Are Low Weight or Cardiopathy Contraindications for Thoracoscopic Repair of Esophageal Atresia with Tracheoesophageal Fistula?

BACKGROUND: Thoracoscopic repair of esophageal atresia (EA) with tracheoesophageal fistula (TEF) is becoming an increasingly widespread technique; there is still controversy about its indication in certain patients. Our objective is to analyze if potential risk factors such as major congenital heart disease (CHD) or low birth weight (LBW) are a limitation to this approach. METHODS: Retrospective study (2017-2021) of patients with EA and distal TEF who underwent thoracoscopic repair were included. Patients with LBW less than 2,000 g or major CHD were compared with the rest. RESULTS: Twenty-five patients underwent thoracoscopic surgery. Nine patients (36%) had major CHD. Five of them (20%) were LBW less than 2,000 g, and only 8% (2/25) presented both risk factors. There were no differences in terms of operative time, conversion rate, tolerance evaluated with gasometric parameters (pO2, pCO2, pH) or complications (anastomotic leak and stricture, both early or during follow-up) in patients with major CHD and LBW (1,473 ± 319 vs. 2,664 ± 402 g). One conversion to thoracotomy was performed in a neonate weighing 1,050 g due to anesthetic intolerance. There was no recurrence of TEF. One patient died at the age of 9 months, due to major uncorrectable heart disease. CONCLUSION: Thoracoscopic repair of EA/TEF is feasible technique in patients with CHD or LBW, with similar results to other patients. The complexity of this technique warrants individualizing the indication in each case. LEVEL OF EVIDENCE: IV.

Anastomosis near to the ileocecal valve in neonates with focal intestinal perforation, is it safe.

BACKGROUND: Anastomosis near the ileocecal valve (ICV) are controversial due to the increased pressure on the suture; in this situation, the valve could be removed at a first stage or at the moment of stoma closure. However, preservation of the ICV has proved important benefits in the long term. The aim of this study is to evaluate its feasibility in neonates with focal intestinal perforation (FIP). METHODS: Retrospective study (2010-2019) of neonates with FIP who underwent intestinal resection and primary anastomosis. Patients were divided into group A (anastomosis less than 5 cm from ICV) and group B (more than 5 cm). RESULTS: Forty patients were treated. Patients ostomized or with resection of ICV were excluded. Finally, 24 patients (birth weight 1043 ± 594 g (520-3000), age 8.8 ± 7.8 days (2-39)) were included for analysis. Patent ductus arteriosus was present in 75%. There were 6 patients in group A (25%) and 18 in group B (75%). Groups were comparable in terms of gestational age, birth weight, and age at the time of surgery (p > .05). There were no cases of dehiscence nor stenosis of the anastomosis. There were no differences in reoperation rate, infectious complications, time to enteral feeding, days of parenteral nutrition, hospital stay nor survival (p > .05). CONCLUSION: Ileo-ileal anastomosis closer to the ileocecal junction, in neonates with focal intestinal perforation, is an effective and safe option which also allows the preservation of the ICV avoiding the complications derived from its absence in a group of patients with high morbidity.

Pulmonary Interstitial Glycogenosis: A Reversible Underlying Condition Associated With D-Transposition of the Great Arteries and Severe Persistent Pulmonary Hypertension.

Transposition of the great arteries with intact ventricular septum and persistent pulmonary hypertension (TGA-IVS PPHN) is a rare association with a poor prognosis. We report the case of a term newborn with TGA-IVS PPHN successfully managed with perioperative extracorporeal membrane oxygenation (ECMO) and aggressive pulmonary vasodilation therapy that underwent successful arterial switch procedure. A lung biopsy obtained during the surgical procedure showed pulmonary interstitial glycogenosis, a reversible condition. Concerns over left ventricle deconditioning after ECMO could be minimized with appropriate management and monitoring of the ductus arteriosus and appropriate timing of surgery.

Novetats en RCP 2005: RCP pediàtrica básica / No disponible

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Gemelos monocoriales afectos de transfusión feto-fetal: consecuencias a corto y largo plazo / Monochorionic twins with twin-to-twin transfusion syndrome: acute and long-term effects

No disponibleFundamentos y fisiopatología básica. La transfusiónfeto-fetal es una complicación presente aproximadamenteen un 10% de las gestaciones monocoriales. Su origen fisiopatológicose sitúa en la presencia de determinadas conexionesvasculares intraplacentarias que dan lugar a undesequilibrio en el pase de sange de un gemelo al otro.Ello condiciona que uno de los dos gemelos resulte hipovolémico(donante) y el otro hipervolémico (receptor). Loscriterios diagnósticos clásicos (diferencia en el peso y en lahemoglobinemia al nacimiento) ya no son válidos, dadoque en la actualidad el diagnóstico de la transfusión fetofetales exclusivamente ecográfico prenatal.Objetivo. Actualizar la problemática neonatal y pediátrica.Las consecuencias sobre los niños se clasifican en lassiguientes categorías: hidropesía fetal, lesiones cerebrales,problemas propios del gemelo donante, problemas propiosdel feto receptor, presencia de infartos, problemas delgemelo superviviente, trastornos hormonales, prematuridad,mortalidad y neurodesarrollo a largo plazo.Método. Cada categoría es revisada exhaustivamente,mediante un repaso fisiopatológico, una descripción de laincidencia, las implicaciones sobre el manejo en las unidadesde neonatología y un análisis de las principales referenciasbibliográficas.Conclusiones. La población de gemelos afectos detranfusión feto-fetal puede presentar una patología muyvariada, a menudo de conocimiento impreciso, que condicionauna elevada mobimortalidad. La aplicación de lasdiferentes medidas terapéuticas –en especial la ablacióncon láser de las anastomosis placentarias– ha conseguidomejorar su pronóstico, aunque sigue considerándose unapoblación de alto riesgo que requiere un estricto controlobstétrico, una detallada valoración neonatal y un cuidadososeguimiento a largo plazo

Background. Twin-to-twin transfusion syndrome (TTTS)occurs in 10% of monochorionic twin pregnancies, and itresults from the presence of placental vascular anastomosesthat lead to an umbalance of the normal inter-twinblood flow. One fetus becomes hypovolemic (donor twin)whereas the other becomes hypervolemic (recipient twin).The classical diagnostic criteria of TTTS (discordance inbirthweight and hemoglobin concentrations at birth) havenow been replaced by the prenatal ultrasonographicfindings. Objectives. To provide an update on TTTS. The effectsof TTTS on both twins are classified as follows: hydropsfaetalis, brain damage, individual problems for donor andrecipient twins and for the survivor twin, infarctions, hormonaldisturbances, prematurity, early mortality, andeffects on neurodevelopment.Method. A review of the literature is performed, andthe pathophysiology, incidence, and management of TTTSare reviewed.Conclusions. Monochorionic twins with TTTS are at riskof developing multiple problems, which result in highmorbidity and mortality rates. Although better outcomesare currently obtained with prenatal techniques (such asplacental laser surgery) and better postnatal management,this is a high-risk population whose managementinvolves obstetric control and treatment, careful neonatalevaluation and treatment, and a long-term follow-up