International Journal of Contemporary Pediatrics

Probiotics in pediatric cardiac surgery: biological effects and clinical outcomes – a systematic review of randomized evidence

Muhammad Shahzad — 2026-10-27

Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are vulnerable to intestinal barrier dysfunction, systemic inflammation, and postoperative infection. Probiotics may restore gut microbiota balance and modulate inflammation, but evidence in pediatric cardiac populations is limited. The objective is to systematically analyze the effects of perioperative probiotic supplementation in pediatric cardiac surgery, and incorporating indirect evidence from adult CPB trials. Following PRISMA 2020 guidelines, major databases (PubMed, Embase, Scopus, CENTRAL, and ClinicalTrials.gov) were searched through March 2025. Eligible studies were randomized controlled trial (RCTs) and pilot studies that evaluated the probiotics in pediatric or adult cardiac-surgery patients. Data extraction and risk-of-bias assessment (RoB2) were performed independently by three reviewers. Owing to clinical heterogeneity and sparse events, findings were narratively synthesized, with quantitative pooling limited to comparable continuous outcomes. Five RCTs (three pediatric, two adult) met the inclusion criteria. Pediatric trials using Bifidobacterium breve or Bifidobacterium longum demonstrated improved intestinal microbiota and trends toward reduced endotoxin and I-FABP levels, but no significant differences in infection or ICU length of stay. Adult CPB trials showed reduced acute gastrointestinal injury and nosocomial infections. No adverse events or probiotic-associated sepsis were reported. Overall certainty of evidence ranged from low to moderate, limited by sample size and outcome heterogeneity. Perioperative probiotic supplementation in pediatric cardiac surgery appears safe and biologically active but lacks conclusive evidence for clinical benefit. Larger, standardized multicenter RCTs are warranted to determine efficacy and optimize strain selection, dosing, and timing.

Closing the first-hour gap: nurse- and midwife-led interventions during the golden hour after birth and their impact on maternal and newborn outcomes

G. S. Nithya — 2026-10-27

The first hour after birth, commonly referred to as the golden hour, is a critical period for implementing evidence-based interventions that optimize maternal recovery and neonatal physiological adaptation. Nurses and midwives play a central role in delivering timely, coordinated care during this period through interventions such as immediate skin-to-skin contact, early initiation of breastfeeding, delayed umbilical cord clamping, thermal protection, maternal surveillance, infection prevention, and parental education. This systematic review aimed to synthesize current evidence on the effectiveness of nurse- and midwife-led golden hour interventions and their impact on maternal and newborn outcomes. A comprehensive search of PubMed, Scopus, Web of Science, CINAHL, and the Cochrane Library was conducted for studies published between January 2015 and June 2026, following the PRISMA 2020 guidelines. Eligible studies included randomized controlled trials, quasi-experimental studies, cohort studies, and observational studies evaluating golden hour interventions delivered by nurses or midwives. The evidence consistently demonstrated that these interventions improve breastfeeding initiation, neonatal thermoregulation, cardiorespiratory stability, maternal satisfaction, mother-infant bonding, and early detection of postpartum complications while reducing neonatal hypothermia, hypoglycemia, preventable morbidity, and unnecessary neonatal intensive care admissions. Delayed umbilical cord clamping also improved neonatal hemoglobin concentration and iron stores without increasing maternal adverse outcomes. Overall, nurse- and midwife-led golden hour care represents a safe, effective, and evidence-based approach to improving maternal and newborn health. Strengthening standardized protocols, workforce training, and implementation strategies may further enhance the quality, safety, and equity of postnatal care worldwide.

A rare case of vertical Chikungunya transmission presenting with neurological depression and postnatal hyperpigmentation

Simrat Kaur — 2026-10-27

Chikungunya (CHIKV) is a virus that spreads through mosquito bites. Neonatal chikungunya is rare, and congenital transmission whether occurring when the virus crosses the placenta or is transmitted perinatally is even more uncommon. Due to limited awareness and overlapping symptoms with other neonatal infections or metabolic conditions, congenital chikungunya may be underdiagnosed. The increased risk of vertical transmission has been linked to maternal viremia near delivery. About 50% of neonates with CHIKV symptoms develop neurodevelopmental delay. We report a rare case of vertically transmitted chikungunya in a neonate presenting with repeated apnoea’s and generalised hypotonia.

The SPINK1 c.101A>G variant in a 6-year-old with recurrent pancreatitis: causal mutation or phenotypic modifier?

Divya Sri Sabbu — 2026-10-08

The serine peptidase inhibitor Kazal-type 1 (SPINK1) p.Asn34Ser variant is a pancreatitis risk factor often linked to a c.-4141G>T upstream enhancer mutation that reduces protective enzyme expression. Symptoms usually begin in late adolescence or early adulthood and typically require environmental triggers. Early pediatric presentation is exceptionally rare. A six-year-old male presented with recurrent periumbilical and epigastric abdominal pain. Investigations revealed elevated serum amylase and lipase levels and a mildly enlarged pancreas. Fecal elastase-1 testing indicated severe exocrine pancreatic insufficiency. There was a positive paternal history of early-adulthood pancreatitis. Confirmatory whole-exome sequencing identified a heterozygous c.101A>G (p.Asn34Ser) SPINK1 mutation. Initial management included bowel rest, analgesics, and intravenous hydration, followed by pancreatic enzyme replacement therapy. Parents were counseled to strictly avoid environmental triggers, such as high-fat meals. At the six-month follow-up, the patient remained asymptomatic and pain-free, with successful weight gain. Identifying SPINK1 variants in early-childhood recurrent pancreatitis is critical. Understanding its pathogenic mechanism, potentially driven by linked upstream regulatory mutations, guides targeted interventions. Early enzyme replacement and strict trigger avoidance are essential to prevent future attacks and to optimize pediatric growth.

Severe hypertension as an unusual presentation of intussusception in a 6-month-old infant: a case report

Saravanan M. — 2026-10-14

Intussusception is a common pediatric gastrointestinal emergency that typically presents with abdominal pain, vomiting, and blood-stained stools. Severe hypertension is an uncommon and potentially overlooked manifestation of intussusception. We report a 6-month-old female infant who presented with lethargy, poor feeding, blood-stained stools, and severe hypertension of 130/80 mmHg, exceeding the 95th percentile for age, sex, and length. Serial blood pressure measurements were obtained during quiet, non-distressed periods using an appropriately sized cuff to minimize the possibility of pain- or agitation-related elevation. Initial management included oral nifedipine, followed by intravenous labetalol infusion because of persistent hypertension. Abdominal ultrasonography demonstrated the characteristic target sign of intussusception, which was successfully treated with fluoroscopy-guided pneumatic reduction. Following successful reduction, blood pressure progressively normalized. Evaluation for secondary causes of hypertension, including serum electrolytes, renal function tests, urinalysis, screening echocardiography, and dedicated renal Doppler ultrasonography, revealed no evidence of renal parenchymal disease, renovascular pathology, including renal artery stenosis, or structural cardiovascular abnormalities. Antihypertensive therapy was subsequently tapered and completely discontinued within 5 days after discharge. At 3-month follow-up, the infant remained asymptomatic and normotensive, with no evidence of recurrence. Intussusception may therefore be considered in the differential diagnosis of acute severe hypertension in infants, particularly when gastrointestinal manifestations are present.

Benign acute childhood myositis: a self-limiting condition with observed bone marrow suppression and vitamin D deficiency

Mohd Ayub Ansari — 2026-10-27

Benign acute childhood myositis (BACM) is a rare, self-limiting condition seen primarily in school aged boys following viral infections, especially influenza. It presents with sudden onset bilateral calf pain, gait disturbances, and elevated creatine kinase (CK) levels. We report an 8 year old male with BACM following a febrile illness, severe calf pain, difficulty walking, leucopenia, thrombocytopenia, and hypocalcemia. Supportive care with non-steroidal anti-inflammatory drugs (NSAIDs), Intravenous fluids, and antivirals, led to full recovery in 10 days. This case highlights the importance of recognizing BACM to prevent unnecessary interventions and explores its association with transient bone marrow suppression and vitamin D deficiency.

Goldenhar syndrome in an infant with possible familial association: a case report

Pranjali Varshney — 2026-10-27

Goldenhar syndrome, is a rare congenital disorder characterized by craniofacial anomalies, auricular malformations, and vertebral defects. We report the case of an 8-month-old female presenting with an ocular mass, which was confirmed to be an epibulbar dermoid. Further evaluation revealed bilateral anotia/microtia and facial asymmetry. Systemic evaluation did not demonstrate vertebral, cardiac, or renal anomalies. Notably, the mother exhibited mild craniofacial anomalies, suggesting a possible familial association. This case highlights the importance of early diagnosis, thorough systemic evaluation, parental counselling, and consideration of recurrence risk and prenatal detection in future pregnancies.

Digital dentistry in pediatric rehabilitation: CAD/CAM printed polymethyl methacrylate crown

Kola Srikanth Reddy — 2026-10-27

Pulpectomized primary teeth need full coverage restorations to restore function, maintain arch integrity and prevent secondary caries. Digital dentistry has significantly improved pediatric care by enabling metal-free, biomimetic restorations through intraoral scanning and CAD/CAM technology. An 8-year-old patient was diagnosed with chronic irreversible pulpitis w.r.t 75, a treatment plan was made as pulp therapy followed by milled polymethyl methacrylate crown (PMMA). Advanced digital technologies, including an intraoral scanner and CAD-CAM, were utilised in the process, making the process child-friendly. Milled PMMA crowns enables precise fit, allows comfort and helping positive experience for children. Signifying utility of digital technology.

Hemisection of an immature mandibular first permanent molar with vertical root fracture: preserving arch space and supporting second premolar eruption

Shahina Khanam — 2026-10-27

Vertical root fracture (VRF) in an immature permanent tooth is uncommon and presents a treatment challenge, particularly in a growing child where premature tooth loss may compromise arch integrity and eruption of the succeeding dentition. A male child in the mixed dentition period presented with a grossly carious mandibular left first permanent molar with chronic hyperplastic pulpitis. Further clinical and radiographic evaluation revealed a VRF involving the mesial root. Considering the developing dentition and the importance of preserving the first permanent molar, complete extraction was avoided. Hemisection was performed with removal of the fractured mesial segment and preservation of the healthy distal segment, followed by MTA apexification, obturation, and definitive restoration. At 6 months, the patient remained asymptomatic with satisfactory clinical and radiographic healing, while the mandibular second premolar continued to erupt through the space created by hemisection and progressed toward a favourable position. This case highlights hemisection as a conservative, developmentally oriented approach for preserving a functional portion of an immature permanent molar while maintaining arch space and facilitating favourable eruption of the successor premolar.

Rising with resilience – strengthening the inner world of Indian pre-adolescents

Meera Saravanan — 2026-10-27

Pre-adolescence 9-12 years is a critical developmental period characterized by rapid biological, emotional, cognitive, and social changes that influence future mental health and well-being. Indian pre-adolescents increasingly encounter academic pressure, changing family dynamics, peer challenges, and extensive digital exposure, creating potential risks to emotional adjustment. Resilience, defined as the ability to adapt positively to adversity and recover from challenging experiences, is an important protective factor during this formative stage. This article aims to examine the determinants and dimensions of resilience among Indian pre-adolescents and to propose a culturally relevant, integrated framework for promoting resilience across biological, psychological, social, and digital domains. This article highlights key factors that strengthen resilience, including emotional regulation, self-esteem, self-compassion, problem-solving skills, supportive parenting, positive school environments, healthy peer relationships, and community connectedness. Digital resilience is also emphasized, encompassing safe technology use, digital literacy, responsible online behavior, and adaptive coping with cyberbullying, online risks, and excessive screen exposure. Based on existing evidence and contextual insights, the integrated pre-adolescent resilience model (IPARM) is proposed, integrating biological, psychological, social, and digital dimensions. Resilience promotion strategies are discussed at individual, family, school, community, and healthcare levels, with nurses and other health professionals playing an important role in early identification of vulnerable children, mental health promotion, and implementation of resilience-building interventions. Strengthening resilience during pre-adolescence represents a valuable preventive mental health strategy. A holistic and culturally responsive approach can foster emotional competence, psychological well-being, adaptability, and healthy development, enabling Indian children to navigate contemporary challenges and develop into confident and resilient individuals.

Beyond screen time: artificial intelligence, algorithmic media and the future of child health

Venugopal Reddy I. — 2026-10-27

Digital media has evolved from passive screen viewing into an algorithmically curated ecosystem of social platforms, short form video, games, generative artificial intelligence (AI), conversational agents, connected toys and educational technologies. These systems can support learning, creativity, communication, disability access and healthcare; however, engagement optimized design, commercial surveillance and synthetic content create risks that are not adequately captured by screen-time measures alone. This narrative review examines the effects of contemporary digital ecosystems on child and adolescent health and outlines implications for pediatric practice. PubMed/MEDLINE, Google Scholar and guidance from the World Health Organization, United Nations Children's Fund, UNESCO and the American Academy of Pediatrics were reviewed, with emphasis on evidence published from 2019 to June 2026. Associations have been reported between problematic digital media use and sleep disruption, reduced physical activity, visual and musculoskeletal symptoms, obesity related behaviours, anxiety, depressive symptoms, cyberbullying, disordered eating and impaired attention. Causal interpretation remains difficult because effects are heterogeneous, often small, bidirectional and strongly modified by age, content, context, displacement, family relationships and pre-existing vulnerability. AI adds distinct concerns: persuasive personalization, inaccurate health information, anthropomorphic dependency, deepfakes, sexual exploitation, biased outputs, privacy loss and erosion of learning through uncritical outsourcing. Benefits are also substantial when technologies are developmentally appropriate, evidence-based, inclusive and used with adult support. Pediatric counselling should shift from counting hours alone toward assessing the child's digital ecosystem, sleep, function, content, compulsivity, safety and relationships. Effective protection requires shared family practices, school digital literacy, safety by design, age-appropriate assurance, transparent algorithms, data minimization and independent research. The goal is not a screen free childhood but a child centred digital environment that supports health, agency and development.

Burden and clinical characteristics of measles in pre-vaccination age infants

Pandora Glory — 2026-10-27

Background: Measles remains an important cause of childhood morbidity, particularly among infants who are below the routine age for measles-rubella vaccination. These infants may be vulnerable because of declining maternal antibodies and absence of vaccine-derived protection. This study assessed the burden and clinical characteristics of measles among hospitalized children, with particular attention to the pre-vaccination-age group.

Methods: This hospital-based cross-sectional study was conducted in the Department of Pediatrics, Mugda Medical College Hospital, Dhaka, from March 2026 to May 2026. A total of 300 children aged 1 month to 12 years admitted to the measles isolation ward were included. Data on demographic characteristics, age, clinical manifestations, complications, management and outcomes were collected using a structured proforma. Measles was diagnosed according to the WHO clinical case definition.

Results: Males constituted 61.7% of participants, while 38.3% were female. Infants younger than 1 year represented 57.1% of cases, including 102 (34.0%) infants below 9 months. Fever and rash were present in all patients. Cough, coryza and conjunctivitis were reported in 82.7%, 78.9% and 73.7%, respectively. Pneumonia was the most frequent complication, affecting 63.9% of patients, followed by diarrhea (45.1%) and vomiting (30.1%). All patients received supportive care, while 18.8% required oxygen therapy. ICU admission was required in 0.72% and mortality was 1.0%.

Conclusions: Measles caused substantial morbidity among hospitalized children, with pre-vaccination-age infants comprising a considerable proportion of cases. Early recognition, prompt supportive management and strengthened preventive strategies are essential to reduce severe measles-related outcomes.

Evaluation of clinical, hematological and radiological parameters among Bangladeshi children with pneumonia

Tohmina Yasmin — 2026-10-27

Background: Pneumonia is a leading cause of death among children under 5 years worldwide and poses a major burden in Bangladesh. This study compared the clinical, hematological, and radiological features of pneumonia among Bangladeshi children.

Methods: This case-control study was conducted at the Institute of Child Health (ICH) and Shishu Sasthya Foundation (SSF), Dhaka, from July to December 2012. Fifty children with clinically and radiologically confirmed pneumonia were enrolled as cases, along with 50 age-matched children with common cold as controls. All participants underwent clinical evaluation, complete blood count, and chest X-ray. Data were analyzed using the chi-square test and independent sample t-test in SPSS version 26.

Results: Most cases were male (72%) and aged 7–12 months (58%). Fast breathing, chest indrawing, and crepitations were present in all cases but absent in controls. Anemia occurred in 84% of cases versus 44% of controls. Cases had significantly higher WBC counts (14432±2144 vs. 8310±853) and neutrophil percentages (71.22±10.03 vs. 55.08±7.11), while MCV, MCH, and MCHC were significantly lower. Chest X-ray showed patchy opacity in 86% and consolidation in 14% of cases.

Conclusions: Pneumonia in Bangladeshi children was characterized by distinct clinical features, leukocytosis, neutrophilia, and microcytic hypochromic anemia, with patchy opacity as the predominant radiological finding. Integrating clinical, hematological, and radiological assessments may improve diagnosis, evaluation, and management.

Assessment of level of self esteem and perceived parenting style among school going adolescents in Puducherry: a cross-sectional analytical study

Reshma Shahul Hamid — 2026-10-27

Background: Adolescence is a critical developmental period during which self-esteem and family relationships may influence psychosocial well-being. Parenting style contributes to the emotional climate in which adolescents develop. This study assessed self-esteem and perceived parenting styles and examined their associations among school-going adolescents in Puducherry.

Methods: A cross-sectional analytical study was conducted among 486 school-going adolescents aged 13-17 years from government and private higher secondary schools in urban and rural areas of Puducherry between September and October 2024. Participants were selected using stratified cluster sampling technique. Data were collected using a socio-demographic questionnaire, the Rosenberg self-esteem scale and a perceived parenting style scale. Descriptive statistics, chi-square tests and Pearson correlation were used.

Results: Most adolescents had moderate self-esteem (91.6%); 4.3% had low and 4.1% had high self-esteem. Authoritative parenting was the most commonly perceived style (53.5%), followed by authoritarian (34.2%) and permissive (12.3%). Self-esteem showed weak negative correlations with authoritative (r=-0.045; p=0.318) and authoritarian parenting (r=-0.027; p=0.555), and a weak positive correlation with permissive parenting (r=0.085; p=0.060); none was statistically significant. Type of school (p=0.009) and area of residence (p=0.022) were associated with self-esteem. Gender (p≤0.001), type of school (p=0.018) and area of residence (p=0.017) were associated with perceived parenting style.

Conclusions: Most adolescents had moderate self-esteem and perceived authoritative parenting as the predominant style. No statistically significant correlation was observed between self-esteem and perceived parenting style. Adolescent mental health programmes should consider family, school and community contexts.

Pulmonary function in overweight and obese children aged 6-12 years: a hospital and school-based observational study

Hariharan A. — 2026-10-27

Background: Childhood overweight and obesity may adversely influence respiratory mechanics and pulmonary function through mechanical restriction of the chest wall, altered diaphragmatic excursion, and changes in lung volumes. This study aimed to assess pulmonary function among overweight and obese children aged 6 to 12 years and compare spirometric parameters between BMI categories.

Methods: A hospital-and school-based observational study was conducted among 45 overweight and obese children aged 6 to 12 years at Government Medical College and Hospital, Cuddalore District, Tamil Nadu, and selected schools in the district from December 2024 to May 2026. Baseline demographic and anthropometric characteristics were recorded. Pulmonary function was assessed using spirometry, including peak expiratory flow rate (PEFR), forced expiratory volume in the first second (FEV₁), forced vital capacity (FVC), and FEV₁/FVC ratio. Observed values were compared with normal predicted values derived using Chhabra equations, and pulmonary function parameters were compared between overweight and obese children. Data were analysed using SPSS version 26.0.

Results: The mean age was 10.31±0.90 years, and the mean BMI was 22.13±3.08 kg/m². Of the 45 participants, 21 (46.7%) were overweight and 24 (53.3%) were obese. The mean PEFR, FEV₁, and FVC were 3.74±0.96 L/s, 1.37±0.36 L, and 1.36±0.37 L, respectively. Their corresponding mean percentage predicted values were 69.82±21.62, 53.71±13.06, and 48.43±12.55. The mean FEV₁/FVC percentage predicted remained preserved at 107.52±2.56. Obese children showed slightly higher absolute spirometric values than overweight children.

Conclusions: Overweight and obese children demonstrated reduced PEFR, FEV₁, and FVC compared with predicted normal values, while the FEV₁/FVC ratio remained preserved. Early pulmonary assessment and appropriate weight-management interventions may help reduce long-term respiratory consequences.

Comparative prognostic performance of the neonatal sequential organ failure assessment and score for neonatal acute physiology with perinatal extension-II score for predicting in-hospital mortality among neonates with sepsis: a retrospective cohort study

Muhammad Talha — 2026-10-27

Background: Accurate risk stratification is essential for identification of neonates with sepsis at high risk of mortality. The neonatal sequential organ failure assessment (nSOFA) score reflects dynamic organ dysfunction, whereas the score for neonatal acute physiology with perinatal extension-II (SNAPPE-II) assesses baseline illness severity at admission.

Methods: This retrospective cohort study included neonates with clinical sepsis admitted to a tertiary neonatal intensive care unit between September 2024 and March 2025. SNAPPE-II scores were calculated using admission data within the first 12 hours of NICU stay. nSOFA scores were calculated using the worst physiological parameters within 24 hours of sepsis diagnosis. The primary outcome was in-hospital mortality. Discriminative performance was assessed using receiver operating characteristic (ROC) curve analysis, correlation analysis, and binary logistic regression.

Results: Among 175 neonates, 35 (20.0%) died during hospitalization. Mean nSOFA and SNAPPE-II scores were higher among the non-survivors than survivors (nSOFA: 5.7±2.1 vs 2.3±1.9; SNAPPE-II: 56.4±19.8 vs 31.7±17.3; both p<0.001). The area under the ROC curve was 0.754 for nSOFA and 0.877 for SNAPPE-II. On logistic regression analysis, higher values of both scores were independently associated with increased odds of mortality.

Conclusions: Both nSOFA and SNAPPE-II are effective predictors of in-hospital mortality in neonates with sepsis. SNAPPE-II demonstrated higher discriminative accuracy while nSOFA provides a dynamic insight of organ dysfunction. The complementary use of these scoring systems may enhance early risk stratification in neonatal intensive care units, particularly in resource-limited settings.

Cross-sectional study of blood biochemical profile in malnourished children admitted in pediatrics indoor in a tertiary care hospital with respect to severity of malnutrition

Ebna Rushad — 2026-10-27

Background: Malnutrition encompasses both undernutrition and overnutrition. In India, undernutrition is widely prevalent among under-five children in resource limited rural and tribal dominated areas of Bankura district of West Bengal, where the study was conducted. In undernourished state, there is alteration in blood glucose, electrolytes, liver function tests, renal function tests, lipid profile etc. These metabolic and biochemical markers are very important for feeding and fluid management of malnourished children.

Methods: The present study will provide an overview of blood biochemical changes in malnourished children aged 6 months to 60 months and admitted in Paediatric indoor of Bankura Sammilani Medical College. This observational study included 105 children aged 6 months to 5 years, admitted with undernutrition and was categorized as per WHO classification according to its severity into moderate acute malnutrition (MAM) numbering 65 and severe acute malnutrition (SAM) numbering 40. Initial blood sugar, serum Na⁺, K⁺, liver function tests (ALT, AST, albumin, alkaline phosphatase), urea, creatinine, lipid profile were estimated as per standard protocol after taking consent from the parents of children included and were correlated with respect to severity of malnutrition.

Results: Significant difference in mean serum values of ALT, alkaline phosphatase, albumin, urea, sodium, potassium, cholesterol and triglyceride was observed between MAM and SAM groups. However, differences in mean values of blood glucose, AST, HDL and creatinine were not significant. Changes in blood biochemical parameters were also observed in phenotypic variants of malnutrition, namely marasmus and kwashiorkor.

Conclusions: Levels of blood biochemical parameters vary with severity of malnutrition.

Profile and outcomes of referred neonates needing immediate resuscitation at admission

Ruchi Rai — 2026-10-27

Background: Referral of sick newborns to a tertiary centre for management is common. Deterioration in the baby’s condition can occur during transport and affects the outcome of babies. Many babies reach the referral centre in an unstable condition and need resuscitation immediately on arrival in the emergency. We aimed to study the profile and outcomes of such babies.

Methods: This prospective observational study over a period of 8 months aimed at understanding the profile and demographic characters of neonates needing immediate resuscitation at admission and analysing their outcomes. We included all neonates who were resuscitated at admission and followed their hospital course until discharge or death.

Results: A total of 133 (21%) of all the referred babies who fulfilled the inclusion criteria were enrolled. Most of the babies were male, born at term and were less than 24 h old. Ambulances were the mode of transport for 117 (88%) babies. Mortality was seen in 68 (51.1%) babies with 36 (52.9%) deaths occurring within 24 hours of admission. Need for inotropes at admission was strongly associated with mortality, the relative risk being 5.30 with a confidence interval of (2.3, 12). Age<48 hours and distance travelled >15 km were also associated with high risk of mortality.

Conclusions: Neonates needing immediate resuscitation at admission have high rates of mortality. Factors like shock at admission, distance travelled, and age of the baby should be considered and taken into account before a baby is referred to another centre for management. Risk factors associated with poor outcomes should be considered and managed before and during transport.

Prognostic value of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in critically ill children – a retrospective cohort study from a tertiary care pediatric intensive care unit

K. Surya Savarnika Reddy — 2026-10-27

Background: Early risk stratification is essential in pediatric intensive care. Simple, inexpensive biomarkers are needed, especially in resource-limited settings. We evaluated the prognostic value of trends in neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for predicting mortality in critically ill children and compared their performance with the pediatric logistic organ dysfunction-2 (PELOD-2) score.

Methods: The study consisted of children aged 1 month to 18 years admitted to the pediatric intensive care unit (ICU) of Navodaya Medical College Hospital and Research Centre, Raichur, India from January 2024 to December 2025 with a stay ≥5 days. Various ratios were calculated on days 1 and 5. PELOD-2 was calculated on admission. The primary outcome was PICU mortality. Trends were compared between survivors and non-survivors.

Results: Among 100 children (mean age 5.2±3.8 years, 60% male), overall mortality was 20% (n=20). Sepsis was the most common diagnosis (45%). Non-survivors showed a marked increase in NLR (day 1: 6.8±2.2; day 5: 12.5±3.6) and PLR (day 1: 180±55; day 5: 320±80), whereas survivors exhibited decreasing trends (NLR: 4.5±1.8 to 3.2±1.4; PLR: 140±45 to 110±40). Between-group differences in day 5 NLR and PLR were highly significant (p<0.001). PELOD-2 was higher in non-survivors (14.8±4.1 versus 6.2±2.5, p<0.001). ROC analysis yielded AUCs of 0.82 (95% CI 0.73-0.91) for day 5 NLR, 0.79 (95% CI 0.69-0.89) for day 5 PLR, and 0.86 (95% CI 0.78-0.94) for PELOD-2 (p<0.001 for each). Optimal cut-offs (NLR ≥7.2, PLR ≥210) gave sensitivities of 83% and 80%, and specificities of 78% and 75%, respectively.

Conclusions: An increase in the PL ratio and the NL ratio over the first five PICU days had a strong association with the outcome in terms of mortality. These simple markers can complement established scores for dynamic risk assessment, particularly in resource-constrained settings.

Prevalence and pattern of congenital heart defects in infants of diabetic mothers, an experience from central India: a cross-sectional observational study

Rajkumar M. Meshram — 2026-10-27

Background: Genetic factors account for 10% cases of congenital heart defects (CHD), while maternal pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) are notable risk factors. Objective was to estimate the prevalence and pattern of CHD among infants of diabetic mothers (IDMs).

Methods: This one-year cross-sectional observational study was conducted at a tertiary care teaching institute in Central India. Maternal diabetic status was defined using American Diabetes Association guidelines. One hundred neonates born to mothers with PGDM or GDM were selected via simple random sampling. Exclusion criteria comprised a family history of CHD, exposure to cardiac teratogens, and neonates with known genetic syndromes. Demographic, maternal, and neonatal data were collected. Two-dimensional echocardiography was performed by a cardiologist following American Society of Echocardiography guidelines. Categorical and continuous variables were analyzed using Chi-square, Fisher's exact, and unpaired t tests, with significance set at p<0.05.

Results: Of the 100 neonates, 78% were born to mothers with GDM and 22% to mothers with PGDM. The overall prevalence of CHD was 30%. Acyanotic CHD constituted 96.67% of cases, while cyanotic CHD accounted for 3.33%. Patent ductus arteriosus (PDA) was the most common defect (44.33%), followed by ventricular septal defect (23.3%), atrial septal defect (20%), and a concurrent PDA-ASD combination (10%). A single case of transposition of the great arteries was observed. The CHD prevalence difference between the PGDM (36.36%) and GDM (28.21%) groups was not statistically significant.

Conclusions: The prevalence of CHD among IDMs was 30%, with acyanotic defects, particularly PDA, being the most frequent presentation. Universal fetal and neonatal echocardiography should be routinely performed in these vulnerable infants to mitigate morbidity and mortality.

Recognizing Mycoplasma pneumoniae early in children: a clinico-laboratory pattern and a simple hematology clue

Sandeep Garg — 2026-10-27

Background: Early diagnosis of Mycoplasma pneumoniae pneumonia (MPP) is challenging because its presentation overlaps with viral and typical bacterial pneumonia. Although polymerase chain reaction (PCR) is the diagnostic standard, it is not routinely available in most Indian laboratories, leaving clinicians dependent on serology, which has recognized limitations. We aimed to identify a practical clinicolaboratory pattern, including a simple hematological clue, for early recognition of pediatric MPP.

Methods: This retrospective observational study included 60 children managed during a three-month community outbreak of clinically suspected and/or serologically confirmed MPP at a tertiary care pediatric center. Clinical, laboratory, radiographic, treatment and outcome data were reviewed, emphasizing automated complete blood count (CBC) abnormalities and their correction after incubating EDTA samples at 37°C.

Results: Children presented with prolonged fever, persistent dry cough, mild respiratory distress despite radiographic pneumonia and poor response to β-lactam antibiotics. Inflammatory markers were modestly elevated, with normal or mildly increased leukocyte counts. Chest radiographs showed lower lobe consolidation, although bilateral pneumonia, pleural effusion, lobar collapse and severe extrapulmonary manifestations also occurred. Several children showed spuriously elevated mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) with reduced red blood cell counts due to cold agglutinin-mediated agglutination, which normalized after warming samples to 37°C. Most improved rapidly after azithromycin or doxycycline.

Conclusions: Recognition of a characteristic clinicolaboratory pattern, together with reversible cold agglutinin-mediated CBC abnormalities, may facilitate early suspicion of MPP where molecular diagnostics are unavailable. Awareness of this simple hematological clue may enable earlier targeted therapy, reduce unnecessary β-lactam exposure and improve outcomes.

Clinical spectrum and outcome determinants in persistent pulmonary hypertension of the newborn in a tertiary care centre: a cross-sectional study

Deepti Omkar Pai — 2026-10-27

Background: Persistent pulmonary hypertension of the newborn (PPHN) is a serious neonatal condition characterized by elevated pulmonary vascular resistance after birth, resulting in hypoxemia. It may be associated with perinatal risk factors such as birth asphyxia, meconium aspiration syndrome, respiratory distress syndrome, and sepsis. Early diagnosis and appropriate management are essential to improve neonatal outcomes. This study aims to assess the risk factors, clinical profile, treatment modalities, and outcomes in newborns with PPHN.

Methods: This cross-sectional study was conducted in the Level 3 neonatal unit in Western India, data of the neonates diagnosed to have PPHN on echocardiography admitted during the period from October 2019 till July 2021 were recorded. The normality of the continuous data was tested by Shapiro-Wilk test. The continuous variables were analysed by Mann-Whitney U test and Kruskal-Wallis test. Post-hoc Dunn’s test is used to do pairwise comparisons. Categorical data is analysed using Fisher’s Exact test. P<0.05 are accepted as indicative of statistical significance.

Results: Total 36 neonates were included in the study with incidence of 8.2 per 1000 live births with mortality of 27.8% with better survival in inborn neonates. Resuscitation at birth in neonates correlated with the severity of PPHN. ABG parameters showing metabolic and respiratory acidosis, hypoxemia and poor oxygenation indices were associated with mortality. On Echocardiography, parameters like right to left shunt across PDA/PFO, right ventricular dysfunction and septal position deviated to left were associated with mortality. Requirement of surfactant, multiple inotropes, HFOV and iNO were independently associated with mortality.

Conclusions: PPHN is a disease with significant mortality and long-term morbidity which can be prevented with timely intervention, targeted Echocardiography, monitoring of parameters and requires multiple modalities of treatment.

Clinical and hematological profile and outcomes of children with dengue infection: a prospective observational study

Chaitanya Rajendra Bhattad — 2026-10-27

Background: Dengue is an important cause of morbidity among children in tropical countries, with clinical manifestations ranging from a self-limiting febrile illness to severe dengue associated with plasma leakage, shock, and organ dysfunction. Early identification of children at risk of severe disease is essential for prompt management and improved outcomes. The present study aimed to evaluate the clinical and hematological profile of pediatric dengue infection and determine its association with disease severity and clinical outcomes.

Methods: This prospective observational study was conducted in the Department of Pediatrics at a rural tertiary-care teaching hospital in Maharashtra, India, between September 2022 and February 2024. A total of 195 children aged 0-13 years with laboratory-confirmed dengue infection (positive NS1 antigen and/or dengue IgM antibody) were enrolled consecutively. Patients were classified according to the World Health Organization (WHO) 2009 dengue classification into dengue fever (DF), dengue fever with warning signs (DFWS), and severe dengue. Clinical characteristics, laboratory parameters, treatment received, duration of hospitalization, and outcomes were analyzed. Results: Out of the 195 children, 156 (80.0%) had DF, 28 (14.4%) had DFWS, and 11 (5.6%) had severe dengue. Increasing age was significantly associated with disease severity (p<0.05), whereas sex distribution was comparable across groups (p=0.81). Bleeding manifestations (p<0.001), nausea/vomiting (p<0.001), abdominal pain (p<0.001), myalgia (p=0.013), hepatomegaly (p=0.001), ascites (p=0.001), and shock (p<0.001) were significantly associated with severe disease. Progressive thrombocytopenia, lower nadir platelet count, higher total leukocyte count, and increased highest packed cell volume were significantly associated with disease severity (all p<0.05). NS1 antigen positivity showed a significant association with severe disease (p<0.01), whereas dengue IgM positivity did not (p=0.56). Increasing disease severity was associated with greater requirements for intravenous fluids, plasma transfusion, platelet transfusion, inotropic support, and longer hospital stay (all p<0.01). All children recovered, and no mortality was observed.

Conclusions: Older age, gastrointestinal symptoms, bleeding manifestations, hepatomegaly, ascites, shock, thrombocytopenia, leukocytosis, and elevated packed cell volume were significantly associated with severe dengue in children. Careful clinical assessment together with serial hematological monitoring remains essential for early recognition of severe dengue and timely institution of supportive management, contributing to favorable clinical outcomes.

Serial changes in oxygenation indices and arterial blood gas parameters during high flow nasal cannula therapy in children with moderate to severe respiratory distress: a prospective observational study

B. Lokeswari — 2026-10-27

Background: Aims and objectives were to evaluate the impact of high-flow nasal cannula (HFNC) therapy on ABG parameters, oxygenation indices, and clinical outcomes in children with moderate to severe respiratory distress admitted to the PICU.

Methods: This prospective observational study was conducted over 10 months at a tertiary care center. A total of 133 children aged 1 month to 14 years with respiratory distress were included. Severity was assessed using the Pediatric respiratory severity score (PRESS). Clinical and laboratory parameters were recorded at baseline, 1 hour, 12 hours, and 24 hours after initiation of HFNC therapy. Oxygenation indices, including A-a gradient, respiratory index, P/F ratio, S/F ratio, ROX index, and modified ROX index, were analyzed. Statistical analysis was performed using SPSS version 25.0.

Results: Of the 133 children, 90.23% had severe respiratory distress. Significant improvements were observed in heart rate, respiratory rate, and SpO₂ over time (p<0.05). ABG analysis showed significant reductions in pCO₂ and lactate, along with improvements in pO₂, HCO₃, and base excess (p<0.05). Both ABG-dependent and independent oxygenation indices improved significantly within 24 hours (p<0.0001). HFNC failure and need for mechanical ventilation were low (1.5% each). Median ICU and hospital stay were 4 and 6 days, respectively, with 100% survival.

Conclusions: HFNC therapy is a safe and effective non-invasive respiratory support modality in children with moderate to severe respiratory distress. It significantly improves oxygenation, ABG parameters, and clinical outcomes, while reducing the need for invasive ventilation.

Knowledge, attitude and practices among mothers of children regarding vitamin supplementation in selected rural areas of Chitradurga

C. Lalbiakngheta — 2026-10-27

Background: Vitamins are essential micronutrients required for growth, immunity, and overall development in children. Inadequate knowledge and improper practices regarding vitamin supplementation among mothers may lead to adverse health outcomes, particularly in rural populations. Therefore, this study aimed to assess the knowledge, attitude, and practices (KAP) regarding vitamin supplementation, evaluate the impact of an educational intervention, and determine the association with socioeconomic factors.

Methods: A community-based, cross-sectional study was conducted among 204 mothers aged 0-12 years across three selected rural areas of Chitradurga. Data were collected using self-designed, pre-validated questionnaire consisting of five 10-item sections covering socio-demographics, KAP before and 1-2 weeks following an educational intervention delivered via leaflets and verbal communication. Data were analysed using IBM SPSS version 27, employing descriptive statistics, paired t-tests, and chi-square tests.

Results: At baseline, only 33 (16.2%) of participants had good knowledge and 30 (14.7%) demonstrated good practices, while over 184 (90%) showed a positive attitude toward vitamin supplementation. Awareness regarding the correct age 16 (7.8%) and dosage 5 (2.5%) was notably low. Following the educational intervention, practice scores improved significantly from 3.08 to 5.55 (p<0.001). No significant association was found between socioeconomic status and practice levels.

Conclusions: Mothers demonstrated poor knowledge and practices despite having a positive attitude toward vitamin supplementation. Educational interventions significantly improved practices, indicating that lack of awareness rather than financial constraints is the primary barrier.

Clinical and etiological profile of children hospitalized with acute undifferentiated febrile illness in South-Eastern Rajasthan, India: a prospective observational study

Anjali Tiwari — 2026-10-27

Background: Etiological data on acute undifferentiated febrile illness (AUFI) in India come mainly from adults in humid, high-endemicity regions; pediatric data from semi-arid north-west India are sparse. We determined the etiology, laboratory profile, outcomes and laboratory discriminators in hospitalized children in south-eastern Rajasthan.

Methods: Prospective observational study at a tertiary teaching hospital in Jhalawar, Rajasthan. Two hundred children aged 2 months–18 years with fever ≤7 days and no identifiable focus after baseline assessment underwent a standardized diagnostic panel. Proportions carry Wilson 95% confidence intervals (CIs). Sparse cell counts required Monte Carlo permutation testing (100 000 replicates) with Holm adjustment across 16 comparisons; threshold performance was assessed post hoc.

Results: No etiology was identified in 105 children (52.5%, 95% CI 45.6–59.3). Scrub typhus predominated (33, 16.5%, CI 12.0–22.3; 34.7% of resolved diagnoses), then urinary tract infection (25, 12.5%), dengue (22, 11.0%), malaria (10, 5.0%) and enteric fever (5, 2.5%). Enrollment peaked in August–October (88, 44.0%; p<0.001). All laboratory parameters except creatinine differed by diagnosis (adjusted p≤0.002), as did length of stay, complications and defervescence time. Thresholds were specific but insensitive: hemoglobin <80 g/l for scrub typhus (specificity 97.0%, sensitivity 45.5%, likelihood ratio 15.2), platelets <100×10⁹/l for dengue (86.0%, 68.2%, 4.9). Complications affected 39 children (19.5%), intensive care 25 (12.5%); none died.

Conclusions: Scrub typhus, not dengue or malaria, led identifiable causes and accounted for most transfusions. Empirical doxycycline warrants evaluation in post-monsoon fever. Routine thresholds modify suspicion but cannot replace specific testing; the unresolved half defines the gap molecular diagnostics must close.

Effect of a structured educational intervention on maternal knowledge and self-reported home-based care practices among mothers of preterm newborns: a pre-experimental study

Bomyir Doyom — 2026-10-27

Background: The period surrounding discharge is a critical transition for mothers of preterm newborns, as responsibility for several aspects of infant care gradually shifts from healthcare professionals to the family. Mothers must manage feeding, thermal protection, Kangaroo Mother Care (KMC), hygiene, infection prevention, follow-up, and recognition of neonatal danger signs at home. Adequate preparation is essential for the safe continuation of care after discharge.

Methods: A quantitative, pre-experimental one-group pre-test-post-test study was conducted among 90 postnatal mothers of preterm newborns in a tertiary-care teaching hospital in Greater Noida, Uttar Pradesh, India. Baseline knowledge and self-reported caregiving practices were assessed before the intervention and again seven days later. Each participant received an individualized 45-minute educational session incorporating a PowerPoint presentation, interactive discussion, practical demonstrations, and a take-home brochure. Data were analyzed using descriptive statistics, paired-samples t-tests, Pearson’s correlation coefficient, and chi-square tests.

Results: The proportion of mothers with adequate knowledge increased from 2.2% before the intervention to 45.6% at seven-day follow-up. The proportion reporting good caregiving practice increased from 2.2% to 57.8%. Mean knowledge scores increased from 4.96±1.66 to 10.24±1.60, giving a mean difference of 5.28 points (t=33.768, df=89, p<0.001). Mean practice scores increased from 5.16±1.69 to 10.52±1.38, with a mean difference of 5.36 points (t=34.229, df=89, p<0.001). Baseline knowledge demonstrated a positive correlation with baseline self-reported practice (r=0.376, p<0.01).

Conclusions: Maternal knowledge and self-reported home-based caregiving practices showed substantial improvement seven days after participation in the structured educational programme. Structured and individualized discharge education may serve as an effective strategy for strengthening maternal preparation for caring for preterm newborns at home.

Digital image display manipulation and observer variability in pediatric chest radiograph interpretation

Chris Neil James — 2026-10-27

Background: Interpretation of pediatric chest radiographs is subject to observer variability, and digital image processing may further influence visual assessment. We evaluated interobserver agreement and the effect of controlled contrast manipulation on the interpretation of pediatric chest radiographs.

Methods: Sixty anonymised pediatric chest radiographs, comprising 30 classified as normal and 30 as abnormal, were presented in three display conditions: original (OI), contrast-reduced (CRR), and contrast-enhanced (CER). Five pediatricians independently assessed all 180 image presentations for image quality, radiographic features, and final interpretation as normal or abnormal. Interobserver agreement was assessed using Fleiss' kappa and intraobserver consistency using Cohen's kappa. Display-related changes in abnormal and lung-opacity assessments were compared at the underlying radiograph level using paired Wilcoxon signed-rank tests.

Results: Overall interobserver agreement for final interpretation was moderate (κ=0.528), with complete agreement in 48.3% of presentations. Agreement was κ=0.496, 0.594, and 0.479 for OI, CRR, and CER, respectively. Among radiographs classified as normal, lung-opacity identification increased from 8.7% with OI to 32.7% with CRR (p=0.012) and 27.3% with CER (p=0.018). Final normal/abnormal classification did not differ significantly between display conditions.

Conclusions: Controlled contrast manipulation influenced recognition of lung opacity despite unchanged underlying radiographic content. Standardised display conditions and awareness of perceptual variability may be important in pediatric chest radiograph interpretation.

Temperature control and short-term outcomes of phase-changing material versus servo-controlled whole-body cooling in neonates with hypoxic-ischemic encephalopathy: a prospective comparative cohort study

Shrikant Giri — 2026-10-27

Background: Therapeutic hypothermia improves outcomes in neonates with moderate-to-severe hypoxic-ischaemic encephalopathy (HIE), but access to servo-controlled systems may be limited. Phase-changing material (PCM) devices are a lower-complexity alternative requiring continuous core-temperature monitoring.

Methods: This prospective, single-centre, observational comparative cohort study included 60 neonates with moderate-to-severe HIE treated for 72 hours with either servo-controlled whole-body cooling (n=30) or PCM cooling (n=30). Allocation was non-randomised and determined by device availability at admission. The primary outcomes were time to target temperature (33.5-34.5°C) and proportion of cooling time within the target range. Secondary outcomes included rewarming duration, respiratory and haemodynamic support, complications, treatment completion, seizures, neuroimaging and neurological status at discharge.

Results: Servo-controlled cooling reached target temperature faster than PCM cooling (1.81±0.37 vs 2.53±0.77 hours; mean difference -0.72 hours, 95% CI -1.03 to -0.41; p<0.001) and maintained the target range for a greater proportion of cooling time (90.94±4.38% vs 79.52±6.86%; mean difference 11.42 percentage points, 95% CI 8.45 to 14.39; p<0.001). Rewarming duration did not differ significantly (7.10±0.99 vs 7.48±1.16 hours; p=0.175). No statistically significant between-group differences were detected for ventilation, inotropic support, thrombocytopenia, coagulopathy, electrolyte abnormalities, skin complications, completion of 72-hour cooling, seizures, neuroimaging or discharge neurological outcome. In exploratory multivariable analysis, HIE severity, timing of cooling and occurrence of a major adverse event were associated with unfavourable discharge outcome; cooling modality was not (adjusted OR 0.71, 95% CI 0.21-2.38; p=0.581).

Conclusions: In this small, non-randomised cohort, servo-controlled cooling provided faster and more precise temperature control than PCM cooling. PCM cooling was feasible when continuous core-temperature monitoring and intensive neonatal care were available. The study did not establish equivalence of PCM and servo-controlled cooling for clinical or neurological outcomes.

Caregiver knowledge, socioeconomic challenges and treatment practices in pediatric thalassemia: experience from a resource-constrained setting

Mohammad Ahad Adnan — 2026-10-27

Background: Transfusion-dependent thalassemia (TDT) requires lifelong blood transfusion and comprehensive supportive care. In resource-constrained settings, caregiver knowledge and socioeconomic factors may influence treatment adherence and clinical outcomes. This study assessed caregiver knowledge, treatment practices, socioeconomic challenges, and factors associated with blood transfusion adherence among children with TDT in Bangladesh.

Methods: A hospital-based cross-sectional study was conducted at the Institute of Child and Mother Health, Dhaka, Bangladesh, between July 2023 and June 2025. One hundred caregiver-child pairs were consecutively enrolled. Data were collected using a pretested structured interviewer-administered questionnaire and verified with hospital records where available. Blood transfusion adherence was categorized as regular or irregular. Multivariable binary logistic regression was performed to identify independent predictors of regular transfusion adherence.

Results: Among the 100 enrolled children, 65% had HbE/β-thalassemia and 35% had β-thalassemia major. Regular blood transfusion adherence was observed in 56% of participants. Caregiver knowledge was generally inadequate: 82% had no prior awareness of thalassemia, only 4% knew all recommended treatment modalities, and satisfactory knowledge of nutritional management and disease complications was reported by 13% and 9%, respectively. Nevertheless, 78% expressed willingness to undergo family carrier screening. Most families (80%) financed treatment from their own income, while 17% relied on loans or begging. Paternal educational attainment below the primary level was independently associated with lower odds of regular blood transfusion adherence (adjusted OR 0.324, 95% CI 0.128-0.817; p=0.017).

Conclusions: In this study, caregiver knowledge regarding TDT was limited, and nearly half of the children did not receive regular blood transfusions (BT). Financial hardship remained common, with many families relying on loans or begging to sustain treatment. These findings support strengthening caregiver education, genetic counselling, and financial support for affected families.

Giftedness in the Indian context: nurturing exceptional potential

Rachana Gopalakrishna — 2026-10-27

As a developmental pediatrician, I’ve had the privilege of meeting children whose abilities are nothing short of extraordinary. These children might be the ones who read books meant for older kids, solve complex problems with ease, or create art that leaves you awestruck. They are often described as gifted but in India, this label isn’t always understood or embraced. Many gifted children go unnoticed, and as a result, their exceptional abilities remain untapped. Their needs aren't met, and their potential stays hidden. The time has come to recognize and nurture these gifted children.