Detection of Bronchiolitis Obliterans Syndrome after Pediatric Hematopoietic Stem Cell Transplantation: An Official American Thoracic Society Clinical Practice Guideline.

Many children undergo allogeneic hematopoietic stem cell transplantation (HSCT) for the treatment of malignant and nonmalignant conditions. Unfortunately, pulmonary complications occur frequently post-HSCT, with bronchiolitis obliterans syndrome (BOS) being the most common noninfectious pulmonary complication. Current international guidelines contain conflicting recommendations regarding post-HSCT surveillance for BOS, and a recent NIH workshop highlighted the need for a standardized approach to post-HSCT monitoring.

Troubleshooting the pediatric gastrostomy.

Gastrostomy tubes benefit patients but also introduce hazards and costs. Most of these costs tend to be administratively invisible, but clinically expensive. Nurses, residents, emergency physicians, surgeons, and others routinely manage complaints about gastrostomy tubes or sites, and the time and effort costs are enormous.

Surgical Interventions During End-of-Life Hospitalizations in Children's Hospitals.

Objectives: To characterize patterns of surgery among pediatric patients during terminal hospitalizations in children's hospitals.

Methods: We reviewed patients ≤20 years of age who died among 4 424 886 hospitalizations from January 2013-December 2019 within 49 US children's hospitals in the Pediatric Health Information System database. Surgical procedures, identified by International Classification of Diseases procedure codes, were classified by type and purpose.

Coil-Localized Laparoscopic-Assisted Resection of Symptomatic Gastrointestinal Vascular Malformations in Children and Young Adults.

Unlabelled: Gastrointestinal (GI) bleeding from pediatric vascular malformation is uncommon and difficult to diagnose and manage. The preferred treatment is surgical resection; however, it can be challenging to precisely localize the lesion, particularly if it is not serosal.

Objectives: To describe a technique of intentional preoperative coil localization of symptomatic pediatric GI vascular malformations by pediatric interventional radiology to facilitate fluoroscopically assisted laparoscopic resection.

Disrupting the Fellowship Match: COVID-19 and the Applicant Arms Race.

Resident and fellow selection carried out via "the Match" has historically relied upon in-person interviews to evaluate and rank candidates. However, the COVID-19 pandemic has required fellowship matches and the upcoming Main Residency Match® to become wholly virtual. The 2020 pediatric surgery match offers a unique case study in the benefits and shortcomings of a virtual process and begins a much-needed conversation regarding opportunities for innovation in candidate selection.

Pediatric firearm mortality in the United States, 2010 to 2016: A National Trauma Data Bank analysis.

Background: Pediatric firearm injury is a leading cause of death for U.S. children.

Life-saving interventions in pediatric trauma: A National Trauma Data Bank experience.

Background: Emergent procedures are infrequent in pediatric trauma. We sought to determine the frequency and efficacy of life-saving interventions (LSI) performed for pediatric trauma patients within the first hour of care at a trauma center.

Methods: The National Trauma Data Bank (2010-2014) was queried for patients 19 years or younger who underwent LSIs within 1 hour of arrival to the emergency department.

Laparoscopic Management of Pediatric Abdominal Trauma: A National Trauma Data Bank Experience.

To characterize injury patterns and institutional trends associated with the utilization of laparoscopy in the management of pediatric abdominal trauma. The National Trauma Data Bank (2010-2014) was queried for encounters involving patients ≤14 years who underwent an open or laparoscopic abdominal operation within 48 hours of emergency department arrival. Patient, injury, and hospital characteristics associated with each approach were identified.

Qualities and Methods of Highly Effective Surgical Educators: A Grounded Theory Model.

Objective: To identify personal qualities and teaching methods of highly effective surgical educators using a novel research design.

Design: In this qualitative study, surgical residents were sent an electronic survey soliciting nominations for faculty perceived as highly effective surgical educators. In-depth, semistructured interviews were conducted with surgeons receiving the most nominations.

Pediatric Perioperative DNR Orders: A Case Series in a Children's Hospital.

Context: Do-not-resuscitate (DNR) orders are common among children receiving palliative care, who may nevertheless benefit from surgery and other procedures. Although anesthesia, surgery, and pediatric guidelines recommend systematic reconsideration of DNR orders in the perioperative period, data regarding how clinicians evaluate and manage DNR orders in the perioperative period are limited.

Objectives: To evaluate perioperative management of DNR orders at a tertiary care children's hospital.

Thoracoscopic thymectomy for juvenile myasthenia gravis.

Purpose: A randomized controlled trial of thymectomy in myasthenia gravis demonstrated improved clinical outcomes in adults, but data surrounding juvenile cases, especially those treated with minimally invasive approaches, are limited. Here, we review our experience with thoracoscopic thymectomy for juvenile myasthenia gravis (JMG) in the largest cohort to date.

Methods: All cases of thymectomy for JMG in a single tertiary referral center between 2007 and 2018 were reviewed (N = 50).

Special equipment considerations for neonatal ECMO.

Extracorporeal membrane oxygenation (ECMO) for neonates is applied routinely at major children's hospitals around the world. While the practice seems routine, the peculiar physiology of the small human imposes particular constraints on selection of equipment, performance of the circuit, and risks to the child. The physiology of small patients and physics of circuit elements leave many areas opaque and far from optimal, but still allow assembly of a set of useful heuristics for good practice.

Predictors of pediatric blunt cerebrovascular injury.

Background/purpose: Blunt cerebrovascular injury (BCVI) is clinically challenging because these injuries are hard to detect and can have serious neurological consequences, and optimal screening criteria have not been established for children. This study aims to determine risk factors for BCVI in pediatric patients and to evaluate screening practices in a single institutional series.

Methods: A retrospective review of all pediatric blunt trauma patients evaluated over a 10-year period was performed.

Automatically rating trainee skill at a pediatric laparoscopic suturing task.

Background: Minimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task.

Bilateral congenital lobar emphysema: staged management.

Background: Only a few isolated cases in the literature exist to guide management of bilateral congenital lobar emphysema (CLE). Here, we review our experience in infants with bilateral CLE.

Methods: A case series of all infants presenting with bilateral CLE from 2014 to 2015 in a single institution.

Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center.

Aim Of The Study: Present the outcomes of patients younger than 2years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication.

Methods: Retrospective review of patients <2years who underwent laparoscopic fundoplication between January 2009 and December 2014.

Main Results: 458 infants younger than 2years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications).

When a Surgical Colleague Makes an Error.

Professionalism requires that doctors acknowledge their errors and figure out how to avoid making similar ones in the future. Over the last few decades, doctors have gotten better at acknowledging mistakes and apologizing to patients when a mistake happens. Such disclosure is especially complicated when one becomes aware of an error made by a colleague.

Vessel sealing comparison: old school is still hip.

Background: Ligation with either absorbable or non-absorbable sutures has been the traditional state of the art, but a proliferation of technology now offers a host of methods to close and divide vessels. Only limited data are available that objectively compare different vessel sealing methods. The objective of this study was to compare a broad variety of methods of surgical vessel closure in a reproducible, independent, standardized test-to-failure ex vivo pressure challenge.

Laparoscopy in Pediatric Abdominal Trauma: A 13-Year Experience.

 Abdominal injuries are common, costly, deadly, and a source of considerable uncertainty in pediatric trauma. In some circumstances, laparoscopy offers a diagnostic and therapeutic alternative with less morbidity than standard exploration, and more certainty than most imaging. In this study, we review our experience with laparoscopic exploration for trauma.