The prevalence of Hirschsprung disease in premature infants after suction rectal biopsy.

BACKGROUND: The prevalence of Hirschsprung disease (HD) in the premature infant population is not well documented. However, delayed passage of stool is common in premature infants, and suction rectal biopsy (SRB) is often used to evaluate for HD in this population. The use of SRB is unknown. Therefore, we evaluated the role of SRB in premature infants with abnormal stooling patterns. METHODS: After Institutional Review Board approval, a retrospective study was conducted on all infants having an SRB performed to exclude HD from January 2000 to December 2010. Infants were divided into two groups according to gestational age (premature < 37 wk; term ≥ 37 wk). Demographics, diagnosis, treatments, and outcomes were collected. A subset analysis was performed on patients diagnosed with HD. RESULTS: Two hundred sixty-nine infants were identified (113 premature and 156 term). Six premature infants (5.3%) and 79 term infants (50.6%) were found to have HD (P < 0.01). As expected, gestational age was significantly different between groups (31.7 versus 38.9 wk, P < 0.01) (Table 1). Premature infants were less likely to have prenatal care (35% versus 55%, P < 0.01) and had longer lengths of hospital stay (45.6 versus 17.6 d, P < 0.01). The most common location of aganglionosis was rectosigmoid in both groups (group 1, 50%; group 2, 33%, P = 0.7). CONCLUSIONS: HD occurs significantly less often in premature infants than in term infants. Alternative diagnoses should be investigated in this population when delayed stooling patterns are encountered. SRB should be used more selectively in this group.

Laparoscopic repair of incarcerated congenital diaphragmatic hernias presenting beyond the newborn period.

PURPOSE/BACKGROUND: Congenital diaphragmatic hernias (CDHs) diagnosed outside of the newborn period are an uncommon occurrence in developed countries. Incarceration of viscera presenting as bowel obstruction is a rare clinical scenario with only a few cases reported in the literature, all of which have been repaired via laparotomy. We have recently encountered a series of these cases that we approached laparoscopically. SUBJECTS AND METHODS: We performed a retrospective review to identify patients who underwent laparoscopic repair of CDH with incarceration after the neonatal period. Demographics, presentation characteristics, operative details, and outcomes were reviewed. results: Between 2008 and 2011, three patients underwent laparoscopic repair of left-sided incarcerated CDH presenting with bowel obstruction. The mean age was 60.8 months (range, 2-157 months) with a mean weight of 30.2 kg (range, 11-66.5 kg). All cases were completed laparoscopically using a 5-mm umbilical port with three to four additional 3-mm instruments. The mean operative time was 133 minutes (range, 117-164 minutes). There were no intraoperative or postoperative complications. Mean length of hospital stay was 4 days (range, 1-8 days). Median follow-up was 6.3 months (range, 0.8-42.3 months). One patient suffered a recurrence after a motor vehicle collision and subsequently underwent a successful second laparoscopic repair. CONCLUSIONS: The laparoscopic approach for patients presenting with an incarcerated CDH beyond the newborn period appears to be an appropriate approach and should be considered when this diagnosis is encountered.

Topical silver sulfadiazine vs collagenase ointment for the treatment of partial thickness burns in children: a prospective randomized trial.

BACKGROUND: The 2 most commonly used topical agents for partial thickness burns are silver sulfadiazine (SSD) and collagenase ointment (CO). Silver sulfadiazine holds antibacterial properties, and eschar separation occurs naturally. Collagenase ointment is an enzyme that cleaves denatured collagen facilitating separation but has no antibacterial properties. Currently, there are no prospective comparative data in children for these 2 agents. Therefore, we conducted a prospective randomized trial. METHODS: After institutional review board approval, patients were randomized to daily debridement with SSD or CO. Primary outcome was the need for skin grafting. Patients were treated for 2 days with SSD with subsequent randomization. Polymyxin was mixed with CO for antibacterial coverage. Debridements were performed daily for 10 days or until the burn healed. Grafting was performed after 10 days if not healed. RESULTS: From January 2008 to January 2011, 100 patients were enrolled, with no differences in patient characteristics. There were no differences in clinical course, outcome, or need for skin grafting. Wound infections occurred in 7 patients treated with CO and 1 patient treated with SSD (P = .06). Collagenase ointment was more expensive than SSD (P < .001). However, total hospital charges did not differ. CONCLUSION: There are no differences in outcomes between topical SSD or CO in the management of childhood burns results.