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Article ; Online: Reply to Letter to Editor regarding: Do we really need gastrostomy in every anatomical anomaly? A comment on patient selection for pediatric gastrostomy tubes: Are we placing tubes that are not being used?

Jackson, Jordan E / Theodorou, Christina M / Beres, Alana L

2022 Volume 57, Issue 10, Page(s) 480

MeSH term(s)	Child ; Enteral Nutrition ; Gastrostomy ; Humans ; Patient Selection ; Surgical Stomas
Language	English
Publishing date	2022-04-22
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2022.04.012
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Zs.A 607: Show issues

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Article ; Online: Chest Wall Reconstruction in Pediatric Patients with Chest Wall Tumors: A Systematic Review.

Theodorou, Christina M / Lawrence, Yemi S / Brown, Erin G

Journal of pediatric surgery

2022 Volume 58, Issue 7, Page(s) 1368–1374

Abstract: Background: Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe ... ...

Abstract	Background: Resection of pediatric chest wall tumors can result in large defects requiring reconstruction for function and cosmesis. Multiple reconstructive methods have been described. We performed a systematic review of the literature to describe commonly used approaches and outcomes. Methods: A systematic literature search was performed for English-language publications describing chest wall tumor resection and reconstruction using implantable materials in patients ≤21 years, excluding soft tissue resection only, sternal resection, and reconstruction by primary repair or muscle flaps alone. Data were collected on diagnoses, reconstructive method, and outcomes. Rigid chest wall reconstruction was compared to mesh reconstruction. Results: There were 55 articles with 188 patients included. The median age was 12 years. Most tumors were malignant (n = 172, 91.5%), most commonly Ewing's sarcoma (n = 65, 34.6%), followed by unspecified sarcomas (n = 34, 18.1%), Askin's tumor (n = 16, 8.5%; a subset of Ewing's sarcoma) and osteosarcoma (n = 16, 8.5%). A median of 3 ribs were resected (range 1-12). Non-rigid meshes were most common (n = 138, 73.4%), followed by rigid prostheses (n = 50, 26.6%). There were 19 post-operative complications (16.8%) and 22.2% of patients developed scoliosis. There were no significant differences in complications (20.5% rigid vs. 10.6% non-rigid, p = 0.18) or scoliosis (22.7% vs. 14.0%, p = 0.23) by reconstruction method, but complications after rigid reconstruction were more likely to require surgery (90.0% vs. 53.9%, p = 0.09). The median follow-up duration was 24 months. Conclusions: In this review of the literature, there were no significant differences in overall post-operative complications or scoliosis development by reconstruction method, yet complications after rigid reconstruction were more likely to require surgical intervention. Level of evidence: Level IV.
MeSH term(s)	Humans ; Child ; Sarcoma, Ewing/surgery ; Sarcoma, Ewing/complications ; Thoracic Wall/surgery ; Scoliosis/surgery ; Plastic Surgery Procedures ; Bone Neoplasms/surgery ; Thoracic Neoplasms/surgery ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
Language	English
Publishing date	2022-11-23
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2022.11.008
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Zs.A 607: Show issues

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Article: Laparoscopic repair of bilateral inguinal hernias each containing sigmoid colon in a premature infant.

Stasyuk, Anastasiya / Theodorou, Christina M / Beres, Alana L

Journal of pediatric surgery case reports

2021 Volume 74

Abstract: Inguinal hernias are rare in the general population but are more frequently seen in premature infants. Risk factors include male gender, small for gestational age, low birth weight and respiratory distress. Infant inguinal hernias most frequently contain ...

Abstract	Inguinal hernias are rare in the general population but are more frequently seen in premature infants. Risk factors include male gender, small for gestational age, low birth weight and respiratory distress. Infant inguinal hernias most frequently contain small bowel. Other contents can include the appendix and cecum, and rarely, the sigmoid colon. Sigmoid colon as content of inguinal hernia in children has only been reported twice in literature, and in both cases it was unilateral. We present the first reported case of bilateral inguinal hernias containing the sigmoid colon in a premature boy, who additionally had the appendix and the cecum in the right hernia. This is also the first reported laparoscopic repair of such a hernia.
Language	English
Publishing date	2021-09-05
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2715451-8
ISSN	2213-5766
ISSN	2213-5766
DOI	10.1016/j.epsc.2021.102023
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Article: Necrotizing enterocolitis following diazoxide therapy for persistent neonatal hypoglycemia.

Theodorou, Christina M / Hirose, Shinjiro

Journal of pediatric surgery case reports

2019 Volume 52

Abstract: Recalcitrant neonatal hypoglycemia poses a treatment challenge for clinicians. When a patient's hypoglycemia does not respond to dextrose infusion, several medication options are available, including diazoxide(1,2). Several side effects of diazoxide are ... ...

Abstract	Recalcitrant neonatal hypoglycemia poses a treatment challenge for clinicians. When a patient's hypoglycemia does not respond to dextrose infusion, several medication options are available, including diazoxide(1,2). Several side effects of diazoxide are described in the literature, including fluid retention with the risk of development of congestive heart failure(3,4). We describe a case of necrotizing enterocolitis in a patient with Beckwith-Wiedemann Syndrome with persistent neonatal hypoglycemia who was treated with increasing doses of diazoxide.
Language	English
Publishing date	2019-11-21
Publishing country	Netherlands
Document type	Journal Article
ISSN	2213-5766
ISSN	2213-5766
DOI	10.1016/j.epsc.2019.101356
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Article ; Online: Child Abuse and the COVID-19 Pandemic.

Theodorou, Christina M / Brown, Erin G / Jackson, Jordan E / Beres, Alana L

The Journal of surgical research

2022 Volume 276, Page(s) 18–23

Abstract: Introduction: The COVID-19 pandemic has widespread effects, including enhanced psychosocial stressors and stay-at-home orders which may be associated with higher rates of child abuse. We aimed to evaluate rates of child abuse, neglect, and inadequate ... ...

Abstract	Introduction: The COVID-19 pandemic has widespread effects, including enhanced psychosocial stressors and stay-at-home orders which may be associated with higher rates of child abuse. We aimed to evaluate rates of child abuse, neglect, and inadequate supervision during the COVID-19 pandemic. Methods: Patients ≤5 y old admitted to a level one pediatric trauma center between 3/19/20-9/19/20 (COVID-era) were compared to a pre-COVID cohort (3/19/19-9/19/19). The primary outcome was the rate of child abuse, neglect, or inadequate supervision, determined by Child Protection Team and Social Work consultations. Secondary outcomes included injury severity score (ISS), mortality, and discharge disposition. Results: Of 163 total COVID-era pediatric trauma patients, 22 (13.5%) sustained child abuse/neglect, compared to 17 of 206 (8.3%) pre-COVID era patients (P = 0.13). The ISS was similar between cohorts (median 9 pre-COVID versus 5 COVID-era, P = 0.23). There was one mortality in the pre-COVID era and none during COVID (P = 0.45). The rate of discharge with someone other than the primary caregiver at time of injury was significantly higher pre-COVID (94.1% versus 59.1%, P = 0.02). In addition, foster family placement rate was twice as high pre-COVID (50.0% versus 22.7%, P = 0.10). Conclusions: The rate of abuse/neglect among young pediatric trauma patients during COVID did not differ compared to pre-pandemic, but discharge to a new caregiver was significantly lower. While likely multifactorial, this data suggests that resources during COVID may have been limited and the clinical significance of this is concerning. Larger studies are warranted to further evaluate COVID-19's effect on this vulnerable population.
MeSH term(s)	COVID-19/epidemiology ; Child ; Child Abuse ; Humans ; Pandemics ; Retrospective Studies ; SARS-CoV-2 ; Trauma Centers
Language	English
Publishing date	2022-02-25
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.02.039
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Zs.A 178: Show issues

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Article ; Online: Traumatic Abdominal Wall Hernia in Children: A Systematic Review.

Theodorou, Christina M / Stokes, Sarah C / Beres, Alana L

The Journal of surgical research

2021 Volume 262, Page(s) 181–189

Abstract: Background: Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature ... ...

Abstract	Background: Traumatic abdominal wall hernia (TAWH) in children is an uncommon injury and most commonly occurs after blunt abdominal trauma. There is no consensus on the management of these rare cases. We performed a systematic review of the literature to describe injuries, management, and outcomes. Materials and methods: Following Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, a systematic literature search of PubMed, Web of Science, Embase, and Google Scholar was performed to identify English-language publications of blunt TAWH in patients <18 y old. Conflicts were resolved by consensus. Data were collected on demographics, associated injuries, management, and outcomes. Results: A total of 71 articles were reviewed with 100 cases of TAWH. A total of 82.5% of patients were male, and the median age was 9 y old (range 2-15). Injury by bicycle handlebars was most common (72%) followed by motor vehicle collision (14%). Forty patients had intraabdominal injuries, most commonly bowel (70%) or mesentery (37.5%). Rate of intraabdominal injury was significantly higher in patients with injuries due to nonbicycle handlebar injuries when compared with bicycle handlebar injuries (60.7% versus 33.3%, P = 0.02). Most patients were managed operatively (85%), most commonly via laparotomy (68/85, 80%), with six laparoscopic repairs and five laparoscopic converted to open repairs. There were three reported complications and no recurrences over a median of follow-up of 5 mo in patients who underwent repair. Conclusions: Pediatric TAWH is a rare injury with a high rate of intraabdominal injuries, particularly when due to high-impact mechanisms such as motor vehicle collision. Although open repair is more commonly performed, laparoscopic repair has been described with success. Recurrence rates appear low, but follow-up has been short term.
MeSH term(s)	Abdominal Injuries/diagnosis ; Abdominal Injuries/surgery ; Adolescent ; Child ; Child, Preschool ; Female ; Hernia, Abdominal/diagnosis ; Hernia, Abdominal/surgery ; Humans ; Laparoscopy ; Male ; Postoperative Complications/epidemiology ; Recurrence
Language	English
Publishing date	2021-02-15
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Systematic Review
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2020.12.068
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Zs.A 178: Show issues

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Article ; Online: Variations in Perceptions of Postoperative Opioid Need for Pediatric Surgical Patients.

Stokes, Sarah C / Theodorou, Christina M / Brown, Erin G / Saadai, Payam

JAMA surgery

2021 Volume 156, Issue 9, Page(s) 885–887

MeSH term(s)	Adolescent ; Analgesics, Opioid/therapeutic use ; Child ; Humans ; Pain, Postoperative/drug therapy ; Practice Patterns, Nurses'/statistics & numerical data ; Practice Patterns, Physicians'/statistics & numerical data ; Surveys and Questionnaires ; United States
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2021-06-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2021.2076
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Article ; Online: Increased mortality in very young children with traumatic brain injury due to abuse: A nationwide analysis of 10,965 patients.

Theodorou, Christina M / Nuño, Miriam / Yamashiro, Kaeli J / Brown, Erin G

Journal of pediatric surgery

2021 Volume 56, Issue 6, Page(s) 1174–1179

Abstract: Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher ... ...

Abstract	Background: Traumatic brain injury (TBI) is the leading cause of death and disability in young children; however, the impact of mechanism on outcomes has not been fully evaluated. We hypothesized that children with TBI due to abuse would have a higher mortality than children with accidental TBI due to motor vehicle collisions (MVC). Methods: We performed a retrospective review of the National Kids' Inpatient (KID) hospitalizations database of children <2 years old with TBI due to abuse or MVC (2000-2016). The primary outcome was mortality. Secondary outcomes were length of stay (LOS) and hospital charges. We investigated predictors of mortality with multivariable regression. Results: Of 10,965 children with TBI, 65.2% were due to abuse. Overall mortality was 9.8% (n = 1074). Abused children had longer LOS (5.7 vs 1.6 days, p < 0.0001) and higher hospital charges ($34,314 vs $19,360, p < 0.0001) than children with TBI due to MVC. The odds of mortality were 42% higher in children with abusive head trauma (OR 1.42, 95% CI 1.10-1.83, p = 0.007) compared to MVCs after adjusting for age, race, sex, neurosurgical intervention, injury severity, and insurance. Conclusion: Children with abusive traumatic brain injury have increased risk of mortality, longer LOS, and higher hospital charges compared to children with TBI due to motor vehicle collision after adjusting for relevant confounders. Resources must be directed at prevention and early identification of abuse.
MeSH term(s)	Brain Injuries, Traumatic/epidemiology ; Brain Injuries, Traumatic/etiology ; Child ; Child, Preschool ; Hospital Charges ; Hospitalization ; Humans ; Length of Stay ; Retrospective Studies
Language	English
Publishing date	2021-02-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2021.02.044
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Zs.A 607: Show issues

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Article ; Online: Additional prophylactic antibiotics do not decrease surgical site infection rates in pediatric patients with appendicitis and cholecystitis.

Stokes, Sarah C / Theodorou, Christina M / Brown, Erin G

Journal of pediatric surgery

2020 Volume 56, Issue 10, Page(s) 1718–1722

Abstract: Background: Administration of antibiotics within an hour of incision is a common quality metric for reduction of surgical site infections (SSI). Many pediatric patients who undergo surgery for an acute intraabdominal infection are already receiving ... ...

Abstract	Background: Administration of antibiotics within an hour of incision is a common quality metric for reduction of surgical site infections (SSI). Many pediatric patients who undergo surgery for an acute intraabdominal infection are already receiving treatment antibiotics. For these patients, we hypothesized that additional prophylactic antibiotic coverage would not decrease rates of SSI. Methods: Single institution retrospective review of patients <18 years old undergoing appendectomy or cholecystectomy 7/2014-7/2019. Patients were categorized based on administration of an additional prophylactic antibiotic to cover gram positive bacteria within an hour of incision. The primary outcome was SSI. Secondary outcomes were Clostridium difficile colitis, intraoperative allergic reaction and readmission within 30 days due to infection. Results: Of 363 patients, 261 received pre-operative prophylactic antibiotics and 92 received treatment antibiotics only. There was no difference in rates of organ space SSI (4.3% no prophylaxis vs 4.4% prophylaxis, p = 0.97) or superficial SSI (1.1% no prophylaxis vs. 0.7% prophylaxis, p>0.999). One patient who received prophylactic antibiotics was readmitted on post-operative day 29 with C. difficile colitis. There was no difference in rates of intraoperative allergic reaction or readmission. Conclusion: In pediatric patients receiving treatment antibiotics for acute intraabdominal infection, additional prophylactic antibiotics may not reduce SSIs.
MeSH term(s)	Adolescent ; Anti-Bacterial Agents/therapeutic use ; Antibiotic Prophylaxis ; Appendicitis/complications ; Appendicitis/drug therapy ; Appendicitis/surgery ; Child ; Cholecystitis ; Clostridioides difficile ; Humans ; Retrospective Studies ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2020-11-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2020.11.014
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Zs.A 607: Show issues

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Article ; Online: Routine chest X-rays after pigtail chest tube removal rarely change management in children.

Theodorou, Christina M / Hegazi, Mennatalla S / Moore, Hope Nicole / Beres, Alana L

Pediatric surgery international

2021 Volume 37, Issue 10, Page(s) 1447–1451

Abstract: Background: The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of ...

Abstract	Background: The need for chest X-rays (CXR) following large-bore chest tube removal has been questioned; however, the utility of CXRs following removal of small-bore pigtail chest tubes is unknown. We hypothesized that CXRs obtained following removal of pigtail chest tubes would not change management. Methods: Patients < 18 years old with pigtail chest tubes placed 2014-2019 at a tertiary children's hospital were reviewed. Exclusion criteria were age < 1 month, death or transfer with a chest tube in place, or pigtail chest tube replacement by large-bore chest tube. The primary outcome was chest tube reinsertion. Results: 111 patients underwent 123 pigtail chest tube insertions; 12 patients had bilateral chest tubes. The median age was 5.8 years old. Indications were pneumothorax (n = 53), pleural effusion (n = 54), chylothorax (n = 6), empyema (n = 5), and hemothorax (n = 3). Post-pull CXRs were obtained in 121/123 cases (98.4%). The two children without post-pull CXRs did not require chest tube reinsertion. Two patients required chest tube reinsertion (1.6%), both for re-accumulation of their chylothorax. Conclusions: Post-pull chest X-rays are done nearly universally following pigtail chest tube removal but rarely change management. Providers should obtain post-pull imaging based on symptoms and underlying diagnosis, with higher suspicion for recurrence in children with chylothorax.
MeSH term(s)	Change Management ; Chest Tubes ; Child ; Child, Preschool ; Humans ; Pneumothorax/diagnostic imaging ; Pneumothorax/etiology ; Retrospective Studies ; Thoracostomy ; X-Rays
Language	English
Publishing date	2021-06-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	632773-4
ISSN	1437-9813 ; 0179-0358
ISSN (online)	1437-9813
ISSN	0179-0358
DOI	10.1007/s00383-021-04951-w
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