From PSION (Pediatric Surgery International Online Network)
The 9th Biennial Pan African Paediatric Surgical Association conference in Cape Town has brought together surgeons from not only many African countries but also from across the globe. The Rainbow Nation exemplifies a mixture of cultures, mirrored in the origin of the conference delegates. Many with a shared goal of reducing the inequity of paediatric surgery provision between resource rich and resource poor nations.
After a dramatic introduction during the first morning on paediatric trauma, the focus turned to infections, another significant cause of mortality in developing countries. In particular the HIV epidemic has changed the spectrum of disease facing the paediatric surgeon in these areas.
Dr Kapelowsky, a surgeon previously at Red Cross Children’s Hospital in Cape Town, set the scene; 44% of childhood deaths in the Western Cape are related to HIV. Through his prospective study on postoperative complications in HIV infected children he has quantified the excess risk as x12 that in uninfected children. Most complications being due to wound sepsis.
Dr Arnold went onto present even more concerning data regarding premature infants requiring surgery for NEC, who were born to HIV infected mothers. Despite having adequate antiretroviral prophylaxis, these exposed (in-utero) but non infected babies developed more (p=0.03) post-operative infections including ventilator associated pneumonia. However, mortality was not significantly different.
Continuing on the NEC theme, Professor Sam Moore from Tygerburg Hospital in Cape Town presented a study looking at placental pathology in patients subsequently developing Bell stage 2 or higher NEC. Placental infarcts or other vascular pathology was seen in 54% of NEC cases compared with 20% non-NEC and Chorio-amnionitis in 38% compared with 12% non-NEC. The pathogenesis of NEC may be related to events way before the introduction of milk!
One of the highlights of the first day of the conference was the first mini-symposium, discussing Vascular Anomalies. Dr Pillay, consultant pathologist at Red Cross Children’s Hospital was given the daunting task of describing the modern classification of vascular tumours and malformations.
Dr Cox (Red Cross Hospital) and Prof Azizkhan (Cincinnati Children’s Hospital) then described the management of various cases. The modalities of medical treatment (propranolol vs steroids) or invasive (angiographic embolisation vs open surgery) were discussed in some detail. One third of children having some form of vascular anomaly, this is therefore an area that we frequently deal with and the identification of complex cases is paramount if they are to be correctly managed.