International Journal of Contemporary Pediatrics

High-flow nasal cannula versus standard oxygen therapy for acute bronchiolitis in infants: a retrospective analytical study

2026-06-23T06:55:52+0530

Background: Acute Bronchiolitis is a highly prevalent lower respiratory tract infectious diseases among infants. Despite accounting for most hospitalizations in children under 5 years, all pharmaceutical treatments have not demonstrated clear efficacy. Thus, management is mostly by oxygen support. High-flow nasal cannula (HFNC) therapy was recently incorporated as an alternative to standard oxygen therapy (SOT). Given the conflicting results, its efficacy in the treatment of acute bronchiolitis remains unclear. Our study aimed to assess the efficacy of HFNC compared with SOT in terms of length of hospital stay, child discomfort and early discharge.

Methods: This retrospective analytical study was conducted at Ghayathi-AlDhafra hospitals, Abu Dhabi, United Arab Emirates, between January 2023 and December 2024. Data were extracted from electronic health records of infants admitted with acute bronchiolitis. All statistical analyses were performed using R version 4.4.1 in RStudio. Between-group comparisons used Fisher’s exact and Mann-Whitney U tests, with multivariable linear and logistic regression models employing bootstrap confidence intervals to assess length of stay and early discharge.

Results: A total of 81 infants (HFNC: n=15; SOT: n=66) were included in the analysis. Median length of stay was significantly longer in the HFNC group compared with SOT (4 (IQR 3-5) vs 3 (IQR 2-3) days; p=0.002) and HFNC use remained independently associated with prolonged hospitalization after adjustment (β=1.31 days; 95% CI 0.41-2.18). Early discharge within 48 hours was less frequent among infants receiving HFNC (13.33% vs 37.88%), although this difference did not reach statistical significance.

Conclusions: Use of HFNC is associated with longer hospital stays, suggesting that early HFNC use does not alter the course of disease in moderate bronchiolitis. Large-scale studies with standardized protocols are needed to accurately assess the efficacy of HFNC in the treatment of bronchiolitis to identify patients who would benefit most.

Neonatal hypothermia in a tertiary health facility in Ondo state: prevalence, outcomes and way forward

2026-06-23T06:54:21+0530

Background: Hypothermia, by the World Health Organization (WHO) is defined as a core temperature of less than 36.5⁰C. It is one of the neonatal emergencies which increases morbidity and mortality in the newborn period if not resolved quickly. The study sets out to determine the prevalence, associated factors, outcomes and possibly proffer solution to the problems.

Methods: This was a prospective study in which all babies admitted into the Special Care Baby Unit (SCBU) in the University of Medical Sciences Teaching Hospital, Akure were monitored for hypothermia over a nine-month period.

Results: A total of 145 neonates were admitted over the study period. The overall prevalence of hypothermia was 51.7%, with preterm neonates significantly more affected than term neonates (59.3% vs 46.5%, p=0.02). Moderate hypothermia was more common among preterm neonates while mild hypothermia predominated among term neonates. Radiant warmer use was the most common form of thermal care (80.0%), while skin-to-skin care was utilized in only 3.4% of cases. Time of delivery (p=0.011) and low Apgar score (p=0.042) were significantly associated with hypothermia. The overall mortality was 4.1%.

Conclusions: Neonatal hypothermia was prevalent in over half of admitted neonates, with prematurity, low Apgar score, and time of delivery and mode of delivery as significant risk factors. Strengthening thermal care practices, particularly skin-to-skin care utilization and consistent delivery room protocols, remains essential to reducing hypothermia related neonatal morbidity and mortality in this setting.

Predictors of therapeutic response to monthly pulse IV methylprednisolone in pediatric epileptic encephalopathy: a cohort study

2026-06-23T06:54:11+0530

Background: Pediatric epileptic encephalopathies (EE) are severe, drug-resistant epilepsy syndromes that often require adjunctive therapies beyond standard antiseizure medications. Data on predictors of response to intravenous methylprednisolone (IVMP), particularly in low- and middle-income countries, are limited.

Methods: This prospective cohort study at the Department of Paediatric Neurology and the Institute of paediatric neurodisorder and autism (IPNA) at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. The study period spanned January 2020 to June 2021, included 25 children with EE treated with monthly IVMP at a tertiary care center in Bangladesh. Clinical, electroclinical, and neuroimaging variables were analyzed to identify predictors of seizure response (≥50% reduction) using univariate and multivariate logistic regression.

Results: Sixteen children (64%) responded to IVMP. Responders were more likely to have CSWS (68.8% vs. 0%, p<0.001), normal neuroimaging (88.9% vs. 11.1%, p=0.005), and lower baseline seizure frequency (median 5 vs. 20 seizures/day, p=0.003), and none had cerebral palsy (p=0.003). Multivariate analysis confirmed CSWS (adjusted OR (aOR)=35.12, p=0.003), normal neuroimaging (aOR=18.21, p=0.022), and lower seizure burden (aOR=0.92, p=0.038) as independent predictors of response. Concomitant clobazam use showed an association in univariate analysis but did not remain significant after adjustment.

Conclusions: IVMP is a viable, cost-effective immunotherapy for selected children with EE, particularly those with CSWS, structurally normal neuroimaging, and lower seizure burden. Early recognition of these predictors can guide personalized treatment strategies and optimize outcomes in resource-limited settings.

The language of wheezing children: a study of symptoms described by parents

2026-06-12T07:10:13+0530

Background: Respiratory disorders are a leading cause of pediatric hospital admissions. Parental understanding of respiratory sounds, particularly the term "wheeze," is critical for accurate symptom reporting, asthma diagnosis and epidemiological research. In multilingual countries such as India, linguistic diversity may significantly affect how parents perceive and describe such symptoms.

Methods: A single-centre cross-sectional observational study was conducted over 12 months (March 2023-March 2024) enrolling 160 children aged 1 month to 12 years with paediatrician-confirmed wheeze. Parents completed a structured multilingual questionnaire. Statistical analysis was performed using Mann-Whitney U test, Chi-square test, and Fisher's exact test.

Results: Only 9.4% of parents recognized the term "wheeze." The most common sound descriptors were "Khad-Khad" (48.8%) and "Ghar-Ghar" (41.9%). Cough (39.4%) and visual chest movement changes (27.5%) were the predominant identifying cues. Parental awareness was significantly associated with educational status (p=0.001), family history of asthma (p=0.0077), past wheezing history (p=0.0138), and physician-diagnosed asthma (p=0.0086).

Conclusions: Parental awareness of the term "wheeze" is poor in multilingual Indian populations. Clinicians should employ culturally adapted, symptom-focused history-taking to improve diagnostic accuracy in pediatric respiratory illness.

The association of mother-infant attachment with cognitive development in infancy using the Bayley scale of infant development: a cross-sectional study

2026-06-19T06:53:36+0530

Background: Maternal attachment is deep-rooted in humans and primates. Both are designed to protect and preserve the species through nurturing behaviors. Early childhood attachment is foundational to an individual’s adult attachment style, affecting parenting and social relationships across generations. Thus, mother–infant attachment is fundamental to optimal child development and future outcomes.

Methods: This was a cross-sectional study conducted at the Pediatric Outpatient Department, Bharati Vidyapeeth Medical College Hospital & Research Centre, Pune, from April 2022 to September 2022. A total of 34 mother–infant dyads with children aged 1±3 months were included in the study. Dr. Bhakoo’s Mother–Infant Attachment Scale was used to evaluate attachment between mothers and children. The higher the score, the greater the mother–infant attachment.

Results: Working mothers (p=0.027), separation from the mother (p=0.022) and socioeconomic status (p=0.042) significantly affected mother–infant attachment. Mother–infant attachment was not significantly associated with cognitive development in infancy (p=0.80). Studies with larger samples may be required to explore further associations.

Conclusions: We found no significant correlation between mother–infant attachment and cognitive development. The results provided further evidence that studies with larger samples are required to determine the impact of attachment and overall development.

A prospective study to evaluate the utility of blood culture in hospitalized children with community acquired pneumonia (age three months to eighteen years)

2026-06-23T06:55:57+0530

Background: Community-acquired pneumonia (CAP) remains a leading cause of morbidity and mortality among children worldwide. Although blood culture is the diagnostic gold standard for bacteremia, its routine use in paediatric CAP is debated due to low yield and contamination risk. To evaluate the diagnostic and prognostic utility of blood culture in hospitalized children with CAP.

Methods: A prospective analytical study was conducted among 100 children aged 3 months-18 years admitted with CAP at GBH General Hospital, AIIMS Udaipur (January 2023-July 2025). Demographic, clinical, laboratory and radiological data were recorded. Blood cultures were obtained before antibiotic therapy and processed using standard microbiological methods. Associations between culture results and outcomes were analysed using SPSS v25 (p<0.05).

Results: Blood culture was positive in 22% of cases, with Streptococcus pneumoniae as the predominant isolate (45.5%). Positive cultures were significantly associated with ICU admission (81.8%), complications (31.8%), antibiotic escalation (81.8%) and mortality (36.4%) (p<0.001). Kaplan–Meier survival analysis showed markedly lower survival among culture-positive patients (63.6%) compared to culture-negative (98.7%, p<0.001).

Conclusions: Blood culture positivity in pediatric CAP signifies severe disease and adverse outcomes. Selective use in moderate-to-severe cases can guide rational antibiotic therapy and improve prognostic assessment.

Transcutaneous bilirubin measurement in preterm infants less than 35 weeks of gestation

2026-06-23T06:55:57+0530

Background: Neonatal hyperbilirubinemia is a common clinical condition in preterm infants due to hepatic immaturity and increased bilirubin production. Monitoring bilirubin levels is essential to prevent bilirubin-induced neurological dysfunction. Total serum bilirubin (TSB) estimation is considered the gold standard for diagnosis and monitoring; however, repeated blood sampling in preterm infants may lead to iatrogenic blood loss, procedural pain and increased risk of infection. Transcutaneous bilirubin (TcB) measurement offers a rapid, non-invasive alternative for bilirubin estimation, but its reliability in very preterm infants requires further evaluation.

Methods: A hospital-based cross-sectional study was conducted over twelve months (June 2024-July 2025) in the neonatal intensive care unit in RajaRajeswari Medical College and Hospital. Preterm infants born before 35 weeks of gestation fulfilling inclusion criteria were enrolled. Transcutaneous bilirubin measurements were obtained using a TcB device from the forehead or sternum. Blood samples for serum bilirubin estimation were collected simultaneously or shortly after TcB measurement. Data were analysed using SPSS version 23. Pearson correlation coefficient and Bland–Altman analysis was used to assess correlation and agreement between TcB and TSB values.

Results: Sixty-three paired TcB and TSB measurements were analysed. The mean TcB value was 8.20±1.70 mg/dl, while the mean TSB value was 8.75±1.80 mg/dl. A strong positive correlation was observed between TcB and TSB (r=0.864, p<0.001). Bland–Altman analysis showed a mean difference of 0.546 mg/dl with acceptable limits of agreement.

Conclusions: Transcutaneous bilirubin measurement demonstrates strong correlation and good agreement with serum bilirubin levels in preterm infants less than 35 weeks of gestation. TcB is a reliable non-invasive tool for monitoring neonatal jaundice and may reduce the need for frequent blood sampling in neonatal intensive care units.

Clinical, immunophenotypic and cytogenetic profile of acute lymphoblastic leukemia in children aged 1–12 years at a tertiary care centre in central India: a prospective observational study

2026-06-23T06:55:53+0530

Background: Acute leukemias, particularly ALL, constitute one of the most common and curable malignancies in children across India. Their heterogeneity mandates detailed evaluation of clinical, immunophenotypic and cytogenetic features to guide therapy and prognostication. Indian studies highlight variable survival, with rural populations often disadvantaged in access and outcomes.

Methods: We conducted a two-year prospective study (2022–2024) at a tertiary center in central India to assess the clinical, immunophenotypic and cytogenetic profile of children (1–12 years) with newly diagnosed ALL. The study compared clinical features, immunophenotypic subtypes and cytogenetic abnormalities between patients with poor outcomes and others to improve diagnostic accuracy, risk stratification and treatment planning in resource-limited settings.

Results: This study evaluated 40 pediatric patients with ALL to identify factors influencing clinical outcomes. B-cell ALL was the predominant subtype (82.5%) and was associated with better outcomes compared to T-cell ALL. Extremes of age (<3 years and >10 years), high total leukocyte count (>50,000/µl), severe thrombocytopenia and high-risk stratification were significantly associated with poorer outcomes. Immunophenotypic markers suggestive of T-cell lineage and unfavourable cytogenetic abnormalities such as t (9;22) were linked to poorer prognosis, while t (12;21) was associated with favorable outcomes. Overall, only 40% of patients achieved remission, highlighting the need for early risk stratification and close monitoring of high-risk children.

Conclusions: Immunophenotypic and cytogenetic profiles significantly influenced patient outcomes. Specifically, T-cell markers (CD3, CD5, CD7) and unfavorable translocations like t (9;22) or t (1;19) were associated with a poor prognosis. Conversely, B-cell markers (CD19, CD10) and the t (12;21) translocation predicted more favorable results. Although the cohort was stratified into standard (22.5%), intermediate (65%) and high-risk (22.5%) groups, the trend linking high-risk status to poorer outcomes was not statistically significant, likely due to the small sample size.

Correlation between neonatal foot length and gestational age: a tertiary care hospital-based study

2026-06-23T06:55:52+0530

Background: Accurate gestational age (GA) assessment is crucial for neonatal care, particularly in resource-limited settings where ultrasonography and trained personnel may be unavailable. Foot length measurement offers a simple, low-cost alternative for identifying preterm newborns who require specialized care.

Methods: A cross-sectional study was conducted at Mother Hospital, Thrissur, Kerala, from December 2022 to December 2023. Two hundred healthy newborns above 34 weeks gestation were included. Foot length was measured using sliding calipers with millimeter accuracy. Gestational age was calculated from the last menstrual period. Other anthropometric parameters including head circumference, crown-heel length and birth weight were also measured. Pearson correlation coefficient and linear regression analysis were performed to determine the relationship between foot length and gestational age.

Results: Of 200 neonates studied, 59% were male and 41% female; 77% were term and 23% preterm. Mean foot length was significantly higher in term babies (7.89±0.29 cm) compared to preterm babies (7.23±0.22 cm). Foot length showed a strong positive correlation with gestational age (r=0.76, p<0.001), which was superior to correlations with head circumference (r=0.37), crown-heel length (r=0.62) and birth weight (r=0.69). The regression equation derived was: gestational Age=15.614+2.814×foot length. ROC curve analysis demonstrated excellent discriminatory ability (AUC=0.945) with an optimal cut-off of 7.55 cm (sensitivity 91.3%, specificity 91.6%).

Conclusions: Neonatal foot length is a reliable, simple and accurate proxy measure for gestational age assessment. This measurement can be effectively utilized by trained or untrained personnel in resource-poor settings for early identification of preterm newborns requiring specialized care.

Comparison of serum vitamin B12 levels in exclusively breastfed and mixed-fed term infants aged 3-6 months: a hospital-based observational study

2026-06-23T06:55:50+0530

Background: Vitamin B12 is essential for DNA synthesis, neurological development, red blood cell productio- and myelination during infancy. Infants depend mainly on maternal stores and breast milk during the first few months of life. Maternal deficiency is common in vegetarian populations and may predispose infants to deficiency.
Methods: This hospital-based observational study was conducted in the Department of Paediatrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, from July 2024 to December 2025. A total of 80 term infants aged 3-6 months were enrolled. Forty infants were exclusively breastfed and forty infants were mixed-fed. Serum vitamin B12 levels, complete blood count parameters, feeding history and maternal dietary practices were assessed.
Results: Mean serum vitamin B12 was significantly lower in exclusively breastfed infants (379.90±205.60 pg/ml) compared with mixed-fed infants (514.85±227.73 pg/ml). Vitamin B12 deficiency (<200 pg/ml) was found in 22.5% of exclusively breastfed infants and 5% of mixed-fed infants. Maternal vegetarian diet was significantly associated with lower infant vitamin B12 levels. Exclusive breastfeeding was identified as an independent predictor of vitamin B12 deficiency.

Conclusions: Exclusively breastfed infants, particularly those born to vegetarian mothers, are at increased risk of vitamin B12 deficiency. Early screening, maternal nutritional counselling and timely supplementation may help prevent long-term hematological and neurological complications.

Mortality and major morbidity profile of extremely preterm newborns at a tertiary level neonatal intensive care unit in Western India

2026-06-23T06:54:31+0530

Background: Extremely premature newborns are at highest risk of mortality and long-term morbidities. A few studies were conducted on the outcomes of extreme preterm newborns in developing countries like India.

Methods: This retro prospective observational study was done at neonatal intensive care unit of Deenanath Mangeshkar hospital, Pune, a tertiary care hospital in Maharashtra. Study included all extremely preterm newborns over a period of 32 months.

Results: Among 64 eligible newborns, overall mortality rate was 35.9%. Overall survival to discharge among study population was 53.1%. Survival to discharge increased with advancing gestational age:20 % at 23 weeks, 12.5% at 24 weeks, 37.5% at 25 weeks, 46.7% at 26 weeks, 81.5% at 27 weeks of gestational age. 90.6% newborns had any 1 major morbidity and 17.4% newborns survived without any major morbidity. The major morbidities in this study were 60.9% moderate -severe BPD, 9.4% PVL,4.7% severe IVH ,1.6% definite NEC, 45.3 % sepsis, 1.6 % severe ROP. Other morbidities such as RDS (95%), Apnoea of prematurity (83%), Anaemia of prematurity (69%), HsPDA (56%) and SIP (11%) were also observed. The survival rate was observed more among intramural newborns as compared to extramural newborns.

Conclusions: The mortality and morbidities of extreme preterm newborn are still higher. Survival increases with advancing gestational age. Knowing the outcome of extremely preterm newborns guides in clinical decision making, framing resuscitation guidelines, standard protocols as well as in parent counselling.

Prevalence of prediabetes and diabetes in overweight and obese children aged 5 to 15 years and their association with triglycerides, blood pressure, ALT and acanthosis nigricans: a single centre cross-sectional study

2026-06-23T06:54:30+0530

Background: The rising prevalence of childhood obesity has led to an increasing burden of metabolic disorders, including prediabetes and diabetes. Early identification of metabolic risk factors in overweight and obese children is crucial for timely intervention and prevention of long-term complications.

Methods: A cross-sectional study was conducted on 141 children, classified as overweight or obese using BMI percentiles. Anthropometric data, blood pressure and presence of acanthosis nigricans were recorded. Laboratory tests included fasting blood sugar, HbA1c, serum triglycerides and ALT. Statistical analysis evaluated prevalence and associations with glycemic status.

Results: Of the children,58.9% were males; 71.6% were obese and 28.4% overweight. Glycaemic distribution was 24.1% non-diabetic, 69.5% prediabetic and 6.4% diabetic. Prediabetes was most common in both overweight (62.5%) and obese (72.3%) groups. Among overweight children, systolic blood pressure (SBP) was significantly associated with glycaemic status (p=0.022); all diabetics had SBP in the 90-95th percentile. In obese children, SBP differences were not significant. Triglyceride abnormalities were significant in obese children (p=0.0001), especially in diabetics (100%) and prediabetics (43.8%), with the highest mean level in diabetics (182.7±33.1 mg/dl; p=0.023). ALT levels showed no significant association in either group (p=0.782 in overweight, p=0.399 in obese). Acanthosis nigricans was significantly more common in obese children (p=0.031), seen in 93.2% of prediabetics and 100% of diabetics.

Conclusions: Prediabetes was highly prevalent (69.5%) among overweight and obese children. Elevated SBP was linked to diabetes in overweight children, while triglyceride abnormalities were prominent in obese diabetics. Acanthosis nigricans emerged as a strong clinical marker of insulin resistance. These findings highlight the need for early detection, targeted lifestyle interventions and public health strategies, with longitudinal studies essential to confirm associations and evaluate interventions.

A retrospective study of clinical profile of acute lower respiratory tract infections in children between 2 and 60 months

2026-06-23T06:54:29+0530

Background: Acute lower respiratory tract infections (ALRTI) is one of the main causes of illness and mortality in children under 5, especially in developing nations like India. The most common illness that necessitate hospitalizations are pneumonia, bronchiolitis and wheeze associated LRTI.

Methods: This retrospective observational study was conducted at a tertiary care teaching hospital. The study was conducted at a tertiary care teaching hospital, where medical records of children aged 2 months to 60 months admitted with ALRTI were reviewed over the study period. Demographic details, clinical features, nutritional and immunization history, laboratory findings, treatment modalities and outcomes were all carefully analyzed.

Results: The study involved ninety children. Overall, infants were commonly involved, with male predominance. The most frequent diagnosis was pneumonia, which was followed by WALRTI and bronchiolitis. Cough, fever, tachypnea and respiratory distress are the common presenting symptoms. Risk factors that are often noted was overcrowding, exposure to biomass burning, malnutrition and incomplete immunization. While a small proportion of children required acute care and ventilator support, majority children recovered with proper care.

Conclusions: ALRTI remain a significant cause of hospitalization in children until 5 years of age. Pneumonia remains the predominant clinical entity. Early diagnosis, prompt treatment and addressing modifiable risk factors can significantly improve outcomes.

A study of anthropometric parameters in children with beta thalassemia major

2026-06-23T06:55:56+0530

Background: Growth failure is a common and persistent complication in children with beta thalassemia major despite advances in regular blood transfusion, bone marrow transplantation and supportive care, which have improved survival.

Methods: This cross-sectional study was conducted among 100 children with beta thalassemia major attending the pediatric outpatient department or admitted to a tertiary care center in Surat. Anthropometric measurements were recorded and correlated with serum ferritin levels.

Results: The majority of children were aged 6–10 years (47%), followed by 1–5 years (39%), while 1% were below 1 year. Boys constituted 60% of the study population. Among children with hemoglobin <8 g/dl, 58.62% had serum ferritin >2000 μg/l, while 69.23% of those with Hb ≥8 g/dl also had ferritin >2000 μg/L. The mean weight, height and BMI were 17.9 kg, 109 cm and 15.02 kg/m², respectively. Nearly one-third of children had weight below the 3rd centile and about one-fifth were between the 3rd and 10th centiles.

Conclusions: Growth impairment remains highly prevalent among children with beta thalassemia major, with significant stunting and underweight. Most children were aged 6–10 years and predominantly male. Nearly half were stunted. While weight centiles showed no significant association with serum ferritin levels, height and BMI centiles demonstrated significant correlation, indicating a greater impact of iron overload on linear growth.

Clinico-etiological profile and outcomes of bicytopenia and pancytopenia in children at a tertiary care hospital

2026-06-23T06:54:27+0530

Background: Bicytopenia and pancytopenia in children are haematological manifestations indicating underlying bone marrow dysfunction, peripheral destruction or systemic disease. The etiological spectrum in developing countries varies with nutritional deficiencies and infections playing a predominant role. There is limited data describing the clinicoetiological profile of bicytopenia and pancytopenia in children in recent times.

Methods: This is a cross-sectional observational study conducted at a teaching hospital, over a period of 18 months. A total of 110 children aged 1 month to 12 years (68 with pancytopenia, 42 with bicytopenia) were enrolled after obtaining informed consent. Basic patient information and clinical findings along with relevant investigations including complete blood count, peripheral smear, bone marrow examination and relevant biochemical and serological tests were done. Data was obtained on a predesigned proforma and analyzed using descriptive statistics.

Results: There was a male predominance (54.5%) with the majority (49%) in the 6–12-year age group. Fever (88.18%) was the most common presentation. The leading causes of cytopenia were infections 48 (43.6%) followed by nutritional deficiencies 43(39%). Other less common causes were primary haematological disorders that included acute leukaemia 11(10 %), thalassemia with hypersplenism 3 (2.72%), ITP 2 (1.8%) and aplastic anaemia 2 (1.8%).

Conclusions: Bicytopenia/pancytopenia is predominantly caused by treatable nutritional and infectious conditions with excellent prognosis. However, significant patients have life-threatening disorders like leukemia and aplastic anemia, which account for all mortality and morbidity.

Electrolyte disturbances in infants with enterostomy: a prospective analysis

2026-06-23T06:54:25+0530

Background: Aim was to prospectively evaluate the incidence, pattern, and longitudinal trends of electrolyte disturbances, including serum electrolytes and urinary sodium levels, in infants with enterostomies compared to controls.

Methods: This prospective case-control study was conducted at a tertiary care center between May 2023 and December 2024. Fifty infants aged 0-3 months undergoing ileostomy were compared with 50 age-and sex-matched controls without malabsorption. Serum electrolytes (sodium, potassium, calcium, phosphate, magnesium) and urinary sodium were assessed at discharge and at 1, 3, and 6 months. Electrolyte abnormalities were defined using standard pediatric reference ranges, and urinary sodium <10 mmol/L indicated sodium depletion.

Results: Infants with ileostomy demonstrated a significantly higher prevalence of sodium depletion compared to controls. Urinary sodium <10 mmol/L was observed in 50%, 50%, and 54.2% at 1, 3, and 6 months, respectively. Hyponatremia occurred in 62.5%, 60.4%, and 52.1% of infants at corresponding time points. Other electrolyte disturbances were less frequent but clinically relevant, with hypocalcemia and hypokalemia observed in 10.4% of infants at 6 months.

Conclusions: Hyponatremia, along with low urinary sodium levels, is commonly observed in infants with enterostomies and indicates underlying total body sodium depletion secondary to ongoing gastrointestinal losses. Although other electrolyte abnormalities are less common, periodic surveillance remains important. Early recognition and targeted management are essential to optimize growth and clinical outcomes.

Correlation of cord blood alkaline phosphatase level with serum bilirubin level in term neonates with jaundice: an observational study

2026-06-23T06:54:24+0530

Background: Neonatal hyperbilirubinemia remains a significant concern in neonatal care, affecting newborn health and requiring early identification for timely intervention.

Methods: This observational study was conducted in the Department of Pediatrics at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, from July 2024 to December 2025. A total of 145 term inborn neonates were enrolled. Cord blood samples were collected at birth for estimation of alkaline phosphatase (ALP) levels. Neonates were followed up for the first 5 d of life with daily transcutaneous bilirubin monitoring, and serum bilirubin estimation was performed when indicated. Statistical analysis included Spearman’s correlation and receiver operating characteristic (ROC) curve analysis. Sensitivity, specificity, and predictive values were calculated.

Results: Cord blood ALP levels showed a moderate positive correlation with maximum serum bilirubin levels (ρ=0.541, p=0.001). Of the 145 neonates, 33 (22.8%) required phototherapy. Roc analysis demonstrated fair predictive ability of alp for phototherapy requirement (auc=0.695). The optimal cut-off value of 117.5 u/l yielded sensitivity of 51.85%, specificity of 84.85%, positive predictive value of 91.80%, and negative predictive value of 35.0%.

Conclusions: Cord blood alp is a simple, non-invasive, and cost-effective biomarker that correlates significantly with serum bilirubin levels. It may be useful for early identification of neonates at risk of hyperbilirubinemia, enabling timely monitoring and intervention, particularly in resource-limited settings.

The utility of umbilical cord blood culture in the diagnosis of early onset sepsis in neonates at a tertiary care hospital

2026-06-23T06:54:23+0530

Background: Umbilical cord offers an alternative site for blood culture collection. Umbilical cord blood culture (UCBC), obtained aseptically immediately after delivery, is painless, technically simpler method that allows collection of an adequate blood volume before antibiotic exposure. Objective was to study utility of UCBC in the diagnosis of early onset sepsis in neonates

Methods: Hospital based prospective study was carried out among 100 neonates delivered by normal vaginal delivery (NVD) and lower segment caesarean section (LSCS), who were at risk of developing EOS. Information was collected from structured proforma for each patient. Details of newborn and mother/Risk factors including maternal and neonatal risk factor was taken/clinical feature of newborn risk for early onset sepsis was taken. Qualifying patient underwent detailed history, clinical examination and sepsis screening was sent in NICU. Umbilical cord blood sample was processed for five days and growth and antibiotic sensitivity was reported.

Results: Majority mothers were <20 years (47%). Mostly they belonged to gestational age of 28-34 week. Majority had birth weight between 1-1.5 kg (37%). Most common risk factor was pre-mature rupture of membranes (72%). Tachypnea was most common clinical feature (35%). 33% were culture positive by UCBC compared to 17% by peripheral venous blood culture (PVBC). Most common organism isolated by UCBC was Acinetobacter (11%). Sensitivity, specificity, PPV, NPV sepsis screening compared to UCBC was 90.9%, 53.7%, 49.2%, 92.3% respectively. Sensitivity, specificity, PPV, NPV of sepsis screening compared to PVBC was 82.4%, 43.4%, 22.9%, 92.3% respectively. Sensitivity, specificity, PPV, NPV of UCBC compared to PVBC was 77.8%, 76.8%, 42.4%, 94.03% respectively.

Conclusions: Early-onset neonatal sepsis was more common among preterm, low-birth-weight neonates and those exposed to maternal risk factors, particularly PROM.

Magnetic resonance imaging evaluation of intracranial abnormalities causing neonatal seizures in the post-COVID era: a cross-sectional study

2026-06-23T06:54:23+0530

Background: Neonatal seizures are the most common neurological emergency in the neonatal period, representing the earliest sign of underlying cerebral pathology. Magnetic resonance imaging (MRI) has become the preferred imaging modality due to its superior soft-tissue contrast and ability to detect subtle structural abnormalities. In the post-COVID era, evolving patterns of neonatal neurological injury warrant renewed evaluation of MRI findings in this population. Objectives were to evaluate the spectrum of intracranial abnormalities on MRI in neonates presenting with seizures, and to determine the probable etiology based on MRI findings, in the post-COVID era.

Methods: Hospital-based cross-sectional observational study conducted over 18 months at a tertiary care centre. Forty-five consecutive neonates presenting with seizures underwent MRI brain within one week of onset, using a 1.5 Tesla scanner with T1W, T2W, FLAIR, diffusion-weighted imaging (DWI)/ apparent diffusion coefficient (ADC), and susceptibility-weighted imaging (SWI) sequences. Descriptive statistics were applied.

Results: MRI was abnormal in 77.8% (35/45) of neonates. Hypoxic-ischemic encephalopathy (HIE) was the most common etiology (40.0%), followed by intracranial haemorrhage (31.1%) and infective encephalitis pattern (20.0%). White matter involvement (55.6%) and diffusion restriction (40.0%) were the most frequent MRI findings. Bilateral involvement was present in 64.4%. Normal MRI was seen in 22.2%.

Conclusions: MRI demonstrates high diagnostic yield in neonatal seizures. HIE remains the leading cause; however, the relatively elevated proportions of intracranial haemorrhage and infective encephalitis patterns suggest evolving etiological trends in the post-COVID era. Early MRI with DWI and SWI is essential for timely diagnosis and targeted management.

Atypical hepatic, cardiac, and renal manifestations in pediatric dengue: a prospective study

2026-06-23T06:54:20+0530

Background: Dengue fever is the most prevalent arboviral infection worldwide and is characterized by a broad clinical spectrum, ranging from self-limiting febrile illness to severe, life-threatening complications. In recent years, there has been growing recognition of atypical presentations, collectively referred to as expanded dengue syndrome (EDS), encompassing involvement of organs such as the liver, heart, and kidneys. The aim of this study was to evaluate the atypical hepatic, cardiac, and renal manifestations in children with dengue infection.

Methods: This prospective cohort study included 100 pediatric patients with serologically confirmed dengue infection. All participants underwent detailed clinical assessment along with laboratory investigations, including complete blood counts (CBC), liver function tests (LFT), renal function tests (RFT), coagulation profiles, and electrocardiographic (ECG)evaluation.

Results: The mean age of the study population was 8.65±3.34 years, with a slight male predominance (55%). Serological analysis showed that 72% of patients were positive for NS1 antigen alone, whereas 28% demonstrated both NS1 and IgM positivity. Hepatic involvement was common, with elevated SGOT levels observed in 51% of cases, while SGPT elevation was noted in only 6%. Hematological abnormalities were prominent, with anemia detected in 93% and thrombocytopenia in 86% of patients. Renal involvement was relatively infrequent; elevated serum creatinine was seen in 9% of cases, and proteinuria in 1%. No electrocardiographic abnormalities were identified in the study cohort. On subgroup analysis, patients with combined NS1 and IgM positivity had significantly lower platelet counts (p=0.0397) and hemoglobin levels (p<0.0001) compared to those with isolated NS1 positivity.

Conclusions: Hepatic transaminitis and hematological cytopenias constitute common systemic manifestations, with occasional atypical involvement in pediatric dengue. Concurrent positivity for NS1 antigen and IgM antibody is associated with a more severe clinical profile, suggesting its potential role as a marker of disease severity.

Pattern of neonatal birth injuries among deliveries conducted at Kamla Nehru hospital, Shimla: a prospective cross-sectional study

2026-06-23T06:54:19+0530

Background: Neonatal birth injuries refer to anatomical or functional harm sustained during childbirth and encompass a broad clinical spectrum. This study aimed to evaluate the pattern of neonatal birth injuries on physical examination among deliveries conducted at Kamla Nehru Hospital, Himachal Pradesh.

Methods: A prospective cohort study was conducted over 12 months on 376 live neonates. A standardized physical examination was performed within the first 2 hours of life to detect injuries such as caput succedaneum, cephalohematoma, fractures and soft tissue trauma. Associations with maternal, intrapartum and neonatal risk factors were analysed.

Results: The overall incidence of neonatal birth injuries was 20.7% (78 out of 376 neonates). Head and neck injuries were the most common (89.7%), followed by limb and joint injuries (7.7%). A statistically significant association was observed between the mode of delivery and birth injuries (p<0.001); 62.8% of injured neonates were delivered via normal vaginal delivery. Prolonged labor was a highly significant predictor of birth trauma (OR: 33.94, p<0.001). Neonatal sex, maternal comorbidities and gravida status showed no statistically significant association with the occurrence of birth injuries.

Conclusions: Birth injuries remain a prevalent clinical challenge that is predominantly influenced by intrapartum mechanical factors, particularly prolonged labor and mode of delivery, rather than maternal demographics.

Awareness and knowledge of specific learning disorder among rural primary school teachers in South India: a cross-sectional questionnaire-based study

2026-06-23T06:54:17+0530

Background: Specific learning disorder (SLD), particularly dyslexia, is a common neurodevelopmental condition that is often under-recognized in rural settings. Primary school teachers play a key role in early identification. Objectives were to assess awareness and knowledge of SLD among rural government primary school (GPS) teachers and identify associated factors.

Methods: A cross-sectional study was conducted among 220 rural GPS teachers in rural, South India (February-March 2024). All rural GPS were included, and all available teachers were invited to participate. Data were collected using a validated questionnaire assessing awareness (8 items) and knowledge (12 items). Scores were categorized using the 25^th percentile cut-off. Associations were analyzed using the chi-square test and expressed as odds ratio (OR) with 95% confidence intervals (CI).

Results: Of 220 teachers (mean age 39.2±6.5 years; 80% female), 30.0% (95% CI: 24.1-36.4) had received special education training (SET). Lower-quartile awareness and knowledge scores were observed in 20.9% (95% CI: 15.8-26.9) and 24.1% (95% CI: 18.7-30.2), respectively. Knowledge gaps were greatest for dyslexia (41.5%). SET and prior experience teaching children with SLD were associated with lower odds of poor awareness and knowledge. Most teachers expressed willingness for further training.

Conclusions: Gaps in SLD knowledge persist among rural teachers. Strengthening teacher training within existing school systems may improve early identification and referral.

Paracetamol use in pediatric fever: a cross-sectional survey of clinicians in India

2026-06-23T06:54:16+0530

Background: Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in pediatric patients. However, clinicians’ preferences and perspectives regarding their safety and efficacy may vary in clinical practice. This survey aimed to assess the clinical practices and perceptions regarding the use of paracetamol in the management of fever in pediatric patients in India.

Methods: This cross-sectional study was conducted among clinicians managing febrile pediatric patients across India. A structured 22-item questionnaire was administered covering antipyretic agent selection, formulation preferences, comparative safety of paracetamol versus NSAIDs, adverse drug reactions, and clinician-rated efficacy on a five-point global improvement scale. Data were analyzed using descriptive statistics, with categorical variables expressed as frequencies and percentages.

Results: The survey included 506 practitioners. Most clinicians reported initiating fever management with paracetamol or NSAIDs (87%), and nearly all (98%) preferred paracetamol as the antipyretic of choice in children. A large proportion (81%) preferred paracetamol as the initial step in 21-30% of patients, while 52% used suppositories in fewer than 10% of febrile cases. Fewer gastrointestinal side effects were identified as the main advantage of paracetamol syrup or drops over ibuprofen by 44% of clinicians, and 57% considered paracetamol to have a better gastrointestinal safety profile. Most clinicians had not encountered adverse drug reactions with paracetamol (86%), and 55% rated its efficacy as showing marked improvement on the global improvement scale.

Conclusions: Paracetamol is the most commonly preferred first-line antipyretic among clinicians for pediatric fever management in India. It is widely regarded as having a favorable gastrointestinal safety profile compared with ibuprofen, a low burden of adverse drug reactions, and good clinician-rated efficacy.

Barriers to exclusive breastfeeding encountered by mothers in and around Raichur district

2026-06-23T06:54:15+0530

Background: Exclusive breastfeeding (EBF) is the ideal method of infant feeding during the first six months of life, providing optimal nutrition, immune protection, and support for infant growth and development. However, its practice remains suboptimal due to multiple maternal, socio-cultural, occupational, and healthcare-related barriers. Objectives were to assess the prevalence of EBF and identify barriers influencing its practice among mothers in and around Raichur district.

Methods: This community-based descriptive cross-sectional study was conducted over 12 months among 225 mothers with children aged less than 2 years. Data were collected using a pretested semi-structured questionnaire covering socio-demographic details, obstetric and infant characteristics, breastfeeding practices, and barriers to EBF.

Results: The prevalence of EBF was 57.8%. Early initiation of breastfeeding within one hour was reported by 46.2% of mothers, and colostrum feeding was practiced by 69.3%. The most common barriers were lack of counselling (45.3%), inadequate knowledge (36.9%), poor family support (35.1%), perceived inadequate milk production (32.4%), and cultural practices (32.0%). EBF was significantly associated with maternal occupation, antenatal care visits, mode of delivery, prelacteal feeding, bottle feeding, pacifier use, and cultural practices.

Conclusions: EBF prevalence was moderate but below the recommended universal target. Modifiable factors such as inadequate counselling, maternal employment, cesarean delivery, prelacteal feeding, bottle feeding, pacifier use, and cultural practices negatively influenced EBF. Strengthening antenatal and postnatal counselling, improving family support, and addressing harmful traditional feeding practices are essential to improve EBF rates.

Implementation of quality improvement principles for antimicrobial stewardship program in the level III B neonatal intensive care unit of a tertiary care public hospital

2026-06-23T06:54:10+0530

Background: Antibiotic overuse in neonatal intensive care units (NICUs) is associated with increased mortality, multidrug-resistant organisms (MDROs) and adverse neurodevelopmental outcomes. This study aimed to implement and evaluate a Quality improvement (QI)-based Antimicrobial stewardship program (AMSP) to reduce unnecessary antibiotic use in a busy public sector NICU in Chhatrapati Sambhaji Nagar in Central Maharashtra, India.
Methods: A quasi-experimental interrupted time-series study was conducted from July 2024 to June 2025. After a 2-month baseline phase, AMSP interventions were implemented through nine sequential Plan–do–study–act (PDSA) cycles, including standardized antibiotic policy, early discontinuation of antibiotics at 48-72 hours, preauthorization for higher antibiotics and de-escalation based on blood culture. This intervention phase lasted for 7 months, followed by a 3-month sustenance phase. The primary outcome was Antibiotic usage rate (AUR; Days of therapy per 1000 patient-days).
Results: Among 3696 neonates (52.2% male; median GA 37.6 weeks; median birth weight 1990 g), baseline admission-antibiotic exposure was 63.66%. After implementation, admission-antibiotic exposure decreased to 56.73% (p=0.0075) and AUR decreased from 540.09 to 441.71 (18.21% relative reduction, p=0.0018). Culture-negative AUR decreased by 10.50%. Early discontinuation in screen-negative neonates increased from 14.4% to 29.15% (p<0.0001). Two outbreaks (Klebsiella pneumoniae, Candida tropicalis) occurred during implementation and were controlled through revised antibiograms and antifungal protocols.

Conclusions: Structured Point-of-care-quality improvement (POCQI)-based AMSP implementation reduced antibiotic use in this high-burden NICU. AMSP scale-up across Indian NICUs is urgently warranted.

Clinical spectrum of cerebral palsy in children aged up to 16 years using gross motor function classification system score for management at a tertiary care centre

2026-06-23T06:54:07+0530

Background: Cerebral palsy is the most common and costly form of chronic motor disability that begins in childhood. Cerebral palsy is a well-recognised neurodevelopment condition beginning in early childhood and persisting through the lifespan In India prevalence of cerebral palsy ranges between 1.4 to 3.1 per 1000 lives birth. Gross motor function classification system (GMFCS) score for cerebral palsy is based on self-initiated movement with emphasis on sitting, transfer and mobility.

Methods: This is observational cross-sectional study with sample size of 45 patients aged up to 16 years (taken according to inclusion and exclusion criteria). A detail history regarding prenatal, natal and postnatal events were asked and etiology was grouped under antenatal, natal, postnatal or idiopathic. Past history of admission (NICU) or any events will be noted. Severities of grading will be classified according to GMFCS.

Results: The mean age of the children studied was 3.31 years, with a greater prevalence in males (68.9%) than females (31.1%). A significant number of children were born preterm (26.7%), with most deliveries occurring in hospitals (75.6%). Key risk factors identified included low birth weight (46.7%), prematurity (28.9%) and birth asphyxia (17.8%). Spastic cerebral palsy was the most common type, affecting 93.4% of the children in the study.

Conclusions: The Present study suggests that early diagnosis and assessment of the GMFCS score are crucial for optimizing the ambulatory management of children with cerebral palsy, potentially improving their functional outcomes. In this study, spastic quadriplegic cerebral palsy has a statistically significant association with GMFCS score. The GMFCS Score is instrumental in setting rehabilitation goals for cerebral palsy, catering to various ages and severity levels. It is key in assessing functional outcomes in diverse settings, enhancing quality of life.

Atypical location of nodular fasciitis in a pediatric patient: a case report and literature review

2026-06-23T06:56:01+0530

Nodular fasciitis (NF) is a benign, rapidly growing soft tissue lesion that can mimic malignant neoplasms. First described in 1955, it is commonly seen in adults but remains rare in pediatric populations, particularly in the orbital region. A comprehensive literature review was conducted, analyzing all reported cases of orbital NF between 1990 and 2022. Key parameters included patient demographics, clinical presentation, histopathological findings, treatment approaches, and outcomes. Twenty cases were identified, with an equal distribution of male and female patients. The most common clinical presentation was a rapidly growing, painless orbital mass. Histopathological analysis revealed a spindle cell proliferation with myxoid stroma, positive immunostaining for actin and vimentin, and variable expression of other markers. Surgical excision was the primary treatment, with no reported recurrences or postoperative complications. Although rare, orbital NF should be considered in the differential diagnosis of pediatric soft tissue tumors. Awareness of its benign nature is crucial to avoid unnecessary aggressive treatments. Surgical excision remains the treatment of choice, although spontaneous regression has been reported. Further studies are needed to elucidate its etiology and optimize management strategies.

A rare occurrence of lobular nasal hemangioma in an adolescent female

2026-06-23T06:56:00+0530

Nasal hemangiomas are uncommon benign vascular tumors rarely seen arising from the nasal cavity. Here, we present a case of a 19-year-old female with lobular capillary hemangioma on right side of the nasal septum; an infrequent presentation both in terms of age and anatomical site. This case report highlights a rare septal origin with discussion on clinical course, diagnostics and management.

A neonate with multiple skeletal deformities and pathological fractures: a case of osteogenesis imperfecta

2026-06-23T06:55:58+0530

Full term male child born to a multigravida mother presenting with brachycephaly, widely patent anterior fontanelle, low-set ears, a high-arched palate and profound limb deformities marked by shortening, bowing, bilateral genu varum and congenital talipes equinovarus and multiple pathological fractures. Whole exome sequence was suggestive of COL1A2 mutation confirming our diagnosis of Osteogenesis Imperfecta. Child was managed with a multidisciplinary approach involving paediatrician, orthopaedics opinion, endocrinologist for further evaluation and management. Child was administered with Inj. Pamidronate and discharged on calcium supplements along on direct breast feeding.

Congenital cochlear aplasia presenting as recurrent meningitis and cerebrospinal fluid rhinorrhea: a diagnostic challenge

2026-06-23T06:55:55+0530

Cerebrospinal fluid (CSF) otorrhea presenting as "pseudo-rhinorrhea" via the Eustachian tube is a rare and deceptive diagnostic entity. In pediatric patients, congenital inner ear malformations can cause this phenomenon, often leading to misdiagnosis, treatment delays, and life-threatening recurrent meningitis. This case highlights the importance of distinguishing otogenic sources in patients presenting with apparent rhinorrhea. A 3-year-old boy presented with persistent clear watery nasal discharge and a history of recurrent bacterial meningitis. Initial brain MRI failed to identify an anatomical defect or leak source. However, a focused history revealed prior ear pain, prompting targeted imaging. High-resolution CT (HRCT) and CT cisternography identified a complex right-sided congenital malformation, including cochlear aplasia, a cystic vestibule, and an absent stapes footplate (Type I leak). The diagnosis of CSF otorrhea manifesting as rhinorrhea was confirmed as contrast tracked from the inner ear through the middle ear and down the Eustachian tube. The patient underwent definitive surgical repair via a post-auricular approach, involving a canal wall down mastoidectomy, oval window plugging, Eustachian tube obliteration, and blind sac closure of the external auditory canal. The patient remained symptom-free with no recurrence of meningitis at the 6-month follow-up. Clinicians must consider otogenic sources for apparent CSF rhinorrhea in children with recurrent meningitis. Standard brain MRI may overlook subtle otic capsule defects; therefore, HRCT of the temporal bone and a high index of suspicion for inner ear malformations are essential for accurate diagnosis.

Progressive familial intrahepatic cholestasis type 2 with trisomy x reverse Occam’s razor: a case report

2026-06-23T06:54:28+0530

Progressive familial intrahepatic cholestasis type 2 (PFIC-2) is a rare autosomal recessive liver disorder caused by ABCB11 mutations, leading to severe cholestasis and liver failure. Triple X syndrome (47,XXX) is a sex chromosome aneuploidy with variable clinical features. An 80-day-old female presented with severe neonatal cholestasis and conjugated hyperbilirubinemia. Genetic testing confirmed biallelic ABCB11 variants consistent with PFIC-2 and a supernumerary X chromosome (47,XXX). Despite supportive therapy, she developed intractable ascites and died of septicemia. This case highlights the importance of genomic testing in neonatal cholestasis and the need for multidisciplinary care in complex dual genetic diagnoses.

Acute nephritic syndrome as the sentinel presentation of class III A lupus nephritis in a young patient

2026-06-23T06:54:26+0530

Lupus nephritis (LN) is one of the most serious manifestations of Systemic lupus erythematosus (SLE), occurring in 50-75% of children with SLE, with over 90% developing renal involvement within two years of diagnosis. We describe a diagnostically challenging case of a 12-year-old girl presenting with nephritic syndrome, in whom further evaluation revealed an underlying diagnosis of Systemic lupus erythematosus (SLE). Investigations revealed hypocomplementemia (C3 21.0 mg/dl, C4 1.6 mg/dl), positive antinuclear antibody (ANA IF titre 1:80, ANA ELISA 7.9), strongly positive anti-double-stranded DNA (anti-dsDNA +++), significant proteinuria on 24-hour collection (888 mg/day), and microscopic haematuria. She fulfilled three of eleven American college of rheumatology (ACR) 1997 criteria for SLE. Light microscopy demonstrated focal segmental endocapillary hypercellularity with focal mesangial prominence. Renal biopsy confirmed focal proliferative lupus nephritis (ISN/RPS Class IIIA) with a NIH activity index of 3/24 and a characteristic ‘full house’ immunofluorescence pattern comprising deposits of IgG (2+), IgA (3+), IgM (1+/2+), C3 (1+/2+), C1q (3+), kappa (1+/2+), and lambda (2+). This case underscores the importance of maintaining a high index of suspicion for SLE in children with nephritic features and hypocomplementemia. Renal biopsy is essential for definitive classification and treatment planning even when ACR criteria are not fully met. Early histopathological diagnosis and class-guided immunosuppressive therapy are critical to preventing progression to end-stage renal disease in paediatric lupus nephritis.

Missed for years: tuberous sclerosis complex presenting as status epilepticus with tuberous sclerosis complex associated neuropsychiatric disorders in an adolescent girl

2026-06-23T06:54:18+0530

Tuberous sclerosis complex (TSC) is a multisystem neurocutaneous disorder commonly presenting with seizures in early childhood. Delayed diagnosis remains frequent in resource-limited settings. Presentation as status epilepticus during adolescence, particularly with prominent TSC-associated neuropsychiatric disorders (TAND), is uncommon and underreported. A 16-year-old adolescent girl presented with generalized convulsive status epilepticus. She had a history of untreated recurrent seizures since the age of 10 years, along with significant cognitive, behavioural and adaptive functioning impairment. Physical examination revealed multiple characteristic cutaneous stigmata suggestive of TSC. Neuroimaging demonstrated cortical tubers and subependymal nodules and abdominal ultrasonography revealed a renal angiomyolipoma, confirming the diagnosis of TSC. The patient was managed as per standard status epilepticus protocols, resulting in seizure control. Comprehensive evaluation identified significant neuropsychiatric manifestations. Formal screening using the TAND-L checklist revealed multi-domain involvement, including intellectual, behavioural, neuropsychological and psychosocial domains. A multidisciplinary management plan including optimization of antiepileptic therapy, behavioural interventions, low dose risperidone, caregiver counselling and neurodevelopmental follow-up was initiated. This case highlights the consequences of delayed recognition of TSC, where missed neurocutaneous markers resulted in late diagnosis and life-threatening neurological presentation. It underscores the importance of systematic screening for TAND in all individuals with TSC and emphasizes the need for heightened clinical vigilance and multidisciplinary care to improve long-term outcomes.

Atypical Apert syndrome with mitten-hand deformity and mild neurodevelopmental delay: a case report highlighting phenotypic variability in a resource-limited setting

2026-06-23T06:54:14+0530

Apert syndrome (AS) is a congenital disorder that is inherited in an autosomal dominant manner. It accounts for approximately 4.5% of all cases of craniosynostosis. This report describes a rare case of a three-year-old male who presented with classical features of AS, including complex syndactyly of the hands and feet, midface hypoplasia, and congenital speech difficulties. The child had macrocephaly at birth that resolved without surgical intervention. Despite the craniofacial abnormalities, the child exhibited normal hearing and vision. This case report highlights an atypical presentation of AS with spontaneous correction of cranial morphology and mild neurodevelopmental involvement. This underscores the clinical heterogeneity of AS and emphasizes the importance of functional assessment and genetic counselling, especially in sporadic cases. The phenotypic overlap with other craniosynostosis syndromes, such as Carpenter, Crouzon, Pfeiffer, and Saethre-Chotzen, remains a diagnostic challenge.

Inflammatory dentigerous cyst in a pediatric patient: a case report with review

2026-06-23T06:54:12+0530

Dentigerous cysts are developmental odontogenic cysts commonly associated with unerupted permanent teeth. However, their occurrence in mixed dentition and presentation as an inflammatory variant is uncommon in pediatric patients. We report a case of an 11-year-old boy presenting with pain and extraoral swelling, initially suggestive of a radicular cyst on CBCT imaging of the left maxillary region revealed a large, well-circumscribed cystic lesion attached to an unerupted premolar tooth, extending into the alveolar arch and encroaching upon the sinus floor. The cyst was surgically removed through a Caldwell-Luc procedure performed under general anesthesia. Timely diagnosis using advanced imaging modalities is crucial, as untreated cysts may expand, compromise surrounding anatomical structures, and in rare instances undergo neoplastic transformation. Complete surgical removal remains the treatment of choice-particularly for larger lesions-to minimize morbidity and prevent further progression. Histopathological evaluation confirmed the lesion to be an inflammatory variant of a dentigerous cyst. This case highlights the importance of meticulous clinical and radiographic assessment, along with prompt surgical management when indicated. Early recognition and appropriate intervention play a vital role in preventing complications and ensuring favorable outcomes in patients with inflammatory dentigerous cysts.

Diagnostic dilemma between Mycoplasma pneumoniae, leptospirosis and severe dengue in a child presenting with shock: a case report

2026-06-23T06:54:08+0530

Acute febrile illness with shock in children is a common pediatric emergency in tropical countries and often poses a diagnostic challenge. Severe dengue and leptospirosis are important differentials because of their overlapping manifestations, including thrombocytopenia, hepatic dysfunction, shock and multiorgan involvement. Rarely, atypical bacterial infections such as mycoplasma pneumoniae may present with severe extrapulmonary manifestations closely mimicking tropical infections. An 8-year-old boy presented with fever for 7 days, vomiting, facial and pedal edema, abdominal pain, red-coloured urine and altered sensorium. On examination, he had hypovolemic shock, respiratory distress, tender hepatomegaly, splenomegaly and encephalopathy. Laboratory investigations revealed anemia, thrombocytopenia, hyponatremia, transaminitis, conjugated hyperbilirubinemia, hypoalbuminemia, hematuria and proteinuria. Initial dengue IgM was weakly reactive, raising suspicion of severe dengue. Leptospirosis was also considered because of disproportionate hyperbilirubinemia and splenomegaly. The child deteriorated with respiratory failure requiring mechanical ventilation and inotropic support. The tropical fever panel, including dengue PCR, leptospira PCR, malaria and typhoid testing, was negative. Subsequently, Mycoplasma pneumoniae IgM returned positive. Following the treatment with azithromycin along with intensive supportive care, the child improved clinically and was discharged after 10 days. Mycoplasma pneumoniae is classically described as a cause of “walking pneumonia" but rarely can present with severe extrapulmonary manifestations, including shock and multiorgan dysfunction. This case highlights the diagnostic overlap between severe dengue, leptospirosis and mycoplasma pneumoniae infection in tropical settings. Clinicians should maintain a broad differential diagnosis in children presenting with shock and thrombocytopenia, particularly when initial investigations for common tropical infections are inconclusive.

A rare case of spondyloepimetaphyseal dysplasia with joint laxity, type 3 (EXOC6B gene) (SEMDJL3)

2026-06-23T06:54:07+0530

Spondyloepimetaphyseal dysplasia with joint laxity, type 3 (SEMDJL3) is an ultra-rare condition, inherited in autosomal recessive manner caused by mutations in EXOC6B gene, encoding a component of the exocyst complex, crucial for cell growth and exocytosis. It is characterized by multiple joint dislocations, joint laxity, genu valgum, short stature, and skeletal dysplasia. There are approximately 6 confirmed cases reported worldwide and only one or two cases in India. Patient presented with complain of not gaining height and was later diagnosed with SEMDJL3.This case review aims to increase awareness of this rare disorder, which remains underdiagnosed due to the scarcity of documented cases and some overlap with other syndromes.

Cardiac care of children with common genetic syndromes: a practical review for pediatricians and pediatric cardiologists

2026-06-09T07:18:02+0530

Genetic syndromes are an important consideration in pediatric cardiac care because the specific syndrome can influence the likelihood of particular cardiac anomalies, timing and nature of cardiac evaluation, imaging modality, pulmonary hypertension risk, anesthesia planning, and intensity of subsequent surveillance. This review covers the evaluation and management of children with Down syndrome, 22q11.2 deletion syndrome, Turner syndrome, Noonan syndrome and related RASopathies, Williams syndrome, Marfan syndrome and Loeys-Dietz syndrome, Duchenne muscular dystrophy, and several less common genetic syndromes of high yield. Each section focuses on clinical and epidemiologic features, typical entry points into cardiac evaluation, timing of evaluation, minimum cardiac evaluation, stabilization or disposition tier, management modifiers, and criteria for escalation of care. A practical principle that guides this review is that the cardiac findings define acuity, whereas the genetic findings define what to look for, how long to follow the child, and whether normal baseline imaging ends surveillance. Newborn echocardiography is indicated in children with Down syndrome; conotruncal or arch anomalies should prompt consideration of 22q11.2 deletion syndrome; Turner syndrome requires lifelong aortic and blood pressure surveillance; Williams syndrome requires arteriopathy and anesthesia-risk assessment; and Duchenne muscular dystrophy requires presymptomatic cardiomyopathy surveillance.

Understanding precocious puberty management and diagnosis: a review

2026-06-23T06:55:59+0530

The precocious puberty (PP) typically defined as the onset of secondary sexual characteristics prior to the age of 8 years in females and 9 years in males. The retrospective studies proved that the rate of PP significantly elevated in last few decades. This can be the result of early activation of the hypothalamic-pituitary-gonadal axis or due to autonomous production of sex steroids, independent of gonadotropin stimulation. The central precocious puberty is more common and is gonadotropin-dependent, whereas peripheral precocious puberty is gonadotropin-independent. Precocious puberty is associated with several challenges, including accelerated secondary sexual transformation, reduced adult height, psychosocial disturbances, and increased risk of certain malignancies. Recent years have witnessed a growing interest in understanding the genetic, environmental, and metabolic underpinnings of this condition, especially with the rising global incidence. In this review, we discuss the mechanism of precocious puberty and explore the epidemiology, etiology, clinical presentation, diagnostic workup, and management of PP, with a focus on recent advances in therapy and molecular insights. A multidisciplinary approach is essential to optimize outcomes and ensure psychological well-being.

Pneumococcal conjugate vaccines and dosing regimens in India: a perspective on evidence-based choices for pediatric immunization

2026-06-23T06:54:12+0530

In India, Pneumococcal infections account for significant under 5 years health burden and mortality. Immunization with the Pneumococcal conjugate vaccine (PCV) is the best prevention method especially in developing countries where complications and hospitalization rates are high. Available vaccines include PCV10, PCV13 and PCV14 while approved dosage regimens range from 2 or 3 primary (p) doses with or without booster. The objective of this review is to compare different valency vaccines based on their serotype data and protection, as well as understand the immune protection of different primary regimens and the importance of the booster dose in the PCV immunization schedule.

The next era in pediatric cardiology: from lesion-based repair to precision, prediction and lifelong care

2026-06-09T07:17:58+0530

Pediatric cardiology is evolving from a disease-oriented model to a more precision-oriented, predictive, long-term follow-up-oriented and practically implementable discipline across care settings. With congenital heart disease (CHD) present in approximately 1% of live births, an increasing number of children and adults are living with heart defects that have been completely repaired, incompletely repaired, palliated, or medically managed. This review follows the child’s heart from fetal diagnosis and newborn detection through precise diagnosis, intervention, prediction of late outcomes, neurodevelopmental monitoring, transition to adult CHD care and prevention of acquired cardiovascular disease. New strategies, including updated algorithms for critical congenital heart disease screening, fetal cardiac programs and selected interventions, exome/genome sequencing, 3D surgical planning, catheter-based PDA closure in infants weighing ≥700 g, ductal stenting versus shunting, AI-assisted ECG and imaging analysis, wearables for heart failure monitoring, neurodevelopmental guidance, transition programs and global surgical quality registries, will only have value when matched to a specific patient, setting, threshold, owner, action and limitation.