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Esophageal atresia-tracheoesophageal fistula (EA-TEF) is one of the common congenital anomalies occurring in newborns. Over the last eight decades, various technical modifications have been proposed in the surgical repair of EA-TEF. Preservation of azygos vein is one such modification that has gained considerable attention. However, a consensus statement regarding the superiority of its preservation over its division is lacking. We aim to compare the outcomes of surgery between the two groups of newborns, i.e., those undergoing repair with and without azygos vein preservation, in terms of its complications. The authors systematically searched the databases PubMed, EMBASE, Web of Science, and Scopus through December 2020. The incidence of anastomotic complications and chest infection was compared among the two groups of newborns, i.e., those undergoing surgical repair with (group A) and without azygos vein preservation (group B). Statistical analysis was performed using a fixed-effects model, and pooled risk ratio (RR) and heterogeneity (I2) were calculated. The methodological quality of the studies was assessed using the Downs and Black scale. Six comparative studies, consisting of a total of 671 newborns, were included in the meta-analysis. As compared to group B, newborns belonging to group A showed a significantly lower incidence of pneumonitis in the postoperative period (RR 0.31; 95% CI 0.17–0.57, p = 0.0001). However, no significant difference in the incidence of anastomotic complications including anastomotic leak (RR 0.73; 95% CI 0.48–1.12, p = 0.15) and stricture (RR 0.63; 95% CI 0.36–1.09, p = 0.10) was observed between the two groups. The average Downs and Black scale scores ranged from 20 to 24. The risk of bias was low (n = 1) and moderate (n = 5) in the included studies. Kappa statistics showed a value of 0.902 (p < 0.001), highlighting an almost perfect agreement among the two observers. The present meta-analysis revealed the superiority of surgical repair of EA-TEF performed with preservation of azygos vein in terms of the incidence of postoperative chest infection. However, no significant difference in the occurrence of anastomotic leak and stricture was observed between the two groups. The level of evidence of the published comparative studies is limited. Therefore, well designed, randomized controlled trial utilizing a standardized operative approach on a larger sample-size needs to be conducted for optimal comparison between the two approaches.

ObjectiveEarly-onset sepsis (EOS), which occurs within the first 72 hours of life, can often be fatal for neonates. Machine learning (ML) models demonstrate promise for timely diagnosis. However, current ML models primarily rely on data from high-income countries, which reduces their applicability to low-income and middle-income countries (LMICs) that have a higher burden and different disease profiles. We developed an ML model for the timely prediction of culture-proven EOS in LMICs.MethodsWe conducted a secondary analysis of the Delhi Neonatal Infection Study (2011–2014) carried out in three level-3 neonatal units in India. Data from inborn neonates suspected of having EOS were extracted, and cases of culture-negative sepsis were excluded. By implementing a dynamic 80:20 (train:test) data split, two feature selection methods were employed—Boruta and Lasso—across 64 variables, and five ML techniques were applied. The aim was to achieve 90% sensitivity to identify the optimal model based on performance metrics. The developed model was integrated into a web application and validated in an external cohort of neonates born between 2015 and 2021.ResultsOf 2924 neonates, 548 (18.7%) had culture-proven sepsis. The mean gestation and birth weight were 35.3 (±3.8) weeks and 2112 (±754) g, respectively. The Boruta and random forest classifier yielded the best model, which included 28 perinatal–neonatal variables. The sensitivity and specificity of the model were 90.3% and 40.6%, respectively. In external validation (n=147; 26 culture-proven sepsis cases), the model’s sensitivity, specificity, positive predictive value and negative predictive value were 92.3%, 37.2%, 24.0% and 95.7%, respectively. The sensitivity was 100% in asymptomatic neonates with only perinatal risk factors for EOS. The use of the model could have reduced antibiotic usage from 74.8% to 55.7% (risk difference: −19.1%; 95% CI −8.3 to −29.7).ConclusionsThe ML model demonstrated high sensitivity and acceptable specificity in predicting EOS. This prediction model has the potential to assist in the timely and reliable identification of culture-positive sepsis and may serve as a bedside decision support tool in LMICs.

Isolated renal mucormycosis is rare in children. A case of 3-month-old infant presenting with right-sided flank lump and fever is being reported. Investigations revealed a nonfunctioning right kidney with intrarenal abscesses and a low percent-frequency of T-cells. He made an uneventful recovery following surgery and systemic antifungal therapy. Compared to the other forms of deep mucormycosis, a review of literature suggests favorable prognosis in children with isolated renal involvement.

Reliable estimation of pulse oximetry (SpO 2 ) is indispensable in a neonatal intensive care setting. Along with clinical examination, SpO 2 is a validated non-invasive correlate of PaO 2 to dictate the level of respiratory support. Any alterations that may interfere with this correlation pose significant challenges and lead to inadvertent over- or under-treatment. The authors report a case with an unusual discrepancy between SpO 2 and PaO 2 in a neonate with jaundice who developed bronze baby syndrome while receiving phototherapy. A review of similar previous reports suggests that abnormal pigment accumulation in bronze baby syndrome may render pulse oximetry transiently unreliable.

Background and objective Fragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). Method Twenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. Results A total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. Conclusion Based on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.Background and objective Fragility Index (FI) of meta-analyses determines their stability in terms of the level of confidence and strength behind the results depicted by them. The present study was conducted to estimate the FI of recently published meta-analyses in the Journal of Pediatric Urology (JPUrol). Method Twenty recently published articles on meta-analyses were screened to identify the eligible ones. The baseline data of each meta-analysis including the details of the author, number of included studies, total sample size, the total number of events, the status of the overall outcome (significant or non-significant), type of effect measure, type of method used for pooling the estimates, and type of effects model were recorded. FI was calculated by doing each single status modification. The 95% CI of the treatment effect was re-calculated until the statistical significance of the meta-analysis was reversed. Results A total of seven articles incorporating 22 meta-analyses were included. Seven (32%) of them had a statistically significant outcome prior to FI estimation. The risk ratio (17/22; 77%) was the most commonly used effect measure. The random-effects model (15/22; 68%) and the Mantel-Haenszel method (20/22; 91%) of pooling the estimates were utilized in the majority of meta-analyses. The median (Q1-Q3; range) FI of statistically significant, non-significant, and total meta-analyses were 5 (3-19.5; 2-39), 5 (3.5-6; 1-17), and 5 (3-13; 1-39) respectively. FI of ≤5 was noticed in four out of seven (57%), 9/15 (60%), and 13/22 (59%) of these meta-analyses respectively. Conclusion Based on our findings, the majority of the recently published meta-analyses in the field of pediatric urology are fragile and depend upon the event status of ≤5 participants.