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Helicobacter pylori (Hp) was discovered in 1982 by the Australians Robin Warren and Barry Marshall. Initially rejected by a skeptical scientific community, it has since gained worldwide recognition as a clinically significant bacterium. The incidence of colonization with Hp increases with age, affecting approximately one third of the world's population. Hp is uniquely capable of surviving in the acid environment of the stomach, and has properties of adherence to epithelial cells that resist parastalsis. Strains of Hp associated with human disease produce specific cytotoxic proteins. After ingestion, there is a period of intense proliferation and ensuing gastric inflammation that may result in chronic gastritis. Hp infection in children may produce symptomatic antral gastritis or duodenal ulceration. The diagnosis of Hp infection is confirmed by gastric biopsy and culture, where the organism is recognized by its characteristic histological appearance. Treatment for Hp includes combinations of bismuth amoxicillin and metronidazole administered for several weeks. In adults, chronic infection with Hp is associated with chronic gastritis, achlorhydria, and gastric cancer. An organism that was unheard of 15 years ago is now recognized as a clinically significant pathological entity. The ultimate significance of Hp as an agent of disease remains to be seen.

Structural anomalies of the gastrointestinal tract and anterior abdominal wall diagnosed in the perinatal period often require prompt surgical intervention. This article highlights the pathophysiology, evaluation, and management of the more common lesions encountered in the neonate.

Intraarterial access is used to provide continuous monitoring of systemic arterial blood pressure and to provide access to sample arterial blood. The use of chronic indwelling arterial catheters became commonplace in the 1970s and was rapidly adapted to the care of infants and children. The placement of intraarterial catheters can be technically challenging for even the most experienced surgeon, especially in small infants. Arterial catheters can directly injure vessels, resulting in thrombosis or occlusion. Distal embolization or ischemia can also occur. Catheter flushing may cause retrograde flow with the potential for embolization at remote sites. Local insertion site complications, such as hematoma, hemorrhage, and infection, can occur. Arterial catheters can also be a source of systemic sepsis. Although the risks and complication rates are low, the potential for devastating injury exists and deserves the greatest respect whenever placement of an arterial catheter is contemplated.

Intraosseous infusion was used extensively for the parenteral administration of blood, fluids, and pharmacological agents in the 1940s. The technique was "discovered" and popularized again during the 1980s. Substances injected intraosseously are found rapidly in the central circulation. Drugs should be given in the equivalent dose used for intravenous administration. The preferred site for intraosseous infusion is the proximal tibia. Insertion is performed 1 to 3 cm below the tibial tuberosity on the flat anteromedial surface of the tibia. After about 5 years of age, the distal tibia or femur are the preferred sites. Needles made specifically for resuscitative intraosseous infusion are available. Increased awareness of the role of intraosseous infusion, familiarity with the technique of insertion, and careful use of landmarks to guide insertion should minimize complications.

ECMO is capable of safely supporting respiration and circulation in newborns with severe respiratory failure and a moribund clinical presentation. The results thus far suggest that term infants with respiratory failure are the best candidates for ECMO, with a survival rate of 83 per cent. Infants under 35 weeks' gestation have a very high incidence of intracranial hemorrhage. Consequently, we do not currently accept them for ECMO treatment. The outcome of the survivors is largely determined by the clinical condition before ECMO and by major complications. Research must be directed toward cost effectiveness, timing and earlier use, alternative vascular access, cannula and circuit design, and expanded indications.