September 2019 HSC Section 1 Congenital and Pediatric Problems

T ABLE OF C ONTENTS Selected Recent Materials - Reproduced in this Study Guide

SECTION 1: CONGENITAL AND PEDIATRIC PROBLEMS SEPTEMBER 2019

ADDITIONAL REFERENCE MATERIAL…….........………………………………………i - iii

I.

General Caruso TJ, Munshey F, Aldorfer B, Sharek PJ. Safety stop: a valuable addition to the pediatric universal protocol. Jt Comm J Qual Patient Saf . 2018; 44(9):552-556. EBM level 4...................1-5 Summary : This manuscript describes a multidisciplinary perioperative quality improvement project in a tertiary care children’s hospital to improve the time-out component of the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery for pediatric cases. The protocol implemented a novel adjunct, the safety stop, that took place just prior to preparation and draping, in addition to the required time out that took place prior to incision. Sixty audits of the process took place over 4 weeks, demonstrating 96.7% (58/60) compliance with the new policy. The safety stop is expected to lessen the risk of wrong-site or wrong-patient surgery, because the small bodies of pediatric patients are not obscured by drapes as may occur during the traditional time-out. Duncan DR, Mitchell PD, Larson K, et al. Association of proton pump inhibitors with hospitalization risk in children with oropharyngeal dysphagia. JAMA Otolaryngol Head Neck Surg . 2018 Oct 11. doi: 10.1001/jamaoto. 2018.1919 [Epub ahead of print]. EBM level 3...................6-14 Summary : In this retrospective cohort study of 293 children under 2 years of age with aspiration/penetration on videofluoroscopic swallow studies, patients treated with proton pump inhibitors had significantly higher hospitalization rates (incident rate ratio 1.77 [95% CI 1.16 – 2.68]) and hospital nights (incident rate ratio 2.51 [95% CI 1.36-4.62]) compared to those not treated, even after adjustment for comorbidities. These results support growing concerns about the risks of proton pump inhibitor use in children. O’Leary JD, Janus M, Duku E, et al. Influence of surgical procedures and general anesthesia on child development before primary school entry among matched sibling pairs. JAMA Pediatr . 2019; 173(1):29-36. EBM level 3...........................................................................................................15-22 Summary : This population-based study of 10,897 sibling pairs aged 5 to 6 years of scores on the Early Development Instrument before primary school entry in Ontario, Canada, found no differences in the adjusted odds of developmental vulnerability (scores in the lowest 10 th percentile) for the overall score and the five major domains (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge) between biological siblings exposed or unexposed to surgical procedures that required general anesthesia. Scores were adjusted for age at testing, sex, mother’s age at birth, and eldest sibling status. By controlling for genetic and environmental factors, exposure to general anesthesia was not associated with adverse developmental outcomes.