Purpose: This study assessed the efficacy and safety of preoperative chlorhexidine gluconate (CHG) double-cleansing in reducing the incidence of surgical site infections (SSI) in surgical patients in neonatal intensive care units. Methods: A retrospective chart review involved 56 patients who underwent 73 surgical procedures in the neonatal intensive care unit (NICU) from 2013 to 2022. CHG double-cleansing involves the following 2 processes. Firstly, preoperative cleansing with 0.5% CHG for elective surgeries the night before or at least 1 hour before emergency surgery. The anterior trunk cleansing spanned from the neck to the pubis, including both axillary lines. Secondly, the surgical site underwent skin preparation using 2% CHG with 72% isopropyl alcohol before an incision. A control group (2013–2018) that used iodine and a CHG group (2019–2022) employing CHG double-cleansing were compared. The occurrence of SSIs within 30 days after the surgical procedure was assessed. Results: The overall SSI rate was 16.4% (n = 12) in the total procedures. The SSI rate was significantly higher (22.6%) in the control group; no SSI occurred in the CHG group (P = 0.029). No significant differences were observed in the other parameters. No adverse effects were observed in the CHG group. Conclusion CHG double-cleansing, a modified approach for surgical patients in the NICU, effectively reduced the incidence of SSI compared to traditional iodine-based skin preparations. This study supports the safe use of CHG in neonates, including premature infants, without significant complications.

Purpose: This study assessed the efficacy and safety of preoperative chlorhexidine gluconate (CHG) double-cleansing in reducing the incidence of surgical site infections (SSI) in surgical patients in neonatal intensive care units. Methods: A retrospective chart review involved 56 patients who underwent 73 surgical procedures in the neonatal intensive care unit (NICU) from 2013 to 2022. CHG double-cleansing involves the following 2 processes. Firstly, preoperative cleansing with 0.5% CHG for elective surgeries the night before or at least 1 hour before emergency surgery. The anterior trunk cleansing spanned from the neck to the pubis, including both axillary lines. Secondly, the surgical site underwent skin preparation using 2% CHG with 72% isopropyl alcohol before an incision. A control group (2013–2018) that used iodine and a CHG group (2019–2022) employing CHG double-cleansing were compared. The occurrence of SSIs within 30 days after the surgical procedure was assessed. Results: The overall SSI rate was 16.4% (n = 12) in the total procedures. The SSI rate was significantly higher (22.6%) in the control group; no SSI occurred in the CHG group (P = 0.029). No significant differences were observed in the other parameters. No adverse effects were observed in the CHG group. Conclusion CHG double-cleansing, a modified approach for surgical patients in the NICU, effectively reduced the incidence of SSI compared to traditional iodine-based skin preparations. This study supports the safe use of CHG in neonates, including premature infants, without significant complications.

Purpose: This study assessed the efficacy and safety of preoperative chlorhexidine gluconate (CHG) double-cleansing in reducing the incidence of surgical site infections (SSI) in surgical patients in neonatal intensive care units. Methods: A retrospective chart review involved 56 patients who underwent 73 surgical procedures in the neonatal intensive care unit (NICU) from 2013 to 2022. CHG double-cleansing involves the following 2 processes. Firstly, preoperative cleansing with 0.5% CHG for elective surgeries the night before or at least 1 hour before emergency surgery. The anterior trunk cleansing spanned from the neck to the pubis, including both axillary lines. Secondly, the surgical site underwent skin preparation using 2% CHG with 72% isopropyl alcohol before an incision. A control group (2013–2018) that used iodine and a CHG group (2019–2022) employing CHG double-cleansing were compared. The occurrence of SSIs within 30 days after the surgical procedure was assessed. Results: The overall SSI rate was 16.4% (n = 12) in the total procedures. The SSI rate was significantly higher (22.6%) in the control group; no SSI occurred in the CHG group (P = 0.029). No significant differences were observed in the other parameters. No adverse effects were observed in the CHG group. Conclusion CHG double-cleansing, a modified approach for surgical patients in the NICU, effectively reduced the incidence of SSI compared to traditional iodine-based skin preparations. This study supports the safe use of CHG in neonates, including premature infants, without significant complications.

Purpose: Sirolimus has emerged as a safe and effective treatment for complicated lymphatic malformations (LMs). We aim to prove the effectiveness and safety of sirolimus as a therapeutic option for patients with complicated LMs. Methods: Fifty-eight patients with complicated LMs treated with sirolimus for at least 6 months at multicenter between July 2018 and January 2023 were enrolled. All patients were administered oral sirolimus starting at 0.8 mg/m 2 every 12 hours, with target serum concentration levels of 8–15 ng/mL. Evaluation for clinical symptoms and LMs volume on MRI were reviewed to assess treatment response and toxicities. Evaluation of disease response was divided into 3 values:complete response, partial response (significant, moderate, and modest), and progressive disease. Results: The median age at the initiation of sirolimus treatment was 6.0 years (range, 1 month–26.7 years). The median duration of treatment was 2.0 years (range, 6 months–4.4 years). The most common lesions were head and neck (25 of 58, 43.1%). Forty-six patients (79.3%) demonstrated a reduction in LMs volume on MRI or improvement of clinical symptoms including 2 complete responses. The young age group and the patients who underwent few prior therapies showed better responses. None of the patients had toxicities attributable to sirolimus with a Common Terminology Criteria for Adverse Events grade of ≥3. Conclusion Oral sirolimus treatment brought a successful outcome without severe adverse effects. It could be the firstline therapy, especially for the young age group of complicated LMs, and an additional option for refractory lesions that did not respond to conventional treatment.

Purpose: We investigated the clinical characteristics and treatment outcomes of symptomatic Meckel diverticulum (MD) in adolescents by comparison with children and adults. Methods: We retrospectively reviewed the medical records of patients who underwent symptomatic MD surgery from January 2002 to December 2019. Demographic information, clinical presentations, preoperative evaluations, operative variables, postoperative outcomes, and pathologic findings were collected. We performed analyses by dividing all patients into three groups according to age at surgery: child group (<10 years), adolescent group (10–19 years), and adult group (≥20 years). Results: Forty-three patients underwent symptomatic MD surgery (the child group, 14; the adolescent group, 17; and the adult group, 12). Vomiting and intestinal obstruction decreased significantly with age (P = 0.042 and 0.001), whereas hematochezia and gastrointestinal bleeding showed an increasing trend with age, although not statistically significant (P = 0.064 and 0.064). Ultrasound performance decreased significantly with age (P = 0.002), whereas CT performance showed an increasing trend with age, although not statistically significant (P = 0.193). Preoperative diagnosis rate increased significantly with age (P = 0.029). Laparoscopic surgery was performed significantly more in the adult group than in other groups (P = 0.001). The sizes of MD were significantly greater in the adolescent group than in other groups (P = 0.006 and 0.002). Conclusion The clinical characteristics and treatment outcomes of symptomatic MD in adolescents exhibit a transitional pattern between children and adults. Therefore, it is important for clinicians to recognize that adolescent patients with symptomatic MD have the characteristics of both children and adult patients to ensure optimal care.

Purpose: We analyzed the timing of inguinal hernia repair in premature infants in the neonatal intensive care unit (NICU) considering recurrence, incarceration, and other complications. Methods: In this multicenter retrospective review, premature infants (<37 weeks) in the NICU diagnosed with inguinal hernia between 2017 and 2021 were segregated into 2 groups based on the timing of inguinal hernia repair. Results: Of 149 patients, 109 (73.2%) underwent inguinal hernia repair in the NICU and 40 (26.8%) after discharge. Preoperative incarceration did not differ, but complications with recurrence and postoperative respiratory insufficiency were higher in the NICU group (11.0% vs. 0%, P = 0.029; 22.0% vs. 5.0%, P = 0.01). Multivariate analysis showed that the significant factors affecting recurrence were preoperative ventilator dependence and body weight of <3,000 g at the time of surgery (odds ratio [OR], 16.89; 95% confidence interval [CI], 3.45–82.69; P < 0.01 and OR, 9.97; 95% CI, 1.03–95.92; P = 0.04). Conclusion Our results suggest that when premature infants are diagnosed with inguinal hernia in the NICU, inguinal hernia repair after discharge may decrease the odds of recurrence and postoperative respiratory insufficiency. In patients who have difficulty delaying surgery, it is thought that surgery should be performed carefully in a ventilator preoperatively or weighed <3,000 g at the time of surgery.

Purpose: Intussusception is the most common cause of bowel obstruction in children; however, it is rarely diagnosed in newborn infants. This study aimed to describe the clinical features of intussusception in newborn infants. Methods: Medical records of eight patients diagnosed with intussusception during the newborn period at Ulsan University Hospital between March 2007 and March 2020 were retrospectively reviewed. Results: Among the eight cases, two occurred in the intrauterine period and six occurred in the postnatal period. Intrauterine intussusception presented with symptoms of bowel obstruction within 1 to 2 days after birth, and ileal atresia was diagnosed simultaneously through exploratory laparotomy. All the postnatal patients were extremely low birth weight infants (median gestational age and birth weight: 25+6 weeks and 745 g, respectively). Four cases were diagnosed preoperatively using abdominal ultrasonography. One patient was diagnosed by exploratory laparotomy because the clinical symptoms were nonspecific and difficult to differentiate from those of necrotizing enterocolitis, a more prevalent complication in preterm infants. The site of intussusception in all six patients was the small bowel. Meckel’s diverticulum (one case) and meconium obstruction (two cases) were found to be the lead point. Conclusion Neonatal intussusception tends to show different clinical features according to its period of occurrence. Intussusception, especially in preterm infants, has nonspecific clinical features; therefore, clinicians should always be cautious of this disease for its early diagnosis.

Purpose: Intussusception is the most common cause of bowel obstruction in children; however, it is rarely diagnosed in newborn infants. This study aimed to describe the clinical features of intussusception in newborn infants. Methods: Medical records of eight patients diagnosed with intussusception during the newborn period at Ulsan University Hospital between March 2007 and March 2020 were retrospectively reviewed. Results: Among the eight cases, two occurred in the intrauterine period and six occurred in the postnatal period. Intrauterine intussusception presented with symptoms of bowel obstruction within 1 to 2 days after birth, and ileal atresia was diagnosed simultaneously through exploratory laparotomy. All the postnatal patients were extremely low birth weight infants (median gestational age and birth weight: 25+6 weeks and 745 g, respectively). Four cases were diagnosed preoperatively using abdominal ultrasonography. One patient was diagnosed by exploratory laparotomy because the clinical symptoms were nonspecific and difficult to differentiate from those of necrotizing enterocolitis, a more prevalent complication in preterm infants. The site of intussusception in all six patients was the small bowel. Meckel’s diverticulum (one case) and meconium obstruction (two cases) were found to be the lead point. Conclusion Neonatal intussusception tends to show different clinical features according to its period of occurrence. Intussusception, especially in preterm infants, has nonspecific clinical features; therefore, clinicians should always be cautious of this disease for its early diagnosis.

PURPOSE: Several published policy statements have warned against the risks associated with trampoline use and recommended safety guidelines. However, few studies have focused on trampoline-related injuries in Korea. This study aimed to assess the incidence and characteristics of pediatric trampoline-related injuries presented to Ulsan University Hospital. METHODS: We retrospectively reviewed the medical records of children aged <16 years with trampoline-related injuries who visited our Emergency Department between 2008 and 2017. RESULTS: Over the 10-year period, 178 trampoline-related injuries were reported, which represented a significant increase (P=0.016). Most (87.6%) of the injuries occurred during the last 5 study years, and a rapid increase in injuries was observed in children aged <6 years. Lower extremity injuries (62.4%) were the most common, followed by injuries of the upper extremities, head and face, and trunk, including injuries to the neck and spine. Sixty-seven children (37.6%) had fractures, and proximal tibia fractures were the most common. Fractures were significantly more common in younger children (<6 years old) than in older children (P=0.026). CONCLUSION: In Korea, the mechanism of trampoline injury is similar to that of injuries incurred in indoor trampoline parks but is characterized by smaller spaces and multiple users. Trampoline use and the incidence of trampoline-related injuries in children aged <6 years are increasing rapidly. Prohibiting the use of trampolines for children aged <6 years, restricting simultaneous use by multiple children, and ensuring adult supervision should be strictly emphasized. Public awareness and policy guidelines are needed to reduce the incidence of trampoline-related injuries.
Adult ; Child ; Emergency Service, Hospital ; Head ; Humans ; Incidence ; Korea ; Lower Extremity ; Medical Records ; Neck ; Organization and Administration ; Retrospective Studies ; Spine ; Tibia ; Ulsan ; Upper Extremity

Inspissated bile syndrome (IBS) is a rare condition in which thick intraluminal bile, including bile plugs, sludge, or stones, blocks the extrahepatic bile ducts in an infant. A 5-week-old female infant was admitted for evaluation of jaundice and acholic stool. Diagnostic tests, including ultrasound sonography, magnetic resonance cholangiopancreatography, and a hepatobiliary scan, were not conclusive. Although the diagnosis was unclear, the clinical and laboratory findings improved gradually on administration of urodeoxycholic acid and lipid emulsion containing omega-3 polyunsaturated fatty acids (PUFAs) for 3 weeks. However, a liver biopsy was suggestive of biliary atresia. This finding forced us to perform intraoperative cholangiography, which revealed a patent common bile duct with impacted thick bile. We performed normal saline irrigation and the symptom was improved, the final diagnosis was IBS. Thus, we herein report that IBS can be treated with omega-3 PUFAs as an alternative to surgical intervention.
Bile Ducts, Extrahepatic ; Bile* ; Biliary Atresia ; Biopsy ; Cholangiography ; Cholangiopancreatography, Magnetic Resonance ; Cholestasis ; Common Bile Duct ; Diagnosis ; Diagnostic Tests, Routine ; Fatty Acids, Omega-3 ; Fatty Acids, Unsaturated* ; Female ; Humans ; Infant ; Jaundice ; Liver ; Sewage ; Ultrasonography