MF Vaikų chirurgijos klinika (04.42)

The importance of the microbiome and its impact on human health have become increasingly evident, particularly in early life. In newborns the microbiome plays a crucial role in nutrient absorption, metabolic regulation, and immune system development, thereby influencing long-term health and growth1 . Factors related to pregnancy and delivery have been proposed to contribute to the initial microbial colonization of the neonatal gut, laying out a foundation for its development2 . The meconium microbiome profile reflects this early microbial seeding. Preterm infants, who are often of low birth weight, are especially vulnerable to health issues. This study aims to investigate the difference in the meconium microbiome profile in preterm and full-term born neonates, additionally looking for alterations associated with clinical factors, like the mode of delivery and antibiotic administration during delivery, and their effects in the two groups. A total of 184 meconium samples were included in the study, with 96 stool samples being taken from normal-weight full-term and 88 from very low-weight preterm born neonates. Genomic DNA was extracted from stool samples, and the bacterial V3–V4 hypervariable region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq platform. The data were processed using bioinformatic tools and analysed bioinformatically and statistically to assess microbiome composition, abundances, alpha- and beta-diversities. The analysis revealed significant differences in the bacterial profiles found in the meconium of very lowweight preterm and full-term newborns. Preterm infants exhibited higher richness but lower evenness, indicating a greater presence of low-abundance taxa alongside increased dominance of specific bacteria. At the genus level, Staphylococcus was most abundant in preterm samples, whereas EscherichiaShigella predominated in full-term neonates. The compositional difference was statistically significant. We observed that clinical factors, like the mode of delivery and maternal antibiotic use, influence the meconium microbiome, with partially differing effects between preterm and full-term groups. In conclusion, the meconium microbiome of preterm, low-birth-weight infants differs significantly from that of full-term neonates, both in composition and distribution. Preterm infants show a microbiome characterized by increased dominance and a higher prevalence of potentially pathogenic taxa. The immaturity of the preterm neonates seems to impact the initial microbial colonization of the gut microbiome, possibly playing together with different and often more severe clinical and health conditions preterm infants are in and exposed to. Comparing the microbiome dynamics in neonates of different gestational ages over time could provide valuable insights into the development of the microbiome and its impact onto neonatal diseases.

Vaikų chirurgijos istorija Kaune prasidėjo kukliomis sąlygomis XIX a. pabaigoje, kai mieste veikė vos dvi pagrindinės gydymo įstaigos -100 lovų miesto ligoninė ir 10-15 lovų žydų ligoninė. Nors pediatrija dar nebuvo savarankiška medicinos šaka, mažieji pacientai jau tada patekdavo į chirurgų rankas. Chirurginės pagalbos galimybės buvo labai ribotos - nebuvo antibiotikų, taikyta chloroformo ar eterio nejautra, o sterilizacijos priemonės, palyginti su dabartinėmis, buvo primityvios. [...].

Background/Objectives LAS is common in adolescents, yet early management strategies differ. The traditional PRICE + NSAIDs protocol focuses on short-term symptom relief, whereas the PEACE and LOVE framework emphasizes education, early optimal loading, and progressive exercise. This study compared functional recovery between these two approaches.

Omphalocele is a congenital defect of the abdominal wall with high morbidity and high practice variation. Evidence based guidance on its management is currently absent. The European Reference Network for Rare Inherited and Congenital Anomalies (ERNICA) developed this guideline to aid clinical decision-making.

Introduction Traffic-related blunt trauma is the leading cause of pediatric renal injuries, yet grade V lesions remain rare and often challenging to manage [1]. We present a grade V renal rupture successfully treated nonoperatively. Case Presentation A 12-year-old boy fell from an electric scooter and presented with abdominal and nasal pain, without loss of consciousness. Initial head and chest X-rays were unremarkable. Abdominal CT revealed a grade V left renal laceration with a large perirenal hematoma, contrast extravasation suspicious for pelvi-ureteric junction injury, and a splenic contusion. Hemodynamically stable, he was transferred to LSMUL KK with gross hematuria. Angiography showed a thrombosed segmental renal artery without active bleeding; embolization was not indicated. Ultrasound confirmed a sizable hematoma with preserved perfusion of both renal poles. On day 2, cystoscopy with retrograde pyelography showed no bladder or definite ureteral injury; a double-J stent and Foley catheter were placed. During hospitalization, fever and elevated inflammatory markers required antibiotic escalation. Serial ultrasound showed gradual hematoma liquefaction and stable renal perfusion. Clinical improvement occurred by day 10. The ureteral stent was removed on day 14, and the patient was discharged after 15 days. At one-month outpatient follow-up, ultrasound revealed a persistent perirenal fluid collection. As differentiation between liquefied hematoma and urinoma remained uncertain, percutaneous drainage was performed. Clear urine was obtained, a drain was left in situ, and the kidney was re-stented. Drain output progressively decreased, and no signs of systemic inflammation were observed during outpatient follow-up. Discussion Nonoperative management of high-grade pediatric renal trauma is increasingly supported in hemodynamically stable patients [2]. Careful monitoring and timely imaging are crucial for detecting delayed complications while preserving renal function. Ultrasound follow-up limits radiation exposure and enables safe surveillance [3]. Conclusions This case highlights that even grade V renal trauma can be managed nonoperatively in hemodynamically stable pediatric patients when supported by vigilant monitoring, appropriate imaging, timely drainage, and prompt management of complications.

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy.

Aim: Acute abdominal pain is a frequent pediatric emergency department (PED) complaint, with appendicitis as the top surgical cause. Diagnosis is challenging, especially in young children with vague symptoms. In this study we aimed to examine the alignment of Alvarado, PAS scores, and ultrasound with final appendicitis diagnoses. Materials and Methods: We conducted a retrospective single-center study of children aged 1–17 presenting with abdominal pain to our PED in September 2018. Alvarado, PAS, and HAS scores were calculated, and their diagnostic accuracy was assessed using AUC analysis. Results: Of 254 children (52.8% female, mean age 9.26 ± 4.64 years), 53 were diagnosed with appendicitis. Blood tests were performed in ~50%, and 95% had an abdominal US. Appendicitis was more common in older children and significantly associated with leukocytosis, neutrophilia, and CRP >60 mg/L. The Alvarado score showed a significant association (p < 0.001) and highest AUC (0.612), while PAS and HAS had slightly lower AUCs and were not statistically significant. Conclusions: Among clinical scoring systems, the Alvarado Score demonstrated the strongest, though moderate, predictive value for diagnosing appendicitis in this population.

Kasos solidinė pseudopapilinė karcinoma (SPN) – reta, mažo piktybiškumo potencialo kasos neoplazma, dažniausiai pasireiškianti jauniems pacientams. Nors liga dažniau diagnozuojama suaugusiesiems, SPN sudaro apie 8–12 proc. visų vaikams nustatomų kasos navikų. Diagnostiką apsunkina tai, kad dažniausiai navikai ilgą laiką nesukelia jokių simptomų, todėl aptinkami jau dideli – 5–7 cm. Be to, daliai sergančiųjų gali pasireikšti nespecifiniai simptomai, kurie taip pat gali komplikuoti diagnostinį procesą. Pirmojo pasirinkimo gydymas – kasos rezekcinė operacija, kurios metu radikaliai pašalinamas navikas. Ilgalaikė SPN prognozė įprastai gera, tačiau pooperaciniu laikotarpiu dažnai išsivysto kasos fistulė, kuriai gydyti gali reikėti antibiotikų terapijos ir parapankreatinio skysčio sankaupų drenavimo. Straipsnyje pristatomas klinikinis atvejis, kai 15 m. mergaitei atsitiktinai diagnozuota kasos solidinė pseudopapilinė karcinoma, lokalizuota kasos uodegoje, ir atlikta formali kasos rezekcija. Aptariama atidaus paciento stebėjimo pooperaciniu laikotarpiu svarba, galimos pooperacinių komplikacijų priežastys.

Introduction: Over recent decades, the study of the bacterial microbiome has gained increasing attention due to its vital role in human health. The development of the gut microbiome is especially critical during infancy, as it supports nutrient absorption, metabolic regulation, and immune system maturation. Several perinatal factors, including delivery mode, gestational age, and health status, have been shown to influence micro -biome establishment. Preterm and low-birth-weight infants, in particular, face heightened vulnerability to disruptions in microbiome development, which may contribute to adverse health outcomes. Aims & Methods: This study aimed to analyze the longitudinal development of the gut microbiome in preterm, low-birth-weight neonates over the first two months of life and to identify microbial patterns and alterations associated with delivery mode, gestational age, and clinical conditions. The study cohort included 115 low-birth-weight preterm infants and 99full-term, normal-weight controls. Stool samples from preterm infants were collected at multiple time points between day 1 and day 61 of life and grouped into six age categories for analysis. In total, 819 stool samples were examined. DNA was extracted and amplified targeting the V3–V4 region of the 16S rRNA gene, followed by sequencing on the Illumina MiSeq platform. Microbiome data were analyzed using bioinformatic and statistical tools to assess taxonomic composition, alpha diversity, and beta diversity. Results: Significant differences in microbiome profiles were associated with gestational age, mode of delivery, postnatal age, maternal medication, and the presence of necrotizing enterocolitis (NEC). Bacterial com-munities began to stabilize between days 26 and 35. A total of 56 bacterial genera — including Bifidobacterium, Clostridium, Escherichia-Shigella, Gemella, Klebsiella, Lactobacillus, and Streptococcus — showed a positive correlation with infants’ age in days, while 31 genera — including Bacillus, Cutibacterium, Flavobacterium, Macrococcus, Pseudomonas, and Staphylococcus — were negatively correlated. Eighteen bacterial genera were associated with the mode of delivery at various time points. Genera such as Fusobacterium, Bacteroides, Entero-coccus, Streptococcus, Gemella, and Corynebacterium were more commonly associated with vaginal birth, while Staphylococcus, Rahnella, Yokenella, Millisia, Negativicoccus, Finegoldia, Haemophilus, Acinetobacter, Conservatibacter, Serratia, Stenotrophomonas, and Peptoniphilus were associated with Caesarean section delivery. Moderate differences in early-life microbiome composition were also ob -served between low-birth-weight preterm and full-term infants. Conclusion: Gut microbiome development in preterm, low-birth-weight newborns is strongly influenced by clinical and perinatal factors, particularly during the first month of life. Mode of delivery, gestational maturity, and disease presence such as NEC contribute to microbial variability and delayed community stabilization. These findings highlight the importance of early-life monitoring and tailored interventions to support healthy microbiome development in vulnerable neonates.

Įžanga Įgimtos inkstų ir šlapimo takų anomalijos (ĮIŠTA) – ligų grupė, atsirandanti dėl ydingo šių organų formavimosi [1]. Dažniausia iš šių anomalijų – hidronefrozė, kurios pagrindinė priežastis – pieloureterinės jungties obstrukcija dėl jungties susiaurėjimo arba papildomos inksto kraujagyslės [2]. Tai retos ir įvairialypės patologijos, kurios ilgalaikėje perspektyvoje gali lemti lėtinės inkstų ligos išsivystymą. Būtent dėl to, svarbiausias šių ligų gydymo tikslas – išsaugoti geriausią įmanomą inkstų funkciją [1]. Dabartiniai diagnostiniai metodai vaikų populiacijoje kelia iššūkius (sunkiai prieinami, gali būti atliekami bendrinėje nejautroje), o kartais yra ir nepakankamai jautrūs ar specifiški. Nesant aiškių diagnostikos algoritmų, sunku parinkti tinkamiausius tyrimus konkretiems pacientams. Taip pat nėra tikslių chirurginio gydymo indikacijų: sprendimas dėl intervencijos priimamas įvertinus inkstų obstrukcijos laipsnį ir prognozuojant, inkstų nepakankamumo progresavimą ateityje [3]. Dėl šių priežasčių vyksta naujų diagnostikos ir prognostikos priemonių paieška – biologinių žymenų analizė. MCP-1 yra C-C superšeimai priklausantis citokinas, atsakingas už uždegiminius procesus, pritraukiant ir aktyvinant uždegimines ląsteles, taip skatinant fibrozės vystymąsi. Šio tyrimo tikslas įvertinti MCP-1 žymens diagnostinę reikšmę vaikams, sergantiems įgimtomis inkstų ir šlapimo takų anomalijomis [4]. Metodika Atliktas prospektyvinis atvejo – kontrolės tyrimas, į kurį įtraukti pacientai, gydyti LSMUL KK Vaikų chirurgijos skyriuje 2021–2025 m. Pacientai suskirstyti į 2 grupes: tiriamųjų ir kontrolinę. Tiriamųjų grupei priskirti pacientai vaikai, kuriems buvo diagnozuota hidronefrozė ir taikytas chirurginis gydymas. Kontrolinei grupei – sveiki pacientai. Tyrimo metu buvo renkami demografiniai ir klinikiniai duomenys, kraujo mėginiai. Laboratorijoje mėginiai buvo centrifuguojami 1,800 × g 10 min, serumas iki tyrimo buvo saugomas –80 °C. Vasaros praktikos projekto metu buvo atliktas kiekybinis imunologinis tyrimas PGR metodu. MCP-1 kiekis buvo įvertintas ProQuantum™ Human MCP-1 imunoanalizės rinkiniu pagal nurodytus protokolus (kalibravimo kreivė: 0.064–1,000 pg/mL). Serumo mėginiai buvo atskiesti santykiu 1:10. Panaudojant QuantStudio™ 5 System termociklerį buvo atliktas ELISA tyrimas. Gauti duomenys apdoroti naudojant ProQuantum™ analizės sistemą – taikant keturių parametrų logistinės regresijos (angl. four-parameter logistic, 4-PL) metodą kartu su pusiau logaritmine skale. Rezultatai Į tyrimą įtraukti 64 pacientai: 34 tiriamieji ir 30 kontrolinės grupės. Tiriamojoje grupėje buvo 18 (52,9 %) berniukų ir 16 (47,1 %) mergaičių, o kontrolinėje 20 (66,7 %) berniukų ir 10 (33,3 %) mergaičių. Į tyrimą įtrauktų pacientų amžiaus mediana buvo 49,5 (0 – 209) mėn.: tiriamojoje grupėje – 63,5 (0–209) mėn., o kontrolinėje 46,0 (5–201) mėn. Didžiajai daliai tiriamųjų operacijos metu diagnozuota II-III laipsnio hidronefrozė, pagal ONEN klasifikaciją: 8 (23,5%) II laipsnio ir 18 (52,9%) – III laipsnio. GFG mediana pagal Schwartz tiriamųjų grupėje buvo 108 (71–214). AP matmens mediana prieš operaciją – 24,5 (11–89) mm. Tik 9 (26,5%) tiriamieji buvo persirgę šlapimo organų infekcijomis iki operacijos. Remiantis tyrimo duomenimis galima teigti, kad tiriamosios grupės MCP-1 koncentracijos (198,8 pg/ml (22,0–491,1 pg/ml)) yra reikšmingai mažesnės nei kontrolinės grupės (271,6 pg/ml (101,4–1138,8 pg/ml)), (Z = –2,126, p = 0,034). (1 lent.) Tyrimo metu nustatyta, kad MCP-1 koncentracijos serume yra reikšmingai mažesnės pacientų, sergančių įgimtomis inkstų ir šlapimo takų anomalijomis. MCP-1 gali būti vertinamas kaip potencialus biologinis žymuo įgimtoms inkstų ligų patologijoms, vaikų populiacijoje, tačiau tikslesnei diagnostinei ir prognostinei reikšmei įvertinti reikalingi didesnės imties tyrimai. Tyrimo ribotumas Gauti rezultatai patvirtina MCP-1 biologinę reikšmę ir sąsają su uždegiminiais procesais inkstuose. Nustatytas vidutinio stiprumo efektas rodo, kad MCP-1 galėtų būti laikomas potencialiu biomarkeriu, tačiau jo diagnostinė vertė šiuo metu yra ribota. Maža imtis ir klinikinės tiriamųjų charakteristikos galėjo turėti įtakos rezultatams. Norint patikimai įvertinti MCP-1 diagnostines ir prognostines galimybes reikalingi tolimesni tyrimai.