Research Appraisals

Pediatric surgery international

Pediatric colonic diverticulitis: clinical presentation, management, and review of the literature

Colonic diverticulitis is rare in the pediatric population and often presents with nonspecific symptoms that may be misdiagnosed as other causes of acute abdominal pain, such as appendicitis, leading to diagnostic uncertainty and variability in management. We report a case of pediatric colonic diverticulitis and present a systematic review to characterize its clinical presentation, diagnostic challenges and management. Clinical data for the index patient were retrospectively reviewed, and parental consent was obtained. A structured literature search was performed using PubMed, Scopus, and Embase. Studies reporting patients younger than 18 years were included. A 16-year-old male presented with right lower quadrant pain. CT suggested cecal diverticulitis. Worsening symptoms prompted diagnostic laparoscopy, revealing an inflamed diverticulum adjacent to a normal appendix. The postoperative course was uneventful. The review identified 27 studies including 101 patients. Median age was 14 years (IQR 12-16; range 3-17), with 57% male preponderance. Most cases involved a solitary right-sided diverticulum. CT correctly identified diverticulitis in 85%. Complicated disease occurred in 17%. In conclusion, in the pediatric age diverticulitis often arises from a solitary cecal diverticulum and can closely mimic appendicitis. Awareness may improve diagnosis, and uncomplicated cases can be treated conservatively with careful follow-up and appropriate clinical monitoring.

21 July 2026

45CEBM

Pediatric surgery international

ARM in ARM? Investigating the co-occurrence of anorectal malformations and labioscrotal anomalies.

Anorectal malformations (ARMs) are known to be associated with other defects, however there is no evidence addressing the co-occurrence of ARMs with anomalies of structures derived from the labioscrotal folds. We performed a systematic review (Prospero: CRD420251013945) aiming at investigating correlations and patterns between ARMs and labioscrotal anomalies (LSAs), when presenting simultaneously. Our search identified 1642 articles. After abstract screening, 344 full texts were assessed and 144 met the inclusion criteria. In total, these reported on 319 individual cases with both ARM and LSA. Individuals with complex ARMs had proportionally the most LSAs associated with their ARM - 58.4% of these were associated with only a single LSA. For 'high' and 'low' ARMs, 66.0% and 77.0% of cases were associated with a single LSA respectively. As data reporting prevalence of each type of ARM lacks information about LSAs, the potential to predict the presence of LSAs according to type of ARM is limited. Nevertheless, this review demonstrates a frequent association of ARMs with LSAs, that has not been previously described. This evidence highlights the importance of early screening and timely management of LSAs in patients with any type of ARM, with close collaboration between paediatric surgeons, urologists and other clinicians.

20 July 2026

70CEBM

Pediatric surgery international

Single-stage versus staged reconstruction for high and intermediate anorectal malformations in neonates: a systematic review and meta-analysis

The surgical approach to high and intermediate anorectal malformations remains controversial. This systematic review compared continence and infection outcomes between the two approaches. MEDLINE, Embase, and Cochrane CENTRAL were searched per a registered protocol (PROSPERO CRD420261291319). Comparative studies of single-stage versus staged repair in neonates with high or intermediate anorectal malformations were included. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis with prediction intervals was performed. Four comparative studies (746 patients: 399 single-stage, 347 staged) were included. Pooled analysis showed no significant difference in incontinence outcomes (RR 0.93, 95% CI: 0.52-1.66, p = 0.80; 95% prediction interval: 0.28-3.08) with substantial heterogeneity (I²=83%). Infection data could not be pooled due to methodological concerns in outcome reporting. All included studies demonstrated moderate to serious risk of bias. GRADE certainty was LOW for incontinence and VERY LOW for infection. Current evidence does not demonstrate superiority of either approach for bowel continence (LOW certainty). Infection evidence was insufficient for synthesis (VERY LOW). Wide prediction intervals indicate substantial uncertainty; available data cannot confirm or refute inferior outcomes after single-stage repair. Prospective studies with standardized outcomes are needed. Protocol registration: PROSPERO CRD420261291319.

17 July 2026

50CEBM

Journal of pediatric surgery

Artificial intelligence in rare pediatric solid tumor research and clinical care: A scoping review

BACKGROUND: Clinical and research advances for children with solid tumors are limited by their rare nature. Artificial intelligence (AI) and machine learning (ML) hold potential for advancing diagnosis, risk stratification, and treatment in rare diseases where individual patients contribute high-dimensional data. This review characterizes current AI/ML applications in rare pediatric solid tumors. METHODS: PubMed, Embase, and Web-of-Science Core Collection databases were queried for relevant articles published before February 10, 2025. Eligible studies applied AI/ML methods to study rare tumors in pediatric populations (≤19 years). Articles were evaluated for tumor diagnosis, AI/ML methods, clinical applications, comparators, effectiveness, and interpretability. RESULTS: Twenty-three studies (2009-2025) were included. Hepatoblastoma (12/23) and pediatric thyroid cancers (4/23) were most frequently studied. Supervised learning predominated (20/23), followed by unsupervised (9/23), deep learning (4/23), and hybrid/ensemble models (6/23). Applications included diagnosis (12/23), prognosis (10/23), and risk stratification (9/23). Twenty studies reported effectiveness measures, with many models achieving AUCs >0.85. In comparative analysis (17/23), AI/ML often equaled or exceeded expert consensus, traditional models, or alternative algorithms. Eight studies reported external validation. CONCLUSIONS: Current AI/ML research in rare pediatric extra-cranial solid tumors focuses on diagnosis, risk stratification, and prognosis, often outperforming traditional methods. Future work should prioritize external validation and clinical applicability.

1 July 2026

50CEBM

World journal of urology

Non-operative management of early onset small urethrocutaneous fistula post hypospadias repair: a systematic review

BACKGROUND: Urethrocutaneous fistulas (UCF) after hypospadias repair are typically managed surgically, but conservative approaches may offer a less invasive, cost-effective alternative. While surgical repair remains the standard, non-operative strategies may eliminate anesthesia exposure, shorten recovery time, and lower healthcare costs. However, systematic evidence regarding these approaches remains limited. METHODS: This narrative systematic review evaluates non-operative management for small (typically ≤ 2 mm) UCFs. A comprehensive search was conducted across PubMed, Cochrane, ScienceDirect, Wiley, and Google Scholar up to April 2025. The study followed PRISMA guidelines and is registered in PROSPERO (CRD420251069870). We included randomized controlled trials (RCTs), comparative trials, case series, and anecdotal reports involving children (< 18 years). Risk of bias was assessed using Cochrane RoB-2, ROBINS-I, and JBI Critical Appraisal tools. RESULTS: Five studies involving 73 patients were included for analysis. Due to significant clinical heterogeneity in fistula characteristics and interventions, a pooled closure rate was not calculated. Reported individual study closure rates ranged from 53.8% to 62.5% in the primary series, with one anecdotal report (n = 1) showing 100% success. Success was more frequently observed in early-onset UCFs (diagnosed within 14 days post-catheter removal) and those with a diameter ≤ 2 mm. Minor adverse events included localized heat (42.8%) and transient dysuria (4.7%). Cost-analysis from one RCT indicated that non-operative adhesive application cost approximately 9.3% compared to total operative costs. Most included studies were classified as having a high risk of bias. CONCLUSION: Non-operative approaches using tissue adhesives, fibrin glue, or recatheterization may be viable for small (≤ 2 mm), early-onset UCFs. However, the current evidence is limited, heterogeneous, and carries a high risk of bias. These findings should be considered hypothesis-generating, and further high-quality comparative studies are required to establish definitive clinical protocols. TRIAL REGISTRATION: PROSPERO CRD420251069870.

19 June 2026

60CEBM

Annals of medicine

Association between packed red blood cell transfusion and clinical deterioration in neonatal necrotizing enterocolitis: a systematic review and meta-analysis

BACKGROUND: No systematic review has evaluated the existing evidence regarding the association between packed red blood cell (pRBC) transfusion and clinical worsening of necrotizing enterocolitis (NEC) in neonates. This systematic review and meta-analysis was conducted to address this knowledge gap. MATERIALS AND METHODS: We searched the Cochrane Library, EBSCO, Embase, Web of Science, Google Scholar, and PubMed for studies on pRBC transfusion and NEC published before May 10, 2025. Relevant articles were selected through title, abstract, and full-text screening. English-language case-control studies or cohort studies, or randomized controlled trials involving newborns with NEC that compared pRBC transfusion with no transfusion and reported changes in NEC clinical status were included. Review articles, systematic reviews, case reports, editorials, animal studies, duplicate publications, and studies with incomplete data were excluded. RESULTS: Five studies involving 971 neonates with NEC were included. The pooled analysis demonstrated a potential association between pRBC transfusion and clinical deterioration of NEC in neonates (odds ratio: 6.05, 95% confidence interval: 3.02-12.14). CONCLUSIONS: pRBC transfusion was associated with an exacerbation of NEC in neonates. However, these findings should be interpreted cautiously because of the small number of eligible studies included in this meta-analysis, and future large-scale, well-designed studies are needed to confirm the observed association. Published studies have identified an association between pRBC transfusion and NEC progression; however, whether this association is causal remains unclear.Despite consistent evidence from observational studies suggesting a potential association between pRBC transfusion and NEC progression, the overall quality of the evidence is low because of the lack of randomized controlled trials to determine causality.

25 May 2026

60CEBM

The Cochrane database of systematic reviews

Gastrostomy plus fundoplication or gastro-jejunal tube or gastrostomy alone for treating or preventing gastro-esophageal reflux in children and adolescents with neurological impairment

RATIONALE: Children with neurological impairment (NI) represent a vulnerable pediatric population who often experience multiple co-occurring chronic conditions and may develop worsening comorbidities over time due to primary dysfunctions of the nervous system. Among the most significant of these are gastro-esophageal reflux (GER) and dysphagia, which likely account for much of the associated morbidity and mortality. There is substantial variation in the management of GER, and few studies have been conducted to evaluate the effects of antireflux procedures in preventing and improving outcomes in this population. OBJECTIVES: To assess the benefits and harms of the two most common enteral feeding tubes and associated antireflux procedures. We aimed to compare: 1) gastrostomy tube (GT) plus fundoplication, 2) gastrostomy plus insertion of a gastro-jejunal (GJ) tube, and 3) GT alone for treating or preventing GER in children and adolescents with NI. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers, together with reference checking and contact with two experts in the field, to identify studies for inclusion in the review. There were no restrictions on language. The latest search date was 17 September 2024. ELIGIBILITY CRITERIA: Randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) in children with NI, with or without GER, comparing the three interventions. We excluded studies of neurologically normal children. OUTCOMES: Our critical outcomes were symptoms of GER and mortality. Important outcomes included major surgical complications (perforation or peritonitis), length of stay (LOS), number of hospitalizations for respiratory morbidity (pneumonia), number of emergency department (ED) visits, and child's quality of life (QoL). RISK OF BIAS: We used the ROBINS-I tool to assess bias in NRSIs. We did not find any RCTs. SYNTHESIS METHODS: We meta-analyzed the results for each outcome where possible (inverse-variance, random-effects). Where this was precluded by the nature of the data, we synthesized results according to Synthesis Without Meta-analysis (SWiM) guidelines. We used GRADE to assess the certainty of evidence. INCLUDED STUDIES: We included 11 NRSIs with a total of 3122 children with NI. Among these, seven cohort studies compared GT plus fundoplication versus GT alone (2654 participants); one cohort study compared GJ tubes versus GT alone (50 participants); and three cohort studies compared GT plus fundoplication versus GJ tubes (418 participants). SYNTHESIS OF RESULTS: GT plus fundoplication compared to GT alone for GER in children with NI The evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER (odds ratio [OR] 2.02, 95% confidence interval [CI] 0.64 to 6.44; 3 NRSIs, 180 participants; very low-certainty evidence); mortality (OR 2.62, 95% CI 0.41 to 16.80; 3 NRSIs, 415 participants; very low-certainty evidence); major surgical complications (OR 2.61, 95% CI 0.46 to 14.87; 3 NRSIs, 412 participants; very low-certainty evidence); and LOS (1 NRSI with no comparison, 130 participants; very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia (mean difference [MD] 0.04 higher, 95% CI 0.01 lower to 0.09 higher; 1 NRSI, 2054 participants; low-certainty evidence). The evidence is very uncertain about the effect of GT plus fundoplication on the number of ED visits (OR 1.82, 95% CI 0.78 to 4.27; 1 NRSI, 130 participants; very low-certainty evidence). Child's QoL was not reported. GJ tubes compared to GT alone for GER in children with NI The evidence is very uncertain about the effect of GJ tubes on mortality (OR 5.38, 95% CI 0.40 to 73.09; 1 NRSI, 50 participants; very low-certainty evidence) and child's QoL (effect estimate not reported; no effect of the type of tube on quality of life; 1 prospective NRSI, 50 participants; very low-certainty evidence). Symptoms of GER, major surgical complications, LOS, number of hospitalizations for respiratory morbidity (pneumonia), and number of ED visits were not reported. GT plus fundoplication compared to GJ tubes for GER in children with NI The evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER (3 NRSIs with conflicting results, including 1 unmatched cohort, 1531 participants; very low-certainty evidence); mortality (OR 1.12, 95% CI 0.52 to 2.41; 3 NRSIs, 418 participants; very low-certainty evidence); major surgical complications (OR 2.84, 95% CI 0.45 to 17.82; 2 NRSIs, 190 participants; very low-certainty evidence); and LOS (1 NRSI with no comparison, 79 participants; very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia (MD 0.05 lower, 95% CI 0.21 lower to 0.11 higher; 1 NRSI, 228 participants; low-certainty evidence). Number of ED visits and child's QoL were not reported. We downgraded the certainty of evidence for risk of bias and imprecision. Most studies were at serious risk of bias due to confounding, except for hospitalizations for pneumonia for the comparisons of GT plus fundoplication versus GT alone and versus GJ tubes. AUTHORS' CONCLUSIONS: In children with NI, the evidence is very uncertain about the effect of GT plus fundoplication on symptoms of GER, mortality, major surgical complications, and LOS, when compared to GT alone or GJ tubes (very low-certainty evidence). GT plus fundoplication may result in little to no difference in the number of hospitalizations for pneumonia when compared to GT alone or GJ tubes (low-certainty evidence). The evidence is very uncertain about the effect of GT plus fundoplication on the number of ED visits when compared to GT alone (very low-certainty evidence). The evidence is very uncertain about the effect of GJ tubes on mortality and child's QoL when compared to GT alone (very low-certainty evidence). We found no RCTs, and our results should be interpreted with caution due to the limited number of studies and the limitations of NRSIs. Additional research is necessary. It is likely that RCTs will be difficult to conduct; however, better-designed NRSIs could improve the quality of evidence in this area. FUNDING: This review was funded by Foundation Fresno, Universidad Católica de Chile, for librarian support only. The foundation had no role in the design or conduct of this review. REGISTRATION: Protocol available via DOI: 10.1002/14651858.CD015007.

21 May 2026

50CEBM

International journal of cancer

Testicular cancer in intersex individuals: A systematic review for clinical practice

The objective of this systematic review was to identify the evidence of testicular cancer risk for people with intersex conditions. This assessment is hoped to help refine risk stratification tools for assessing gonadal malignancy risk and guide the development of more robust evidence-based management strategies. The literature was searched in Ovid MEDLINE, Embase, and Cumulative Index of Nursing and Allied Health using a search string developed by a multidisciplinary team. The protocol was registered at Prospective Register of Systematic Reviews as CRD42021231313. A total of 3608 articles were found. After selection, 301 publications were included (1215 individuals). The results identified significant evidence that pre-pubertal gonadectomy may be linked to lower rates of malignant gonadal changes for patients with partial gonadal dysgenesis, Turner's syndrome with Y-chromosome material, complete androgen insensitivity, partial androgen insensitivity, and patients with ovotestis/es. The evidence was not significant for patients with complete gonadal dysgenesis, Klinefelter syndrome, nor WT1-related syndromes. Specific cancer outcomes were unable to be assessed due to small sample sizes and thus it is unknown if clinically significant cancer outcomes are meaningfully altered by pre-pubertal gonadectomy. Importantly, the quality of data on the topic of gonadal malignancy in intersex patients with testicular tissue was determined to be poor overall. The quality was relatively more robust regarding the conditions of Complete Androgen Insensitivity, Klinefelter syndrome, and patients with ovotestis/es. More high-quality research is needed to draw specific conclusions on the risks and benefits of performing pre-pubertal gonadectomy for intersex patients. When counseling these patients, clinicians should be transparent regarding the paucity of data supporting pre-pubertal gonadectomy.

17 May 2026

Randomised Controlled TrialEvidence: Moderate

Pediatric surgery international

Effect of anticholinergics vs. alpha-1 blockers vs. combination therapy on bladder function in patients with posterior urethral valve after transurethral fulguration: a pilot randomized controlled trial

PURPOSE: To identify preliminary efficacy signals of anticholinergics, alpha-1 blockers, and their combination on bladder and renal function in boys with bladder dysfunction following posterior urethral valve (PUV) ablation, and to assess the feasibility of conducting a definitive randomized, controlled trial. STUDY DESIGN: In this single-center, prospective, randomized pilot trial boys under 12 years who had undergone cystoscopic valve ablation were randomized into three groups: anticholinergic therapy (Group I), alpha-1 blocker therapy (Group II), and combination therapy (Group III). The study was designed to detect within-group preliminary efficacy signals in urodynamic parameters following 6 months of pharmacotherapy. Secondary outcomes included changes in patient-reported symptom scores, renal function, and feasibility metrics. Between-group comparisons were performed as exploratory analyses. Feasibility and safety outcomes were analyzed in the intention-to-treat population, while efficacy analyses were conducted in participants who received intervention and had evaluable baseline and follow-up data. RESULTS: Thirty-five eligible patients were randomized (Group I, n = 12; Group II, n = 11; Group III, n = 12). and their clinical and biochemical analyses at baseline were recorded. Two deaths in Group II occurred prior to baseline urodynamics and pharmacotherapy initiation; efficacy analyses, therefore, included 33 patients (Group I, n = 12; Group II, n = 9; Group III, n = 12) with evaluable data. Urodynamic evaluation demonstrated favourable within-group trends: Group I showed a significant improvement in voided volume, while changes in voiding time, cystometric capacity (CC), static compliance, and maximum detrusor pressure (Pdetmax) were favourable but not uniformly statistically significant. Group II showed modest, favourable effects on Qmax, Time@Qmax, CC, and Pdetmax, with wide confidence intervals and no clear significant changes across most UDS measures. Group III demonstrated the most consistent favourable pattern, particularly for CC and Pdetmax, although most confidence intervals overlapped the null. Baseline-adjusted exploratory analyses did not demonstrate statistically significant between-group differences. Symptom scores improved across all groups. Feasibility outcomes were robust, with 81% recruitment, 91% urodynamic study completion, and 94% participant retention. CONCLUSION: This pilot trial demonstrates the feasibility of conducting urodynamic-guided pharmacotherapy studies in young boys with PUV-related bladder dysfunction. The observed within-group efficacy signals across all treatment arms-particularly with combination therapy-are hypothesis-generating and provide effect size and variability estimates to inform the design of a definitive randomized controlled trial.

13 May 2026

Systematic ReviewEvidence: Moderate

Journal of investigative surgery : the official journal of the Academy of Surgical Research

Vascular and Wound-Healing Implications of Single-Stage Versus Multistage Repair of Anorectal Malformations: A Systematic Review and Meta-Analysis

BACKGROUND: Anorectal malformations (ARMs) are managed using either single-stage or multistage surgical repair. However, concerns persist regarding wound-related complications and long-term functional outcomes, which remain inconsistently reported across surgical approaches. OBJECTIVE: To compare wound-related complications and long-term functional outcomes following single-stage versus multistage repair of ARMs, with emphasis on wound perfusion, dehiscence, and vascular healing dynamics. METHODS: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251006245). PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies published between 2000 and 2024 comparing single-stage and staged ARM repair in neonates and infants. Outcomes included wound dehiscence, surgical site infection (SSI), stenosis, prolapse, redo surgery, constipation, soiling, and voluntary bowel movements. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: Nineteen studies involving 1,972 patients were included. Single-stage repair was associated with a significantly higher risk of wound dehiscence (OR 3.31; 95% CI 1.90-5.79; p < 0.0001), while no significant differences were observed for SSI, stenosis, prolapse, redo surgery, constipation, soiling, or voluntary bowel movements. Moderate to high heterogeneity was noted for selected outcomes. CONCLUSIONS: Single-stage repair provides comparable infection rates and long-term functional outcomes to multistage surgery but carries an increased risk of wound dehiscence. Optimizing tissue perfusion and minimizing tension are essential to improve outcomes. This study highlights the important role of vascular and wound-healing mechanisms in determining outcomes after anorectal malformation (ARM) repair. While single-stage surgery reduces the burden of multiple procedures, it exposes perineal tissues to fecal contamination and potential microvascular stress, which may increase the risk of wound complications.An understanding of tissue perfusion, venous drainage, and local tissue tension is critical during neonatal reconstructive surgery. Incorporating techniques that preserve vascular integrity, minimize tension, and protect the surgical site can help optimize postoperative healing and reduce the risk of wound dehiscence.

13 May 2026

Systematic ReviewEvidence: Moderate

75CEBM

Archives of disease in childhood

How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis.

OBJECTIVES: Primary: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) in the diagnosis of appendicitis in paediatric patients presenting with suspected appendicitis.Secondary: To investigate how the use of POCUS affects length of stay in the paediatric emergency department and CT utilisation. METHODS: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) up until February 2025 for studies involving patients presenting to the paediatric emergency department with suspected appendicitis, who underwent POCUS. Studies were assessed for risk of bias using the Quality Assessment Tool for Diagnostic Accuracy Studies framework. The primary outcome of interest was the ability of POCUS to detect appendicitis in terms of sensitivity and specificity. RESULTS: Eight studies were included encompassing 993 patients. Calculated pooled sensitivity was 85.6% (95% CI 68.9% to 94.1%) with a specificity of 90.2% (95% CI 86.5% to 93.0%). There was a wide range of reported sensitivities for POCUS, ranging from 53% to 100%. There was less variation in reported specificities that ranged from 82% to 95.2%. The studies analysed were of variable quality with the reference standard and flow and timing being the main areas subject to bias. CONCLUSIONS: Based on the findings of this systematic review and meta-analysis, it is reasonable to conclude that POCUS can be used as an effective tool to diagnose paediatric appendicitis. With a moderately high sensitivity, it may not be recommended to be used to exclude appendicitis based on POCUS findings alone. Further prospective studies evaluating the reliability of POCUS in excluding appendicitis, either alone or when combined with a clinical prediction rule, are required. Secondary findings from this study demonstrate that POCUS may result in a reduced length of stay in the paediatric emergency department and lead to a reduction in CT utilisation, though insufficient data were available to draw firm conclusions in relation to this.

19 Apr 2026

otherEvidence: Moderate

European journal of pediatrics

Randomised crossover trial of neurally adjusted ventilatory assist (NAVA) for neonates with congenital diaphragmatic hernias: the NAN-C study

Retrospective studies comparing NAVA to assist control ventilation (ACV) in neonates with congenital diaphragmatic hernia (CDH) have shown that ventilatory mode may improve respiratory parameters. The aim of this study is to determine if infants with CDH studied post-operatively had a lower oxygenation index (OI) on NAVA compared to ACV. This dual-centre randomised cross-over trial compared post-operative NAVA with ACV in infants with CDH. Infants were randomised to receive either NAVA or ACV first in a 1:1 ratio for a 4-h period. At the end of each 4-h period, blood gas analysis was performed and the OI calculated. The inspired oxygen concentration (FiO2), the peak inflation (PIP), and mean airway pressure (MAP) were averaged from the last 5 min on each mode. Eleven infants were randomised. Nine infants completed the trial. with median gestational age of 38 (range 34.6-39.3) weeks and median postnatal age of 7 (range 5-36) days. Eight had left-sided CDH, six had patch repair and two had thoracoscopic repair. The mean OI after 4 h on NAVA was 3.9 ± 1.8 compared to 5.9 ± 1.61 on ACV (p = 0.008). The peak Edi (6.05 ± 4.5 versus 9.86 ± 7.3 µV, p = 0.028), PIP (17 ± 6.3 versus 22 ± 5.3 cmH2O, p = 0.017), and MAP (8.7 ± 2.6 versus 11.1 ± 1.8 cmH2O, p = 0.008), expiratory tidal volume (5.06 ± 0.71 versus 9.86 ± 1.29 ml/kg, p = 0.043) were lower on NAVA versus ACV. Two infants were randomised, but the trial was stopped due to a low Edi signal.Conclusion: NAVA compared to ACV improved oxygenation postoperatively in infants with CDH. On NAVA, infants had lower oxygen indices, peak Edi, expiratory tidal volume and peak and mean airway pressures.

10 Apr 2026

Systematic ReviewEvidence: Moderate

80CEBM

European journal of orthopaedic surgery & traumatology : orthopedie traumatologie

Radiological and surgical outcomes after graduation to posterior spinal fusion surgery following magnetically controlled growing rod treatment for early-onset scoliosis: a systematic review and single-arm meta-analysis

PURPOSE: Early-onset scoliosis (EOS) is a challenging condition for spinal surgeons. Growing rods represent the standard treatment for patients requiring surgery, and magnetically controlled growing rods (MCGR) are increasingly adopted. Many patients ultimately transition to posterior spinal fusion (PSF), although the necessity of definitive fusion remains debated. This systematic review and single-arm meta-analysis aimed to evaluate radiographic and surgical outcomes of PSF following MCGR treatment. METHODS: A systematic literature search was conducted in PubMed, Google Scholar, Medline, Scopus, Embase, and the Cochrane Library up to April 2025, following PRISMA guidelines. Eligible studies were identified using a PIO (Population, Intervention, Outcome) framework. Extracted data included demographic, radiographic, and surgical outcomes, including complications. A single-arm meta-analysis compared pre- and post-PSF radiographic parameters (main curve magnitude, thoracic kyphosis (TK), T1-T12 and T1-S1 lengths). Risk of bias was assessed using the MINORS tool. RESULTS: Eight retrospective studies were included (370 patients), of which six were eligible for quantitative synthesis. The meta-analysis demonstrated significant improvements in all radiographic parameters (main curve magnitude, TK, T1-T12 and T1-S1 lengths, p < 0.05). The pooled overall postoperative complication rate after PSF was 17.2%. CONCLUSIONS: PSF appears to be a viable treatment option following MCGR, providing significant deformity correction with a relatively acceptable complication rate. Nevertheless, the current evidence is limited by small, retrospective cohorts. Larger, prospective studies with standardized reporting of surgical variables and clinical outcomes are needed to better define the role of final fusion and to optimize treatment protocols.

4 Apr 2026