Neonates are highly susceptible to infections owing to their immature cellular and humoral immune functions, as well the need for invasive devices. There is a wide practice variation in the choice and duration of antimicrobial treatment, even for relatively common conditions in the NICU, attributed to the lack of evidence-based guidelines. Early decisive treatment with broad-spectrum antimicrobials is the preferred clinical choice for treating sick infants with possible bacterial infection. Prolonged antimicrobial exposure among infants without clear indications has been associated with adverse neonatal outcomes and increased drug resistance. Herein, we review and summarize the best practices from the existing literature regarding antimicrobial use in commonly encountered conditions in neonates.

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Background Given the rarity of duodenal neuroendocrine tumours (dNETs), limited guidelines exist for resection of well-differentiated, ≤10 mm dNETS. As incidence rises, alternatives to surgery are valuable. We present 9 cases of endoscopic dNET resections and a literature review. Aims To demonstrate efficacy and safety of endoscopic resection for dNETs ≤10 mm at 2 Canadian hospitals. Methods We retrospectively analyzed data on 7 patients that had endoscopic dNET resection from 2013–2018. Endoscopic resection occurred if dNETs were ≤10 mm in diameter, did not extend to the muscularis propria and lymphovascular invasion was absent. WHO 2017 classification was used. Results All patients had biopsies and 5 (71%) had EUS prior to resection; 4 females and 3 males underwent resection of 9 dNETs; 2 via cap-assisted snare polypectomy; 4 with cap-assisted band mucosectomy; and 2 over-the-scope clip-assisted resection. The median size was 10 mm (4–11); 6 (67%) dNETS were found in the duodenal bulb, 2 at the D1/D2 junction and 1 in D2 alone. The median age was 68.5 (50–79) years. All dNETs were submucosal and well-differentiated. The dNETs were resected en bloc, but 3 did not have clear margins. Two procedures were complicated by duodenal perforation; 1 requiring surgery and 18 days in hospital. One case was complicated by bleeding with successful endoscopic hemostasis. The majority (75%) of resections were day procedures. Patients were followed for 6–12 months with an EGD or chromogrannin A. None of the patients had endoscopic residual disease, but 1 patient required a second procedure to remove a dNET left in situ following the initial resection of 2 dNETs 12 months earlier. In our literature review of 178 patients, the majority of dNETs were resected by EMR 81% (150/185) versus ESD, similar to our experience. Patients were slightly younger with a mean age of 63.28, and most dNETs (46%) were found in the duodenal bulb. Complications included intraoperative bleeding, perforation and death in 17 (9.55%), 9 (5.06%) and 1 (0.06%) patient(s) respectively. The rate of recurrence was 4/178 (2.25%) and patients had a mean follow up of 26.1 months. Conclusions Well-differentiated dNETs ≤10 mm in diameter can be successfully resected endoscopically. Complications can be managed intraoperatively and hospital stay remains minimal. Funding Agencies None

Background and Aim: Progression of endoscopic diagnosis contributes improvement of detecting early gastric cancer (EGC). Endoscopic resection like endoscopic submucosal dissection (ESD) achieves surefire treatment of EGC. Now metachronous gastric cancer (MGC) after ESD becomes a problem. We analyzed the patients who had MGC after ESD to clarify the feature of MGC. Methods: We conducted retrospective analysis of EGC cases resected by ESD in our institution. From April 2014 through August 2019, 393 patients were performed ESD and 38 cases (9.7%) were MGC including 10 synchronous (within 1 year after ESD). We analyzed age, sex, interval of recurrence, location, macroscopic type, histological type, size of tumor, depth of invasion, history of eradication of Helicobacter Pylori (HP), detecting method and curative ratio by ESD. The study was approved by IRB. Result: The outcomes were as follows: MGC including synchronous was 9.7% (38/393) during this surveillance. Sex: male/female ratio was 35/3. Average age: 74.0AE4.7 years old (61-86, median 74). Average interval of recurrence: 45.7AE41.6 months (2-168, median 33.5). 68% (26/38) of cases experienced a recurrence within 5 years after previous ESD. The maximum recurrence was 3 times. Location: Upper 19, Middle 4, Lower 15. 76% (29/38) of cases arose from different location from the previous one. Macroscopic type: 0-IIa 12, 0-IIb 4, 0-IIc 22. 42% of cases were same type as previous one. Histological type: 37 tubular adenocarcinoma and 1 poorly differentiated adenocarcinoma. Average size: 11.4AE7.8 mm (1.5-37, median 10). Depth of invasion: M 36, SM 2. History of eradication of HP: 53% (20/38). In those cases, the longest interval of recurrence was 12 years and the shortest one was 2 years. Detecting method: white-light imaging 74%, indigo carmine dye 26%. Narrow-band imaging (NBI) or magnifying endoscopy with NBI was not used at the first detection of EGC. Curative ratio by ESD: 97% (37/38). Almost cases were less than 30mm tubular adenocarcinoma existed in mucosal layer, therefore, they were curative. Just one case (por, SM1) was not curative by ESD. Conclusion: In our analysis, MGC after ESD was 9.7%. The majority of cases were curative by ESD. 53% of cases had history of eradication of HP. They had severe atrophic gastritis and metaplasia. Even after eradication of HP, the patients performed ESD for EGC also still need continuous periodic endoscopic examination. To make sure effectivity of eradication of HP after ESD for EGC, additional prospective analysis is necessary.