[Gastroschisis and omphalocele: Incidence and outcome].

INTRODUCTION: Gastroschisis and omphalocele are the most common congenital abdominal wall defects. The main purpose of this study was to investigate the incidence, other associated anomalies and the course of these diseases in Iceland. MATERIAL AND METHODS: The study was retrospective. The population was all newborns who were admitted to the NICU of Children's Hospital Iceland due to gastroschisis or omphalocele in 1991-2020. Furthermore, all fetuses diagnosed prenatally or post mortem where the pregnancy ended in spontaneous or induced abortion, were included. RESULTS: During the study period, 54 infants were born with gastroschisis and five with omphalocele. The incidence of gastroschisis was 4.11 and omphalocele 0,38/10,000 births. There was no significant change in the incidence of the diseases during the study period. In addition, five fetuses were diagnosed with gastroschisis and 31 with omphalocele where the pregnancy was terminated. In addition to gastroschisis in the live born infants and fetuses the most common associated anomalies were in the gastrointestinal or urinary tract but in infants and fetuses with omphalocele anomalies of the cardiac, central nervous or skeletal systems were the most common. Sixteen fetuses diagnosed with omphalocele had trisomy 18. Mothers aged 16-20 were more likely to give birth to an infant with gastroschisis than older mothers (p< 0.001). Primary closure was successful in 86% of the infants. Those reached full feedings significantly earlier and were discharged earlier. Overall survival rate was 95%. Three children were still receiving parenteral nutrition at discharge due to short bowel syndrome. CONCLUSIONS: The incidence of gastroschisis in Iceland is in accordance with studies in other countries but but the incidence of omphalocele is lower, which can be partly explained by spontaneous or induced abortions. Other anomalies associated with omphalocele are more severe than those associated with gastroschisis. Primary closure was associated with more benign course. Children with gastroschisis may need prolonged parenteral nutrition due to shortening of their intestines.

Abdominal pain is a common and recurring problem in paediatric emergency departments.

AIM: Abdominal pain is a frequent reason for paediatric emergency department visits, but specific research is lacking. Our aim was to obtain information on the diagnosis of abdominal pain and what healthcare services children with this condition need. METHODS: This retrospective study focused on patients visiting the emergency department of the Children's Hospital Iceland in 2010 with abdominal pain and any subsequent visits up to 1 January 2015. RESULTS: There were 11 340 visits to the emergency department in 2010 and 1118 children made 1414 (12%) visits due to abdominal pain. The majority (58%) with abdominal pain were girls (p < 0.001) and they were older than the boys, with an average age of 12 versus 10 years (p < 0.001). The most common diagnoses were non-specific abdominal pain (40%), constipation (22%) and viral infections (13%). During the follow-up period, 423/1118 children (38%) visited the emergency department 883 times, 58% were girls and the most common diagnosis was non-specific abdominal pain (37%). Of the 436 children initially diagnosed with non-specific abdominal pain, 154 (35%) revisited the emergency department during the follow-up period. CONCLUSION: Abdominal pain was a common reason for visits to the paediatric emergency room and a third paid more than one visit.

Cultural bias in the AAP's 2012 Technical Report and Policy Statement on male circumcision.

The American Academy of Pediatrics recently released its new Technical Report and Policy Statement on male circumcision, concluding that current evidence indicates that the health benefits of newborn male circumcision outweigh the risks. The technical report is based on the scrutiny of a large number of complex scientific articles. Therefore, while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report's conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia. In this commentary, a different view is presented by non-US-based physicians and representatives of general medical associations and societies for pediatrics, pediatric surgery, and pediatric urology in Northern Europe. To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

[Burn injuries in children: admissions at Landspitali University Hospital in Iceland 2000-2008]. / Brunaslys barna: innlagnir á Landspítala 2000-2008.

BACKGROUND: Causes of burn injuries in children are universally associated with social and environmental factors. Epidemiological studies are therefore important in identifying risk factors and for planning preventive interventions. METHODS: Children younger than 18 years with skin burns who were treated as inpatients at Landspitali University Hospital over a 9-year period, 2000 and 2008, were included in this retrospective descriptive study. Data was collected from medical records. RESULTS: Of 149 children included in the study 41.6% were four years old or younger. The average annual incidence of hospital admissions was 21/100,000. Cold water as first aid was applied in 78% of cases. Half of the accidents occurred in the home where a close family member was the caretaker. Risk factors were identified in 11.4% of the accidents and abuse or neglect was suspected in 3.4% of cases. Scalds were the most common type of burn injury (50.3%) followed by burns caused by fire (20.4%) including gas or petrol (14.9%) and fireworks (17.6%). The most common source of scalds was exposure to hot water from hot water mains (12,9%) and heated water (12,9%). The mean time from emergency room admission to the paediatric ward was two hours and 22 minutes. The mean length of stay was 13 days; median 9 days (range 1-97). CONCLUSION: Incidence of hospital admissions for burn injury has decreased when compared with earlier Icelandic studies. Children four years and younger and boys between 13-16 years old are most at risk for burn injuries. Stronger preventive measures as well as better documentation of burn accidents are imperative.

[Appendicitis and appendectomy in children in Reykjavik Hospitals in 1996 and 2006]. / Botnlangabólga og botnlangataka hjá börnum á sjúkrahúsum í Reykjavík 1996 og 2006.

INTRODUCTION: Appendicitis is a common disease and can be life-threatening if not adequately treated. Studies have shown that if less than 20% of appendices removed are normal it indicates missing or delaying the diagnosis of appendicitis, resulting in an increased incidence of perforation. The purpose of this study was to analyze appendicitis in children during two separate time periods in the pediatric wards of the hospitals in Reykjavík and to increase our knowledge of appendicitis in children in the country. MATERIALS AND METHODS: Patients entering this study are two groups of 100 children (< or =16 years) consecutively undergoing appendectomy in the Reykjavik hospitals, one group in 1996 and the other in 2006. Data on sex, age, clinical symptoms and treatment was obtained from patients records. The impression of the surgeon at time of operation on the inflammation of the removed appendix was compared with results of histopathology analysis. All histopathology slides from appendices from 2006 were re-evaluated. The parameters in open appendectomies were compared to those in laparoscopic appendectomies. The two study periods were compared. RESULTS: The proportion of normal appendices was similar in both periods of the study, 18% in 2006 and 20% in 1996. The appendices were more often normal in female patients (p<0.05) and the large majority of those were removed by laparoscopic surgery. Perforation was present in 17% of inflamed appendices in both study groups. The time from patients arrival to hospital until surgery surpassed 10 hours in only one case in each study group. A discrepancy between the surgeon's assessment and the pathology result was noted only once in 2006 and in one additional case was the histopathological diagnosis altered following re-evaluation of the pathology slides. DISCUSSION: The proportion of non-inflamed appendices in appendectomies in children in Reykjavik is in accordance with that reported elsewhere and perforation is not common. There is a good concordance between surgical and pathological assessment with regard to inflammation of the appendices.

[The results of surgical treatment for cryptorchidism at Landspitalinn, 1970-1993.].

OBJECTIVE: Cryptorchidism is a common congenital genito-urological anomali in males with increased risk of infertility and testicular cancer. In this retrospective study the results of operations for undescended testis at Landspitalinn University Hospital were reviewed with special emphasis on patients diagnosed with testicular cancer later in life. MATERIAL AND METHODS: The study includes 593 males with undescended testis who were operated on between 1970 and 1993. Information was gathered from hospital records, including birth-weight, age at diagnosis and operation, localization of the testes and complications to surgery. Information on patients diagnosed with testicular cancer was aquired from the Icelandic Cancer Registry. RESULTS: The average birth-weight was 3461 g, including 58 boys (10%) with low birth-weight (