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Understanding complications of surgery in infancy

Bishay, M; (2017) Understanding complications of surgery in infancy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

This thesis investigates complications of surgery in infants, particularly infections and liver disease in infants receiving parenteral nutrition (PN) following gastrointestinal surgery, and intraoperative hypercapnia and acidosis in surgery for congenital diaphragmatic hernia (CDH) and oesophageal atresia with tracheo-oesophageal fistula (OA/TOF), using a series of clinical studies. A pilot randomised controlled trial comparing open versus thoracoscopic surgery in neonates with CDH and OA/TOF showed that neonatal thoracoscopy resulted in more severe intraoperative hypercapnia and acidosis than open surgery, particularly in patients with CDH. This highlights a need for studies assessing neurodevelopmental outcomes following neonatal thoracoscopy. In surgical infants receiving PN, chlorhexidine antisepsis to clean central venous catheter connectors was associated with a significant reduction in the rate of septicaemia (particularly staphylococcal). In such infants, septicaemia due to bowel organisms occurred later than septicaemia due to coagulase-negative staphylococci. In congenital duodenal obstruction, while avoidance of initial PN was successful for two thirds of cases in which it was attempted, one third subsequently required PN, and this group showed poorer growth than children who commenced PN soon after surgery. One third of surgical infants with intestinal failure develop intestinal failure associated liver disease (IFALD), and 61% developed septicaemia. I found no association between septicaemia and IFALD. In a randomised controlled trial to investigate whether glutamine supplementation affects the incidence of microbial invasion in surgical infants receiving PN, microbial invasion was detected by blood cultures, broad-range and targeted PCR for bacterial DNA, and assays of endotoxin, and lipopolysaccharide binding protein. Monocyte HLA-DR expression was measured by flow cytometry. Glutamine had no effect on microbial invasion, which was detected in 60% of patients (half of which was detected by blood culture). Glutamine supplementation significantly enhanced recovery of monocyte function. Among patients with low monocyte function at enrolment, glutamine was protective against microbial invasion.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Understanding complications of surgery in infancy
Language: English
Additional information: Third party copyright material has been removed from ethesis.
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > UCL GOS Institute of Child Health
URI: http://discovery.ucl.ac.uk/id/eprint/1575528
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