ABSTRACT
Infantile fibrosarcoma (IFS) is a rare nonrhabdomyosarcoma soft tissue tumor and accounts for less than 1% of childhood cancers. Forty per cent are present at birth and only 10% of IFS occurs in the abdomen. Our case of neonatal fibrosarcoma presented as a distal small bowel stenosis complicated with meconium peritonitis. The diagnosis was by histology of the surgical resection. The diagnosis of IFS is challenging as there are no specific features of IFS on imaging. Any unexpected solid lesion should raise the suspicion of complicated bowel tumoral lesion. If a neoplastic lesion is suspected extensive, surgery may be postponed until the final diagnosis is made.
ABSTRACT
BACKGROUND: The aim of our study was to report our experience in thoracoscopy in infants and neonates for vascular surgical conditions in neonates and infants and to compare our results to open surgery regarding the short-term outcome. PATIENTS AND METHODS: We retrospectively reviewed all the patients operated in a single institution from 1997 to 2016 for persistent ductus arteriosus (PDA) and vascular ring (VR) anomalies. We compared our thoracoscopic series to a historical control group operated by open surgery. Data collection from charts and office notes included age and weight at surgery, cardiac ultrasound data for PDA, preoperative clinical symptoms for VR, type of surgery, operating time, analgesic treatment requirements, ventilation status during postoperative course, and early complications. RESULTS: The thoracoscopic group included 13 PDA (median age and weight at surgery: 34 days and 1800 g) and 11 VR (median age and weight at surgery: 8 months and 7000 g). The thoracoscopic group did not differ in preoperative symptoms and work-up, operating time, ventilation status, length of hospital-stay, and postoperative complications with the group operated on by thoracotomy, for either PDA or VR. CONCLUSION: Our short-term results in thoracoscopic PDA closure and VR anomalies surgery in neonates and infants are comparable to open surgery. Thoracoscopy seems to provide less pain especially for neonates and premature babies and allows to decrease the risk for postoperative chest wall deformities. Long-term outcome is mandatory to confirm these preliminary results.
Subject(s)
Ductus Arteriosus, Patent/surgery , Thoracoscopy/methods , Thoracotomy/methods , Vascular Ring/surgery , Vascular Surgical Procedures/methods , Ductus Arteriosus , Ductus Arteriosus, Patent/complications , Humans , Infant , Infant, Newborn , Length of Stay/statistics & numerical data , Operative Time , Postoperative Complications/epidemiology , Retrospective Studies , Thoracoscopy/adverse effects , Thoracotomy/adverse effects , Treatment Outcome , Vascular Ring/complications , Vascular Surgical Procedures/adverse effectsABSTRACT
BACKGROUND: Perinatal lung growth is highly vulnerable to inflammation and intrauterine growth restriction (IUGR), two major risk factors for chronic lung disease (CLD) in preterm neonates. However, the balance between extremely low gestational age (ELGA) and IUGR in very preterm infants as risk factors for CLD and co-morbidities remains poorly explored. OBJECTIVES: This single-center study aims to compare neonatal morbidity (including CLD) and mortality among ELGA infants with normal birth weight (ELGA-AGA), very preterm infants with IUGR <3rd percentile (VLGA-IUGR) and very preterm infants with a birth weight appropriate for gestational age (VLGA-AGA), matched with VLGA-IUGR infants. METHODS: Selected characteristics of the perinatal and neonatal periods were recorded and retrospectively compared among the three groups. Infants with major congenital anomalies were excluded. The diagnosis of CLD was based on whether the infant was receiving supplemental oxygen and/or non-invasive ventilation at a postmenstrual age of 36 weeks. RESULTS: We found that, despite a median difference of 3 weeks in gestational age at birth between VLGA-IUGR and ELGA-AGA infants, neonatal mortality was 35% higher in neonates who had experienced fetal growth restriction, and that VLGA- IUGR was five times more predictive of CLD than was ELGA-AGA. These differences persisted after adjustment for confounding factors such as antenatal steroids, gender and respiratory distress syndrome. CONCLUSIONS: This study reports that VLGA-IUGR infants are at higher risk of neonatal mortality and CLD than both ELGA-AGA and VLGA-AGA infants.
Subject(s)
Fetal Growth Retardation/physiopathology , Infant, Extremely Premature , Lung Diseases/physiopathology , Lung/growth & development , Birth Weight , Child Development , Chronic Disease , Female , Fetal Growth Retardation/mortality , Gestational Age , Hospital Mortality , Humans , Infant , Infant Mortality , Infant, Newborn , Lung Diseases/diagnosis , Lung Diseases/mortality , Lung Diseases/therapy , Male , Oxygen Inhalation Therapy , Paris , Respiration, Artificial , Retrospective Studies , Risk Assessment , Risk FactorsABSTRACT
Disabilities related to premature birth can be multiple, and can include motor, cognitive, neurosensory, behavioural and respiratory conditions. With an increasing number of premature births in developed countries, preventing and treating these disabilities will constitute a real medical, human and social challenge in the years ahead.
