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%).

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.

Isolated primary diaphragmatic hydatid disease (HD) occurs in approximately 1% of adult cases. However, this unique presentation of a pediatric diaphragmatic cystic mass has not been previously described in the literature. This study reports a rare case of a 12-year-old girl who was diagnosed with a diaphragmatic hydatid cyst. Surgical exploration via subcostal incision revealed an isolated cyst, free from the thoracic and abdominal viscera. Cystotomy, removal of daughter cysts, and excision of the pericyst cavity were performed, followed by diaphragmatic repair. Histopathological examination confirmed the diagnosis. The postoperative course was uneventful, and the patient completed an 8-week mebendazole regimen with no recurrence at 3 months’ follow-up. This paper recommends including HD in the differential diagnosis for pediatric patients presenting with diaphragmatic lesions, particularly in regions endemic for echinococcosis.

Introduction: Retroperitoneal cystic immature teratoma (RCIT) is a rare disease. Its diagnosis and management are challenging. Although, the prognosis is relatively favorable, the post-operative morbidity is not rare. We hereby report a case of RCIT in an infant and describe the difficulties in diagnosis and pre-, per- and post-operative treatment. Case presentation: Our patient was a 50-day-old female born at 35 weeks of gestation without prenatal diagnosis. She was admitted for abdominal distension noticed a few days earlier. Physical examination revealed a large abdominal mass located between the right hypochondrium and the left flank. Computerized tomography showed a 10*12*11 cm heterogeneous retroperitoneal mass with fat components and calcification responsible for the compression of the right kidney. Due to the respiratory distress caused by the tumor, we decided to operate the patient urgently prior to the anatomopathological examination result. The surgical procedure consisted in a large resection of the tumor which necessitated the removal of the right kidney. Postoperatively, our patient developed chylous ascites which was managed with total parenteral nutrition and continuous intravenous infusion of Octreotide. The follow up was uneventful with no recurrence so far. Conclusion: RCIT is a clinically rare disease. The mainstay treatment remains the complete surgical resection of the tumor which could be a complicated procedure. Chylous ascites constitute a rare postoperative complication which can be managed safely by parenteral nutrition and continuous intravenous infusion of Octreotide.