Background: The severity of liver fibrosis and optimal surgical timing in infants with prenatally diagnosed choledochal cysts (CDCs) remain contentious. This study aims to identify risk factors for significant liver fibrosis in prenatally diagnosed CDCs and guide optimal surgical timing.Methods: This retrospective case-control study reviewed infants with prenatally diagnosed CDCs between January 2016 and January 2024. Liver fibrosis was staged (S0–S4) using the Batts-Ludwig system. Infants were categorized into mild/no fibrosis (<S2) and significant fibrosis (≥S2) groups based on histopathology. The aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) were validated, and multivariate logistic regression analyses were performed to identify independent risk factors. The receiver operating characteristic (ROC) curve was used to assess diagnostic performance.Results: A total of 50 infants (20 male, 30 female) were enrolled, with a median gestational age at diagnosis of 28 weeks (range: 19–39 weeks) and a median surgical age of 54 days (range: 7–360 days). Liver fibrosis was present in 40 cases (80%), with 34 cases (68%) classified as <S2 and 16 cases (32%) as ≥S2. Univariate analysis showed that infants with significant liver fibrosis had a higher proportion of clinical symptoms and Type IV CDCs, as well as elevated AST, TBil, DBil, GGT, WBC, and cysts width before surgery (p < 0.05). Multivariate logistic regression analysis identified Type IV CDCs (OR = 11.39, 95% CI: 1.04–124.65) and GGT (OR = 1.003, 95% CI 1.00–1.01) as independent influencing factors (p < 0.05). For diagnosing significant fibrosis (≥S2), GGT demonstrated an area under the ROC curve (AUROC) of 0.86, with an optimal cutoff of 327 U/L (sensitivity: 75%, specificity: 88%). APRI showed an AUROC of 0.76 (95% CI 0.61–0.92, p < 0.01) with an optimal cutoff of 0.23 (sensitivity: 75%, specificity: 80%).Conclusion: Liver fibrosis is common in infants with prenatally diagnosed CDCs, primarily presenting as mild. Type IV CDCs and GGT > 327 U/L are significant risk factors, highlighting the need for close monitoring and timely surgical intervention.

Background: Anorectal malformations (ARMs) are often associated with tethered cord syndrome (TCS). This study focused on children with ARM to explore the risk factors for the co-occurrence of TCS and to investigate the impact of untethering surgery on anorectal function among these children. Methods: A retrospective analysis was conducted on 130 children with ARM treated at Fujian Provincial Children's Hospital (Fujian Hospital of Shanghai Children's Medical Center) from May 2021 to January 2024. A total of 114 children were included in the study on the basis of the inclusion and exclusion criteria. The patients were divided into two groups according to the presence of TCS: the ARM group (n=83) and the ARM+TCS group (n=31). to explore the risk factors for the co-occurrence of ARM and TCS. All children diagnosed with TCS underwent untethering surgery regardless of symptoms. Anorectal function was compared between the ARM and ARM+TCS groups. Results: In the multivariate analysis, intermediate or high-type ARM increased the risk of children with ARM having TCS, with an OR of 3.571, 95% CI from 0.106 to 0.738, and p= 0.010. Additionally, the presence of other malformations also increased the risk of children with ARM having TCS (p=0.026). When the ARM+TCS group was compared with the ARM group, children with low-type ARM in the ARM+TCS group exhibited a significant improvement in constipation following untethering surgery (p=0.043). However, when children with intermediate or high-type ARM were compared, the anorectal function of the children in both groups was comparable. Conclusions: Intermediate or high-type ARM and the presence of other malformations are risk factors for the co-occurrence of TCS in children with ARM. In children with low-type ARM, those with TCS and ARM showed significant improvement in constipation after untethering surgery compared with those with ARM without TCS. We recommend that children with relevant conditions actively undergo untethering surgery.