Abstract: Dysphagia in children poses a significant health concern. Difficulties in swallowing can lead to an impairment in food intake and malnutrition, as well as a risk of aspiration and pneumonia. It is a life-threatening condition, especially for newborns and infants. Children with dysphagia and their parents are experiencing increased anxiety and stress. Traditional methods of dysphagia therapy involve manual exercises of the orofacial muscles and modifications of the diet to fit the child's abilities. These methods often do not achieve the desired results, which prompts researchers to look for new solutions to increase the effectiveness of standard therapy. One promising approach is neuromuscular electrical stimulation (NMES) applied to muscles involved in the process of swallowing. The purpose of this paper is to highlight and discuss the feeding difficulties associated with pediatric dysphagia, as well as the possibility of NMES application in its treatment. It is anticipated that NMES, by enhancing muscles that regulate swallowing, may improve the nutritional status of children with dysphagia. More research is needed to show that NMES is effective in improving the feeding and nutritional status of children with dysphagia.

Abstract: Introduction: Hyperbilirubinemia in newborns can lead to kernicterus, a severe form of neonatal encephalopathy caused by bilirubin toxicity. Despite timely interventions such as exchange transfusion, kernicterus can still develop, especially in high-risk infants. MRI is crucial for detecting early and evolving signs of bilirubin-induced brain damage. Case Report: We report a term newborn who developed severe hyperbilirubinemia and kernicterus despite receiving exchange transfusion. The infant presented on day 3 of life with jaundice, hypotonia, and feeding difficulties, and had a bilirubin level of 51 mg/dL. After exchange transfusion, bilirubin levels normalized, but neurotoxicity persisted. Initial MRI at one month showed mild T1 hyperintensity in the hippocampi with no changes in the basal ganglia. At two months, T1 hyperintensities in the hippocampi partially resolved. By six months, MRI revealed T2 hyperintensities in the globus pallidus and hippocampal atrophy, consistent with kernicterus. Magnetic Resonance Spectroscopy (MRS) showed reduced N-acetylaspartate (NAA) levels, indicating neuronal loss. Discussion: MRI is essential in monitoring bilirubin-induced brain injury. In this case, early MRI findings showed mild hippocampal T1 hyperintensity, which resolved partially. At six months, T2 hyperintensities in the globus pallidus confirmed chronic bilirubin encephalopathy. MRS demonstrated a reduction in N-acetylaspartate, indicative of neuronal loss. Susceptibility Weighted Imaging (SWI) showed no abnormalities, likely due to the myelination process in neonates. Conclusion: This case highlights the importance of repeated MRI in detecting bilirubin-induced brain damage. Early neuroimaging enables timely interventions and improves long-term neurodevelopmental outcomes in infants with severe hyperbilirubinemia.

Abstract: Background/Objectives In children and infants, thoracic empyema commonly arises as a complication of parapneumonic effusions evolving into purulent collections. With an incidence of 0.6% among pneumonia cases, our study aimed to systematically characterize pediatric empyema by exploring the interplay between clinical, biochemical, and radiological parameters and their influence on patient outcomes. Materials and Methods: This is a retrospective single center study comprising patients diagnosed with parapneumonic pleural empyema, treated in the Pulmonology Department of “Grigore Alexandrescu” Emergency Hospital for Children, between January 2021-December 2024. We selected patients who were treated surgically, either with a simple pleural drain or Video-Assisted Thoracic Surgery (VATS). None of the patients received fibrinolytics, due to a lack of experience with their use in our department. Patients were stratified by initial treatment into chest-tube drainage-group or VATS-group. Clinical, laboratory, and radiographic data were extracted from hospital records. Results: This study included a final cohort of 33 patients. Median [IQR] age at inclusion was 4 years [3-8]. Median time until initial intervention for the entire cohort was 2 [1-5] days. Fourteen (42.4%) of children undergo VATS as initial intervention, p=0.384, after a median time of 4.5 [2-6.3] days. In 19 children, chest-tube drainage was implemented initially, after a median time of 1[0-3] days with a mean duration of 21.2 11.5 days. Median hospitalization length was 27 [21-38.5] days for the overall cohort. A linear regression model identified loculations and septations as significant predictors of hospitalization length. Drainage duration was significantly shorter in the initial VATS group (n=14, median 9.5 days [IQR 7.8–12.5]) compared to the chest tube group (n=19, 19 days [IQR 11–30]; p=0.011). Pleural fluid thickness, septations, and loculations on thoracic ultrasound were not significantly associated with the choice of primary intervention (VATS vs. chest tube drainage). Dyspnea was a strong predictor of intervention type, significantly increasing the likelihood of VATS over chest tube drainage (OR 18.00, 95% CI 1.86–174.21; p= 0.013). Patients were equally divided between early and late VATS intervention groups, each included 11 patients. Early VATS did not significantly reduce hospital stay (29 vs. 31 days; p=0.151), and VATS timing had minimal impact (R²=0.042; p=0.358). VATS overall did not reduce hospitalization length compared to chest tube drainage alone (24 vs. 28 days; p=0.665). CT was performed in 15 children (45.5%) and revealed complications including bronchopleural fistula (21.2%), empyema necessitans (12.1%), and pyopneumothorax (21.2%), with 15.2% presenting multiple complications. CT imaging was associated with longer hospitalization. Conclusions In this cohort, chest-tube drainage represented the primary treatment, with decision-making guided by a combination of clinical features, paraclinical data, and institutional protocols, rather than imaging findings alone. Thoracic ultrasound (TUS) played a key role in assessing effusion complexity and guiding management, yet demonstrated limited prognostic value, similar to biochemical markers. The absence of fibrinolytic use—due to limited institutional experience—resulted in nearly half of the patients requiring escalation to VATS, underscoring the need for standardized symptom-driven algorithms combined with biomarkers and imagistic findings to guide escalation of care

Abstract: This article examines the complex relationship between seizures, epilepsy, and multiple sclerosis (MS) in pediatric patients, based on detailed findings from a single-center study. Background : Although multiple sclerosis is primarily recognized as an adult-onset disease, its occurrence in children presents distinctive challenges, especially related to seizure disorders. Methods : We reviewed 120 pediatric MS patients evaluated over 7 years; 6 of these (5%) experienced seizures (including one case of acute status epilepticus), and 5 were diagnosed with epilepsy according to the latest ILAE classification. This study aims to evaluate the occurrence rates and types of seizures while investigating their management strategies in this specific group. Results: Through detailed case analysis and patient follow-up, we identified key factors contributing to seizure onset and explored implications for treatment and care. In our cohort, children with MS and seizures showed a higher risk for disease progression and greater cumulative disability, evidenced by a significantly higher last Expanded Disability Status Scale (EDSS) score (after a minimum 2-year follow-up) in the seizure group (p < 0.006). The analysis recognized early MS onset and highly active disease types as further risk factors that led to worse health outcomes. Conclusions: Genetic causes of epilepsy in children are common and may interplay with MS-related inflammation in the same patient; our observations underscore the need to investigate how these two conditions interact. This work contributes to the broader understanding of epilepsy comorbidity with MS among pediatric patients, to facilitate the creation of improved interdisciplinary clinical practices in pediatric neurology.

Abstract: Streptococcus pneumoniae remains a leading cause of bacterial pneumonia and meningitis in children globally, despite pneumococcal conjugate vaccine (PCV) implementation. We report a case of fatal pneumococcal meningitis in a fully vaccinated 2-year-old male. Despite prior PCV13 vaccination, the patient developed meningitis caused by S. pneumoniae serotype 15B in the cerebrospinal fluid and 15C in the blood. Genomic sequencing revealed nearly identical isolates differing by a capsular switch mutation. This case highlights the limitations of PCV13 against emerging serotypes like 15B and 15C. The recent approval of PCV20, which includes serotype 15B, represents a significant advancement. We propose a PCV20 booster dose for children under five previously vaccinated with PCV13 to enhance protection against the evolving landscape of pneumococcal serotypes and reduce invasive disease. Continued surveillance and adaptive vaccination strategies are crucial, as S. pneumoniae continues to pose a significant threat to young children worldwide.

Abstract: Lower respiratory tract infections caused by viruses are a leading cause of death in children under one year old. This communication describes, for the first time globally, a real-life practice of how nitazoxanide and Kelleni’s protocol can safely manage infants over six months old with viral lower respiratory tract infections.

Abstract: Vitamin B12 deficiency during infancy is not unusual in newly industrialized and developing countries however reports of vitamin B12 deficiency during infancy are uncommon in the industrialized areas of Western and Northern Europe, North America, Australia and New Zealand, and the majority of reported cases are in exclusively breastfed infants of mothers consuming vegetarian or vegan diets. Neonatal vitamin B12 status at birth is determined by mother’s vitamin B12 status during pregnancy and vitamin B12 concentrations in breast milk are highly correlated with maternal vitamin B12 levels. Due to rapid brain and somatic growth, infant vitamin B12 stores can be quickly depleted if there is insufficient vitamin B12 in the breast milk. The most commonly described symptoms of deficiency during infancy are irritability, apathy, hypotonia, growth failure, refusal to wean from the breast or to eat complementary foods and developmental regression. Recent literature suggests vitamin B12 deficiency in breast-fed infants is much more common than previously recognized and given vitamin B12 plays an important role in the synthesis and methylation of DNA, the methylation of histones and other regulators of gene expression, and mitochondrial metabolism, even modest deficiency may be associated with subtle neurologic abnormalities and developmental delays.

Abstract: Introduction. Paediatric intensive care units (PICUs) provide special and comprehensive care and treatment to critically ill children. These factors lead to the exposure of the personnel to stress and the risk of developing burnout syndrome. Methods and participants. In order to evaluate burnout syndrome among physicians employed at PICUs, we carried out our study between September and December of 2023. With the authors' consent, we used a survey that was published in June 2023 in Acta Paediatrica (https://onlinelibrary.wiley.com). The survey was distributed to the physicians working in the existing PICUs in Bulgaria after being translated and reviewed. Results. A total of 37/43 (83.7%) doctors and two clinical psychologists completed the survey. More women than men took part in the study. Of the respondents, 36% were paediatricians, and 30% were specialists in Anesthesiology and Intensive care. In total, 70.3% of the staff reported working between 40-50 hours/week, and 24.3% working more than 50 hours/week; 73% of the employees experienced an episode of overheating, depression, and anxiety. Of all, 75.6% felt exhausted from work, and 43.2% defined themselves as "crushed”. Despite the difficulties that the staff faced, the majority of the doctors express satisfaction with their work and would choose the same specialty again. Conclusion. This study presents for the first time quantitative data on Bulgarian physicians' burnout in PICUs. Burnout among healthcare professionals is a worldwide issue that has a detrimental effect on staff productivity, patient care quality, and hiring medical personnel. Specific solutions are required, such as the establishment of paediatric intensive care as a distinct specialty.

Abstract: Background: Disorders of Gut-Brain-Interaction (DGBIs) are present in 22%-23% according to Rome IV. Latin American (LA) prevalence of DGBIs in children with Autism Spectrum Disorder (ASD) is unknown. The aim was to determine the prevalence of DGBIs and possible associations in schoolchildren and adolescents with ASD, from LA. Methods: observational analytical study conducted in six LA cities. Caregivers of children with ASD completed Rome IV Questionnaire for Pediatric Gastrointestinal Symptom to identify DGBIs. Sociodemographic, clinical, and family variables were included. Statistical analysis involved central tendency measures, univariate and bivariate analysis, calculation odds ratios (OR), 95% confidence intervals (95%CI), with p<0.05 significant. Results: The study included 353 children with ASD. Predominantly male (78.8%), white (56.1%), attending private schools (85.4%), normal nutritional status according BMI (58.8%) and height-for-age (85.6%), born by c-section (57.5%), firstborn (54.7%), and level 1 autism (45.0%). A total of 58.9% presented some DGBI. Functional constipation (FC) was the most frequent (27.2%). Those from Central America (CA) had higher likelihood of presenting a DGBI (OR=1.98, 95% CI=1.25–3.12, p=0.0018). Conclusions: Over a half of LA schoolchildren and adolescents with ASD presented some DGBI, with FC being the most common, and higher likelihood of DGBI for those from CA.

Abstract: Background/Objectives: Preterm infants are at high risk for extrauterine growth restriction and suboptimal neurological development due to cumulative nutrient deficits. Standard fortification (SF) of human milk does not account for individual macronutrient variability, potentially leading to inadequate intake. Target fortification (TFO) adjusts supplementation based on measured macronutrient content, aiming to optimize growth and development. This study compares TFO and SF regarding growth, body composition, and neurological outcomes at 18 months corrected age. Methods: In this double-blind, randomized controlled trial, preterm infants (< 32 weeks gestation) received either SF or TFO for at least three weeks. Macronutrient levels in breast milk were analyzed three times per week, with modular adjustments in the TFO group. Growth parameters, body composition at 36 weeks postmenstrual age, and Bayley Scales of Infant and Toddler Development III (BSID-III) scores at 18 months corrected age were assessed (n=69). Results: TFO significantly increased protein, fat, and carbohydrate intake compared to SF, leading to higher weight gain (2,514 ± 289 g vs. 2,283 ± 332 g, p < 0.01) and growth velocity (21.7 ± 2.3 g/kg/d vs. 19.2 ± 2.2 g/kg/d, p < 0.001). In infants whose mother’s milk had low protein levels, fat-free mass was significantly higher with TFO compared to SF. BSID-III scores were higher in the TFO group across cognitive, language, and motor domains, with significant improvements in expressive language scores in infants whose mother’s milk had high protein levels (p < 0.05). The number of preterm infants with a motor BSID-III score of ≤ 70 was significantly lower in the TFO group compared to the SF group. Conclusions: TFO enhanced growth and body composition and may support better neurological outcomes in preterm infants. While most BSID-III differences were not statistically significant, the data suggest that TFO may reduce the risk of developmental delays. Larger, multicenter trials are needed to confirm these findings.

Abstract: The aim of the review is to explore possible connections that might lead to both obesity and asthma; it will explain particularly factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, lung functions, the genetics/genomics of obese asthma, risk of exacerbation, atopy, and response to treatment. It highlights the role that obesity plays as a risk factor for and disease modifier of asthma, understanding the evidence supporting lifestyle changes in influencing disease progression. Pathophysiological mechanisms in obesity-related asthma have influence on the course of the pathology. Due to these factors, the child with obese asthma needs specific therapeutic approach taking into account the common unresponsiveness to bronchodilator, increased requirement for controller medications, poorer steroid effectiveness and better response to leukotriene receptor (LTR) inhibitors. Therapeutic strategies centred on prevention are suggested and the development of resources to assist families with weight loss strategies and lifestyle changes seems useful for effective weight control and optimal asthma management. Obese children with asthma generally should receive interventions that encourage daily physical activity, weight loss, normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult-to-control asthma. Recognizing and identifying an asthmatic patient is not always easy and a detailed medical history of the patient, a particular attention to his presenting and past symptoms, complete physical examination play a pivotal and fundamental role in determining the final diagnosis.

Abstract: Autistic spectrum disorders (ASD) are the most common neurodevelopmental pathology, with a global trend of increasing prevalence. The biomarker-based diagnosis and signaling pathways based modulation could improve both clinical symptoms and long-term outcomes. In the review, the role of viruses in causing prenatal CNS damage and the development of autism is discussed. The distinct CNS involvement of the most common pathogens such as Rubella, CMV, HSV, Influenza and Covid-19 virus elucidated. The specific importance of a retinoid metabolism disorder in the brain in prenatal rubella virus infection and of low levels of IgF-1 as a neurotrophic factor in Covid-19 infection has been demonstrated. The role of ferroptosis and changes in ferritin and transferrin levels in the development of ASD-like symptoms have been shown. Altered serotonin signaling could related to early prenatal factors and result in negative ASD symptoms. Hypermethylation of the oxytocin receptor gene in ASD patients results in impaired oxytocin metabolism, discoordination between nucleus basalis and ventral pallidum, and impaired visual attention and motivated behavior. The role of NMDA receptors and SHANK scaffolding proteins in ASD cognitive signs demonstrated. Clinically relevant biomarkers and a combined modulation approach were proposed based on the analysed information.

Abstract: Background: The intrauterine and early extrauterine development represents a “window of opportunity” in the immunological development. The underlying mechanisms are still poorly understood. The aim of this study was to provide reference values on B cell subpopulations in cord blood of term newborns, and peripheral venous blood of juveniles and adults to analyze the potential spectrum of their physiological age-related variation. Methods: Flow cytometry was used to evaluate human B lymphocytes and subpopulations in cord blood (n = 10), and peripheral blood from healthy children and adolescence, further called juveniles, aged 1 to 17 years (n=20) and adults aged 24 to 62 years (n = 10). Results: Our findings showed increasing frequencies of IgM memory B cells, class-switched memory B cells, marginal zone B cells and plasmablasts, from cord blood to peripheral blood of juveniles and adults. In contrast, the percentage of naïve B cells was higher in newborns than in juveniles and adults. The frequencies of immature B cells were similar in all three groups and B1 cell were similar in cord blood and peripheral blood of adults. Interestingly, transitional B cells frequencies were similar in cord blood and adults but significantly lower in juveniles. Conclusions: The frequencies of circulating B cell subpopulation are subject to considerable changes during ontogeny, reflecting overlying effects of maturation and of the acquisition of an adaptive immune memory.

Abstract: Background/Objectives: Hyoscine butylbromide (HBB) is a spasmolytic drug classified as indispensable by the World Health Organization. While mostly used in adults, it is also approved for use in adolescents and children aged 6 years and older. We have comprehensively reviewed the efficacy and safety of HBB in approved and off-label childhood indications. Results: Childhood studies covered an age range starting as early as 2 days. A randomized controlled trial (RCT) found a similar efficacy as compared to paracetamol in the approved indication of abdominal cramps and pain. Among off-label uses, several studies demonstrate efficacy in general anesthesia and various diagnostic procedures, but the largest body of evidence relates to a used in childbirth/labor including 17 RCTs. While these largely focused on efficacy outcomes on the mother, fetal safety outcomes were reported in 12 of these studies, mostly as effects on the APGAR score and/or heart rate. The overall evidence supports safety in infants and children including those younger than the approved use of 6 years and older. Conclusions: While only limited pediatric efficacy data from RCTs are available in the approved indications, data from thousands of patients in RCTs, case series and non-randomized trials do not raise concerns on the safety and tolerability of HBB in childhood. Additional dedicated childhood studies, particularly RCTs, on efficacy are recommended.

Abstract: Background: Adequate nutrition in early childhood is crucial for growth and development. Picky eating behaviors are common and contribute to undernutrition. Growth milk, a fortified milk product, has been suggested to address nutritional gaps, but its effectiveness remains uncertain. Methods: This clustered randomized controlled trial aimed to assess the effects of growth milk on nutritional status, immune resilience, appetite, and cognitive function of children aged 2-5 years in Kampung Melayu, East Jakarta. The intervention lasted three months, with 49 participants from two clusters randomly assigned to either the growth milk group or the control group, which received only nutritional education. Nutritional status was assessed monthly. Illness incidence, visual analog scale (VAS) for appetite, Child Eating Behavior Questionnaire (CEBQ) for food fussiness, and Brigance for cognitive function were assessed at baseline and endline. Results: Children in the intervention group showed significant improvements in weight (0.41 kg), height (1.93 cm), and head circumference (0.81 cm) (p &lt; 0.001). Z-scores for height-for-age from -1.65 to -1.58 and BMI also increased, suggesting positive effects on growth. The intervention group showed notable physical growth, but no significant differences were observed between groups in illness incidence, appetite, food fussiness, or cognitive function. Both groups had similar levels of appetite and reported similar cognitive development outcomes, with language scores slightly declining for both groups. Conclusions: Growth milk supplementation resulted in improved growth parameters, but its impact on overall health and cognitive development was minimal. Longer studies and the inclusion of younger children may provide a better understanding of its broader benefits.

Abstract: Introduction: Inlet Patch (IP) is a congenital anomaly characterized by gastric heterotopia in the cervical esophagus. While extensively described in adults, it remains poorly characterized in pediatric populations.Material and Methods: This retrospective, single-center study included all pediatric patients (0–14 years) diagnosed with IP between 2018 and 2025. Sociodemographic and clinical data were collected. A blinded pathologist assessed the presence and severity of gastritis within the IP.Results: Nine patients (median age: 12 years) were included, 78% male. Cervical esophageal symptoms were identified in 67%, primarily dysphagia and gastroesophageal reflux disease-related complaints, although concomitant conditions such as eosinophilic esophagitis were frequently present. Endoscopic examination revealed characteristic well-demarcated salmon-red plaques in all patients, with multiple lesions observed in three cases. Histology confirmed gastric heterotopia with varying degrees of chronic inflammation in all cases. A strong correlation was observed between the severity of gastritis in the stomach, the severity of inflammation in the IP, and the presence of H. pylori, with 75% of patients with moderate-to-severe IP inflammation also exhibiting gastric H. pylori-associated gastritis. All patients except one received proton pump inhibitors, and symptoms improved in all cases.Conclusions: A thorough and targeted examination of the cervical esophagus significantly increased IP detection at our center, with most cases (88%) being diagnosed in the last 12 months. While mostly asymptomatic and incidental, IP can be symptomatic. In this case series, we found a correlation between the severity of inflammation in the IP, the severity of gastritis and the presence of H. pylori. Further studies are needed to define pediatric IP clinical significance and optimal management.

Abstract: Introduction: Lipomas are among the most encountered neoplasms in clinical practice, occurring mainly in adults between the fourth and sixth decades of life. Deep-seated lipomas in children are found in the thorax, chest wall, mediastinum, pleura, pelvis, retroperitoneum, and paratesticular area. Herein, we present a case of a three-year-old child with a giant mesenteric lipoma, along with a review of the literature on mesenteric lipomas in childhood. Case presentation: A three-year-old male toddler was referred to our hospital for severe, intermittent abdominal pain. Imaging studies at admission revealed a fat lesion occupying most of the peritoneal cavity and dislocating adjacent structures. An urgent laparotomy was performed. A giant lipoma arising from the mesentery and leading to the torsion of the mesenteric radix was confirmed and completely excised alongside an adherent small tract of jejunum. The child recovered uneventfully and is still being followed-up with no signs of recurrence. Discussion: Lipomas of the mesentery in children are very rare, and they are reported to be more common among children younger than three years of age. Mesenteric lipomas appeared to be more frequent in males than females. Even though they might be asymptomatic, voluminous lipomas can also create a lead point for intermittent torsion of the mass causing ischemia and infarction. Abdominal pain was the most frequent symptom, and the ileum was the tract of bowel more frequently involved by the tumor. Laparotomy was reported to be the preferable approach to safely remove this abdominal mass, especially in case of huge dimensions.

Abstract: Benign Paroxysmal Torticollis (BPT) describes torticollis with episodes of head tilt that alter sides. It is probably an underestimated diagnosis and milder cases may be mistaken for Congenital Muscular Torticollis (CMT). Physical Therapists (PT) should be aware of BPT as infants with BPT recover spontaneously and should not be treated for CMT. It is important to follow these infants to exclude other reasons for torticollis. A case description of an infant with suspected BPT is described.

Abstract: Background: Nepal’s diverse geography creates significant challenges for healthcare accessibility, particularly for neonatal care. Rural areas, especially in the mountainous regions, face severe healthcare gaps due to isolation, inadequate infrastructure, and a shortage of skilled staff. Strengthening healthcare in these underserved regions is essential to reducing neonatal mortality. Methods: A comprehensive literature search identified studies on neonatal mortality and interventions, particularly Helping Babies Breathe (HBB), analyzed using a narrative synthesis approach. The review examined disparities in neonatal health outcomes, regional differences, and barriers to healthcare access. Findings: The review identified key themes related to healthcare disparities, neonatal mortality, and birth outcomes in Nepal's remote regions. Geographical isolation, inadequate healthcare infrastructure, and cultural barriers contribute to persistently high neonatal mortality, particularly in mountainous areas such as Jumla and Dolpa, where rates exceed 60 per 1,000 live births. HBB has shown a significant impact, reducing neonatal mortality by up to 60% when effectively implemented. However, infrastructural gaps, lack of emergency transport, and the uneven distribution of skilled birth attendants (SBAs) remain critical challenges. Addressing these disparities requires expanded training, increased availability of neonatal resuscitation equipment, and culturally sensitive healthcare strategies. Recommendations: Future research should explore sustainable neonatal resuscitation training, telemedicine support, and emergency referral systems to improve neonatal survival in remote Nepal. Further studies on healthcare infrastructure gaps and policy-driven interventions are needed to enhance maternal and newborn care. Conclusions: While HBB and other neonatal interventions have demonstrated success in reducing neonatal mortality, their impact is limited by persistent disparities in healthcare infrastructure, workforce availability, and geographic inaccessibility. To achieve sustainable reductions in neonatal mortality, a multi-faceted approach combining expanded SBA training, improved emergency healthcare infrastructure, and community-based interventions is essential.

Abstract:

Introduction:The pre-operative planning for complex renal masses in children can be challenging, especially when nephron-sparing surgery (NSS) is recommended. We re-port our experience with the use of 3D-virtual reconstruction (3DVR) and its impact on surgical decision making. Materials and methods: Patients with complex renal masses underwent preoperative 3DVR. DICOM data were obtained from abdominal MRI and/or CT scans. 2D images segmentation was then performed. Three oncology surgeons were asked to individually evaluate each patient's preoperative MRI, CT and 3DVR. A questionnaire regarding the quality of conventional imaging compared to 3DVR was completed following surgery. Results: 8 patients (4♂,4♀) were included: Cases 1,2 and 4 were circumscribed tumours in the right upper pole, left lower pole (Bosniak cyst IV) and right mid-upper pole (Bosniak cyst IIF) respectively; Case 3 was a large hilar mass involving the whole kidney, unresponsive to chemotherapy; Case 5 and 7 were stage IV Wilms' tumour with venous thrombosis; case 6 was a left mid lower renal mass in a patient with WAGR syndrome and acute lymphoblastic leukae-mia (ALL) and case 8 was a recurrent central right WT after previous NSS in a child with Beckwith-Wiedemann syndrome(BWS). Four radical nephrectomies and three NSS were performed. In comparison to conventional imaging, the 3DVR models were judged to be superior by the expert reviewers for all anatomical structures except the urinary tract(p< 0.05). Conclusions: Our study suggests that 3DVR can be considered a useful tool in the pre-operative evaluation of children with complex renal masses and can facilitate NSS in selected patients.