Minimally Invasive Pediatric Surgery During Remote Humanitarian Missions Is Feasible, Safe, and Effective.

PURPOSE: There remains a critical need for the provision for pediatric humanitarian aid worldwide. Historically, the emphasis of global pediatric health needs has been focused on infectious diseases. Today, we are witnessing a shift in this paradigm, with growing attention being paid toward the surgical needs of children. The use and deployment of minimally invasive surgery (MIS) in these austere environments with its concomitant reduction in length of hospitalization, pain, and morbidity is logical. The goal of this study was to report our deployment strategy and review our experience with pediatric MIS during humanitarian missions to determine if it is safe, feasible, and efficacious. METHODS: As part of the World Pediatric Project (WPP), data were collected retrospectively from the general pediatric surgery (GPS) team missions from January 2007 to January 2017. All cases were performed at a single medical center in the Eastern Caribbean Island Nation of St. Vincent and the Grenadines (SVG). Data included patient demographics, diagnosis, procedure, conversion to open procedure, complications, and postoperative course. The teams utilized a dedicated WPP operating theater, prepositioned and deployed GPS supplies, and MIS resources. All anesthesia, surgical, and nursing personal were board certified and trained professionals functioning as part of the WPP team. RESULTS: One hundred thirty-four children underwent general and thoracic pediatric surgical procedures during the study period. Mean age 9.2 years (2-19 years). Thirty-seven children underwent MIS procedures (27%). There were no conversions to open procedures. There were only two postoperative complications, cellulitis following laparoscopic appendicostomies, which required intravenous antibiotics and were discharged on a course of oral antibiotics. The postoperative course for all children was uneventful and no child required readmission. There were no technical failures in the MIS systems or instrumentation. CONCLUSIONS: Our retrospective review supports the use of MIS techniques as part of GPS humanitarian missions. We have found it to be a safe, feasible, and effective modality that may reduce length of stay, pain, and morbidity compared with open procedures in these remote environments. Although our MIS systems and instrumentations functioned effectively, concerns regarding the storage and sustainability for future missions are significant. Onsite health care partners, redundant systems, and remote technical support access could potentially alleviate these concerns.

Outcome of teenage pregnancy in St. Vincent: neonatal outcome and adequacy of milk from teenage mothers

In a longitudional study, pregnancy, neonatal outcome and lactation performance of adolescent and adult primigravidae were examined and compared in 33 randomly selected women (14-25 years) in St. Vincent. The whole group of women were subdivided into three sub-groups: Group I (n=10, age 14-16 years), Group II (n=12, age 17-18 years), and Group III (n=11, age 19-25 years). Detailed data on obstetrical and neonatal (neurological) outcome were collected. After birth, information was obtained on early infant growth, maternal dietary intake and breast milk composition. Milk samples (transitional and mature milk) and maternal dietary information and neonatal anthropometric measurements were collected twice during the first month after birth through home visits. Between the 3 groups no significant differences in obstetric conditions, birthweight and early infant growth were found. The Neurological Optimality Score (NOS) was comparable for all groups, but a trend of more infants diagnosed as neurologically "suspect" infants in the younger age group shows the urgent need for more research in this field. Regarding the analysis of breastmilk samples, apart from lactose content, no major differences in the composition of macro-nutrients were found. Concerning the fatty acid composition of the milk fat, no major differences between the groups occurred, although a small number of individual fatty acids were different between the groups. Early infant growth patterns were similar in all groups. It is concluded that previously reported perinatal problems of healthy teenage primigravidae (14-16 years) were not substantiated fully in this series but neonatal outcome of infants of these mothers suggests that careful developmental follow-up of these children is indicated (AU)

Outcome of teenage pregnancy in St. Vincent: the adequacy of milk from teenage mothers in relation to neonatal growth - abstract

In a longitudinal study pregnancy, neonatal outcome and lactation performances of adolescent and adult primigravidae were examined and compared in 33 randomly selected women (14-25 years of age) in St. Vincent. The whole group of women were subdivided in three subgroups: Group I (n=10, age 14-16 years), Group II (n=12, age 17-18 years) and Group III (n=11, age 19-25 years). Detailed data on obstetrical and neonatal (neurological) outcome were collected. After birth information was obtained on early infant growth, maternal dietary intake and breast milk composition. Milk samples (transitional and mature milk) and maternal dietary information were collected twice during home visits, together with neonatal anthropometric measurements. Between the 3 groups no significant differences in obstetrical conditions, birth weight and early infant growth were found. However, in the youngest group the number of infants diagnosed as neurologically "suspect" was higher compared to the older groups. Regarding the analysis of breast milk samples, apart from lactose content, no major differences in the composition of macro-nutrients were found. Concerning the fatty acid composition of the milk fat no major differences between groups occurred, although a small number of individual fatty acids were different between the groups. It is concluded that previously reported perinatal problems of healthy teenage primigravidae (14-16 years) are not substantiated in this series (AU)