children's Hospital were found to have a Richter's hernia at laparotomy. In all cases Richter's hernia was at the internal inguinal ring. Two of them had suture of the hernial sac from within the abdomen at the time of laparotomy. These cases have been presented to emphasize the importance of considering Richter's hernia as a possible cause of small bowel obstruction in the neonate and also to indicate that the hernial sacs in such cases could be dealt with by suturing the sac from within the abdomen at the time of laparotomy.