Vol 26, No 2 (2026)

BACKGROUND: Esophageal atresia (EA) is a congenital malformation often associated with defects of other organs. Advances in neonatal resuscitation have improved survival rates in children with severe comorbidities. However, questions regarding surgical access selection, prevention, and treatment of early and late complications remain unresolved.

AIM: To analyze the treatment outcomes of children with EA and isolated tracheoesophageal fistula.

METHODS: This retrospective study included 63 children (25 girls, 38 boys) treated in the pediatric surgery department of the Novosibirsk Regional Hospital from March 2020 to December 2025. Anthropometric data, gestational age, Gross classification type, and the presence of associated congenital anomalies were analyzed. Surgical access, intraoperative parameters, and the early postoperative course were examined. Intraoperative and postoperative complications were recorded. Predictors of major surgical complications were identified.

RESULTS: Associated congenital anomalies were present in 31 (49.2%) children, with heart defects being the most common (19.1%). The majority of EA cases were Gross type C, 55 patients (87.3%). Surgery was performed in 62 (98.4%) children (median age 2 days). Definitive repair was performed in 58 (93.5%) patients: 32 (55.2%) by open surgery, and 26 (44.8%) by thoracoscopy. Staged surgery was performed in 4 (6.5%) children. The only intraoperative complication was tracheal perforation (1.6%). Complications occurred in 48 (77.4%) patients, the most significant being anastomotic leakage in 10 (16.1%) at 4.1 ± 1.52 days; and anastomotic stricture in 30 (48.4%) children. Tracheomalacia was a significant predictor of anastomotic stricture: its presence increased the risk of stricture 4.6-fold (95% CI 1.381–15.320; p = 0.013). Overall survival was 90.4% (6 deaths, all due to severe congenital anomalies, except for one unoperated child). The median follow-up was 25 months. Event-free survival was 31.7%, with a median time to event of 0.8 months.

CONCLUSION: The main cause of mortality in EA is associated with associated congenital anomalies. A differentiated approach to surgical access based on weight, gestational age, and comorbidities yields comparable treatment outcomes. The incidence of postoperative complications remains relatively high; in our study, we noted overdiagnosis of esophageal strictures at early stages. However, tracheomalacia was identified as a significant predictor of anastomotic stricture formation, whereas no significant predictors of anastomotic leakage were found.

BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is the leading adverse event after heart surgery with cardiopulmonary bypass. In most cases, AKI is transient and does not require aggressive treatment, including renal replacement therapy, and does not affect treatment outcomes. However, when it progresses to clinically significant manifestations, it leads to a complicated postoperative course and affects long-term outcomes. Current diagnostic criteria for CSA-AKI still fail to provide timely identification of children with early renal dysfunction. Therefore, the search for diagnostic and prognostic strategies for risk assessment and prevention of this complication is highly relevant.

AIM: To identify risk factors for AKI in children with septal heart defects after cardiac surgery with cardiopulmonary bypass and to evaluate their prognostic value.

METHODS: A single-center cohort study included 67 children aged 6 to 36 months who underwent elective repair of a septal heart defect. In the postoperative period, the AKI diagnostic algorithm was supplemented by measurement of kidney injury biomarker concentrations (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP), and interleukin-18 (IL-18)) in serum and urine at three time points: 10 minutes after urethral catheter placement, before skin closure, and 16 hours postoperatively.

RESULTS: Postoperative AKI (KDIGO criteria) developed in 20 children (29.85%). Preoperative risk factors were younger age, lower weight, smaller body surface area, anemia, and ventricular septal defect. The most important intraoperative risk factors included cardiopulmonary bypass time, aortic cross-clamp time, and weight-adjusted transfusion volume. A transfusion volume threshold of 13.763 ml/kg (AUC 0.719, 95% CI 0.560–0.877, Se 0.75, Sp 0.698, p = 0.006) was identified as a threshold for AKI risk with an optimal balance of safety and efficacy.

CONCLUSION: Risk factors for CSA-AKI in children with septal heart defects were identified. The major role of transfusion to CSA-AKI was determined, particularly as a modifiable factor and the efficacy and safety of a restrictive transfusion strategy were demonstrated. Threshold values for the most critical intraoperative risk factors were identified, allowing early risk stratification of children into AKI risk groups to guide intensive care strategy immediately after surgery. Given the small sample size and the absence of children with other types of congenital heart defects in this study, further multicenter research is required.

BACKGROUND: A current trend in Russian pediatrics is an increase in the number of inpatient palliative care units for children and, accordingly, the number of beds and patients in this population.

AIM: To identify the need for various types, forms, and techniques of surgical interventions depending on the pathology that indicates palliative care, clinical manifestations, risks of underlying disease complications, and planned procedures.

METHODS: This retrospective observational study included data from 240 children with palliative status who underwent 405 different procedures between 2021 and 2025 at the G.N. Speransky Children's City Clinical Hospital No. 9. Older patients predominated (30.8%); no gender differences were found. The main group consisted of patients with cerebral palsy (40.4%), chronic (recurrent) respiratory failure (22.5%), and brain lesions (21.3%) of various etiologies. The assessment protocol included clinical, imaging, endoscopic, and laboratory methods.

RESULTS: The most common procedures were gastrostomy (56.4%), tracheostomy (17.2%), thoracentesis with pleural drainage (10.3%), and fundoplication (9.1%). The number of procedures increased from 33 to 127 annually over the study period. We identified procedures aimed at improving quality of life and care conditions (75.8%), relieving (15.1%), and preventing (9.1%) complications. Elective surgery was performed in 66.9% of patients, while urgent and emergency procedures accounted for 17.5% and 15.6% of cases, respectively. Among early complications, wound suppuration predominated (1.7%); late complications included "bumper" syndrome and gastrostomy anchor failure in 3 (1.3%) patients. No procedure-related deaths occurred.

CONCLUSION: Comprehensive palliative care for children was successfully implemented in a multidisciplinary children's hospital, where the surgical component is focused on preventing or alleviating suffering, improving quality of life for the child, family comfort, and working conditions for medical staff. With interdisciplinary agreement among specialists and a constructive approach from the patient's family, surgical interventions effectively and safely improve the quality of life of terminally ill children, alleviate suffering, and improve working conditions for medical staff.

Improvements in intensive care for extremely preterm, extremely low birth weight (ELBW) infants have significantly improved their survival rates but have also increased the incidence of meconium-related intestinal obstruction. Despite the pathogenetic rationale for the use of water-soluble iodinated contrast agents (WSICA), optimal protocols for their use in ELBW infants remain controversial. This review aimed to summarize and critically evaluate the evidence on the use of WSICA for the diagnosis and treatment of this condition in ELBW neonates. We searched in PubMed, Scopus, Web of Science, the Cochrane Library, and eLibrary for the period January 2000 to December 2025. We included clinical trials of various designs, systematic reviews, and meta-analyses on very-low-birth-weight and extremely-low-birth-weight preterm neonates who received WSICA for meconium obstruction. The initial search identified 127 records; after abstract review and full-text screening, 40 were included in the final analysis. We analyzed the mechanisms of action of ionic (diatrizoate meglumine, sodium diatrizoate) and non-ionic (iopromide, iopamidol, iohexol) contrast agents, their administration protocols, efficacy, and tolerability. Conservative therapy with WSICA resolves obstruction in 48.6% to 100% of cases. This wide range reflects not method inconsistency but differences in selection criteria and cohort composition: the higher values were obtained with strict selection of patients with confirmed meconium-related obstruction, while the lower values came from cohorts that included exclusively ELBW infants with severe comorbidities. Factors consistently associated with conservative treatment failure include body weight < 700 g, onset after day 10 of life, and marked intestinal dilatation. Intestinal perforation occurs in 5%–9% of cases. Most such episodes are related not to the method itself but to protocol violations — administration of undiluted contrast, use of balloon catheters, and delayed treatment initiation. Direct comparison of Russian (48.6%–65%) and international (54.5%–100%) data is inappropriate due to differences in cohorts, protocols, and outcomes assessed. The use of WSICA is pathogenetically justified and can avoid surgery in a significant proportion of ELBW neonates. This review presents the mechanisms of action and comparative characteristics of WSICA, consistently reproducible factors for conservative treatment failure, and current approaches to minimizing complication risks. Priority areas for future research include prospective multicenter studies aimed at developing an international consensus, prognostic scales to stratify the risk of conservative treatment failure, and long-term neurodevelopmental follow-up.

Neonatal sepsis is a life-threatening condition with a high mortality rate, despite significant advances in perinatology and neonatology. The clinical signs of sepsis in newborns are nonspecific and can mimic a wide range of non-infectious pathologies, making early diagnosis challenging. The aim of this review was to analyze current data on laboratory markers of neonatal sepsis. A search was conducted in the PubMed database using the keywords neonatal sepsis, biomarker, prognosis. The search yielded 66 publications, an additional 9 publications were retrieved from the eLibrary database using the keywords биомаркеры (biomarkers), сепсис (sepsis), прогноз (prognosis). The search period was 5 years (2020–2025), in accordance with PRISMA 2020 guidelines. A review of the current literature confirms that no single laboratory marker, whether classical (C-reactive protein, procalcitonin, interleukin-6) or novel (presepsin, CD64, serum amyloid A, sTREM-1), is ideal due to limited specificity, the influence of non-infectious factors, and variability with gestational age. The most promising approach to diagnosing neonatal sepsis is a combined approach that includes simultaneous measurement of several biomarkers alongside clinical data. Artificial intelligence and machine learning technologies, which can analyze multidimensional data, predict sepsis at a preclinical stage, and create personalized diagnostic algorithms, show particular promise. Further research should therefore focus on developing integrated diagnostic systems to improve the accuracy, speed, and efficacy of sepsis detection in newborns.

Teratomas are neoplasms composed of cellular elements derived from the three germ layers: endoderm, mesoderm, and ectoderm. The most common sites of teratomas are the sacrococcygeal region and ovaries (51%–60%). However, other locations are also possible: testes, the retroperitoneal space, the stomach, the neck, and the floor of the oral cavity. Teratomas in two different body cavities are extremely rare. A 15-year-old girl presented with a mass in the chest that was an incidental finding on routine chest X-ray. Subsequent inpatient workup (multislice CT and aortoarteriography) showed that the lesion had a thoracoabdominal location with a large feeding artery arising from the upper abdominal aorta. Surgery involved a right posterolateral thoracotomy through the 7th intercostal space. During the procedure, dense adhesion of the cystic mass to the right lower lobe was found. After mobilization of the tumor from the lung and ligation of its vascular pedicle, it was found that the tumor extended into the abdominal cavity through the esophageal hiatus. The diaphragmatic crura were divided, and the cyst was completely mobilized bluntly from the esophagus and stomach. The tumor was removed from the pleural cavity, and damaged tissues were repaired. Operating time was 155 minutes. There were no intraoperative complications such as bleeding or esophageal or gastric perforation. The chest tube was removed on day 2, and ultrasound showed no hydrothorax. Histopathology revealed a mature cystic teratoma. Follow-up multislice CT of the chest and abdomen showed no residual tumor. The relevance of this report lies in the extreme rarity of thoracoabdominal mature teratomas in children and the lack of standardized surgical guidelines. This description of successful radical resection of a large tumor via a single thoracotomy approach broadens the clinical understanding of the topographic anatomy of such tumors and demonstrates the feasibility of minimizing surgical trauma when the tumor involves two body cavities.

Vadim G. Geldt, one of a vanishing generation of renowned Russian pediatric surgeons, has passed away. A graduate of the Leningrad surgical school, led by Corresponding Member of the USSR Academy of Medical Sciences G.A. Bairov, he retained, along with the knowledge he acquired, the school’s characteristic intellectual and communication style. He spent most of his professional life at the Department of Pediatric Surgery of the Central Institute for Advanced Medical Studies (now the Russian Medical Academy of Continuous Professional Education), headed by Academician of the USSR Academy of Medical Sciences S.Ya. Doletsky. Under Doletsky’s supervision, he defended his Candidate of Sciences dissertation on thoracoscopy, and then his Doctor of Sciences dissertation on neonatal and infant urology. Within the institute, he advanced through the ranks, from assistant professor to dean of the pediatric faculty, and then to department head. His main professional interests were neonatal surgery and urology. He was an excellent teacher, known to practically all pediatric surgeons in Russia. For the last 20 years, he worked at the Moscow Research Institute of Pediatrics and Pediatric Surgery (now the Veltishchev Institute), working on urological problems.