Pub Date : 2025-02-05DOI: 10.1016/j.jpedsurg.2025.162238
Sherif Emil, Colleen Fant, Erik N Hansen, Nicole Chicoine, Michelle Niescierenko, Robin T Petroze, Sarah Greenberg, Bindi Naik-Mathuria, Saleem Islam, Jennifer H Aldrink
Background: Global pediatric surgery has developed into a sophisticated system of teaching, training, sustaining, and serving, in order to equip low- and middle-income countries to offer the best possible care for their children.
Methods: The American Academy of Pediatrics section on surgery presented a multidisciplinary symposium highlighting and educating the members on current practice models and various opportunities for engagement, presented by experts devoted to these principles.
Results: Topics surrounding the history and development of global surgery, collaborative models for sustained service and education, faith-based surgical training opportunities, trainee engagement including barriers and challenges, and capacity building on a global scale were topic of discussion, and are highlighted in this manuscript.
Conclusion: Providing equitable pediatric surgical care worldwide remains a challenge that mandates attention and is essential to achieving health equity and improving the quality of life for children and their families worldwide.
{"title":"Recent Progress and Current Challenges in the Care of the Child Around the World.","authors":"Sherif Emil, Colleen Fant, Erik N Hansen, Nicole Chicoine, Michelle Niescierenko, Robin T Petroze, Sarah Greenberg, Bindi Naik-Mathuria, Saleem Islam, Jennifer H Aldrink","doi":"10.1016/j.jpedsurg.2025.162238","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162238","url":null,"abstract":"<p><strong>Background: </strong>Global pediatric surgery has developed into a sophisticated system of teaching, training, sustaining, and serving, in order to equip low- and middle-income countries to offer the best possible care for their children.</p><p><strong>Methods: </strong>The American Academy of Pediatrics section on surgery presented a multidisciplinary symposium highlighting and educating the members on current practice models and various opportunities for engagement, presented by experts devoted to these principles.</p><p><strong>Results: </strong>Topics surrounding the history and development of global surgery, collaborative models for sustained service and education, faith-based surgical training opportunities, trainee engagement including barriers and challenges, and capacity building on a global scale were topic of discussion, and are highlighted in this manuscript.</p><p><strong>Conclusion: </strong>Providing equitable pediatric surgical care worldwide remains a challenge that mandates attention and is essential to achieving health equity and improving the quality of life for children and their families worldwide.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162238"},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.jpedsurg.2025.162214
Zhuyuan Si , Zhixin Zhang , Shengqiao Zhao , Tianran Chen , Ruofan Wang , Guoyin Zou , Chong Dong , Kai Wang , Chao Sun , Weiping Zheng , Xinzhe Wei , Zhongyang Shen , Wei Gao
Background
The definition of early allograft dysfunction (EAD) varies, and has hardly been studied in pediatric transplantation (pLT) since the adult EAD definition is not easily applicable to pLT.
Methods
A retrospective analysis was conducted on consecutive pLT patients aged <18 at the Department of Pediatric Transplantation of Tianjin First Central Hospital from April 2013 to December 2022. The definition of EAD explored in this study is (1) international normalized ratio ≥2.8 on day 1 and aspartate aminotransferase >1500 IU/mL within the first 7 days or (2) total bilirubin ≥5 mg/dL on day 7. The overall survival of patients and graft survival at 90 days after surgery were compared between this new definition and the adult EAD definition.
Results
A total of 1620 pLT recipients were included in the study, of which 179 (11.0 %) recipients met the new definition of EAD for pLT. Twenty-five (13.97 %) died and 37 (20.67 %) graft lost within 90 days. The RR_death under Olthoff’s EAD definition and our EAD definition are 3.45 and 9.57, respectively; The RR_graft_loss under Olthoff’s EAD definition and our EAD definition are 4.18 and 11.48, respectively. A total of 97 (18.98 %) of 511 recipients who received deceased donor liver transplantation (DDLT) met the new definition of EAD, 18 (18.56 %) died and 29 (29.90 %) graft lost within 90 days. In DDLT group, the RR_death under Olthoff’s EAD definition and our EAD definition are 2.29 and 10.98, respectively; The RR_graft_loss under Olthoff’s EAD definition and our EAD definition are 2.34 and 11.24, respectively.
Conclusion
The broadly used Olthoff’s EAD definition in adult liver transplantation is unsuitable for pLT use. The EAD definition established in this study is more suitable for patients <18 years old who received pLT, especially those <18 years old who received DDLT.
{"title":"Definition, Prognosis, and Complication Analysis of Early Allograft Dysfunction in Pediatric Liver Transplantation: A Retrospective Cohort Study","authors":"Zhuyuan Si , Zhixin Zhang , Shengqiao Zhao , Tianran Chen , Ruofan Wang , Guoyin Zou , Chong Dong , Kai Wang , Chao Sun , Weiping Zheng , Xinzhe Wei , Zhongyang Shen , Wei Gao","doi":"10.1016/j.jpedsurg.2025.162214","DOIUrl":"10.1016/j.jpedsurg.2025.162214","url":null,"abstract":"<div><h3>Background</h3><div>The definition of early allograft dysfunction (EAD) varies, and has hardly been studied in pediatric transplantation (pLT) since the adult EAD definition is not easily applicable to pLT.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on consecutive pLT patients aged <18 at the Department of Pediatric Transplantation of Tianjin First Central Hospital from April 2013 to December 2022. The definition of EAD explored in this study is (1) international normalized ratio ≥2.8 on day 1 and aspartate aminotransferase >1500 IU/mL within the first 7 days or (2) total bilirubin ≥5 mg/dL on day 7. The overall survival of patients and graft survival at 90 days after surgery were compared between this new definition and the adult EAD definition.</div></div><div><h3>Results</h3><div>A total of 1620 pLT recipients were included in the study, of which 179 (11.0 %) recipients met the new definition of EAD for pLT. Twenty-five (13.97 %) died and 37 (20.67 %) graft lost within 90 days. The RR_death under Olthoff’s EAD definition and our EAD definition are 3.45 and 9.57, respectively; The RR_graft_loss under Olthoff’s EAD definition and our EAD definition are 4.18 and 11.48, respectively. A total of 97 (18.98 %) of 511 recipients who received deceased donor liver transplantation (DDLT) met the new definition of EAD, 18 (18.56 %) died and 29 (29.90 %) graft lost within 90 days. In DDLT group, the RR_death under Olthoff’s EAD definition and our EAD definition are 2.29 and 10.98, respectively; The RR_graft_loss under Olthoff’s EAD definition and our EAD definition are 2.34 and 11.24, respectively.</div></div><div><h3>Conclusion</h3><div>The broadly used Olthoff’s EAD definition in adult liver transplantation is unsuitable for pLT use. The EAD definition established in this study is more suitable for patients <18 years old who received pLT, especially those <18 years old who received DDLT.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162214"},"PeriodicalIF":2.4,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143377652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study aimed to develop a prediction model for intestinal perforation from meconium ileus (MI) based on findings from plain X-ray images.
Methods
Very low birth weight (VLBW) infants with MI hospitalized in two tertiary centers between 2011 and 2022 were included in this study. We retrospectively reviewed clinical parameters and assessed plain X-ray images from 0 to 5 days of age. The standardized transverse diameter of intestinal gas (STDI) was calculated by dividing the largest diameter of the intestinal gas by the distance from the upper edge of L1 to the lower edge of L4. We then compared the STDI of patients with and without intestinal perforation.
Results
Among 81 VLBW infants with MI, intestinal perforation occurred in 6 (7 %). Among known risk factors, significant differences were observed between the two groups regarding pregnancy-induced hypertension (p = 0.03), weeks of gestation (p < 0.01), birthweight (p = 0.02), and indomethacin administration (p < 0.01). The mortality rate was higher in the perforation group (33 %) than in the non-perforation group (3 %) (p = 0.021). There were significant differences between the perforated and non-perforated groups regarding STDI except at 0 days of age. The positive and negative predictive cut-off values of STDI were respectively 0.08 and 0.93 on day 0, 0.30 and 1.00 on day 1, 0.33 and 0.97 on day 2, 0.33 and 1.00 on day 3, 0.29 and 1.00 on day 4, and 0.33 and 0.98 on day 5, respectively.
Conclusions
Our novel prediction model, using STDI, predicted intestinal perforation in VLBW infants with MI.
{"title":"Prediction of Intestinal Perforation by Daily Radiographic Findings in Very Low Birth Weight Infants With Meconium Ileus","authors":"Yoshio Katsumata , Keita Terui , Ayako Takenouchi , Shugo Komatsu , Yunosuke Kawaguchi , Katsuhiro Nishimura , Naoko Mise , Gen Matsuura , Mamiko Endo , Yoshiteru Osone , Yuko Sonoda , Kazushi Yoshida , Tomoro Hishiki","doi":"10.1016/j.jpedsurg.2024.162076","DOIUrl":"10.1016/j.jpedsurg.2024.162076","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to develop a prediction model for intestinal perforation from meconium ileus (MI) based on findings from plain X-ray images.</div></div><div><h3>Methods</h3><div>Very low birth weight (VLBW) infants with MI hospitalized in two tertiary centers between 2011 and 2022 were included in this study. We retrospectively reviewed clinical parameters and assessed plain X-ray images from 0 to 5 days of age. The standardized transverse diameter of intestinal gas (STDI) was calculated by dividing the largest diameter of the intestinal gas by the distance from the upper edge of L1 to the lower edge of L4. We then compared the STDI of patients with and without intestinal perforation.</div></div><div><h3>Results</h3><div>Among 81 VLBW infants with MI, intestinal perforation occurred in 6 (7 %). Among known risk factors, significant differences were observed between the two groups regarding pregnancy-induced hypertension (<em>p</em> = 0.03), weeks of gestation (<em>p</em> < 0.01), birthweight (<em>p</em> = 0.02), and indomethacin administration (<em>p</em> < 0.01). The mortality rate was higher in the perforation group (33 %) than in the non-perforation group (3 %) (<em>p</em> = 0.021). There were significant differences between the perforated and non-perforated groups regarding STDI except at 0 days of age. The positive and negative predictive cut-off values of STDI were respectively 0.08 and 0.93 on day 0, 0.30 and 1.00 on day 1, 0.33 and 0.97 on day 2, 0.33 and 1.00 on day 3, 0.29 and 1.00 on day 4, and 0.33 and 0.98 on day 5, respectively.</div></div><div><h3>Conclusions</h3><div>Our novel prediction model, using STDI, predicted intestinal perforation in VLBW infants with MI.</div></div><div><h3>Levels of Evidence</h3><div>Level Ⅲ</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162076"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpedsurg.2024.162004
Jack H. Scaife , Christopher E. Clinker , Abigail J. Alexander , Stephanie E. Iantorno , R. Scott Eldredge , Robert A. Swendiman , Stephen J. Fenton , Katie W. Russell
Introduction
The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals that have implemented guidelines to optimize pediatric trauma care. The purpose of this study was to determine whether preventable transfer (PT) rates decreased following the establishment of the UTPN and what hospital characteristics were associated with decreased preventable transfers.
Methods
Children with traumatic injuries transferred from hospitals in the UPTN to the state’s only Level I Pediatric Trauma Center between 2013 and 2023 were retrospectively analyzed. A PT was a child discharged within 48 h of arrival without surgical intervention or advanced imaging studies. The main hospital-level outcome measure was an overall decrease in PT after the UPTN establishment in 2019.
Results
After 2019, 34 of the 46 hospitals meeting inclusion criteria saw a decrease in the percentage of PTs, while 12 saw an increase in PT rate, with an overall median change of −7 % (IQR -14 %, 0 %). We observed that hospitals with decreased PT had higher rates of PT before the establishment of the UPTN and had higher overall transfer volume than hospitals without a decreased PT rate. Can we put the overall p value in this?
Conclusion
Most hospitals were able to successfully decrease PT rates following the creation of the UPTN. More smaller hospitals did not successfully decrease PT, so more work may need to be done to target lower-volume hospitals.
{"title":"Association of Initiation of Statewide Pediatric Trauma Collaborative and Hospital Preventable Transfer Rates","authors":"Jack H. Scaife , Christopher E. Clinker , Abigail J. Alexander , Stephanie E. Iantorno , R. Scott Eldredge , Robert A. Swendiman , Stephen J. Fenton , Katie W. Russell","doi":"10.1016/j.jpedsurg.2024.162004","DOIUrl":"10.1016/j.jpedsurg.2024.162004","url":null,"abstract":"<div><h3>Introduction</h3><div>The Utah Pediatric Trauma Network (UPTN), established in 2019, is a collaboration of hospitals that have implemented guidelines to optimize pediatric trauma care. The purpose of this study was to determine whether preventable transfer (PT) rates decreased following the establishment of the UTPN and what hospital characteristics were associated with decreased preventable transfers.</div></div><div><h3>Methods</h3><div>Children with traumatic injuries transferred from hospitals in the UPTN to the state’s only Level I Pediatric Trauma Center between 2013 and 2023 were retrospectively analyzed. A PT was a child discharged within 48 h of arrival without surgical intervention or advanced imaging studies. The main hospital-level outcome measure was an overall decrease in PT after the UPTN establishment in 2019.</div></div><div><h3>Results</h3><div>After 2019, 34 of the 46 hospitals meeting inclusion criteria saw a decrease in the percentage of PTs, while 12 saw an increase in PT rate, with an overall median change of −7 % (IQR -14 %, 0 %). We observed that hospitals with decreased PT had higher rates of PT before the establishment of the UPTN and had higher overall transfer volume than hospitals without a decreased PT rate. Can we put the overall p value in this?</div></div><div><h3>Conclusion</h3><div>Most hospitals were able to successfully decrease PT rates following the creation of the UPTN. More smaller hospitals did not successfully decrease PT, so more work may need to be done to target lower-volume hospitals.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 162004"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142569030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The optimal balance between the graft volume (GV) and portal venous flow (PVF) in living donor liver transplantation (LDLT) is unclear. As lactate is mainly metabolized in the liver, perioperative lactate levels are reportedly a useful biomarker for early graft dysfunction (EGD). The present study analyzed perioperative lactate levels according to the PVF.
Methods
The PVF/GV (mL/min per 100 g GV) of 97 recipients from 1996 to 2022 was retrospectively classified as low (LPVF; PVF/GV ≤ 100, N = 29), moderate (MPVF; PVF/GV 100–250, N = 40), or high (HPVF; PVF/GV > 250, N = 28). Lactate levels were obtained preoperatively (L0), immediately after graft reperfusion (L1), 4 h after reperfusion (L2), and on postoperative day 3 (L3). The lactate clearances were then calculated.
Results
The lower the PVF/GV ratio, the younger the age at LDLT and the higher the graft-to-recipient weight ratio. The median L2 and L3 in the HPVF group were significantly higher than those in the other groups (p = 0.019 and p = 0.003, respectively). The median ΔL1 in the HPVF group was lower than that in the LPVF and MPVF groups (0.23 vs. 0.50, p < 0.0001 and 0.23 vs. 0.41, p = 0.011, respectively). ΔL1 was negatively correlated with the PVF/GV. Although no patient had EGD, three patients with HPVF with low ΔL1 developed small-for-size syndrome.
Conclusions
Graft hyperperfusion may delay the recovery of the graft function and result in poor lactate clearance. The combination of the PVF/GV and lactate clearance may be useful as a prognostic marker for optimal graft perfusion in LDLT.
Level of evidence
IV.
{"title":"Serum Lactate Clearance as a Predictive Biomarker for Optimal Graft Perfusion in Living Donor Liver Transplantation","authors":"Keisuke Kajihara, Toshiharu Matsuura, Yasuyuki Uchida, Maeda Shohei, Yukihiro Toriigahara, Yoshiaki Takahashi, Tatsuro Tajiri","doi":"10.1016/j.jpedsurg.2024.07.032","DOIUrl":"10.1016/j.jpedsurg.2024.07.032","url":null,"abstract":"<div><h3>Background</h3><div>The optimal balance between the graft volume (GV) and portal venous flow (PVF) in living donor liver transplantation (LDLT) is unclear. As lactate is mainly metabolized in the liver, perioperative lactate levels are reportedly a useful biomarker for early graft dysfunction (EGD). The present study analyzed perioperative lactate levels according to the PVF.</div></div><div><h3>Methods</h3><div>The PVF/GV (mL/min per 100 g GV) of 97 recipients from 1996 to 2022 was retrospectively classified as low (LPVF; PVF/GV ≤ 100, N = 29), moderate (MPVF; PVF/GV 100–250, N = 40), or high (HPVF; PVF/GV > 250, N = 28). Lactate levels were obtained preoperatively (L0), immediately after graft reperfusion (L1), 4 h after reperfusion (L2), and on postoperative day 3 (L3). The lactate clearances were then calculated.</div></div><div><h3>Results</h3><div>The lower the PVF/GV ratio, the younger the age at LDLT and the higher the graft-to-recipient weight ratio. The median L2 and L3 in the HPVF group were significantly higher than those in the other groups (p = 0.019 and p = 0.003, respectively). The median ΔL1 in the HPVF group was lower than that in the LPVF and MPVF groups (0.23 vs. 0.50, p < 0.0001 and 0.23 vs. 0.41, p = 0.011, respectively). ΔL1 was negatively correlated with the PVF/GV. Although no patient had EGD, three patients with HPVF with low ΔL1 developed small-for-size syndrome.</div></div><div><h3>Conclusions</h3><div>Graft hyperperfusion may delay the recovery of the graft function and result in poor lactate clearance. The combination of the PVF/GV and lactate clearance may be useful as a prognostic marker for optimal graft perfusion in LDLT.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161647"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141841380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpedsurg.2025.162234
Elizabeth Brits , Stephen Brown , Lezelle Botes , Joseph B. Sempa , Michael Pienaar
Background
Biliary atresia (BA) is a severe paediatric liver disease causing cirrhosis without prompt treatment. Aspartate aminotransferase-to-platelet ratio index (APRi), a non-invasive biomarker, shows promise in assessing fibrosis and cirrhosis severity, offering an alternative to liver biopsy. However, standardised criteria and research on APRi accuracy in paediatric BA, especially across diverse populations, remain limited.
Objectives
To assess the correlation between APRi values, liver fibrosis and cirrhosis severity in children with BA, evaluate APRi's diagnostic accuracy and clinical utility, and identify appropriate cut-off values for significant fibrosis and cirrhosis.
Methods
This systematic review and meta-analysis, conducted per PRISMA guidelines, evaluated non-invasive biomarkers for liver fibrosis in BA patients. Data were managed using REDCap and analysed with R software. Heterogeneity was assessed with the Cochrane Q test and I2 values.
Results
Fourteen studies (retrospective, prospective, and one cross-sectional) examined APRi and liver fibrosis in BA. APRi cut-off values for diagnosing fibrosis and cirrhosis ranged from 0.7 to 2.26 for advanced fibrosis (F3). The meta-analysis provided pooled means and 95% confidence intervals for APRi, assessing its diagnostic performance. Significant heterogeneity was noted in studies with favourable histology, while none was observed in those with unfavourable histology, highlighting variability in APRi values.
Conclusion
Limited patient numbers and significant heterogeneity across studies impeded the establishment of a definitive threshold for identifying unfavourable histology in BA. Consequently, APRi's clinical utility remains unclear. Further research is required to determine its precise role as a biopsy surrogate and in clinical decision-making during BA diagnosis.
Type of article
Study of diagnostic test.
Level of evidence
IV.
{"title":"Aspartate Aminotransferase-to-platelet Ratio Index (APRi) as Biomarker for Liver Damage in Biliary Atresia (BA): A Meta-analysis","authors":"Elizabeth Brits , Stephen Brown , Lezelle Botes , Joseph B. Sempa , Michael Pienaar","doi":"10.1016/j.jpedsurg.2025.162234","DOIUrl":"10.1016/j.jpedsurg.2025.162234","url":null,"abstract":"<div><h3>Background</h3><div>Biliary atresia (BA) is a severe paediatric liver disease causing cirrhosis without prompt treatment. Aspartate aminotransferase-to-platelet ratio index (APRi), a non-invasive biomarker, shows promise in assessing fibrosis and cirrhosis severity, offering an alternative to liver biopsy. However, standardised criteria and research on APRi accuracy in paediatric BA, especially across diverse populations, remain limited.</div></div><div><h3>Objectives</h3><div>To assess the correlation between APRi values, liver fibrosis and cirrhosis severity in children with BA, evaluate APRi's diagnostic accuracy and clinical utility, and identify appropriate cut-off values for significant fibrosis and cirrhosis.</div></div><div><h3>Methods</h3><div>This systematic review and meta-analysis, conducted per PRISMA guidelines, evaluated non-invasive biomarkers for liver fibrosis in BA patients. Data were managed using REDCap and analysed with R software. Heterogeneity was assessed with the Cochrane Q test and I<sup>2</sup> values.</div></div><div><h3>Results</h3><div>Fourteen studies (retrospective, prospective, and one cross-sectional) examined APRi and liver fibrosis in BA. APRi cut-off values for diagnosing fibrosis and cirrhosis ranged from 0.7 to 2.26 for advanced fibrosis (F3). The meta-analysis provided pooled means and 95% confidence intervals for APRi, assessing its diagnostic performance. Significant heterogeneity was noted in studies with favourable histology, while none was observed in those with unfavourable histology, highlighting variability in APRi values.</div></div><div><h3>Conclusion</h3><div>Limited patient numbers and significant heterogeneity across studies impeded the establishment of a definitive threshold for identifying unfavourable histology in BA. Consequently, APRi's clinical utility remains unclear. Further research is required to determine its precise role as a biopsy surrogate and in clinical decision-making during BA diagnosis.</div></div><div><h3>Type of article</h3><div>Study of diagnostic test.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 4","pages":"Article 162234"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143350216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Features Associated with Delayed Diagnosis of Appendicitis in Children: A Retrospective Analysis of 1411 Cases","authors":"Mohamed Zouari, Manel Belhajmansour, Oumaima Jarboui, Najoua Ben Kraiem, Riadh Mhiri","doi":"10.1016/j.jpedsurg.2024.161878","DOIUrl":"10.1016/j.jpedsurg.2024.161878","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161878"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142268557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpedsurg.2024.161990
Xiaopan Chang , Lu Liu , Jieqin Wang , Qifeng Liang , Jiankun Liang , Zhenyin Liu , Zhe Wen
Background
The categorization of intrahepatic portal venous system (IHPS) patterns using wedged hepatic venous portography (WHVP) has proven to be an effective tool in the preoperative evaluation of Rex recessus and in identifying pediatric patients with extrahepatic portal vein obstruction (EHPVO) who are suitable for meso-Rex bypass (MRB). Despite this classification system being proposed a decade ago, its clinical application remains underutilized.
Methods
A single-center retrospective study of 182 children with EHPVO was conducted between October 2014 and July 2023 when MRB was attempted. Data on demographics, etiology, imaging examinations, procedures, and follow-up were collected for 161 patients included. Two interventional radiologists used deVille’s method to classify patients into types A to E based on WHVP imaging, with interobserver agreement analyzed. Associations between IHPS patterns and surgical outcomes following MRB were investigated.
Results
Two radiologists had a high level of agreement on identifying IHPS patterns and suitable patients for MRB. Of the 161 cases, 130 were type A, 10 were type B, 5 were type C, 7 were type D, and 9 were type E. One hundred and forty-five patients with types A, B and C underwent successful MRB, showing feasibility for 90% of patients. Children categorized as types A and B experienced more significant benefits than type C, including intraoperatively decreased portal vein pressure, esophageal/gastric varices relief, decreased portal venous collaterals and a lower rate of bypass occlusion after one year. The surgical outcomes of patients with types A and B were not influenced by the diameter of the Rex recessus as suggested by WHVP.
Conclusions
The majority of pediatric patients with EHPVO in mainland China have opportunities to receive successful MRB. There are potential differences in the etiology of Chinese and Western patients. The IHPS classification system aids in guiding preoperative surgical decisions and predicting hypotensive effects after MRB. Type C patients should be carefully chosen for MRB.
背景：使用楔形肝静脉造影术（WHVP）对肝内门静脉系统（IHPS）模式进行分类，已被证明是一种有效的工具，可用于术前评估雷克斯凹陷（Rex recessus），并确定哪些小儿肝外门静脉阻塞（EHPVO）患者适合进行中-雷克斯搭桥术（MRB）。尽管该分类系统早在十年前就已提出，但其临床应用仍然不足：方法：2014 年 10 月至 2023 年 7 月期间，对尝试 MRB 的 182 名 EHPVO 患儿进行了单中心回顾性研究。收集了161名患者的人口统计学、病因学、影像学检查、手术和随访数据。两名介入放射科医生采用德维尔方法，根据 WHVP 成像将患者分为 A 至 E 型，并分析观察者之间的一致性。研究了IHPS模式与MRB术后手术结果之间的关联：结果：两位放射科医生在识别 IHPS 模式和适合 MRB 的患者方面意见高度一致。在161例患者中，130例为A型，10例为B型，5例为C型，7例为D型，9例为E型。A 型和 B 型患儿比 C 型患儿有更明显的获益，包括术中门静脉压力降低、食管/胃静脉曲张缓解、门静脉袢减少以及一年后旁路闭塞率降低。A型和B型患者的手术效果并不受WHVP提出的Rex凹直径的影响：结论：在中国大陆，大多数小儿高血压脑血管畸形患者都有机会成功接受MRB手术。中西方患者的病因可能存在差异。IHPS分类系统有助于指导术前手术决策和预测MRB术后的降压效果。C 型患者应慎重选择 MRB。
{"title":"Effectiveness of Preoperative Intrahepatic Portal Venous Classification System in Guiding Preoperative Surgical Decisions and Predicting Hypotensive Effects After Meso-rex Bypass for Children With EHPVO","authors":"Xiaopan Chang , Lu Liu , Jieqin Wang , Qifeng Liang , Jiankun Liang , Zhenyin Liu , Zhe Wen","doi":"10.1016/j.jpedsurg.2024.161990","DOIUrl":"10.1016/j.jpedsurg.2024.161990","url":null,"abstract":"<div><h3>Background</h3><div>The categorization of intrahepatic portal venous system (IHPS) patterns using wedged hepatic venous portography (WHVP) has proven to be an effective tool in the preoperative evaluation of Rex recessus and in identifying pediatric patients with extrahepatic portal vein obstruction (EHPVO) who are suitable for meso-Rex bypass (MRB). Despite this classification system being proposed a decade ago, its clinical application remains underutilized.</div></div><div><h3>Methods</h3><div>A single-center retrospective study of 182 children with EHPVO was conducted between October 2014 and July 2023 when MRB was attempted. Data on demographics, etiology, imaging examinations, procedures, and follow-up were collected for 161 patients included. Two interventional radiologists used deVille’s method to classify patients into types A to E based on WHVP imaging, with interobserver agreement analyzed. Associations between IHPS patterns and surgical outcomes following MRB were investigated.</div></div><div><h3>Results</h3><div>Two radiologists had a high level of agreement on identifying IHPS patterns and suitable patients for MRB. Of the 161 cases, 130 were type A, 10 were type B, 5 were type C, 7 were type D, and 9 were type E. One hundred and forty-five patients with types A, B and C underwent successful MRB, showing feasibility for 90% of patients. Children categorized as types A and B experienced more significant benefits than type C, including intraoperatively decreased portal vein pressure, esophageal/gastric varices relief, decreased portal venous collaterals and a lower rate of bypass occlusion after one year. The surgical outcomes of patients with types A and B were not influenced by the diameter of the Rex recessus as suggested by WHVP.</div></div><div><h3>Conclusions</h3><div>The majority of pediatric patients with EHPVO in mainland China have opportunities to receive successful MRB. There are potential differences in the etiology of Chinese and Western patients. The IHPS classification system aids in guiding preoperative surgical decisions and predicting hypotensive effects after MRB. Type C patients should be carefully chosen for MRB.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161990"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jpedsurg.2024.161982
Norah E. Liang , Katherine Alvarez , Kyla Dalusag, Katy Chan, Brittney Bunnell, Melanie Stroud, Kathleen Steele, Stephanie D. Chao
Introduction
Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive.
Methods
In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services.
Results
205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, ∗P<0.0001). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory.
Conclusion
Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.
{"title":"Beyond Physical Injury: Routine Screening for Acute Stress Disorder and Posttraumatic Stress Disorder in Pediatric Trauma Patients – A Longitudinal Cohort Pilot Study","authors":"Norah E. Liang , Katherine Alvarez , Kyla Dalusag, Katy Chan, Brittney Bunnell, Melanie Stroud, Kathleen Steele, Stephanie D. Chao","doi":"10.1016/j.jpedsurg.2024.161982","DOIUrl":"10.1016/j.jpedsurg.2024.161982","url":null,"abstract":"<div><h3>Introduction</h3><div>Early identification of children at risk for PTSD is critical for improving mental health outcomes after traumatic injury. Currently, there is no standard PTSD screen for pediatric trauma patients and limited data on long-term quality of life for those who screen positive.</div></div><div><h3>Methods</h3><div>In 2022, we piloted a comprehensive routine screening program for ASD and PTSD at our Level I PTC. All admitted trauma patients ≥8 years old were eligible for screening. Inpatients were administered the ASC3. Those who screened positive were referred for follow-up and repeat mental health evaluation. PTSD screening (CTSQ, CPSS) and quality-of-life screening (PedsQL™) surveys were administered to eligible discharged trauma patients at 1-month post-injury. Children who screened positive on the CTSQ or CPSS were referred for behavioral health services.</div></div><div><h3>Results</h3><div>205 children were screened for ASD using the ASC3. 49/205 children (23.9 %) had a positive screen (score ≥3). 56 children completed PTSD screening at 1-month post-discharge. 14/54 children (25.9 %) screened positive on CTSQ, and 8/50 children (16 %) screened positive on CPSS. There was a significant positive correlation between CTSQ and CPSS scores (r 0.76, <em>∗P</em><<em>0.0001</em>). When stratified by screening results, patients who screened positive on CTSQ and CPSS were found to have the most significant correlations with poor School and Emotional Functioning on their quality-of-life inventory.</div></div><div><h3>Conclusion</h3><div>Early screening for ASD may be predictive of later development of PTSD in children. Screening using previously validated tools (ASC3, CTSQ, CPSS) were effective in identifying children with negative emotional functioning lasting beyond the acute phase of physical recovery following injury. CTSQ and CPSS both performed well for screening at one-month post-discharge. Early identification can facilitate timely referral to mental health services to potentially minimize long-term socioemotional impact of PTSD.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 2","pages":"Article 161982"},"PeriodicalIF":2.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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