Objectives This study aimed to describe the incidence and spectrum of postoperative complications in infants who underwent their first cardiac surgery for the repair of congenital heart diseases. Methods This is a single-center retrospective study. Data of infants admitted to King Faisal Specialist Hospital & Research Center; Jeddah; Saudi Arabia, from January 2015 to December 2019 who underwent the first cardiac procedure for congenital heart disease at an age of less than 3 months, were analyzed. The primary outcome is the prevalence and spectrum of postoperative complications during hospitalization. Data were analyzed by using descriptive and analytical statistics using SAS software version 9.4. Results Data of 130 procedures were analyzed. The most frequent procedure performed was the Norwood procedure (31.5%), aortic coarctation repair (13.8%), arterial switch operation (13%), and Blalock-Taussig and central shunts (10%). The overall postprocedural complications were reported in 96 (73.8%) of the procedures. The most frequent complications were prolonged postoperative mechanical ventilation (27%), pleural effusion (21%), excessive bleeding (19%), cardiac arrest (18%), and systemic infections (18%). Conclusion Cardiac surgery for congenital heart disease in young infants has a substantial risk for postoperative complications. The high incidence of these complications in these cases makes necessary attention to prove the outcomes in the cardiac centers.

Objectives Osteogenesis imperfecta (OI) is a heterogeneous group of inherited connective tissue disorders, characterised by skeletal fragility. Patients with OI may also exhibit extra-skeletal features like blue or grey scleral colour, fragile skin, easy bruising, joint laxity, short stature, deafness, cardiac valve abnormalities and abnormal pulmonary function. The objective of this study is to describe genetic mutations, prevalence of hearing issues, cardiac complications and impaired pulmonary function in children with OI. Methods This is a cross-sectional study of 23 Saudi children aged 6 months to 18 years who were diagnosed with OI. The revised Sillence classification (2,105) was used to classify the OI type. Whole exome sequencing was performed for genetic mutations. The hearing was assessed by either pure-tone audiometry and/or otoacoustic emission testing. Cardiac defects were screened by echocardiograms. Spirometry was performed to assess pulmonary function. Data were analysed with descriptive statistics. Results Based on the Sillence classification, 16 patients had OI type III, 6 had type IV and 1 had type I. Of the18 patients who had genetic sequencing, 66.6% had autosomal dominant and 33.3% had autosomal recessive mutations. Among children who had screening, hearing loss was diagnosed in 53% (9/17), congenital cardiac malformations in 26% (5/19) and restrictive lung disease in 70% (7/10). Conclusions We found significant extra-skeletal features and a high yield of genetic mutations associated with OI. We suggest further studies to develop a screening protocol for extra-skeletal features in children with OI.

In recent years, the nasal route has increasingly been viewed as an alternative option for the delivery of analgesia, especially when the traditional ways are complicated or time-intensive. However, little is known about the value of this intervention in acute pain management in pediatric emergency medicine. This evidence-based analysis review aims to assess the current evidence regarding the use, safety, and effectiveness of intranasal analgesics in acutely painful conditions encountered in Pediatric Emergency Departments (PEDs). A systemic electronic searching of Cochrane library, PubMed, and EMBASE databases from the beginning of each database until October 2018 was conducted using a maximally sensitive searching strategy. Only randomized controlled trials (RCTs) or quasirandomized controlled trials that evaluated the use of intranasal analgesia for acute pain in children in the Emergency Department and published between January 1990 and October 2018 were included. The methodological quality of the trials was assessed using the Grading of Recommendations Assessment, Development, and Evaluation criteria. Risks of bias within each included study were evaluated according to the Cochrane Risk of Bias Tool for RCTs. This review was reported following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses statement. Seven RCTs and one quasi-randomized study met the inclusion criteria. Five studies compared an intranasal analgesic and an alternative intervention, two compared intranasal fentanyl against ketamine, and one compared two different concentrations of intranasal fentanyl. All included trials reported reductions in pain scores, especially within the first 10 to 30 minutes post-intervention; however, pain reduction was maintained to 60 minutes in only one study. No evidence of significant adverse events was associated with the administration of any intranasal analgesic in any of the included studies. This review identified eight articles that discussed the intranasal analgesia as a possible route of analgesia in the PED. While no paper was entirely perfect, the findings support the idea that intranasal analgesia may be an effective analgesic for the treatment of children (3-18 years) with acute moderate to severe pain, and its administration appears to cause minimal adverse effects.