Pediatric Surgery International最新文献

{"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}

{"title":"Growth and dietary effects on gastrointestinal symptoms in children with Hirschsprung's disease.","authors":"Lovisa Telborn, Irene Axelsson, Christina Granéli, Pernilla Stenström","doi":"10.1007/s00383-026-06657-3","DOIUrl":"10.1007/s00383-026-06657-3","url":null,"abstract":"<p><strong>Purpose: </strong>Growth and diet are major concerns for patients with Hirschsprung's disease yet are rarely described. This study aimed to investigate self-reported growth and the dietary impact on gastrointestinal symptoms in children with Hirschsprung's disease.</p><p><strong>Methods: </strong>This observational cross-sectional study used a validated self-report questionnaire. All children aged 1-18 years old (n = 85) with Hirschsprung's disease treated at a national center were invited to participate.</p><p><strong>Results: </strong>In total, 71 children (84%) participated (median age 6 years [range 1-17]). Stunting was reported in 6 of 71 children (9%), with no significant difference between those with rectosigmoid and long-segment aganglionosis (4/58 [7%] vs. 2/13 [15%], p = 0.328). The majority (55/71; 77%) reported diet-induced gastrointestinal symptoms, again with no significant difference between the groups (43/58 [74%] vs. 12/13 [92%] p = 0.227). Of the 90 food items assessed, the most frequently reported to trigger symptoms were high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), free sugar and fat.</p><p><strong>Conclusion: </strong>Diet-related gastrointestinal complaints are reported frequently in children with Hirschsprung's disease, regardless of aganglionic extent. The findings highlight the need to assess growth and dietary factors in follow-up care and support further interventional studies on dietary strategies.</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/PMC13615995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063328","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}

{"title":"Long-term management of adult patients with persistent cloaca from adolescence to adulthood.","authors":"Masahiro Zenitani, Shohei Hiwatashi, Yuki Noguchi, Satoshi Umeda, Futoshi Matsui, Kisa Matsuo, Keigo Nara","doi":"10.1007/s00383-026-06627-9","DOIUrl":"10.1007/s00383-026-06627-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the management of patients with persistent cloaca from adolescence to adulthood.</p><p><strong>Methods: </strong>We retrospectively reviewed 21 adult patients with persistent cloaca and investigated their urinary and bowel management, menstrual status, and sexual function during adolescence and adulthood.</p><p><strong>Results: </strong>The median age at the last follow-up was 23 years (range: 18-38 years). Antegrade continence enema, irrigation, and stoma were performed in 12 patients (57%) during both adolescence and adulthood. Clean intermittent catheterization via the urethra, vesicostomy, or catheterizable channel was performed in 10 patients (48%) during both periods. In adulthood, two patients (10%) experienced soiling and all the patients, excluding one patient with severe intellectual disability, achieved urinary continence. Surgical interventions for menstrual outflow obstruction and for sexual function were performed for four patients (19%) during adolescence and seven patients (33%) during adulthood, respectively. Vaginal patency was confirmed in seven patients (33%) by pelvic examination. One patient delivered two children via cesarean section.</p><p><strong>Conclusion: </strong>Multidisciplinary long-term management for patients with persistent cloaca is crucial to enable them to achieve a better quality of life.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063448","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":"Appendix tip biopsy for Total colonic aganglionosis: technical aspects and diagnostic accuracy in a prospective cohort of 107 pediatric patients.","authors":"Judith Lindert, Laura Stigler, Carla Sternke-Curvello, Andreas Erbersdobler, Stefanie Märzheuser","doi":"10.1007/s00383-026-06656-4","DOIUrl":"10.1007/s00383-026-06656-4","url":null,"abstract":"<p><strong>Introduction: </strong>The diagnosis of Total colonic aganglionosis (TCA) remains challenging, frequently resulting in delayed treatment and multiple surgical procedures. Appendix biopsy has been proposed as a diagnostic technique. Concerns exist regarding reliability. This study evaluated the diagnostic accuracy and technical applicability of appendix tip biopsy in children with suspected TCA.</p><p><strong>Methods: </strong>A prospective observational study was conducted in 107 consecutive children (≤ 15 years) undergoing abdominal surgery with appendix tip biopsy between October 2022 and September 2024. Patients were allocated to three groups: Hirschsprung disease without TCA (n = 25), TCA (n = 19), and non-Hirschsprung controls (n = 63). Histopathological examination assessed the presence or absence of ganglion cells at the tips of the appendix.</p><p><strong>Results: </strong>Ganglion cells were identified in 24/25 (96%) patients with Hirschsprung disease not involving the entire colon and in 61/63 (96.8%) controls. Ganglion cells were absent in all patients with TCA. Three inconclusive specimens resulted from inadequate sampling or very advanced inflammatory tissue destruction. Appendix tip biopsy achieved a sensitivity of 100%, specificity of 96.6%, positive predictive value of 86.4%, negative predictive value of 100%, and an overall diagnostic accuracy of 97.2%. Assessment was unaffected by patient age, including neonates, and generally possible in appendicitis when adequate full-thickness biopsy was obtained.</p><p><strong>Conclusions: </strong>Appendix tip biopsy is an accurate and tissue-sparing adjunct for diagnosing total colonic aganglionosis. When combined with appropriate histopathological assessment, it provides rapid diagnostic information while preserving the proximal appendix for potential future reconstructive procedures. These findings support its incorporation into the diagnostic pathway for children with suspected TCA.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149063264","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}

{"title":"Analysis of factors influencing the timing of Kasai portoenterostomy in biliary atresia and the impact of early surgery on prognosis.","authors":"Zequan Ding, Zhengchen Lu, Xiaofeng Lv, Changgui Lu, Hua Xie, Weibing Tang","doi":"10.1007/s00383-026-06648-4","DOIUrl":"10.1007/s00383-026-06648-4","url":null,"abstract":"<p><strong>Purpose: </strong>Early diagnosis and Kasai portoenterostomy (KPE) are crucial for improving prognosis in biliary atresia (BA) patients. This study aims to identify factors influencing the timing of KPE and to explore potential strategies for optimizing the diagnosis and treatment of BA.</p><p><strong>Methods: </strong>Infants diagnosed with type III BA who underwent KPE were enrolled in this study. Patients were classified into Early (≤ 30 days), Middle (31-60 days), and Late (> 60 days) surgery groups based on age at KPE. Clinical information including medical history, preoperative examination data and postoperative outcomes was collected.</p><p><strong>Results: </strong>165 BA patients were included, comprising 23 in Early, 82 in Middle, and 60 in Late surgery group. The mean age at KPE has been decreasing in the past two years (50.40 ± 20.99 days, 23.33% in Early surgery group). In the Late surgery group, 48.33% patients had not had pale stools identified before referral to a specialist center. Preoperative levels of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and direct bilirubin were significantly lower in the Early surgery group. The Early surgery group exhibited milder liver fibrosis. The Early surgery group demonstrated significantly higher rates of jaundice clearance post-KPE (1 month: 56.52%, 2 months: 78.26%, 3 months: 91.30%) and native liver survival (90.87% at both 1 and 2 years).</p><p><strong>Conclusion: </strong>Delayed recognition of pale stools and multiple referrals contribute to delayed KPE. Effective screening programs and optimized diagnostic workflows require continuous promotion.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040338","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":"Practicing for life: landscape and priorities for simulation-based education in global children's surgery.","authors":"Yemi S Lawrence, Chisom R Udeigwe-Okeke, Nimanya A Stella, Kara L Faktor, Ramesh M Nataraja, Caroline Q Stephens, Doruk E Ozgediz, Emmanuel A Ameh","doi":"10.1007/s00383-026-06607-z","DOIUrl":"10.1007/s00383-026-06607-z","url":null,"abstract":"<p><strong>Purpose: </strong>Simulation-based education (SBE) is increasingly used in surgical training worldwide. With a shortage of specialized surgeons, SBE allows for skills acquisition in a safe environment, preserving patient safety and standardizing care. However, in global children's surgery, knowledge about SBE interest, use, and feasibility is limited.</p><p><strong>Methods: </strong>A 17-item survey was developed to examine simulation in global children's surgery. The survey was piloted (Nov 2024) and distributed (Dec 2024-Feb 2025) through the Global Initiative for Children Surgery (GICS), an organization with 1100+ members across 60 countries. Descriptive statistics and free responses were reported.</p><p><strong>Results: </strong>Of 85 respondents from 36 countries (approximately 7.7% response rate), over half used SBE in the past year, reaching about 1270 learners. The most common methods were low-cost models, mannequins, and bench trainers. Respondents identified several significant barriers to establishing SBE programs. Most (75%) simulation costs were under $300.</p><p><strong>Conclusion: </strong>Access to SBE resources remains a major barrier, highlighting the critical need for access to open-source education materials. The low cost suggests a need to evaluate cost-effectiveness. Despite a limited response rate and sampling from one organization, the use of low-cost simulation and interest in advanced technologies reflect a trend toward enhancing simulation in global children's surgical education.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025638","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}

{"title":"The characteristics of liver nodules in biliary atresia native liver survivors.","authors":"John Yeh Joon Park, Patrick Ho Yu Chung, Fanny Yeung, Kenneth Kak Yuen Wong","doi":"10.1007/s00383-026-06644-8","DOIUrl":"10.1007/s00383-026-06644-8","url":null,"abstract":"<p><strong>Purpose: </strong>To delineate features of hepatic nodules in native liver survivors (NLS) of biliary atresia (BA) post-Kasai portoenterostomy (KPE) and determine the surveillance utility of tumour markers and imaging studies.</p><p><strong>Methods: </strong>This retrospective study conducted in a tertiary referral centre evaluated post-KPE patients who developed liver nodules following operations performed between 1979-2020. These included NLS at time of writing and liver transplant (LT) recipients with evidence of nodules before LT. Demographic, biochemistry, tumour markers, imaging, and histopathological data were collected. Dysplastic and non-dysplastic nodules were compared using Mann-Whitney U and Fisher's exact test.</p><p><strong>Results: </strong>Among 163 BA patients, of 96 NLS, 17 developed nodules; of 67 post-LT patients, 6 developed nodules before LT. Together, 23 post-KPE patients with nodules were analyzed: 4 dysplastic (one progressed into early hepatocellular carcinoma) and 19 benign lesions. Dysplastic nodules appeared earlier (8.2 vs. 21.2 years, p=0.286) and were larger (11.6 vs. 2.2cm², p=0.284). Alpha-fetoprotein (AFP) levels were similar (2.0ng/mL vs. 3.0ng/mL, p=0.232). All dysplastic nodules exhibited arterial-phase enhancement without portovenous washout on contrast-enhanced computed tomography (CT).</p><p><strong>Conclusion: </strong>In BA NLS, one-quarter develop hepatic nodules over time; malignant changes are rare, but can occur. Additionally, contrast-enhanced CT surveillance may be useful for larger, or earlier-detected hepatic nodules.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13597636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025656","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}

{"title":"Semi-automated erythema quantification in infantile haemangioma receiving propranolol: a pilot feasibility study.","authors":"Bitesh Kumar, Vishesh Jain, Prabudh Goel, Devendra Kumar Yadav, Sandeep Agarwala, Anjan Kumar Dhua","doi":"10.1007/s00383-026-06590-5","DOIUrl":"10.1007/s00383-026-06590-5","url":null,"abstract":"<p><strong>Background: </strong>Infantile haemangioma (IH) is the most common vascular tumour of infancy. Propranolol is first-line treatment, but response monitoring relies on subjective clinical assessment. Semi-automated photographic erythema quantification may offer a reproducible, low-cost adjunct monitoring tool.</p><p><strong>Objectives: </strong>To develop a semi-automated Python-based erythema quantification tool for serial clinical photographs of IH, evaluate its feasibility and intra-rater reliability, and characterise the relationship between colour-based erythema change and clinician-assessed composite response.</p><p><strong>Methods: </strong>Retrospective analysis of a prospective photographic registry at a tertiary paediatric surgery centre. Forty-nine infants with IH treated with propranolol were included. Serial clinical photographs (n = 251) were analysed using a custom Python tool. The erythema index (EI = [R - G] / [R + G + B]), a formula validated for quantification of cutaneous erythema from digital photographs, was calculated from manually selected lesion regions of interest (ROI). Intra-rater reliability was assessed by re-rating 22 photographs from five patients one week apart. Absolute EI change was correlated with prospectively recorded, blinded clinician response scores (0-10).</p><p><strong>Results: </strong>Of 251 photographs, 242 (96.4%) were analysable (mean 4.9 visits per patient, range 2-11). Intra-rater reliability was high: ICC(A,1) = 0.990(95% CI 0.97-1.00); Bland-Altman mean difference - 0.005 EI units (95% limits of agreement - 0.023 to + 0.013). Mean baseline EI was 0.122 ± 0.058 and mean final EI was 0.115 ± 0.053. Absolute EI change did not correlate with clinician response scores (Pearson r = - 0.084, 95% CI - 0.357 to 0.202, p = 0.566; Spearman r = - 0.087, p = 0.554), consistent across three sensitivity analyses.</p><p><strong>Conclusions: </strong>Semi-automated erythema quantification from clinical photographs of IH is feasible with high intra-rater reliability. These pilot findings should be interpreted as hypothesis-generating; the study is underpowered for definitive correlation testing, and prospective replication in an adequately powered cohort is required. In this pilot cohort, colour-based EI change alone was insufficient to track the clinician's composite response assessment under real-world uncalibrated photography conditions, consistent with the partial-biomarker nature of colour-only analysis. Prospective studies with standardised photography incorporating colorimetric calibration and composite colour-plus-area scoring are warranted.</p>","PeriodicalId":19832,"journal":{"name":"Pediatric Surgery International","volume":"42 1","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025614","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}