Analysis of Prognostic Factors in Congenital Diaphragmatic Hernia in Neonates.

AIM: The aim is to study the demographic characteristics of neonates with congenital diaphragmatic hernia (CDH) and to analyze the prognostic factors determining mortality. SETTINGS AND DESIGN: A retrospective cohort of CDH admitted at a tertiary level hospital during January 2005-December 2017. MATERIALS AND METHODS: All cases of CDH admitted to our tertiary care neonatal intensive care unit before undergoing surgery were included in the study. Babies admitted after surgery and those with eventration of the diaphragm were excluded from the study. RESULTS: Thirty cases (66.66% males, 53.33% inborn, and 63.3% >37 weeks) formed the study cohort. Mean birth weight was 2762 ± 579.67 g and mean gestational age was 37.12 ± 1.76 weeks. About 56.66% of the cases were detected antenatally. The survival rate was 60%. Predictors of poor survival included herniation of the liver or stomach (P < 0.05), low Apgar score at 5 min (<5), presence of moderate-to-severe persistent pulmonary hypertension of the newborn (PPHN) (P < 0.001), presence of shock (P < 0.003), low partial pressure of oxygen, high alveolar-arterial oxygen gradient, and high oxygenation index during first 24 h. CONCLUSIONS: Majority of the neonates with CDH at our center were >37 weeks and survival was 60%. The predictors of adverse outcome were low Apgar score, presence of moderate-to-severe PPHN, need for higher ventilatory settings, and shock. Antenatal detection of diaphragmatic hernia did not impact survival rates.

Pediatric cholelithiasis and laparoscopic management: A review of twenty two cases.

AIM: To evaluate the role of laparoscopic cholecystectomy (LC) in the management of cholelithiasis in children. MATERIALS AND METHODS: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and March 2009 was done. Data points reviewed included patient demographics, clinical history, haematological investigations, imaging studies, operative techniques, postoperative complications, postoperative recovery and final histopathological diagnosis. RESULTS: During the study period of 36 months, 22 children (10 males and 12 females) with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3 to 18 years). Twenty-one children had symptoms of biliary tract disease and one child was incidentally detected with cholelithiasis during an ultrasonogram of the abdomen for an unrelated cause. Only five (22.7%) children had definitive etiological risk factors for cholelithiasis and the remaining 13(77.3%) cases were idiopathic. Twenty cases had pigmented gallstones and two had cholesterol gallstones. All the 22 patients underwent LC, 21 elective and one emergency LC. The mean operative duration was 74.2 minutes (range 50-180 minutes). Postoperative complications occurred in two (9.1%) patients. The average duration of hospital stay was 4.1 days (range 3-6 days). CONCLUSION: Laparoscopic chloecystectomy is confirmed to be a safe and efficacious treatment for pediatric cholelithiasis. The cause for an increased incidence of pediatric gallstones and their natural history need to be further evaluated.

Evaluation of ultrastructural changes by electron microscopy in neonatal cholestasis.

BACKGROUND: Biliary atresia (BA) and idiopathic neonatal hepatitis (NH) account for 50-70% of all cases with neonatal cholestasis. The treatment of the former is early surgical intervention, while the latter requires non-surgical supportive care. Failure to differentiate the two conditions may result in avoidable surgery in NH, which may significantly increase morbidity. The lack of differentiating clinical features, biochemical markers and other specific investigations to distinguish the two is still a major problem. AIM: This study was thus initiated to evaluate electron microscopic changes in the liver in patients with NH and BA, to correlate these with changes on light microscopy and look for specific differentiating features between the two. METHODS: Ten patients with neonatal cholestasis whose liver specimens were available for electron microscopic analysis were included in the study. There were 6 patients with BA and 4 patients with NH. RESULTS: Among the biochemical parameters, serum alkaline phosphatase and gamma glutamyl transpeptidase were significantly higher in BA than in patients with NH. On light microscopy, giant cell transformation was seen in 75% patients with NH and 33.3% of patients with BA. Even in BA, intracellular cholestasis was more prominent than ductular cholestasis (100% vs. 50%). Ductular proliferation was seen in 50% of NH patients and all patients of BA. Electron microscopy revealed prominent endoplasmic changes in all patients with NH and to a milder degree in BA. Changes in mitochondria and glycogen content were similar in both groups. CONCLUSION: Ultrastructural changes in neonatal cholestasis seen through electron microscopy are largely non-specific and do not differentiate BA from NH.