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INTRODUCTION: The incidence of pediatric Wilms tumor (WT) is high in Africa, though patients abandon treatment after initial diagnosis. We sought to identify factors associated with WT treatment abandonment in Uganda. METHODS: A cohort study of patients  25 cm (OR 2.67, 95% CI 1.05-6.81). CONCLUSIONS: Children with WT in Uganda frequently abandon care during neoadjuvant therapy, particularly those with large tumors with poor response. Further investigation into the factors that influence treatment abandonment and a deeper understanding of tumor biology are needed to improve treatment adherence of children with WT in Uganda.

In patients with drug-resistant epilepsy, difficulties in identifying the epileptogenic zone are well known to correlate with poorer clinical outcomes post-surgery. The integration of PET and MRI in the presurgical assessment of pediatric patients likely improves diagnostic precision by confirming or widening treatment targets. PET and MRI together offer superior insights compared to either modality alone. For instance, PET highlights abnormal glucose metabolism, while MRI precisely localizes structural anomalies, providing a comprehensive understanding of the epileptogenic zone. Furthermore, both methodologies, whether utilized through simultaneous PET/MRI scanning or the co-registration of separately acquired PET and MRI data, present unique advantages, having complementary roles in lesional and non-lesional cases. Simultaneous FDG-PET/MRI provides precise co-registration of functional (PET) and structural (MR) imaging in a convenient one-stop-shop approach, which minimizes sedation time and reduces radiation exposure in children. Commercially available fusion software that allows retrospective co-registration of separately acquired PET and MRI images is a commonly used alternative. This review provides an overview and illustrative cases that highlight the role of combining 18F-FDG-PET and MRI imaging and shares the authors' decade-long experience utilizing simultaneous PET/MRI in the presurgical evaluation of pediatric epilepsy. [ABSTRACT FROM AUTHOR]

Background Aim Method Results Conclusion Pharmacist surgical preadmission review is common in adult healthcare settings, however there is little evidence of this practice in the paediatric setting. This research describes a pilot surgical preadmission pharmacist service in a paediatric hospital.To evaluate the impact of a surgical preadmission pharmacist service on patient flow and the quality of medication management.A retrospective review (2 months) was conducted to compare an intervention group (1 May 2019–30 June 2019) to historical baseline (1 October 2018–30 November 2018). Children and adolescents (aged 0–18 years) presenting for elective surgery and overnight admission were included. Relevant clinical data and timestamps were extracted from the electronic medical record. Multiple linear regression models were built to examine the difference in outcomes between the control and intervention groups. This project was exempt due to the local policy requirements that constitute research by the Queensland Children's Hospital Human Research Ethics Committee (Reference no: LNR/19/QCHQ/53406). The justification for this exemption was as follows: the study presented no foreseeable risk of patient harm as it involved evaluation of an established standard of clinical care and involved the use of existing collections of records that contain only non‐identifiable patient data.In total, 135 patients were included in the baseline and 96 patients were included in the intervention group. The intervention group had statistically significant lower time to best possible medication history (BPMH) by 47.57 h (95% confidence interval [CI] −53.25 to −41.89, p < 0.001). Time to prescription of home medications was significantly reduced in the intervention group by 5.26 h (95% CI −10.45 to −0.08, p = 0.05). There was no difference in proportion of patients with home medications omitted (71–62%, p = 0.38) or requiring modification (14–12%, p = 0.58) between the two groups.Implementation of a surgical preadmission pharmacist service in our paediatric hospital demonstrated earlier BPMH documentation and prescription of home medications, without negative effects on perioperative patient flow. [ABSTRACT FROM AUTHOR]

Background: The technical complexity and limited casuistry of neonatal surgical pathology limit the possibilities of developing the necessary technical competencies by specialists in training. Esophageal atresia constitutes the paradigm of this problem. The use of synthetic 3D models for training is a promising line of research, although the literature is limited. Methods: We conceptualized, designed, and produced an anatomically realistic model for the open correction of type III oesophageal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content-validity questionnaires. Results: The model was validated by nine experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 34.0 and 38.4 min, respectively. Two non-experts did not complete the procedure at the designed time (45 min). Regarding the face validity questionnaire, the mean rating of the model was 3.2 out of 4. Regarding the construct validity, we found statistically significant differences between groups for the equidistance between sutures, 100% correct in the expert group vs. 42.9% correct in the non-expert group (p = 0.02), and for the item "Confirms that tracheoesophageal fistula closure is watertight before continuing the procedure", correctly assessed by 66.7% of the experts vs. by 11.1% of non-experts (p = 0.05). Concerning content validity, the mean score was 3.3 out of 4 for the experts and 3.4 out of 4 for the non-experts. Conclusions: The present model is a cost-effective, simple-to-produce, and validated option for training open correction of type III esophageal atresia. However, future studies with larger sample sizes and blinded validators are needed before drawing definitive conclusions. [ABSTRACT FROM AUTHOR]

Background: Off-label intranasal administration of injectable dexmedetomidine has been widely applied in the pediatric sedation setting. However, the development of an improved drug delivery system that is easy to use is needed. We developed a novel dexmedetomidine nasal spray that can be administered directly without dilution or configuration for pediatric pre-anesthetic sedation. This nasal spray has a fixed dose and is stable during storage. To the best of our knowledge, this is the first licensed nasal spray preparation of dexmedetomidine worldwide. Objective: To evaluate the pre-anesthetic sedation efficacy and safety of the novel dexmedetomidine nasal spray in children. Methods: The study was conducted at 11 sites in China between 24 November 2021 and 20 May 2022 and was registered in ClinicalTrials.gov (NCT05111431, first registration date: 20/10/2021). Subjects (n = 159) between 2 and 6 years old who were to undergo elective surgery were randomized to the dexmedetomidine group (n = 107) or the placebo group (n = 52) in a 2:1 ratio. The dosage was 30 µg or 50 µg based on the stratified body weight. The primary outcome measure was the proportion of subjects who achieved the desired child-parent separation and Ramsay scale ≥ 3 within 45 min of administration. Safety was monitored via the assessments of adverse events, blood pressure, heart rate, respiratory rate and blood oxygen saturation. Results: The proportion of subjects achieving desired parental separation and Ramsay scale ≥ 3 within 45 min was significantly higher in the dexmedetomidine group (94.4%) vs the placebo group (32.0%) (P < 0.0001). As compared with placebo, dexmedetomidine treatment led to more subjects achieving Ramsay scale ≥ 3 or UMSS ≥ 2, and shorter time to reach desired parental separation, Ramsay scale ≥ 3 and UMSS ≥ 2 (all P < 0.0001). Adverse events were reported in 90.7% and 84.0% of subjects in the dexmedetomidine and placebo groups, respectively, and all the events were mild or moderate in severity. Conclusions: This novel dexmedetomidine nasal spray presented effective pre-anesthetic sedation in children with a tolerable safety profile. [ABSTRACT FROM AUTHOR]

Purpose: To undertake a global assessment of existing ultrasound practices, barriers to access, point-of-care ultrasound (POCUS) training pathways, and the perceived clinical utility of POCUS in Child Surgery. Methods: An electronic survey was disseminated via the GICS (Global Initiative of Children's Surgery) network. 247 anonymized responses from 48 countries were collated. 71.3% (176/247) worked in child surgery. Results: Ultrasound was critical to practice with 84% (147/176) of requesting one daily or multiple times per week. Only 10% (17/176) could access emergency ultrasound < 1 h from request. The main barrier was a lack of trained personnel. HIC surgeons were more likely to have ultrasound training (24/29; 82.8%) compared with LMICs (74/147; 50.3%) (p =.001319; CI 95%). Self-perceived POCUS competence was associated with regularity of POCUS use (p < 0.001; CI 95%). Those who already practice POCUS most commonly use it for trauma, intussusception, and ultrasound-guided procedures. Majority (90%; 159/176) of child surgeons would attend formal POCUS training if available. Conclusions: Ultrasound is critically important in children's surgery globally, however, many surgeons experience barriers to timely access. There is a strong interest in learning POCUS for relevant pediatric surgical applications. Further research is needed to evaluate the best methods of training, accreditation, and governance. [ABSTRACT FROM AUTHOR]

Introduction: Ensuring patient safety in minimally invasive surgery (MIS) within the field of pediatric surgery requires systematic and extensive practice. Many groups have proposed mastery learning programs encompassing a range of training methods. However, short courses often have a narrow focus on specific objectives, limiting opportunities for sustained training. Our aim was to analyze our results with an online long-term competency-based and supervised training. Methods: This is a retrospective cohort study with prospective data collection of scores and performance of trainees during online courses from October 2020 to April 2023. Results: All participants (n = 76) were able to set up their personal training gym and complete the intensive stage of the course. The total score evolved from 2.60 ± 0.56 at the first meeting to 3.67 ± 0.61 at the fourth meeting, exhibiting a significant difference (P < .013). A considerable drop out was observed in the follow-up stage, with only 53.8% of the participants completing the course. When compared with the first meeting, they also showed a significant improvement with a mean general score of 3.85 ± 0.25 (P < .013) Conclusion: We have presented a novel online training program, based on continuous training that demonstrated that the unlimited access to a personal training gym allows surgeons to improve and maintain MIS skills. [ABSTRACT FROM AUTHOR]

Purpose: To report on the occurrence of postoperative visual axis opacification (VAO) in children younger than 5 years of age operated for cataract in Sweden, and to analyse correlations with age at surgery and surgical method. Methods: Data were derived from the Swedish Pediatric Cataract Register (PECARE). All children operated on between 1 January 2007 and 31 December 2020 were included. Follow‐ups at 1, 2 and 5 years of age were analysed. Results: Cataract surgery were performed on 770 eyes belonging to 549 children (n = 282 boys, 51.4%); 327/770 (42.5%) of the children underwent surgery before 3 months of age and 216/770 (28%) before 6 weeks of age. Data on 881 follow‐up visits were registered. At the follow up‐visits at 1, 2 and 5 years of age, VAO was present in 154/349 (44.1%), 41/323 (12.7%) and 25/208 (12%). The majority of the children with VAO underwent cataract surgery before age 6 months, with a predominance before age 2 months. Primary IOL was implanted in 601/770 (78%) of eyes; 40.8% had an acrylic one‐piece lens, 31.8% had a bag‐in‐the‐lens IOL, 21.9% were aphakic and 5.2% had an acrylic three‐piece lens. Implantation of a bag‐in‐the‐lens IOL was related to a significantly lower occurrence of VAO compared to other types of IOL, including aphakia (p < 0.0002). Conclusion: Our results are in accordance with the literature. Primary bag‐in‐the‐lens IOL implantation before 2 years of age seems adequate and safe, with a low occurrence of VAO, and can thus be continued as routine in Sweden. [ABSTRACT FROM AUTHOR]

Background: The rise of value-based purchasing has led to decreased compensation for hospital-acquired conditions, including surgical site infections (SSI). This study aims to assess the risk factors for SSI in children and teenagers undergoing gastrointestinal surgery across US hospitals. Methods: The 2018-2020 Nationwide Readmissions Database was queried for patients undergoing gastrointestinal surgery under the age of 18. The primary outcome was SSI during index admission or readmission within a year. Comparison groups were elective, trauma, and emergent surgery based on anatomic location and urgency. Univariable comparison used chi-squared tests for relevant variables. Confounders were addressed through multivariable logistic regression with significant variables from univariable analysis. Results: 113 108 total patients met the study criteria. The SSI rate during admission or readmission was 2.9% (n = 3254). Infections during admission and readmission were 1.4% (n = 1560) and 1.5% (n = 1694), respectively. The most common site was organ space (48.6%, n = 1657). Increased infection risk was associated with trauma (OR 1.80 [1.51-2.16] P <.001), emergency surgery (OR 1.31 [1.17-1.47] P <.001), large bowel surgery (OR 2.78 [2.26-3.43] P <.001), and those with three or more comorbidities (OR 2.03 [1.69-2.45] P <.001). Investor-owned hospitals (OR.65 [.56-.76] P <.001) and highest quartile income (OR.80 [.73-.88] P <.001) were associated with decreased infection risk. Conclusions: Pediatric patients undergoing gastrointestinal surgery face an elevated risk of SSI, especially in trauma and emergency surgeries, particularly with multiple comorbidities. Meanwhile, a reduced risk is observed in high-income and investor-owned hospital settings. Hospitals and surgeons caring for high risk patients should advocate for risk adjustment in value-based payment systems. [ABSTRACT FROM AUTHOR]

Background: In the setting of limited funding and high expectations for quality care, safety net hospitals play a crucial role in treating pediatric trauma patients. This study aimed to compare outcomes and hospitalization costs of pediatric trauma patients in safety net hospitals across the United States. Methods: The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years hospitalized for traumatic injury. Patients admitted to safety net hospitals were propensity matched 1:1 to all other patients. The primary outcome was mortality. The secondary outcomes were readmission within 1-year, mean length of stay (LOS), total charges, and total hospitalization costs including readmissions. Results: There were 176,325 patients meeting inclusion criteria, and 30,869 were admitted to safety net hospitals. All safety net patients were successfully matched across predictors, and 61,738 patients were included. The overall mortality rate was 1.4% (n = 834), and the mortality risk was similar in safety net hospitals (OR 1.11 [.96-1.27] P =.15). The overall readmission rate, mean LOS, and mean total cost were similar for safety net hospitals when compared to all hospitals. However, the overall mean total charge was $78,724 (±$224,884) and was lower in safety net hospitals ($76,575 [±$198,342], P =.02). Discussion: Safety net hospitals deliver comparable outcomes as other health care facilities when caring for pediatric trauma patients. Notably, these hospitals appear to undercharge for their services, despite incurring similar costs in the process. These results shed light on the resilience of safety net hospitals in delivering quality and cost-effective care. [ABSTRACT FROM AUTHOR]

Objectives: The optimal time for intervention in surgical necrotizing enterocolitis (sNEC) remains to be elucidated. Surgical management varies between peritoneal drain (PD), laparotomy (LAP), and PD with subsequent LAP (PD + LAP). We propose that some infants with surgical NEC benefit from late (>48 h) operative intervention to allow for resuscitation. Methods: A retrospective comparison of clinical information in infants with sNEC from 2012 to 2022 was performed. Early intervention was defined as less than 48 hours from time of NEC diagnosis to surgical intervention. Results: 118 infants were identified, 92 underwent early intervention (62 LAP; 22 PD; 8 PD + LAP) and 26 underwent late intervention (20 LAP; 2 PD; 4 PD + LAP). Infants with early intervention were diagnosed younger (DOL 8 [6, 15] vs 20 [11, 26]; P =<.05) with more pneumoperitoneum (76% vs 23%; P =<.05). The early intervention group had a higher mortality (35% vs 15%; P =<.05). When excluding infants with pneumoperitoneum, the early intervention group had a higher mortality rate (10/22 (45%), 4/26 (15%); P <.05) and had more bowel resected (29 ± 17 cm vs 9 ± 8 cm; P <.05), with the same number of patients scoring above 3 on the MD7 criteria. Conclusion: Infants with NEC who underwent early surgical intervention had a higher mortality and more bowel resected. While this study has a provocative finding, it is severely limited by the non-specific 48-hour cut off. However, our data suggests that a period of medical optimization may improve outcomes in infants with sNEC and thus more in-depth studies are needed. [ABSTRACT FROM AUTHOR]

Introduction: Unintentional injury is the leading cause of death among children. Much can be gleaned from the adult literature in understanding the characteristics that lead to recidivism in efforts to establish interventions for prevention. Our study aims to evaluate the rates, demographics, and features of pediatric trauma recidivism. Methods: This was a retrospective single-institution review at a level-1 pediatric trauma center of children and young adults (ages 0-28) with traumatic injuries from January 2008 to April 2023. Patients with 1 or more prior visits to our institution's trauma center (recidivists) were identified and compared with those with single admissions. Chi-square tests were used to statistically analyze the two groups. Results: Pediatric/young adult trauma recidivists were 4.4% of the total trauma population captured (n = 14,613). Of the total trauma group, 55% were under 18 years old. Recidivists had higher percentages of patients who were male (82% vs 69%, P <.01), African American (36% vs 24%, P <.01), involved in penetrating trauma (33% vs 17%, P <.01), self-pay/uninsured (17% vs 12%, P <.01), and have abuse reported (5% vs 4%, P =.04). The primary county for recidivism patients was Forsyth with most patients from a specific zip code in an urban area of the county. The average time between visits for recidivists was 1,066 days. Conclusions: Pediatric/young adult trauma recidivism is associated with specific characteristics including male, African American race, penetrating trauma, and uninsured status. Recidivists are primarily presenting from a zip code with low socioeconomic status. It is critical to develop targeted interventions to help this population in trauma prevention. [ABSTRACT FROM AUTHOR]

Background: Choledocholithiasis in children is commonly managed with an "endoscopy first" (EF) strategy (endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) under a separate anesthetic). Endoscopic Retrograde Cholangiopancreatography is limited at the end of the week (EoW). We hypothesize that a "surgery first" (SF) approach with LC, intraoperative cholangiogram (IOC), and possible laparoscopic common bile duct exploration (LCBDE) can decrease length of stay (LOS) and time to definitive intervention (TTDI). Methods: This is a retrospective single-center cohort study conducted between 2018 and 2023 in pediatric patients with suspected choledocholithiasis. Work week (WW) presentation included admission between Monday and Thursday. Time to definitive intervention was defined as time to LC. Results: 88 pediatric patients were identified, 61 managed with SF (33 WW and 28 EoW) and 27 managed with EF (18 WW and 9 EoW). Both SF groups had shorter mean LOS for WW and EoW presentation (64.5 h, 92.4 h, 112.9 h, and 113.0 h; P <.05). There was a downtreading TTDI in the SF groups (SF: WW 24.7 h and EoW 21.7 h; EF: WW 31.7 h and EoW 35.9 h; P =.11). 44 patients underwent LCBDE with similar success rates (91.6% WW and 85% EoW; P = 1.0). All EF patients received 2 procedures; 69% of SF patients were definitively managed with one. Conclusion: Children with choledocholithiasis at the EoW have a longer LOS and TTDI. These findings are amplified when children enter an EF treatment pathway. An SF approach results in shorter LOS with fewer procedures, regardless of the time of presentation. [ABSTRACT FROM AUTHOR]

Cyst excision and Roux-en-Y hepaticojejunostomy (RYHJ) is the standard treatment for choledochal cysts (CCs). In the present study, the results of totally laparoscopic surgery for CCs (TLCCs) in a pediatric population were evaluated. The clinical data of 28 children with CCs between June 2020 and June 2023 were retrospectively reviewed. All patients underwent TLCCs involving cyst excision and RYHJ. The jejunojejunal anastomosis was completed laparoscopically using manual sutures. Age at operation, operative time, postoperative recovery and complications were evaluated. The 28 patients comprised 8 boys and 20 girls who underwent TLCCs at a mean age of 4.2 years (range, 1 month-12.3 years) with a mean weight of 15.9 kg (range, 4.6-43 kg). All patients received ultrasound and magnetic resonance cholangiopancreatography examinations, which revealed a mean cyst diameter and length of 1.74±0.76 cm and 3.85±1.25 cm, respectively. The mean operative time was 214±43.8 min. The mean time until starting an oral diet after surgery was 2.89±1.23 days. Apart from bile leakage and wound infection, no other complications occurred during a median follow-up period of 18 months (range, 4-42 months). TLCCs can be performed safely by skilled surgeons in pediatric patients. TLCCs may be more physiologically compatible and accelerate recovery of intestinal function with reduced trauma and better esthetic outcomes than conventional laparoscopic surgery for CCs. Therefore, TLCCs with manual sutures may be considered as an option for minimally invasive surgery in pediatric patients with CCs. [ABSTRACT FROM AUTHOR]

Introduction: To improve and maintain quality and safety in anesthesia, standards have been proposed regarding human resources, facilities and equipment, medications and intravenous fluids, monitoring, and the conduct of anesthesia. Compliance with these standards remains a challenge in French‐speaking sub‐Saharan Africa (SSA) and results in high morbidity and mortality particularly in children. This aim of this study was to assess the progress made in improving the pediatric anesthesia infrastructures, human resources, education, medications, and equipment in French‐speaking SSA over the past 10 years (2013–2022). Methods: This is a descriptive, multicenter, cross‐sectional study with retrospective data collection, conducted from September 1 to November 5, 2023. Comparative data from 2012 to 2022 were collected through an online survey. Descriptive statistics were used to summarize data. Results: Data were obtained from 12 countries out of 14. The number of hospitals providing pediatric surgery and anesthesia rose from 94 in 2012 to 142 in 2022 (+51%). The total number of physician anesthesiologists rose from 293 (0.1 physician anesthesiologists/100 000 inhabitants) in 2012 to 597 (0.2 physician anesthesiologists/100 000 inhabitants) in 2022 (+103.7%). Five (0.006 physician anesthesiologists/100 000 children) had completed a fellowship in pediatric anesthesia and intensive care in 2012, and 15 (0.01 physician anesthesiologists/100 000 children) in 2022 (+200%). Five physician anesthesiologists had an exclusive pediatric anesthesia practice in 2012, whereas they were 32 in 2022 (+540%). There is no specialized training in pediatric anesthesia and intensive care in any of these countries. Halothane was always available in 81.5% of the hospitals in 2012, and in 50.4% of the hospitals in 2022. Sevoflurane was always available in 5% of the hospitals in 2012, and in 36.2% in 2022. Morphine was always available in 32.2% in 2012, whereas it was available in 52.9% of them in 2022. Pediatric pulse oximeter sensors were available in 36% of the hospitals in 2012, and in 63.4% in 2022. Capnography was available in 5.3% of the hospitals in 2012, and in 48% in 2022. Conclusion: Progress have been made over the last 10 years in French‐speaking SSA to improve infrastructures, human resources, education, medications, and equipment for pediatric anesthesia in French‐speaking SSA. However, major efforts must be continued. Standards adapted to the local context should be formulated. [ABSTRACT FROM AUTHOR]

Pediatric cardiac surgery patients are predisposed to blood loss. Blood product administration can lead to complications. Prothrombin complex concentrates (PCCs) offer potential advantages of factor composition, small volume, decreased immunogenicity/infectious risks, and accessibility. The objective of this study was to describe dosing, monitoring, blood product utilization, and thromboembolic complications of administering four-factor PCC (4F-PCC) in pediatric cardiac surgery. We performed a retrospective review of patients aged <18 years undergoing cardiac surgery from June 2020 to May 2022 (inclusive) who received 4F-PCC. Outcomes of interest included 4F-PCC dosing (units/kg) and number of doses administered, chest tube output, blood product administration, donor exposure, length of stay, and thromboembolic events. Eighty-six patients met eligibility criteria. The median (range) age and weight were 0.37 (0.01–16.3) years and 5.3 (1.6–98) kg, respectively. Median (range) total 4F-PCC dose per patient was 25 (9.2–50) units/kg, with 6 patients (7%) receiving a total of two doses. Median (range) 24-hour postoperative packed red blood cells, platelet, plasma, and cryoprecipitate administration volumes were 0 (0–2.57) mL/kg/24 h, 0 (0–1.09), 0 (0–2.64), and 0 (0–0.28 mL/kg/24 h), respectively. Median (range) length of stay and 24-hour postoperative chest tube output were 10 (6–26) days and 1.1 (0.1–4.2) mL/kg/h, respectively. Two (2%) patients experienced a thromboembolic event within 30 days of 4F-PCC administration. These retrospective findings suggest no worsening of hemostatic parameters, a mild median improvement in fibrinogen, low blood product utilization, and low thromboembolism rates following 4F-PCC use in pediatric cardiac surgery. [ABSTRACT FROM AUTHOR]

The aim of this study is to examine the effects of preoperative therapeutic play on fear and anxiety levels in preschool children. The study had an experimental pre-intervention-post-intervention design with a control group. The study was carried out with 37 children aged 3–6 years who were brought for surgical procedures at XX Research and Training Hospital between July 2020 and January 2021. While a therapeutic play intervention was performed with the children in the experimental group (n = 20), routine preoperative practices were performed in the control group (n = 17). Data were analyzed using chi-squared tests, the Mann-Whitney U test, and the Wilcoxon test. p < 0.05 was considered significant. The fear and anxiety levels of the children in the experimental and control groups were similar pre-intervention (p > 0.05). In the post-intervention, the mean anxiety and fear scores of the experimental group were 2.15 ± 1.63 and 1.15 ± 0.58, their mean ranks were 10.80 and 12.65, while the mean anxiety and fear scores of the control group were 7.94 ± 2.07 and 2.53 ± 1.00, their mean ranks were 28.65 and 26.47, respectively, and the difference between the groups was statistically significant (respectively, MU = 6.00 p = 0.000, MU = 43.00 p = 0.000). It was determined that the therapeutic play method applied before surgery reduced the anxiety and fear levels of children. Considering this situation, improving the skills of nurses in therapeutic play and increasing the number of personnel certified for interactive therapeutic games can reduce the risk of preoperative emotional trauma in children. The therapeutic play method applied before surgery reduced the anxiety and fear levels of children. The routine use of therapeutic play in pediatric surgery clinics is recommended. • Surgical procedures performed on children affect their anxiety and fear levels. • Therapeutic play opportunities provided before surgery reduces the anxiety and fear levels of children. • The routine use of therapeutic play in pediatric surgery clinics is recommended. [ABSTRACT FROM AUTHOR]

Enhanced recovery after surgery (ERAS) protocols are evidence-based, multimodal approaches to optimize patient recovery and minimize complications. Our team evaluated clinical outcomes following the implementation of an ERAS protocol for adolescents undergoing metabolic and bariatric surgery. Academic hospital, New York, NY, USA. We performed a single-institution longitudinal assessment of adolescents who underwent laparoscopic vertical sleeve gastrectomy (VSG) between August 2021 and November 2022. Unpaired t -tests and Fisher's exact test were used to compare means between groups and categorical factors. Forty-three patients were included in the study, 21 who participated in the ERAS protocol and 22 control patients. ERAS cohort was 52% females, with a median age of 17.5 years and a median body mass index (BMI) of 46.3 kg/m2. The non-ERAS cohort was 59% females, with a median age of 16.7 years and a median BMI of 44.0 kg/m2. There were no significant differences between baseline characteristics. Patients in the ERAS group had a shorter time to oral intake (10.7 hours versus 21.5 hours, P <.01), lower morphine milligram equivalents (18.2 versus 97.0, P <.01), and shorter length of stay (1.5 days versus 2.0 days, P =.01). There were no significant differences between return visits to the emergency department (ED) within 30 days (3 versus 2, P =.66) or readmissions (0 versus 1, P = 1.0). The described ERAS protocol is safe and effective in adolescents undergoing laparoscopic VSG and is associated with shorter time to oral intake, reduced opioid requirements, and shorter hospital lengths of stay with no increase in return ED visits or readmissions. • Patients in the enhanced recovery after surgery (ERAS) group had a shorter time to oral intake. • Patients in the ERAS group had lower morphine milligram equivalents. • Patients in the ERAS group had shorter length of stay. • ERAS protocol is effective in adolescents undergoing laparoscopic sleeve gastrectomy. [ABSTRACT FROM AUTHOR]

Social determinants of health (SDOH) have been identified as factors that influence patient health outcomes. These are well described in adult and pediatric general populations, however, there is a paucity of data for surgical patients. This study compares the prevalence of health-related social needs (HRSN) among pediatric surgery and general pediatric patients. We retrospectively assessed electronic health record data to identify patients who completed a standardized HRSN screener within our health system and underwent surgery by a pediatric surgeon between January 2019 and December 2021. We compared this population to non-surgical pediatric patients during this time. Bivariate and multivariate logistic regressions were conducted to estimate the likelihood of having 1 or more HRSN given a patient's surgery status. Logistic and linear regressions were conducted to estimate healthcare utilization in pediatric surgery patients given their HRSN status. 33,989 general pediatric and pediatric surgery patients (age <21 years) were screened for HRSNs, and 2112 operations were performed during the study period. 343 (20%) of the surgical patients operated on by pediatric surgeons were screened for HRSNs. Surgical patients were more likely to be younger, Latinx, Spanish-speaking, and non-commercially insured (p < 0.0001). Surgical patients were 50% more likely to report one or more HRSN, when adjusting for demographic characteristics (aOR 1.50, 95% CI 1.16, 1.94). Pediatric surgery patients are more likely to report HRSNs compared to the general pediatric population. Surgical patients may represent an at-risk group, and universal HRSN screening and support should be considered to improve outcomes. Level III. [Display omitted] • What is currently known about this topic : HRSNs have been linked to numerous health outcomes and have been studied in adult populations however their prevalence in the pediatric surgery population is unknown. • What new information is contained in this article : This is the first retrospective study using patient-reported data from health questionnaires to define the prevalence of HRSNs in the pediatric surgery population. [ABSTRACT FROM AUTHOR]

This academic article discusses the historical underrepresentation of female in science, with a focus on Latin America. It highlights the importance of both technical and non-technical skills in the medical-surgical field, particularly the role of research skills. The study aims to quantify and characterize the scientific output of Latin American female researchers over the past decade, providing insights into the challenges and opportunities in low and middle-income countries. A retrospective cross-sectional bibliometric study was conducted in 2023, focusing on pediatric surgical science journals in Scopus and PubMed. It assessed Latin American female participation, journal details, and interaction networks, using SPSS and Gephi software. The period analyzed was from January 2012 to December 2022. Between 2012 and 2022, 727 articles with Latin authorship in pediatric surgery were analyzed across 304 journals. Of these, 63.69% had female co-authors. The majority were original articles (53.13%), with contributions from Brazil, Mexico, and Chile. Notable journals included the Journal of Pediatric Surgery and Child's Nervous System. Keywords like Laparoscopy and Cardiac surgery were common. A growth trend in female Latin American publications was observed, despite temporary declines. This study highlights a growing trend in Latin American females' scientific contributions to pediatric surgery from 2012 to 2022, although a gender gap persists. The research mainly consists of primary data studies, with a focus on Brazil and Mexico from public institutions. The Journal of Pediatric Surgery featured prominently, and common topics included Laparoscopy, Cardiac surgery, Liver transplant, Congenital heart defects, and COVID-19. IV. • Latin American Women's Contribution to Pediatric Surgical Research: female co-authorship accounted for 63.69% of the identified articles. • Latin America contributes with less than 10% to the global scientific production in this area. • There has been a growth trend in the past 11 years with interruptions in 2017 and 2018, likely influenced by economic conditions in some Latin American countries. • The study highlights the centralization of scientific development in Latin American countries, with Brazil and Mexico leading in terms of publication volume. • The study shows that Latin American women's research in pediatric surgery aligns with the most relevant topics in the field, such as gastrointestinal and cardiovascular specialties, minimally invasive laparoscopic surgery, and the impact of the COVID-19 pandemic on pediatric surgical research. [ABSTRACT FROM AUTHOR]

Push-PEG (percutaneous endoscopic gastrostomy) with T-fastener fixation (PEG-T) allows one-step insertion of a balloon tube or button, and avoids contamination of the stoma by oral bacteria. However, PEG-T is a technically more demanding procedure with a significant learning curve. The aim of the present study was to compare outcomes after PEG-T and pull-PEG in a setting where both procedures were well established. The study is a prospective cohort study including all patients between 0 and 18 year undergoing PEG-T and pull-PEG between 2017 and 2020 at a combined local and tertiary referral center. Complications and parent reported outcomes were recorded during hospital stay, after 14 days and 3 months postoperatively. 82 (93%) of eligible PEG-T and 37 (86%) pull-PEG patients were included. The groups were not significantly different with regard to age or weight. Malignant disorders and heart conditions were more frequent in the pull-PEG group, whilst neurodevelopmental disorders were more frequent in the PEG-T group (p < 0.001). 54% in both groups had a complication within 2 weeks. Late complications (between 2 weeks and 3 months postoperatively) occurred in 63% PEG-T vs 62% pull-PEG patients (p = 0.896). More parents in the pull-PEG group (49%) reported that the gastrostomy tube restricted their child's activity, compared to PEG-T (24%) (p = 0.01). At 3 months follow-up, more pull-PEG patients (43%) reported discomfort from the gastrostomy compared to PEG-T (21%) (p = 0.03). Overall complication rates were approximately similar, but pull-PEG was associated with more discomfort and restriction of activity. Treatment study level II. • Few studies have compared outcomes after gastrostomy placement with pull-PEG or push-PEG technique, or asked parents/patients about their experiences. • Pull-PEG was associated with more discomfort and restriction of activity than push-PEG. The overall complication rates between pull-PEG and PEG-T were approximately similar. [ABSTRACT FROM AUTHOR]

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Background: Pediatric patients with medically-intractable epilepsy may require modulation of seizure foci to reduce frequency and severity of seizures. These neuromodulatory procedures, which include responsive neurostimulator (RNS) and deep brain stimulator (DBS), involve the implantation of high-profile and long-term cranial hardware, placing patients at risk of wound healing complications, hardware exposure and infection. A multidisciplinary neurosurgical and plastic surgical approach utilizing pericranial flap coverage of hardware may decrease wound healing complications in these cases. This study compares the wound-healing outcomes in patients undergoing RNS/DBS insertion with and without pericranial flap coverage. Methods: A retrospective chart review was conducted of all patients who underwent RNS and DBS insertion with or without pericranial flap coverage at a level 1 pediatric medical center between 2014 and 2022. Wound healing outcomes at 60 days were evaluated. Data were compared using Fisher's exact test. Results: Twenty-seven patients underwent 29 neuromodulatory epilepsy procedures (14 DBS, 15 RNS). Twenty of the procedures included a pericranial flap to cover hardware. Median length of stay was 2.0 days for both cohorts. Two subjects without pericranial flap reconstruction had a wound healing complication (22.2%), compared to none of the procedures that included a pericranial flap (P =.09). Conclusion: In pediatric patients undergoing insertion of responsive neurostimulators and deep brain stimulators for medically-intractable epilepsy, a multidisciplinary neurosurgery and plastic surgery approach utilizing pericranial flap reconstruction may reduce the risk of postoperative wound complications. [ABSTRACT FROM AUTHOR]

Globally, a great number of children have been suffering from physical dysfunction and psychological stress due to uncontrollable scar growth and a lack of effective modalities. Despite chemotherapy's established role as a primary treatment for pathological scarring in adults, its efficacy in preventing or minimizing scar formation in paediatric patients remains underexplored. This retrospective cohort study aimed to refine the relevant clinical evidence and investigate the effect of chemotherapy on pathological scars in children. In this single‐centre retrospective cohort study, the data of children aged ≤18 years who underwent thoracic surgery at the Children's Hospital of Fudan University between 1 January 2018, and 31 December 2021 were assessed. The primary outcome was pathological scarring, and the secondary outcomes were subjective symptoms accompanying pathological scarring, such as pain and itching. To mitigate indication bias, analysis was performed by inverse probability weighting (IPTW) log‐binomial regression models. The cohort comprised 102 children, among whom 36 received adjuvant chemotherapy perioperatively, while 66 did not. Under the IPTW model, a statistically significant difference in pathological scarring incidence was observed between the chemotherapy and non‐chemotherapy groups (16.7% vs. 29.4%, p = 0.027). And the children received chemotherapy post‐operatively had a lower relative risk of pathological scarring, compared with those received chemotherapy both before and after surgery (19.8% vs. 28.8%). Adjuvant chemotherapy treatment after surgery may reduce the incidence of post‐operative pathological scarring in children. [ABSTRACT FROM AUTHOR]

Background: The main barriers to the broad implementation of pediatric minimally invasive surgery (MIS) are technological, technical, and epistemological barriers, as well as the rarity of certain pathologies. These issues are presumed to be more significant in low- and middle-income countries. This study aimed to identify and analyze the factors limiting the diffusion and implementation of pediatric MIS in Brazil. Methods: A nationwide cross-sectional survey was conducted via an online questionnaire in Brazil from January 2022 to July 2022. The sample was taken by convenience from the population of pediatric surgeons in Brazil. A total of 187 surgeons were included. The collected data were divided into three sections to evaluate technological, technical, and epistemological limitations to pediatric MIS implementation. Results: Although 85% of the participants had previous training, a lack of adequate training was identified as a significant limiting factor, particularly among those who had taken only short courses (42.3% vs. 64.3%, p = 0.033). Only 14% of the participants reported performing MIS for major pediatric procedures. With respect to intracorporeal suturing, 38.1% of the surgeons with extensive training considered it a limiting factor compared with 60.7% (p = 0.029) of those without prior training. Among those without previous training, 61% cited a lack of financial support or encouragement from their department as the reason. Additionally, 65% of the surgeons considered the lack of basic instruments a limiting factor. Although 95% of the participants agreed that simulation training is indispensable, pediatric surgery fellowship programs in Brazil do not include a standardized curriculum or mandatory training in MIS, and only 47% reported providing training space for their current fellows. Conclusion: A combination of technological, technical, and epistemological barriers hinders the implementation of pediatric MIS. Despite its limitations, this study serves as a foundational guide for future analysis and overcoming the identified barriers. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to provide a comprehensive analysis of ocular biometric parameters in pediatric patients with cataracts to optimize surgical outcomes. By evaluating various biometric data, we seek to enhance the decision-making process for intraocular lens (IOL) placement, particularly with advanced technologies like femtosecond lasers. Methods: This retrospective comparative study included pediatric patients with cataracts who underwent ocular biometric measurements and cataract extraction with anterior vitrectomy at the Medical University of Vienna between January 2019 and December 2021. Parameters measured included corneal diameter (CD), axial length (AL), corneal thickness (CT) and flat and steep keratometry (Kf and Ks). The study explored the correlations between these parameters and IOL placement. Results: A total of 136 eyes from 68 pediatric patients were included in the study. Significant positive correlations were found between corneal diameter, age and AL. The mean CD was 11.4 mm, mean AL was 19.5 mm, CT was 581.2 ± 51.8 µm, Kf was 7.76 ± 0.55 mm and Ks 7.41 ± 0.59 mm, respectively. Older pediatric patients with larger corneal diameters and longer ALs were more likely to receive in-the-bag IOL implantation. Conversely, younger patients often required alternative IOL placements or remained aphakic. Our data indicated that over 95% of the study population and all patients aged one year and older had a corneal diameter of 10 mm or larger. Conclusions: Detailed ocular biometric analysis is crucial for optimizing both surgical outcomes and postoperative care in pediatric cataract patients. The positive correlations between CD, age and AL underline the importance of individualized surgical planning tailored to each patient's unique anatomical features. Additionally, our findings suggest that the use of a femtosecond laser is both feasible and safe for pediatric patients aged one year and older, potentially offering enhanced surgical precision and improved outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Accidental caustic burns of the esophagus in children represent a significant global health challenge, often necessitating esophageal reconstruction. The aim of this study is to compare the efficacy and morbidity related to esophagus replacement with colonic and gastric tube transplants in a pediatric population followed for caustic stenosis. Methods: This retrospective study was conducted at a tertiary pediatric surgery unit for children treated from January 1989 to December 2022. We compared colonic and gastric tube esophageal replacement. Short term (within 30 days) and mid-term outcomes and complications were reviewed. Statistical evaluation was considered using a Chi-square test for categorical data analysis. Results: A total of 124 children with caustic esophageal burns were included. Among them, 23 (18.5%) had a gastric tube transplant for esophagus replacement and 101 (81.5%) a colonic transplant. During surgical intervention, we found a significantly higher risk of complications when using a colonic transplant (34%, p < 0.001). There was no significant statistical difference in postoperative short term and mid-term complications between the two techniques. Twenty-six (26%) of the children required a reoperation, with a higher risk in the gastric tube transplant group (p < 0.001). Endoscopic dilatation after surgery was also performed on a higher number of children who had received a gastric tube transplant (p = 0.005). Overall, 97.6% recovered full normal oral feeding. Conclusions: We found that colonic and gastric tube replacement are both good options for pediatric esophageal replacement after a caustic injury and show effectiveness over time. Gastric tube transplants carried a slightly higher risk of reoperations and a higher number of dilatations post-surgery. However, our groups are not really comparable, due to the much higher number of colonic transplants. Both surgical options have to be considered during surgery, and the choice depends on the anatomy of the patient. Our future research will focus on assessing long term quality of life and the potential risk of neoplastic complications. [ABSTRACT FROM AUTHOR]

Purpose: Recently, children with trisomy 18 have been receiving more active treatment for malignancies. We report herein seven cases complete resection was achieved, and discuss multidisciplinary treatment for hepatoblastoma in patients with trisomy 18. Method: The medical records of children with trisomy 18 who were treated at the study center between 2010 and 2023 were reviewed. Result: Six of 69 patients had hepatoblastoma development, and three of these underwent multidisciplinary treatment. In addition, 6 patients had been referred by another hospital for treatment, and four of these underwent multidisciplinary treatment. Among the seven patients who underwent multidisciplinary treatment, three, two, and two were categorized in Pre-treatment Extent of Disease (PRETEXT) classification group I, II, and III, respectively. Neoadjuvant chemotherapy resulting in tumor reduction was performed in three cases. In all the cases, complete resection was achieved with pathologically safe margins. Perioperative complications included circulatory failure in one case and bile leakage in two cases. Adjuvant chemotherapy was administered in four cases. The postoperative observation period ranged from 3 months to 11 years, and all the patients are recurrence-free. Conclusion: Children with trisomy 18 complicated with hepatoblastoma whose cardiopulmonary conditions are stable may be good candidates for chemotherapy and surgery. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Treatment with glucocorticoids following paediatric cataract surgery is crucial to prevent inflammation, but may lead to secondary glaucoma, and hypothalamic–pituitary–adrenal axis suppression. We wish to compare glaucoma outcomes following high‐dose and low‐dose glucocorticoid treatment after paediatric cataract surgery.This cohort study included Danish children undergoing cataract surgery before 10 years of age, receiving either a low‐dose or high‐dose postoperative glucocorticoid treatment. Case identification and collection of a standardized dataset were retrospective, from 1 January 2010 to 31 December 2016, and prospective thereafter, until 31 December 2021. High‐dose treatment included 0.5–1.0 mg subconjunctival depot dexamethasone or methylprednisolone, followed by 6–8 drops of dexamethasone for 1 week, tapered by one drop weekly. Low‐dose treatment included 6 drops for 3 days, followed by 3 drops for 18 days. Sustained (>3 months) ocular hypertension or glaucoma was compared between the two groups.Overall, 267 children (388 eyes) were included in the study. Ninety‐five children (133 eyes) had received high‐dose treatment and had a median follow‐up time of 89 months (IQR: 57.2–107.4), while 173 children (255 eyes) had received the low‐dose treatment and had a median follow‐up time of 40.5 months (IQR: 22.9–60.4). Survival curves showed a lower risk of glaucoma in the low‐dose group for children with axial lengths ≥18 mm.Low‐dose glucocorticoid treatment was associated with a lower risk of glaucoma in children with axial lengths ≥18 mm. The same effect was not observed in children with shorter eyes. High‐dose glucocorticoid should be limited in children undergoing cataract surgery. [ABSTRACT FROM AUTHOR]

Purpose: Salivary cortisol (SalC) and low to high pulse ratio (LHR) were used for evaluating perioperative stresses in children. Methods: Children aged 6 months-16 years having elective general (thoracic/abdominal) or minor (open/minimally invasive: MI) procedures underwent pulse monitoring during AM (08:00–12:00) and PM (17:00–21:00) saliva collections from the day before surgery (S-1) to 3 days after surgery (S + 3). SalC/LHR were correlated with age, sex, caregiver attendance, operative time, and surgical site/approach using mixed model analysis and face/numeric pain rating scales (FRS/NRS). Results: Mean ages (years): minor-open (n = 31) 4.7 ± 2.0, thoracic-open (n = 2) 8.7 ± 4.9, thoracic-MI (n = 6) 9.6 ± 6.1, abdominal-open (n = 14) 4.3 ± 4.1, and abdominal-MI (n = 32) 8.0 ± 5.0. Postoperative SalC increased rapidly and decreased to preoperative levels by S + 3 (p < 0.001). LHR increased slightly without decreasing (p = 0.038). SalC correlated positively with operative time (p = 0.036) and open surgery (p = 0.0057), and negatively with age (p < 0.0001) and caregiver attendance (p < 0.001). SalC correlated positively with FRS (n = 51) at S + 2(PM) (p = 0.023), S + 3(AM) (p < 0.001), S + 3(PM) (p = 0.012) and NRS (n = 34) at S + 1(AM) (p = 0.031), S + 3(AM) (p < 0.044). LHR positively correlated with age (p = 0.0072), female sex (p = 0.0047), and caregiver attendance (p = 0.0026). Postoperative SalC after robotic-assisted MI was significantly lower than after open surgery at S + 2(AM) (p = 0.020). Conclusions: SalC correlated with pain. Caregiver attendance effectively alleviated stress. [ABSTRACT FROM AUTHOR]

Objectives: While significant evidence supports the benefits of normothermic cardiopulmonary bypass (NCPB) over hypothermic techniques, many institutions in developing countries, including ours, continue to employ hypothermic methods. This study aimed to assess the early postoperative outcomes of normothermic cardiopulmonary bypass (NCPB) for complete surgical repair via the Tetralogy of Fallot (TOF) within our national context. Methods: We conducted this study in the Pediatric Cardiac Intensive Care Unit (PCICU) at the University Children's Hospital. One hundred patients who underwent complete TOF repair were enrolled and categorized into two groups: the normothermic group (n = 50, temperature 35–37 °C) and the moderate hypothermic group (n = 50, temperature 28–32 °C). We evaluated mortality, morbidity, and postoperative complications in the PCICU as outcome measures. Results: The demographic characteristics were similar between the two groups. However, the cardiopulmonary bypass (CPB) time and aortic cross-clamp (ACC) time were notably longer in the hypothermic group. The study recorded seven deaths, yielding an overall mortality rate of 7%. No significant differences were observed between the two groups concerning mortality, morbidity, or postoperative complications in the PCICU. Conclusions: Our findings suggest that normothermic procedures, while not demonstrably effective, are safe for pediatric cardiac surgery. Further research is warranted to substantiate and endorse the adoption of this technique. [ABSTRACT FROM AUTHOR]

Background: Nurses provide care to meet the complex needs of patients in the increasing workload in the health system and are at risk of compassion fatigue. The concept of compassion fatigue has begun drawing attention in the last decade, as it negatively affects nurses' physical and mental health, job performance and satisfaction, and therefore patient care quality. Objectives: This study was to examine compassion fatigue and predictive factors in paediatric surgery nurses. Participants and research context: The study was cross-sectional, predictive and quantitative. It was conducted with the 135 paediatric surgery nurses. The data were sent to the email addresses of the members via Google Survey. Research data were collected with the Nurse Information Form, Compassion Fatigue Scale, Life Satisfaction Scale and Multidimensional Perceived Social Support Scale. Ethical considerations: After obtaining the approval of the University's ethics committee, the study was carried out after obtaining participants' informed written and verbal consent. Results: There was a difference between the level of compassion fatigue according to the paediatric surgery unit that worked the longest and the thought of changing their profession. Burn unit nurses and nurses who were considering changing professions have higher compassion fatigue scores. When the predictors of compassion fatigue were examined, the thought of changing the nursing profession and life satisfaction were significant predictors of compassion fatigue. The thought of changing the nursing profession and life satisfaction explained 22% of compassion fatigue. The same variables and the longest working period of the paediatric surgery unit were the estimators of the level of occupational burnout; explaining 29% of occupational burnout. Conclusions: Compassion fatigue, life satisfaction and perceived social support of paediatric surgery nurses are moderate. Compassion fatigue is affected by working time, the thought of changing the profession, life satisfaction and perceived social support. [ABSTRACT FROM AUTHOR]

Background/Objectives: Otosclerosis is a relatively uncommon condition that causes conductive hearing loss in children. The preferred treatment for adults is stapedotomy, while for individuals under 18 years old, there is an ongoing discussion about the best treatment approach. Thus, the surgical procedure for the stapes in pediatric patients continues to be a subject of debate. This study aimed to evaluate the results of stapes surgery in children, trying to understand, based on our results, whether this is actually the most suitable option. Methods: The study included 18 patients who underwent surgery between January 2013 and December 2023. The patients' ages ranged from 11 to 18 years, with an average age of 14.7. Out of the total 21 surgeries, three patients opted for bilateral surgery. Pre- and post-operative data were compared, focusing on the mean air conduction (AC) and bone conduction (BC) thresholds at frequencies of 0.5, 1, 2, and 4 kHz. Additionally, pre-operative thresholds and the post-operative air–bone gap (ABG) were examined. Results: After a year, the air–bone gap was effectively reduced to 10 dB or less in 94% of the 21 cases, and to 20 dB or less in 98% of all cases. Conclusions: Our results and research in the field have consistently shown that stapedotomy, when conducted by skilled otosurgeons, is a reliable and successful procedure for a considerable number of patients. The outcomes it generates are similar to those achieved through the procedure conducted during adulthood. [ABSTRACT FROM AUTHOR]

Purpose: The coronavirus disease 2019 (COVID-19) pandemic limited the delivery of medical resources. Although surgeries are triaged according to disease severity and urgency, a delay in diagnosis and surgery can be detrimental. We conducted this study to analyze data on the impact of the COVID-19 pandemic on pediatric surgery for different diseases or disorders. Methods: We compiled and compared data on pediatric surgical cases from 2018 to 2020, using the National Clinical Database. The number of diseases, severity, complication rates, mortality rates by disease/disorder, and the COVID-19 pandemic areas were analyzed. Results: The total number of cases of pediatric surgery in 2018, 2019, and 2020 was 50,026, 49,794, and 45,621, respectively, reflecting an 8.8% decrease in 2020 from 2018 and an 8.4% decrease in 2020 from 2019. A decrease was observed when the number of patients with COVID-19 was high and was greater in areas with a low infection rate. There was a marked decrease in the number of inguinal hernia cases. The number of emergency room visits and emergency surgeries decreased, but their relative proportions increased. Conclusions: The COVID-19 pandemic decreased the number of pediatric surgeries, reflecting the limitations of scheduled surgeries and infection control measures. [ABSTRACT FROM AUTHOR]

In this paper, we summarize the current knowledge on refractive surgery performed in the myopic pediatric population. We describe the main concerns about refractive surgery in myopic children and the indications for refractive surgery in this age group. We present a range of surgical procedures that are being used for the management of unilateral/bilateral myopia in children: corneal refractive surgery (PRK, LASEK, LASIK, FS-LASIK and SMILE) and intraocular refractive surgery (phakic intraocular lens implantation, refractive lens exchange or clear lens extraction), with both their advantages and drawbacks. We also describe the various complications and measures to prevent them. [ABSTRACT FROM AUTHOR]

Introduction: Children mortality was mostly dominated by deaths in the early life, some were attributed to congenital abnormalities. Access to pediatric surgical services, represented in the form of pediatric surgeon workforce density (PSWD), were expected to contribute to the reduction of the under-five mortality rate (U5MR). However, there still no established study that determine the ideal number of pediatric surgeons worldwide, especially in Indonesia. This study aims to calculate the optimal ratio of pediatric surgeon in Indonesia based on U5MR and PSWD. Method: This study was a quantitative study using cross-sectional design by processing secondary data from the Seventh Indonesian Demographic Health Survey (IDHS 7th). The research sample consists of 36,665 child mortality records that were collected using two-stage stratified cluster sampling technique. Variables used in this study were PSWD and U5MR, obtained from Indonesian Pediatric Surgery Association (PERBANI) and 7th IDHS, respectively. The data were analyzed using spearman and regression test. Result: The average U5MR and PSWD across 34 provinces in Indonesia were 32/8.89, 30/23.5, 31/7.98, 45/7.19, 47/3.25, and 80/6.36 for Sumatra, Java-Bali, Kalimantan, Sulawesi, Maluku-Nusa Tenggara, and Papua region respectively. PSWD strongly correlated with U5MR with Spearman coefficient -0.582 (p=0.000) and identified the value of PSWD by 51 as the threshold to reduce the U5MR optimally. Conclusion: The optimal ratio of pediatric surgeon in Indonesia based on children mortality rate was 1: 1,960. Currently, average of PSWD in Indonesia still inadequate to meet the criteria for reducing child mortality optimally. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric surgical cases pose significant challenges to Indonesia’s healthcare system. Understanding patient profiles, particularly at tertiary levels, is crucial for improving outcomes and guiding targeted interventions. Methods: Using a retrospective cohort design with statistical analysis, this study focused on a single pediatric surgical center in Indonesia. Data were extracted and analyzed from the Big Data Universitas Gadjah Mada Academic Health System, covering pediatric surgical cases admitted between 2017 and 2021. Results: In a five-year analysis involving 1457 pediatric surgical cases, a male-to-female ratio of 3:1 (75.1% and 29.5%) was identified. Patient ages spanned from 0 to 17 years, with a median age of 9.5 years. Hospital stays reached a maximum of 46 days, ICU stays at 22 days, and the mortality rate stood at 0.2%. Diagnoses were categorized into nine major groups, predominantly featuring congenital anomalies. The top five cases included hypospadias (14%), Hirschsprung’s disease (12%), undescended testicle (7%), phimosis and paraphimosis (7%), and inguinal hernia (5%). Trauma cases contributed less to the overall findings. Conclusion: There is a higher burden of congenital anomalies than other diseases in this analysis. The findings are a crucial foundation for evidence-based policies, enhanced clinical decision-making, and further research to optimize pediatric surgical care and ultimately improve patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Anorectal malformation (ARM) is one of the most common congenital anomalies found in pediatric surgery. The consensus asserts that fecal continence represents the most crucial endpoint in patients with anorectal malformations post-definitive surgery. We aimed to analyze the functional outcomes in ARM patients after a definitive surgery using Rintala scoring. Methods: This study was a retrospective design using medical records of ARM patients who underwent a definitive surgery at our institution from 2012 to 2016. Results: Forty-five ARM patients were ascertained in this study, of whom 25 were males and 20 were females. There are 66.7% of patients with high lesions and 33.3% of patients with low lesions. Most patients showed the ability to withhold defecation and experience the urge to defecate (48.9%) and defecation frequency of every day or twice a day (66.7%). Soiling was identified in 11.1% of subjects, while constipation was found in 22.2% of patients. None of the patients revealed accidents and social problems. High lesion ARM patients showed worse for having the ability to withhold defecation/sensation of the urge to defecate (OR=5.29, 95% CI=1.44-19.45) than low lesion ARM subjects (p=0.010). In addition, high lesion ARM patients showed a higher risk of having abnormal Rintala score (OR=5.11, 95% CI=1.33-19.72) than low lesion ARM subjects (p=0.014). Conclusion: Our study shows relatively good functional outcomes of ARM patients following definitive surgery. High lesions of ARM might affect the ability to hold back defecation, feels the urge to defecate, and the overall Rintala score in ARM patients after definitive surgery [ABSTRACT FROM AUTHOR]

Importance: Cataract is one of the leading causes of childhood blindness in Africa. The management of this condition requires timely surgical extraction of the cataractous lens with immediate optical correction and long-term follow-up to monitor visual improvement and manage complications that may arise. This review provides an opportunity to benchmark outcomes and to shed light on the reasons for those outcomes. Objectives: To review the published literature and report on the outcomes of paediatric cataract surgery with intraocular lens insertion in sub-Saharan Africa. Data source: The EMBASE, PubMed, Scopus, and Web of Science were searched for relevant articles. Study selection: We included all published primary studies from sub-Saharan Africa on cataract surgery outcomes in children aged 0–16 years with primary intraocular lens implantation conducted between 1990 and 2020. Eligible studies were those published in English or for which an English translation was available. In addition, reviewers screened the reference lists of all studies included in the full-text review for eligible studies. During the review, studies fitting the inclusion criteria above except for having been conducted in middle and high-income countries were tagged and placed in a comparison arm. Data extraction and synthesis: Study eligibility was determined by two independent reviewers, and data extraction was conducted by one reviewer with entries checked for accuracy by another reviewer. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines for data synthesis were followed. The Joanna Briggs Institute (JBI) critical appraisal checklist was used for quality appraisal of the studies. The statistical software R was used in the analysis, and data were pooled using a random-effects model. Forest plots were generated using the R package 'metafor'. Main outcomes and measures: The primary outcome was visual acuity (VA) after cataract surgery and the proportions of eyes that achieved good, borderline, or poor visual outcome according to the World Health Organisation (WHO) categorisation of post-operative visual acuity. The secondary outcome measures reported included lag time to surgery, rates of follow-up, and rate of complications. Results: Eight out of 4763 studies were eligible for inclusion in this review, and seven were included in the quantitative analysis. There was a male preponderance in the study population, and the mean age at the time of cataract surgery ranged from 3.4 to 8.4 years. Visual outcomes were available for short-term visual outcomes (1 to 6 months) as the studies had a significant loss to follow-up. The pooled proportion of eyes that achieved a good visual acuity (i.e. equal to or greater than 6/18) in the short-term period was 31% (CI, 20–42). The comparative studies from middle and high-income countries reported proportions ranging from 41 to 91%, with higher thresholds for good visual acuity of 6/12 and 6/15. Conclusion and relevance: This review reports that there is a lower proportion of eyes with good outcomes after undergoing paediatric cataract surgery in sub-Saharan Africa than in middle- and high-income countries. Furthermore, this review states that there is a high proportion of patients lost to follow-up and suboptimal refractive correction and amblyopia treatment after paediatric cataract surgery. [ABSTRACT FROM AUTHOR]

BACKGROUND: No study has contextualized the aggregate human costs attributable to disparities in pediatric postsurgical mortalities in the United States, a critical step needed to convey the scale of racial inequalities to clinicians, policymakers, and the public. METHODS: We conducted a population-based study of 673 677 children from US hospitals undergoing intermediate to high-risk surgery between 2000 and 2019. We estimated the excess deaths that could be avoided if Black and Hispanic children had comparable mortality rates to white children. We estimated the mortality reduction required to eliminate disparities within the next decade. We finally evaluated the impact of policy changes targeting a modest annual 2.5% reduction in disparity-attributable mortality. RESULTS: During 2000 to 2019, risk-adjusted postoperative mortality trended consistently higher for both Black (adjusted RR [aRR]: 1.42, 95% confidence interval [CI]: 1.36-1.49) and Hispanic children (aRR: 1.22, 95% CI: 1.17-1.27) than for white children. These disparity gaps were driven by higher mortality in Black and Hispanic children receiving surgery in nonteaching hospitals (Black versus white aRR: 1.63, 95% CI: 1.38-1.93; Hispanic versus white aRR: 1.50, 95% CI: 1.33-1.70). There were 4700 excess deaths among Black children and 5500 among Hispanic children, representing. 10 200 (average: 536 per year) excess deaths among minoritized children. Policy changes achieving an annual 2.5% reduction in postoperative mortality would prevent approximately 1100 deaths among Black children in the next decade. CONCLUSIONS: By exploring the solution, and not just the problem, our study provides a framework to reduce disparities in pediatric postoperative mortality over the next decade. [ABSTRACT FROM AUTHOR]

Pathogenic variants in COL4A1 , encoding the α chain of type IV collagen, have been associated with cerebrovascular pathology as well as malformations of cortical development, thereby causing structural epilepsy. This case illustrates successful resective epilepsy surgery in a 12-month-old girl with left occipital focal cortical dysplasia (FCD) associated with a heterozygous splice-donor variant in COL4A1. She presented with drug-resistant focal epilepsy with daily seizures from the age of 2 months, refractory to several combinations of antiseizure medications, as well as mild right-sided hemiparesis and developmental delay. All presurgical diagnostic modalities, including ictal and interictal electroencephalography, magnetic resonance imaging, and ictal fluorodeoxyglucose positron emission tomography, showed congruent findings, pointing toward one single left occipital epileptogenic zone (EZ). We performed a left occipital lobectomy, using intraoperative electrocorticography to confirm the boundaries of the EZ. After surgery, the patient has remained seizure free, and both cognitive and motor developments have improved. Histopathology of the resected brain tissue showed FCD type Ia. Resective epilepsy surgery can have a very good outcome, also in patients with genetic mutations in COL4A1 , constituting a less invasive option than the previously used more radical surgical procedures such as hemispherectomy. [ABSTRACT FROM AUTHOR]

Fast-track or enhanced recovery after surgery (ERAS) is a care pathway for surgical patients based on a multidisciplinary team approach aimed at optimising recovery without increasing risk with protocols based on scientific evidence, which is monitored continuously to ensure compliance and improvement. These protocols have been shown to reduce the duration of postoperative mechanical ventilation and intensive care unit (ICU) length of stay (LOS) following paediatric cardiac surgery. We present the first structured implementation of ERAS in paediatric cardiac surgery in Australia. All patients enrolled in the ERAS pathway between October 2019 and July 2023 were identified. Demographic and perioperative data were collected retrospectively from hospital records for patients operated before June 2021 and prospectively from June 2021. A control group (non-ERAS) was identified using propensity matching from patients who underwent similar procedures and were not enrolled in the ERAS pathway (prior to October 2019). Patients were matched for age, weight, and comprehensive Aristotle score. Outcomes of interest were duration of postoperative mechanical ventilation, ICU LOS, readmission to the ICU, hospital LOS, cardiac reintervention rate, postoperative complication rate, and number of 30-day readmissions. Of 1,084 patients who underwent cardiac surgery during the study period (October 2019–July 2023), 121 patients (11.2%) followed the ERAS pathway. The median age at the time of surgery was 4.8 years (interquartile range [IQR] 2.8–8.8 years). The most common procedure was the closure of atrial septal defect (n=58, 47.9%). The median cardiopulmonary bypass and cross-clamp times were 40 min (IQR 28–53.5 minutes) and 24.5 min (IQR 13–34 minutes) respectively. The majority were extubated in the operating theatre (n=108, 89.3%). The median ICU and hospital LOS were 4.5 hrs (IQR 4.1–5.6 hours) and 4 days (IQR 4–5 days) respectively. None of the patients required readmission to the ICU within 24 hrs of discharge from the ICU. Three (3) patients (2.5%) required reintervention. When compared with the non-ERAS group, the duration of postoperative mechanical ventilation, ICU and hospital LOS were significantly lower in the ERAS group. There was no significant difference in the ICU readmission rate, reintervention rate, complication rate, and number of 30-day readmissions between both groups. ERAS after paediatric cardiac surgery is feasible and safe in select patients with low preoperative risk. This pathway reduces the duration of postoperative mechanical ventilation, ICU and hospital LOS without increasing risks, enabling the optimisation of resources. [ABSTRACT FROM AUTHOR]

Introduction: Optimizing perioperative analgesia in patients undergoing abdominal surgery remains a challenge given the side effects of narcotics and the potential for abuse. While transversus abdominis plane block has been shown to improve clinical outcomes, such as decreased opioid consumption and pain scores among adult patients, there is limited data regarding its efficacy for pediatric patients. This study evaluates efficacy amongst pediatric patients undergoing landmark-guided transversus abdominis plane (LTAP) during laparoscopic appendectomy. Methods: A retrospective chart review of patients, ages 0-18 years old, who underwent laparoscopic appendectomy for uncomplicated appendicitis at a single institution from January 2021 to December 2022 was conducted. Pearson's chi-square test or Fisher's exact test and Welch's t test were used to assess differences between the two cohorts for categorical and continuous variables, respectively. Results are statistically significant at P <.05. Results: Of the 90 patients who met inclusion criteria, 40% (n = 36) underwent LTAP block. Those with LTAP block had a shorter average operative time than those without LTAP block (.6 vs.7 hours; P =.009). Similarly, patients with LTAP block had a shorter average time to discharge (4.1 vs 11.0 h; P =.039). There were no other statistically significant differences in postoperative outcomes including narcotic use between both cohorts. Discussion: Landmark-guided transversus abdominis plane blocks did not increase operative times yet reduced time to discharge for pediatric patients who underwent laparoscopic appendectomy at our institution. Larger studies are needed to evaluate the relationship between LTAP administration and postoperative narcotic consumption to make clinical recommendations. [ABSTRACT FROM AUTHOR]

Background: The rising prevalence of work-related musculoskeletal disorders has numerous physical, financial, and mental repercussions for surgeons. This study aims to establish whether the use of a wearable posture device can improve the operating time spent in suboptimal, high-risk postures. Methods: Surgeons were recruited in Phase 1 of this prospective randomised study and baseline postural data was obtained. In Phase 2, participants were randomised to receive either a traditional educational workshop or intraoperative vibrations from the device to correct postural lapses. During minor elective day cases, intraoperative postural data was collected and stratified by forward flexion angle, into five risk categories (negligible to very high). Participants' experience with the sensor was also assessed. Results: A total of 100 surgical procedures (Phase 1: n = 50; Phase 2: n = 50) were performed by eight surgeons of varying seniority. Exposure to the educational intervention increased time spent in suboptimal posture (Phase 1 vs. Phase 2); 47.5% vs. 67.8%, p = 0.05. However, the vibrational intervention significantly reduced this time; 50.0% vs. 20.7%, p = 0.005. Procedure type didn't influence posture although, laparoscopic interventions spent most time in negligible-risk postures; 47.7% vs. 49.3%, compared to open procedures. Surgical consultants spent less time in suboptimal posture compared to fellow/registrars; 30.3% vs. 72.6% (Phase 1) and 33.8% vs. 65.3% (Phase 2). Conclusion: Vibrational intervention from the device significantly decreased the time spent in suboptimal, high-risk postures. As procedure type wasn't correlated with postural changes, surgeon-specific factors in regulating posture are paramount. Finally, surgeon experience was positively correlated with improved surgical ergonomics. [ABSTRACT FROM AUTHOR]

Epilepsy surgery is an underutilized resource for children with drug-resistant epilepsy. Palliative and definitive surgical options can reduce seizure burden and improve quality of life. Palliative epilepsy surgery is often seen as a "last resort" compared to definitive surgical options. We compare patient characteristics between palliative and definitive epilepsy surgical patients and present palliative surgical outcomes from the Pediatric Epilepsy Research Consortium surgical database. The Pediatric Epilepsy Research Consortium Epilepsy Surgery database is a prospective registry of patients aged 0-18 years undergoing evaluation for epilepsy surgery at 20 pediatric epilepsy centers. We included all children with completed surgical therapy characterized as definitive or palliative. Demographics, epilepsy type, age of onset, age at referral, etiology of epilepsy, treatment history, time-to-referral/evaluation, number of failed anti-seizure medications (ASMs), imaging results, type of surgery, and postoperative outcome were acquired. Six hundred forty patients undergoing epilepsy surgery were identified. Patients undergoing palliative procedures were younger at seizure onset (median: 2.1 vs 4 years, P = 0.0008), failed more ASM trials before referral for presurgical evaluation (P =<0.0001), and had longer duration of epilepsy before referral for surgery (P =<0.0001). During presurgical evaluation, patients undergoing palliative surgery had shorter median duration of video-EEG data collected (P =0.007) but number of cases where ictal data were acquired was similar between groups. The most commonly performed palliative procedure was corpus callosotmy (31%), followed by lobectomy (21%) and neuromodulation (82% responsive neurostimulation vs 18% deep brain stimulation). Palliative patients were further categorized into traditionally palliative procedures vs traditionally definitive procedures. The majority of palliative patients had 50% reduction or better in seizure burden. Seizure free outcomes were significantly higher among those with traditional definitive surgeries, 41% (95% confidence interval: 26% to 57%) compared with traditional palliative surgeries and 9% (95% confidence interval: 2% to 17%). Rate of seizure freedom was 46% at 24 months or greater of follow-up in the traditional definitive group. Patients receiving palliative epilepsy surgery trialed more ASMs, were referred later after becoming drug resistant, and had longer gaps between drug resistance and epilepsy surgery compared with patients undergoing definitive epilepsy surgery. The extent of surgical evaluation is impacted if surgery is thought to be palliative. A majority of palliative surgery patients achieved >50% seizure reduction at follow-up, both in groups that received traditionally palliative and traditionally definitive surgical procedures. Palliative surgical patients can achieve greater seizure control and should be referred to an epilepsy surgery center promptly after failing two appropriate anti-seizure medications. [ABSTRACT FROM AUTHOR]

Traumatic injury is responsible for eight million childhood deaths annually. In Uganda, there is a paucity of comprehensive data describing the burden of pediatric trauma, which is essential for resource allocation and surgical workforce planning. This study aimed to ascertain the burden of non-adolescent pediatric trauma across four Ugandan hospitals. We performed a descriptive review of four independent and prospective pediatric surgical databases in Uganda: Mulago National Referral Hospital (2012-2019), Mbarara Regional Referral Hospital (2015-2019), Soroti Regional Referral Hospital (SRRH) (2016-2019), and St Mary's Hospital Lacor (SMHL) (2016-2019). We sub-selected all clinical encounters that involved trauma. The primary outcome was the distribution of injury mechanisms. Secondary outcomes included operative intervention and clinical outcomes. There was a total of 693 pediatric trauma patients, across four hospital sites: Mulago National Referral Hospital (n = 245), Mbarara Regional Referral Hospital (n = 29), SRRH (n = 292), and SMHL (n = 127). The majority of patients were male (63%), with a median age of 5 [interquartile range = 2, 8]. Chiefly, patients suffered blunt injury mechanisms, including falls (16.2%) and road traffic crashes (14.7%) resulting in abdominal trauma (29.4%) and contusions (11.8%). At SRRH and SMHL, from which orthopedic data were available, 27% of patients suffered long-bone fractures. Overall, 55% of patients underwent surgery and 95% recovered to discharge. In Uganda, non-adolescent pediatric trauma patients most commonly suffer injuries due to falls and road traffic crashes, resulting in high rates of abdominal trauma. Amid surgical workforce deficits and resource-variability, these data support interventions aimed at training adult general surgeons to provide emergency pediatric surgical care and procedures. [ABSTRACT FROM AUTHOR]

Purpose: Coherence analysis in electroencephalography (EEG) allows measurement of the degree of consistency of amplitude between pairs of electrodes. Theoretically, disconnective epilepsy surgery should decrease coherence between corresponding areas. The study aimed to evaluate postoperative changes in interhemispheric coherence values after corpus callosotomy (CC). Methods: Non-lesional, drug-resistant, generalized epilepsy patients who underwent total CC were retrospectively collected. To evaluate coherence, we divided the scalp interictal EEG into "baseline" and "discharge" states after excluding periods with artifacts. Interhemispheric coherence values were obtained between eight pairs of symmetrically opposite scalp electrodes in six different frequency bands. We analyzed both pre- and postoperative EEG sessions and calculated the percentage of difference (POD) in coherence values. Results: We collected 13 patients and analyzed 2496 interhemispheric coherence values. Preoperative coherence values differed significantly between baseline and discharge states (p = 0.0003), but postoperative values did not (p = 0.11). For baseline state, coherence values were decreased after CC and median POD was − 22.3% (p < 0.0001). Delta frequency showed the most decreased POD (-44.3%, p = 0.0009). Median POD was lowest in the Fp1-Fp2 pair of electrodes. For discharge state, coherence values were decreased after CC and median POD was − 24.7% (p < 0.0001). Delta frequency again showed the most decreased POD (-55.9%, p = 0.0016). Median POD was lowest in the F7-F8 pair. Conclusion: After total CC, interhemispheric coherence decreased significantly in both baseline and discharge states. The most decreased frequency band was the delta band, which may be used as a representative frequency band in future studies. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine the surgical indications and postoperative outcomes among pediatric patients with lobar cerebral cavernous malformations (CCMs). Methods: We retrospectively reviewed pediatric patients operated on for lobar CCM between March 2010 and August 2021. Indications for surgery included (1) intracranial hemorrhage, (2) symptomatic superficially located lesion, and (3) asymptomatic CCM in non-eloquent area in case of strong parental preferences. Patients presenting with seizures were assessed using Engel Epilepsy Surgery Outcome Scale. Results: Twenty-one patients were included. The predominant symptoms were seizures (57.1%), headaches (33.3%), and focal neurological deficits (23.8%). Patients were qualified for surgery due to symptomatic intracranial hemorrhage (47.6%), drug-resistant epilepsy (28.6%), and focal neurological deficits (9.5%). Three patients (14.3%) were asymptomatic. A gross total resection of CCM with the surrounding hemosiderin rim was achieved in all patients. The mean follow-up was 52 months. No patient experienced surgery-related complications. In all individuals with a preoperative first episode of seizures or focal neurological deficits, the symptoms subsided. All six patients with drug-resistant epilepsy improved to Engel classes I (67%) and II (33%). Conclusion: Surgical removal of symptomatic lobar CCMs in properly selected candidates remains a safe option. Parental preferences may be considered a sole qualifying criterion for asymptomatic lobar CCM excision. [ABSTRACT FROM AUTHOR]