Journal of pediatric surgery最新文献

{"title":"'Impact of a Regional Damage Control Surgery Pathway on Time to Surgery for Neonates with Severe Necrotising Enterocolitis. A prospective cohort study.'","authors":"G Suren Arul, Alison Jones, Jeffrey Martin, Alex Philpott, Matt Nash, Andrea Hughes, Sarah Hulbert, Myrthe Tajik, Max Pachl, Giampiero Soccorso, Michael Singh, Ingo Jester, Hetal Patel, Anthony Lander, Hari Krishnan Kanthimathinathan","doi":"10.1016/j.jpedsurg.2025.162692","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162692","url":null,"abstract":"<p><strong>Background: </strong>In the UK, published time from diagnosis of perforation to surgery for babies with Necrotising Enterocolitis (NEC) was 23·5 hours. We aimed to determine if a standardised regional referral pathway, combined with a damage control surgical approach (DCS) could reduce timings associated with referral to first surgical intervention.</p><p><strong>Method: </strong>Our pathway standardised referrals, transfer, blood-crossmatching and DCS. Criteria to trigger pathway was a neonate with NEC and either perforation or requiring inotropes. Pathway implementation used quality improvement and appreciative inquiry principles. Timings and physiological data were collected prospectively as were other secondary outcomes including mortality, stoma rate and time on parenteral nutrition.</p><p><strong>Results: </strong>From 01/08/2021 to 31/12/2023, 60 neonates (median gestation 26 weeks, birth weight 815g) with NEC, triggered our DCS pathway. All timing metrics (referral to PICU admission, admission to blood availability, PICU to surgery, and referral to surgery) showed statistically significant reduction over the course of the study. The time from referral to surgery was median [interquartile range] 347 [289-514] minutes, with reduction from 449 minutes in the earlier part of study to 323 minutes in the latter half[p=0.01]. Median operative time for DCS 26 minutes. Twenty patients (33%) had stoma. Seventeen patients died within 28 days (28%) after surgery. There were 42 babies with birthweight <1000g (mortality 33%). Median time on PN after primary anastomosis was 30 days versus 93 days after stoma.</p><p><strong>Conclusion: </strong>This is the first prospective report of interventions to expedite time to surgery in severe NEC. In this study we demonstrated reduction in all timings measured. Clinical outcomes were better than expected compared with historical datasets. Further work is needed to establish whether improved outcomes are associated with earlier transfer to surgery, the damage control approach, the standardised coordinated regional approach, or the cumulative effect from all aspects of this pathway.</p><p><strong>Level of evidence: </strong>2B.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162692"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145186168","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":"Beyond Cloacal malformation. Addressing unclassifiable complexity.","authors":"Zeni Haveliwala, Athanasios Tyraskis, Kathryn Ford, Tanvi Singh, Neetu Kumar, Hazel Learner, Sonia Basson, Stavros Loukogeorgakis, Simon Blackburn, Abraham Cherian, Joe Curry","doi":"10.1016/j.jpedsurg.2025.162695","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2025.162695","url":null,"abstract":"<p><strong>Introduction: </strong>Cloacal malformations are a spectrum of complex congenital anomalies traditionally classified by common channel length, urethral length, Müllerian configuration, and sacral or spinal abnormalities. Classification guides reconstructive strategy and informs prognosis. However, a subset of patients present with atypical anatomy that defies standard classification systems, complicating surgical planning and prediction of outcomes.</p><p><strong>Aim: </strong>Our cloacal malformation multidisciplinary service utilises a pathway based on common channel length, Mullerian anomalies, urethral length and sacral spinal abnormalities. We aimed to assess the management and faecal continence outcomes of these unclassifiable cases.</p><p><strong>Methods: </strong>We conducted a retrospective review of 82 patients referred for primary reconstruction from 2010, analysing categorical and numerical data using Fisher's exact and Mann-Whitney U tests. Patients were categorised as classic cloaca, posterior cloaca, and unclassifiable (exhibited complex/atypical anatomy such as indistinct of absent common channels, duplication of urogenital structures or associated covered cloacal exstrophy variants).</p><p><strong>Results: </strong>Of 82 patients, 15 were unclassifiable. The latter group had more co-morbidities: 75% (n=6) with spinal anomalies requiring neurosurgery, and 93% (n=14) with renal anomalies. They were more likely to undergo laparotomy (n=10) and had poorer faecal continence outcomes, with bowel function score of 6, compared to 13 in the classic cloaca group. Surgical management was more complex, with all patients requiring functional diversion procedures rather than standard anatomical reconstruction, representing a form of \"non-anatomical reconstruction\".</p><p><strong>Conclusion: </strong>Unclassified cloacal malformation group represent a significant challenge, with poorer functional outcomes likely due to greater anatomical complexity and coexisting anomalies. Successful management requires experience in cloacal reconstruction and operative planning tailored to each patient's unique anatomy.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162695"},"PeriodicalIF":2.5,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182134","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":"Internal anal sphincter achalasia in chronic functional constipation in children: A myth rather than reality.","authors":"Alireza S Keshtgar, Zahra Almatar, Sadaf Kader, Mudher Al-Adnani, Moein Mobini, Haasher Monib, Simran Sehdev","doi":"10.1016/j.jpedsurg.2025.162693","DOIUrl":"10.1016/j.jpedsurg.2025.162693","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims of the study: &lt;/strong&gt;Internal anal sphincter achalasia (IASA) is characterised by chronic constipation and it is diagnosed based on an absent rectoanal inhibitory reflex (RAIR) on manometry despite a ganglionated rectal biopsy. This study evaluates the pathophysiology of IASA in children with chronic functional constipation (CFC) and determines whether it represents a distinct disorder or a functional variant of constipation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review of prospectively collected data was conducted on 205 children aged 1-16 years with symptoms of constipation and soiling, who failed optimised medical management at Evelina London Children's Hospital between May 2011 and June 2024. Patients were diagnosed with constipation based on the Rome IV criteria. They did not respond to conventional medical treatment of constipation and underwent anorectal investigations and botulinum toxin injection into the external anal sphincter under ketamine anaesthesia. All patients underwent high-resolution anorectal manometry (HRARM) using 8- or 24-channel water-perfused catheters and endosonography under ketamine anaesthesia; and rectal biopsy if RAIR was absent or inconclusive. We compared 178 children, who had symptoms of functional constipation and normal RAIR on manometry with 27 patients, who had chronic functional constipation (CFC) and absent/inconclusive RAIR on manometry and had normal ganglionated rectal biopsy. Findings were compared with 10 children diagnosed with Hirschsprung disease (HD), who had obstructive defecation symptoms after Duhamel pull-through surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 205 children, 27 (13 %) had chronic functional constipation (CFC) and absent or inconclusive RAIR and normal rectal biopsy findings. These patients were comparable with 178 children with functional constipation (FC), who had normal RAIR on manometry. Compared to FC patients, children with CFC presented earlier at median 6.5 (0.83-12) year vs 7 (1.1-16.3) year, p &lt; 0.05. However comparing CFC children to HD patients they presented at an older median age 6.5 (0.83-12) year vs. 2.75 (1.16-8.75) year, p &lt; 0.06); had a longer duration of symptoms 3 (0.5-11.5) years vs. 1 (0.25-3) years, p &lt; 0.001); exhibited greater RAIR relaxation on manometry 23 % vs. 0 %, p &lt; 0.001), and had a thicker internal anal sphincter (IAS) on endosonography 0.84 (0.3-1) vs. 0.71 (0.3-1) mm, p &lt; 0.04). Manometry showed paradoxical contraction of the external anal sphincter (EAS) muscles in 8/27, megarectum in 12/27, both in 4/27, and neither in 4/27. Notably, 24/27 (89 %) children with CFC and absent/inconclusive RAIR responded to botulinum toxin injection into the EAS with significant improvement of their preoperative total symptom severity (SS) score from median score of 26 to 15 at 3 and 12 months follow up, (p &lt; 0.01), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In children with chronic functional constipation (CFC) and soiling and n","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162693"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176169","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":"Letter to editor: Two-stage Fowler-Stephens orchidopexy in management of undescended testes: Is it time for a change? A UK multi-centre retrospective study.","authors":"Milan Gopal","doi":"10.1016/j.jpedsurg.2025.162694","DOIUrl":"10.1016/j.jpedsurg.2025.162694","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162694"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176122","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 of perianal abscesses in infants: A systematic review from the APSA outcomes and evidence-based practice committee","authors":"Shannon N. Acker ,&nbsp;Jason Sulkowski ,&nbsp;Henry L. Chang ,&nbsp;John Cyrus ,&nbsp;Emily Christison-Lagay ,&nbsp;Sara A. Mansfield ,&nbsp;Diana L. Diesen ,&nbsp;Brian C. Gulack ,&nbsp;Katie Russell ,&nbsp;Alana L. Beres ,&nbsp;Rebecca M. Rentea ,&nbsp;Yasmine Yousef ,&nbsp;Hanna Alemayehu ,&nbsp;Melissa E. Danko ,&nbsp;Sandra K. Kabagambe ,&nbsp;Afif N. Kulaylat ,&nbsp;Tamar L. Levene ,&nbsp;Christopher Pennell ,&nbsp;Stephanie F. Polites ,&nbsp;Joshua K. Ramjist ,&nbsp;Rob Ricca","doi":"10.1016/j.jpedsurg.2025.162691","DOIUrl":"10.1016/j.jpedsurg.2025.162691","url":null,"abstract":"<div><h3>Background</h3><div>Management of infant perianal disease, including perianal abscess and fistula-in- ano (FIA), remains controversial. There is lack of consensus regarding the risks and benefits of operative and non-operative approaches.</div></div><div><h3>Methods</h3><div>The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee created <em>a priori</em> consensus-based questions regarding the various approaches to management of perianal abscess and FIA in infants. A comprehensive search strategy was created, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to identify and review relevant articles and answer the established questions.</div></div><div><h3>Results</h3><div>Over 2460 titles and abstracts were screened to identify 31 manuscripts describing the expected course of perianal disease when managed with nonoperative management (NOM) strategies (such as hygiene, sitz baths, and systemic antibiotics), operative intervention for abscess only (incision and drainage (I&amp;D)) or direct surgical management of the FIA (e.g. upfront fistulotomy). Initial failure of NOM is approximately 37.5 %. Recurrence rate after initial success with NOM or I&amp;D is approximately 21 % and 24 %, respectively. The rate of FIA development is approximately 21 % after NOM and 20 % after I&amp;D. Recurrence after operative management of FIA, regardless of approach, is 7 %. Time to complete resolution varies widely and does not appear to differ based on treatment strategy.</div></div><div><h3>Conclusions</h3><div>Both operative and non-operative approaches can be safely used in the management of perianal abscess and FIA but recurrence is common regardless of approach. Risks and benefits of each approach should be considered on a case-by-case basis.</div></div><div><h3>Type of Study</h3><div>Systematic Review of level 3-4 studies.</div></div><div><h3>Level of Evidence</h3><div>Level 4.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 12","pages":"Article 162691"},"PeriodicalIF":2.5,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124872","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":"Letter to the editor: The use of extracorporeal membrane oxygenation in neonates with congenital renal failure.","authors":"Meihui Zhou, Ying Xu, Guoying Wang","doi":"10.1016/j.jpedsurg.2025.162690","DOIUrl":"10.1016/j.jpedsurg.2025.162690","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162690"},"PeriodicalIF":2.5,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145113634","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":"Effect of a pediatric surgeon's primarily performed technique on inguinal hernia recurrence rates: A multicenter retrospective cohort study","authors":"Kathleen Heller ,&nbsp;Brielle V. Ochoa ,&nbsp;Stephanie F. Brierley ,&nbsp;Benjamin E. Padilla","doi":"10.1016/j.jpedsurg.2025.162688","DOIUrl":"10.1016/j.jpedsurg.2025.162688","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the effect of surgeons’ preferred repair technique for pediatric inguinal hernia repair (IHR) -laparoscopic versus open-on hernia recurrence rates.</div></div><div><h3>Methods</h3><div>We conducted a multicenter retrospective cohort study of patients aged &lt;18 years old who underwent IHR at 21 children's hospitals from 2017 to 2019 with 3 year follow up. Surgeons preferring open hernia repair performed ≥70 % of hernia repairs open (Open surgeons). Surgeons preferring laparoscopic hernia repair performed ≥70 % of hernia repairs laparoscopically (Laparoscopic surgeons). Descriptive statistics and multivariable regression were utilized.</div></div><div><h3>Results</h3><div>Among 207 surgeons, 125 (60.4 %) were Open surgeons, and of those 54 (43.2 %) performed at least 1 laparoscopic IHR. The inguinal hernia recurrence rates for Open surgeons were 0.9 % for open IHR and 3.6 % for laparoscopic IHR, p &lt; 0.001. There were 58 (28.0 %) Laparoscopic surgeons and of those 44 (75.9 %) performed at least 1 open IHR. The inguinal hernia recurrence rates for Laparoscopic surgeons were 1.7 % for laparoscopic IHR and 1.7 % for open IHR, p = 1.000. For open IHR, no significant difference in recurrence rates was observed between Open and Laparoscopic surgeons (0.9 % versus 1.7 %, p = 0.230). For laparoscopic inguinal hernia repairs, Open surgeons had higher recurrence rates than Laparoscopic surgeons with odds ratio of (3.6 % versus 1.7 %, p = 0.019).</div></div><div><h3>Conclusions</h3><div>Open surgeons have higher inguinal hernia recurrence rates when performing laparoscopic IHR. No difference in hernia recurrence rates following open and laparoscopic repair was noted for Laparoscopic surgeons. Pediatric surgeons dividing cases between open and laparoscopic IHR should take caution to maintain adequate proficiency in both.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 12","pages":"Article 162688"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102760","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":"Lessons in patient-centered care and perioperative practices for children with neurodivergent conditions.","authors":"Nzuekoh Nchinda, Krystalanne Pacheco Cabral, Chantal Frigon, Judy Colton, Marion Henry","doi":"10.1016/j.jpedsurg.2025.162689","DOIUrl":"10.1016/j.jpedsurg.2025.162689","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162689"},"PeriodicalIF":2.5,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102861","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":"Perinatal prognostic factors of recurrence or functional sequelae in neonatal sacrococcygeal teratoma, and implications for prenatal counselling: A multicenter retrospective study","authors":"Nicolas Vinit ,&nbsp;Arnaud Bonnard ,&nbsp;Sabine Irtan ,&nbsp;Virginie Fouquet ,&nbsp;Yves Ville ,&nbsp;Jonathan Rosenblatt ,&nbsp;Jean-Marie Jouannic ,&nbsp;Alexandra Benachi ,&nbsp;Naziha Khen-Dunlop ,&nbsp;Alexandre Lapillonne ,&nbsp;Sylvie Beaudoin ,&nbsp;Véronique Rousseau ,&nbsp;Laurent J. Salomon ,&nbsp;Sabine Sarnacki","doi":"10.1016/j.jpedsurg.2025.162687","DOIUrl":"10.1016/j.jpedsurg.2025.162687","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the risk of recurrence and functional sequelae in sacrococcygeal teratoma (SCT).</div></div><div><h3>Methods</h3><div>Children with fetal/neonatal SCT (diagnosis &lt;6 months) managed in five different centers (January 2007-Decempber 2017) were retrospectively included (NCT04623658). Syndromic and malignant SCT were excluded. Data from prenatal diagnosis, birth, neonatal surgery, recurrence and functional sequelae (digestive, urinary, orthopedic, cosmetic) were analyzed. Clinical follow-up was reviewed at one, three, ten years and at last follow-up, and occurrence of SCT recurrence or functional sequelae was noted. Digestive sequelae were defined as constipation ≥grade 2, soiling ≥grade 2 or the need for transanal irrigation (Krickenbeck classification). Urinary sequelae were defined as the presence of a neurogenic bladder.</div></div><div><h3>Results</h3><div>Fifty-five children (80%) survived the neonatal period, with a prenatal diagnosis of SCT in 75% of cases. All of them survived to last follow-up. Recurrence occurred in 11% of cases (median age: 25 months), including 50% of malignancy. No significant association was found between tumor recurrence and patients/tumor characteristics or perinatal course. After a median follow-up of 4.9 years [3.4-7.4], 22% (n=12/55) of children had functional sequelae: digestive (22%), urinary (7%), orthopedic (4%), cosmetic (9%). Endopelvic tumors with prenatal signs of urinary tract compression were associated with neurogenic bladder. Children with neurogenic bladder were more likely to have digestive sequelae.</div></div><div><h3>Conclusion</h3><div>This study highlights the importance of addressing the three distinct risks of fetal SCT during prenatal counselling: perinatal life-threatening risk, risk of recurrence warranting clinical, radiological and biological monitoring, and long-term risk of functional sequelae.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 12","pages":"Article 162687"},"PeriodicalIF":2.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091917","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":"Silent messengers in the nano-world: Harnessing extracellular vesicles as theranostic tools for neonatal surgical conditions.","authors":"Augusto Zani","doi":"10.1016/j.jpedsurg.2025.162670","DOIUrl":"10.1016/j.jpedsurg.2025.162670","url":null,"abstract":"<p><p>Extracellular vesicles (EVs) are lipid bilayer-enclosed nanoparticles secreted by all cells that mediate intercellular communication by transferring proteins, lipids, and nucleic acids. Among their cargo, microRNAs are key post-transcriptional regulators of organogenesis. In fetal lung development, EV-mediated signaling is essential for the coordination of epithelial, mesenchymal, endothelial, and immune cells. In congenital diaphragmatic hernia (CDH), disruption of these interactions leads to pulmonary hypoplasia and pulmonary hypertension, the primary causes of morbidity and mortality. Amniotic fluid stem cell-derived EVs (AFSC-EVs) have emerged as a promising cell-free therapy to restore this impaired communication. In rodent, rabbit, and human models of pulmonary hypoplasia, AFSC-EV administration rescues branching morphogenesis, promotes epithelial and mesenchymal differentiation, and attenuates macrophage-driven inflammation. Cargo analyses identified enrichment of the miR-17∼92 cluster, whose regulatory role in branching and progenitor differentiation is indispensable for normal lung growth. Mechanistic studies demonstrated that RNA degradation or selective inhibition of these microRNAs abolished the regenerative effects, underscoring the central role of EV small RNAs. Single-nucleus RNA sequencing confirmed restoration of transcriptional programs in AFSC-EV-treated lungs to profiles resembling healthy controls. Together, these findings establish AFSC-EVs as potent mediators of fetal lung repair in experimental models. Beyond CDH, EVs represent a promising theranostic strategy for pediatric surgical conditions in which restoration of intercellular communication is critical.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"162670"},"PeriodicalIF":2.5,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086345","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}