Journal of pediatric surgery最新文献

{"title":"Cost Effectiveness of Pediatric Blunt Cerebrovascular Injury Screening: A Decision Tree Analysis","authors":"Alexandra L. Campbell ,&nbsp;Dennis Xuan ,&nbsp;Prashanth Balaraman ,&nbsp;Danielle Tatum ,&nbsp;Brian Yorkgitis ,&nbsp;David Yu ,&nbsp;Patrick McGrew ,&nbsp;Jeanette Zhang ,&nbsp;Kevin Harrell ,&nbsp;Juan Duchesne ,&nbsp;Lizheng Shi ,&nbsp;Sharven Taghavi","doi":"10.1016/j.jpedsurg.2025.162296","DOIUrl":"10.1016/j.jpedsurg.2025.162296","url":null,"abstract":"<div><h3>Background</h3><div>Early identification of blunt cerebrovascular injury in the pediatric (&lt;18 years) population (pBVCI) is essential to minimize stroke. However, the most cost-effective screening strategy for pBCVI is unknown, and there is high variability in practice nationwide. We sought to identify the most cost-effective screening strategy for identifying pBCVI and hypothesized that Memphis criteria (MC) would be the most cost-effective due to its high sensitivity.</div></div><div><h3>Study design</h3><div>A Decision Tree analysis model was used to compare the following BCVI screening strategies in peds: (1) no screening (NS); (2) Denver criteria (DC); (3) Expanded Denver criteria (eDC); (4) MC; (5) McGovern criteria (MG); (6) Utah criteria (UC); and (7) universal screening (US). The model considered a range of pBCVI incidences (0.2–2.7 %) and analyzed costs and utilities over a 5-year time horizon. pBCVI cases detected by screening modalities were assumed to be given antithrombotic therapy which mitigates the risk of stroke and mortality.</div></div><div><h3>Results</h3><div>Our analysis revealed that at low pBCVI incidences, UC was most cost-saving per additional quality-adjusted life year (QALY) compared to NS, while MC yielded the highest savings at high incidences compared to MG. Sensitivity analyses indicated the cost-effectiveness of screening strategies varied significantly with pBCVI incidence.</div></div><div><h3>Conclusions</h3><div>The cost-effectiveness of pBCVI screening is contingent upon accurate incidence rates, with no one-size-fits-all solution. Pediatric trauma centers should tailor their screening strategies to local pBCVI rates to enhance cost-efficiency and patient outcomes. Further research is needed to better define BCVI incidence rates in children to inform these decisions.</div></div><div><h3>Type of study</h3><div>Clinical Research Paper.</div></div><div><h3>Level of evidence</h3><div>2.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162296"},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730554","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}

{"title":"Postoperative Pain Management After Minimally Invasive Repair of Pectus Excavatum: A Systematic Review and Network Meta-analysis","authors":"Elise J. Van Polen,&nbsp;Chiel J. Franssen,&nbsp;Jean H.T. Daemen,&nbsp;Austin J. Isabella,&nbsp;Aimée J.P.M. Franssen,&nbsp;Karel W.E. Hulsewé,&nbsp;Yvonne L.J. Vissers,&nbsp;Erik R. de Loos","doi":"10.1016/j.jpedsurg.2025.162282","DOIUrl":"10.1016/j.jpedsurg.2025.162282","url":null,"abstract":"<div><h3>Background</h3><div>Minimally invasive repair of pectus excavatum is the accepted standard approach for correction of pectus excavatum. This procedure is associated with significant postoperative pain, which is the dominant factor determining the duration of hospitalization. To date, a multitude of analgesic modalities are used, however, the most effective is to be corroborated. The aim of this study is to systematically evaluate and compare all available analgesic modalities for pain management after minimally invasive repair of pectus excavatum through a network meta-analysis.</div></div><div><h3>Methods</h3><div>Electronic scientific databases were systematically searched. Articles were eligible for inclusion when designed as a comparative study evaluating perioperative pain management techniques for patients undergoing minimally invasive repair of pectus excavatum and where length of hospitalization was reported as an outcome. Data concerning length of hospitalization were extracted and submitted for network meta-analysis.</div></div><div><h3>Results</h3><div>Thirty-nine studies were included, enrolling 4241 patients. Through a network meta-analysis intercostal nerve cryoablation with an adjunct analgesic intervention (e.g., intercostal nerve block or patient controlled analgesia) showed a statistically significant reduction in the length of hospitalization ranging from 0.9 days (95 % confidence interval (CI): −1.7 to −0.1) when compared to locoregional blocks with an adjunct analgesic intervention to 2.5 days (95 % CI: −3.7 to −1.3) when compared to thoracic epidural analgesia.</div></div><div><h3>Conclusion</h3><div>Regarding postoperative pain management after minimally invasive repair of pectus excavatum, intercostal nerve cryoablation with adjunct analgesic intervention is more effective in terms of length of hospitalization compared to other forms of analgesia.</div></div><div><h3>Type of Study</h3><div>Systemic review and meta analysis.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162282"},"PeriodicalIF":2.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692512","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}

{"title":"Factors Associated With Short- and Long-term Survival in Oesophageal Atresia With Tracheoesophageal Fistula","authors":"Joseph R. Davidson ,&nbsp;Ahmed Refaat Khodary ,&nbsp;Aiysha Puri ,&nbsp;Simon Eaton ,&nbsp;Dominika Borselle ,&nbsp;Verity Haffenden ,&nbsp;Dhanya Mullassery ,&nbsp;Stefano Giuliani ,&nbsp;Simon Blackburn ,&nbsp;Kate Cross ,&nbsp;Dariusz Patkowski ,&nbsp;Antti Koivusalo ,&nbsp;Mikko Pakarinen ,&nbsp;Iain Yardley ,&nbsp;Paolo De Coppi ,&nbsp;Joe Curry ,&nbsp;Stavros Loukogeorgakis","doi":"10.1016/j.jpedsurg.2025.162293","DOIUrl":"10.1016/j.jpedsurg.2025.162293","url":null,"abstract":"<div><h3>Background</h3><div>Risk stratification scores for oesophageal atresia with tracheoesophageal fistula (OA-TOF) are useful to predict survival. Scores from single-centre series may lack external validity. We aimed to model survival in OA-TOF and validate a new risk score using an international, multicentre cohort of patients.</div></div><div><h3>Method</h3><div>Retrospective data (2000–2022) from 4 tertiary centres were used; a multivariable logistic regression model for survival to discharge was derived from single centre data, and then validated on the whole dataset using bootstrapping. In addition, Cox regression was used to analyse determinants of longer-term survival in those infants who had survived to one year of age.</div></div><div><h3>Results</h3><div>Survival to discharge was 94 % (668/708). After internal validation, mortality prior to discharge was significantly predicted by lower birthweight (aOR 1.174/100 g; p = 0.007), major cardiac lesion requiring surgery (aOR 12.8; p &lt; 0.001) or an additional associated major structural anomaly or syndrome (aOR 5.12; p &lt; 0.001). A further 19 patients died after hospital discharge at a median 453 days [range 60–2640]. Factors associated with long-term mortality in those who had survived to one year of age were: major renal disease (bilateral or unilateral structural anomaly with impaired function, aOR 11.08 p &lt; 0.001) or an additional major structural anomaly or syndrome (aOR 6.41 p &lt; 0.001). We propose a new Oesophageal Atresia Risk (OAR) Score.</div></div><div><h3>Conclusion</h3><div>Low birthweight infants and those with cardiac disease are at risk of early mortality; these factors are less significant than the presence of major renal disease for those infants who survive to discharge. Major structural anomalies and syndromic associations remain significant determinants of mortality throughout.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162293"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692508","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}

{"title":"Unicentric Series of 82 Consecutive Patients With Ultralong Hirschsprung Disease: How Experience Leads Management","authors":"A. Pini Prato ,&nbsp;G. Mottadelli ,&nbsp;A. Bertolino ,&nbsp;L. Giacometti ,&nbsp;S. Casella ,&nbsp;M. Novi ,&nbsp;M. Erculiani","doi":"10.1016/j.jpedsurg.2025.162283","DOIUrl":"10.1016/j.jpedsurg.2025.162283","url":null,"abstract":"<div><h3>Introduction</h3><div>Total Colonic (TCSA), Extended (EA), and Total Intestinal Aganglionosis (TIA) are rare forms of Hirschsprung (HSCR) grouped under the term Ultralong HSCR. We aim at presenting the features of the largest unicentric series reported so far and at sharing the algorithm for management adopted in our Center for Digestive Diseases.</div></div><div><h3>Materials and methods</h3><div>We enrolled all consecutive patients with Ultralong HSCR admitted between 2017 and 2024. Data regarding clinical features, diagnosis, management, and outcome have been recorded along with details regarding definition, classification and management.</div></div><div><h3>Results</h3><div>A total of 82 patients were included, 69 being TCSA, 7 EA and 6 TIA. Length of involved ileum in TCSA ranged between 5 and 75 cm. Average age at pull-through (PT) was 2 years. Surgical complications were experienced by 36 % of patients regardless of type of PT. Postoperative enterocolitis (HAEC) were more frequent after Duhamel procedures. Stoma was fashioned 40 cm from the Ligament of Treitz (LOT) in TIA or as a levelling jejunostomy in EA. Three EA patients underwent Skipped Aganglionic Lengthening Transposition (SALT) to improve enteral autonomy with good results. Other lengthening procedures or autologous reconstructions proved to be less effective. Five patients with EA/TIA received total enterectomy nullifying the possibility for subsequent lengthening procedures. Mortality rate was 2.4 %.</div></div><div><h3>Conclusions</h3><div>Based on these results and on literature data, we propose an outcome-driven classification based on the length of ganglionated bowel below the LOT. We also suggest a management protocol aimed at improving survival for these delicate subgroups of HSCR patients.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162283"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674087","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}

{"title":"Case-matched Comparison of Outcomes Following Neonatal Mucous Fistula Refeeding: 13-year Institutional Review.","authors":"Goeto Dantes, Swathi Raikot, Caroline Chivily, Benjamin Herron, Lauriane Pinto, Zhulin He, Laura M Johnson, Megan Bouchard, Megan Durham, Gregory Sysyn, Anthony Piazza, Hanna Alemayehu","doi":"10.1016/j.jpedsurg.2025.162276","DOIUrl":"10.1016/j.jpedsurg.2025.162276","url":null,"abstract":"<p><strong>Background: </strong>Refeeding ostomy effluent into the residual bowel via the mucus fistula (MFR) has been associated with decreased parenteral nutrition needs and decreased cholestasis. However, MFR is also associated with risks and the literature is not definitive. We performed a case matched comparison of neonates treated with and without MFR.</p><p><strong>Methods: </strong>All neonates who underwent enteral diversion between 2010 and 2023 were identified. Neonates who received MFR were propensity score matched with non-MFR neonates. Primary objectives included cholestasis and ability to achieve full feeds prior to enterostomy closure (EC). We also evaluated MFR complications (perforation, ostomy stricture, leak or prolapse).</p><p><strong>Results: </strong>262 neonates were case matched (131 MFR and 131 non-MFR). Age, height, and weight on admission were comparable. We found no difference in ability to achieve full feeds prior to EC. MFR neonates did have a lower incidence of cholestasis (p < 0.001). Complications occurred in 24 (18 %) of MFR neonates and abdominal reoperations prior to EC occurred more frequently in MFR (18 %) vs non-MFR (6.9 %) neonates, odds ratio 3.21 (1.44, 7.61).</p><p><strong>Conclusion: </strong>MFR is an important tool in the postoperative management of diverted neonates. However, when critically analyzed via statistical case matching, our study shows that the benefits may be more nuanced.</p><p><strong>Level of evidence: </strong>Level III.</p><p><strong>Study type: </strong>Retrospective Chart Review.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162276"},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692503","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}

{"title":"25-OH Vitamin D Deficiency Does Not Significantly Predispose Young Children to Multiple Fractures From Minimal Trauma","authors":"Gregory Dyba ,&nbsp;Camryn Capoot ,&nbsp;Nicole Becher ,&nbsp;Kelly Finnegan ,&nbsp;Carmelle Wallace ,&nbsp;David Mong ,&nbsp;Antonia Chiesa ,&nbsp;Nina S. Ma ,&nbsp;Jennifer Stevens ,&nbsp;Alexander M. Kaizer ,&nbsp;Kaitlin E. Olson ,&nbsp;Steven L. Moulton ,&nbsp;Daniel M. Lindberg","doi":"10.1016/j.jpedsurg.2025.162281","DOIUrl":"10.1016/j.jpedsurg.2025.162281","url":null,"abstract":"<div><h3>Background</h3><div>In the absence of significant accidental trauma, the identification of multiple fractures in a young child raises concern for abuse. One group has suggested that there is an unrecognized “epidemic” of 25-OH vitamin D deficiency that produces findings frequently mistaken for child abuse.</div></div><div><h3>Objective</h3><div>Test whether 25-OH vitamin D deficiency predisposes young children to fractures.</div></div><div><h3>Participants and setting</h3><div>Children &lt;5 years old with blood obtained during acute trauma care at a large, regional pediatric center.</div></div><div><h3>Methods</h3><div>This cross-sectional study compared the number of fractures in children with 25-OH Vitamin D deficiency to those with sufficient levels.</div></div><div><h3>Results</h3><div>Among 656 eligible participants, 25-OH vitamin D levels were obtained in 203 (31 %). Using a threshold of 20 ng/mL, 35 (17 %) participants were found to have 25-OH vitamin D deficiency. Among children with deficiency, 19/35 (54 %) had at least one fracture, compared to 97/168 (58 %) of those with sufficiency (p = 0.712). Among those with fractures, the mean number of fractures was 2.9 for sufficient children and 3.2 for deficient children (p = 0.70). Fourteen children had five or more fractures, including 11 with physical abuse, and 3 with severe accidental trauma. Among 35 children with deficiency, 17 (49 %) were reported to Child Protective Services, compared to 62/168 (37 %) with sufficiency (OR 1.62, 95%CI 0.78–3.36)</div></div><div><h3>Conclusion</h3><div>25-OH vitamin D deficiency in the absence of significant trauma is not a plausible explanation for multiple fractures.</div></div><div><h3>Type of study</h3><div>Prospective, Cross-sectional Study.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162281"},"PeriodicalIF":2.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674035","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}

{"title":"Outcomes of Kasai Portoenterostomy in Patients With Congenital Heart Disease: A Silent Comorbidity","authors":"Mario O'Connor ,&nbsp;Hugo R. Martinez ,&nbsp;Maria E. Hoyos ,&nbsp;Charles D. Fraser ,&nbsp;Andrew Well","doi":"10.1016/j.jpedsurg.2025.162279","DOIUrl":"10.1016/j.jpedsurg.2025.162279","url":null,"abstract":"<div><h3>Introduction</h3><div>Biliary atresia (BA) is the most common cause of end-stage liver disease in children. Around 5 %–15 % of patients with BA have a congenital heart disease (CHD) diagnosis. Despite high prevalence of a CHD diagnosis in patients with BA, outcomes of Kasai portoenterostomy (KPE) in the CHD population remain unexplored.</div></div><div><h3>Methods</h3><div>This is a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database from 2012 to 2022. All patients undergoing KPE were included. Patients with CHD were identified using previously validated ICD9/10 codes.</div></div><div><h3>Results</h3><div>A total of 854 patients underwent a KPE during the study period. Of this cohort, 502 (59 %) were female, 342 (40 %) White Non-Hispanic, median age of 57.0[IQR: 40.0–72.0] days, and a median weight of 9.4 [IQR: 8.1–10.7] kilograms. A total of 89 (10 %) patients had a diagnosis of CHD. Of those, 63 (7 %) had a simple-CHD diagnosis and 26 (3 %) a complex-CHD diagnosis. A single-ventricle (SV-CHD) diagnosis was present in 7 (1 %) patients. Notably, no in-hospital mortalities were found. When compared to non-CHD, simple-CHD (OR: 2.51; 95 % CI: 1.45–4.36, p = 0.001) and complex-CHD (OR: 3.20; 95 % CI: 1.30–7.87, p = 0.011) had increased risk for any complication. Furthermore, when compared to non-CHD complex-CHD patients had higher odds of undergoing a Kasai related reintervention (OR: 5.01; 95 % CI: 1.76–14.22, p = 0.002. After propensity score matching, when compared to non-CHD a CHD diagnosis was only associated with an increased risk for any complication (OR: 2.50; 95 % CI: 1.30–4.81, p = 0.005).</div></div><div><h3>Conclusion</h3><div>A CHD diagnosis is present in 10 % of children undergoing KPE. KPE appears to be safe in patients with CHD, but associated with increased in-hospital resource utilization. Further studies are needed to understand the impact of a CHD diagnosis on the long-term outcomes after KPE.</div></div><div><h3>Type of study</h3><div>Retrospective Review.</div></div><div><h3>Level of evidence</h3><div>Level 3.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162279"},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143670179","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}

{"title":"Management, Trends, and Recommendations for Intra-abdominal Lymphatic Malformations-A Single-Center Retrospective Review: A Contribution to Management.","authors":"Maria Camila Altamar, Gustavo Triana","doi":"10.1016/j.jpedsurg.2025.162278","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162278","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162278"},"PeriodicalIF":2.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710370","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}

{"title":"Quality of Life, Wellbeing and Participation in Adults Born With Congenital Diaphragmatic Hernia","authors":"Rebecca Pulvirenti ,&nbsp;Ulrike S. Kraemer ,&nbsp;Lieke S. Kamphuis ,&nbsp;J. Marco Schnater ,&nbsp;Ivo de Blaauw ,&nbsp;Hanneke IJsselstijn ,&nbsp;Andre B. Rietman","doi":"10.1016/j.jpedsurg.2025.162275","DOIUrl":"10.1016/j.jpedsurg.2025.162275","url":null,"abstract":"<div><h3>Background</h3><div>As more neonates born with congenital diaphragmatic hernia (CDH) survive, interest in long-term morbidities and their health-related quality of life (HRQoL) is growing. For adolescents and young adults with CDH, information on HRQoL is anecdotal. Therefore, our aim was to evaluate HRQoL and its determinants in a recently studied cohort of adult CDH survivors.</div></div><div><h3>Methods</h3><div>We conducted a prospective, nationwide observational cohort study in CDH patients born 1989 to 2001. Demographic and clinical characteristics were collected, and participants completed questionnaires assessing HRQoL, participation and autonomy, fatigue, and emotional and behavioral wellbeing. Descriptive and inferential statistical analyses were performed.</div></div><div><h3>Results</h3><div>Sixty-one CDH patients aged 19–31 years were included. Overall, participants experienced normal HRQoL for both physical (mean (SD) z-score: 0.03 (1.01); p = 0.088) and mental (z-score −0.23 (1.05); p = 0.316) components. Their participation and autonomy exceeded that of a reference population with one chronic disorder (p &lt; 0.001), but they experienced significantly more fatigue (z-score: −0.46 (1.24); p = 0.006); which was severe in 16 %. Patients reported significantly more frequent internalizing problems, particularly within the ‘somatic complaints’ domain (p = 0.004). Among positive determinants of physical HRQoL were attendance of regular education, a higher exercise capacity, and better outdoors autonomy. Positive determinants of mental HRQoL included undergoing primary diaphragmatic repair and having fewer internalizing problems.</div></div><div><h3>Conclusions</h3><div>CDH patients perceive their HRQoL to be comparable to that of the general population, achieving similar participation and autonomy. However, fatigue warrants attention during long-term follow-up, and psychological counseling in childhood and adolescence may be beneficial for addressing emotional problems.</div></div><div><h3>Level of evidence</h3><div>Not applicable.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 6","pages":"Article 162275"},"PeriodicalIF":2.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769343","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":"Why Pediatric Surgeons Need to Care About Climate Change.","authors":"Colleen M Fitzpatrick, Christopher S Muratore, Richard D Glick, Mehul V Raval, Linda Li","doi":"10.1016/j.jpedsurg.2025.162280","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162280","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162280"},"PeriodicalIF":2.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795624","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}