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Seminars in Pediatric Surgery

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https://www.readbyqxmd.com/read/29275819/stem-cell-therapy-in-necrotizing-enterocolitis-current-state-and-future-directions
#1
Natalie A Drucker, Christopher J McCulloh, Bo Li, Agostino Pierro, Gail E Besner, Troy A Markel
Stem cell therapy is a promising treatment modality for necrotizing enterocolitis. Among the many promising stem cells identified to date, it is likely that mesenchymal stem cells will be the most useful and practical cell-based therapies for this condition. Using acellular components such as exosomes or other paracrine mediators are promising as well. Multiple mechanisms are likely at play in the positive effects provided by these cells, and further research is underway to further elucidate these effects.
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275818/neurodevelopmental-considerations-in-surgical-necrotizing-enterocolitis
#2
Jamie R Robinson, Clark Kennedy, Kyle J van Arendonk, Alyssa Green, Camilia R Martin, Martin L Blakely
The majority of surviving infants with surgical necrotizing enterocolitis (NEC) will have some degree of neurodevelopmental impairment. The impact of specific medial and surgical treatments for infants with severe NEC remains largely unknown but is being actively investigated. It is incumbent upon all providers caring for these infants to continue to focus on long term neurodevelopmental outcomes and to develop more widespread methods of neurodevelopmental assessment.
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275817/anemia-red-blood-cell-transfusions-and-necrotizing-enterocolitis
#3
Akhil Maheshwari, Ravi M Patel, Robert D Christensen
In the past 15 years, multiple clinical studies have identified a temporal association between red blood cell (RBC) transfusions and necrotizing enterocolitis (NEC). With some variability, most of these studies indicate that up to one-third of all cases of NEC involving very low-birth weight infants may occur within 24-48h after receiving a RBC transfusion. There is also evidence that the risk of such transfusion-associated NEC may be higher in infants transfused with the greatest severity of anemia. In this article, we summarize the clinical evidence pertaining to these issues; specifically, the contribution of RBC transfusions, and the contribution of severity of underlying anemia, to the pathogenesis of a type of NEC potentially termed, "transfusion/anemia-associated NEC...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275816/probiotics-and-necrotizing-enterocolitis
#4
Ravi Mangal Patel, Mark A Underwood
In this review, we summarize existing knowledge regarding the effects of probiotics on necrotizing enterocolitis (NEC). We review the role of the microbiome in NEC and pre-clinical data on mechanisms of probiotic action. Next, we summarize existing randomized controlled trials and observational studies of probiotics to prevent NEC. We also summarize findings from several recent meta-analyses and report a new cumulative meta-analysis of probiotic trials. Finally, we review data from cohorts routinely using commercially available probiotics...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275815/human-milk-and-necrotizing-enterocolitis
#5
Aloka L Patel, Jae H Kim
NEC is a multifactorial disease that occurs when multiple risk factors and/or stressors overlap, leading to profound inflammation and intestinal injury. Human milk feedings, both from the infant's mother and donor human milk, have been associated with reductions in NEC in preterm infants. This article will review the protective factors in human milk, clinical studies of human milk and NEC, and practices to enhance human milk use in neonatal intensive care units.
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275814/changing-the-paradigm-of-defining-detecting-and-diagnosing-nec-perspectives-on-bell-s-stages-and-biomarkers-for-nec
#6
Sheila M Gephart, Phillip V Gordon, Alexander H Penn, Katherine E Gregory, Jonathan R Swanson, Akhil Maheshwari, Karl Sylvester
Better means to diagnose and define necrotizing enterocolitis are needed to guide clinical practice and research. Adequacy of Bell's staging system for clinical practice and clarity of cases used in NEC clinical datasets has been a topic of controversy for some time. This article provides reasons why a better global definition for NEC is needed and offers a simple alternative bedside definition for preterm NEC called the "Two out of Three" rule. Some argue that biomarkers may fill knowledge gaps and provide greater precision in defining relevant features of a clinical disease like NEC...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275813/the-science-and-necessity-of-using-animal-models-in-the-study-of-necrotizing-enterocolitis
#7
Guillermo J Ares, Steven J McElroy, Catherine J Hunter
Necrotizing enterocolitis (NEC) remains one of the highest causes of mortality and of acute and long-term morbidity in premature infants. Multiple factors are involved in the pathophysiology of NEC including the immaturity of the immune system and the complex changing composition of the intestinal microbiome. This is compounded by the fact that the premature infant should ideally still be a developing fetus and has an immature intestinal tract. Because these complexities are beyond the scope of studies in single-cell cultures, animal models are absolutely essential to understand the mechanisms involved in the pathophysiology of NEC and the effects of inflammation on the immature intestinal tract...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275812/development-of-the-necrotizing-enterocolitis-society-registry-and-biorepository
#8
Matthew W Ralls, Samir K Gadepalli, Karl G Sylvester, Misty Good
Necrotizing enterocolitis (NEC) is a devastating disease affecting premature infants. New advances in diagnostic and treatment options are desperately needed. Accordingly, the NEC Society initiated a research collaborative with a group of investigators dedicated to advancing the state of NEC-associated knowledge. Recent advances in high-content molecular interrogation and bio-computation (e.g., genomics, transcriptomics, proteomics, and metabolomics) can provide new insights from afflicted infants with NEC, however, individual centers do not have sufficient cases to conduct these studies independently...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275811/enhancing-nicu-parent-engagement-and-empowerment
#9
Erin Umberger, Jennifer Canvasser, Sue L Hall
Within the neonatal intensive care unit (NICU), parent engagement and empowerment are of critical importance, particularly when infants are at risk of developing severe complications, such as necrotizing enterocolitis (NEC). Stakeholders within the NICU, including the fragile patients, families, clinicians, staff, and administration, benefit when parents are a valued member of their baby's care team. The 2017 NEC Symposium explored the experiences of families whose infants were impacted by NEC, the barriers to effective partnership, and promising solutions...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275810/necrotizing-enterocolitis-pathophysiology-from-a-historical-context
#10
David Hackam, Michael Caplan
Necrotizing enterocolitis (NEC) continues to afflict approximately 7% of preterm infants born weighing less than 1500g, though recent investigations have provided novel insights into the pathogenesis of this complex disease. The disease has been a major cause of morbidity and mortality in neonatal intensive care units worldwide for many years, and our current understanding reflects exceptional observations made decades ago. In this review, we will describe NEC from a historical context and summarize seminal findings that underscore the importance of enteral feeding, the gut microbiota, and intestinal inflammation in this complex pathophysiology...
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29275809/preface-the-nec-society
#11
EDITORIAL
Troy A Markel, Mark A Underwood
No abstract text is available yet for this article.
February 2018: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126510/long-term-outcomes-of-pediatric-inflammatory-bowel-disease
#12
Soheila Nasiri, Mary Ellen Kuenzig, Eric I Benchimol
The incidence and prevalence of childhood-onset inflammatory bowel diseases (IBD), including subtypes Crohn's disease and ulcerative colitis, have risen dramatically in recent years, and have emerged globally as important pediatric chronic diseases. Therefore, health care providers are more frequently encountering very young children with IBD, a chronic and incurable condition requiring life-long therapy. These children are living long lives with IBD and therefore knowledge of long-term outcomes is increasingly important to better counsel families and determine the best course of treatment...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126509/treatment-of-perianal-crohn-s-disease
#13
Jill M Zalieckas
Perianal Crohn's is a common manifestation of Crohn's disease. Primary manifestations of perianal disease mirror common anorectal conditions, however treatment is less successful than in those patients without Crohn's related perianal disease. A multimodal approach to therapy including medical and surgical modalities is often necessary. The goal of treatment is to manage symptoms while maintaining continence.
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126508/complications-in-children-with-ulcerative-colitis-undergoing-ileal-pouch-anal-anastomosis
#14
Dani O Gonzalez, Benedict C Nwomeh
Total colectomy with ileal pouch-anal anastomosis (IPAA) is considered the standard procedure for the surgical management of ulcerative colitis. Despite the widespread utility of the procedure, as many as 75% of patients who undergo IPAA, experience at least 1 complication. This review highlights difficult intraoperative scenarios and complications of pouch surgery in children, including intraoperative, postoperative, and functional complications. Intraoperative scenarios include insufficient mesenteric length and positive leak tests...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126507/surgical-options-in-the-treatment-of-ulcerative-colitis
#15
Daniel P Ryan, Daniel P Doody
Children and young adults with ulcerative colitis tend to present with more extensive colonic disease than an adult population. The need for surgical intervention in the pediatric population with ulcerative colitis occurs earlier after diagnosis and has a greater incidence than a comparably matched adult population with an estimated need for colectomy at 5 years following diagnosis of 14-20%. Perhaps, even more than the adult population, there is a desire to restore intestinal continuity for the pediatric patient to achieve as healthy and normal quality of life as possible...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126506/surgical-care-of-the-pediatric-crohn-s-disease-patient
#16
Dylan Stewart
Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126505/management-of-acute-severe-ulcerative-colitis-in-children
#17
Vei Shaun Siow, Riha Bhatt, Kevin P Mollen
The incidence of pediatric-onset ulcerative colitis (UC) is rising. Children often present with a more severe disease phenotype as compared to adults with over a third requiring hospitalization for the management of acute severe ulcerative colitis (ASUC). Further, in pediatric patients presenting with inflammatory bowel disease (IBD) limited to the colon, a definitive diagnosis of UC vs. Crohn's disease is often unclear. Here, we review the unique aspects of pediatric ASUC including the epidemiology, diagnosis, medical, and surgical management of this disease...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126504/medical-management-of-pediatric-inflammatory-bowel-disease
#18
Katherine R Baldwin, Jess L Kaplan
Inflammatory bowel diseases (IBD) are chronic autoimmune conditions of the gut affecting both pediatric and adult patients. Medical therapy is often successful at inducing and maintaining remission and preventing disease complications. The mainstays of treatment are medications and other therapies that reduce inflammation and suppress the overactive immune system. Here we review current medical therapies for pediatric IBD, discuss future therapeutics, and present current treatment goals and approaches.
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126503/very-early-onset-inflammatory-bowel-disease
#19
Christopher J Moran
Very early onset inflammatory bowel disease (VEO-IBD) represents a unique and growing subset of patients with inflammatory bowel disease (IBD). Some VEO-IBD patients present with immunodeficiency and possess loss of function genetic mutations involving immune pathways that cause their IBD. A search for Mendelian causes of IBD is likely most beneficial when the presentation involves extra-intestinal autoimmunity or involves intestinal histopathology that is atypical for IBD. While a subset of these young patients will have highly aggressive courses (and likely present with immunodeficiency), the majority of patients with VEO-IBD appear to have disease courses similar to that of their older counterparts...
December 2017: Seminars in Pediatric Surgery
https://www.readbyqxmd.com/read/29126502/clinical-presentation-of-crohn-s-ulcerative-colitis-and-indeterminate-colitis-symptoms-extraintestinal-manifestations-and-disease-phenotypes
#20
Yangyang R Yu, J Ruben Rodriguez
The incidence of inflammatory bowel disease (IBD) is rising with 25% of IBD diagnosed in children under 18 years of age. The clinical presentation of IBD in children is often vague leading to initial misdiagnosis as infectious colitis or irritable bowel syndrome. When IBD is identified, overlap in histologic and endoscopic features may lead to difficulty distinguishing Crohn's disease from ulcerative colitis, resulting in a higher frequency of the diagnosis indeterminate colitis or IBD unspecified. Recognizing the common and the atypical presentation of pediatric IBD and extraintestinal manifestations will aid in expeditious referral and early diagnosis...
December 2017: Seminars in Pediatric Surgery
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