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  1. Article ; Online: Strategies in liver Trauma.

    Duron, Vincent / Stylianos, Steven

    Seminars in pediatric surgery

    2020  Volume 29, Issue 4, Page(s) 150949

    Abstract: The management of pediatric liver trauma has evolved significantly over the last few decades. While surgical intervention was frequently and mostly unsuccessfully practiced during the first half of the last century, the 1960s were witness to the birth ... ...

    Abstract The management of pediatric liver trauma has evolved significantly over the last few decades. While surgical intervention was frequently and mostly unsuccessfully practiced during the first half of the last century, the 1960s were witness to the birth and gradual acceptance of non-operative management of these injuries. In 2000, the American Pediatric Surgical Association (APSA) Trauma Committee disseminated evidenced-based guidelines to help guide the non-operative management of pediatric blunt solid organ injury. The guidelines significantly contributed to conformity in the management of these patients. Since then, a number of well-designed studies have questioned the strict categorization of these injuries and have led to a renewed reliance on clinical signs of the patient's hemodynamic status. In 2019, APSA introduced an updated set of guidelines emphasizing the use of physiologic status rather than radiologic grade as a driver of clinical decision making for these injuries. This review will focus on liver injuries, in particular blunt injury, as this mechanism is by far the most commonly seen in children. Procedures required when non-operative management fails will be detailed, including surgery, angioembolization, and less commonly employed interventions. Finally, the updated inpatient and post-discharge aspects of care will be reviewed, including hemoglobin monitoring, bedrest, length of hospital stay, and activity restriction.
    MeSH term(s) Child ; Humans ; Liver/injuries ; Liver Diseases/complications ; Liver Diseases/diagnosis ; Liver Diseases/surgery ; Liver Diseases/therapy ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/therapy
    Language English
    Publishing date 2020-07-23
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1133381-9
    ISSN 1532-9453 ; 1055-8586
    ISSN (online) 1532-9453
    ISSN 1055-8586
    DOI 10.1016/j.sempedsurg.2020.150949
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    Zs.A 3544: Show issues Location:
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  2. Article: Neonate with congenital pulmonary airway malformation concurrent with enteric duplication cyst: a case report of a rare anomaly.

    Krishnan, Amit / Schmoke, Nicholas / Nemeh, Christopher / Wu, Yeu Sanz / Duron, Vincent

    Journal of surgical case reports

    2023  Volume 2023, Issue 9, Page(s) rjad502

    Abstract: A congenital pulmonary airway malformation (CPAM) occurring concurrently with an enteric duplication cyst is a rare anomaly. Definitive management for both abnormalities is usually surgical resection. We present the uncommon case of a neonate with a CPAM ...

    Abstract A congenital pulmonary airway malformation (CPAM) occurring concurrently with an enteric duplication cyst is a rare anomaly. Definitive management for both abnormalities is usually surgical resection. We present the uncommon case of a neonate with a CPAM and ileal duplication cyst, including pre-natal and post-natal workup. The patient was brought to the operating room for laparoscopic duplication cyst excision at 3 months of age. The patient returned to the operating room for a thoracoscopic right lower lobectomy at five months of age. This case presents a rare congenital anomaly with the concurrent presentation of a CPAM and enteric duplication cyst, with both being successfully excised minimally invasively.
    Language English
    Publishing date 2023-09-15
    Publishing country England
    Document type Case Reports
    ZDB-ID 2580919-2
    ISSN 2042-8812
    ISSN 2042-8812
    DOI 10.1093/jscr/rjad502
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  3. Article ; Online: Thoracoscopic Excision of Mediastinal Bronchogenic Cysts in Children: A Case Series.

    Schmoke, Nicholas / Porigow, Chloe / Wu, Yeu Sanz / Alexander, Matthew / Chalphin, Alexander V / Rothenberg, Steven / Duron, Vincent

    Journal of laparoendoscopic & advanced surgical techniques. Part A

    2024  

    Abstract: Background: ...

    Abstract Background:
    Language English
    Publishing date 2024-02-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1381909-4
    ISSN 1557-9034 ; 1092-6429
    ISSN (online) 1557-9034
    ISSN 1092-6429
    DOI 10.1089/lap.2023.0385
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    Zs.A 3246: Show issues Location:
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  4. Article: Pilot randomized controlled trial of restricted versus liberal crystalloid fluid management in pediatric post-operative and trauma patients.

    Duron, Vincent P / Ichinose, Rika / Stewart, Latoya A / Porigow, Chloe / Fan, Weijia / Rubsam, Jeanne M / Stylianos, Steven / Dorrello, Nicolino V

    Pilot and feasibility studies

    2023  Volume 9, Issue 1, Page(s) 185

    Abstract: Background: Intravenous (IV) fluid therapy is essential in the treatment of critically ill pediatric surgery and trauma patients. Recent studies have suggested that aggressive fluids may be detrimental to patients. Prospective studies are needed to ... ...

    Abstract Background: Intravenous (IV) fluid therapy is essential in the treatment of critically ill pediatric surgery and trauma patients. Recent studies have suggested that aggressive fluids may be detrimental to patients. Prospective studies are needed to compare liberal to restricted fluid management in these patients. The primary objective of this pilot trial is to test study feasibility-recruitment and adherence to the study treatment algorithm.
    Methods: We conducted a two-part pilot randomized controlled trial (RCT) comparing liberal to restricted crystalloid fluid management in 50 pediatric post-operative (1-18 years) and trauma (1-15 years) patients admitted to our pediatric intensive care unit (PICU). Patients were randomized to a high (liberal) volume or low (restricted) volume algorithm using unblinded, blocked randomization. A revised treatment algorithm was used after the 29th patient for the second part of the RCT. The goal of the trial was to determine the feasibility of conducting an RCT at a single site for recruitment and retention. We also collected data on the safety of study interventions and clinical outcomes, including pulmonary, infectious, renal, post-operative, and length of stay outcomes.
    Results: Fifty patients were randomized to either liberal (n = 26) or restricted (n = 24) fluid management strategy. After data was obtained on 29 patients, a first study analysis was performed. The volume of fluid administered and triggers for intervention were adapted to optimize the treatment effect and clarity of outcomes. Updated and refined fluid management algorithms were created. These were used for the second part of the RCT on patients 30-50. During this second study period, 54% (21/39, 95% CI 37-70%) of patients approached were enrolled in the study. Of the patients enrolled, 71% (15/21, 95% CI 48-89%) completed the study. This met our a priori recruitment and retention criteria for success. A data safety monitoring committee concluded that no adverse events were related to study interventions. Although the study was not powered to detect differences in outcomes, after the algorithm was revised, we observed a non-significant trend towards improved pulmonary outcomes in patients on the restricted arm, including decreased need for and time on oxygen support and decreased need for mechanical ventilation.
    Conclusion: We demonstrated the feasibility and safety of conducting a single-site RCT comparing liberal to restricted crystalloid fluid management in critically ill pediatric post-operative and trauma patients. We observed trends in improved pulmonary outcomes in patients undergoing restricted fluid management. A definitive multicenter RCT comparing fluid management strategies in these patients is warranted.
    Trial registration: ClinicalTrials.gov, NCT04201704 . Registered 17 December 2019-retrospectively registered.
    Language English
    Publishing date 2023-11-08
    Publishing country England
    Document type Journal Article
    ZDB-ID 2809935-7
    ISSN 2055-5784
    ISSN 2055-5784
    DOI 10.1186/s40814-023-01408-w
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  5. Article ; Online: Management of fetal head and neck masses: Evaluation of prenatal factors associated with airway obstruction and decision for definitive airway and ex-utero intrapartum treatment at birth.

    Schmoke, Nicholas / Nemeh, Christopher / Wu, Yeu Sanz / Wilken, Terri / Wang, Pengchen / Kurlansky, Paul / Maddocks, Alexis / Nhan-Chang, Chia-Ling / Miller, Russell / Simpson, Lynn L / Duron, Vincent

    Prenatal diagnosis

    2024  

    Abstract: Objective: Fetal head and neck masses can result in critical airway obstruction. Our study aimed to evaluate prenatal factors associated with the decision for a definitive airway, including ex-utero intrapartum treatment (EXIT), at birth among at-risk ... ...

    Abstract Objective: Fetal head and neck masses can result in critical airway obstruction. Our study aimed to evaluate prenatal factors associated with the decision for a definitive airway, including ex-utero intrapartum treatment (EXIT), at birth among at-risk fetuses.
    Methods: A single-institution retrospective review evaluated all fetal head and neck masses prenatally diagnosed from 2005 to 2023. The primary outcome was the decision for a definitive airway at birth, including intubation, tracheostomy, or EXIT.
    Results: Thirty four patients were included, with 23 deliveries occurring at our institution. 8/23 (35%) patients received a definitive airway at birth, six underwent an EXIT procedure, and two required intubation only. Patients who received a definitive airway had higher rates of polyhydramnios (50% vs. 7%, p = 0.03), tracheal narrowing on ultrasound (US) (50% vs. 0%, p = 0.01), tracheal displacement on US (63% vs. 0%, p < 0.01), abnormal fetal breathing on US (50% vs. 0%, p = 0.01), tracheal narrowing or displacement on magnetic resonance imaging (MRI) (75% vs. 7%, p < 0.01), and larger mass maximum diameter (7.9 vs. 4.3 cm, p = 0.02). In our series, 100% of patients with polyhydramnios, tracheal narrowing or displacement on either US or MRI, and abnormal fetal breathing on US received a definitive airway at birth.
    Conclusion: Prenatal findings of tracheal narrowing or displacement, polyhydramnios, and abnormal fetal breathing are strongly associated with the decision for a definitive airway at birth and warrant mobilization of appropriate resources.
    Language English
    Publishing date 2024-05-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 82031-3
    ISSN 1097-0223 ; 0197-3851
    ISSN (online) 1097-0223
    ISSN 0197-3851
    DOI 10.1002/pd.6586
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    Zs.A 1625: Show issues Location:
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  6. Article ; Online: Hybrid lung lesions in children with segmental infantile hemangiomas, a new association?

    Modiri, Omeed / Malick, Mahavrat Shaheen S / Scollan, Margaret E / Duron, Vincent / Morel, Kimberly / Middlesworth, William / Garzon, Maria C

    Pediatric dermatology

    2022  Volume 40, Issue 1, Page(s) 144–147

    Abstract: Infantile hemangiomas (IHs) are the most common tumors of infancy and, in rare instances, can present in the setting of congenital structural anomalies or as part of syndromic disorders. In this study, we present three cases of children with segmental ... ...

    Abstract Infantile hemangiomas (IHs) are the most common tumors of infancy and, in rare instances, can present in the setting of congenital structural anomalies or as part of syndromic disorders. In this study, we present three cases of children with segmental IHs born with concurrent pulmonary anomalies: congenital pulmonary airway malformations and bronchopulmonary sequestration. To date, no known association between these entities and hemangiomas has been described.
    MeSH term(s) Humans ; Child ; Infant ; Hemangioma/complications ; Hemangioma/diagnosis ; Hemangioma/pathology ; Hemangioma, Capillary/complications ; Lung/pathology
    Language English
    Publishing date 2022-09-04
    Publishing country United States
    Document type Case Reports
    ZDB-ID 605539-4
    ISSN 1525-1470 ; 0736-8046
    ISSN (online) 1525-1470
    ISSN 0736-8046
    DOI 10.1111/pde.15123
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    Zs.A 1882: Show issues Location:
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  7. Article ; Online: Prenatal ultrasound-and MRI-based imaging predictors of respiratory symptoms at birth for congenital lung malformations.

    Gerall, Claire / Chumdermpadestuk, Ritah / Jacobs, Shimon / Weijia, Fan / Maddocks, Alexis / Ayyala, Rama / Miller, Russell / Simpson, Lynn / Rothenberg, Steven / Duron, Vincent

    Journal of pediatric surgery

    2022  Volume 58, Issue 3, Page(s) 420–426

    Abstract: Background: Congenital lung malformations (CLM) are rare developmental anomalies of the fetal lung with a minority of patients exhibiting symptoms around the time of birth. Although ultrasound remains the gold standard, fetal MRI has recently been ... ...

    Abstract Background: Congenital lung malformations (CLM) are rare developmental anomalies of the fetal lung with a minority of patients exhibiting symptoms around the time of birth. Although ultrasound remains the gold standard, fetal MRI has recently been incorporated as an adjunct imaging modality in the workup and prenatal counseling of patients with CLM as it is thought to more accurately delineate lesion boundaries and diagnose lesion type. We evaluate what prenatal variables correlate with postnatal respiratory symptoms.
    Methods: We performed a retrospective review of patients with prenatal diagnosis of CLM treated at our institution between 2006-2020. Fetal ultrasound and magnetic resonance imaging (MRI) parameters including maximal congenital pulmonary airway malformation volume ratio (CVR), absolute cyst volume, and observed to expected normal fetal lung volume (O/E NFLV) were correlated with outcomes including postnatal respiratory symptoms, need for supplementary oxygen or mechanical ventilation, delay in tolerating full feeds, resection in the neonatal period.
    Results: Our study included 111 patients, all of whom underwent fetal ultrasound with 64 patients additionally undergoing fetal MRI. Postnatal respiratory symptoms were noted in 22.5% of patients, 19.8% required supplemental oxygen, 2.7% mechanical ventilation and two patients requiring urgent resection. Ultrasound parameters including absolute cyst volume and maximal CVR correlated with need for mechanical ventilation (p=0.034 and p=0.024, respectively) and for urgent resection (p=0.018 and p=0.023, respectively) and had a marginal association with postnatal respiratory symptoms (p=0.050 and p=0.052). Absolute cyst volume became associated with postnatal respiratory symptoms (p=0.017) after multivariable analysis controlling for maternal steroid administration and gestational age. O/E NFLV did not correlate with perinatal outcomes.
    Conclusion: We have found that ultrasound-based measurements correlate with postnatal respiratory symptoms, while MRI derived O/E NFLV does not. Further studies are needed to elucidate the role of MRI in the prenatal workup of congenital lung malformations.
    Type of study: Study of Diagnostic Test.
    Level of evidence: Level I.
    MeSH term(s) Pregnancy ; Infant, Newborn ; Female ; Humans ; Lung/abnormalities ; Lung Diseases/congenital ; Respiratory System Abnormalities/diagnostic imaging ; Respiratory System Abnormalities/surgery ; Ultrasonography, Prenatal/methods ; Magnetic Resonance Imaging/methods ; Retrospective Studies
    Language English
    Publishing date 2022-09-21
    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.2022.08.026
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  8. Article ; Online: Primary gastrojejunostomy tube placement using laparoscopy with endoscopic assistance: A novel technique.

    Gerall, Claire / Mencin, Ali-Andre / DeFazio, Jennifer / Griggs, Cornelia / Kabagambe, Sandra / Duron, Vincent

    Journal of pediatric surgery

    2020  Volume 56, Issue 2, Page(s) 412–416

    Abstract: Background: Gastrojejunostomy (GJ) tubes are commonly used to provide postpyloric enteral nutrition in pediatric patients who cannot tolerate gastric feeds. Most techniques depend on a preexisting gastrostomy tube (GT) site to convert to a ... ...

    Abstract Background: Gastrojejunostomy (GJ) tubes are commonly used to provide postpyloric enteral nutrition in pediatric patients who cannot tolerate gastric feeds. Most techniques depend on a preexisting gastrostomy tube (GT) site to convert to a gastrojejunostomy. Several minimally invasive techniques have been described; however, their risk profile varies widely.
    Description of the operative technique: We present a technique for primary laparoscopic GJ tube placement that minimizes the risk of hollow viscus injury and the use of fluoroscopy through endoscopic assistance.
    Results: Eleven GJ tubes were placed using this technique in patients ranging from 5 months to 17 years of age and weighing 6.3 to 46.0 kg. Endoscopy through the gastrostomy site allowed direct visualization of wire and tube placement. There were no intraoperative or postoperative complications within 30 days of operation. Use of fluoroscopy was limited with minimal total radiation exposure.
    Conclusion: The described technique of laparoscopic primary gastrojejunostomy tube placement with endoscopic assistance was associated with a low complication rate and minimal use of fluoroscopy.
    Level of evidence: IV.
    MeSH term(s) Child ; Enteral Nutrition ; Gastric Bypass ; Gastrostomy ; Humans ; Intubation, Gastrointestinal ; Laparoscopy
    Language English
    Publishing date 2020-11-05
    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.2020.10.012
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  9. Article ; Online: Congenital Heart Disease with Congenital Diaphragmatic Hernia: Surgical Decision Making and Outcomes.

    Stewart, Latoya A / Hernan, Rebecca R / Mardy, Christopher / Hahn, Eunice / Chung, Wendy K / Bacha, Emile A / Krishnamurthy, Ganga / Duron, Vincent P / Krishnan, Usha S

    The Journal of pediatrics

    2023  Volume 260, Page(s) 113530

    Abstract: Objective: To describe the types of congenital heart disease (CHD) in a congenital diaphragmatic hernia (CDH) cohort in a large volume center and evaluate surgical decision making and outcomes based on complexity of CHD and associated conditions.: ... ...

    Abstract Objective: To describe the types of congenital heart disease (CHD) in a congenital diaphragmatic hernia (CDH) cohort in a large volume center and evaluate surgical decision making and outcomes based on complexity of CHD and associated conditions.
    Study design: A retrospective review of patients with CHD and CDH diagnosed by echocardiogram between 01/01/2005 and 07/31/2021. The cohort was divided into 2 groups based on survival at discharge.
    Results: Clinically important CHD was diagnosed in 19% (62/326) of CDH patients. There was 90% (18/20) survival in children undergoing surgery for both CHD and CDH as neonates, and 87.5 (22/24) in those undergoing repair initially for CDH alone. A genetic anomaly identified on clinical testing was noted in 16% with no significant association with survival. A higher frequency of other organ system anomalies was noted in nonsurvivors compared with survivors. Nonsurvivors were more likely to have unrepaired CDH (69% vs 0%, P < .001) and unrepaired CHD (88% vs 54%, P < .05), reflecting a decision not to offer surgery.
    Conclusions: Survival was excellent in patients who underwent repair of both CHD and CDH. Patients with univentricular physiology have poor survival and this finding should be incorporated into pre and postnatal counseling about eligibility for surgery. In contrast, patients with other complex lesions including transposition of the great arteries have excellent outcomes and survival at 5 years follow-up at a large pediatric and cardiothoracic surgical center.
    MeSH term(s) Infant, Newborn ; Humans ; Child ; Hernias, Diaphragmatic, Congenital/complications ; Transposition of Great Vessels/complications ; Survival Rate ; Heart Defects, Congenital/complications ; Retrospective Studies ; Decision Making
    Language English
    Publishing date 2023-05-31
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 3102-1
    ISSN 1097-6833 ; 0022-3476
    ISSN (online) 1097-6833
    ISSN 0022-3476
    DOI 10.1016/j.jpeds.2023.113530
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  10. Article ; Online: Postpyloric Feeding Access in Infants and Children: A State of the Art Review.

    Jazayeri, Amir / McConnie, Randolph M / Ross, Albert M / Montijo-Barrios, Ericka / Ballengee Menchini, Cortney / Tulin-Silver, Sheryl / Duron, Vincent / Walsh, Catharine M / Lerner, Diana G / Mencin, Ali

    Journal of pediatric gastroenterology and nutrition

    2022  Volume 75, Issue 3, Page(s) 237–243

    Abstract: Achieving postpyloric feeding access is a clinical challenge faced by the pediatric gastroenterologist in everyday practice. Currently, there is limited literature published on the topic. This article provides a practical summary of the literature on the ...

    Abstract Achieving postpyloric feeding access is a clinical challenge faced by the pediatric gastroenterologist in everyday practice. Currently, there is limited literature published on the topic. This article provides a practical summary of the literature on the different methods utilized to achieve postpyloric feeding access including bedside, fluoroscopic, endoscopic and surgical options. Indications and complications of these methods are discussed as well as a general approach to infants and children that require intestinal feeding.
    MeSH term(s) Child ; Enteral Nutrition ; Fluoroscopy ; Humans ; Infant ; Intubation, Gastrointestinal
    Language English
    Publishing date 2022-08-09
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 603201-1
    ISSN 1536-4801 ; 0277-2116
    ISSN (online) 1536-4801
    ISSN 0277-2116
    DOI 10.1097/MPG.0000000000003518
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