Diller B. Groff

Gastrointestinal perforation following indomethacin therapy in very low birth weight infants.

Over an 18-mo period patent ductus arteriosus (PDA) was diagnosed in 112 (50%) of 222 very low birth weight infants (

Complications of intravenous hyperalimentation in newborns and infants.

Abstract New systems and methods of patient management, such as total intravenous feeding, give rise to their own unique complications as they are used extensively. The advantages of the method must be weighed against the hazards of the complications, and either be discarded or accepted in light of the overall benefit to the patient. Although the benefits of intravenous hyperalimentation in infants as introduced in the Childrens Hospital of Philadelphia 1,2 far outweigh the dangers of the method, there are problems with hyperalimentation which this paper will discuss. Hyperalimentation has been used in 18 patients over a 20-month period for a total of 391 patient days of treatment (Table 1). (This excludes the patient initially reported in March of 1968 who has now been on hyperalimentation for 20 months.) The duration of hyperalimentation ranged from 3 to 91 days (average 22 days). A complication of this technic is defined as an event or circumstance which caused the catheter to be removed before 14 days of therapy, or an event which was related to the IV catheter and which threatened the continuation of hyperalimentation in a patient to whom it was vitally important (Table 2).

Subclavian vein catheterization in the infant

Summary The results of performing 103 subclavian catheterization procedures on 20 newborns, 8 patients under 6 mo of age, and 15 patients under 2 yr of age are reported. The complications of the procedures were one pneumothorax, two hydrothoraces, and one hemothorax. The patient with the hemothorax died after this complication. The authors feel that percutaneous subclavian catheterization can be performed on newborns and infants when a jugular vein is unsuitable and if the surgeon is experienced in subclavian catheterization in adults and older children and has had extensive experience with infant vascular cannulations of all types.2Nasim Ahmed, M.D.: Chief Pediatric Surgical Resident, Childrens Hospital of Newark, Newark, N.J.

Early excision of major burns in children: Effect on morbidity and mortality

The advantage of early excision and grafting in the treatment of limited full-thickness burns has been clearly established. The goal of the present study was to evaluate the role of early burn wound excision in major pediatric burns. Of the 470 pediatric burn admissions between 1979 and 1984 that were reviewed, 53 patients met the criteria of deep second or third degree burns greater than 25% total body surface area (TBSA). Of these, 20 had burn wound excision within 7 days (Early) and 33 had delayed excision and grafting (Late). The Early group, despite having greater transfusion requirements (69.4 v 36.2 cc/kg), had shorter hospital stays (35.3 v 49.1 d, P less than 0.05), fewer metabolic complications (20% v 79%, P less than 0.001), and less burn wound contamination (55% v 90%, P less than 0.01) than the Late group. Mortality was lower in the Early group (0% v 12%), but this was not statistically significant. Early excision and grafting are therefore recommended in the care of major burns in children.

Necrotizing tracheobronchitis: A new indication for emergency bronchoscopy in the neonate

Necrotizing tracheobronchitis (NTB) is a recently recognized cause of tracheal obstruction in the mechanically ventilated neonate. This process involves inflammation and necrosis of the mucosa of the distal trachea and mainstem bronchi. The sloughing of this material into the tracheal lumen results in plugging and acute respiratory distress. We documented this diagnosis in 19 infants. Four were diagnosed at autopsy. Fifteen had emergency bronchoscopy performed in the neonatal intensive care unit with removal of the obstructing debris. Ten of these 15 neonates survived (66.7%). The diagnosis of necrotizing tracheobronchitis should be suspected in those neonates requiring positive pressure ventilation in whom a sudden unexplained increase in ventilatory requirements develops. This is often associated with hypercarbia and a history of high-peak inspiratory pressures with or without hypoxia. Emergency bronchoscopy in these neonates is necessary both for diagnosis and treatment of the necrotizing tracheobronchitis.

Cutaneous burns caused by sulfuric acid drain cleaner.

BACKGROUND Highly concentrated solutions of sulfuric acid are available to unclog drains. We have noted a substantial number of both accidental and intentional cutaneous burns caused by these agents. METHODS A retrospective review was conducted of children and adults who sustained sulfuric acid burns over a 13-year period ending in May 1996. Reports of injuries related to drain cleaners filed with the United States Consumer Product Safety Commission between 1991 and 1995 were also reviewed. RESULTS Twenty-one patients (13 children, 8 adults) sustained cutaneous burns caused by concentrated sulfuric acid solutions. In 8 instances, the burn was accidental, whereas in 13 cases, sulfuric acid was used as a weapon. Median total body surface area burned was 5% (range, 1-25%). Approximately 50% of burns involved the face and neck. Skin grafting was required in 14 patients (66%). It is estimated that nationwide approximately 3,000 injuries per year are related to drain cleaners and that one-third of these involve cutaneous burns. CONCLUSION Highly concentrated sulfuric acid drain cleaner can produce full-thickness cutaneous burns that require skin grafting in the majority of cases. Proper use of these agents and sequestering them from children may reduce accidental contact; however, their abuse as agents of assault remains a source of significant morbidity.

The concomitant presence of gastroschisis and prune belly syndrome in a twin

This is a report of a case of gastroschisis and prune belly syndrome in a black male infant, the second born of dizygotic twins. This infant died of sepsis secondary to peritonitis that developed from a leaking gastrostomy site.

Effect of indomethacin on mesenteric circulation in mongrel dogs

Necrotizing enterocolitis has been attributed to the use of indomethacin (INDO) for medical closure of patent ductus arteriosus. To study the effect of INDO on cardiac output and mesenteric circulation, INDO was given by rectum (0.25 mg/kg, 0.5 mg/kg, 1.25 mg/kg--3 dogs in each group) and the control group received none. The cardiac output and organ blood flow were measured before and 1 hr after INDO with radioactive microspheres using 4 isotopes (Cr53, Ni95, Co57, Sn113). The blood flow to different parts of the GI tract was measured as percent of cardiac output using a gamma counter. Paired t test was used to calculate percent reduction in organ blood flow. During the experiment, there was no reduction in cardiac output in the entire group. Anesthesia had no effect on the control group. In the three INDO treated groups, percent reduction of mucosal blood flow of the stomach (63%, 32%, 68%, p less than 0.01), mid ileum (19%, 59%, 57%, p less than 0.05) and terminal ileum (57%, 35%, 54%, p less than 0.015) was significant. A strong trend in reduction of organ blood flow was noted in other regions. There was no significant change due to different dosages of INDO. The area of ischemia in this dog model corresponds to clinical pathology noted in necrotizing enterocolitis.

Suprapublic dermoid sinus

Two newborns with suprapublic sinuses ending in relationship to the urachus at the umbilicus are reported. Other recent reports indicate that these sinuses are not so uncommon and are due to abnormalities of urachal development in conjunction with a suprapublic dermoid sinus.

Rectal prolapse in infants and children

Rectal prolapse that is intractable to the usual medical therapy was successfully managed without significant complications in 10 patients by simple subcutaneous encirclement of the anus with a heavy nonabsorbable suture, which was in place until the suture was removed or broke after 4 to 6 months. Four patients required two sutures and one needed a third insertion. Since this procedure is simple, has no serious complications, and controls rectal prolapse, it is recommended as the preferred initial surgical treatment of this condition.