Purpose: Virtual reality (VR) has emerged as a valuable tool in surgical planning, offering detailed anatomical spatial orientation and three‐dimensional (3D) navigation. This study explores using virtual reality head‐mounted display (VR‐HMD) technology in preoperative planning for pediatric surgery, aiming to improve outcomes in treating congenital malformations and tumors while advancing surgical education. Methods: A retrospective analysis was performed on pediatric patients diagnosed with congenital malformations and tumors who received treatment between 2021 and 2024 at the “V. Buzzi” Children's Hospital in Milan, Italy. Patient‐specific 3D VR models were generated from reconstructed computed tomography/magnetic resonance imaging (CT/MRI) images and analyzed preoperatively to optimize surgical planning and strategy development. The advantages of preoperative VR compared to traditional imaging techniques were assessed. Results: Fifty VR models were included in the study ( n = 35: congenital malformations and n = 15 tumors). The VR‐HMD setup facilitated interactive anatomical exploration, enabling precise surgical navigation and planning. Compared to conventional imaging, preoperative VR simulations modified the surgical approach in 75.0% of cases, enabling minimally invasive strategies in complex congenital malformations and guiding the decision for open surgery in anatomically challenging tumors such as adrenal and hepatic masses. VR images demonstrated superior anatomical resolution and identified potential intraoperative complications in 92.0% of cases compared to conventional imaging. Remarkably, examining the vascular hilum in pulmonary, hepatic, and renal structures provided enhanced guidance for determining the surgical approach, ensuring a safer and more precise respect for the anatomy in complex cases. As a result, preoperative VR navigation demonstrated the feasibility of minimally invasive procedures in 45.6% of complex cases whereas recommending an open surgical approach in 55.4% of the models. Limitations in visualizing urological structures (e.g., ureters and bladder in complex urogenital malformations) limited the VR's utility in those cases, underscoring the need for future advancements in segmentation and multimodal imaging to enhance anatomical accuracy. Conclusion: Preoperative VR enables customized surgical planning, potentially minimizes intraoperative risks, and provides valuable educational opportunities for pediatric surgical teams. Future advancements in VR technology promise to further enhance its integration into clinical practice, ultimately improving pediatric patients' outcomes.

Esophageal atresia (EA) is the most common congenital esophageal malformation. An improvement in survival led to a focus on functional outcomes and quality of life (QoL). We analyzed the long-term outcomes and QoL of patients submitted to surgery for EA. Perinatal characteristics, surgical procedures, gastrointestinal and respiratory current symptoms and QoL were investigated. Thirty-nine patients were included. Long Gap patients had a higher rate of prematurity and low birth weight. The prevalent surgical procedure was primary esophageal anastomosis, followed by gastric pull-up. Twenty-four patients had post-operative stenosis, while gastroesophageal reflux (GER) required fundoplication in eleven cases. Auxological parameters were lower in Long Gap patients. The lowest scores of QoL were in the Long Gap group, especially in younger patients, which was the group with the highest number of symptoms. In the long term, the QoL appeared to be more dependent on the type of esophageal atresia rather than on associated malformations. Surgical management of GER was indicated in all patients with Long Gap EA, supposedly due to the prevalence of gastric pull-up for this type of EA. The assessment of QoL is part of surgeon’s management and needs to be performed in each phase of a child’s development.

This narrative review examines the integration of Artificial Intelligence (AI) in prenatal care, particularly in managing pregnancies complicated by Fetal Growth Restriction (FGR). AI provides a transformative approach to diagnosing and monitoring FGR by leveraging advanced machine‐learning algorithms and extensive data analysis. Automated fetal biometry using AI has demonstrated significant precision in identifying fetal structures, while predictive models analyzing Doppler indices and maternal characteristics improve the reliability of adverse outcome predictions. AI has enabled early detection and stratification of FGR risk, facilitating targeted monitoring strategies and individualized delivery plans, potentially improving neonatal outcomes. For instance, studies have shown enhancements in detecting placental insufficiency‐related abnormalities when AI tools are integrated with traditional ultrasound techniques. This review also explores challenges such as algorithm bias, ethical considerations, and data standardization, underscoring the importance of global accessibility and regulatory frameworks to ensure equitable implementation. The potential of AI to revolutionize prenatal care highlights the urgent need for further clinical validation and interdisciplinary collaboration.

Introduction: To evaluate the clinical usefulness of demographic data, fetal imaging findings and urinary analytes were used for predicting poor postnatal renal function in children with congenital megacystis. Materials and methods: A systematic review was conducted in MEDLINE’s electronic database from inception to December 2023 using various combinations of keywords such as “luto” [All Fields] OR “lower urinary tract obstruction” [All Fields] OR “urethral valves” [All Fields] OR “megacystis” [All Fields] OR “urethral atresia” [All Fields] OR “megalourethra” [All Fields] AND “prenatal ultrasound” [All Fields] OR “maternal ultrasound” [All Fields] OR “ob-stetric ultrasound” [All Fields] OR “anhydramnios” [All Fields] OR “oligohydramnios” [All Fields] OR “renal echogenicity” [All Fields] OR “biomarkers” [All Fields] OR “fetal urine” [All Fields] OR “amniotic fluid” [All Fields] OR “beta2 microglobulin” [All Fields] OR “osmolarity” [All Fields] OR “proteome” [All Fields] AND “outcomes” [All Fields] OR “prognosis” [All Fields] OR “staging” [All Fields] OR “prognostic factors” [All Fields] OR “predictors” [All Fields] OR “renal function” [All Fields] OR “kidney function” [All Fields] OR “renal failure” [All Fields]. Two reviewers independently selected the articles in which the accuracy of prenatal imaging findings and fetal urinary analytes were evaluated to predict postnatal renal function. Results: Out of the 727 articles analyzed, 20 met the selection criteria, including 1049 fetuses. Regarding fetal imaging findings, the predictive value of the amniotic fluid was investigated by 15 articles, the renal appearance by 11, bladder findings by 4, and ureteral dilatation by 2. The postnatal renal function showed a statistically significant relationship with the occurrence of oligo- or anhydramnion in four studies, with an abnormal echogenic/cystic renal cortical appearance in three studies. Single articles proved the statistical prognostic value of the amniotic fluid index, the renal parenchymal area, the apparent diffusion coefficient (ADC) measured on fetal diffusion-weighted MRI, and the lower urinary tract obstruction (LUTO) stage (based on bladder volume at referral and gestational age at the appearance of oligo- or anhydramnios). Regarding the predictive value of fetal urinary analytes, sodium and β2-microglobulin were the two most common urinary analytes investigated (n = 10 articles), followed by calcium (n = 6), chloride (n = 5), urinary osmolarity (n = 4), and total protein (n = 3). Phosphorus, glucose, creatinine, and urea were analyzed by two articles, and ammonium, potassium, N-Acetyl-l3-D-glucosaminidase, and microalbumin were investigated by one article. The majority of the studies (n = 8) failed to prove the prognostic value of fetal urinary analytes. However, two studies showed that a favorable urinary biochemistry profile (made up of sodium < 100 mg/dL; calcium < 8 mg/dL; osmolality < 200 mOsm/L; β2-microglobulin < 4 mg/L; total protein < 20 mg/dL) could predict good postnatal renal outcomes with statistical significance and urinary levels of β2-microglobulin were significantly higher in fetuses that developed an impaired renal function in childhood (10.9 ± 5.0 mg/L vs. 1.3 ± 0.2 mg/L, p-value < 0.05). Conclusions: Several demographic data, fetal imaging parameters, and urinary analytes have been shown to play a role in reliably triaging fetuses with megacystis for the risk of adverse postnatal renal outcomes. We believe that this systematic review can help clinicians for counseling parents on the prognoses of their infants and identifying the selected cases eligible for antenatal intervention.

Objectives: Bronchiolitis remains a major cause of morbidity and mortality in children under 24 months. During the first year of the pandemic, non-pharmacological interventions resulted in a significant reduction of bronchiolitis cases. Early in 2021, a rebound of bronchiolitis was reported with a description of out-of-season outbreaks. In this study, we prospectively evaluated the impact of bronchiolitis in two Italian University centers located in different geographical areas, aiming to compare two post-pandemic bronchiolitis seasons (2021/22 and 2022/23) in terms of severity, outcomes, microbiology and temporal distribution. Methods: This was a bicentric prospective observational cohort study. All consecutive children under 24 months of age assessed in the participating institutions during the specified seasons and receiving a clinical diagnosis of bronchiolitis were included. Results: A total of 900 patients were enrolled. Patients in the second season were globally younger and had comorbidities less often. Temporal distribution changed between the two seasons. Of the patients, 56% were tested for RSV; 60% of these was positive. Patients with RSV were globally younger (3.5 months vs. 4.9, p < 0.001), more often had a need for any kind of respiratory and fluid support and more often needed ward or PICU admission. At the end of the ED visit, 430 patients were discharged home, 372 (41.3%) were admitted to an inpatient ward and 46 (5.1%) to a pediatric intensive care unit. Conclusions: The 2022/23 post-COVID bronchiolitis was mostly similar to that of 2021/22, and was in line with pre-pandemic expectations.

Introduction: Lung ultrasound (LUS) has demonstrated a good correlation with clinical severity scores in bronchiolitis but should be combined with clinical data to achieve the best results. The aim of the study is to create a quick and reliable clinical-ultrasound score to predict the risk of paediatric intensive care (Picu) admission as soon as the patient enters the emergency department (ED). Methods: A retrospective study conducted at two paediatric EDs. The lung was divided into six zones and scanned with ultrasound; every zone received a score. Clinical data were obtained. For the outcomes “PICU admission” and “CPAP support”, a multivariate analysis was conducted and the significant factors resulting were used to create a 3-item score to predict PICU admission. Area under the receiver-operating curve (AUC) for specificity and sensibility of the score was obtained. Results: Seventy-four patients were enrolled; 34% were admitted to PICU. Thirty-one percent were treated with CPAP. For the outcome “PICU admission”, multivariate analysis demonstrated the presence of wheezing and reduced oral intake to be significant together with ultrasound involvement of the right posterior upper zone and left posterior basal zone. For the outcome “CPAP support”, same clinical factors plus involvement of the right posterior upper zone were significant. A 3-item score (1: presence of wheezing; 2: reduced oral intake; 3: LUS involvement of right posterior upper zone) for prediction of PICU admission was created which presents an AUC of 0.8249. Conclusions: We were able to create a simple and quick score to predict the need for PICU admission in bronchiolitis.