Inguinal hernias in children: Update on management guidelines.

Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics.

Administration of Burns First Aid Treatment to Aboriginal and Torres Strait Islander children in community settings.

Objective: This paper investigates Burn First Aid Treatment (BFAT) provided to Aboriginal and Torres Strait Islander children in Australia at the scene of injury using data from a population-based cohort study.

Study Design: The participants were 208 Aboriginal and Torres Strait Islander children aged < 16 years who sustained a burns injury between 2015-2018, and their carers. The primary outcome measure was gold standard BFAT, (defined as at least 20 min of cool, running water within 3 h of the injury); additional measures included type of first aid, length of first aid provided, and carer's knowledge of first aid.

Unremitting pro-inflammatory T-cell phenotypes, and macrophage activity, following paediatric burn injury.

Objectives: The aim of this study was to characterise the dynamic immune profile of paediatric burn patients for up to 18 months post-burn.

Methods: Flow cytometry was used to measure 25 cell markers, chemokines and cytokines which reflected both pro-inflammatory and anti-inflammatory immune profiles. Peripheral blood mononuclear cells from 6 paediatric burn patients who had returned for repeated burn and scar treatments for > 4 timepoints within 12 months post-burn were compared to four age-matched healthy controls.

Reduction of Urinary Tract Infection in Pediatric Surgical Patients Using NSQIP-P and Quality Improvement Methodology.

Background: Hospital-acquired urinary tract infections (UTIs) have a detrimental effect on patients, families, and hospital resources. The Sydney Children's Hospital Network (SCHN) participates in the NSQIP-Pediatric (NSQIP-P) to monitor postoperative complications. NSQIP-P data revealed that the median UTI rate at SCHN was 1.

Laryngotracheal stenosis post mechanical ventilation in paediatric burns patients.

Introduction: The duration of endotracheal intubation is thought to be the most important factor in the development of acquired laryngotracheal stenosis (LTS); however, there is a paucity of studies examining the incidence of LTS in the paediatric burn population. The aim of this study was to determine the incidence of LTS in paediatric burns patients requiring mechanical ventilation to develop guidelines for consideration of a tracheostomy.

Methods: A retrospective review of all children treated at The Children's Hospital at Westmead (CHW) Burns Unit (BU) from December 2009 to December 2019 who required intubation for their burn injury.

Predictors of 12 month functional outcomes and length of stay of severely injured children in NSW, Australia. A longitudinal multi-centre study.

Background: The majority of paediatric injury outcomes studies focus on mortality rather than the impact on long-term quality of life, health care use and other health-related outcomes. This study sought to determine predictors of 12-month functional and psychosocial outcomes for children sustaining major injury in NSW.

Methods: The study included all children < 16 years requiring intensive care or an injury severity score (ISS) ≥ 9 treated in NSW at a paediatric trauma centre (PTC).

Emergency department management of severely injured children in New South Wales.

Objective: Presentations to EDs for major paediatric injury are considerably lower than for adults. International studies report lower levels of critical intervention, including intubation, required in injured children. A New South Wales study demonstrated an adverse event rate of 7.

Pathways and factors that influence time to definitive trauma care for injured children in New South Wales, Australia.

Background: Timely definitive paediatric trauma care influences patient and parental physical and emotional outcomes. New South Wales (NSW) covers a large geographical area with all three NSW paediatric trauma centres (PTC) located in two approximated major cities, meaning it is inevitable that some injured children receive initial treatment locally and then require transfer. Little is known about the factors that then impact timely arrival of injured children to definitive care.

Acticoat versus biobrane: a retrospective review on the treatment of paediatric mid-dermal torso burns.

Objectives: Scalds involving toddlers commonly involve the torso and are frequently mid-dermal in depth. Initial management of a mid-dermal burn is conservative, progressing to grafting if healing has not been achieved in 10-14 days. Historically Biobrane (UDL Laboratories, Inc.

Assessment and management of minor burns in children.

Background: Approximately 1% of the Australian and New Zealand population seeks medical assistance for a burn injury each year, and many patients presenting with burns are children. Minor burns that do not meet referral criteria can be managed by the family general practitioner (GP). If there are any concerns about the injury or progress of the burn wound healing, GPs are encouraged to contact their local burns service for advice.

Hospitalised burns in children up to 16 years old: A 10-year population-based study in Australia.

Aim: Globally, burns remain a significant public health issue that disproportionately affect young children. The current study examines the 10-year epidemiological profile of burn hospitalisations, hospital treatment cost and health outcomes by age group for children ≤16 years in Australia.

Methods: National, population-based, linked hospital and mortality data from 1 July 2002 to 30 June 2012 were used to identify burn-related hospitalisations.

Biobrane™ versus acticoat™ for the treatment of mid-dermal pediatric burns: a prospective randomized controlled pilot study.

Objectives: The management of pediatric mid-dermal burns is challenging. Anecdotal evidence suggests Biobrane™ (UDL Laboratories, Inc., Sugar Land, TX) may expedite epithelization, reducing the requirement for skin grafting.

A population-based comparison of the post-operative outcomes of open and laparoscopic appendicectomy in children.

Objective: To assess and compare the post-operative outcomes of open and laparoscopic appendicectomy in children.

Design: Record linkage analysis of administrative hospital (Admitted Patient Data Collection) and emergency department (Emergency Department Data Collection) data.Participants, setting: Children under 16 years of age who underwent an appendicectomy in a public or private hospital in New South Wales between January 2002 and December 2013.

The impact of general anesthesia on child development and school performance: a population-based study.

Background: There has been considerable interest in the possible adverse neurocognitive effects of exposure to general anesthesia and surgery in early childhood.

Aims: The aim of this data linkage study was to investigate developmental and school performance outcomes of children undergoing procedures requiring general anesthesia in early childhood.

Methods: We included children born in New South Wales, Australia of 37+ weeks' gestation without major congenital anomalies or neurodevelopmental disability with either a school entry developmental assessment in 2009, 2012, or Grade-3 school test results in 2008-2014.

The effect of ambient lighting on Laser Doppler Imaging of a standardized cutaneous injury model.

Objective: The aim of this study was to investigate the potential confounding effects of four different types of ambient lighting on the results of Laser Doppler Imaging (LDI) of a standardized cutaneous injury model.

Methods: After applying a mechanical stimulus to the anterior forearm of a healthy volunteer and inducing a wheal and arteriolar flare (the Triple response), we used a Laser Doppler Line Scanner (LDLS) to image the forearm under four different types of ambient lighting: light-emitting-diode (LED), compact fluorescent lighting (CFL), halogen, daylight, and darkness as a control. A spectrometer was used to measure the intensity of light energy at 785 nm, the wavelength used by the scanner for measurement under each type of ambient lighting.

Trauma hazards in children: An update for the busy clinician.

Trauma and injury continue to be common in children and remain an important cause of mortality and morbidity. Legislation mandating the use of helmets for all cyclists appears to have been effective in reducing the incidence and severity of head and facial injuries, with no clear evidence of a reduction in cycling usage or activity. Straddle injuries, whilst uncommon and generally minor, require careful clinical assessment as they may be associated with urethral trauma.

Differences in survival outcome for severely injured paediatric trauma by type of trauma centre.

Aim: Whether treatment at paediatric trauma centres (PTCs) provides a survival advantage for injured children over treatment at adult trauma centres (ATCs) remains inconclusive. This study examines the association between trauma centre type and in-hospital mortality for severely injured paediatric trauma patients in New South Wales, Australia.

Methods: A retrospective examination of paediatric patient characteristics (aged ≤15 years), treatment and injury outcome was conducted using data from the New South Wales Trauma Registry for 2009-2014.

A novel device to create consistent deep dermal burns in a porcine model.

We conducted this study to evaluate a novel device to create a consistent and reproducible deep partial thickness burn in a porcine model. A thermostatically controlled, heated aluminium disc device was fashioned by the Biomedical Department of our institution. Contact burns were made on the flank of two Great White pigs by applying the device heated to 92°C at intervals of 5, 10, 15 and 20 seconds to four separate test areas area of skin.

Biobrane™ and skin staples: beware of necrotic ulceration.

Biobrane™ is a product used for temporary wound coverage post major paediatric burn wound debridement. We report two cases of necrotic ulceration associated with the use of Biobrane™ with skin staples. We suggest securing Biobrane™ with alternatives such as adhesive tapes and glue to prevent the occurrence of this adverse outcome.

Acute costs and predictors of higher treatment costs for major paediatric trauma in New South Wales, Australia.

Aims: To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres; to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia.

Method: Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries.

Early developmental outcome following surgery for oesophageal atresia.

Aim: To compare the developmental outcome of infants with oesophageal atresia with or without trachea-oesophageal fistula (OA/TOF) who underwent surgery in early infancy with healthy control infants in New South Wales, Australia.

Methods: Infants diagnosed with OA/TOF requiring surgical intervention were enrolled prospectively between 1 August 2006 and the 31 December 2008. Healthy control infants were enrolled in the same time period.

Developmental outcomes following major surgery: what does the literature say?

Relative to the wealth of information in the medical literature regarding developmental outcome for infants who have had cardiac surgery available, few studies specifically detail how those who have undergone major surgery grow and develop. The few published studies tend to be disease specific, making their results difficult to translate to a more general setting. As mortality for most infants who require surgery in infancy continues to decrease, the focus for researchers and clinicians should be on how these children will grow and develop.