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Elena Hanganu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

FACTORI PROGNOSTICI IN EVOLUTIA POSTOPERATORIE PRECOCE A ATREZIEI ESOFAGIENE. EXPERIENTA UNUI CENTRU TERTIAR INTR-UN INTERVAL DE 5 ANI

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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FACTORI PROGNOSTICI IN EVOLUTIA POSTOPERATORIE PRECOCE A ATREZIEI ESOFAGIENE. EXPERIENTA UNUI CENTRU TERTIAR INTR-UN INTERVAL DE 5 ANI

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REZUMAT

Scop. Studierea factorilor prognostici care pot influenţa evoluţia postoperatorie a pacienţilor cu atrezie de esofag, ţinând cont de particularităţile loco-regionale ale problemei.
Metode. S-a efectuat o analiză retrospectivă a documentelor medicale pentru 28 de pacienţi diagnosticaţi cu atrezie esofagiană între 2009-2014 în centrul autorilor, utilizând ca instrument de prelucrare a datelor regresia logistică. Supravieţuirea a fost considerată variabilă dependentă, iar detaliile demografice, greutatea la naştere, vârsta intervenţiei chirurgicale, anomaliile asociate, evoluţia postoperatorie şi managementul complicaţiilor au fost studiate ca şi variabile independente.
Rezultate. Aplicând clasificarea prognostică propusă de Spitz, grupul I cu greutatea la naştere (G.N.) ≥ 1.500 g, fără malformaţii cardiace majore, a cuprins 21 de nou-născuţi cu o mortalitate de 33%. Pentru 3 copii încadraţi în grupul II (G.N.≤1.500 g sau malformaţii cardiace majore) şi, respectiv, 4 copii din grupul III (G.N.≤1.500 g şi malformaţii cardiace asociate), mortalitatea a fost de 100%. Greutatea medie la naştere a fost de 2.282 g ±2DS, iar vârsta gestaţională medie de 31 de săptămâni. Vârsta la internare a fost de peste 24 de ore în 15 cazuri, cu deces în 13 dintre situaţii. Malformaţiile asociate cu cea mai mare pondere au fost cele cardiace. Tratamentul chirurgical a constat în: anastomoză primară (21 de cazuri), cervico- şi gastrostomie (6 cazuri), tehnica Foker (1 caz). Complicaţia postoperatorie cea mai frecventă a fost dezunirea anastomozei (la 6 pacienţi, cu deces în 4 situaţii).
Concluzii. Analiza seriei studiate indică o rată de supravieţuire scăzută pentru această patologie în centrul autorilor. În plus, faţă de factorii de prognostic citaţi în literatură (greutatea şi vârsta mică la naştere, anomaliile congenitale asociate), întârzierea diagnosticului şi, implicit, a internării într-un centru terţiar, au contribuit la creşterea mortalităţii în lotul studiat. Rafinarea abordării multidisciplinare a acestei patologii ar putea determina în viitor o supravieţuire mai mare şi o îmbunătăţire a rezultatelor managementului terapeutic.

Cuvinte cheie: Esophageal atresia, survival rate, gap-length, anastomotic leak, demographic factors

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PROGNOSTIC FACTORS IN THE EARLY POSTOPERATIVE OUTCOME OF ESOPHAGEAL ATRESIA. THE EXPERIENCE OF A TERTIARY CENTER OVER A 5 YEARS PERIOD

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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PROGNOSTIC FACTORS IN THE EARLY POSTOPERATIVE OUTCOME OF ESOPHAGEAL ATRESIA. THE EXPERIENCE OF A TERTIARY CENTER OVER A 5 YEARS PERIOD

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ABSTRACT

Purpose. The aim of this study was to determine the influence of prognostic factors on the postoperative outcome of esophageal atresia patients, taking into consideration loco-regional particular features.
Methods. A retrospective analysis of the medical records of 28 patients diagnosed with esophageal atresia was conducted, using a logistic regression model. Patients had been admitted in our hospital between 2009-2014. The survival rate was recorded separately from the independent factors, such as demographic features, weight at birth, the timing of surgical treatment, co-morbidities, postoperative prognosis and management of complications.
Results. According to the Spitz prognostic classification, there were 21 patients in group I (birth weight over 1500 g with no major anomaly), 3 patients in group II (birth weight less than 1500 g or major cardiac anomaly) and 4 patients in group III (birth weight less than 1500 g plus major cardiac anomaly). The mortality rate was 33% in group I, 100% in group II and 100% in group III. The mean birth weight was 2282 g ±2SD, and the mean gestational age was 31 weeks. The age at initial presentation was over 24 hours in 15 patients, with fatal outcome in 13 of them. The cardiac malformations presented as the associated anomalies with the highest risk. Surgical treatment was as follows: primary anastomosis in 21 cases, cervicostomy and gastrostomy in 6 cases, and Foker technique in 1 case.
Conclusions. The analysis of this series indicated a low survival rate for this pathology in our center. Besides the prognostic factors cited in literature (low birth weight and age at birth, associated cardiac malformations), we include, as risk factors for the increased mortality, the delayed diagnosis and presentation at our tertiary center. The further refinement of a multidisciplinary approach towards this pathology would contribute to a higher survival rate and an improved result of the therapeutic management.

Keywords: Esophageal atresia, survival rate, gap-length, anastomotic leak, demographic factors

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EVENTRATIA DIAFRAGMULUI – FACTOR DE RISC PENTRU INFECTIILE RESPIRATORII. PREZENTARE DE CAZ

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 2, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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EVENTRATIA DIAFRAGMULUI – FACTOR DE RISC PENTRU INFECTIILE RESPIRATORII. PREZENTARE DE CAZ

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REZUMAT

Eventraţia diafragmului este o anomalie congenitală sau dobândită, cu o incidenţă de 1 la 10.000 de copii. Presupune ascensiunea anormală a domului diafragmatic, datorată înlocuirii fibrelor musculare cu un ţesut fibroelastic în exces. Simptomatologia este variată, putând fi absentă sau sub forma unor acuze respiratorii ce pot merge până la detresă respiratorie. Infecţiile respiratorii recurente sunt cele mai frecvente manifestări. Autorii prezintă cazul unui pacient în vârstă de 3 ani de sex masculin, spitalizat în repetate rânduri pentru infecţii respiratorii, „dextrocardie“ aparentă, datorate unei eventraţii diafragmatice stângi, pentru care s-a realizat cu succes plicatura diafragmului.

Cuvinte cheie: eventraţia diafragmului, infecţii respiratorii, plicaturare

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EVENTRATION OF THE DIAPHRAGM, A RISK FACTOR FOR RECURRENT RESPIRATORY TRACT INFECTION – A CASE REPORT

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 2, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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HIGHLIGHTS

National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

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EVENTRATION OF THE DIAPHRAGM, A RISK FACTOR FOR RECURRENT RESPIRATORY TRACT INFECTION – A CASE REPORT

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ABSTRACT

Eventration of the diaphragm, congenital or acquired, represents a rare condition (1 to 10,000 live births), in which the dome of the diaphragm is abnormally elevated, due to an excessive amount of fibro-elastic diaphragmatic tissue. The child may be asymptomatic or present with respiratory symptoms as aggressive as life threatening respiratory distress. Recurrent pulmonary infections are the commonest presenting complaints. We present the case of a 3 years old boy with recurrent chest infections and apparent “dextrocardia”, both caused by a left eventration of the diaphragm, successfully treated by plication.

Keywords: Eventration of the diaphragm, respiratory infections, plication

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ENTEROCOLITA ULCERO-NECROTICA: DATE CLINICE SI POSIBILITATI DE TRATAMENT

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

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Promoting Global Health

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ENTEROCOLITA ULCERO-NECROTICA: DATE CLINICE SI POSIBILITATI DE TRATAMENT

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ABSTRACT

Obiective. Identificarea corelaţiilor între evoluţia clinică a nou-născuţilor cu enterocolita ulceronecrotică (EUN) şi stadiul de boală, factorii de risc asociaţi, respectiv tipul de tratament utilizat.

Material şi metodă. S-a realizat un studiu retrospectiv pe o perioadă de 6 ani pe baza cazuisticii Centrului Regional de Terapie Intensivă Neonatală „Cuza Voda“ şi s-au identificat 205 cazuri de enterocolită ulceronecrotică dintr-un total de 6.183 de nou-născuţi îngrijiţi aici. Bolnavii au fost împărţiţi în loturi de studiu în funcţie de vârsta de gestaţie (VG), respectiv greutatea la naştere (GN). Protocolul de analiză s-a realizat pe baza unei fişe de lucru care a cuprins datele epidemiologice ale pacienţilor, factorii de risc, tipul alimentaţiei, vârstă în momentul diagnosticului, stadiul de boală conform clasificării Bell, modalitatea de tratament (medical, chirurgical sau mixt), complicaţiile înregistrate şi evoluţia pacienţilor. Prelucrarea statistică a datelor s-a făcut utilizând programul SPSS Statistics 20.

Rezultate. Enterocolita ulceronecrotică a avut o frecvenţă de 3,3% în lotul studiat şi a fost diagnosticată la nounăscuţii prematuri în 75,6% dintre cazuri. VG medie în grupul de studiu a fost de 33 săptămâni. GN medie a fost de 1.896 g, cu 43% dintre cazuri în grupul cu greutate foarte mică la naştere (VLBW) şi 31,2% în grupul cu greutate mică la naştere (LBW). Incidenţa procentuală a factorilor de risc a fost următoarea în ordinea frecvenţei: persistenţa canalului arterial 19,5%, asfixia perinatală 13,7%, detresa respiratorie 100% dintre cazuri. 75,5% dintre cazuri au fost tratate şi externate din CRTIN, 16,6% dintre cazuri au fost transferate în Clinica de Chirurgie Pediatrică a Spitalului „Sf. Maria“ şi 3,9% au decedat la CRTIN. Din cele 34 de cazuri transferate, 19 cazuri au fost tratate chirurgical: 8 cazuri cu drenaj peritoneal (DP), 8 cazuri cu laparotomie primara (LAP) şi 3 cazuri cu LAP şi DP. Rata supravieţuirii în acest grup a fost 2,4%, iar pentru grupul cu tratament medical a fost 4,9%.

Concluzii. Prematuritatea se corelează statistic cu stadii avansate de enterocolită în momentul diagnosticului. Modalitatea de tratament chirurgical aleasă (drenaj peritoneal sau laparotomie) nu influenţează rezultatele, iar alimentaţia enterală precoce cu formula de lapte este cel mai important factor de risc pentru apariţia EUN, urmat de vârsta de gestaţie şi greutatea foarte mică la naştere.

Cuvinte cheie: enterocolită ulceronecrotică, nou-născut, posibilităţi de tratament

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NEONATAL NECROTIZING ENTEROCOLITIS: CLINICAL DATA AND TREATMENT POSSIBILITIES

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Revista Romana de PEDIATRIE | Volumul LXIII, Nr. 4, An 2014
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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National Awards “Science and Research”

NEW! RJP has announced the annually National Award for "Science and Research" for the best scientific articles published throughout the year in the official journal.

ICMJE- Recommendations

Read the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly work in Medical Journals.

Promoting Global Health

The published medical research literature is a global public good. Medical journal editors have a social responsibility to promote global health by publishing, whenever possible, research that furthers health worldwide.

NEONATAL NECROTIZING ENTEROCOLITIS: CLINICAL DATA AND TREATMENT POSSIBILITIES

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ABSTRACT

Objectives. The aim of this paper is to identify the correlations between the clinical evolution of the neonates with necrotizing enterocolitis (NEC) and the stage of disease, associated risk factors and the type of treatment used.

Material and methods. A 6 years retrospective study was performed based on reviewing the casuistry of the Regional Centre of Neonatal Intensive Care Unit (NICU) „Cuza Voda” and 205 cases of necrotizing enterocolitis were identified from a total number of 6183 neonates admitted there. Patients were divided in to study groups based on the gestational age (GA) and birth weight (BW). The analysis protocol was realized based on a working sheet that included the epidemiological data of the patients, the risk factors, type of nutrition, age at diagnosis, stage of disease according to Bell classification, type of treatment (medical, surgical or combined), complications and the general evolution. The statistical data processing was performed in SPSS Statistics 20 program.

Results. NEC had a frequency of 3.3% is the study group and was diagnosed in premature newborns in 75.6% of cases. The mean GA for the study group was 33 weeks. The mean BW was 1896 g with 43% of the cases in very low birth weight (VLBW) group and 31.2% in low birth weight (LBW) group. The percentage incidence of the risk factors was as follows: persistence of ductusarteriossus 19.5%, perinatal asphyxia 13.7% and respiratory distress 100% of cases. 75.5% were treated and discharged from NICU, 16.6% were transferred to Pediatric Surgery Department „Sf. Maria” and 3.9% died in NICU. From the 34 cases transferred19 cases were surgically treated: 8 cases with peritoneal drainage (PD), 8 cases with primary laparotomy (LAP) and 3 cases with PD and LAP. The survival rate in this group was 2.4% and for the medically treated group was 4.9%.

Conclusions. Prematurity is statistically correlated with encountering advanced stages of enterocolitis at the time of diagnosis. The option for surgical treatment (peritoneal drainage or laparotomy) does not influence the results and early enteral feeding with formula is the most important risk factor for NEC followed by age of gestation and very low birth weight.

Keywords: necrotizing enterocolitis, newborn, treatment possibilities

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