Abstract:
BACKGROUND/PURPOSE:Failure of the gut barrier and endotoxemia have been implicated in sepsis and multiple organ failure (MOF) syndromes in adults. The contributions of endotoxin (ETX) and proinflammatory cytokines (CKs) to the pathophysiology of disease and the outcomes of infants in the neonatal intensive care unit (NICU) are not clear. We measured ETX and CK concentrations in infants who presented with clinical signs of sepsis and/or necrotizing enterocolitis (NEC) to study their impact on MOF and outcomes. METHODS:Blood samples from infants with signs of NEC and/or sepsis were collected for culture and determination of complete blood cell counts and concentrations of CKs (interleukin [IL]-1beta, tumor necrosis factor [TNF] alpha, and IL-6) and ETX at the onset of illness. Infants with signs of sepsis but without those of NEC were classified by blood culture results into a confirmed sepsis group (ie, positive culture) or a control group (ie, negative culture). Endotoxin concentrations were determined by chromogenic Limulus amebocyte lysate assay, and CK levels were quantitated by enzyme-linked immunoassay. Data are expressed as mean +/- SD and as odds ratios (ORs) with 95% confidence intervals (CIs). P values lower than .05 were considered to be significant. RESULTS:There was no demographic or clinical difference among the NEC (n = 27), sepsis (n = 44), and control (n = 56) groups, except that fewer (P = .02) infants in the NEC group (11%) had received maternal milk feedings as compared with infants in the sepsis group (23%) and those in the control group (39%). Endotoxin concentrations were higher (P < .0001) in the NEC group (3.30 +/- 2.11) as compared with the sepsis group (0.67 +/- .86) and the control group (0.09 +/- 0.24). Generalized linear regression analysis using formula feeding, mechanical ventilation, and gram-negative bacteremia as covariates demonstrated that NEC increased ETX concentrations independently (r = .80; P < .0001). Endotoxemia correlated with higher concentrations of all 3 CKs (P < .0001). There was an inverse association between ETX and both platelet count (r = -0.30; P = .0003) and absolute neutrophil count (r = -0.29; P = .0009). Infants who died of MOF had higher concentrations of ETX (2.83 +/- 3.04 vs 0.67 +/- 1.04 EU/mL; P < .0001), IL-1beta (509 +/- 493 vs 106 +/- 223 pg/mL; P < .0001), IL-6 (416 +/- 308 vs 99 +/- 165 pg/mL; P < .0001), and TNF-alpha (503 +/- 449 vs 126 +/- 237 pg/mL; P < .0001) as compared with those without MOF. Eighty-six percent of the infants with MOF died. Multivariate logistic regression analysis demonstrated that higher ETX concentrations (OR = 2.47; 95% CI = 1.39-4.40; P = .002) and lower gestational age (OR = 1.41; 95% CI = 1.12-1.77; P = .003) predicted mortality. CONCLUSIONS:Neonatal endotoxemia and release of proinflammatory CKs are important contributors to MOF and mortality in the NICU. Endotoxemia was most severe at the onset of illness among the infants with NEC, suggesting that gut barrier failure plays an important role in adverse outcomes in the NICU.
journal_name
J Pediatr Surgjournal_title
Journal of pediatric surgeryauthors
Sharma R,Tepas JJ 3rd,Hudak ML,Mollitt DL,Wludyka PS,Teng RJ,Premachandra BRdoi
10.1016/j.jpedsurg.2006.10.038subject
Has Abstractpub_date
2007-03-01 00:00:00pages
454-61issue
3eissn
0022-3468issn
1531-5037pii
S0022-3468(06)00793-7journal_volume
42pub_type
杂志文章abstract:BACKGROUND:Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. METHOD:Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scr...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2006.04.026
更新日期:2006-08-01 00:00:00
abstract:BACKGROUND/PURPOSE:The aim of this study was to review the authors' surgical experience in pediatric pulmonary hydatid disease focusing on clinical presentation, parenchyma saving operations, and long-term results. METHODS:One hundred twenty-two children with pulmonary hydatid cyst were treated surgically over the las...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2000.19219
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:This study aims to evaluate the effect of bladder diverticula (BD) on bladder function using a rabbit model, based on urodynamic findings. METHODS:A total of 32 New Zealand white rabbits were randomly assigned to four groups: (1) sham surgery; (2) a single, 1-cm-diameter BD; (3) a single, large, 3-cm-diamete...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2016.02.087
更新日期:2016-09-01 00:00:00
abstract::Small bowel atresia is associated with a large size discrepancy between the proximal and distal segments of bowel that has traditionally been managed by resection of the dilated segment, tapering enteroplasty, or plication. Longitudinal intestinal lengthening is rarely performed at the time of the initial operation. M...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2004.11.005
更新日期:2005-03-01 00:00:00
abstract::In order to interpret the interrelation of cholinergic and adrenergic myenteric neural elements in the developing human, histochemical methods were used to demonstrate cholinergic and adrenergic activity independently in consecutive cryostat sections of the esophagus, ileocecal region, and colon of fetuses of 9 to 22 ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(88)80729-2
更新日期:1988-03-01 00:00:00
abstract:BACKGROUND:In adults, the gold standard for surgical repair of an inguinal hernia is a mesh repair, whereas, in children, the standard is high ligation of the hernia sac. However, adolescents represent a "gray zone" between children and adults, and there is no consensus on the most appropriate operation for inguinal he...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2020.11.006
更新日期:2020-11-13 00:00:00
abstract:PURPOSE:The aim of this study was to investigate influences of fecal incontinence on children's quality of life after surgically corrected anorectal malformation. METHODS:Seventy-one children with anorectal malformation underwent follow-up for 8 to 16 years postoperatively. They were divided into good, fair, and poor ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(00)90215-x
更新日期:2000-03-01 00:00:00
abstract:PURPOSE:Previous single-center studies have reported favorable outcomes when preformed silos (PFS) are used for the staged reduction of gastroschisis. The aim of this study was to assess the frequency and nature of complications associated with PFS in a large population and provide an insight into the practicalities of...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.06.006
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:Pediatric surgery (PS) is among the most competitive fellowship opportunities for general surgery residents. Prior investigations into factors associated with successful matriculation to PS have relied on surveys, which have inherent biases. STUDY DESIGN:Data were extracted from the Electronic Residency App...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2019.10.057
更新日期:2020-10-01 00:00:00
abstract:BACKGROUND/PURPOSE:Primary hyperhidrosis affects 1%-3% of the general population, with increased incidence in teenagers, having an important impact in the quality of life. This study evaluates the efficacy and patients' satisfaction after bilateral thoracoscopic sympathotomy. METHODS:Retrospective analysis of pediatri...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2019.11.024
更新日期:2020-11-01 00:00:00
abstract::Eight cases of imperforate anus with short colon were seen in our hospital from April 1982 to December 1987. Five were boys, three were girls, and their ages ranged from 2 days to 2 years. The international literature about this kind of disease was reviewed. The disease's name, embryology, diagnoses, differential diag...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,评审
doi:10.1016/0022-3468(90)90442-c
更新日期:1990-02-01 00:00:00
abstract:PURPOSE:Our objective was to investigate the feasibility of engineering cartilage on the esophagus layer and outside the esophagus. Moreover, we investigated the feasibility of tracheoplasty with cartilage engineered on the esophagus in rabbits. METHODS:Chondrocytes were isolated from auricular cartilages. 1. Engineer...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2014.07.005
更新日期:2015-07-01 00:00:00
abstract::A 15-day male neonate presented with postprandial nonbilious vomiting. Barium meal suggested pyloric obstruction. Ultrasound of the stomach after saline loading revealed an echogenic antral valve. Subsequent laparotomy confirmed the ultrasound findings. Excision of the valve resulted in excellent recovery. To our know...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2006.01.002
更新日期:2006-04-01 00:00:00
abstract:BACKGROUND/PURPOSE:Percutaneous endoscopic gastrostomy (PEG) is of great benefit to a defined population of children, but gastrostomy has been implicated in causation or exacerbation of gastroesophageal reflux (GER). The aim of this study was to quantitatively and qualitatively analyze the effect of PEG on GER. METHOD...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2002.30267
更新日期:2002-02-01 00:00:00
abstract:PURPOSE:The adrenal cortex is a critical component of the hypothalamic-pituitary-adrenal/gonadal axis that coordinates the stress response and maintains homeostasis. The authors hypothesize that adrenal cortical cells can be transplanted in adrenal insufficiency states to regenerate the adrenal cortex. METHODS:Murine ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2004.08.006
更新日期:2004-12-01 00:00:00
abstract:OBJECTIVE:To review and compare robotic ipsilateral uretero-ureterostomy (RIUU) and laparoscopic ipsilateral uretero-ureterostomy (LIUU) in terms of safety, efficacy, and outcomes. MATERIALS AND METHODS:A retrospective chart review, including all pediatric patients who underwent RIUU and LIUU at 5 different medical ce...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2020.12.022
更新日期:2021-01-07 00:00:00
abstract:BACKGROUND/PURPOSE:The purpose of this study is to present a summary of paediatric Spigelian hernia (SH) reported to date, and discuss possible aetiology of SH associated with ipsilateral ectopic testis (SH-ET). METHODS:Search of PubMed, Medline, Embase, and CINAHL was performed using keywords "Spigelian hernia". The ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,评审
doi:10.1016/j.jpedsurg.2014.10.059
更新日期:2015-02-01 00:00:00
abstract:PURPOSE:The purpose of this study is to describe the occurrence and management of bowel obstruction caused by Ascaris lumbricoides, a common parasite in warm climates that affects children with limited socioeconomic means. METHODS:Eighty-seven patients with intestinal infestation owing to Ascaris lumbricoides were tre...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(96)90348-6
更新日期:1996-01-01 00:00:00
abstract::Eleven patients have been followed from 1 to 6 yr after diagnosis and treatment during infancy of partially obstructing antral web. Seven had surgical correction, six with web excision and pyloroplasty. Four were treated nonoperatively with antispasmodics and small curd formula. Five of the seven operated infants had ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(80)80006-6
更新日期:1980-04-01 00:00:00
abstract::The combination of megacystis with microcolon and severe intestinal hypoperistalsis constitutes a rarely encountered syndrome in neonates. Of 16 previously reported cases, 14 have occurred in females and all but one have been fatal. Various forms of intestinal diversions have been unsuccessful. Aganglionosis has been ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(85)80122-6
更新日期:1985-06-01 00:00:00
abstract::In nine patients with left-sided congenital diaphragmatic hernia (CDH) developing within 24 hours of birth, the authors measured the dimensions of the bilateral main pulmonary arteries by echocardiography, and investigated whether the left:right main pulmonary artery dimension ratio (PAD ratio) was a useful index for ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/0022-3468(94)90726-9
更新日期:1994-05-01 00:00:00
abstract:BACKGROUND/PURPOSE:Aggressive neuroblastomas avoid apoptosis and have increased expression of the antiapoptotic protein, Bcl-2. Insulin-like growth factor-I (IGF-I) is mitogenic and may promote tumor survival by inhibiting apoptosis. The authors hypothesize that IGF-I may protect neuroblastoma cells from apoptosis by u...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2002.30869
更新日期:2002-03-01 00:00:00
abstract::Wandering spleen usually causes clinical symptoms by torsion. Cases of torsion or hemorrhage after blunt trauma are reported. The authors experienced avulsion of wandering spleen after traumatic torsion in the victim of pedestrian injury. The spleen had been located in the left upper quadrant on the time of torsion, b...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1053/jpsu.2003.50136
更新日期:2003-04-01 00:00:00
abstract::The endoparasitic twin is the most common form of asymmetric fetal duplication (heteropagus). A 2-month-old girl who had a parasitic right lower limb with axial skeleton, vertebral column, uterus, fallopian tube, ovary, and bladder implanted in the sternum region is described as another example of exoparasitic twin, t...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(97)90573-x
更新日期:1997-10-01 00:00:00
abstract::Esophageal polyps are rare in children, whereas colorectal juvenile polyps are common. An 11-year-old boy with an esophageal colonic interposition for an esophageal stricture secondary to caustic injury was found to have a polypoid mass in the interposed colon. Fiberoptic endoscopic removal with diathermy was performe...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(98)90024-0
更新日期:1998-09-01 00:00:00
abstract::In some children, contrast radiography and endoscopy fail to confirm suspected Crohn's disease, or fail to evaluate the extent of disease. This report documents seven cases in which laparoscopy was used to look for creeping mesenteric fat involving the small intestine, a pathological finding reported only for Crohn's ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/s0022-3468(96)90150-5
更新日期:1996-06-01 00:00:00
abstract:BACKGROUND:There is limited time within the clinical workflow of most pediatric surgeons to obtain a comprehensive, well informed consent. This study evaluates whether ad-lib access to an online video on the consent dialogue enhances the consent process for inguinal hernia repair (IHR) in children. METHODS:The study w...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jpedsurg.2019.09.047
更新日期:2020-01-01 00:00:00
abstract::Intrapericardial diaphragmatic hernia is a very rare phenotype of neonatal diaphragmatic hernia which is thought to be caused by the developmental failure of the septum transversum. There have been only 10 cases reported since 1980, and among them, only 2 cases were diagnosed in fetal life. We herein report a new case...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2005.07.044
更新日期:2005-11-01 00:00:00
abstract:PURPOSE:The aim of this study was to investigate the structural characteristics and the expression of a group of neuropeptides in the esophagus of patients with congenital esophageal atresia and tracheoesophageal fistula (EA-TEF), as well to elucidate the roles of these neuropeptides in the pathogenesis of postoperativ...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2007.03.050
更新日期:2007-08-01 00:00:00
abstract:PURPOSE:The aim of the study is to investigate the effects of erythropoietin on torsion/detorsion injury in rats. METHODS:Forty rats were divided randomly into 5 groups: group I (sham, S), sham operation; group II (torsion/detorsion 1, T/D(1)), 3 hours ischemia and 1 hour reperfusion; group III (torsion/detorsion 2, T...
journal_title:Journal of pediatric surgery
pub_type: 杂志文章
doi:10.1016/j.jpedsurg.2009.02.071
更新日期:2009-10-01 00:00:00