International Journal of Contemporary Pediatrics

Climate change and paediatric health outcomes: implications for primary care practice

2025-10-25T09:34:37+0530

Climate change is increasingly recognized as a significant determinant of child health worldwide, affecting nearly every aspect of paediatric well-being through both direct and indirect mechanisms. Children are vulnerable due to their developing physiology, higher metabolic demands, and limited capacity to adapt to environmental stressors. Rising global temperatures, worsening air quality, extreme weather events, and disruptions in food and water systems contribute to an expanding spectrum of paediatric health consequences. These include heat-related illnesses, respiratory and allergic disorders, vector-borne infections, nutritional deficiencies, and psychosocial effects such as climate anxiety. In addition to physical health risks, displacement, food insecurity, and community disruption exacerbate disparities in child health outcomes. Paediatricians and primary care providers occupy a critical frontline role in recognizing climate-sensitive health conditions, integrating anticipatory guidance into routine visits, and advocating for family-centered adaptation and mitigation strategies. This review synthesizes current evidence on the health impacts of climate change in children, outlines the clinical and public-health implications for primary care, and identifies research priorities and practice recommendations to strengthen resilience within paediatric systems of care. Addressing climate change as a child health crisis requires collaboration among clinicians, researchers, educators, and policymakers to safeguard the well-being of future generations.

Prevalence of malnutrition in admitted children and post-intervention parental awareness at a tertiary care hospital

2025-10-29T08:35:07+0530

Malnutrition is a major contributor to childhood morbidity and mortality in India, particularly among hospitalized children who are vulnerable due to underlying illnesses. Parental education has the potential to reduce malnutrition through improved awareness and feeding practices. Objectives were to assess the prevalence of malnutrition among pediatric inpatients and to evaluate the effectiveness of a structured parental education session on caregiver knowledge regarding malnutrition prevention and feeding during illness. A cross-sectional pre-post educational intervention study was conducted among 20 children (6 months-12 years) admitted to a tertiary care hospital in New Delhi, along with their caregivers. Nutritional status was assessed using anthropometric indices and MUAC, based on WHO standards. Caregiver knowledge was assessed using a structured questionnaire before and after a 20-minute education session. Data were analysed using descriptive statistics and paired t-test. The prevalence of malnutrition was high, with 70% of children classified as malnourished. Specifically, 35% had grade I, 20% grade II, and 15% grade III malnutrition, while MUAC assessment revealed 30% severe and 40% moderate malnutrition. Chronic illnesses such as kidney disorders and cancer were commonly associated. The mean caregiver knowledge score improved significantly from 13.3 (pre-test) to 21.0 (post-test), with a mean difference of 7.7 (t=-17.5, p<0.05). Malnutrition was highly prevalent among hospitalized children. A brief structured parental education session significantly improved caregiver knowledge, underscoring the importance of integrating parental counselling into routine pediatric ward care to address malnutrition.

Neonatal bacteremia and meningitis caused by Elizabethkingia, treatment and challenges: a case report and literature review

2025-10-19T06:48:56+0530

Elizabethkingia is a gram-negative, rod-shaped bacterial genus that is commonly detected in the environment (particularly in soil and water), but it rarely causes human infection; however, following an increased incidence of Elizabethkingia infections among patients in adulthood, pediatric and neonatal intensive care units, since 2004. Elizabethkingia is considered an emerging pathogen in hospital settings, and it has been linked to outbreaks due to contaminated medical equipment. Moreover, this infection can also be a pathogen causing neonatal sepsis which is associated with high rates of morbidity and mortality, including potential long-term neurological complications. Early recognition as well as identification of appropriate, often prolonged, combination of antibiotic therapy is essential in managing such infections. In our report, we present a case of acute meningitis caused by E. meningoseptica in a premature baby 33 weeks of gestational age, admitted to our pediatric word at the 13 days old as a case of neonatal fever, with past history of 18 hours PROM and oligohydramnios. The organism is identified through blood and cerebrospinal fluid cultures. For the treatment of this infection, we started on triple antibiotic therapy (Rifampicin, vancomycin and trimethoprim/sulphamethoxazole) due to known multidrug resistance to many standard antibiotic regimens, making treatment challenging mainly in preterm babies and immunocompromised children. In conclusion, effective management of multidrug resistant bacteria such Elizabethkingia requires a multidisciplinary approach, including intensive care support (in some cases), and coordination with infection control teams to prevent further transmission and improve the outcome.

An unusual presentation of congenital protein S deficiency: cerebral venous thrombosis with right atrial thrombi in an infant

2025-10-29T08:34:47+0530

Cerebral venous thrombosis (CVT) is an uncommon but serious cause of pediatric stroke. In infants, it is most often related to dehydration, infection, or perinatal complications, while inherited thrombophilia is a rare underlying factor. Protein S deficiency, a congenital prothrombotic disorder, predisposes to severe thrombotic events from early life, though its presentation with intracardiac thrombosis is exceptional. We report the case of a six-month-old infant admitted with status epilepticus, in whom brain magnetic resonance imaging (MRI) demonstrated extensive CVT involving the superior sagittal, lateral, and straight sinuses. Echocardiography further revealed right atrial thrombi causing functional tricuspid stenosis, an atrial septal defect, and partial thrombosis of the superior vena cava. Etiological work-up confirmed congenital protein S deficiency. The association of CVT with right atrial thrombi in the absence of central venous catheters or structural heart disease is extremely rare. Functional obstruction of the tricuspid valve and the presence of an interatrial communication raised the possibility of paradoxical embolism as a contributing mechanism. The patient was successfully stabilized with anticoagulation alone. This case highlights the severity and unusual presentations of congenital protein S deficiency and underscores the importance of considering inherited thrombophilia in infants with extensive or multifocal thrombosis.

Prepubertal-type mature cystic teratoma of the testis in an infant: a rare benign entity with excellent prognosis-managed with testis sparing approach

2025-10-07T06:37:38+0530

Testicular tumors in infants are rare, accounting for only 1-2% of pediatric solid tumors. Among these, teratomas are the most common type, particularly in the prepubertal age group. Unlike their post-pubertal counterparts, prepubertal-type mature teratomas are usually benign, lack malignant potential, and are remotely associated with germ cell neoplasia in situ (GCNIS). While mature teratomas are typically found in the abdomen, intratesticular prepubertal-type teratomas in infants are infrequent. The present study describes the case of an infant with an intratesticular mature teratoma. Five months old infant presented with painless right sided scrotal swelling detected incidentally. Scrotal ultrasound revealed a large anechoic cystic lesion measuring 28×18 mm with no septation, calcification, or solid component. Blood parameters including tumor markers viz. alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG) were within normal range for age. Surgical tumor enucleation (testis sparing surgery) was performed, and the histopathological examination revealed a benign, prepubertal-type teratoma composed entirely of mature elements. Based on the findings diagnosis of prepubertal-type mature teratoma (MT) was thus made. Child was later was kept under observation in follow-up. Surgical intervention is commonly used for the management of benign testicular tumors in pediatric patients, including prepubertal teratomas. Indeed, testis-sparing surgery is a recommended option in prepubertal age patients with such a presentation of testicular mass with a benign ultrasonography finding like homogeneous, unilocular, non-septated cyst without any internal echoes, no calcification, no solid component and negative serum markers.

A diagnostic challenge in a child: a rare brain tumour or tuberculous meningitis

2025-10-29T08:35:08+0530

A case of non-responding tuberculous meningitis in a 10-year-old male child who was diagnosed and received Anti-Tubercular Therapy twice. After exploring for alternative diagnosis, biopsy was suggestive of DLGNT. High prevalence of tuberculosis in India and similarity in MRI brain findings might have contributed for delay in diagnosis. Leptomeningeal enhancement in Paediatric patients is a common MRI finding associated with numerous conditions including infections, inflammatory process, neoplasms, and post-ictal hyperaemia. Presence of leptomeningeal enhancement along with hydrocephalous in the patients living in developing world are often labelled as tuberculous meningitis. DLGNT is a rare neoplasm, which was previously known as a disseminated oligodendroglia-like leptomeningeal tumour of childhood. DLGNT has been defined as a neuronal/glioneuronal tumour as per the 2021 World Health Organization (WHO) classification of brain tumours. This tumour may also present with hydrocephalous in initial stages. The confirmatory diagnosis of tuberculous meningitis is often difficult as its clinical features are not very specific. Detection of Mycobacterium tuberculosis in cerebrospinal fluid (CSF) by acid-fast staining, culture, or DNA analysis with polymerase chain reaction (PCR) has low sensitivity. DLGNT needs histologic confirmation through brain biopsy. Although rare, DLGNT should be considered as a differential diagnosis. Especially in children who are solely diagnosed on radiological evidences of tuberculosis. The current case highlights the importance of histologic confirmation through brain biopsy for cases presenting leptomeningeal enhancement in the basal cistern in MRI with equivocal laboratory examinations to explain the aetiology.

A case of juvenile recurrent parotitis with thrombocytopenia

2025-10-29T08:35:02+0530

Juvenile recurrent parotitis is defined as recurrent inflammatory parotitis in children of unknown etiology. Juvenile recurrent parotitis is the second most common cause of parotitis in childhood, only after mumps. It is a rare disease characterised by recurrent parotid inflammation associated with non-obstructive sialectasis. Here we present a 10-year-old boy with 6 recurrent episodes. The child came with complaints of bilateral swelling below the ear, fever and malaise for 1 week. He had recurrent episodes of painful swelling below both the ears for the past 2 years. He previously had 5 episodes which was unilateral associated with pain and fever, lasting for 7–10 days and treated with analgesics and antibiotics. During these episodes he had no dryness of mouth and eyes, increased salivation or altered taste sensation, joint pains/swelling, weight loss, night sweats and skin rashes. There is no pain during eating and no family history. Lab findings reveal thrombocytopenia during each episode and resolved spontaneously. Relevant investigations ruled out Systemic Lupus Erythematous, Sjogren syndrome, Tuberculosis, Infectious mononucleosis and immunodeficiencies. FNAC reveals granulomatous sialadenitis. Bone marrow examination shows normocellular marrow with increase in megakaryocytes. Serum ACE and IgG4 levels were normal. IgG levels were elevated. Child was started on oral steroids and improved clinically. This case depicts a rare association of recurrent parotitis with thrombocytopenia.

Hypothalamic hamartoma presenting as central precocious puberty in a girl: a case report

2025-10-29T08:34:59+0530

Central precocious puberty (CPP) is defined as the early onset of secondary sexual characteristics due to premature activation of the hypothalamic pituitary gonadal (HPG) axis. Hypothalamic hamartomas are rare but classical causes of CPP. We report a case of a 2 years 7 months old girl with progressive breast enlargement and pubic hair development, found to have a hypothalamic hamartoma on MRI.

Prenatal diagnosis of limb body wall complex: early sonographic findings

2025-10-29T08:34:55+0530

Limb body wall complex (LBWC) is a rare syndrome that consists of, combination of multiple fetal malformations of the thoracoabdominal wall, extremities, cranium, facial and spine. The sonographic hallmarks are abdominal/thoracic wall defect, neural tube defect, severe scoliosis, positional deformity and abnormal fetal membranes. Authors present a case of LBWC abnormality, which was detected in the antenatal ultrasonography at the POG of 13 weeks and later confirmed in the abortus. Early diagnosis of LBWC is only possible through ultrasonography, and it being a fatal condition needs to be distinguished from gastroschisis and omphalocele, which has a better prognosis.

Kawasaki disease with cavitary pulmonary nodules

2025-10-29T08:34:48+0530

Kawasaki disease (KD) is a systemic medium vessel vasculitis syndrome which usually affects the cardiovascular system, can rarely affect renal, respiratory, hepatobiliary, musculoskeletal and central nervous system. This is a report of a 3 years old girl who presented with all the clinical and biochemical features of Kawasaki disease with pulmonary involvement in the form of pulmonary nodules with cavitary changes and normal ECHO. As the child didn’t improve with single dose of IvIg, she was treated with repeat dose of IvIg and steroid. Three months after discharge, her repeat CT Chest showed disappearance of all the pulmonary nodules with fibrosis. This case is reported for the very rare finding of cavitation in the pulmonary nodule with minimal changes in ECHO in KD. In children with prolonged fever and elevated inflammatory parameters, those with pulmonary nodules should be evaluated for KD after ruling out Tuberculosis.

Congenital Langerhans cell histiocytosis with hematological manifestations: a rare case

2025-10-29T08:34:46+0530

Langerhans cell histiocytosis is a rare disorder of immune cells typically found in skin whose abnormal proliferation leads to inflammation and multi organ damage. It is even rarer in the neonatal population, particularly in preterm neonates. The clinical manifestations of disease could be limited or skin or involve multiple organs to become the more lethal multi systemic LCH. The risk organs include liver, spleen and bone marrow. Immuno histo chemistry using Langerin (CD207) and CD1a provide a definitive diagnosis. The case report is of a preterm neonate with Multisystemic involvement of skin, eyes and bone marrow and aims to highlight the importance of having a high degree of clinical 37 suspicion for early diagnosis and timely treatment of the disease. Despite modern advancements the prognosis for these patients remains bleak.

Salmonella typhimurium sepsis in a neonate: a rare and challenging case

2025-10-29T08:34:44+0530

Neonatal sepsis attributed to Salmonella infection is a relatively rare phenomenon. It can have varied presentation encompassing mild, subclinical presentations to severe life-threatening complications and death. Prompt administration of appropriate antibiotics forms cornerstone of treatment. Authors present a case of 25-day-old neonate, who presented with fever, lethargy, respiratory distress, and signs of dehydration. Upon evaluation, the neonate was diagnosed with sepsis caused by Salmonella enterica serovar typhimurium. Prompt medical management was initiated, and the neonate responded well to treatment. The patient made a full recovery without any residual comorbidities or complications.

From fragility to recovery: a case of severe acute malnutrition in a 22-month-old

2025-10-29T08:34:43+0530

Severe acute malnutrition (SAM) remains a major public health concern in many low-income and middle-income countries. It is characterized by markedly low weight-for-height (less than –3 z-scores according to World Health Organization (WHO) growth standards), evident severe wasting, or nutritional edema. Affected children have an estimated 9–11-fold greater risk of illness and death than those with adequate nutrition. This case report highlights the clinical presentation, diagnostic challenges, and management of a 22-month-old female patient diagnosed with SAM. The child presented with inadequate growth, recurrent infections, and severe nutritional deficits compounded by delayed weaning and improper feeding practices. Examination revealed hallmark signs of malnutrition, including stunting, muscle wasting, and dermatosis. Laboratory findings indicated anemia and leukocytosis, which further supported the diagnosis. The management adhered to the WHO’s 10-step protocol for SAM, incorporating nutritional rehabilitation, micronutrient supplementation, and infection control, which led to gradual improvement. This case highlights the complex and varied causes of SAM, and stresses the need for timely management, improved community awareness regarding adequate nutrition, and coordinated care involving multiple health disciplines. Addressing the underlying causes of malnutrition is crucial for prevent recurrence and improve outcomes.

Dyke Davidoff Masson syndrome: rare cause of hemiparesis

2025-10-29T08:34:42+0530

Dyke-Davidoff-Masson syndrome (DDMS) is a rare clinical entity caused by a neurological disorder that results from cerebral injury in -utero or in early infancy resulting in unilateral brain atrophy. The resulting clinical presentation is with hemiplegia, seizures, developmental delay and behavioural disorders. Our case is a 12-year-old boy who presented with hemiparesis, poor scholastic performance and seizures. The MRI brain revealed a decreased volume of the right cerebral hemisphere with gliotic change in the frontal region. The right cerebral peduncle appeared small in size with cystic encephalomalacia and thinning of the corpus callosum. MRI findings were suggestive of DDM syndrome. The electroencephalogram was abnormal. An early recognition will help reduce disability with physiotherapy and anticonvulsant therapy.

Still disease with persistent atypical dermatomyositis-like skin eruption with macrophage activation syndrome: a rare presentation

2025-10-29T08:34:39+0530

Still’s disease is a type of inflammatory arthritis that causes fevers, rashes, and inflammation of joints and, sometimes, internal organs. Still’s is also called systemic-onset juvenile idiopathic arthritis (SJIA), as it was first diagnosed in children. SJIA is a type of juvenile idiopathic arthritis (JIA), a group of arthritis conditions affecting children. JIA is one of the most common pediatric chronic diseases, with a prevalence rate varying from 3.8 to 400 cases/100,000 children, and a yearly incidence between 1.6 and 23 new cases for 100,000 children. SoJIA when considered as a JIA subtype includes about 10–20% of all JIA patients, but the percentage is higher in some countries and when only severe cases are considered. Indeed, in parts of Asia, it may account for up to 30–40% of all JIA cases. Here we report a case of Still’s disease in pediatric patient with a persistent atypical dermatomyositis like skin eruption complicated by MAS, highlighting diagnostic challenges and management strategies.

Transcranial Doppler imaging ultrasound assessment of cerebral blood flow velocity and abnormalities in steady-state sickle cell anaemia children, Southwest Nigeria

2025-10-29T08:34:52+0530

Background: Monitoring cerebral blood flow velocity in children with sickle cell anaemia is valuable and advocated and early detection of abnormal velocity affords appropriate management. This study assessed the blood flow velocities in the large intracranial arteries of the participants and determined abnormalities (risks for stroke).

Methods: The blood flow velocity in the middle and anterior cerebral arteries of the study participants (2–14 years) was assessed using a transcranial doppler (TCD) imaging ultrasound machine. The risk of stroke for each patient was determined by the greatest time-average mean maximum velocity (TAMMV) in centimeters/second (cm/s) in any of the insonated arteries. And using the Stroke Prevention Trial (STOP) criteria, the subjects were classified into having standard, conditional or high risk for stroke.

Results: Out of the 110 participants, males were 61 (55.5%) and females 49 (44.5%). The overall mean TAMMV was 135.50±28.62 cm/s and the 2‒5-year-old group presented the highest mean TAMMV (141.31±29.97). The overall mean TAMMVs for the middle and anterior cerebral arteries were 151.95±39.29 cm/s and 117.38±39.85 cm/s, respectively (t=8.583, p<0.001). According to the STOP criteria, fifty-four (49.1%), 40 (36.4%) and 16 (14.5%) of the subjects had standard, conditional and high risk for stroke, respectively. A comparison of the pattern of risk for stroke identified by Stop criteria (non-imaging) and the adjusted Stop criteria (imaging) revealed a statistically significant difference (p<0.001).

Conclusions: The prevalence (50.9%) of abnormal velocity (Stop criteria) in this study was high and therefore, regular measurement of the TAMMV in SCA patients is recommended.

Clinico-pathological profile of bronchiolitis in Dhaka Medical College Hospital, Bangladesh

2025-10-29T08:35:06+0530

Background: Bronchiolitis is a lower respiratory tract infection characterized by obstruction of small airways caused by acute inflammation, edema and necrosis of the epithelial cells. It is mostly present in infants aged three to six months. The most common etiology is the respiratory syncytial virus (RSV) with the highest incidence of RSV infection occurring between December and March. This study was undertaken to assess clinico-pathological profile of children affected by bronchiolitis.

Methods: This descriptive cross-sectional observation study was conducted at department of paediatrics, Dhaka medical college and hospital (DMCH), Dhaka, Bangladesh between January to December of 2013. To find out the clinico-epidemiological and radiological profile of bronchiolitis. Children below 24 months of age diagnosed as bronchiolitis were studied.

Results: 100 children were evaluated, including 73 boys and 27 girls; Infants below 6 months accounted for the highest proportion (64%). All the bronchiolitis patients had runny nose, cough or cold with respiratory distress. Other symptoms were feeding difficulty (56.0%) and fever (46.0%). On examination lower chest in drawing and rhonchi were found in all cases. Increased translucency (82%) and hyperinflation (77%) was the most prevalent radiological findings.

Conclusions: Most children present with typical clinical and radiological feature of bronchiolitis which can help the clinicians to clinically identify this disease more efficiently.

Clinical profile and underlying causes of recurrent pneumonia in children: a hospital based study

2025-10-29T08:35:05+0530

Background: Recurrent pneumonia (RP) remains a challenge for the pediatrician. There are limited data on RP specially in developing countries. Identification of underlying cause of RP is crucial for managing the patients.

Methods: This retrospective study was conducted in pediatric pulmonology ward of Bangladesh medical university from January 2023 to December 2024 to observe the clinical profile and to recognize the underlying causes of RP in children. Total 65 undiagnosed cases of RP children aged 1 month to 18 years were enrolled in this study.

Results: Out of the 253 children with pneumonia around 26% had experienced recurrent episodes. Most of the patients presented before the age of 6 months. Cough was present in 65 (100%), fever in 60 (92.3%), followed by breathing difficulty in 50 (76.9%). Tachypnea was observed in 39 (60%), crackles in 43(65.07%) and wheezing in 13 (17.4%) cases. A considerable number, 85.7% belonged to low socioeconomic class. Leukocytosis (55%) and raised ESR (64.6%) were the most common lab findings. Bronchopneumonia (40%) was the common findings in chest x-ray and in CT scan consolidation (39.02%) followed by interstitial pneumonitis (29.2%) were the predominant findings. Underlying causes were detected in 92% cases, of which most predominant causes were cystic fibrosis (35.3%) followed by congenital heart disease (CHD) (16.9%) and congenital airway disease (12.3%).

Conclusions: Cystic fibrosis was the predominant underlying cause followed by CHD and congenital airway abnormality. Children of RP should be carefully evaluated for cystic fibrosis and CHD.

Frequency of anemia in children at discharge from a pediatric intensive care unit of Pakistan

2025-10-29T08:35:01+0530

Background: Anemia in critically-ill children is reported in one-third to three-fourth at admission and during stay in Pediatric Intensive Care Units (PICU). Limited data is available on anemia in children at discharge from PICU (post-PICU anemia). To determine the prevalence of anemia in critically-ill children discharged from a PICU of public-sector Children hospital.

Methods: A descriptive, retrospective cohort study was conducted on children (1mo-15 years) who had more than one hemoglobin (Hb) value measurement and last one was done within 24-hour of discharge in the PICU from January to December 2024. Anemia is defined as Hb <10 g/dl and severe anemia was Hb <7g/dl. Data like age, gender, admitting diagnosis and Hb prior to discharge were recorded.

Results: A total of 457 patients met the eligibility criteria. The median age at admission was 10 (IQR 5.0-24.0) months, and 57.5% (n=263) were male. The most common admitting diagnoses were respiratory illnesses (52.7%, n=241), followed by infections related illnesses (23.2%, n=106), and neurological disorders 17.3% (n=79). At admission, 259 patients (56.7%) had anemia, of whom 35 (13.5%) had severe anemia (Hb <7 g/dl). At the time of discharge, anemia was present in 288 patients (63%), including 13 patients (4.5%) with severe anemia. Only 14.6% (29) developed anemia during PICU stay. However, there were fewer patients have severe anemia at discharge than at admission.

Conclusions: Nearly two-third of critically-ill children have anemia at discharge from a PICU of low-middle income countries. More studies required to analyze post-PICU anemia to prevent significant reversible morbidity associated with it.

Comparison of pediatric liver injury unit score and King’s college hospital criteria as a predictor of outcome in children with acute liver failure

2025-10-29T08:35:00+0530

Background: Pediatric acute liver failure (ALF) is a life-threatening condition with high morbidity and mortality, necessitating accurate prognostic tools for early risk stratification. The pediatric liver injury unit (PLIU) Score is a relatively new scoring model developed to improve mortality prediction in pediatric ALF. This study compares PLIU Score and King’s College Hospital Criteria (KCHC) in predicting clinical outcomes in pediatric ALF patients.

Methods: This prospective observational study included 28 pediatric ALF patients admitted to a tertiary care hospital in Bangladesh. Clinical and laboratory parameters were assessed at admission, and both KCHC and PLIU Scores were calculated. The primary outcome measure was survival without liver transplantation vs. mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were analyzed for both scoring systems. ROC curve analysis was performed to determine the predictive performance of PLIU Score.

Results: Among the 28 patients, 64.29% survived without liver transplantation, while 35.71% succumbed to ALF. Wilson’s disease (50% mortality) and indeterminate ALF (40% mortality) were associated with the highest fatality rates. PLIU Score >233 was significantly correlated with mortality (p=0.04), whereas KCHC showed no significant association with mortality (p=0.09). PLIU Score demonstrated higher sensitivity (80%), specificity (66.7%), PPV (57.1%), and NPV (85.7%) compared to KCHC (40%, 22.2%, 22.2%, and 40%, respectively). ROC curve analysis confirmed the superior predictive ability of PLIU (AUC=0.75) over KCHC.

Conclusion: PLIU Score outperforms KCHC in predicting mortality outcomes in pediatric ALF, offering a more reliable prognostic tool for early risk stratification. Its higher sensitivity and predictive accuracy support its potential integration into clinical practice. Future research should focus on validating PLIU Score in larger cohorts and exploring additional biomarkers to enhance its prognostic utility.

Safety and efficacy of use of aminophylline and caffeine in management of apnea of prematurity

2025-10-29T08:34:45+0530

Background: Both aminophylline and caffeine have been used to manage apnea of prematurity in various NICUs. We aimed to investigate the efficacy and safety of these two drugs in the mentioned scenario.

Methods: This randomized controlled trial was carried out from July 2024 to June 2025 in the ICMH, Dhaka. All the preterm newborns with ≤ 34 completed weeks of GA were enrolled. Those having major congenital anomalies, respiratory depression from medications and patent ductus arteriosus (PDA) as a cause of apnea were excluded. Among 53 participants, 27 received caffeine and 26 received aminophylline.

Results: In the caffeine group average gestational age was 33.1 days and the birth weight was 1330 grams. On average, treatment was started at 2.5 days and was continued for 18 days. While in the aminophylline group average gestational age was 32.8 days and the birth weight was 1402 grams. On average, treatment was started at 4.1 days and was continued for 21 days. The aminophylline group observed relatively more apneic spells and other adverse effects. Except for treatment starting days, neither of the changes in these groups was statistically significant.

Conclusions: Regarding effectiveness and safety, caffeine exerted as much performance as aminophylline without any superiority of one over the other.

The hospital-based incidence of influenza infection in children with type C symptoms: an observational study

2025-10-07T06:37:39+0530

Background: Influenza, a contagious respiratory illness, poses a significant threat to children, especially those with severe symptoms (Category C). This study aimed to investigate the hospital-based incidence, clinical profile, and outcomes of influenza in pediatric patients.

Methods: This prospective cross-sectional study was conducted from June 2019 to August 2021, enrolling 220 children (6 months to 18 years) with category C influenza-like symptoms. Influenza was diagnosed via reverse transcription polymerase chain reaction (RT-PCR) using nasopharyngeal and oropharyngeal swabs. Clinical data, laboratory findings, and treatment outcomes were analyzed.

Results: Influenza was detected in 47 (21.63%) patients, with peak incidence in October 2019 and February 2020. No cases were recorded in 2021. No significant differences were observed between influenza-positive and-negative groups in demographics or clinical symptoms. ICU admission was higher in the influenza-positive group (14.9% vs. 1.7%). Mortality was significantly higher in influenza-positive patients (12.8% vs. 1.2%). Vaccination rates were low (2.3%).

Conclusions: Influenza poses a considerable health burden in children with severe respiratory symptoms, with increased mortality in positive cases. The marked decline in influenza cases during the COVID-19 pandemic highlights the effectiveness of public health measures. Clinicians should consider influenza in the differential diagnosis of children with severe respiratory illness, particularly during winter. Low vaccination rates emphasize the need for improved vaccination strategies.

Electrolyte imbalances and their impact on outcomes in critically ill children: a prospective study from North India

2025-10-29T08:34:58+0530

Background: Electrolyte imbalances are frequent in critically ill children and significantly influence prognosis, yet pediatric data from North India remain scarce. To determine the prevalence of electrolyte imbalances in a tertiary care pediatric intensive care unit (PICU) and assess their associations with morbidity, mortality and clinical outcomes.

Methods: This prospective observational study included 196 children (1 month–18 years) admitted to a North Indian tertiary PICU over 18 months. Electrolyte levels were measured at admission and monitored daily. Associations between dyselectrolytemia and outcomes including ventilatory and inotropic needs, complications, length of stay and mortality were analyzed using chi-square tests.

Results: Electrolyte imbalance was observed in 58.2% of patients, with hyponatremia (52.6%) being most common, followed by hypocalcemia (13.8%) and hyperkalemia (7.1%). Dyselectrolytemia was significantly associated with prolonged PICU stay (p<0.0001), need for ventilation and inotropes (p<0.0001), complications (42.9%), MODS (11.2%) and higher mortality (p<0.0001). Seizures were the most frequent complication (20.4%). Mortality was highest with hyperkalemia (78.6%), followed by hypernatremia (57.1%) and hypokalemia (57.1%), whereas hyponatremia showed a non-significant trend. Overall mortality was 9.2%, lower than prior reports, possibly due to early monitoring and timely correction.

Conclusions: Electrolyte disturbances are common in PICU and strongly associated with adverse outcomes. Hyperkalemia and hypernatremia carry the greatest mortality risk. Early recognition and prompt correction of dyselectrolytemia may reduce morbidity and improve survival. Larger multicentre studies incorporating additional electrolytes such as magnesium and phosphate are warranted.

Longitudinal follow up study of clinical and anthropometric profile of severely malnourished children admitted at nutrition rehabilitation centre

2025-10-29T08:33:43+0530

Background: Nutritional status of children is the common factor to identify the nutritional status of the entire community. Hence, this study was designed to look for clinical and anthropometric profiles of severely malnourished children during admission, discharge and follow up of the child admitted at nutrition rehabilitation centre (NRC) of our hospital.

Methods: Patients will be monitored and outcome will be seen in the form of vital and clinical parameters and detailed anthropometric assessment at admission, discharge and follow up. Total 3 follow up will be done at an interval of 15 days as per MOHFW operational guideline.

Results: Females (n=42, 56%) were slightly more as compared to males (n=33, 44%). Statistically significant results were found with respect to increase in the mean MUAC among subjects from discharge to 3^rd follow-up. At discharge mean weight of the subject was 7.38 which increased to 8.99 after 3^rd follow-up. When weight was compared with different time interval using ANOVA test; statistically significant result was found as p=0.002. At admission mean height of the subject was 74.73, after 3^rd follow-up increased up to mean of 81.02, this shows from the discharge to 3^rd follow-up as per time height of the subjects was increasing. When height was compared according to different time interval using ANOVA test; statistically significant result was found.

Conclusions: NRCs provide life-saving care for complicated severe acute malnutrition (SAM) children with high chances of recovery rate in clinical and anthropometric parameter. Follow up visits are more important for clinical and anthropometric assessment of child and counselling of parent. Large number of uncomplicated SAM child can be treated in their community with traditionally available energy dense food.

Effect of play therapy in reduction of postoperative pain perception among the children aged 6-12 years in All India Institute of Medical Sciences, Patna

2025-10-29T08:35:04+0530

Background: Postoperative pain in children remains a significant concern, often leading to delayed recovery and distress. This study evaluated the effect of play therapy on postoperative pain among children aged 6-12 years in AIIMS Patna.

Methods: A quasi-experimental, non-randomized control group design was used. The 54 children meeting inclusion criteria were selected through non-probability convenience sampling from pediatric surgery wards. Demographic data were collected from parents and children. Pain was assessed on postoperative days 1-4 using the Wong-Baker FACES pain rating scale (WBPS). The experimental group received 50 minutes/day of play therapy; the control group received standard care without intervention. Data were analyzed using descriptive and inferential statistics.

Results: In the experimental group, 16 (59.3%) children reported ‘pain whole lot.’ 6 (22.2%) ‘pain even more.’ and 5 (18.5%) ‘pain little more.’ In the control group, 14 (51.9%) experienced ‘pain even more’ and 13 (48.1%) ‘pain whole lot.’ Post-test mean pain scores were 1.37±0.742 (experimental) and 3.37±0.792 (control) at p=0.001, confirming significant reduction in pain with play therapy. Experimental group pre-test mean was 3.41±0.797, with a mean difference of 2.04 post-therapy (p=0.001). Control group change was not significant (p=0.537). Significant associations were found between age (p<0.013) and postoperative sedation (p<0.012) with post-test scores in the experimental group; no associations were observed in the control group.

Conclusions: Play therapy is effective in reducing postoperative pain perception in children aged 6-12 years.

Prevalence of rheumatic heart disease among school children of Patna District in Eastern India and an insight into its prevention

2025-10-29T08:35:03+0530

Background: Bihar is considered as a ‘hot spot’ for rheumatic heart disease (RHD). The objective of our study was to determine the prevalence of RHD among school children in Patna district in Bihar.

Methods: We conducted a population-based cross-sectional study in school children of Patna district.

Results: This study estimated that the prevalence of RHD was 1.06 per 1,000 among school children in Patna. None of the factors, including mother’s education, father's education, and family income, was a significant risk factor for its causation.

Conclusions: Considering the significant morbidity and mortality it causes, preventive measures at all levels, especially the secondary prevention, must be applied in any region to reduce the disease burden of RHD and its impact on society due to disease severity.

Levetiracetam vs. phenobarbitone in neonatal seizures - a randomised controlled trial at a tertiary care hospital in Southern Rajasthan

2025-10-29T08:34:54+0530

Background: Neonatal seizures, most commonly due to hypoxic-ischemic encephalopathy (HIE), represent a medical emergency with substantial morbidity. While phenobarbitone (PB) remains the first-line antiepileptic, its efficacy varies and adverse effects are frequent. Levetiracetam (LEV) may offer a safer and equally effective alternative.

Methods: In this randomized controlled trial conducted at RNT Medical College NICU, Udaipur, 120 EEG-confirmed neonatal seizure cases were randomized equally to receive either LEV or PB. Seizure control within 24 hours without switching was the primary outcome; secondary outcomes included drug switching, adverse events, discharge rate and mortality.

Results: Baseline characteristics were well-matched between groups. Initial seizure control was achieved in 81.6% of the LEV group and 71.6% of the PB group (p=0.195). After switching, seizure control rates significantly favored LEV over PB (96.7% vs 86.7%, p=0.048). Adverse events occurred in 11.7% of neonates receiving LEV versus 23.3% with PB (p=0.036). No significant difference was observed in mortality or discharge rates between the two groups.

Conclusions: Levetiracetam demonstrated a comparable efficacy to phenobarbitone in neonatal seizure control, with a significantly better safety profile and higher effectiveness after drug switching. LEV shows promise as a preferable first-line or adjunctive therapy for neonatal seizures.

Outcome determinants in pediatric severe malaria: evidence from a tertiary care hospital in Odisha

2025-10-29T08:34:40+0530

Background: The objectives of the study were to assess socio-demographic, clinical, and laboratory predictors of outcomes in pediatric patients with severe malaria, focusing on sex-based differences and complication profiles.

Methods: A cross-sectional study was conducted among 102 children aged 0–14 years with confirmed severe malaria admitted to a tertiary care hospital. Data on socio-demographic characteristics, clinical features, and laboratory abnormalities were collected. Outcomes were categorized as treated, referred, or deceased. Associations between variables and outcomes were analyzed using the Chi-square test, with Cramer’s V for effect size. A p value <0.05 was considered statistically significant.

Results: Most participants were aged 5–10 years (47.1%), female (58.8%), from rural areas (76.5%), and of upper-lower socio-economic class (86.3%). The most frequent complications were severe anemia with prostration (29.4%), prostration alone (25.5%), and renal failure with prostration (15.7%). Overall, 80.4% were successfully treated, 11.8% referred, and 7.8% died. Sex showed a significant association with outcome (χ²=15.619, p<0.001, Cramer’s V=0.39), with males having higher mortality (14.3% versus 3.3%) and referral rates (23.8% versus 3.3%), while females had better treatment success (93.3% versus 61.9%). Laboratory complications were also strongly associated with outcomes (χ²=121.046, p<0.001), with multi-organ dysfunction predicting fatality and isolated prostration linked to recovery. Socio-economic status (p=0.412) and age group (p=0.179) showed no significant association.

Conclusion: Male sex and severe laboratory abnormalities are key predictors of adverse outcomes in pediatric severe malaria. Early identification of high-risk patients through sex-specific and laboratory-based risk stratification may improve clinical management and survival rates.

Respiratory outcomes in preterm neonates (<32 weeks): impact of complete, partial, and absent antenatal steroid exposure

2025-10-10T06:54:52+0530

Background: Preterm birth is a leading cause of neonatal morbidity and mortality, with respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), and prolonged respiratory support as major complications. While antenatal corticosteroids improve respiratory outcomes, the effects of complete, partial, and absent exposure in infants <32 weeks are inconsistently reported. Aim of the study was to compare respiratory outcomes among preterm neonates <32 weeks based on complete, partial, or no antenatal corticosteroid exposure.

Methods: A prospective observational study conducted in the neonatal intensive care unit (NICU) of Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Srinagar, from January 2021 to June 2025. 185 preterm neonates <32 weeks gestation were included: complete antenatal corticosteroids (ACS) (n=127), partial ACS (n=41), and no ACS (n=17). Outcomes included incidence and severity of RDS, need for surfactant therapy, need for respiratory support, BPD at 36 weeks postmenstrual age, and mortality. Statistical analysis included Chi-square, Kruskal–Wallis, and multivariate logistic regression.

Results: Complete ACS significantly reduced RDS (32.3% versus 46.3% and 58.8%), severe RDS, invasive ventilation, and surfactant use (all p<0.05). Median ventilation duration (3 versus 5 versus 7 days) and time to room air (20 versus 30 versus 50 days) were shortest with complete ACS (p<0.001). BPD (16.5% versus 22.0% versus 58.8%, p<0.001) and mortality (17.3% versus 31.7% versus 52.9%, p=0.002) were also lowest. ACS coverage, gestational age, and birth weight independently predicted outcomes.

Conclusions: Complete ACS markedly improves outcomes in preterm infants <32 weeks, underscoring the need for timely administration in high-risk pregnancies.

A cross-sectional study on burden and predictors of obesity and anemia in school-going adolescents from Northern India

2025-10-29T08:34:57+0530

Background: Adolescence, a period of rapid growth and high nutritional demand, faces a dual burden of malnutrition. This study assessed anemia and obesity prevalence and their demographic, dietary and anthropometric associations among school-going adolescents in India.

Methods: A cross-sectional study was conducted from August 2023 to January 2025 in selected schools in Sitapur, India, enrolling 386 adolescents via multistage random sampling. Data on sociodemographic, dietary habits and clinical history were collected through structured interviews. Anthropometry (weight, height, body mass index (BMI), waist-hip ratio (WHR), mid-upper arm circumference (MUAC)) and hemoglobin levels (automated hematology analyser) were measured. Anemia and obesity were classified using WHO guidelines and CDC BMI percentiles/WHR cut-offs, respectively. Data were analyzed using SPSS v26.0; p<0.05 was considered significant.

Results: The mean age was 14.19±2.63 years. Overweight and obesity prevalence were 7.8% and 30.8%, respectively, with 10.6% underweight. Central obesity was present in 45.6% (WHR). Anemia affected 32.4% and was associated with female gender (OR=2.77, p<0.001), nuclear family (B=-0.900, OR=0.41, p=0.005), vegetarian diet (B=-1.903, OR=0.15, p<0.001) and low socioeconomic status (OR=10.26, p<0.001). Obesity was linked to non-vegetarian diet (OR=2.467, p=0.009), daily fast-food intake (OR=3.323, p=0.005) and inversely associated with lower SES (B=-2.083, OR=0.124, p<0.001). No significant association was observed between BMI and anemia (p=0.591).

Conclusions: High prevalence of overweight/obesity (38.6%) and anemia (32.4%), with notable coexistence, highlights the dual burden of malnutrition. Integrated school-based interventions focusing on screening, nutrition education and early management are essential to improve adolescent health in India.

Prevalence and interventions for anxiety and depression in children and adolescents

2025-10-29T08:34:56+0530

Anxiety and depression rank among the most prevalent mental health disorders impacting children and adolescents globally, carrying significant consequences for development, academic achievement, and long-term well-being. It is essential to comprehend the prevalence and effectiveness of interventions to enhance mental health outcomes in this population. A systematic literature review was performed in accordance with PRISMA guidelines to identify peer-reviewed studies regarding the prevalence and interventions for anxiety and depression in children and adolescents, published from January 2015 to July 2025. Thorough searches were conducted in PubMed, Scopus, Web of Science, and PsycINFO utilizing pertinent keywords. After removing 815 duplicates from a total of 2,147 records, 1,332 unique records underwent title/abstract screening and full-text assessment. Thirty studies meeting rigorous inclusion criteria were included in the final synthesis. The findings demonstrate a high prevalence of anxiety and depression in children and adolescents, with pooled rates varying from 13% to 25% across various countries and contexts. Cognitive Behavioral Therapy (CBT) has been consistently recognized as the most effective intervention, demonstrating positive outcomes for anxiety and depressive symptoms. Selective serotonin reuptake inhibitors (SSRIs) and digital interventions offer supplementary advantages, especially for moderate-to-severe cases and in resource-limited environments. Nonetheless, disparities persist in access to care, management of comorbidities, and long-term outcomes. Anxiety and depression are common and frequently co-occur in young individuals; however, there are effective interventions available. Improving access to evidence-based therapies and expanding digital health options are critical measures to address unmet needs and enhance mental health in this vulnerable population.