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Alberti P, Ade-Ajayi N, Greenough A. Respiratory Support Strategies for Surgical Neonates: A Review. CHILDREN (BASEL, SWITZERLAND) 2025; 12:273. [PMID: 40150556 PMCID: PMC11941308 DOI: 10.3390/children12030273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 02/16/2025] [Accepted: 02/22/2025] [Indexed: 03/29/2025]
Abstract
Neonates with congenital conditions which require surgical management frequently experience respiratory distress. This review discusses the management of pulmonary complications and the respiratory support strategies for four conditions: oesophageal atresia-tracheoesophageal fistula (OA-TOF), congenital diaphragmatic hernia (CDH), congenital lung malformations (CLM), and anterior abdominal wall defects (AWD). Mechanical ventilation techniques which can reduce the risk of ventilator-induced lung injury (VILI) are discussed, as well as the use of non-invasive respiratory support modes. While advances in perioperative respiratory support have improved outcomes in infants with OA-TOF, managing respiratory distress in premature OA-TOF neonates remains a challenge. In CDH infants, a randomised trial has suggested that conventional ventilation may improve outcomes compared to high-frequency ventilation. Echocardiographic assessment is essential in the management of CDH infants with pulmonary hypertension. Lung-protective ventilation settings may lower the rate of postoperative complications in symptomatic CLM infants, but there remains debate regarding the choice of expectant versus surgical management in neonates with asymptomatic CLMs. Infants with AWDs can require ventilation due to pulmonary hypoplasia, but the effects of this on their long-term respiratory health are poorly understood. As surgical techniques continue to evolve and novel ventilation techniques become available, prospective multi-centre studies will be required to define the optimal respiratory support strategies for neonatal surgical conditions that affect lung function.
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Affiliation(s)
- Piero Alberti
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
| | - Niyi Ade-Ajayi
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
- Department of Paediatric Surgery, King’s College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Anne Greenough
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9RS, UK; (P.A.); (N.A.-A.)
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Cömert HSY, Güney D, Durakbaşa ÇU, Dökümcü Z, Soyer T, Fırıncı B, Çiftçi İ, Öztan MO, Demirel BD, Parlak A, Göllü G, Karaman A, Akkoyun İ, Gül C, İlhan H, Oral A, Özcan R, Özen Ö, Kıyan G, Erdem AO, Özaydın S, Uzunlu O, Yıldız A, Erginel B, Ertürk N, Bilici S, Samsum H, Özen MA, Özçakır E, Aydın E, Mert M, Topbaş M. The effect of postoperative ventilation strategies on postoperative complications and outcomes in patients with esophageal atresia: Results from the Turkish Esophageal Atresia Registry. Pediatr Pulmonol 2023; 58:763-771. [PMID: 36398363 DOI: 10.1002/ppul.26251] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. STUDY DESIGN Among the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. RESULTS Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. CONCLUSION We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.
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Affiliation(s)
| | - Doğuş Güney
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul Medeniyet University, İstanbul, Turkey
| | - Zafer Dökümcü
- Department of Pediatric Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Binali Fırıncı
- Department of Pediatric Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - İlhan Çiftçi
- Department of Pediatric Surgery, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Mustafa Onur Öztan
- Department of Pediatric Surgery, Faculty of Medicine, Izmir Katip Celebi University, İzmir, Turkey
| | - Berat Dilek Demirel
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ayşe Parlak
- Department of Pediatric Surgery, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Gülnur Göllü
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ayşe Karaman
- Department of Pediatric Surgery, Dr Sami Ulus Maternity and Children Health and Research Application Center, Ankara, Turkey
| | - İbrahim Akkoyun
- Department of Pediatric Surgery Konya, Konya Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Cengiz Gül
- Department of Pediatric Surgery, Zeynep Kamil Maternity and Children Health and Research Application Center, University of Health Sciences Turkey, İstanbul, Turkey
| | - Hüseyin İlhan
- Department of Pediatric Surgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Akgün Oral
- Department of Pediatric Surgery, Dr. Behcet Uz Education and Research Hospital, Izmir, Turkey
| | - Rahşan Özcan
- Department of Pediatric Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Önder Özen
- Department of Pediatric Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gürsu Kıyan
- Department of Pediatric Surgery, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Ali Onur Erdem
- Department of Pediatric Surgery, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Seyithan Özaydın
- Department of Pediatric Surgery, Başakşehir Çam and Sakura City Hospital, University of Health Sciences Turkey, İstanbul, Turkey
| | - Osman Uzunlu
- Department of Pediatric Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Abdullah Yıldız
- Department of Pediatric Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Başak Erginel
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nazile Ertürk
- Department of Pediatric Surgery, Faculty of Medicine, Muğla Sıtkı Kocaman University, Muğla, Turkey
| | - Salim Bilici
- Department of Pediatric Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Hakan Samsum
- Department of Pediatric Surgery, Private Antakya Academy Hospital, Hatay, Turkey
| | - Mehmet Ali Özen
- Department of Pediatric Surgery, School of Medicine, Koç University, Istanbul, Turkey
| | - Esra Özçakır
- University of Health Sciences Bursa Yuksek Ihtisas Training And Research Hospital, Bursa, Turkey
| | - Emrah Aydın
- Department of Pediatric Surgery, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Mehmet Mert
- University of Health Sciences Van Training And Research Hospital, Van, Turkey
| | - Murat Topbaş
- Department of Public Health, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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De Rose DU, Landolfo F, Giliberti P, Santisi A, Columbo C, Conforti A, Ronchetti MP, Braguglia A, Dotta A, Capolupo I, Bagolan P. Post-operative ventilation strategies after surgical repair in neonates with esophageal atresia: A retrospective cohort study. J Pediatr Surg 2022; 57:801-805. [PMID: 35680465 DOI: 10.1016/j.jpedsurg.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Infants affected by Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) may require non-invasive ventilation (NIV) in the post-operative period after elective extubation, especially if born preterm. The aim of the paper is to evaluate the role of different ventilation strategies on anastomotic complications, specifically on anastomotic leak (AL). MATERIALS AND METHODS Retrospective single Institution study, including all consecutive neonates affected by EA with or without TEF in a 5-year period study (from 2014 to 2018). Only infants with a primary anastomosis were included in the study. All infants were mechanically ventilated after surgery and electively extubated after 6-7 days. The duration of invasive ventilation was decided on a case-by-case basis after surgery, based on the pre-operative esophageal gap and intraoperative findings. The need for non-invasive ventilation (NCPAP, NIPPV, and HHHFNC) after extubation and extubation failure with the need for mechanical ventilation in the post-operative period were assessed. The primary outcome evaluated was the rate of anastomotic leak. RESULTS 102 EA/TEF infants were managed in the study period. Sixty-seven underwent primary anastomosis. Of these, 29 (43.3%) were born preterm. Patients who required ventilation (n = 32) had a significantly lower gestational age as well as birthweight (respectively p = 0.007 and p = 0.041). 4/67 patients had an AL after surgical repair, with no statistical differences among post-operative ventilation strategies. CONCLUSION We found no significant differences in the rate of anastomotic leak (AL) according to post-operative ventilation strategies in neonates operated on for EA/TEF.
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Affiliation(s)
- Domenico Umberto De Rose
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy; PhD course in Microbiology, Immunology, Infectious Diseases, and Transplants (MIMIT), University of Rome "Tor Vergata", Rome, Italy.
| | - Francesca Landolfo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Paola Giliberti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Santisi
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Claudia Columbo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Conforti
- Newborn Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy; Congenital Esophageal Disorders Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Maria Paola Ronchetti
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Annabella Braguglia
- Congenital Esophageal Disorders Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Andrea Dotta
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Irma Capolupo
- Neonatal Intensive Care Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy
| | - Pietro Bagolan
- Newborn Surgery Unit, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy; Neonatal Sub-Intensive Care Unit and Follow-up, Medical and Surgical Department of Fetus - Newborn - Infant, "Bambino Gesù" Children's Hospital IRCCS, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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Bronicki RA, Benitz WE, Buckley JR, Yarlagadda VV, Porta NFM, Agana DO, Kim M, Costello JM. Respiratory Care for Neonates With Congenital Heart Disease. Pediatrics 2022; 150:189881. [PMID: 36317970 DOI: 10.1542/peds.2022-056415h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ronald A Bronicki
- Baylor College of Medicine, Section of Critical Care Medicine and Cardiology, Texas Children's Hospital, Houston, Texas
| | - William E Benitz
- Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California
| | - Jason R Buckley
- Medical University of South Carolina, Divison of Pediatric Cardiology, Shawn Jenkins Children's Hospital, Charleston, South Carolina
| | - Vamsi V Yarlagadda
- Stanford School of Medicine, Division of Cardiology, Lucile Packard Children's Hospital, Palo Alto, California
| | - Nicolas F M Porta
- Northwestern University Feinberg School of Medicine, Division of Neonatology, Pediatric Pulmonary Hypertension Program, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Devon O Agana
- Mayo Clinic College of Medicine and Science, Department of Anesthesiology and Pediatric Critical Care Medicine, Mayo Eugenio Litta Children's Hospital, Rochester, Minnesota
| | - Minso Kim
- University of California San Francisco School of Medicine, Division of Critical Care, University of California San Francisco Benioff Children's Hospital, San Francisco, California
| | - John M Costello
- Medical University of South Carolina, Divison of Pediatric Cardiology, Shawn Jenkins Children's Hospital, Charleston, South Carolina
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Wang H, Gauda EB, Chiu PPL, Moore AM. Risk factors for prolonged mechanical ventilation in neonates following gastrointestinal surgery. Transl Pediatr 2022; 11:617-624. [PMID: 35685067 PMCID: PMC9173873 DOI: 10.21037/tp-22-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prolonged mechanical ventilation (MV) should be avoided in neonates. Noninvasive ventilation (NIV) can facilitate weaning from MV but has risks for patients immediately following foregut surgery due to the potential risk of anastomotic leak. We evaluated the risk factors for prolonged MV following intestinal surgery in neonates. Methods We retrospectively reviewed 253 neonates undergoing intestinal surgery in 2017-2018 to identify risk factors for prolonged MV, and determine the correlation between NIV and anastomotic leak in a tertiary neonatal intensive care unit that performs the greatest number of neonatal surgeries in Ontario. Results The most common diagnoses were necrotizing enterocolitis/spontaneous intestinal perforation (NEC/SIP) 21%, intestinal atresia 16%, esophageal atresia/tracheoesophageal fistula 14%, ano-rectal malformation 13%, malrotation/volvulus 11%, gastroschisis 9% and omphalocele 4%. The median (IQR) duration of MV post-surgery was 3 (1-8) days with 25.7 % (n=65) of neonates on MV for >7 days. Compared to infants on MV post-surgery for ≤7 days, those with MV>7 days were of lower gestational age, birth weight and weight at surgery, but a higher proportion underwent stoma creation, had a longer duration of opioid administration and higher rates of moderate to severe bronchopulmonary dysplasia (BPD) and mortality (P<0.05). Generalized linear regression analysis showed lower gestational age (GA) and longer opioid administration were associated with longer duration of MV (P<0.001), but indication for surgery, weight at surgery and stoma creation didn't correlate with longer duration of MV (P>0.05). Of the 122 patients handled by one-stage resection with primary anastomosis, 22.1% (n=27) received NIV with 74.1% (n=20) commenced on NIV after 7 days post-surgery, anastomotic leak was detected in 2.5 % (3/122) patients and didn't correlate with NIV. Conclusions Lower GA and longer opioid administration were risk factors for prolonged MV in neonates following intestinal surgery. Further research is needed to investigate modifiable practices around pain assessment/ventilation in these patients, and the correlation between NIV and anastomotic leak.
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Affiliation(s)
- Huanhuan Wang
- Division of Neonatology, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China
| | - Estelle B. Gauda
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Priscilla P. L. Chiu
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Aideen M. Moore
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Aworanti OM, O'Connor E, Hannon E, Powis M, Alizai N, Crabbe DCG. Extubation strategies after esophageal atresia repair. J Pediatr Surg 2022; 57:360-363. [PMID: 34344531 DOI: 10.1016/j.jpedsurg.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Early extubation following repair of esophageal atresia (EA) is desirable unless the anastomosis is under tension, in which case paralysis and post-operative ventilation may reduce the risk of anastomotic leakage. However, complications from emergency reintubations do occur with either strategy. We aim to examine the risk/benefit balance of early and delayed extubation following EA repair. METHODS A seven-year retrospective review of all babies that underwent EA repair was performed. Babies extubated within 24 h of surgery were classified as early extubation (EE). Babies intubated beyond the first 24 h were classified as delayed extubation (DE). The EE group was subdivided into babies extubated in operating room (EIOR), and babies who returned to the neonatal intensive care unit (NICU) intubated but extubated within 24 h (EW24). RESULTS Forty-six babies were analyzed, and overall 15 (32.6%) required 24 reintubation episodes. Eight (28.6%) babies in the EE group required reintubation. The EIOR group (n = 12) had significantly increased risk of requiring reintubation (OR:7, 95%CI:1.08 to 45.16:p = 0.04) compared to the EW24 group (n = 16). Seven (38.9%) babies in the DE group required reintubation. The complication rate from reintubation after EA repair was 17%. CONCLUSIONS Extubation on the NICU within 24 h of surgery carried the lowest risk of reintubation. For babies with a tight anastomosis, elective postoperative ventilation appeared to confer a protective benefit without incurring a high risk of complications from reintubation.
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Affiliation(s)
- Olugbenga Michael Aworanti
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
| | - Elizabeth O'Connor
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Edward Hannon
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Mark Powis
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - Naved Alizai
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - David C G Crabbe
- Department of Pediatric Surgery, Leeds Childrens Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
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Zhao J, Yang S, Li S, Wang P, Zhang Y, Zhao Y, Hua K, Gu Y, Liao J, Li S, Chen Y, Huang J. Retrospective analysis of pneumothorax after repair of esophageal atresia/tracheoesophageal fistula. BMC Pediatr 2021; 21:543. [PMID: 34861834 PMCID: PMC8641193 DOI: 10.1186/s12887-021-02948-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background To analyze the possible causes, treatment and outcomes of postoperative pneumothorax in patients with Gross type C esophageal atresia/tracheoesophageal fistula (EA/TEF). Methods Medical records of patients with Gross type C EA/TEF who were diagnosed and treated in Beijing Children’s Hospital from January 2007 to January 2020 were retrospectively collected. They were divided into 2 groups according to whether postoperative pneumothorax occurred. Univariate and multivariate logistic regression analysis were performed to identify risk factors for pneumothorax. Results A total of 188 patients were included, including 85 (45 %) in the pneumothorax group and 103 (55 %) in the non-pneumothorax group. Multivariate logistic regression analysis showed that postoperative anastomotic leakage [P < 0.001, OR 3.516 (1.859, 6.648)] and mechanical ventilation [P = 0.012, OR 2.399 (1.210, 4.758)] were independent risk factors for pneumothorax after EA/TEF repair. Further analysis of main parameters of mechanical ventilation after surgery showed that none of them were clearly related to the occurrence of pneumothorax. Among the 85 patients with pneumothorax, 33 gave up after surgery and 52 received further treatment [conservative observation (n = 20), pleural puncture (n = 11), pleural closed drainage (n = 9), both pleural puncture and closed drainage (n = 12)]. All of the 52 patients were cured of pneumothorax at discharge. Conclusions Anastomotic leakage and postoperative mechanical ventilation were risk factors for pneumothorax after repair of Gross type C EA/TEF, but the main parameters of mechanical ventilation had no clear correlation with pneumothorax. After symptomatic treatment, the prognosis of pneumothorax was good. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02948-x.
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Affiliation(s)
- Jiawei Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shen Yang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Siqi Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Peize Wang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yanan Zhang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yong Zhao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Kaiyun Hua
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yichao Gu
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Junmin Liao
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Shuangshuang Li
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Yongwei Chen
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China
| | - Jinshi Huang
- Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, Beijing, China.
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Landoni G, Likhvantsev V, Kuzovlev A, Cabrini L. Perioperative Noninvasive Ventilation After Adult or Pediatric Surgery: A Comprehensive Review. J Cardiothorac Vasc Anesth 2021; 36:785-793. [PMID: 33893015 DOI: 10.1053/j.jvca.2021.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
Postoperative pulmonary complications and acute respiratory failure are among the leading causes of adverse postoperative outcomes. Noninvasive ventilation may safely and effectively prevent acute respiratory failure in high-risk patients after cardiothoracic surgery and after abdominal surgery. Moreover, noninvasive ventilation can be used to treat postoperative hypoxemia, particularly after abdominal surgery. Noninvasive ventilation also can be helpful to prevent or manage intraoperative acute respiratory failure during non-general anesthesia, primarily in patients with poor respiratory function. Finally, noninvasive ventilation is superior to standard preoxygenation in delaying desaturation during intubation in morbidly obese and in critically ill hypoxemic patients. The few available studies in children suggest that noninvasive ventilation could be safe and valuable in treating hypoxemic or hypercapnic acute respiratory failure after cardiac surgery; on the other hand, it could be dangerous after tracheoesophageal correction.
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Affiliation(s)
- Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; Faculty of Medicine, Vita Salute San Raffaele University, Milan, Italy.
| | - Valery Likhvantsev
- Department of Anesthesiology and Intensive Care, First Moscow State Medical University, Moscow, Russia; V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Artem Kuzovlev
- V. Negovsky Reanimatology Research Institute, Moscow, Russia
| | - Luca Cabrini
- Università degli Studi dell'Insubria, Varese, Italy; Ospedale di Circolo e Fondazione Macchi, Varese, ASST-Settelaghi, Varese, Italy
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Koumbourlis AC, Belessis Y, Cataletto M, Cutrera R, DeBoer E, Kazachkov M, Laberge S, Popler J, Porcaro F, Kovesi T. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55:2713-2729. [PMID: 32716120 DOI: 10.1002/ppul.24982] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Mary Cataletto
- Division of Pediatric Pulmonary Medicine, New York University, Winthrop University Hospital, Mineola, New York
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Emily DeBoer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver, Children's Hospital Colorado Breathing Institute, Aurora, Colorado
| | - Mikhail Kazachkov
- Department of Pediatric Pulmonology, Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, New York
| | - Sophie Laberge
- Department of Pediatrics, Division of Respiratory Medicine, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Jonathan Popler
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Federica Porcaro
- Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Thomas Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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Pellen G, Pandit C, Castro C, Robinson P, Seton C, Fitzgerald DA, Waters K, Cheng AT. Use of non-invasive ventilation in children with congenital tracheal stenosis. Int J Pediatr Otorhinolaryngol 2019; 127:109672. [PMID: 31539787 DOI: 10.1016/j.ijporl.2019.109672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/31/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Congenital tracheal stenosis (CTS) is a rare airway condition characterized by complete tracheal rings. Most patients undergo a slide tracheoplasty, which greatly reduces mortality but significant morbidity remains. The assessment of sleep disordered breathing (SDB) and use of non-invasive ventilation (NIV) in these children has not been described. AIM To describe the presence of SDB and use of NIV in children diagnosed with CTS over a 10-year period (2005-2015). DESIGN Retrospective case series at a tertiary children's hospital. RESULTS There were 16 patients identified with CTS with a median [range] age at diagnosis of 2.5 months (0-9 months). One child died in the immediate post-operative period following a slide tracheoplasty, leaving 15 survivors. There were no later deaths during follow-up while using NIV for up to 3 years after surgery. Slide tracheoplasty was undertaken in (12/15) with long-segment tracheal stenosis. 3/15 patients had a short-segment tracheal stenosis and were managed conservatively. The use of NIV occurred in 10/15 (66.67%) patients, all of whom had long-segment CTS. Pre-operative polysomnography (PSG) showed a median (±SD) obstructive apnoea/hypopnoea index (OAHI) of 14.6/hr (±6.2) which reduced to 7.2/hour (±4.2) on NIV prior to slide tracheoplasty. The median oxygen desaturation index (ODI) before NIV use was 15.3 (±19.4) episodes/hour, which reduced to 6.3 (±11) on NIV. The median period of NIV use was 5 [1-24 months] months. CONCLUSION Patients with CTS have obstructed sleep disordered breathing. Trials of NIV are well-tolerated and improve sleep disordered breathing.
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Affiliation(s)
- G Pellen
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia
| | - C Pandit
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia.
| | - C Castro
- Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia
| | - P Robinson
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia
| | - C Seton
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia
| | - D A Fitzgerald
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia
| | - K Waters
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Respiratory and Sleep Medicine, The Children's Hospital at Westmead, Australia
| | - A T Cheng
- Discipline of Paediatrics & Child Health, Sydney Medical School, University of Sydney, Australia; Department of Ear Nose and Throat, The Children's Hospital at Westmead, Australia
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Ferrand A, Roy SK, Faure C, Moussa A, Aspirot A. Postoperative noninvasive ventilation and complications in esophageal atresia-tracheoesophageal fistula. J Pediatr Surg 2019; 54:945-948. [PMID: 30814037 DOI: 10.1016/j.jpedsurg.2019.01.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 01/27/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the impact of postoperative noninvasive ventilation strategies on outcomes in esophageal atresia-tracheoesophageal fistula (EA-TEF) patients. METHODS A single center retrospective chart review was conducted on all neonates followed at the EA-TEF Clinic from 2005 to 2017. Primary outcomes were: survival, anastomotic leak, stricture, pneumothorax, and mediastinitis. Statistical significance was determined using Chi-square and logistic regression (p ≤ .05). RESULTS We reviewed 91 charts. Twenty-five infants (27.5%) were bridged with postextubation noninvasive ventilation (15 on Continuous Positive Airway Pressure (CPAP), 5 on Noninvasive Positive Pressure Ventilation (NIPPV), and 14 on High-Flow Nasal Cannula (HFNC)). Overall, 88 (96.7%) patients survived, 25 (35.7%) had a stricture, 14 (20%) had anastomotic leak, 9 (12.9%) had a pneumothorax, and 4 (5.7%) had mediastinitis. Use of NIPPV was associated with increased risk of mediastinitis (P = .005). Use of HFNC was associated with anastomotic leak (P = .009) and mediastinitis (P = .036). CONCLUSIONS These data suggest that postoperative noninvasive ventilation techniques are associated with a significantly higher risk of anastomotic leak and mediastinitis. Further prospective research is needed to guide postoperative ventilation strategies in this population. TYPE OF STUDY Retrospective study. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Amaryllis Ferrand
- Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Shreyas K Roy
- Pediatric Surgery, Centre Hospitalier Universitaire, Sainte-Justine, Canada
| | - Christophe Faure
- Esophageal Atresia Clinic, Department of Pediatric Gastroenterology, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Ahmed Moussa
- Neonatology, Department of Pediatrics, Centre Hospitalier Universitaire, Sainte Justine, Canada
| | - Ann Aspirot
- Pediatric Surgery, Centre Hospitalier Universitaire, Sainte-Justine, Canada; Esophageal Atresia Clinic, Department of Pediatric Gastroenterology, Centre Hospitalier Universitaire, Sainte Justine, Canada.
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de Raaff CA, Kalff MC, Coblijn UK, de Vries CE, de Vries N, Bonjer HJ, van Wagensveld BA. Influence of continuous positive airway pressure on postoperative leakage in bariatric surgery. Surg Obes Relat Dis 2018; 14:186-190. [PMID: 29175283 DOI: 10.1016/j.soard.2017.10.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 09/10/2017] [Accepted: 10/25/2017] [Indexed: 10/18/2022]
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Abstract
BACKGROUND Tracheoesophageal fistula (TEF) and esophageal atresia (EA) are rare anomalies in neonates. Up to 50% of neonates with TEF/EA will have Vertebral anomalies (V), Anal atresia (A), Cardiac anomalies (C), Tracheoesophageal fistula (T), Esophageal atresia (E), Renal anomalies (R), and Limb anomalies (L) (VACTERL) association, which has the potential to cause serious morbidity. PURPOSE Timely management of the neonate can greatly impact the infant's overall outcome. Spreading latest evidence-based knowledge and sharing practical experience with clinicians across various levels of the neonatal intensive care unit and well-baby units have the potential to decrease the rate of morbidity and mortality. METHODS/SEARCH STRATEGY PubMed, CINAHL, Cochrane Review, and Google Scholar were used to search key words- tracheoesophageal fistula, esophageal atresia, TEF/EA, VACTERL, long gap, post-operative management, NICU, pediatric surgery-for articles that were relevant and current. FINDINGS/RESULTS Advancements in both technology and medicine have helped identify and decrease postsurgical complications. More understanding and clarity are needed to manage acid suppression and its effects in a timely way. IMPLICATIONS FOR PRACTICE Knowing the clinical signs of potential TEF/EA, clinicians can initiate preoperative management and expedite transfer to a hospital with pediatric surgeons who are experts in TEF/EA management to prevent long-term morbidity. IMPLICATIONS FOR RESEARCH Various methods of perioperative management exist, and future studies should look into standardizing perioperative care. Other areas of research should include acid suppression recommendation, reducing long-term morbidity seen in patients with TEF/EA, postoperative complications, and how we can safely and effectively decrease the length of time to surgery for long-gap atresia in neonates.
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Piro E, Schierz IAM, Giuffrè M, Cuffaro G, La Placa S, Antona V, Matina F, Puccio G, Cimador M, Corsello G. Etiological heterogeneity and clinical variability in newborns with esophageal atresia. Ital J Pediatr 2018; 44:19. [PMID: 29373986 PMCID: PMC5787270 DOI: 10.1186/s13052-018-0445-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/02/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The aim of this study was to define different characteristics of infants with esophageal atresia and correlations with neonatal level of care, morbidity and mortality occurring during hospital stay. METHODS Charts of all newborns with esophageal atresia (EA) admitted to our University NICU between January 2003 and November 2016 were reviewed and subdivided in four groups related to different clinical presentations; EA as an isolated form (A), with a concomitant single malformation (B), as VACTERL association (C), and in the context of a syndrome or an entity of multiple congenital anomalies (D). RESULTS We recruited 67 infants with EA (with or without tracheoesophageal fistula), distributed in groups as follows: A 31.3%, B 16.4%, C 26.8% and D 25.3%. Type of atresia was not statistically different among different groups. Mortality was higher in groups C and D, especially if associated with congenital heart defects. In survivors, we found different auxological evolution and prognostic profiles considering duration in days of invasive mechanical ventilation and total parenteral nutrition, as well as length of stay and corrected gestational age at discharge. CONCLUSIONS In the context of genetic and syndromic entities, subjects with VACTERL association showed a lower mortality rate although a higher and more complex level of intensive care was noted in comparison to infants without VACTERL genetic and syndromic entities.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Anal Canal/abnormalities
- Cohort Studies
- Databases, Factual
- Esophageal Atresia/diagnosis
- Esophageal Atresia/epidemiology
- Esophageal Atresia/genetics
- Esophagus/abnormalities
- Female
- Genetic Predisposition to Disease/epidemiology
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/genetics
- Hospital Mortality
- Humans
- Infant, Newborn
- Intensive Care Units, Neonatal
- Kidney/abnormalities
- Length of Stay
- Limb Deformities, Congenital/diagnosis
- Limb Deformities, Congenital/epidemiology
- Limb Deformities, Congenital/genetics
- Male
- Prognosis
- Retrospective Studies
- Risk Assessment
- Spine/abnormalities
- Survival Analysis
- Trachea/abnormalities
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Affiliation(s)
- Ettore Piro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Ingrid Anne Mandy Schierz
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Mario Giuffrè
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Cuffaro
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Simona La Placa
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Vincenzo Antona
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Federico Matina
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giuseppe Puccio
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Marcello Cimador
- Pediatric Surgical Unit. A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
| | - Giovanni Corsello
- Neonatal Intensive Care Unit, A.O.U.P. “P. Giaccone”, Department of Sciences for Health Promotion and Mother and Child Care “G. D’Alessandro”, University of Palermo, Via Alfonso Giordano n. 3, Palermo, 90127 Italy
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