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  Improving Treatment for Infant Perianal Abscesses

  Artem Dadamyan, Nathan Novotny, and Ngan Nguyen

  Publication Date: 5-2025

  Perianal abscesses: • Tender masses located at the anal verge, typically in the 3 o’clock and 9 o’clock positions1

  • Develop due to infection in abnormally deep crypts of Morgagni 1

  • If left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space.2

  • Some may develop into fistula in ano, which can be difficult to treat3 Treatment:

  • The standard has always been incision and drainage (I&D), but non-invasive management of Sitz baths is increasingly being used.

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  Safety and Utility of Robotics in Pediatric Surgery: Implementation

  Luke J. Man, Kristin LeMarbe, Nathan Novotny, Anthony Stallion, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2025

  • Minimally invasive laparoscopic surgery is considered standard of care for adult and pediatric patients .

  • Robotic surgery (RS) for adult patients has been widely adopted due to superior ergonomics, visualization, depth perception, and access to deeper anatomical structures2,3.

  • Historically, RS is associated with longer operative times, higher cost, and lacks haptic feedback1,2.

  • RS has had inconsistent adoption in the pediatric surgery community2.

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  Impact of Michigan Public Act 246 on Opioid Prescribing for Pediatric Surgical Patients

  Madison Saunders and Pavan Brahmamdam

  Publication Date: 5-2025

  1. Opioid misuse is an epidemic in the U.S. affecting 3.1% of pediatric patients.2,3.

  2. Most common way adolescence obtain access to opioids is by their own prescription or a family member. 3,4 3.

  3. In December 2017, Michigan enacted Public Act 246 (P246) in an attempt to address rising opioid misuse.

  4. P246 states that as of June 1, 2018, a prescriber of a controlled substance must discuss the risks of opioid usage minor and the minor’s parent or guardian and sign a consent form.

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  Implementation of an Opioid Free Pediatric Hernia Repair Protocol

  Corey Shafer, Antonela Muca, Randy Hilleary, Kristin LeMarbe, Diane Studzinsk, Kaveh Aslani, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2025

  Surgery most often provides children with their first exposure to opioids which may lead to misuse and overuse. Protocolizing pain management perioperatively can reduce opioid exposure in children while still providing adequate pain management.

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  Surgical Site Infection Bundle For Babies: Preliminary Data

  Cullen Woodley, John Nida, Alexis Lonjin, Katelyn Ward, Diane Studzinski, and Begum Akay

  Publication Date: 5-2025

  Surgical Site Infections (SSIs) are infections that occur in or around the area where a surgery was recently performed. They are estimated to account for 20% of all healthcare associated infection, and lead to an increase in morbidity and mortality. Perioperative care bundles show promise in reducing SSIs in adults but are not often used in neonatal surgery. Infections in babies after surgery are less common than adults but carry significant morbidity in a fragile patient.

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  Water-Soluble Contrast Challenge in the Management of Pediatric Adhesive Small Bowel Obstruction: A Systematic Review

  Max Fliegner, Daniel Finn, Spencer Wilhelm, Nathan Novotny, and Anthony Stallion

  Publication Date: 5-2024

  Background: Adhesive small bowel obstruction (ASBO) is a serious complication of intra-abdominal surgery1 Water-soluble contrast (WSC) challenges have been used for medical management in the adult population2,3

  Knowledge Gap: The therapeutic value of water-soluble contrast challenge in the pediatric population with ASBO is under-studied3,4

  Research Question: Does administration of water-soluble contrast challenge reduce the need for surgery in pediatric patients with adhesive small bowel obstruction?

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  Perioperative Antibiotic Use in Neonatal General Surgery: A Survey of APSA Membership

  Samuel K. Osei, Ashley Williams, Diane Studzinski, Patrick Karabon, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2024

  • Guidelines for antibiotic prophylaxis for surgical site infection (SSI) are widely used for adult patients.
  • There is limited data on prophylaxis in pediatrics, and there are no standardized guidelines for neonates.
  • Perioperative antibiotic use in neonates based on the surgeon’s preference.

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  Prospective Qualitative Analysis of Minimally Invasive Repair of Pectus Excavatum

  Timothy Elton, Diane Studzinski, Robert S. Morden, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  Pectus Excavatum is the most common chest wall deformity and is frequently corrected with the Nuss procedure. Although this procedure has existed for several decades, new strategies are being adapted to reduce complications and improve efficiency. The aim of this study is to perform a qualitative review of the patient experience after minimally invasive repair of Pectus Excavatum.

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  Let Them Play: A Prospective Study of Postoperative Activity Restrictions in Children

  Rachel Harvey, Begum Akay, Diane Studzinski, Nathan Novotny, Anthony Stallion, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  We aim to compare time to resume full activity, postoperative outcomes, and describe family preferences of self-directed activity restrictions (SDAR) and physician-directed activity restrictions (PDAR) following routine pediatric surgeries.

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  Clearance of the Cervical Spine in Obtunded Pediatric Blunt Trauma Patients: Quality Assessment of an Existing Clearance Pathway

  Rachel Kalthoff, Elizabeth Boudiab, Diane Studzinski, Nathan Novotny, Pavan Brahmamdam, and Begum Akay

  Publication Date: 5-2-2022

  INTRODUCTION
  Obtunded patients following blunt trauma need clearance of the cervical spine (c-spine) that cannot depend on a clinical exam. Our center’s current pediatric c-spine evaluation pathway includes both Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). The objective of this study was to review our use of both CT and MRI for obtunded pediatric trauma patients to assess the quality of our pathway and utility of MRI.

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  Perioperative Antibiotic Use in Neonatal Surgery

  Lior Kopel, Patrick Karabon, Nathan Novotny, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  The ideal duration of perioperative antibiotic prophylaxis to prevent surgical site infection (SSI) in neonates is undetermined. The aim of this study is to evaluate the association between the duration of perioperative antibiotics and SSIs in the neonatal surgical population.

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  Blunt Trauma and Diaphragm Injury in Children: An Analysis of the National Trauma Data Bank

  Sammie Lai, Patrick Karabon, Patrick Modren, Begum Akay, Anthony Stallion, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  Trauma is the leading cause of mortality and morbidity in children. Traumatic diaphragm rupture (TDR) is a rare but serious injury that can be difficult to identify. The current literature includes individual case reports and single center case series only, which limits our ability to generalize those findings. The purpose of this study is to use the National Trauma Data Bank (NTDB) in order to examine the clinical outcomes of blunt TDR in the pediatric population.

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  Spontaneous Pneumomediastinum in Children is Not Associated with Esophageal Perforation

  Kevin Roby, Catherine Barkach, Diane Studzinski, Nathan Novotny, Begum Akay, and Pavan Brahmamdam

  Publication Date: 5-2-2022

  INTRODUCTION
  We hypothesize that esophageal perforation is not a common etiology for spontaneous pneumomediastinum (SPM), and that SPM is a self-limited disease not requiring routine admission.