Journal of Indian Association of Pediatric Surgeons最新文献

{"title":"Association of Anogenital Distance with Hypospadias Severity and Chordee: A Prospective Observational Study.","authors":"T Narasimha Murty, Nitinkumar Borkar, Charu Tiwari, Reyaz Ahmad Wani, Prince Raj, Rahul Giri","doi":"10.4103/jiaps.jiaps_16_26","DOIUrl":"10.4103/jiaps.jiaps_16_26","url":null,"abstract":"<p><strong>Introduction: </strong>Anogenital distance (AGD) is a sexually dimorphic parameter. Although reduced AGD has been associated with hypospadias, its relationship with hypospadias severity and chordee remains incompletely defined. In this study, we aim to measure AGD in patients with hypospadias and compare it with published age-specific nomogram. We also aim to find an association of measured AGD with hypospadias severity and chordee.</p><p><strong>Materials and methods: </strong>This prospective observational study included all boys presenting with hypospadias for the first between November 2023 and April 2025. AGD was measured under anesthesia before surgery; the severity of chordee was assessed intraoperatively by artificial erection test and categorized as mild (<30°) or severe (>30°). AGD values were with published age-specific reference values and analyzed as a continuous variable and compared across hypospadias subtypes and chordee severity. The association between AGD and hypospadias and chordee severity was also evaluated.</p><p><strong>Results: </strong>Among 102 patients, six patients had AGD within the published age-specific reference percentile range, whereas 96 patients had smaller AGD; this difference was statistically significant (<i>P</i> = 0.0001). Chordee severity increased significantly with more proximal meatal location. Mean AGD showed a decreasing trend from distal to proximal hypospadias and also with increasing chordee severity.</p><p><strong>Conclusion: </strong>We observed that children with hypospadias had shorter AGD with more proximal meatal location and increasing chordee severity. The measured AGD was found to be smaller than the age-specific published nomograms. AGD may serve as an adjunctive marker reflecting the degree of genital developmental disruption.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"775-779"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Case of Ovarian Torsion in an Incarcerated Inguinal Hernia in a Neonate Mimicking an Inguinal Abscess.","authors":"Priyanka Bamoria, Md Fahim Ahmad, Simmi K Ratan, Prafull Kumar, Chiranjiv Kumar, Shadia Bano","doi":"10.4103/jiaps.jiaps_117_26","DOIUrl":"10.4103/jiaps.jiaps_117_26","url":null,"abstract":"","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"875-876"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophageal Atresia in Asia: Regional Disparities in Incidence, Congenital Anomalies, Mortality, and Morbidity - A Systematic Narrative Review.","authors":"M Alfath Bagus Pratama, Tantri Thahirah Pasaribu, M Maulana Raihandi, Khalisha Aprilia Desyandra Siregar","doi":"10.4103/jiaps.jiaps_441_25","DOIUrl":"10.4103/jiaps.jiaps_441_25","url":null,"abstract":"<p><strong>Background: </strong>Esophageal atresia (EA), with or without tracheoesophageal fistula, remains associated with substantial early mortality and long-term morbidity. Reported incidence and outcomes vary across Asia, but interpretation is complicated by differences in case capture, referral pathways, diagnostic capacity, and neonatal intensive care availability.</p><p><strong>Methods: </strong>We performed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020-aligned systematic narrative review of observational studies from Asian countries published up to March 2024 (PubMed and Google Scholar). Studies reporting incidence, associated anomalies, morbidity, or mortality were included. Findings were synthesized descriptively and presented stratified by study base (population-based vs. hospital-based) and resource setting (World Bank income proxy). Risk of bias was assessed using a generic domain-based framework (D1-D6).</p><p><strong>Results: </strong>Thirty-four studies (3304 infants) were included. Six population-based studies reported incidence ranging from 6.17 to 20.30 per 100,000 live births. Hospital-based reports documented 921 associated anomalies, most commonly gastrointestinal (36%) and cardiovascular (27%). Mortality across 19 cohorts ranged from 2% to 83%. Morbidity profiles differed by setting: in higher-resource cohorts, reported events were dominated by gastroesophageal reflux and anastomotic stricture, whereas in lower-resource cohorts, septicemia (47% of events) and wound infection (10%) were prominent.</p><p><strong>Conclusion: </strong>EA incidence in Asia is within international ranges, but published outcomes vary widely and should be interpreted descriptively given referral and ascertainment differences, variable anomaly detection, heterogeneous definitions, and limited follow-up. Priorities include strengthening prenatal detection and referral, improving neonatal stabilization and safe transport, standardizing perioperative care with infection prevention, and establishing feasible long-term follow-up supported by a pragmatic action framework.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"689-698"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spectrum of Hydrometrocolpos in Pediatric Patients: A Pictorial Essay and Authors' Experience.","authors":"Rahul Gupta, Pooja Soni","doi":"10.4103/jiaps.jiaps_463_25","DOIUrl":"10.4103/jiaps.jiaps_463_25","url":null,"abstract":"<p><strong>Context: </strong>Hydrometrocolpos (HMC) is an uncommon congenital condition affecting females with a range of symptoms that can arise due to various structural abnormalities, including an imperforate hymen, vaginal atresia, transverse vaginal septum, urogenital sinus, cloacal malformations, and rarely syndromic disorders.</p><p><strong>Aims: </strong>This study aims to deepen the understanding of the diverse manifestations, emphasize the importance of early diagnosis, and explore surgical management strategies to improve outcomes of HMC in pediatric patients.</p><p><strong>Settings and design: </strong>An ambispective study was performed in a tertiary care teaching institute from 2016 to 2024.</p><p><strong>Materials and methods: </strong>All pediatric patients with HMC managed by the authors were evaluated for their symptoms, radiological imaging results, associated anomalies, surgical procedures, and treatment outcomes.</p><p><strong>Results: </strong>There were 17 pediatric patients; six showed a vestibular bulge, another eight had an abdominal mass, and three were diagnosed with anorectal malformations. One case was detected before birth, presenting with bilateral hydroureteronephrosis and oligohydramnios. Two patients had complex syndromic associations, including Herlyn-Werner-Wunderlich syndrome and McKusick-Kaufman syndrome. Treatment strategies varied depending on the underlying cause, with simpler cases, including an imperforate hymen and transverse vaginal septum, being managed with incision and drainage, and more complex conditions requiring abdominal vaginostomy. All patients exhibited varying degrees of hydroureteronephrosis caused by lower urinary tract obstruction.</p><p><strong>Conclusion: </strong>HMC presents with diverse etiologies, necessitating individualized management approaches. Early diagnosis and comprehensive evaluation are critical in preventing complications and optimizing surgical outcomes. A multidisciplinary approach, integrating pediatric surgery, radiology, and gynecology, is essential for effective diagnosis and management.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"699-709"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic-assisted versus Open Placement of Ventriculoperitoneal Shunts in the Pediatric Population with Congenital Hydrocephalus: A Randomized Controlled Trial.","authors":"Amit Kumar, Rashi Rashi, Amit Kumar Sinha, Md Mokarram Ali, Shamshad Ahmad, Bindey Kumar","doi":"10.4103/jiaps.jiaps_45_26","DOIUrl":"10.4103/jiaps.jiaps_45_26","url":null,"abstract":"<p><strong>Background: </strong>Ventriculoperitoneal (VP) shunt is the standard surgical treatment for hydrocephalus. Conventional open insertion of the distal catheter is widely practiced; however, laparoscopic-assisted right VP shunt (LARVS) provides direct visualization of peritoneal entry, potentially reducing complications and improving accuracy.</p><p><strong>Aim: </strong>The aim of this study was to compare LARVS with conventional open right VP shunt (RVS) in terms of operative parameters, postoperative outcomes, and complication rates.</p><p><strong>Materials and methods: </strong>A randomized controlled trial was conducted on 76 patients undergoing primary RVS between July 2020 and August 2024. The patients were divided into two groups: Group A - LARVS (<i>n</i> = 37) and Group B - RVS (<i>n</i> = 39). The data analyzed included age, operative time, duration of hospital stay, type of hydrocephalus, and postoperative complications. Statistical analysis was performed using the <i>t</i>-test and Chi-square tests; <i>P</i> < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The two groups were comparable in terms of baseline characteristics (age, <i>P</i> = 0.089). The mean operative time was 62.14 ± 8.9 min for LARVS and 64.97 ± 9.8 min for RVS (<i>P</i> = 0.296). The average hospital stay was 5.94 ± 1.1 days for LARVS and 5.55 ± 1.2 days for RVS (<i>P</i> = 0.797). Noncommunicating hydrocephalus predominated (LARVS: 89%; RVS: 87%). Overall complication rates were low and not significantly different (<i>P</i> = 0.300). Shunt revision was required in 8.1% (LARVS) and 7.7% (RVS), cerebrospinal fluid leak occurred in 2.6% of the RVS group and 2.7% in the LARVS group. No visceral injury or port-related morbidity occurred in the laparoscopic group.</p><p><strong>Conclusion: </strong>LARVS is a safe and effective alternative to open RVS. Both approaches yield comparable operative times and outcomes, with LARVS offering the added advantage of direct peritoneal visualization, although its impact on morbidity was not statistically different in this cohort.<b>Type of study:</b> Clinical research.<b>Level of evidence:</b> Level II.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"762-768"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Genitourinary Trauma.","authors":"Gali Divya, Vijay Kumar Kundal, N S Bharathi Prabakaran, Pinaki Ranjan Debnath","doi":"10.4103/jiaps.jiaps_19_26","DOIUrl":"10.4103/jiaps.jiaps_19_26","url":null,"abstract":"<p><strong>Background: </strong>Pediatric genitourinary trauma constitutes a significant proportion of childhood trauma, with unique anatomical and clinical considerations. While conservative management has become standard for stable patients in pediatric solid organ injuries, data regarding the management of genitourinary trauma in children is sparse. This study aims to characterize the spectrum, treatment strategies, and outcomes of pediatric genitourinary trauma in a tertiary care center in India.</p><p><strong>Methods: </strong>A prospective observational study was conducted between August 2018 and March 2022. Children under 12 years with documented genitourinary trauma were enrolled. Exclusion criteria included thermal injuries. Demographic details, clinical, radiological, and operative data, and their outcomes were recorded. Injuries were graded as per the American Association for the Surgery of Trauma criteria. Outcomes were monitored over 3 years. Statistical analysis was performed using Epi Info™ 7.2.2.2.</p><p><strong>Results: </strong>Out of 62 admitted patients of trauma, 30 patients were included in the study (M: F = 4:1) with a mean age of presentation of 6.5 years. Different modes of injury were fall from height, road traffic accidents, and other causes included sexual assaults and post-circumcision complications. Renal trauma was the most common type, primarily Grade IV injuries. Bladder trauma ranged from Grade I-V. Conservative treatment was effective in 74% of cases. Operative interventions were performed in eight patients. Complications occurred in 26%, predominantly among higher-grade injuries. However, statistical analysis revealed no significant correlation between injury grade and outcomes (<i>P</i> = 0.15).</p><p><strong>Conclusion: </strong>Pediatric genitourinary trauma, though infrequent, often results in favorable outcomes even in high-grade injuries. Grade of injury does not correlate with the outcome in high-grade injuries in stable children.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"769-774"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of Quality of Life in Children with Extrahepatic Portal Vein Obstruction: A Cross-sectional Comparative Study.","authors":"Shreya Tomar, Bitesh Kumar, Minu Bajpai, Sandeep Agarwala, Sujata Satapathy, Rohan Malik, Veereshwar Bhatnagar, Vishesh Jain, Devendra Kumar Yadav, Prabudh Goel, Anjan Kumar Dhua","doi":"10.4103/jiaps.jiaps_87_26","DOIUrl":"10.4103/jiaps.jiaps_87_26","url":null,"abstract":"<p><strong>Background: </strong>Extrahepatic portal venous obstruction (EHPVO) is a chronic condition in children associated with recurrent gastrointestinal bleeding, hypersplenism, and growth impairment. While surgical and endoscopic interventions address portal hypertension, their impact on Health-related Quality of Life (HRQoL) remains incompletely understood.</p><p><strong>Materials and methods: </strong>This cross-sectional comparative study evaluated HRQoL using the Pediatric Quality of Life Inventory (PedsQL™ 4.0) in children with EHPVO undergoing endoscopic management (preshunt group), those who had undergone surgical intervention (postshunt group), and age-matched healthy sibling controls. Both child self-reports and parent proxy-reports were analyzed. Nonparametric statistical methods were used, and effect sizes were calculated to assess clinical relevance.</p><p><strong>Results: </strong>Children with EHPVO demonstrated significantly lower overall HRQoL compared with healthy controls across all domains (<i>P</i> < 0.001), with large effect sizes (r ≈ 0.8), indicating clinically meaningful impairment. No statistically significant difference was observed between pre- and postshunt groups, with small effect sizes suggesting minimal variation at the time of assessment. Median follow-up duration in the postoperative cohort exceeded 1 year across all surgical subgroups. Domain-wise analysis revealed the greatest impairment in school functioning, followed by physical and emotional domains. Strong concordance was observed between child self-reports and parent proxy-reports.</p><p><strong>Conclusion: </strong>Children with EHPVO experience substantial impairment in HRQoL compared with healthy peers. While no significant differences were observed between treatment groups, HRQoL remains suboptimal within the follow-up period captured in this cross-sectional study. These findings highlight the need for comprehensive, multidisciplinary care addressing psychosocial, educational, and nutritional aspects alongside standard medical and surgical management.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"796-803"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can One-port Laparoscopic Percutaneous Internal Ring Suturing Technique be an Alternative to Conventional Laparoscopic Repair for Female Inguinal Hernia? - A Nonrandomized Comparative Cohort Study.","authors":"Roshan Chanchlani, Abhishek Tiwari, Himanshu Acharya, Rajesh Mishra, Rohit Harchandani, Vikesh Agrawal","doi":"10.4103/jiaps.jiaps_98_26","DOIUrl":"10.4103/jiaps.jiaps_98_26","url":null,"abstract":"<p><strong>Background: </strong>The optimal laparoscopic technique for pediatric female inguinal hernia remains debated. While intracorporeal Incision, Dissection, Excision, and Suturing (IDES) closely emulates open herniotomy, Percutaneous Internal Ring Suturing (PIRS) offers a simpler, one-port alternative. This study compares the feasibility, safety, and long-term efficacy of PIRS versus conventional IDES in female children.</p><p><strong>Materials and methods: </strong>In this single-center case-control study conducted over 10 years, 178 female children (1-12 years) undergoing elective laparoscopic inguinal hernia repair were included. Ninety-three patients underwent IDES repair, and 85 underwent one-port PIRS. Perioperative parameters, intraoperative events, postoperative recovery, and long-term recurrence were analyzed. Patients were followed up at regular intervals for a mean duration of approximately 9 years. Statistical analysis included fragility index assessment for significant outcomes.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. The mean operative time was significantly shorter in the PIRS group (<i>P</i> < 0.001). Detection and repair rates of contralateral patent processus vaginalis were similar (~15%). Postoperative pain scores, analgesic requirements, time to oral feeds, hospital stay, and early complications were comparable. One recurrence occurred in each group during long-term follow-up, with no statistically significant difference. Suture breakage and minor subperitoneal hematoma were infrequent and statistically fragile findings without clinical consequence. No major vascular injuries or long-term morbidity were observed.</p><p><strong>Conclusion: </strong>One-port PIRS provides outcomes equivalent to conventional laparoscopic IDES repair in female pediatric inguinal hernia, with the advantage of reduced operative time and technical simplicity. In experienced hands, PIRS represents a safe, durable, and cosmetically superior alternative suitable for routine use in girls.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"823-828"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Imaging-based Stratification and Management of Pediatric Liver Abscess with Rupture: Experience from a Tertiary Care Center.","authors":"Rishabh Patel, Palak Paliwal, Shalu Shah, Bhanu Khokhar, Atul Kumar Meena, Tanmay Anand, Pinaki Ranjan Debnath","doi":"10.4103/jiaps.jiaps_470_25","DOIUrl":"10.4103/jiaps.jiaps_470_25","url":null,"abstract":"<p><strong>Background: </strong>Liver abscess in the pediatric age group is an uncommon but serious condition. Extension or rupture of a liver abscess may result in intrathoracic or intra-abdominal contamination and has traditionally been considered an indication for surgical intervention. With advances in imaging, antibiotics, and minimally invasive techniques, management strategies have evolved toward selective nonoperative approaches.</p><p><strong>Aim: </strong>This study aims to evaluate clinical presentation, radiological patterns, management strategies, and outcomes of pediatric liver abscess with true rupture, using imaging-based anatomical stratification.</p><p><strong>Materials and methods: </strong>This prospective observational study was conducted between August 2022 and August 2024 at a tertiary care pediatric surgery unit. Children with radiologically confirmed liver abscesses demonstrating either contained extension or true rupture were included. Contrast-enhanced computed tomography was used to classify patients based on capsular integrity and extent of spillage. Management strategies included antibiotics, selective image-guided drainage, and surgery for strict indications. Nutritional status and serum albumin levels were assessed at admission and during follow-up.</p><p><strong>Results: </strong>A total of 94 children out of 349 patients with liver abscess extension or rupture were included. Contained subcapsular extension beneath an intact liver capsule constituted 52% of cases and was successfully managed with intravenous antibiotics alone. True rupture, defined by capsular breach with free spillage, accounted for the remaining cases, including thoracic rupture (18%), subdiaphragmatic rupture (16%), and free intraperitoneal rupture (14%). Minimally invasive drainage was required selectively. An exploratory laparotomy was performed in 2 children (2.1%) who developed generalized peritonitis. No mortality was observed.</p><p><strong>Conclusion: </strong>Contained subcapsular extension of pediatric liver abscess can be safely managed conservatively. Rupture requires careful imaging-based stratification, selective minimally invasive drainage, and timely surgical intervention when indicated. Surgery remains essential in children with generalized peritonitis or failed nonoperative management.</p>","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"746-749"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Serum Procalcitonin and High-sensitivity C-reactive Protein as Prognostic Markers of Postoperative Outcomes in Surgical Neonates: A Prospective Observational Study.","authors":"Simmi K Ratan, Tanvi Luthra, Mehak Sehgal, Gaurav Saxena, Sujoy Neogi, Chiranjiv Kumar, Bhawna Mahajan, Nitin Jain, Nitesh Kumar Sharma, Sonal Saxena, Hariom Kumar Solanki","doi":"10.4103/jiaps.jiaps_101_26","DOIUrl":"10.4103/jiaps.jiaps_101_26","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Neonatal sepsis is a major cause of morbidity and mortality. Procalcitonin (PCT) and high-sensitivity C-reactive protein (hs-CRP) are increasingly evaluated as early markers of infection. This study assessed the predictive value of PCT and hs-CRP at admission and 24 h postsurgery for adverse outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A total of 120 operated neonates admitted to our surgical neonatal intensive care unit were prospectively enrolled. Demographic data, clinical parameters, blood investigations, blood culture results, and biomarker levels were recorded at admission and 24 h postoperatively. Note was also made of any surgical or anesthetic events. Outcomes were assessed at discharge or death and classified as favorable (discharge) or adverse (Clavien-Dindo Grade 4 or death). Receiver operating characteristic curves determined sensitivity, specificity, and optimal cutoffs; Spearman's correlation assessed associations of outcome with biomarkers, total leukocyte count (TLC), and blood culture. Multivariable logistic regression (backward stepwise) was performed to identify independent predictors of adverse outcome, with model fit assessed using the Hosmer-Lemeshow test and Nagelkerke &lt;i&gt;R&lt;/i&gt; &lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 120 neonates (mean age: 3.5 ± 4.5 days; male = 69, female = 51), 97% had congenital conditions pertaining to the gastrointestinal tract and required either bowel anastomosis or stoma. Culture-proven sepsis was present in 23% of neonates at admission and increased to 39% at 24 h postsurgery (almost 60% rise). Clinically suspected sepsis was observed in 41% of neonates at admission and 57% at 24 h after surgery (about 40% increase). Abnormal TLC was noted in 22.5% at admission, which increased marginally after surgery, while absolute neutrophil count remained comparable across time points. At admission, elevated hs-CRP and PCT were detected in 58% and 54% of neonates, respectively; these incidences increased to 82% and 61.6% at 24 h postsurgery, indicating a 20% postoperative rise in biomarker levels. Adverse outcomes occurred in 59% of neonates, and most of these patients had elevated PCT and hs-CRP (70% and 65%, respectively), which had a correlating trend at admission and 24 h (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). Using standard laboratory thresholds, hs-CRP demonstrated a marked increase in sensitivity from 57.7% at admission to 91.5% at 24 h postsurgery (50% increase), while specificity declined marginally from 40.8% to 30.6% for predicting adverse outcomes. In contrast, PCT showed modest improvement in postoperative performance, with sensitivity increasing from 57.7% to 73.2% (35% increase), and specificity remained roughly the same (51.0% to 55.1%). All neonates with intraoperative events suffered poor outcomes, and all of them had high biomarker levels at admission. On multivariable analysis, lower birth weight (odds ratio [OR]: 0.29, 95% confidence interval [CI]: 0.12","PeriodicalId":16069,"journal":{"name":"Journal of Indian Association of Pediatric Surgeons","volume":"31 5","pages":"829-838"},"PeriodicalIF":0.0,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}