PEDIATRICS

In this very sensitive and emotional medical field, French medical teams excel. 

Taking care of children means specific protocols, closer attention - as some pathologies differ from adults (in the case of cancers – for example). Child patients are highly reactive to heavy treatments and less able to cope with them, needing more attentive and kinder psychological support throughout the care process.

In this field, Necker-Enfants Malades (Children’s Hospital) plays a fundamental role.

Necker-Enfants Malades Hospital, founded in 1778, the first dedicated children's hospital of its kind in the world, maintains its pioneering role, thanks to regular world premieres in leading-edge medicine. 

For example, in transplants and the complex surgery field, the most recent premiere is the first complete autologous tracheal reconstruction in a child - from its own tissues - performed in May 2018.  

Out of the 3,065 French hospitals and clinics, 597 have dedicated teams and specific infastructures to welcome children, young adults and their parents – in the case of a long stay - of which 132 deal with pediatric leukemia.

Among these, C3Medical is proud to closely work with Necker-Enfants Malades Hospital in Paris, in delicate surgery fields related to brain and ENT cancers, complex digestive cancers and cardiology diseases. 
 

Necker Hospital

History


At the beginning of the 18th century, the vicar of the Saint-Sulpice church transformed an old boarding school into a small parish hospital: the hospital of the Jesus Child. In 1751, it became a Royal Foundation. The French Revolution made it the National Orphan House.

Then, in 1778, Suzanne Necker, the wife of the Finance Minister of Louis XVI, created a hospital located next door, in Sevres street, devoted to medicine and surgery for adults. She wanted it to be an exemplary hospital where each patient had an individual bed. In this hospital, René Laennec invented the stethoscope in 1816.

In 1802, the Hospital General Council decided to gather the orphans in a children’s home, called the Found Children, in the Saint-Antoine suburbs. The former Orphan House then became the place of care for all the sick children under 15 years of age, who were previously hospitalized in the adult hospitals Hotel Dieu, La Charité, Necker, Cochin and Beaujon. 

These 250 beds hospital was named Hôpital des Enfants Malades (Hospital of the Sick Children). It was the first pediatric hospital created in the world.

Today

Necker-Enfants Malades hospital is the heir to this double history: beside its services devoted to children medicine and surgery, it has a young adults’ department of more than 200 beds. 

Taking advantage of its unique origins, its medical teams have developed a world class medical service, supported by an exceptional synergy between technical expertise, the research units and the clinical units.

At a major referral center for rare diseases and for complex pathologies, the hospital Necker-Enfants Malades provides services well beyond Paris and its area: more than 20% of the patients come from other provinces in France or from aboard.

Facts and figures

•    Care (per annum)

– 310,000 Consultations 
– 74,000 Emergencies
– 62,000 Hospitalizations
– 2,400 Baby Deliveries
– 240 Organ transplants 
– 100,000 Imaging analysis and 140 million Laboratory analysis

•    9 Departments

– Specialized Pediatrics
– Pediatric Surgery
– Obstetrics and Pediatric Cardiology
– Intensive care, Emergencies, Anesthesiology
– Hematology, Immunology, Infectiology
– Uro-Nephrology, Ophtalmology
– Imaging
– Laboratory Medicine and Pharmacy
– Clinical Research, Informatics and Public Health
 

7 ORGANS TRANSPLANTED INTO A CHILD

In 2010, at the Necker-Enfants Malades Hospital of Paris, in the greatest discretion, a child received a transplant of seven organs, from the stomach to the colon, via the kidneys.  

Explanations with Pr. Christophe Chardot, Head of Pediatric and Transplant Surgery at Necker Hospital, one of the three surgeons who performed this multi-organ transplant 

It's an amazing operation, the last chance operation. In 2010, Erika, a German girl aged 5 at the time, receives the liver, the two kidneys, the stomach, the small intestine, the right colon and finally the duodeno-pancreas of the same donor. 

Since her birth, Erika has been living with Hirschsprung's disease, one of the most common malformations of the digestive tract, a condition that prevents the terminal part of the bowel from working well. In his case, it is the whole area of the stomach to the rectum that does not work. The nerves of the digestive wall being malformed, the digestive tract cannot contract normally to ensure the progression of food. Result: intestinal transit is not done, the girl cannot eat normally and all other organs are affected. The only solution is the transplant.

Twelve hours of surgical intervention

At the Necker Hospital, three surgeons are preparing for this multi-organ transplant in the operating room. 

Pr. Sabine Irtan, Pr. Yves Aigrain and Pr. Christophe Chardot will work for twelve hours. "We removed all the diseased organs in one bloc that we replaced with the graft in one bloc," says Professor Christophe Chardot. "The impression is strange because the abdomen is completely unoccupied, it is a situation that we do not meet very often in surgery". 

After the intervention, the girl is supported by a resuscitation team. It will take several weeks of complex care, involving hepatology, immunology radiology so she can go home. 

This transplant of several organs was not a world first, but it is the culmination of the intestinal transplant that began a few years ago by the intestine alone then by the intestine and the liver until arriving in the case of Erika, to all the digestive organs. The other difficulty was to find a graft of suitable size for the child, it can take several months or even years.

An almost normal life

Today, the little girl aged 8 and a half is fine. She has found an almost normal life, she goes to school, and no longer has a catheter. Thanks to her new intestine, she is cured of Hirschprung's disease.

Erika eats almost normally, at night only she receives a supplement of food thanks to a gastrostomy, a small button which goes directly in the stomach. Nevertheless, explains Prof. Chardot, "this little girl will have anti-rejection treatment for life, but also a very close monitoring to check that her organs do not show rejection and that she does not develop complications of immuno-suppressive treatment especially infections or tumors ".
 

Source : “Allodocteurs.fr” – 08 April 2014

A French multidisciplinary team performed for the first time in the world a complete autologous tracheal reconstruction in a child (from its own tissues)

A French multidisciplinary team performed for the first time in the world a complete autologous tracheal reconstruction in a child (from its own tissues).

The team included Dr. Frédéric Kolb, plastic surgeon to Gustave Roussy, the team of Necker-Children's Hospital AP-HP University Descartes - Prs. Vincent Couloigner and Erea-Noël Garabedian, ENT and Dr. Régis Gaudin, cardiac surgeon - and Dr. Sacha Mussot, a thoracic surgeon at Marie Lannelongue Hospital.

This procedure conducted in 2014, allows the patient to breathe without tracheotomy and resume a normal life.

Management of tracheal stenosis in a child is complex, and patients with severe tracheal stenosis often require tracheal replacement. There is no ideal method to reproduce the biomechanical properties or mucosal function of the trachea.

Here, we report the findings from a 4-year follow-up in a child who had undergone an autologous complete tracheal replacement. Although another child underwent tracheal reconstruction 8 years ago,1,2 that child has required repeated insertions of endoluminal stents.

A 12-year-old girl with congenital long-segment tracheal stenosis required urgent complete tracheal replacement after all other available treatments had failed. A long-segment slide trachea-broncho-plasty to repair the trachea at 6 months of age and further multiple endoscopic and open procedures (e.g., insertion of multiple endotracheal stents, a rib-cartilage graft, and a pericardial patch) had failed to restore a stable functional windpipe.

Ultimately, granulation of both main bronchi because of a stent led to repeated life-threatening episodes of pneumonia, two cardiac resuscitations, and cachexia (weight of approximately 20 kg at 12 years of age). Since the patient had no option aside from palliative care, three surgical teams (head and neck, cardiothoracic, and plastic surgery) collaborated to attempt autologous complete tracheal replacement according to the techniques used in successful procedures that had been performed in adults. 
.
Autologous Complete Tracheal Replacement in the Patient.

The patient and her parents provided written informed consent. She received extracorporeal membrane oxygenation, and after a sternotomy was performed, a 12-cm tracheal segment was removed, with preservation of the first cartilage ring superiorly and the carina inferiorly (Figure 1A). Simultaneously, a new trachea was manufactured. It consisted of a myocutaneous latissimus dorsi free flap into which four chondrocartilage slings were inserted every 2 cm subdermally (Figure 1B and 1C). The flap was formed into tubular structures around a Y-shaped silicone tracheal prosthesis (Novatech) (Figure 1D). The tracheotomy was performed at the junction between the native trachea and the new trachea (Figure 1E and 1F).

The postoperative course was uneventful, and the silicone stent was removed at postoperative day 9. Daily aspiration of particulate matter from the tracheobronchial tree was necessary for 6 weeks to prevent bronchial plugging and pneumonia due to skin desquamation and lack of endoluminal clearance.

The patient was discharged from the intensive care unit on day 55, and she returned home on day 68. The tracheostomy was maintained for more than 2 years for safety reasons and to facilitate checkups. When closure of the tracheostomy was considered, tracheal stenosis at the junction between the flap and native trachea required removal of the first tracheal cartilage ring, including the stenotic portion, and a reanastomosis was performed.

A total of 44 months after the complete tracheal replacement and 13 months after closure of the tracheostomy (Figure 1G through 1J), the patient did not require a stent, immunosuppressive therapy, or a tracheotomy and engaged in the usual activities of a 15-year-old girl. She weighed 36 kg, and her height was approximately 150 cm; both of these values were below the third percentile for her age. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 16 (the eighth percentile). She required only physiotherapy.

Improvements concerning the lumen lining and the cartilage rings (graft rigidity) still have to be addressed in this technique. Until bioengineered organs1,2,4,5 can be manufactured for patients with tracheal stenosis, other pragmatic solutions such as autologous complete tracheal replacement are necessary.

Source: “New England Journal of Medicine /NEJM.org.”, published on April 05, 2018 and updated on May 17, 2018

Necker Hospital

History


At the beginning of the 18th century, the vicar of the Saint-Sulpice church transformed an old boarding school into a small parish hospital: the hospital of the Jesus Child. In 1751, it became a Royal Foundation. The French Revolution made it the National Orphan House.

Then, in 1778, Suzanne Necker, the wife of the Finance Minister of Louis XVI, created a hospital located next door, in Sevres street, devoted to medicine and surgery for adults. She wanted it to be an exemplary hospital where each patient had an individual bed. In this hospital, René Laennec invented the stethoscope in 1816.

In 1802, the Hospital General Council decided to gather the orphans in a children’s home, called the Found Children, in the Saint-Antoine suburbs. The former Orphan House then became the place of care for all the sick children under 15 years of age, who were previously hospitalized in the adult hospitals Hotel Dieu, La Charité, Necker, Cochin and Beaujon. 

These 250 beds hospital was named Hôpital des Enfants Malades (Hospital of the Sick Children). It was the first pediatric hospital created in the world.

Today

Necker-Enfants Malades hospital is the heir to this double history: beside its services devoted to children medicine and surgery, it has a young adults’ department of more than 200 beds. 

Taking advantage of its unique origins, its medical teams have developed a world class medical service, supported by an exceptional synergy between technical expertise, the research units and the clinical units.

At a major referral center for rare diseases and for complex pathologies, the hospital Necker-Enfants Malades provides services well beyond Paris and its area: more than 20% of the patients come from other provinces in France or from aboard.

Facts and figures

•    Care (per annum)

– 310,000 Consultations 
– 74,000 Emergencies
– 62,000 Hospitalizations
– 2,400 Baby Deliveries
– 240 Organ transplants 
– 100,000 Imaging analysis and 140 million Laboratory analysis

•    9 Departments

– Specialized Pediatrics
– Pediatric Surgery
– Obstetrics and Pediatric Cardiology
– Intensive care, Emergencies, Anesthesiology
– Hematology, Immunology, Infectiology
– Uro-Nephrology, Ophtalmology
– Imaging
– Laboratory Medicine and Pharmacy
– Clinical Research, Informatics and Public Health
 

7 ORGANS TRANSPLANTED INTO A CHILD

In 2010, at the Necker-Enfants Malades Hospital of Paris, in the greatest discretion, a child received a transplant of seven organs, from the stomach to the colon, via the kidneys.  

Explanations with Pr. Christophe Chardot, Head of Pediatric and Transplant Surgery at Necker Hospital, one of the three surgeons who performed this multi-organ transplant 

It's an amazing operation, the last chance operation. In 2010, Erika, a German girl aged 5 at the time, receives the liver, the two kidneys, the stomach, the small intestine, the right colon and finally the duodeno-pancreas of the same donor. 

Since her birth, Erika has been living with Hirschsprung's disease, one of the most common malformations of the digestive tract, a condition that prevents the terminal part of the bowel from working well. In his case, it is the whole area of the stomach to the rectum that does not work. The nerves of the digestive wall being malformed, the digestive tract cannot contract normally to ensure the progression of food. Result: intestinal transit is not done, the girl cannot eat normally and all other organs are affected. The only solution is the transplant.

Twelve hours of surgical intervention

At the Necker Hospital, three surgeons are preparing for this multi-organ transplant in the operating room. 

Pr. Sabine Irtan, Pr. Yves Aigrain and Pr. Christophe Chardot will work for twelve hours. "We removed all the diseased organs in one bloc that we replaced with the graft in one bloc," says Professor Christophe Chardot. "The impression is strange because the abdomen is completely unoccupied, it is a situation that we do not meet very often in surgery". 

After the intervention, the girl is supported by a resuscitation team. It will take several weeks of complex care, involving hepatology, immunology radiology so she can go home. 

This transplant of several organs was not a world first, but it is the culmination of the intestinal transplant that began a few years ago by the intestine alone then by the intestine and the liver until arriving in the case of Erika, to all the digestive organs. The other difficulty was to find a graft of suitable size for the child, it can take several months or even years.

An almost normal life

Today, the little girl aged 8 and a half is fine. She has found an almost normal life, she goes to school, and no longer has a catheter. Thanks to her new intestine, she is cured of Hirschprung's disease.

Erika eats almost normally, at night only she receives a supplement of food thanks to a gastrostomy, a small button which goes directly in the stomach. Nevertheless, explains Prof. Chardot, "this little girl will have anti-rejection treatment for life, but also a very close monitoring to check that her organs do not show rejection and that she does not develop complications of immuno-suppressive treatment especially infections or tumors ".
 

Source : “Allodocteurs.fr” – 08 April 2014

A French multidisciplinary team performed for the first time in the world a complete autologous tracheal reconstruction in a child (from its own tissues)

A French multidisciplinary team performed for the first time in the world a complete autologous tracheal reconstruction in a child (from its own tissues).

The team included Dr. Frédéric Kolb, plastic surgeon to Gustave Roussy, the team of Necker-Children's Hospital AP-HP University Descartes - Prs. Vincent Couloigner and Erea-Noël Garabedian, ENT and Dr. Régis Gaudin, cardiac surgeon - and Dr. Sacha Mussot, a thoracic surgeon at Marie Lannelongue Hospital.

This procedure conducted in 2014, allows the patient to breathe without tracheotomy and resume a normal life.

Management of tracheal stenosis in a child is complex, and patients with severe tracheal stenosis often require tracheal replacement. There is no ideal method to reproduce the biomechanical properties or mucosal function of the trachea.

Here, we report the findings from a 4-year follow-up in a child who had undergone an autologous complete tracheal replacement. Although another child underwent tracheal reconstruction 8 years ago,1,2 that child has required repeated insertions of endoluminal stents.

A 12-year-old girl with congenital long-segment tracheal stenosis required urgent complete tracheal replacement after all other available treatments had failed. A long-segment slide trachea-broncho-plasty to repair the trachea at 6 months of age and further multiple endoscopic and open procedures (e.g., insertion of multiple endotracheal stents, a rib-cartilage graft, and a pericardial patch) had failed to restore a stable functional windpipe.

Ultimately, granulation of both main bronchi because of a stent led to repeated life-threatening episodes of pneumonia, two cardiac resuscitations, and cachexia (weight of approximately 20 kg at 12 years of age). Since the patient had no option aside from palliative care, three surgical teams (head and neck, cardiothoracic, and plastic surgery) collaborated to attempt autologous complete tracheal replacement according to the techniques used in successful procedures that had been performed in adults. 
.
Autologous Complete Tracheal Replacement in the Patient.

The patient and her parents provided written informed consent. She received extracorporeal membrane oxygenation, and after a sternotomy was performed, a 12-cm tracheal segment was removed, with preservation of the first cartilage ring superiorly and the carina inferiorly (Figure 1A). Simultaneously, a new trachea was manufactured. It consisted of a myocutaneous latissimus dorsi free flap into which four chondrocartilage slings were inserted every 2 cm subdermally (Figure 1B and 1C). The flap was formed into tubular structures around a Y-shaped silicone tracheal prosthesis (Novatech) (Figure 1D). The tracheotomy was performed at the junction between the native trachea and the new trachea (Figure 1E and 1F).

The postoperative course was uneventful, and the silicone stent was removed at postoperative day 9. Daily aspiration of particulate matter from the tracheobronchial tree was necessary for 6 weeks to prevent bronchial plugging and pneumonia due to skin desquamation and lack of endoluminal clearance.

The patient was discharged from the intensive care unit on day 55, and she returned home on day 68. The tracheostomy was maintained for more than 2 years for safety reasons and to facilitate checkups. When closure of the tracheostomy was considered, tracheal stenosis at the junction between the flap and native trachea required removal of the first tracheal cartilage ring, including the stenotic portion, and a reanastomosis was performed.

A total of 44 months after the complete tracheal replacement and 13 months after closure of the tracheostomy (Figure 1G through 1J), the patient did not require a stent, immunosuppressive therapy, or a tracheotomy and engaged in the usual activities of a 15-year-old girl. She weighed 36 kg, and her height was approximately 150 cm; both of these values were below the third percentile for her age. Her body-mass index (the weight in kilograms divided by the square of the height in meters) was 16 (the eighth percentile). She required only physiotherapy.

Improvements concerning the lumen lining and the cartilage rings (graft rigidity) still have to be addressed in this technique. Until bioengineered organs1,2,4,5 can be manufactured for patients with tracheal stenosis, other pragmatic solutions such as autologous complete tracheal replacement are necessary.

Source: “New England Journal of Medicine /NEJM.org.”, published on April 05, 2018 and updated on May 17, 2018