Pediatric surgical research continues to expand along technical avenues while addressing issues of basic science.
Splenic salvage is an established goal which can ordinarily be achieved without surgical intervention. Operative approaches, when indicated, can be done with minimal moribidity. Although the spleen acts as a bacterial monitor under normal circumstances by direct phagocytosis, opsonization, and modulation of macrophage function, our understanding of how the injured spleen resumes these activities remains fragmentary.
Extracorporeal membrane oxygenation shows increasing promise for newborns with refractory respiratory failure. New applications of pulmonary vasoactive meidators will yield a better understanding of how this radical therapy affects cardiopulmonary homeostasis. The lungs either synthesize, modify, or pass on a number of substances including eicosanoids, vasoactive amines, and carboxypeptidases which form a resonating feedback network that controls pulmonary vascular tone. Disturbed homeostasis results in the various disease states that have pulmonary hypertension and lung injury as common features.
Developments in fetal surgery have permitted creation of improved models of in utero conditions. These models variably mimic the human condition, particularly obstructive uropathy, congenital diaphragmatic hernia, and neural tube defects. Complex problems remain for patient/fetus selection and timing of surgical intervention.