Helene Flageole | McMaster University (original) (raw)
Papers by Helene Flageole
Journal of pediatric surgery, Jan 19, 2015
Postoperative emesis commonly affects infants after pyloromyotomy for pyloric stenosis. This rand... more Postoperative emesis commonly affects infants after pyloromyotomy for pyloric stenosis. This randomized controlled trial investigates the impact of preoperative nasogastric tubes (NGTs) on postoperative emesis rate and length of stay (LOS). Patients from January 2010 to June 2012 were screened and randomized to have an 8 French NGT or no NGT inserted prior to surgery. Patients contraindicated for NGT or pyloromyotomy, those <6months of age, born prematurely, or with cardiac malformations were excluded. Patient demographics, blood work, postoperative feeding, postoperative emesis rate, and postoperative LOS were collected. Student's t test and Fisher's exact test were used to compare postoperative emesis rate and LOS. Of 125 patients screened, 65 (52%) were eligible, and 50 (77%) were recruited. The NGT (n=25) and no NGT (n=25) groups had no significant difference in baseline characteristics. Postoperative emesis occurred in 17 (68%) patients with NGT compared to 12 (48%) ...
Journal of pediatric surgery, Jan 20, 2015
The purpose of this study is to examine the scientific program of the Canadian Association of Ped... more The purpose of this study is to examine the scientific program of the Canadian Association of Pediatric Surgeons (CAPS) to determine if the quality of research has improved. CAPS abstracts from 2010 to 2013 were reviewed by two independent researchers. Presentation type, study design, and level of evidence (LOE) were recorded. All differences were adjudicated by an epidemiologist. Fisher's exact test compared results to a previous study that assessed LOE in CAPS abstracts from 2005 to 2009. 291 abstracts were reviewed with 53 excluded and 238 included in final analysis. Reviewers demonstrated high agreement for study design (ICC=0.767 95%CI 0.715-0.810) and LOE (ICC=0.914 95%CI 0.892-0.931). Out of 238 studies, 117 (49%) were podium and 122 (51%) posters. Number of high-quality studies increased in 2010-2013 versus 2005-2009 (n=253), specifically systematic reviews (n=15 (6%) vs. n=3 (1%) p<0.01), randomized controlled trials (n=4 (2%) vs. n=0 (0%), p=0.05), and prospective c...
Journal of Pediatric Surgery, 2015
Recommendations for postoperative antibiotics for appendicitis were published by the American Ped... more Recommendations for postoperative antibiotics for appendicitis were published by the American Pediatric Surgical Association (APSA) in 2010. However, implementation of practice recommendations often takes years. We measured compliance of pediatric surgeons (who receive reminders every 6months from the Division Chief) with the APSA recommendations. With Research Ethics Board approval, we completed a retrospective review of children who underwent appendectomy since 2010. Compliance with APSA recommendations was analyzed descriptively. Agreement between pediatric surgeons and pathologists was analyzed by kappa. We reviewed 242 charts. Patients were excluded for missing data (n=5) and diagnosis other than appendicitis (n=27), resulting in 210 patients with appendicitis (119 acute, 91 perforated). Agreement of perforation status between surgeons and pathologists was good (κ=0.75; 95% CI: 0.66-0.83). Many patients with nonperforated appendicitis received antibiotics in excess of the APSA recommendations (62/119 (52%)), as did those with uncomplicated perforated appendicitis (52/84 (62%)). Despite the availability of published recommendations, surgeons continue to prescribe postoperative antibiotics for appendicitis in excess of the recommendations. Overtreatment leads to potential medication errors and increased length-of-stay/medication costs. An intensive implementation program with ongoing education/monitoring may improve compliance with established recommendations to decrease the use of excess postoperative antibiotics and their associated costs/risks.
Pediatric Surgery International, 2014
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with post... more Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications. A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications. Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92%) and retrospective (76%); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0%) patients. Average follow-up was 53.2 months (14 studies). The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.
Journal of Pediatric Surgery, 2014
There is variation in the management of postoperative gastroesophageal reflux (GER) in esophageal... more There is variation in the management of postoperative gastroesophageal reflux (GER) in esophageal atresia-tracheoesophageal fistula (EA-TEF). Well-reported literature is important for clinical decision-making. We assessed the quality of reporting (QOR) of postoperative GER management in EA-TEF. A comprehensive search of MEDLINE, EMBASE, CINHAL, CENTRAL databases and gray literature was conducted. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with antireflux medications. The QOR was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Retrieval of 2910 articles resulted in 48 relevant articles (N=2592 patients) with an overall quality percentage score of 48%-95% (median=65%). The best reported items were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;outcome data&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (93.8% each), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;generalisability&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (91.7%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;background/rationale&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (89.6%). Less than 20% of studies provided detailed &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;main results&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; less than 5% of studies reported adequately on &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;bias&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;funding.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Sample size calculation and study limitations were included in 17 (35.4%) and 16 (33.3%) studies respectively. Follow-up time was inconsistently reported. Although the overall QOR is moderate using STROBE, important areas are underreported. Inadequate methodological reporting may lead to inappropriate clinical decisions. Awareness of STROBE, emphasizing proper reporting is needed.
Paediatric Respiratory Reviews, 2004
Congenital Pulmonary Airway Malformation (CPAM) and lung sequestration are often discovered on ro... more Congenital Pulmonary Airway Malformation (CPAM) and lung sequestration are often discovered on routine prenatal sonography. While some lesions may be large and cause serious complications in the fetus or newborn, many will be asymptomatic at birth. Some authors advocate simple observation because of the lack of data on the incidence of long-term complications. However, there are very few described cases where CPAM and intralobar sequestration (ILS) have remained asymptomatic throughout life; complications eventually develop in virtually all patients. The most common complication is pneumonia, which may respond poorly to medical treatment. Other complications include the development of malignancies (carcinomas and pleuropulmonary blastomas), pneumothorax and hemoptysis or hemothorax.
Journal of Pediatric Surgery, 2012
Some centers advocate using antibiotics before enema reduction to prevent septic complications. O... more Some centers advocate using antibiotics before enema reduction to prevent septic complications. Our objective was to determine whether using antibiotics before reduction provided any improvement in outcomes. With institutional review board approval, patients from 2 centers were compared: 1 where antibiotics were administered, and one where they were not. This retrospective cohort study from January 2005 to December 2010 evaluated demographic data, episodes of postreduction fever, hospital stay, and analgesia requirements. One hundred eighteen patients were identified: 83 males (70.3%) and 35 females (29.7%). The median age was 24 months (range, 1-180). Fifty-six patients (57.7%) received antibiotics, whereas 41 (42.7%) did not. Twenty-one patients (17.8%) had missing data and were excluded. The incidence of fever postreduction was not statistically different between groups: 12.8% for those who received antibiotics vs 17.9% for those who did not (P = .7367). No adverse antibiotic reactions were reported. Average time to oral feeds was 7.3 vs 10.6 hours (P = .06), and the length of stay was 1.7 vs 1.4 days (P = .07). Although antibiotics are administered routinely in some centers, they appear of little value. Financial costs and potential adverse reactions must be considered. Further prospective evaluation is being conducted using a larger sample size to confirm these results.
Journal of Pediatric Surgery, 2010
Purpose: Literature is lacking regarding the role of nasogastric tubes in patients with pyloric s... more Purpose: Literature is lacking regarding the role of nasogastric tubes in patients with pyloric stenosis. There is also no consensus among surgeons. Some believe that pyloric stenosis is a form of gastric outlet obstruction, and the stomach should be drained until the obstruction is relieved. Others claim that infants can handle their secretions, and draining the stomach may further exacerbate the alkalosis. This chart review examines the use of preoperative nasogastric tubes in a single pediatric institution and its effect on vomiting rates and length of stay. Methods: After research ethics board approval, a retrospective review was performed on 109 patients admitted between January 1, 2007, and December 31, 2008, with pyloric stenosis who underwent pyloromyotomy. Data were collected on presence of a preoperative nasogastric tube, preoperative electrolyte levels, ultrasound characteristics, episodes of postoperative vomiting, and length of stay. Results: One hundred six patients were used in the final analysis. A nasogastric tube was placed in 77 patients (73%). Patients with a preoperative nasogastric tube had significantly higher episodes of postoperative vomiting (P = .015; 95% confidence interval [CI] 0.29-2.63) and length of stay (P = .017; 95% CI, 2.49-25.01). Bicarbonate levels were also significantly higher in patients with a nasogastric tube. There was no difference in the duration of symptoms, ultrasound characteristics, or type of operation between the 2 cohorts. Conclusion: The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial.
Journal of Pediatric Surgery, 2001
Purpose: Congenital diaphragmatic hernia (CDH) is associated with thickened pulmonary arteries (P... more Purpose: Congenital diaphragmatic hernia (CDH) is associated with thickened pulmonary arteries (PA) contributing to pulmonary hypertension. In the current study, the effects of antenatal glucocorticoids and reversible tracheal occlusion (TO) on PA structure were assessed in a hypoplastic lung model.
Journal of Pediatric Surgery, 2004
Experimental Lung Research, 2005
& Previously, the authors have shown that tracheal occlusion (TO) partially reverses the onset of... more & Previously, the authors have shown that tracheal occlusion (TO) partially reverses the onset of congenital diaphragmatic hernia (CDH)-induced pulmonary hypertension (PH) and abnormal pulmonary vascular development whereas release of the occlusion (TR) abolishes these clinical benefits. As a consequence of their mitogenic and vasoactive properties, the authors hypothesize that the expression of endothelin (ET)-1 and ET receptor (ET A ) genes is increased in lungs of CDH lambs, and that this increase is abolished partially in CDH þ TO but not in CDH þ TO þ TR. A surgical left-sided CDH was created in fetal lambs at 80 days of gestation (gd), followed by TO at 108 gd, and by TR at 129 gd. Four groups were compared: CDH, CDH þ TO, CDH þ TO þ TR, and nonoperated controls (C). Assessment of mRNA expression by Northern blot showed significantly lower ET-1 and ET A levels in the CDH group than in the CDH þ TO AE TR groups (P < :05). Endothelin protein expression levels were lower in CDH AE TO AE TR groups when compared with controls for airways and vessels (P < :05) with the exception of endothelial cells. In contrast, ET A protein expression levels were higher in CDH AE TO AE TR groups compared with controls for airways and blood vessels smooth muscles (P < :05). These results suggest that involvement of the endothelin system in the pulmonary
Journal of Pediatric Surgery, 2011
Purpose: This scoping review assesses the literature and summarizes the current evidence on scler... more Purpose: This scoping review assesses the literature and summarizes the current evidence on sclerotherapy for the treatment of lymphatic malformations in pediatric patients. Methods: A comprehensive search of published and unpublished literature was conducted using multiple databases. Title, abstract, and full-text screening was conducted by 2 independent clinicians. All discrepancies were resolved during consensus meetings. Results: A total of 182 articles were retrieved. Forty-four articles were removed as duplicates, and 11 articles were added after reviewing prominent studies. After full-text abstraction, 44 articles and 2 conference proceedings (N = 882 patients) were included in the final results. Twelve articles were classified as level II and 34 articles as level IV evidence. Picibanil (OK-432) was the primary agent used in most included studies. Postinjection symptoms with OK-432 were primarily fever, swelling, and erythema at the site. Life-threatening complications were uncommon and involved postinjection swelling of cervical lesions causing airway compromise. Conclusions: The literature regarding sclerotherapy for lymphatic malformations is of a low level of evidence and suffers from a lack of standardization. Randomized clinical trials focused on OK-432, bleomycin, or alcoholic solution of zein; standardized dosing protocols; and consistent and reliable outcome reporting will be necessary for further development of treatment guidelines.
Journal of pediatric …, 2004
A retrospective analysis was performed for infants born with gastroschisis between 1990 and 2000 ... more A retrospective analysis was performed for infants born with gastroschisis between 1990 and 2000 at 2 pediatric hospitals. Patients were segregated into 3 groups based on birth weight corrected for gestational age: group 1 (IUGR, <fifth percentile), group 2 (fifth to 25th percentile), and ...
Journal of Pediatric Surgery, 2005
Background: The rarity of pediatric melanoma prompted our review of sentinel lymph node biopsy (S... more Background: The rarity of pediatric melanoma prompted our review of sentinel lymph node biopsy (SLNB) and associated prognosis. Methods: A chart review from 1989 to 2004 revealed 12 cases of cutaneous melanoma. Variables analyzed included demographics, site, histology, tumor characteristics, nodal status, and distant metastasis (TMN status), SLNB and/or therapeutic lymph node dissection (TLND), adjuvant treatment, disease-free survival, and overall survival. Results: Mean age at diagnosis was 8.5 years with 7 of 12 patients younger than 10 years (range, 0.3-17.9 years). Site distribution was the extremity , trunk (4), and head and neck (1). All patients had wide local excision and primary closure or skin graft. Breslow's thickness averaged 3.5 mm (range, 0.8-6 mm). Only patients diagnosed after 2000 with melanomas thicker than 1 mm were offered SLNB (extremity = 2, trunk = 1, head and neck = 1). Two patients had positive sentinel lymph node: one received TLND and interferon and one is followed closely (unclear pathology). Disease-free survival and overall survival by stage were stage I (n = 2, 3.9 years, 100%), stage II (n = 6, 7.7 years, 83%), stage III (n = 4, 2.6 years, 75%), and stage IV (n = 0). A stage II patient with negative SLNB, adjuvant chemotherapy, and interferon died 26 months after diagnosis, and a stage III patient with clinically and pathologically positive nodes after TLND died 15 months after diagnosis. Conclusion: Although a negative SLNB does not guarantee a favorable prognosis, its increasing use will further define its role in pediatric melanoma. D
Journal of Surgical Research, 2008
Background. Fetal tracheal occlusion (TO) has been investigated as a treatment option for lung hy... more Background. Fetal tracheal occlusion (TO) has been investigated as a treatment option for lung hypoplasia secondary to congenital diaphragmatic hernia (CDH). TO increases lung size, but it is unclear whether TO stimulates mature lung growth or simply induces alveolarization without concomitant bronchial development. In this study, we characterize bronchial branch development in fetal rats with CDH with or without TO through conventional histological and morphometric analysis as well as lung casting.
Journal of Pediatric Surgery, 2001
Purpose: The goal of this study was to identify the proportion of sequestrations that were atypic... more Purpose: The goal of this study was to identify the proportion of sequestrations that were atypical or associated with other entities, such as congenital cystic adenomatoid malformations, communicating bronchopulmonary foregut malformations, bronchogenic cyst, and scimitar syndrome.
Journal of Pediatric Surgery, 2014
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated ... more Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated with gastroesophageal reflux (GER) after surgical repair. One risk factor for anastomotic stricture is post-operative GER. This survey assessed practice patterns among attendees at the Canadian Association of Pediatric Surgeons (CAPS) annual meeting with respect to management of GER post EA-TEF repair. A pre-piloted survey was handed out and collected at the 2012 CAPS annual meeting. Data were entered and coded, and descriptive statistics were calculated. We distributed 70 surveys, and 57 (81.4%) surveys were returned. On average, the incidence of EA-TEF is 8-10 cases per institution, per year. Anti-reflux medication is started immediately post-operatively in 74% of patients at institution of feeds (11%), or if symptoms of reflux develop (14%). Proton pump inhibitors and H2-receptor antagonists are used in approximately equal proportion. Patients are typically kept on anti-reflux medication for 3-6 months (37%) or 6-12 months (35%). Most CAPS attendees treat postoperative GER prophylactically. However, there is no consistency in management strategy regarding which anti-reflux agent to use or for how long. A multi-centered study is required to establish a standardized protocol for the post-operative management of EA-TEF to prevent reflux and its effect on anastomotic strictures.
Journal of pediatric surgery, Jan 19, 2015
Postoperative emesis commonly affects infants after pyloromyotomy for pyloric stenosis. This rand... more Postoperative emesis commonly affects infants after pyloromyotomy for pyloric stenosis. This randomized controlled trial investigates the impact of preoperative nasogastric tubes (NGTs) on postoperative emesis rate and length of stay (LOS). Patients from January 2010 to June 2012 were screened and randomized to have an 8 French NGT or no NGT inserted prior to surgery. Patients contraindicated for NGT or pyloromyotomy, those <6months of age, born prematurely, or with cardiac malformations were excluded. Patient demographics, blood work, postoperative feeding, postoperative emesis rate, and postoperative LOS were collected. Student's t test and Fisher's exact test were used to compare postoperative emesis rate and LOS. Of 125 patients screened, 65 (52%) were eligible, and 50 (77%) were recruited. The NGT (n=25) and no NGT (n=25) groups had no significant difference in baseline characteristics. Postoperative emesis occurred in 17 (68%) patients with NGT compared to 12 (48%) ...
Journal of pediatric surgery, Jan 20, 2015
The purpose of this study is to examine the scientific program of the Canadian Association of Ped... more The purpose of this study is to examine the scientific program of the Canadian Association of Pediatric Surgeons (CAPS) to determine if the quality of research has improved. CAPS abstracts from 2010 to 2013 were reviewed by two independent researchers. Presentation type, study design, and level of evidence (LOE) were recorded. All differences were adjudicated by an epidemiologist. Fisher's exact test compared results to a previous study that assessed LOE in CAPS abstracts from 2005 to 2009. 291 abstracts were reviewed with 53 excluded and 238 included in final analysis. Reviewers demonstrated high agreement for study design (ICC=0.767 95%CI 0.715-0.810) and LOE (ICC=0.914 95%CI 0.892-0.931). Out of 238 studies, 117 (49%) were podium and 122 (51%) posters. Number of high-quality studies increased in 2010-2013 versus 2005-2009 (n=253), specifically systematic reviews (n=15 (6%) vs. n=3 (1%) p<0.01), randomized controlled trials (n=4 (2%) vs. n=0 (0%), p=0.05), and prospective c...
Journal of Pediatric Surgery, 2015
Recommendations for postoperative antibiotics for appendicitis were published by the American Ped... more Recommendations for postoperative antibiotics for appendicitis were published by the American Pediatric Surgical Association (APSA) in 2010. However, implementation of practice recommendations often takes years. We measured compliance of pediatric surgeons (who receive reminders every 6months from the Division Chief) with the APSA recommendations. With Research Ethics Board approval, we completed a retrospective review of children who underwent appendectomy since 2010. Compliance with APSA recommendations was analyzed descriptively. Agreement between pediatric surgeons and pathologists was analyzed by kappa. We reviewed 242 charts. Patients were excluded for missing data (n=5) and diagnosis other than appendicitis (n=27), resulting in 210 patients with appendicitis (119 acute, 91 perforated). Agreement of perforation status between surgeons and pathologists was good (κ=0.75; 95% CI: 0.66-0.83). Many patients with nonperforated appendicitis received antibiotics in excess of the APSA recommendations (62/119 (52%)), as did those with uncomplicated perforated appendicitis (52/84 (62%)). Despite the availability of published recommendations, surgeons continue to prescribe postoperative antibiotics for appendicitis in excess of the recommendations. Overtreatment leads to potential medication errors and increased length-of-stay/medication costs. An intensive implementation program with ongoing education/monitoring may improve compliance with established recommendations to decrease the use of excess postoperative antibiotics and their associated costs/risks.
Pediatric Surgery International, 2014
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with post... more Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications. A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications. Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92%) and retrospective (76%); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0%) patients. Average follow-up was 53.2 months (14 studies). The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.
Journal of Pediatric Surgery, 2014
There is variation in the management of postoperative gastroesophageal reflux (GER) in esophageal... more There is variation in the management of postoperative gastroesophageal reflux (GER) in esophageal atresia-tracheoesophageal fistula (EA-TEF). Well-reported literature is important for clinical decision-making. We assessed the quality of reporting (QOR) of postoperative GER management in EA-TEF. A comprehensive search of MEDLINE, EMBASE, CINHAL, CENTRAL databases and gray literature was conducted. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with antireflux medications. The QOR was assessed using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Retrieval of 2910 articles resulted in 48 relevant articles (N=2592 patients) with an overall quality percentage score of 48%-95% (median=65%). The best reported items were &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;participants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;outcome data&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (93.8% each), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;generalisability&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (91.7%) and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;background/rationale&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; (89.6%). Less than 20% of studies provided detailed &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;main results&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; less than 5% of studies reported adequately on &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;bias&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; or &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;funding.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Sample size calculation and study limitations were included in 17 (35.4%) and 16 (33.3%) studies respectively. Follow-up time was inconsistently reported. Although the overall QOR is moderate using STROBE, important areas are underreported. Inadequate methodological reporting may lead to inappropriate clinical decisions. Awareness of STROBE, emphasizing proper reporting is needed.
Paediatric Respiratory Reviews, 2004
Congenital Pulmonary Airway Malformation (CPAM) and lung sequestration are often discovered on ro... more Congenital Pulmonary Airway Malformation (CPAM) and lung sequestration are often discovered on routine prenatal sonography. While some lesions may be large and cause serious complications in the fetus or newborn, many will be asymptomatic at birth. Some authors advocate simple observation because of the lack of data on the incidence of long-term complications. However, there are very few described cases where CPAM and intralobar sequestration (ILS) have remained asymptomatic throughout life; complications eventually develop in virtually all patients. The most common complication is pneumonia, which may respond poorly to medical treatment. Other complications include the development of malignancies (carcinomas and pleuropulmonary blastomas), pneumothorax and hemoptysis or hemothorax.
Journal of Pediatric Surgery, 2012
Some centers advocate using antibiotics before enema reduction to prevent septic complications. O... more Some centers advocate using antibiotics before enema reduction to prevent septic complications. Our objective was to determine whether using antibiotics before reduction provided any improvement in outcomes. With institutional review board approval, patients from 2 centers were compared: 1 where antibiotics were administered, and one where they were not. This retrospective cohort study from January 2005 to December 2010 evaluated demographic data, episodes of postreduction fever, hospital stay, and analgesia requirements. One hundred eighteen patients were identified: 83 males (70.3%) and 35 females (29.7%). The median age was 24 months (range, 1-180). Fifty-six patients (57.7%) received antibiotics, whereas 41 (42.7%) did not. Twenty-one patients (17.8%) had missing data and were excluded. The incidence of fever postreduction was not statistically different between groups: 12.8% for those who received antibiotics vs 17.9% for those who did not (P = .7367). No adverse antibiotic reactions were reported. Average time to oral feeds was 7.3 vs 10.6 hours (P = .06), and the length of stay was 1.7 vs 1.4 days (P = .07). Although antibiotics are administered routinely in some centers, they appear of little value. Financial costs and potential adverse reactions must be considered. Further prospective evaluation is being conducted using a larger sample size to confirm these results.
Journal of Pediatric Surgery, 2010
Purpose: Literature is lacking regarding the role of nasogastric tubes in patients with pyloric s... more Purpose: Literature is lacking regarding the role of nasogastric tubes in patients with pyloric stenosis. There is also no consensus among surgeons. Some believe that pyloric stenosis is a form of gastric outlet obstruction, and the stomach should be drained until the obstruction is relieved. Others claim that infants can handle their secretions, and draining the stomach may further exacerbate the alkalosis. This chart review examines the use of preoperative nasogastric tubes in a single pediatric institution and its effect on vomiting rates and length of stay. Methods: After research ethics board approval, a retrospective review was performed on 109 patients admitted between January 1, 2007, and December 31, 2008, with pyloric stenosis who underwent pyloromyotomy. Data were collected on presence of a preoperative nasogastric tube, preoperative electrolyte levels, ultrasound characteristics, episodes of postoperative vomiting, and length of stay. Results: One hundred six patients were used in the final analysis. A nasogastric tube was placed in 77 patients (73%). Patients with a preoperative nasogastric tube had significantly higher episodes of postoperative vomiting (P = .015; 95% confidence interval [CI] 0.29-2.63) and length of stay (P = .017; 95% CI, 2.49-25.01). Bicarbonate levels were also significantly higher in patients with a nasogastric tube. There was no difference in the duration of symptoms, ultrasound characteristics, or type of operation between the 2 cohorts. Conclusion: The data strongly suggest that preoperative nasogastric tube placement adversely affects postoperative vomiting and consequently increases length of stay. The lack of consensus about the use of preoperative nasogastric tubes coupled with these findings indicates the need to evaluate this practice with a prospective randomized controlled trial.
Journal of Pediatric Surgery, 2001
Purpose: Congenital diaphragmatic hernia (CDH) is associated with thickened pulmonary arteries (P... more Purpose: Congenital diaphragmatic hernia (CDH) is associated with thickened pulmonary arteries (PA) contributing to pulmonary hypertension. In the current study, the effects of antenatal glucocorticoids and reversible tracheal occlusion (TO) on PA structure were assessed in a hypoplastic lung model.
Journal of Pediatric Surgery, 2004
Experimental Lung Research, 2005
& Previously, the authors have shown that tracheal occlusion (TO) partially reverses the onset of... more & Previously, the authors have shown that tracheal occlusion (TO) partially reverses the onset of congenital diaphragmatic hernia (CDH)-induced pulmonary hypertension (PH) and abnormal pulmonary vascular development whereas release of the occlusion (TR) abolishes these clinical benefits. As a consequence of their mitogenic and vasoactive properties, the authors hypothesize that the expression of endothelin (ET)-1 and ET receptor (ET A ) genes is increased in lungs of CDH lambs, and that this increase is abolished partially in CDH þ TO but not in CDH þ TO þ TR. A surgical left-sided CDH was created in fetal lambs at 80 days of gestation (gd), followed by TO at 108 gd, and by TR at 129 gd. Four groups were compared: CDH, CDH þ TO, CDH þ TO þ TR, and nonoperated controls (C). Assessment of mRNA expression by Northern blot showed significantly lower ET-1 and ET A levels in the CDH group than in the CDH þ TO AE TR groups (P < :05). Endothelin protein expression levels were lower in CDH AE TO AE TR groups when compared with controls for airways and vessels (P < :05) with the exception of endothelial cells. In contrast, ET A protein expression levels were higher in CDH AE TO AE TR groups compared with controls for airways and blood vessels smooth muscles (P < :05). These results suggest that involvement of the endothelin system in the pulmonary
Journal of Pediatric Surgery, 2011
Purpose: This scoping review assesses the literature and summarizes the current evidence on scler... more Purpose: This scoping review assesses the literature and summarizes the current evidence on sclerotherapy for the treatment of lymphatic malformations in pediatric patients. Methods: A comprehensive search of published and unpublished literature was conducted using multiple databases. Title, abstract, and full-text screening was conducted by 2 independent clinicians. All discrepancies were resolved during consensus meetings. Results: A total of 182 articles were retrieved. Forty-four articles were removed as duplicates, and 11 articles were added after reviewing prominent studies. After full-text abstraction, 44 articles and 2 conference proceedings (N = 882 patients) were included in the final results. Twelve articles were classified as level II and 34 articles as level IV evidence. Picibanil (OK-432) was the primary agent used in most included studies. Postinjection symptoms with OK-432 were primarily fever, swelling, and erythema at the site. Life-threatening complications were uncommon and involved postinjection swelling of cervical lesions causing airway compromise. Conclusions: The literature regarding sclerotherapy for lymphatic malformations is of a low level of evidence and suffers from a lack of standardization. Randomized clinical trials focused on OK-432, bleomycin, or alcoholic solution of zein; standardized dosing protocols; and consistent and reliable outcome reporting will be necessary for further development of treatment guidelines.
Journal of pediatric …, 2004
A retrospective analysis was performed for infants born with gastroschisis between 1990 and 2000 ... more A retrospective analysis was performed for infants born with gastroschisis between 1990 and 2000 at 2 pediatric hospitals. Patients were segregated into 3 groups based on birth weight corrected for gestational age: group 1 (IUGR, <fifth percentile), group 2 (fifth to 25th percentile), and ...
Journal of Pediatric Surgery, 2005
Background: The rarity of pediatric melanoma prompted our review of sentinel lymph node biopsy (S... more Background: The rarity of pediatric melanoma prompted our review of sentinel lymph node biopsy (SLNB) and associated prognosis. Methods: A chart review from 1989 to 2004 revealed 12 cases of cutaneous melanoma. Variables analyzed included demographics, site, histology, tumor characteristics, nodal status, and distant metastasis (TMN status), SLNB and/or therapeutic lymph node dissection (TLND), adjuvant treatment, disease-free survival, and overall survival. Results: Mean age at diagnosis was 8.5 years with 7 of 12 patients younger than 10 years (range, 0.3-17.9 years). Site distribution was the extremity , trunk (4), and head and neck (1). All patients had wide local excision and primary closure or skin graft. Breslow's thickness averaged 3.5 mm (range, 0.8-6 mm). Only patients diagnosed after 2000 with melanomas thicker than 1 mm were offered SLNB (extremity = 2, trunk = 1, head and neck = 1). Two patients had positive sentinel lymph node: one received TLND and interferon and one is followed closely (unclear pathology). Disease-free survival and overall survival by stage were stage I (n = 2, 3.9 years, 100%), stage II (n = 6, 7.7 years, 83%), stage III (n = 4, 2.6 years, 75%), and stage IV (n = 0). A stage II patient with negative SLNB, adjuvant chemotherapy, and interferon died 26 months after diagnosis, and a stage III patient with clinically and pathologically positive nodes after TLND died 15 months after diagnosis. Conclusion: Although a negative SLNB does not guarantee a favorable prognosis, its increasing use will further define its role in pediatric melanoma. D
Journal of Surgical Research, 2008
Background. Fetal tracheal occlusion (TO) has been investigated as a treatment option for lung hy... more Background. Fetal tracheal occlusion (TO) has been investigated as a treatment option for lung hypoplasia secondary to congenital diaphragmatic hernia (CDH). TO increases lung size, but it is unclear whether TO stimulates mature lung growth or simply induces alveolarization without concomitant bronchial development. In this study, we characterize bronchial branch development in fetal rats with CDH with or without TO through conventional histological and morphometric analysis as well as lung casting.
Journal of Pediatric Surgery, 2001
Purpose: The goal of this study was to identify the proportion of sequestrations that were atypic... more Purpose: The goal of this study was to identify the proportion of sequestrations that were atypical or associated with other entities, such as congenital cystic adenomatoid malformations, communicating bronchopulmonary foregut malformations, bronchogenic cyst, and scimitar syndrome.
Journal of Pediatric Surgery, 2014
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated ... more Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated with gastroesophageal reflux (GER) after surgical repair. One risk factor for anastomotic stricture is post-operative GER. This survey assessed practice patterns among attendees at the Canadian Association of Pediatric Surgeons (CAPS) annual meeting with respect to management of GER post EA-TEF repair. A pre-piloted survey was handed out and collected at the 2012 CAPS annual meeting. Data were entered and coded, and descriptive statistics were calculated. We distributed 70 surveys, and 57 (81.4%) surveys were returned. On average, the incidence of EA-TEF is 8-10 cases per institution, per year. Anti-reflux medication is started immediately post-operatively in 74% of patients at institution of feeds (11%), or if symptoms of reflux develop (14%). Proton pump inhibitors and H2-receptor antagonists are used in approximately equal proportion. Patients are typically kept on anti-reflux medication for 3-6 months (37%) or 6-12 months (35%). Most CAPS attendees treat postoperative GER prophylactically. However, there is no consistency in management strategy regarding which anti-reflux agent to use or for how long. A multi-centered study is required to establish a standardized protocol for the post-operative management of EA-TEF to prevent reflux and its effect on anastomotic strictures.