Objective:The indications of routine skull X-rays after mild head trauma are still in discussion, and the clinical management of a child with a skull fracture remains controversial. The aim of our retrospective study was to evaluate our diagnostic and clinical management of children with skull fractures following minor head trauma.Methods:We worked up the medical history of all consecutive patients with a skull fracture treated in our hospital from January 2009 to October 2014 and investigated all skull X-rays in our hospital during this period.Results:In 5217 skull radiographies, 66 skull fractures (1.3%) were detected. The mean age of all our patients was 5.9 years (median age: 4.0 years); the mean age of patients with a diagnosed skull fracture was 2.3 years (median age: 0.8 years). A total of 1658 children (32%) were <2 years old. A typical boggy swelling was present in 61% of all skull fractures. The majority of injuries were caused by falls (77%). Nine patients (14%) required a computed tomography (CT) scan during their hospital stay due to neurological symptoms, and four patients had a brain magnetic resonance imaging. Nine patients (14%) showed an intracranial hemorrhage (ICH; mean age: 7.3 years); one patient had a neurosurgery because of a depressed skull fracture. Nine patients (14%) were observed at our pediatric intensive care unit for a mean time of 2.9 days. The mean hospital stay was 4.2 days.Conclusions:Our findings support previous evidence against the routine use of skull X-rays for evaluation of children with minor head injury. The rate of diagnosed skull fractures in radiographs following minor head trauma is low, and additional CT scans are not indicated in asymptomatic patient with a linear skull fracture. All detected ICHs could be treated conservatively. Children under the age of 2 years have the highest risk of skull fractures after minor head trauma, but do not have a higher incidence of intracranial bleeding. Neuroobservation without initial CT scans is safe in infants and children following minor head trauma and CT scans should be reserved for patients with neurological symptoms.

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Background The aim of this retrospective analysis was to evaluate the clinical feasibility of the supraclavicular ultrasound‐guided cannulation of the brachiocephalic vein in infants weighing less than 1500 g. Methods The ultrasound probe was placed in the supraclavicular region so as to obtain the optimum sonographic long‐axis view of the brachiocephalic vein. By using an in‐plane approach the brachiocephalic vein was cannulated by using a 24‐gauge intravenous cannula under real‐time ultrasound guidance into the vein followed by the insertion of a 2‐French single lumen catheter using the Seldinger technique. Results Forty‐six brachiocephalic vein cannulations in infants weighing between 0.55 and 1.5 kg (Median: 1.2; 95%‐CI: 0.9‐1.2) were included. Ultimate success rate was 89.1% (41 out of 46). One cannulation attempt was required in 30 (65.2%) patients, 2 in 6 (13%) and 3 in 5 (10.8%), respectively. Smaller weight babies did not require significantly more cannulation attempts. The probability of successful cannulation on the first attempt increased significantly from 40% (2010) to more than 80% (2019) over the time course of this series. Median catheter dwell time was 15 days (95%‐CI: 9‐20) with one catheter being removed prematurely after 8 days due to obstruction. Conclusion Supracalvicular in‐plane real‐time ultrasound‐guided cannulation of the brachiocephalic vein seems to be a convenient and feasible option to provide large‐bore central venous access for very small and sick babies.

BACKGROUND: Patients following repair of an esophageal atresia (EA) or tracheoesophageal fistula (TEF) carry an increased risk of long-term cardiopulmonary malaise. The role of the airway microbiome in EA/TEF patients remains unclear. METHODS: All EA/TEF patients treated between 1980 and 2010 were invited to a prospective clinical examination, spirometry, and spiroergometry. The airway microbiome was determined from deep induced sputum by 16 S rRNA gene sequencing. The results were compared to a healthy age-and sex-matched control group. RESULTS: Nineteen EA/TEF patients with a mean age of 24.7 ± 7 years and 19 age-and sex-matched controls were included. EA/TEF patients showed a significantly lower muscle mass, lower maximum vital capacity (VC max), and higher rates of restrictive ventilation disorders. Spiroergometry revealed a significantly lower relative performance capacity and lower peak VO 2 in EA/TEF patients. Alphaand beta-diversity of the airway microbiome did not differ significantly between the two groups. Linear discriminant effect size analysis revealed significantly enriched species of Prevotella_uncultured, Streptococcus_anginosus, Prevotella_7_Prevotella_enoeca, and Mogibacterium_timidum. CONCLUSION: EA/TEF patients frequently suffer from restrictive ventilation disorders and impaired cardiopulmonary function associated with minor alterations of the airway microbiome. Long-term examinations of EA/TEF patients seem to be necessary in order to detect impaired cardiopulmonary function.

This study focuses on the impact of a prevention program regarding dog bites in children. As a consequence of our previous investigation in 2005, we have initiated a child safety program for primary school children starting January 2008 until present to teach children how to avoid dog attacks and how to behave in case of an attack. In our retrospective study, we analyzed all patients younger than 15 years presenting with dog-related injuries between 2014 and 2018. As the main indicator for success of the prevention measures taken, we have defined the severity of injury in comparison to our previous study. Out of 296 children with dog-related injuries, 212 (71.6%) had sustained a dog bite. In the vast majority (n = 195; 92%), these patients presented with minor injuries; the extremities were most commonly affected (n = 100; 47%). Injuries to the head (n = 95; 45%) and trunk (n = 18; 8%) were less frequent. The proportion of severe injuries (8%) was significantly lower compared to our previous study, where 26% of children presented with severe injuries necessitating surgical intervention, while the number of patients requiring in-hospital treatment declined from 27.5% in the period 1994–2003 to 9.0% in the period between 2014 and 2018 (p < 0.05).Conclusion: Teaching of primary school children may effectively reduce the injury severity of dog bites. What is Known:• Dog bites are a substantial healthcare problem especially in children. What is New:• This study shows that a broad-based prevention program for primary school children can effectively decrease the severity but not the frequency of dog bite injuries in children.