Journal Club Part 1

This episode is our first audio journal club. We discuss 5 papers today with our guests, Dr Dan von Allmen, Dr George Whit Holcomb, and Dr Aaron Lipskar. Table of contents: 00:00 Introduction 00:55 Corticosteroids for biliary atresia 05:21 Dr von Allmen’s comments 10:54 Antiseptic agents and surgical site infection 14:15 Dr Holcomb’s comments 20:17 Non-operative management of non-perforated appendicitis 25:19 Dr Holcomb’s comments 30:41 Enteral autonomy after intestinal failure 33:37 Dr Lipskar’s comments 36:41 Anesthesia neurotoxicity 40:27 Dr Lipskar’s comments Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial Discussed by Dr Dan von Allmen Bezerra JA, et al. Use of Corticosteroids After Hepatoportoenterostomy for Bile Drainage in Infants With Biliary Atresia: the START randomized clinical trial. JAMA. 2014 May 7;311(17):1750–10. Dr von Allmen’s comments: • Dr von Allmen would not use corticosteroids after Kasai procedure. • The difference of bile drainage in the steroid group versus control (58.6% vs 48.6%) was not significant enough to continue use of corticosteroids. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program Discussed by Dr George Whit Holcomb Hakkarainen TW, et al. Comparative Effectiveness of Skin Antiseptic Agents in Reducing Surgical Site Infections: A Report from the Washington State Surgical Care and Outcomes Assessment Program. J Am Coll Surg. 2014 Mar 1;218(3):336–44. Dr Holcomb’s comments: • This paper would not change his choice of antiseptic agent. Dr Holcomb feels that iodine based agents and chlorhexidine agents are equally appropriate based on these results. • Dr Holcomb uses chlorhexidine and isopropyl alcohol for skin preparation. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial Discussed by Dr George Whit Holcomb Svensson JF, et al. Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: a pilot randomized controlled trial. Annals of Surgery. 2015 Jan;261(1):67–71. Dr Holcomb’s comments: • This is a well done pilot study that shows that a larger randomized trial is needed. • Long term follow-up is needed to determine the true risk of recurrent appendicitis after non-operative management. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study Discussed by Dr Aaron Lipskar Khan FA, et al. Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study. J Pediatr. 2015 Jul;167(1):29–34.e1. Dr Lipskar’s comments: • It is counterintuitive that NEC is a protective factor for enteral autonomy. • It is difficult to make sense of the data as centers with transplant programs likely attract sicker patients. • This highlights the importance of intestinal failure patients being managed in a multidisciplinary intestinal failure program. Anesthetic neurotoxicity--clinical implications of animal models Discussed by Dr Aaron Lipskar Rappaport BA, et al. Anesthetic neurotoxicity--clinical implications of animal models. N Engl J Med. 2015 Feb 26;372(9):796–7. Dr Lipskar’s comments: • Until further trials in humans are conducted and provide more conclusive evidence, elective cases should be deferred until the age of 3. • It may be difficult to define what constitutes an elective procedure in pediatric surgery. Intro track is adapted from "I dunno" by grapes, featuring J Lang, Morusque. Artist URL: ccmixter.org/files/grapes/16626 License: creativecommons.org/licenses/by/3.0/