The diagnosis of appendicitis in children: outcomes of a strategy based on pediatric surgical evaluation.

Objective: To determine the accuracy of a protocol for diagnosis of appendicitis in children based on clinical evaluation by a pediatric surgeon with selective use of diagnostic imaging studies. We performed this study because 1) current reports in the medical, pediatric, emergency medical, and surgical literature advocate imaging, particularly computed tomography (CT), as the gold standard for diagnosis of appendicitis, and 2) the value of pediatric surgical evaluation early in the management of the child with possible appendicitis has rarely been emphasized. METHODS, DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of 356 children (mean age: 9.

Extracorporeal life support for the treatment of adult respiratory distress syndrome after burn injury.

The pediatric population comprises 38% of hospital admissions for burns in the United States. In the age group of 1- to 14-year-olds, a 62% total body surface area burn represents the median lethal dose and carries a lower mortality rate for burn size than in infants or adults. Adult respiratory distress syndrome (ARDS) is a common accompaniment to severe burn injury.

Persistent pulmonary hypertension of the newborn infant. Comparison of conventional versus extracorporeal membrane oxygenation in neonates fulfilling Bartlett's criteria.

Persistent pulmonary hypertension of the newborn (PPHN) is a challenge for the neonatologist and a common indication for treatment with extracorporeal membrane oxygenation (ECMO) when medical management fails. We observed 132 neonates born between January 1985 and December 1988 with the diagnosis of persistent pulmonary hypertension of the newborn: 73 (55%) met the Bartlett criteria for treatment with ECMO with 80% predicted mortality; 21 (29%) deteriorated despite conventional medical treatment, were thought to be dying, and were sent for ECMO. Among the 52 patients who were medically treated 40 (77%) survived, a marked difference compared with a predicted 20% survival.

Coagulation parameter instability as an early predictor of intracranial hemorrhage during extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation (ECMO) has been used to treat over 2,000 neonates with severe respiratory distress due to a number of different diagnoses. Its application has been expanded into the pediatric population as well. Despite both technical advances and refinement of management techniques, intracranial hemorrhage remains a major cause of both morbidity and mortality during ECMO.

Neonatal presentation of cystic fibrosis requiring ECMO.

This is a case of cystic fibrosis causing respiratory distress in a newborn who was treated successfully with extracorporeal membrane oxygenation (ECMO). To date, this is the only such case reported to the Neonatal ECMO Registry at the University of Michigan. ECMO can be a life-saving intervention in these neonates.