Pub Date : 2026-01-14DOI: 10.1016/j.jpedsurg.2026.162924
Steven C. Mehl , Jorge I. Portuondo , Yao Tian , Mehul V. Raval , Alice King , Kristy L. Rialon , Adam M. Vogel , Nader N. Massarweh
Background
It is unknown if there is hospital variation in postoperative mortality among infants. The purpose of this study is to describe variation in hospital postoperative mortality among infants and the extent to which gestational age may be a contributing factor.
Methods
The Pediatric Health Information System® database (2012–2020) was used to identify infants (<365 days old at the time of surgery) who underwent one of 38 operations associated with significant postoperative morbidity and mortality. Infants were stratified by gestational age (>36 weeks, 33–36 weeks, 29–32 weeks, 25–28 weeks, <25 weeks). Hospitals were stratified into tertiles of risk and reliability-adjusted postoperative mortality (below average mortality [tertile 1—T1]; above average mortality [tertile 3—T3]). Nonparametric test of trend was used to compare mortality rates across hospital tertiles stratified by gestational age. Multivariable hierarchical regression was used to evaluate the association between mortality, hospital mortality tertile, and gestational age.
Results
Overall, 69,963 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 3.4 % [2.5–4.3] to 8.8 % [7.7–10.0]. Relative to infants treated at T1 mortality hospitals, the odds of mortality increased by 75% at T3 mortality hospitals (odds ratio [OR] 1.75 [1.57–1.94]). This relationship was consistent across all gestational ages and demonstrated a dose-dependent association with decreasing gestational age for preterm infants (33–36 weeks, OR 1.52 [1.09–2.13]; 29–32 weeks, OR 1.59 [1.18–2.15]; 25–28 weeks, OR 1.77 [1.37–2.27]; <25 weeks, OR 2.06 [1.39–3.05]).
Conclusions
There is over 2-fold variation in infant postoperative mortality with variation more pronounced among infants with extreme prematurity (≤28 weeks). These findings suggest future work is needed to understand the care processes at high performing centers associated with better surgical outcomes.
{"title":"Hospital variation in postoperative mortality among preterm infants","authors":"Steven C. Mehl , Jorge I. Portuondo , Yao Tian , Mehul V. Raval , Alice King , Kristy L. Rialon , Adam M. Vogel , Nader N. Massarweh","doi":"10.1016/j.jpedsurg.2026.162924","DOIUrl":"10.1016/j.jpedsurg.2026.162924","url":null,"abstract":"<div><h3>Background</h3><div>It is unknown if there is hospital variation in postoperative mortality among infants. The purpose of this study is to describe variation in hospital postoperative mortality among infants and the extent to which gestational age may be a contributing factor.</div></div><div><h3>Methods</h3><div>The Pediatric Health Information System® database (2012–2020) was used to identify infants (<365 days old at the time of surgery) who underwent one of 38 operations associated with significant postoperative morbidity and mortality. Infants were stratified by gestational age (>36 weeks, 33–36 weeks, 29–32 weeks, 25–28 weeks, <25 weeks). Hospitals were stratified into tertiles of risk and reliability-adjusted postoperative mortality (below average mortality [tertile 1—T1]; above average mortality [tertile 3—T3]). Nonparametric test of trend was used to compare mortality rates across hospital tertiles stratified by gestational age. Multivariable hierarchical regression was used to evaluate the association between mortality, hospital mortality tertile, and gestational age.</div></div><div><h3>Results</h3><div>Overall, 69,963 infants were identified across 48 academic, pediatric hospitals. Adjusted hospital mortality rates ranged from 3.4 % [2.5–4.3] to 8.8 % [7.7–10.0]. Relative to infants treated at T1 mortality hospitals, the odds of mortality increased by 75% at T3 mortality hospitals (odds ratio [OR] 1.75 [1.57–1.94]). This relationship was consistent across all gestational ages and demonstrated a dose-dependent association with decreasing gestational age for preterm infants (33–36 weeks, OR 1.52 [1.09–2.13]; 29–32 weeks, OR 1.59 [1.18–2.15]; 25–28 weeks, OR 1.77 [1.37–2.27]; <25 weeks, OR 2.06 [1.39–3.05]).</div></div><div><h3>Conclusions</h3><div>There is over 2-fold variation in infant postoperative mortality with variation more pronounced among infants with extreme prematurity (≤28 weeks). These findings suggest future work is needed to understand the care processes at high performing centers associated with better surgical outcomes.</div></div><div><h3>Level of evidence</h3><div>Level II, Retrospective cohort study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162924"},"PeriodicalIF":2.5,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989743","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 : 2026-01-14DOI: 10.1016/j.jpedsurg.2026.162919
Asad Saulat Fatimi , Rafay Salman , Hadia Manal , Khizer Masroor Anns , Humza Thobani , Anam N. Ehsan , Asad Gul Rao , Daniel Tahan , Timothy F. Tirrell , Saleem Islam , Faraz A. Khan
Background
Congenital diaphragmatic hernia (CDH) often requires non-primary repair of large defects using either a prosthetic patch or an autologous muscle flap. However, their comparative effectiveness remains uncertain. We systematically reviewed the existing literature to synthesize outcomes relevant to durability and perioperative safety of patch versus flap repair in neonates.
Methods
PubMed, Embase, and Scopus were systematically searched from inception to May 2025 for pediatric studies directly comparing patch versus flap repair for CDH in neonates. Meta-analyses were performed using random-effects models on RevMan v5.4.1. Risk of bias was assessed using the ROBINS-I tool.
Results
Ten single-center retrospective cohorts comprising a total of 450 patients (Patch Repair: 220, Flap Repair: 230) who underwent CDH repair were included in our synthesis. Patch repair was associated with an increased risk of hernia recurrence (RR: 3.57 [95 % CI: 1.47–8.69]), postoperative bleeding complications (RR: 2.15 [95 % CI: 1.09–4.24]), and in-hospital mortality (RR: 1.66 [95 % CI: 1.13–2.43]). No statistically significant differences were detected in the rates of chest wall deformities, scoliosis, bowel obstruction, ventral incisional hernia, operative time, or hospital length of stay. However, the overall certainty of evidence was very low across most outcomes, reflecting the retrospective designs, small sample sizes, and inconsistent follow-up/definitions.
Conclusions
Within low-certainty evidence, patch repair was associated with higher observed hernia recurrence. Data on postoperative bleeding and mortality, including among on-ECMO repairs, were limited and insufficient to support causal inference. Definitive guidance will require prospective multicenter studies using standardized techniques, adjudicated bleeding endpoints, and long-term surveillance.
{"title":"Patch repair versus flap repair for congenital diaphragmatic hernia: A systematic review and meta-analysis","authors":"Asad Saulat Fatimi , Rafay Salman , Hadia Manal , Khizer Masroor Anns , Humza Thobani , Anam N. Ehsan , Asad Gul Rao , Daniel Tahan , Timothy F. Tirrell , Saleem Islam , Faraz A. Khan","doi":"10.1016/j.jpedsurg.2026.162919","DOIUrl":"10.1016/j.jpedsurg.2026.162919","url":null,"abstract":"<div><h3>Background</h3><div>Congenital diaphragmatic hernia (CDH) often requires non-primary repair of large defects using either a prosthetic patch or an autologous muscle flap. However, their comparative effectiveness remains uncertain. We systematically reviewed the existing literature to synthesize outcomes relevant to durability and perioperative safety of patch versus flap repair in neonates.</div></div><div><h3>Methods</h3><div>PubMed, Embase, and Scopus were systematically searched from inception to May 2025 for pediatric studies directly comparing patch versus flap repair for CDH in neonates. Meta-analyses were performed using random-effects models on RevMan v5.4.1. Risk of bias was assessed using the ROBINS-I tool.</div></div><div><h3>Results</h3><div>Ten single-center retrospective cohorts comprising a total of 450 patients (Patch Repair: 220, Flap Repair: 230) who underwent CDH repair were included in our synthesis. Patch repair was associated with an increased risk of hernia recurrence (RR: 3.57 [95 % CI: 1.47–8.69]), postoperative bleeding complications (RR: 2.15 [95 % CI: 1.09–4.24]), and in-hospital mortality (RR: 1.66 [95 % CI: 1.13–2.43]). No statistically significant differences were detected in the rates of chest wall deformities, scoliosis, bowel obstruction, ventral incisional hernia, operative time, or hospital length of stay. However, the overall certainty of evidence was very low across most outcomes, reflecting the retrospective designs, small sample sizes, and inconsistent follow-up/definitions.</div></div><div><h3>Conclusions</h3><div>Within low-certainty evidence, patch repair was associated with higher observed hernia recurrence. Data on postoperative bleeding and mortality, including among on-ECMO repairs, were limited and insufficient to support causal inference. Definitive guidance will require prospective multicenter studies using standardized techniques, adjudicated bleeding endpoints, and long-term surveillance.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162919"},"PeriodicalIF":2.5,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989717","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 : 2026-01-14DOI: 10.1016/j.jpedsurg.2026.162930
Yan Lu, Yingzhe Zhang
{"title":"Letter to the editor regarding: Pediatric complicated appendicitis: Results of a standardized antibiotic protocol in a tertiary center.","authors":"Yan Lu, Yingzhe Zhang","doi":"10.1016/j.jpedsurg.2026.162930","DOIUrl":"10.1016/j.jpedsurg.2026.162930","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162930"},"PeriodicalIF":2.5,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989720","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}
Esophageal atresia-tracheoesophageal fistula (EA-TEF) is amongst the most common life-threatening developmental anomalies. For the surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF), several interventional modifications have been suggested. One such modification is the preservation of the azygos vein, a key draining vein for the esophagus and surrounding structures. However, there is no clear consensus on the subject.
Objective
To evaluate whether preservation of the azygous vein offers clinical benefits compared with its ligation during primary repair of esophageal atresia.
Methodology
A comprehensive review of the literature was conducted across PubMed, Cochrane Library (CENTRAL), ScienceDirect, and Google Scholar for eligible studies from inception till July 2025. Eligible studies included were Randomized Controlled Trials (RCTs) and non-Randomized Control Trials (non-RCTs) comparing surgical correction of EA-TEF in neonates with Azygous vein ligation vs preservation. Quality assessment was done using Cochrane RoB-2 and ROBINS-I, while Eggers Begg test was used for Publication bias. Data was pooled using a Random-effects model, and heterogeneity was assessed via I2 statistics.
Results
Nine studies, six RCTs, two retrospective studies, and one prospective study, including a total of 955 newborns, met the inclusion criteria. The analysis indicated that preservation of the azygos vein was associated with decreased incidence infections (RR = 0.34; 95 % CI: 0.22 to 0.52; P < 0.001), and mortality (RR = 0.46; 95 % CI = 0.27 to 0.77; P = 0.003). However, no significant difference in operative time, anastomotic leakage, incidence of tracheoesophageal fistula and esophageal stricture were identified between the two groups.
Conclusion
Preservation of the azygos vein during esophageal atresia repair appears to reduce mortality and postoperative infections. However, further high-quality multicenter studies are needed to confirm these benefits.
{"title":"Preservation of the azygos vein versus ligation of the azygos vein during surgical repair of esophageal atresia-tracheoesophageal fistula-a systematic review and meta-analysis","authors":"Usama Shahid , Khadija Jameel , Areeba Sajid , Eesha Baig , Ummulkiram Hasnain , Barka Sajid , Vania Saqib , Shajie Ur Rehman Usmani","doi":"10.1016/j.jpedsurg.2026.162929","DOIUrl":"10.1016/j.jpedsurg.2026.162929","url":null,"abstract":"<div><h3>Introduction</h3><div>Esophageal atresia-tracheoesophageal fistula (EA-TEF) is amongst the most common life-threatening developmental anomalies. For the surgical repair of esophageal atresia-tracheoesophageal fistula (EA-TEF), several interventional modifications have been suggested. One such modification is the preservation of the azygos vein, a key draining vein for the esophagus and surrounding structures. However, there is no clear consensus on the subject.</div></div><div><h3>Objective</h3><div>To evaluate whether preservation of the azygous vein offers clinical benefits compared with its ligation during primary repair of esophageal atresia.</div></div><div><h3>Methodology</h3><div>A comprehensive review of the literature was conducted across PubMed, Cochrane Library (CENTRAL), ScienceDirect, and Google Scholar for eligible studies from inception till July 2025. Eligible studies included were Randomized Controlled Trials (RCTs) and non-Randomized Control Trials (non-RCTs) comparing surgical correction of EA-TEF in neonates with Azygous vein ligation vs preservation. Quality assessment was done using Cochrane RoB-2 and ROBINS-I, while Eggers Begg test was used for Publication bias. Data was pooled using a Random-effects model, and heterogeneity was assessed via I<sup>2</sup> statistics.</div></div><div><h3>Results</h3><div>Nine studies, six RCTs, two retrospective studies, and one prospective study, including a total of 955 newborns, met the inclusion criteria. The analysis indicated that preservation of the azygos vein was associated with decreased incidence infections (RR = 0.34; 95 % CI: 0.22 to 0.52; P < 0.001), and mortality (RR = 0.46; 95 % CI = 0.27 to 0.77; P = 0.003). However, no significant difference in operative time, anastomotic leakage, incidence of tracheoesophageal fistula and esophageal stricture were identified between the two groups.</div></div><div><h3>Conclusion</h3><div>Preservation of the azygos vein during esophageal atresia repair appears to reduce mortality and postoperative infections. However, further high-quality multicenter studies are needed to confirm these benefits.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 5","pages":"Article 162929"},"PeriodicalIF":2.5,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145989751","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 : 2026-01-12DOI: 10.1016/j.jpedsurg.2026.162920
Laura J. Wilkie , Stephanie Malarbi , Nicholas P. Ryan , Leah M. Hickey , Amanda G. Wood
Purpose
Research examining the long-term mental health needs of NICU graduates treated for non-cardiac congenital anomalies is limited, restricting guidance for clinical practice. This study aimed to characterise mental health outcomes at developmentally important ages and explore risk factors for poor mental health outcomes in these children.
Methods
Emotional and behavioural functioning was examined in 222 children at 5-year-old follow-up and 168 children at 8-year-old follow-up. Participants were treated for non-cardiac congenital anomalies at a large tertiary-level paediatric hospital in Australia. Parent-rated T-scores on the Behaviour Assessment System for Children (BASC) Second or Third Edition were compared to normative data. T-scores were classified according to BASC norms for problem indices: ‘normal’ (T < 60), ‘at-risk’ (T = 60–69), and ‘clinically significant’ (T ≥ 70). ‘Elevated’ ratings were defined as T ≥ 60. Clinical and sociodemographic risk factors for ‘clinically significant’ BASC T-scores were examined.
Results
Internalising Problems T-scores were significantly elevated at 5-year-old follow-up (p < 0.0004). The proportion of ‘clinically significant’ ratings was significantly higher than expected across all BASC domains at both 5-year-old and 8-year-old follow-up (p < 0.0004). In unadjusted models, parent-reported neurodevelopmental diagnoses (p = 0.001), small for gestational age (p = 0.005), and genetic diagnoses (p = 0.037) were associated with ‘clinically significant’ BASC ratings. However, these associations did not remain significant following adjustment for multiple comparisons.
Conclusion
According to parent-reports, children treated neonatally for non-cardiac congenital anomalies may be at risk of long-term mental health difficulties. These findings highlight the importance of incorporating routine, developmentally timed mental health assessments and follow-up into the standard clinical care of these children.
{"title":"Long-term mental health outcomes of NICU graduates treated for congenital anomalies: A prospective cross-sectional study","authors":"Laura J. Wilkie , Stephanie Malarbi , Nicholas P. Ryan , Leah M. Hickey , Amanda G. Wood","doi":"10.1016/j.jpedsurg.2026.162920","DOIUrl":"10.1016/j.jpedsurg.2026.162920","url":null,"abstract":"<div><h3>Purpose</h3><div>Research examining the long-term mental health needs of NICU graduates treated for non-cardiac congenital anomalies is limited, restricting guidance for clinical practice. This study aimed to characterise mental health outcomes at developmentally important ages and explore risk factors for poor mental health outcomes in these children.</div></div><div><h3>Methods</h3><div>Emotional and behavioural functioning was examined in 222 children at 5-year-old follow-up and 168 children at 8-year-old follow-up. Participants were treated for non-cardiac congenital anomalies at a large tertiary-level paediatric hospital in Australia. Parent-rated <em>T</em>-scores on the Behaviour Assessment System for Children (BASC) Second or Third Edition were compared to normative data. <em>T</em>-scores were classified according to BASC norms for problem indices: ‘normal’ (<em>T</em> < 60), ‘at-risk’ (<em>T</em> = 60–69), and ‘clinically significant’ (<em>T</em> ≥ 70). ‘Elevated’ ratings were defined as <em>T</em> ≥ 60. Clinical and sociodemographic risk factors for ‘clinically significant’ BASC <em>T</em>-scores were examined.</div></div><div><h3>Results</h3><div>Internalising Problems <em>T</em>-scores were significantly elevated at 5-year-old follow-up (<em>p</em> < 0.0004). The proportion of ‘clinically significant’ ratings was significantly higher than expected across all BASC domains at both 5-year-old and 8-year-old follow-up (<em>p</em> < 0.0004). In unadjusted models, parent-reported neurodevelopmental diagnoses (<em>p</em> = 0.001), small for gestational age (<em>p</em> = 0.005), and genetic diagnoses (<em>p</em> = 0.037) were associated with ‘clinically significant’ BASC ratings. However, these associations did not remain significant following adjustment for multiple comparisons.</div></div><div><h3>Conclusion</h3><div>According to parent-reports, children treated neonatally for non-cardiac congenital anomalies may be at risk of long-term mental health difficulties. These findings highlight the importance of incorporating routine, developmentally timed mental health assessments and follow-up into the standard clinical care of these children.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162920"},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985063","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}
Recurrent laryngeal nerve (RLN) injury causing vocal fold movement impairment (VFMI) is a complication of pediatric aerodigestive surgery that can lead to aspiration and respiratory morbidity. The natural history of VFMI as it relates to aspiration risk remains unclear.
Methods
Retrospective cohort study of children (0–18 years) with new VFMI after cervicothoracic aerodigestive surgery (2018–2023). VFMI was confirmed by awake flexible nasolaryngoscopy; children with pre-existing VFMI or missing preoperative laryngoscopy were excluded. Aspiration risk was evaluated using modified barium swallow (MBS) studies interpreted via the Penetration–Aspiration Scale (PAS), categorized as no (scores 1–2), medium (3–5), or high risk (6–8). MBS timing was Immediate (≤30 days postop), Follow-Up (31–365 days), and Most Recent (latest available). Data on MBS results, diet modifications, and VFMI recovery assessed outcomes.
Results
Among 317 children undergoing surgery, 50 (15.7 %) developed new VFMI. Of these, 26 (52 %) had ≥1 MBS: Immediate MBS (n = 19) showed 79 % high aspiration risk and 68 % silent aspiration; Follow-Up MBS (n = 14) showed 21 % high risk and silent aspiration; Most Recent MBS (n = 14) showed 14 % high risk and silent aspiration. Sixteen (32 %) recovered from VFMI, 14 (28 %) had persistent impairment, and 20 (40 %) lacked VFMI follow-up. No consistent relationship was found between VFMI recovery and aspiration risk improvement, although clinical improvement was observed over time.
Conclusion
Children with post-surgical VFMI commonly exhibit silent aspiration, highlighting limits of symptom-based screening. To guide safe oral feeding, objective and serial assessments of aspiration risk should be considered for children with new VFMI.
{"title":"Vocal fold movement impairment and aspiration risk in children undergoing aerodigestive surgery","authors":"Abdimajid Mohamed , Shawn Izadi , Kathryn Davidson , Kayla Hernandez , Farokh Demehri , Somala Mohammed , Sukgi Choi , Benjamin Zendejas","doi":"10.1016/j.jpedsurg.2026.162925","DOIUrl":"10.1016/j.jpedsurg.2026.162925","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent laryngeal nerve (RLN) injury causing vocal fold movement impairment (VFMI) is a complication of pediatric aerodigestive surgery that can lead to aspiration and respiratory morbidity. The natural history of VFMI as it relates to aspiration risk remains unclear.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of children (0–18 years) with new VFMI after cervicothoracic aerodigestive surgery (2018–2023). VFMI was confirmed by awake flexible nasolaryngoscopy; children with pre-existing VFMI or missing preoperative laryngoscopy were excluded. Aspiration risk was evaluated using modified barium swallow (MBS) studies interpreted via the Penetration–Aspiration Scale (PAS), categorized as no (scores 1–2), medium (3–5), or high risk (6–8). MBS timing was Immediate (≤30 days postop), Follow-Up (31–365 days), and Most Recent (latest available). Data on MBS results, diet modifications, and VFMI recovery assessed outcomes.</div></div><div><h3>Results</h3><div>Among 317 children undergoing surgery, 50 (15.7 %) developed new VFMI. Of these, 26 (52 %) had ≥1 MBS: Immediate MBS (n = 19) showed 79 % high aspiration risk and 68 % silent aspiration; Follow-Up MBS (n = 14) showed 21 % high risk and silent aspiration; Most Recent MBS (n = 14) showed 14 % high risk and silent aspiration. Sixteen (32 %) recovered from VFMI, 14 (28 %) had persistent impairment, and 20 (40 %) lacked VFMI follow-up. No consistent relationship was found between VFMI recovery and aspiration risk improvement, although clinical improvement was observed over time.</div></div><div><h3>Conclusion</h3><div>Children with post-surgical VFMI commonly exhibit silent aspiration, highlighting limits of symptom-based screening. To guide safe oral feeding, objective and serial assessments of aspiration risk should be considered for children with new VFMI.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162925"},"PeriodicalIF":2.5,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145985104","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}
Urethrocutaneous fistula remains the most common complication after hypospadias repair. We performed an updated systematic review and meta-analysis to identify modifiable and non-modifiable risk factors for fistula formation following primary hypospadias surgery.
Methods
PubMed, Scopus, Embase, Web of Science, and Cochrane databases were systematically searched from January 2000 to November 2025. Studies reporting risk factors for urethrocutaneous fistula after primary pediatric hypospadias repair with extractable odds ratios or raw data were included. Pooled odds ratios (OR) and mean differences were calculated using random-effects models. PRISMA 2020 guidelines were followed.
Results
Fourteen studies comprising 3794 patients were included. Proximal hypospadias (OR 2.03, 95 % CI 1.12–3.70) and one-stage repair (OR 1.67, 95 % CI 1.05–2.67) were significantly associated with higher fistula risk. Shorter postoperative stenting duration (<7 days) was associated with markedly increased odds (OR 3.96, 95 % CI 1.88–8.37) and longer urethral defect length (≥2 cm) with a modestly increased risk (OR 1.57, 95 % CI 1.05–2.33); however, both findings are derived from only two studies each, are imprecise, and should be considered hypothesis-generating rather than practice-changing. Age at surgery, chordee severity, suture material/technique, and urethroplasty method (TIP vs. Others) showed no significant association.
Conclusion
Proximal meatal location and one-stage repair are robust predictors of urethrocutaneous fistula (moderate certainty of evidence). Shorter postoperative stenting duration (<7 days) and longer urethral defect length (≥2 cm) show preliminary associations with higher risk (low certainty). These findings support preferential consideration of staged repair in proximal cases and prolonged stenting (≥7 days) in selected high-risk patients, while acknowledging the need for confirmatory trials. Age, suture characteristics, and choice of TIP versus flap techniques do not meaningfully affect fistula rates in modern series.
背景：尿道瘘仍然是尿道下裂修复后最常见的并发症。我们进行了一项最新的系统回顾和荟萃分析，以确定原发性尿道下裂手术后瘘形成的可改变和不可改变的危险因素。方法：系统检索2000年1月至2025年11月的PubMed、Scopus、Embase、Web of Science、Cochrane等数据库。通过可提取的优势比或原始数据报道了小儿原发性尿道下裂修复术后尿道瘘的危险因素。采用随机效应模型计算合并优势比（OR）和平均差异。遵循PRISMA 2020指南。结果：纳入14项研究，共3794例患者。近端尿道下裂（OR 2.03, 95% CI 1.12-3.70）和一期修复（OR 1.67, 95% CI 1.05-2.67）与较高的瘘管风险显著相关。较短的术后支架放置时间(结论：近端金属定位和一期修复是尿道瘘的可靠预测因素（证据确定性中等）。术后支架置入术时间缩短(
{"title":"Risk factors for urethrocutaneous fistula following primary hypospadias repair in children: a systematic review and meta-analysis","authors":"Rahman Khosravi , Hatef Alizadeh , Hossein Khosravi","doi":"10.1016/j.jpedsurg.2026.162928","DOIUrl":"10.1016/j.jpedsurg.2026.162928","url":null,"abstract":"<div><h3>Background</h3><div>Urethrocutaneous fistula remains the most common complication after hypospadias repair. We performed an updated systematic review and meta-analysis to identify modifiable and non-modifiable risk factors for fistula formation following primary hypospadias surgery.</div></div><div><h3>Methods</h3><div>PubMed, Scopus, Embase, Web of Science, and Cochrane databases were systematically searched from January 2000 to November 2025. Studies reporting risk factors for urethrocutaneous fistula after primary pediatric hypospadias repair with extractable odds ratios or raw data were included. Pooled odds ratios (OR) and mean differences were calculated using random-effects models. PRISMA 2020 guidelines were followed.</div></div><div><h3>Results</h3><div>Fourteen studies comprising 3794 patients were included. Proximal hypospadias (OR 2.03, 95 % CI 1.12–3.70) and one-stage repair (OR 1.67, 95 % CI 1.05–2.67) were significantly associated with higher fistula risk. Shorter postoperative stenting duration (<7 days) was associated with markedly increased odds (OR 3.96, 95 % CI 1.88–8.37) and longer urethral defect length (≥2 cm) with a modestly increased risk (OR 1.57, 95 % CI 1.05–2.33); however, both findings are derived from only two studies each, are imprecise, and should be considered hypothesis-generating rather than practice-changing. Age at surgery, chordee severity, suture material/technique, and urethroplasty method (TIP vs. Others) showed no significant association.</div></div><div><h3>Conclusion</h3><div>Proximal meatal location and one-stage repair are robust predictors of urethrocutaneous fistula (moderate certainty of evidence). Shorter postoperative stenting duration (<7 days) and longer urethral defect length (≥2 cm) show preliminary associations with higher risk (low certainty). These findings support preferential consideration of staged repair in proximal cases and prolonged stenting (≥7 days) in selected high-risk patients, while acknowledging the need for confirmatory trials. Age, suture characteristics, and choice of TIP versus flap techniques do not meaningfully affect fistula rates in modern series.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162928"},"PeriodicalIF":2.5,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959463","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 : 2026-01-10DOI: 10.1016/j.jpedsurg.2026.162921
Colleen P Nofi, Katerina Jou, Christina M Theodorou, Morris C Edelman, Barrie S Rich, Richard D Glick
Background: Thymic epithelial tumors (TETs), including thymoma and thymic carcinoma, are rare in young patients, with limited data on clinical characteristics and outcomes. We aimed to evaluate demographics, treatment strategies, and outcomes in pediatric/adolescent, and young adult (YA) patients with TETs.
Methods: The National Cancer Database was queried for patients aged 0-39 years with thymoma or thymic carcinoma from 2004-2019. Descriptive statistics were performed, and overall survival was analyzed using Cox regressions. Kaplan-Meier analysis was stratified by age (pediatric/adolescent: 0-21 years; YA: 22-39 years) and tumor type.
Results: 1,069 patients were identified, of which 193 (18%) had thymic carcinoma and 876 (82%) had thymoma. Pediatric/adolescent patients accounted for 98 cases (9%). Most patients underwent surgical resection (77%), primarily via open approach (72%); fewer received radiation (43%) or chemotherapy (45%). Five-year survival was 36% for thymic carcinoma and 87% for thymoma. On multivariable analysis, thymic carcinoma (HR 2.9, p<0.001), advanced Masaoka stage (III: HR 2.0, p=0.001; IV: HR 3.0, p<0.001), positive margins (HR 1.6, p=0.015), and chemotherapy (HR 1.5, p=0.020) were associated with worse survival, while surgery (HR 0.2, p<0.001) and older age (HR 0.97, p=0.002) were associated with improved survival. Thymic carcinoma outcomes were significantly worse for pediatric/adolescent patients compared to YAs (p=0.03) - a difference not observed in thymoma (p=0.17).
Conclusion: Thymic carcinoma and advanced disease predict poor survival, while complete resection is associated with improved outcomes. Notably, younger patients with thymic carcinoma have significantly worse survival, highlighting the need for age- and histology-specific treatment strategies.
{"title":"Thymic Epithelial Tumors in Pediatric, Adolescent, and Young Adult Patients: A National Cohort Analysis of Clinical Characteristics, Treatment Patterns, and Survival Outcomes.","authors":"Colleen P Nofi, Katerina Jou, Christina M Theodorou, Morris C Edelman, Barrie S Rich, Richard D Glick","doi":"10.1016/j.jpedsurg.2026.162921","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2026.162921","url":null,"abstract":"<p><strong>Background: </strong>Thymic epithelial tumors (TETs), including thymoma and thymic carcinoma, are rare in young patients, with limited data on clinical characteristics and outcomes. We aimed to evaluate demographics, treatment strategies, and outcomes in pediatric/adolescent, and young adult (YA) patients with TETs.</p><p><strong>Methods: </strong>The National Cancer Database was queried for patients aged 0-39 years with thymoma or thymic carcinoma from 2004-2019. Descriptive statistics were performed, and overall survival was analyzed using Cox regressions. Kaplan-Meier analysis was stratified by age (pediatric/adolescent: 0-21 years; YA: 22-39 years) and tumor type.</p><p><strong>Results: </strong>1,069 patients were identified, of which 193 (18%) had thymic carcinoma and 876 (82%) had thymoma. Pediatric/adolescent patients accounted for 98 cases (9%). Most patients underwent surgical resection (77%), primarily via open approach (72%); fewer received radiation (43%) or chemotherapy (45%). Five-year survival was 36% for thymic carcinoma and 87% for thymoma. On multivariable analysis, thymic carcinoma (HR 2.9, p<0.001), advanced Masaoka stage (III: HR 2.0, p=0.001; IV: HR 3.0, p<0.001), positive margins (HR 1.6, p=0.015), and chemotherapy (HR 1.5, p=0.020) were associated with worse survival, while surgery (HR 0.2, p<0.001) and older age (HR 0.97, p=0.002) were associated with improved survival. Thymic carcinoma outcomes were significantly worse for pediatric/adolescent patients compared to YAs (p=0.03) - a difference not observed in thymoma (p=0.17).</p><p><strong>Conclusion: </strong>Thymic carcinoma and advanced disease predict poor survival, while complete resection is associated with improved outcomes. Notably, younger patients with thymic carcinoma have significantly worse survival, highlighting the need for age- and histology-specific treatment strategies.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162921"},"PeriodicalIF":2.5,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145959478","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 : 2026-01-09DOI: 10.1016/j.jpedsurg.2026.162927
Nzuekoh N. Nchinda , Eustina G. Kwon , Carrie Foster , Mihai Puia-Dumitrescu , Jimiane L. Ashe , Akila B. Ramaraj , Matthew B. Dellinger , Kimberly J. Riehle , Samuel E. Rice-Townsend , Rebecca A. Stark
Purpose
Children with congenital diaphragmatic hernia (CDH) are vulnerable to lung injury secondary to aspiration and have an elevated risk of dysphagia. This study assesses video fluoroscopic swallow study (VFSS) utilization to detect aspiration and aims to identify prenatal indicators of swallow dysfunction in infants with CDH.
Methods
This is a single center, retrospective observational study of infants with CDH born between January 2014 and October 2022. VFSS results were analyzed, along with potential associations between aspiration and lung-to-head ratio (LHR) or the presence of polyhydramnios.
Results
A total of 105 infants were included. The majority of patients were born at term (87, 83 %), had left-sided CDH (81, 77 %), and underwent patch repair (56, 53 %). Most patients (78, 74 %) were discharged with a feeding tube for supplementary nutrition. Twenty patients (19 %) had a VFSS performed prior to discharge, and an additional 29 patients (28 %) completed outpatient VFSS within five years of discharge. The majority of patients with inpatient VFSS (12, 60 %) showed aspiration compared to 10 patients (35 %) who had outpatient VFSS. CDH size, laterality, repair type, LHR, and polyhydramnios were not consistently associated with aspiration on VFSS. For most patients who received inpatient VFSS (11, 92 %), findings resulted in changes in feeding management.
Conclusion
Although most infants with congenital diaphragmatic hernia required tube feeds due to feeding difficulties, less than half underwent formal VFSS. In the absence of consistent predictors, a low threshold for initiating formal swallow evaluation in patients with CDH is recommended.
{"title":"Evaluation of swallow function in patients with congenital diaphragmatic hernia","authors":"Nzuekoh N. Nchinda , Eustina G. Kwon , Carrie Foster , Mihai Puia-Dumitrescu , Jimiane L. Ashe , Akila B. Ramaraj , Matthew B. Dellinger , Kimberly J. Riehle , Samuel E. Rice-Townsend , Rebecca A. Stark","doi":"10.1016/j.jpedsurg.2026.162927","DOIUrl":"10.1016/j.jpedsurg.2026.162927","url":null,"abstract":"<div><h3>Purpose</h3><div>Children with congenital diaphragmatic hernia (CDH) are vulnerable to lung injury secondary to aspiration and have an elevated risk of dysphagia. This study assesses video fluoroscopic swallow study (VFSS) utilization to detect aspiration and aims to identify prenatal indicators of swallow dysfunction in infants with CDH.</div></div><div><h3>Methods</h3><div>This is a single center, retrospective observational study of infants with CDH born between January 2014 and October 2022. VFSS results were analyzed, along with potential associations between aspiration and lung-to-head ratio (LHR) or the presence of polyhydramnios.</div></div><div><h3>Results</h3><div>A total of 105 infants were included. The majority of patients were born at term (87, 83 %), had left-sided CDH (81, 77 %), and underwent patch repair (56, 53 %). Most patients (78, 74 %) were discharged with a feeding tube for supplementary nutrition. Twenty patients (19 %) had a VFSS performed prior to discharge, and an additional 29 patients (28 %) completed outpatient VFSS within five years of discharge. The majority of patients with inpatient VFSS (12, 60 %) showed aspiration compared to 10 patients (35 %) who had outpatient VFSS. CDH size, laterality, repair type, LHR, and polyhydramnios were not consistently associated with aspiration on VFSS. For most patients who received inpatient VFSS (11, 92 %), findings resulted in changes in feeding management.</div></div><div><h3>Conclusion</h3><div>Although most infants with congenital diaphragmatic hernia required tube feeds due to feeding difficulties, less than half underwent formal VFSS. In the absence of consistent predictors, a low threshold for initiating formal swallow evaluation in patients with CDH is recommended.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 4","pages":"Article 162927"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952336","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 : 2026-01-09DOI: 10.1016/j.jpedsurg.2026.162922
Emily M Scire, Alex L Huang, Thais Boccia, Ina Kycia, Tanya T Dang, Beatriz S Bechara, Eva Zacharakis, Melody Tai, David Zurakowski, Dario O Fauza
Purpose: We investigated whether transamniotic fetal mRNA vaccination could be a viable strategy for perinatal immunization against Zika virus (ZIKV) infection in a rodent model.
Methods: Twenty pregnant Sprague Dawley dams underwent volume-matched intra-amniotic injections in all their fetuses (n = 280) of either a suspension of a custom-made mRNA encoding for the ZIKV pre-membrane (ZIVK-prM) and envelope (ZIKV-E) structural proteins encapsulated in a semi-synthetic composite lipopolyplex (vaccinated, n = 153), or of the same lipopolyplex without mRNA (control, n = 127) on gestational day 17-18 (E17-18; term = E21-22). Pup serum levels of ZIKV-E antigen-specific IgG antibodies were measured by ELISA at term up to 3 months of age. Splenocyte and lymph node cell suspensions were incubated either with or without ZIKVE challenge, followed by flow cytometry to assess T-cell response.
Results: When controlled by mRNA-free injections, ZIKV-E-specific IgG was not detected in the serum of term fetuses; however, levels were significantly elevated in vaccinated pups from postnatal day 5-16 (p = 0.005-0.002). Splenocytes from vaccinated pups showed significant increases in IL-6 and IFN- γ productions after the antigen-specific challenge at 2 and 3 months (p = 0.049 to 0.003 vs. nonchallenged cells), along with a significant decrease in IL-13 production at 3 months (p = 0.006). Lymph node cells also demonstrated increased production of IFN-γ (p < 0.001 vs. non-challenged cells), along with a significant decrease in IL-13 production, both at 3 months (p = 0.014).
Conclusions: Transamniotic fetal mRNA vaccination with a Zika virus antigen can induce adaptive humoral and cellular immune responses extending into the neonatal period in a healthy rat model.
Level of evidence: N/A (animal and laboratory study).
{"title":"Transamniotic fetal mRNA vaccination: Active immunization against Zika virus in a rodent model.","authors":"Emily M Scire, Alex L Huang, Thais Boccia, Ina Kycia, Tanya T Dang, Beatriz S Bechara, Eva Zacharakis, Melody Tai, David Zurakowski, Dario O Fauza","doi":"10.1016/j.jpedsurg.2026.162922","DOIUrl":"10.1016/j.jpedsurg.2026.162922","url":null,"abstract":"<p><strong>Purpose: </strong>We investigated whether transamniotic fetal mRNA vaccination could be a viable strategy for perinatal immunization against Zika virus (ZIKV) infection in a rodent model.</p><p><strong>Methods: </strong>Twenty pregnant Sprague Dawley dams underwent volume-matched intra-amniotic injections in all their fetuses (n = 280) of either a suspension of a custom-made mRNA encoding for the ZIKV pre-membrane (ZIVK-prM) and envelope (ZIKV-E) structural proteins encapsulated in a semi-synthetic composite lipopolyplex (vaccinated, n = 153), or of the same lipopolyplex without mRNA (control, n = 127) on gestational day 17-18 (E17-18; term = E21-22). Pup serum levels of ZIKV-E antigen-specific IgG antibodies were measured by ELISA at term up to 3 months of age. Splenocyte and lymph node cell suspensions were incubated either with or without ZIKVE challenge, followed by flow cytometry to assess T-cell response.</p><p><strong>Results: </strong>When controlled by mRNA-free injections, ZIKV-E-specific IgG was not detected in the serum of term fetuses; however, levels were significantly elevated in vaccinated pups from postnatal day 5-16 (p = 0.005-0.002). Splenocytes from vaccinated pups showed significant increases in IL-6 and IFN- γ productions after the antigen-specific challenge at 2 and 3 months (p = 0.049 to 0.003 vs. nonchallenged cells), along with a significant decrease in IL-13 production at 3 months (p = 0.006). Lymph node cells also demonstrated increased production of IFN-γ (p < 0.001 vs. non-challenged cells), along with a significant decrease in IL-13 production, both at 3 months (p = 0.014).</p><p><strong>Conclusions: </strong>Transamniotic fetal mRNA vaccination with a Zika virus antigen can induce adaptive humoral and cellular immune responses extending into the neonatal period in a healthy rat model.</p><p><strong>Level of evidence: </strong>N/A (animal and laboratory study).</p><p><strong>Type of study: </strong>Animal and laboratory study.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162922"},"PeriodicalIF":2.5,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145952377","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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