Pelvic fractures comprise a small number of annual Level I pediatric trauma center admissions. This is a review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures. This is a retrospective review of the University of Chicago Level I Pediatric Trauma Center experience with pediatric pelvic fractures during the 12-year period from 1992 to 2004. From 1992 to 2004, there were 2850 pediatric trauma admissions. Thirteen patients were identified with pelvic fractures; seven were boys and six were girls. The average age was 8 years old. The mechanism of injury in all cases was motor vehicle related; 11 patients (87%) sustained pedestrian-motor vehicle crashes. According to the Torode and Zeig classification system, type III fractures occurred in eight patients (62%) and type IV fractures occurred in six patients (31%). Associated injuries occurred in eight patients (62%). Seven of these patients (88%) had associated injuries involving two or more organ systems. Of the associated injuries, additional orthopedic injuries were the most common, occurring in 62 per cent of our patients. Neurological injuries occurred in 54 per cent of patients, vascular injuries in 39 per cent, pulmonary injuries in 31 per cent, and genitourinary injuries in 15 per cent. Five patients (38%) were treated operatively; only two patients underwent operative management directly related to their pelvic fracture. The remaining three patients underwent operative management of associated injuries. The mortality rate was 0 per cent. Although pelvic fractures are an uncommon injury in pediatric trauma patients, the morbidity associated with these injuries can be profound. The majority of pelvic fractures in children are treated nonoperatively, however, more than one-half of these patients have concomitant injuries requiring operative management. When evaluating and treating pediatric pelvic fractures, a systematic multidisciplinary approach must be taken to evaluate and prioritize the pelvic fracture and the associated injuries.
Objective: To determine the effect of neonatal and maternal blood group on the mortality risk from necrotizing enterocolitis (NEC).Study Design: Retrospective chart review of all neonates admitted to the neonatal intensive care unit over 24 years. Data on birth date, gestational age, maternal/neonatal blood group, number of transfusions, and survival time (defined as date of birth to date of death/discharge) were collected on those with NEC.Result: 276 neonates with Bell stage II-III NEC were analyzed. AB neonates had a significantly higher risk of mortality from NEC compared with other blood groups (HR 2.87; 95% CI 1.40 to 5.89; P ¼ 0.003). Multivariate analysis showed AB blood group to be an independent risk factor for mortality from NEC.
Conclusion:Neonatal and maternal blood groups are significantly associated with a neonate's survival from NEC. The increased mortality of AB neonates may be related to factors such as neonatal blood group antigens and/or transplacental transfer of isoagglutinins.
Background
Necrotizing enterocolitis (NEC) affects up to 10% of extremely-low-birthweight infants, with a 30% mortality rate. Currently, no biomarker reliably facilitates early diagnosis/prevention. Since thrombocytopenia and bowel ischemia are consistent findings in advanced NEC, we prospectively investigated the impact of two potential biomarkers: reticulated platelets (RP) and intestinal alkaline phosphatase (iAP).
Methods
Infants born ≤32 weeks and/or ≤1500g were prospectively enrolled from 2009–2012. Starting within 72 hours of birth, 5 weekly whole blood specimens were collected to measure RP and serum iAP. Additional specimens were obtained at NEC onset (Bell stage II or III) and 24 hours later. Dichotomous cut-points for both biomarkers sought to maximize sensitivity. The Mann-Whitney U test highlighted differences in median biomarker levels between NEC and non-NEC infants. Chi-square or Fisher’s exact test highlighted categorical differences. The Kaplan-Meier method and Logrank test estimated the probability of developing NEC. The Cox proportional hazards model estimated hazard ratios.
Results
Of 177 infants, 8.5% developed NEC. Of these, 40% required surgery, 20% expired before discharge, 93% had “low” RP (≤2.3%), and 60% had high iAP (>0 U/L). Infants with “low” RP were significantly more likely to develop NEC [HR=11.0 (1.4–83); p=0.02], while those with “high” iAP showed a similar trend [HR=5.2 (0.7–42); p=0.12]. Median iAP levels were significantly higher at week 4 (p=0.02), preceding the average time to NEC onset by one week (35.7 ± 17.3 days).
Conclusion
Decreased RP serves as a sensitive marker for NEC onset, thereby enabling early preventative strategies. iAP overexpression may signal NEC development.
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