搜索结果：Journal of pediatric surgery

The standard surgical approach to the treatment of pediatric VUR is ureteral reimplantation. Although open surgery is still the standard benchmark for its long-term durability and high success rate, the development of minimally invasive techniques led to the creation of laparoscopic ureteral reimplantation. The high learning curve and technical difficulty needed for accurate intracorporeal suturing, however, have limited its widely adopted in clinical practice. Robotic platforms have since emerged as a promising alternative, offering enhanced dexterity and improved visualization, which facilitate complex suturing and achieve success rates comparable to open surgery. However, most available meta-analytical data are limited by high degrees of heterogeneity because previous studies have often combined laparoscopic and robotic procedures and have combined intravesical and extravesical reimplantation. This is a very general classification that can introduce systematic bias and mask underlying differences between modalities. Through this direct comparison of these two specific surgical approaches, the goal of this study is to isolate these variables to provide highly granular, clinically relevant evidence to inform surgical selection for modern practice. We conducted a comprehensive literature search across PubMed, Embase, Web of Science, and the Cochrane Library to identify clinical studies that directly compared the efficacy of RAUR via the extravesical approach with OUR for the treatment of VUR in pediatric patients. For the OUR group, no restriction was placed on the surgical approach, and both extravesical and intravesical techniques were included. The operative time, hospital stay, success rates, and postoperative complications such as urinary tract infection, urinary retention, and other complications were extracted for comparative analysis. A total of 473 patients from seven studies were analyzed. The results of the meta-analysis showed that there was no significant difference between the two groups in terms of total complications, but the RAUR group had significantly longer operative time (WMD&#x2009;=&#x2009;48.1 min, 95% CI [27.43, 68.76], p&#x2009;<&#x2009;0.05) and significantly shorter length of hospitalization (WMD = -0.54 days, 95% CI [-0.96, -0.13], p&#x2009;<&#x2009;0.05) when compared with the OUR group. When assessing surgical success rate, postoperative urinary tract infection, postoperative urinary retention, or overall complications, no significant differences were recorded between the two groups. In summary, these preliminary findings indicate that RAUR is associated with significantly longer operative time, which should be interpreted in the context of the learning curve. Although RAUR showed a statistically shorter hospital stay, the clinical benefit may be limited as most patients were discharged after overnight observation. Success and complication rates, including urinary tract infection and retention, were comparable to OUR, supporting the safety and efficacy of the robotic platform. Given equivalent key outcomes and expected experience accumulation, RAUR may be a viable alternative to OUR. However, owing to inherent confounding factors such as study design and surgical approach variations, these conclusions require further validation through high-quality multicenter randomized controlled trials.

To evaluate and compare the clinical accuracy, reliability, comprehensiveness and readability of three prominent Large Language Models (LLMs) (ChatGPT, Gemini, and Copilot) in the management of pediatric ureteropelvic junction obstruction. A total of 125 unique clinical scenarios representing various stages and complexities of pediatric ureteropelvic junction obstruction(UPJO) were developed. Responses from ChatGPT (GPT-5.3 version, OpenAI), Gemini(Google), and Copilot GPT 5 (Microsoft) were independently evaluated by two expert pediatric urologists across four domains: Clinical Accuracy, Completeness, Reliability, and Readability (scored 1-5). Initial inter-rater discrepancies were resolved through a consensus-building process. Statistical analysis included Kruskal-Wallis tests for performance comparison and weighted Cohen's kappa for inter-rater agreement. ChatGPT demonstrated significantly higher scores in clinical accuracy (4.13 +/- 1.31) and reliability (4.08 +/- 1.30) compared to its counterparts, showing the closest alignment with international guidelines. Conversely, Copilot achieved the highest readability score (4.13 +/- 0.65) but exhibited a "readability-accuracy paradox," where professional formatting masked frequent clinical inaccuracies (3.49 +/- 1.67). Gemini provided comprehensive content but was hindered by structural deficits and the lowest readability score (2.88&#x2009;&#xb1;&#x2009;0.83). The expert consensus process successfully improved inter-rater agreement (&#x3ba;&#x2009;=&#x2009;0.532) to (&#x3ba;&#x2009;=&#x2009;0.586). While LLMs show promise as decision-support tools in pediatric surgery, their performance is inconsistent. ChatGPT is currently the most robust model for guideline-based management of UPJO. However, the "deceptive confidence" of models like Copilot poses a risk of misinformation. Future integration should explore multimodal capabilities, including the analysis of imaging and ongoing validation against standardized reporting frameworks.

Pediatric vascular surgical problems are rare and variable in presentation, thus making them challenging to characterize and treat. The diversity of patient conditions and size combined with variability in pediatric vascular surgical training leads to an ad hoc approach to these patients. With few published guidelines as well as a lack of robust research to support evidence-based assertions, pediatric vascular practices have been largely driven by anecdotal evidence and limited retrospective single-institution reviews. Collaborative data collection in vascular surgery is necessary to generate more robust data, improve understanding of nuances in pediatric vascular surgery, and establish standardized practices in the pediatric patient population. The aim of this review is to assess multicenter surgical registries and identify opportunities for similar entities in pediatric vascular surgery. LEVEL OF EVIDENCE: n/a.

We previously created an e-health platform of perioperative education for families of children undergoing gastrostomy (GT) placement. We aimed to assess the impact of implementation of the e-health platform on readiness for surgery and patient outcomes. All families of patients who underwent GT placement at a single children's hospital between 1/25 and 7/25 were eligible to participate. Families were invited to create an account with our e-health platform and access the education. Surveys assessing readiness for surgery were administered. Patient outcomes were assessed via retrospective review of the medical record. Comparisons were made between a historic cohort of GT patients (9/22-5/23) and those who underwent GT placement during the study (1/25-7/25) using t-tests, chi-squared, and Fisher's exact tests. Poisson hurdle models were used to compare number of calls to clinic within 8 weeks between cohorts and across demographics and clinical characteristics. During the study period, 207 patients underwent GT placement; 69 families created e-health accounts. Twenty-four completed the initial survey (46%) and 14 (27%) completed the second survey prior to the follow up clinic visit. In the first survey, 100% of e-health users understood why their child needed a GT, where the GT was placed, and reported their questions and concerns had been sufficiently addressed. Three families (12%) reported they did not know what to expect after surgery; two families (8%) reported they needed more information about caring for their child's GT. In the second survey, 100% reported watching the GT videos was helpful, they felt comfortable exchanging the GT with supervision, and they know where to go to find information about GT exchange. Thirteen of 14 families (93%) reported they felt comfortable exchanging their child's GT on their own. Most families reported using the website was useful for their child's health, it improved access to healthcare services, helped them care for the GT, and they would recommend it to a friend. When comparing clinical outcomes between cohorts, groups did not differ with regard to age, sex, race, or ethnicity. The study cohort had a lower rate of phone calls to the clinic nurses, readmissions, and tube dislodgements and a higher rate of granulation tissue episodes. Implementation of an e-health platform of perioperative education is associated with adequate preparation for surgery by families as well as decreased utilization of hospital resources including clinic phone calls, ED visits, and tube dislodgements.

This study aims to evaluate the mid-term clinical and functional outcomes of juxta-epiphyseal fractures of the proximal phalanx in pediatric patients. Between July 2013 and December 2023, a total of 23 pediatric patients treated for juxta-epiphyseal fractures of the proximal phalanx were retrospectively analyzed. Functional outcomes were assessed using four subtests of the Jebsen-Taylor Hand Function Test. To compare the Jebsen-Taylor Hand Function Test, a control group of healthy children (n = 23) from the outpatient clinic was formed. Patients were treated either with closed reduction and splinting or with closed reduction followed by Kirschner wire (K-wire) fixation according to fracture displacement and stability. Radiographs were evaluated for residual deformity and malunion using Campbell's lines. Of a total of 23 patients, 13 were male and 10 were female with a mean age of 7.24 &#xb1; 2.21 (range, 6 to 13) years. The fifth digit was the most commonly affected (n = 14), followed by the fourth (n = 5), middle (n = 2), and thumb (n = 2). In 15 patients, the injury occurred on the non-dominant hand. No malunions were detected. One patient demonstrated a pseudo-claw deformity. Hand function tests revealed statistically significant delays in patients with dominant-hand injuries compared to healthy controls (p < 0.05). Seven patients reported a change in hand dominance after injury. Our study results suggest that appropriate reduction techniques, including closed or K-wire-assisted fixation, offer favorable outcomes with minimal complications. However, functional impairment can be more notable, when the dominant hand is involved. Taken together, these findings emphasize the need for early intervention, close follow-up, and consideration of hand dominance during recovery planning.

Workforce shortages and geography may limit access to pediatric surgical care. Locum tenens (LT) surgeons help fill staffing gaps, yet their role in pediatric surgery remains poorly defined. This study evaluates the prevalence, practice settings, and clinical coverage of LT pediatric surgeons to inform workforce planning and access strategies. The American Pediatric Surgical Association (APSA) membership list was used to identify United States pediatric surgery practices. Each practice was contacted to obtain data on surgeon composition, use of LT, advanced practice providers (APPs) composition, and the number of hospitals, clinics, consultation sites, and operating rooms covered as of July 31, 2025. Service locations were geocoded by zip code. Values are expressed as median and interquartile range [IQR]. Comparisons between practices using and not using LT were done by Mann-Whitney U tests, with p < 0.05 considered significant. Of 248 practices, 59 (23.8%) reported using LT. LT practices are in 29 of 50 states and the District of Columbia (56.9%), most commonly in Florida (n = 6), Texas (n = 5), New Jersey, and Pennsylvania (n = 4 each). LT surgeons cover a median of 1 [1-1] hospital. Compared with non-LT (NLT) practices, groups using LT were significantly smaller (median 2 [2-3] vs. 4 [3-6.5] surgeons, p < 0.001) and less likely to host a fellowship (8.5% vs. 24.9%, p = 0.006). They covered fewer hospitals, clinics, consultation sites, and operating sites (all p < 0.01). APP employment and practices that cross state lines were similar between groups. Maintaining LT-supported practices substantially improves access, reducing median travel distances by almost half (from 48.6 to 29.2 miles across state lines and from 51.5 to 31.3 miles within state lines). The proportion of children living >60 miles from surgical care dropped from 19.9% to 6.7%, reducing the number affected from &#x223c;14.5 million to about 5 million. LT surgeons play a critical role in pediatric surgery, expanding access and reducing travel distances for children, particularly in smaller, non-fellowship practices. While LT reliance helps fill gaps, it also highlights potential workforce vulnerabilities. Understanding LT utilization is essential for planning a resilient pediatric surgical workforce and ensuring equitable care nationwide.

Congenital adrenal hyperplasia (CAH) is a chronic endocrine disorder requiring lifelong management that may significantly impact health-related quality of life (HRQoL) in pediatric patients. Despite growing recognition of psychosocial outcomes in CAH, data from diverse populations remain limited. This cross-sectional study evaluated HRQoL in 40 children and adolescents with CAH (aged 2-18&#xa0;years) followed at our pediatric endocrinology clinic, compared with 82 healthy controls. The Pediatric Quality of Life Inventory (PedsQL) was administered to assess physical, emotional, social, and school functioning domains. Clinical data including 17-hydroxyprogesterone (17-OHP), adrenocorticotropic hormone (ACTH), androstenedione levels, bone age, treatment regimens, and surgical history were collected. Statistical analyses included Mann-Whitney U test, chi-square test, and Spearman correlation. The mean age of patients with CAH was 11.85&#x2009;&#xb1;&#x2009;4.3&#xa0;years. Based on child self-reports, total HRQoL scores were significantly lower in the CAH group compared with controls (81.69&#x2009;&#xb1;&#x2009;11.6 vs. 87.95&#x2009;&#xb1;&#x2009;6.0, p&#x2009;=&#x2009;0.007). Emotional functioning (p&#x2009;=&#x2009;0.001), social functioning (p&#x2009;=&#x2009;0.039), school functioning (p&#x2009;=&#x2009;0.048), and psychosocial health scores (p&#x2009;=&#x2009;0.002) were also significantly lower in patients, whereas physical functioning scores were comparable between groups (p&#x2009;=&#x2009;0.117). Parent proxy-reports similarly demonstrated significantly lower total HRQoL (p&#x2009;=&#x2009;0.001), social functioning (p&#x2009;<&#x2009;0.001), school functioning (p&#x2009;=&#x2009;0.010), and psychosocial health scores (p&#x2009;=&#x2009;0.001) in the CAH group. No significant differences were observed between child and parent assessments. Disease duration showed positive correlations with child-reported physical functioning (r&#x2009;=&#x2009;0.402, p&#x2009;=&#x2009;0.012), emotional functioning (r&#x2009;=&#x2009;0.595, p&#x2009;<&#x2009;0.001), psychosocial health (r&#x2009;=&#x2009;0.394, p&#x2009;=&#x2009;0.014), and total HRQoL scores (r&#x2009;=&#x2009;0.393, p&#x2009;=&#x2009;0.015). No consistent associations were identified between HRQoL scores and glucocorticoid dose, BMI SDS, height SDS, biochemical control, or history of surgery. Children and adolescents with CAH experience substantial impairments in HRQoL across all functional domains, particularly in psychosocial functioning.These findings should be interpreted with caution given the relatively small sample size of this study. Nevertheless, they suggest.Nevertheless, they suggest the need for comprehensive, multidisciplinary care approaches that address not only biochemical control but also psychological and social well-being in pediatric CAH management. &#x2022; Congenital adrenal hyperplasia requires lifelong glucocorticoid therapy. Its potential to impair health-related quality of life in affected children is increasingly recognized. &#xa0; &#x2022; Children and adolescents with CAH had significantly lower HRQoL than healthy controls on both self- and parent proxy-reports, with impairment concentrated in the psychosocial (emotional, social, and school) domains rather than physical functioning. &#x2022; HRQoL scores were unrelated to glucocorticoid dose, biochemical control, anthropometry, or surgical history.

Kidney transplant is the preferred treatment for end-stage renal disease in children due to superior effects on survival, growth, and quality of life versus dialysis. However, childhood kidney transplant presents unique challenges for long-term social, academic, and professional integration as recipients transition into adulthood. We assessed the educational attainment, employment status, and marital outcomes of an adult cohort of childhood kidney transplant recipients. We retrospectively reviewed all pediatric kidney transplants at Ba&#x15f;kent University Hospital from January 2015 through December 2024. Eligibility was defined as a renal graft before the age of 18 years with subsequent follow-up into adulthood. Data were collected via a structured, voluntary questionnaire administered during telephone interviews, which captured academic qualifications, employment status, marital status, posttransplant caregiver arrangements, and demographic information of patients' parents, including education and employment. We included 98 patients (mean age, 25.98&#x202f;&#xb1;5.58 years; mean age at transplant, 14.12&#x202f;&#xb1;&#x202f;3.83 years), comprising 53 male (54.1%) and 45 female participants (45.9% ). Living-related donors were predominant. Regarding the recipients' parents, maternal education was predominantly low, and 82.7% of the maternal parents were homemakers. Paternal parents demonstrated higher employment rates (n = 47; 48.0% ) and more varied educational attainment. Educational attainment revealed that 48 patients (49.0% ) completed high school, 15 (15.3% ) attended university, and 9 (9.2% ) earned a bachelor-level degree. Employment status was reported by 47 recipients (47.9% ), with 48 (46.9% ) unemployed and 3 (3.1% ) employed part time. Seventeen participants (17.3% ) were married with at least 1 child. Pediatric kidney transplant recipients encounter substantial future challenges in social and professional integration as they progress through adulthood. Our cohort demonstrated moderate educational achievement and employment rates, and most were unmarried. Our findings emphasize the importance of long-term multidisciplinary support to promote successful transitions into adulthood, addressing not only medical needs but also social and occupational needs.

The incidence of invasive fungal infection (IFI) in pediatric liver transplant (LT) recipients in Korea has not been characterized; consequently, antifungal prophylaxis is not covered by the national health insurance. We aimed to determine the incidence and epidemiology of IFI. We conducted a single-center, retrospective study of children (age &#x2264;19 years) who underwent LT at Severance Children's Hospital, Republic of Korea (2012-2023). IFI was defined as fungal isolation from a sterile site (fluid/blood/tissue) with compatible clinical features. Of the 126 LT cases involving 115 children, 69.0% (n=87) were performed due to biliary atresia. Twenty-four IFI episodes in 20 recipients yielded a 90-day post-LT crude incidence of 19.0% and an incidence rate of 0.14 per 1000 patient-days. Invasive candidiasis predominated (95.4%) with Candida albicans (40.9%), C. parapsilosis (31.8%), and C. auris (9.1%). The most common clinical manifestations were peritonitis (54.2%) and fungemia (16.7%). Emergency LT [subdistribution hazard ratio (sHR), 3.97; 95% confidence interval (CI), 1.39-11.3; p=0.010] and reoperation or interventional procedures (sHR, 4.05; 95% CI, 1.53-10.7; p=0.005) were independently associated with IFI. One-year overall survival was significantly lower in the IFI group than in the non-IFI group (58.4% vs. 82.8%, p=0.037). IFIs impose a burden on pediatric LT recipients in Korea and are associated with poorer survival. These data support the consideration of universal antifungal prophylaxis. However, multicenter studies are warranted to validate these findings and define the prophylaxis regimen.

To evaluate the efficacy and safety of prostacyclin in the treatment of persistent pulmonary hypertension in congenital diaphragmatic hernia. A systematic literature search was conducted in four main databases (PubMed, Web of Science, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL). The protocol was registered in advance in the International Prospective of Systematic Reviews (CRD420261325458). A total of nine studies were included involving a total of 7,009 infants in this systematic review and meta-analysis. GRADE assessment revealed substantial heterogeneity in the quality of evidence across outcomes, with most outcomes rated very low quality and only one rated moderate quality. Studies were performed meta-analysis, which showed the use of prostacylin resulted a statistically significant decrease in the OI compared to the control group (Mean Difference(MD), 9.34; I2 0%; p < 0.00001 ), no statistically significant in mortality (OR, 0.83; I2 84%; p = 0.70), ECMO (OR = 4.9; I2 98%; p = 0.27), BNP (std MD, 6.98; I2 98%; p =0.31 ), FiO2 (SMD = 8.0;, I2 64%; p = 0.11), Systolic orientation of IVS curvature(SMD = 0.69; I2 97%; p = 0.32), Diastolic orientation of IVS differences (MD = 0.62; I2 93% p = 0.26). After applying the Hartung-Knapp adjustment, with the exception of BNP, the pooled effects of the other outcomes were not statistically significant, and there was high heterogeneity in measures such as ECMO and ventricular septal curvature. In conclusion, this meta-analysis has confirmed that prostacyclin may temporarily improve oxygenation. However, after applying the Hartung-Knapp adjustment, with the exception of BNP, the pooled effects of the other outcomes were not statistically significant, and there was high heterogeneity in measures such as ECMO and ventricular septal curvature. Further validation through high-quality studies are still needed. PROSPERO: CRD420261325458.

To characterize short term clinical outcomes among pediatric patients with appendiceal neoplasms. The National Cancer Database was queried for pediatric patients 0-17 years of age diagnosed with appendiceal tumors for 2004-2023. We analyzed demographic characteristics as well as short-term outcomes, tumor characteristics, and short-term outcomes. Patients were divided into AJCC stage, histology groups, and surgical approach for further subgroup analysis. All univariate statistical analysis was performed using GraphPad Prism 11 (GraphPad, La Jolla, CA, USA). Pediatric appendiceal tumors are rare in the United States and often found incidentally on appendectomy, with an estimated annual incidence rate of 0.12% from 2004-2023. Patients with pediatric appendiceal neoplasms are more likely to be female, White, non-Hispanic, have private insurance, and live in high median household income areas. Most patients had neuroendocrine tumors that were well differentiated. Most patients underwent surgery, most commonly appendectomy followed by hemicolectomy. Advanced stage tumors, and more invasive surgery (hemicolectomy/partial colectomy) were all associated with prolonged hospital length of stay after surgery with very low overall mortality rates. Pediatric appendiceal tumors are predominantly early-stage neuroendocrine neoplasms. Advanced stage, non-neuroendocrine histology, and more invasive surgery are associated with longer hospital length of stay and higher readmission rates, but no increased risk for mortality. Further studies are needed to optimize management and follow up for pediatric appendiceal neoplasms.

To evaluate the safety and efficacy of ultrasound (US)-guided percutaneous needle biopsy combined with FAL tissue adhesive needle tract sealing in pediatric hypervascular malignant solid tumors. A retrospective analysis was conducted on 149 pediatric patients with Adler grade &#x2265;2 malignant solid tumors who underwent US-guided percutaneous needle biopsy between January 2021 and October 2025. Based on the application of FAL sealing, patients were divided into the FAL group (n=57) and control group (n=92). Using 1:1 propensity score matching (PSM) for baseline covariates (e.g., age, tumor size, Adler grade, biopsy needle size, and hematological metrics), we generated 39 matched pairs. The number of needle passes, postoperative changes in laboratory values, complication rates, and follow-up outcomes were compared between the two cohorts. Before matching, the FAL group presented with larger tumors, lower preoperative hemoglobin levels, a different pathological distribution, and imbalance in biopsy needle size than the control group. After PSM, baseline characteristics were balanced between the two groups. Patients in the FAL group more frequently underwent &#x2265;4 needle passes than those in the control group [84.6% (33/39) vs. 60.5% (23/38), P=0.034]. Furthermore, there were no significant differences in postoperative laboratory changes, complication rates, or diagnostic accuracy among surgically validated cases between the two groups. No FAL-related adverse events or needle tract seeding were observed during a median follow-up of 140 days in the matched FAL group. In pediatric hypervascular malignant solid tumors, US-guided PNB combined with FAL tract sealing was associated with a higher number of biopsy passes without an observed increase in procedure-related complications, while diagnostic accuracy remained comparable. Further prospective multicenter and large-sample studies are needed for validation.

To review the need for secondary major urogenital reconstruction of a novel function preserving technique, AVUBI-preserve for cloacal reconstruction and to compare the results with that using conventional techniques METHODS: A retrospective cohort study was performed in patients who underwent definitive cloacal reconstruction at a single tertiary paediatric surgical centre between 1988 and 2018, with follow-up until 2023. Patients were included if follow-up data regarding the need for major secondary surgical intervention were available. Major secondary surgery was defined as redo cloacal reconstruction, redo vaginoplasty, or urinary diversion/continence surgery. Patients were divided into two groups according to the primary reconstructive technique: 1. Conventional cloacal reconstruction using total urogenital mobilisation (TUM) and/or urogenital sinus separation (UGS) with vaginoplasty. 2. AVUBI-preserve reconstruction involving in situ preservation of the anterior vaginal wall-urethra-bladder neck-introitus complex with selective reconstruction of the posterior vaginal wall and introitus. Redo rates were compared using Fisher's exact test, with statistical significance set at p < 0.05. A total of 98 patients were included. Eighty-six underwent conventional reconstruction and 12 underwent AVUBI-preserve reconstruction. Median age at reconstruction was comparable between groups (Mann-Whitney U test, p = 0.84). Major secondary urogenital surgery was required in: &#xb7; 36/86 patients (41.9%) in the conventional group &#xb7; 2/12 patients (16.7%) in the AVUBI-preserve group These difference did not reach statistical significance (Fisher's exact test, p = 0.12). The relative risk of major redo surgery after AVUBI-preserve reconstruction was approximately 0.4, corresponding to an estimated 60% relative reduction in redo risk. Notably, no patient in the AVUBI-preserve group required redo cloacal reconstruction, compared with 7/86 patients (8.1%) in the conventional group, although this did not reach statistical significance. This study did not show a significant difference in the rate of secondary uogenital reconstructions between the function-preserving AVUBI-preserve technique as compared to conventional techniques. The clinical impression of possible lower need for redo cloaca surgery and secondary urogenital reconstructions needs further evaluation from a larger pool of patients and further evaluation in a larger multicentre study.

The aim of this study was to compare outcomes of neonates born at 22-24 weeks of gestational age (GA) to those born at 25-26 weeks GA after emergent surgeries to determine the association between GA and post-operative mortality and morbidity. This study was conducted using Pediatric National Surgical Quality Improvement Project (NSQIP-P) data from 2012-2024 and included infants born GA 22-26 weeks who had emergent surgery within the first 60-days of life. Thirty-day post-operative outcomes of morbidity and mortality were compared between those born GA 22-24 and 25-26. Logistic regression models assessed the association between GA and postoperative mortality and morbidity among those who had an emergent exploratory laparotomy. Of 2,998 extremely preterm infants, 46.7% (n=1399) patients were born at a GA 22-24 weeks and 53.3% (n=1599) at 25-26 weeks. Infants of GA 22-24 weeks had a 25.0% post-operative mortality rate and 42.2% post-operative complications rate, compared to infants of GA 25-26 weeks, who had a 19.7% post-operative mortality rate and 35.3% post-operative complication rate. Multivariable regression models indicated 1.23 times higher odds of post-operative mortality after exploratory laparotomy for GA 22-24 weeks than GA 25-26 weeks, and 1.30 times higher odds of post-operative complications among those born GA 22-24 CONCLUSION: Neonates born at GA 22-24 had a higher likelihood of death or complications after emergent operations compared to those born at 25-26 weeks. With more patients being born at younger GA, new research is required to improve outcomes in this unique population.

Sacrococcygeal teratoma (SCT) is the most frequent congenital tumor in neonates. Despite excellent survival rates after early surgical resection, survivors may face significant long-term sequelae that affect health-related quality of life (HRQoL). We conducted an ambispective cohort study of all SCT patients treated at a tertiary pediatric hospital between 1995 and 2020. Clinical, surgical, and follow-up data were collected, and HRQoL was evaluated using the PedsQL 4.0 Generic Core Scales and Spinal Cord Injury Module, compared with age- and sex-matched controls. We included 18 SCT patients treated at our center. HRQoL was evaluated in 12 patients. Median age at inclusion was 17.1 years. Complications occurred in 72.2% of patients, and recurrence in 27.7%. Functional sequelae included urinary (55.6%), digestive (46.2%), and neurological (23.1%) dysfunctions. HRQoL scores were significantly lower than controls (patients 73.1 vs 86.7; p=&#xa0;0.002). Urinary dysfunction was the main determinant of impaired HRQoL, impacting physical, emotional, and social domains. The presence of associated congenital anomalies (61.1%) was also frequent. Although survival after SCT resection is excellent, functional morbidity remains high. Urinary dysfunction is the leading cause of reduced HRQoL. Long-term multidisciplinary follow-up -including urology, gastroenterology, and psychological support- and systematic HRQoL assessment are essential to optimize long-term outcomes in this population. El teratoma sacrococc&#xed;geo (TSC) es el tumor cong&#xe9;nito m&#xe1;s frecuente en neonatos. A pesar de las excelentes tasas de supervivencia tras la resecci&#xf3;n quir&#xfa;rgica precoz, los supervivientes pueden presentar secuelas significativas a largo plazo que afectan a la calidad de vida relacionada con la salud (CVRS). Se realiz&#xf3; un estudio de cohorte ambispectivo de todos los pacientes con TSC tratados en un hospital pedi&#xe1;trico terciario entre 1995 y 2020. Se recopilaron datos cl&#xed;nicos, quir&#xfa;rgicos y de seguimiento, y la CVRS se evalu&#xf3; mediante las escalas PedsQL 4.0 Generic Core Scales y Spinal Cord Injury Module, en comparaci&#xf3;n con controles emparejados por edad y sexo. Se incluyeron 18 pacientes con TSC tratados en nuestro centro. La CVRS se evalu&#xf3; en 12 pacientes. La mediana de edad en el momento de la inclusi&#xf3;n fue de 17,1 a&#xf1;os. Se produjeron complicaciones en el 72,2% de los pacientes y recurrencia en el 27,7%. Las secuelas funcionales incluyeron disfunciones urinarias (55,6%), digestivas (46,2%) y neurol&#xf3;gicas (23,1%). Las puntuaciones de CVRS fueron significativamente inferiores a las de los controles (pacientes: 73,1 frente a 86,7; p = 0,002). La disfunci&#xf3;n urinaria fue el principal factor determinante del deterioro de la CVRS y afect&#xf3; a los &#xe1;mbitos f&#xed;sico, emocional y social. Tambi&#xe9;n fue frecuente la presencia de anomal&#xed;as cong&#xe9;nitas asociadas (61,1%). Aunque la supervivencia tras la resecci&#xf3;n del TSC es excelente, la morbilidad funcional sigue siendo elevada. La disfunci&#xf3;n urinaria es la principal causa de disminuci&#xf3;n de la CVRS. El seguimiento multidisciplinar a largo plazo &#x2014;que incluya urolog&#xed;a, gastroenterolog&#xed;a y apoyo psicol&#xf3;gico&#x2014; y la evaluaci&#xf3;n sistem&#xe1;tica de la CVRS son esenciales para optimizar los resultados a largo plazo en esta poblaci&#xf3;n.

Nasal allergen provocation testing (NAPT) has been shown to be a safe and reproducible test in adults; however, pediatric data are limited. This study aims to investigate the clinical applications, feasibility, reproducibility and safety of NAPT in the pediatric population. In this prospective study, 294 patients (4.16-14.25 years old, mean of 7.33 years), with symptoms and medical history of allergic rhinitis (AR) and IgE-mediated sensitization to Dermatophagoides pteronyssinus and Dermatophagoides farinae were recruited. Participants underwent NAPT with negative control and with increasing concentrations of crude Dermatophagoides farinae (50&#x2009;&#xb5;g/ml, 500&#x2009;&#xb5;g/ml, and 5000&#x2009;&#xb5;g/ml) at 15&#x2009;min intervals. Pre- and post-test subjective symptom scores and objective active anterior rhinometry measurements were analyzed. Among the 245 participants (83.3%) with a positive NAPT, the majority (n&#x2009;=&#x2009;193, 78.8%) tested positive at 500&#x2009;&#xb5;g/ml or less. They (n&#x2009;=&#x2009;226, 92.2%) were diagnosed based on an increase in total nasal symptoms score (TNSS)&#x2009;&#x2265;&#x2009;5 points. The remaining 7.8% (n&#x2009;=&#x2009;19) required objective measurements to fulfill the criteria for a positive result. Five participants were unable to fully comply with the instructions provided. There were no adverse events recorded during the study. The group which tested positive on NAPT recorded higher sIgE levels than that which tested negative. Furthermore, those with higher serum sIgE levels tested positive on NAPT at lower allergen concentrations. The baseline visual analog scale (VAS) was significantly higher in the group testing positive on NAPT at the lowest allergen concentration, compared with the other groups. Our study demonstrates that NAPT is safe and feasible to be conducted on the pediatric population.

Adhesions are a recognised complication of intra-abdominal surgery and can result in adhesional bowel obstruction (ABO), which often requires adhesiolysis. This retrospective cohort study aimed to compare characteristics and outcomes of patients undergoing laparoscopic and open adhesiolysis at a tertiary paediatric surgery centre. Following institutional approval, a retrospective review of electronic medical records was performed for patients <18 years old managed surgically for ABO between September 2013 and July 2024. Of 111 patients identified, 62 (56%) had laparoscopic adhesiolysis, with 46% requiring conversion to open. Median age at surgery was lower for open than laparoscopic adhesiolysis (five vs eight years, p=0.01), although sex and presence of co-morbidities was similar. The most common index operation for laparoscopic adhesiolysis was appendicectomy (27%), compared to surgery for necrotising enterocolitis for open adhesiolysis (16%, p=0.01). Sub-group analysis of laparoscopic adhesiolysis converted to open showed similar distribution of sex, age, and comorbidities, but bowel resection was more common in the latter (3% vs 32%, p=0.01). Open adhesiolysis was associated with double the length of hospital stay compared to laparoscopic adhesiolysis (p<0.01). The rate of post-operative complications and recurrent ABO was similar between both groups. Our findings suggest that laparoscopic adhesiolysis is safe and feasible in children, with a significantly shorter length of stay, a similar rate of post-operative complications and recurrent adhesional bowel obstruction, but a high rate of conversion to open surgery.

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