RESUMEN
BACKGROUND/PURPOSE: The aim of this study was to critically evaluate the clinical outcomes of two different surgical treatment approaches for infants born with gastroschisis. METHODS: The medical records of 65 infants with gastroschisis treated at one institution from 1991 to 2000 were available. Infants in group I (prior to December 1998) underwent attempted early repair of the gastroschisis defect on their first day of life. Infants in group II had delayed repair after the initial placement of a preformed silo. RESULTS: Group I had 39 patients; group II had 26 patients. The two groups were equal with respect to maternal age, gestational age, and birth weight. Complete reduction and fascial closure were accomplished for 32 patients (82%) in group I and 25 patients (96%) in group II (P <.02). Median time on the ventilator was significantly less for group II (P <.0001). Infants in group II had shorter times until first postoperative feeding (P <.01) and full feedings (P <.006). Group II had fewer complications than group I (23% v 56%; P <.01). There appeared to be less necrotizing enterocolitis in group II. The average length of hospital stay was 14 days less for group II. CONCLUSIONS: The use of a preformed silo initially followed by delayed fascial closure in infants with gastroschisis is associated with improved fascial closure rates, fewer ventilator days, more rapid return of bowel function, and fewer complications compared with attempts at initial early repair.
Asunto(s)
Gastrosquisis/cirugía , Adulto , Parto Obstétrico , Enterocolitis Necrotizante/epidemiología , Enterocolitis Necrotizante/etiología , Enterocolitis Necrotizante/prevención & control , Fasciotomía , Femenino , Gastrosquisis/complicaciones , Edad Gestacional , Humanos , Recién Nacido , Tiempo de Internación , Masculino , Edad Materna , Nutrición Parenteral Total/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Embarazo , Prótesis e Implantes , Respiración Artificial/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
This case report describes a 4350-gram male infant of 38 weeks gestation who was placed on extracorporeal life support. On day 4 of life, a large bilateral ecchymotic area involving the scapula and extending to the mid sacral-lumbar-thoracic area was noted, placing the infant at significant risk for pressure ulcer formation. The infant's initial presentation, evaluation, treatment, and response to therapy are discussed. A review of the anatomy and physiology of neonatal skin and the etiology of pressure ulcers is described. The incidence and staging of pressure ulcers is outlined, and high-risk infants and skin zones are identified. Skin care challenges in the patient on extracorporeal life support (ECLS) are outlined, and strategies to assess and treat affected areas are offered. The use of a novel mattress surface for global pressure reduction in the infant undergoing ECLS therapy is discussed.
Asunto(s)
Ropa de Cama y Ropa Blanca , Oxigenación por Membrana Extracorpórea/efectos adversos , Úlcera por Presión/etiología , Úlcera por Presión/prevención & control , Humanos , Recién Nacido , Masculino , Úlcera por Presión/diagnóstico , Úlcera por Presión/fisiopatología , Piel/anatomía & histología , Fenómenos Fisiológicos de la PielRESUMEN
BACKGROUND/PURPOSE: Snowmobiling is a popular form of wintertime recreation but can be associated with significant morbidity and mortality. To better understand snowmobile trauma in children, medical records were reviewed, evaluating the relationships between demographic data, mechanisms, and resultant injuries. In addition, because prior studies of childhood snowmobile fatalities have reviewed only national databases, state and national data were combined to evaluate possible underreporting. METHODS: Medical records were reviewed of children