Purpose: This meta-analysis compares thoracoscopic versus open thoracotomy repair of esophageal atresia with tracheoesophageal fistula (EA/TEF). Methods: We systematically searched PubMed, Web of Science, Cochrane Library, and Scopus from inception to April 2025 for studies comparing thoracoscopic versus conventional thoracotomy approaches. Two independent reviewers screened studies, extracted data, and assessed risk of bias using appropriate tools. Meta-analyses were conducted using RevMan 5.4 software. Results: A total of 25 studies (24 observational and one randomized controlled trial, including 3087 patients) were included. Thoracoscopic repair was associated with longer operative time (mean difference [MD] = 20.94 min; p = 0.005) but showed significant advantages in reducing mortality (risk ratio [RR] = 0.52; p = 0.01), musculoskeletal complications (RR = 0.08; p < 0.0001), and wound infections (RR = 0.21; p = 0.02). It also led to shorter ICU stays (MD = −1.09 days; p = 0.005) and earlier initiation of oral feeding (MD = −1.12 days; p = 0.02). However, the risk of anastomotic stricture requiring dilation was higher (RR = 1.54; p < 0.00001). No significant differences were found in anastomotic leak rates, recurrent fistula, respiratory complications, or need for fundoplication. Conclusions: Thoracoscopic repair of EA/TEF is associated with perioperative benefits over conventional thoracotomy, including significantly lower mortality and a markedly reduced incidence of musculoskeletal complications. However, this approach is associated with a higher risk of anastomotic stricture requiring dilation, and these differences may partly reflect patient selection factors.

Late-onset neonatal sepsis (LONS) remains a leading cause of morbidity and mortality in neonates, particularly among preterm and low birth weight infants. Interleukin-6 (IL-6) has emerged as a promising biomarker for early detection of LONS, yet the diagnostic performance of IL-6 remains inconsistent across studies. This meta-analysis aimed to evaluate the overall diagnostic accuracy of IL-6 in detecting LONS and to assess the certainty of evidence using the GRADE approach. A comprehensive search of five databases was conducted up to July 15, 2025. Twenty-two studies were eligible for inclusion, of which 20 ( n = 3527 neonates) were included in the meta-analysis. A bivariate random-effects model was used to estimate pooled sensitivity and specificity, and the area under the SROC curve was used to assess overall diagnostic accuracy. Pooled sensitivity and specificity were 85.2% (95% CI: 80.0–89.3%) and 84.1% (95% CI: 77.5–89.0%), respectively. The positive and negative likelihood ratios were 5.43 and 0.18, with a diagnostic odds ratio of 31.4. The AUC was 0.91, indicating excellent diagnostic accuracy. Subgroup and sensitivity analyses confirmed the robustness of the findings, and no significant threshold effect was detected. However, suspected publication bias was noted. The GRADE assessment rated the certainty of evidence as moderate. Conclusion : IL-6 demonstrates high diagnostic accuracy for LONS and may serve as a valuable tool for early identification, though standardization of cutoff thresholds and further validation studies are warranted. What is Known: • IL-6 is an early-rising biomarker for late-onset neonatal sepsis (LONS), but its diagnostic accuracy varies across studies. What is New: • This meta-analysis used a bivariate model to estimate IL-6 performance, yielding high pooled sensitivity (85.2%) and specificity (84.1%).

Aim: This review examines the effectiveness, implementation factors, and outcomes of telemedicine applications in managing surgical emergencies and trauma in pediatric patients. Methods: We conducted a systematic review following PRISMA guidelines. Comprehensive searches were performed across four major databases (PubMed, Scopus, Web of Science, and Cochrane Library) from inception to January 2025. Studies that investigate telemedicine interventions in pediatric (ages 0–18) emergency surgery and trauma settings were included. Results: Eleven studies met inclusion criteria, comprising 6 retrospective cohorts, 3 cross-sectional studies, 1 prospective cohort, and 1 case series. Diagnostic accuracy was consistently high across applications (sensitivity: 93.8–100%; specificity: 82.6–99.7%). Telemedicine demonstrated effectiveness in preventing unnecessary transfers, with one study reporting 16 prevented transfers. Remote-guided procedures showed comparable accuracy to in-person assessment, particularly in point-of-care ultrasound (sensitivity: 93.8%, specificity: 99.7%). High satisfaction rates were reported among families and healthcare providers. Conclusions: This review highlights the potential of telemedicine in pediatric emergency surgery and trauma care, particularly in enhancing access to specialized care and maintaining diagnostic accuracy. However, the generalizability of findings remains limited due to variations in study methodologies. Future research should emphasize prospective designs and economic evaluations to clarify the cost–benefit ratio of implementation. Establishing standardized protocols and enhancing provider training will be essential for the effective and sustainable integration of telemedicine into pediatric trauma systems.

Background: Recurrence of hepatic hydatid cysts after laparoscopic surgery poses a significant challenge in pediatric patients. The administration of albendazole therapy pre- and post-operatively is proposed to reduce recurrence rates, yet its impact requires further investigation. This study aims to identify predictive factors associated with recurrence of hepatic hydatid cysts in children following laparoscopic surgery, focusing on cyst characteristics and perioperative albendazole therapy. Methods: A retrospective cross-sectional analytical study was conducted using medical records of pediatric patients under 16 years of age who underwent laparoscopic surgery for hepatic hydatid cysts between 2006 and 2021. Collected data included patient demographics, cyst characteristics (size, location, and number), preoperative and postoperative albendazole therapy, surgical duration, and intraoperative complications. Logistic regression analysis was used to identify factors associated with cyst recurrence during the follow-up period, with statistical significance set at p < 0.05. Results: A total of 152 pediatric patients were included, with a mean age of 7.9 ± 3.3 years. The recurrence rate was 12% (n = 18). In multivariate analysis, longer surgical duration (HR = 1.02; 95% CI 1.00–1.03; p = 0.013) and cysts located outside liver segment II (HR = 0.11; 95% CI 0.01–0.9; p = 0.039) were independently associated with recurrence. Albendazole therapy, administered pre- or post-operatively, was more frequent in the non-recurrence group but did not reach statistical significance. No cases of peritoneal hydatidosis were recorded during follow-up. Conclusion: Key predictors of post-laparoscopy recurrence included extended surgical duration and cyst location. Although perioperative albendazole therapy was more frequent in the non-recurrence group, it did not reach statistical significance in reducing recurrence rates. These findings highlight the importance of tailored surgical approaches and careful postoperative monitoring to improve patient outcomes.

Pediatric emergencies pose significant challenges in healthcare. Telemedicine offers a promising solution by enabling remote assessments, improving specialist access, reducing unnecessary ER visits and admissions, optimizing resources, and enhancing patient satisfaction. This systematic review and meta-analysis uniquely aimed to quantify the effect of telemedicine on key outcomes in pediatric emergency and post-emergency care. We searched PubMed, Scopus, the Cochrane Library, and Web of Science to identify studies focusing on the impact of telemedicine in pediatric emergency settings. Both single- and double-arm studies were included. Statistical analysis was performed using RevMan and CMA software, with a random-effects model applied to all analyses. We assessed differences in admissions, hospital length of stay (LOS), and mortality. Event rates were calculated for single-arm analyses, and risk ratios and mean differences were used for dichotomous and continuous outcomes in double-arm analyses. A total of 23 studies were included. Telemedicine significantly reduced hospital LOS (MD = -1.01, 95% CI: -1.3 to -0.71) and overall mortality (RR = 0.17, 95% CI: 0.13 to 0.24). The admission rates to the emergency department, hospital ward, and pediatric intensive care unit (PICU) were comparable between both groups. Single-arm analysis revealed that telemedicine was associated with an ED admission rate of 18% (95% CI: 5.2–47%), a hospital ward admission rate of 16.7% (95% CI: 4.6–45.7%), and a pooled mortality rate of 1.8% (95% CI: 1–3.3%). Telemedicine appears to be an effective tool in pediatric emergency care. While our analysis suggests reductions in hospital length of stay and mortality, these findings should be interpreted with caution due to variability and potential confounding across studies. The impact on admission rates remains inconclusive. Nonetheless, telemedicine offers a promising approach to enhancing healthcare delivery and optimizing resource use in pediatric emergency and early post-emergency settings.

Hydatid disease (echinococcosis) is a zoonotic infection caused by Echinococcus species, characterized by cyst formation in various organs, most commonly the liver and lungs. While often asymptomatic in the early stages, progressive cyst growth can lead to severe complications, including organ dysfunction, secondary infections, or rupture. In this review, we aimed to assess the incidence of hydatid disease among pediatric populations across different regions. We searched PubMed, Scopus, Cochrane, and Web of Science for studies reporting the incidence of hydatid disease in children up to February 20, 2025. A random-effects meta-analysis was performed using STATA version 28. Subgroup analyses were conducted based on country, geographic region, and cyst location. Study quality was assessed using the Newcastle–Ottawa Scale. We pooled data from nine studies, yielding an overall incidence of 3.37 per 1,000 children (95% confidence interval [CI]: 0.52–8.48), with substantial heterogeneity ( I ² = 99.97%). The highest incidence was reported in China (17.86 per 1,000), followed by Turkey (1.48 per 1,000) and Bulgaria (1.47 per 1,000). Lower incidence rates were reported in Iran (0.62 per 1,000) and Romania (0.12 per 1,000). Studies conducted in rural areas showed a higher incidence (14.84 per 1,000) compared to those including patients from diverse geographic regions (1.91 per 1,000). Based on the available evidence, we conclude that the incidence of hydatid cysts in children varies across countries, with the highest rates observed in China and in rural areas. Echinococcosis poses a significant threat to both public health and livestock; therefore, effective monitoring and control strategies are crucial to reduce its impact.