Objective Develop a model to predict gastrostomy tube (GT) for feeding at discharge in infants born < 30 weeks’ (w) gestational age (GA). Study design A single-center retrospective study at academic NICU. Total of 391 (78 GT, 313 non-GT) infants < 30 w GA admitted in 2015–2018 split into test (15–16) and validation (17–18) cohorts. Classification and regression tree analysis was used to identify predictive factors for GT. Results Several factors were associated with GT requirements. Four factors included in the model were postmenstrual age (PMA) at first oral feeding, birth GA, high-frequency ventilation exposure, necrotizing enterocolitis stage II/III. Area under the receiver operator characteristic curve was 0.944 in the test cohort, 0.815 in the validation cohort. Implementation plan based on the model was developed. Conclusions We developed a predictive model to risk-stratify infants born < 30 w GA for failing full oral feeding. We hope implementation at 38 w PMA will result in earlier placement of needed GT and discharge.

Background Appendicitis is the most common abdominal surgical emergency in children. With the rise of the Coronavirus-19 pandemic, quarantine measures have been enforced to limit the viral transmission of this disease. The purpose of this study was to identify differences in the clinical presentation and outcomes of pediatric acute appendicitis during the Coronavirus-19 pandemic. Methods A single-institution retrospective assessment of all pediatric patients (<18 years old) with acute appendicitis from December 2019 to June 2020 was performed at a tertiary care children’s hospital. Patients were divided into two groups: (1) the Pre-COVID group presented on or before March 15, 2020, and (2) the COVID group presented after March 15, 2020. Demographic, preoperative, and clinical outcomes data were analyzed. Results 45 patients were included with a median age of 13 years [IQR 9.9 - 16.2] and 35 males (78%). 28 patients were in the Pre-COVID group (62%) and 17 in the COVID group (38%). There were no differences in demographics or use of diagnostic imaging. The COVID group did have a significantly delayed presentation from symptom onset (36 vs 24 hours, P < .05), higher Pediatric Appendicitis Scores (8 vs 6, P = .003), and longer hospital stays (2.2 vs 1.3 days, P = .04). There were no significant differences for rates of re-admission, re-operation, surgical site infection, perforation, or abscess formation. Conclusion During the Coronavirus-19 pandemic, the incidence of pediatric acute appendicitis was approximately 40% lower. These children presented in a delayed fashion with longer hospital stays. No differences were noted for postoperative complications.

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BACKGROUND:Rib fractures serve as both a marker of injury severity and a guide for clinical decision making for trauma patients. Although recent studies have suggested that rib fractures are dynamic, the degree of progressive offset remains unknown. The purpose of this study was to further characterize the change that takes place in the acute trauma setting. METHODS:A 4-year (2016-2019) retrospective assessment of adult trauma patients with rib fracture(s) admitted to a level I trauma center was performed. Initial and follow-up computed tomography scans were analyzed to determine the magnitude of offset. Relevant clinical course variables were examined, and location of chest wall instability was examined using the difference of interquartile range of median change. Statistical Product and Services Solutions (Version 25, IBM Corp. Armonk, NY) was then used to generate a neural network-multilayer perceptron that highlighted independent variable importance. RESULTS:Fifty-three patients met the inclusion criteria for severe injury. Clinical course variables that either trended or significantly predicted the occurrence of progressive offset were Abbreviated Injury Scale Thoracic Scores (3.1 ± 0.4 no progression vs. 3.4 ± 0.6 yes progression; p = 0.121), flail segment (14% no progression vs. 43% yes progression; p = 0.053), and number of ribs fractured (4 [2-8] no progression vs. 7 [5-9] yes progression; p = 0.023). The location of progressive offset largely corresponded to the posterolateral region as demonstrated by the differences of interquartile range of median change. The neural network demonstrated that ribs 4 to 6 (normalized importance [NI], 100%), the posterolateral region (NI, 87.9%), and multiple fractures per rib (NI, 66.6%) were valuable in predicting whether progressive offset occurred (receiver operating characteristic curve − area under the curve = 0.869). CONCLUSION:Rib fractures are not stable, particularly for those patients with multiple fractures in the mid-to-upper ribs localized to the posterolateral region. These findings may identify both trauma patients with worse outcomes and help develop better management strategies for rib fractures.