Articles

Impact of a 6-12-h Delay Between Ileocolic Intussusception Diagnostic US and Fluoroscopic Reduction on Patients’ Outcomes.[1] Lopez-Rippe J et al., Pediatr Radiol. 2024 Jul;54(8):1294-1301. Epub 2024 Jun 6. PMID: 38842614.

Ileocolic intussusception is a common cause of abdominal pain and requires swift diagnosis and treatment to minimize morbidity and mortality. Historically, it is considered an urgent radiologic issue requiring 24-h radiologist and technologist availability. Recent studies suggest that ileocolic intussusception may not be as emergent of a condition, with some showing delays up to 48-h may not confer additional risks of reduction success. Pediatric radiology is experiencing a nationwide shortage in their workforce, with many institutions turning to remote radiologists to cover nighttime or weekends. This impacts our ability to continue delivering the highest standards of care as pediatric surgeons if we do not have fellowship trained colleagues in critical fields available around the clock.

· This retrospective review found that reduction < 6h after diagnosis and between 6-12h did not show significant difference in reduction success, need for surgical intervention after attempted reduction, recurrence, or hospitalization length after reduction.

· Short delays in fluoroscopic reduction of ileocolic intussusception may not significantly impact clinical outcomes.

· The authors acknowledge that delaying therapeutic procedures will lead to increased duration of patient discomfort, parental anxiety, and increased healthcare costs related to extended monitoring and hospital length of stay. Additionally, there is no recommendation for who will admit and be medically responsible until the patient undergoes reduction.

The Pediatric Anesthesiology Workforce in the United States: How to Curb the Crisis? [2]Salik I et al., Paediatr Anaesth. 2025 Mar;35(3):196-198. Epub 2024 Dec 17. PMID: 39688202.

There continues to be a growing shortage of pediatric anesthesiologists in the United States. This impacts our ability to deliver sub-specialized care for pediatric surgical patients. The percentage of unfilled programs in the Pediatric Anesthesia fellowship match has increased from 10% in 2015 to 67.2% in 2023. Factors affecting this include retirement of current pediatric anesthesia physicians, changing workload expectations, emphasis on wellness, decline in prestige, and job market forces.

The authors list strategies to help mitigate the shortfall of fellowship trained pediatric and pediatric cardiac anesthesiologists:

· Trained anesthesiologists must lead the advanced perioperative management of high-risk infants and children

· Financial incentivization via increased compensation during and after fellowship

· Importance of work-life balance to the next generation of trainees and anesthesiologists must be acknowledged and addressed via reduced work hours, encouraging a more manageable case-load, and providing access to wellness resources

· Improved national awareness and advocacy regarding the impending staffing crisis to stimulate interest in maintaining the high standard of perioperative outcomes for high-acuity pediatric patients and increasing the prestige of the field

· Streamlined training pathways via combined or integrated residency-fellowship models

· Early and strong mentorship

· Implementing recommendations from collaborative pediatric anesthesiology task force for a standardized national curriculum with more rigorous didactic standards, an updated case log system, and a standardized toolkit for summative and formative assessment

Pediatric surgical border health: Supply may not be meeting demand in South Texas communities [3] Akinpelu Tet al., Am J Surg. 2024 Aug 19:115908. Epub ahead of print. PMID: 39198119

The Rio Grande Valley (RGV), situated along the Texas-Mexico border, is a medically underserved area with a population experiencing a high percentage of socio-economic challenges such as lack of a high school education and long distances to centers providing tertiary care.

Database analysis was used to determine the incidence and mortality of congenital birth defects. Regional medical board information and physician demand projections were used to estimate the available workforce over the coming decade. The region ranks as high as 5th in the United States for mortality rates associated with congenital birth defects, necessitating the care of pediatric surgical subspecialists. Possible etiologies cited were low engagement of prenatal care and monitoring and low access to corrective surgical services. The current available workforce supply of pediatric surgical subspecialists in the region, compared to the rest of Texas is remarkably, low. Despite an expansion in training programs and graduates of fellowships in pediatric surgery, projections for the workforce in the RGV suggest a trend in the opposite direction. This study is one example of regions in the United States where access to pediatric surgical subspecialists, including pediatric general surgeons, is disproportionately low compared to most of the nation. Proactive measures to correct the imbalance such as support in the forms of state and national funding were recommended

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