Neonatal Burns - A Romanian Experience From A Tertiary Care Burn Unit.

Burns in neonates is a unique pathology that poses management challenges, as, besides treating the burn injury, the medical team needs to be familiar with the unique physiology of the newborn. This study aimed to review our center's experience with the management of neonatal burns. A 7-year retrospective study of neonatal burns managed at a tertiary national referral unit in Bucharest, Romania, was performed. Patients were divided into two groups, preterm and term, based on gestational age. Collected data included demographics, treatment, complications and follow-up. Our center managed 13 neonates with burns (5 term and 8 preterm), with a mean age at injury of 8.6 days. All neonatal burns were thermal injuries. For preterm babies, all burns were iatrogenic, consisting of victims of a fire in a Maternity Hospital, while for the term group only one was iatrogenic. Burns were more extensive in the premature group (65% vs. 20% mean TBSA, p=0.0001). All premature patients had associated inhalation injuries. Surgical treatment was indicated for two term patients. Survival rate was 77% and was negatively influenced by inhalation injury, burn shock and TBSA >50%. In conclusion, the majority of hospitalized neonatal burns in Romania were the result of a fire disaster secondary to an infrastructure deficiency. Their management is complex, posing specific challenges, and needs to be led by a multidisciplinary team that can ensure an individualized continuum of acute burn care and recovery.

Les brûlures du nouveau- né (NN) posent une problème physiopathologique spécifique, tenant non seulement aux conséquences de la brûlure mais aussi à la physiologie particulière du NN. Cet article décrit notre expérience. Il s'agit d'une étude rétrospective reprenant les 13 NN pris en charge dans un CTB de référence de Bucarest, pour une brûlure survenue en moyenne à 8,6J. Les patients ont été répartis entres prématurés (P,8) et à terme (T,5). Toutes les brûlures étaient thermiques, toutes iatrogènes dans le groupe P, consécutives à un incendie à la maternité quand une seule était iatrogène dans le groupe T. Elles étaient plus étendues dans le groupe P (65% SCT) que dans le groupe T (20%, p= 0,0001). Tous les P avaient des lésions d'inhalation. Une greffe a été nécessaire pour 2 T. La mortalité était de 23%, influencée par la surface brûlée, l'inhalation et une surface atteinte >50 %. En conclusion, la plupart des brûlures de NN roumains ayant nécessité une hospitalisation étaient dues à l'incendie d'une maternité à l'architecture déficiente. Leur prise en charge est complexe et spécifique, ce qui nécessite une équipe entraînée, à même de proposer des soins adaptés, de la phase aiguë à la rééducation.

Etiology Of Neonatal Burns: A Systematic Review.

Burns in neonates are a rare pathology with a significant impact on the patient, the family and the healthcare system. At present, scarce information exists on the etiology of this type of injury. A comprehensive worldwide literature review of all publications, including our personal case series, was conducted in order to analyse the etiology of neonatal burns and summarize the available evidence. A total of 41 publications were identified in the last 4 decades, comprising of 105 cases from 20 countries, thus confirming that neonatal burns are, indeed, a rare pathology. All types of burns were recorded in neonates, the most frequent being contact burns, followed by flames and scalds. Almost 60% of burns occurred in a hospital setting due to human factors, malfunctioning devices, or hospital infrastructure deficiency. Compared to domestic burns, iatrogenic injuries occurred at an earlier age (5.4±9.1 days vs. 15.7±9.8 days, p<0.0001) and in neonates with significantly smaller weights (2102.7±1350g vs. 3197±300.8g, p<0.0001). The number of cases was almost equally distributed between developed and developing countries, but developed countries were characterised by a significantly higher preponderance of iatrogenic burns, while in developing countries domestic burns were more frequent (p<0.0001). We believe that this systematic review outlines the potential causes of neonatal burns and provides essential information for formulating prevention strategies.

Les brûlures néonatales, rares, ont un impact important sur l'enfant, ses parents et le système de santé. Nous ne disposons de que de peu de données étiologiques à leur sujet. Nous avons de ce fait réalisé une revue bibliographique et y avons adjoint nos données personnelles. Sur les quarante dernières années, nous avons trouvé 41 publications sur les 40 dernières années, compilant 105 cas dans 20 pays, confirmant la rareté des brûlures néonatales. On trouve tous les groupes de cause, par ordre de fréquence contact, flammes et ébouillantement. Presque 60% d'entre elles surviennent en milieu hospitalier, dues à une erreur humaine, un dispositif fonctionnant mal ou un défaut structurel. Les brûlures nosocomiales surviennent plus tôt (5,4 +/-9,1 j VS 15,7 +/-9,8; p<0,0001) que les brûlures au domicile, chez des enfants de plus petit poids (2 102,7 +/-1 350 g VS 3 197 +/-300,8 g; p< 0,0001). Le nombre de cas était également répartis selon les revenus des pays, les brûlures iatrogènes étant plus fréquentes dans les pays à IDH élevé (<0,0001). Les causes que nous avons retrouvées devraient permettre le développement de stratégies de prévention.

Optimal timing for burned hands in children.

Hand burns in children are frequent, severe, and require adequate treatment. A fundamental, though problematic aspect of this treatment is the assessment of the burn depth as this determines the surgical strategy. From a retrospective study of 369 hand burns admitted to our clinic, we were able to identify some patterns. A total of 14.91% required surgery, with varying etiology among these patients. Differences were also noticed in the number of days post-burn prior to surgical intervention. The patterns revealed by our results are reviewed in order to improve therapeutic strategy.

Les brûlures à la main chez les enfants sont fréquentes et graves, et nécessitent un traitement adéquat. Un aspect fondamental de ce traitement est l'évaluation de la profondeur de la brûlure, car cela détermine la stratégie chirurgicale. D'une étude rétrospective de 369 brûlures à la main admis à notre clinique, nous avons pu identifier certaines tendances. Un total de 14,91% de ces cas, avec des étiologies varies, ont nécessité une chirurgie. On a remarqué également des différences dans le nombre de jours aprés la brûlure avant l'intervention chirurgicale. Ces résultats sont revus afin d'améliorer la stratégie thérapeutique.

Peripheral nerve allografting - why and how?

The authors briefly present the methods of reconstruction of peripheral nerve gaps. Of these methods, the reconstruction with nerve allografts is reviewed mainly in what concerns the ways to achieve host tolerance for the allograft. The authors underline the fact that, for the recipient it is better to suppress the graft antigenicity than to suppress the host immune response. Further, the authors present the most important methods to denaturate a nerve allograft in order to make it nonantigenic and insist upon developing methods that can be used in human beings. The authors conclude that reconstruction of nerve defects with peripheral nerve allografts is a very rewarding method that should be extended in clinical practice.

Histopathologic features of Spitzoid lesions in different age groups.

Spitz nevus is one of the most difficult melanocytic lesions to diagnose in regard of malignancy, even for experienced dermatopathologists. We analyzed 28 tumors with Spitzoid morphology from 15 children (three little children 2-4-year-old, 12 peripubertary children 9-17-year-old) and 13 adults; there were 21 Spitz nevi, five atypical Spitz tumors and two Spitzoid melanomas in order to establish the diagnostic value of several morphologic parameters in different age groups. No significant differences in respect of age and/or tumor type occurred for gender, location, dimension, symmetry, sharp lateral demarcation, junctional nests orientation, adipose tissue extension, side-to-side cytologic symmetry, uniform melanin deposits, nuclear pleomorphism, presence of mitoses, inflammation and epidermal alterations. Pagetoid growth and/or melanin deposits in the keratin layer were significantly higher in little children. In adults, presence of isolated cells within the lateral margins allows differentiating Spitz nevus from atypical Spitz tumor and Spitzoid melanoma. Deep located mitoses were statistically associated with Spitzoid melanoma in adults. Ulceration was statistically more frequent in peripubertary patients than in adults, probably due to trauma. In conclusion, presence of worrisome morphologic features (pagetoid growth, isolated cells within the lateral margins or ulceration) is correlated to patient's age and less to tumor type; there is no unique morphologic feature to relay on when evaluating a Spitzoid tumor, the final diagnosis being the results of interpretation of multiple clinical, morphologic, immunohistochemical and molecular data and not least dermatopathologist's personal experience.

Peripheral nerve allograft, a reconstructive solution: outcomes and benefits.

Every year millions of individuals worldwide require complex reconstructive procedures as a result of various traumatic events. Recent success in composite tissue allotransplant, has shown that allografts generally present an enormous potential in reconstructive surgery. Peripheral nerve allograft represents a relatively new research field, therefore many aspects are still to be clarified. The main interests of this study concerning nerve allograft are directed to harvesting from cadaver or living donor, allografts denaturation and conservation, recipient tolerance to allograft, immunosuppressive medication, and quantifying the outcomes of nerve regeneration.

Schwann cell cultures: recent advances and novel approaches to the reconstruction of peripheral nerve defects.

Current techniques in tissue engineering may offer a choice regarding the reconstructive strategies of peripheral nerves. Schwann cell cultures are to be considered an appropriate option in the reconstruction of peripheral nerve and spinal cord large defects. Schwann cells availability from peripheral nerve autografts creates a great benefit concerning their usefulness in the nervous autogenic transplantation. Allogeneic Schwann cells transplantation can be effective in the reconstruction without delay of peripheral nerve defects.

An alternative for local treatment of superficial burns.

There is a wide variety of local therapeutical methods for partial superficial burns. Burns require meticulous local treatment as part of the complex therapeutic protocol. Local treatment for burns is essential, influencing the patient's evolution and future. All local burn treatment methods are adapted in relation to the particular aspects of the burn lesion (patient's age, aetiology, localization, associated pathologies). Immerci H3 was clinically tested for partial superficial burns treatment and the results were favourable. Healing was more rapid and there was a decrease in mean hospital stay and treatment costs.

[Liver transplantation--considerations over 8 cases operated in the year 2000]. / Transplantul hepatic--consideratii asupra a 8 cazuri operate în anul 2000.

In the year 2000, at the Department for General Surgery and Liver Transplantation from The Fundeni Clinical Institute Bucharest, seven OLTs and one living-related transplantation were performed in 6 adults and 2 children. Postoperative complications were: bile leakage, hemoperitoneum, lower gastrointestinal hemorrhage, parietoabdominal hematoma. There was only one postoperative death due to septic complications in the 18th p.o.d. and one late death due to pneumonia of unknown origin. After the results in the year 2000 there was an increased number of donors and referrals. We consider that now in Romania this is an established program that will continue depending on the number of donors and financing.

Paediatric burns in Bucharest, Romania; 4327 cases over a 5-year period.

This is a retrospective study based upon 4327 paediatric burns (0-16 years of age) admitted over a period of 5 years, as from January 1988. Epidemiological data include age, sex, cause of burn, extent of injury, social and economic status, period of time between the accident and the admission to hospital. The overall mortality rate was 5.8 per cent. We tried to correlate the mortality rate with the epidemiological data. The recent use of Flamazine cream in our centre (as from January, 1993) seems to have decreased the mortality rate to 2.6 per cent (12 deaths out of 450 patients admitted during the first 7 months of 1993). No study of childhood burns has previously been reported from Romania.