BACKGROUND AND OBJECTIVES: Congenital obstructive hydrocephalus (HCP) causes progressive, irreversible fetal brain damage through ventricular enlargement and increasing fetal cerebral tissue compression. Postnatal treatments of choice include ventriculoperitoneal shunting or endoscopic third ventriculostomy (ETV). Intrauterine treatments, such as ventriculoamniotic shunting, were attempted unsuccessfully 4 decades ago and failed to improve postnatal outcomes, likely due to inadequate fetal patient selection. The aim of this study was to evaluate the efficacy of prenatal ETV for early ventricular decompression and potential prevention of fetal brain damage in hydrocephalic fetal lambs. METHODS: HCP was induced in 24 fetal lambs by injecting BioGlue into the cisterna magna at E85. Three weeks later (E105-110), fetal ETV was successfully performed on 8 fetuses using a small rigid cystoscope. Fetal brain lateral ventricular diameters and cerebral mantle thicknesses were monitored by prenatal and postnatal ultrasounds and fetal MRI. RESULTS: According to the Cincinnati HCP Severity Scale, moderate and severe HCP subgroups responded positively to fetal ETV with reduced cerebral ventricular diameters. Ten days post-ETV, severe HCP fetal lambs improved to moderate levels, whereas those with moderate HCP normalized by birth. A similar improvement pattern was seen for the mechanical compression threshold (ventricular diameters/biparietal diameter). Biparietal diameter values did not significantly differ among nontreated, treated, and normal control groups during pregnancy. MRI revealed a significant increase in brain mantle thickness in the prenatally treated fetuses. CONCLUSION: Prenatal ETV is feasible in hydrocephalic fetal lambs and effectively reverses ventriculomegaly and brain compression in cases of severe or moderate fetal HCP in this ovine model.

Introduction: delayed abdominal closure following congenital diaphragmatic hernia (CDH) repair is required in patients with large defects in whom primary fascial closure would risk abdominal compartment syndrome. Several strategies have been described, but most require prolonged time to definitive closure. We present a novel technique based on a Gore-Tex^® abdominal patch with dynamic traction under intra-abdominal pressure monitoring. Methods: retrospective observational study of 41 neonates undergoing CDH repair at a tertiary referral center (2015–2023). Patients were divided into primary closure (n = 27) and delayed dynamic abdominal wall closure (DDAC) (n = 14) groups. Baseline characteristics, surgical outcomes, and mortality were compared between groups using Fisher’s exact test and the Wilcoxon rank-sum test. Results: patients requiring DDAC had more severe baseline disease, including lower O/E LHR (26.30 [21.40–31.00] vs. 42.00 [34.00–46.00], p < 0.001), higher rates of liver herniation (13/14 vs. 4/27, p < 0.001), more advanced defect type (p < 0.001) and greater need of ECMO (9/14 vs. 3/27, p < 0.001). Definitive fascial closure was achieved at a median of 6 days. In-hospital mortality after diaphragmatic repair was 19.5% (8/41), with 7 deaths occurring in the DDAC group. Mortality was strongly associated with the gradient of disease severity across prenatal and anatomical markers, although an independent contribution of the abdominal closure strategy cannot be excluded. Conclusions: DDAC achieves early definitive fascial closure and appears technically feasible in CDH patients unsuitable for primary closure. Higher mortality in this group was strongly associated with baseline disease severity, though its independent relationship with the closure technique remains to be established.

Background: Thoracoamniotic shunting (TAS) is a well-established fetal therapy for severe pleural effusions complicated by hydrops. Although survival in selected cases exceeds 60%, retained or migrated shunts can pose significant postnatal management challenges. Case presentation: We report a neonate with intrathoracic migration of a Somatex^® shunt placed at 26 weeks’ gestation for hydropic pleural effusion. Although initially asymptomatic, the infant developed recurrent pleural effusions requiring multiple readmissions. Thoracoscopic retrieval on day 76 of life allowed safe removal despite dense adhesions, leading to complete clinical resolution. Discussion: Retained thoracoamniotic shunts may remain asymptomatic or cause recurrent effusions, pneumothorax, or other complications. This case highlights the limitations of conservative management in the presence of clinical deterioration and supports timely surgical removal. Standardized criteria for intervention are lacking and urgently needed. Conclusions: In infants with retained TAS, recurrence of effusions or respiratory compromise should prompt active removal. Thoracoscopic retrieval is a safe and effective minimally invasive option.

Background: Same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis has been proposed as a strategy to reduce hospital costs without compromising safety, but evidence in pediatric patients remains limited. Methods: We conducted a retrospective study of pediatric patients undergoing laparoscopic appendectomy for uncomplicated appendicitis, comparing same-day and next-day discharge. Baseline differences were addressed using 1:2 propensity score matching. Costs were analyzed using linear regression with cluster-robust standard errors, and inverse probability of treatment weighting was used as a sensitivity analysis. Results: Among 102 patients (37 same-day discharge and 65 delayed discharge), 28 same-day discharge patients were matched to 36 delayed-discharge controls. Same-day discharge was associated with a mean reduction in total cost of €319.9 (95% CI: −€413.6 to −€226.2; p < 0.0001), mainly explained by lower admission-related costs, with no significant difference in outpatient consultation costs. Sensitivity analysis using inverse probability weighting in the full cohort showed a similar estimate (−€311.7; 95% CI: −€421.1 to −€202.3; p < 0.0001). Complications were rare and similar in both groups (1/28 vs. 1/36), which limited formal comparison of complication risk. Conclusions: Same-day discharge after laparoscopic appendectomy for uncomplicated appendicitis was associated with lower healthcare costs, largely due to reduced admission-related costs, with no apparent signal of increased complications.

Objective: To determine whether the observed-to-expected lung-to-head ratio (O/E LHR) independently predicts the need for delayed abdominal wall closure (DAC) in isolated left-sided congenital diaphragmatic hernia (CDH), and to establish an optimal cut-off value. Design: Retrospective, single-centre cohort study. Setting: Tertiary referral centre, Hospital Universitario La Paz, Madrid, Spain, January 2015 to May 2026. Patients: 45 neonates with isolated left-sided CDH; 28 underwent primary abdominal closure and 17 required DAC. Interventions: None (observational study). Main outcome measures: Need for DAC; discriminative capacity of O/E LHR for DAC and its optimal cut-off; O/E LHR–DAC association adjusted for liver herniation. Results: DAC was associated with lower gestational age at birth (37.00 [34.00–38.00] vs 39.00 [38.00–39.00] weeks), lower birth weight (2,690 [2,290–3,210] vs 3,120 [2,968– 3,285] g), higher rates of liver herniation (13/17 vs 1/28), greater ECMO requirement (9/17 [52.9%] vs 3/28 [10.7%]), and higher in-hospital mortality (35.3% vs 3.6%) than primary closure. O/E LHR showed excellent discriminative ability for DAC (AUC 0.939, 95% CI 0.877 to 1.000), with an optimal cut-off of 34.1% (sensitivity 82.4%, specificity 82.1%, positive predictive value 73.7%, negative predictive value 88.5%). O/E LHR remained independently associated with DAC after adjustment for liver herniation (adjusted OR 0.82 per one-point increase, 95% CI 0.67 to 0.94). Conclusions: O/E LHR was independently associated with the risk of DAC beyond the effect of liver herniation. These preliminary findings suggest a role for O/E LHR in prenatal risk stratification for DAC, pending external validation in larger, multicentre cohorts. What’s already known about this topic?: O/E LHR is an established prenatal predictor of survival and pulmonary morbidity in isolated CDH. Delayed abdominal closure has been linked to lower LHR, liver herniation, and higher ECMO use and mortality, but without adjusting for confounders or using O/E LHR. What does this study add?: O/E LHR independently predicts DAC risk beyond liver herniation, with excellent discriminative ability (AUC 0.939) and a proposed cut-off of 34.1%, extending its prognostic role to this surgical outcome. Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request. Note: This study is based on a cohort that partially overlaps with our previously published report on delayed dynamic abdominal wall closure using a Gore-Tex patch ¹ , which addressed surgical technique and outcomes. The present study addresses the distinct question of prenatal predictors of the need for delayed closure. This overlap is disclosed in accordance with ICMJE recommendations.