Background: Nutritional support plays an essential role for recovery in infants who undergo gastrointestinal surgery. The current standard type of intravenous lipid emulsion (IVLE) used as parenteral nutrition is the mixture of medium-chain triglyceride (MCT) and long chain triglyceride (LCT) rich in ω-6. Studies showed that ω-6 is associated with higher level of proinflammatory cytokines, leading to increased mortality rate, morbidity rate, and postoperative recovery time. The latest generation of emulsion is a mixture of MCT, LCT, olive oil (OO), and fish oil (FO) which may optimize the ω6/ω3 ratio. This study aimed to compare the effect of MCT/LCT/OO/FO IVLE to standard IVLE on IL-1β, IL-8 and serum fatty acids in infants who had undergone gastrointestinal surgery. Methods: A single-blind, randomised controlled, pretest-posttest design study was done in twelve subjects that were classified into two groups. Group 1 received standard IVLE, group 2 received MCT/LCT/OO/FO IVLE. The type of standard and MCT/LCT/OO/FO IVLE used in this study were Lipofundin 20% and SMOFlipid 20%, respectively, both administered for three consecutive days in 1-4 gram/kilogram/day. IL-1β and IL-8 were examined using ELISA while fatty acids was analyzed using gas chromatography tandem mass spectrometry (GC-MS). Statistical analyses were performed using SPSS for Mac 23. Results: No statistical difference was found in age, gender, birth weight and diagnosis between both groups. Leukocyte was significantly lower in MCT/LCT/OO/FO group 3 days after surgery (p=0.025). CRP was lower in MCT/LCT/OO/FO group 3 days after surgery (p=0.01) and in changes within 3 days (p=0.016). There were no differences in IL-1β, IL-8 and ω-3 but ω-6 was higher in standard IVFE group on third day after surgery (p=0,048) Conclusion: MCT/LCT/OO/FO IVLE can significantly lower leukocyte, CRP and ω-6 levels and is comparable with standard IVLE on IL-1β, IL-8 and ω-3 levels in infants who had undergone gastrointestinal surgery.

Background: The golden standard of Hirschsprung's disease diagnosis is through a histopathological examination of the aganglionic site. The significance of serum acetylcholinesterase (AChE) immunohistochemistry for diagnosing Hirschsprung's disease has been widely accepted. However, the study of serum AChE levels in Hirschsprung's disease patients is still scarce. We aimed to examine the serum levels of AChE in individuals with Hirschsprung's disease. Methods: An analytical observational study with a cross sectional design was conducted on 29 patients with Hirschsprung's disease. We divided the patients into two groups: 14 in Hirschsprung's disease group and 15 in the control group. Serum AChE level was measured using the enzyme-linked immunosorbent assay (ELISA) method. The optimal cut-off value for detecting Hirschsprung’s disease was determined using the ROC analysis. Results: The prevalence of Hirschsprung was higher in males than in females. The average AChE level in the Hirschsprung group was 95.89 ± 51.11 Units/mL, while the average level of AChE in the control group was 44.45 ± 33.40 Units/mL. The optimal cut-off value was 46.615 Units/mL. We found that this study's sensitivity, specificity, positive predictive value, negative predictive value, and accuracy values ​​were 83.3%, 70.6%, 66.7%, 85.7%, and 75.9%, respectively. There was a significant relationship between serum AChE levels and Hirschsprung's disease (p=0.004). Conclusion: The AChE levels in blood serum can be used as an alternative diagnostic parameter for Hirschsprung's disease. Patients with Hirschsprung's disease had higher serum AChE levels than patients without Hirschsprung's disease.

Background: Congenital diaphragmatic hernia (CDH) is a rare, complex and severe abnormality in an infant. Globally, neonatal mortality as a consequence of congenital anomalies is increasing and is therefore outlined as an emerging priority to be addressed by the UN Sustainable Development Goals (SDGs) in the post-2015 child health agenda. Although numerous cases are discovered prenatally or in the early postnatal period, 5-25% of CDH are detected in delayed onset after birth. The aim of this article was to discuss the case of CDH with moderate persistent pulmonary hypertension, moderate muscular ventricular septal defect, and small patent ductus arteriosus. Case Presentation: A-8 days old, 3,060 g, a full-term male infant was referred to our tertiary hospital with transient tachypnea of the newborn and a suspected case of congenital heart disease. The defect was repaired after stabilization of the cardiac output and gas exchange. During recovery after surgery, the patient was placed on high-frequency oscillation after surgery and was given potent inotropic support. The patient made an uneventful postoperative recovery. Conclusion: The management of CDH patients should be multidisciplinary. More clinical studies were required to elaborate on a suitable management protocol for the CDH

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This chapter describes how bovine amniotic membrane could be indicated for wound healing, especially in complex surgery such as urethral reconstruction. Chemical studies have assessed both histologically and immunohistochemically that bovine amniotic membrane creates scaffold for wound healing. Whereas, clinical studies have shown that bovine amniotic membrane property could be substituted for wound dressing hence improving skin or mucosal integrity. Bovine membrane has been known to be used for many specialties such as ocular surgery, neurosurgery, maxillofacial and orthopedic surgery. This chapter includes such studies and shows the usage possibility of bovine amniotic membrane for other complex defect as shown in urethral reconstruction.