Notes

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Since the gap between two atretic segments of oesophagus is a critical determinant of prognosis for oesophageal atresia/tracheoesophageal fistula (EA/TEF), the search for a surrogate non-invasive pre-operative marker of long gap atresia continues.

The purpose of the study was to compare the presence of normal and supernumerary ribs with length of EA and survival rates.

A prospective observational study was conducted at a tertiary care referral neonatal intensive care unit in North Karnataka, India, from January 2016 to June 2019.

Amongst babies with EA/TEF, pre-operative radiograph helped determine the number of ribs, and babies were divided into two groups; Group I babies with 12 ribs and Group II babies with supernumerary ribs.

Nominal variables were expressed as percentage and continuous variables as mean standard deviation. MedCalc software was used to compare proportions and means. A P < 0.05 was considered statistically significant.

Of the 61 cases, 51 were operated. Long gap EA was predominantly seen amongst babies in Group II (40% in Group II vs. 27% in Group I, P= 0.424). Survival rates by percentage were lower in babies in Group II (60% in Group II vs. 80% in Group I, P= 0.188). Both the above findings were proven statistically insignificant. The overall survival rate amongst the study population was 78.4% (39/51).

Supernumerary ribs were associated with a higher occurrence of long gap EA and lower survival rates, though statistically insignificant. Multicentre collaboration may provide significant input for strengthening or refuting the above hypothesis.
Supernumerary ribs were associated with a higher occurrence of long gap EA and lower survival rates, though statistically insignificant. Multicentre collaboration may provide significant input for strengthening or refuting the above hypothesis.
The aim of this study was to determine the epidemiological, lesion, treatment and outcome of the 'floating elbow' in children.

It was two boys and a girl with a mean age of 7 years. The average consultation time was 3.6 h. In two patients, the trauma had occurred during playful accident with fall from a height. Supracondylar fracture was associated with a fracture epiphyseal separation-type II distal end of the right radius in one case, a fracture of the distal quarter of the bones 2 of the forearm in the second patient and fracture quarter distal radius in the third patient. All fractures of the elbow were treated by osteosynthesis as well as a fracture of the distal radius ¼. BL-918 The average hospital stay was 5 days. After a mean of 8 months was rated limitation of elbow flexion to 100° in a patient, an externalisation of the pins at the elbow in M3 in one patient and a limitation of elbow extension at 30° in 2 patients. One patient had a varus ulna. The pronosupination was preserved in all patients.

The 'floating elbow' is unusual in children and usually occurs during a high-energy trauma. His treatment is not yet the subject of consensus. Complications often involve the elbow.
The 'floating elbow' is unusual in children and usually occurs during a high-energy trauma. His treatment is not yet the subject of consensus. Complications often involve the elbow.
The circumcision is the most frequent procedure in paediatric surgery worldwide, performed for medical and ritual purposes. In developing countries, because of the difficult accessibility to healthcare, even a common procedure could be unsafe.

The aim of the article is to compare the perioperative and anaesthesiological management of circumcision in children between two Italian and two sub-Saharan African hospitals.

Medical records of paediatric circumcision from January 2014 to December 2016 have been reviewed. The involved hospitals were Padua (Italy), Ferrara (Italy), Sao José em Bor (Guinea Bissau) and Yaoundé (Cameroun).

In Padua, 77 circumcisions were performed, 19 of these (24.6%) were ritual. In 75 children (97.4%), locoregional anaesthesia (LRA) together with sedation was used; only one complication (1.3%) occurred. In Ferrara, 200 interventions were done, 140 (70%) ritual; general anaesthesia was administered to 183 (93.5%) patients. There were five complications (2.5%). In Bissau, 53 procedures were performed, 21 (39.6%) ritual; in 34 children (64.1%), LRA with sedation was preferred. Two complications (3.8%) were reported. In Yaoundé, 60 children were circumcised, 15 (25%) for ritual purposes; in 51 (85%), only LRA was performed; there was only one (1.7%) complication. In the African hospital, no post-operative analgesia was administered.

Despite the different anaesthesiological techniques, the study shows no difference in rate of complications for the in-hospital setting. Training of the local medical team in pain management and post-operative care should be emphasised.
Despite the different anaesthesiological techniques, the study shows no difference in rate of complications for the in-hospital setting. Training of the local medical team in pain management and post-operative care should be emphasised.
Birth defects have medical, surgical and aesthetic consequences. The impact of birth defects is particularly severe in low-income countries where health-care resources are limited.

The aim of this study was to determine the prevalence and types of birth defects in live newborns delivered at the two tertiary hospitals in Enugu, South East Nigeria.

This was a hospital-based observational study carried out on neonates delivered in the maternity units of the University of Nigeria Teaching Hospital Ituku/Ozalla and Enugu State University Teaching Hospital Parklane, Enugu during the periods of January 2015 and December 2018. All the live-born babies born in the two hospitals during this period were recruited into the study. The neonates were examined by a paediatrician for the presence of birth defects. The birth defects were classified according to the system involved and also into major and minor.

During the study period, 9492 babies were born, of which 166 had birth defects, which gave a prevalence of 1.75%. The predominant system affected by birth defects was the musculoskeletal system (45.2%) followed by the central nervous system (34.9%), urogenital system (10.8%) and gastrointestinal tract (9%). 13 (7.8%) patients had their birth defects diagnosed prenatally during the maternal ultrasound scan. Fifteen (9%) and 13 (7.8%) mothers of the neonates who had birth defects were diabetics and hypertensives, respectively. Most of the neonates were delivered vaginally.

Birth defects are not uncommon. This study showed a prevalence of 1.75% in the two tertiary hospitals in Enugu, South East Nigeria. The most commonly affected system was the musculoskeletal system.
Birth defects are not uncommon. This study showed a prevalence of 1.75% in the two tertiary hospitals in Enugu, South East Nigeria. The most commonly affected system was the musculoskeletal system.
Anorectal malformations (ARMs) in the sub-Saharan Africa are a common cause of neonatal referral for intestinal obstruction, and the posterior sagittal anorectoplasty (PSARP) approach is rapidly spreading. The small number of paediatric surgeons and the low-resource context limit children's access to care and constrain the quality of results. A retrospective, observational study has been done on a consecutive series of ARM cases admitted to a Sudanese tertiary paediatric surgical centre within the framework of a partnership between Italian and Sudanese academic institutions addressed to review and upgrade the standard of care of major congenital anomalies.

The authors collected 94 ARM cases in a 3 years' period. Conditions on referral, operative procedures, post-operative course and follow-up were recorded and examined. Their correlations with complications and outcome were analysed.

The male/female ratio was 47/47. Eighty patients presented with an untreated ARM; 66 had a divided stoma and 14 had alrearisk of complications and failures is high. Primary management is often inappropriate, and a high rate of colostomy-related complications is observed. Poverty and lack of transportation reduce attendance to follow-up, hampering the final results. Investments in healthcare facilities and retention of trained health providers are needed to improve the standard of care.
Corrosive ingestion in children occurs usually at home and frequently results in debilitating strictures. Prevention and early intervention programs are very important for good outcomes.

This study aims at examining the immediate causative factors and problems of this subset of patients with a special focus on treatment and outcome. This study was to audit the management of patients in the paediatric age group who presented for treatment with history and sequelae of corrosive ingestion seen by the cardiothoracic unit of the University of Benin Teaching Hospital from January 2005 till December 2018.

This is a 14year retrospective study of patients that presented with oesophageal burn injuries from ingestion of corrosive agents to the Cardiothoracic Unit at the University of Benin Teaching Hospital between January 2005 and December 2018. Essentially the first 5years were retrospectively included but the subsequent years were prospective. All available medical data on these patients were retrieved and stud early intervention.
In conclusion, corrosive oesophageal stricture is a debilitating disease in children and affects males more, but it is treatable by multiple dilatations and oesophageal replacement with colon. Prevention should be actively pursued as well as early intervention.
Paediatric laparoscopic surgery is fast growing worldwide, with many pathologies now being treated even in the youngest of patients. We hereby report our experience with the first 114 cases.

Our aim was to highlight our progress and lessons learnt practicing laparoscopic paediatric surgery in our institution.

This is a retrospective study of the first 114 children who underwent laparoscopic surgery in our hospital. We focussed on demographics, indications, procedures performed, rate of conversion to open and complications. Records were retrieved from January 2011 to December 2019. Data were analysed using the SPSS software version 23 (SPSS Inc., Chicago, Illinois, USA).

There were 83 males and 31 females (ratio of 31). Age groups included infants (13.2%), 1-5 years (21.9%), 5-10 years (33.3%) and > 10 years (31.6%). There was a remarkable increase in the frequency and complexity of cases performed from an average of 5 per year between 2011 and 2015 to an average of 23.5 per year between 2016 and 2019. The conversion rate was 6%, 5 appendectomies, 1 Swenson pull-through, 1 diagnostic laparoscopy and 1 Ladd's procedure. Four complications were noted; one recurrent adhesive intestinal obstruction, one residual intra-abdominal abscess, one port site abscess and one excessive bleeding from liver biopsy requiring conversion to open surgery.

We have demonstrated that the routine use of laparoscopy in children is feasible and safe in our environment. However, the need for training, endurance through a steep learning curve and the willingness to battle the technical challenges are necessary for success.
We have demonstrated that the routine use of laparoscopy in children is feasible and safe in our environment. However, the need for training, endurance through a steep learning curve and the willingness to battle the technical challenges are necessary for success.
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