[size=20px]While on call, you cover a community hospital 25 miles away. This hospital has a small NICU and pediatric ward. The neonatologists and hospitalists are the same group you work with at your children’s center. There are no additional pediatric specialists at this hospital. You are called in the middle of the night by an experienced neonatologist that a full-term, 3 kg baby girl was born and incidentally found to have a proximal esophageal atresia (EA) and distal tracheoesophageal fistula (TEF). The patient had some respiratory distress and was just intubated. The baby is stable and now on minimal ventilatory settings. You inform the neonatologist that the most appropriate management is

 

A Extubate the patient

 

B Transfer to a children’s center

 

C Immediate repair of EA/TEF

 

D Immediate TEF ligation only

 

E Wait until the next morning for repair of EA/TEF[/size]

B

B

B

B

B

B

B

Correct answer

B Transfer to a children’s center

 

A 2020 position statement on pediatric surgery training, sub-specialization, and continuous certification titled “The Right Child/Right Surgeon” initiative was published by the American Pediatric Surgical Association. This paper addresses factors involved in how and where and by whom a child’s surgical care is provided and advocates for the best delivery of pediatric surgical care possible. A significant emphasis of this paper is to ensure that the most appropriate resources are available for the care of children undergoing surgery. In this scenario, this patient with an EA/TEF should be transferred to a center with appropriate pediatric resources to optimize the care of the patient. Although the surgeon and neonatologist may have the experience and training to care for this patient, the community hospital in this case is not equipped with appropriate pediatric resources thus warranting transfer to a children’s center. Below is a summary of the principles.

 

The “Right Child/Right Surgeon” initiative is based on 5 principles:

1. Pediatric Surgery should maintain the highest standards in training, certification, and continuous certification for its trainees and practicing surgeons.
   
2. Different patients and practice environments require different levels of expertise.
   
3. Practice and knowledge gaps exist within environments and among surgeons, especially for underserved areas.
   
4. Passively allowing political market forces to effect change will be detrimental to patients and caregivers.
   
5. APSA should be the driving force to understand and begin to close the existing gaps.
   

B