Seminars in Pediatric Surgery最新文献

Enhanced recovery after surgery (ERAS) is a multidisciplinary, evidence-based protocol designed to standardize perioperative care, minimize complications, and optimize recovery. While ERAS has demonstrated significant benefits in adult populations, widespread adoption in pediatric surgery remains in progress. One of its central goals is reducing postoperative infections, particularly surgical site infections (SSIs), which represent a common source of morbidity in children. Core ERAS elements-including perioperative nutrition, glycemic control, fluid and temperature management, antibiotic prophylaxis, wound care, device removal, and early mobilization-directly or indirectly influence infection risk. Although pediatric-specific data remain limited, growing evidence supports that ERAS protocols are safe and may reduce SSI incidence. This narrative review outlines how individual ERAS components target SSI prevention, highlights current pediatric evidence, and identifies knowledge gaps where further research is needed to optimize infection prevention strategies for children undergoing surgery.

State-of-the-art minimally invasive in utero interventions involving stem cell, protein, and nucleic acid-based therapies represent a new frontier in medicine, which offers hope for devastating fetal diagnoses and promises the restoration of lifetimes. Yet they also introduce serious concerns regarding health risks posed to mother, fetus, and future generations. Recent international consensus statements provide general guidance for structuring trials to maximize health and minimize the risk of experimental treatments for both a pregnant mother and fetus. This article offers additional ethical guidance for translating interventions from first-in-human studies by focusing on a more holistic and nondirective consent process and encouraging pretrial publication of proposed studies to increase dialogue, fine-tune protocols, and potentially improve access.

Surgical site infections (SSIs) remain a significant source of morbidity in pediatric surgery, prolonging hospital stays, increasing readmissions, and driving up healthcare costs. Manual chart reviews and static risk models limit traditional SSI prediction and detection. The rise of artificial intelligence (AI), including machine learning (ML), natural language processing (NLP), and large language models (LLMs), offers a transformative opportunity to enhance prediction and surveillance. This review synthesizes current literature on AI applications in pediatric SSI, emphasizing predictive models built on NSQIP-P data and detection strategies leveraging EHRs and wearable technologies. Despite encouraging retrospective results, real-world adoption remains constrained by poor validation, limited generalizability, and workflow misalignment. Ethical and regulatory concerns, including bias, transparency, and pediatric-specific data limitations, must be addressed to ensure safe, equitable implementation. Thoughtfully developed and deployed, AI-driven tools can transform pediatric surgical care by enabling earlier intervention and improving outcomes.

Introduction: This prospective, randomized, double-blinded study aimed to compare the incidence of postoperative complications and perioperative analgesic efficacy between caudal and penile block in children undergoing primary hypospadias repair.

Methods: Sixty-two boys aged 6-48 months were randomly assigned to receive either caudal block group (CB, n = 31) or penile block group (PB, n = 31) for preemptive analgesia before surgery. All patients underwent tubularized incised plate urethroplasty. The primary outcome was the incidence of postoperative complications, including urethrocutaneous fistula and meatal stenosis, assessed at 3- and 6-months post-surgery. Secondary outcomes included total perioperative fentanyl consumption and the number of patients requiring rescue analgesia.

Results: There were no significant differences in the incidence of total complications (9.7 % vs. 16.1 %, p = 0.449), fistula (6.5 % vs. 3.2 %, p = 0.554), or meatal stenosis (3.2 % vs. 12.9 %, p = 0.162) between the CB and PB groups. However, fistula rate was significantly higher in patients with midpenil compared to distal hypospadias (13 % vs. 0 %, p = 0.021). Total perioperative fentanyl consumption and the number of patients requiring rescue analgesia were significantly lower in the CB group (p = 0.041 and p = 0.01, respectively).

Conclusion: In conclusion, caudal block provides superior perioperative analgesia without increasing the risk of postoperative complications compared to penile block in children undergoing primary hypospadias repair.

Level of evidence: Level I.