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Background: Surgical intervention in neonates with Gastro-esophageal Reflux Disease (GERD) is usually reserved for failure of medical management or those having life-threatening complications of GERD. The optimal timing of intervention is still debatable.  We aimed to identify the high-risk neonates with GERD requiring early surgical intervention. Methods: This prospective cohort study was conducted at NICU and Pediatric Surgery Department, Ain Shams University, from June 2017 to June 2020, and enrolled the neonates and infants below 2 months with symptoms and signs suggestive of GERD. Demographic data, clinical history, medical management, need for antireflux surgery, and outcomes were recorded. Results: In this study, 40 patients were enrolled and all were started on medical treatment. After the failure of medical management or life-threatening complications, 12 of these underwent anti-reflux surgery. In the medical group, six patients suffered from major complications (bronchopulmonary dysplasia and sepsis) and four mortalities. In the surgical group, three mortalities related to the development of bronchopulmonary dysplasia due to prolonged ventilation prior to surgery were recorded. The need for surgical intervention was significantly associated with younger gestational age (p = 0.001), younger age at presentation (p = 0.006), and lower weight at presentation (p = 0.034). Conclusion: Medical treatment of more than 35 days with unsatisfactory response, low birth weight, gestational age (≤32 weeks), and NICU admission in the first 10 days of life are considered high-risk factors for early anti-reflux surgery in neonates.

Background: Abdominal trauma in pediatrics is common. Abdomen is the most common site of initially unrecognized fatal injury in traumatized children. Aim of the Work:To analyse the value of conservative treatment versus early operative intervention for solid organs injury in the pediatric age group with blunt abdominal trauma. Patients and Methods:The study was carried out by collecting data from a random group of 140 children whose ages ranged from 6 to 16 years who suffered from abdominal trauma associated with solid organ injury, during the period between January 2017 to December 2020, at Ain Shams University hospital, Ahmed Maher teaching hospital and Nasser Institute. A clinical examination was signed for the patients, vital signs were evaluated, the necessary laboratory investigations were carried out, and FAST was performed on the abdomen in the emergency department. Also CT abdomen and pelvis was done on haemodynamic stable patients or after stabilization. Results:The study showed that periods of hospital stay were significantly higher in the surgical treatment group compared to conservative treatment group. Also blood transfusion, need of ICU hospitalization, need of mechanical ventilation and mortality were significantly higher in the surgical treatment group compared to conservative treatment group. The research showed the success of conservative treatment in the treatment of traumatic abdominal injuries, which resulted in injury to the spleen and liver in children, especially low-grade injuries, and that conservative treatment is safe and less expensive compared to surgical intervention. We also support the expansion of the use of interventional radiology in children, as it greatly reduces the child's exposure to surgical intervention. Conclusion:The present study confirmed the effectiveness of NOM in patients with liver and splenic injuries, suggesting a safe and effective therapeutic approach. According to these findings, the majority of patients can be treated with NOM in a less invasive manner, avoiding unnecessary laparotomies. Hemodynamic stability together with injury grading scale will provide a good plan for management.

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