Postpneumonectomy syndrome in a newborn after esophageal atresia repair

Esophageal Trachea, a Unique Foregut Malformation Requiring Multistage Surgical Reconstruction: Case Report

Abnormal connections between the esophagus and low respiratory tract can result from embryological defects in foregut development. Beyond well-known malformations, including tracheo-esophageal fistula and laryngo-tracheo-esophageal cleft, rarer anomalies have also been reported, including communicating bronchopulmonary foregut malformations and tracheal atresia. Herein, we describe a case of what we have called "esophageal trachea," which, to our knowledge, has yet to be reported. A full-term neonate was born in our institution presenting with a foregut malformation involving both the middle esophagus and the distal trachea, which were found to be longitudinally merged into a common segment, 3 cm in length, located just above the carina and consisted of esophageal tissue without cartilaginous rings. At birth, the esophagus and trachea were surgically separated via right thoracotomy, the common segment kept on the tracheal side only, creating a residual long-gap esophageal atresia. The resulting severe tracheomalacia was treated via simultaneous posterior splinting of such diseased segment using an autologous pericardium patch, as well as by anterior aortopexy. Terminal esophagostomy and gastrostomy were created at that stage due to the long distance between esophageal segments. Between ages 18 and 24 months, the patient underwent native esophageal reconstruction using a multistage traction-and-growth surgical strategy that combined Kimura extra-thoracic esophageal elongations at the upper esophagus and Foker external traction at the distal esophagus. Ten months after esophageal reconstruction, prolonged, refractory, and severe tracheomalacia was further treated via anterior external stenting using a semitubular ringed Gore-Tex® prosthesis, through simultaneous median sternotomy and tracheoscopy. Currently, 2 years after the last surgery, respiratory stabilization, and full oral feeding were stably achieved. Multidisciplinary management was crucial for assuring lifesaving procedures, correctly assessing anatomy, and planning for multiple sequential surgical approaches that aimed to restore long-term respiratory and digestive functions.

Prevalence of obesity and overweight in Iranian children aged less than 5 years: a systematic review and meta-analysis

Purpose

The present study aimed to determine the prevalence of childhood obesity and overweight in Iranian children under 5 years of age using a systematic review and meta-analysis.

Methods

We searched MEDLINE (PubMed), Web of Science, Google Scholar, Scopus, CINHAL, and the Iranian databases, including Scientific Information Database (www.sid.ir), Iranian Research Institute for Information Science and Technology (Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com), for all articles published between January 1989 and August 2017. Sources of heterogeneity were determined using subgroup analysis and meta-regression.

Results

Six articles were ultimately included in the meta-analysis to estimate the pooled prevalence, based on which the prevalence of obesity and overweight were estimated to be 8% (95% confidence interval [CI], 6%–10%) and 9% (95% CI, 7%–11%), respectively. The results of the subgroup analysis showed that the prevalence of obesity in boys and girls was 9% (95% CI, 6%–13%) and 7% (95% CI, 4–10%), respectively, and the prevalence of overweight in boys and girls was 10% (95% CI, 5%–15%) and 9% (95% CI, 5%–13%), respectively.

Conclusion

Despite high heterogeneity among the results of the articles included in the meta-analysis, the prevalence of obesity and overweight is higher in Iranian children under 5 years of age. Therefore, parents and the health system must pay more attention to the lifestyle, nutritional habits, and physical activity of these children.

Analysis of neonatal respiratory distress syndrome among different gestational segments

OBJECTIVE

To find more effective diagnosis and treatment of NRDS through comparatively analyzing the different gestational neonates with respiratory distress syndrome in risk factors, clinical characteristics, treatment and prognosis.

METHODS

The clinical data of 232 neonates were retrospectively analyzed who had been admitted into the neonatal intensive care unit and diagnosed with NRDS from January 2008 to December 2010. These cases were divided into three groups according to gestational age, which included full-term group, late preterm and early preterm group. Statistical analysis was used to detect the differences of relative factors among the three groups.

RESULTS

For pathogen, the full-term and late preterm infants accounted for more than 50% The majority of full-term infants were less than 39 weeks, taking up 83.7%. As many as 61.1% of the late preterm infants were born at maternal age over 30 years. The incidence of Cesarean section was high among the three groups, especially the full-term (90.7%) and late preterm group (86.1%). For clinical features, full-term infants had late onsets more than 12 h after birth. Air bronchogram could be found commonly in early preterm neonates, influencing 92% of them. However, it was rare in the other two groups. The incidence of lung infection in each group was all about 50%. In addition, Gas leakage and PPHN were more common complications in full-term and late preterm group, while for the early preterm group was the bronchopulmonary dysplasia and intracranial hemorrhage. For treatment, the proportions of full-term infants receiving application of HFOV and NO were 57.0% and 24.4%, and for late preterm infants were 36.1% and 22.2%. The application of HFOV and NO was not as much to early preterm infants as other groups. There was no significant difference in the duration of invasive ventilation between all groups. However, the noninvasive ventilation time after extubation was as long as 10.1±0.5 days in early preterm infants. The proportions of infants receiving application of PS were 53.5%, 83.3% and 81.8%, respectively. OI values improved greatly 2 h after application of PS on early preterm infants. However, the obvious difference was found only after 24 h for full-term and late preterm infants.

CONCLUSION

Besides early preterm infants, full-term and late preterm have the growing trend in the pathogenesis of NRDS. Infants of different gestational age have their own characteristics of the risk factors, which cesarean section impacts greatly on the incidence of term and late preterm infants. The clinical feature, chest X-ray changes and common complications were characteristics between term and premature infants with NRDS. The PS treatment work slower in term and late preterm infants, who needed more HFOV and NO treatment.