1. In infants with Bochdalek type congenital diaphragmatic
hernia the severity of pulmonary hypoplasia
and the resultant pulmonary hypertension are key
determinants of survival. Barotrauma and hypoxia
should be avoided.
2. During initial management of an infant with esophageal
atresia and distal tracheoesophageal fistula,
every effort should be made to avoid distending the
gastrointestinal tract, especially when using
mechanical ventilation. The patient should be evaluated
for components of the VACTERL (vertebral,
anorectal, cardiac, tracheoesophageal, renal, limb)
anomalies. Timing and extent of surgery is dictated
by the stability of the patient.
3. Although malrotation with midgut volvulus occurs
most commonly within the first few weeks of life, it
should always be considered in the differential diagnosis
in a child with bilious emesis. Volvulus is a
surgical emergency; therefore in a critically ill child,
prompt surgical intervention should not be delayed
for any reason.
4. When evaluating a newborn infant for vomiting, it is
critical to distinguish between proximal and distal
causes of intestinal obstruction utilizing both prenatal
and postnatal history, physical examination and
5. Risk factors for necrotizing enterocolitis (NEC) include
prematurity, formula feeding, bacterial infection, and
intestinal ischemia. Critical to the management of
infants with advanced (Bell stage III) or perforated
NEC is timely and adequate source control of peritoneal
contamination. Early sequelae of NEC include
perforation, sepsis, and death. Later sequelae include
short-bowel syndrome and stricture.
6. In patients with intestinal obstruction secondary to
Hirschsprungâs disease a leveling ostomy or
endorectal pull through should be performed using
ganglionated bowel, proximal to the transition zone
between ganglionic and aganglionic intestine.
7. Prognosis of infants with biliary atresia is directly
related to age at diagnosis and timing of portoenterostomy.
Infants with advanced age at the time of
diagnosis or infants who fail to demonstrate evidence
of bile drainage after portoenterostomy usually
require liver transplantation.
8. Infants with omphaloceles have greater associated
morbidity and mortality than infants with gastroschisis
due to a higher incidence of congenital
anomalies and pulmonary hypoplasia. Gastroschisis
can be associated with intestinal atresia, but not
with other congenital anomalies. An intact omphalocele
can be repaired electively, while gastroschisis
requires urgent intervention to protect the exposed
9. Prognosis for children with Wilmsâ tumor is defined
by the stage of disease at the time of diagnosis and
the histologic type (favorable vs. unfavorable). Preoperative
chemotherapy is indicated for bilateral
involvement, a solitary kidney, or tumor in the inferior
vena cava above the hepatic veins. Gross tumor
rupture during surgery automatically changes the
stage to 3 (at a minimum).
10. Injury is the leading cause of death in children older
than 1 year of age. Blunt mechanisms account for
the majority of pediatric injuries. The central nervous
system is the most commonly injured organ
system and the leading cause of death in injured