Current Issue : October - December Volume : 2020 Issue Number : 4 Articles : 6 Articles
There is very little published literature and none that discussed care in a neonate regarding\nanesthetic risk and management of neonate with congenital bronchobiliary fistula during thoracoscopy and\nthoracotomy. This article analyzes related risk factors and literature review from perioperative ventilation, circulation\nand other aspects of management.\nCase presentation: A neonate diagnosed as congenital bronchobiliary fistula combined with severe chemical\npneumonia, consolidation of the lungs, and infection was facing the risk of anaesthesia under thoracoscopy\nexploration surgery, who experiened more than 20 days diagnostic period before operation. Many risk factors have\nled to conversion from minimally invasive surgery to thoracotomy, including persistent hypoxemia, hypercapnia,\ndifficult surgical exposure and extremly difficulty of intraoperative ventilation management. Anesthesia maintenance\nafter conversion to open access remained problematic. Fortunately the patient showed no sign of any adverse CNS\neffects after 4 months of follow-up.\nConclusions: The most prominent anesthesia challenges are hypoxemia, increased airway resistance, impaired\nventilation, and the risk of metabolic acidosis. Close cooperation among the entire neonatal medical team is the\nkey factors in successful management of this rare case....
The COVID-19 pandemic has surprised the entire population. The world has had to face an unprecedented pandemic.\nOnly, Spanish flu had similar disastrous consequences. As a result, drastic measures (lockdown) have been adopted\nworldwide. Healthcare service has been overwhelmed by the extraordinary influx of patients, often requiring high\nintensity of care. Mortality has been associated with severe comorbidities, including chronic diseases. Patients with\nfrailty were, therefore, the victim of the SARS-COV-2 infection. Allergy and asthma are the most prevalent chronic\ndisorders in children and adolescents, so they need careful attention and, if necessary, an adaptation of their regular\ntreatment plans. Fortunately, at present, young people are less suffering from COVID-19, both as incidence and severity.\nHowever, any age, including infancy, could be affected by the pandemic.\nBased on this background, the Italian Society of Pediatric Allergy and Immunology has felt it necessary to provide a\nConsensus Statement. This expert panel consensus document offers a rationale to help guide decision-making in the\nmanagement of children and adolescents with allergic or immunologic diseases....
Furosemide is approved in full term neonates to treat edema associated with congestive\nheart failure, cirrhosis and renal diseases. It is often administered off-label in premature neonates, to treat respiratory\nconditions and at doses greater-than-recommended. We conducted a national survey on behalf of the Neonatal\nPharmacotherapy Study Group of the Italian Society of Neonatology (SIN), to investigate its use in Italian neonatal\nintensive care units (NICUs), in conformity with current guidelines.\nMethods: Between December 2016 and June 2017, a 14-item multiple-choice online questionnaire was sent to all\nNICU directors from the SIN directory.\nGestational age, route of administration, posology, indications, referenced guidelines, adverse effects monitoring\nand the presence of Paediatric Cardiology or Cardiosurgery service on site were assessed. A chi-square test was\nperformed 1) to evaluate differences in the distribution of responses between NICUs administering furosemide at\ndoses higher-than-recommended; 2) to compare the proportion of NICUs administering furosemide at high doses\nin institutions with versus without a Paediatric Cardiology or Cardiosurgery service.\nResults: The response rate was 50% (57/114). The intravenous and oral routes were chosen primarily; the\nintravenous administration in single doses predominated over continuous infusion. Its main therapeutic indications\nwere congestive heart failure/overload (94.7%) and oligo-anuria (87.7%) however furosemide was also frequently\nused for broncopulmonary dysplasia (50.9%) and respiratory distress syndrome and/or transient tachypnea of the\nnewborn (24.6%).\nIn 28/57 NICUs furosemide was administered at doses higher-than-recommended. In most NICUs the same\nposology was used in term and preterm neonates. Compared to the total sample, a larger proportion of NICUs\nadministering doses greater-than-recommended referenced current literature for reasons to do so (19.3 and 32.1%\nrespectively). The presence of a Paediatric Cardiology or Cardiosurgery service on site did not correlate with the\nchosen posology.\nThe majority of NIC...
An epidemiological transition is interesting Sub-Saharan Africa increasing the burden of non-communicable\ndiseases most of which are of surgical interest. Local resources are far from meeting needs and, considering that 50% of the\npopulation is less than 14 years of age, Pediatric surgical coverage is specially affected. Efforts are made to improve standards\nof care and to increase the number of Pediatric surgeons through short-term specialist surgical Missions, facilities supported\nby humanitarian organization, academic Partnership, training abroad of local surgeons. This study is a half term report about\nthree-years Partnership between the University of Chieti- Pescara, Italy and the University of Gezira, Sudan to upgrade\nstandard of care at the Gezira National Centre for Pediatric Surgery (GNCPS) of Wad Medani. Four surgical Teams per year\nvisited GNCPS. The Program was financed by the Italian Agency for Development Cooperation.\nMethods: The state of local infrastructure, current standard of care, analysis of caseload, surgical activity and results are\nreported. Methods utilized to assess local needs and to develop Partnership activities are described.\nResults: Main surgical task of the visiting Team were advancements in Colorectal procedures, Epispadias/Exstrophy Complex\nmanagement and Hypospadias surgery (20% of major surgical procedures at the GNCPS). Intensive care facilities and staff to\nassist more complex cases (i.e. neonates) are still defective. Proctoring, training on the job of junior surgeons, anaesthetists\nand nurses, collaboration in educational programs, advisorship in hospital management, clinical governance, maintenance of\ninfrastructure together with training opportunities in Italy were included by the Program. Despite on-going efforts, actions\nhave not yet been followed by the expected results. More investments are needed on Healthcare infrastructures to increase\nhealth workers motivation and prevent brain drain.\nConclusions: The key role that an Academic Partnership can play, acting through expatriated Teams working in the same\nconstrained contest with the local workforce, must be emphasized. Besides clinical objectives, these types of Global Health\nInitiatives address improvement in management and clinical governance. The main obstacles to upgrade standard of care\nand level of surgery met by the Visiting Team are scarce investments on health infrastructure and a weak staff retention\npolicy, reflecting in poor motivation and low performance....
The thrombocytopenia-absent radius (TAR) syndrome is an autosomal recessive\ndisease characterized by bilateral absence of radius with the presence of\nboth thumbs and thrombocytopenia, many times associated with cardiac\nanomalies, intolerance or allergy to cowâ??s milk and phocomelia. Imaging study\nis important for the correct diagnosis at birth and documentation of one of\nthe diagnosis criteria (absence of radius) in prenatal care. The main hematologic\nsymptoms and the most feared of them, intracranial bleeding, occurs\nwhen platelets levels are below 10,000/mm3, which is more common during\nthe first months. Therefore, imaging study is crucial to quickly identify complications\nand correctly manage the case. In this case report, the patient had\nupper limps alterations at birth and at first week presented seizures, with\ntransfontanellar ultrasound and head computed tomography without contrast\ndemonstrating intracranial hemorrhage. Laboratory results and imaging review\nwere able to diagnose TAR syndrome. The patient was treated with\nplatelets transfusion and thrombocytopenia was solved. She is currently under\nspecialized medical care, with no neurological deficits and showing satisfactory\ndevelopment....
Pulmonary agenesis is a rare congenital abnormality defined\nby the absence of parenchyma, bronchi and pulmonary vessels, frequently\nassociated with other malformations. We describe a case of isolated right\npulmonary agenesis diagnosed in the pediatric ward of the Mali Hospital.\nClinical case: He was a month-old baby boy, born at term by cesarean section\nof a well-followed pregnancy. He was not resuscitated. He developed\ndyspnea after a cold. An emergency chest X-ray revealed a right opaque lung.\nHe was referred to the hospital for the exploration of this opacity. At the entrance,\nit weighed 3910 g, size: 54 cm and the temperature was...................
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