Journal of pediatric surgery最新文献

{"title":"Ultra-low dose, short-interval indocyanine green for pediatric fluorescence-guided surgery: A multicenter evaluation.","authors":"Silvana Prodan, Cecilia Gigena Heitsman, Julia Udaquiola, Carolina Millan, Horacio Bignon","doi":"10.1016/j.jpedsurg.2026.163452","DOIUrl":"10.1016/j.jpedsurg.2026.163452","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the safety and fluorescence performance of an ultra-low-dose, short-interval indocyanine green (ICG) protocol in pediatric fluorescence guided surgery (FGS), and to compare dose and timing with pediatric publications.</p><p><strong>Methods: </strong>A multicenter retrospective analysis of prospectively collected data from pediatric patients undergoing FGS with ICG at eight institutions between March 2021 and November 2025. Variables included demographics, target structures, ICG dosing, and timing, which were compared to established pediatric dosing guidelines: 0.25-0.5 mg/kg given 45-720 min prior to biliary imaging, and a bolus of 0.1-0.5 mg/kg for angiography and tissue perfusion.</p><p><strong>Results: </strong>In 28 cases, more than 89% of intraoperative visualizations were rated satisfactory. The median ICG dose for biliary imaging was 0.05 mg/kg (0.03-0.11), corresponding to a 60-90% reduction compared with published recommendations. Administration occurred 30-75 min before visualization (median 55 min), which is below the intervals reported in the pediatric literature (45-720 min). Biliary procedures achieved reliable delineation of the common bile duct and cystic structures, showing favorable visualization at lower levels than previously reported. Perfusion applications also produced effective fluorescence using 0.05 mg/kg.</p><p><strong>Conclusions: </strong>This multicenter study demonstrated that very low doses of ICG administered at short intervals are safe and can be reliable for FGS in children. Clear imaging was achieved despite the use of lower doses and shorter timing than current guidelines recommend. These findings support the adoption of the lowest effective ICG dose in pediatric FGS.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163452"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911326","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":"Comparative analysis of medium-term outcomes between robotic-assisted and Open Kasai portoenterostomy for biliary atresia.","authors":"Yuanli Wang, Chengyan Tang, Bo Wang, Zhu Jin, Xingrong Xia, Yuan Gong, Qing Du, Daiwei Zhu, Zeping Li, Wankang Zhou, Lu Huang, Yu Liao, Shengying He, Yanyi Li, Yuanmei Liu, Shaotao Tang, Zebing Zheng","doi":"10.1016/j.jpedsurg.2026.163456","DOIUrl":"10.1016/j.jpedsurg.2026.163456","url":null,"abstract":"<p><strong>Objective: </strong>To compare the mid-term outcomes of robotic-assisted Kasai portoenterostomy (RAKPE) and open Kasai portoenterostomy (OKPE) in children with biliary atresia.</p><p><strong>Methods: </strong>In this retrospective dual-center cohort study, 70 children with biliary atresia underwent Kasai portoenterostomy between January 2022 and February 2024, including 38 who underwent RAKPE and 32 who underwent OKPE. Overall postoperative complications, jaundice clearance rate (JCR), cumulative incidence of cholangitis, liver stiffness, and native liver survival (NLS) were compared. Follow-up continued through February 2026.</p><p><strong>Results: </strong>The overall complication rate was lower in the RAKPE group than in the OKPE group (10.5% vs. 31.2%, P = 0.038). JCR was higher after RAKPE, although the difference was not statistically significant (73.7% vs. 53.1%, P = 0.074). The cumulative incidence of cholangitis was comparable between groups at 6 months (17.9% vs. 18.3%, P = 0.920), but was lower in the RAKPE group at 1 year (22.6% vs. 33.7%, P = 0.031) and 2 years (31.2% vs. 43.3%, P = 0.022); however, the overall between-group difference was not statistically significant by Gray's test (P = 0.174). Liver stiffness did not differ significantly between groups. NLS was better in the RAKPE group (log-rank χ² = 5.44, P = 0.020); the 1- and 2-year NLS rates were 78.9% and 68.4% versus 75.0% and 53.1%, respectively.</p><p><strong>Conclusions: </strong>Compared with OKPE, RAKPE was associated with fewer postoperative complications, a lower mid-term cumulative incidence of cholangitis, and improved native liver survival in children with biliary atresia.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163456"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912733","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 complications after laparoscopic gastrostomy tube placement: Does gastropexy suture technique matter?","authors":"Stephanie F Brierley, Ryan Hare, Rebecca Payne, Cong Wang, Craig Egan, Erin M Garvey, Erik N Hansen, Jamie C Harris, Ramin Jamshidi, Patrick E McGovern, Lisa E McMahon, Mark S Molitor, David M Notrica, Kathleen van Leeuwen, Benjamin E Padilla, Jason D Fraser","doi":"10.1016/j.jpedsurg.2026.163454","DOIUrl":"10.1016/j.jpedsurg.2026.163454","url":null,"abstract":"<p><strong>Introduction: </strong>To compare postoperative complications among three common gastropexy techniques used in pediatric patients undergoing laparoscopic gastrostomy tube (GT) placement.</p><p><strong>Methods: </strong>Patients ≤7 years of age who underwent laparoscopic GT placement at our institution between 1/2019-1/2025 were retrospectively reviewed. Patients were categorized and compared based on gastropexy technique: external transabdominal, buried transabdominal, or laparoscopic-assisted trans-fascial. The primary outcome was 30-day surgical site infection. Secondary outcomes included other postoperative complications, such as tube dislodgement, granulation tissue, reoperations, and mortality.</p><p><strong>Results: </strong>A total of 916 patients were analyzed: 86 (9.4%) external transabdominal sutures, 254 (27.7%) buried transabdominal, and 576 (62.9%) laparoscopic-assisted trans-fascial. Median age was 11 months [IQR 5.0, 24.0] and weight was 8.01 kg [IQR 5.53, 11.20]. There was no statistically significant difference in demographics across the three groups. There were no statistically significant differences among the external transabdominal, buried transabdominal and laparoscopic-assisted trans-fascial cohorts in 30-day surgical site infections (2.3% vs. 3.1% vs. 4.9%, p = 0.455), emergency department visits (11.6% vs. 12.2% vs. 13.5%, p = 0.805), or hospital readmissions (2.3% vs. 2.0% vs. 4.5%, p = 0.189). Similarly, there was no difference in 90-day outcomes among the cohorts: GT dislodgement (12.8% vs. 7.1% vs. 6.6%, p = 0.119) and GT site granulation tissue (60.5% vs. 54.3% vs. 57.1%, p = 0.572). On regression analysis, there were no factors associated with an increased risk for SSI.</p><p><strong>Conclusion: </strong>Postoperative complications did not differ across three gastropexy techniques. Granulation tissue formation was the most frequent complication, whereas SSI occurred less commonly and was not independently associated with gastropexy technique or suture type. Gastropexy method may be selected based on surgeon preference without increasing the risk of adverse postoperative outcomes following laparoscopic gastrostomy tube placement.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163454"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912708","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":"Does indocyanine green guidance alter surgeons' behavior in laparoscopic kasai portoenterostomy and improve outcomes?","authors":"Soichi Shibuya, Hiroki Goto, Shiho Yoshida, Yuichiro Miyake, Masahiro Takeda, Shunsuke Yamada, Hiroyuki Koga, Atsuyuki Yamataka, Go Miyano","doi":"10.1016/j.jpedsurg.2026.163455","DOIUrl":"10.1016/j.jpedsurg.2026.163455","url":null,"abstract":"<p><strong>Background: </strong>The effect of indocyanine green (ICG) guidance during laparoscopic Kasai portoenterostomy (Lap-KPE) on intraoperative decision-making and postoperative outcomes remains unclear. This study evaluated whether ICG guidance influences surgical behavior and short-term outcomes.</p><p><strong>Methods: </strong>Consecutive patients who underwent Lap-KPE between 2010 and 2025 were retrospectively reviewed. JF was defined as a serum total bilirubin level <1.2 mg/dL at any time after surgery. Short-term NLS was assessed at 1 year postoperatively. Operative video recordings were reviewed to identify additional cuts guided by ICG fluorescence at the porta hepatis following initial transection.</p><p><strong>Results: </strong>Thirty-five patients were included, of whom 12 (34.3%) underwent ICG-guided surgery. Overall, JF was achieved in 27/35 patients (77.1%), with no significant difference between the non-ICG and ICG groups (19/23, 82.6% vs 8/12, 66.7%; p = 0.40). The 1-year NLS rate was 25/35 (71.4%), without a significant difference between groups (73.9% vs 66.7%; p = 0.70). After adjustment for age at operation, ICG guidance was not significantly associated with JF (adjusted OR 0.47, 95% CI 0.08-2.60; p = 0.385). Among ICG-guided cases, additional cuts based on ICG fluorescence were performed in 6/12 patients (50.0%), without differences in JF (66.7% vs 66.7%; p = 1.00) or 1-year NLS (66.7% vs 66.7%; p = 1.00) between cases with and without additional cuts.</p><p><strong>Conclusions: </strong>ICG guidance influences intraoperative decision-making during Lap-KPE, as reflected by additional transection, but was not associated with improved short-term outcomes.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163455"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912750","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":"Healthcare utilization following implementation of a standardized gastrostomy tube care pathway: A retrospective cohort study.","authors":"Johanna M Borst, John B Rode, Sahita I Manda, Rayan A Rahmani, Mallory N Perez, Michela M Carter, Alexandra Highet, Courtney J Harris, Ellen Kluck, Timothy B Lautz, Mehul V Raval","doi":"10.1016/j.jpedsurg.2026.163450","DOIUrl":"10.1016/j.jpedsurg.2026.163450","url":null,"abstract":"<p><strong>Background: </strong>Perioperative management of pediatric gastrostomy tube placement varies widely across institutions, particularly with respect to time to first feed, length of stay (LOS), and resource utilization. We evaluated the impact of implementing a standardized perioperative care pathway on postoperative recovery and hospital resource utilization.</p><p><strong>Methods: </strong>We conducted a single-institution retrospective cohort study of children undergoing planned gastrostomy tube placement from March 2019 to June 2025. Patients were categorized into pre-implementation (3/2019 to 11/2022), dissemination (12/2022 to 4/2024), and post-implementation (5/2024 to 6/2025) periods based on pathway rollout. Time to first feed, postoperative LOS, and standardized hospital cost derived from PHIS data were compared across implementation periods using Kruskal-Wallis tests and multivariable generalized linear models adjusted for age, sex, race/ethnicity, and medical complexity.</p><p><strong>Results: </strong>Among 343 patients, 179 underwent surgery pre-implementation, 96 during dissemination, and 68 post-implementation. From pre-to post-implementation, median time to first feed decreased from 6.9 to 3.6 hours (p < 0.001), LOS decreased from 29.7 to 24.8 hours (p < 0.001), same-day discharge increased from 2.8% to 29.4% (p < 0.001), and median standardized costs decreased from $9554 to $7517 (p < 0.001). In adjusted analyses, standardized hospital costs were 28% lower post-implementation compared with pre-implementation (adjusted cost ratio 0.72, 95% CI 0.66 to 0.79).</p><p><strong>Conclusions: </strong>Implementation of a standardized gastrostomy tube care pathway was associated with shorter time to first feed, shorter postoperative LOS, and lower standardized hospital costs, supporting the role of structured perioperative pathways in improving efficiency and resource utilization in pediatric surgical care.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163450"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912772","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":"Impact of timing of intercostal nerve cryoablation on postoperative opioid use and outcomes in MIRPE.","authors":"Rebecca Payne, Ryan Hare, Stephanie F Brierley, David M Notrica, Lawrence Willis, Emily Khoury, Kristin Rassam, Lisa McMahon, Mark Molitor, Kathleen Heller, Justin Lee, Patrick McGovern, Benjamin E Padilla","doi":"10.1016/j.jpedsurg.2026.163457","DOIUrl":"10.1016/j.jpedsurg.2026.163457","url":null,"abstract":"<p><strong>Introduction: </strong>To determine if the intraoperative timing of intercostal nerve cryoablation (INC) during minimally invasive repair of pectus excavatum (MIRPE) impacts postoperative opioid use or outcomes.</p><p><strong>Methods: </strong>A single-center, retrospective cohort study of patients aged ≤ 21 years who underwent MIRPE with INC from 2023 to 2025 was evaluated. Patients were stratified by timing of INC during their MIRPE operation: INC before bar placement versus INC after bar placement. Patient demographics, operative details, opioid use, and postoperative outcomes were collected.</p><p><strong>Results: </strong>A total of 151 patients who underwent MIRPE with INC were analyzed. Of these, 41 (27%) underwent INC before bar placement while 110 (73%) underwent INC after bar placement. The two groups were similar in age, weight, gender, BMI, and pectus severity. There was no statistically significant difference in inpatient opioid use (in oral morphine equivalents (OME)) (0.20 vs 0.19 OME/kg/day, p = 0.751) or discharge opioid use (1.02 vs 1.19 OME/kg, p = 0.148). On multivariable analysis adjusting for regional nerve block use, number of bars, and intercostal levels treated, neither cryoablation timing nor regional nerve block use was independently associated with inpatient opioid consumption (p = 0.577 and p = 0.775, respectively). Hospital length of stay, emergency department visits within 30 days, and 30-day readmissions were comparable between the two cohorts.</p><p><strong>Conclusion: </strong>INC was most often performed after bar placement during MIRPE in this cohort. The timing of intercostal nerve cryoablation relative to bar placement does not significantly impact opioid use or postoperative outcomes, suggesting timing of INC can be left up to surgeon discretion.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163457"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912705","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":"Endoluminal vacuum-assisted closure for pediatric esophageal leaks: Outcomes and factors associated with clinical success.","authors":"Abdimajid Mohamed, Shivani Mehta, Alex Huang, Brian P Fallon, Somala Mohammed, Farokh R Demehri, Denis Chang, Peter D Ngo, Benjamin Zendejas, Jessica L Yasuda","doi":"10.1016/j.jpedsurg.2026.163447","DOIUrl":"10.1016/j.jpedsurg.2026.163447","url":null,"abstract":"<p><strong>Purpose: </strong>Esophageal leaks in children are associated with significant morbidity. While they are traditionally managed with prolonged fasting and drains, endoluminal vacuum-assisted closure (EVAC) is a minimally invasive alternative. We evaluated outcomes and factors associated with EVAC success.</p><p><strong>Methods: </strong>Retrospective single-center review of pediatric patients treated with EVAC for esophageal leaks (2019-2025). Leak episodes were analyzed independently. Data included leak characteristics, timing of EVAC initiation, procedural details, and outcomes. The primary outcome was leak resolution without surgery.</p><p><strong>Results: </strong>Thirty-eight children with 40 leak events were included. Median age was 1.5 years (IQR 0.6-2.5). Etiologies included postsurgical (53%), endoscopic (45%), and perforation due to foreign body ingestion (2.5%); 78% were contained leaks. EVAC achieved leak resolution without surgery in 83% of cases (94% endoscopic vs 71% surgical). Median time to closure was 11 days (IQR 6-16). Median number of EVAC exchanges was 2 (IQR 1-3). During EVAC therapy, most patients maintained enteral post-pyloric feeding (65%), and drains were only required in 26%. No EVAC-related adverse events occurred. Strictures requiring surgery developed in 31%.</p><p><strong>Conclusion: </strong>EVAC is an effective treatment strategy for pediatric esophageal leaks, with high rates of leak resolution without surgery. Many patients were managed without pleural drainage while maintaining enteral nutrition, supporting EVAC as an active treatment option for selected pediatric esophageal leaks.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163447"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912769","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":"Development and validation of simulation models for thoracoscopic and percutaneous cryoanalgesia training.","authors":"Cecilia Gigena Heitsman, Matías Garnica, Inés Lariguet, Sofía Tachella, Silvana Prodan, Gaston Bellía Munzón, Carolina Millán","doi":"10.1016/j.jpedsurg.2026.163458","DOIUrl":"10.1016/j.jpedsurg.2026.163458","url":null,"abstract":"<p><strong>Aim: </strong>To develop and validate simulation models for thoracoscopic and percutaneous cryoanalgesia and compare biological with synthetic designs.</p><p><strong>Methods: </strong>Four cryoanalgesia simulation models (percutaneous and thoracoscopic, biological and synthetic) were developed and evaluated. First, we utilized biological components (porcine or caprine ribs integrated into 3D-printed platforms). After, we employed synthetic models using 3D-printed ribs with ballistic gel or thermosensitive conductive material. The models were used during structured training sessions led by chest wall surgical specialists.</p><p><strong>Participants: </strong>evaluated six domains for percutaneous simulation models and five for thoracoscopic models using a 5-point Likert scale. Demographic data and surgical experience were recorded. Comparisons between biological and synthetic models were performed using Student's t-test.</p><p><strong>Results: </strong>Biological models were used by 24 specialists, 62.5% had over 10 years of surgical experience. Synthetic models were evaluated by 14 specialists, with 57% having over 5 years of experience. All the models achieved high ratings across the eleven evaluated domains, with mean scores being consistently ≥4, and an overall pooled mean score of 4.46/5. There were no statistical differences between biological and synthetic models in any of the assessed characteristics.</p><p><strong>Conclusions: </strong>All four simulation models provided realistic and effective training platforms for thoracoscopic and percutaneous cryoanalgesia. Synthetic models demonstrated equivalent performance to biological models while offering advantages in durability, portability, and sustainability. These models represent a valuable tool for structured training and may help shorten the learning curve for pediatric thoracic cryoanalgesia.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163458"},"PeriodicalIF":2.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912783","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":"Child physical abuse and cervical spine injury: A prospective observational study of over 1,200 children in the western pediatric cervical spine study.","authors":"Anastasia M Kahan, Tagrid Ruiz-Maldonado, Hsuan-Yu Wan, Vijay M Ravindra, Sean S Ciullo, Mauricio A Escobar, Katie W Russell","doi":"10.1016/j.jpedsurg.2026.163445","DOIUrl":"10.1016/j.jpedsurg.2026.163445","url":null,"abstract":"<p><strong>Background: </strong>The incidence and patterns of cervical spine injury (CSI) have not been well described in children who present after suspected child physical abuse (CPA). The purpose of this study was to describe the pattern of CSI in patients evaluated for suspected CPA in a large, prospectively collected dataset.</p><p><strong>Methods: </strong>This is a secondary analysis of a prospectively collected, multicenter, pediatric CSI dataset which included 72 trauma centers across the United States. All children with suspected CPA were included, with concerns for CPA determined by each participating center. All children had cervical spine imaging within 24 h of injury.</p><p><strong>Results: </strong>Among 19,995 pediatric blunt trauma patients, 1251 children with suspected CPA were identified. Median age was 6 months (IQR 2-12), 42% female, 19% presented with a GCS less than 14, and 11% required intubation. Concomitant traumatic brain injury (TBI) was present in 61% of patients. Overall, 75 children (6%) were diagnosed with CSI. Ligamentous injury was most common (68%), followed by spinal cord injury (19%). No patient underwent operative cervical spine stabilization. Unstable ligamentous injury occurred in seven patients. Four were identified on CT, three were detected on MRI. One patient had a normal initial XR prior to MRI diagnosis with a presenting GCS of 10. On multivariable regression, GCS 3-13 (OR 3.29, 95% CI 1.61-6.47), and intubation (OR 3.07, 95% CI 1.57-6.27) were associated with CSI.</p><p><strong>Conclusion: </strong>In this large prospective multicenter cohort, CSI occurred in 6% of children evaluated for suspected CPA and consisted primarily of ligamentous injuries. Low GCS and intubation were strongly associated with CSI. Unstable injuries were rare, CT identified all injuries in patients who underwent CT, and no missed unstable injuries were observed in neurologically intact children with normal screening radiographs. These findings suggest that CT may be a useful adjunct for CSI evaluation in obtunded patients with suspected CPA (GCS <14) and support a low threshold for advanced imaging in this population. In children with suspected physical abuse who undergo CT imaging, our findings support that a normal CT may be sufficient to allow removal of cervical immobilization regardless of mental status.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"163445"},"PeriodicalIF":2.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897436","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":"Timing of Inguinal Hernia Repair Does Not Influence Recurrence in Premature Infants","authors":"Stephanie F. Brierley,&nbsp;Brielle Ochoa,&nbsp;Amir Alhajjat,&nbsp;Emily Byrd,&nbsp;Stephanie D. Chao,&nbsp;Matthew S. Clifton,&nbsp;Christopher E. Clinker,&nbsp;Goeto Dantes,&nbsp;Jose Diaz-Miron,&nbsp;Elizabeth A. Fialkowski,&nbsp;Lauren Gillory,&nbsp;Juan P. Gurria,&nbsp;Yigit Guner,&nbsp;Zaid Haddadin,&nbsp;Alexandra Highet,&nbsp;Carlos T. Huerta,&nbsp;Olivia A. Keane,&nbsp;Pablo Laje,&nbsp;Hau D. Le,&nbsp;Justin Lee,&nbsp;Benjamin E. Padilla","doi":"10.1016/j.jpedsurg.2026.163442","DOIUrl":"10.1016/j.jpedsurg.2026.163442","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>The optimal timing of inguinal hernia repair (IHR) in premature infants remains unclear. Our study aims to compare recurrence rates between IHRs performed before and at/after 55 weeks postmenstrual age (PMA).</div></div><div><h3>METHODS</h3><div>A multicenter retrospective cohort study was conducted of premature infants who underwent IHR at ≤1 year of age between 1/2017-12/2019. The primary outcome was inguinal hernia recurrence, defined as recurrence requiring surgical re-repair. Demographic, clinical, perioperative and postoperative variables were analyzed. Multivariable logistic regression was performed to identify factors associated with recurrence.</div></div><div><h3>RESULTS</h3><div>A total of 2,412 premature infants underwent 3,808 IHRs: 3,292 (86.4%) hernias were repaired early (before 55 weeks PMA), and 516 (13.6%) were repaired late (after 55 weeks PMA). Incarceration rates were similar between the groups (9.4% vs. 8.2%, p=0.422), as were the proportion of repairs performed laparoscopically (30.0% vs. 31.2%, p=0.594). Patients undergoing early repair were more frequently admitted postoperatively (81.2% vs. 27.2%, p&lt;0.001).</div><div>There were no significant differences in hernia recurrence (1.2% vs. 0.8%, p=0.358) or time to recurrence (3 months [IQR 2.0, 9.0] vs. 9 months [IQR 4.3, 11.5], p=0.218) between early and late repair groups. On multivariable regression, laparoscopic repair (OR 1.910 [95% CI 1.018, 3.581], p=0.044) and concurrent procedure (OR 2.046 [95% CI 1.034, 4.047], p=0.040) were independently associated with a higher risk of recurrence, while late repair was not (OR 0.749 [95% CI 0.259, 2.165], p=0.593).</div></div><div><h3>CONCLUSION</h3><div>Time of repair was not an independent predictor of hernia recurrence. Therefore, recurrence risk alone should not drive the decision for early repair; rather timing should be individualized based on patient physiology, anesthetic considerations, and reliability of follow-up.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"61 12","pages":"Article 163442"},"PeriodicalIF":2.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887962","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}