Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment.

Contemporary trends in choledochal cyst excision: An analysis of the pediatric national surgical quality improvement program.

Background: Choledochal cysts are rare congenital anomalies of the biliary tree that may lead to obstruction, chronic inflammation, infection, and malignancy. There is wide variation in the timing of resection, operative approach, and reconstructive techniques. Outcomes have rarely been compared on a national level.

Maternal-fetal surgery as part of pediatric palliative care.

Maternal-fetal surgical interventions have become a more common part of prenatal care. This third option, beside termination or post-natal interventions, complicates prenatal decision-making: while interventions may be lifesaving, survivors may face a life with disability. Pediatric palliative care (PPC) is more than end of life or hospice care, it aims at helping patients with complex medical conditions live well.

Impact of COVID-19 on Admissions and Outcomes for Children With Complex Chronic Conditions.

Background: Although pediatric health care use declined during the coronavirus disease 2019 (COVID-19) pandemic, the impact on children with complex chronic conditions (CCCs) has not been well reported.

Objective: To describe the impact of the pandemic on inpatient use and outcomes for children with CCCs.

Methods: This multicenter cross-sectional study used data from the Pediatric Health Information System.

Omental cyst: a case report and review of the literature.

Background: Omental cysts are rare, predominantly occur in children, and often initially present with symptoms masquerading as other more common intra-abdominal pathologies. In this case report, we present the case of a child with an omental cyst that originated from the lesser sac. Due to the location of this cyst, resection presented unique technical challenges that have not been described in existing literature.

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.

Ethics in prenatal consultation for surgically correctable anomalies and fetal intervention.

Pediatric surgeons play an essential role in prenatal consultation for congenital anomalies likely to require surgery in the newborn period. The involvement of pediatric surgeons during multi-disciplinary prenatal meetings has been an important part of the evolution of comprehensive fetal care, characterized by detailed prenatal evaluation, diagnosis, prognosis, and planned perinatal and post-natal care. Advances in fetal diagnostics and treatments, as well as complex postnatal medical care and decision-making create a broad range of care options for pregnant women with fetal surgical anomalies.

Inpatient Use and Outcomes at Children's Hospitals During the Early COVID-19 Pandemic.

Background And Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care use, including decreased emergency department visits for children. In this study, we sought to describe the impact of the COVID-19 pandemic on inpatient use within children's hospitals.

Methods: We performed a retrospective study using the Pediatric Health Information System.

Should Pediatric Patients Be Prioritized When Rationing Life-Saving Treatments During COVID-19 Pandemic.

Coronavirus disease 2019 can lead to respiratory failure. Some patients require extracorporeal membrane oxygenation support. During the current pandemic, health care resources in some cities have been overwhelmed, and doctors have faced complex decisions about resource allocation.

Extracorporeal Membrane Oxygenation for Pediatric Patients With Coronavirus Disease 2019-Related Illness.

Objective: To describe current hospital guidelines and the opinions of extracorporeal membrane oxygenation leaders at U.S. children's hospitals concerning the use of extracorporeal membrane oxygenation for coronavirus disease 2019-positive pediatric patients.

Pouchogram Prior to Ileostomy Reversal after Ileal Pouch-Anal Anastomosis in Pediatric Patients: Is it Useful in the Setting of Routine EUA?

Purpose: To determine if there is a role for routine pouchogram before ileostomy reversal after IPAA in pediatric patients.

Methods: The medical records of pediatric patients who underwent pouchogram between 2007 and 2017 prior to ileostomy reversal after IPAA at two affiliated hospitals were reviewed for concordance between exam under anesthesia (EUA) and pouchogram findings, management of abnormal pouchogram findings, and short and long-term outcomes after ileostomy reversal. Clinical notes were used to find patient-reported symptoms at the time of pouchogram.

Pediatric neurosurgeons' views regarding prenatal surgery for myelomeningocele and the management of hydrocephalus: a national survey.

Objective: The Management of Myelomeningocele Study (MOMS) compared prenatal with postnatal surgery for myelomeningocele (MMC). The present study sought to determine how MOMS influenced the clinical recommendations of pediatric neurosurgeons, how surgeons' risk tolerance affected their views, how their views compare to those of their colleagues in other specialties, and how their management of hydrocephalus compares to the guidelines used in the MOMS trial.

Methods: A cross-sectional survey was sent to all 154 pediatric neurosurgeons in the American Society of Pediatric Neurosurgeons.

Parental Attitudes Towards Prenatal Genetic Testing For Sickle Cell Disease.

Uptake of prenatal genetic testing (PGT) is low among those with sickle cell disease (SCD). This study evaluated the association of knowledge and attitudes towards prenatal genetic counseling (PGC), awareness of posttesting intervention options and omission bias with attitudes towards PGT. In addition, we explored changes among knowledge, attitudes, and awareness of options following exposure to an educational, clinical vignette among parents of children with SCD.

US Physicians' Reactions To ACA Implementation, 2012-17.

Physicians play a key role in implementing health policy, and US physicians were split in their opinions about the Affordable Care Act (ACA) soon after its implementation began. We readministered elements of a prior survey of US physicians to a similar sample to understand how US physicians' opinions of the ACA may have changed over a crucial five-year implementation period (2012-17), and we compared responses across both surveys. Of the 1,200 physicians to whom we sent a survey in the summer of 2017, 489 responded (a response rate of 41 percent).

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.

The experience of parents with children with myelomeningocele who underwent prenatal surgery.

Background: Prenatal surgery for myelomeningocele (MMC) has been demonstrated to have benefits over postnatal surgery. Nevertheless, prenatal surgery requires a significant emotional, physical, and financial commitment from the entire family.

Methods: Mixed methods study of parents' perceptions regarding provider communication, treatment choices, and the family impact of having a child with MMC.

Reduced oxygen concentration for the resuscitation of infants with congenital diaphragmatic hernia.

Objective: To evaluate whether infants with congenital diaphragmatic hernia (CDH) can be safely resuscitated with a reduced starting fraction of inspired oxygen (FiO) of 0.5.

Study Design: A retrospective cohort study comparing 68 patients resuscitated with starting FiO 0.

Weighing the Social and Ethical Considerations of Maternal-Fetal Surgery.

Objectives: The ethics of maternal-fetal surgery involves weighing the importance of potential benefits, risks, and other consequences involving the pregnant woman, fetus, and other family members. We assessed clinicians' ratings of the importance of 9 considerations relevant to maternal-fetal surgery.

Methods: This study was a discrete choice experiment contained within a 2015 national mail-based survey of 1200 neonatologists, pediatric surgeons, and maternal-fetal medicine physicians, with latent class analysis subsequently used to identify groups of physicians with similar ratings.

Definitive airway management after prehospital supraglottic rescue airway in pediatric trauma.

Introduction: Supraglottic airway (SGA) use and outcomes in pediatric trauma are poorly understood. We compared outcomes between patients receiving prehospital SGA versus bag mask ventilation (BVM).

Methods: We reviewed pediatric multisystem trauma patients (2005-2016), comparing SGA and BVM.

Growth trajectory and neurodevelopmental outcome in infants with congenital diaphragmatic hernia.

Purpose: The purpose of this study was to evaluate the impact of impaired growth on short-term neurodevelopmental (ND) outcomes in CDH survivors.

Methods: Between 9/2005-12/2014, 84 of 215 (39%) CDH survivors underwent ND assessment at 12months of age using the BSID-III.

Results: Mean cognitive, language, and motor scores were 92.

Attitudes of paediatric and obstetric specialists towards prenatal surgery for lethal and non-lethal conditions.

Background: While prenatal surgery historically was performed exclusively for lethal conditions, today intrauterine surgery is also performed to decrease postnatal disabilities for non-lethal conditions. We sought to describe physicians' attitudes about prenatal surgery for lethal and non-lethal conditions and to elucidate characteristics associated with these attitudes.

Methods: Survey of 1200 paediatric surgeons, neonatologists and maternal-fetal medicine specialists (MFMs).

Responsible surgical innovation and research in maternal-fetal surgery.

The field of maternal-fetal intervention is rapidly evolving with new technologies and innovations. This raises complex ethical and medico-legal challenges related to what constitutes innovative treatment versus human experimentation, with or without the umbrella of "medical research." There exists a gray zone between these black and white classifications, but there are also clear guidelines that should be responsibly negotiated when making the essential transition between an innovative treatment and a validated therapy.

Acceptability of In Utero Hematopoietic Cell Transplantation for Sickle Cell Disease.

Background: In utero hematopoietic cell transplantation (IUHCT) has curative potential for sickle cell disease (SCD) but carries a risk of fetal demise.

Methods: We assessed the conditions under which parents of children with SCD and young adults with SCD would consider IUHCT in a future pregnancy, given a 5% fixed risk of fetal demise. Participants were randomized to consider a hypothetical cure rate (20%, 40%, or 70%).