Quick Literature Updates Ep 27
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Key Takeaways
- Preoperative rigid bronchoscopy has limited predictive value for post-op tracheomalacia in EA patients (50% sensitivity, 67% specificity).
- Post-NEC intestinal strictures occur commonly after conservative management; all required primary resection and anastomosis in this series.
- Expectant management is non-inferior to early ibuprofen for PDA in preterm infants, with lower BPD and mortality rates observed.
- Routine preoperative TBS before EA repair may not justify its use solely for predicting postoperative tracheomalacia development.
- Conservative NEC management requires vigilant follow-up for stricture development; 19% of conservatively managed patients needed delayed surgery.
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Hello pediatric surgery family, I'm Em Gdy from Cincinnati Children's Hospital Medical Center, and today our team is gonna deliver the articles that you should know about. We have 3 papers today, but don't have much time, so let's start. Our first paper titled The Value of Preoperative rigid tracheobronchoscopy for the diagnosis of tracheomalacia in esophageal atresia Patients by Van Haal et al. This paper is summarized by Lizzie Lee, a physician associate by profession and a member of our team here at Cincinnati Children's dedicated to creating content for pediatric surgery. This retrospective cohort study in the Netherlands included 79 patients who had a rigid tracheal bronchoscopy, abbreviated TBS, done before and after esophageal atresia surgery. They wanted to know whether TBS is useful for diagnosing tracheomalacia and whether tracheomalacia worsens after the surgical repair. Results showed that the pre-op TBS for the presence of post-op tracheomalacia had a sensitivity of 50% and a specificity of 67%. This shows that pre-op TBS, though routine, has limited predictive value for post-op tracheomalacia. Our second paper is Conservative Management of Necrotizing Entercolitis in Newborns. Incidence and Management of Intestinal Strictures by Mina et al. and this paper is summarized by Alex Halpern. He is a research fellow at Children's National and collaborates with us to produce these article reviews. To try and answer this question, men et al. performed the retrospective review of all patients who underwent conservative management of modified Bell stage 2A or greater neck at a single institution from 2011 to 2022. They found that 126 patients underwent conservative management of neck, and 24 of those patients eventually underwent surgery for a post-neck stricture. Primary resection and anastomosis was performed in all cases. So it seems like post-neck strictures are a common occurrence after conservative management of neck. Let's move to the last paper of the day. Expectant Management or Early ibuprofen for patent ductus arteriosis by Huncheid et al. This paper is summarized by Cecilia Ina. She's one of the previous research fellows at Cincinnati Children's Hospital. This is a multi-center non-inferiority trial that compared preterm infants treated with expectant management versus early ibuprofen for PDA. They had 273 infants. 136 were treated with expectant management and 137 with early ibuprofen. In the expectant management group, they got 17.6% of necrotizing enterocolitis, 33% of bronchopulmonary dysplasia. And 14% of death rates, whereas in the ibuprofen group, they got 15.4% of necrotizing enterocolitis, 50% of bronchopulmonary dysplasia, and 80% of death rates. So it seems that expectant management is not inferiority that early ibuprofen in preterm patients with PDA. Thank you for listening. Please check the link in the description below to read each paper. We hope you liked this episode. Please follow Stay Current MD on social media, give us a rating, and subscribe to our YouTube channel. And don't forget to download the Stay Current app on the App Store or Play Store for tons of content.