L’arbre décisionnel pour l’exploration des uropathies est encore affaire d’école dans les services de médecine nucléaire, de néphrologie, mais aussi de chirurgie pédiatrique. Ce qui est abordé dans ...cet article pourra donc être sujet à controverse, d’autant plus si l’on élargit la discussion à l’échelle internationale. Deux principales imageries rénales se complètent en médecine nucléaire pour l’exploration diagnostique : la scintigraphie dynamique au Tc99m-MAG3 et la scintigraphie planaire au Tc99m-DMSA. Elles viennent en complément de l’imagerie morphologique que sont l’échographie, la cystographie et l’Uro-IRM. En pédiatrie, les scintigraphies occupent dès la naissance une place cruciale pour le suivi urologique. Ces examens isotopiques se complètent avantageusement pour donner une information sur la fonction des reins et sur la vidange urinaire. Leur interprétation pourrait cependant souvent bénéficier d’une discussion au sein d’une concertation multidisciplinaire. Elles jalonnent le parcours urologique des premières années de vie afin de prévenir les futures séquelles de pyélonéphrites, l’objectif à terme étant l’épargne néphronique parfois au prix d’un geste de résection chirurgicale. Elles vont ainsi orienter pour un même patient soit vers un traitement médical, soit vers un traitement chirurgical avec un éventail allant du geste endoscopique en hospitalisation de jour, à la chirurgie ouverte, en passant par la cœlioscopie parfois robot assistée.
The decision-making tree for the exploration of uropathies by children is still a matter of debate in the departments of nuclear medicine, nephrology, but also pediatric surgery. What is discussed in this article may therefore be subject to controversy, especially if the discussion is broadened to an international scale. Two main renal imaging techniques complement each other in nuclear medicine for diagnostic exploration: diuretic renal scintigraphy with Tc99m-MAG3 and standard renogram with Tc99m-DMSA. They complement morphological imaging such as ultrasound, cystography, and uro-MRI. Scintigraphies play a crucial role from birth in pédiatric urological monitoring. These two isotopic examinations complement each other advantageously to provide information on kidney function and urine flow. Their interpretation is sometimes questionable because they measure more relative than absolute values, an argument that places them in a multidisciplinary discussion. They mark the urological journey in the early years of life in order to prevent future pyelonephritis, with the ultimate goal being nephron sparing, sometimes at the cost of a resection procedure. They will thus guide the treatment for the same patient either towards medical treatment or towards surgical treatment, ranging from endoscopic procedures in day hospitalization to open surgery, including sometimes robot-assisted laparoscopy.
The aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population.
Pediatric patients (n = 184) with acute ...appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery.
Patients were further divided in two groups, those with non-perforated (n = 148; 79%) and perforated appendicitis (n = 38; 21%).
The mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, p < 0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963–1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2–99.3) and 88.5% (95% CI: 88.2–93.2) respectively (p < 0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, p = 0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, p < 0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, p < 0.001), body temperature >38.5 °C (47.4% vs. 11.0%, p < 0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, p < 0.001).
Hyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning.
Prospective comparative study
II
Recent studies have described the use of telehealth for pediatric surgical care during the COVID-19 pandemic. We aimed to evaluate equity in telehealth use by comparing rates of utilization and ...satisfaction with pediatric surgical telemedicine among Hispanic patients.
We conducted a retrospective cohort study of patients seen by a surgical subspecialty provider in the outpatient setting at a quaternary pediatric hospital between April 1 and June 30, 2020. Patients evaluated in the same three-month period in 2019 were analyzed as a historic control. Differences in Family Experience Survey (FES) responses based on race and ethnicity and preferred language of care were assessed using univariable and multivariable generalized linear modeling.
The pandemic cohort included fewer patients of Hispanic ethnicity and fewer Spanish-speakers. After controlling for visit type, comparison of Spanish-speaking and English-speaking patients revealed that Spanish-speaking families had significantly lower scores for FES items that evaluated healthcare provider explaining (IRR 0.74, 95% CI: 0.61–0.90), listening (IRR 0.76, 95% CI: 0.63–0.92), and time spent with the family (IRR 0.73, 95% CI: 0.60–0.89). There were no differences in FES responses based on insurance status or degree of medical complexity.
Telehealth services were less commonly used among Hispanic and Spanish-speaking patients. Language may differentially affect family satisfaction with healthcare and telehealth solutions. Strategies to mitigate these inequities are needed and may include strengthening interpreter services and providing language-concordant care.
Level IV.
•What is currently known about this topic?•Literature has ease of use and satisfaction with telehealth for pediatric surgical care in predominately non-Hispanic white cohorts.•What new information is contained in this article?•We evaluate rates of utilization and satisfaction with telehealth among Hispanic and Spanish-speaking populations.
•Discharge four hours after successful enema reduction is safe, but AoNZ practice is unknown.•The median observation period after successful reduction was 21.6 h. Routine discharge at four hours ...could have saved NZD 883,632 and 7342 ward hours. Intussusception recurrence occurred between 4 - 24 h in 11 children (3.5%).
Intussusception is the most common cause of preschool intestinal obstruction. International data suggest that following uncomplicated enema reduction, 4-hour observation with prompt return to oral diet is safe. We aimed to investigate the rate and timing of intussusception recurrence across Aotearoa New Zealand, compared to the cost of routine post-reduction observation.
We performed a national 15-year retrospective, multicenter cohort study of all children treated for intussusception between 01 Jan 2007 and 01 Jan 2022 across AoNZ. A robust clinical dataset was collected using a REDCap proforma. We also investigated the financial and time costs of current in-hospital observation practices.
During this period, primary enema reduction without general anesthetic was successful in 339 cases, requiring a median of 2 attempts (1–8). The median age was 0.8 years; 70.8% were male, and 17.1% were Māori. The median length of hospital stay was 25.9 h, primarily comprised of post-reduction observation (21.6 h). Intussusception recurrence within 30 days occurred in 29 children (8.5%) at a median time of 24.7 h post-reduction. Of the 19 cases recurring before discharge, 12 (3.5%) recurred between 4 and 24 h. The median observation period for those with successful primary enema reduction was 21.6 h; if reduced to 4 h, savings of NZD 883,632 (USD 529,825) and 7342 ward hours were possible.
Nationally, the intussusception recurrence rate after uncomplicated enema reduction was 8.5%, but only 3.5% occurred between the 4–24 hour period post-reduction. Expediting discharge by avoiding routine overnight observation appears safe and economically viable.
Prior to COVID-19, the use of telemedicine within pediatric surgery was uncommon. To curb the spread of the virus many institutions restricted non-emergent clinic appointments, resulting in an ...increase in telemedicine use. We examined the value of telemedicine for patients presenting to a pediatric surgery clinic before and after COVID-19
Perspectives and the potential value of telemedicine were assessed by surveying patients or caregivers of patients being evaluated by a general pediatric surgeon in-person prior to COVID-19 and by patients or caregivers of patients who completed a telemedicine appointment with a pediatric surgical provider during the COVID-19 period.
The pre-COVID survey was completed by 57 respondents and the post-COVID survey by 123. Most respondents were white and were caregivers 31–40 years of age. Prior to COVID-19, only 26% were familiar with telemedicine, 25% reported traveling more than 100 miles and >50% traveled more than 40 miles for their appointment. More than 25% estimated additional travel costs of at least $30 and in 43% of households, at least one adult had to miss time from work. Following a telemedicine appointment during the COVID-19 period, 76% reported the care received as excellent, 86% were very satisfied with their care, 87% reported the appointment was less stressful for their child than an in-person appointment, and 57% would choose a telemedicine appointment in the future.
For families seeking an alternative to the in-person encounter, telemedicine can provide added value over the traditional in-person encounter by reducing the burden of travel without compromising the quality of care. Telemedicine should be viewed as a viable option for pediatric surgery patients and future research directed toward optimizing the experience for patients and providers.
III.
Since December 2019, an epidemic caused by novel coronavirus (2019-nCoV) infection has occurred unexpectedly in China. As of 8 pm, 31 January 2020, more than 20 pediatric cases have been reported in ...China. Of these cases, ten patients were identified in Zhejiang Province, with an age of onset ranging from 112 days to 17 years. Following the latest
National recommendations for diagnosis and treatment of pneumonia caused by 2019-nCoV
(the 4th edition) and current status of clinical practice in Zhejiang Province, recommendations for the diagnosis and treatment of respiratory infection caused by 2019-nCoV for children were drafted by the National Clinical Research Center for Child Health, the National Children’s Regional Medical Center, Children’s Hospital, Zhejiang University School of Medicine to further standardize the protocol for diagnosis and treatment of respiratory infection in children caused by 2019-nCoV.
Background
An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No ...information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19.
Methods
We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children’s Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19.
Results
The onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-γ (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home.
Conclusions
In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.
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