Pediatric Surgical Waitlist in Low Middle Income Countries During the COVID-19 Pandemic.

INTRODUCTION: Coronavirus disease-19 led to a significant reduction in surgery worldwide. Studies, however, of the effect on surgical volume for pediatric patients in low-income and middle-income countries (LMICs) are limited. METHODS: A survey was developed to estimate waitlists in LMICs for priority surgical conditions in children. The survey was piloted and revised before it was deployed over email to 19 surgeons. Pediatric surgeons at 15 different sites in eight countries in sub-Saharan Africa and Ecuador completed the survey from February 2021 to June 2021. The survey included the total number of children awaiting surgery and estimates for specific conditions. Respondents were also able to add additional procedures. RESULTS: Public hospitals had longer wait times than private facilities. The median waitlist was 90 patients, and the median wait time was 2 mo for elective surgeries. CONCLUSIONS: Lengthy surgical wait times affect surgical access in LMICs. Coronavirus disease-19 had been associated with surgical delays around the world, exacerbating existing surgical backlogs. Our results revealed significant delays for elective, urgent, and emergent cases across sub-Saharan Africa. Stakeholders should consider approaches to scale the limited surgical and perioperative resources in LMICs, create mitigation strategies for future pandemics, and establish ways to monitor waitlists on an ongoing basis.

Impact of the COVID-19 Pandemic on Pediatric Surgical Volume in Four Low- and Middle-Income Country Hospitals: Insights from an Interrupted Time Series Analysis.

BACKGROUND: The impact of the COVID-19 pandemic on surgical care delivery in low- and middle-income countries (LMIC) has been challenging to assess due to a lack of data. This study examines the impact of COVID-19 on pediatric surgical volumes at four LMIC hospitals. METHODS: Retrospective and prospective pediatric surgical data collected at hospitals in Burkina Faso, Ecuador, Nigeria, and Zambia were reviewed from January 2019 to April 2021. Changes in surgical volume were assessed using interrupted time series analysis. RESULTS: 6078 total operations were assessed. Before the pandemic, overall surgical volume increased by 21 cases/month (95% CI 14 to 28, p < 0.001). From March to April 2020, the total surgical volume dropped by 32%, or 110 cases (95% CI - 196 to - 24, p = 0.014). Patients during the pandemic were younger (2.7 vs. 3.3 years, p < 0.001) and healthier (ASA I 69% vs. 66%, p = 0.003). Additionally, they experienced lower rates of post-operative sepsis (0.3% vs 1.5%, p < 0.001), surgical site infections (1.3% vs 5.8%, p < 0.001), and mortality (1.6% vs 3.1%, p < 0.001). CONCLUSIONS: During the COVID-19 pandemic, children's surgery in LMIC saw a sharp decline in total surgical volume by a third in the month following March 2020, followed by a slow recovery afterward. Patients were healthier with better post-operative outcomes during the pandemic, implying a widening disparity gap in surgical access and exacerbating challenges in addressing the large unmet burden of pediatric surgical disease in LMICs with a need for immediate mitigation strategies.

Bases de pediatría crítica / Bases of pediatría critical

Aanaliza las enfermedades críticas neonatales, infantiles y de los adolescentes, así como los principales cuidados pediátricos intensivos y su farmacología. Presenta un estudio sobre ética en la práctica médica y sus connotaciones dentro de la pediatría...

Linfangiomas quísticos abdominales en el niño

Presentamos seis pacientes afectados de linfangioma quístico del abdomen (LQA), ocurridos entre enero de 1987 y enero de 1994, en el Hospital de Niños "Baca Ortiz" de Quito. El LQA es una rara enfermedad típica de la infancia, que no es realmente un tumor, sino una displasia linfática consecutiva a un trastorno de conexión entre los espacios primitivos linfáticos, provenientes de las hendiduras mesenquimatosas y del sistema central de los troncos colectores. Destacamos el LQA como una entidad quirúrgica, de diagnóstico basado en la ecografía y a tomarse en cuenta en el diagnóstico diferencial de los tumores abdominales.

Hendidura laringo-traqeo-esofágica

En base a la historia clínica de un paciente con diagnóstico de hendidura laringo-traqueo-esofágica tipo III, realizamos una revisión de la literatura acerca de esta rara patología. Esta debe ser parte del diagnósticodiferencial en pacientes con llanto anormal al momento de nacer, dísnea y cianosis luego de la ingesta. Su diagnóstico es dificil y el principal método para hacerlo es la laringo-traqueoscopia, valíendose en ocasiones de instrumental quirúrgico para exponer la hendidura e incluso, en los tipos I y II, para cerrarlos endoscopicamente. El manejo de las hendiduras tipo III y IV requiere de procedimientos quirúrgicos más complejos. El pronóstico está relacionado con el grado de extensión de la hendidura y de las malformaciones acompañantes.