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Caudal duplication syndrome (CDS) is a rare developmental anomaly in which embryonic cloaca and notochord structures are duplicated [1]. Due to the diverse clinical manifestation and rarity of CDS, it is crucial to report every case and to share experience and outcomes of individually adjusted management plans. We report here the case of a 2-year-old girl born with duplication of the urogenital (bladder, urethra, uterus, vagina, vulva) and gastrointestinal (gallbladder, appendix vermiformis) systems. Additionally, coccygeal agenesis, lipomyelomeningocele and vertical talus were present. A thorough examination and urological reconstructive surgery were performed. While there may be a desire from patients, parents and healthcare specialists to modify all malformations to an anatomically correct state, the current opinion is that only anatomical variants that influence function should be modified. Consent from patients should be sought for decisions regarding more sensitive matters such as vulva surgery for cosmetic reasons or correction of anatomical variants without functional consequences.

Introduction. Congenital diaphragmatic hernia (CDH) - a relatively rare developmental defect due to a failure of pleuroperitoneal canal closure. The size of the defect between abdominal and thoracic cavities may be variable and it may have a significant impact on the clinical manifestation and prognosis. In this study we set out additional factors to determine if they affect the outcome of the newborns with CDH. Aim of the Study. To investigate and analyze the influence of selected postnatal prognostic factors for predicting the outcome. The primary outcome measure was survival. Material and methods. The present study is retrospective including the data collection and analysis of medical documentation of patients born with CDH and treated in the Children’s Clinical University hospital between 2012 and 2017. The selected prognostic factors included antenatal diagnostics, Apgar score at 1' and 5', need for an early intubation (≤ 3 h after birth), initial blood gases in first 24 h of life, time interval between delivery and surgical therapy, the stomach and liver presence in the thorax, additional congenital abnormalities, a type and duration of invasive ventilatory support. Outcome parameters were compared between survivors (S) and non-survivors (NS). Results. 19 patients (pts) were identified - 14 S and 5 NS. Total mortality rate - 26%. 17/19 had left-sided, 2/19 - right-sided CDH. 17/19 pregnancies were monitored, prenatal diagnosis was made in 8 pts - 3 of them NS. The mean Apgar score at 1’ in S group was 5,5, NS - 5,0. At 5’ - 6,7 and 5,6. Need for an early intubation was 64% for S, 100% - NS. Initial blood gases in S (n=11) and NS (n=5) showed the mean pH value of 7,18 and 7,02. Mean PaCO2 - 62,92 and 77,42 mm Hg. 16/19 underwent the operation. 2 pts died before and 3 after surgical therapy. The average time interval between delivery and surgical therapy in S group was 31,6 hours, NS - 73,7 h. The intrathoracic liver was observed in 3 pts, 2 of them died, the intrathoracic stomach - 2, none of them died. 14/16 pts had a primary surgical repair (PR), 2/16 - Silo closure before total repair. 6 pts had additional congenital defects - 2/14 S and 4/5 NS. 5 out of all 6 had cardiac anomalies. The average required conventional ventilation time in S (n=9) was 175,9 h, NS (n=3) - 25,7 h. High-frequency oscillatory ventilation for S (n=6) was applied for 255 h, NS (n=5) 157,3 h. The results showed statistically significant relationship between the outcome and additional abnormalities (r(17)=.623, p=0.017) and time interval between delivery and surgical therapy (r(11)=.768, p=.014). Conclusions. The possible predictors of outcome were additional abnormalities and time interval between delivery and surgical therapy.

Summary Introduction. For acute appendicitis - the most frequent condition to perform an urgent abdominal operation in pediatric surgery - surgical appendectomy still remains the gold standard regarding treatment, nevertheless nonsurgical management has become more and more recognized as a treatment method for uncomplicated acute appendicitis (UAA). However there are still many unanswered questions regarding possible factors that could predict the treatment outcome as well as appropriate antimicrobial drug regimens. Aim of the Study. The aim was to investigate if there is a possible association between factors such as C-reactive protein (CRP) level, presence of appendicolith, the diameter of the appendix and treatment outcome; as well as to identify most successfully used antimicrobial drug combinations. Material and methods. A retrospective analysis of hospital cases, admitted to a single reference center during the time period from 2013 to 2015. Patients with clinical signs of acute appendicitis, elevated inflammatory markers and radiological findings suggestive for acute appendicitis were included in the study. Nonsurgical treated patients were divided in two groups based on the treatment outcome - successful or unsuccessful. Analysis of the three factors (CRP level, presence of appendicolith and the diameter of the appendix) and most commonly used antimicrobial drug regimen association with treatment outcome was performed. Results. Overall 384 children medical records with acute appendicitis were registered and non-surgical treatment was initiated in 147/384 (38 %) cases. Successful treatment outcome of nonsurgical management was identified in 114/147 (78 %) cases. Analyzing prognostic adverse factors results presents no statistically significant difference in association with CRP level >25 mg/l (p=0,479), presence of appendicolith (p=0,183) and the diameter of appendix >1 cm (p=0,183) with successful or unsuccessful treatment outcome. The two most commonly used antimicrobial drug combinations were - Ampicillin/Metronidazole for 49 patients and Ampicillin/Gentamicin for 44 patients. No relevance with treatment outcome and used antimicrobial agents was detected (p=0,597). The overall recurrence rate after initial presentation is 15 % (17/114). In 3 cases (3 %) recurrent appendicitis developed one month after discharge and in 14 cases (12 %) up to one year after discharge. Conclusions. Prognostic adverse factors - CRP, presence of appendicolith and diameter of appendix - were not statistically reliable in association with initial non-surgical treatment outcome. The success rate of conservative treatment with narrow spectrum antibiotics was 78 %, which is just as high as in cases treated conservatively with broad-spectrum antibiotics from previous studies. Therefore the question of which factors and antimicrobial drug combinations influence the course of treatment still remains unanswered and further studies are required.

Summary Acute appendicitis is common condition in the pediatric population. Despite that, there is still actual discussion on most approriate treatment. In adult population there are evidence that non-surgical treatment in uncomplicated cases is safe and effective, it could avoid unnecessary appendectomies. The experience is very little on pediatric population, but it is known that in certain part of cases conservative management is feasible. Moreover this approach could reduce complication rates associated with surgery.

Introduction. Neonatal anthropometric measurements, including body weight, length, head circumference and abdominal circumference are routine procedures in obstetric and neonatal departments. Standard values for neonatal population are established for body weight, length, head and thoracic circumference, however there are no reference values for neonatal abdominal circumference, futhermore, this measurement currently is not a routine procedure in every obstetric and neonatal unit. In order to evaluate the increase of abdominal circumference in newborns with a disease of organs of abdominal cavity including necrotizing enterocolitis (NEC), the abdominal girth of newborns soon after birth without pathology in the abdominal cavity should be ascertained. Thereby, the average value of the abdominal circumference of newborns in Latvia could be obtained. Aim of the Study. The aim of our study is to measure the abdominal circumference in premature and term-born neonates soon after birth and to define the correlation between abdominal circuit and birth weight. Materials and Methods. The measurement of waist girth was carried out in 460 neonates within 30 minutes after birth. Newborns were divided into 4 groups according to birth weight: extremely low birth weight (ELBW) - under 1000 g, very low birth weight (VLBW) - 1001 g - 1500 g, low birth weight (LBW) - 1501 g - 2500 g and term neonates with 2501 g - 4590 g birth weight. The abdominal circumference was measured in 2 obstetric units in accordance with the previously established measurement methods. Results. There was no statistical difference between abdominal circumference in boys and girls in ELBW, VLBW and LBW groups (p>0.05). Mean abdominal circumference in ELBW group was 18,70 cm (SD=0,84) in boys and 18,67 cm (SD=1,40) in girls, VLBW group was 22,20 cm (SD=1,42) and 21,94 cm (SD=1,29) in boys and girls, respectively. Mean abdominal circumference in LBW group was 24.47 cm (SD=2.36) in boys, and 24.92 cm (SD=2.23) in girls. Independent Samples Test: Mean abdominal circumference was statistically different in boys and girls in 2500g -4590g birth weight group with median value 30.56 cm in boys, and 33.23 cm in girls (p Conclusions. The difference of mean abdominal circumference was not statistically significant in boys and girls in ELBW, VLBW and LBW groups, however, the difference was significant in the term-born neonates group. As a result of this study reference values and specific formula were established, which allows determination of normal abdominal circumference in neonates depending on birth weight.

Background Body weight, length and head and thoracic circumference are routinely measured in obstetric and neonatal departments. Reference values for these measurements have been established for the neonatal population. Neonatal abdominal circumference is not routinely measured, and no reference values for this measurement have been determined. To evaluate the increase in abdominal circumference in newborns with abdominal pathology such as necrotizing enterocolitis, information about normal abdominal circumference in healthy neonates shortly after birth is needed. The aim of this study was to determine the correlation between abdominal circumference and birth weight by measuring the abdominal circumference of premature neonates soon after birth. Methods Abdominal circumference was measured within 30 min of birth in 220 neonates born between 23 and 35 weeks’ gestation. Results There was no statistically significant difference in abdominal circumference between boys and girls in the study population. A specific formula for estimating normal abdominal circumference was developed: y = 0.0053x + 14.83 (y = abdominal circumference in cm; x = body weight in g; 0.0053 = regression coefficient; 14.83 = regression constant). Conclusion A positive linear correlation between abdominal circumference and birth weight was found in infants at birth. The correlation can be summarized as a linear regression equation. Further studies are needed to investigate possible factors associated with abdominal circumference in fed versus unfed preterm infants.