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        <title>Frontiers in Pediatrics | Pediatric Surgery section | New and Recent Articles</title>
        <link>https://www.frontiersin.org/journals/pediatrics/sections/pediatric-surgery</link>
        <description>RSS Feed for Pediatric Surgery section in the Frontiers in Pediatrics journal | New and Recent Articles</description>
        <language>en-us</language>
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        <pubDate>2026-05-14T22:17:50.640+00:00</pubDate>
        <ttl>60</ttl>
        <item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1814290</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1814290</link>
        <title><![CDATA[Acquired external auditory canal stenosis: clinical characteristics, surgical strategies and prognostic analysis]]></title>
        <pubdate>2026-05-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>CaiYun Meng</author><author>Ruosha Lai</author><author>WeiJing Wu</author><author>Shu Yang</author>
        <description><![CDATA[BackgroundAcquired external auditory canal stenosis (EACS) is a major cause of conductive hearing loss in children and adults, with multiple etiologies including otological surgical procedures, blunt trauma, and chronic inflammatory diseases, which can lead to persistent hearing loss and other adverse outcomes. Due to children's unique anatomical fragility and strong tissue proliferative capacity, the clinical management of EACS remains challenging.This study aims to explore the clinical characteristics, optimal surgical approaches and prognostic factors of traumatic EACS in children, so as to provide evidence-based references for clinical practice.MethodsA retrospective medical record review was conducted for patients diagnosed with EACS who received treatment at The Second Xiangya Hospital between November 2020 and November 2025. Data were collected regarding age, gender, etiology, clinical symptoms, surgical methods, and postoperative outcomes. Descriptive statistics and Fisher's exact test were used for data analysis.ResultsThe findings indicated that the characteristics of EACS in children were unilateral involvement (100%), with the primary etiologies being associated with prior ear surgeries (86%) and isolated hearing loss (100%). The postoperative recurrence rate was 57%, and all recurrent cases were accompanied by restenosis. In pediatric surgeries, the temporoparietal fascial flap was the most frequently utilized graft (43%), 43% of patients underwent conchal cartilage resection, and 86% received absorbable drug—eluting stent (DES) implantation. All patients adhered to a unified DES implantation and postoperative care protocol. Type I tympanoplasty (Wullstein classification) was carried out in one pediatric case and one adult case for tympanic membrane repair. The adult cohort exhibited multiple etiologies (50% related to prior ear surgeries, 17% post—trauma, 25% post—inflammation), frequent accompanying symptoms (25% with tinnitus, 50% with otorrhea, 17% with earache), a recurrence rate of 25%, and no postoperative restenosis. Statistical analysis verified that the restenosis rate in pediatric patients was significantly higher than that in adults (P = 0.012), and there was no significant correlation between recurrence and flap selection, cartilage resection, or DES implantation (all P > 0.05).ConclusionThis study tentatively indicates that there exist disparities in the clinical characteristics of acquired external auditory canal stenosis between children and adults. The risk of postoperative restenosis in children is notably elevated, and this tendency might be associated with the inherent anatomical fragility and robust tissue proliferation capacity in children. Comprehensive preoperative imaging assessment, individualized surgical plan development, standardized drug—eluting stent implantation, structured long—term postoperative follow-up, and postoperative care may be conducive to enhancing the prognosis of acquired external auditory canal stenosis in children. Multicenter prospective studies with a larger sample size are required to further validate the optimal treatment strategy for acquired external auditory canal stenosis in children.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1769108</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1769108</link>
        <title><![CDATA[Identification of safe trocar insertion sites guided by ultrasonography to minimize epigastric vessel injuries in pediatric laparoscopic procedures]]></title>
        <pubdate>2026-05-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Cemal Bilir</author><author>Zeynep Ayvat Öcal</author>
        <description><![CDATA[Background & aimIn pediatric laparoscopy, deep epigastric vessels are among the structures most frequently injured during trocar insertion, potentially leading to significant bleeding. Although the anatomical course of these vessels has been described in adults, a systematic ultrasonographic mapping in children is lacking. The aim of this study was to determine the location of deep epigastric vessels in pediatric patients using Doppler ultrasonography and to identify safe zones for trocar placement.MethodsThis study involved 90 pediatric patients who underwent color doppler ultrasound evaluation of the deep epigastric vessels before laparoscopic surgery. The deep epigastric vessels were identified at 5 equidistant levels between the xiphoid process and the symphysis pubis. Bilateral measurements of the distance of the epigastric vessels from the midline were taken at each level. Predictive analysis utilized a linear mixed model with maximum likelihood estimation.ResultsThe mean distances of the deep epigastric vessels to the midline at different levels in the abdominal region were 6.18 ± 0.7 cm at the right pubic symphysis, 4.64 ± 0.6 cm from the umbilicus, and 3.21 ± 0.5 cm at the level of the xiphoid. On the left, it was 6.46 ± 0.69 cm from the pubic symphysis, 4.64 ± 0.6 cm from the umbilicus, and 3.19 ± 0.5 cm at the level of the xiphoid.ConclusionSignificant variation in the distance of deep epigastric vessels from the midline in pediatric patients was observed, with no significant differences between male and female children. Consistent with the existing literature, the findings identify relatively safe avascular areas for lateral trocar placement in the pediatric population.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1802899</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1802899</link>
        <title><![CDATA[Retrospective analysis of single-center experience in ultrasound-guided puncture drainage for pediatric appendiceal abscess]]></title>
        <pubdate>2026-05-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chuankai Lv</author><author>Zhiru Wang</author><author>Cheng Zhang</author><author>Xin Wei</author><author>Xiaoman Wang</author>
        <description><![CDATA[ObjectiveTo evaluate the clinical efficacy of ultrasound-guided puncture drainage for pediatric appendiceal abscess and summarize operational experience.MethodsThis study conducted a retrospective analysis of clinical data from pediatric patients who underwent ultrasound-guided percutaneous drainage for appendiceal abscess at Beijing Children's Hospital between January 2022 and June 2025. The safety and efficacy of ultrasound-guided abscess drainage were analyzed, along with key technical points and experiences for different types of appendiceal abscesses. Categorical variables were compared using the χ2 or Fisher's exact test, and continuous variables were analyzed using the t-test or Mann–Whitney U test. A P-value < 0.05 was considered statistically significant.ResultsA total of 90 children underwent ultrasound-guided puncture of the appendiceal abscess and were included in this study, and the control group consisted of 41 children with appendiceal abscess who received conservative treatment during the same period. Children who underwent ultrasound-guided abscess drainage under local anesthesia showed a faster decrease in white blood cell count (7.0 ± 2.0 vs. 11.0 ± 3.0 × 109/L; t = 4.0, P < 0.05) and C-reactive protein levels (7.3 ± 2.1 vs. 11.3 ± 3.1 mg/L; t = −7.6, P < 0.05) after one week of treatment, shorter duration of abdominal pain (4.3 ± 1.5 vs. 5.8 ± 1.3 days; t = −5.7, P < 0.05), and quicker resolution of the abscess compared (11.3 ± 1.2 vs. 15.7 ± 1.1 days; t = −21.1, P < 0.05) to those who received intravenous antibiotics alone. Ultrasound-guided abscess drainage resulted in minimal trauma and lower rates of early and late postoperative complications. A retrospective review of ultrasound data from 90 children who underwent ultrasound-guided abscess drainage demonstrated that our hospital had extensive operational experience in performing drainage for various types of complicated appendiceal abscesses.ConclusionUltrasound-guided percutaneous drainage is a safe and effective minimally invasive treatment for pediatric appendiceal abscess in children who can cooperate with local anesthesia. Physicians must master the indications for drainage and specific puncture techniques for different types of appendiceal abscesses.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1726347</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1726347</link>
        <title><![CDATA[Long-term headaches in children with idiopathic intracranial hypertension—a 10 years follow-up]]></title>
        <pubdate>2026-05-14T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Jacob Genizi</author><author>Moran Cymbrowicz</author><author>Lilach Shemer-Meiri</author><author>Noam Ganz</author><author>Ayellet Sadeh</author><author>Rony Cohen</author><author>Rajech Sharkia</author><author>Abdelnaser Zalan</author><author>Salam Abd El Karim Murad</author><author>Esther Ganelin-Cohen</author><author>Muhammad Mahajnah</author>
        <description><![CDATA[IntroductionIdiopathic Intracranial Hypertension (IIH) is characterized by increased intracranial pressure, often accompanied by headaches, which were traditionally expected to resolve with pressure reduction. The aim of present study was to assess the prevalence of persistent headache and quality of life 10 years after the initial diagnosis of IIH and to determine the factors, at the time of the diagnosis, that predict associated with these ongoing symptoms.Materials and methodsIn a cross-sectional multicenter cohort study, patients diagnosed with IIH (all included patients met the Friedman criteria) in 2007–2012 were contacted by telephone at least 10 years after initial diagnosis, in 10.24–12.24. Participants responded to two questionnaires: the HIT-6, to evaluate headache burden, and the WHOQOL-BREF quality-of-life questionnaire.ResultsOf the 98 patients, 81 were recruited for the study. Mean age at IIH diagnosis was 13 (±2) years and mean age at follow-up was 24 (±5) years. Sixty-six percent (54/81) were females. Of these, 47 patients (58%) were experiencing headaches at the time of follow-up, with no significant difference between the sex. Relative to the no-headaches group, those with headaches at follow-up had higher BMI (32 vs. 25, p = 0.041) and lower quality of life (QoL). Within the headaches at follow-up group, those with more significant headache burdens (HIT-6 levels 3–4) were older, had higher BMI, and had lower QoL relative to those with lower headache burdens (p = 0.020, p = 0.006, p = 0.010 respectively).ConclusionsA large proportion of patients with IIH continue to suffer from headaches many years after initial diagnosis, with negative effects on their quality of life.Clinical Trial Registration:ClinicalTrials.gov, Identifier NCT06581185.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1794967</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1794967</link>
        <title><![CDATA[Meckel's diverticulum complicated by a congenital intestinal adhesive band: a case report and literature review]]></title>
        <pubdate>2026-05-13T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yuming Wang</author><author>Tingliang Fu</author><author>Shuai Sun</author><author>Yewen Wang</author><author>Xiaoliang Xu</author><author>Lei Geng</author>
        <description><![CDATA[As one of the most common congenital gastrointestinal malformations, Meckel's diverticulum (MD) often has its clinical significance underestimated due to its atypical manifestations. MD may coexist as “concomitant lesions” with various abdominal surgical diseases, increasing the risk of misdiagnosis and missed diagnosis. This article reports an extremely rare case of a 5-month-old male infant with necrotic Meckel's diverticulitis coexisting terminal ileal necrosis and perforation due to a congenital intraabdominal fibrous band. Through a systematic review of the literature on MD with surgical complications associated with other surgical diseases in the PubMed database from 1982 onward (including a total of 12 cases), this study aims to explore the diagnostic challenges and treatment strategies of this condition.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1818097</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1818097</link>
        <title><![CDATA[Efficacy of interventions in peripheral arterial and venous malformations of the limbs in children: protocol for a systematic review]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Study Protocol</category>
        <author>Zhaokun Guo</author><author>Zhongjing Zhang</author><author>Ying Jiang</author><author>Jun Zhou</author><author>Ke-Heng Deng</author><author>Wen-Xiang Zhu</author><author>Xiangyou Zhao</author><author>Pan Jiao</author>
        <description><![CDATA[BackgroundPeripheral arteriovenous malformations (pAVMs) of the limbs are common in children, with distinct clinical features and high intervention difficulty. Existing research on its interventions is controversial due to non-standardized criteria, small-sample uncontrolled studies and inconsistent efficacy evaluation, leaving clinicians without high-quality evidence-based guidance.Methods and analysisThis study will conduct a PROSPERO-registered systematic review, searching PubMed, Embase and other databases for relevant clinical studies. Two researchers will independently screen literature, extract data and assess evidence quality via GRADE. RevMan 5.4 will be used for qualitative and quantitative statistical analysis, with subgroup and sensitivity analyses to explore heterogeneity. Primary outcome is short-term symptom improvement rate within 3 months post-intervention; secondary outcomes include adverse event incidence and quality of life.Ethics and disseminationEthical approval is not required because this study is a secondary analysis of existing data. We will disseminate the findings through peer-reviewed publications.Clinical Trial RegistrationPROSPERO (CRD420261326988).]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1814850</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1814850</link>
        <title><![CDATA[Efficacy of transumbilical single-port and two-port laparoscopy in the treatment of pediatric inguinal hernia: a systematic review and meta-analysis]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Bo Yang</author><author>Yi Zhou</author><author>Shipeng Tang</author>
        <description><![CDATA[ObjectiveTo systematically evaluate the perioperative efficacy and safety of transumbilical single-port laparoscopic surgery and two-port laparoscopic surgery in the treatment of pediatric inguinal hernia, and to provide high-quality evidence-based medical evidence for the selection of clinical surgical methods.MethodsA comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases to collect relevant controlled studies published from the establishment of the databases to December 31, 2025. After screening the literature and extracting data according to the pre-set inclusion and exclusion criteria, the ROB2 tool and ROBINS-I tool were used to evaluate the risk of bias in RCT and non-RCT studies, respectively. Meta-analysis was performed using RevMan 5.3 software and R software.ResultsA total of 13 studies were included, involving 22,846 children. Meta-analysis showed that the postoperative recurrence rate in the single-port laparoscopic group was significantly lower than that in the two-port laparoscopic group (RR = 0.60, 95% CI: 0.39–0.94, P = 0.02); there were no statistically significant differences between the two groups in terms of operation time (MD = −1.43, 95% CI: −3.42–0.57, P = 0.16), hospital stay (MD = −2.34, 95% CI: −7.73–3.06, P = 0.40), detection rate of contralateral occult hernia (RR = 1.03, 95% CI: 0.94–1.13, P = 0.55), conversion to open surgery rate (RR = 1.57, 95% CI: 0.14–17.93, P = 0.71), and the incidence of various postoperative complications (all P > 0.05). Subgroup analysis showed that in large sample size studies, the operation time in the single-port laparoscopic group was significantly shorter (MD = −4.27, 95% CI: −7.25–1.28, P < 0.001), and in small sample size studies, the recurrence rate advantage of the single-port laparoscopic group was more significant (RR = 0.43, 95% CI: 0.25–0.71, P = 0.001).ConclusionTransumbilical single-port laparoscopic surgery has a significant advantage in reducing postoperative recurrence rate in the treatment of pediatric inguinal hernia. In large sample size studies, its advantage in operation time is more evident, and its safety is comparable to that of two-port laparoscopic surgery. For medical centers with mature single-port operation techniques, single-port laparoscopy can be the preferred surgical method; for complex hernias or when technical conditions are limited, two-port laparoscopy remains a reliable choice.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1836614</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1836614</link>
        <title><![CDATA[Clinical characteristics and surgical treatment of congenital gluteal dermal sinus tract in children: a 15-year retrospective single-center clinical experience]]></title>
        <pubdate>2026-05-08T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Debao Li</author><author>Shan Zheng</author><author>Xianmin Xiao</author><author>Yangyang Ma</author><author>Qingchi Zhang</author><author>Chenbin Dong</author><author>Weijing He</author><author>Gong Chen</author><author>Chun Shen</author><author>Song Sun</author>
        <description><![CDATA[ObjectiveTo summarize the clinical features, diagnosis, treatment, and prognosis of congenital gluteal dermal sinus tracts in children, providing insights for better clinical management.MethodsA retrospective analysis was conducted on 20 patients diagnosed with congenital gluteal dermal sinus tracts at the Children's Hospital of Fudan University over 15 years. The analysis focused on age, gender, diagnostic delay, diagnostic methods, course and opening of the sinus tract, and postoperative follow-up.ResultsThe study included 6 males and 14 females, with symptom onset ranging from birth to 12 years (median age of 9.5 months). Initial symptoms included abnormal gluteal depression with recurrent infections (n = 8), unexplained recurrent infections (n = 6), and asymptomatic gluteal depression or small holes (n = 6). The time from symptom onset to diagnosis ranged from 1 to 102 months (median: 13.5 months). MRI was positive in 87.5%, identifying the tract in 81.25%. CT scans were positive in all cases, but only 50% identified the tract. Sinus tractography successfully identified the tract in 7 of 10 patients. The sinus tracts were classified into three types based on the opening location. All sinus tracts were excised during surgery, with an average length of 4.95 cm. Two patients experienced recurrence and underwent reoperation, while the remaining 15 had no recurrence.ConclusionCongenital gluteal dermal sinus tracts are more common in females and often misdiagnosed. CT is more sensitive but less specific than MRI. Sinus tractography helps determine the tract's path. Prognosis is generally good after complete excision, with recurrence being the main postoperative complication.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1792500</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1792500</link>
        <title><![CDATA[Ophthalmologic assessment and intracranial pressure in children: diagnostic methods, clinical correlations, and future directions]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Elena Hernández-García</author><author>Barbara Burgos-Blasco</author><author>Noemi Güemes-Villahoz</author><author>Laura Morales-Fernandez</author><author>Jose Ignacio Fernandez-Vigo</author><author>Enrique Santos-Bueso</author><author>Rosario Gomez-de-Liaño</author><author>Julian García-Feijóo</author>
        <description><![CDATA[Increased intracranial pressure (ICP) in the pediatric population represents a critical and potentially life-threatening condition that may lead to severe neurological sequelae, including brain herniation, cerebral ischemia, and irreversible neurological impairment, such as visual loss. The diagnosis of elevated ICP in children is particularly complex, as clinical manifestations are frequently subtle and non-specific, especially in infants and young children. Symptoms such as irritability, poor feeding, lethargy, and failure to thrive often overlap with a wide range of common pediatric disorders, thereby contributing to delayed diagnosis and an increased risk of adverse neurological outcomes. Within this context, ophthalmologic evaluation constitutes a key non-invasive tool in the early detection of increased ICP. Fundoscopic examination provides critical diagnostic information, with optic disc abnormalities among the most sensitive markers of elevated ICP. However, these findings may be less pronounced or exhibit distinct characteristics in children compared to adults, and their interpretation is further complicated by age-related variability in ocular anatomy and intracranial pressure norms. This review provides an integrated synthesis of current diagnostic strategies for assessing elevated ICP in children, with a particular focus on ophthalmologic assessment. It examines the association between specific ocular findings and ICP, with the aim of improving early recognition, guiding clinical management, and enhancing patient outcomes. Furthermore, it addresses the inherent challenges of pediatric ICP diagnosis and highlights key gaps in the literature that warrant further investigation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1805856</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1805856</link>
        <title><![CDATA[Prenatal ultrasound diagnosis, intrauterine monitoring and postnatal management of a giant fetal abdominopelvic lymphangioma: a case report and scoping review]]></title>
        <pubdate>2026-05-07T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Matteo Giudice</author><author>Milena Viggiano</author><author>Chiara Vassallo</author><author>Alice Novak</author><author>Laura Valfrè</author><author>Irma Capolupo</author><author>Andrea Dotta</author><author>Andrea Conforti</author><author>Marco Bonito</author><author>Maurizio Guida</author><author>Leonardo Caforio</author><author>Isabella Fabietti</author>
        <description><![CDATA[BackgroundFetal lymphangioma is a rare congenital malformation, generally isolated and clinically asymptomatic, except when it invades adjacent tissues, causing compression-related symptoms.ObjectivesTo present a rare case of a giant fetal abdominopelvic lymphangioma and to perform, to our knowledge, the first scoping review of the literature specifically addressing prenatal diagnosis, intrauterine monitoring and postnatal management of this condition.MethodsThe PubMed, Scopus and Embase databases were searched up to September 2025. No limitations on the country were made.ResultsWe present the case of a 38-year-old primigravida with gestational diabetes, hypothyroidism and severe obesity referred to our institute for a second opinion after prenatal detection of a large multiloculated cystic abdominal mass in the fetus, extending to the pelvis, without vascularization. Follow-up imaging, including a fetal magnetic resonance imaging (MRI), confirmed the suspicion of a giant lymphatic malformation with progressive fetal ascites and associated symptomatic polyhydramnios requiring amnioreduction. A male infant was delivered via emergency cesarean section at 34 + 3 weeks and admitted to neonatal intensive care unit (NICU) with respiratory distress. Due to progressive clinical worsening and persistent fluid accumulation, an abdominal drain was placed, followed by debulking surgery at four months, which confirmed the diagnosis of lymphangioma. Gradual clinical improvement enabled the patient's transfer to the Nutritional Rehabilitation Unit and subsequent discharge. Regarding the scoping review, 20 case reports fulfilled the inclusion criteria. Patients were analyzed concerning the prenatal ultrasound diagnosis of a fetal abdominal lymphangioma, pregnancy outcomes, intrauterine and postnatal treatment of the mass.ConclusionClinical presentation and outcomes of fetal abdominal and abdominopelvic lymphangiomas are highly heterogeneous and strongly influenced by lesion extent and intra-abdominal involvement. Our case, characterized by diffuse intestinal and mesenteric disease, highlights the limitations of curative surgical strategies and underscores the need for early recognition of patients who may require prolonged supportive management rather than a complete excision. The scoping review suggests that while focal lesions are often amenable to surgery with favorable outcomes, diffuse forms often require a multidisciplinary, staged approach, with realistic prognostic counseling and long-term follow-up.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1752616</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1752616</link>
        <title><![CDATA[Systemic propranolol and topical moist wound dressings for ulcerated infantile hemangioma of the scrotum: a case report]]></title>
        <pubdate>2026-05-04T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Jiejun Xia</author><author>Kunshan Chen</author><author>Zhenyin Liu</author><author>Xiaoyun Tan</author><author>Shifeng Xie</author><author>Haibo Li</author>
        <description><![CDATA[BackgroundUlceration is a common complication of infantile hemangioma, and its management poses unique difficulties when the lesion is located in high-risk areas like the scrotum. This case report details the successful management of this condition using topical moist wound dressings combined with propranolol.Case presentationA 5-month-old male presented with a rapidly progressing, ulcerated scrotal infantile hemangioma characterized by purulent exudate. Systemic treatment involved oral propranolol solution (maintenance dose of 2 mg/kg/d). Local wound care was managed using a tailored moist wound healing strategy: alginate dressing combined with recombinant human epidermal growth factor gel, secured with a transparent film dressing. The patient was treated successfully; localized infection was controlled within 3 days. The wound achieved complete epithelialization after a total of 12 days of consistent combined treatment, accompanied by simultaneous regression of the hemangioma volume. Three-month Follow-up confirmed favorable cosmetic results with no significant hypertrophic scarring.ConclusionThis case underscores that a synergistic regimen of systemic propranolol and a customized moist wound healing strategy can significantly accelerate healing timelines and improve the quality of tissue repair in ulcerated infantile hemangiomas.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1749724</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1749724</link>
        <title><![CDATA[Reactive lymphoid hyperplasia of the appendix in children: a descriptive analysis of accompanying neural and stromal features]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Neslihan Gulcin</author><author>Ilkay Tosun</author><author>Ceyhan Sahin</author>
        <description><![CDATA[BackgroundReactive lymphoid hyperplasia (RLH) is frequently identified in pediatric appendectomy specimens performed for suspected acute appendicitis. However, its associated neural and stromal alterations remain incompletely characterized.MethodsThis retrospective descriptive study evaluated pediatric appendectomy specimens obtained between January 2019 and January 2024. RLH cases were identified based on histopathological criteria. Archived specimens were re-evaluated using hematoxylin and eosin staining, S-100 immunohistochemistry, and Masson's trichrome staining. Neural alterations were classified according to Höfler's criteria, and fibrosis was graded semiquantitatively.ResultsAmong 468 appendectomies, 100 cases fulfilled the criteria for RLH. The mean age was 11.34 ± 4.31 years, and 63% were male. Neural and stromal alterations, including S-100–positive nerve elements and varying degrees of fibrosis, were frequently observed. Höfler Type 1 and Type 3 patterns were the most common, and fibrosis was predominantly mild to moderate. Postoperative symptom resolution was observed in patients with available follow-up.ConclusionRLH in children is commonly associated with reactive neural and stromal alterations. However, these findings should be interpreted as nonspecific reactive changes rather than disease-specific features. Further studies are needed to clarify their clinical significance.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1803495</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1803495</link>
        <title><![CDATA[Erector spinae plane block for opioid sparing in children undergoing laparoscopic appendectomy: a randomized controlled trial]]></title>
        <pubdate>2026-05-01T00:00:00Z</pubdate>
        <category>Clinical Trial</category>
        <author>Ming-wen Yang</author><author>Yu-zhu Cai</author><author>Ling-li Zhang</author><author>Jun Wang</author><author>Ran Tang</author><author>Ying-ying Sun</author>
        <description><![CDATA[BackgroundDespite being a minimally invasive procedure, laparoscopic appendectomy (LA) frequently induces substantial postoperative pain in children. While erector spinae plane block (ESPB) has demonstrated efficacy for postoperative analgesia in pediatric open abdominal surgery, its analgesic benefits and safety profile in laparoscopic procedures remain unestablished.PurposeTo evaluate the opioid-sparing effects, analgesic efficacy, and safety of ESPB in children undergoing LA.DesignA single-center, double-blind, randomized, superiority trial.MethodsChildren aged 6–12 years with American Society of Anesthesiologists (ASA) physical status I–II scheduled for LA at Anhui Provincial Children's Hospital were enrolled. Participants were randomly allocated 1:1 using a computer-generated sequence to receive either bilateral ultrasound-guided ESPB at T8 (0.25% ropivacaine, 0.5 mL/kg per side) after tracheal intubation (ESPB group) or no block (Control group). Both groups received standardized multimodal analgesia comprising hydromorphone-based patient-controlled intravenous analgesia (PCIA) and scheduled acetaminophen. The primary outcome was 0–24 h cumulative hydromorphone consumption; secondary outcomes included pain scores, PCIA parameters, rescue analgesia requirements, recovery milestones, parental satisfaction, and adverse events.ResultsOf the 80 children randomized (40 per group), 75 completed follow-up and were analyzed (ESPB, n = 37; control, n = 38). The ESPB group exhibited significantly lower 24 h hydromorphone consumption (32.8 ± 10.1 vs. 72.9 ± 14.5 μg/kg; mean difference: −40.1 μg/kg; P < 0.001), representing a 55% reduction compared with the Control group. Secondary outcomes favoring ESPB included lower pain scores during the early postoperative period (PACU to 6 h; P < 0.05), prolonged time to first PCIA demand (201.0 vs. 58.5 min; P < 0.001), fewer total PCIA presses (10 vs. 17; P < 0.001) and effective presses (9 vs. 17; P < 0.001) within 0–24 h, reduced rescue analgesia requirements (2.7% vs. 21.1%; P = 0.028), and higher parental satisfaction scores (8 vs. 7 points; P = 0.001). No serious block-related complications occurred.ConclusionsIn children undergoing LA, a single-injection bilateral ultrasound-guided ESPB at T8 provides significant opioid-sparing effects and alleviates acute postoperative pain during the first 24 h without increasing adverse event rates, supporting its incorporation as a component of multimodal analgesia for postoperative pain management in this population.Clinical Trial Registration: https://www.chictr.org.cn, identifier ChiCTR2500108148, Date of Registration: August 26, 2025.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1824435</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1824435</link>
        <title><![CDATA[Neonatal immature gastric teratoma: a case report]]></title>
        <pubdate>2026-04-29T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Shiqi Liu</author><author>Jian Ji</author><author>Siqi Li</author><author>Yinmin Sun</author><author>Yufeng Li</author>
        <description><![CDATA[BackgroundGastric teratomas (GTs) are exceedingly rare neoplasms, accounting for less than 1% of all teratomas in children. Notably, GT arising from the anterior gastric wall is even rarer, with only a handful of cases reported in the literature, and the transmural growth pattern of such tumors further adds to their clinical uniqueness.Case presentationWe report a case of immature gastric teratoma arising from the anterior gastric wall in a term male neonate. The mass was detected on prenatal ultrasonography at 37 weeks and 6 days of gestation, and the infant was admitted on the first day of life for evaluation. Abdominal computed tomography revealed a heterogeneous mass measuring 51.9 mm × 47 mm × 39 mm in the hepatogastric space, containing calcifications and fatty components with close adhesion to the gastric wall; the transmural growth characteristic of the tumor was subsequently confirmed during surgical exploration. Laboratory studies demonstrated markedly elevated alpha-fetoprotein (AFP) (>60,500 ng/mL), neuron-specific enolase (NSE) (63.8 ng/mL), and lactate dehydrogenase (LDH) (575 U/L), which were suggestive of a germ cell tumor with comprehensive reference to clinical manifestations and imaging findings. The patient underwent complete surgical resection on postnatal day four. Histopathological examination confirmed a grade III immature teratoma with negative resection margins. Postoperative recovery was uneventful, with declining inflammatory markers at one-week follow-up.ConclusionsThis case highlights the importance of including gastric teratoma in the differential diagnosis of neonatal abdominal masses, the diagnostic value of integrated imaging and tumor marker evaluation, and the necessity of complete surgical resection. Furthermore, it demonstrates the critical role of multidisciplinary collaboration in the timely diagnosis and management of rare neonatal tumors.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1811576</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1811576</link>
        <title><![CDATA[Robot-assisted vs. laparoscopic-assisted surgery for choledochal cyst in children: a systematic review and meta-analysis]]></title>
        <pubdate>2026-04-28T00:00:00Z</pubdate>
        <category>Review</category>
        <author>Fei Liu</author><author>Ke Zhang</author>
        <description><![CDATA[ObjectiveComprehensive analyses specifically comparing robot-assisted surgery(RS) and laparoscopic surgery(LS) for choledochal cyst(CC) in children remained scarce. This study aimed to evaluate the safety and efficacy of RS vs. LS for pediatric CC.MethodsA systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted to identify studies published up to December 31, 2025, that compared laparoscopic and robot-assisted surgery for CC in children. Meta-analysis was performed using Stata 18.ResultsA total of 19 retrospective studies were included. Meta-analysis results demonstrated that the RS group had significantly lower incidences of postoperative biliary stones (OR = 0.10, 95% CI: 0.01–0.89), bile leakage (OR = 0.28, 95% CI: 0.11–0.70), anastomotic stricture (OR = 0.27, 95% CI: 0.12–0.65), and overall complications (OR = 0.26, 95% CI: 0.13–0.51) compared to the LS group. Total operative time was longer in the RS group (SMD = 1.02; 95% CI: 0.30–1.74), whereas intraoperative blood loss was significantly lower (SMD = −1.22; 95% CI: −2.19 to −0.24). Additionally, the RS group exhibited shorter hepaticojejunostomy time (SMD = −1.43; 95% CI: −2.30 to −0.56), drainage tube indwelling time (SMD = −0.74; 95% CI: −1.01 to −0.47), postoperative fasting time (SMD = −0.80; 95% CI: −1.11 to −0.50), and hospital stay (SMD = −1.16; 95% CI: −2.08 to −0.23). No significant differences were observed in other outcomes, including postoperative cholangitis (OR = 0.59, 95% CI: 0.22–1.57), residual cyst (OR = 0.22, 95% CI: 0.02–1.94), incision infection (OR = 0.17, 95% CI: 0.02–1.41), intestinal obstruction (OR = 0.97, 95% CI: 0.40–2.33), pancreatitis (OR = 0.74, 95% CI: 0.08–6.47), pancreatic leakage (OR = 0.43, 95% CI: 0.10–1.92), and conversion to open surgery (OR = 0.79, 95% CI: 0.36–1.75). Furthermore, no statistically significant difference was found in cyst excision time between the two groups (SMD = −1.77; 95% CI: −3.91 to −0.77).ConclusionIn the treatment of pediatric CC, RS offered potential advantages over LS in terms of reducing postoperative biliary-related complications, decreasing intraoperative blood loss, accelerating postoperative gastrointestinal function recovery, and shortening hospital stay. Although RS required longer operative time, this limitation might be mitigated with accumulated surgical experience and technological advancements. However, current evidence is primarily derived from retrospective studies conducted in Asian countries and lacked long-term follow-up data. Well-designed multicenter prospective studies or randomized controlled trials were urgently needed to provide higher-level evidence and further validate our findings.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1766851</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1766851</link>
        <title><![CDATA[Impact of comfort theory–guided nursing care on anxiety reduction and recovery outcomes in pediatric strabismus surgery patients]]></title>
        <pubdate>2026-04-27T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Tingting Liu</author><author>Qing Liao</author>
        <description><![CDATA[ObjectiveThis study aimed to evaluate the effectiveness of Comfort Theory–guided nursing care in reducing perioperative anxiety and improving recovery outcomes among children undergoing strabismus surgery. The hypothesis was that a structured comfort-based nursing approach addressing physical, psychospiritual, sociocultural, and environmental needs would yield superior emotional and functional outcomes compared with conventional care.MethodsA prospective study was conducted involving 184 pediatric patients scheduled for elective strabismus correction. Participants were randomly assigned to receive either routine nursing (n = 92) or Comfort Theory–guided nursing interventions (n = 92). The comfort-based model included individualized psychological preparation, environmental optimization, parental involvement, and continuous emotional support. Anxiety was measured using the Modified Yale Preoperative Anxiety Scale (m-YPAS), pain using the Face–Legs–Activity–Cry–Consolability (FLACC) scale, and behavioral recovery using the Post-Hospitalization Behavior Questionnaire (PHBQ).ResultsCompared with routine care, the Comfort Theory group showed markedly lower anxiety both before induction (44.1 ± 8.9 vs. 61.5 ± 9.7, p < 0.001) and on postoperative day 1 (40.6 ± 7.5 vs. 53.4 ± 8.2, p < 0.001). Physiological stress responses were also blunted, with lower heart rate (100.2 ± 8.8 vs. 108.5 ± 9.2 bpm, p < 0.001) and mean arterial pressure (83.1 ± 6.7 vs. 88.4 ± 7.1 mmHg, p < 0.001) before induction. Postoperative pain scores were significantly reduced across all time points (p < 0.001), and behavioral recovery improved, with lower PHBQ scores (7.4 ± 3.1 vs. 10.2 ± 3.7, p < 0.001). Children in the intervention group regained consciousness earlier (19.6 ± 3.8 vs. 22.4 ± 4.1 min, p < 0.001), resumed oral intake faster (4.9 ± 1.0 vs. 5.8 ± 1.2 h, p < 0.001), and had shorter hospital stays (3.4 ± 0.7 vs. 3.9 ± 0.8 days, p < 0.001).ConclusionComfort Theory–guided nursing care may help alleviate perioperative anxiety, stabilize physiological stress responses, reduce postoperative pain, and support behavioral and functional recovery in pediatric strabismus surgery. As a holistic nursing approach, it may offer a practical framework for improving perioperative care; however, the findings should be interpreted in light of the single-center design, lack of full blinding, and multimodal nature of the intervention.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1793866</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1793866</link>
        <title><![CDATA[Association of image-defined risk factors with clinical features in thoracic neuroblastoma and the development of a prognostic prediction model]]></title>
        <pubdate>2026-04-22T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Chong Shen</author><author>Zihao Bai</author><author>Kaiqian Zhou</author><author>Yujun Ma</author><author>Ming Yang</author><author>Jirong Qi</author><author>Bo Qian</author><author>Kaihong Wu</author>
        <description><![CDATA[BackgroundImage-defined risk factors (IDRFs) were critical in managing and predicting outcomes for neuroblastoma. This study systematically evaluated baseline clinical features, IDRFs prevalence, and prognosis in thoracic neuroblastoma, explored the association between IDRFs and these features, and developed a nomogram to predict event-free survival (EFS).MethodsClinical and prognostic data were collected retrospectively from pediatric patients diagnosed with thoracic neuroblastoma at Children's Hospital of Nanjing Medical University. Logistic regression was used to identify factors associated with IDRFs presence. Kaplan–Meier analysis assessed the effect of IDRFs on survival. Cox regression identified independent predictors of EFS, with model selection based on the Akaike Information Criterion (AIC). A nomogram was developed from these predictors and evaluated using calibration curves, time-dependent AUC curves, and decision curve analysis (DCA).ResultsTotal of 105 patients were included, 56 males, with a median diagnosis age of 55 (29, 77) months. The most common diagnosis was ganglioneuroblastoma intermixed (GNBi) (n = 49). Preoperative imaging found 93 IDRFs in 64 patients (60.95%), with infiltrative IDRFs being the most prevalent. 65.63% of patients had only one IDRF. Logistic regression showed that total protein (TP) ≥ 69.90 g/L and maximum tumor diameter (MTD) ≥ 5.50 cm independently predicted IDRFs presence. Among 85 patients with non-ganglioneuroma diagnoses, IDRFs did not significantly affect overall survival (OS) (p = 0.289), but were linked to worse EFS (p < 0.05). Cox regression identified infiltrative IDRFs, vascular IDRFs, LDH ≥273.00 U/L, and TP ≥ 70.00 g/L as independent risk factors for poor EFS. Nomogram based on these variables showed favorable discrimination with C-index = 0.77, good calibration, and clinical utility.ConclusionsThoracic neuroblastoma had unique demographic and clinical features. TP levels and tumor size were associated with the presence of IDRFs, which significantly affected EFS. The nomogram accurately predicted EFS and held potential for clinical utility.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1733741</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1733741</link>
        <title><![CDATA[Case Report: Right phrenic nerve palsy following esophageal atresia repair: a report of two cases and literature review of management strategies]]></title>
        <pubdate>2026-04-21T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Wenyue Liu</author><author>Bingliang Li</author><author>Xiaoxia Wu</author><author>Baohong Zhao</author><author>Yuanyuan Jin</author><author>Liang Zhao</author><author>Hongxia Ren</author>
        <description><![CDATA[BackgroundPhrenic nerve palsy (PNP) following esophageal atresia (EA) repair is an extremely rare complication with limited global experience. This report of two cases, integrated with a literature review, aims to synthesize available evidence to propose a structured management strategy.Case presentationWe describe two neonates who developed right PNP after type III EA repair. Case 1 was diagnosed with right phrenic nerve palsy on postoperative day (POD) 7 via chest x-ray and ultrasound and achieved full recovery after five weeks of non-invasive respiratory support. Case 2 was diagnosed on POD 14; after six weeks of failed conservative management, the infant underwent successful diaphragmatic plication. Both infants had favorable outcomes at follow-up.ConclusionBased on the present cases and a review of all documented literature, we recommend a stepwise approach for managing post-EA repair PNP: Preventively, intraoperative phrenic nerve monitoring should be considered during EA/TEF repair to reduce the risk of iatrogenic injury. For diagnosed cases, we suggest early diagnosis using bedside x-ray and ultrasound, followed by an initial trial of 4–6 weeks of non-invasive support, with diaphragmatic plication reserved for weaning failure.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1790096</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1790096</link>
        <title><![CDATA[Case Report: Early surgical intervention for epilepsy with mild MOGHE: timing and clinical efficacy]]></title>
        <pubdate>2026-04-21T00:00:00Z</pubdate>
        <category>Case Report</category>
        <author>Yaning Sun</author><author>Liuyin Chen</author><author>Mei Jin</author><author>Fan Yang</author><author>Yakun Du</author><author>Jiangshun Fang</author><author>Baoguang Li</author><author>Zhixuan Sun</author><author>Lingyan Wang</author><author>Zhenghai Cheng</author><author>Zhiguo Yang</author><author>Yi Qu</author>
        <description><![CDATA[BackgroundMild malformation of cortical development with oligodendroglial hyperplasia in epilepsy (MOGHE) is a new histopathological entity identified in resected brain tissue from patients with drug-resistant epilepsy. Clinically, this epilepsy subtype most commonly presents as epileptic spasms in early childhood. Conventional anatomical-electro-clinical approaches struggle to accurately delineate the epileptogenic zone, posing substantial challenges to clinical management.Case descriptionThis paper reports a 2-year-and-11-month-old male infant who developed significant intellectual and language regression merely 3 months after the onset of epileptic seizures. Scalp video-electroencephalography (VEEG) demonstrated generalized epileptiform discharges, cranial magnetic resonance imaging (MRI) revealed abnormal signals in the left frontal lobe, and fused cranial 18F-fluorodeoxyglucose positron emission tomography (PET)-MRI imaging showed no obvious hypometabolic foci. Following oral vigabatrin administration, clinical seizures were absent, yet neurodevelopmental regression progressed continuously. For children with early-onset developmental regression, a clinical decision-making dilemma exists: whether to continue medication adjustment and await fulfillment of traditional drug-resistant epilepsy criteria before surgery, or to implement active early surgical intervention.ConclusionThrough full-course follow-up of this child with MOGHE-associated epilepsy, this study integrated the evolution of clinical symptoms, electroencephalographic characteristics, imaging findings, and treatment responses to explore the rationale for surgical timing selection. The results suggest that for childhood epilepsy caused by definite cerebral structural abnormalities (particularly MOGHE) that has already led to obvious neurodevelopmental regression, active early surgical treatment should be considered to prevent disease progression and create favorable conditions for subsequent rehabilitation.]]></description>
      </item><item>
        <guid isPermaLink="true">https://www.frontiersin.org/articles/10.3389/fped.2026.1802302</guid>
        <link>https://www.frontiersin.org/articles/10.3389/fped.2026.1802302</link>
        <title><![CDATA[A 10-year review of pediatric inguinal hernia management at a tertiary center]]></title>
        <pubdate>2026-04-20T00:00:00Z</pubdate>
        <category>Original Research</category>
        <author>Bingran Yu</author><author>Shuan Liu</author><author>Zai Song</author>
        <description><![CDATA[AimsTo analyze the epidemiology, clinical characteristics, surgical outcomes, and risk factors for incarceration and recurrence in a large cohort of children undergoing inguinal hernia repair, and to evaluate differences across sex, laterality, and surgical approaches.MethodsWe retrospectively reviewed the children who underwent inguinal hernia repair at a tertiary pediatric center over ten years. Demographic characteristics, perioperative outcomes, and postoperative complications were analyzed. Subgroup comparisons were performed by sex, laterality, and surgical approach. Multivariate logistic regression models were used to identify independent predictors of incarceration and recurrence.ResultsOf 9590 children, 72.2% were male, and the median age was 2 years and 10 months. Laparoscopic surgery was performed in 93.1% of cases. Incarceration occurred in 4.2% of children and recurrence in 1.4%. Females, children ≤1 year, and unilateral hernias were independently associated with higher risk of incarceration. Male sex and age >1 year predicted recurrence, while laparoscopic technique served as a protective factor. Laparoscopy identified synchronous contralateral hernias in 39.2% of children initially diagnosed with unilateral hernia, compared with only 0.9% detected during open repair. Laparoscopic approach was also associated with shorter operative time, fewer complications, and faster recovery.ConclusionsThis large cohort study highlights the epidemiology and surgical outcomes of pediatric inguinal hernia. Age, sex, and hernia laterality were associated with clinical presentation and complication risk. Laparoscopic surgery showed favorable perioperative outcomes and facilitated detection of contralateral hernias. Because surgical approach selection was not randomized, comparisons between techniques should be interpreted cautiously. These findings emphasize the importance of individualized risk stratification and surgical decision-making.]]></description>
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