International Journal of Contemporary Pediatrics

Paediatric posterior reversible encephalopathy syndrome: a review of aetiologies, clinical and radiological spectrum, pathophysiology, diagnostic criteria and management

Rachna Sehgal — 2026-08-26

Posterior reversible encephalopathy syndrome (PRES) is a rare clinico-radiological syndrome postulated to be due to disturbed cerebral autoregulation characterized by acute onset seizures, altered sensorium, headache, visual disturbances, and typical neuroimaging findings of vasogenic oedema in parietooccipital white matter. Although originally described in adults, PRES is increasingly recognized in children, particularly in association with renal disease, hypertension, autoimmune disorders, malignancy, chemotherapy, transplantation, infections, and immune-mediated conditions. Paediatric PRES differs from adult PRES in having a higher frequency of atypical imaging findings involving brainstem, spinal cord, basal ganglia; and broader etiological diversity. Advances in neuroimaging, molecular biology, and endothelial dysfunction research have improved understanding of disease mechanisms. However, diagnostic criteria remain largely clinico-radiological. This review summarizes current evidence regarding diagnosis, typical and atypical radiological findings, aetiologies, tertiary-care experiences, pathophysiological mechanisms, emerging genetic associations, and an algorithmic approach to management.

Proportion of insulin resistance in overweight and obese children of the age group 5-15 years using the homeostasis model assessment of insulin resistance index

Devi Poikayil Saji — 2026-08-11

Background: Childhood obesity is increasingly recognized as a major public health concern and is associated with insulin resistance, the underlying mechanism behind many components of metabolic syndrome. Early detection of insulin resistance may provide an opportunity for timely intervention. The homeostasis model assessment of insulin resistance (HOMA-IR) is a simple and validated index used to quantify insulin resistance.

Methods: We conducted a hospital-based cross-sectional study among 165 children attending the outpatient department or admitted under the Department of Paediatrics at a tertiary care centre in southern India. Detailed history, clinical examination, anthropometric measurements, and laboratory investigations were performed. Insulin resistance was assessed using HOMA-IR, with a value ≥2.5 considered indicative of insulin resistance.

Results: Insulin resistance (HOMA-IR≥2.5) was present in 124 (75.2%) children. Significant associations were observed between insulin resistance and acanthosis nigricans, and a positive family history of type 2 diabetes mellitus. Although 78.2% of children had normal fasting blood glucose levels, a substantial proportion exhibited insulin resistance. Mean total cholesterol and triglyceride levels were 180.2±25.9 mg/dl and 105±34.5 mg/dl, respectively, and both showed significant positive correlations with HOMA-IR (r=0.417 and r=0.511, respectively; p<0.01).

Conclusions: Insulin resistance is highly prevalent among overweight and obese children and may precede overt abnormalities in blood glucose. Reliance on fasting blood glucose alone may underestimate the burden of metabolic dysfunction. Early identification using HOMA-IR may facilitate timely lifestyle interventions during a potentially reversible stage and help prevent future metabolic complications.

Accuracy and correlation of transcutaneous bilirubin with total serum bilirubin in preterm neonates born at 28-34 weeks of gestation during the first week of life

Nixon Lopez — 2026-08-05

Background: Transcutaneous bilirubin (TcB) measurement is a non-invasive method for screening neonatal hyperbilirubinemia and may reduce the need for repeated blood sampling. Although its accuracy has been well established in term and late preterm neonates, evidence in preterm infants remains limited. This study aimed to evaluate the correlation between TcB and total serum bilirubin (TSB) levels in preterm neonates born between 28 and 34 weeks of gestation during the first seven days of life.

Methods: This prospective observational study included 100 preterm neonates (28-34 weeks' gestation) admitted to the neonatal intensive care unit of a tertiary care hospital over a two-year period. TcB was measured using the BiliCare™ device on the helix of the ear immediately before or within five minutes of blood sampling for TSB estimation. The correlation between TcB and TSB values was evaluated by using Spearman's and Pearson's correlation coefficients.

Results: The mean gestational age was 31.4±1.97 weeks, and the mean birth weight was 1.56±0.35 kg. TcB and TSB mean values were 10.74±2.77 mg/dl and 10.16±3.59 mg/dl, respectively. It showed positive correlation between TcB and TSB (Spearman's rho=0.794, p<0.05; Pearson's correlation=0.870, p<0.05). The linear regression analysis showed the equation: TSB=1.6667×TcB-8.3333. This shows good predictive ability of TcB for serum bilirubin levels estimation.

Conclusions: TcB measurement showed positive correlation with TSB in preterm neonates of 28-34 weeks' gestation before initiation of phototherapy. TcB is a reliable, non-invasive screening tool that may avoid the need for invasive blood sampling in neonates, while TSB estimation should continue to guide therapeutic decisions.

The association between obesity and hormonal imbalances in children: a prospective study

Rakhi Jain — 2026-08-14

Background: Hormonal alterations, may complicate the metabolic consequences linked to childhood obesity. To study the relation between pediatric obesity and hormonal abnormalities, along with the correlation between body mass index (BMI) and other metabolic and endocrine markers.

Methods: A prospective observational study including 325 children aged 6 to 14 years was conducted at a tertiary care teaching hospital in north India over 30 months (January 2024 to July 2026). Individuals were classified into three categories based on their BMI percentiles for age and gender as normal weight, overweight, and obese. In addition to blood pressure and anthropometric data, fasting biochemical markers such as cortisol, free thyroxine (free T4), glucose, insulin, and thyroid-stimulating hormone (TSH) were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated to determine insulin resistance. One-way analysis of variance and multivariate linear regression with age and gender adjustments were used for statistical analysis.

Results: Obese children demonstrated markedly elevated levels of cortisol, TSH, HOMA-IR, and fasting insulin compared to their normal-weight counterparts, along with reduced levels of free T4 (p<0.05). A multivariate regression analysis, after controlling for age and gender, indicated that BMI was significantly associated with indicators of insulin resistance and thyroid hormone levels.

Conclusions: Childhood obesity is associated with significant hormonal and metabolic alterations, suggesting early endocrine adaptations that may have metabolic implications. While these changes (particularly thyroid-related shifts) represent reversible, adaptive responses rather than primary pathology, findings highlight need for early identification and intervention to prevent potential long-term cardiometabolic risks associated with pediatric-onset obesity.

Evaluation and comparison of taste perception and caries experience between father, mother and child

Poornima P. — 2026-08-26

Background: Individual taste perception is used to evaluate the clinical assessment of caries susceptibility. Given that parents have a major influence on their children's eating habits, it would be beneficial to evaluate the relationship between the father, mother and child's taste perception and caries experience in order to predict the child's susceptibility to dental caries. Thus the aim of the present study is to compare the taste perception and caries experience between father, mother and child.

Methods: A sample of 113 parents and their child aged between 6-12 years were selected for the study. After gathering information on dietary patterns and dental hygiene procedures through cross sectional-based questionnaire survey, caries experience of parents and their child were recorded using DMFT and deft indices respectively, then the 6-n propylthiouracil (PROP) test strips were used to evaluate taste. Participants were grouped into supertasters, medium tasters and non-tasters based on their perception of taste. The obtained data was statistically analyzed by using Kruskal Wallis and chi square test in SPSS software 21.0.

Results: Statistically significant results were obtained in comparing taste perception of mother and child, but no significance was noted between taste perception of father and child. Significance was noted regarding caries experience among parents and children and no correlation was noted between parents’ taste perception and child’s caries experience.

Conclusions: The present study concluded that there is strong inverse correlation between the ability to taste the bitterness of PROP tester strip and the caries experience but there is no correlation between taste perception of parents to caries experience of their child. PROP sensitivity test can be a valuable tool in the future to assess the inherent genetic sensitivity of a person for dietary preferences.

A study on the quality of life of children with epilepsy and the impact of disease on family functioning

Aveepsa Prusty — 2026-08-26

Background: Epilepsy is one of the most common chronic neurological disorders in childhood and is associated with significant physical, emotional, social, and educational consequences. Beyond seizure control, children with epilepsy often experience impaired health-related quality of life (HRQoL), while their caregivers face substantial psychosocial burden. So, the study is aimed to assess the QoL of children with epilepsy and to evaluate the impact of the disease on family functioning.

Methods: This hospital-based prospective observational study was conducted in the Department of Paediatrics at Hi-Tech Medical College and Hospital over a period of January 2024 to December 2025. A total of 110 children aged 8-12 years with epilepsy and their primary caregivers were included. Data on demographic and clinical variables were collected using a structured proforma. QoL was assessed using the Pediatric QoL Inventory (PedsQL™ 4.0 Generic core scales) and family functioning was evaluated using the PedsQL™ family impact module. Statistical analysis was performed using SPSS version 26, with p<0.05 considered statistically significant.

Results: The mean age of participants was 9.95±1.42 years, with a male predominance (59.1%). The mean QoL score was 66.20±13.45, indicating moderate impairment, with emotional functioning being the most affected domain. The mean family impact score was 60.67±14.42. Children with uncontrolled seizures had significantly lower QoL scores compared to those with controlled seizures (p<0.001). Polytherapy and the presence of comorbidities were also associated with poorer QoL and greater family burden.

Conclusions: Childhood epilepsy significantly impairs QoL and adversely affects family functioning. Clinical factors such as seizure control, treatment complexity, and comorbidities are key determinants of these outcomes. These findings highlight the need for a comprehensive, multidisciplinary, and family-centered approach to epilepsy management that extends beyond seizure control.

Rapid multiplex polymerase chain reaction for the detection of respiratory pathogens in pediatric patients under 5 years of age: a single center study

M. Zahirul Islam — 2026-08-26

Background: Acute respiratory tract infections (ARTIs) are leading causes of morbidity and mortality in children under 5 years, with similar clinical presentations making pathogen identification challenging. The objective of this study is to rapidly detect the causative organism of acute upper respiratory tract infection using the FilmArray respiratory panel 2.1 plus (FARP).

Methods: A cross-sectional prospective study was conducted at the Bangladesh Institute of Tropical and Infectious Diseases from September 2024 to February 2025. Nasopharyngeal swab specimens were collected from 60 pediatric patients (≤5 years) presenting with ARTI symptoms within 7 days of onset. Samples were analyzed using FARP 2.1 plus, capable of detecting 19 viruses and 4 atypical bacteria within 45 minutes.

Results: The cohort comprised 35 males (58.33%) and 25 females (41.67%) with a mean age of 20±17 months. The diagnostic yield was 95% (57/60). Human rhinovirus/enterovirus was most prevalent (53.3%), followed by respiratory syncytial virus (43.3%) and adenovirus (33.3%). mixed infections predominated, occurring in 55% of cases, with rhinovirus/enterovirus and RSV being the most common combination (21.2%). Age-stratified analysis revealed higher rhinovirus/enterovirus prevalence in infants <1 year (68.1%) compared to children 1-5 years (44.7%).

Conclusions: FilmArray demonstrated excellent diagnostic performance with high pathogen detection rates and revealed complex coinfection patterns in pediatric ARTI. The predominance of mixed infections and age-specific pathogen distributions emphasizes the importance of comprehensive molecular diagnostics for optimal clinical management and infection control strategies in pediatric respiratory medicine.

Sepsis in the newborn: urgency and uncertainty in neonatal sepsis

Abhay Kumar Yadav — 2026-08-26

Background: Neonatal sepsis is a syndrome characterized by systemic signs and symptoms of infection along with bacteremia in the first month of life. It remains a leading cause of neonatal morbidity and mortality worldwide, particularly in low- and middle-income countries. Early diagnosis is challenging because of non-specific clinical manifestations.

Methods: A cross-sectional study was conducted from February 2026 to April 2026 at Rapti Academy of Health Sciences, Nepal. Medical records of 125 neonates aged 0-28 days who underwent sepsis screening were analyzed. Clinical, demographic, and laboratory parameters were evaluated to identify predictors of culture-confirmed neonatal sepsis.

Results: Among 125 neonates, 62 (50%) had culture-confirmed sepsis. Gestational age below 30 weeks, CRP ≥12 mg/L, increased monocyte percentage, and low Apgar score (<7 at 5 minutes) were significant predictors of neonatal sepsis. Hypoglycemia, elevated micro-ESR, and abnormal gastric aspirate smear findings were commonly associated with sepsis.

Conclusions: Neonatal sepsis remains a major cause of morbidity and mortality. Early recognition of clinical and laboratory predictors may facilitate prompt diagnosis and timely management, thereby improving neonatal outcomes.

Clinical utility of serum interleukin-6 in predicting outcomes in pediatric intensive care unit

Harini Venugopal — 2026-08-05

Background: Early identification of critically ill children at high risk of mortality is essential for timely intervention. Biomarkers reflecting the inflammatory response may improve prognostication beyond conventional severity scores. This study evaluated the prognostic utility of serial serum interleukin-6 (IL-6) levels in children requiring intensive care.

Methods: This observational cross-sectional study included 45 children aged 1 month to 18 years admitted to a pediatric intensive care unit. Serum IL-6 levels were measured at admission, 24 hours, and 72 hours. The severity of illness was assessed by the pediatric logistic organ dysfunction-2 (PELOD-2) score. The primary outcome was in-hospital mortality, while secondary outcomes were duration of pediatric intensive care unit stay, hospital stay, and need for respiratory and inotropic support.

Results: Five (11.1%) children died during hospitalization. The median IL-6 levels at 24 hours and 72 hours were significantly higher in non-survivors compared to survivors, with values of 1122 (IQR 1305) pg/ml versus 564 (IQR 153) pg/ml at 24 hours, and 1263 (IQR 626) pg/ml versus 82 (IQR 191) pg/ml at 72 hours, both with p values less than 0.0001. Non-survivors had significantly higher IL-6 levels at 24 and 72 hours than survivors (p<0.001). Higher IL-6 levels were also associated with illness severity.

Conclusions: Serial serum IL-6 measurement is a valuable prognostic biomarker in children requiring intensive care. Incorporating serial IL-6 estimation with clinical severity assessment may facilitate early risk stratification and optimize management in the pediatric intensive care unit.

Clinicopathological profile of significant cervical lymphadenopathy in children

Pratibha Manjunath Patagar — 2026-08-26

Background: In children enlarged cervical lymph nodes is one of the common presentations and requires evaluation. The aetiology of cervical lymphadenopathy can be either due to benign self-limiting conditions (viral or bacterial infection) or due to some serious systemic diseases like tuberculosis or malignancy. This study intends to analyse wide etiological presentations of cervical lymphadenopathy in children with cytopathological correlation by fine needle aspiration cytology (FNAC) for timely diagnosis and if required to refer early for further management.

Methods: This is a hospital based prospective observational study conducted at department of Paediatrics at IGICH, Bengaluru among children between 1 month-18 years of age with significant cervical lymphadenopathy.

Results: Total of 100 cases of significant cervical lymphadenopathy were included in the study. Most common age group involved was between 4-8 years with male preponderance (M:F=1.5:1). Fever and swelling in the neck were the most common presenting complaints. After investigation, reactive lymphadenitis (55%) was the most common aetiology among which tonsillitis (38%) and otitis media (11%) were most common. Second most common aetiology was tuberculosis (30%). Five (5%) patients had malignancy. Sensitivity of FNAC in detecting tuberculosis (TB) lymphadenitis was found to be 90.9% in this study.

Conclusions: Cervical lymphadenopathy is one of the common clinical conditions which paediatricians face in daily practice that requires detailed evaluation for accurate diagnosis and treatment. Reactive lymphadenitis and tubercular lymphadenitis remain the most common aetiologies. Presently FNAC has emerged as important tool in the initial diagnosis and management of patients with lymphadenopathy.

Effect of COVID-19 pandemic on health seeking behavior of children with cerebral palsy and their caregivers

Sattiraju Sarvani — 2026-08-26

Background: COVID-19 pandemic exacerbated the already existing challenges face by children with cerebral palsy (CP) and their caregivers. This study was conducted to analyze the effect of COVID-19 pandemic on the health seeking behavior of children with CP and their caregivers.

Methods: Parents/ caregivers of sixty-one children, who could be contacted were asked a set of questions using a pre-structured questionnaire including demographic details, information related to change in health status and reasons for change in health seeking behavior during and after pandemic.

Results: Out of 61 caregivers, 34 (55.7%) reported worsening in child’s health after COVID-19. 59 (96.7%) caregivers reported decrease in the frequency follow up visits after COVID-19 pandemic. The 38 (62.3%) shifted to rehabilitation at home by self. 59 (96.7%) caregivers reported consultation at hospital and two (3.3%) cases at private clinics during acute illness before COVID-19 pandemic. Fear of COVID infection was cited as most common reason for change followed by closure of health facilities during COVID pandemic. Post covid, irritability increased in 23% cases, tone increased in 54.1% cases, contractures increased in 6.6% cases, seizures increased in 27.9% cases.

Conclusions: Children with CP and their caregivers need special care during major events such as pandemic to avoid negative impact on their health status.

Pro-calcitonin as a marker of sepsis in NICU setup in comparison to C-reactive protein

Chandrakumar Ramesh — 2026-08-26

Background: Neonatal sepsis is a major cause of morbidity and mortality, particularly in developing countries. Early diagnosis is difficult because clinical signs are non-specific, blood culture requires 48–72 hours and may have limited sensitivity, while C-reactive protein (CRP) rises relatively late. Procalcitonin (PCT) increases earlier during bacterial infection and may serve as a useful diagnostic marker. This study evaluated PCT as an early marker of neonatal sepsis and compared its diagnostic performance with CRP.

Methods: This prospective cross-sectional study was conducted in the NICU of Al Ameen Medical College, Bijapur, Karnataka, from May 2024 to April 2025. Seventy-five neonates aged less than 72 hours with clinical features or risk factors for sepsis were enrolled. Investigations included complete blood count, absolute neutrophil count, immature-to-total neutrophil ratio, CRP, PCT and blood culture. CRP≥10 mg/l and PCT>0.5 ng/ml were considered positive. Neonates were classified as proven sepsis, suspected sepsis or no sepsis. Data were analysed using Chi-square and Fisher’s exact tests.

Results: Of 75 neonates, 46 (61.3%) were male and 39 (52.0%) had low birth weight. Blood culture was positive in 7 cases (9.3%), with Staphylococcus aureus being the most common isolate. PCT showed higher sensitivity than CRP (85.7% vs 42.8%) and a higher negative predictive value (97.5% vs 93.4%), whereas CRP had greater specificity (83.8% vs 58.8%).

Conclusions: PCT is a more sensitive early marker than CRP for neonatal sepsis. Its high negative predictive value makes it useful for ruling out sepsis and guiding antibiotic decisions.

Vitamin D and vitamin B12 status in children with complicated severe acute malnutrition

Ravi Shankar — 2026-08-26

Background: Severe acute malnutrition (SAM) is a major public health challenge frequently accompanied by hidden micronutrient deficiencies. This study evaluated the prevalence of vitamin D and vitamin B12 deficiencies and their clinical associations among children hospitalized with complicated SAM.

Methods: A hospital-based cross-sectional study was conducted among 100 children (aged 6–59 months) admitted with complicated SAM at a tertiary care center in eastern Uttar Pradesh. Anthropometric data, clinical complications and feeding practices were documented. Serum 25-hydroxy vitamin D and vitamin B12 levels were quantified using standardized assays.

Results: The cohort (mean age: 33.2±15.6 months; 58% male) exhibited frequent complications, including pallor (72%), convulsions (62%), pneumonia (58%) and acute gastroenteritis (56%). Vitamin D deficiency (<20 ng/ml) was present in 62% of children and vitamin B12 deficiency (<200 pg/ml) was found in 54%. Notably, 38% of the patients exhibited concurrent deficiencies of both micronutrients. Despite these significant overlapping nutritional deficits, standard inpatient nutritional rehabilitation yielded robust clinical recovery rates that were comparable across isolated vitamin D deficiency (83.9%), isolated vitamin B12 deficiency (88.9%) and combined deficiency (86.8%) groups.

Conclusions: Vitamin D and vitamin B12 deficiencies are highly prevalent and frequently coexist among children with complicated SAM. While standard inpatient rehabilitation remains highly effective across all deficiency subgroups, routine micronutrient screening and targeted supplementation should be integrated into SAM management protocols to optimize overall recovery and mitigate long-term health consequences.

Thyroid function profile in children with epilepsy receiving sodium valproate monotherapy: a cross-sectional study from North India

Rishabh Gupta — 2026-08-26

Background: To evaluate the thyroid function profile in children with epilepsy receiving sodium valproate monotherapy for at least six months and to determine the prevalence and correlates of thyroid dysfunction.

Methods: A hospital-based cross-sectional observational study was conducted at a tertiary care centre in Jaipur, Rajasthan, over 12 months (January–December 2024). Sixty-five children aged 1–17 years on sodium valproate monotherapy for a minimum of six months were enrolled by consecutive sampling. Thyroid function tests (free triiodothyronine (fT3), free thyroxine (fT4) and thyroid-stimulating hormone (TSH)) were measured at enrollment and compared with baseline values obtained prior to therapy initiation. Thyroid status was classified as euthyroid, subclinical hypothyroidism (TSH >5 µIU/ml with normal fT3 and fT4) or overt hypothyroidism. Associations with age, sex, valproate dose and duration of therapy were analyzed using the chi-square test and paired t-test.

Results: After ≥6 months of valproate therapy, 44.62% of children developed subclinical hypothyroidism, 20.00% developed overt hypothyroidism and only 35.38% remained euthyroid. Paired t-test revealed significant increases in mean TSH (2.25±0.37 vs 5.49±2.68 µIU/ml; p<0.001), a decrease in mean fT4 (1.42±0.05 vs 1.20±0.18 ng/dl; p<0.001) and a mild increase in mean fT3 (3.61±0.16 vs 3.72±0.16 pg/ml; p<0.001). Thyroid dysfunction was significantly associated with older age (p<0.001), higher valproate dose (p=0.015) and longer duration of therapy (p=0.006), but not with sex (p=0.833).

Conclusions: Sodium valproate monotherapy is associated with significant thyroid dysfunction in a substantial proportion of children, even within the first six months of therapy. Older age, higher doses and longer treatment duration are important risk factors. Routine monitoring of thyroid function is recommended for all children on long-term valproate therapy.

Comparison of attention-deficit/hyperactivity disorder and socioeconomic status among school-going children

Ummu Gulthoom M. — 2026-08-26

Background: Attention-deficit/hyperactivity disorder (ADHD) was a common neurodevelopmental disorder among school-going children, with Indian prevalence estimates ranging widely (5–25%) depending on setting and screening tools. Socioeconomic status (SES) had been proposed as a key determinant of ADHD risk, acting through chronic stress, reduced healthcare access and inconsistent parenting. To determine the prevalence of ADHD among school-going children aged 7–12 years and to examine its association with socioeconomic status.

Methods: A cross-sectional study was conducted from April 2024 to October 2025 among 400 children aged 7–12 years, recruited from Government/Government-aided schools around Chidambaram (community-based) and a tertiary hospital paediatric OPD (hospital-based confirmation) using multistage cluster sampling. ADHD was screened using the Vanderbilt Assessment Scale (teacher-completed), with positive screens confirmed via CBCL evaluation and psychiatric assessment. SES was classified using a standard composite scale. Associations were assessed using chi-square testing and multivariate logistic regression (p<0.05 considered significant).

Results: Overall ADHD prevalence was 11.0% (44/400), with a significant association found between ADHD and SES (p=0.041); prevalence rose as SES declined, from 6.3% in the upper class to 12.5% in the lower-middle and upper-lower classes. Adjusted odds remained elevated for lower-middle (AOR 1.72), upper-lower (AOR 1.65) and lower-class (AOR 1.58) children relative to the upper class but did not retain significance after adjustment for gender, family type and parental education.

Conclusions: Approximately one in ten children had ADHD, with a consistent gradient of higher prevalence among lower and lower-middle socioeconomic strata. SES appeared to act alongside other familial and psychosocial factors rather than independently, supporting broader, multi-factorial intervention strategies.

Clinical profile, laboratory predictors, and impact of delayed presentation on disease severity in pediatric acute appendicitis

Naveena Thiagarajan — 2026-08-26

Background: Acute appendicitis is the most common surgical emergency in children, often presenting with variable clinical features leading to diagnostic challenges. Early identification of disease severity is essential to prevent complications. This study aimed to evaluate the clinical profile, laboratory parameters, ultrasonographic findings, and the impact of duration of symptoms prior to presentation on disease severity in paediatric appendicitis.

Methods: This hospital-based prospective observational study was conducted over two years in a tertiary paediatric centre. Seventy-five children under 18 years with suspected acute appendicitis undergoing surgery were included. Data on clinical features, laboratory parameters, imaging findings, timing of surgery, and outcomes were analysed using appropriate statistical methods.

Results: Among 75 children, 56.0% were males, with most in the 7–12 years age group (54.7%). Simple appendicitis was observed in 68.0% and complicated in 32.0%. Abdominal pain (94.7%) and tenderness (98.7%) were predominant. Ultrasonography identified acute appendicitis in 72.0% and showed significant association with severity (p=0.0005). Complicated appendicitis had higher WBC counts (p=0.001) and lower serum sodium levels (p=0.009). Longer duration of symptoms prior to presentation (3–5 days) was associated with increased complications (50.0%) (p=0.050). Hospital stay was longer in complicated cases (p=0.0005).

Conclusion: Clinical evaluation supported by laboratory markers and ultrasonography aids in assessing disease severity. Early presentation and timely management are associated with reduced complications, while delayed presentation increases morbidity in paediatric appendicitis.

Evaluating the efficacy of the SICK score in predicting clinical outcomes among paediatric patients presenting to the emergency department of a tertiary care centre in Kerala

Akhil Joshy — 2026-08-26

Background: Early risk stratification in the paediatric emergency department (ED) is crucial for optimal resource use and prevention of avoidable mortality. The signs of inflammation in children that kill (SICK) score is a bedside tool based on observable physiological parameters. However, evidence regarding its role in guiding level-of-care decisions and its association with hospital stay is limited. This study evaluated its ability to predict pediatric intensive care unit (PICU) admission and its correlation with length of stay.

Methods: This prospective observational study was conducted over 18 months in a tertiary pediatric ED in Kerala. A total of 340 children aged 1 month to 12 years were consecutively enrolled. SICK scores were calculated at presentation. Patients were triaged to ward or PICU based on clinical assessment. Data were analyzed using descriptive statistics, independent t-test, chi-square test, Pearson correlation, and ROC curve analysis. A p value <0.05 was considered significant.

Results: Of 340 children, 40 (11.8%) required PICU admission. PICU patients were younger (43.8 versus 74.0 months; p<0.001). Mean SICK score was higher in the PICU group (5.23±1.69 versus 2.62±2.11; p<0.001). Hospital stay was longer in PICU patients (9.13±2.61 versus 2.62±1.15 days; p<0.001). SICK score showed a moderate positive correlation with length of stay (r=0.324; p<0.001). ROC analysis showed good discrimination (AUC=0.820; 95% CI: 0.756–0.884), with an optimal cut-off ≥3.5 (sensitivity 90.0%, specificity 71.7%).

Conclusions: The SICK score is a reliable tool for predicting PICU admission and correlates with hospital stay, supporting its use in paediatric ED triage, especially in resource-limited settings.

Association of maternal and perinatal factors with umbilical cord blood thyroid profile in newborns: a prospective observational study

Mahesh Jadav — 2026-08-26

Background: Congenital hypothyroidism (CH) is a preventable cause of intellectual disability. Cord blood thyroid-stimulating hormone (TSH) is widely used for newborn screening; however, several perinatal factors may influence TSH levels and increase false-positive results. Objectives were to evaluate the effect of maternal and perinatal factors on cord blood thyroid profiles in neonates.

Methods: A hospital-based cross-sectional observational study was conducted among 90 neonates. Cord blood samples collected at birth were analyzed for TSH levels. Maternal age, parity, gestational age, mode of delivery, weight of the baby, gender, and birth asphyxia were recorded. A student's t test, one-way ANOVA, and chi-square test were used to analyze the data. Statistical significance was considered at p<0.05.

Results: The mean cord blood TSH level was 13.53±6.22 µIU/ml. Elevated TSH (>20 µIU/ml) was observed in 14.4% of neonates. Higher cord blood TSH levels were significantly associated with parity (p=0.010), mode of delivery (p<0.001), and birth asphyxia (p=0.006). Assisted vaginal delivery was associated with the highest mean TSH level (20.76 µIU/ml). Cord blood TSH levels were not significantly associated with maternal age, gestational age, birth weight, and gender.

Conclusions: Cord blood TSH is a useful screening test for CH. However, interpretation should be based on perinatal factors, mainly mode of delivery, parity, and birth asphyxia, to minimize false positive results and improve screening accuracy.

Clinical spectrum, complications and management outcomes in paediatric dengue: a retrospective analysis

Abhishek S. Parlikar — 2026-08-26

Background: The dengue fever remains a major cause of acute febrile illness among children in India. To provide region-specific data from central Maharashtra, this study evaluated the clinical spectrum, complications, outcomes and impact of steroid therapy in paediatric dengue patients.

Methods: This retrospective observational study was conducted at a tertiary care centre in Chhatrapati Sambhajinagar, Maharashtra covering the period of January 2021 to December 2025. A total of 355 children (<18 years) with serologically confirmed dengue (NS1/IgM positive) were included. Patients were classified into mild, moderate and severe dengue according to WHO guidelines. Clinical features, laboratory parameters, steroid use in context of complications, duration of hospital stay and outcomes were analysed.

Results: A total of 355 patients, 60.3% were males, with 49.0% aged 10–15 years. Mild dengue was seen in 55.8%, moderate in 38.6% and severe in 5.6% of cases. Fever was the most common symptom (98.03%), followed by abdominal pain (20.85%). Warning signs included fluid accumulation (10.70%) and mucocutaneous bleeding (9.57%). Severe manifestations such as shock (3.09%), ARDS (1.97%) and altered sensorium (1.69%) were uncommon. No cases of renal failure or major haemorrhage were observed in this cohort. Hospital stays increased with disease severity. Outcomes were favourable, with minimal mortality.

Conclusions: Paediatric dengue in this cohort was predominantly mild to moderate with low complication rates. Early diagnosis and standardized, WHO-guideline-based management contributed to favourable outcomes. The judicious use of steroids in moderate and severe cases appeared to reduce complications and improve outcomes, though its effect on hospital stay remains unclear. Thus, larger prospective studies are needed to confirm the role and timing of steroids in early dengue management.

An in vitro comparative assessment of microleakage among different pit and fissure sealants using dye penetration after thermocycling

Vishaka Karthikeyan — 2026-08-26

Background: Dental caries is a highly prevalent condition among children and adolescents. Primary prevention is more cost-effective and lowers the risk of caries, especially with pit and fissure sealants. To evaluate and compare the microleakage of various pit and fissure sealants by dye penetration.

Methods: Eighty caries-free permanent premolars were randomly assigned into four groups (n=20): unfilled resin-based sealant (Clinpro; 3M), filled resin-based sealant (Helioseal F; Ivoclar), nano-filled flowable composite (Filtek Z350XT; 3M) and self-adhering composite (Constic; DMG). Groups 1-3 had their enamel etched and bonded before application whereas Group 4 received self-adhering composite directly. The specimens were thermocycled (1000 cycles, 5°C–55°C) and light-cured. After 24 hours, microleakage was assessed using 2% basic fuchsine dye penetration and evaluated under 50× magnification using a stereomicroscope. Data was analyzed using one-way ANOVA and post hoc tests.

Results: Filtek Z350XT had the lowest mean microleakage (0.45), whereas Clinpro had the highest (3.40). There was a statistically significant difference between the groups.

Conclusions: The nano-filled flowable composite demonstrated least microleakage, suggesting superior marginal sealing ability and alternative to conventional sealants in pediatric patients.

Association between iron deficiency anaemia and febrile seizures in children aged 1–5 years: a case-control study

Asfiya Iram — 2026-08-26

Background: Febrile seizures (FS) constitute the most prevalent seizure disorder in early childhood. Iron deficiency anaemia (IDA) has been hypothesised as a modifiable neurobiological risk factor for FS, potentially mediated through altered dopaminergic and GABAergic neurotransmission. This study assesses the association between iron deficiency anaemia and febrile seizures in children aged 1–5 years.

Methods: A prospective case-control study enrolled 50 children (25 cases with febrile seizures; 25 controls with febrile illness without seizures) aged 1–5 years at Al Ameen Medical College Hospital, Vijayapura. Haematological parameters including haemoglobin (Hb), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and red cell distribution width (RDW) were assessed. IDA was defined as Hb <11 g/dl with supportive red cell indices.

Results: Mean Hb was significantly lower in cases (9.2±1.4 g/dl) than in controls (10.6±1.2 g/dl) (p <0.01). IDA (Hb <11 g/dl) was present in 68% of cases versus 40% of controls. Moderate anaemia was more frequent among cases (56%) than controls (20%). MCV <70 fl was detected in 44% of cases and 32% of controls. MCH <27 pg was present in 20% of cases compared to 8% of controls. The overall association between IDA and febrile seizures was statistically significant (p<0.05).

Conclusion: Iron deficiency anaemia is significantly more prevalent among children with febrile seizures compared to febrile controls. Routine haematological screening for IDA in febrile young children may facilitate early identification and intervention to potentially reduce seizure recurrence risk.

Effect of hydrocolloid dressing on nasal injury among preterm neonates on nasal continuous positive airway pressure: a randomized controlled trial

Bideshwori Takhelmayum — 2026-08-26

Background: Respiratory distress in preterm neonates is a common cause of neonatal intensive care unit (NICU) admissions. Nasal continuous positive airway pressure (nCPAP) is widely used in the management of respiratory distress. Preterm neonates are at high risk for nasal injury during nCPAP. The present study was aimed to assess the effect of hydrocolloid dressing on nasal injury among preterm neonates on nCPAP.

Methods: A randomized controlled trial was carried out among 78 preterm neonates in a NICU of a tertiary care centre. Simple random sampling technique was used to enroll the preterm neonates who met the inclusion criteria. Data pertaining to demographic clinical characteristics were collected from medical record and the skin condition of the nares was assessed daily by observation. Data were analysed using SPSS software version 22. To analyze the data descriptive statistics including frequency, percentage and inferential statistics including chi-square test were utilized.

Results: Though the incidence of nasal injury in experimental group was lesser than control group (12.8% vs 23% respectively) it was not statistically significant p=0.23. There was a significant association between the level of nasal injury and the duration of nCPAP (p=0.04).

Conclusions: Prophylactic use of hydrocolloid dressing during nCPAP reduces nasal injury in preterm neonates.

Level of agreement on SpO2 and response time between fingertip pulse oximeter and conventional bedside pulse oximeter among preterm neonates: a tertiary care study

Devadarshini Mohan — 2026-08-26

Background: Fingertip pulse oximeters are used to measure peripheral oxygen saturation (SpO₂) levels in newborns and have been recommended to improve access to monitoring devices in resource-limited settings. However, evidence regarding their use in preterm neonates is limited. Therefore, this study aimed to assess the level of agreement in peripheral oxygen saturation and response time between fingertip pulse oximeters and conventional bedside pulse oximeters in preterm neonates.

Methods: A cross-sectional analytical study was conducted among 201 preterm neonates admitted to the neonatal intensive care unit (NICU) of a tertiary care hospital in Puducherry, India. Preterm neonates who met the inclusion criteria were enrolled using consecutive sampling. Medical records were reviewed to obtain information on clinical and sociodemographic characteristics. Both a conventional bedside pulse oximeter and a fingertip pulse oximeter were used to assess SpO₂ and response times. Data were analyzed using paired t-tests (t-test), Wilcoxon signed-rank tests (Wilcoxon SR test), Intraclass correlation coefficients (ICC) and Bland-Altman analyses.

Results: A significant difference in SpO₂ values (p<0.001) was observed between the devices, while response times showed no significant difference (p=0.107). The ICC indicated fair to good agreement for both parameters (p<0.001). Bland-Altman analysis revealed no significant bias, supporting the consistency between the devices.

Conclusions: The fingertip pulse oximeter demonstrated clinically acceptable agreement with the conventional bedside device for measuring SpO₂ in preterm neonates.

3% saline versus mannitol in the treatment of cerebral edema in children: a randomized controlled trial

Misbah Sultana S. — 2026-08-26

Background: Cerebral edema with raised intracranial pressure is a pediatric neurological emergency associated with coma, herniation and death. Mannitol and hypertonic saline are commonly used osmotic agents, but comparative pediatric data remain limited and heterogeneous. To compare the efficacy and safety of 3% hypertonic saline with 20% mannitol in children aged 3 months to 12 years with cerebral edema.

Methods: This randomized controlled trial was conducted from 2023 to 2025 among 70 children with clinical or radiological evidence of cerebral edema. Eligible children were randomized equally into the mannitol group (n=35) and 3% saline group (n=35). Mannitol was administered as 20% mannitol at 1.5 ml/kg intravenously over 20 minutes every 8 hours, whereas 3% saline was administered at 5 ml/kg intravenously over 20 minutes every 8 hours. Other supportive management was standardized. Outcomes included early Glasgow Coma Scale improvement, time to recovery from coma, duration of ventilation, survival and treatment-related complications.

Results: Baseline age, sex, nutritional status, admission GCS, etiology and diagnostic features were comparable between groups. Early GCS improvement of at least 2 points within 6 hours occurred in 23 children (65.7%) in the 3% saline group compared with 13 children (37.1%) in the mannitol group (p=0.031). Coma duration ≤24 hours was observed in 18 children (51.4%) receiving 3% saline and 9 children (25.7%) receiving mannitol (p=0.026). Ventilation duration ≤24 hours was more frequent with 3% saline (14 (40.0%)) than mannitol (6 (17.1%)) (p=0.034). Survival was higher in the 3% saline group (32 (91.4%)) than in the mannitol group (26 (74.3%)), but this difference was not statistically significant (p=0.110). Hypernatremia was more frequent with 3% saline (9 (25.7%) vs 2 (5.7%); p=0.045), while renal dysfunction was numerically more frequent with mannitol (5 (14.3%) vs 1 (2.9%); p=0.198).

Conclusions: In children with cerebral edema, 3% hypertonic saline was associated with faster early neurological improvement and shorter coma and ventilation duration compared with mannitol, while mortality difference was not statistically significant. Hypernatremia requires close monitoring during hypertonic saline therapy.

Prevalence of hypertension and obesity in children aged 6-18 years in a city of Central India: a cross-sectional study

Varsha Tiwari — 2026-08-26

Background: Historically, hypertension in children was deemed uncommon and primarily attributable to underlying medical illnesses, such as renal or endocrine abnormalities. However, this phenomenon is evolving, as a growing proportion of youngsters are now being diagnosed with primary (essential) hypertension, a disorder formerly believed to impact mainly adults. Objective was to study prevalence of hypertension and obesity in children aged 6-18 years.

Methods: School-based cross-sectional study was carried out among 1000 school children of age 6-18 years. Height, weight and body mass index were measured and classified as per standard guidelines. Blood pressure was measured and classified as per standard guidelines.

Results: Prevalence of obesity and overweight was 10.6% and 14.6% respectively and combined was 24.8%. Prevalence of obesity decreased as age increased from 6-7 years (12.7%) to 11-12 years (7.5%) and increased to 14.5% at 16-18 years. Prevalence of hypertension was 4.1%. It was 2.5% in 11-12 years and increased to 8.5% in 16-18 years. Prevalence of overweight and obesity was statistically not different in males and females (p=0.6347) and as per school type (p=0.1699). Prevalence of prehypertension and stage-1 hypertension was not much different in the males and females (p=4162).

Conclusions: Prevalence of overweight, obesity, pre-hypertension and stage-1 hypertension was quite high in this study population. The factors like gender and school types were not associated with overweight, obesity, pre-hypertension and stage-1 hypertension.

Hematological parameters as predictors of short-term outcomes in perinatal birth asphyxia in term neonates: a prospective case-control study

Mansi D. Patel — 2026-08-26

Background: Perinatal asphyxia is a significant cause of neonatal morbidity and mortality globally. Haematological changes, particularly in nucleated red blood cell (nRBC) counts, may offer early diagnostic and prognostic insights.

Objective: To estimate and compare haematological parameters in term neonates with and without birth asphyxia and to evaluate their association with short-term outcomes, including hypoxic ischemic encephalopathy (HIE) and meconium aspiration syndrome (MAS).

Methods: A hospital-based prospective observational case-control study was conducted among 170 term neonates, comprising 85 neonates with birth asphyxia and 85 healthy controls. Haematological parameters including haemoglobin, haematocrit, platelet count, total leukocyte count, absolute nRBC count and nRBCs/100 white blood cells (WBCs) were analysed within six hours of birth. Statistical analysis was performed using Student’s t-test, Chi-square test and ANOVA, with p<0.05 considered statistically significant.

Results: Cases demonstrated significantly higher absolute nRBC counts (0.784±0.5957 vs. 0.0609±0.0156) and nRBCs/100 WBCs (2.3035±1.4014 vs. 0.6098±0.15633) compared with controls (p<0.001). Elevated nRBC levels showed significant associations with the severity of birth asphyxia, HIE staging, occurrence of MAS and prolonged hospital stay. Total leukocyte count was also significantly increased among cases, whereas haemoglobin, haematocrit and platelet counts did not differ significantly between the groups.

Conclusions: Absolute nRBC count and nRBCs/100 WBCs are inexpensive, readily available haematological markers that correlate with the severity and short-term outcome of perinatal asphyxia. Their incorporation into the routine evaluation of asphyxiated neonates may facilitate early risk stratification and prognostication.

Diagnostic utility of cerebrospinal fluid analysis in children presenting with acute neurological emergencies at a tertiary care hospital

Kalaimathi Muthulingam — 2026-08-26

Background: Acute neurological emergencies include a wide range of conditions with variable and overlapping clinical presentations, making clinical diagnosis challenging. Advances in cerebrospinal fluid (CSF) analysis, serum antibody testing and neuroimaging have improved diagnostic accuracy. This study aimed to analyse the differentiating clinical, laboratory and neuroimaging features in children with various neurological emergencies.

Methods: It was prospective observational study in children aged 1 month to 18 years between July 2022 and June 2024 presenting with acute neurological emergencies necessitating CSF analysis. Data were collected and analysed using IBM SPSS version 29.

Results: Of the total (135), 37% were infants. CNS infections were most common (67; 49.6%), followed by demyelinating disorders (33; 24.4%), autoimmune encephalitis (7; 5.2%), metabolic encephalopathy (2; 1.5%) and other diagnoses (26; 19.3%). Bacterial meningitis (28.4%) and acute demyelinating encephalomyelitis (45.5%) were the most common conditions in their respective groups. Fever and lethargy predominated in CNS infections and demyelinating disorders. Key features in ADEM were difficulty in walking (45.5%) and acute onset weakness (45.5%). Altered sensorium (71.4%) and altered behaviour (42.9%) were predominant in autoimmune encephalitis. 93.3% ADEM and 87.5% optic neuritis were MOG (Myelin Oligodendrocyte Glycoprotein) antibody positive with MRI abnormalities (90.9%). 47% autoimmune encephalitis positive for anti-NMDAR (N-methyl-D-aspartate receptor) antibody with EEG (electroencephalogram) abnormalities (57.1%).

Conclusions: Serum antibody testing aids in diagnosing demyelinating and autoimmune disorders, while CSF polymerase chain reaction (PCR) helps identifying pathogens in culture-negative CNS infections. CSF analysis has limited utility in noninfective conditions.

One-year neurological outcomes in critically ill children: prognostic value of the pediatric cerebral performance category score

M. Shahid — 2026-08-26

Background: Improved pediatric intensive care survival leaves many with long-term neurological impairments, highlighting the need for simple, reliable tools to monitor post-discharge functional outcomes. Objective of the study was to evaluate the utility of the pediatric cerebral performance category (PCPC) score in assessing neurological outcomes and predicting long-term prognosis among children admitted to the pediatric intensive care unit (PICU).

Methods: This prospective cohort study was conducted in the PICU of a tertiary care hospital and included 150 children aged 40 days to 14 years. Baseline demographic, clinical characteristics and pediatric risk of mortality (PRISM III-24) scores were recorded. Neurological outcome was assessed using the PCPC score at admission, discharge and follow-up over a period of one year. Risk factors were analyzed using multivariate logistic regression.

Results: Respiratory infection was the commonest indication for PICU admission. Neurological status deteriorated during critical illness with the proportion of children having normal neurological function decreasing from 72.0% before illness to 28.0% at discharge. Higher PRISM III-24 scores were associated with increased mortality and poorer neurological outcomes. Baseline neurological impairment, prolonged mechanical ventilation, seizures, cardiopulmonary resuscitation, central nervous system infections, and a discharge PCPC score ≥4 were significant predictors of adverse outcomes. Twelve children died during the study period. A discharge PCPC score ≥4 predicted poor neurological outcome at 12 months with a sensitivity of 75.0%, specificity of 84.9%, and AUC of 0.86 (95% CI 0.79-0.93).

Conclusions: The PCPC score is a simplest and reliable clinical tool for evaluating neurological progression and predicting long-term prognosis in critically ill children.

Prelacteal feeding practices among mothers of infants: prevalence, patterns, and determinants

Kashish Grover — 2026-08-26

Background: Prelacteal feeding is the practice of providing a newborn any food or fluid other than mother's milk, before breastfeeding is established. It delays the early initiation of breastfeeding, and increases the risk of neonatal infections. Prelacteal feeding is still strongly ingrained in Indian culture and traditions, despite national guidelines discouraging this practice. The objective of the study was to determine the prevalence of prelacteal feeding among mothers of children aged up to one year, to describe the types of prelacteal feeds used and identify the associated determinants.

Methods: A community-based cross-sectional study was conducted among 400 mothers of children aged up to one year. Multistage stratified sampling was employed, and data were collected using a validated semi-structured questionnaire. Associations between socio-demographic/obstetric factors and prelacteal feeding practice were evaluated and a p value of <0.05 was considered statistically significant.

Results: Among the 400 participants, 211 (52.8%), had given prelacteal feeds to their newborn, while 162 (40.5%) had not and 27 (6.8%) were unaware. Ghutti was the most commonly used feed (114; 54.0%). Elder's suggestion was the predominant reason cited (107; 50.7%). No socio-demographic/obstetric factors showed a statistically significant association with prelacteal feeding practice.

Conclusions: Prelacteal feeding was practiced by more than half of the mothers in this community. The absence of a significant association with any individual-level socio-demographic or obstetric factor may suggest that the practice is sustained by deep-rooted, family-mediated cultural norms that cut across education and socio-economic strata.

Efficacy and maternal experience with manual breast pump versus electric breast pump in mothers of preterm infants: a prospective observational study

Hillori B. Vithalani — 2026-08-26

Background: Mother's own milk is the optimal nutrition for preterm infants admitted in neonatal intensive care unit (NICU). Effective breast milk expression is essential to establish and maintain lactation. Although manual and electric breast pumps are widely used, evidence comparing their efficacy and maternal experience.

Methods: This prospective observational study was conducted over six months at Setu Newborn Care Centre, Ahmedabad. 100 mothers of preterm infants (<34 weeks' gestation) were enrolled and allocated into two groups based on the type of breast pump used: manual (n=50) and electric (n=50). Outcomes assessed included expressed milk volume on days 3, 7, 14, and 21, nipple injury, nipple pain (Numerical rating scale), maternal satisfaction, expression time, and neonatal outcomes.

Results: Baseline maternal and neonatal characteristics were comparable between groups. Milk volume increased significantly over time in both groups (p<0.001), with consistently higher mean volumes in the electric pump (EP) group; however, between-group differences were not statistically significant. Nipple injury was significantly less frequent in the EP group (12% vs. 34%; p=0.009). Mothers using EPs also reported better ease of use and lower pain scores, while galactagogue use was similar between groups.

Conclusions: Both manual and electric breast pumps effectively support milk expression in preterm infants’ mother. While milk yield was comparable, electric breast pumps were associated with significantly lower nipple injury and greater maternal comfort, suggesting they may be the preferred option for improving maternal experience and sustaining lactation in the NICU setting.

Implementation of a standardized neonatal skin-care bundle using the neonatal skin condition score: a quality improvement initiative in a resource-limited neonatal intensive care unit

Rupam Das — 2026-08-26

Background: Neonatal skin, particularly in preterm and low-birth-weight (LBW) infants, is structurally immature and prone to injury, predisposing to increased transepidermal water loss, infection and prolonged hospitalization. Objective assessment of skin condition is seldom embedded in routine practice in many resource-limited neonatal intensive care units (NICUs). In our NICU, skin assessment was subjective, without a standardized scoring system, and root cause analysis identified inadequate staff training and lack of routine documentation as the main modifiable contributors. Objectives were to reduce abnormal skin findings by 50% within four weeks by embedding routine neonatal skin condition score (NSCS) assessment into practice.

Methods: This prospective quality improvement initiative ran for four weeks in a 35-bed tertiary NICU using two plan-do-study-act (PDSA) cycles. A standardized skin-care bundle comprising staff education, routine NSCS assessment, bedside charts and improved adhesive practices, was implemented. Proportions with dryness, erythema and breakdown were compared before and after using Fisher's exact test.

Results: Baseline prevalence of dryness, erythema and breakdown was 54.5%, 27.3% and 4.5%. By four weeks, dryness fell to 26.1% (p=0.07) and erythema to 13.0% (p=0.28), each with ~52% relative reduction, while breakdown was unchanged (4.3%; p=1.00). Neither reached statistical significance, but both showed a downward trend, and routine NSCS assessment continued beyond the project.

Conclusions: A standardized skin-care bundle incorporating routine NSCS assessment was feasible and associated with clinically meaningful reductions in dryness and erythema, with sustained adoption of objective skin assessment. Larger, longer initiatives are warranted to confirm these findings.

Effect of duration of rupture of membranes on early-onset neonatal sepsis and short-term outcomes

Sakthi R. — 2026-08-26

Background: Early-onset neonatal sepsis (EOS) remains a major contributor to neonatal mortality, disproportionately affecting low- and middle-income countries. Prolonged rupture of membranes (ROM) is a recognized risk factor, but integrated Indian data linking graded ROM duration, culture-confirmed sepsis and biomarkers such as red cell distribution width (RDW) remain limited. To evaluate the effect of ROM duration on EOS and short-term outcomes and the diagnostic utility of RDW, alone and combined with blood culture, for identifying at-risk neonates.

Methods: This prospective observational study enrolled 195 neonates born to mothers with recognized intrapartum risk factors at a tertiary care institution in Tamil Nadu, India, from April 2024-October 2025. Maternal and neonatal data, blood cultures and complete blood counts including RDW were recorded and analyzed using chi-square/Fisher's exact and t-test/Mann-Whitney U tests; ROC analysis determined the optimal RDW cut-off.

Results: Prolonged ROM was present in 40.0% of mothers; 53.8% of neonates had ROM ≥12 hours. Respiratory distress was the commonest feature (34.9%); 34.9% screened positive for sepsis. Cord culture positivity was 24.6% versus 20.5% for peripheral culture. Gram-negative organisms predominated (Pseudomonas 29.2%, Acinetobacter 22.9%). RDW was higher in septic neonates (19.1±2.4% vs. 16.7±1.8%; p<0.001), with AUC 0.81 at cut-off 18.0%. Combining RDW with cord culture raised accuracy to 84.6%.

Conclusions: Prolonged ROM is a graded, dose-dependent risk factor for culture-confirmed EOS. RDW is a rapid, low-cost adjunct that, combined with cord blood culture, enhances diagnostic accuracy and supports bedside risk stratification in resource-constrained neonatal units.

Balanced crystalloids versus normal saline for fluid therapy in pediatrics diabetic ketoacidosis: a systematic review

Danny Alsalloum — 2026-08-26

Fluid therapy is a cornerstone of management in paediatric diabetic ketoacidosis (DKA). Although normal saline has traditionally been the preferred resuscitation fluid, concerns regarding hyperchloremic metabolic acidosis have led to increasing interest in balanced crystalloids such as Ringer’s lactate and Plasma-lyte. However, evidence regarding their efficacy and safety in children with DKA remains limited and has not been comprehensively synthesized. A systematic review of the literature was conducted to evaluate balanced crystalloids versus normal saline for fluid therapy in paediatric DKA. PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane central register of controlled trials were searched from database inception to March 2026. Randomized controlled trials and comparative observational studies involving children and adolescents with DKA were included. Outcomes of interest included time to DKA resolution, resolution of acidosis, incidence of hyperchloremia, serum bicarbonate recovery, incidence of acute kidney injury (AKI), cerebral edema and duration hospital stay. Four comparative studies involving 49,920 paediatric patients were included in this systematic review. Out of these studies three were randomized controlled trials and one was retrospective observational study. Balanced crystalloids were consistently found to be associated with lower chloride accumulation, decreased incidence of hyperchloremia and improved bicarbonate recovery as compared to cases treated by normal saline. DKA and acidosis resolution demonstrated a trend toward earlier metabolic recovery with balanced crystalloids. No clear difference was observed in the incidence of AKI, intensive care unit stay, or hospital stay between treatment groups. One large observational study reported a lower rate of cerebral edema among children receiving Ringer’s lactate compared with normal saline. Balanced crystalloids appear to be safe and effective alternatives to normal saline for fluid therapy in paediatric DKA. They are associated with favorable clinical and biochemical outcomes specially with respect to chloride homeostasis and bicarbonate recovery. Larger multicenter randomized controlled trials are required to confirm these findings and determine their impact on clinically important outcomes.

Effectiveness of tele-nursing interventions on maternal and newborn health outcomes in low- and middle-income countries

Hemavathi R. — 2026-08-26

Maternal and newborn health remains a major public health priority in low- and middle-income countries (LMICs), where limited access to quality healthcare contributes to high maternal and neonatal morbidity and mortality. Tele-nursing has emerged as an innovative digital health strategy to improve continuity of care by providing remote nursing assessment, education, counselling, monitoring, and follow-up throughout pregnancy and the postpartum period. This systematic review aimed to evaluate the effectiveness of tele-nursing interventions on maternal and newborn health outcomes in LMICs. A comprehensive literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, Embase, CINAHL, and the Cochrane Library for studies published between January 2010 and December 2025. The review followed the PRISMA 2020 guidelines, and study quality was assessed using the Cochrane Risk of Bias 2 tool, ROBINS-I, and the GRADE approach. Thirty-eight studies met the eligibility criteria and were included in the review. The findings demonstrated that tele-nursing interventions significantly improved antenatal and postnatal care attendance, maternal health knowledge, medication adherence, birth preparedness, exclusive breastfeeding, maternal psychological well-being, newborn care practices, immunization uptake, and patient satisfaction. Tele-nursing also enhanced continuity of care and facilitated early recognition and referral of maternal and neonatal complications. However, implementation challenges included limited digital infrastructure, poor internet connectivity, low digital literacy, and shortages of trained healthcare professionals. Overall, tele-nursing is an effective and feasible strategy for strengthening maternal and newborn healthcare in LMICs. Integrating tele-nursing into routine maternal health services may improve healthcare accessibility, quality of care, and progress toward achieving sustainable development goal 3.

Clinical insights on nutrition support in pediatric cancer care: a survey of pediatric oncologists

Sripriya Venkiteswaran — 2026-08-26

Cuddles Foundation, an NGO in India providing comprehensive nutrition care to children with cancer, conducted a nationwide survey among pediatric oncology professionals to understand the perceived impact of nutrition intervention programs on clinical outcomes, treatment tolerance, and caregiver empowerment for pediatric oncology patients. Responses from 48 pediatric oncology doctors, including residents, consultants, and department heads, revealed overwhelmingly positive perceptions of nutrition in improving patient outcomes.

Childhood overweight and obesity in India (2015–2025): a systematic review and meta-analysis of epidemiology and socioeconomic correlates

Riddhi U. Solanki — 2026-08-26

Childhood overweight and obesity are emerging public health challenges in India, driven by rapid urbanization, dietary transitions, and lifestyle changes. This systematic review and meta-analysis synthesized evidence published between 2015 and 2025 to estimate the prevalence of overweight and obesity among Indian children and adolescents and examine associated socioeconomic and lifestyle factors. Following PRISMA guidelines and PROSPERO registration (CRD420251165983), a comprehensive search identified 47 eligible studies comprising 54,915 participants. Using random-effects meta-analysis, the pooled prevalence of obesity was 5.01% (95% CI: 4.25–5.83; I²=94.47%), while overweight prevalence was 11.64% (95% CI: 9.83–13.57; I²=97.85%), indicating substantial heterogeneity across studies. Gender-stratified analyses revealed a slightly higher burden among boys than girls for both obesity (5.21% versus 4.58%) and overweight (11.02% versus 10.73%). Geographical analyses demonstrated higher prevalence in Eastern and Southern India compared with Northern and Western regions. Narrative synthesis consistently identified higher socioeconomic status, urban residence, private schooling, reduced physical activity, sedentary behaviour, unhealthy dietary practices, and increased screen time as important correlates of excess weight. Despite considerable heterogeneity, publication bias was not detected. These findings suggest that approximately one in nine Indian children are overweight and one in twenty is obese, representing a substantial and growing public health burden. The observed demographic, geographic, and socioeconomic disparities highlight the need for standardized surveillance systems, context-specific prevention strategies, and early interventions targeting modifiable lifestyle risk factors to prevent the rising epidemic of childhood obesity in India.

Etiological diversity of otogenic facial nerve palsy in children – a case series and literature review

Thirunavukkarasu Saravanamuthu — 2026-08-26

Facial nerve palsy in children causes a significant impact on the quality of life. Infectious cause such as otitis media is the second most common etiology for facial nerve palsy in children. We describe the presentation, management and outcomes of four such children who presented to our institution with facial nerve palsy secondary to acute or chronic otitis media. Case one was unique due to the underlying immunodeficiency and severe grade of facial nerve palsy. Case three was managed conservatively, hence emphasising that early treatment can completely curb the need for a surgical intervention. Cases two and four, with grade two to three facial nerve palsy showed good clinical improvement after surgery. Timely reference to otolaryngology by pediatric peers can prevent the onset or worsening of complications secondary to otitis media such as facial nerve palsy. Recurrent episodes of otitis media should raise a high degree of suspicion of immunodeficient states, which will require a multi-disciplinary treatment.

An experience in the integrated management of paediatric burns in a tertiary care centre: a case series

Sugapradha G. Ravikumar — 2026-08-26

Paediatric burns are the leading cause of unintentional injuries in children. The leading cause of burns in the majority is scalds (70–85%) followed by flame burns, electrical, and chemical burns. Globally, burn injuries pose a substantial public health challenge, with a high risk of mortality and morbidity, accounting for over 310,000 annual deaths. Six patients of paediatric burn injuries admitted in our tertiary care centre were discussed as case series. All the children were managed by an integrated team of paediatrician, plastic and reconstructive surgeon, anaesthetist and physio therapist. All the children were in the age group between 2 years and 10 years. Five patients had scalds and one had electrical burns. Out of 5 scald burns three children had hot cauldron burns and two children had accidental spill burns. The hospital stay was between 12 days and 36 days. There was no mortality in this case series. Most of the paediatric burns are accidental and hence preventable. Most often it is the parent’s carelessness or oversight which leads to accidental burns in children. We must ensure that not only the children survive the initial injury, but also the morbidity and complications are minimized.

Neonatal-onset maculopapular cutaneous mastocytosis presenting with pigmented plaques in an infant

Alexa M. Flores-Leonel — 2026-08-26

Cutaneous mastocytosis is a clonal disorder characterized by abnormal accumulation of mast cells in the skin. Maculopapular cutaneous mastocytosis (urticaria pigmentosa) is the most common form in children and usually presents within the first two years of life. Neonatal onset and blistering may complicate recognition and mimic other pigmentary dermatoses. We report a 10-month-old male with six well-defined brown plaques measuring 2–3 cm, two with central scars. A blister was noted at birth on the knee, followed by progressive lesion development. Physical examination revealed no lymphadenopathy or visceromegaly. Histopathology demonstrated dense dermal mast cell infiltration with metachromatic granules on Giemsa staining, confirming maculopapular cutaneous mastocytosis. The patient was treated with oral ketotifen with stable disease at six-month follow-up. Early recognition is essential to ensure appropriate counseling, monitoring, and avoidance of unnecessary investigations.

Glucagon-like peptide-1 analog in the treatment of metabolic dysfunction-associated steatotic liver disease

Inês Eiras — 2026-08-26

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease in children with obesity. No pharmacological therapies are currently approved specifically for paediatric MASLD. A 12-year-old boy with obesity presented with persistent hypertransaminasemia and ultrasound-confirmed hepatic steatosis. After lifestyle interventions failed to improve liver enzymes, a glucagon-like peptide 1 (GLP-1) analog was initiated and titrated to 1.8 mg/day. Six months later, transaminases improved, accompanied by a 4 kg weight loss. After one year, liver enzymes normalized without adverse effects. This case supports the potential role of GLP-1 analog as a therapeutic option for paediatric MASLD, warranting further study.

A rare triad: complicated meconium ileus with type 3b jejunal atresia and antenatal mid jejunal perforation complicated by late-onset sepsis induced hemophagocytic lymphohistiocytosis

Sumit Jeena — 2026-08-26

Complicated meconium ileus (MI) involving mid jejunal perforation with congenital adhesions bands with type IIIB jejunal atresia (apple-peel deformity) is a high-risk surgical emergency. While surgical management is often the primary focus, the postoperative course can be derailed by systemic inflammatory syndromes. We report a rare case of a 35-week neonate with antenatal perforation and Type IIIB atresia who, following successful surgical repair, developed late-onset culture-proven sepsis. This subsequently triggered hemophagocytic lymphohistiocytosis (HLH), a life-threatening hyperinflammatory condition. Through aggressive multidisciplinary management, the neonate survived and is currently a healthy two-year-old. This case emphasizes the need for early recognition of HLH in neonatal sepsis cases that fail to respond to standard therapy.

A tale of two cases: early diagnosis and variable outcomes in vitamin D-dependent rickets

Madhu Manaswini — 2026-08-26

Vitamin D-dependent rickets (VDDR) is a rare inherited disorder of vitamin D metabolism or action, presenting with early-onset hypocalcemia, rickets, and growth failure. We report two contrasting cases of VDDR type I and type II that highlight important diagnostic and therapeutic differences. The first case, a female infant presenting with seizures, delayed milestones and limb deformities, showed hypocalcemia, elevated alkaline phosphatase, secondary hyperparathyroidism, and low 1,25-dihydroxyvitamin D levels; genetic testing confirmed a CYP27B1 mutation (VDDR-I), and treatment with oral calcium and calcitriol led to complete biochemical, radiological, and clinical recovery with near-normal growth. The second case, a male child from a consanguineous family with severe skeletal deformities, alopecia, and poor growth, demonstrated hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, markedly elevated alkaline phosphatase, normal 25-hydroxyvitamin D, and elevated 1,25-dihydroxyvitamin D levels; a vitamin D receptor (VDR) mutation confirmed VDDR-II, and despite aggressive therapy with high-dose calcium, active vitamin D, phosphate, and intermittent intravenous calcium, response remained suboptimal. These cases emphasize that early diagnosis and targeted therapy in VDDR-I can result in excellent outcomes, whereas VDDR-II is a severe, treatment-resistant condition, underscoring the critical role of detailed biochemical evaluation and genetic confirmation in children with refractory rickets.

From pneumonia to pulmonary embolism: refractory Mycoplasma pneumoniae in a 13-year-old girl

Sneha Maria Joy Kallely — 2026-08-26

Macrolide-resistant Mycoplasma pneumoniae pneumonia (MRMP) is increasingly reported in children and may present with extrapulmonary complications, including pulmonary thromboembolism and immune-mediated organ dysfunction. Thromboembolic events related to M. pneumoniae are rare but potentially life-threatening and often associated with transient antiphospholipid antibodies such as anti-beta-2 glycoprotein. A previously healthy 13-year-old girl presented with 7 days of high-grade intermittent fever and productive cough, unresponsive to Oseltamivir and Amoxicillin-Clavulanate. Examination and imaging showed right upper lobe consolidation with minimal pleural effusion. Laboratory evaluation revealed raised ESR and elevated CRP, LDH, ferritin, D-dimer, and procalcitonin, with subsequent maculopapular rash, transaminitis, positive cold agglutinins, following which M. pneumoniae IgM was positive. CTPA confirmed pulmonary thromboembolism, thrombophilia workup showed positive beta-2 glycoprotein antibodies. She was treated with Ceftriaxone and Azithromycin, escalated to Meropenem and Linezolid, and then Doxycycline for suspected MRMP. Persistent fever, high inflammatory markers, and radiological progression warranted Methylprednisolone, resulting in defervescence and clinical improvement. Progressive pleural effusion required thoracentesis, and pulmonary emboli were managed with Enoxaparin. Refractory M. pneumoniae pneumonia in children can be complicated by pulmonary embolism (PE) and transient antiphospholipid antibodies, even without structural heart disease or limb thrombosis. Early suspicion of thrombosis in the presence of elevated D-dimer, prompt CT pulmonary angiography, and combined second-line antibiotics, corticosteroids, and anticoagulants are crucial to optimize outcomes.

Primary hypokalemic periodic paralysis with sinus bradycardia: a case report and review of literature

Sugapradha G. Ravikumar — 2026-08-26

Hypokalemic periodic paralysis (HPP) is a rare autosomal dominant disorder caused by mutations affecting skeletal muscle ion channels, most commonly CACNA1S or SCN4A. It manifests as recurrent episodes of flaccid paralysis associated with low serum potassium levels, often precipitated by rest after exertion, high-carbohydrate intake, or intercurrent illness. Although the condition typically presents during adolescence, diagnosis is often delayed due to its episodic nature and overlap with other causes of acute weakness. The estimated incidence is 1:100,000. HPP with cardiac arrhythmias have been reported but sinus bradycardia is not reported so far. Hence, we present a rare case of primary HPP type 2 with sinus bradycardia and a pathogenic genetic variant. A 16-year-old male child born to third-degree consanguineous parents, presented to the emergency department with an acute episode of fever, vomiting, headache, generalized weakness with difficulty in getting up or standing since waking up that morning. The weakness initially involved the lower limbs and then progressed to the upper limbs within few hours. Electrocardiogram showed sinus bradycardia with prominent U waves. Serum potassium was 1.2 mmol/l with sodium, magnesium and calcium within normal limits. The paralysis and ECG abnormality became normal following replacement of potassium. There was a similar history in father and paternal uncle. Genetic study detected a heterozygous missense variant in exon 12 of the SCN4A gene (chr17: g.63959279G>C; Depth: 85x) that results in the amino acid substitution of glycine for arginine at codon 669 (p.Arg669Gly; ENST00000435607.3) causative of HPP, type 2. HPP is a rare neuromuscular disease that can present with cardiac arrhythmias. We present a case of primary HPP type 2 with sinus bradycardia which resolved spontaneously with potassium supplementation.

A rare case of SCALP syndrome presenting with progressive hydrocephalus and refractory epilepsy successfully treated with ventriculoperitoneal shunting

Priyanka R. — 2026-08-26

SCALP syndrome is an exceptionally rare neurocutaneous disorder characterized by sebaceous nevus, central nervous system malformations, Aplasia cutis congenita, limbaldermoid, and pigmented nevus. Neurological manifestations are variable, and severe hydrocephalus requiring neurosurgical intervention has rarely been reported. A 4-year-old girl with developmental delay, epilepsy, and progressive macrocephaly presented with status epilepticus. Seizures were controlled with intravenous levetiracetam and fosphenytoin. Examination revealed a sebaceous nevus over the nape of the neck, multiple areas of aplasia cutis congenita, a left limbaldermoid, and giant congenital melanocytic nevi involving the face and abdomen. Magnetic resonance imaging (MRI) of the brain demonstrated severe communicating hydrocephalus with marked dilatation of all ventricles and diffuse cerebral parenchymal thinning. The constellation of dermatological, ocular, and neurological findings was consistent with SCALP syndrome. The child underwent ventriculoperitoneal shunt placement, following which head circumference decreased by 2 cm at one-month follow-up, with no further seizures. This case highlights severe communicating hydrocephalus as a potentially reversible neurological manifestation of SCALP syndrome. Recognition of its characteristic cutaneous features should prompt early neuroimaging and multidisciplinary evaluation. Timely neurosurgical intervention may prevent neurological deterioration and improve clinical outcomes in affected children.

A diagnostic challenge in painless rectal bleeding in a 10-month-old infant: a case report

Pradeep K. Ranabijuli — 2026-08-26

Painless rectal bleeding in infants can occur due to various causes, including cow’s milk protein allergy (CMPA), juvenile polyp, Meckel’s diverticulum, angiodysplasia and internal hemorrhoids. Symptoms typically arise in the first or second year of life, with an average age of 2.5 years. Intermittent painless rectal bleeding is often caused by ulceration of the adjacent normal ileal mucosa and may be associated with iron deficiency anemia. We present the case of a 10-month-old female infant with complaints of painless rectal bleeding and iron deficiency anemia. The child had a history of cow’s milk as a primary source of nutrition along with inadequate and improper complementary feeding practices despite advice. She had a similar episode of blood in the stool at the age of 6 months. Clinical examination revealed an anal fissure on the posterior wall. Initial Meckel’s scan at 6 months was negative. The patient was advised to discontinue cow’s milk due to suspected cow’s milk protein allergy, following which the bleeding subsided. However, at the age of 10 months, the child again presented with bleeding per rectum. A repeat Meckel’s scan demonstrated focal tracer uptake in the right iliac fossa, suggestive of ectopic gastric mucosa, consistent with Meckel’s diverticulum. The child subsequently underwent Meckel’s diverticulectomy.