International Journal of Contemporary Pediatrics

Transforming midwifery education and practice: leveraging innovative learning frameworks, digital health technologies and interprofessional collaborative care to improve maternal-neonatal outcomes

2026-05-27T09:37:05+0530

Midwifery plays a pivotal role in improving maternal and neonatal health outcomes through the provision of skilled, respectful, and woman-centered care. However, variations in educational preparation and care delivery models continue to influence the quality and consistency of midwifery practice across settings. This systematic review aimed to synthesize evidence on innovative midwifery educational frameworks and collaborative care models and their impact on maternal and neonatal outcomes. A comprehensive search of PubMed, Scopus, CINAHL, and Cochrane Library databases was conducted in accordance with PRISMA 2020 guidelines. Studies published between 2000 and 2025 evaluating midwifery education innovations, midwife-led continuity of care, and collaborative maternity care models were included. A total of 35 studies met the inclusion criteria, comprising systematic reviews, randomized controlled trials, cohort studies, mixed-methods research, and policy analyses. Findings indicate that competency-based education, simulation-based training, and structured mentorship significantly enhance midwives’ clinical competence, teamwork, and preparedness for obstetric emergencies. Care model evidence demonstrates that midwife-led continuity of care is associated with increased spontaneous vaginal birth rates, reduced obstetric interventions, improved maternal satisfaction, and comparable or improved neonatal outcomes. Collaborative care models further strengthened care coordination and safety when supported by effective referral systems and interprofessional collaboration. Overall, integrating innovative educational strategies with midwifery-centered and collaborative care models contributes to improved maternal–neonatal outcomes and quality of care. Strengthening midwifery education and expanding evidence-based care models should be prioritized in maternal health policy and practice.

Shprintzen Goldberg syndrome: a classic case

2026-05-27T09:36:58+0530

Shprintzen Goldberg syndrome (SGS) is an uncommon genetic condition marked by a mix of craniofacial, skeletal, and cardiovascular abnormalities. This syndrome was initially detailed in 1984 by Dr. Shprintzen and Dr. Goldberg, as a distinct clinical condition. Since then, only a small number of cases have been reported in literature. A total of just 50 instances of SGS have been documented globally. A 6 months old male child presented with Acute respiratory illness. On examination child had marked failure to thrive features with Marfaniod habitus along with craniosynostosis, low set ears, prominent eyes, small lower jaw, long, slender fingers, joint hypermobility, high arched palate, flat feet and developmental delay. Supportive management of active complaints was done given but patient has poor prognosis. Our patient came as a case of acute respiratory infection but on examination had typical features consistent with SGS and on further investigations Genotype was found to have SKI mutation and on ECHO patient had Mitral valve involvement. All this led us to the rare diagnosis of SGS.

Joubert syndrome with typical magnetic resonance imaging findings

2026-05-27T09:36:56+0530

Joubert syndrome (JS) is an autosomal recessive disorder characterized by hypotonia, ataxia, specific breathing irregularities such as episodic apnea and hyperapnea (which improves with age), global developmental delay, nystagmus, strabismus, ptosis, and oculomotor apraxia. A 4 months old male child presented in ER as a case of acute respiratory illness. There was no h/o any seizure in the past or any family history of seizure with history of 3^rd degree consanguineous marriage. On examination there was no head control with unilateral Ptosis in right eye and horizontal nystagmus as shown in figure 1 along with global developmental delay. Patient was managed for Acute respiratory illness but on magnetic resonance imaging (MRI) brain which was done in view of global developmental delay with hypotonia and nystagmus showed classical molar tooth appearance and was diagnosed with JS. As this patient had abnormal head movements and MRI brain showing Joubert like presentation, so patient was labelled with diagnosis of JS and was discharged after counselling.

Refractory focal epilepsy in a child with Sturge–Weber syndrome: a case report

2026-05-27T09:36:35+0530

Sturge–Weber syndrome (SWS) is a rare neurocutaneous disorder characterized by leptomeningeal angiomatosis, glaucoma, and port-wine nevus, frequently associated with refractory epilepsy and developmental delay. We report a 2-year-3-month-old boy with known SWS who presented with breakthrough focal motor seizures despite polytherapy. Clinical assessment revealed focal neurological deficits and global developmental delay. Neuroimaging demonstrated left cerebral atrophy with serpentine calcifications and choroid plexus enlargement consistent with SWS. Antiepileptic therapy optimization achieved seizure control, and the patient was discharged with neuro rehabilitation support. This case highlights the course of epilepsy in SWS, management challenges, and need for long-term multidisciplinary care.

A rare case of Crigler–Najjar syndrome type II in a preterm infant: clinical, genetic and therapeutic insights into the UGT1A1 Pro176Leu variant

2026-05-27T09:36:20+0530

Crigler–Najjar syndrome type II is a rare autosomal recessive disorder caused by partial deficiency of uridine diphosphate-glucuronosyltransferase (UGT1A1), resulting in unconjugated hyperbilirubinemia. Differentiating Crigler–Najjar syndrome type II from common neonatal jaundice can be challenging, particularly in premature infants, yet early diagnosis is critical to prevent bilirubin-induced neurotoxicity. We report a 32-week preterm male neonate presenting with progressive jaundice, with peak total serum bilirubin reaching 24 mg/dl. Hemolysis and hepatic dysfunction were excluded through laboratory evaluation. Genetic analysis was performed to identify underlying enzymatic defects. The infant was managed with intensive blue-light phototherapy and phenobarbital at a dose of 5 mg/kg/day, with serial bilirubin monitoring. Genetic testing demonstrated a homozygous UGT1A1 Pro176Leu mutation, confirming Crigler–Najjar syndrome type II. Following initiation of therapy, serum bilirubin levels declined by approximately 25% within one week, consistent with typical Crigler–Najjar syndrome type II responsiveness to phenobarbital. The neonate exhibited no clinical features of kernicterus, and bilirubin levels stabilized below 15 mg/dl by day 12 of life. This case underscores the diagnostic difficulty of distinguishing Crigler–Najjar syndrome type II from physiological or prematurity-related jaundice. Identification of the rarely reported Pro176Leu variant in a preterm neonate provides additional genetic and developmental insight. Early recognition, prompt initiation of phototherapy, phenobarbital therapy, and caregiver education remain essential to prevent bilirubin-induced neurological injury.

Witteveen-Kolk syndrome with hypogonadotropic hypogonadism - a diagnostic challenge in syndromic delineation

2026-05-27T09:34:34+0530

Witteveen–Kolk syndrome (WITKOS) is a rare neurodevelopmental disorder characterized by developmental delay or intellectual disability, behavioural disorders including autism spectrum disorders, obsessive–compulsive behaviours as well as attention deficit hyperactivity disorder symptoms. It also presents with facial dimorphisms and short stature. The syndrome is caused by loss of function of switch-insensitive 3 transcription regulator family member A (SIN3A). We report a novel case of WITKOS presenting with hypogonadotropic hypogonadism along with neurological manifestation. The need of early diagnosis and anticipation of subsequent manifestations of the syndrome during childhood along with a multidisciplinary approach to treatment has been emphasized.

Unraveling Menkes kinky hair disease: a rare but telltale disorder in infancy

2026-05-27T09:34:25+0530

Menkes kinky hair disease also known as “trichopoliodystrophy” resulting from a mutation in the ATP7A gene, which disrupts copper distribution across various tissues. Herein this report presents a case of a 4-month-old boy who presented with unprovoked seizures in status and developmental delay. He was evaluated for refractory seizures and developmental delay, and his serum copper and serum ceruloplasmin levels were found to be low and was later genetically diagnosed as Menkes kinky hair disease. Despite copper histidine therapy and multiple antiepileptics, seizures persisted until initiation of adjunctive cannabinoid therapy, after which the child became seizure-free. This case underscores the diagnostic and therapeutic challenges of Menkes disease and highlights the potential role of cannabinoids in seizure management.

Atypical presentation of systemic onset juvenile idiopathic arthritis: a case report

2026-05-27T09:34:19+0530

Systemic Onset Juvenile Idiopathic Arthritis (SOJIA) is an autoinflammatory disorder that can present with a wide range of symptoms, often mimicking infectious etiologies like tuberculosis and other bacterial infections, so atypical presentations can pose a diagnostic challenge. Here, we report a case of a 4-year-old female who presented with high-grade fever for 2 weeks, unresponsive to initial antibiotic therapy. Despite extensive investigations, the focus of infection was not found. Imaging revealed bilateral shoulder joint abscesses, which were sterile, with significantly elevated serum inflammatory markers. Clinical and laboratory findings were consistent with diagnosis of Systemic Onset Juvenile Idiopathic Arthritis (SOJIA) and subsequently corticosteroid and methotrexate therapy were started, to which the child responded.

Successful rescue of a child with Griscelli syndrome type 2 from lethal respiratory distress

2026-05-27T09:34:16+0530

In this study, we report a known case of GS type 2, in a four-year-old male child. The child initially presented with fever, tachypnea, severe anemia, massive hepatosplenomegaly, wheezing on auscultation. A chest x- ray revealed bilateral perihilar infiltrates. The child was managed with high flow, heated and humidified oxygen support at 20 liters/min, inhaled corticosteroids, salbutamol nebulization and antibiotics. A respiratory viral panel PCR sent to rule out viral pathogens. There was gradual improvement, and the child was tapered off oxygen within one week. The hepatosplenomegaly gradually regressed after receiving the HLH protocol. At the time of discharge, the child was maintaining saturation on room air without any distress, had no hepatomegaly and spleen had regressed to 5 cm under right costal margin. Work up for Bone marrow transplantation (BMT), was simultaneously started. GS2 can have heterogenous clinical manifestations. Early diagnosis and rapid control of HLH by using the HLH-1994 regimen along with supportive care for the complications is the key to successful treatment.

A case report of Chung-Jansen syndrome

2026-05-27T09:33:45+0530

Global developmental delay (GDD) has a wide range of underlying causes, and advances in genetic testing, particularly whole exome sequencing (WES), have improved diagnostic accuracy. Chung–Jansen syndrome is a rare neurodevelopmental disorder caused by variants in the PHIP gene and is characterized by developmental delay, intellectual disability, hypotonia, and behavioural abnormalities. We report a 6-year-old girl with global developmental delay, hypotonia, and inattention. She had delayed motor and speech milestones along with progressive cognitive decline. Examination revealed generalized hypotonia, mild distal weakness, bilateral ptosis, and refractive error. WES identified a heterozygous missense variant in the PHIP gene, classified as a variant of uncertain significance (VUS). The clinical presentation showed partial overlap with Chung–Jansen syndrome. The child is on multidisciplinary supportive therapy. Genetic counselling and parental testing were advised. This case highlights the importance of WES in unexplained GDD and the need for clinic genetic correlation when interpreting VUS.

Falls leading to weakness or weakness leading to falls: an eternal dilemma

2026-05-27T09:33:39+0530

Falls are common among children. A fall may be the consequence of an underlying stroke, or conversely, a fall itself may precipitate a stroke. Additionally, paediatric stroke can present with varied and nonspecific manifestations, making diagnosis challenging. Urgent diagnosis requires timely identification and starting of therapy, which makes recovery faster. Case 1: An 8-month-old male infant developed acute right-sided hemiparesis following trivial fall. MRI brain showed left lentiform nucleus acute infarct, and linear calcification on CT. Child was treated with aspirin, iron, and physiotherapy, with improvement over three months. Case 2: A 16-month-old boy presented with left-sided weakness after a fall. CT head showed linear hyperdensity in right caudate nucleus. Child was managed with aspirin and physiotherapy, with gradual recovery over six months. Aspirin therapy, along with physiotherapy and supportive treatment led to a good response in both the cases. Importance of considering mineralizing microangiopathy in paediatric patients with unexplained neurological symptoms following trauma is emphasized.

Elevated blood pressure in the paediatric population: the Nigerian experience

2026-05-27T09:35:02+0530

Background: The prevalence of hypertension in children is increasing, hence the need for updated information on the causes, clinical assessment, and treatment of childhood hypertension among Pediatricians. This study assessed the experiences and challenges in the management of childhood hypertension among Pediatricians in Nigeria.

Methods: The study was a cross-sectional study conducted from responses from 73 Paediatric cardiologists and residents. An online self-administered structured questionnaire was used to collect information from participants. The results were analyzed using Statistical Package for the Social Sciences (SPSS) version 25.

Results: Sixty-nine (94.5%) participants practiced at the tertiary level of health care. Respondents came from the country's geopolitical zones, mostly the south West (39.7%). About a third (31.5%) of children have elevated blood pressure on average. The availability of age-appropriate blood pressure monitoring instruments increased with age (from 60.3% in infants to 94.5% in adolescents). The nephrologist manages childhood hypertension in most centers (38.4). Secondary hypertension was the more common cause reported by respondents (91.8%), and acute glomerulonephritis (22.3%) and renal parenchymal disease (15.6%) were the leading causes. Almost half 34 (46.6%) are aware of guidelines for the management of hypertension in children, but only 64.7% of these use any. The calcium channel blockers (72.9%) are the leading antihypertensives used by respondents, and hydralazine is used for hypertensive emergencies.

Conclusions: There are still challenges with the diagnosis and management of childhood hypertension in Nigeria. Providing age-appropriate BP measurement equipment and following management guidelines would enhance the care of childhood hypertension nationwide.

Characteristics of adolescents with mental health emergencies requiring inpatient psychiatric hospitalization

2026-05-27T09:34:14+0530

Background: Pediatric psychiatric crisis was pushed to the forefront during the COVID-19-pandemic. Emergency departments (ED) and inpatient pediatric hospitals saw much higher volumes of mental health complaints, with many patients staying in these places until definitive care was available. The study objective was to evaluate pediatric psychiatric emergency visits and hospital admissions before and during the pandemic and identify the high-risk features of the patients requiring inpatient psychiatric hospitalization.

Methods: Retrospective chart review of ED and inpatient visits conducted from 3/1/2010-2/29/2022 of adolescents aged 13-18-years with a range of psychiatric diagnoses. Part I included data collection prior to the first case of COVID-19 in Michigan (3/1/2010-3/9/2020), and part II included data collection after the first case (3/10/2020-2/28/2022). Charts of patients needing inpatient psychiatric admissions during the pandemic were reviewed for factors affecting mental health.

Results: Retrospective chart review of ED and inpatient visits conducted from 3/1/2010-2/29/2022 of adolescents aged 13-18-years with a range of psychiatric diagnoses. Part I included data collection prior to the first case of COVID-19 in Michigan (3/1/2010-3/9/2020), and part II included data collection after the first case (3/10/2020-2/28/2022). Charts of patients needing inpatient psychiatric admissions during the pandemic were reviewed for factors affecting mental health.

Conclusions: Decreased prescribed medication use and inconsistent therapy appointments were seen in adolescents requiring inpatient psychiatric hospitalization. Identifying the gaps in care presents an opportunity for reducing the need for inpatient psychiatric care.

Relationship between maternal C-reactive protein, cord blood C-reactive protein and early onset neonatal sepsis in a tertiary care centre in North Kerala

2026-05-05T07:02:27+0530

Background: Early-onset neonatal sepsis (EONS) remains a major cause of neonatal morbidity and mortality, with diagnosis often delayed due to non-specific presentation. Maternal and neonatal inflammatory markers such as C-reactive protein (CRP) have been explored as early predictors of infection. Objectives were to determine the relationship between maternal CRP, cord blood CRP, and EONS in high-risk mothers, and to evaluate the diagnostic performance of these markers.

Methods: This prospective observational study included 96 high-risk mothers and their neonates at Malabar Medical College, Kozhikode. Maternal serum CRP and cord blood CRP were measured, followed by serial neonatal CRP assessments at 24 and 48 hours of life. Blood culture served as the diagnostic gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of maternal and cord blood CRP were calculated.

Results: There was no significant association between maternal or cord blood CRP and neonatal sepsis (p>0.05). However, serial CRP at 24 and 48 hours showed significant association with confirmed EONS (p<0.05). Maternal CRP had sensitivity 85.7%, specificity 22.7%, PPV 23.7%, and NPV 85%. Cord CRP showed sensitivity 4.8%, specificity 100%, PPV 100%, and NPV 78.9%.

Conclusions: Maternal and cord CRP alone are not reliable indicators of early-onset sepsis, but serial neonatal CRP monitoring at 24-48 hours aids in diagnosis. Maternal CRP has good sensitivity and NPV, whereas cord CRP shows high specificity and PPV.

Point-of-care ultrasound-guided hemodynamic assessment and resuscitation in neonatal shock: a prospective observational study

2026-05-27T09:37:09+0530

Background: Neonatal shock is a major contributor to morbidity and mortality in neonatal intensive care units (NICUs). Clinical assessment alone often fails to accurately identify the underlying hemodynamic disturbance, which can delay appropriate management. Point-of-care ultrasound (POCUS) has emerged as a rapid bedside tool for evaluating cardiovascular status in critically ill neonates. This study aimed to assess the utility of POCUS in identifying the etiology of neonatal shock and its influence on therapeutic decision-making.

Methods: This prospective observational study was conducted in the NICU of the Department of Pediatrics and Neonatology in collaboration with the Department of Cardiology at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, over an 18-month period. Neonates presenting with clinical features of shock were enrolled. Infants with congenital heart disease, cardiomyopathy, or structural valvular abnormalities were excluded. Bedside POCUS with focused echocardiography was performed at admission and during follow-up. Hemodynamic parameters including inferior vena cava (IVC) diameter, IVC collapsibility index (IVC-CI), and IVC/aorta ratio (AO) ratio were assessed. The relationship between ultrasound findings, etiology of shock, and subsequent management decisions was analyzed.

Results: A total of 110 neonates with shock were included. Septic shock was the most common etiology (41.6%), followed by cardiogenic shock (34.5%) and hypovolemic shock (23.6%). Early-onset shock (≤24 hours of life) was observed in 72.7% of cases. Significant variations in IVC parameters were observed among the different types of shock (p<0.05). Neonates with hypovolemic shock demonstrated higher IVC collapsibility, while cardiogenic shock was associated with increased IVC diameter and reduced collapsibility. POCUS findings resulted in modification of clinical management in a substantial proportion of cases, including optimization of fluid resuscitation, initiation or adjustment of inotropic therapy, and targeted supportive care. The overall mortality rate was 9.1%.

Conclusions: POCUS provides rapid, bedside hemodynamic assessment in neonates with shock and aids in differentiating underlying etiologies. Its integration into routine NICU practice can facilitate timely, targeted management and may improve clinical outcomes.

Clinical profile, risk factors and impact of maternal health on the outcome of infants under 6 months with severe acute malnutrition: a prospective observational study

2026-05-27T09:36:52+0530

Background: Malnutrition in infants under 6 months (U6M) remains an under-recognized but serious public health challenge, especially in low- and middle-income countries like India. Many of these infants are born with low birth weight or face feeding problems in early infancy due to various issues. Maternal health and wellbeing also play major role in growth and development of infants.

Methods: This is a prospective observational study conducted over a period of 12 months (March 2024 to March 2025) at SSG Hospital, Baroda. Infants meeting World Health Organization (WHO) criteria for SAM were enrolled with parental consent. Data was collected through detailed clinical assessments, anthropometry, breastfeeding evaluation, and maternal health screening using BMI, Hb, and PHQ-2score.

Results: From total enrolled 92 infants our study revealed a higher prevalence of SAM among males and infants aged 2–4 months and rural population. Important risk factors noted were low birth weight (57.6%), prematurity (11.95%), congenital malformation (18.47%), suboptimal feeding practices and maternal undernutrition or mental health concerns. Only 50% were on exclusive breastmilk while rest were on top milk, formula feeding or mixed feed which increased the risk of malnutrition. Majority mothers of these infants had low body mass index (BMI) (19.10%) and low Hb (85.40%) affecting their nutritional status. 50% infants were discharged while 30.43% were expired due to one or more complications.

Conclusion: SAM in U6M infants is multifactorial, with significant contributions from maternal health and suboptimal feeding practices. Early identification, integrated infant-maternal care, breastfeeding support, and maternal nutritional interventions are essential for improving outcomes. Health programs should provide more emphasis on early infancy care, optimal breastfeeding practices, maternal education and maternal nutrition.

Clinical profile of tuberculous meningoencephalitis in pediatric patients at a tertiary care center

2026-05-27T09:36:46+0530

Background: Tuberculous meningoencephalitis (TBME) is the most severe form of childhood tuberculosis and is associated with high mortality and long-term neurological sequelae. Despite availability of effective anti-tubercular therapy, delayed diagnosis, malnutrition, and poor immunization status continue to adversely affect outcomes in children.

Methods: This prospective observational study was conducted from January 2023 to June 2024 in the paediatric wards and pediatric intensive care unit of a tertiary care centre in western India. Children aged 1 month to 12 years diagnosed with TBME were included. Detailed clinical evaluation, laboratory investigations, neuro imaging, Bacillus Calmette–Guérin (BCG) vaccination status, nutritional status, complications, and outcomes were recorded using a pre-structured proforma.

Results: A total of 75 children with TBME were studied. Majority of patients (68%) were below five years of age. Fever, seizures, vomiting, and altered sensorium were the most common presenting features. BCG-vaccinated children had milder disease and better outcomes. Malnutrition was significantly associated with advanced disease stage, increased complications, and poor neurological outcome. Hydrocephalus was the most common complication. Mortality was higher in children with severe malnutrition and advanced stage of disease.

Conclusion: TBME remains a serious and life-threatening illness in children. BCG vaccination and good nutritional status play a protective role. Early diagnosis, prompt initiation of antitubercular therapy, and aggressive management of complications are essential to reduce morbidity and mortality.

Comparative nutritional analysis of four commercial infant formulas: compliance with food and drug administration regulations and developmental appropriateness across 0-6 and 6-12-month stages

2026-05-27T09:36:43+0530

Background: Infant formula serves as the primary nutritional source for non- breastfed infants, requiring strict adherence to regulatory standards while meeting developmental needs across different age stages. Objectives were to comparatively evaluate four commercially available infant formulas (Nestlé NAN PRO, Similac Advance, Aptamil Gold, and Nestlé Lactogen PRO) against Food and Drug administration (FDA) nutrient specifications and analyze their compositional appropriateness for stage 1 (0-6 months) and stage 2 (6-12 months).

Methods: Label-based comparative analysis of macronutrients, micronutrients, functional lipids Docosahexaenoic acid/ arachidonic acid (DHA/ARA), bioactive components [(probiotics, prebiotics, human milk oligosaccharides (HMOs), and added sugars. All values were normalized per 100 kcal and compared against food and drug administration (FDA) minimum and maximum requirements.

Results: All four formulas met FDA macronutrient specifications. Stage 2 formulations showed 14-48% protein increases and 40-300% sugar increases compared to stage 1. Aptamil Gold demonstrated the most comprehensive functional profile with five HMOs, GOS/FOS prebiotics, and DHA/ARA across both stages. NAN PRO maintained DHA/ARA consistency but discontinued probiotics in stage 2. Similac Advance exhibited the highest added sugar content in stage 2 (30 g/100 g) while retaining milk fat. Lactogen PRO emphasized digestibility through probiotics but lacked long-chain polyunsaturated fatty acids (LC-PUFAs). Iron content across all brands (6.5-9 mg/100 g stage 2) exceeded FDA minimum requirements, appropriately addressing post-6-month Anemia risk.

Conclusions: While all formulas comply with FDA nutrient specifications, significant compositional heterogeneity exists in functional ingredients and added sugars, potentially impacting gut microbiome development, neurocognitive outcomes, and metabolic programming. These findings underscore the importance of evidence-based formula selection aligned with individual infant nutritional needs.

Screens — a technological advancement: a study on screen time in the pediatric population of the Himalayan state, Uttarakhand

2026-05-27T09:36:31+0530

Background: In the modern era, children’s proclivity towards screen-based devices is steadily increasing. Excessive screen exposure has raised concerns regarding its impact on physical, social, and behavioural health in the pediatric population.

Methods: A 9-month cross-sectional study (July 2019–March 2020) was conducted among 491 children aged 1–18 years attending routine hospital visits. Data were collected using a structured questionnaire, including demographic details, BMI, duration of screen time, age at first exposure, context of usage, reactions after screen removal, and associated physical, social, and behavioral changes. Counseling interventions were provided to children exhibiting comorbidities or behavioral issues linked to excessive screen use, along with general awareness based on recommended screen time guidelines.

Results: The study included 128 toddlers, 122 pre-school children, 154 school-aged children, and 87 adolescents. Among them, 185 were underweight, 26 overweight, and 37 obese. The majority of children spent 30 minutes to 2 hours daily on television and mobile devices, with a statistically significant association with male gender. A positive correlation was observed between BMI and duration of television (r=0.228, p=0.000) and mobile exposure (r=0.366, p=0.000). Most children were first exposed to screens between 2–3 years of age. Common contexts of screen use included before sleeping and during meals, while adolescents predominantly used screens for recreation. Irritability was the most frequent reaction upon screen removal. Physical effects included loss of appetite and weight loss, while social changes involved altered sleep patterns and reduced attention span. Behavioural changes were most commonly anger, with loneliness being the least reported.

Conclusions: Implementation of family screen plans, limiting routine screen time, and promoting screen-free periods are essential strategies to support healthy growth and balanced development in children in the digital age.

Revisiting the usefulness of cold agglutinin test and direct Coombs test for bedside diagnosis of paediatric Mycoplasma pneumoniae pneumonia: a prospective observational study

2026-05-27T09:36:29+0530

Background: Mycoplasma pneumoniae is an important cause of community‑acquired pneumonia in children. Access to specific serological assays is limited in many resource‑constrained settings, necessitating evaluation of simple bedside diagnostic tests such as cold agglutinin test (CAT).

Methods: In this prospective observational study, children admitted with radiologically confirmed lobar pneumonia that showed no response to beta-lactams were evaluated with direct Coombs test (DCT) and CAT, and results were compared with Mycoplasma pneumoniae IgM serology as the reference standard. Clinical profile, inflammatory markers, treatment response and outcomes including need for paediatric intensive care and length of hospital stay were also recorded.

Results: Among IgM‑positive children, normal total leucocyte counts were significantly more frequent than in IgM‑negative cases, while erythrocyte sedimentation rate was commonly elevated, supporting an atypical pneumonia pattern. DCT showed low sensitivity and poor negative predictive value, whereas CAT demonstrated very high specificity and positive predictive value, making it a useful rule‑in test but unsuitable as a stand‑alone screening tool. CAT positivity was associated with a significantly longer duration of hospital stay, indicating more severe or protracted clinical course among children with demonstrable cold agglutinins.

Conclusions: Mycoplasma pneumoniae pneumonia in this cohort was characterized by normal total leucocyte counts with raised erythrocyte sedimentation rate, and CAT emerged as a highly specific rule‑in test, though it could not replace confirmatory serology testing.

Radiation exposure in neonatal intensive care unit of tertiary care hospital: a retrospective study

2026-05-27T09:35:06+0530

Background: This is retrospective observational study with aims to determine the mean number of radiographs exposure of neonates during their stay in the NICU and to identify risk factors for higher radiation exposure.

Methods: Total 1139 neonates were included in study. The following data were collected, birth weight, gestational age, risk factor, duration of stay, number and indication of radiograph and total radiation exposure. Radiograph was done by using Genuine ^TM portable X-ray machine. Each radiograph exposure accounts to 0.02 millisieverts (mSv) as per the manufacturer brochure. Statistical analysis was done by using SPSS var 23, ANOVA test, unpaired t-test was applied to test significance and p value of <0.05 was considered significant.

Results: Total 1139 neonates were enrolled of which 624 (54.8%) were male babies. Mean number of radiographs for entire sample was 2.76 (radiation exposure 0.05 mSv) with standard deviation (SD) of 2.97 (0.06mSv). Newborns < 28 weeks of gestation are more exposed to radiation with mean radiation of 0.1mSv±0.1mSv. Study observed that there is significant negative correlation of birth weight (r=-0.277) and gestational Age (r=-0.345) to radiation exposure. This indicates babies with prematurity and low birth weight are more exposed to radiation.

Conclusions: There is significant positive correlation between radiograph exposure and duration of stay (r=0.568) showing prolonged hospitalization causes more radiation exposure. Strategies to reduce radiation exposure, like using point-of-care ultrasound thus avoiding long term adverse effect. To know whether early radiation exposure may lead to adverse long-term consequences, follow-up study is necessary.

Role of pulse oximetry screening at 1 hour and 24 hours for early detection of congenital heart disease in newborns

2026-05-27T09:34:28+0530

Background: Congenital heart disease (CHD) is one of the most common congenital anomalies affecting newborns worldwide. Early detection of critical CHD is essential for reducing neonatal morbidity and mortality. Pulse oximetry screening is a simple, non-invasive, and cost-effective tool for early identification of hypoxemia associated with congenital cardiac defects.

Methods: This prospective observational study was conducted in the Department of Paediatrics, Rajarajeshwari Medical College and Hospital, Bangalore, from 1st January 2026 to 31^st march 2026. A total of 116 term neonates underwent pulse oximetry screening at 1 hour and 24 hours after birth using pre-ductal and post-ductal oxygen saturation measurements.

Results: Among the screened neonates, 57 (49.1%) were males and 59 (50.9%) were females. Three neonates (2.6%) screened positive and were referred for echocardiographic evaluation. Majority of neonates remained asymptomatic during screening.

Conclusions: Pulse oximetry screening is an effective and feasible screening modality for early detection of CHD in asymptomatic newborns.

Predictors of recurrence of febrile seizures: a prospective cohort study from a tertiary care centre

2026-05-27T09:35:00+0530

Background: This study was done to estimate various risk factors associated with the recurrence of febrile seizures in children aged 6 months to 5 years.

Methods: This prospective cohort study was conducted at Max Smart Super Speciality Hospital, New Delhi, on children aged 6 months to 5 years, admitted from June 2023 to May 2024. A total of 115 children presenting with their first episode of febrile seizures were enrolled and they were followed up for a period of 1 year. Children with CNS infections, afebrile seizures, or other exclusion criteria were omitted. History, clinical examination, and laboratory parameters including haemoglobin and serum sodium were recorded. Follow-up was conducted over one year. Data were analyzed using SPSS v24 with univariate analysis.

Results: Out of 115 children, 35 (30.4%) developed recurrent febrile seizures. Statistically significant associations were observed for age ≤1 year (p=0.008), prolonged seizure >5 minutes (p=0.0001), positive family history of FS (p=0.009), and haemoglobin <11 gm/dl (p=0.028). Gender, fever intensity, duration of fever, seizure type, and serum sodium levels were not significantly associated.

Conclusions: Younger age, prolonged seizures, positive family history, and anaemia were key predictors of FS recurrence. Early recognition of these factors can improve parental counselling and follow-up care strategies.

Improving positioning practices in preterm neonates: a point-of-care quality improvement initiative

2026-05-27T09:34:57+0530

Background: Optimum positioning is one of the core components of developmental supportive care (DSC). Preterm neonates lack sufficient neurological and musculoskeletal maturity and are at risk of developing misalignment, skeletal deformation, and gross motor delay. Maintaining consistent, developmentally appropriate positioning in routine NICU care remains challenging.

Methods: The aim of this study is to improve optimal positioning practices by 50% among preterm neonates admitted to the NICU using a structured quality improvement (QI) approach This single-centre QI study was conducted over a 12-week intervention period (1^st April to 30^th June 2025) following a 4-week baseline assessment (1^st March to 31^st March 2025). Positioning quality was assessed using the infant positioning assessment tool (IPAT), with scores >8 considered optimal. The point-of-care QI (POCQI) model was applied, and five plan-do-study-act (PDSA) cycles were implemented. Interventions included nurse training, provision of linen to create nesting boundaries, use of appropriately sized diapers, reinforcement of correct positioning practices, and training mothers in proper positioning practices

Results: During the baseline phase, the mean IPAT score was 6.7, and 30% of preterm neonates achieved mean IPAT score more than 8. Following the interventions, the mean IPAT score increased to 10.2, with 86% of preterm neonates achieving mean IPAT score more than 8, demonstrating a significant improvement in positioning practices.

Conclusions: This study shows that simple, low-cost, and collaborative interventions can effectively improve positioning practices in preterm neonates. Incorporating structured QI strategies into routine NICU care may enhance delivery of DSC.

Survival till discharge and risk factors of mortality among outborn extremely-low-birth-weight neonates: an experience from Central India

2026-05-27T09:34:07+0530

Background: Outborn extremely-low-birth-weight (ELBW) neonates have a poor outcome compared to institutionally born neonates. Objectives were to evaluate the risk factors of outcome in outborn ELBW neonates.

Methods: This prospective cohort study was conducted at a tertiary care institute in central India over 2.5 years. Exclusion criteria included death within one hour of arrival or withdrawal of medical advice. Demographic, maternal, neonatal, and transport characteristics were noted until discharge or death. Survival until discharge status and risk factors of mortality were identified. Statistical significance was determined using Chi-square, Mann-Whitney, and unpaired t-test; and multiple logistic regression models were used to identify independent risk factors of mortality. P<0.05 was considered significant.

Results: Survival-to-discharge rate was 19.9%. On univariate analysis, neonates who had longer transport distance (p=0.04), no communication before transport (p<0.0001), and no treatment during transport (p=0.0003); and neonates with hypoglycemia (p=0.05), delayed capillary refill time (CRT) (p=0.01), low oxygen saturation (p<0.0001), and hypothermia (p<0.0001) had risk factors of mortality. Age at admission (adjusted odds ratio [aOR] 0.97, 95% confidence interval [CI] 0.96-0.99, p=0.0001), hypothermia (aOR 0.036, 95% CI 0.004-0.31, p=0.003), and no communication before transport (aOR 46.95, 95% CI 7.57-291.25, p<0.0001) were the independent risk factors of mortality.

Conclusion: Outborn ELBW neonates face a high mortality rate. Age at admission, hypothermia, and lack of communication before transport were independent risk factors of mortality. The study highlights that clinical stabilization, specifically management of body temperature and improvement in pre-transport care and communication, is vital for increasing survival rates in this vulnerable population.

Utility of mid-parental height in predicting linear growth among school-aged children: a cross-sectional study

2026-05-27T09:34:52+0530

Background: Aim was to evaluate the correlation between height of children aged 5-12 years and parental heights, including mid-parental height (MPH).

Methods: This cross-sectional study was conducted from October 2022 to April 2024 at a tertiary care children’s hospital in Guntur, Andhra Pradesh. A total of 580 children aged 5-12 years were included. Heights of children and parents were measured using a standardized stadiometer. MPH was calculated using sex-adjusted formulas. Data normality was assessed using the Shapiro-Wilk test, and non-parametric tests were applied as appropriate.

Results: Among the participants, 58.45% were males. The mean age was 101.65±23.4 months, and mean height was 127.72±13.38 cm. Mean father’s height was 165.8±7.24 cm, mother’s height was 156.23±6.62 cm, and mean MPH was 162.11±8.91 cm. Overall, 33.45% of children were taller than their MPH, 63.62% were within the expected range, and 2.93% were below it. Children’s height showed significant positive correlations with father’s height (r=0.275), mother’s height (r=0.291), and MPH (r=0.223) (p<0.0001). No significant association was found with age or gender.

Conclusions: Nearly one-third of children exceeded their MPH, suggesting early growth acceleration influenced by environmental and nutritional factors, supporting the need to revise Tanner’s formula and update growth charts.

Incidence of hearing loss in high-risk neonates admitted in neonatal intensive care unit in a tertiary care centre using otoacoustic emissions

2026-05-27T09:34:49+0530

Background: Neonates admitted in neonatal intensive care units (NICU) are at higher risk of hearing impairment due to multiple perinatal and postnatal risk factors. Early detection of hearing loss is essential for timely intervention and prevention of speech and language delay. This study was conducted to estimate the incidence of hearing loss in high-risk neonates admitted in NICU in a tertiary care hospital and to identify the associated risk factors.

Methods: A hospital-based observational study was conducted among neonates admitted in the NICU of SAT Hospital, Thiruvananthapuram. A total of 384 neonates with risk factors as defined by the Joint Committee on Infant Hearing were included. Hearing screening was performed using otoacoustic emission (OAE). Neonates who failed OAE screening underwent confirmatory testing using brainstem evoked response audiometry (BERA). Data regarding antenatal history, perinatal events, clinical risk factors and NICU course were collected and analysed.

Results: A total of 384 neonates were screened. Thirty-two neonates failed OAE screening, of which 11 had unilateral failure and 21 had bilateral failure. Among these neonates, BERA was normal in 15 and abnormal in 17 cases. The incidence of hearing loss among high-risk neonates was 4.4%. Significant associations with hearing loss were observed with low APGAR score, presence of external anomalies, exposure to ototoxic drugs, culture positive sepsis, hypoxic ischemic encephalopathy, meningitis, intraventricular haemorrhage, respiratory distress syndrome, mechanical ventilation, recurrent apnoea and longer duration of NICU stay.

Conclusions: The incidence of hearing loss among high-risk neonates admitted in NICU is considerably higher compared to the general newborn population. Early screening using OAE followed by confirmatory BERA can facilitate early diagnosis and timely intervention.

Etiological spectrum and clinical outcomes of paediatric patients with fever and hepatosplenomegaly: a retrospective study from a tertiary care center

2026-05-27T09:34:46+0530

Background: Fever with hepatosplenomegaly is a common presentation in children. Etiologies range from infectious, hematological, malignancies and storage disorders. Early identification of underlying cause is crucial to reduce morbidity and mortality.

Methods: A hospital based retrospective observational study conducted in the Department of Paediatrics, Navodaya Medical College, Raichur for a duration of 6 months with sample size of 150. Children from 1 month - 18 years of age with medical records including laboratory tests indicating both fever and hepatosplenomegaly on clinical or radiological examination were included.

Results: The most common etiology was infectious (65%) including malaria (34.02%), dengue (28.88%), and enteric fever (19.58%), followed by hematological disorders (24.66%) and congestive (8%). Mean age was between 1 month and 5 years of age years (46%), with slight male predominance (58%).

Conclusions: Infections are the leading cause of fever with hepatosplenomegaly in children. A structured diagnostic approach can aid in early identification of serious conditions like leukemia or hemophagocytic lymphohistiocytosis (HLH).

Beyond B lines: role of pleural line thickness in a novel thoracic ultrasound score for predicting surfactant requirement in preterm neonates

2026-05-27T09:34:42+0530

Background: Lung ultrasound is a valuable tool for assessing neonatal respiratory distress. Standard lung ultrasound scores (LUS) quantify B-lines, but the role of pleural line thickness, a potential marker of pulmonary edema and inflammation, is less explored. Objective was to assess the diagnostic accuracy of a novel thoracic ultrasound score (TUS), which includes pleural line thickness, in evaluating oxygenation and predicting surfactant need in preterm neonates, compared to the standard LUS.

Methods: This prospective study included 80 preterm neonates. After stabilization, infants underwent lung ultrasound (based on Brat et al) and thoracic ultrasound within 3 hours of life. Both the TUS and the standard LUS were calculated.

Results: Surfactant was administered to 25 infants (31.25%). These infants had lower gestational age (30.80±3.19 versus 33.56±2.35 weeks, p<0.001), higher FiO₂ requirements, and worse oxygenation indices (S/F ratio: 199.96±26.00 versus 376.18±62.95, p<0.001). TUS and LUS were both significantly higher in the surfactant group (8.60±1.61 versus 3.71±1.42, p<0.001 and 10.80±1.68 versus 6.80±1.99, p<0.001, respectively). Pleural line thickness was greater in the surfactant group (1.42±0.15 mm versus 0.99±0.30 mm, p<0.001). For predicting surfactant need, the optimal TUS cut-off was 5 (sensitivity 96%, specificity 92.73%) and LUS cut-off was 9 (sensitivity 92%, specificity 94.55%). In infants >34 weeks, TUS showed sensitivity (100%) and NPV (100%). Both scores demonstrated strong correlations with OSI (TUS: r=0.77; LUS: r=0.71, p<0.001) and S/F ratio (TUS: r=-0.76; LUS: r=-0.72, p<0.001).

Conclusions: The thoracic ultrasound score, incorporating pleural line thickness, is feasible and accurate tool for early prediction of surfactant need and correlates strongly with oxygenation status in preterm neonates. It performs exceptionally well, particularly in near-term infants.

Stress perception and its determinants among parents of NICU-admitted neonates: a tertiary care study

2026-05-27T09:34:39+0530

Background: Admission of a newborn to the Neonatal Intensive Care Unit (NICU) is frequently associated with significant psychological stress among parents due to uncertainty regarding prognosis, complex medical interventions, and disruption of expected parental roles. Assessing parental stress and identifying influencing factors are essential for strengthening family-centered neonatal care.

Methods: A single-center, hospital-based cross-sectional study was conducted among 60 parents (60 couples) of neonates admitted to the NICU of LNMC & JK Hospital, Bhopal. Parents of neonates admitted for ≥24 hours were enrolled using consecutive convenience sampling. Sociodemographic and neonatal clinical details were recorded using a semi-structured proforma. Parental stress was assessed using the validated Parental Stressor Scale: NICU (PSS:NICU). Data were analyzed using R statistical software. Descriptive statistics, paired and independent t-tests, and Pearson’s correlation were applied. A p-value <0.05 was considered statistically significant.

Results: Mothers reported significantly higher stress scores than fathers in sight and sound (63.11±12.23 vs 56.85±13.33), infant appearance (79.83±6.84 vs 72.53±6.19), and parental role alteration (87.48±5.22 vs 77.90±5.39) domains (p<0.001). Staff-related stress was comparable (p=0.653). Parental role alteration was the highest stress domain overall. A significant negative correlation was observed between parental age and stress (fathers r=-0.441; mothers r=-0.351; p<0.001). Birth weight and NICU stay duration were not significantly associated with stress levels.

Conclusions: Parental stress in the NICU is significant and predominantly affects mothers. Early identification of vulnerable parents and implementation of structured counseling and family-centered interventions are essential to enhance coping and improve neonatal care outcomes.

A study to assess the effectiveness of breast feeding on pain level among infants during immunization at selected health and wellness centre, Daman

2026-05-27T09:34:37+0530

Background: Pain is a global health problem experienced from birth to the last stages of life. It has been proven that infants are able to feel painful stimuli during immunization. Multiple adverse effects of pharmacological agents due to their side effects prevent providers from adequately addressing procedural pain. Breast feeding should be the first-choice analgesic during painful procedures in neonates. Aim was to assess the effectiveness of breast feeding on pain level among infants during immunization at a selected health and wellness center, Daman.

Methods: A quasi-experimental, non-equivalent control group post-test-only design was adopted. 60 infants were selected using a non-probability convenient sampling technique; 30 were assigned to the control group and 30 to the experimental group.

Results: The mean pain score in the control group was 7.50 and in the experimental group was 2.70, with a mean difference of 4.800. The calculated unpaired "t" value of 12.829 was higher than the table value of 1.672 at p<0.05 level of significance, demonstrating the effectiveness of breast feeding in reducing pain during immunization.

Conclusions: Breast feeding is a simple, safe, cost-effective, and easy-to-administer pain intervention during immunization. It should be incorporated in all immunization centres as a pain management measure.

The impact of oscillometric blood pressure measurement on pain response in preterm neonates

2026-05-27T09:34:35+0530

Background: Preterm neonates admitted to neonatal intensive care unit (NICU) are subjected to numerous painful and potentially noxious procedures. Oscillometric blood pressure (BP) measurement, although classified as non-invasive, involves repeated application and inflation of a cuff on a fragile limb, and may elicit a significant pain response in this vulnerable population. The extent of this pain in preterm neonates, particularly in the Indian context, remains inadequately studied. Aim was to assess the pain response to non-invasive oscillometric BP measurement in preterm neonates using the premature infant pain profile-revised (PIPP-R).

Methods: A prospective observational study was conducted at the NICU of Rajarajeswari Medical College and Hospital, Bangalore, enrolling 50 preterm neonates (gestational age <36 weeks and post menstrual age <37 weeks). PIPP-R scores were recorded at three timepoints: baseline (T1), during BP measurement (T2), and 10 minutes after the procedure (T3). For within-group analysis, the Friedman test with post-hoc Wilcoxon signed-rank tests (Bonferroni correction) was used. Clinical characteristics were compared between neonates with pain and without pain using Mann-Whitney U and chi-square tests.

Results: Median PIPP-R scores were significantly higher during BP measurement (T2) compared to baseline (T1) and 10 minutes post-procedure (T3) (χ²=38.99, p<0.001). Out of 50 neonates, forty two percent of neonates (n=21) had pain during the procedure. Neonates with pain had significantly lower gestational age, birth weight, post menstrual age. (p<0.05).

Conclusions: Oscillometric BP measurement causes clinically significant pain in a substantial proportion of preterm neonates, particularly those with lower gestational age and birth weight. Individualized monitoring strategies and non-pharmacological pain management should be considered in this population.

Clinical and etiological profile of neonatal seizures in neonatal intensive care unit: a tertiary care hospital-based study

2026-05-27T09:34:12+0530

Background: Neonatal seizures are the most common neurological emergency in the neonatal period and are associated with significant morbidity and mortality. Biochemical abnormalities represent an important and potentially reversible cause of neonatal seizures, particularly in resource-limited settings where electroencephalographic monitoring is often unavailable. This study aimed to evaluate the clinico-etiological profile of neonatal seizures among neonates admitted to the neonatal intensive care unit (NICU).

Methods: This one-year prospective observational study was conducted in the neonatal unit of a tertiary care hospital in the Bundelkhand region. Term and preterm neonates with first-onset seizures within 28 days of life and no prior antiepileptic exposure were included, while those with major congenital malformations, jitteriness, tetanic spasms, or previous anticonvulsant treatment were excluded. Detailed clinical characteristics, seizure types, etiological factors, and biochemical parameters, including blood glucose and serum electrolytes, were systematically evaluated.

Results: Out of 1475 NICU admissions, 188 neonates developed seizures (incidence 12.74%); 150 cases were included for analysis. Most neonates (82%) presented within the first three days of life, with a male predominance (60%). Subtle seizures were the most common type (40%). Hypoxic-ischemic encephalopathy (HIE) (31.3%) was the leading etiology, followed by sepsis (27.3%). Biochemical abnormalities were observed in 28% of cases, with hypoglycemia (11.3%) and hypocalcemia (10%) being the most frequent. Preterm neonates showed a higher incidence of metabolic disturbances. All neonates with isolated biochemical abnormalities recovered completely following appropriate correction. Overall mortality was 9.3%, predominantly among neonates with HIE and sepsis.

Conclusion: HIE remains the leading cause of neonatal seizures. Biochemical abnormalities are common, reversible contributors and are associated with excellent outcomes when promptly corrected. Routine metabolic evaluation in all neonates with seizures is essential to improve prognosis and minimize unnecessary anticonvulsant use.

Study on microbial profile and antibiotic resistance patterns in culture proven neonatal sepsis: a three-year retrospective analysis from Rajarajeswari Medical College and Hospital, Bangalore, India

2026-05-27T09:33:58+0530

Background: Neonatal sepsis remains a significant cause of morbidity and mortality, particularly in developing countries, due to varying microbial patterns and rising antimicrobial resistance. Continuous surveillance of causative organisms and their antibiotic susceptibility is essential for effective management. The objective of the study was to analyze the microbial profile and antibiotic resistance patterns in culture-proven neonatal sepsis cases in a tertiary care hospital.

Methods: A retrospective observational study was conducted over a period of three years (January 2023 to January 2026) in Rajarajeswari Medical College and Hospital, Bangalore. A total of 75 neonates with clinically suspected sepsis were included based on predefined inclusion and exclusion criteria. Blood culture reports, demographic details, and antibiotic susceptibility patterns were collected from hospital records. Microbial identification and antibiotic sensitivity testing were performed using standard microbiological methods in accordance with CLSI guidelines. Data were analyzed using descriptive and inferential statistics.

Results: Among the 75 neonates, 61.33% were male and 85.33% presented with early-onset sepsis. The culture positivity rate was 36.00%. Klebsiella pneumoniae (44.44%) was the most common pathogen, followed by coagulase-negative Staphylococcus (18.52%) and Pseudomonas spp. (14.81%). Gram-negative organisms (59.26%) predominated over gram-positive organisms (40.74%). High sensitivity (100%) was observed for cefotaxime, ceftazidime, amikacin, meropenem, vancomycin, and linezolid. However, high resistance was noted for penicillin (70.83%), ampicillin (66.67%), and high-level gentamicin (75.00%). Multidrug resistance was observed in 66.67% of isolates. No statistically significant association was found between demographic factors and culture positivity (p>0.05).

Conclusion: Neonatal sepsis in the present study was predominantly caused by gram-negative organisms with a high prevalence of multidrug resistance. While higher-generation antibiotics remain effective, increasing resistance to first-line drugs highlights the need for antibiotic stewardship, regular surveillance, and institution-specific treatment guidelines.

A study of prevalence and outcome of shock in patients admitted to the pediatric intensive care unit at a tertiary care hospital

2026-05-27T09:33:50+0530

Background: Shock is the most common condition in children admitted in PICU with high morbidity and mortality rate in children. The knowledge about the etiology and risk factors will give an early clue in identifying and prioritizing management of Shock and its outcome in children. To study the prevalence of shock in children admitted in PICU and identify the etiology and response to treatment and assess the PRISM score and compare it with the outcome in Children.

Methods: Prospective Observational study in children admitted in PICU at a tertiary care hospital.

Results: Out of 878 cases admitted in PICU, shock was observed in 43 children (4.9%). shock at the time of admission and duration of stay in the hospital were found in 26 (70.3%) and 11 (29.7%) respectively. M: F ratio was 1.1:1. Children in the age group of <1 year, 1-5 years and 6-12 years were 17(46%), 16 (43.2%) and 4 (10.8%) respectively. Among the children with shock the distribution of etiology was septic shock 19 (51.4%), hypovolemic shock 10 (27%), distributive shock 4 (10.8%) and cardiogenic shock 4 (10.8%). The mortality rate was 16 (43.3%) and highest in Infants 14 (82.4%) with PRISM Score>30. The mortality rate was highest with septic shock 14 (71.4%) whereas all children with hypovolemic shock survived. Children presented with Compensated shock, decompensated shock and MODS in 14 (37.8%), 23 (62.2%) and 19 (51.4%) children respectively. The most common causes of mortality were MODS and decompensated shock.

Conclusions: Early screening, identification and intervention are key to improve the outcome in children with shock.

Serum absolute eosinophil count: bridging diagnosis and severity assessment in allergic rhinitis among children

2026-05-27T09:33:35+0530

Background: Allergic rhinitis (AR) is a non-infectious, IgE-mediated inflammatory disorder of the nasal mucosa characterized by nasal congestion, sneezing, itching, and rhinorrhoea. Diagnostic evaluation includes serum AEC, nasal smear eosinophilia, SPT, and IgE measurement. This study aimed to assess the diagnostic efficacy of serum absolute eosinophil count in identifying allergic rhinitis among children presenting with varying degrees of symptom severity.

Methods: A cross-sectional observational study was conducted involving 65 school going children diagnosed with allergic rhinitis aged 9-16 years. Disease severity was evaluated using TNSS. CBC and serum AEC were performed for all participants.

Results: The mean pediatric age group was 12.21 years, with 58.5% boys. Based on TNSS, 20% had mild, 47.7% moderate, and 32.3% severe disease. Elevated AEC was observed in 61.5% of children. Serum AEC showed significant positive correlation with TNSS severity (ρ=0.661, p<0.001) and excellent diagnostic accuracy (AUC=0.955).

Conclusions: Serum AEC is a simple, affordable, objective biomarker for early diagnosis and severity assessment in routine clinical practice.

Tubercular aortitis mimicking Takayasu arteritis: a diagnostic challenge in an endemic region

2026-05-27T09:36:23+0530

Takayasu arteritis (TA) is a chronic granulomatous large-vessel vasculitis involving the aorta and its major branches, with a possible pathogenic association with Mycobacterium tuberculosis, particularly in endemic regions due to shared immunopathological and epidemiological features. We report three pediatric cases of TA with concurrent or recent tuberculosis infection, all presenting with systemic symptoms, hypertension, and vascular insufficiency; computed tomography (CT) angiography confirmed large-vessel involvement, and inflammatory markers were elevated in all. Tuberculosis screening revealed positive Mantoux tests in each case, with one child having microbiologically confirmed rifampicin-sensitive tuberculosis on cartridge-based nucleic acid amplification test (CBNAAT) from gastric aspirate and two showing granulomatous lymphadenitis suggestive of tubercular etiology. Management included antihypertensives, anti-tubercular therapy, and carefully timed immunosuppression, resulting in clinical improvement and better blood pressure control, although vascular changes persisted. This case series highlights the clinically significant coexistence of TA and tuberculosis in children from endemic regions. The overlapping clinical, radiological, and immunological features pose diagnostic and therapeutic challenges. Screening for tuberculosis should be considered in all patients with suspected or confirmed TA prior to initiating immunosuppressive therapy. Early recognition and a coordinated treatment strategy integrating anti-tubercular therapy with immunosuppression are crucial for optimal patient outcomes.

From kidneys to cerebral vessels: diverse faces of paediatric hypertensive emergencies

2026-05-27T09:34:55+0530

Hypertensive emergency in children is rare but potentially life-threatening, requiring urgent recognition and management. Etiologies range from renal to vascular and hematological disorders. We report a descriptive case series of six paediatric patients (ages 1.5-12 years) presenting with acute severe hypertension and target organ damage. Clinical features, underlying causes, diagnostic findings, treatment, and outcomes were analysed. Six cases were analyzed with mean age 8.5 years and male predominance (4:2). Etiologies included atypical hemolytic uremic syndrome (33%, n=2), chronic kidney disease (17%, n=1), autosomal recessive polycystic kidney disease (17%, n=1), Moyamoya disease with β-thalassemia (17%, n=1), and drug-induced post-bone marrow transplant (17%, n=1). Neurological symptoms occurred in 83% cases, with headache, seizures, and altered sensorium being predominant presentations. All patients presented with blood pressure above 99^th percentile requiring immediate intervention. Treatment included intravenous antihypertensives (labetalol, sodium nitroprusside) combined with etiology-specific therapy including plasmapheresis, hemodialysis, peritoneal dialysis, and immunosuppressive withdrawal. Complete recovery occurred in 50% cases (n=3), partial recovery in 17% (n=1), and mortality in 33% cases (n=2). Deaths were associated with atypical HUS and ARPKD indicating poor prognosis in this subgroup. Hypertensive emergencies in children have diverse etiologies and high morbidity risk. Rapid blood pressure control combined with management of the underlying cause is essential for improving outcomes. Early diagnosis, individualized therapy, and multidisciplinary care remain crucial in reducing adverse outcomes.