Concurrent infantile pneumomediastinum and pneumoperitoneum.

Pneumomediastinum in an infant is uncommon, and most literature on the subject is anecdotal or retrospective. Concurrent pneumomediastinum and pneumoperitoneum in an infant is even more unusual. We report the case of a 7-month-old infant with long-chain acyl-coenzyme A dehydrogenase deficiency who was admitted to the hospital because of respiratory failure and in whom radiographs revealed simultaneous pneumomediastinum and pneumoperitoneum. Benign findings at the abdominal examination and the presence of pneumomediastinum in the setting of assisted mechanical ventilation led to the diagnosis of air dissection syndrome. We review the radiographic findings associated with air dissection syndrome and discuss the management of concurrent nonsurgical pneumomediastinum and pneumoperitoneum in an infant.

Risk stratification of 4344 patients with gastroschisis into simple and complex categories.

BACKGROUND: Gastroschisis is a congenital full-thickness abdominal wall defect characterized by the protrusion of intraabdominal organs outside the abdominal domain that requires surgical management in the early neonatal period. The goal of this study was to validate a previous risk stratification classification of infants born with this defect. METHODS: A retrospective analysis of a nonoverlapping combination of the databases National Inpatient Sample and Kids' Inpatient Database (1988-2003) was performed. These combined databases contain information from nearly 93 million discharges in the United States. Infants with gastroschisis were identified by an International Classification of Diseases, Ninth Revision procedure code of 54.71 (repair of gastroschisis) and an age at admission of less than 8 days. Infants were divided into simple and complex categories based on the absence or presence of intestinal atresia, stenosis, perforation, necrosis, or volvulus. Variables of sex, race, geographic region, coexisting diagnoses, hospital type and charges adjusted to 2005 dollars, length of stay, inpatient mortality, and complications were collected. Comparison between the 2 groups was performed using Pearson chi2 for categorical outcomes and the Kruskal-Wallis test for non-normally distributed continuous variables. RESULTS: A total of 4344 infants with gastroschisis were identified and divided into simple and complex categories. Simple gastroschisis represented 89.1% (n = 3870) of the group, whereas 10.9% (n = 474) had complex disease. Simple and complex patients differed in coexisting cardiac disease (8.3% vs 11.8%, P = .01), hospital type (78.7% vs 84.1% treated at urban teaching centers, P < .01), median length of stay (28 vs 67 days, P < .01), median inflation-adjusted hospital charges ($90,788 vs $197,871; P < .01), and inpatient mortality (2.9% vs 8.7%, P < .01). Gastrointestinal (14.4% vs 83.5%, P < .01), respiratory (2.6% vs 4.6%, P = .01), and infectious disease complications (24.3% vs 45.4%, P < .01) also differed between the groups. CONCLUSIONS: These data use the largest data set to date to validate the risk stratification of infants with gastroschisis. This analysis improves the characterization and understanding of clinical subsets of infants in whom this congenital condition is diagnosed.