A National Multicenter Analysis of Hospitalization Admission Records for Lymphatic Malformations in China from 2016 to 2023

A National Multicenter Analysis of Hospitalization Admission Records for Lymphatic Malformations in China from 2016 to 2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A National Multicenter Analysis of Hospitalization Admission Records for Lymphatic Malformations in China from 2016 to 2023 Lin Mei, Linyue Sun, Xiaodan Li, Nian Sun, Qiaoyin Liu, Xunxi Zhang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8857709/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Lymphatic malformation (LM) is a low-flow vascular malformation caused by the abnormal development of the lymphatic system. This study aimed to provide an update on pediatric LM by investigating its clinical characteristics and hospitalization burden in multiple medical centers across China. Methods This study utilized data from the Futang Research Center of Pediatric Development (FRCPD). All hospitalization records from January 1, 2016, to December 31, 2023 (N = 10,974,595) were screened to identify children with LM. For these patients, a comprehensive analysis of clinical characteristics (e.g., demographics, lesion location, treatment, comorbidity/complication) and hospitalization burden (i.e., length of stay and total cost) was conducted. Results Our study comprised 24,207 inpatients with LM, predominantly from the eastern region. The typical hospitalized patient was a child aged 1–3 years or trunk involvement. Strikingly, sclerotherapy was 1.57 times more common than surgical resection. The most frequent comorbidity/complication were infectious diseases. Treatment patterns also varied by anatomy: lesions in the trunk favored surgical resection, while other areas usually undergo sclerotherapy. Critically, hospitalization burden differed significantly based on lesion site, treatment received, and the presence of comorbidity and complication. Conclusions By analyzing a national cohort of pediatric inpatients with LM, this study provides contemporary insights into the clinical characteristics and hospitalization burden of this condition in China. These findings underscore the substantial healthcare impact of LM and are critical for informing future healthcare strategies and resource allocation. hospital admission records lymphatic malformation (LM) clinical characteristics hospitalization burden Figures Figure 1 Figure 2 Figure 3 Introduction Lymphatic malformation (LM) is a congenital, non-proliferative vascular anomaly resulting from aberrant development of the lymphatic system during embryogenesis. It originates from lymphatic endothelial cells (LECs) and demonstrates a predilection for the head, neck, and axillary regions [1] . According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, LMs are categorized into three morphological types based on cyst size: macrocystic (>2 cm), microcystic (<2 cm), and mixed, which combines features of both [2] . The estimated incidence ranges from 1 in 6,000 to 1 in 16,000 live births [3] , with an overall prevalence of approximately 1 in 4,000 [4] . Subjects and methods The Futang Research Center of Pediatric Development (FRCPD) is a large, non-profit medical consortium in China dedicated to advancing pediatric medical research [5] . Its network comprises 47 tertiary children's hospitals, 37 of which routinely contribute annual hospitalization records. We conducted a retrospective analysis of this large-scale, multi-center FRCPD database to delineate the clinical characteristics and hospitalization burden of inpatients with LM, thereby providing a comprehensive epidemiological profile of this condition in Chinese children. Data source and categories of children with LM Cohort identification commenced with the screening of 10,974,595 admission records from the FRCPD database (2016-2023). Inclusion required a primary diagnosis of LM and that the admission represented the patient's first hospitalization for the condition. Exclusion was applied to records lacking complete data on demographics, diagnosis, or parameters of hospitalization burden (e.g., length of stay (LOS) and total cost). Subsequently, the following data were extracted for analysis: patient demographics (gender, age, region), lesion site (head, neck, trunk, limbs, unknown), treatment modality (sclerotherapy, surgical resection), comorbidity/complication (congenital, infectious, circulatory system diseases, and others), and hospitalization burden (LOS and total cost). Patients were categorized into five age groups: <1, 1-3, 4-6, 7-12, and 13-18 years. Geographically, the 37 participating hospitals were classified into seven major regions of China: Northeast, North, East, Northwest, Southwest, South, and Central China. Statistical analysis In this study, gender, age, region, lesion site, treatment method, comorbidity/complication were treated as categorical variables, while length of stay (LOS) and hospitalization expenses were treated as continuous variables. Group comparisons for categorical variables were performed using the Pearson chi-square test or Fisher’s exact test, as appropriate. Continuous variables (LOS and total cost) were found to be non-normally distributed by the Shapiro-Wilk test and were therefore compared using non-parametric tests, with post-hoc analyses conducted via the Steel-Dwass test. All analyses were carried out using JMP Pro, version 15.0. A two-sided P value < 0.05 was considered statistically significant. Results Demographic characteristics and disease situation of inpatients with LM This study retrospectively screened 10,974,595 pediatric admission records from the FRCPD database (2016-2023), identifying 24,207 inpatients with LM (prevalence: 0.22%). As summarized in Table 1, males accounted for a higher proportion (57.97%) than females (42.03%), yielding a male-to-female ratio of 1.39:1. The age distribution was dominated by the 1-3 years subgroup (45.66%), followed by 4-6 years (22.32%), 7-12 years (15.73%), <1 year (14.17%), and 13-18 years (2.13%). Geographically, the highest case volumes were from East China (38.84%), Central China (20.07%), and North China (13.65%) (Figure 1). Among the 24,207 admission records, the trunk was the most frequently involved site (27.10%). The primary treatments for LM were sclerotherapy and surgical resection, with sclerotherapy being more commonly performed (ratio:1.57:1). Regarding associated conditions, infectious diseases were the most common comorbidity/complication (N=417), followed by congenital diseases (N=381) and circulatory system diseases (N=188), as detailed in Table 1. Subgroup analysis of inpatients with LM A significant male predominance was observed across all lesion sites (χ²=57.55, p <0.001; Figure 2A/B, Supplementary Table 1). Analysis of lesion distribution by age revealed that the trunk was the most common site in most age groups. Conversely, the neck was more frequently involved in children aged <1 year (χ²=378.01, p <0.001; Figure 3A, Supplementary Table 1). Treatment preferences varied by location: truncal lesions were more likely to be managed with surgical resection, whereas sclerotherapy was more commonly employed for other sites (Figure 3B). This association between lesion site and treatment modality was statistically significant for both sclerotherapy (χ²=1785.55, p <0.001) and surgical resection (χ²=339.48, p <0.001; Supplementary Table 1). The hospitalization burden included LOS and total cost of inpatients with LM Leveraging this multi-center database, we were able to characterize the hospitalization burden associated with LM. As shown in Table 2, inpatients with truncal lesions incurred the highest burden among the lesion site subgroups. Furthermore, the hospitalization burden was significantly greater for surgical resection than for sclerotherapy. The presence of comorbidity/complications was also associated with increased LOS and total cost. Collectively, these results demonstrate that hospitalization burden varies importantly by lesion site, treatment modality, and the presence of comorbidity/complications. Discussion Lymphatic malformation (LM) is a low-flow vascular malformation resulting from aberrant development of the lymphatic system during embryogenesis. It typically arises between 6 and 10 weeks of gestation, when immature lymphatic tissues fail to establish normal connections with the venous or lymphatic systems. The incidence of LM is comparable between males and females, with no significant sex-based differences. Clinically, LM usually present as soft, compressible masses consisting of fluid-filled cysts or channels, which are evident at birth or 2 years of age [4] . Consistent with this clinical course, our findings indicate that children aged 1 to 3 years constitute the primary demographic requiring hospitalization for LM management. Moreover, LM may enlarge due to intralesional hemorrhage or infection. Superficial cysts are prone to fluid leakage, which can lead to localized infection, cellulitis, or even systemic sepsis [6] . In line with this, our data identified infectious diseases as the most frequent comorbidity/complication among hospitalized children with LM. Thus, antibiotic therapy remains an essential component of the clinical management of LM. LM typically develop in anatomical regions rich in lymphatic vessels, such as the head, neck, abdomen, groin, mediastinum, and axilla. Previous studies report that approximately 75% of LM occur in the head or neck region, where they can cause serious complications including speech disorders, dysphagia, and airway obstruction [7] . In the abdomen, LM is most commonly located in the mesentery, omentum, and mesocolon [8] . Intraperitoneal LM accounts for 3%-9.2% of all cases, while retroperitoneal LM is exceedingly rare, comprising less than 1% [9] . In contrast, our findings indicated that among hospitalized pediatric patients with documented lesion sites, truncal involvement (41.99%) was more frequent than head and neck involvement (39.00%). This discrepancy may be attributable, in part, to the inpatient-focused design of our study, which did not include outpatient cases, and the fact that lesion site information was unavailable for 35.34% (8555/24207) of the included inpatients. Lymphatic malformation (LM) is currently managed in clinical practice primarily through sclerotherapy, surgical resection, and laser therapy, with the principal goals of restoring or preserving function and addressing aesthetic concerns [10] . The selection of a specific treatment modality depends on the location, size, and clinical manifestations of the LM. Surgical resection is mainly indicated for well-localized microcystic or macrocystic LM. However, complete excision is often challenging due to the complex and infiltrative nature of these lesions. Reported recurrence rates after surgical resection range from 13% to 33%, with a 2-6% risk of permanent nerve damage [11] -12] . Consequently, percutaneous sclerotherapy and pharmacotherapy play a crucial role in managing extensive or deep-seated lesions that are not amenable to surgery. Commonly used sclerosants include 3% sodium tetradecyl sulfate, doxycycline, and bleomycin. Notably, bleomycin is the only sclerosant effective against microcystic disease [13] , with one study reporting significant treatment response in 80% of macrocystic and 50% of microcystic LM during 1-3 years of follow-up [14] . Percutaneous sclerotherapy is also considered safe for infants, including newborns under one year of age [15] . Nevertheless, some studies have indicated that surgery-sometimes combined with sclerotherapy-may yield superior outcomes compared to sclerotherapy alone [16-] [19] . In addition, carbon dioxide laser therapy is a safe and effective option for superficial intraoral and cutaneous lesions, albeit with a relatively high recurrence rate [20] . Our findings reflect a clear anatomical preference in treatment selection: sclerotherapy was predominantly used for head/neck and extremity lesions, whereas surgical resection was more frequently applied to truncal lesions. It should be noted that laser therapy for LM is mostly performed in outpatient settings and was therefore not captured in this inpatient-based study. Despite advances in treatment, approximately one-third of patients with refractory LM experience recurrence after surgical excision or sclerotherapy. The precise pathogenesis of LM remains incompletely elucidated; however, growing evidence indicates that multiple genes and regulatory factors collectively orchestrate lymphatic vascular development, and their dysregulation contributes to the initiation and progression of LM. Notably, recurrent somatic mutations in PIK3CA have been identified in the majority of LM cases, underscoring the central role of the PI3K/AKT/mTOR signaling pathway in its pathogenesis [21] . Sirolimus, an mTOR inhibitor, is supported by the strongest clinical evidence for treating diffuse or complex LM. Several multi-center studies have reported that oral sirolimus leads to clinical regression in 50-80% of pediatric patients [22, 23] . Given the heterogeneity in lesion location, extent, and morphological sub-type, the management of LM necessitates individualized therapeutic strategies tailored to the specific clinical scenario. This study represents the first systematic report on the hospitalization burden of pediatric LM. Our results demonstrated that sclerotherapy was associated with a significantly shorter length of stay and lower hospitalization expenses compared to surgical resection, which may partly account for its more frequent utilization in clinical practice. Limitation This study has several limitations. First, its retrospective design relies on the accuracy and completeness of medical records, which may affect data reliability. Second, the analysis was confined to conventional treatments such as sclerotherapy and surgery, and did not include emerging targeted therapies like PI3K/mTOR inhibitors. Future studies should incorporate multimodal strategies-combining molecular targeted therapy, interventional procedures, and pharmacotherapy-to enable more comprehensive clinical evaluations. Conclusion By analyzing a large multi-center cohort of pediatric inpatients with LM, this study provides contemporary insights into the clinical characteristics and hospitalization burden of this condition in China. These findings highlight the significant healthcare resource utilization associated with LM and underscore the need for enhanced clinical awareness and informed resource allocation to better address the needs of this patient population. Abbreviations Abbreviation Full Term LM Lymphatic malformation FRCPD Futang Research Center of Pediatric Development LECs lymphatic endothelial cells ISSVA International Society for the Study of Vascular Anomalies LOS length of stay Declarations Funding The study was supported by Beijing Natural Science Foundation (No. 7244337 and 7244334)，Construction of the Clinical Diagnosis and Research Centre of Capital Medical University (0400-190003),Science and Technology Innovation Development Project, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health (YN2020402). Ethics approval and consent to participate The protocol for this study received ethical approval from the Ethics Committee of Beijing Children's Hospital, Capital Medical University (Number: 2020-k-10) and was performed in line with the tenets of the Declaration of Helsinki.Informed consent for participation in the study was obtained from the parents or legal guardians of all participants under the age of 16. Data availability The datasets generated and analyzed during the current study are not publicly available as they contain sensitive, personally identifiable health information, but are available from the corresponding author on reasonable request. Competing interests The authors have no conflicting interest associated with this manuscript. Acknowledgment We are grateful to investigators from members of the Futang Research Center of Pediatric Development (FRCPD). Authors’ contributions The authors’ contributions were as follows. SW, LM, LS, XL, NS, QL, XZ, ZL YM, GZ contributed to the conception and design of the study. LM contributed to acquisition, analysis and interpretation of the data. LM, LS wrote the MS. SW, LM, LS, XL, NS, QL, XZ, ZL YM, GZ collected data. XL, NS, QL, XZ, ZL YM, GZ revised the MS. All authors read and approved the final manuscript. Clinical Trial Number Clinical trial number: not applicable. References Zhang C, Liu J, Wang Y, Zheng Y, Malashicheva A, Qi L. Xiaohong Shi, Ju Liu; Lymphatic Malformation: Classification, Pathogenesis, and Therapeutic Strategies. Ann Vasc Surg. 2025;121:35–46. Acord M, Abhay S, Srinivasan. Anne Marie Cahill; Percutaneous Treatment of Lymphatic Malformations. Tech Vasc Interv Radiol. 2016;19(4):305–11. Josée, Dubois. Frédéric Thomas-Chaussé, Gilles Soulez; Common (Cystic) Lymphatic Malformations: Current Knowledge and Management. Tech Vasc Interv Radiol. 2019;22(4):100631. Taija Mäkinen, Laurence M, Boon M, Vikkula. Kari Alitalo; Lymphatic Malformations: Genetics, Mechanisms and Therapeutic Strategies. Circulation Res 2021 06 25;129(1):136–54. Xinyu Wang Y, Zeng J, Tian H, Xu F, Song Y, Guo X, Xu G, Feng. Xin Ni; A brief introduction to the FUTang Updating medical REcords (FUTURE) database. Pediatr Invest. 2021;5(3):247–8. 10.1002. Ravindhra G, Elluru K, Balakrishnan, Horacio M. Padua; Lymphatic malformations: diagnosis and management. Semin Pediatr Surg. 2014;23(4):178–85. Ann M, Kulungowski M. Lymphatic malformations. Semin Pediatr Surg. 2020;29(5):150971. Alex Guachilema Ribadeneira, Ángel Raúl Tapia Monard, Endara MC. Cristian German Garcia, Milton Omar Sandoval, David Alejandro Cárdenas, Andrea Daniela Basantes; Intra-abdominal cystic lymphangioma of the mesocolon sigmoids: a rare entity in adult patient woman. Journal of surgical case reports 2020;2020(5):rjaa031. Van Hoang T, Nguyen MD. Hoang Anh Thi Van, Duc Thanh Hoang; Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Japanese J Radiol. 2023;41(3):283–301. Neil M, Kalwani, Stanley G, Rockson. Management of lymphatic vascular malformations: A systematic review of the literature Journal of vascular surgery. Venous lymphatic disorders. 2021;07(4):1077–82. Zobel MJ, Nowicki D, Gomez G, Lee J, Howell L, Miller J, Zeinati C, Dean M. Anselmo; Management of cervicofacial lymphatic malformations requires a multidisciplinary approach. J Pediatr Surg. 2021;56(5):1062–7. Kento Suzuki S, Fumino M, Iguchi S, Takayama K, Kim S, Hirano. Shigeru Ono; Multidisciplinary therapeutic strategy with appropriate timing and modalities for treating cervicofacial lymphatic malformations in children. Pediatr Surg Int. 2024;41(1):35. Gulraiz Chaudry CJ, Guevara KL, Rialon C, Kerr JB, Mulliken AK, Greene SJ, Fishman. Debra Boyer, Ahmad I Alomari; Safety and efficacy of bleomycin sclerotherapy for microcystic lymphatic malformation. Cardiovasc Interv Radiol. 2014;37(6):1476–81. Muir T, Kirsten M, Fourie P, Dippenaar N, Ionescu GO. Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations. Pediatr Surg Int. 2004;19(12):766–73. Caton MT, Duvvuri M, Baker A, Smith ER, Kazim H, Narsinh MR, Amans, Steven W, Hetts, Randall T, Higashida DL, Cooke, Christopher F. Dowd; Percutaneous sclerotherapy for head and neck lymphatic malformations in neonates and infants ≤ 12 months of age. J neurointerventional Surg. 2023;15(12):1242–6. Jin L, Chen J, Li X. Surgical Excision With Bleomycin Irrigation: A Better Primary Treatment Choice for Pediatric Submandibular Lymphatic Malformations. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2017;75(2):437.e1-437.e7. Bai Y, Jia J, Huang X-X, Alsharif MJ, Zhao J-H. Sclerotherapy of microcystic lymphatic malformations in oral and facial regions. J oral maxillofacial surgery: official J Am Association Oral Maxillofacial Surg. 2009;67(2):251–6. Tadaharu Okazaki S, Iwatani T, Yanai H, Kobayashi Y, Kato T, Marusasa GJ, Lane. Atsuyuki Yamataka; Treatment of lymphangioma in children: our experience of 128 cases. J Pediatr Surg. 2007;42(2):386–9. Wang Y, Tang W. Safety and efficacy of surgery combined with bleomycin irrigation for complex cervical-facial lymphatic malformations of children. Int J Pediatr Otorhinolaryngol. 2020;128:109724. Gerald G, Behr, Craig M. Vascular anomalies: hemangiomas and beyond–part 2, Slow-flow lesions AJR. Am J Roentgenol. 2013;200(2):423–36. Calne RY, Collier DS, Lim S, Pollard SG, Samaan A, White DJ. Rapamycin for immunosuppression in organ allografting. Lancet (London England). 1989;2(8656):227. Wiegand S, Wichmann G. Treatment of Lymphatic Malformations with the mTOR Inhibitor Sirolimus: A Systematic Review. Lymphatic Res biology. 2018;08(4):330–9. 10.1089/lrb.2017.0062 . Melissa Dodds M, Tollefson L, Castelo-Soccio MC, Garzon M, Hogeling K, Hook. Christina Boull, Sheilagh Maguiness; Treatment of superficial vascular anomalies with topical sirolimus: A multicenter case series. Pediatr Dermatol. 2020;37(2):272–7. Tables Table 1 The baseline characteristics of patients with Lymphatic malformation (LM). Categories Pediatric inpatients (numbers) SUM 24207 Gender Male 14033 Female 10174 Age < 1 years old 3429 1–3 years old 11054 4–6 years old 5402 7–12 years old 3807 13–18 years old 515 Region Northeast China 848 North China 3305 East China 9401 South China 1667 Central China 4859 Northwest China 2350 Southwest China 1777 Lesion site Head 2042 Neck 4051 Trunk 6561 Limbs 2998 Unknown 8555 Treatment method Sclerotherapy Yes 12027 No 12180 Surgical resection Yes 7669 No 16538 Comorbidites and complications Congenital diseases 381 Infectious diseases 417 Circulatory system diseases 188 Others 149 Table 2 The LOS and total cost of patients with LM in different groups. Hospitalization burden Length of hospital stay (LOS, days) χ2 P Total cost (¥) χ2 P Lesion site 1479.67 < 0.001 1421.35 < 0.001 Head 4(2,6) 7617.83 (5144.18,9932.47) Neck 5(3,8) 8087.25 (4976.6,11553.94) Trunk 7(4,11) 11044.48 (6962.24,18433.95) Limbs 4(2,7) 8093.03 (5735.46,10387.75) Unknown 4(2,7) 7761.25 (5603.59,10413.49) Treatment method Sclerotherapy Yes 3(2,5) 5518.37 < 0.001 7585.98 (5521.05, 9715.10) 1267.75 < 0.001 No 7(4,11) 9962.82 (6129.38,15530.17) Surgical resection Yes 7(3,11) 1634.89 < 0.001 10293.73 (7735.95,14885.92) 2417.47 < 0.001 No 4(2,7) 7561.73 (4604.36,10604.67) Comorbidity/complication Congenital diseases 9(4,15) 110.85 < 0.001 13018.09 (8318.71,21888.21) 148.75 < 0.001 Infectious diseases 11(7,17) 403.42 < 0.001 15676.40 (7373.33,27225.80) 198.59 < 0.001 Circulatory system diseases 12(7,16) 172.70 < 0.001 16657.31 (10381.23,23373.05) 147.12 < 0.001 Others 12(6,19) 129.22 < 0.001 24621.04 (12127.27,42288.65) 163.55 < 0.001 Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.docx Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 24 Mar, 2026 Reviews received at journal 23 Mar, 2026 Reviews received at journal 10 Mar, 2026 Reviews received at journal 02 Mar, 2026 Reviewers agreed at journal 26 Feb, 2026 Reviewers agreed at journal 25 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers invited by journal 24 Feb, 2026 Editor assigned by journal 24 Feb, 2026 Editor invited by journal 24 Feb, 2026 Submission checks completed at journal 23 Feb, 2026 First submitted to journal 23 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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11:54:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3009211,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8857709/v1/3652e8c0-76ce-42f7-910c-ddf441a6ecbc.pdf"},{"id":103533388,"identity":"c08dfe85-3453-4818-a580-03b998bb5792","added_by":"auto","created_at":"2026-02-26 17:40:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18722,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-8857709/v1/a8cbbd7e18d77358a895a205.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A National Multicenter Analysis of Hospitalization Admission Records for Lymphatic Malformations in China from 2016 to 2023","fulltext":[{"header":"Introduction","content":"\u003cp\u003eLymphatic malformation (LM) is a congenital, non-proliferative vascular anomaly resulting from aberrant development of the lymphatic system during embryogenesis. It originates from lymphatic endothelial cells (LECs) and demonstrates a predilection for the head, neck, and axillary regions\u003csup\u003e[1]\u003c/sup\u003e. According to the International Society for the Study of Vascular Anomalies (ISSVA) classification, LMs are categorized into three morphological types based on cyst size: macrocystic (\u0026gt;2 cm), microcystic (\u0026lt;2 cm), and mixed, which combines features of both\u003csup\u003e[2]\u003c/sup\u003e. The estimated incidence ranges from 1 in 6,000 to 1 in 16,000 live births\u003csup\u003e[3]\u003c/sup\u003e, with an overall prevalence of approximately 1 in 4,000\u003csup\u003e[4]\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Subjects and methods","content":"\u003cp\u003eThe Futang Research Center of Pediatric Development (FRCPD) is a large, non-profit medical consortium in China dedicated to advancing pediatric medical research\u003csup\u003e[5]\u003c/sup\u003e. Its network comprises 47 tertiary children\u0026apos;s hospitals, 37 of which routinely contribute annual hospitalization records. We conducted a retrospective analysis of this large-scale, multi-center FRCPD database to delineate the clinical characteristics and hospitalization burden of inpatients with LM, thereby providing a comprehensive epidemiological profile of this condition in Chinese children.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData source and\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;categories of children with LM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCohort identification commenced with the screening of 10,974,595 admission records from the FRCPD database (2016-2023). Inclusion required a primary diagnosis of LM and that the admission represented the patient\u0026apos;s first hospitalization for the condition. Exclusion was applied to records lacking complete data on demographics, diagnosis, or parameters of hospitalization burden (e.g., length of stay (LOS) and total cost).\u003c/p\u003e\n\u003cp\u003eSubsequently, the following data were extracted for analysis: patient demographics (gender, age, region), lesion site (head, neck, trunk, limbs, unknown), treatment modality (sclerotherapy, surgical resection), comorbidity/complication (congenital, infectious, circulatory system diseases, and others), and hospitalization burden (LOS and total cost). Patients were categorized into five age groups: \u0026lt;1, 1-3, 4-6, 7-12, and 13-18 years. Geographically, the 37 participating hospitals were classified into seven major regions of China: Northeast, North, East, Northwest, Southwest, South, and Central China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, gender, age, region, lesion site, treatment method, comorbidity/complication were treated as categorical variables, while length of stay (LOS) and hospitalization expenses were treated as continuous variables. Group comparisons for categorical variables were performed using the Pearson chi-square test or Fisher\u0026rsquo;s exact test, as appropriate. Continuous variables (LOS and total cost) were found to be non-normally distributed by the Shapiro-Wilk test and were therefore compared using non-parametric tests, with post-hoc analyses conducted via the Steel-Dwass test. All analyses were carried out using JMP Pro, version 15.0. A two-sided P value \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic characteristics and disease situation of inpatients with LM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study retrospectively screened 10,974,595 pediatric admission records from the FRCPD database (2016-2023), identifying 24,207 inpatients with LM (prevalence: 0.22%). As summarized in Table 1, males accounted for a higher proportion (57.97%) than females (42.03%), yielding a male-to-female ratio of 1.39:1. The age distribution was dominated by the 1-3 years subgroup (45.66%), followed by 4-6 years (22.32%), 7-12 years (15.73%), \u0026lt;1 year (14.17%), and 13-18 years (2.13%). Geographically, the highest case volumes were from East China (38.84%), Central China (20.07%), and North China (13.65%) (Figure 1).\u003c/p\u003e\n\u003cp\u003eAmong the 24,207 admission records, the trunk was the most frequently involved site (27.10%). The primary treatments for LM were sclerotherapy and surgical resection, with sclerotherapy being more commonly performed (ratio:1.57:1). Regarding associated conditions, infectious diseases were the most common comorbidity/complication (N=417), followed by congenital diseases (N=381) and circulatory system diseases (N=188), as detailed in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analysis of inpatients with LM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant male predominance was observed across all lesion sites (\u0026chi;\u0026sup2;=57.55, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; Figure 2A/B, Supplementary Table 1). Analysis of lesion distribution by age revealed that the trunk was the most common site in most age groups. Conversely, the neck was more frequently involved in children aged \u0026lt;1 year (\u0026chi;\u0026sup2;=378.01, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; Figure 3A, Supplementary Table 1). Treatment preferences varied by location: truncal lesions were more likely to be managed with surgical resection, whereas sclerotherapy was more commonly employed for other sites (Figure 3B). This association between lesion site and treatment modality was statistically significant for both sclerotherapy (\u0026chi;\u0026sup2;=1785.55, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001) and surgical resection (\u0026chi;\u0026sup2;=339.48, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.001; Supplementary Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ehospitalization burden\u0026nbsp;included LOS and total cost of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003einpatients with LM\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLeveraging this multi-center database, we were able to characterize the hospitalization burden associated with LM. As shown in Table 2, inpatients with truncal lesions incurred the highest burden among the lesion site subgroups. Furthermore, the hospitalization burden was significantly greater for surgical resection than for sclerotherapy. The presence of comorbidity/complications was also associated with increased LOS and total cost. Collectively, these results demonstrate that hospitalization burden varies importantly by lesion site, treatment modality, and the presence of comorbidity/complications.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eLymphatic malformation (LM) is a low-flow vascular malformation resulting from aberrant development of the lymphatic system during embryogenesis. It typically arises between 6 and 10 weeks of gestation, when immature lymphatic tissues fail to establish normal connections with the venous or lymphatic systems. The incidence of LM is comparable between males and females, with no significant sex-based differences. Clinically, LM usually present as soft, compressible masses consisting of fluid-filled cysts or channels, which are evident at birth or 2 years of age\u003csup\u003e[4]\u003c/sup\u003e. Consistent with this clinical course, our findings indicate that children aged 1 to 3 years constitute the primary demographic requiring hospitalization for LM management. Moreover, LM may enlarge due to intralesional hemorrhage or infection. Superficial cysts are prone to fluid leakage, which can lead to localized infection, cellulitis, or even systemic sepsis\u003csup\u003e[6]\u003c/sup\u003e. In line with this, our data identified infectious diseases as the most frequent comorbidity/complication among hospitalized children with LM. Thus, antibiotic therapy remains an essential component of the clinical management of LM.\u003c/p\u003e\n\u003cp\u003eLM typically develop in anatomical regions rich in lymphatic vessels, such as the head, neck, abdomen, groin, mediastinum, and axilla. Previous studies report that approximately 75% of LM occur in the head or neck region, where they can cause serious complications including speech disorders, dysphagia, and airway obstruction\u0026nbsp;\u003csup\u003e[7]\u003c/sup\u003e. In the abdomen, LM is most commonly located in the mesentery, omentum, and mesocolon\u003csup\u003e[8]\u003c/sup\u003e. Intraperitoneal LM accounts for 3%-9.2% of all cases, while retroperitoneal LM is exceedingly rare, comprising less than 1%\u003csup\u003e[9]\u003c/sup\u003e. In contrast, our findings indicated that among hospitalized pediatric patients with documented lesion sites, truncal involvement (41.99%) was more frequent than head and neck involvement (39.00%). This discrepancy may be attributable, in part, to the inpatient-focused design of our study, which did not include outpatient cases, and the fact that lesion site information was unavailable for 35.34% (8555/24207) of the included inpatients.\u003c/p\u003e\n\u003cp\u003eLymphatic malformation (LM) is currently managed in clinical practice primarily through sclerotherapy, surgical resection, and laser therapy, with the principal goals of restoring or preserving function and addressing aesthetic concerns\u003csup\u003e[10]\u003c/sup\u003e. The selection of a specific treatment modality depends on the location, size, and clinical manifestations of the LM. Surgical resection is mainly indicated for well-localized microcystic or macrocystic LM. However, complete excision is often challenging due to the complex and infiltrative nature of these lesions. Reported recurrence rates after surgical resection range from 13% to 33%, with a 2-6% risk of permanent nerve damage\u003csup\u003e[11]\u003c/sup\u003e\u003csup\u003e-12]\u003c/sup\u003e. Consequently, percutaneous sclerotherapy and pharmacotherapy play a crucial role in managing extensive or deep-seated lesions that are not amenable to surgery. Commonly used sclerosants include 3% sodium tetradecyl sulfate, doxycycline, and bleomycin. Notably, bleomycin is the only sclerosant effective against microcystic disease\u003csup\u003e[13]\u003c/sup\u003e, with one study reporting significant treatment response in 80% of macrocystic and 50% of microcystic LM during 1-3 years of follow-up\u003csup\u003e[14]\u003c/sup\u003e. Percutaneous sclerotherapy is also considered safe for infants, including newborns under one year of age\u003csup\u003e[15]\u003c/sup\u003e. Nevertheless, some studies have indicated that surgery-sometimes combined with sclerotherapy-may yield superior outcomes compared to sclerotherapy alone\u003csup\u003e[16-]\u003c/sup\u003e\u003csup\u003e[19]\u003c/sup\u003e. In addition, carbon dioxide laser therapy is a safe and effective option for superficial intraoral and cutaneous lesions, albeit with a relatively high recurrence rate\u003csup\u003e[20]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eOur findings reflect a clear anatomical preference in treatment selection: sclerotherapy was predominantly used for head/neck and extremity lesions, whereas surgical resection was more frequently applied to truncal lesions. It should be noted that laser therapy for LM is mostly performed in outpatient settings and was therefore not captured in this inpatient-based study.\u003c/p\u003e\n\u003cp\u003eDespite advances in treatment, approximately one-third of patients with refractory LM experience recurrence after surgical excision or sclerotherapy. The precise pathogenesis of LM remains incompletely elucidated; however, growing evidence indicates that multiple genes and regulatory factors collectively orchestrate lymphatic vascular development, and their dysregulation contributes to the initiation and progression of LM. Notably, recurrent somatic mutations in\u0026nbsp;PIK3CA\u0026nbsp;have been identified in the majority of LM cases, underscoring the central role of the PI3K/AKT/mTOR signaling pathway in its pathogenesis\u003csup\u003e[21]\u003c/sup\u003e. Sirolimus, an mTOR inhibitor, is supported by the strongest clinical evidence for treating diffuse or complex LM. Several multi-center studies have reported that oral sirolimus leads to clinical regression in 50-80% of pediatric patients \u003csup\u003e[22, 23]\u003c/sup\u003e. Given the heterogeneity in lesion location, extent, and morphological sub-type, the management of LM necessitates individualized therapeutic strategies tailored to the specific clinical scenario.\u003c/p\u003e\n\u003cp\u003eThis study represents the first systematic report on the hospitalization burden of pediatric LM. Our results demonstrated that sclerotherapy was associated with a significantly shorter length of stay and lower hospitalization expenses compared to surgical resection, which may partly account for its more frequent utilization in clinical practice.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study has several limitations. First, its retrospective design relies on the accuracy and completeness of medical records, which may affect data reliability. Second, the analysis was confined to conventional treatments such as sclerotherapy and surgery, and did not include emerging targeted therapies like PI3K/mTOR inhibitors. Future studies should incorporate multimodal strategies-combining molecular targeted therapy, interventional procedures, and pharmacotherapy-to enable more comprehensive clinical evaluations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBy analyzing a large multi-center cohort of pediatric inpatients with LM, this study provides contemporary insights into the clinical characteristics and hospitalization burden of this condition in China. These findings highlight the significant healthcare resource utilization associated with LM and underscore the need for enhanced clinical awareness and informed resource allocation to better address the needs of this patient population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFull Term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eLM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eLymphatic malformation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eFRCPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eFutang Research Center of Pediatric Development\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eLECs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003elymphatic endothelial cells\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eISSVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eInternational Society for the Study of Vascular Anomalies\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003eLOS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 284px;\"\u003e\n \u003cp\u003elength of stay\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was supported by Beijing Natural Science Foundation (No. 7244337 and 7244334)，Construction of the Clinical Diagnosis and Research Centre of Capital Medical University (0400-190003),Science and Technology Innovation Development Project, Beijing Children\u0026rsquo;s Hospital, Capital Medical University, National Center for Children\u0026rsquo;s Health (YN2020402).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol for this study received ethical approval from the Ethics Committee of Beijing Children\u0026apos;s Hospital, Capital Medical University (Number: 2020-k-10) and was performed in line with the tenets of the Declaration of Helsinki.Informed consent for participation in the study was obtained from the parents or legal guardians of all participants under the age of 16.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are not publicly available as they contain sensitive, personally identifiable health information, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflicting interest associated with this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to investigators from members of the Futang Research Center of Pediatric Development (FRCPD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026rsquo; contributions were as follows. SW, LM, LS, XL, NS, QL, XZ, ZL YM, GZ contributed to the conception and design of the study. LM contributed to acquisition, analysis and interpretation of the data. LM, LS wrote the MS. SW, LM, LS, XL, NS, QL, XZ, ZL YM, GZ collected data. XL, NS, QL, XZ, ZL YM, GZ revised the MS. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eZhang C, Liu J, Wang Y, Zheng Y, Malashicheva A, Qi L. Xiaohong Shi, Ju Liu; Lymphatic Malformation: Classification, Pathogenesis, and Therapeutic Strategies. Ann Vasc Surg. 2025;121:35\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAcord M, Abhay S, Srinivasan. Anne Marie Cahill; Percutaneous Treatment of Lymphatic Malformations. Tech Vasc Interv Radiol. 2016;19(4):305\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJos\u0026eacute;e, Dubois. Fr\u0026eacute;d\u0026eacute;ric Thomas-Chauss\u0026eacute;, Gilles Soulez; Common (Cystic) Lymphatic Malformations: Current Knowledge and Management. Tech Vasc Interv Radiol. 2019;22(4):100631.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaija M\u0026auml;kinen, Laurence M, Boon M, Vikkula. Kari Alitalo; Lymphatic Malformations: Genetics, Mechanisms and Therapeutic Strategies. Circulation Res 2021 06 25;129(1):136\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXinyu Wang Y, Zeng J, Tian H, Xu F, Song Y, Guo X, Xu G, Feng. Xin Ni; A brief introduction to the FUTang Updating medical REcords (FUTURE) database. Pediatr Invest. 2021;5(3):247\u0026ndash;8. 10.1002.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRavindhra G, Elluru K, Balakrishnan, Horacio M. Padua; Lymphatic malformations: diagnosis and management. Semin Pediatr Surg. 2014;23(4):178\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnn M, Kulungowski M. Lymphatic malformations. Semin Pediatr Surg. 2020;29(5):150971.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlex Guachilema Ribadeneira, \u0026Aacute;ngel Ra\u0026uacute;l Tapia Monard, Endara MC. Cristian German Garcia, Milton Omar Sandoval, David Alejandro C\u0026aacute;rdenas, Andrea Daniela Basantes; Intra-abdominal cystic lymphangioma of the mesocolon sigmoids: a rare entity in adult patient woman. Journal of surgical case reports 2020;2020(5):rjaa031.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVan Hoang T, Nguyen MD. Hoang Anh Thi Van, Duc Thanh Hoang; Review of diagnosis, differential diagnosis, and management of retroperitoneal lymphangioma. Japanese J Radiol. 2023;41(3):283\u0026ndash;301.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNeil M, Kalwani, Stanley G, Rockson. Management of lymphatic vascular malformations: A systematic review of the literature Journal of vascular surgery. Venous lymphatic disorders. 2021;07(4):1077\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZobel MJ, Nowicki D, Gomez G, Lee J, Howell L, Miller J, Zeinati C, Dean M. Anselmo; Management of cervicofacial lymphatic malformations requires a multidisciplinary approach. J Pediatr Surg. 2021;56(5):1062\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKento Suzuki S, Fumino M, Iguchi S, Takayama K, Kim S, Hirano. Shigeru Ono; Multidisciplinary therapeutic strategy with appropriate timing and modalities for treating cervicofacial lymphatic malformations in children. Pediatr Surg Int. 2024;41(1):35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGulraiz Chaudry CJ, Guevara KL, Rialon C, Kerr JB, Mulliken AK, Greene SJ, Fishman. Debra Boyer, Ahmad I Alomari; Safety and efficacy of bleomycin sclerotherapy for microcystic lymphatic malformation. Cardiovasc Interv Radiol. 2014;37(6):1476\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuir T, Kirsten M, Fourie P, Dippenaar N, Ionescu GO. Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations. Pediatr Surg Int. 2004;19(12):766\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCaton MT, Duvvuri M, Baker A, Smith ER, Kazim H, Narsinh MR, Amans, Steven W, Hetts, Randall T, Higashida DL, Cooke, Christopher F. Dowd; Percutaneous sclerotherapy for head and neck lymphatic malformations in neonates and infants\u0026thinsp;\u0026le;\u0026thinsp;12 months of age. J neurointerventional Surg. 2023;15(12):1242\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJin L, Chen J, Li X. Surgical Excision With Bleomycin Irrigation: A Better Primary Treatment Choice for Pediatric Submandibular Lymphatic Malformations. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 2017;75(2):437.e1-437.e7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBai Y, Jia J, Huang X-X, Alsharif MJ, Zhao J-H. Sclerotherapy of microcystic lymphatic malformations in oral and facial regions. J oral maxillofacial surgery: official J Am Association Oral Maxillofacial Surg. 2009;67(2):251\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTadaharu Okazaki S, Iwatani T, Yanai H, Kobayashi Y, Kato T, Marusasa GJ, Lane. Atsuyuki Yamataka; Treatment of lymphangioma in children: our experience of 128 cases. J Pediatr Surg. 2007;42(2):386\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Y, Tang W. Safety and efficacy of surgery combined with bleomycin irrigation for complex cervical-facial lymphatic malformations of children. Int J Pediatr Otorhinolaryngol. 2020;128:109724.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGerald G, Behr, Craig M. Vascular anomalies: hemangiomas and beyond\u0026ndash;part 2, Slow-flow lesions AJR. Am J Roentgenol. 2013;200(2):423\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCalne RY, Collier DS, Lim S, Pollard SG, Samaan A, White DJ. Rapamycin for immunosuppression in organ allografting. Lancet (London England). 1989;2(8656):227.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiegand S, Wichmann G. Treatment of Lymphatic Malformations with the mTOR Inhibitor Sirolimus: A Systematic Review. Lymphatic Res biology. 2018;08(4):330\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/lrb.2017.0062\u003c/span\u003e\u003cspan address=\"10.1089/lrb.2017.0062\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMelissa Dodds M, Tollefson L, Castelo-Soccio MC, Garzon M, Hogeling K, Hook. Christina Boull, Sheilagh Maguiness; Treatment of superficial vascular anomalies with topical sirolimus: A multicenter case series. Pediatr Dermatol. 2020;37(2):272\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":" \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe baseline characteristics of patients with Lymphatic malformation (LM).\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCategories\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003ePediatric inpatients (numbers)\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSUM\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e24207\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eGender\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eMale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e14033\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e10174\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eAge\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;1 years old\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3429\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e1\u0026ndash;3 years old\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11054\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e4\u0026ndash;6 years old\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5402\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e7\u0026ndash;12 years old\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3807\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e13\u0026ndash;18 years old\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e515\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eRegion\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNortheast China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e848\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNorth China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3305\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eEast China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9401\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSouth China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1667\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCentral China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4859\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNorthwest China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2350\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSouthwest China\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e1777\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLesion site\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHead\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2042\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNeck\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4051\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTrunk\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e6561\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLimbs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e2998\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnknown\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e8555\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTreatment method\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSclerotherapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12027\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12180\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical resection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7669\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e16538\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eComorbidites and complications\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCongenital diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e381\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eInfectious diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e417\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCirculatory system diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e188\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOthers\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e149\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cdiv class=\"SimplePara\"\u003eThe LOS and total cost of patients with LM in different groups.\u003c/div\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHospitalization burden\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003eLength of hospital stay\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(LOS, days)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003eχ2\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003eP\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003eTotal cost\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(\u0026yen;)\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003eχ2\u003c/div\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003eP\u003c/div\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eLesion site\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1479.67\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1421.35\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eHead\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4(2,6)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e7617.83\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(5144.18,9932.47)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eNeck\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e5(3,8)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e8087.25\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(4976.6,11553.94)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eTrunk\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7(4,11)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e11044.48\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(6962.24,18433.95)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eLimbs\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4(2,7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e8093.03\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(5735.46,10387.75)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eUnknown\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4(2,7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e7761.25\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(5603.59,10413.49)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTreatment method\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSclerotherapy\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e3(2,5)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e5518.37\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e7585.98\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(5521.05, 9715.10)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e1267.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7(4,11)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e9962.82\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(6129.38,15530.17)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eSurgical resection\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eYes\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e7(3,11)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e1634.89\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e10293.73\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(7735.95,14885.92)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e2417.47\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cdiv class=\"SimplePara\"\u003eNo\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e4(2,7)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e7561.73\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(4604.36,10604.67)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eComorbidity/complication\u003c/span\u003e\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCongenital diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e9(4,15)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e110.85\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e13018.09\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(8318.71,21888.21)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e148.75\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eInfectious diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e11(7,17)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e403.42\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e15676.40\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(7373.33,27225.80)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e198.59\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eCirculatory system diseases\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12(7,16)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e172.70\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e16657.31\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(10381.23,23373.05)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e147.12\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cdiv class=\"SimplePara\"\u003eOthers\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cdiv class=\"SimplePara\"\u003e12(6,19)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cdiv class=\"SimplePara\"\u003e129.22\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cdiv class=\"SimplePara\"\u003e24621.04\u003c/div\u003e \u003cdiv class=\"SimplePara\"\u003e(12127.27,42288.65)\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cdiv class=\"SimplePara\"\u003e163.55\u003c/div\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cdiv class=\"SimplePara\"\u003e\u0026lt;\u0026thinsp;0.001\u003c/div\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"hospital admission records, lymphatic malformation (LM), clinical characteristics, hospitalization burden","lastPublishedDoi":"10.21203/rs.3.rs-8857709/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8857709/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eLymphatic malformation (LM) is a low-flow vascular malformation caused by the abnormal development of the lymphatic system. This study aimed to provide an update on pediatric LM by investigating its clinical characteristics and hospitalization burden in multiple medical centers across China.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study utilized data from the Futang Research Center of Pediatric Development (FRCPD). All hospitalization records from January 1, 2016, to December 31, 2023 (N\u0026thinsp;=\u0026thinsp;10,974,595) were screened to identify children with LM. For these patients, a comprehensive analysis of clinical characteristics (e.g., demographics, lesion location, treatment, comorbidity/complication) and hospitalization burden (i.e., length of stay and total cost) was conducted.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOur study comprised 24,207 inpatients with LM, predominantly from the eastern region. The typical hospitalized patient was a child aged 1\u0026ndash;3 years or trunk involvement. Strikingly, sclerotherapy was 1.57 times more common than surgical resection. The most frequent comorbidity/complication were infectious diseases. Treatment patterns also varied by anatomy: lesions in the trunk favored surgical resection, while other areas usually undergo sclerotherapy. Critically, hospitalization burden differed significantly based on lesion site, treatment received, and the presence of comorbidity and complication.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eBy analyzing a national cohort of pediatric inpatients with LM, this study provides contemporary insights into the clinical characteristics and hospitalization burden of this condition in China. These findings underscore the substantial healthcare impact of LM and are critical for informing future healthcare strategies and resource allocation.\u003c/p\u003e","manuscriptTitle":"A National Multicenter Analysis of Hospitalization Admission Records for Lymphatic Malformations in China from 2016 to 2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-26 17:40:13","doi":"10.21203/rs.3.rs-8857709/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-24T06:47:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T10:59:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-10T16:41:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T19:20:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331293160277406185549634909731295079929","date":"2026-02-26T16:38:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"84405621960967056615717059490081164470","date":"2026-02-25T08:43:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"308516259279181134141341746374440359116","date":"2026-02-25T01:01:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311459274458857168400622542731925766325","date":"2026-02-24T19:12:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"61203294925586025219950545927436919396","date":"2026-02-24T14:37:33+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T13:49:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-24T13:45:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-24T06:15:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-23T12:42:45+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-02-23T12:39:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0766c330-ab9e-44a1-b1d6-4d9ede61d86c","owner":[],"postedDate":"February 26th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T06:08:05+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-26 17:40:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8857709","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8857709","identity":"rs-8857709","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}