We compared the postnatal course, morbidity and early results after repair for cases of isolated or "pure" TEF with those for cases of esophageal atresia (EA) with distal tracheoesophageal fistula (TEF). Twenty-four consecutive infants were divided into two groups: isolated TEF [TEF group] (n = 5) and EA with distal TEF [EA group] (n = 19). A high rate of prematurity (29%) and major cardiac and other surgically-relevant malformations (0.8 vs. 0.7 per infant) was found in both groups. The median age at surgery was 8 days for the TEF group vs. 1 day for the EA group (p < 0.01). Most infants of both cohorts had stable acid-base and respiratory parameters at admission. Generally, tracheoscopy provided valuable information regarding the position of the TEF. Surgery for isolated TEF was performed via right cervicotomy in 4 cases and via thoracotomy in one. Postoperative thoracostomy tubes were inserted in 3 cases and one emergency gastrostomy was created for acute gastric overextension (exclusively in patients with EA). The duration of postoperative mechanical ventilation (49 vs. 113 h, p = 0.045) and the median length of stay in the pediatric surgery unit (10 vs. 20.5 days, p = 0.003) were shorter for the isolated TEF group. Four EA patients experienced severe events. Total mortality was 8% (0 out of 5 with TEF vs. 2 out of 19 with EA). Developmental delay and a high rate of morbidity were found in both groups. More complex surgery increased perioperative morbidity in cases of EA. With early recognition of isolated TEF, a less complicated course can be expected in comparison with esophageal atresia.

The aim was to assess the results of primary anastomosis (PA) compared to enterostomy (ES) in infants with spontaneous intestinal perforation (SIP) and a weight below 1000 g. Between 2014 and 2016, enterostomy was routinely carried out on extremely low birth weight (ELBW) patients with SIP. From 2016 until 2019, all patients underwent anastomosis without stoma formation. We compared outcome and complications in both groups. Forty-two patients with a median gestational age of 24.3 weeks and a birth weight of 640 g with SIP were included. Thirty patients underwent PA; ES was performed in 12 patients. Overall in-hospital mortality was 11.9% (PA: 13.3%, ES: 8.3%). Reoperations due to complications became necessary in 10/30 patients with PA and 4/12 patients with ES. Length of stay was 110.5 days in the PA group and 124 days in the ES group. Median weight at discharge was higher in the PA group (PA: 2258 g, ES: 1880 g, p = .036).Conclusion: Primary anastomosis is a feasible treatment option for SIP in infants < 1000 g and may have a positive impact on weight gain and length of hospitalization. However, further studies on selection criteria for PA are necessary. What is Known:• Enterostomy (ES) and primary anastomosis (PA) are feasible treatment options in preterm infants with spontaneous intestinal perforation (SIP).• Stomal complications or failure to thrive due to poor food utilization can pose significant problems. What is New:• Primary anastomosis in case of SIP is equal to enterostomy in terms of mortality and revision rate; however, length of stay and weight gain can be presumably positively influenced.• Primary anastomosis is a valid treatment option even for patients weighing less than 1000 g.

We report on an infant, presenting with a cord-like accessory muscle crossing the anterior axillary fold. The accessory structure appeared as an axillary web and caused tethering of the humerus together with an abnormal shape of the shoulder. The chondroepitrochlearis muscle is thought to be of phylogenetic origin. In our patient the tendinous sling was resected at the age of 7 month with normalization of function and cosmetics. Wir berichten über einen Säugling, bei dem ein die vordere Achsel kreuzender Stang auffällig wurde. Dieser entpuppte sich als Sehne eines M. chondroepitrochlearis. Dabei handelt es sich um ein entwicklungsgeschichtliches Residuum. Klinisch zeigte sich eine axilläre Flügelbildung und es resultierten eine Bewegungseinschränkung des Humerus im Schultergelenk sowie eine auffallende Schulterkontur. Der ganz sehnige Muskelrest wurde chirurgisch entfernt, was zur Entfesselung der Schulter führte.

Purpose: Neuroblastoma, the most common extracranial solid tumor in children under 5 years, often surrounds visceral arteries. This study aimed to analyze the working space provided by standardized surgical techniques at key arterial landmarks in adult cadavers. Methods: We assessed in eight adult cadavers the mobilization of the left colon, spleen and pancreas, right colon, duodenum and mesenteric root, access to the bursa omentalis. The average working space score (AWSS) was evaluated at the left and right renal artery, left and right side of the coeliac trunk, superior mesenteric and common hepatic artery. The score was defined as: (0) vessel not visible, (1) working space at the vessel ≤ 1x diameter of the aorta, (2) < 3x the diameter of the aorta, (3) ≥ 3x diameter of the aorta. Results: The maximum AWSS of 3 was achieved at key vascular landmarks through specific mobilization techniques. Conclusion: Additional mobilization of spleen, pancreas and mesenteric root and access to the bursa omentalis increase surgical working space at major visceral arteries. The results of our investigation provide surgeons with a useful guide to prepare for abdominal neuroblastoma resection.

Surgical access to the cervico-thoracic junction in pediatric tumors presents substantial challenges due to complex anatomy and the proximity of critical n

Background: Recurrent vomiting in infantile hypertrophic pyloric stenosis (IHPS) leads to metabolic alkalosis and a respiratory-driven compensatory hypercapnia. Alkalosis has been identified as the main causal factor for respiratory depression on admission. The value of contribution of hemoglobin and carbon dioxide partial pressure to this phenomenon will be evaluated. Materials and Methods: A retrospective cohort study was conducted on 105 infants with IHPS. The acid/base status, including levels of hemoglobin and lactate, were recorded. Statistical comparisons, correlation analysis, linear regression and multivariate regression analysis were applied. Results: Hypercapnia was associated with hemoconcentration. We found a positive correlation was found between pCO₂ and hemoglobin (p = 0.042). The multivariate linear regression analysis showed that pCO₂ is dependent on hemoglobin (p = 0.002). Lactate, which is used as a marker for anaerobic glycolysis, showed no systematic correlation with pCO₂. Conclusions: An increase in carbon dioxide cannot easily be attributed to a reduced transport function of carbon dioxide due to hemoglobin deficiency. Further investigation is needed to determine the extent to which low hemoglobin levels and increased pCO₂ interact with hemoconcentration to contribute to respiratory problems.