Pediatric Surgery International最新文献

{"title":"Indocyanine green fluorescence-guided transumbilical three-port laparoscopic suprainguinal varicocelectomy with testicular artery and lymphatic preservation for pediatric varicocele: a retrospective cohort study.","authors":"Yang Zhao, Yanpei Yang, Xiaowei Zhang, Kuan Lu, Lifei Ma, Tian Tao, Xiaoguang Zhou, Yuandong Tao, Huixia Zhou","doi":"10.1007/s00383-026-06669-z","DOIUrl":"10.1007/s00383-026-06669-z","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the technical feasibility and short-term perioperative and cosmetic outcomes of indocyanine green (ICG) fluorescence-guided transumbilical three-port laparoscopic suprainguinal varicocelectomy with testicular artery and lymphatic preservation in pediatric patients, and to describe changes in testicular volume and testicular volume discrepancy (TVD) at 6 months after surgery.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pediatric patients with varicocele who underwent surgical treatment at our institution between January 2023 and December 2024. All patients underwent ICG fluorescence-guided transumbilical three-port laparoscopic suprainguinal varicocelectomy with testicular artery and lymphatic preservation. Perioperative outcomes, postoperative complications, cosmetic outcomes, and ultrasonographic testicular-volume measurements were analyzed. Paired preoperative and 6-month postoperative testicular-volume measurements were compared.</p><p><strong>Results: </strong>All 42 procedures were completed laparoscopically without conversion or intraoperative complications. The median operative time was 26 min, median estimated blood loss was 2 mL, and postoperative hospital stay was 1 day. Lymphatic vessels were visualized and preserved in all patients. During a median follow-up of 11 months, no hydrocele, recurrent varicocele, testicular atrophy, or Doppler-detected venous reflux was observed. At 3 months, the median Vancouver Scar Scale score was 1; 31 patients (73.8%) were very satisfied and 11 (26.2%) were satisfied with the cosmetic outcome. At 6 months, mean ipsilateral testicular volume increased from 9.45 to 10.84 mL, while mean TVD decreased from 14.92% to 7.65%.</p><p><strong>Conclusion: </strong>ICG fluorescence-guided transumbilical three-port laparoscopic suprainguinal varicocelectomy with testicular artery and lymphatic preservation was technically feasible in this retrospective cohort and was associated with favorable short-term perioperative and cosmetic outcomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood socioeconomic opportunity and clinical presentation, recurrence, and longitudinal treatment intensity in adolescent pilonidal disease.","authors":"Anam N Ehsan, Claire Abrajano, Bill Chiu","doi":"10.1007/s00383-026-06673-3","DOIUrl":"10.1007/s00383-026-06673-3","url":null,"abstract":"<p><strong>Background: </strong>Pilonidal disease is a chronic inflammatory condition of adolescence requiring sustained outpatient management, yet the impact of neighborhood-level social determinants of health on disease course and treatment intensity remains unclear.</p><p><strong>Method: </strong>We conducted a retrospective cohort study of adolescents evaluated for pilonidal disease at a high-volume specialty clinic from 2019 to 2024. Residential addresses were geocoded and linked to census tract-level socioeconomic opportunity using the California Healthy Places Index (HPI). HPI was analyzed continuously, by quintiles, and using a prespecified lowest-quintile (Q1) threshold contrast. Outcomes included disease stage at presentation, symptom duration, recurrence, receipt of laser epilation, and number of completed laser sessions. Multivariable models adjusted for age and sex; treatment intensity models additionally adjusted for stage and recurrence.</p><p><strong>Results: </strong>Among 393 adolescents (median age 17.0 years[IQR:15.3-18.8]), neighborhood opportunity was not associated with disease severity, symptom duration, recurrence, or receipt of laser therapy. However, among laser recipients (92%), Q1 residence was independently associated with fewer completed laser sessions (adjusted IRR:0.78; 95% CI:0.65-0.93), reflecting approximately 22% lower treatment intensity.</p><p><strong>Conclusions: </strong>Neighborhood-level social determinants were associated with reduced continuity of ambulatory surgical care, reflected by lower longitudinal laser treatment intensity, suggesting structural influences on continuity of ambulatory surgical care rather than biologic disease trajectory.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and clinical outcomes of postoperative small bowel obstruction after neonatal abdominal surgery: a single-center retrospective study.","authors":"Masahiro Fukuhara, Hiroaki Matsumoto, Yasuyuki Uchida","doi":"10.1007/s00383-026-06676-0","DOIUrl":"10.1007/s00383-026-06676-0","url":null,"abstract":"<p><strong>Purpose: </strong>The long-term incidence and clinical course of neonatal abdominal surgery remain unclear. We evaluated the incidence, management, and outcomes of postoperative SBO following neonatal abdominal surgery.</p><p><strong>Methods: </strong>We retrospectively reviewed the records of neonates who underwent abdominal surgery within 30 days of birth in 2000-2025. Patients with postoperative SBO were identified, and their clinical characteristics, treatment, and outcomes were analyzed. The cumulative incidence was estimated using a competing risk analysis, with death before SBO treated as a competing event.</p><p><strong>Results: </strong>Among 312 neonates, 19 (6.1%) developed postoperative SBO, with 29 SBO events. The median interval from the initial surgery to the first SBO was 10.9 months, and 11 patients (57.9%) developed SBO within 1 year. During the first SBO episode, surgical intervention was required in 10 patients (52.6%). Bowel resection was required in 4 (21.1%). Seven patients developed recurrence (36.8%). No deaths occurred during SBO treatment. The cumulative incidence at 1, 5, 10, and 20 years was 4.6%, 7.3%, 8.1%, and 13.2%, respectively.</p><p><strong>Conclusion: </strong>SBO after neonatal abdominal surgery frequently occurs within 1 year, but the risk persists for a long time. The high surgical intervention and recurrence rates support its importance as a long-term complication of after neonatal abdominal surgery.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent biliary atresia and intestinal atresia: a systematic review of clinical characteristics, pathogenesis, management, and outcomes.","authors":"Zaheer Hasan, Ramjee Prasad, Om Prakash Purbey, Md Mokarram Ali, Vinit Kumar Thakur, Ramdhani Yadav, Vijayendra Kumar","doi":"10.1007/s00383-026-06665-3","DOIUrl":"10.1007/s00383-026-06665-3","url":null,"abstract":"<p><strong>Purpose: </strong>The coexistence of biliary atresia (BA) and intestinal atresia (IA) is exceptionally rare. Delayed recognition of BA in neonates undergoing surgery for IA may adversely affect outcomes. This systematic review aimed to evaluate the available evidence regarding the clinical presentation, pathogenesis, management strategies, and outcomes of patients with concurrent BA and IA.</p><p><strong>Methods: </strong>A systematic literature search of PubMed, MEDLINE, and Google Scholar was conducted for studies published up to December 2025. Relevant studies encompassing case reports, case series, and retrospective reviews were identified. Data regarding demographics, type of intestinal atresia, associated anomalies, diagnostic methods, surgical management, and outcomes were extracted.</p><p><strong>Results: </strong>Fifteen studies comprising 98 patients met inclusion criteria. The association of BA with IA is rare, affecting 0.5-5% of BA patients. Duodenal atresia (DA) represents the most common intestinal association (0-1.5% of BA), followed by jejunoileal atresia (JIA) (0.5-5%). Among 98 identified cases, mortality exceeds 50% in combined presentations. Early Kasai portoenterostomy (KPE) before 60 days improves outcomes, but concomitant short bowel limits Roux-en-Y limb length, increasing cholangitis risk.</p><p><strong>Conclusions: </strong>Concurrent BA and IA represent a rare but severe neonatal condition associated with substantial morbidity and mortality. Careful biliary assessment during IA surgery, prompt investigation of persistent cholestasis, and timely Kasai portoenterostomy are essential for improving outcomes.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149148591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age-adjusted shock index vs. reverse shock index multiplied by Glasgow Coma Scale to evaluate mortality in pediatric trauma: a systematic literature review and meta-analysis.","authors":"Natalia Alexandra Fonseca Páez, Álvaro Andrés Trujillo Ceballos, Javier Aguilar Mejía, Miguel Andrés Cañón Plazas","doi":"10.1007/s00383-026-06662-6","DOIUrl":"10.1007/s00383-026-06662-6","url":null,"abstract":"<p><strong>Objective: </strong>Early identification of high-risk pediatric trauma patients is essential for timely intervention. The Shock Index, Pediatric Age-adjusted (SIPA) and the reverse Shock Index multiplied by Glasgow Coma Scale (rSIG, including rSIM variants) are commonly studied physiologic scores that have not been systematically compared. This study evaluated and compared the performance of SIPA and rSIG/rSIM for predicting mortality in pediatric trauma, and secondarily, blood product transfusion and other resource-use outcomes.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD42025641021). Five databases were searched from inception to September 10, 2025. Observational studies including trauma patients younger than 18 years that reported SIPA and/or rSIG/rSIM in relation to mortality and/or secondary outcomes were eligible. Screening and data extraction were performed in duplicate. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random-effects models (DerSimonian-Laird, with restricted maximum likelihood sensitivity analysis) synthesized odds ratios (ORs). Subgroup analyses compared SIPA versus rSIG/rSIM, and publication bias was explored using funnel plots and Egger's test.</p><p><strong>Results: </strong>Thirty-three studies were included qualitatively. Fourteen studies (n = 352,871) contributed to the mortality meta-analysis. The pooled effect favored rSIG/rSIM over SIPA for mortality (OR for SIPA vs. rSIG/rSIM = 0.19; 95% CI, 0.08-0.42; P < 0.001), with substantial heterogeneity (I²=98.8%), which was markedly lower within the rSIG/rSIM subgroup (I²=22.6%) than SIPA (I²=99.0%; between-subgroup difference, P = 0.019). Eleven studies contributed to transfusion outcomes; both indices captured increased transfusion risk (OR for SIPA vs. rSIG/rSIM = 0.28; 95% CI, 0.18-0.42; P < 0.001), without a significant SIPA-rSIG/rSIM contrast (P = 0.149). Egger's tests did not suggest small-study effects for either outcome.</p><p><strong>Conclusion: </strong>Indices incorporating neurologic status (rSIG/rSIM) showed a stronger and more consistent association with mortality than SIPA in pediatric trauma, supporting rSIG/rSIM for early mortality risk stratification when the Glasgow Coma Scale is reliably measured. SIPA remains informative for transfusion and resource-use enrichment.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic landmark models predicting native liver survival after kasai portoenterostomy: a bicentric study.","authors":"Yu Meng, Qianhui Yang, Xin Li, Pu Yu, Qi Ji, Yuqiang Chen, Zhijie Liu, Chen Yu, Yilin Zhao, Yaqiong Qiu, Hui Zhang, Yuan Yang, Xiqian Xiong, Cong Zhang, Jianghua Zhan","doi":"10.1007/s00383-026-06661-7","DOIUrl":"10.1007/s00383-026-06661-7","url":null,"abstract":"<p><strong>Objectives: </strong>Native liver survival (NLS) after Kasai portoenterostomy (KPE) for biliary atresia (BA) is highly heterogeneous, and clinically practical approaches that update prognostic estimates across prespecified postoperative follow-up time points remain limited.</p><p><strong>Methods: </strong>In this retrospective bicentric cohort study (training, n = 168; validation, n = 80), Cox proportional hazards landmark models were developed at five prespecified time points (preoperative and 2 weeks, 1, 3, and 6 months post-KPE) using a LASSO/Boruta dual-algorithm intersection approach with variance inflation factor (VIF)-based collinearity pruning. Internal validation used 500-replicate bootstrap resampling; external validation was performed in an independent cohort.</p><p><strong>Results: </strong>Preoperative and 2-week models showed limited discrimination (C-index ≤0.576). The 3-month two-variable model (TBA + TBil clearance ratio [TBil-CR]) achieved a training C-index of 0.812 (optimism 0.003) and an external C-index of 0.778 (95% CI 0.679-0.878). Risk stratification yielded a 35-percentage-point difference in 2-year cumulative event rates (41.7% vs. 7.0%; log-rank P < 0.001), consistently reproduced in the validation cohort. TBil-CR HR declined progressively across postoperative landmarks, and its single-variable C-index exceeded the jaundice clearance criterion by 0.103 at 3 months.</p><p><strong>Conclusions: </strong>A parsimonious two-variable landmark model incorporating TBil-CR and TBA at 3 months post-KPE accurately predicts long-term NLS in children with BA, outperforming traditional binary bilirubin thresholds.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-Operative Ketorolac in Children After Crohn's Ileocecectomy.","authors":"Kara Kennedy, Rosa Hwang, Camryn Krumbhaar, Yunliang Zhao, Chris Penney, Keith Baxelbaum, Elana Mitchel, Andrew Grossman, Peter Mattei","doi":"10.1007/s00383-026-06660-8","DOIUrl":"10.1007/s00383-026-06660-8","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate complications and flare rates in children with Crohn's disease who received ketorolac following ileocecectomy.</p><p><strong>Methods: </strong>Electronic medical record data of patients < 18 years with Crohn's disease undergoing ileocecectomy at a single institution from 1/1/2013-9/1/2023 were retrospectively reviewed. Demographics, operative course, 30-day complications, and Crohn's flares, small bowel obstructions (SBO), and strictures within two years were collected. Patients who received post-operative ketorolac were compared to those who did not.</p><p><strong>Results: </strong>191 patients met criteria. 169(88.5%) received ketorolac and 22(11.5%) did not. Median age was 15.9[14.2, 17.8] years. Age, sex, pre-operative steroid use, biologic use, and labs were similar between groups. The majority (97.9%) were laparoscopic-assisted. Post-operatively, ketorolac-exposed patients required significantly less opioids (17.0[3.9, 35.2] morphine milli-equivalents vs. 39.7[8.4, 58.7], p = 0.048). Length of stay, days to first flatus, and days to ambulation were similar. There were 18(9.4%) 30-day complications, with no differences between groups. There was no difference in the number of Crohn's flares (3(1.8%) vs. 1(4.5%), p = 0.39), SBOs (8(4.7%) vs. 0(0%), p = 0.6), or strictures (1(0.6%) vs. 0(0%), p > 0.99).</p><p><strong>Conclusion: </strong>In this single-institution analysis, no association between post-operative ketorolac and Crohn's flares was detected, though further study is required. Patients who receive ketorolac may benefit from decreased opioid consumption.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149113375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Between technique and virtue: a bioethical reflection on the management of patients with anorectal malformations.","authors":"Catalina Correa, Clara Cossio-Uribe","doi":"10.1007/s00383-026-06649-3","DOIUrl":"10.1007/s00383-026-06649-3","url":null,"abstract":"<p><p>Anorectal malformations (ARM) present complex clinical and ethical challenges that extend from neonatal surgical decision-making to long-term functional rehabilitation. This review explores three bioethical issues that emerge in the care of patients with ARM: first, the application of Beauchamp and Childress's principles of biomedical ethics to surgical management and rehabilitation; second, the identification of an ethical framework to navigate the intersection between clinical and ethical decision-making in rare diseases; and third, the ethical challenges related to acquiring professional competence in the management of complex pediatric surgical conditions. We argue that virtue ethics and medical professionalism complement Beauchamp and Childress's principles by providing practical guidance for pediatric surgeons facing difficult decisions throughout the continuum of care. This review offers a bioethical framework for addressing clinical decision-making and questions regarding professional competence in ARM. It highlights the role of bioethics in promoting patient safety, professional accountability, and responsible professional development.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of prior pulmonary infection on surgical outcomes in pediatric pulmonary sequestration: a multicenter retrospective study from the East Asia Pediatric Surgery Research Consortium.","authors":"Nanako Nishida, Shun Onishi, Phoenix Wong, Kazuki Ota, Takamasa Suzuki, Koshiro Sugita, Eugene Lau, Yuichiro Miyake, Soichi Shibuya, Chiyoe Shirota, Michelle Yu, Takahisa Tainaka, Go Miyano, Hiroo Uchida, Kenneth Kak Yuen Wong, Satoshi Ieiri","doi":"10.1007/s00383-026-06658-2","DOIUrl":"10.1007/s00383-026-06658-2","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to compare the clinical and surgical characteristics of intralobar (IPS) and extralobar (EPS) pulmonary sequestration, with focus on the impact of prior pulmonary infection on IPS.</p><p><strong>Methods: </strong>This retrospective multicenter study included pediatric patients with pulmonary sequestration who underwent surgery between 2005 and 2024 at four institutions in Hong Kong and Japan. Patients with hybrid lesions were excluded. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) were performed in the IPS subgroup.</p><p><strong>Results: </strong>Among 133 patients (73 IPS, 60 EPS), IPS had higher prior infection rates (27.4% vs. 3.3%, p < 0.01), required lobectomy more frequently (63.0% vs. 0%, p < 0.001), and showed longer operative time (182 vs. 75 min, p < 0.001) than EPS. After IPTW adjustment, prior infection remained associated with longer operative time (+ 92.9 min, p = 0.002) and a trend toward increased lobectomy (OR 6.85, p = 0.089). Early postoperative complications were comparable.</p><p><strong>Conclusion: </strong>IPS showed greater operative complexity than EPS, primarily driven by prior infection and the need for lobectomy. Early elective resection before infection develops may reduce operative complexity while maintaining surgical safety.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification and validation of a robust inflammation-related three-gene signature for the diagnosis of neonatal necrotizing enterocolitis via machine learning integration.","authors":"Lihua Yuan, Xiaobo Wang, Kenneth Kak Yuen Wong","doi":"10.1007/s00383-026-06659-1","DOIUrl":"10.1007/s00383-026-06659-1","url":null,"abstract":"<p><strong>Purpose: </strong>Neonatal necrotizing enterocolitis (NEC) is a severe gastroesophageal emergency in neonates, especially premature infants, with acute inflammation and necrosis. Due to the nonspecific nature of early clinical manifestations, delayed diagnosis remains an issue often associated with high mortality and morbidity, hence finding molecular biomarkers with high diagnostic specificity is critical for better clinical outcomes. This work combines transcriptomic data with machine learning algorithms to identify a diagnostic signature that strongly correlates to NEC.</p><p><strong>Methods: </strong>The GSE64801 transcriptome dataset from GEO was trained and the independent GSE46619 dataset was validated externally. A bioinformatics pipeline was developed to detect differentially expressed genes (DEG) between NEC and control tissues intersected with 935 known inflammation-related genes (IRGs) to identify inflammation-specific candidates. For feature robustness, the combinatorial screening strategy involving least absolute shrinkage and selection operator regression and Boruta random forest algorithm was used. Diagnostic performance of identified core biomarkers was validated across cohorts. A diagnostic nomogram was constructed and performance was evaluated using Receiver Operating Characteristics (ROC) curves, calibration plots, Decision Curve Analysis (DCA). Various downstream analyses including GSEA, regulatory network construction, drug target prediction were performed.</p><p><strong>Results: </strong>In the training cohort 452 DEGs were identified, down to 20 candidates after intersecting with IRGs. The two machine learning strategies identified three key biomarkers: REG3A, CXCL9 and Kininogen 1 (KNG1). Validation assays showed that these genes are upregulated in NEC tissues in both cohorts. The nomogram constructed from this three genes was more diagnostically effective and achieved Area Under the Curve (AUC) of 0.956 in the training cohort. Mechanistically GSEA plays a significant role in key immune-inflammatory processes such as chemokine signaling, intestinal immune networks and graft-versus-host responses. Further upstream transcriptional regulation network was constructed and potential therapeutic agents such as avoralstat were predicted.</p><p><strong>Conclusion: </strong>We identified and validated a novel three gene inflammatory signature (REG3A, CXCL9, KNG1) high diagnostic accuracy for NEC. These biomarkers are involved in the basic pathophysiology of the disease, providing a scientific basis for early diagnostic tools and precise treatments.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}