Enhanced Recovery After Surgery (ERAS) protocols have been successfully implemented in adult surgical practice, demonstrating reductions in postoperative complications, the length of hospital stay, and healthcare costs. In pediatric surgery, however, the adoption of ERAS principles has progressed more slowly due to age-related physiological variability, the heterogeneity of surgical procedures, and the limited availability of high-quality evidence in certain pediatric populations. This narrative review aims to summarize and critically evaluate the current evidence on the implementation of ERAS protocols in pediatric surgery, with a focus on core principles, clinical outcomes, implementation challenges, and future directions. A narrative review of the literature was conducted using PubMed and Scopus databases. Articles published between 2010 and 2025 were identified using keywords related to enhanced recovery, pediatric surgery, and perioperative care. Original studies, reviews, and clinical guidelines involving pediatric surgical patients were included, while studies exclusively involving adult populations, editorials, and conference abstracts without full text were excluded. Available evidence suggests that the implementation of ERAS protocols in pediatric surgery is associated with shorter hospital stays, improved postoperative pain control, the earlier resumption of oral intake and mobilization, and high levels of patient and family satisfaction, without an increase in postoperative complications. Most of the published evidence originates from pediatric colorectal, abdominal, and urologic surgeries. However, challenges remain regarding protocol standardization, multidisciplinary team adherence, and the adaptation of ERAS pathways to different age groups, particularly neonates and infants. ERAS protocols represent a promising strategy for optimizing perioperative care in pediatric surgery. Although current evidence supports their safety and effectiveness in selected procedures, further prospective and multicenter studies are needed to develop age-specific protocols and expand ERAS implementation across pediatric surgical subspecialties.
Background The “suicidal left ventricle” (LV) is a rare but potentially fatal complication after transcatheter aortic valve replacement (TAVR), caused by dynamic LV outflow tract obstruction following abrupt afterload reduction. Case Summary A 77-year-old woman with severe symptomatic aortic stenosis underwent successful TAVR. Shortly after the procedure, she developed hypotension, hypoperfusion, and cardiogenic shock. Initial management with fluids and vasopressors provided transient improvement; however, inotropic support worsened her condition. Urgent transthoracic echocardiography revealed a small, hyperdynamic LV with a dagger-shaped dynamic intraventricular gradient, without prosthetic dysfunction. A diagnosis of suicidal LV was established. Inotropes were discontinued, and treatment with volume expansion, vasopressors, and beta-blockers led to rapid hemodynamic recovery. Discussion This case highlights the importance of early recognition of dynamic obstruction after TAVR and the need for targeted hemodynamic management, which differs from the conventional cardiogenic shock treatment. Take-Home Message Early echocardiographic diagnosis and avoidance of inotropes are critical to reverse this potentially reversible cause of cardiogenic shock after TAVR.
Triple-negative breast cancer (TNBC) is characterized by aggressive behaviour, high tumor heterogeneity, and an increased likelihood of recurrence and early metastasis. These factors hinder successful treatment. Genetic diagnosis enables personalized clinical recommendations and treatment options. The objective of this study was to validate whole-exome sequencing (WES) and variant prioritization in cancer susceptibility genes (CSG) associated with hereditary cancer (HC) predisposition in TNBC patients (n = 24). We present the development of a reproducible bioinformatic pipeline and its technical validation in a validation cohort (n = 25). This cohort comprised individuals with diverse primary tumors who had a previously confirmed molecular diagnosis of a hereditary cancer syndrome, serving as gold-standard cases to assess the pipeline's analytical accuracy. We consolidated a comprehensive panel of cancer genes and determined all variants in the TNBC discovery cohort (12.5% of patients), identifying three pathogenic germline variants (gPV) in ATM, RAD51D, and BRCA1. These genes are involved in the molecular pathway of DNA repair by homologous recombination (HRD). Our results demonstrate that the developed bioinformatic pipeline provides reliable genetic diagnosis of cancer predisposition syndromes from exome data, applicable not only to TNBC patients but also to individuals with any cancer suspected of having a hereditary component.
Highlights • Sensibilización: cuando la vida y la muerte confluyen, el cuidado de enfermería se convierte en el acto más humano. • Situaciones a la que la familia se expone frente a un suceso de necesidad de cuidado paliativo perinatal. • Sensaciones y sentimientos a los cuales se enfrentan los padres en situación pre, trans y post al cuidado perinatal. • Teorías de enfermería que se alinean al cuidado de enfermería en la atención del cuidado paliativo perinatal. En la actualidad, cuando se habla de embarazo, parto, nacimiento o la llegada de un nuevo miembro a la familia, a menudo se asocia con sentimientos de alegría y vida. Sin embargo, en el ámbito del cuidado materno y neonatal, muchos fetos y recién nacidos enfrentan el riesgo de morir en días, meses o años posteriores1. En este sentido, teniendo en cuenta lo mencionado, según la metasíntesis realizada por Kuforiji et al.2 en el Reino Unido, uno de los principales problemas que surgen como consecuencia de una muerte perinatal, desde la perspectiva de las mujeres que lo han vivido, es la falta de comprensión y apoyo por parte de los profesionales de la salud y la comunidad. Esto se debe a que, en muchas ocasiones, las mujeres se sienten culpables y experimentan emociones negativas, las cuales pueden ser exacerbadas por la falta de explicaciones médicas adecuadas sobre la causa de la muerte perinatal. Además, las respuestas negativas de la familia y la comunidad, basadas en creencias culturales, también contribuyen a esta falta de apoyo. De situaciones o escenarios como estos, Cacciatore y Thieleman3, exponen que la muerte de un recién nacido representa una compleja serie de cambios hormonales en la madre, instaurándose de dicho modo una intrincada experiencia emocional, fisiológica y espiritual que desencadena sentimientos de dolor y vergüenza; no obstante, en la mayoría de los casos, esta tragedia es pasada por alto y no se presta la atención necesaria de uno o varios actores relacionado a dicho acontecimiento, sea minimizando la vida del neonato o los sentimientos de los padres. Esta serie de sucesos, desencadenan un proceso de duelo que puede verse interrumpido o alterado por los factores ya expuestos, que de continuar sin atención dan lugar a heridas emocionales de gran alcance. Como citar este artículo: Palomino-Alzate Damaris Angélica, Basto-Rueda Jhon Edinson, Martínez-Torres Kenia Yoelis, Sánchez-Rodríguez Javier Mauricio, Sarmiento-Velasco German Andrey. Cuidado Paliativo Perinatal: Retos y Prioridades en la Atención Integral de Enfermería. Revista Cuidarte. 2026;17(1):e5415. https://doi.org/10.15649/cuidarte.5415
