Seminars in Pediatric Surgery最新文献

{"title":"Infections in pediatric surgical practice in low- and middle-income countries: Resource-adapted clinical decision-making","authors":"Omar Obaid ,&nbsp;Britney L. Grayson ,&nbsp;Robin T. Petroze ,&nbsp;Benedict Nwomeh","doi":"10.1016/j.sempedsurg.2026.151623","DOIUrl":"10.1016/j.sempedsurg.2026.151623","url":null,"abstract":"<div><div>Pediatric infections in low- and middle-income countries (LMICs) represent a substantial proportion of the pediatric surgical burden. Overall in-hospital mortality for surgically treated infections is 12.5 %. The incidence, morbidity, and mortality associated with pediatric infections are all higher in LMICs due to delayed presentation, lack of access to primary care, and a greater incidence of communicable diseases. Over 1.7 billion children and adolescents do not have access to safe, timely, and affordable surgical care, and a disproportionate number of these children reside in LMICs making them a vulnerable population. Within this context, pediatric surgeons are frequently required to make diagnostic and therapeutic decisions in the setting of limited supportive infrastructure. This review examines common infectious conditions encountered in pediatric surgical practice in LMICs through the lens of resource-adapted decision-making, highlighting how constraints in diagnostics, operative capacity, anesthesia, and postoperative support shape management strategies and outcomes.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151623"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429159","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":"Artificial intelligence for prediction and detection of pediatric surgical site infection","authors":"Andrew P. Bain ,&nbsp;Jeffrey S. Upperman","doi":"10.1016/j.sempedsurg.2025.151577","DOIUrl":"10.1016/j.sempedsurg.2025.151577","url":null,"abstract":"<div><div>Surgical site infections (SSIs) remain a significant source of morbidity in pediatric surgery, prolonging hospital stays, increasing readmissions, and driving up healthcare costs. Manual chart reviews and static risk models limit traditional SSI prediction and detection. The rise of artificial intelligence (AI), including machine learning (ML), natural language processing (NLP), and large language models (LLMs), offers a transformative opportunity to enhance prediction and surveillance. This review synthesizes current literature on AI applications in pediatric SSI, emphasizing predictive models built on NSQIP-P data and detection strategies leveraging EHRs and wearable technologies. Despite encouraging retrospective results, real-world adoption remains constrained by poor validation, limited generalizability, and workflow misalignment. Ethical and regulatory concerns, including bias, transparency, and pediatric-specific data limitations, must be addressed to ensure safe, equitable implementation. Thoughtfully developed and deployed, AI-driven tools can transform pediatric surgical care by enabling earlier intervention and improving outcomes.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151577"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897100","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":"Infections in pediatric extracorporeal life support","authors":"Vikas S Gupta ,&nbsp;Joseph T. Church ,&nbsp;Kevin N. Johnson","doi":"10.1016/j.sempedsurg.2025.151578","DOIUrl":"10.1016/j.sempedsurg.2025.151578","url":null,"abstract":"","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151578"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918868","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":"Surgical site infections in neonates: A contemporary review","authors":"Sophia MV Schermerhorn ,&nbsp;Christian S McEvoy ,&nbsp;Romeo C. Ignacio","doi":"10.1016/j.sempedsurg.2026.151582","DOIUrl":"10.1016/j.sempedsurg.2026.151582","url":null,"abstract":"<div><div>Despite major advances in neonatal and perioperative care, surgical site infections remain a persistent source of morbidity in neonatal surgery. Compared to older pediatric patients, neonates possess unique physiological vulnerabilities, including immature immune function, underdeveloped skin barriers, and frequent exposure to invasive devices, that heighten infection risk. Reported surgical site infection (SSI) rates range from 2.6% to 12.6%, with the highest incidence observed following abdominal wall defect repair, necrotizing enterocolitis surgery, and colorectal procedures. <em>Staphylococcus</em> is the predominant pathogen, although Gram-negative enteric organisms are frequent in gastrointestinal cases. Evidence guiding prophylaxis is limited; available data suggest that prolonged antibiotic use does not reduce SSI risk and may increase adverse outcomes such as fungal infection or necrotizing enterocolitis. Similarly, standard adult-derived wound classifications and prophylactic frameworks often fail to account for neonatal-specific factors. Prevention strategies must therefore be tailored to the neonatal population, emphasizing appropriate antibiotic stewardship, optimized skin preparation, temperature regulation, and neonatal intensive care unit (NICU) infection control. Future research should focus on defining procedure-specific prophylaxis, neonatal SSI definitions, and multicenter quality improvement efforts to standardize care and reduce infection-related morbidity.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151582"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208282","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":"Diagnosis and treatment of chronic infection after internal fixation for long bone fractures in children: a report of 6 cases","authors":"Haiqiong Chen,&nbsp;Xufei Zhao,&nbsp;Shi Gao,&nbsp;Chaojin Qin,&nbsp;Guoqiang Zhao","doi":"10.1016/j.sempedsurg.2026.151589","DOIUrl":"10.1016/j.sempedsurg.2026.151589","url":null,"abstract":"<div><h3>Objective</h3><div><em>:</em> To analyze the diagnosis and treatment of infection following internal fixation for long bone fractures in children. <em>Methods:</em> From January 2022 to 2024, 6 children with chronic infection following internal fixation for long bone fractures were admitted to the Department of Trauma. All the cases showed chronic infection with nonunion of the fracture, including 4 males and 2 females, 4 cases of falling from height, 1 case of traffic accident and 1 case of falling injury. The patients were treated with repeated debridement, antibiotic calcium sulfate filling, bone grafting, and intravenous antibioticsstable. The patients were followed up for at least 3 months after discharge, the symptoms, signs, and imaging changes were observed, and the Paley Fracture Healing Score.¹ was recorded at the last follow-up. <em>Results:</em> All patients on admission showed different degrees of fracture nonunion or thinning of the fracture on X-rays, but the internal fixation was stable and the infection site was covered by soft tissue. All patients retained their implants and were treated 2-5 vacuum sealing drainage (VSD), antibiotic calcium sulfate combined with bone graft local anti-infection treatment. Secondly, Linezolid was the main antibiotic used in the perioperative and postoperative period, and Rifampicin (RFP) was added to 3 cases. Bacterial culture showed that 3 cases were Gram-positive bacteria (G+), 1 case was Serratia marcescens, and Sulperazon were added, Pseudomonas aeruginosa and Klebsiella variicola (Gram-negative bacteria, G-) were isolated from the 2 cases, and Meropenem and Imipenem (IPM) were added to increase the antimicrobial spectrum, respectively. All patients were followed up for 4-14 months, with an average of 7.8 months and achieved clinical healing without recurrence of infection. According to the Paley Fracture Healing Score¹, the results were excellent in 5 patients and good in 1 patient. <em>Conclusion:</em> In 6 children with chronic infection after internal fixation of fracture, imaging showed nonunion of fracture. In order to avoid secondary internal fixation of fracture or later orthopedic surgery, careful retention of internal fixation, thorough debridement, local antibiotic filling and release of anti-infection, combined with systemic antibiotic treatment for a sufficient period, and constant monitoring of inflammatory indicators were performed. Infection control and fracture healing can be achieved clinically.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151589"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202945","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":"Management of postoperative leaks and infections in patients with esophageal atresia","authors":"Mary Peyton French ,&nbsp;Drew Johnson ,&nbsp;Jamie Robinson","doi":"10.1016/j.sempedsurg.2026.151597","DOIUrl":"10.1016/j.sempedsurg.2026.151597","url":null,"abstract":"<div><div>Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) remains a common, complex congenital anomaly with high survival but significant postoperative morbidity. Despite advances in surgical technique and neonatal care, one of the main contributors to postoperative morbidity is infection with anastomotic leakage occurring in up to 25 % of cases. Leakage of the esophageal anastomosis is associated with mediastinal and thoracic infection, prolonged hospitalization, and long-term sequelae. Prompt recognition and management can minimize short- and long-term complications for these patients. Here we present a narrative review of contemporary literature incorporating retrospective cohort studies, multicenter analyses, and guideline statements to summarize the clinical presentation and management strategies of anastomotic leaks following surgical intervention for EA.</div><div>We highlight the symptoms specific to infections following EA repair and diagnostic modalities such as contrast esophagram. Treatment requires an individualized approach based on clinical status ranging from conservative management utilizing chest drainage, antibiotics, and parenteral nutrition, to large or uncontained leaks that necessitate endoscopic interventions or surgical re-exploration. Endoscopic stenting and vacuum therapy are increasingly employed modalities that may reduce the need for invasive revisional surgery, although pediatric data remain limited.</div><div>Long-term follow-up demonstrates children who experience anastomotic leaks are more likely to develop late complications including esophageal strictures, dysmotility, reflux, and chronic respiratory issues. Vigilant surveillance and multidisciplinary care are therefore essential to optimize outcomes and preserve esophageal function.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151597"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147365714","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":"The influence of preoperative bowel preparation on surgical site infection in pediatric colorectal surgery","authors":"Katlyn G. McKay ,&nbsp;Naomi-Liza Denning ,&nbsp;Rebecca M. Rentea ,&nbsp;Eunice Y. Huang","doi":"10.1016/j.sempedsurg.2026.151588","DOIUrl":"10.1016/j.sempedsurg.2026.151588","url":null,"abstract":"<div><div>Surgical site infection (SSI) is one of the most common nosocomial infections that occur in pediatric patients in the United States, with colorectal procedures consistently demonstrating the highest rates of SSI. Strategies to reduce SSI in colorectal surgery include standardized perioperative colorectal care bundles, which commonly incorporate preoperative bowel preparation. Robust adult literature exists supporting the use of mechanical bowel preparation in combination with oral antibiotics to mitigate SSI; however, pediatric evidence remains less definitive. Current pediatric literature shows heterogeneity of bowel preparation use amongst surgeons, with existing literature consisting primarily of small retrospective studies. A well-designed pediatric randomized controlled trial comparing the four available bowel preparation strategies would provide much needed evidence to define best practice for preoperative colorectal surgery care amid current variations in clinical practice.</div></div>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151588"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221706","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":"fm i -- Contents","authors":"","doi":"10.1016/j.sempedsurg.2026.151616","DOIUrl":"10.1016/j.sempedsurg.2026.151616","url":null,"abstract":"","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":"40 ","pages":"Article 151616"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147429158","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":"What should ethics guidelines look like for clinical trials of in utero stem cell, protein, mRNA, and gene therapies to treat fetal disease?","authors":"Emily M Scire, Dario O Fauza","doi":"10.1016/j.sempedsurg.2026.151579","DOIUrl":"10.1016/j.sempedsurg.2026.151579","url":null,"abstract":"<p><p>State-of-the-art minimally invasive in utero interventions involving stem cell, protein, and nucleic acid-based therapies represent a new frontier in medicine, which offers hope for devastating fetal diagnoses and promises the restoration of lifetimes. Yet they also introduce serious concerns regarding health risks posed to mother, fetus, and future generations. Recent international consensus statements provide general guidance for structuring trials to maximize health and minimize the risk of experimental treatments for both a pregnant mother and fetus. This article offers additional ethical guidance for translating interventions from first-in-human studies by focusing on a more holistic and nondirective consent process and encouraging pretrial publication of proposed studies to increase dialogue, fine-tune protocols, and potentially improve access.</p>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":" ","pages":"151579"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146041894","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":"How is pediatric surgical innovation regulated?","authors":"Anjali D Deshmukh","doi":"10.1016/j.sempedsurg.2026.151585","DOIUrl":"10.1016/j.sempedsurg.2026.151585","url":null,"abstract":"<p><p>Surgical innovation can improve patients' lives yet untested procedures can pose serious risks, especially for children. Clear ethical guidelines and responsible oversight are essential to determine when and how pediatric surgical innovation should safely proceed. However, distinguishing ethically permissible clinical adaptation from innovation benefiting from additional review presents definitional challenges, creating a regulatory \"grey zone.\" This Article reviews how courts, federal agencies, state legislatures, and private regulators shape the regulation of surgical innovation, with a focus on challenges unique to pediatric surgery. Well-designed surgical innovation committees offer a practical governance mechanism to protect pediatric patients, promote responsible innovation, and provide clinicians with clearer guidance, particularly when committee composition intentionally integrates surgical, clinical, ethical, and caregiver perspectives.</p>","PeriodicalId":49543,"journal":{"name":"Seminars in Pediatric Surgery","volume":" ","pages":"151585"},"PeriodicalIF":2.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146203410","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}