Surgical treatment for necrotizing enterocolitis: a new score to extreme surveillance.

BACKGROUND: The time to perform a surgical intervention in necrotizing enterocolitis remains a challenge for the pediatric surgeon. We design a novel score system to predict infants in high risk for the development of surgical necrotizing enterocolitis. METHODS: A total of 124 consecutively patients diagnosed of NEC at the University Hospital of A Coruña, Spain were included in the study. Associations were analyzed by bivariate and multivariate analysis. We applied multivariate logistic regression modeling to identify factors that could provide accurate risk of surgical NEC. We include not only analytical and radiological parameters or physical examination, but we also analyzed prenatal, sociodemographic, perinatal and peripartum variables that conditioned the presence of predispose factors, which could determine the debut of this entity and in its progression. RESULTS: Patients requiring surgical treatment have presented an antecedent of respiratory distress (worsening of the ventilatory requirements) in the perinatal period, they present higher values of glycemia at diagnosis of the illness, debut with coagulopathy and have in laboratory findings marked neutrophilia. CONCLUSIONS: Our score system obtained by combining several parameters could detect infants at risk of developing severe necrotizing enterocolitis improving the morbidity and mortality associated with delay in the surgical treatment.

[Factors involved in the success or failure of endoscopic treatment in paediatric primary vesicoureteral reflux: A systematic review.] / Factores condicionantes de éxito o fracaso del tratamiento endoscópico en el reflujo vesicoureteral primario pediátrico: una revisión sistemática.

OBJECTIVE: The objective of this paper isidentifying the factors that may condition the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population.MATERIAL AND METHODS: A bibliographic review was performed in the Cochrane Library and PUBMED of all the studies which the principal subject was about identifying factors involved in the success or failure of endoscopic therapy for vesicoureteral reflux in the paediatric population. RESULTS: Of a total of 1410 studies, 14 studies and17 factors potentially involved in the success or failure of endoscopic therapy were fully analysed according to the different studies reviewed. After analyzing these studies, we identified that the most widely accepted factors that determine the success or failure of endoscopic therapy are the high degree of pre-surgical reflux, the previous injection of antireflux material, the surgical experience and the presence of dysfunction of the lower urinary tract (UTD). Other factors such as the amount of bulking substance used, meatal morphology, renal damage and age at the time of injection could be potentially involved. The technique used and the bulking material do not seem to be associated with the response to therapy. Exists a great heterogeneity of the reviewed studies, both in relation to the characteristics of the patients included, criteria and surgical technique and evaluation of results. CONCLUSIONS: The degree of pre-surgical reflux, the presence of UTD, previous injections and surgical experience are the most widely accepted determining factors in the results of endoscopic therapy according to the different studies published in this topic.

OBJETIVO: Identificar los factores que puedan condicionar el éxito o fracaso de la terapia endoscópica del reflujo vesicoureteral en la población pediátrica.MATERIAL Y MÉTODOS: Se realizó una búsqueda bibliográfica en Cochrane Library y PUBMED de todos los estudios sobre factores implicados en el éxito o fracaso de la terapia endoscópica del reflujo vesicoureteral en la población pediátrica. RESULTADOS: De un total de 1410 trabajos se analizaron íntegramente 14 estudios y 17 factores potencialmente implicados en el éxito o fracaso de la terapia endoscópica según los diferentes trabajos evaluados. Tras el análisis de estos trabajos identificamos que los factores que condicionan el éxito o fracaso de la terapia endoscópica más ampliamente aceptados son, el alto grado de reflujo prequirúrgico, la inyección previa de material antirreflujo, la menor experiencia quirúrgica y la presencia de disfunción del tracto urinario inferior (DTUI). Otros factores como el volumen de sustancia de abultamiento empleada, la morfología meatal postpunción, la presencia de daño renal previo o la edad en el momento de la inyección podrían así mismo estar potencialmente asociados. La técnica empleada y el material de abultamiento no parecen asociarse al éxito de la terapia endoscópica. Destaca tras dicho análisis la gran heterogeneidad de los estudios revisados tanto en relación a características de los pacientes incluidos, criterios y técnica quirúrgica y evaluación de resultados. CONCLUSIONES: El grado de reflujo prequirúrgico, la presencia de DTUI, las inyecciones previas y la experiencia quirúrgica son los condicionantes más ampliamente aceptados en los resultados de la terapia endoscópica según los diferentes estudios publicados al respecto.