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Fundamentals of Pediatric Surgery 2nd ed New York, NY: Springer; 2017 Harting MT, Tsao K Congenital diaphragmatic hernia In: Mattei P, ed Fundamentals of Pediatric Surgery 2nd ed New York, NY: Springer: 2017 Hedrick HL Evaluation and management of congenital diaphragmatic hernia Pediatr Case Rev 2001;1:25–36 Scott DA Genetics of congenital diaphragmatic hernia Semin Pediatr Surg 2007;16(2):88–93 Chest Wall Tumors Hines MH Video-assisted diaphragm plication in children Ann Thorac Surg 2003;76(1):234–236 Hwang Z, Shin JS, Cho YH, et al A simple technique for the thoracoscopic plication of the diaphragm Chest 2003;124(1):376–378 LaQuaglia MP Chest wall tumors in childhood and adolescence Semin Pedatr Surg 2008;17(3):173–180 Soyer T, Karnak I, Ciftci AO, et al The results of surgical treatment of chest wall tumors in childhood Pediatr Surg Int 2006;22(2):135–139 CHAPTER 125 ■ TRANSPLANTATION EMERGENCIES HEIDI C WERNER, KARAN MC BRIDE EMERICK, MARYANNE CHRISANT GOALS OF EMERGENCY CARE Solid organ transplantation is an effective and acceptable form of therapy that results in pediatric patients living healthy lives in an immunocompromised state These children are active and social, and as a result experience the usual range of pediatric ailments and conditions They are also, however, subject to ailments unique to transplant patients because of their recipient status and need for daily immunosuppression The survival and longevity of these patients improves with increased understanding of immune function, rejection, and medically induced tolerance In emergent situations, the morbidity and mortality of these patients is directly related to prompt diagnosis and treatment KEY POINTS In transplant patients, fever may be sign of infection or acute rejection Immunosuppressive medications put transplant patients at risk of adverse effects or altered metabolism of common therapies used in the emergency department (ED) Decisions about initiation of new therapies should be made in consultation with the transplant team RELATED CHAPTERS Signs and Symptoms Abdominal Distension: Chapter 12 Diarrhea: Chapter 23 Gastrointestinal Bleeding: Chapter 33 Pain: Abdomen: Chapter 53 Medical, Surgical, and Trauma Emergencies Cardiac Emergencies: Chapter 86 Renal and Electrolyte Emergencies: Chapter 100 POSTTRANSPLANT INFECTIOUS COMPLICATIONS CLINICAL PEARLS AND PITFALLS Presentation of infectious conditions in a transplant recipient may range from benign to uncharacteristically severe Early identification of infectious etiologies allows for directed treatment Patients on immunosuppression may not mount fever or elevated white blood cell count Significant infections, such as bacterial sepsis or varicella, may progress rapidly Unusual infections should be considered in immunocompromised patients with clinical signs or symptoms Avoid NSAIDs for antipyresis in patients taking calcineurin inhibitors (CNIs) (e.g., cyclosporine, tacrolimus) In combination, these drugs can cause acute renal insufficiency Fever and elevated aminotransferases may be a sign of infection, rejection, or venous thrombosis in the pediatric liver transplant patient Current Evidence In the immediate posttransplant period, the transplant patient is at risk for bacterial, viral, and fungal infections Etiologies of the increased infectious susceptibility include high-dose immunosuppression and indwelling central venous access Bacterial sources of infection include wound infection, urinary tract infection, and central-line infections Both gram-positive organisms, such as staphylococcal or streptococcal species, and gram-negative organisms, especially enteric species, may be the etiologic agents of these infections The risk of fungal sepsis is highest in children who have received numerous courses of antibiotics or require multiple operative procedures Viral infections in the posttransplant period are typically caused by members of the herpes virus family Epstein–Barr virus (EBV) and cytomegalovirus (CMV) serologies are routinely screened in both donor and recipient with prophylaxis typically required for CMV naïve recipients Following the immediate posttransplant period, there remains an increased incidence of opportunistic infections and increased severity of common childhood infections Yet, most children post solid organ transplant retain enough immune function so that they are able to fight and recover from typical infections Goals of Treatment Infectious complications represent a common cause of posttransplant morbidity and mortality with fever being a primary presenting sign However, a fever in a transplant patient may be a manifestation of infection, rejection, or anatomic complication As such, the goal of treatment is to identify the etiology of fever and direct treatment appropriately The most common etiologies are typical childhood infections such as otitis media, sinusitis, viral respiratory illnesses, pharyngitis, and gastroenteritis For the majority of patients, the care is supportive and not substantially different than for nontransplant recipients Careful attention must be paid, however, to hydration status, drug interactions with immunosuppressive medications, and establishing appropriate follow-up with the transplant team and the primary healthcare provider ( Fig 125.1 ) ... BRIDE EMERICK, MARYANNE CHRISANT GOALS OF EMERGENCY CARE Solid organ transplantation is an effective and acceptable form of therapy that results in pediatric patients living healthy lives in... immunocompromised state These children are active and social, and as a result experience the usual range of pediatric ailments and conditions They are also, however, subject to ailments unique to transplant... transplant patients at risk of adverse effects or altered metabolism of common therapies used in the emergency department (ED) Decisions about initiation of new therapies should be made in consultation