Sternal wound infections occur with an incidence between 0.4 and 5% in the adult as well as the pediatric population. However, in contrast to the adults, established treatment options do not exist in the pediatric population. We evaluated our preliminary results with 3 neonates, respectively, small infants (mean age 20.3+/-6 days) who underwent vacuum assisted closure (VAC) therapy for the treatment of sternal wound infections with the intention to enable secondary closure and preservation of the sternal bone. The mean VAC duration was 11.3 days, ranging from 10 to 12 days. After three dressing changes (every 48 to 72 h) the infection resolved and a secondary closure was feasible in all three patients. Isolated specimens were Candida albicans, Staphylococcus aureus and MRSA, respectively. These preliminary results show that VAC therapy is a promising alternative to the current treatment options available to neonates. Especially, the preservation of the sternal bone which enables normal thoracic cage stability and growth, is a clear advantage over the currently used muscle flaps.

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Despite the established success of surfactant application in neonates, the use of surfactant in older children is still a matter of discussion. We hypothesized that surfactant application in children with acute respiratory distress syndrome (ARDS) secondary to a pulmonary or systemic disease or after cardiac surgery improves pulmonary function. We also asked whether repeated treatment could further improve pulmonary function. To answer these questions, we measured oxygenation index (OI) and hypoxemia score after the first and after a second application of surfactant (50-100 mg/kg body wt) at least 24 h later. We enrolled 19 children (older than 4 weeks) for a retrospective chart review study, and six of them underwent cardiac surgery. Demographic data were extracted. OI and hypoxemia score were estimated before and 2 and 24 h after surfactant application. Lung injury score was calculated before and 24 h after surfactant application. Outcome measures included survival, duration of mechanical ventilation, and pediatric ICU and hospital stay. The median patient age was 9.0 (quarter percentile 3.7/25) months. The median weight was 8.4 (4.1/11.5) kg. The median lung injury score before the first surfactant application was 2.3 (2.3/2.6). Hospital duration and pediatric ICU stay for all patients was 31.0 (20.0/49.5) days and 27.0 (15.5/32.5) days, respectively. The duration of mechanical ventilation was 24.0 (18.5/31.0) days. The overall mortality was 53%. Twenty-four hours after the first surfactant application, pulmonary function significantly improved. The median OI was 14 (5.5/26) before and 7 (4.5/14.5) 24 h after surfactant application (P= 0.027). The hypoxemia score was 91.7 (69.9/154.2) before and 148.4 (99.2/167.6) 24 h after surfactant application (P = 0.0026). Seven children received a second application, which did not further improve pulmonary function. The lung injury score was not influenced by either surfactant application. We conclude that a single surfactant application improves pulmonary function in children with ARDS. A second application of surfactant showed no further benefit. Outcome was not affected in our study population.

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