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Pediatric Surgery International (Online First™)
A review of patch options in the repair of congenital diaphragm defects
Wed, 01 Feb 2012 17:10:05 -0000
Abstract Repair of congenital diaphragmatic hernia (CDH) continues to pose a dilemma for the pediatric surgeon. While the management of CDH has evolved from surgical urgency to delayed repair after medical optimization with substantial improvements in mortality, morbidity continues to perplex clinicians. Significant morbidity occurs with recurrence, re-recurrence and complications such as obstructions, principally with mesh repair. When primary closure is not possible, mesh repair is indicated. While there are several non-absorbable prosthetic, absorbable biosynthetic and composite mesh types available, the ideal mesh remains elusive. In this article, we reviewed the current materials, reported advantages, and animal and clinical studies of non-absorbable prosthetic, absorbable biosynthetic and composite mesh. However, adequate comparative data are lacking, leaving a wide void for future animal models and clinical studies. Content Type Journal ArticleCategory Review ArticlePages 1-7DOI 10.1007/s00383-012-3059-9Authors Alessandra C. Gasior, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USAShawn D. St. Peter, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Pediatric surgical site infection in the developing world: a Kenyan experience
Wed, 01 Feb 2012 17:10:04 -0000
Abstract Background The purpose of the current study was to determine the incidence of pediatric surgical site infections (SSIs) at an academic children’s hospital in rural sub-Saharan Africa and to identify potentially modifiable risk factors. Methods Prospectively collected data from 1,008 surgical admissions to BethanyKids Kijabe Hospital (Kijabe, Kenya) were analyzed retrospectively. Follow-up data were available in 940 subjects. Results SSIs occurred in 6.8% of included subjects (N = 64). Superficial (69%) and deep (29%) infections of the back (38%) and head (25%) were most common. When comparing children who developed SSI to those who did not, we found that wound contamination classification and duration of operation were the only variables with significant differences between groups. Conclusions Our rate of SSI among pediatric patients in sub-Saharan Africa is the lowest reported in the literature to date. More work is needed to identify modifiable risk factors for pediatric SSI in low- and middle-income countries. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00383-012-3058-xAuthors James H. Wood, Department of Surgery, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Box C302, Aurora, CO 80045, USAPeter M. Nthumba, BethanyKids at Kijabe Hospital, Kijabe, KenyaEdita Stepita-Poenaru, BethanyKids at Kijabe Hospital, Kijabe, KenyaDan Poenaru, BethanyKids at Kijabe Hospital, Kijabe, Kenya Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Single trocar retroperitoneoscopic nephrectomy for unilateral multicystic dysplastic kidney in children
Tue, 31 Jan 2012 07:05:59 -0000
Abstract The author presents the first report in performing single trocar nephrectomy for five patients with multicystic dysplastic kidney (MCDK). The mean operative time was 66 min and mean postoperative hospital stay was 36 h. There were no perioperative complications. The one-trocar nephrectomy is a feasible and safe procedure for patients with MCDK. Content Type Journal ArticleCategory Technical InnovationPages 1-3DOI 10.1007/s00383-012-3056-zAuthors N. T. Liem, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamL. A. Dung, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamN. D. Viet, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, Vietnam Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Does necrotizing enterocolitis affect growth and neurodevelopmental outcome in very low birth weight infants?
Tue, 24 Jan 2012 12:27:17 -0000
Abstract Aim To evaluate the effect of necrotizing enterocolitis (NEC) on growth and neurodevelopmental outcome. Patients and methods Neurodevelopmental outcome of 20 of 39 surviving very low birthweight infants (VLBW) diagnosed with NEC between 2007 and 2009 was compared with 40 control infants matched for gestational age and year of admission. Follow-up studies were performed at 18 and 24 months of corrected age. Bayley Scales of Infant Development-Second Edition scale was used for neurodevelopmental assessment. Results At 18–24 months corrected age, body weight, body length, and head circumference did not differ significantly between the NEC and without NEC groups. The median mental developmental index (62 vs. 75, p = 0.008) and psychomotor developmental index points (72 vs. 91.5, p = 0.002) were lower in infants with NEC compared to without NEC, respectively. Although the rate of neurodevelopmental impairment was slightly higher in infants with NEC, there were no differences between the groups according to the frequency of minimal impairment and cerebral palsy. Growth or neurodevelopmental outcome did not differ between the NEC survivors with and without surgery. Conclusion Necrotizing enterocolitis has affected neurodevelopmental outcome but not growth in VLBW infants at 18–24 months of corrected age. Both those treated medically or requiring surgery need close neurodevelopmental follow-up for the first years of life. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3051-4Authors Dilek Dilli, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyZeynep Eras, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyHülya Özkan Ulu, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyUğur Dilmen, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyEvrim Durgut Şakrucu, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Therapeutic outcome and prognosis in young patients with papillary and follicular thyroid cancer
Tue, 24 Jan 2012 12:27:15 -0000
Abstract Background Papillary and follicular thyroid cancer is a common malignancy in young patients, and the incidence of this cancer has been increasing. The aims of this study are to assess the clinical characteristics of papillary and follicular thyroid cancer in young patients and evaluate the long-term therapeutic outcomes and prognostic factors for cancer mortality and recurrence. Methods We performed a retrospective analysis of 116 patients aged ≤20 years who underwent thyroidectomy and a mean follow-up of 11.1 ± 0.6 years. Results There were 28 (24.1%) patients classified into the residual cancer or relapse groups. The progression-free survival rate for the young patients was lower than that of the patients between 20 and 45 years of age; however, the difference between the thyroid cancer survival rates was not statistically different. Two of the 28 patients died of thyroid cancer. Thirteen patients who showed relapsed underwent 131I whole-body scan; 6 of the 13 patients were diagnosed with distant metastases to the lung and 1 was diagnosed with distant metastases to the bones. Among the young patients, the 5- and 10-year progression-free survival rates were 79.1 and 73.4%, respectively, and the corresponding cancer survival rates were 99.1, and 96.5%, respectively. Conclusion The progression-free survival in young patients with papillary and follicular thyroid cancer was lower than the patients of age 20–45 years; otherwise, cancer survival was higher than age group over or equal to 45 years. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3054-1Authors Chung-Huei Huang, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCTzu-Chieh Chao, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCChuen Hseuh, Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCKun-Ju Lin, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCTsung-Ying Ho, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCShu-Fu Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCJen-Der Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROC Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The use of Onyx for embolization of peripheral vascular malformations in pediatric patients
Tue, 24 Jan 2012 07:28:25 -0000
Abstract Purpose The management of congenital peripheral vascular malformations (VMs) can present a difficult therapeutic challenge. Endovascular transcatheter embolization of peripheral VMs is widely accepted as a first therapeutic option for many VMs. However, data describing the use of Onyx are limited in children with peripheral VMs. Our aim is to retrospectively evaluate the results of transcatheter arterial embolization with Onyx for peripheral VMs in children. Materials and methods We analyzed clinical and imaging records of 16 patients who underwent 25 embolization procedures by using Onyx for peripheral VMs. In eight cases, embolization procedures were performed once; in seven cases, twice; and in one case, thrice. Results Embolization was technically complete in 4 patients and incomplete in 12 patients. Clinically, complete success was achieved in nine patients, and partial success was achieved in six patients. In one patient, reflux to the anterior and posterior tibial arteries caused peripheral ischemia, and the patient was referred to undergo plastic surgery. There were no complications in the other 15 patients. Conclusion With future studies to better characterize the safety profile of this agent in peripheral vasculature, embolization with Onyx may become a valuable treatment option for peripheral VMs in pediatric patients. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00383-012-3052-3Authors Murat Cantasdemir, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeySerdar Solak, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyGokce Yalcin Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Kantarci, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFuruzan Numan, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
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A review of patch options in the repair of congenital diaphragm defects
Wed, 01 Feb 2012 17:10:05 -0000
Abstract Repair of congenital diaphragmatic hernia (CDH) continues to pose a dilemma for the pediatric surgeon. While the management of CDH has evolved from surgical urgency to delayed repair after medical optimization with substantial improvements in mortality, morbidity continues to perplex clinicians. Significant morbidity occurs with recurrence, re-recurrence and complications such as obstructions, principally with mesh repair. When primary closure is not possible, mesh repair is indicated. While there are several non-absorbable prosthetic, absorbable biosynthetic and composite mesh types available, the ideal mesh remains elusive. In this article, we reviewed the current materials, reported advantages, and animal and clinical studies of non-absorbable prosthetic, absorbable biosynthetic and composite mesh. However, adequate comparative data are lacking, leaving a wide void for future animal models and clinical studies. Content Type Journal ArticleCategory Review ArticlePages 1-7DOI 10.1007/s00383-012-3059-9Authors Alessandra C. Gasior, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USAShawn D. St. Peter, Department of Pediatric Surgery, The Children’s Mercy Hospital and Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Pediatric surgical site infection in the developing world: a Kenyan experience
Wed, 01 Feb 2012 17:10:04 -0000
Abstract Background The purpose of the current study was to determine the incidence of pediatric surgical site infections (SSIs) at an academic children’s hospital in rural sub-Saharan Africa and to identify potentially modifiable risk factors. Methods Prospectively collected data from 1,008 surgical admissions to BethanyKids Kijabe Hospital (Kijabe, Kenya) were analyzed retrospectively. Follow-up data were available in 940 subjects. Results SSIs occurred in 6.8% of included subjects (N = 64). Superficial (69%) and deep (29%) infections of the back (38%) and head (25%) were most common. When comparing children who developed SSI to those who did not, we found that wound contamination classification and duration of operation were the only variables with significant differences between groups. Conclusions Our rate of SSI among pediatric patients in sub-Saharan Africa is the lowest reported in the literature to date. More work is needed to identify modifiable risk factors for pediatric SSI in low- and middle-income countries. Content Type Journal ArticleCategory Original ArticlePages 1-5DOI 10.1007/s00383-012-3058-xAuthors James H. Wood, Department of Surgery, University of Colorado Denver School of Medicine, 12631 East 17th Avenue, Box C302, Aurora, CO 80045, USAPeter M. Nthumba, BethanyKids at Kijabe Hospital, Kijabe, KenyaEdita Stepita-Poenaru, BethanyKids at Kijabe Hospital, Kijabe, KenyaDan Poenaru, BethanyKids at Kijabe Hospital, Kijabe, Kenya Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Single trocar retroperitoneoscopic nephrectomy for unilateral multicystic dysplastic kidney in children
Tue, 31 Jan 2012 07:05:59 -0000
Abstract The author presents the first report in performing single trocar nephrectomy for five patients with multicystic dysplastic kidney (MCDK). The mean operative time was 66 min and mean postoperative hospital stay was 36 h. There were no perioperative complications. The one-trocar nephrectomy is a feasible and safe procedure for patients with MCDK. Content Type Journal ArticleCategory Technical InnovationPages 1-3DOI 10.1007/s00383-012-3056-zAuthors N. T. Liem, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamL. A. Dung, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, VietnamN. D. Viet, Department of Surgery, National Hospital of Pediatrics, 18/879 La Thanh Road, Dong Da District, Hanoi, Vietnam Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Does necrotizing enterocolitis affect growth and neurodevelopmental outcome in very low birth weight infants?
Tue, 24 Jan 2012 12:27:17 -0000
Abstract Aim To evaluate the effect of necrotizing enterocolitis (NEC) on growth and neurodevelopmental outcome. Patients and methods Neurodevelopmental outcome of 20 of 39 surviving very low birthweight infants (VLBW) diagnosed with NEC between 2007 and 2009 was compared with 40 control infants matched for gestational age and year of admission. Follow-up studies were performed at 18 and 24 months of corrected age. Bayley Scales of Infant Development-Second Edition scale was used for neurodevelopmental assessment. Results At 18–24 months corrected age, body weight, body length, and head circumference did not differ significantly between the NEC and without NEC groups. The median mental developmental index (62 vs. 75, p = 0.008) and psychomotor developmental index points (72 vs. 91.5, p = 0.002) were lower in infants with NEC compared to without NEC, respectively. Although the rate of neurodevelopmental impairment was slightly higher in infants with NEC, there were no differences between the groups according to the frequency of minimal impairment and cerebral palsy. Growth or neurodevelopmental outcome did not differ between the NEC survivors with and without surgery. Conclusion Necrotizing enterocolitis has affected neurodevelopmental outcome but not growth in VLBW infants at 18–24 months of corrected age. Both those treated medically or requiring surgery need close neurodevelopmental follow-up for the first years of life. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3051-4Authors Dilek Dilli, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyZeynep Eras, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyHülya Özkan Ulu, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyUğur Dilmen, Department of Neonatology, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, TurkeyEvrim Durgut Şakrucu, Department of Developmental Pediatrics, Zekai Tahir Burak Maternity and Teaching Hospital, Ankara, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Therapeutic outcome and prognosis in young patients with papillary and follicular thyroid cancer
Tue, 24 Jan 2012 12:27:15 -0000
Abstract Background Papillary and follicular thyroid cancer is a common malignancy in young patients, and the incidence of this cancer has been increasing. The aims of this study are to assess the clinical characteristics of papillary and follicular thyroid cancer in young patients and evaluate the long-term therapeutic outcomes and prognostic factors for cancer mortality and recurrence. Methods We performed a retrospective analysis of 116 patients aged ≤20 years who underwent thyroidectomy and a mean follow-up of 11.1 ± 0.6 years. Results There were 28 (24.1%) patients classified into the residual cancer or relapse groups. The progression-free survival rate for the young patients was lower than that of the patients between 20 and 45 years of age; however, the difference between the thyroid cancer survival rates was not statistically different. Two of the 28 patients died of thyroid cancer. Thirteen patients who showed relapsed underwent 131I whole-body scan; 6 of the 13 patients were diagnosed with distant metastases to the lung and 1 was diagnosed with distant metastases to the bones. Among the young patients, the 5- and 10-year progression-free survival rates were 79.1 and 73.4%, respectively, and the corresponding cancer survival rates were 99.1, and 96.5%, respectively. Conclusion The progression-free survival in young patients with papillary and follicular thyroid cancer was lower than the patients of age 20–45 years; otherwise, cancer survival was higher than age group over or equal to 45 years. Content Type Journal ArticleCategory Original ArticlePages 1-6DOI 10.1007/s00383-012-3054-1Authors Chung-Huei Huang, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCTzu-Chieh Chao, Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCChuen Hseuh, Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCKun-Ju Lin, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCTsung-Ying Ho, Department of Nuclear Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan Hsien, Taiwan, ROCShu-Fu Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROCJen-Der Lin, Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROC Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
The use of Onyx for embolization of peripheral vascular malformations in pediatric patients
Tue, 24 Jan 2012 07:28:25 -0000
Abstract Purpose The management of congenital peripheral vascular malformations (VMs) can present a difficult therapeutic challenge. Endovascular transcatheter embolization of peripheral VMs is widely accepted as a first therapeutic option for many VMs. However, data describing the use of Onyx are limited in children with peripheral VMs. Our aim is to retrospectively evaluate the results of transcatheter arterial embolization with Onyx for peripheral VMs in children. Materials and methods We analyzed clinical and imaging records of 16 patients who underwent 25 embolization procedures by using Onyx for peripheral VMs. In eight cases, embolization procedures were performed once; in seven cases, twice; and in one case, thrice. Results Embolization was technically complete in 4 patients and incomplete in 12 patients. Clinically, complete success was achieved in nine patients, and partial success was achieved in six patients. In one patient, reflux to the anterior and posterior tibial arteries caused peripheral ischemia, and the patient was referred to undergo plastic surgery. There were no complications in the other 15 patients. Conclusion With future studies to better characterize the safety profile of this agent in peripheral vasculature, embolization with Onyx may become a valuable treatment option for peripheral VMs in pediatric patients. Content Type Journal ArticleCategory Original ArticlePages 1-11DOI 10.1007/s00383-012-3052-3Authors Murat Cantasdemir, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeySerdar Solak, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyGokce Yalcin Gulsen, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFatih Kantarci, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, TurkeyFuruzan Numan, Department of Interventional Radiology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey Journal Pediatric Surgery InternationalOnline ISSN 1437-9813Print ISSN 0179-0358
Sites:
Center for Fetal Diagnosis and Treatment: Division of The Children's Hospital of Philadelphia specializes in open and fetoscopic surgery. Features news, case studies, parent resources, publications, and research.Children's Surgery, Ltd: Practice of Dr. Walton K.T. Shim. Information on specific conditions including hernias, pectus excavatum, and Hirschsprung's disease. [Hawaii]
Craniofacial Group Paris France: Craniofacial Group Paris-France: Management of anomalies of skull and face: craniostenosis, craniosynostosis, facial clefts, hypertelorism, Crouzon, Apert, tumors and trauma
Pediatric Neurosurgery of South Texas: Pediatric neurosurgery - brain surgery
Riley Hospital for Children: Cardiovascular Surgery: Specializes in pediatric cardiothoracic surgery and treatment of congenital heart defects, including valve repairs and complete heart transplantation. Site includes complete profile and credentials of current practicing surgeons.
Rocky Mountain Pediatric Surgery: Rocky Mountain Pediatric Surgery provides pediatric surgery for sick children as well as minimally invasive surgery. Rocky Mountain Pediatric Surgery is located in Denver, Colorado and serves the Denver metro area.
Ronald Lewis M.D.: Provides information about pediatric and adolescent orthopaedic surgery, including scoliosis, developmental dysplasia of the hip, fractures, tumors, and sports injuries. [New York]
Texas Pediatric Surgical Associates: Surgical group at the University of Texas Medical School at Houston, with specialists in pediatric general surgery, urology, ENT (otolayngology), plastic surgery, and neurosurgery. Site has many patient education files on pediatric surgical conditions for families and physicians.
Yale University Pediatric Surgery: Offers full range of general and specialized pediatric surgical services, as well as support to parents of chronically ill children. Affiliated with Yale-New Haven's Children's Hospital.
This directory is based on the Open Directory and may have been modified