International Journal of Contemporary Pediatrics

Beyond nutritional: a case series of thalassemia trait

2026-01-27T21:13:46+0530

Microcytic anemia in children is frequently attributed to iron deficiency, yet not all cases improve with adequate iron therapy. When anemia persists despite normal iron stores, other causes-particularly hemoglobinopathies-must be considered. This report describes three children who presented with ongoing microcytic hypochromic anemia that did not resolve with appropriate iron supplementation. All had documented treatment adherence and iron profiles within the expected range for sufficiency. Each child underwent a structured evaluation. Two were found to have elevated HbA2 levels on hemoglobin electrophoresis, establishing a diagnosis of beta-thalassemia trait. The third child had nondiagnostic electrophoresis findings but demonstrated heterozygous deletions in the HBA1 and HBA2 genes on molecular analysis, confirming alpha-thalassemia trait. None of the children exhibited organomegaly, significant clinical symptoms, or dysmorphic features, and their growth parameters were appropriate for age. The consistent finding across all cases was persistent microcytosis despite biochemical evidence of adequate iron. These cases emphasize the importance of considering thalassemia traits when confronted with pediatric anemia that does not respond as expected to iron therapy. Recognizing characteristic red-cell indices and pursuing targeted investigations can prevent repeated or unnecessary treatment and allow families to receive appropriate genetic counseling. Early and accurate identification of hemoglobinopathies contributes to better long-term management and ensures that healthcare resources are used appropriately.

Retrospective study of ultrasound defined adnexal masses in adolescent girls: a case series

2026-01-27T21:13:38+0530

Ovarian torsion is an uncommon but critical surgical emergency in adolescent girls, often presenting as acute lower abdominal pain that can mimic other abdominal conditions. Prompt diagnosis and timely surgical intervention are essential to prevent irreversible adnexal damage and preserve fertility. Objective was to analyse the clinical presentation, diagnostic findings, surgical management, and histopathological outcomes of ultrasound-defined adnexal masses in adolescent girls. This retrospective study was conducted on 18 adolescent girls aged 11–19 years diagnosed with adnexal masses at Vijaya Hospital, Chennai, from 2019 to 2025. Data regarding demographic details, symptoms, imaging findings, intraoperative observations, management procedures, and histopathological diagnoses were reviewed. The mean age of presentation was 17 years. Most patients presented with acute-onset right-sided lower abdominal pain of less than 48 hours’ duration, often associated with vomiting. Ultrasound was the primary diagnostic modality, though the presence of vascular flow did not exclude torsion. Laparoscopic detorsion with cystectomy was the most frequent management approach. Histopathological evaluation predominantly showed benign lesions such as serous, mucinous, and para-ovarian cysts. Follow-up imaging revealed either normal or polycystic ovaries in most cases. Ovarian torsion should be considered in all adolescent girls presenting with sudden lower abdominal pain. Ultrasound remains the initial diagnostic tool, but surgical exploration confirms the diagnosis. Conservative management with detorsion is recommended to preserve ovarian function and future fertility.

One shade fits all – aesthetic solutions for primary teeth restoration using smart monochromatic composites: a case series

2026-01-27T21:11:30+0530

Achieving optimal aesthetic outcomes in paediatric dental restorations remains a clinical challenge due to limitations in shade matching and durability of conventional materials. This paper consists of series of 8 cases who presented with carious lesions in both anterior and posterior primary teeth. All the cases were treated with smart monochromatic composite restorations and followed up for period of 6 months. The restorations demonstrated excellent colour integration, minimal wear, and no evidence of secondary caries, while both patients and parents reported high levels of satisfaction.

Systematic assessment and management of obesity-related asthma in children: a practical clinical framework

2026-01-23T08:57:21+0530

Childhood obesity significantly worsens asthma risk, symptom burden, and clinical outcomes, yet consistent, practical guidance for managing this common comorbidity is lacking in routine care. This review outlines a clinically actionable framework for assessing and treating obesity‑related asthma in children, emphasizing Body Mass Index percentile classification, age‑appropriate lung function testing, structured asthma control evaluation, and screening for comorbidities such as sleep‑disordered breathing, reflux, metabolic dysfunction, and mental health concerns. Ongoing management should include regular monitoring of respiratory status, weight trajectory, and comorbidity burden. Effective care requires a dual‑target approach that pairs standard asthma pharmacotherapy with comprehensive, family‑centered weight‑management strategies, including nutrition improvement, increased physical activity, behavioral support, and reduced sedentary time, with pharmacologic weight‑management options reserved for select adolescents with severe obesity. Integrating systematic identification, structured follow‑up, and coordinated treatment can meaningfully improve lung function, asthma control, cardiometabolic health, and overall quality of life for affected children.

Serum ferritin and cardiogenic shock in severe pediatric dengue: pathophysiology, evidence and clinical correlation - a narrative review

2026-01-27T21:13:39+0530

Severe dengue infection in children can lead to life-threatening shock classically attributed to plasma leakage. However, emerging evidence links hyperinflammation – often reflected by extreme elevations in serum ferritin – with myocardial dysfunction and cardiogenic shock in dengue. Ferritin, an acute-phase reactant, is markedly elevated in hyperinflammatory syndromes such as hemophagocytic lymphohistiocytosis (HLH), which is increasingly recognized as a complication of severe dengue. This narrative review critically examines the pathophysiology connecting dengue virus infection, hyperferritinemia, and cardiac dysfunction. We summarize key studies demonstrating that serum ferritin levels correlate with dengue severity and outcomes, including recent pediatric cohorts where ferritin >10,000 ng/ml portended higher mortality. Myocardial involvement in dengue – ranging from transient functional impairment to fulminant myocarditis – is discussed in light of cytokine-mediated injury and HLH-like immune activation. We also outline clinical implications, recommending vigilance for “dengue-HLH” in severe cases with unexplained shock and very high ferritin, and considering adjunctive immunomodulatory therapy in addition to standard supportive care. State-of-the-art evidence is presented to guide clinicians in early identification of hyperinflammatory dengue cases, prompt cardiac support (inotropes, fluid management, and extracorporeal life support when needed), and potential interventions to improve outcomes. This review provides a comprehensive, evidence-based update on the role of serum ferritin as both a biomarker and a clue to pathogenic processes (including HLH) that can culminate in cardiogenic shock in pediatric dengue.

Vaccination coverage among children aged 1–59 months admitted to four health facilities in Brazzaville

2026-01-23T08:57:28+0530

Background: Immunization is an effective intervention for preventing morbidity and complications associated with infectious diseases in children. Objectives were to contribute to improving vaccination coverage among children aged 1-59 months admitted to hospitals in Brazzaville.

Methods: A cross-sectional study on childhood vaccination coverage was conducted between January and October 2021 in four health facilities in Brazzaville. Children aged 1-59 months who were hospitalized and whose parents provided consent were included. Study variables included sociodemographic characteristics, parental knowledge of immunization, and children’s vaccination status. Statistical tests used were chi-square and odds ratio with a significance level of p<0.05.

Results: A total of 217 children were included, 53% of whom were boys (sex ratio=1.1). Children older than 2 years accounted for 36.4% (n=79). The rate of vaccination card ownership was 48.4% (n=105). Among these, 75.2% (n=79) were up to date with their vaccines up to the age of 9 months. The dropout rate between BCG and measles vaccine (VAR) was 53.3%, and the lowest coverage was observed for measles and yellow fever vaccines at 46.7% (n=49). Gender, maternal education level, and mothers’ knowledge of target diseases significantly influenced vaccination coverage (p<0.05).

Conclusions: Improving the low vaccination coverage among children aged 1-59 months requires revitalizing the expanded program on immunization (EPI).

Blood culture patterns and antibiotic resistance in preterm low birth weight babies with neonatal sepsis

2026-01-27T21:11:42+0530

Background: Neonatal sepsis remains a leading cause of morbidity and mortality among preterm infants and rising antimicrobial resistance (AMR) among Gram-negative pathogens poses a significant challenge to treatment. This study evaluated blood culture patterns, antibiotic resistance and clinical outcomes in neonates with sepsis admitted to a tertiary care center in Bangladesh.

Methods: A retrospective observational study was conducted in the NICU of Bangladeshi Specialized Hospital, Dhaka, from January 2023 to December 2024. A total of 144 neonates (0–28 days) with suspected or confirmed bacterial sepsis were analyzed. Demographic, clinical, laboratory and treatment data were extracted and blood culture isolates were tested for antibiotic susceptibility using the VITEK 2 system per CLSI guidelines.

Results: The majority of neonates were male (59.7%) and early preterm (50%), with a mean admission age of 2.92±2.21 days. Late-onset sepsis predominated (73.61%) and respiratory distress was the most common clinical sign (66.67%). Blood culture positivity was 22.92%, with Klebsiella pneumoniae (51.52%) and Acinetobacter spp. (33.33%) being the most common isolates. Klebsiella pneumoniae was 100% sensitive to tigecycline and 94.1% to colistin but showed <6% sensitivity to first-line antibiotics. Supportive care included phototherapy (75%), NG feeding (70.14%) and CPAP (63.89%). Survival at discharge was 96.53%, with a mean NICU stay of 14.82±8.24 days.

Conclusions: MDR Gram-negative sepsis is a growing threat in NICUs, with declining efficacy of first-line antibiotics. The reliance on colistin and tigecycline raises concerns for future treatment options if resistance to these agents develops. Strong infection control, antimicrobial stewardship and updated antibiogram surveillance are essential to combat this trend.

Clinical patterns, management and outcomes of shock in children: a five-year review from a tertiary hospital in South-South Nigeria

2026-01-27T21:11:32+0530

Background: Shock is a life-threatening paediatric emergency marked by inadequate tissue perfusion and rapid progression to organ failure if untreated. Mortality remains high in low- and middle-income countries, where delayed recognition and limited resources hinder optimal care. Septic and hypovolaemic shock predominate in sub-Saharan Africa, often driven by infectious diseases and malnutrition. Understanding local patterns is essential for improving early detection and treatment. Therefore, the study aimed to describe the clinical features, management practices and factors associated with mortality among children admitted with shock to the Children’s Emergency Ward of Federal Medical Centre, Yenagoa.

Methods: A retrospective review of children admitted with shock between January 2018 and December 2022 was conducted. Case notes were examined for demographic data, presenting features, laboratory findings, type of shock, interventions and outcomes. Data were analysed using SPSS version 26. Associations were assessed using Chi-square or Fisher’s exact test.

Results: Fifty-four cases were identified among 4,453 admissions. Septic shock was the most common type. Severe malnutrition, hypoglycaemia, anaemia, electrolyte derangements, leukocytosis and low oxygen saturation were significantly associated with mortality. Use of intraosseous access and inotropes was linked with poor outcomes, while fluid-only resuscitation had the best survival. All deaths occurred within 48 hours.

Conclusions: Septic shock remains the dominant and most fatal form of paediatric shock in this setting. Early recognition, prompt resuscitation and strengthened emergency care systems are critical to improving outcomes.

Ultrasound as a first-line imaging tool in paediatric appendicitis: diagnostic yield and limitations

2026-01-27T21:11:28+0530

Background: Acute appendicitis remains a common and clinically significant cause of abdominal pain in children and despite widespread use of ultrasound as the preferred first-line imaging modality, its diagnostic performance continues to show variability across different clinical settings due to factors such as operator dependence and appendix visualization rates. The purpose of the study is to evaluate the diagnostic yield and limitations of ultrasound as a first-line imaging modality in children with suspected acute appendicitis.

Methods: This prospective observational study at the Department of Radiology and Imaging, Bangladesh Shishu hospital and institute, Bangladesh (June 2023–July 2024) included 100 pediatric patients with suspected appendicitis. All underwent abdominal ultrasound and final diagnosis was confirmed by surgery, histopathology or clinical follow-up. Diagnostic performance was calculated using 2×2 tables and analyzed with SPSS 25.0.

Results: The study included 100 pediatric patients (mean age 10.27±3.33 years), with 58% males. The appendix was visualized on ultrasound in 78% of cases; 55% showed features suggestive of appendicitis and 23% appeared normal. Acute appendicitis was confirmed in 60% of patients. Ultrasound yielded 52 true positives, 35 true negatives, 8 false negatives and 5 false positives, resulting in a sensitivity of 86.7%, specificity of 87.5%, positive predictive value of 91.2%, negative predictive value of 81.4% and an overall diagnostic accuracy of 87.0%.

Conclusions: Ultrasound is a reliable first-line imaging tool for pediatric appendicitis, effectively identifying most cases while minimizing the need for invasive or radiation-based investigations.

Study of risk factors associated with anaemia in children admitted to a subdistrict hospital

2026-01-08T07:53:05+0530

Background: Anaemia remains a significant public health problem among children, particularly in developing countries, leading to impaired growth, cognitive delay, and increased morbidity. Identifying the underlying risk factors is essential for effective prevention and management. Objectives were to study the prevalence and risk factors associated with Anaemia among children admitted to a subdistrict hospital.

Methods: A cross-sectional observational study was conducted among 100 children admitted to the paediatric ward of a subdistrict hospital from April to September 2025. Detailed demographic data, dietary history, socioeconomic status (SES), clinical findings, and relevant laboratory investigations were recorded. Haemoglobin estimation was performed, and anaemia was classified as per WHO criteria. The association between potential risk factors and anaemia was analysed using appropriate statistical tests.

Results: Overall, 65% of children were anaemic, with moderate anaemia observed in 55% and severe anaemia in 10%. Anaemia was significantly more prevalent among children with low birth weight (<2.5 kg) (81.0% vs 42.9%; OR=5.70; p<0.001). Children of mothers with low educational status had higher odds of anaemia (84.7% vs 36.6%; OR=9.63; p<0.001). Lower SES was also significantly associated with anaemia (81.1% vs 46.8%; OR=4.89; p<0.001). The prevalence and severity of anaemia increased with worsening nutritional status. Exclusive breastfeeding showed no statistically significant association with anaemia (p=0.23).

Conclusions: Anaemia is highly prevalent among hospitalized under-five children and is strongly associated with low birth weight, poor maternal education, low SES, and malnutrition. Early screening and targeted nutritional and maternal interventions are essential to reduce the burden of childhood anaemia.

Correlation of hypoxemia with clinical signs in children aged 2 months to 5 years with acute lower respiratory tract infection: a prospective observational study

2026-01-27T21:11:29+0530

Background: Acute lower respiratory tract infection (LRTI), particularly pneumonia, is a leading cause of morbidity and mortality in children under five years of age globally. Hypoxemia is a major complication and risk factor for death in these patients. This study aimed to correlate hypoxemia with clinical signs, laboratory markers and outcomes in children with acute LRTI.

Methods: A prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital Dhiraj Hospital Piparia. The study enrolled 61 children aged 2 months to 5 years diagnosed with WHO-defined community-acquired pneumonia. Clinical signs, anthropometry, laboratory parameters (CBC, CRP) and chest X-rays were recorded. Oxygen saturation (SpO2) was monitored every 6 hours. Hypoxemia was defined as SpO2 ≤ 90%. Statistical analysis was performed to determine associations between hypoxemia and clinical variables.

Results: Of 61 patients, 59.02% (36/61) presented with hypoxemia. The majority were infants (75.41%) and males (73.77%). Hypoxemia was significantly associated with nasal flaring (p=0.022), chest indrawing (p=0.011) and the combination of both (p=0.001). All patients presenting with cyanosis (100%) were hypoxemic. Radiological consolidation was significantly associated with lower SpO2 (p=0.003), as were elevated total leukocyte counts (p=0.029) and C-reactive protein levels (p=0.006). Longer duration of oxygen support was required in hypoxemic patients (p=0.012). No significant association was found between hypoxemia and age, gender, nutritional status, severity of anemia or severity of pneumonia classification.

Conclusions: Clinical signs such as nasal flaring, chest indrawing and cyanosis are reliable bedside predictors of hypoxemia in children with LRTI. While pulse oximetry remains the gold sta

Quality improvement initiative to improve the availability of mother’s own milk for feeding preterm babies admitted to NICU

2026-01-27T21:11:23+0530

Background: Ensuring timely availability of mother’s own milk (MOM) for preterm infants admitted to neonatal intensive care units is challenging. We aimed to improve MOM availability for feeding preterm infants by postnatal day 5 (PND5) through a structured quality improvement approach.

Methods: This prospective pre–post intervention QI study was conducted over 6 months in a tertiary-care NICU. Preterm infants <34 weeks with hospital stay ≥5 days were included. The QI phases were baseline (August 2023), three sequential monthly PDSA cycles (September–November 2023) and sustenance (December 2023–January 2024). The primary outcome was a unit-day metric: the mean proportion of prescribed enteral milk requirement met by MOM from PND1–PND5, with PND5 as the primary endpoint. Infant-days with nil per oral status or zero prescribed enteral volume were excluded. Process measures were proportion of mothers expressing milk within 4 hours of birth; and proportion of mothers expressing milk ≥8 times/day.

Results: In all phases of the study, the expression of milk within 4 hours showed improvement and the availability of MOM increased from day 1 to day 5. Process measures improved. Expression within 4 hours and Expression ≥8 times/day also increased from baseline values.

Conclusions: A phased package of counselling, family participatory care, reminder systems and lactation counsellor support were associated with improved MOM availability by PND5. This was accompanied by improved early and frequent milk expression and gains were maintained subsequently.

Incidence of hypocalcemia in pediatric patients with Down syndrome: a prospective observational study

2026-01-27T21:13:47+0530

Background: Down syndrome (DS) is the most frequently occurring chromosomal condition, affecting from 1 in 700 to 1 in 1,500 live-born babies. Children with DS are at high risk of developing metabolic and endocrine abnormalities such as thyroid dysfunction, diabetes mellitus, obesity, short stature, vitamin D deficiency, low bone mineral density, and gonadal dysfunction than the general population. However, the prevalence and persistence of hypocalcemia in early childhood remain underexplored. This study aimed to assess the incidence and significance of hypocalcemia in pediatric patients with DS aged 1 to 5 years.

Methods: A prospective observational study was conducted on 55 children with genetically confirmed DS, aged 1 to 5 years. Serum calcium, phosphate, and parathyroid hormone (PTH) levels were measured at baseline and followed up for over 12 months. Vitamin D levels and dietary calcium intake were also assessed. Statistical analysis was performed to compare hypocalcemia prevalence with general pediatric population data.

Results: Hypocalcemia (serum calcium <8.5 mg/dl) was observed in 21 out of 55 children (38.2%), which was significantly higher than in the general pediatric population (p<0.001). Hypoparathyroidism was identified in 11 cases (20%), with persistently low PTH levels. Vitamin D deficiency was present in 27 children (49%), contributing to secondary hypocalcemia in some cases. Clinical symptoms: Hypotonia (35%), delayed motor milestones (22%), and seizures (7%).

Conclusions: Hypocalcemia is significantly more prevalent in children with DS aged 1 to 5 years, with hypoparathyroidism and vitamin D deficiency being major contributing factors. Routine screening and early calcium and vitamin D supplementation may help prevent complications in this vulnerable population.

Effectiveness of knowledge, confidence and breastfeeding practices among postnatal mothers: a structured educational interventional study

2026-01-27T21:13:45+0530

Background: Breastfeeding is essential for infant and maternal health, but exclusive breastfeeding rates remain low due to lack of knowledge, cultural barriers, and insufficient counselling. Structured educational interventions can bridge this gap.

Methods: A hospital-based interventional study was conducted on 165 postnatal mothers at LN Medical College and JK Hospital, Bhopal. Mothers received structured counselling sessions with demonstrations, interactive discussions, and educational materials. Knowledge, confidence, and breastfeeding practices were assessed before and after the intervention using questionnaires and confidence scales.

Results: The study showed significant improvement in knowledge, confidence, and breastfeeding practices after counselling. Prior to the intervention, only 20% of mothers understood the benefits of colostrum, which increased to 100% post- intervention. Confidence in exclusive breastfeeding improved markedly, with 94% strongly agreeing they could successfully breastfeed their second child even if they had failed with the first. Improvements were statistically significant (p<0.05).

Conclusions: Structured postnatal education effectively improves maternal knowledge, confidence, and breastfeeding practices. Incorporating counselling into routine postnatal care is a low-cost, high-impact strategy to enhance maternal and child health outcomes in India.

Calming contest - a battle between nitrous oxide and oral sedation - who wins in paediatric minds

2026-01-27T21:13:44+0530

Background: The aim of the study was to compare the pre and post use of oral melatonin as oral sedative drug with nitrous oxide-oxygen sedation in young uncooperative children.

Methods: Twenty children aged 5 to 10 years were chosen to participate in the study and were equally divided into two groups: group 1 oral melatonin and group 2 nitrous oxide sedation. Parameters evaluated included Ramsay sedation scale, Houpt behaviour rating scale and Chota Bheem scale for anxiety, heart rate and oxygen saturation. The student t-test was used to compare the groups, and proportions were analysed using the Chi-square test.

Results: The treatment carried out was successful in 80% and 73% of the children in the melatonin and nitrous oxide groups respectively with no statistically significant differences between the two groups.

Conclusion: The study found that children aged 5 to 10 years can be sedated well with either of the sedative regimens. However, administering nitrous oxide oxygen sedation requires clinically higher patient compliance.

Breastfeeding initiation and exclusive breastfeeding practices among postnatal mothers in North Kerala

2026-01-27T21:13:43+0530

Background: Early initiation and exclusive breastfeeding are one of the most effective ways to ensure child’s survival, growth and development. Breast milk is the ideal food for infants which helps to protect against many common childhood illnesses and provides all the energy and nutrients that needed for the first months of life. However, only less than half of infants under 6 months old are exclusively breastfed. This study is aimed to assess the early initiation, knowledge and exclusive breastfeeding practices among postnatal mothers in the community of Perinthalmanna, North Kerala.

Methods: A community based cross sectional study was conducted among 146 postnatal mothers with infants aged 0–6 months for a period of 3 months. Data were collected using a structured questionnaire covering socio-demographic details, early initiation of breastfeeding, exclusive breastfeeding and influencing factors. Descriptive analysis was performed using percentages and proportions.

Results: Among 146 participants, 78% initiated breastfeeding within one hour of delivery, out of which 65% practiced exclusive breastfeeding at the time of study. The main reasons for delayed initiation were cesarean delivery and lack of guidance. Mothers with higher education and prior counseling practiced exclusive breastfeeding.

Conclusions: Although breastfeeding initiation rates are satisfactory, exclusive breastfeeding practices remain suboptimal. Health care professionals should provide continuous breastfeeding education and postnatal counseling to mothers, especially first-time mothers which can improve early initiation and exclusive breastfeeding practices.

Outcomes of different types of urethroplasty in children with hypospadias: a prospective observational study

2026-01-27T21:13:42+0530

Background: Hypospadias is a common congenital anomaly of the male urethra, requiring surgical correction to restore function and appearance. Multiple urethroplasty techniques are used, with outcomes depending on anatomical severity and surgical expertise. Objectives were to assess and compare the outcomes and complications of various urethroplasty techniques performed for different types of hypospadias in children.

Methods: A prospective observational study was conducted over five years (2019-2025) at a tertiary care teaching hospital in Ratlam, Madhya Pradesh. Ninety-two children (<15 years) undergoing hypospadias repair were included. Data on demographics, hypospadias type, surgical technique, and postoperative complications were analyzed using SPSS.

Results: The majority of patients were aged 3-5 years (26%), with distal and mid-penile types being most frequent. The most commonly performed procedure was TIP urethroplasty (45.5%), followed by onlay (22.5%) and two-stage repairs (20%). Postoperative complications were observed in 25% of cases, with urethrocutaneous fistula (10%) and meatal stenosis (5%) being most frequent.

Conclusions: The TIP (Snodgrass) technique remains the preferred procedure for distal and mid-penile hypospadias due to favorable functional and cosmetic outcomes and low complication rates. Two-stage repairs are suitable for proximal and chordee-associated cases. Early surgery and meticulous technique are key to optimal results.

Effectiveness of play therapy on the level of anxiety among hospitalized children admitted to selected wards at a tertiary care centre, Lucknow

2026-01-27T21:13:40+0530

Background: Play is essential for children’s physical and emotional development. Play therapy utilizes this natural ability to promote emotional well-being and self-expression.

Methods: A quasi-experimental, time series non-equivalent control group design was used with 70 children (3-6 years) admitted to paediatric wards at Vivekananda Polyclinic and Institute of Medical Sciences (V. P. I. M. S.), Lucknow. The modified preschool anxiety scale was administered to both groups. Play therapy (building blocks, puzzles, doctor/kitchen sets, drawing) was introduced for the experimental group from day 3 to day 6 (two-hour sessions).

Results: The experimental group showed a significant anxiety reduction (p<0.001), while the control group exhibited minimal improvement.

Conclusions: The findings confirm that play therapy effectively reduces anxiety in hospitalized children.

Evaluating the optimal duration of skin-to-skin contact for normothermia in a newborn: an observational study

2026-01-27T21:13:40+0530

Background: The Neonatal Resuscitation Program (NRP) emphasizes the prevention of hypothermia by providing skin-to-skin contact (SSC) immediately after birth on the mother’s abdomen as a part of routine care for all neonates who cry immediately after birth. However, the duration of SSC in achieving normothermia immediately after birth has not been studied. The duration of SSC for 1 hour is usually consensus-based. In a public sector tertiary care hospital, practicing SSC for one hour may not be feasible because of the high delivery load. Therefore, we studied the minimum duration of SSC immediately after birth necessary to attain normothermia in newborns.

Methods: 525 newborns (≥34 weeks and weight≥1800 grams), who cried immediately after birth, were placed on the mother’s abdomen for routine care. Axillary temperature was monitored using a digital thermometer at 20 min, 30 min and 40 min during SSC. Newborns were observed for breastfeeding within one hour and exclusive breastfeeding at discharge. The chi-square test was used to analyze the data.

Results: 389/525 (74.1%), 507/525 (96.6%) and 525/525 (100%) of newborns achieved normothermia at 20 min, 30 min and 40 min of SSC, respectively. 391/525 (74.5%) of babies were breastfed within the first hour and 486/525 (92.6%) of babies were discharged on EBF. Breastfeeding within 1 hour of birth was significantly higher in the group of newborns who achieved normothermia within 20 minutes of immediate SSC (p value<0.001).

Conclusions: A minimum of 30 minutes of SSC immediately after birth is required to achieve normothermia in a term or near-term newborn, which is feasible and scalable in high delivery load facilities.

A study of maternal hypothyroidism on neonatal thyroid profile and outcome

2026-01-27T21:11:42+0530

Background: Maternal hypothyroidism is one of the most common endocrine disorders during pregnancy and is associated with adverse fetal and neonatal outcomes. Early detection and management are critical, as thyroid hormone deficiency during intrauterine life may lead to irreversible neurodevelopmental impairment.

Methods: This hospital-based observational study was conducted at Government Medical College, Cuddalore, from April 2023 to October 2024. A total of 100 neonates born to mothers diagnosed with hypothyroidism were enrolled. Maternal thyroid profiles were reviewed antenatally. Neonatal thyroid function tests, including serum TSH and free T4, were performed at 72 hours of life. Abnormal results were re-evaluated after two weeks. Data were analysed using STATA version 16 and Microsoft excel, employing descriptive statistics.

Results: Among the neonates studied, 7.07% exhibited elevated TSH levels (>10 mIU/l), and 2% required levothyroxine therapy. Preterm birth was observed in 35% of cases, and 29% required NICU admission. Low birth weight (LBW) and jaundice were the most common clinical findings. Congenital anomalies were rare, with only one case of bilateral congenital talipes equinovarus reported.

Conclusions: Maternal hypothyroidism has a measurable impact on neonatal thyroid function and early neonatal outcomes. Universal antenatal thyroid screening and targeted neonatal follow-up are essential to identify transient or delayed-onset hypothyroidism and prevent long-term neurodevelopmental sequelae.

Quality of life and coping strategies among caregivers of children with thalassemia major in Southern Rajasthan

2026-01-27T21:11:40+0530

Background: Thalassemia major (TM) is a chronic hereditary blood disorder requiring lifelong transfusions and chelation therapy, imposing a substantial physical, psychological, social, and financial burden on caregivers. Assessing caregivers’ quality of life (QoL) and coping strategies is essential to understanding their adaptive functioning and identifying areas requiring psychosocial support. To evaluate the quality of life and coping strategies among caregivers of children with thalassemia major attending a tertiary care hospital in Southern Rajasthan.

Methods: A cross-sectional study among 140 caregivers of children with thalassemia major used a structured questionnaire with sociodemographic data, WHOQOL-BREF, and brief COPE. Data were analyzed using descriptive statistics, chi-square, and ANOVA, with p<0.05 as the significance level.

Results: Most caregivers were male (65.7%), rural residents (80.7%), and belonged to lower socioeconomic strata (70.7%). Emotional support (85.71%), religious coping (84.29%), and informational support (82.14%) were the most frequently adopted strategies. Social relationships showed the highest QoL scores (mean 10.46±2.22), while psychological health was the most affected domain (mean 16.61±3.62). Gender and education were significantly associated with QoL across multiple domains (p<0.05), whereas duration of illness and age showed no significant association.

Conclusion: Caregivers of children with thalassemia major experience considerable psychosocial strain, particularly affecting psychological and environmental well-being. Adaptive coping strategies, especially emotional and religious coping, appear to support resilience.

The digital milestone: exploring the relationship between smartphone use and developmental domains in children aged 1–5 years

2026-01-27T21:11:40+0530

Background: In parallel with fast life-wide adoption of smartphones, even young children receive increased access to digital devices. With excessive screen time being a concern as it is, structured smartphone interactions can also bring fine-motor, behaviour-related, and language skills that reflect developmental progress. Objectives were to assess the association of developmental age with performance on smartphones across 12–60-month children, as well as to determine whether smartphone-based interactions can be used as a surrogate marker for developmental screening.

Methods: Descriptive cross-sectional study was carried out on 24 children from 12–60 months of age in a tertiary healthcare facility in India. Developmental age was scored on four parameters fine motor, gross motor, behaviour, and language—based on milestone charts of Ghai essential pediatrics. Smartphone functioning was tested with ten standard interactive tasks. Associations of developmental age with scores on smartphone functioning were studied with Spearman's rank-order correlation test.

Results: There was a highly significant and strong positive correlation with smartphone performance of tasks in all four fields of developmental stages (fine motor: ρ=0.958, p<0.001; gross motor: ρ=0.937, p<0.001; behavioral: ρ=0.949, p<0.001; language: ρ=0.926, p<0.001). Children with greater developmental maturity demonstrated greater proficiency on smartphones' performance of tasks.

Conclusion: Smartphone interaction performance is significantly associated with young child developmental maturity. Basic smartphone-based tasks can be used as a low-cost adjunctive young child developmental screening tool in under-resourced settings. Multicentric larger trials are needed to confirm these results and create common digital assessment tools.

Bacteriological study and antibiogram of urinary tract infection in children from a tertiary care hospital

2026-01-27T21:11:39+0530

Background: The purpose of this observational study was to evaluate the aetiology and antimicrobial resistance pattern in urinary tract infection among children under 18 years of age.

Methods: It was a retrospective observational study carried out in Sanjay Gandhi memorial hospital, Rewa over a period of 18 months from March 2023 to August 2024. The study included 362 children below 18 years of age whose urine cultures were positive for the growth of an organism. Their demographic characteristics, aetiological agents and antimicrobial resistance were evaluated.

Results: Among the 362 patients UTI was more common among females (54.15%). In age group of 0-1 years of age UTI was more in males as compared to females. Most common isolated organism was E. coli (n=105, 29.05%). In our study gram negative uropathogens showed highest sensitivity to imipenem followed by gentamycin whereas gram positive uropathogens showed highest sensitivity to tetracycline followed by chloramphenicol.

Conclusions: Our study found that Escherichia coli continues to be a predominant cause of urinary tract infections in children. However, there has been a notable shift in antibiotic susceptibility, with many frequently prescribed medications now exhibiting significant resistance. Therefore, it is important to have institute based antibiogram for prompt treatment of UTI and limiting of further antibiotic resistance.

Lived experiences of mothers caring for newborns in mother newborn care units: a phenomenological study on maternal bonding and perinatal mental health

2026-01-27T21:11:38+0530

Background: The mother newborn care unit (MNCU) is a unit offering 24×7 Level II care dedicated for sick newborns and mothers within the same setting. It is crucial to understand the maternal experiences in such a setting, so present study aims to explore the experiences of the mothers whose babies are admitted in MNCU.

Methods: The experiences of postpartum mothers whose newborns were admitted to Safdarjung Hospital's MNCU were explored by using a qualitative phenomenological research design. Through a purposive sampling technique, 15 eligible postpartum mothers were selected. In-depth semi-structured interviews were conducted using demographic details, observational notes, including non-verbal cues. At least 3 follow-up interviews were conducted with mothers to further explore their experiences over time.

Results: Thematic analysis of in-depth interviews with mothers revealed 10 major themes, followed by detailed transcription, translation, systematic coding and the organization of data into meaningful categories and 21 subthemes. According to the study, major themes were positive psychological adaptation, strengthening through active participation, conducive institutional environment, enhanced health awareness, improved maternal satisfaction, decreased anxiety regarding newborn health and enhanced maternal-newborn bonding. Health awareness and psychological resilience of mothers were further improved by peer engagement and nursing assistance. However, challenges like postpartum fatigue and discomfort, decreased time with family as a result of strict visiting guidelines and concerns about newborn’s health have been observed. Despite these concerns, mothers remained hopeful and emotionally resilient.

Conclusions: The findings highlight the positive psychological impacts of the MNCU model, particularly in enhancing bonding, mothers’ emotional well-being, empowerment via active engagement and the adoption of improved coping mechanisms.

Comparative analysis of persistent pediatric asthma with pulmonary function parameters: a cross-sectional study from South India

2026-01-27T21:11:37+0530

Background: Asthma is one of the most common chronic respiratory illnesses in children, causing significant morbidity, absenteeism, and poor quality of life. Despite established guidelines, disparities persist in diagnosis and management, especially in developing regions. Pulmonary function testing remains a crucial tool for assessing airway limitation and disease control, yet its correlation with clinical severity in Indian children is under-reported. Objectives were to compare pulmonary function parameters among children with varying grades of persistent asthma and to examine the association between lung-function indices and disease severity.

Methods: This cross-sectional study was conducted in the Institute of Social Paediatrics, Government Stanley Medical College and Hospital, Chennai, from April 2021 to August 2022. One hundred children aged 6-12 years with persistent bronchial asthma were enrolled consecutively. Spirometry was performed according to ATS/ERS 2019 standards using Indian reference equations, and forced vital capacity (FVC), forced expiratory volume in one second (FEV₁), FEV₁/FVC ratio, and peak expiratory flow rate (PEFR) were recorded. Data were analyzed with ANOVA, Chi-square, and Pearson correlation tests.

Results: Of 100 children, 38% had mild, 35% moderate, and 27% severe persistent asthma. Mean FEV₁ values declined significantly from 86.2±10.4% in mild to 78.5±11.3% in moderate and 67.8±12.5% in severe asthma (p<0.001). Similar trends were noted for FVC and FEV₁/FVC ratio. A strong negative correlation was observed between asthma severity and FEV₁ (r=-0.61, p<0.001) and FEV₁/FVC (r=-0.57, p<0.001). Poor adherence and exposure to household smoke were associated with lower lung-function scores.

Conclusions: Progressive decline in spirometric parameters with increasing asthma severity underscores the value of routine lung-function monitoring in pediatric asthma management. The study re-affirms that FEV₁ and FEV₁/FVC ratios serve as reliable, objective markers for assessing disease control and should complement clinical grading in children with persistent asthma.

Early detection of autism in childhood outpatient department practice: insight from pediatric neurology in Hyderabad, India

2026-01-27T21:11:36+0530

Background: Autism spectrum disorder (ASD) is prevalent neurodevelopmental disorder marked by core challenges in social communication, social interaction and presence of restrictive and repetitive behaviors. Early identification through effective screening is essential, as timely intervention significantly enhances developmental outcomes.

Methods: This descriptive cross-sectional study was conducted on a sample of 506 children aged 16 to 30 months attending the pediatric OPD clinic. Eligible children who met the inclusion criteria were screened for the risk of autism using the revised modified checklist for autism in toddlers (Revised M-CHAT).

Results: Among 506 children screened with the revised M-CHAT tool, 1.6% screened positive for ASD. The study population had a mean age of approximately 21.6 months without male predominance (59.6%). Key factors significantly associated with positive ASD screening included partial immunization, preterm birth, lack of exclusive breastfeeding, and exposure to more than 2 hours of screen time. Other demographic variables such as gender, mode of delivery, and parental education showed no significant association. Revised M-CHAT questionnaire items (notably questions 1, 2, 7, 10, and 12) were frequently positive among ASD screen-positive children, suggesting particular sensitivity for screening. Breastfeeding, screen-time exposure and immunization are confirmed statistically by this study.

Conclusions: All toddlers attending Pediatric clinics should be routinely screened for autism by a child specialist. The revised M-CHAT is a simple, easy-to-administer, and validated screening tool suitable for use in busy pediatric outpatient settings.

Reducing pediatric prescription errors: a quality improvement initiative in a tertiary-care outpatient setting

2026-01-27T21:11:35+0530

Background: Prescription errors are among the most common preventable causes of harm in healthcare, especially in pediatrics. This study was conducted to identify, analyze and reduce prescription errors using Quality improvement methods like Plan-Do-Study-Act (PDSA) cycles. Our study question was “Does implementing PDSA-based quality improvement interventions reduce prescription errors in the pediatric outpatient department of a tertiary care hospital in Western India?

Methods: This study was conducted in the pediatric out-patient department (OPD) of a GMERS Medical College and Sola hospital in Western India from February 2025 to April 2025. The intervention was implemented in two PDSA cycles. PDSA-1 involved the introduction of a revised pediatric formulary and daily pre-OPD educational briefings. PDSA-2 introduced standard treatment protocols (STP) reinforced through interactive sessions. Prescription errors were classified into predefined categories and analyzed across three phases: baseline, PDSA-1, and PDSA-2. Data were analyzed using descriptive statistics, chi-square tests, and ANOVA test with significance set at p<0.05.

Results: A total of 1,188 prescriptions were reviewed (baseline: 591; PDSA-1: 353; PDSA-2: 244). The overall error rate declined from 27.2% at baseline to 20.1% during PDSA-1 and 9.0% during PDSA-2 (p<0.001). Significant reductions were observed in wrong dose errors (5.58% to 1.64%), dose omissions (1.69% to 0.41%), and missing duration (2.54% to 1.23%). Wrong drug errors showed minimal change, indicating the need for more advanced interventions.

Conclusions: Low-cost QI interventions can significantly enhance prescribing safety in resource-limited settings, although more complex errors may require digital or system-level solutions.

A study on clinical profile, liver dysfunction and outcome of dengue infection in children

2026-01-27T21:11:35+0530

Background: Dengue viral illness is a matter of serious concern in all world, specifically because of absence of specific antiviral medicine and vaccine. Severe dengue has a mortality of 2-5%, but when left untreated the mortality rate is high as 20%, and liver involvement tends to be more severe infection in children.

Methods: This is a prospective observational study conduct in our Department from July 2020 to December 2022. Total patients in our study were 90. The objective of our study was to determine the relationship between liver dysfunction, kinetics of liver function tests (LFTs) and severity of hepatitis on the outcome in pediatric dengue illness, with special attention to preserved life of patient because its life-threatening potential.

Results: Dengue confirmed cases were divided into two group; severe dengue (SD) and non-severe dengue (NSD) group. Mean age was 7.2 years ± 3.74-year Age, 38.9% were females. All cases were suffering from fever, abdominal pain was present 51.1% in cases, Liver function tests SGOT (AST), SGPT (ALT) and ALP, bilirubin and albumin were deranged in both groups of children. Outcome of study 8 (25.8%) patients out of 31 were death from severe dengue group.

Conclusions: Liver Function Tests (LFT) monitoring done during acute dengue illness was a predictor of mortality in children with Dengue illness. Higher level of derangement in Liver dysfunction in children with dengue illness associate with higher rate of mortality.

Vitamin D levels in children with autism spectrum disorders and normal children: a comparative cross-sectional study from South Kerala

2026-01-27T21:11:33+0530

Background: Epidemiological evidence indicates that vitamin D deficiency during critical periods may increase the risk of neurodevelopmental disorders including autism spectrum disorder. The present study aimed to assess and compare the vitamin D levels of children with autism spectrum disorder (ASD) and neurotypical children and also to explore the relationship between vitamin D status and the severity of ASD symptoms.

Methods: This comparative cross-sectional study was conducted among children with ASD and children without any neuro developmental disorders. About 207 children aged two to six years were enrolled, comprising 105 participants with ASD and 102 who did not have an ASD diagnosis. ASD diagnosis was done using DSM-5 criteria and severity was assessed using CARS-2 ST scale. Serum 25-hydroxyvitamin D levels were obtained for every participant in the study. Statistical analyses included chi-square and independent t-tests, with significance set at p<0.05.

Results: The majority of children in both groups were in the 24–36-month age range. Individuals with ASD showed a higher likelihood of low vitamin D levels (87.6%) relative to non-ASD cases (76.5%); while desirable vitamin D levels were observed more among normal children (23.5%) than children with ASD (12.4%). The association between Vitamin D levels and ASD status was also found to be statistically significant.

Conclusions: Our findings indicate that low vitamin D levels may be linked to ASD, highlighting a potential area for further investigation and suggest that vitamin D could have a supportive role in management.

Study of the effectiveness and accuracy of transcutaneous bilirubinometer in early diagnosis of neonatal hyperbilirubinemia in North India

2026-01-27T21:11:26+0530

Background: Neonatal hyperbilirubinemia affects 60% of full-term and 80% of premature infants leading to jaundice when serum bilirubin levels reach 5 mg/dl. As the red blood cells undergo the process of lysis, it increases the levels of serum bilirubin. The standard criteria to measure the levels of total serum bilirubin is via taking a blood sample but in contrast to it transcutaneous bilirubin measurement offers non-invasive, rapid results, typically within a minute, for assessing bilirubin levels. To determine the accuracy and reliability of transcutaneous bilirubinometer. Additionally, to investigate the capability of transcutaneous bilirubinometers in facilitating the early diagnosis of hyperbilirubinemia in preterm babies.

Methods: For this study newly, registered neonates were assessed for hyperbilirubinemia, with MBJ20 bilirubinometer on the forehead within 24 hours of life and following up the patients for serum bilirubin levels. We took 400 neonates late preterm and term. The babies who had readings of 6 or more than 6 mg/dl, were further evaluated by total serum bilirubin levels.

Results: In our study using the MBJ-20 transcutaneous bilirubinometer, the mean bilirubin concentration measured via TCB at the forehead was 8.75±2.27 mg/dl, compared to a mean TSB value of 12.28±2.33 mg/dl. A strong positive correlation was observed between TCB and TSB levels (r=0.86). Furthermore, the diagnostic performance of TCB was high, with an area under the ROC curve (AUC) of 89.9%. The sensitivity of TCB forehead ranges between 80.0%–93.5% and the specificity is between 63.5%–79.4%.

Conclusions: The data of our study arrived at a conclusion that the use of TCB is potentially safe and effective. Its measurements are reliable and accurate.

Allergy after a sandwich: case report of beer allergy in an adolescent

2026-01-27T21:11:29+0530

Beer is an uncommon cause of IgE-mediated food allergy despite its widespread consumption. We report an adolescent who developed generalised urticaria and lip angioedema immediately after eating a traditional Portuguese sandwich with a beer-based sauce. He had previously experienced two episodes of delayed generalised urticaria after ingesting small amounts of beer. Serum specific IgE was positive for barley (7.12 kU/l) and barley malt (21.7 kU/l). Prick-to-prick testing was positive for four commercially available beers containing barley malt. He tolerated other barley-containing foods, suggesting that malting and brewing may modify barley proteins and/or generate clinically relevant allergens. The patient was counselled to avoid beer, whisky and foods prepared with barley-malt alcoholic beverages, and was prescribed an adrenaline auto-injector due to the potential risk of anaphylaxis. This case underscores that beer allergy, although rare in paediatrics, should be considered in adolescents presenting with acute urticaria or angioedema after beer consumption or exposure through cooking.

Pfeiffer syndrome: a rare craniosynostosis syndrome – a case report

2026-01-06T07:25:35+0530

Pfeiffer syndrome is a rare autosomal dominant disorder caused by FGFR1 or FGFR2 mutations, characterized by craniosynostosis, midfacial hypoplasia, broad thumbs and toes, and variable neurodevelopmental delay. Type I represents the milder form. In this case, a 15-month-old male presented with macrocephaly, global developmental delay, irritability, and vomiting. Examination revealed a tall head with tense fontanelles, proptosis, midfacial hypoplasia, and broad digits. CT imaging showed bicoronal craniosynostosis with hydrocephalus. Fundoscopy revealed disc edema. Genetic testing confirmed a heterozygous mutation in exon 7 of the FGFR2 gene. Management included acetazolamide and planned ventriculoperitoneal shunt insertion. The patient is under multidisciplinary follow-up for craniofacial reconstruction and neurodevelopmental support. This case highlights an atypical, late presentation of Pfeiffer syndrome Type I with raised intracranial pressure and hydrocephalus. Early diagnosis and intervention, supported by molecular testing, are essential to optimize outcomes.

Angiokeratoma in Hurler syndrome: a rare pediatric case report

2026-01-14T08:36:45+0530

Mucopolysaccharidosis type I (MPS I H, Hurler syndrome) is caused by alpha-L-iduronidase deficiency, leading to glycosaminoglycan (GAG) buildup and severe cognitive and physical impairments, typically presents with coarse facial features and usually manifests as cognitive developmental delay, corneal clouding and characteristic musculoskeletal manifestations. An interesting case of a three-year-old girl with a combination of skeletal, neurological, ophthalmologic, and radiological findings along with Mongolian spots present on back and widespread asymptomatic small, multiple, red skin lesions with rapid progression in the number and size of the lesions with MPS I- (Hurler syndrome) has been presented here in this case report. Diagnosis was confirmed with urinary investigation for GAG and serum levels of alpha-L-iduronidase. Angiokeratomas are bluish-red, hyperkeratotic papules caused by dilated blood vessels in the upper dermis which are typically seen in Fabry disease and rarely in Hurler syndrome. Their occurrence in a 3-year-old with classic Hurler features highlights the importance of considering uncommon dermatologic signs when evaluating patients with metabolic disorders.

A silent invader: disseminated tuberculosis presenting with hepatic abscesses in early childhood

2026-01-27T21:13:36+0530

Disseminated tuberculosis (TB) is a severe and potentially fatal form of Mycobacterium tuberculosis infection caused by haematogenous spread to two or more non-contiguous organs. Diagnosis is often challenging due to its non-specific clinical presentation and resemblance to other systemic infections. We describe a 9-month-old partially immunized male infant presenting with recurrent vomiting, fever, and poor feeding. Imaging revealed hepatic abscesses and pulmonary nodules. Cerebrospinal fluid GeneXpert detected Mycobacterium tuberculosis. The child was managed with first-line antitubercular therapy, supportive care, and nutritional rehabilitation, with marked clinical improvement. Disseminated tuberculosis in infancy is uncommon but carries high morbidity and mortality. Early clinical suspicion, prompt diagnosis, and timely initiation of therapy are crucial for favourable outcomes.

Functional hypogonadotropic hypogonadism in an adolescent male with neurofibromatosis type 1: a case report

2026-01-27T21:11:41+0530

Delayed puberty in males may result from permanent or reversible causes of hypogonadotropic hypogonadism. We describe a 16-year-old adolescent male with neurofibromatosis type 1 (NF1) who presented with delayed puberty. Baseline gonadotropins and testosterone levels were low; however, a robust luteinizing hormone response to leuprolide stimulation confirmed preserved pituitary reserve, consistent with functional hypothalamic suppression. The patient had undergone multiple major surgeries and demonstrated NF1-related sphenoid bone abnormalities on imaging. Testosterone therapy was initiated with gradual dose escalation. This case highlights the importance of identifying reversible causes of delayed puberty in adolescents with chronic multisystem disorders.

Hyper-IgE syndrome: case reports

2026-01-27T21:11:37+0530

Hyper-IgE syndromes (HIES) are rare primary immunodeficiency disorders characterised by markedly elevated serum immunoglobulin E (IgE) levels, recurrent cutaneous and respiratory infections, and variable multisystem involvement. They arise from mutations in genes central to immune signalling pathways, most notably STAT3 in autosomal dominant HIES (AD-HIES) and DOCK8 in autosomal recessive HIES (AR-HIES). The first case, an 11-month-old boy with recurrent staphylococcal skin infections, sepsis, eosinophilia and an IgE level of 9,867 IU/ml, was found on whole-exome sequencing to have a heterozygous STAT3 mutation, confirming AD-HIES. The second case, a 2-year-old boy with severe atopic dermatitis, recurrent wheezing, repeated pneumonias and an IgE level exceeding 100,000 IU/ml, was diagnosed with AR-HIES due to a homozygous DOCK8 mutation. These cases highlight the distinct clinical patterns of the two forms: AD-HIES commonly presents with non-immunologic features such as skeletal and dental anomalies, whereas AR-HIES is associated with severe viral infections, profound IgE elevation and higher mortality. Early recognition through clinical suspicion and genetic confirmation is essential, as management requires multidisciplinary care, prophylactic antimicrobial strategies and, in severe DOCK8 deficiency, consideration of haematopoietic stem-cell transplantation.

A rare confluence: chronic myeloid leukemia in a pediatric case of beta thalassemia

2026-01-27T21:11:34+0530

Chronic myeloid leukemia (CML) is rare in children and extremely uncommon in patients with underlying hemoglobinopathies such as beta thalassemia. This report describes a 12‑year‑old beta thalassemia patient, who presented with fever, pallor and weakness, and was found to have marked hepatosplenomegaly and leukocytosis. Peripheral blood showed leukocytosis with increased myeloid precursors and bone marrow evaluation showed hypercellular marrow with myeloid hyperplasia and basophilia, consistent with a chronic myeloproliferative neoplasm. Karyotyping revealed balanced reciprocal translocation t (9;22) and reverse‑transcriptase polymerase chain reaction (RT‑PCR) detected BCR‑ABL1 p210 fusion transcript, confirming the diagnosis of chronic phase CML in a background of beta thalassemia. The patient had elevated serum ferritin, indirect hyperbilirubinemia and mildly deranged transaminases, attributable to chronic transfusions and iron overload. After initiation of appropriate therapy, leukocyte counts normalized within one month along with disappearance of circulating immature myeloid precursors. This case highlights the importance of maintaining a high index of suspicion for CML in thalassemic patients with unexplained leukocytosis and splenomegaly, and underscores the need for integrated morphologic, cytogenetic and molecular work-up to distinguish disease progression from a second primary hematologic malignancy.

Complex presentation of Klippel-Feil syndrome with scoliosis and Sprengel's deformity: a rare case

2026-01-27T21:11:33+0530

Klippel-Feil syndrome is a rare congenital anomaly. It is characterized by fusion of two or more cervical vertebrae. In this case report, we have presented a rare case of a nine years old male child suffering from Klippel-Feil syndrome associated with congenital scoliosis and sprengel deformity with no other abnormality in accordance with heart, kidneys, and nervous system. As per the literature review very few cases have been reported on this syndrome thus, this case report is a significant contribution to existing literature.

Paediatric autoimmune hepatitis with thalassemia trait: a case report

2026-01-27T21:11:31+0530

Autoimmune hepatitis (AIH) is a chronic inflammatory liver condition characterized by elevated serum aminotransaminase levels, the presence of liver-associated autoantibodies, and/or hypergammaglobulinemia. Three conditions with likely autoimmune origins include AIH, autoimmune sclerosing cholangitis, and de novo AIH following liver transplantation. AIH is classified into two types based on antibody presence: Type 1 and Type 2. Systemic disorders such as hemoglobinopathies, cystic fibrosis, and histiocytic disorders have been associated with liver dysfunction. Early diagnosis requires a high level of suspicion. Paediatricians should consider AIH in patients presenting with jaundice after excluding common causes. The diagnosis is made through a combination of biochemical, immunological, and histological findings, while ruling out other liver diseases with similar serological and histological profiles. We present the case of an 8-year-old female with non-resolving jaundice, diagnosed with AIH alongside thalassemia trait.

Dental management of a child with perisylvian syndrome and associated cerebral palsy under general anaesthesia: a case report

2026-01-27T21:11:27+0530

Cerebral palsy (CP) is a group of non-progressive neurological disorders that affect movement and posture. It is frequently associated with intellectual disabilities, seizure disorders, and oromotor dysfunction. Perisylvian syndrome is a rare cortical malformation that further complicates management due to epilepsy and orofacial motor deficits. This report aims to describe the successful dental management of a child with CP and focal seizures secondary to perisylvian syndrome under general anaesthesia. A male pediatric patient aged 14 years with CP and focal seizures presented with a pain in the upper and lower right posterior teeth for three months. Due to uncooperative behaviour and multiple carious lesions, treatment under general anaesthesia was planned. Dental management included oral prophylaxis, indirect pulp capping, and GIC restorations. The procedure was uneventful, and the patient was discharged with appropriate postoperative care instructions. On one-year follow-up, restorations remained intact, oral hygiene had improved, and there were no new carious lesions or recurrence of symptoms. Comprehensive dental care for children with CP and perisylvian syndrome can be successfully provided under general anaesthesia when conventional management fails. Long-term follow-up demonstrated favourable outcomes, emphasizing the importance of continuous preventive care. This case highlights the importance of a multidisciplinary approach and perioperative planning in delivering safe and effective dental treatment to children with complex neurodevelopmental disorders.

Recurrent severe hyperbilirubinemia due to compound heterozygous UGT1A1 mutations: an early neonatal presentation of Gilbert syndrome

2026-01-27T21:11:26+0530

Gilbert syndrome, a relatively common but less conspicuous condition, is characterized by intermittent episodes of mild to moderate unconjugated hyperbilirubinemia due to limited activity of the enzyme UGT1A1. It is usually benign and often remains unnoticed due to overlap with physiological jaundice. We report a case of term male neonate who developed four distinct episodes of severe, recurrent unconjugated hyperbilirubinemia within the first month of life, each requiring intensive phototherapy. Extensive evaluation excluded hemolysis, sepsis, endocrine dysfunction, and cholestatic liver disease as cause of jaundice. Given the atypical presentation with recurrent neonatal jaundice and no identifiable underlying cause, genetic testing was performed, which revealed compound heterozygosity for UGT1A1 variants (-3279T>G promoter polymorphism and 211G>A exon 1 mutation), confirming Gilbert syndrome. The infant responded promptly to phototherapy and had normal BERA and MRI brain with age-appropriate developmental milestones. This case highlights an atypically severe and recurrent neonatal presentation of Gilbert syndrome in the absence of known exacerbating factors and emphasizes the importance of genetic testing to distinguish Gilbert syndrome from Crigler-Najjar syndrome, guide management, and avoid unnecessary invasive interventions.

A case of paediatric spotted fever presenting with acute hepatitis and encephalopathy

2026-01-27T21:13:45+0530

Rickettsial infections caused by the spotted fever group Rickettsia remain an underrecognized cause of acute febrile illness in children, particularly in endemic regions. Although fever and rash constitute the classical presentation, atypical organ involvement may occur, leading to diagnostic delay. We report a rare presentation of pediatric spotted fever complicated by acute hepatitis and encephalopathy in a child from a rural agricultural background. The child initially presented with fever, anorexia, and malaise, followed by jaundice and altered sensorium. Extensive evaluation excluded common viral, bacterial, and parasitic etiologies. Serological testing supported the diagnosis of spotted fever, and prompt initiation of doxycycline resulted in rapid clinical and biochemical improvement. This case emphasizes the importance of maintaining a high index of suspicion for rickettsial infections in children presenting with unexplained hepatic and neurological involvement, even in the absence of rash or eschar. A child from a rural area developed an uncommon form of spotted fever affecting the liver and brain. Early recognition and treatment with doxycycline led to complete recovery, highlighting the need to consider rickettsial infections even when classical symptoms are absent.

From awareness to accountability: strengthening pediatric antibiotic stewardship in low-resource outpatient setting

2026-01-27T21:13:38+0530

In pediatric outpatient departments, antibiotic prescriptions are frequently empirical and often used for self-limiting viral illnesses, fueling antimicrobial resistance (AMR). While awareness programs have improved knowledge among clinicians and caregivers, sustainable behavioral change remains limited without accountability mechanisms. This letter highlights the critical role of pediatric antimicrobial stewardship programs (ASPs), emphasizing audit-feedback interventions that have shown up to a 23% reduction in unnecessary antibiotic initiation and a 17% reduction in broad-spectrum antibiotic selection. In low-resource outpatient settings, the lack of point-of-care diagnostics perpetuates empirical prescribing. Integrating affordable diagnostic tools, enforcing stewardship policies, and adopting the WHO AWaRe framework within regional healthcare systems can strengthen accountability and optimize antibiotic use in children.