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Article ; Online: The Role of Nitrous Oxide in Minor Pediatric Procedures in the Emergency Department: A Systematic Review.

Veger, Marlies L / van Iterson, Jozua / Bakx, Roel / Ridderikhof, Milan L

2024

Abstract: Background: Pediatric patients undergoing minor, but painful procedures in an Emergency Department (ED) need adequate relief of pain and distress to prevent long term negative effects and adversely impact procedures. Inhaled nitrous oxide (N: Methods!# ...

Abstract	Background: Pediatric patients undergoing minor, but painful procedures in an Emergency Department (ED) need adequate relief of pain and distress to prevent long term negative effects and adversely impact procedures. Inhaled nitrous oxide (N Methods: We searched MEDLINE, Embase, Cochrane and Cinahl databases for controlled trials published in English with pediatric patients in an ED treated with N Results: We included seven studies with a total of 371 patients. Two studies showed N Conclusions: N Level of evidence: IV.
Language	English
Publishing date	2024-01-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2023.12.026
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Article ; Online: Child abuse and neglect in paediatric burns: The majority is caused by neglect and thus preventable.

Loos, Marie-Louise H J / Meij-de Vries, Annebeth / Nagtegaal, Michelle / Bakx, Roel

Burns : journal of the International Society for Burn Injuries

2021 Volume 48, Issue 3, Page(s) 688–697

Abstract: Introduction: It is complex to distinguish negligent burns from inflicted and non-intentional burns, especially since no deliberate action caused the burn. Its recognition is important to create a safe life without (future) burns for our loved-ones who ... ...

Abstract	Introduction: It is complex to distinguish negligent burns from inflicted and non-intentional burns, especially since no deliberate action caused the burn. Its recognition is important to create a safe life without (future) burns for our loved-ones who cannot take care of themselves (yet). Our aim was to investigate the incidence and associated characteristics of negligent burns are among children treated at a burn center. Methods: We retrospectively reviewed medical files of all children attending a Dutch burn center with an acute burn between January 2013-December 2015. The conclusion of the Child Abuse and Neglect team (CAN) was used to define inflicted, negligent or non-intentional burns. The remaining cases were reviewed by an expert panel using a standardized protocol. Demographic and social data as well as clinical information about the burn were collected. Results: In total 330 children were included. Negligent burns accounted for 56%, non-intentional for 42% and inflicted for 2% of the burns. Negligent burns were associated with: hot beverages (OR 4.40, 95%CI 2.75-7.05), a younger age (p < 0.001), occurrence at home (OR 4.87 95%CI 2.80-8.45) and were located at the anterior trunk (OR 2.75, 95%CI 1.73-4.35) and neck (OR 1.98, 95%CI 1.12-3.50). Conclusion: This study shows that neglect is a major factor in the occurrence of burns in young children, therefore we conclude that the majority of paediatric burns are preventable. Educational programs creating awareness and focussing on prevention of these burns should be aimed at households, since the majority of negligent as cause of preventable burns occur at home.
MeSH term(s)	Burn Units ; Burns/epidemiology ; Child ; Child Abuse ; Child, Preschool ; Humans ; Incidence ; Infant ; Retrospective Studies
Language	English
Publishing date	2021-05-21
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	197308-3
ISSN	1879-1409 ; 0305-4179
ISSN (online)	1879-1409
ISSN	0305-4179
DOI	10.1016/j.burns.2021.05.011
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Article ; Online: Implementing Nonoperative Treatment Strategy for Simple Pediatric Appendicitis: A Qualitative Study.

Knaapen, Max / de Wind, Astrid / van der Lee, Johanna H / Bakx, Roel / van Heurn, Ernest Lw / Anema, Johannes R / Gorter, Ramon R

The Journal of surgical research

2022 Volume 279, Page(s) 218–227

Abstract: Introduction: A nonoperative treatment strategy (NOT) with antibiotics for children with simple appendicitis could reduce anesthesia and surgery-related complications. As the implementation of a new treatment in routine clinical practice may take years, ...

Abstract	Introduction: A nonoperative treatment strategy (NOT) with antibiotics for children with simple appendicitis could reduce anesthesia and surgery-related complications. As the implementation of a new treatment in routine clinical practice may take years, this study aims to identify barriers and facilitators for implementation of NOT for children with simple appendicitis. Materials and methods: To identify barriers and facilitators for its implementation, we conducted 14 semistructured interviews and a focus group with health insurance/hospital policymakers, surgical clinicians, and young people-together with their parents-who have been treated surgically or with antibiotics. Transcripts were open coded and categorized as per the framework for healthcare innovations by Fleuren et al. Results: We identified four main themes: (1) Appendicitis is a well-known disease. Children, parents, and clinicians regard appendectomy as routine and safe, making them reluctant toward other treatment options. (2) Clinicians regard uptake of NOT in the national appendicitis guideline necessary for its implementation. (3) For identification of patients best suited for NOT more experience and scientific evidence is needed. (4) Appendectomy and NOT have different risk and benefits making the treatment choice depended on individual patient preferences. Conclusions: By addressing how NOT and operative treatment are regarded by patients and surgeons could have a substantial impact on the implementation of NOT for children with simple appendicitis. Furthermore, the individual preferences of patients need to be taken into account when choosing between operative and NOT. In other words, offering NOT in a shared decision-making model seems the first appropriate step in its implementation.
MeSH term(s)	Adolescent ; Anti-Bacterial Agents/therapeutic use ; Appendectomy ; Appendicitis/drug therapy ; Appendicitis/surgery ; Child ; Humans ; Patient Preference ; Qualitative Research ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2022-07-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.06.011
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Article ; Online: Perianal Abscesses in Infants Are Not Associated With Crohn's Disease in a Surgical Cohort.

Roskam, Mariëlle / de Meij, Tim / Gemke, Reinoud / Bakx, Roel

Journal of Crohn's & colitis

2019 Volume 14, Issue 6, Page(s) 773–777

Abstract: Aims: The aim of this study is to search for an association between infantile perianal abscesses and [development of] Crohn's disease in a surgical population of children.: Methods: Patients who were surgically treated in the Amsterdam UMC between ... ...

Abstract	Aims: The aim of this study is to search for an association between infantile perianal abscesses and [development of] Crohn's disease in a surgical population of children. Methods: Patients who were surgically treated in the Amsterdam UMC between January 2000 and December 2014 were included in this retrospective cohort study. Data collected include: sex, date of birth, underlying conditions, age of onset, additional symptoms, pus cultures, endoscopic examination, histological examination, magnetic resonance imaging, faecal calprotectin levels, antibiotic treatment, surgical treatment strategy, and number of recurrences. Follow-up data were gathered from medical records and by contacting the patients and/or parents or the general practitioner. Results: The study consisted of 62 patients of whom 60 were boys. Median age was 5 months [range 0-17 months]; 92% were under 1 year of age at diagnosis. A minority of patients had accompanying symptoms. In total, 72 abscesses were treated, 19 fistulas and 23 abscesses with fistula-in-ano. Follow-up data of 46 patients [74%] were available; none of the patients developed Crohn's disease. Conclusions: We found no association between isolated perianal abscesses as presenting symptom in early childhood and [development of] Crohn's disease. In young infants with isolated perianal disease, risk for inflammatory bowel disease seems low. In this specific population there seems no place for routine performance of endoscopic investigations. One should always take the risk of very-early-onset inflammatory bowel disease into account. Further research with a larger cohort of children and a longer follow-up time is required.
MeSH term(s)	Abscess/diagnosis ; Abscess/drug therapy ; Abscess/surgery ; Anal Canal/pathology ; Anal Canal/surgery ; Anti-Bacterial Agents/therapeutic use ; Cohort Studies ; Correlation of Data ; Crohn Disease/diagnosis ; Crohn Disease/epidemiology ; Digestive System Surgical Procedures/methods ; Digestive System Surgical Procedures/statistics & numerical data ; Endoscopy/methods ; Female ; Humans ; Infant ; Male ; Netherlands/epidemiology ; Rectal Fistula/diagnosis ; Rectal Fistula/drug therapy ; Rectal Fistula/surgery ; Symptom Assessment/statistics & numerical data ; Unnecessary Procedures
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2019-05-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2390120-2
ISSN	1876-4479 ; 1873-9946
ISSN (online)	1876-4479
ISSN	1873-9946
DOI	10.1093/ecco-jcc/jjz105
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Article ; Online: Enhanced Th17 responses in the appendix of children with complex compared to simple appendicitis are associated with microbial dysbiosis.

The, Sarah-May M L / Schreurs, Renée R C E / Drewniak, Agata / Bakx, Roel / de Meij, Tim G J / Budding, Andries E / Poort, Linda / Cense, Huib A / Heij, Hugo A / van Heurn, L W Ernest / Gorter, Ramon R / Bunders, Madeleine J

Frontiers in immunology

2024 Volume 14, Page(s) 1258363

Abstract: Introduction: Appendicitis is one of the most common causes of acute abdominal surgery in children. The clinical course of appendicitis ranges from simple to complex appendicitis. The mechanisms underlying the heterogeneity of appendicitis in children ... ...

Abstract	Introduction: Appendicitis is one of the most common causes of acute abdominal surgery in children. The clinical course of appendicitis ranges from simple to complex appendicitis. The mechanisms underlying the heterogeneity of appendicitis in children remain largely unclear. Dysregulated T cell responses play an important role in several inflammatory diseases of the intestine, but the extend of T cell dysregulation in appendicitis in children is less well known. Methods: To characterize appendiceal T cells in simple and complex appendicitis we performed in-depth immunophenotyping of appendiceal-derived T cells by flow cytometry and correlated this to appendiceal-derived microbiota analyses of the same patient. Results: Appendix samples of twenty children with appendicitis (n = 8 simple, n = 12 complex) were collected. T cells in complex appendicitis displayed an increased differentiated phenotype compared to simple appendicitis, including a loss of both CD27 and CD28 by CD4 Conclusion: In conclusion, disruption of local T cell responses, and enhanced pro-inflammatory Th17 responses correlating to changes in the appendiceal microbiota were observed in children with complex compared to simple appendicitis. Further studies are needed to decipher the role of a dysregulated network of microbiota and Th17 cells in the development of complex appendicitis in children.
MeSH term(s)	Child ; Humans ; Appendix ; Appendicitis/etiology ; Appendicitis/surgery ; Interleukin-17 ; CD8-Positive T-Lymphocytes ; Th17 Cells ; Dysbiosis/complications
Chemical Substances	Interleukin-17
Language	English
Publishing date	2024-01-04
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2023.1258363
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Article ; Online: Core Outcome Set for Necrotizing Enterocolitis Treatment Trials.

Klerk, Daphne H / van Varsseveld, Otis C / Offringa, Martin / Modi, Neena / Lacher, Martin / Zani, Augusto / Pakarinen, Mikko P / Koivusalo, Antti / Jester, Ingo / Spruce, Marie / Derikx, Joep P M / Bakx, Roel / Ksia, Amine / Kooi, Elisabeth M W / Hulscher, Jan B F

Pediatrics

2024

Abstract: Background and objectives: Variability in outcome reporting in necrotizing enterocolitis (NEC) treatment trials hinders conducting meta-analyses and implementing novel treatments. We aimed to develop a core outcome set (COS) for NEC treatment trials ... ...

Abstract	Background and objectives: Variability in outcome reporting in necrotizing enterocolitis (NEC) treatment trials hinders conducting meta-analyses and implementing novel treatments. We aimed to develop a core outcome set (COS) for NEC treatment trials including outcome measures most relevant to patients and physicians, from NEC diagnosis to adulthood. Methods: Clinicians and/or researchers from low-middle- and high-income countries were approached based on their scientific contributions to NEC literature, and patients and parents through local organizations. We presented participants with 45 outcomes used in NEC research, identified through a systematic review. To achieve consensus, outcomes were rated on a scale of 1 to 9 in 3 online Delphi rounds, and discussed at a final consensus meeting. Results: Seventy-one participants from 25 countries completed all Delphi rounds, including 15 patients and family representatives. Thirteen outcomes reached consensus in one of the stakeholder groups and were included in the consensus meeting, 6 outcomes reached consensus in both groups. Twenty-seven participants from both high- and low-middle-income countries attended the online consensus meeting, including family representatives and NEC patients. After discussion and a final vote, 5 outcomes reached consensus to be included: mortality, NEC-related mortality, short bowel syndrome, quality of life, and neurodevelopmental impairment. Conclusions: This NEC COS includes 5 predominantly long-term outcomes agreed upon by clinicians, patients, and family representatives. Use of this international COS will help standardize outcome selection in clinical trials, ensure these are relevant to those most affected by NEC care, and, ultimately, improve the care of infants with NEC.
Language	English
Publishing date	2024-05-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2023-065619
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Article ; Online: Incidence and characteristics of non-accidental burns in children: A systematic review.

Loos, Marie-Louise H J / Almekinders, Cornelia A M / Heymans, Martijn W / de Vries, Annebeth / Bakx, Roel

Burns : journal of the International Society for Burn Injuries

2020 Volume 46, Issue 6, Page(s) 1243–1253

Abstract: Introduction: The estimated incidence of non-accidental burns varies between 1-25% in children. Distinguishing non-accidental burns from accidental burns can be very complicated but is of utmost importance for prevention of future injuries. Several ... ...

Abstract	Introduction: The estimated incidence of non-accidental burns varies between 1-25% in children. Distinguishing non-accidental burns from accidental burns can be very complicated but is of utmost importance for prevention of future injuries. Several studies concerning non-accidental burns have been published, however a clear overview is lacking. Aim: To conduct a systematic review of the existing literature to identify the incidence and characteristics of burns due to intentional causes and neglect. Methods: The protocol of this systematic review was prospectively registered in an international database (PROSPERO, National Institute for Health Research, York, United Kingdom). We searched literature in electronic databases published from 1948 until July 2018 written in English, Dutch, German and French. Two researchers screened, selected and graded the included articles, using standard methodology. We included primary studies of confirmed non-accidental burns in children. We excluded literature reviews, case-reports and unpublished data. We extracted data regarding demographics, burn characteristics, Child Protective Services (CPS) referral information and parent/household characteristics. Results: 825 studies were screened, 17 were included. The incidence of non-accidental burns was pooled out of 10 studies and is 9.7%. Indicators raising a very high suspicion of intentional burns are deep partial thickness and full thickness burns, burns to the posterior trunk and burns caused by hot tap water. Indicators raising a high to moderate suspicion of an intentional cause are burns to buttocks, genital and legs, a younger age of the child, additional injuries such as cutaneous injuries/bruises and fractures. More commonly caused by accidents are burns to head, neck, anterior trunk, upper extremities and feet. Little data are available regarding burns as a result of neglect. Quality of studies was often low to moderate mostly due to a high heterogeneity. This review is mainly based on retrospective studies. Conclusion: From this review of the literature, the incidence of non-accidental burns in children was 9.7%. Indicators raising a very high suspicion of intentional burns are: location at the posterior trunk, deep partial thickness and full thickness burns and burns caused by hot tap water.
MeSH term(s)	Adolescent ; Burns/epidemiology ; Burns/etiology ; Burns/pathology ; Child ; Child Abuse ; Child Protective Services ; Child, Preschool ; Emergency Service, Hospital ; Humans ; Incidence ; Infant ; Infant, Newborn ; Mortality ; Referral and Consultation ; Torso/injuries
Language	English
Publishing date	2020-02-11
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Systematic Review
ZDB-ID	197308-3
ISSN	1879-1409 ; 0305-4179
ISSN (online)	1879-1409
ISSN	0305-4179
DOI	10.1016/j.burns.2020.01.008
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Article ; Online: Prevalence and distribution of occult fractures on skeletal surveys in children with suspected non-accidental trauma imaged or reviewed in a tertiary Dutch hospital.

Loos, Marie-Louise H J / Ahmed, Tayiba / Bakx, Roel / van Rijn, Rick R

Pediatric surgery international

2020 Volume 36, Issue 9, Page(s) 1009–1017

Abstract: Purpose: The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be ...

Abstract	Purpose: The purpose of the study was to determine the rate of occult fractures (without clinical symptoms) per presenting clinical injury i.e., children presenting with a fracture, bruise, abusive head trauma and the types of fracture most likely to be found, in a series of infants and young children suspected of being victims of NAT. Methods: Skeletal surveys done between 2008 and 2018 of children (< 5 years) were retrospectively analyzed. Both radiographs of admitted children and reassessment images from all over the country were included and reviewed by a forensic paediatric radiologist. Deceased children were excluded. Variables as gender, age, initial clinical injury and occult fractures were collected. Occult fractures on the follow-up skeletal survey were collected. Results: A total of 370 skeletal surveys of 296 children were included. Median age was 22 weeks (IQR 11-48), there were 172 (58%) boys. A total of 195 occult fractures were detected in 111 (32%) children. Occult fractures were detected in 37/126 (29%) children with fracture as presenting symptom, 33/90 (37%) children with head trauma and 26/50 (52%) children with bruises. Rib (n = 56, 50%) and lower leg (n = 40, 36%) fractures were most detected. Conclusion: Occult fractures were detected in 32% of the children. Occult fractures were most prevalent if the initial clinical injury suggestive for NAT to request skeletal survey was a bruise, abusive head trauma or fracture.
MeSH term(s)	Child Abuse/diagnosis ; Child, Preschool ; Female ; Fractures, Bone/diagnosis ; Fractures, Bone/epidemiology ; Fractures, Closed/diagnosis ; Fractures, Closed/epidemiology ; Hospitals/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Male ; Netherlands/epidemiology ; Prevalence ; Radiography/methods ; Retrospective Studies ; Surveys and Questionnaires
Language	English
Publishing date	2020-06-26
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/s00383-020-04706-z
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Article: Trends in Simple and Complex Appendicitis in Children and the Potential Correlation to Common Viral Pathogens-A Retrospective Cohort Study between 2010 and 2019 in The Netherlands.

The, Sarah-May M L / van Amstel, Paul / Noordzij, Sophie M / Bakx, Roel / Bijlsma, Taco S / Derikx, Joep P M / van Heurn, L W Ernest / van der Kuip, Martijn / Gorter, Ramon R

Children (Basel, Switzerland)

2023 Volume 10, Issue 12

Abstract: The aim of this study was to evaluate the annual, seasonal and monthly trends in children with simple and complex appendicitis and their correlation to common viral pathogens in the Netherlands. A consecutive multicenter retrospective cohort study was ... ...

Abstract	The aim of this study was to evaluate the annual, seasonal and monthly trends in children with simple and complex appendicitis and their correlation to common viral pathogens in the Netherlands. A consecutive multicenter retrospective cohort study was performed between 2010 and 2019 including children (<18 years) surgically treated for appendicitis. The primary outcome was the distribution of children with simple and complex appendicitis per year, season and month. Relevant seasonal variation was defined as ≥5%. The secondary outcome was a positive correlation of the number of patients with simple and complex appendicitis to common viral pathogens (data anonymously provided by the Dutch Working Group on Clinical Virology from the Dutch Society for Clinical Microbiology (NVMM)). In total, 896 patients were included: N = 524 (58%) patients with simple and N = 372 (42%) with complex appendicitis. Of the children aged 0-5 years, 81% had complex appendicitis, versus 38% in 6-18 years (
Language	English
Publishing date	2023-12-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2732685-8
ISSN	2227-9067
ISSN	2227-9067
DOI	10.3390/children10121912
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Article ; Online: Appendicitis and its associated mortality and morbidity in infants up to 3 months of age: A systematic review.

The, Sarah-May M L / The, Anne-Fleur M H / Derikx, Joep P M / Bakx, Roel / Visser, Douwe H / de Meij, Tim G J / Ket, Johannes C F / van Heurn, Ernest L W / Gorter, Ramon R

Health science reports

2023 Volume 6, Issue 9, Page(s) e1435

Abstract: Background and aims: Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien-Dindo grades ... ...

Abstract	Background and aims: Although appendicitis is rare in young infants, the reported mortality is high. Primary aim of this systematic review was to provide updated insights in the mortality and morbidity (postoperative complications, Clavien-Dindo grades I-IV) of appendicitis in infants ≤3 months of age. Secondary aims comprised the evaluation of patient characteristics, diagnostic work-up, treatment strategies, comorbidity, and factors associated with poor outcome. Methods: This systematic review was reported according to the PRISMA statement with a search performed in Pubmed, Embase and Web of Science (up to September 5th 2022). Original articles (published in English ≥1980) reporting on infants ≤3 months of age with appendicitis were included. Both patients with abdominal appendicitis and herniated appendicitis (such as Amyand's hernia) were considered. Data were provided descriptively. Results: In total, 131 articles were included encompassing 242 cases after identification of 4294 records. Overall, 184 (76%) of the 242 patients had abdominal and 58 (24%) had herniated appendicitis. Two-hundred (83%) of the patients were newborns (≤28 days) and 42 (17%) were infants between 29 days and ≤3 months of age. Either immediate, or after initial conservative treatment, 236 (98%) patients underwent surgical treatment. Some 168 (69%) patients had perforated appendicitis. Mortality was reported in 20 (8%) patients and morbidity in an additional 18 (8%). All fatal cases had abdominal appendicitis and fatal outcome was relatively more often reported in newborns, term patients, patients with relevant comorbidity, nonperforated appendicitis and those presented from home. Conclusion: Mortality was reported in 20 (8%) infants ≤3 months of age and additional morbidity in 18 (8%). All patients with fatal outcome had abdominal appendicitis. Several patient characteristics were relatively more often reported in infants with poor outcome and adequate monitoring, early recognition and prompt treatment may favour the outcome.
Language	English
Publishing date	2023-09-05
Publishing country	United States
Document type	Journal Article
ISSN	2398-8835
ISSN (online)	2398-8835
DOI	10.1002/hsr2.1435
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