BACKGROUND: Omphalocele (OM) is a congenital defect of the abdominal wall. The main goal of the surgical management is the survival of the neonate. However, the residual scar following the surgery can be extremely burdensome and negatively impact the quality of life (QoL) of these patients. The aim of this study is to assess the cosmetic results of the surgical treatment, the level of satisfaction of patients and surgeons, and the influence of the scar on the QoL of the patient.
METHODS: We conducted an observational retrospective cross-sectional study collecting all data regarding patients born with OM, operated at our Centre between 1998 and 2021. The cosmetic results of the surgical repair were evaluated using the validated Patient and Observer Scar Assessment Scale (POSAS). The assessment of the quality of life determined by the presence of the scar was conducted using PedQL 4.0. At last, the patients were visited by two paediatric surgeons and a medical student, which then scored the cosmetic result of the scar. Statistical analysis was conducted with Spearman linear correlation and Mann-Whitney test. A P-value below 0.05 was considered statistically significant.
RESULTS: In our study, we included a total of 19 patients, with a mean of 12 years of age at the time of the evaluation. The parameters with the major influence on the patient\'s general opinion of the scar were stiffness, thickness, and irregularity. We discovered significant differences in median values of all scores between the giant OM group and the nongiant OM group, in favour of the latter. Finally, we found a low grade of concordance between PedsQL filled by parents and patients.
CONCLUSIONS: The POSAS scale is a valid, feasible, and reliable tool for the assessment of the aesthetic outcome of surgical procedures. The original size of the defect is the most important factor acting on the result. However, it is crucial that any decision on plastic surgery to improve the looks of the scar must be postponed to the adult age of the patient.
METHODS: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Background The \'lethal triad\' of acidosis, hypothermia, and coagulopathy is now considered a diamond of death, with ionised hypocalcaemia (iHypoCa) contributing to cardiovascular decompensation and coagulopathy. iHypoCa may be associated with haemodynamic instability and adverse outcomes in paediatric major trauma patients. However, current data are limited. The primary aim of this pilot study was to report the association between admission iHypoCa and early hypotension on admission in a cohort of paediatric major trauma patients. Secondary aims include reporting the incidence and differential determinants of iHypoCa and the association with treatment (vasoactive agents, blood transfusion, interventional radiology (IR), or surgery) and adverse outcomes (length of stay, morbidity (Glasgow Outcome Scale), and mortality). Methods This pilot study is a retrospective analysis of paediatric major trauma patients (<16 years old) admitted to a major trauma centre (2016-2022). Patients with an admission ionised calcium level obtained before the administration of blood products were included. Multivariable logistic regression was used to assess the dichotomous endpoint of hypotension (systolic blood pressure of <80 mmHg for <1 year, <85 mmHg for one to five years, <90 mmHg for five to 12 years, <100 mmHg for >12 years) for association with hypocalcaemia and adjusted for other potential variables of interest (age, gender, Injury Severity Score, pre-hospital fluids, and acidosis). Results Admission iHypoCa was observed in 8/45 (17.8% (95% confidence interval (CI) 9.3-31.3%)) patients. Other than the adolescent age group (p < 0.05), there were no significant differences in the baseline characteristics. As a pilot study, this was not powered for statistical significance; however, point estimates of the odds of hypotension were almost three times higher for patients with iHypoCa (odds ratio (OR) 2.8 (95% CI 0.4-23.6), p = 0.33). An association between iHypoCa and the need for IR/surgery in the first 24 hours of admission was also observed (OR 10.9 (95% CI 1.4-159.4), p < 0.05). Conclusion iHypoCa was observed in approximately one in six paediatric major trauma patients at admission and may be associated with increased odds of requiring IR/surgery. Larger multicentre studies are required to clarify point estimates for treatment requirements and adverse outcomes.

Background Postoperative nausea and vomiting (PONV) is a common complication in paediatric patients undergoing abdominal surgeries. Dexmedetomidine and clonidine, both α2-adrenergic agonists, have been proposed as potential treatments for PONV due to their antiemetic properties. This study aimed to compare the efficacies of dexmedetomidine and clonidine in the prevention of PONV in paediatric patients following abdominal surgeries Methods Eighty patients, aged five to 12 years undergoing abdominal surgeries under general anaesthesia were enrolled in this study. Patients were randomly assigned to receive either a single intravenous dose of 0.5 µg/kg of dexmedetomidine (Group D; n=40) or 1 µg/kg of clonidine (Group C; n = 40) 10 minutes before extubation. PONV was recorded for the next 24 hours. Results The baseline characteristics of patients were comparable. A higher proportion of patients in the clonidine group developed PONV as compared to the dexmedetomidine group (27.5% vs 20.0%, p=0.189). The visual analogue scale (VAS) score of group C was higher than that of group D (1.38±1.55 vs 1.00±1.26) but was not statistically significant. The Paediatric Anaesthesia Emergence Delirium (PAED) scale score or emergence agitation (EA) score was higher in group C during recovery time. The mean arterial pressures and the heart rates were comparable in both groups. No significant side effects were reported. Conclusion Our study concludes that dexmedetomidine and clonidine effectively control PONV in paediatric abdominal surgery, with no significant difference in incidence or severity. Dexmedetomidine significantly reduced PAED scale scores during recovery, indicating better control of EA. The two treatments showed comparable mean arterial pressures and heart rates without significant side effects.

True human tails, a rare and perplexing congenital phenomenon, continue to intrigue medical practitioners due to their complex aetiology. A male term neonate presented to our paediatric surgery department with a true tail arising from the left lumbosacral region. The antenatal period was uneventful, and the neonate exhibited normal development and vital parameters. Clinical examination revealed a tail-like structure covered by normal skin, devoid of spontaneous movements or bony elements. Neurological assessments and ultrasound examinations showed no associated abnormalities. The patient\'s family history included a sibling with hypospadias. This case adds to the limited literature on true tails and highlights the importance of thorough evaluation and management of such rare anomalies.

In this prospective randomised controlled trial, we compared the impact of the lateral versus supine position for tracheal extubation among infants aged two months to two years after intraabdominal surgery on the incidence of respiratory adverse events that may occur after extubation. The anaesthesia protocol was standardised. Among the 120 infants included (60 in each group), the demographic and perioperative data were comparable between both groups. The incidence of perioperative respiratory adverse events after tracheal extubation was 21.6% and 5% in the supine and lateral position groups, respectively, with p = 0.007 and odds ratio = 3.87; 95% confidence interval: 1.18-12.6. Lateral position also reduced the incidence of airway obstruction with p = 0.004 and odds ratio = 11.8; 95% confidence interval: 1.46-95.3 and oxygen desaturation below 92% with p = 0.008 and odds ratio = 11.8; 95% confidence interval: 1.46-95. The lateral position seems to be practical and beneficial for tracheal extubation among infants.

UNASSIGNED: Difficult airway management is one of the main challenges in paediatric anaesthesia, particularly in low- and middle-income countries.
UNASSIGNED: The aim of this study was to investigate the main predictors of difficult paediatric intubation.
UNASSIGNED: In this observational study, we included all children aged less than five years undergoing intra-abdominal surgery with endotracheal intubation. Patients were divided into two groups according to the incidence of difficult intubation. Then, we investigated predictors for difficult paediatric intubation.
UNASSIGNED: We included 217 children, and difficult intubation was observed in 10% of them. Predictors were as follows: Mallampati III-IV class (adjusted odds ratio = 2.21; 95% confidence interval = 1.1-6.4), limited mouth opening (adjusted odds ratio = 2.4; 95% confidence interval = 1.8-3.5), facial dysmorphia (adjusted odds ratio = 2.6; 95% confidence interval = 1.32-7.4) and anaesthesia without muscle relaxant (adjusted odds ratio = 1.8; 95% confidence interval = 1.0-5.1) or without opioids during crash inductions (adjusted odds ratio = 1.7; 95% confidence interval = 1.01-4.8).
UNASSIGNED: Facial dysmorphia and limited mouth opening were predictors of difficult intubation in children. Furthermore, it seems that Mallampati class and anaesthesia technique may also predict challenging intubation, which may guide us to change our perioperative practice.

Enteric duplication has cystic and tubular varieties. A male infant presented with a large cystic, well-demarcated mass in the right flank. On exploratory laparotomy, multiple cystic and tubular lesions were present adjacent to the mesenteric border of the small bowel along with malrotation of the small bowel. The tubule-cystic structure was excised along with the involved normal bowel segment and Ladd\'s procedure was performed. Histopathological evaluation revealed an intestinal duplication cyst. The occurrence of midgut malrotation and volvulus along with duplication is uncommon. The cyst\'s substantial size could have been an aetiological factor for malrotation and volvulus. The child\'s small bowel had adapted remarkably with time. This case highlights a new variant of duplication cysts.

Rhabdomyosarcoma (RMS) is a form of soft tissue sarcoma that can arise from muscle or fibrous tissue almost anywhere in the body. The two major subtypes of RMS are alveolar and embryonal, whereas the two rarer subtypes are pleomorphic, which typically occurs in adults, and the spindle cell/sclerosing variant, typically seen in children. RMS usually involves the extremities, the head and neck or the genitourinary system. Although it can arise from anywhere in the body, other sites of involvement are rare and usually present only at an advanced stage owing to a mass effect on surrounding tissues and organs. We present a rare case of a child who presented with the signs and symptoms of an acute abdomen, but intraoperatively was found to have a bleeding necrotic mass arising from the anterior abdominal wall. This was histologically confirmed to be a RMS of the embryonal type.

Ventriculoperitoneal shunt (VPS) is the most common procedure done for hydrocephalus in the paediatric population. While shunt infection and shunt malfunction remain the most common complications, shunt migration is not frequently observed. Being present in a large peritoneal cavity, theoretically, a shunt can travel to a variety of locations. Even among these, scrotal migration is quite uncommon. This case highlights the significance of keeping this possibility in mind while evaluating a case of shunt malfunction. It also discusses various nuances of surgically managing scrotal migration.

Phlebectasia of the internal jugular vein (IJV) is an unusual vascular anomaly, particularly in paediatric patients. Here, we present a case of IJV phlebectasia of a girl in her early childhood, highlighting its clinical presentation, diagnostic workup and management. The patient presented with a painless, non-pulsatile neck mass, which was identified as an enlarged IJV on imaging studies. Since it is a benign condition, and the patient is asymptomatic, observation with regular monitoring is advised.