Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

Objective: This study aimed to determine the impact of gestational age (GA) cut-off on the clinical outcome of congenital diaphragmatic hernia (CDH) and assess whether prematurity influences the predictive value of fetal lung volume measurement. Methods: We investigated the medical records of infants with CDH between January 2014 and August 2021. We classified the patients into term CDH (TCDH) and preterm CDH (PCDH) groups and compared their clinical characteristics, including fetal lung volume measured by the observed-toexpected lung-to-head ratio (O/E LHR). Results: Among 145 infants with CDH, 23 (15.9%) were preterm. Mean O/E LHR was significantly higher in survivors than in non-survivors with no difference between TCDH and PCDH groups.Mortality rate was significantly higher in infants with GA <34 weeks (80%) than in late preterm infants (16.7%). O/E LHR, rather than GA <34 weeks, was a risk factor predicting mortality in multivariate analyses. Predictive power of O/E LHR was high in the TCDH and PCDH groups, respectively. The incidence of chronic lung disease did not differ between PCDH and TCDH. Conclusion O/E LHR significantly predicted mortality in preterm infants, suggesting preterm birth alone should not be the determinant of early CDH treatment strategy.

PURPOSE: Recent data suggest that monotherapy with a broad-spectrum antibiotic may be as efficacious as, and potentially less costly than, standard multi-drug therapy. We compared mono-therapy with intravenous piperacillin-tazobactam (PT) with multi-drug therapy with cefotaxime and metronidazole (CM) in aspect of postoperative complications and hospital stay. METHODS: We reviewed the hospital records and medical costs of the pediatric patients who were managed for perforated appendicitis between April 2013 and May 2014 retrospectively. RESULTS: Forty-six patients with laparoscopic appendectomy for perforated appendicitis were included in our study. PT group was 20 and CM group was 26 patients. On admission, there were no significance in sex distribution, duration of symptoms, leukocyte count, and CRP levels. At postoperative third, fifth, and seventh day of each regimen, PT group have no statistical difference with CM group in leukocyte count, percentage of neutrophil, and CRP. There was no difference in abscess formation rate, wound infections, and hospital stay between two groups. There was only one patient who was readmitted with elevation of CRP and leukocyte count in CM group. CONCLUSION: Daily dosing with the mono-therapy of PT offers as efficient as multi-drug therapy of CM. To evaluate the efficacy of broad-spectrum antibiotics monotherapy in perforated appendicitis children, the cohort included more patients should be needed.
Abscess ; Anti-Bacterial Agents ; Appendectomy ; Appendicitis* ; Case-Control Studies* ; Cefotaxime* ; Child* ; Cohort Studies ; Hospital Records ; Humans ; Length of Stay ; Leukocyte Count ; Metronidazole* ; Neutrophils ; Postoperative Complications ; Retrospective Studies ; Sex Distribution ; Wound Infection

PURPOSE: The aim of this study was to evaluate the surgical outcomes of laparoscopic approach for hiatal hernia (HH) in pediatric patients. METHODS: This was a retrospective study of 33 patients younger than 18 years who underwent an operation for HH between January 1999 and December 2012. RESULTS: The HH symptoms were various and included regurgitation, vomiting, weight loss, cough, hoarseness, and cyanosis. Among the 33 patients, there were 25 sliding types, 1 paraesophageal type, and 7 mixed types. Open surgery (OS) and laparoscopic surgery (LS) were used in 16 and 17 patients, respectively. There were no statistically significant differences in sex, age, or body weight between the groups. The median operating time was longer in the LS group (150 minutes; range, 90-250 minutes vs. 125 minutes; range, 66-194 minutes; P = 0.028). Time to oral intake was shorter in the LS group than in the OS group (1 day; range, 1-3 days vs. 2 days; range, 1-7 days; P = 0.001) and time to full feeding was shorter in the LS group than in the OS group (6 days; range, 3-16 days vs. 10 days; range, 3-33 days; P = 0.048). There were no differences in length of hospital stay and complications between the two groups. There was no perioperative mortality or recurrence of HH. CONCLUSION: A good surgical outcome for laparoscopic correction of HH was seen in pediatric patients.
Body Weight ; Child ; Cough ; Cyanosis ; Fundoplication ; Hernia, Hiatal* ; Hoarseness ; Humans ; Laparoscopy ; Length of Stay ; Mortality ; Recurrence ; Retrospective Studies ; Vomiting ; Weight Loss

PURPOSE: The purpose of this study was to compare the diagnostic accuracy of the non-invasive diagnostic methods and rectal suction biopsy for the detection of Hirschsprung disease (HD). METHODS: We reviewed diagnostic methods and results retrospectively in patients who underwent anorectal manometry, barium enema and rectal suction biopsy for the diagnosis of HD at Asan Medical Center from January 2000 to December 2012. RESULTS: There were 97 patients (59 neonates and 38 infants) in the study period. The overall accuracy of anorectal manometry for the diagnosis of HD was 71.1% and its sensitivity was 51.4% (48.1% in neonate and 62.5% in infant, respectively) and its overall specificity was 82.3% (81.3% in neonate and 83.3% in infant, respectively). The Overall accuracy of barium enema was 66.0% (72.8% in neonate and 55.3% in infant, respectively) and specificity of barium enema was 53.2% (56.3% in neonate and 50.0% in infant, respectively). These results were lower than those of anorectal manometry. The overall sensitivity of barium enema was 88.6% (92.6% in neonate and 75.0% in infant, respectively) and it was higher than the sensitivity of anorectal manometry. Histological studies confirmed HD in 35 patients, in one of whom the suction biopsy showed negative finding. CONCLUSION: Accuracy of non-invasive methods for diagnosis of HD in our study is lower than those in previous study, so we need to improve the quality of diagnostic tools in our hospital. We conclude that the rectal suction biopsy is the most accurate test for diagnosing HD, so the biopsy to confirm the diagnosis of the HD is very important.
Barium ; Biopsy ; Chungcheongnam-do ; Diagnosis ; Enema ; Hirschsprung Disease* ; Humans ; Infant ; Infant, Newborn ; Manometry ; Retrospective Studies ; Sensitivity and Specificity ; Suction

PURPOSE: Necrotizing enterocolitis and intestinal perforation are the most common surgical emergency in the neonatal intensive care unit. The purpose of this study is to evaluate if peritoneal drainage (PD) is beneficial in extremely low birth weight infants with intestinal perforation. METHODS: Retrospective cohort study of extremely low birth weight infants with a diagnosis of intestinal perforation. They were received primary PD (n = 23, PD group) or laparotomy (n = 13, LAP group). Laboratory and physiologic data were collected and organ failure scores calculated and compared between preprocedure and postprocedures. Data were analyzed using appropriated statistical tests. RESULTS: Between January 2005 and December 2015, 13 infants (male:female = 9:4) received laparotomy. Of 23 infants (male:female = 16:7) received PD, 20 infants received subsequent laparotomy. There were no demographic differences between PD and LAP groups. And there were no differences in total organ score in either group (PD, P = 0.486; LAP, P = 0.115). However, in LAP group, respiratory score was statistically improved between pre- and postprocedure organ failure score (P = 0.02). In physiologic parameter, PD group had a statistically worsening inotropics requirement (P = 0.025). On the other hand, LAP group had a improvement of PaOâ‚‚/FiOâ‚‚ ratio (P = 0.01). CONCLUSION PD does not improve clinical status in extremely low birth weight infants with intestinal perforation.

Purpose: Although surgical management of Hirschsprung disease (HD) is effective in most patients, some patients experience long-term postoperative complications, and require redo pull-through (PT). The present study evaluated clinical outcomes of redo PT in HD patients at a single center. Methods: Patients with HD who underwent redo PT procedures between 2003 and 2019 were retrospectively reviewed. Results: Thirteen patients were included. Five (38.5%) had undergone initial PT surgery at our center and 8 (61.5%) at other centers. Redo PT procedures were transanal endorectal PT in 12 patients (92.3%) and the posterior sagittal approach in 1 patient (7.7%). Indications for redo PT included pathologic misdiagnosis in 8 patients (61.5%); stricture in 2 (15.4%); and rectal stenosis, obstructing Duhamel pouch and remnant septum in 1 each (7.7%). At a median follow-up of 68 months (range, 3–227 months) after redo PT, 8 patients (61.5%) had normal bowel function, 2 (15.4%) had incontinence, and 1 (7.7%) had constipation. Conclusion Redo PT procedures could be an effective approach for improving obstructive symptoms in HD patients with anatomic or pathologic reasons following primary PT. Careful selection of patients and discreet indications for redo PT are crucial.