Warzone pediatric trauma care: Lessons from civilian medical staff in Kyiv.

INTRODUCTION: The article discusses the challenges faced by civilian healthcare providers in Kyiv, Ukraine, during the conflict in treating pediatric trauma resulting from war-related incidents. METHODS: The authors share their experiences and insights from managing a series of 12 pediatric patients admitted to the Ohmatdyt children's hospital between February 25 and April 1, 2022. During this period, the hospital was under constant threat due to the military conflict. RESULTS: The patients, ranging in age from 3 months to 17 years, suffered injuries from various causes, including vehicle shootings, explosions, and other traumatic events. The interventions and timely management are discussed, and two detailed clinical cases are presented to illustrate the complexities of treating pediatric trauma in a warzone. CONCLUSION: In summary, the article sheds light on the unique challenges faced by healthcare providers in a warzone when treating pediatric trauma. It underscores the importance of timely intervention, effective triage, and the utilization of advanced medical techniques to improve patient outcomes in such challenging circumstances.

HEPATIC VASCULAR TUMORS IN CHILDREN: POTENTIAL RISKS, OPTIMAL IMAGING AND THE ROLE OF SURGICAL INTERVENTION.

OBJECTIVE: The aim: To revise the case-series of hepatic vascular tumors (HVT), particularly to identify optimal visualization, management and role of surgical intervention. PATIENTS AND METHODS: Materials and methods: Out of 96 children with hepatic tumors who hospitalized in a single center from 2011 to 2020, 20 (20,8%) were diagnosed HVT. Hepatic Hemangiomas (HHs) were presented in 19 patients and Kaposiform hemangioendotelioma (KHE) in one case. To determine the type of HH we used radiological classification. For visualisation contrast-enhanced MRI (n=7, 30%) and cCT (n=15,70%) were used. Follow-up period was 14-77 months. RESULTS: Results: All HVT were revealed by sonogram at the age of 0-5 m, with 4 (20%) diagnosed prenatally. Male to female ratio was 3:2. Beta-blockers were prescribed to 12 patients with HHs. Treatment duration was from 6 to 24 month. Steroid therapy was initial in cases when it was impossible to prescribe the curative dose of beta-blockers. Complications of propranolol treatment were transitory bradycardia (n=7) and transitory hypoglycemia (n=2). After vincristine chemotherapy decreases the tumor size by 54%, that allowed a safe liver resection. 4 (20%) patients - two multifocal HHs, one diffuse HH and in patient with KHE manifested congestive heart failure and pulmonary hypertension Mortality rate is 5% (n=1), this patient died against progressive cardiovascular failure. CONCLUSION: Conclusions: life-threatening complication of HVT was congestive heart failure. Early treatment is beneficial for complications prevention. Surgical treatment is optional for KHE when can be removed safely.

Valentyn A. Rohozynskyi, Anatolii F. Levytskyi, Mykola M. Dolianytskyi, Irina M. Benzar TREATMENT OF SEVERE SPINAL DEFORMATIONS IN CHILDREN WITH IDIOPATHIC SCOLIOSIS USING HALO-GRAVITY TRACTION.

OBJECTIVE: The aim: To chose the best way treatment and achievement of 3-dimensional spinal correction in order to maximize its parameters to the physiological norms is a choice of the optimal surgical severe scoliotic spinal deformity correction technology. PATIENTS AND METHODS: Materials and methods: Performed surgical treatments to 60 children of two patient's groups, that were under surgical treatment for severe scoliotic spinal deformations with preliminary used halo-gravity traction and one-step correction; to establish an effective and safe protocol of the treatment for children with severe scoliotic spinal deformations (>100°). The results comparative analysis of 60 patients with severe scoliotic spinal deformations, with a two-step surgery treatments (first step - halo-gravity traction and second step - correcting spinal instrumentation) and patients with one-step correction. Patients were divided into 2 groups with 30 children in each of them. The first group treated with preoperatively HGT (halo-gravity traction) and after that a spinal instrumentation together with osteotomies (3-4 levels by Ponte; VCR (vertebral column resection) osteotomy 1 level) were performed. The second group - performed one-step spinal instrumentation with osteotomies (3-4 levels by Ponte; VCR osteotomy 1 level). RESULTS: Results: One-step implanted construction in children with severe scoliotic spinal deformations, compare to HGT treatment that were carried out in stages - is increasing the danger of neurological deficiency by 17%, HGT allows to make more corrections and to adjust spinal cord for the next correction treatment. CONCLUSION: Conclusions: Halo-gravity traction as a first stage of severe scoliotic spinal deformations treatment allows to increase the mobility of the vertebral column and to adjust spinal cord step by step for the next correction treatment.

VASCULAR ANOMALIES IN NEWBORNS: CLINICAL PRESENTATION, COMPLICATIONS, AND PECULIARITIES OF THERAPY.

OBJECTIVE: The aim: To analyze cases of vascular anomalies in newborns retrospectively to study their main clinical signs and to determine indications for urgent treatment. PATIENTS AND METHODS: Materials and methods: A retrospective review of 281 pediatric vascular anomalies diagnosed between 2011 and 2019 was performed. The results of clinical examination, prenatal history, laboratory, sonography, and radiological data were evaluated. RESULTS: Results: Clinical manifestations in the newborn period documented in 170 (60.5%) patients, anomalies were visualized prenatally in 8.9% cases. Five newborns with head and neck LMs required urgent treatment, which amounted 7.9% of all newborns with LMs. The indication for urgent surgery was acute respiratory failure. Partial malformation resection with tracheostomy was performed to those patients, along with intraoperative injection of sclerotherapeutic agents and argon coagulation of residual malformation tissues. EXIT procedure was performed in one case. No correlation (p=0.2) was found between the number of skin lesions and the severity of liver lesions in children with multifocal hepatic hemangiomas, congestive cardiac failure suddenly occurs in one patient in the third week of life. Two newborns with diffuse hepatic hamangioma were manifested right after the birth with clinical signs of liver failure, hypothyreosis, and cardiac failure. Short courses of corticosteroids performed in 7 patients with KHE and Kasabach-Merritte fenomemn for thrombocytopenia correction. CONCLUSION: Conclusions: Clinical signs of vascular anomalies in neonatal period were seen in 57.5% children with vascular anomalies, and only 2.9% of them required treatment. Treatment itself is advantageous only in cases when life-threatening complications develop, such as airways obstruction, cardiac and/or liver failure, thrombocytopenia.

NEWBORNS WITH KASABACH-MERRITT PHENOMENON-ASSOCIATED KAPOSIFORM HEMANGIOENDOTHELIOMA: A REPORT OF 6 CASES.

OBJECTIVE: Combination of kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon (KMP) in newborn children is a life-threatening constellation. The purpose of the study is the choice of the diagnostic and treatment methods in these patients and evaluating the effectiveness of treatment using radiological methods of investigation. The study enrolled 6 newborn patients with KHE within a period 2013 - 2018. MRI (CT) performed to make the diagnosis and evaluate treatment response. Hypervascular mass accompanied by reticular lymphedema, hyper intensive in T2 WI; isointensive in T1 WI, intense contrast enhancement, heterogeneous diffusion restriction were unique MRI characteristics of KHE. The sustained remission was achieved with treatment by propranolol (n=2), vincristine (n=1), and their combination (n=3).

Sternal cleft and segmental facial hemangiomas in children with phaces syndrome: effectiveness and safety of conservative management and surgical correction.

OBJECTIVE: The aim is to determine the risk factors of sternal cleft and segmental facial hemangiomas association in children with PHACES syndrome. PATIENTS AND METHODS: Materials and methods: 32 inpatient children with segmental facial hemangiomas and 19 children with sternal cleft were investigated concerning the Metry criteria of PHACES syndrome. RESULTS: Results: In 6 children PHACE syndrome was diagnosed. Patients with bilateral S3 hemangiomas (50%, 3/6) had airway involvement with respiratory disorders. Conservative treatment was propranolol monotherapy (66.7%, 4/6), or combination of prednisolone and propranolol (33.3%, 2/6). Duration of propranolol treatment in children with PHACES syndrome was on an average 24.25 ± 4.49 months exceeding the duration of propranolol therapy in children with isolated soft tissue lesions (p<0.05). Primary surgical treatment of sternal cleft performed in children aged 2 (n=3) and 4 (n=1) months. The later period of surgery associated with the localization of hemangioma in the surgery region. Primary repair of sternal cleft was completed successfully in all cases; partial resection of the thymus made closure easier. CONCLUSION: Conclusions: Primary surgical correction of a sternal cleft performed in young children provides good results. Partial resection of the thymus prevents respiratory and cardiovascular complications. Preoperative propranolol treatment averts the hemorrhagic complications in children with hemangiomas in surgical region.

RESULTS OF TREATMENT OF IDIOPATHIC CONGENITAL CLUBFOOT IN CHILDREN: A 3-YEAR FOLLOW UP STUDY.

OBJECTIVE: The aim: Was to analyze the outcome, recurrence rate and complications between Ponseti method and soft-tissue release 3 yearsafter the initial treatment. PATIENTS AND METHODS: Materials and methods: This prospective cohort study was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or soft tissue release between 2006 to 2016 at department of traumatology and orthopedics National Children's Specialized Hospital "Okhmatdet". Total of 113 feet in 95 patients (61 males and 34 females), sixty-two feet (62 patients) were in the Ponseti group and thirty-three feet (33 patients) were in the surgical treatment group. For both groups, descriptive statistics were calculated Pirani score (2004) result before and 3 years after treatment, recurrence rate and complications. The comparison of the Pirani score result and complications between the two groups was analyzed by nonparametric tests (Mann-Whitney U-tests). Statistical data processing was performed in SPSS 17.0 program. RESULTS: Results: The results of Pirani score reveal satisfactory outcomes for both groups. But Ponseti method has the more conservative approach and lower complication rate (11,29±5,27% and 24,24±11,74%, p=0,52). CONCLUSION: Conclusions: Ponseti method is a safe, effective method for treatment of congenital idiopathic clubfoot in children from first days after birth. Open surgery should be reserved for deformity that cannot be completely corrected or for treatment of recurrences.