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Turkish Neurosurgery 2022To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture.
AIM
To compare and analyze the effects of cranial suture reconstruction and frontal frame retraction for surgical treatment of premature closure of the sagittal suture.
MATERIAL AND METHODS
Infants with premature closure of the sagittal suture were included in this study. All infants underwent preoperative skull model reconstruction using imaging techniques and 3D printing. The infants were then allocated to either the experiment group, where the frontal frame retraction was used to guide the surgical treatment of cranial stenosis, or the control group, where traditional cranial suture reconstruction was performed. All interventions were performed by the same operator. The surgical effects of the two groups were compared.
RESULTS
Overall, 28 infants were enrolled in this study, with 15 infants in the experimental group and 13 in the control group. In the one-year post-operative follow-up visit, the cephalic index of scaphoid malformation was 78.3 ± 1.4 in the experimental group and 69.0 ± 4.2 in the control group. The difference between the two groups was statistically significant.
CONCLUSION
Frontal frame retraction surgery can guide the surgical procedure for cranial stenosis, significantly improve the treatment outcome in children with premature closure of the sagittal suture, and improve the form of the head aesthetically in children, and the effect is better than traditional operation; therefore, the technique is worth popularizing in the clinic.
Topics: Child; Constriction, Pathologic; Cranial Sutures; Craniosynostoses; Humans; Infant; Skull; Sutures
PubMed: 35023139
DOI: 10.5137/1019-5149.JTN.35807-21.1 -
Pediatric Cardiology Dec 2022We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the...
We report our experience with transcatheter patent ductus arteriosus (PDA) closure in premature infants and compare patients grouped by the device used for closure: the Microvascular Plug, "MVP" (Medtronic, Minneapolis, MN); Micro Plug Set, "Micro Plug" (KA Medical, Minneapolis, MN); and Amplatzer Piccolo Occluder, "Piccolo" (Abbot, Santa Clara, CA). We also report trends in device selection over time. Studies examining outcomes according to device selection for PDA closure in premature infants are lacking. We performed a retrospective review of all percutaneous PDA closures in premature infants at a single center (June 2018-May 2021). Patients were grouped by initial device selected for PDA closure (intention to treat). Institutional Review Board approval was obtained. 58 premature infants [MVP (n = 25), Micro Plug (n = 25), and Piccolo (n = 8)] underwent successful transcatheter PDA closure (mean gestational age 27 weeks 2 days; mean weight at procedure 1.4 kg; mean age at procedure 28 days). Pre-procedural demographics, procedural data, and follow-up data were similar between groups. There were no significant procedural adverse events. Three devices (2 MVP, 0 Micro Plug, 1 Piccolo p = 0.27) embolized after the procedure. One other device was removed for concern for aortic obstruction. Device selection evolved with a clear trend toward the Micro Plug device over time. Demographic, procedural, and follow-up data were similar between the MVP, Micro Plug, and Piccolo groups. The Micro Plug did not require exchange for suboptimal fitting or embolize and became our preferred device in most cases.
Topics: Infant, Newborn; Infant; Humans; Ductus Arteriosus, Patent; Cardiac Catheterization; Treatment Outcome; Infant, Premature; Septal Occluder Device; Infant, Premature, Diseases; Retrospective Studies
PubMed: 35430709
DOI: 10.1007/s00246-022-02903-2 -
Journal of the American Heart... Jan 2022Background Pharmacologic therapy for patent ductus arteriosus closure is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed....
Background Pharmacologic therapy for patent ductus arteriosus closure is not consistently successful. Surgical ligation (SL) or transcatheter closure (TC) may be needed. Large multicenter analyses comparing outcomes and resource use between SL and TC are lacking. We hypothesized that patients undergoing TC have improved outcomes compared with SL, including mortality, hospital and intensive care unit length of stay, and mechanical ventilation. Methods and Results Using the 2016 to 2020 Pediatric Health Information System database, characteristics, outcomes, and charges of patients aged <1 year who underwent TC or SL were analyzed. A total of 678 inpatients undergoing TC (n=503) or SL (n=175) were identified. Surgical patients were younger (0.1 versus 0.53 years; <0.001) and more premature (60% versus 20.3%; <0.001). Surgical patients had higher mortality (1.7% versus 0%; =0.02). Using inverse probability of treatment weighting by the propensity score, multivariable-adjusted analyses demonstrated favorable outcomes in TC: intensive care unit admission rates (adjusted odds ratio [OR], 0.2; 95% CI, 0.11-0.32; <0.001); mechanical ventilation rates (adjusted OR, 0.3; 95% CI, 0.19-0.56; <0.001); and shorter hospital (adjusted coefficient, 2 days shorter; 95% CI, 1.3-2.7; <0.001) and postoperative (adjusted coefficient, 1.2 days shorter; 95% CI, 0.1-2.3; =0.039) stays. Overall charges and readmission rates were similar. Among premature neonates and infants, hospital (adjusted difference in medians, 4 days; 95% CI, 1.7-6.3 days; <0.001) and postoperative stays (adjusted difference in medians, 3 days; 95% CI, 1.1-4.9 days; =0.002) were longer for SL. Conclusions TC is associated with lower mortality and reduced length of stay compared with SL. Rates of TC continue to increase compared with SL.
Topics: Aged; Child; Ductus Arteriosus, Patent; Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Infant, Premature; Ligation; Retrospective Studies; Treatment Outcome
PubMed: 34970919
DOI: 10.1161/JAHA.121.022776 -
Seminars in Fetal & Neonatal Medicine Apr 2021The published literature on patent ductus arteriosus (PDA) management is challenging to interpret due to poorly designed trials with high rates of open label treatments,... (Review)
Review
The published literature on patent ductus arteriosus (PDA) management is challenging to interpret due to poorly designed trials with high rates of open label treatments, homogenisation of patients with varying physiological subtypes, poor treatment efficacy, and spontaneous closure in more mature infants. The perceived lack of clinical benefit has led to a drift away from medical and surgical treatment of all infants with a PDA. This therapeutic nihilism as a default response to PDA management fails to recognise the physiological relevance of a left-to-right shunt with early haemodynamic instability after birth and subsequent pulmonary volume overload with prolonged exposure. Clinicians need to know if therapeutic nihilism is safe. This review will provide an overview of the available data on the efficacy of known PDA treatments, conservative management and supportive care measures that are currently applied.
Topics: Conservative Treatment; Ductus Arteriosus, Patent; Humans; Infant; Infant, Newborn; Infant, Premature; Treatment Outcome
PubMed: 33653600
DOI: 10.1016/j.siny.2021.101219 -
Medicine Jun 2023The objective of this study was to evaluate the effect of maturing fetal lung on clinical efficacy of acetaminophen in the treatment of premature infants with patent... (Clinical Trial)
Clinical Trial
The objective of this study was to evaluate the effect of maturing fetal lung on clinical efficacy of acetaminophen in the treatment of premature infants with patent ductus arteriosus (PDA). A total of 441 premature infants admitted to our hospital from May 2020 to May 2021 were recruited, including 152 premature infants receiving fetal lung maturation (13 cases of PDA closure with drug use and 2 cases failed) and 289 cases without maturing fetal lung (17 cases of PDA closure and 8 cases failed). Finally, a total of 30 cases were enrolled in this clinical trial. All infants were divided into groups A and B according to whether fetal lung maturation was adopted before delivery. In group A, 13 infants received fetal lung maturation, and 17 in group B did not undergo fetal lung maturation. Infants in both groups were orally given with acetaminophen. After 3-day treatment, the second course of treatment was given immediately if PDA was not closed. The PDA closure rate and patency rate of PDA at the end of 2 treatment courses were statistically compared between 2 groups. The feeding intolerance, upper gastrointestinal bleeding, renal failure, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, the age at total enteral nutrition and the length of hospital stay were also compared between 2 groups. After the 1st and 2nd treatment courses, the PDA closure rate in group A was 84.61%, significantly higher than 52.94% in group B (P < .05), whereas there was no significant difference in the PDA patency rate between 2 groups (P > .05). No significant differences were observed regarding the feeding intolerance, renal failure, necrotizing enterocolitis, periventricular-intraventricular hemorrhage, bronchopulmonary dysplasia, the length of hospital stay and the age at total enteral nutrition between 2 groups (all P > .05). In addition, the incidence of upper gastrointestinal bleeding in group A was 7.69%, slightly lower than 5.88% in group B (P > .05). Compared with premature infants untreated with fetal lung maturation interventions before delivery, premature infants who receive fetal lung maturation interventions combined with acetaminophen for PDA are likely to obtain a higher PDA closure rate and a lower incidence rate of the upper gastrointestinal bleeding.
Topics: Humans; Infant, Newborn; Acetaminophen; Bronchopulmonary Dysplasia; Cerebral Hemorrhage; Ductus Arteriosus, Patent; Enterocolitis, Necrotizing; Gastrointestinal Hemorrhage; Infant, Premature; Lung
PubMed: 37327300
DOI: 10.1097/MD.0000000000034011 -
Turkish Journal of Medical Sciences Aug 2022We aimed to assess the neurodevelopmental status of healthy children with premature anterior fontanel closure. (Observational Study)
Observational Study
BACKGROUND
We aimed to assess the neurodevelopmental status of healthy children with premature anterior fontanel closure.
METHODS
This retrospective observational study was conducted on 40 (20 M, 20 F) children admitted to Mersin University Pediatric Neurology Outpatient Clinic between 2015-2020 with complaints of premature fontanel closure. Patients with dysmorphic features, microcephaly, craniosynostosis, hypoxic-ischemic sequelae, infections, metabolic disorders, intracranial hemorrhage, epilepsy, endocrine problems, additional congenital anomalies, intrauterine growth retardation (IUGR), prematurity, and postmaturity were excluded. The Denver II and Bayley III tests were applied to all patients and controls.
RESULTS
The Denver II identified retardations in gross motor skills (p = 0.015) and personal-social skills (p = 0.042) and Bayley III in cognitive (p = 0.030) and motor skills (p = 0.007) in the study group. None of the participants in the study group had neurodevelopmental retardation, according to the Bayley III normal standards.
DISCUSSION
Our results suggest that children with premature fontanel closure may develop motor retardation. These children should, therefore, be closely monitored for neurodevelopmental aspects.
Topics: Humans; Child; Infant; Cranial Fontanelles; Child Development; Motor Skills; Retrospective Studies
PubMed: 36326403
DOI: 10.55730/1300-0144.5393 -
Turkish Neurosurgery 2023To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants.
AIM
To compare, and to analyze the effects of fronto-orbital band anterior displacement in the operation of premature closure of coronal suture in infants.
MATERIAL AND METHODS
A total of 31 infants with premature closure of coronal suture were randomly divided into two groups; experimental group (n=16) and control group (n=15). In the experimental group, the skull model was reconstructed by an imaging examination and three-dimensional (3D) printing technique before the operation, and the fronto-orbital band was anteriorly displaced during the operation to guide the surgical treatment of craniosynostosis. In the control group, the skull model was reconstructed by an imaging examination and 3D printing technique before the operation, and the fronto-orbital band was not anteriorly displaced during the operation by the same operator. The surgical effects of the two groups were compared.
RESULTS
During the 12-month follow up after the operation, the cephalic index of short head deformity in the experimental group was 80.7 ± 1.1, while that in the control group was 89.3 ± 4.5. There was a significant difference between the two groups.
CONCLUSION
Fronto-orbital band anterior displacement may guide the operation of craniosynostosis and significantly improve the effectiveness of surgical treatment of children with premature closure of coronal suture, which is worth popularizing in the clinical management of cases.
Topics: Child; Humans; Infant; Cranial Sutures; Skull; Craniosynostoses; Head; Tomography, X-Ray Computed
PubMed: 35147968
DOI: 10.5137/1019-5149.JTN.34722-21.3 -
Current Cardiology Reports Jan 2020To review the most recent literature on pediatric transcatheter ductal intervention including ductus arteriosus occlusion and stenting. (Review)
Review
PURPOSE OF REVIEW
To review the most recent literature on pediatric transcatheter ductal intervention including ductus arteriosus occlusion and stenting.
RECENT FINDINGS
With the development and FDA approval of smaller ductal devices, including most recently the Amplatzer Piccolo Occluder (Abbott, Abbott Park, IL), transcatheter ductus arteriosus device closure is now being safely performed in premature infants and patients < 6 kg using a transvenous approach. In patients with ductus-dependent pulmonary blood flow, ductal stenting with pre-mounted coronary artery stents has been shown to be an acceptable alternative to the surgically placed Blalock-Taussig shunt. Centers with experience in ductal stenting have demonstrated success, even with the tortuous ductus. Innovation in transcatheter device technology and procedural practices have allowed for significant advances. Transcatheter ductal device closure is a reasonable alternative to surgical ligation even in premature, low-birthweight infants. Ductal stenting is also an accepted alternative to the modified Blalock-Taussig shunt. We anticipate continued advancement and procedural refinement over the next several years.
Topics: Blalock-Taussig Procedure; Cardiac Catheterization; Child; Ductus Arteriosus; Ductus Arteriosus, Patent; Humans; Infant; Palliative Care; Stents; Treatment Outcome
PubMed: 31997085
DOI: 10.1007/s11886-020-1266-x -
Graefe's Archive For Clinical and... Aug 2021To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese. (Review)
Review
PURPOSE
To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese.
METHODS
Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts.
RESULTS
A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan's syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat's disease, and neurofibromatosis.
CONCLUSIONS
We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.
Topics: Adolescent; Adult; Eye Diseases, Hereditary; Female; Glaucoma, Angle-Closure; Humans; Intraocular Pressure; Male; Retinal Diseases; Retinitis Pigmentosa; Retrospective Studies; Young Adult
PubMed: 33876278
DOI: 10.1007/s00417-021-05172-6 -
Frontiers in Pediatrics 2020The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature...
The aim of this study was to describe our experience with transcatheter device closure of patent ductus arteriosus (PDA) in symptomatic low-birth-weight premature infants. We performed a retrospective study of infants born with a birth body weight of < 2,000 g and admitted to National Cheng Kung University Hospital from September 2014 to December 2019. Basic demographic and clinical information as well as echocardiographic and angiographic data were recorded. Twenty-five premature infants (11 boys and 14 girls) born at gestational ages ranging between 22 and 35 weeks (mean, 25 weeks) were identified. The mean age at procedure was 34.5 ± 5.5 days, and the mean weight was 1,209 ± 94 g (range, 478-1,980 g). The mean diameter of the PDA was 3.4 ± 0.2 mm (range, 2.0-5.4 mm). The following devices were used in this study: Amplatzer Ductal Occluder II additional size ( = 20), Amplatzer Vascular Plug I ( = 1), and Amplatzer Vascular Plug II ( = 4). Complete closure was achieved in all patients. The mean follow-up period was 30.1 ± 17.3 months (range, 6-68 months). In total, 3 patients had left pulmonary artery (LPA) stenosis and 1 patient had coarctation of the aorta during the follow-up period. Younger procedure age and smaller procedure body weight were significantly associated with these obstructions. Performing transcatheter PDA closure in symptomatic premature infants weighing more than 478 g is feasible using currently available devices; moreover, the procedure serves as an alternative to surgery.
PubMed: 33520899
DOI: 10.3389/fped.2020.615919