it's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.
it's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.
it's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.
it's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.
it's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.
it's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.
host_summaryInfants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds.↗
▶Ep 31 · 2:00
host_summaryBased on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated.↗
▶Ep 31 · 2:30
host_summaryImmediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds.↗
▶Ep 31 · 2:45
host_summaryFor babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis.↗
▶Ep 31 · 2:45
quoteit's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.↗
▶Ep 31 · 4:00
host_summaryHigh resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis.↗
▶Ep 31 · 4:15
host_summarySerial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area.↗
▶Ep 31 · 4:30
host_summarySurgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component.↗
▶Ep 31 · 4:45
host_summaryInitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected.↗
▶Ep 31 · 4:45
quoteinitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected.↗
▶Ep 31 · 5:45
host_summaryManagement of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines.↗
▶Ep 31 · 6:00
host_summaryA systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction.↗
▶Ep 31 · 6:30
host_summaryThere was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention.↗
▶Ep 31 · 6:45
host_summaryOutpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality.↗
▶Ep 31 · 6:45
quoteit's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.↗
▶Ep 31 · 7:30
host_summaryThere is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery.↗
▶Ep 31 · 7:45
host_summaryRecent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections.↗
▶Ep 31 · 8:00
host_summaryAdult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery.↗
▶Ep 31 · 8:15
host_summaryRecent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations.↗
▶Ep 31 · 8:45
host_summaryCase-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery.↗
▶Ep 31 · 8:45
quotewe have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents.↗
▶Ep 31 · 9:45
host_summaryFirearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019.↗
▶Ep 31 · 10:00
host_summaryThere are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country.↗
▶Ep 31 · 10:15
host_summaryAs pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is.↗
▶Ep 31 · 10:15
quoteWe believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is.↗
▶Ep 31 · 10:45
host_summaryPediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 31 · 10:45
quoteas pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 31 · 11:45
host_summaryUnwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray.↗
▶Ep 31 · 12:00
host_summaryThe gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise.↗
▶Ep 31 · 12:15
host_summaryCT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress.↗
▶Ep 31 · 12:30
host_summaryLow-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies.↗
▶Ep 31 · 12:45
host_summaryCT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure.↗
▶Ep 31 · 13:30
host_summaryThe largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months.↗
▶Ep 31 · 14:00
host_summaryDeath or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage.↗
▶Ep 31 · 14:15
host_summaryThe prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC.↗
▶Ep 31 · 14:45
quotefor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 31 · 14:45
host_summaryFor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 31 · 15:45
host_summaryRacism and sexism that manifest as microaggressions are commonly experienced by members of minority groups.↗
▶Ep 31 · 16:00
host_summaryIndividuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments.↗
▶Ep 31 · 16:15
host_summaryPlacing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging.↗
▶Ep 31 · 16:15
quotePlacing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging.↗
▶Ep 31 · 16:45
quoteBystanders can and should make an effort to become upstanders, which means bystanders who respond with action.↗
▶Ep 31 · 16:45
host_summaryBystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions.↗
▶Ep 31 · 17:30
host_summaryBlunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures.↗
▶Ep 31 · 18:15
host_summaryA 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission.↗
▶Ep 31 · 18:45
quotepediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 31 · 18:45
host_summaryPediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 31 · 19:30
host_summaryThe IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome.↗
▶Ep 31 · 20:00
host_summaryPatients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy.↗
▶Ep 31 · 20:15
host_summaryPiperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy.↗
▶Ep 31 · 20:30
quotemonotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
▶Ep 31 · 20:30
host_summaryMonotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
host_summaryAt six months, there was no difference in wound outcomes between the three closure groups for either clinicians or parents.↗
▶Ep 138 · 4:17
host_summaryThe cosmesis difference between tissue adhesive and other closure methods disappears by six months.↗
▶Ep 138 · 4:17
host_summaryWounds with tissue adhesive had poorer cosmesis at six weeks compared to other closure methods.↗
Quick Literature Updates Episode 10
▶Ep 143 · 0:00
quoteHello Pediatric Surgery family. I'm M. Tumbush, a research fellow from Cincinnati Children's Hospital Medical Center.↗
▶Ep 143 · 1:21
host_summaryThe Leonard et al. study compared patients presenting with traumatic bleeding, operative bleeding, and medical bleeding.↗
▶Ep 143 · 2:16
host_summaryStandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery.↗
▶Ep 143 · 2:16
host_summaryChildren in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group.↗
▶Ep 143 · 2:16
quotestandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery↗
▶Ep 143 · 3:29
quoteit seems that contrast enema prior to stoma reversal is only useful if patients had neck↗
▶Ep 143 · 3:29
host_summaryContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 144 · 4:32
host_summaryThe COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).↗
▶Ep 144 · 4:32
clinicalThe COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).↗
▶Ep 144 · 4:55
host_summaryThe study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.↗
▶Ep 144 · 4:55
host_summaryA larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period.↗
▶Ep 144 · 4:55
epidemiologicalA larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period.↗
▶Ep 144 · 4:55
epidemiologicalThe study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.↗
▶Ep 144 · 5:28
epidemiologicalSymptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID-19 groups.↗
▶Ep 144 · 5:28
host_summarySymptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID-19 groups.↗
host_summaryMalrotation occurs in about 1 in 200 to 500 live births.↗
▶Ep 48 · 8:33
host_summaryYou can have malrotation without midgut volvulus, but you cannot have midgut volvulus without malrotation.↗
Update Course Rewind: 2022 Top Ten Key Takeaways
▶Ep 50 · 1:00
host_summaryInfants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds.↗
▶Ep 50 · 2:00
host_summaryBased on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated.↗
▶Ep 50 · 2:30
host_summaryImmediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds.↗
▶Ep 50 · 2:45
quoteit's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.↗
▶Ep 50 · 2:45
host_summaryFor babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis.↗
▶Ep 50 · 4:00
host_summaryHigh resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis.↗
▶Ep 50 · 4:15
host_summarySerial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area.↗
▶Ep 50 · 4:30
host_summarySurgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component.↗
▶Ep 50 · 4:45
host_summaryInitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected.↗
▶Ep 50 · 4:45
quoteinitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected.↗
▶Ep 50 · 5:45
host_summaryManagement of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines.↗
▶Ep 50 · 6:00
host_summaryA systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction.↗
▶Ep 50 · 6:30
host_summaryThere was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention.↗
▶Ep 50 · 6:45
host_summaryOutpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality.↗
▶Ep 50 · 6:45
quoteit's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.↗
▶Ep 50 · 7:30
host_summaryThere is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery.↗
▶Ep 50 · 7:45
host_summaryRecent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections.↗
▶Ep 50 · 8:00
host_summaryAdult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery.↗
▶Ep 50 · 8:15
host_summaryRecent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations.↗
▶Ep 50 · 8:45
host_summaryCase-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery.↗
▶Ep 50 · 8:45
quotewe have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents.↗
▶Ep 50 · 9:45
host_summaryFirearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019.↗
▶Ep 50 · 10:00
host_summaryThere are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country.↗
▶Ep 50 · 10:15
host_summaryAs pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is.↗
▶Ep 50 · 10:15
quoteWe believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is.↗
▶Ep 50 · 10:45
quoteas pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 50 · 10:45
host_summaryPediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 50 · 11:45
host_summaryUnwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray.↗
▶Ep 50 · 12:00
host_summaryThe gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise.↗
▶Ep 50 · 12:15
host_summaryCT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress.↗
▶Ep 50 · 12:30
host_summaryLow-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies.↗
▶Ep 50 · 12:45
host_summaryCT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure.↗
▶Ep 50 · 13:30
host_summaryThe largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months.↗
▶Ep 50 · 14:00
host_summaryDeath or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage.↗
▶Ep 50 · 14:15
host_summaryThe prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC.↗
▶Ep 50 · 14:45
host_summaryFor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 50 · 14:45
quotefor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 50 · 15:45
host_summaryRacism and sexism that manifest as microaggressions are commonly experienced by members of minority groups.↗
▶Ep 50 · 16:00
host_summaryIndividuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments.↗
▶Ep 50 · 16:15
quotePlacing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging.↗
▶Ep 50 · 16:15
host_summaryPlacing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging.↗
▶Ep 50 · 16:45
host_summaryBystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions.↗
▶Ep 50 · 16:45
quoteBystanders can and should make an effort to become upstanders, which means bystanders who respond with action.↗
▶Ep 50 · 17:30
host_summaryBlunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures.↗
▶Ep 50 · 18:15
host_summaryA 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission.↗
▶Ep 50 · 18:45
host_summaryPediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 50 · 18:45
quotepediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 50 · 19:30
host_summaryThe IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome.↗
▶Ep 50 · 20:00
host_summaryPatients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy.↗
▶Ep 50 · 20:15
host_summaryPiperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy.↗
▶Ep 50 · 20:30
host_summaryMonotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
▶Ep 50 · 20:30
quotemonotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
Quick Literature Updates Episode 10
▶Ep 51 · 0:00
quoteHello Pediatric Surgery family. I'm M. Tumbush, a research fellow from Cincinnati Children's Hospital Medical Center.↗
▶Ep 51 · 1:21
host_summaryThe Leonard et al. study compared patients presenting with traumatic bleeding, operative bleeding, and medical bleeding.↗
▶Ep 51 · 2:16
host_summaryChildren in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group.↗
▶Ep 51 · 2:16
quotestandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery↗
▶Ep 51 · 2:16
host_summaryStandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery.↗
▶Ep 51 · 3:29
host_summaryContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
▶Ep 51 · 3:29
quoteit seems that contrast enema prior to stoma reversal is only useful if patients had neck↗
host_summaryInfants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds.↗
▶Ep 19 · 2:00
host_summaryBased on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated.↗
▶Ep 19 · 2:30
host_summaryImmediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds.↗
▶Ep 19 · 2:45
host_summaryFor babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis.↗
▶Ep 19 · 2:45
quoteit's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.↗
▶Ep 19 · 4:00
host_summaryHigh resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis.↗
▶Ep 19 · 4:15
host_summarySerial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area.↗
▶Ep 19 · 4:30
host_summarySurgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component.↗
▶Ep 19 · 4:45
host_summaryInitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected.↗
▶Ep 19 · 4:45
quoteinitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected.↗
▶Ep 19 · 5:45
host_summaryManagement of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines.↗
▶Ep 19 · 6:00
host_summaryA systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction.↗
▶Ep 19 · 6:30
host_summaryThere was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention.↗
▶Ep 19 · 6:45
host_summaryOutpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality.↗
▶Ep 19 · 6:45
quoteit's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.↗
▶Ep 19 · 7:30
host_summaryThere is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery.↗
▶Ep 19 · 7:45
host_summaryRecent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections.↗
▶Ep 19 · 8:00
host_summaryAdult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery.↗
▶Ep 19 · 8:15
host_summaryRecent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations.↗
▶Ep 19 · 8:45
quotewe have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents.↗
▶Ep 19 · 8:45
host_summaryCase-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery.↗
▶Ep 19 · 9:45
host_summaryFirearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019.↗
▶Ep 19 · 10:00
host_summaryThere are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country.↗
▶Ep 19 · 10:15
quoteWe believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is.↗
▶Ep 19 · 10:15
host_summaryAs pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is.↗
▶Ep 19 · 10:45
quoteas pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 19 · 10:45
host_summaryPediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 19 · 11:45
host_summaryUnwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray.↗
▶Ep 19 · 12:00
host_summaryThe gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise.↗
▶Ep 19 · 12:15
host_summaryCT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress.↗
▶Ep 19 · 12:30
host_summaryLow-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies.↗
▶Ep 19 · 12:45
host_summaryCT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure.↗
▶Ep 19 · 13:30
host_summaryThe largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months.↗
▶Ep 19 · 14:00
host_summaryDeath or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage.↗
▶Ep 19 · 14:15
host_summaryThe prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC.↗
▶Ep 19 · 14:45
quotefor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 19 · 14:45
host_summaryFor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 19 · 15:45
host_summaryRacism and sexism that manifest as microaggressions are commonly experienced by members of minority groups.↗
▶Ep 19 · 16:00
host_summaryIndividuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments.↗
▶Ep 19 · 16:15
quotePlacing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging.↗
▶Ep 19 · 16:15
host_summaryPlacing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging.↗
▶Ep 19 · 16:45
quoteBystanders can and should make an effort to become upstanders, which means bystanders who respond with action.↗
▶Ep 19 · 16:45
host_summaryBystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions.↗
▶Ep 19 · 17:30
host_summaryBlunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures.↗
▶Ep 19 · 18:15
host_summaryA 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission.↗
▶Ep 19 · 18:45
host_summaryPediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 19 · 18:45
quotepediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 19 · 19:30
host_summaryThe IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome.↗
▶Ep 19 · 20:00
host_summaryPatients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy.↗
▶Ep 19 · 20:15
host_summaryPiperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy.↗
▶Ep 19 · 20:30
host_summaryMonotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
▶Ep 19 · 20:30
quotemonotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 8 · 6:40
host_summary14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies (7 for unilateral disease, 7 for bilateral disease) with a median of 4.5 nodules resected↗
▶Ep 8 · 6:50
host_summary5 high-risk hepatoblastoma patients relapsed and 3 of them were saved; NED status was inversely correlated with 5-year mortality↗
host_summaryMalrotation occurs in about 1 in 200 to 500 live births.↗
▶Ep 57 · 8:33
host_summaryYou can have malrotation without midgut volvulus, but you cannot have midgut volvulus without malrotation.↗
Quick Literature Updates Episode 7
▶Ep 58 · 4:17
host_summaryAt six months, there was no difference in wound outcomes between the three closure groups for either clinicians or parents.↗
▶Ep 58 · 4:17
host_summaryThe cosmesis difference between tissue adhesive and other closure methods disappears by six months.↗
▶Ep 58 · 4:17
host_summaryWounds with tissue adhesive had poorer cosmesis at six weeks compared to other closure methods.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 60 · 4:32
clinicalThe COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).↗
▶Ep 60 · 4:55
epidemiologicalA larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period.↗
▶Ep 60 · 4:55
epidemiologicalThe study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.↗
▶Ep 60 · 5:28
epidemiologicalSymptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID-19 groups.↗
Journal of Pediatric Surgery Article Review: May 2023, CAPS Issue
▶Ep 2 · 4:32
clinicalThe COVID-19 appendicitis study assessed patients from February 2018 to June 2019 (pre-pandemic control) and mid-February 2020 to June 2021 (COVID period).↗
▶Ep 2 · 4:55
epidemiologicalThe study included 1100 patients total: 44% in pre-pandemic control group and 56% in COVID-19 group.↗
▶Ep 2 · 4:55
epidemiologicalA larger proportion of complicated appendicitis occurred during COVID-19 compared to pre-pandemic period.↗
▶Ep 2 · 5:28
epidemiologicalSymptom duration at presentation and length of stay were not significantly different between pre-pandemic and COVID-19 groups.↗
host_summaryMalrotation occurs in about 1 in 200 to 500 live births.↗
▶Ep 70 · 8:33
host_summaryYou can have malrotation without midgut volvulus, but you cannot have midgut volvulus without malrotation.↗
Quick Literature Updates Episode 7
▶Ep 72 · 4:17
host_summaryAt six months, there was no difference in wound outcomes between the three closure groups for either clinicians or parents.↗
▶Ep 72 · 4:17
host_summaryWounds with tissue adhesive had poorer cosmesis at six weeks compared to other closure methods.↗
▶Ep 72 · 4:17
host_summaryThe cosmesis difference between tissue adhesive and other closure methods disappears by six months.↗
Update Course Rewind: 2022 Top Ten Key Takeaways
▶Ep 74 · 1:00
host_summaryInfants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds.↗
▶Ep 74 · 2:00
host_summaryBased on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated.↗
▶Ep 74 · 2:30
host_summaryImmediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds.↗
▶Ep 74 · 2:45
quoteit's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.↗
▶Ep 74 · 2:45
host_summaryFor babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis.↗
▶Ep 74 · 4:00
host_summaryHigh resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis.↗
▶Ep 74 · 4:15
host_summarySerial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area.↗
▶Ep 74 · 4:30
host_summarySurgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component.↗
▶Ep 74 · 4:45
quoteinitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected.↗
▶Ep 74 · 4:45
host_summaryInitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected.↗
▶Ep 74 · 5:45
host_summaryManagement of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines.↗
▶Ep 74 · 6:00
host_summaryA systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction.↗
▶Ep 74 · 6:30
host_summaryThere was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention.↗
▶Ep 74 · 6:45
quoteit's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.↗
▶Ep 74 · 6:45
host_summaryOutpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality.↗
▶Ep 74 · 7:30
host_summaryThere is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery.↗
▶Ep 74 · 7:45
host_summaryRecent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections.↗
▶Ep 74 · 8:00
host_summaryAdult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery.↗
▶Ep 74 · 8:15
host_summaryRecent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations.↗
▶Ep 74 · 8:45
quotewe have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents.↗
▶Ep 74 · 8:45
host_summaryCase-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery.↗
▶Ep 74 · 9:45
host_summaryFirearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019.↗
▶Ep 74 · 10:00
host_summaryThere are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country.↗
▶Ep 74 · 10:15
host_summaryAs pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is.↗
▶Ep 74 · 10:15
quoteWe believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is.↗
▶Ep 74 · 10:45
quoteas pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 74 · 10:45
host_summaryPediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 74 · 11:45
host_summaryUnwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray.↗
▶Ep 74 · 12:00
host_summaryThe gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise.↗
▶Ep 74 · 12:15
host_summaryCT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress.↗
▶Ep 74 · 12:30
host_summaryLow-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies.↗
▶Ep 74 · 12:45
host_summaryCT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure.↗
▶Ep 74 · 13:30
host_summaryThe largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months.↗
▶Ep 74 · 14:00
host_summaryDeath or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage.↗
▶Ep 74 · 14:15
host_summaryThe prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC.↗
▶Ep 74 · 14:45
quotefor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 74 · 14:45
host_summaryFor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 74 · 15:45
host_summaryRacism and sexism that manifest as microaggressions are commonly experienced by members of minority groups.↗
▶Ep 74 · 16:00
host_summaryIndividuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments.↗
▶Ep 74 · 16:15
host_summaryPlacing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging.↗
▶Ep 74 · 16:15
quotePlacing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging.↗
▶Ep 74 · 16:45
quoteBystanders can and should make an effort to become upstanders, which means bystanders who respond with action.↗
▶Ep 74 · 16:45
host_summaryBystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions.↗
▶Ep 74 · 17:30
host_summaryBlunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures.↗
▶Ep 74 · 18:15
host_summaryA 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission.↗
▶Ep 74 · 18:45
quotepediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 74 · 18:45
host_summaryPediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 74 · 19:30
host_summaryThe IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome.↗
▶Ep 74 · 20:00
host_summaryPatients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy.↗
▶Ep 74 · 20:15
host_summaryPiperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy.↗
▶Ep 74 · 20:30
quotemonotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
▶Ep 74 · 20:30
host_summaryMonotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
Quick Literature Updates Episode 10
▶Ep 75 · 0:00
quoteHello Pediatric Surgery family. I'm M. Tumbush, a research fellow from Cincinnati Children's Hospital Medical Center.↗
▶Ep 75 · 1:21
host_summaryThe Leonard et al. study compared patients presenting with traumatic bleeding, operative bleeding, and medical bleeding.↗
▶Ep 75 · 2:16
host_summaryStandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery.↗
▶Ep 75 · 2:16
host_summaryChildren in the high compliance group had a statistically significant decrease in rates of superficial surgical site infection when compared to children in the low compliance group.↗
▶Ep 75 · 2:16
quotestandardization of perioperative care may decrease morbidity and improve outcomes in colorectal surgery↗
▶Ep 75 · 3:29
quoteit seems that contrast enema prior to stoma reversal is only useful if patients had neck↗
▶Ep 75 · 3:29
host_summaryContrast enema prior to stoma reversal is only useful if patients had necrotizing enterocolitis.↗
Journal of Pediatric Article Review: June 2023, AAP Issue
▶Ep 10 · 6:40
clinical14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies (7 for unilateral disease, 7 for bilateral disease) with a median of 4.5 nodules resected↗
▶Ep 10 · 6:40
host_summary14 high-risk hepatoblastoma patients underwent a median of 2.5 pulmonary metastasectomies (7 for unilateral disease, 7 for bilateral disease) with a median of 4.5 nodules resected↗
▶Ep 10 · 6:50
host_summary5 high-risk hepatoblastoma patients relapsed and 3 of them were saved; NED status was inversely correlated with 5-year mortality↗
▶Ep 10 · 6:50
clinical5 high-risk hepatoblastoma patients relapsed and 3 of them were saved; NED status was inversely correlated with 5-year mortality↗
host_summaryInfants with gastroschisis often require prolonged hospitalization for surgical repair and initiation and advancement of feeds.↗
▶Ep 19 · 2:00
host_summaryBased on recently updated protocols from Cincinnati Children's Hospital and Children's Mercy Kansas City, feeds can be started immediately after sutureless abdominal closure for uncomplicated gastroschisis, beginning with 10-20 mL/kg/day and advancing by 20 mL/kg/day if tolerated.↗
▶Ep 19 · 2:30
host_summaryImmediate feeding after gastroschisis closure has been shown to be associated with shorter length of stay and faster attainment of goal feeds.↗
▶Ep 19 · 2:45
host_summaryFor babies with uncomplicated gastroschisis tolerating feeds for a few days, it is okay to continue the feeding protocol even after one bout of emesis.↗
▶Ep 19 · 2:45
quoteit's safe to say that for babies with uncomplicated gastrochesis, it's safe to start feeding immediately after closure. And if they're tolerating for a few days and have even one bout of emesis, it's okay to continue with the feeding protocol.↗
▶Ep 19 · 4:00
host_summaryHigh resolution esophageal manometry, esophagography, and endoscopy can help determine the diagnosis of congenital esophageal stenosis.↗
▶Ep 19 · 4:15
host_summarySerial dilations may be used to manage congenital esophageal stenosis if there is no cartilage component suspected in the stenotic area.↗
▶Ep 19 · 4:30
host_summarySurgical resection for congenital esophageal stenosis can be reserved for patients where serial dilation is unsuccessful or there is concern for a cartilaginous component.↗
▶Ep 19 · 4:45
host_summaryInitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilaginous component is not suspected.↗
▶Ep 19 · 4:45
quoteinitial conservative management should be considered for patients with congenital esophageal stenosis, especially if a cartilagenous component is not suspected.↗
▶Ep 19 · 5:45
host_summaryManagement of intussusception after enema reduction varies in practice, with historically recommended inpatient observation lacking evidence-based guidelines.↗
▶Ep 19 · 6:00
host_summaryA systematic review and meta-analysis found that overall recurrence rates and recurrences within 24 and 48 hours were similar between inpatient and outpatient management groups after intussusception enema reduction.↗
▶Ep 19 · 6:30
host_summaryThere was no significant difference in the rate of return to the emergency department between inpatient and outpatient management after intussusception reduction, and both groups had similar rates of requiring operative intervention.↗
▶Ep 19 · 6:45
host_summaryOutpatient management of intussusception after air enema reduction results in shorter hospital stay with no difference in rate of ED returns, recurrence, need for operation, or mortality.↗
▶Ep 19 · 6:45
quoteit's safe to say that outpatient management of intersusception after air enema reduction results in a shorter hospital stay with no difference in the rate of returns to the emergency department, recurrence, need for an operation, or mortality.↗
▶Ep 19 · 7:30
host_summaryThere is no compelling evidence in pediatric or adult literature to support mechanical bowel preparation reducing surgical site infections in colorectal surgery.↗
▶Ep 19 · 7:45
host_summaryRecent adult studies have shown no benefit from mechanical bowel preparation in reducing surgical site infections, with some studies showing an increase in wound infections.↗
▶Ep 19 · 8:00
host_summaryAdult studies suggest a possible benefit of oral and IV antibiotics to reduce surgical site infections in colorectal surgery.↗
▶Ep 19 · 8:15
host_summaryRecent retrospective studies have not shown the importance of oral antibiotics for pediatric colorectal operations.↗
▶Ep 19 · 8:45
host_summaryCase-appropriate preoperative IV antibiotics may reduce surgical site infection incidence in colorectal surgery.↗
▶Ep 19 · 8:45
quotewe have seen no benefit of mechanical bowel preparations for reducing SSIs. However, case appropriate pre-operative IV antibiotics may reduce SSI incidents.↗
▶Ep 19 · 9:45
host_summaryFirearms are now the leading cause of death in all children and adolescents in the United States, overtaking motor vehicle crashes in 2019.↗
▶Ep 19 · 10:00
host_summaryThere are controversies about whether pediatric surgeons should be involved in firearm violence prevention efforts and advocacy across the country.↗
▶Ep 19 · 10:15
host_summaryAs pediatric surgeons, we need to advocate for protecting children's health and well-being, no matter what the topic is.↗
▶Ep 19 · 10:15
quoteWe believe as pediatric surgeons that we need to advocate with protecting children's health and well-being, no matter what the topic is.↗
▶Ep 19 · 10:45
quoteas pediatric surgeons, we can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 19 · 10:45
host_summaryPediatric surgeons can play key roles for patients affected by firearms, including direct patient care and advocacy.↗
▶Ep 19 · 11:45
host_summaryUnwitnessed foreign body aspiration can be challenging to manage, and many items are not radiopaque so cannot be seen on plain x-ray.↗
▶Ep 19 · 12:00
host_summaryThe gold standard for airway evaluation has been rigid or flexible bronchoscopy, but there are risks of negative bronchoscopy with subsequent airway compromise.↗
▶Ep 19 · 12:15
host_summaryCT bronchoscopy has been proposed as an adjunct in cases of children without obvious respiratory distress.↗
▶Ep 19 · 12:30
host_summaryLow-dose non-contrast CT of the chest has high sensitivity and specificity for identification of airway foreign bodies.↗
▶Ep 19 · 12:45
host_summaryCT can avoid the cost and resources of taking a child to the operating room for a non-therapeutic bronchoscopy procedure.↗
▶Ep 19 · 13:30
host_summaryThe largest study looking at initial laparotomy versus peritoneal drainage for necrotizing enterocolitis was conducted at 20 US centers and examined combined death or neurodevelopmental impairment at corrected age 18-22 months.↗
▶Ep 19 · 14:00
host_summaryDeath or neurodevelopmental impairment occurred in 69% of patients with preoperative diagnosis of NEC who underwent initial laparotomy versus 85% of those who underwent initial peritoneal drainage.↗
▶Ep 19 · 14:15
host_summaryThe prospective randomized cohort study from the National Institute of Child Health and Human Development showed no difference in overall survival but did show improved long-term neurodevelopmental outcomes with initial laparotomy for NEC.↗
▶Ep 19 · 14:45
quotefor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 19 · 14:45
host_summaryFor infants with necrotizing enterocolitis, initial laparotomy may be associated with less neurodevelopmental impairment and improved outcomes for extremely low birth weight babies.↗
▶Ep 19 · 15:45
host_summaryRacism and sexism that manifest as microaggressions are commonly experienced by members of minority groups.↗
▶Ep 19 · 16:00
host_summaryIndividuals from minoritized groups are often left weighing the potential benefits and risks of addressing microaggression comments.↗
▶Ep 19 · 16:15
host_summaryPlacing the burden to interrupt bias on marginalized colleagues is unjust, and microaggressions can harm trainees' performance and sense of belonging.↗
▶Ep 19 · 16:15
quotePlacing the burden to interrupt bias on our marginalized colleagues is unjust and such microaggressions can harm trainees's performance and sense of belonging.↗
▶Ep 19 · 16:45
host_summaryBystanders can and should make an effort to become upstanders, which means bystanders who respond with action to interrupt microaggressions.↗
▶Ep 19 · 16:45
quoteBystanders can and should make an effort to become upstanders, which means bystanders who respond with action.↗
▶Ep 19 · 17:30
host_summaryBlunt head trauma represents the majority of pediatric trauma admissions, but there is very little evidence on how to best manage isolated skull fractures.↗
▶Ep 19 · 18:15
host_summaryA 10-year retrospective review of isolated traumatic skull fractures with normal neurologic exam findings showed that 77% of patients were admitted for observation, but none needed neurosurgical intervention or additional imaging during the index admission.↗
▶Ep 19 · 18:45
host_summaryPediatric isolated skull fractures are low risk conditions with a low likelihood of complications, and these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 19 · 18:45
quotepediatric isolated skull fractures are low risk conditions with a low likelihood of complications. Therefore, these patients can be discharged safely from the emergency department without inpatient observation.↗
▶Ep 19 · 19:30
host_summaryThe IMPACT trial was a multi-institutional prospective randomized trial comparing piperacillin-tazobactam monotherapy versus ceftriaxone-metronidazole combination therapy for perforated appendicitis in children, with 30-day post-operative intra-abdominal abscess rate as the primary outcome.↗
▶Ep 19 · 20:00
host_summaryPatients taking piperacillin-tazobactam had lower incidence of intra-abdominal abscesses, lower usage of CT scans, and fewer ED revisits compared to combination therapy.↗
▶Ep 19 · 20:15
host_summaryPiperacillin-tazobactam monotherapy did not have an increase in antibiotic usage or increase in antibiotic-related complications compared to combination therapy.↗
▶Ep 19 · 20:30
host_summaryMonotherapy with piperacillin-tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
▶Ep 19 · 20:30
quotemonotherapy with piperacilin and tazobactam has been shown to be associated with decreased incidence of intra-abdominal abscesses after surgery for patients with perforated appendicitis.↗
