International Journal of Contemporary Pediatrics

The influence of probiotics on immune system development during early childhood: a systematic review

Joba E. I. Imbaquingo — 2026-09-23

Immune system development during early childhood is closely modulated by the colonization of the gut microbiota. Early interaction between commensal bacteria and the gut-associated lymphoid tissue (GALT) is essential for the maturation of both innate and adaptive immune responses, as well as for the establishment of immunological tolerance. Objective of the study was to analyze the current clinical evidence on the influence of probiotic supplementation on the development, maturation, and modulation of the immune system during early childhood, as well as its impact on preventing immune-based pathologies. Systematic review of scientific literature published between 2020 and 2026 in PubMed, Scopus, and Cochrane Library databases. Randomized controlled trials and cohort studies evaluating probiotic administration in infants and children (0-5 years) and measuring immunological biomarkers (e.g., secretory IgA, Th1/Th2/Th17 cytokine profiles) or immune-mediated clinical outcomes were included. The administration of specific strains, predominantly Lactobacillus rhamnosus GG, Bifidobacterium animalis subsp. lactis, and Lactobacillus reuteri, demonstrated a significant induction in intestinal secretory IgA (sIgA) synthesis and a favorable modulation of the Th1/Th2 ratio, thereby reducing pro-allergic polarization. Clinically, a consistent reduction in the incidence and severity of atopic dermatitis was observed in high-risk infants, alongside a significant decrease in the frequency and duration of upper respiratory and gastrointestinal infectious episodes. Probiotic supplementation during early childhood plays a key immunomodulatory role that supports the maturation of the infantile immune system. These findings support its use as a promising therapeutic and preventive strategy against highly prevalent allergic and infectious diseases, though greater standardization regarding strain specificity, dosage, and critical intervention windows is still required.

Long COVID in the pediatric population – clinical evolution, prevalence and management from the early pandemic to the current era: a systematic review

Paquita R. Q. Donoso — 2026-09-23

Post-acute sequelae of SARS-CoV-2 infection (PASC), or Long COVID, in the pediatric population present a complex clinical picture that has evolved from the initial pandemic waves to the current era characterized by omicron lineages and widespread vaccination. Understanding its prevalence, clinical trajectory, and evidence-based therapeutic strategies remains crucial for pediatric healthcare. Objective of the study was to systematically evaluate the clinical evolution, changing prevalence rates, predominant symptom clusters, and therapeutic management strategies of Long COVID in pediatric patients from the early pandemic to the current era. Systematic review of literature published between 2020 and 2026 across PubMed, Scopus, Cochrane Library, and Embase. Observational studies, prospective cohort analyses, and clinical trial data assessing post-acute symptoms (≥12 weeks post-infection) in children and adolescents aged 0–18 years were included following PRISMA guidelines. Reported prevalence of pediatric Long COVID varied significantly across pandemic phases, decreasing from 10–25% during pre-Omicron variants to 2–8% in the post-Omicron era, largely moderated by pediatric vaccination coverage and previous hybrid immunity. The most persistent clinical manifestations shifted from systemic fatigue, headache, and dyspnea to persistent fatigue, neurocognitive dysfunction ("brain fog"), mood disturbances, and dysautonomia (e.g., POTS-like symptoms). Management strategies remain primarily multidisciplinary and symptom-targeted, focusing on tailored physical rehabilitation, cognitive pacing, and non-pharmacological interventions, with emerging evidence supporting pharmacological targeting of post-viral inflammatory and autonomic dysregulation. Long COVID in pediatric populations continues to present a dynamic clinical burden, with reduced overall incidence in recent years but persistent morbidity in vulnerable subsets. Integrated, multidisciplinary follow-up models and standardized diagnostic criteria are essential to optimize long-term clinical management and functional recovery in pediatric patients.

The climate challenged child: extreme heat, air pollution and emerging infections in contemporary pediatric practice

Venugopal Reddy Iragamreddy — 2026-09-05

Climate change is altering the conditions in which children grow and receive healthcare. Children are disproportionately vulnerable because of immature thermoregulation, higher ventilation and fluid requirements relative to body size, developing organs, dependence on caregivers and greater lifetime exposure. This narrative review synthesises evidence on three interacting hazards of immediate relevance to paediatric and community practice: extreme heat, air pollution and climate-sensitive infections. It also proposes an author-derived four-question clinical lens linking exposure, individual susceptibility, protective-resource failure and immediate versus seasonal action. A structured search of PubMed/MEDLINE, Google Scholar and authoritative reports was undertaken, prioritising systematic reviews, meta-analyses, burden estimates and guidance published from 2019 to August 2026. Extreme heat is associated with heat illness, dehydration, renal stress, asthma exacerbations, adverse perinatal outcomes, impaired learning and mental-health morbidity. Climate change also worsens exposure to particulate matter, ozone, wildfire smoke and aeroallergens, contributing to pneumonia, asthma, impaired lung growth and possible neurodevelopmental harm. Temperature, rainfall, humidity, flooding and ecological disruption are changing transmission of dengue, malaria, diarrhoeal disease and other infections. Risks cluster among children affected by poverty, malnutrition, unsafe housing, chronic disease or weak health systems. Climate-resilient paediatrics requires climate-informed assessment, anticipatory guidance, child responsive heat plans, clean-air policies, integrated surveillance, resilient facilities and child centred disaster planning. Adaptation and mitigation should be treated as core child-health interventions.

Behind the bellyache: a comprehensive review and the novel SAFE child diagnostic algorithm for abdominal pain in children

Venugopal Reddy Iragamreddy — 2026-09-23

Abdominal pain is one of the most common presenting complaints in pediatric practice, spanning a spectrum from self-limited functional discomfort to acute surgical emergencies. The diagnostic challenge is compounded in young children by limited symptom articulation, overlapping presentations across organic and functional disorders, and inconsistent application of validated screening criteria in routine practice. This narrative review synthesises current evidence on the epidemiology, classification, etiology, red-flag recognition, and diagnostic and management approach to abdominal pain in children, drawing on clinical practice guidance from the American Academy of Family Physicians, NASPGHAN, and Rome Foundation criteria, and introduces an original structured clinical algorithm the SAFE-Child Algorithm (Systematic Assessment For Evaluating abdominal pain in Children) unifying triage, age-based differential diagnosis, alarm-symptom screening, and Rome IV functional classification into one stepwise pathway. Acute abdominal pain requires first-pass triage for surgical emergencies (appendicitis, intussusception, malrotation/volvulus, incarcerated hernia) using age-specific differential diagnosis and localizing signs. Chronic or recurrent abdominal pain (RAP), present in up to 19% of children in population-based studies, is functional in the large majority of cases, with an organic cause identified in only 5-10%; a validated alarm-symptom screen and Rome IV criteria allow most children to be confidently classified without unnecessary invasive investigation. The SAFE-Child Algorithm operationalises this evidence into a six-step pathway spanning emergency triage through biopsychosocial management and structured follow-up. A structured, stepwise diagnostic approach can reduce unnecessary investigation in functional abdominal pain while ensuring timely recognition of organic and surgical disease.

Fistula-in-ano in children under three: patterns, outcomes and imaging insights

Mariëlle J. Roskam — 2026-09-23

Background: The incidence of fistula-in-ano (FIA) in the pediatric population is not well established, despite its relatively common occurrence as a perianal disease. The aim of this study is to describe the proportions of simple and complex FIA in young children and to evaluate the treatment strategies applied.

Methods: Children under 3 years of age who were treated for FIA at Amsterdam UMC between January 2012 until April 2021 were included in this retrospective study. The primary endpoints were the proportions simple and complex FIA and the applied treatment strategies. Secondary endpoints were postoperative complications, recurrences, and the diagnostic value of imaging studies performed.

Results: Eighty-one patients were included, all male, with a median age of 9.2 months (range 1-36 months). Spontaneous resolution occurred in 19 patients (23.5%) prior to surgery. Sixty-two patients (76.5%) underwent surgical exploration: simple FIA in 85.5% (53/62), complex FIA in 8.1% (5/62), and healed fistula in 6.5% (4/62). No postoperative complications were observed. Recurrence occurred in 10 patients (16.1%).

Conclusions: Spontaneous resolution occurred in 23.5% of children under 3 years with FIA. Among those undergoing surgery, more than 85% had simple FIA, with a recurrence rate of 16%. These findings highlight that conservative management may be appropriate in a subset of young children with FIA, while surgery is effective for the majority of cases. Routine preoperative imaging and follow-up for inflammatory bowel disease (IBD) appear unnecessary in this age group, except in cases of recurrent or persistent symptoms.

Clinical profile, electrophysiological pattern and predictors of short-term outcome of Guillain-Barré syndrome in children

Sufia Khatun Sumi — 2026-09-23

Background: Guillain-Barré syndrome (GBS) is a rare but potentially life-threatening immune-mediated disorder affecting peripheral nerves, causing acute flaccid paralysis with variable clinical severity. Its diverse presentation and disease course make diagnosis, management, and prognostication difficult, particularly in children. This study aimed to assess the clinical profile, electrophysiological pattern, and predictors of short-term outcomes in pediatric GBS.

Methods: This observational study was conducted at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, from September 2018 to August 2019. A total of 93 children diagnosed with GBS were enrolled by consecutive sampling. Clinical characteristics, electrophysiological findings, treatment modalities, and short-term functional outcomes were analyzed. Outcome was assessed after 3 months of follow-up.

Results: Children aged 5-10 years were most commonly affected, with a male-to-female ratio of 1.7:1. Quadriparesis was the predominant presentation (87.1%), while 19.4% required mechanical ventilation. Electrophysiological studies showed acute motor axonal neuropathy (AMAN) in 65.6%, acute inflammatory demyelinating polyneuropathy (AIDP) in 31.2%, and acute motor-sensory axonal neuropathy (AMSAN) in 3.2% of cases. Patients receiving intravenous immunoglobulin with supportive care had shorter hospital stays than those receiving supportive care alone. At 3 months, 41.9% achieved favorable functional recovery (GBS disability grade 0-2), with no mortality recorded. Poor outcome was significantly associated with quadriplegia, bulbar involvement, neck flexor weakness, low baseline Medical Research Council score, and need for mechanical ventilation.

Conclusions: Quadriplegia, bulbar involvement, neck flexor weakness, poor baseline muscle strength, and mechanical ventilation requirement are significant predictors of poor short-term functional outcomes in pediatric GBS.

Comparison of INSURE and LISA techniques in preterm neonates with respiratory distress

Chaitra Reddy Molugu — 2026-09-18

Background: Respiratory distress syndrome (RDS) is a major cause of morbidity in preterm neonates. Aim of the study is to compare respiratory outcomes, procedure-related complications, neonatal morbidities, and hospitalization outcomes following surfactant administration by Less Invasive Surfactant Administration (LISA) versus INSURE in preterm neonates with RDS.

Methods: This comparative clinical cohort study included 100 preterm neonates diagnosed with RDS. Fifty neonates received surfactant by LISA and 50 by INSURE. In the LISA group, surfactant (200 mg/kg) was administered through a 5F thin catheter while spontaneous breathing was maintained on non-invasive respiratory support. In the INSURE group, surfactant was administered following endotracheal intubation, followed by positive-pressure ventilation and extubation. Demographic characteristics, respiratory outcomes, procedure-related complications, neonatal morbidities, and duration of respiratory support and hospitalization were compared.

Results: Mean gestational age was 30.35±3.12 weeks in the LISA group and 31.50±4.26 weeks in the INSURE group (p=0.127), and mean birth weight was 1952.8±750.92 g and 1968.5±850.88 g, respectively (p=0.956). Desaturation during surfactant administration was significantly less frequent with LISA than INSURE (20% vs. 40%; p=0.029). LISA also showed lower rates of intubation within 72 hours, mechanical ventilation, repeat surfactant administration, and several neonatal complications, although these differences were not statistically significant. Hospital stay was significantly shorter with LISA (9.1±2.1 vs. 12.6±3.2 days; p<0.001).

Conclusion: LISA was associated with significantly less procedure-related desaturation and shorter hospitalization than INSURE. LISA may be a feasible alternative for surfactant administration in spontaneously breathing preterm neonates with RDS.

Clinical, epidemiological and laboratory characteristics of children with febrile seizures

Amoghavarsha Shivamurthy — 2026-09-10

Background: Febrile seizures are the most common seizure disorder in early childhood and represent a frequent cause of pediatric emergency visits. Understanding their clinical, epidemiological, and laboratory characteristics is essential for appropriate evaluation and management.

Methods: A hospital-based observational study was conducted from March 2024 to February 2026 at Kempegowda Institute of Medical Sciences and Research Centre, Bengaluru, after institutional ethics committee approval. Sixty-five children aged 6-60 months presenting with febrile seizures were enrolled. Children with afebrile seizures, central nervous system infections, congenital CNS malformations, or chronic illnesses were excluded. Demographic details, clinical characteristics, and laboratory parameters, including complete blood count, serum electrolytes, blood glucose, C-reactive protein, and urine examination, were recorded. Data were analyzed using descriptive statistics, Chi-square test, fisher's exact test, and independent t-test or Mann-Whitney U test as appropriate. Effect sizes were reported as Cramer's V for categorical associations, with 95% confidence intervals (CI). A p value of <0.05 was considered statistically significant. Statistical analysis was performed using IBM statistical package for the social sciences (SPSS) statistics version 26.0 (IBM Corp., Armonk, NY, USA). Normality of continuous variables was assessed using the Shapiro-Wilk test.

Results: The mean age was 25.02±14.75 months, with most children aged 24-35 months (22/65, 33.8%). Males constituted 41/65 (63.1%) of cases. Most children presented with fever of 100-101 F (30/65, 46.2%), and 56/65 (86.1%) developed seizures within two days of fever onset. A single convulsion occurred in 46/65 (70.8%) of children. Hematological evaluation showed mild anaemia (mean hemoglobin 10.64±1.58 g/dl), leukocytosis (mean total leukocyte count 12,684.86±5,463.75 cells/mm³), and neutrophil predominance. Biochemical parameters were largely within normal limits except for mild hyponatremia (mean serum sodium 134.89±2.70 mEq/l). Urine abnormalities were detected in 11/65 (16.9%) of cases. Lower hemoglobin levels were significantly associated with multiple convulsions (Fisher's exact test, p=0.015, Cramer's V=0.368, 95% CI: 0.102-0.583).

Conclusions: In this study, febrile seizures predominantly occurred in neurologically normal children below three years of age and were usually associated with short-duration fever and single seizure episodes. Mild anaemia was common and was significantly associated with seizure recurrence, suggesting its potential role as a clinically relevant laboratory marker in children with febrile seizures.

Umbilical cord blood lactate dehydrogenase as a predictor of short-term outcomes in term neonates with meconium aspiration syndrome

Amruta Khavatkop — 2026-09-02

Background: Meconium aspiration syndrome (MAS) is an important cause of respiratory problems in term newborns. Early identification of infants at risk for adverse outcomes is essential for timely intervention. Umbilical cord blood lactate dehydrogenase (LDH), a marker of tissue hypoxia and cellular injury, may serve as an early prognostic biomarker in MAS.

Methods: A hospital-based cross-sectional observational study was conducted over 18 months at a tertiary care hospital in Mysore. One hundred term newborns with MAS born through meconium-stained amniotic fluid (MSAF) were enrolled. Umbilical cord blood samples collected immediately after birth were analysed for LDH levels using the UV assay method. The demographic, perinatal, and clinical data were collected. Appropriate statistical tests were performed to analyse associations between cord blood LDH levels and short‐term neonatal outcomes, with p<0.05 considered statistically significant.

Results: Thick MSAF was seen in 64% of the newborns, and 72% required resuscitation at birth. The most frequent presentation was moderate MAS (50%); 30% had severe disease. 11% developed persistent pulmonary hypertension, 25% developed sepsis, and overall mortality was 8%. Higher cord blood LDH levels were significantly associated with adverse short-term outcomes, such as prolonged oxygen requirement and longer NICU stay.

Conclusions: Umbilical cord blood LDH is a simple, easily available, and promising biomarker for short term outcome prediction in term newborns with MAS. Its early assessment may be beneficial in risk stratification and management in tertiary care settings.

A modified bag-valve-mask positive-pressure technique for removal of nasal foreign bodies in young children: a retrospective study from a rural pediatric practice

Sandip M. Kisave — 2026-09-08

Background: Nasal foreign bodies are common in young children, and their removal can be difficult because of fear, distress, and poor cooperation. Positive-pressure techniques provide a non-instrumental alternative, but conventional approaches may require direct mouth-to-mouth contact.

Methods: This retrospective, single-center chart review included 28 consecutive children aged 1-5 years with clinically diagnosed, anteriorly located nasal foreign bodies treated at a rural pediatric outpatient and emergency setting. A modified bag-valve-mask (BVM) technique was used to deliver a brief, controlled positive-pressure puff through the mouth while the contralateral nostril was occluded. Children were observed for at least 30 minutes.

Results: Successful removal was achieved in 26 of 28 children (92.9%; 95% CI=77.4-98.0%). Among successful cases, 22 of 26 (84.6%; 95% CI=66.5-93.9%) were successful on the first attempt. No major complications were recorded during the procedure or observation period.

Conclusions: In this single-operator, single-center pilot series, the modified BVM technique achieved a high removal rate for anteriorly located nasal foreign bodies using equipment commonly available in rural clinical settings. Larger, multicenter comparative studies with standardized pressure protocols are required before broader clinical adoption.

Comparison of single versus multiple doses of antenatal corticosteroid administration on neonatal mortality and morbidity: a prospective observational study

Surya Guhan — 2026-09-05

Background: Antenatal corticosteroids (ACS) reduce respiratory and other complications of prematurity, but the comparative benefit of a single versus a complete multiple-dose course in real-world, resource-limited settings is not well defined. Objectives were to compare the effect of single versus multiple doses of antenatal dexamethasone on neonatal mortality and morbidity among preterm neonates delivered between 24 and 34 weeks of gestation.

Methods: This prospective observational study was conducted over 18 months in the neonatal intensive care unit (NICU), Department of Paediatrics, Government Medical College and Hospital, Cuddalore. Two hundred preterm neonates (24-34 weeks) were enrolled by convenience sampling and stratified into five groups by antenatal dexamethasone exposure: no dose, one, two, three, or four doses. Maternal and neonatal variables were recorded on a structured proforma. Categorical data were analysed with the chi-square test and continuous data with one-way ANOVA/Student’s t-test; multivariate logistic regression identified independent predictors of mortality. P<0.05 was considered significant.

Results: Groups were comparable for maternal age, comorbidities, gestational age, sex and mode of delivery (all p>0.05). Mean birth weight rose from 1385±310 g (no dose) to 1722±238 g (four doses, p<0.001), and 1- and 5-minute APGAR scores improved progressively (p<0.001). Respiratory distress syndrome (RDS) fell from 60.0% to 13.5% (p<0.001), intraventricular haemorrhage (IVH) from 20.0% to 3.8% (p=0.042), necrotising enterocolitis (NEC) from 16.7% to 1.9% (p=0.038), and overall neonatal sepsis from 33.3% to 7.7% (p=0.019). Requirement for CPAP, mechanical ventilation and surfactant, NICU admission and length of NICU stay all declined significantly with increasing dose (p<0.05). Neonatal mortality fell from 20.0% to 3.8% (p=0.043). Hypoglycaemia was more frequent with increasing exposure (16.7% to 25.0%, p=0.042). On multivariate analysis, gestational age <30 weeks (OR 3.24), birth weight <1500 g (OR 2.89), incomplete steroid exposure ≤2 doses (OR 2.52), RDS (OR 2.31), neonatal sepsis (OR 3.76) and IVH (OR 2.14) independently predicted mortality.

Conclusions: Completion of the recommended four-dose antenatal dexamethasone course was associated with a graded, significant reduction in neonatal mortality and major morbidity compared with partial or no exposure. Ensuring timely completion of the full ACS course in women at risk of preterm birth should be prioritised in clinical practice.

Evaluation of cardiac dysfunction in newborns with HIE with special reference to cardiac troponin I (hsTrop I)

Himanshu Saraswat — 2026-09-23

Background: Perinatal asphyxia is a major cause of neonatal and under 5 mortalities particularly in developing countries. Multiorgan dysfunction is common in newborns with perinatal asphyxia and cardiovascular involvement is associated with poor outcome.

Methods: This prospective cohort study conducted at neonatal section of Jawaharlal Nehru Medical College and Hospital (JNMCH), AMU, Aligarh, included 126 newborns with hypoxic-ischemic encephalopathy (HIE) as case study group fulfilling inclusion criteria and 126 normal newborns as control group. All the newborns were then followed with high-sensitivity troponin I (hs-TropI) done in all newborns at 12 hours of life and echocardiography within 72 hours of life to evaluate cardiac function.

Results: In our study cardiac dysfunction was present in 51.56% of newborn with HIE. Systolic dysfunction was present in only 9.4% case study group whereas diastolic dysfunction was present in 60 (46.9%) of case study group which was significantly higher than the control group (n=6;4.7%) (p value <0.001). In our study pulmonary arterial hypertension (PAH), mitral regurgitation (MR), tricuspid regurgitation (TR), and patent ductus arteriosus (PDA) were present in 38.3%, 2.3%, 46.1% and 4.7% in case study group. ROC curve analyses showed that a cut off value of hs-Trop I 64.8 ng/l can predict cardiac dysfunction in HIE newborn with sensitivity, specificity and accuracy of 78.89%, 58.06%, 68.75% respectively.

Conclusions: Cardiac dysfunction was prevalent in children with HIE especially associated with diastolic dysfunction along with PAH. Cardiac dysfunction signifies poor outcome among HIE cases. Hs-Trop I showed positive association with cardiac dysfunction and can early predict the myocardial injury at 12 hours of life.

Sensory profiling in children with attention deficit hyperactivity disorder aged 7-12 years from a tertiary care centre in South Kerala

Anjitha S. — 2026-09-23

Background: Sensory processing abnormalities are increasingly recognized in children with attention deficit hyperactivity disorder (ADHD) and may contribute to academic, behavioural, and social difficulties. This study assessed the prevalence, domain-specific sensory patterns, and associations with ADHD subtypes among children aged 7–12 years attending a tertiary care centre in South Kerala.

Methods: A cross-sectional study was conducted among 56 children with DSM-5 diagnosed ADHD. Sensory processing was evaluated using the short sensory profile (SSP). ADHD subtypes were classified as inattentive (ADHD-I), hyperactive-impulsive (ADHD-HI), and combined (ADHD-C). Associations between sensory domains and ADHD subtypes were analyzed using Chi-square testing.

Results: The majority were males (85.7%), and ADHD-C was the most common subtype (64.3%). Sensory processing abnormalities were present in 98.2% of participants. Tactile sensitivity (76.8% definite difference), vestibular/movement sensitivity (100% abnormal), and low energy/weak endurance (89.3%) were the most affected domains. Under-responsiveness/sensation-seeking behaviour was observed in 66.1%, while auditory filtering difficulties were present in 50%. Visual/auditory and taste/smell sensitivities were largely preserved. Vestibular sensitivity was the only sensory domain significantly associated with ADHD subtype (p=0.044), with greater dysfunction observed in the combined subtype.

Conclusions: Sensory processing disorders are highly prevalent in children with ADHD, particularly involving tactile and vestibular domains. Routine sensory profiling may facilitate early identification of sensory challenges and support targeted interventions to improve functional outcomes.

Comparative study on effectiveness of a traditional brief intervention method versus a virtual teach-to-goal approach in educating hospitalized children with asthma on proper inhaler technique

Ariya Venu — 2026-09-23

Background: Correct inhaler technique is essential for achieving optimal asthma control in children. However, incorrect inhaler use remains common and contributes to poor disease control, recurrent exacerbations, and increased healthcare utilization. Hospitalization provides an important opportunity for inhaler education. This study compared the effectiveness of a traditional brief intervention (BI) with a Virtual Teach-to-Goal (V-TTG) approach in improving inhaler technique among children with asthma.

Methods: This comparative study was conducted in the Department of Paediatrics, Pushpagiri Institute of Medical Sciences and Research Centre, Kerala, over 18 months. Sixty-six children aged 4-15 years with asthma (33 in each group) were enrolled. Participants received either conventional face-to-face inhaler education (BI) or standardized video-based V-TTG education. Inhaler technique was assessed before and after intervention using a validated 12-step metered-dose inhaler with spacer checklist. Follow-up assessment evaluated retention of correct inhaler technique. Continuous variables were analyzed using paired and independent t tests, while categorical variables were compared using Chi-square/Fisher's exact test. A p<0.05 was considered statistically significant.

Results: Both educational interventions significantly improved inhaler technique scores from baseline (BI: 6.94±1.32 to 9.67±1.65, p<0.001; V-TTG: 6.91±1.51 to 10.70±1.33, p<0.001). The V-TTG group achieved significantly higher post-intervention scores than the BI group (10.70±1.33 vs. 9.67±1.65; p=0.007). At follow-up, a greater proportion of children in the V-TTG group demonstrated correct inhaler technique (75.8% vs. 63.6%), although this difference was not statistically significant (p=0.284). Older children demonstrated significantly better inhaler technique than younger children (p<0.001).

Conclusions: Both traditional BI and V-TTG education significantly improved inhaler technique in children with asthma. However, the V-TTG approach resulted in superior immediate improvement in inhaler technique and represents an effective, scalable strategy for asthma education in pediatric practice.

Assessment of the level of parental satisfaction on hospital care given to children admitted in pediatric medical ward

Chubamenla Aier — 2026-09-23

Background: Healthcare quality significantly affects the quality of life for patients and their families, especially in pediatric care where satisfaction of both children and parents is essential. Parental satisfaction serves as a critical measure of care quality, affecting outcomes like early discharge, readmissions, and child mortality. This study aimed to assess the level of parental satisfaction on hospital care of children admitted in Pediatric Medical Ward.

Methods: A cross-sectional observational study was carried out among 386 parents of children admitted in the pediatric medical ward of a tertiary hospital. Convenience sampling technique was used to enroll the parents. Socio-demographic data and clinical variables of the children were collected from their medical records and by interviewing the parents. Parental satisfaction on hospital care was assessed by structured interview using pediatric quality of life healthcare satisfaction scale. Data were analyzed using one-way ANOVA and unpaired t test with SPSS version 20.

Results: The level of parental satisfaction on hospital care given to children was high for 321 (83.2%), moderate for 51 (13.2%) and low for 14 (3.6%) of the parents. Factors associated with parental satisfaction were gender of the parent (p=0.0001), education of parent (p=0.0001), presence of tracheostomy tube (p=0.0001) and need for respiratory support (p=0.016).

Conclusions: To improve parental satisfaction with hospital care for children, it is essential to enhance the quality of information provided, family involvement in the treatment process, effective communication, technical proficiency, emotional support, and overall child-centered approaches to hospitalization.

Awareness and attitude towards major non-communicable diseases among undergraduate students in Dhaka, Bangladesh: a cross-sectional study

Sania Rahman — 2026-09-23

Background: Non-communicable diseases (NCDs) are a major public health challenge in Bangladesh, and many modifiable risk factors begin during adolescence and early adulthood. Undergraduate students are therefore an important group for early health promotion. This study assessed awareness and attitude toward major NCDs among undergraduate students in Dhaka, Bangladesh.

Methods: A descriptive cross-sectional study was conducted among undergraduate students from Jagannath University and Bangladesh Maritime University. A total of 421 valid completed responses were analyzed. Data were collected using a semi-structured, self-administered Google Forms questionnaire covering sociodemographic characteristics, 12 awareness items, and 12 attitude statements. Awareness was scored from 0 to 12 and categorized as low, moderate, or high. Attitude was measured on a five-point Likert scale; seven negatively worded items were reverse-coded before calculating the global attitude score. Data were analyzed using SPSS version 25 with descriptive statistics, chi-square tests, ANOVA, correlation, and regression analyses.

Results: The mean awareness score was 7.58±2.65 out of 12. Low, moderate, and high awareness were observed in 56 (13.3%), 185 (43.9%), and 180 (42.8%) students, respectively. Correct awareness was highest for smoking as an NCD risk factor (87.6%), dietary risk for obesity and type 2 diabetes (83.6%), sugary drink-related health risk (79.6%), and cardiovascular disease definition (79.3%). Important gaps remained for WHO physical activity recommendations (27.8%), organ involvement in type 2 diabetes (35.4%), and identification of malaria as not being an NCD (41.3%). The mean attitude score was 3.55±0.49 out of 5; 52 (12.4%) students had low, 308 (73.2%) moderate, and 61 (14.5%) high attitude scores. Awareness and attitude were positively associated; mean attitude increased from 3.03±0.48 in the low-awareness group to 3.77±0.37 in the high-awareness group (p<0.001), and the awareness-attitude correlation was moderate and positive (r=0.543, p<0.001).

Conclusions: Undergraduate students demonstrated moderate-to-high awareness and generally favorable attitudes toward NCD prevention, but important knowledge gaps and perceived behavioral barriers remained. The positive association between awareness and attitude supports university-based NCD education, but interventions should also address motivation, perceived barriers, and supportive campus environments.

Relationship between intelligence quotient and water fluoride levels of school-going children aged 6-12 years in and around Mahbubnagar district – a cross-sectional study

Kola Srikanth Reddy — 2026-09-23

Background: Excess fluoride exposure during childhood leads to dental fluorosis and, according to some studies, has also been associated with lower neurocognitive test scores. This study assessed the intelligence quotient (IQ) of school-going children aged with aged with 6-12 years in villages of the Mahbubnagar district with varying levels of fluoride in drinking water.

Methods: A cross-sectional study was conducted among the permanent residents of Mahbubnagar district, Telangana state, India. A total of 480 government school-going children aged 6-12 years were selected through stratified random sampling from 3 different areas with varying levels of naturally occurring fluoride in drinking water. The IQ levels of the children were assessed using Ravans standard progressive matrices test (1991, edition).

Results: The mean IQ levels were higher in villages with low fluoride concentration in drinking water (15.26) compared to those with medium fluoride content (12.91) and high fluoride content (9.10). A statistically significant association was observed (p<0.01).

Conclusions: The overall IQ levels of children exposed to high fluoride concentration were significantly lower than those in low-fluoride areas, indicating that high levels of fluoride in drinking water adversely affect children’s intelligence.

Renal angina index versus serum creatinine for early prediction of acute kidney injury in critically ill children: a prospective observational study

Bhavya Bhavana — 2026-09-23

Background: Acute kidney injury (AKI) is common in critically ill children, while serum creatinine is a delayed marker of renal dysfunction. The Renal Angina Index (RAI) combines clinical risk and early signs of renal injury and may permit earlier identification of children likely to develop severe AKI.

Methods: This prospective observational study included 150 children aged 1 month-12 years admitted to a tertiary-care pediatric intensive care unit. RAI was calculated 12-24 hours after admission; a score ≥8 was considered positive. The primary outcome was severe AKI (KDIGO stage 2 or 3) by Day 3. Diagnostic performance of RAI was compared with Day-1 serum creatinine using receiver operating characteristic analysis.

Results: AKI occurred in 55/150 (36.7%) children and 52/150 (34.7%) were RAI positive. Mean RAI was higher in children with AKI than without AKI (9.65±3.23 vs 3.05±1.78; p<0.001). RAI had sensitivity 81.8%, specificity 92.6%, positive predictive value 86.5%, negative predictive value 89.8%, and accuracy 88.7%. Its area under the ROC curve was 0.928 (95% CI 0.887-0.969), compared with 0.307 (95% CI 0.208-0.405) for Day-1 serum creatinine.

Conclusions: RAI was a strong early predictor of AKI in critically ill children and substantially outperformed Day-1 serum creatinine. As a low-cost bedside score using routinely available data, it may facilitate early risk stratification in resource-limited PICUs.

Procalcitonin vs C-reactive protein as diagnostic biomarkers for sepsis in preterm very low birth weight neonates

Nikhil Arora — 2026-09-23

Background: Few studies have compared use of procalcitonin (PCT) and C-reactive protein (CRP) in diagnosis of sepsis in preterm very low birth weight neonates (VLBW). This study aimed to compare sensitivity and specificity of PCT and CRP in predicting sepsis in preterm VLBW neonates and also to compare their levels in gram positive and negative sepsis, as well as in early and late onset sepsis.

Methods: This prospective comparative study included 50 preterm very low birth weight neonates (gestational age <37 weeks and birth weight <1500 grams) with suspected neonatal sepsis. After enrollment, 1 ml of blood was collected for blood culture in Brain Heart Infusion (BHI) broth medium, and another 1 ml was collected for PCT and CRP quantitative determination with Boditech Ichroma^TM kits in Biochemistry lab using fluorescence Immunoassay. Other sepsis screen parameters, including Total Leucocyte Count (TLC), Absolute Neutrophil count (ANC), Immature-to-Total (I:T) Neutrophil ratio were also assessed. Cut-off values for CRP and PCT was taken as 10 mg/l and 2 ng/ml respectively. We considered blood culture as gold standard.

Results: Sensitivity and specificity of PCT was 68.40% and 3.20 % respectively whereas for CRP it was 57.89% and 64.52% respectively. Positive predictive value and negative predictive value of PCT was only 30.2% and 14.30% respectively as compared to 50% and 71.43% with CRP. Median value of PCT and CRP was higher in gram negative sepsis [4.00(1.51-23.25) ng/ml] and [12.70(4.60-49.10) mg/l] respectively as compared to gram positive sepsis [2.25(1.38-3.98) and 5.60(1.70-20.30) ng/ml respectively], but it was not statistically significant. Median of PCT was higher in LONS group as compared to EONS group [15.00(7.3-6.67) vs 4.60(2.01-8.50) ng/ml], but the difference was not statistically significant (p=0.178).

Conclusions: PCT is not a better marker as compared to CRP for diagnosis of sepsis in preterm VLBW neonates.

Neurodevelopmental outcome in neonates with central nervous system insult: an observational study

Stuti Gupta — 2026-09-23

Background: Neonatal central nervous system (CNS) insults are a significant cause of morbidity and long-term neurodevelopmental problems. Common etiologies include hypoxic-ischemic encephalopathy (HIE), meningitis, intraventricular hemorrhage (IVH), and bilirubin encephalopathy. The severity of these conditions influences neurodevelopmental outcomes, making early assessment and intervention crucial for improving prognosis and long-term support.

Methods: This observational study was conducted at the Department of Pediatrics, Vivekananda Polyclinic & Institute of Medical Sciences, Lucknow, over 18 months. A total of 70 neonates with confirmed CNS insults admitted to the NICU were enrolled. The Hammersmith Infant Neurological Examination (HINE) was used for neurodevelopmental assessment at discharge, and at 3, 6-, 9-, 12-, and 18-months post-discharge. The severity of insults was classified based on clinical and imaging findings. Therapeutic interventions ranged from supportive care for mild cases to multidisciplinary rehabilitation for severe cases.

Results: Meningitis was the most common CNS insult (44.29%), followed by HIE (34.29%), bilirubin encephalopathy (12.86%) and IVH (8.57%). Mild cases, such as stage 1 HIE and low Bind scores in bilirubin encephalopathy, showed favorable neurodevelopmental recovery, whereas severe cases, such as stage 3 HIE and Grade 3 IVH, had poorer outcomes. Patients with meningitis consistently exhibited normal neurodevelopmental outcomes. Preterm birth, low birth weight, and perinatal complications were identified as significant risk factors for poor prognosis

Conclusions: This study underscores the critical role of early detection, consistent monitoring, and targeted interventions in optimizing neurodevelopmental outcomes in neonates with CNS injuries. Although mild cases demonstrate excellent recovery potential, severe cases require long-term support. These findings highlight the importance of neonatal care strategies in mitigating long-term developmental deficits.

Role of intravenous iron therapy in children with severe acute malnutrition with iron deficiency anemia

Abhijeet Sharad Naik — 2026-09-23

Background: Iron deficiency anemia (IDA) is the most common micronutrient deficiency among children under five years of age, with severe acute malnutrition (SAM). The coexistence of SAM and IDA increases the risk of impaired growth, developmental delay, recurrent infections, hospitalization, and mortality. Oral iron supplementation is the standard treatment but is often limited in children with SAM because of poor tolerance, reduced absorption. Intravenous (IV) iron sucrose may provide rapid correction of iron deficiency; however, evidence regarding its safety and efficacy in this population is limited. This study evaluated the safety and efficacy of IV iron sucrose therapy in children with SAM and IDA.

Methods: This observational study was conducted in children under five years, with SAM and diagnosed with IDA. Sample size was 65, after stabilization, eligible and clinically stable children received IV iron sucrose in 50ml normal saline administered over 30 minutes on days 7^th, 10^th, and 13^th as per Ganzoni’s formula. Follow-up assessments were performed on day 14, 30, and 45, including anthropometry and hematological parameters. Adverse events were monitored.

Results: A total of 65 children with SAM and IDA were enrolled. Mean hemoglobin (Hb) increased from 6.19 g/dL at baseline to 9.62 g/dL at follow-up. Serum ferritin improved from 28.8 µg/L to 157.49 µg/L. Red cell indices showed significant improvement. No serious adverse reactions were reported.

Conclusions: IV iron sucrose therapy is a safe and effective for correcting IDA in children with SAM, especially where oral iron therapy is poorly tolerated.

Study on serum zinc levels in asthma

Bhavani Binjawadagi — 2026-09-23

Background: Asthma is a chronic inflammatory airway disease characterized by variable respiratory symptoms and reversible airflow limitation. Zinc, an essential trace element with antioxidant and immunomodulatory properties, may influence airway inflammation and asthma outcomes. This study evaluated serum zinc levels in children with asthma and their association with disease severity, asthma control, pulmonary function, and exacerbation frequency.

Methods: This hospital-based cross-sectional comparative study included 120 children aged 6–18 years (60 asthmatic and 60 healthy controls). Asthma diagnosis, severity, and control were assessed according to GINA 2025 guidelines. Serum zinc levels were measured using the colorimetric NITRO-PAPS method, and pulmonary function was evaluated by spirometry. Data were analyzed using SPSS version 28, with p<0.05 considered statistically significant.

Results: Mean serum zinc levels were significantly lower in asthmatic children than in controls (69.68±16.41 vs. 84.47±17.87 µg/dl; p<0.001), with a higher prevalence of hypozincemia (31.7% vs. 15.0%; p=0.031). Lower serum zinc levels were significantly associated with poorer asthma control (p<0.001), greater disease severity (p=0.008), and impaired pulmonary function (FEV₁ <80% predicted; p<0.001). Although hypozincemia increased with exacerbation frequency, the association was not statistically significant (p=0.151).

Conclusion: Reduced serum zinc levels are associated with poor asthma control, increased disease severity, and impaired pulmonary function in children with asthma. Serum zinc may serve as a potential biomarker for disease status and a modifiable factor in asthma management.

Impact of mode of delivery on early initiation and sustained exclusive breastfeeding in infants: a prospective cohort study

Aditi Chawla — 2026-09-23

Background: Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are critical determinants of neonatal and infant health. Caesarean section (CS) has been consistently associated with delayed initiation and early discontinuation of breastfeeding, but prospective evidence from institutional settings in India remains limited. Objectives were to evaluate the association between mode of delivery and EIBF; to assess the impact of early versus late initiation on EBF at day 3, 6 weeks, and 3 months postpartum; and to identify maternal and neonatal factors independently associated with failure of EBF.

Methods: This prospective observational cohort study was conducted in a self-declared baby-friendly tertiary hospital in North India between July and September 2023. Women with singleton pregnancies beyond 34 weeks’ gestation were enrolled and followed until 3 months postpartum. Breastfeeding outcomes in infants were assessed at predefined intervals. Multivariable logistic regression was used to adjust for potential confounders.

Results: Among 585 women, 52% delivered vaginally and 48% by CS. EIBF occurred in 45% overall and was significantly lower following CS (15% vs 73%, p<0.001). EBF rates at day 3, 6 weeks, and 3 months were consistently lower in the CS group (79%, 55%, and 58.4%) compared to vaginal delivery (VD) (90%, 74.3%, and 71.6%). Caesarean delivery remained independently associated with failure of EBF at 6 weeks and 3 months. EIBF was a strong independent predictor of sustained EBF.

Conclusions: Despite a baby-friendly institutional environment, caesarean delivery remains a significant barrier to early initiation and sustained EBF in infants. Targeted, post-caesarean breastfeeding support strategies are urgently required.

Comparative study of sodium valproate monotherapy versus antiepileptic polytherapy on thyroid profile and serum magnesium levels in children with epilepsy

Sapna Gupta — 2026-09-23

Background: Prolonged antiepileptic drug (AED) therapy may alter thyroid homeostasis and serum magnesium levels, both of which are critical for neurodevelopment and growth in children.

Methods: This cross-sectional study enrolled 168 children aged 3–15 years with epilepsy on AED therapy for ≥6 months. Participants were categorised as group A (sodium valproate monotherapy, n=119), group A1 (other monotherapy, n=25), group B1 (polytherapy including valproate, n=17), and group B2 (polytherapy excluding valproate, n=7). Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), and magnesium were measured using standard methods. The chi-square test and student's t-test were applied; p<0.05 was considered significant.

Results: Subclinical hypothyroidism (SCH) was identified in 10 children (5.9%), with the highest prevalence in group B1 (11.8%); the inter-group difference was not statistically significant (p=0.767). Mean FT4 was 1.30±0.25 ng/dL and mean FT3 was 3.20±0.54 pg/ml. Hypomagnesemia was present in 14 children (8.3%), with a statistically significant duration-dependent increase from 3.7% at <1 year to 20.9% at >2 years (p=0.005). No significant inter-group difference in hypomagnesemia was observed (p=0.924).

Conclusions: Polytherapy was associated with a numerically higher, but statistically non-significant, rate of SCH. Hypomagnesemia showed a significant cumulative, duration-dependent increase regardless of drug regimen. Routine monitoring of thyroid function and serum magnesium is recommended for all children on long-term AED therapy, particularly those on polytherapy or treated for more than two years.

Determinants of vaccine hesitancy among caregivers of children in rural South India: a comprehensive cross-sectional framework analysis

Maddineni Sowmya — 2026-09-23

Background: Vaccine hesitancy-the delay in acceptance or refusal of immunization despite availability-poses an important challenge to immunization programmes. This study investigated the behavioral pattern and determinants of vaccine hesitancy among caregivers of children in rural South India using the WHO-SAGE Vaccine Hesitancy framework.

Methods: A descriptive cross-sectional questionnaire-based survey was conducted among 360 caregivers registered in Anganwadi demographic records in Zaheerabad, Raichur, over a three-month period from June 2025 to August 2025. The structured questionnaire assessed caregiver characteristics, childhood vaccination profiles and behavioral variables mapped to SAGE domains. Pearson's chi-square test was used for categorical associations.

Results: Safety concerns were the most frequently reported reason for hesitancy (30.0%, n=108), followed by lack of awareness (25.0%, n=90). Hesitancy was concentrated in HPV (n=121), COVID-19 (n=112) and PCV (n=98), while routine EPI vaccines accounted for 29 responses. Significant associations were observed for primary hesitancy reason (χ²=132.381, p<0.001), vaccine type (χ²=33.785, p<0.001) and SAGE domain (χ²=55.445, p<0.001).

Conclusions: Vaccine hesitancy in this setting was predominantly product-specific and associated with safety concerns, awareness gaps and confidence-related factors. Communication-focused, context-specific interventions may help improve vaccine confidence and acceptance.

Clinicopathological spectrum and diagnostic contribution of liver biopsy in children: a prospective observational study from a tertiary care hospital

Yogeshkumar Chaudhary — 2026-09-23

Background: Liver biopsy remains an important reference standard for histopathological assessment of selected pediatric liver diseases despite advances in non-invasive investigations. It provides important histopathological diagnosis, assesses disease severity, and guides management. This study evaluated the clinicopathological spectrum and diagnostic contribution of liver biopsy in children.

Methods: This prospective observational study included 25 children aged 1 month to 12 years who underwent percutaneous liver biopsy for suspected liver disease at a tertiary care teaching hospital in Gujarat, India, between September 2006 and September 2008. Demographic, clinical, laboratory, ultrasonographic, and histopathological findings were analysed using descriptive statistics. Diagnostic contribution was defined as confirmation of the suspected diagnosis, establishment of a previously unconfirmed diagnosis, or exclusion of intrinsic hepatic disease.

Results: Twenty-five children underwent liver biopsy, with a male-to-female ratio of 1.5:1. Jaundice (80%), fever (76%), pallor (64%), and hepatomegaly (100%) were the most common clinical features. Hyperbilirubinemia (80%), elevated alanine aminotransferase (72%), hypoalbuminemia (44%), and prolonged prothrombin time (12%) were the predominant laboratory abnormalities. On histopathology chronic hepatitis and its variants were present in 11 (44%) children, including cirrhosis in 2 (8%) children, followed by acute inflammatory liver disease (20%), neonatal hepatitis (8%), metabolic liver disease (8%), hemolytic disorders (8%), portal triaditis (4%), and normal liver histology (8%). Liver biopsy established or confirmed the diagnosis and provided clinically important additional information in 92% of children, including assessment of inflammatory activity and fibrosis, differentiated overlapping disorders, and excluded intrinsic hepatic disease in selected cases.

Conclusions: Liver biopsy remains an important diagnostic tool in pediatric liver disease. When interpreted alongside clinical, laboratory, and imaging findings, it contributes to diagnostic clarification and disease staging, particularly in chronic liver disease, neonatal cholestasis, and suspected metabolic liver disorders. The findings should be interpreted in the historical context of pediatric hepatology during 2006-2008.

Incidence of hypoglycemia during the first 48 hours of life in small-for-gestational-age neonates in a tertiary care hospital

Chaitra Reddy Molugu — 2026-09-18

Background: To determine the incidence of hypoglycemia during the first 48 hours of life among small-for-gestational-age (SGA) neonates and compare its occurrence between term and preterm SGA neonates.

Methods: A prospective observational study was conducted among 100 SGA neonates admitted to a tertiary care neonatal intensive care unit. Blood glucose was measured at 1, 2, 4, 6, 12, 24, and 48 hours of life. Maternal and neonatal characteristics, risk factors, feeding practices, clinical manifestations, and outcomes were recorded. Associations with hypoglycemia were assessed using univariate and multivariable logistic regression.

Results: Of 625 newborns enrolled, 100 (16.0%) were SGA; 66 (66.0%) were term and 34 (34.0%) preterm. Hypoglycemia occurred in 26 (26.0%) neonates and was significantly more frequent in preterm than term SGA neonates (47.1% vs. 15.2%, p<0.001). Among hypoglycemic neonates, 16 (61.5%) were symptomatic. The highest frequency of hypoglycemia occurred at 2 hours of life. Delayed initiation of enteral feeding was significantly associated with hypoglycemia. Blood glucose levels differed significantly between neonates weighing <1.8 kg and those weighing ≥1.8 kg at 2 and 4 hours. Univariate analysis identified low birth weight, prematurity, anthropometric measures, caesarean delivery, and 1-minute Apgar score as significant factors. On multivariable analysis, head circumference, chest circumference, 1-minute Apgar score, and caesarean delivery remained significantly associated with hypoglycemia. Two neonates with concomitant sepsis died.

Conclusion: Hypoglycemia was common among SGA neonates, particularly those born preterm. Early glucose monitoring, especially during the first 4 hours, together with timely enteral feeding, may facilitate early detection and prevention of neonatal hypoglycemia.

Diagnostic utility of electroencephalography and magnetic resonance imaging in children with a first unprovoked seizure: a prospective observational study

Vinay Kumar N. — 2026-09-16

Background: Electroencephalography (EEG) is recommended as part of the neurodiagnostic evaluation of children presenting with a first unprovoked seizure. However, the role of neuroimaging, particularly magnetic resonance imaging (MRI), remains less clearly defined. This study aimed to evaluate the diagnostic utility of EEG and MRI in children presenting with a first episode of unprovoked seizure.

Methods: This prospective observational study was conducted at Mysore Medical College, Mysuru. Children presenting with a first unprovoked seizure were enrolled after obtaining parental consent. Detailed clinical and developmental histories were taken and general and neurological examinations were done. A complete blood count, blood glucose, serum sodium, potassium, and calcium were done to rule out metabolic causes. Seizures were classified according to the International League Against Epilepsy classification. EEG was done within 48 hours of the seizure using the 18‐channel EEG machine and interpreted by a pediatric neurologist. Cranial MRI was performed on a 1.5-Tesla scanner. EEG and MRI findings were classified as normal or abnormal.

Results: EEG abnormalities were present in 62.5% of children and MRI abnormalities in 25%. MRI abnormalities were identified in some children with normal EEG findings, including developmental abnormalities and ring-enhancing lesions.

Conclusions: EEG demonstrated a substantial diagnostic yield and should be considered an important investigation in children presenting with a first unprovoked seizure. MRI abnormalities were less common but can provide further diagnostic information for some children with normal EEG findings and may aid in detection of structural and developmental problems.

Knowledge, attitude and practice regarding childhood immunization among mothers of under-five children: a hospital-based cross-sectional study from upper Assam, India

Mithun Roy — 2026-09-23

Background: Immunization is among the most cost-effective public health interventions, but awareness does not necessarily translate into timely completion of the schedule. This study assessed mothers' knowledge, attitude, and practice (KAP) regarding immunization of under-five children and factors associated with immunization status.

Methods: A hospital-based cross-sectional study was conducted at the pediatric outpatient department of Assam Medical College and Hospital, Dibrugarh, from June 2015 to May 2016. In all, 360 mothers of under-five children were interviewed using a predesigned, pretested proforma. Associations were tested using chi-square and Fisher exact tests, with p<0.05 considered significant.

Results: Overall, 322 mothers (89.44%) were aware of childhood immunization, the commonest source being health facilities (40.99%). Knowledge regarding the purpose of immunization (72.78%) and the correct starting age at birth (85%) was good; however, schedule-specific knowledge was weaker, notably the correct age for measles (46.67%) and the number of DPT doses (41.67%). Attitudes were largely favourable (86.11% considered immunization important). However, only 264 children (73.33%) were completely immunized; 51 (14.17%) were partially immunized and 45 (12.50%) unimmunized. Child sickness (46.88%) and lack of knowledge (39.58%) were the leading reasons for incomplete immunization, and lack of knowledge accounted for 62.38% of missed scheduled doses. Maternal literacy was associated with immunization knowledge, and immunization status with child sex and maternal religion (p<0.05).

Conclusions: A clear knowledge–practice gap was evident; awareness and attitudes were favourable, but about one in four children was incompletely immunized. Schedule-specific counselling, appropriate advice during childhood illness and reduction of access barriers may help convert favourable attitudes into timely immunization.

Clinical profile and early outcomes of neonates born to mothers with thyroid dysfunction at a tertiary care center in North-East India

Priyanka Chettri — 2026-09-23

Background: The objectives of the study were to assess early neonatal outcomes among infants born to mothers with thyroid dysfunction and compare outcomes between subclinical and overt hypothyroidism.

Methods: This hospital-based cross-sectional study (May 2023-April 2025) included 72 neonates born to mothers with thyroid dysfunction. Comparative analysis was performed in neonates born to mothers with subclinical or overt hypothyroidism. Associations between neonatal morbidities and thyroid function were analysed using the Chi-square or Fisher’s exact test, with odds ratios and 95% confidence intervals.

Results: Subclinical hypothyroidism (SCH) was the most common maternal disorder (63.9%). Neonatal hyperbilirubinemia was the predominant morbidity (50%). Prematurity was significantly higher in the SCH group than in the overt hypothyroidism group (41.3% versus 16.7%, p=0.037). Other morbidities showed no significant differences. Congenital hypothyroidism (CH) was detected in 5.6% of neonates.

Conclusions: Subclinical maternal hypothyroidism is associated with prematurity, and the high prevalence of CH emphasizes the need for targeted neonatal thyroid screening.

Study of retinopathy of prematurity in neonates admitted to a neonatal intensive care unit: a prospective observational study

Sneha M. Sherkhane — 2026-09-23

Background: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retina and a leading cause of preventable childhood blindness. With improving neonatal survival in resource-limited settings, the burden of ROP is rising. To determine the incidence and identify maternal and neonatal risk factors of ROP in neonates admitted to a tertiary care neonatal intensive care unit (NICU).

Methods: A prospective observational study was conducted over 18 months (July 2023-July 2025). Sixty-eight neonates meeting eligibility criteria were enrolled. ROP screening was performed by indirect ophthalmoscopy following NNF guidelines.

Results: ROP incidence was 33.8%, 82.6% had mild ROP (stages 1-3) and 17.4% had severe ROP. Pregnancy-induced hypertension (PIH) was the only significant maternal risk factor (p=0.002). Significant neonatal risk factors included gestational age 28-32 weeks and birth weight 1-1.5 kg (both p<0.001), respiratory distress syndrome (p=0.001), apnea (p=0.002), sepsis (p=0.011), necrotising enterocolitis (p=0.001), culture-positive sepsis (p=0.004), mechanical ventilation (p=0.003), non-invasive ventilation (p=0.006), surfactant therapy (p=0.002), and blood transfusion (p=0.001). Among neonates with ROP, apnea was the sole predictor of severe disease (p=0.024). All four severe ROP cases received laser photocoagulation; in addition, two babies also required anti-VEGF therapy.

Conclusions: ROP incidence was 33.8%, consistent with Indian tertiary-centre reports. Prematurity, low birth weight, PIH, sepsis, RDS, NEC, apnea, ventilatory support, and blood transfusion are key risk factors. Apnea is a significant predictor of severe ROP. Timely screening and management of modifiable risk factors are essential to reduce ROP-associated blindness.

Performance of WHO-defined clinical criteria for diagnosing pneumonia in children with severe acute malnutrition

Sarita Hathila — 2026-09-23

Background: Severe acute malnutrition (SAM) and pneumonia are major contributors to childhood morbidity and mortality, particularly in developing countries. Malnourished children often exhibit a blunted inflammatory response, resulting in atypical clinical presentations that may delay the diagnosis of pneumonia. Evidence regarding the performance of the World Health Organization (WHO)-recommended respiratory rate cut-offs for diagnosing pneumonia in children with SAM remains limited. This study aimed to evaluate the diagnostic performance of WHO-defined clinical criteria for pneumonia among under-five children with severe acute malnutrition.

Methods: This prospective hospital-based observational study included 95 children aged 2–59 months with severe acute malnutrition who were admitted with suspected pneumonia. Chest radiography was performed in all participants. Seventy-five children with radiologically confirmed pneumonia were considered cases, while 20 children without radiological evidence of pneumonia served as controls. The diagnostic performance of WHO-defined fast breathing was evaluated by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios.

Results: WHO-defined fast breathing demonstrated a sensitivity of 77.3% (95% CI: 66.2–86.2%) and a specificity of 40.0% (95% CI: 19.1–64.0%) for diagnosing radiologically confirmed pneumonia in children with SAM. The positive predictive value was 82.9%, while the negative predictive value was 32.0%. Overall diagnostic accuracy was 69.5%.

Conclusions: WHO-defined respiratory rate criteria retain acceptable sensitivity for identifying pneumonia in children with severe acute malnutrition. The findings support the continued use of WHO clinical criteria in resource-limited settings; however, larger multicenter studies are warranted to further validate their diagnostic performance in this high-risk population.

Effect of parental education on screen exposure, development and socio-emotional outcomes in early childhood: a prospective comparative interventional study

Mukesh Kumar Rai — 2026-09-23

Background: Early childhood screen exposure may displace developmentally important activities and caregiver–child interaction. This study evaluated the effect of structured parental education on screen exposure and developmental and socio-emotional outcomes among children aged 9-18 months.

Methods: This prospective comparative interventional study included 176 children enrolled at 9 months of age and followed prospectively until 18 months. Caregivers in intervention group received structured education regarding appropriate screen use, parental media practices, responsive parenting, and alternative age-appropriate activities, with periodic reinforcement. The comparison group received routine care. Screen exposure, anthropometric parameters, developmental outcomes using ages and stages questionnaire, third edition (ASQ-3), and socio-emotional outcomes using ages and stages questionnaire: social-emotional, second edition (ASQ:SE-2) were assessed at baseline at 9 months of age and reassessed at 18 months following intervention.

Results: Total screen exposure decreased by 5.85 minutes/day in intervention group and increased by 24.15 minutes/day in comparison group (between-group difference: -30.00 min/day; 95% CI: -34.37 to -25.63; p<0.001). Mobile screen exposure was reduced by 23.52 min/day more in intervention group (95% CI: -26.45 to -20.59; p<0.001). Intervention group demonstrated significantly greater improvements in all ASQ-3 domains (all p<0.05). ASQ:SE-2 scores also showed greater reduction in intervention group (between-group difference: -5.23; 95% CI: -6.25 to -4.21; p<0.001). No significant between-group differences were observed in anthropometric outcomes.

Conclusions: Structured parental education with periodic reinforcement was associated with reduced screen exposure and more favourable developmental and socio-emotional outcomes. Caregiver-focused screen-time counselling may be beneficial in routine pediatric services.

Impact of neonatal jaundice and neurological complications on developmental outcomes among children under 3 years of age

Nancy Rana — 2026-09-23

Background: Neurodevelopmental delay (NDD) remains major concern in early childhood, particularly among infants exposed to perinatal complications. Neonatal jaundice (NJ) and neurological complications (NC) are common in high-risk infants and can adversely affect brain development, yet detailed clinical profiling of developmental domains in such populations is limited in hospital-based Indian settings.

Methods: In this study, we assessed patterns of NDD using the Developmental Assessment Scale for Indian Infants (DASII) in a cohort of 30 children aged up to 30 months attending tertiary care centre in Vadodara, Gujarat. Children were grouped based on clinical profiles into Group-I, those with NJ and/or NC and Group-II, those with other medical conditions.

Results: The median age at assessment was 21.3 months. NC (60%) and NJ (43.3%) were the most common perinatal conditions, with frequent overlap. Overall, children showed marked developmental delay, with median motor and mental developmental quotient (DQ) of 47 and 42, respectively. Mental developmental impairment was consistently greater and less variable than motor impairment across both groups. Moderate to severe delay was observed in 50% children in motor domain and 70% in mental domain. Children in Group-I showed more uniform and pronounced impairment, particularly in mental domain. Cluster-wise analysis revealed predominant deficits in body control and manipulation in motor domain, and social interaction and imitative behaviour in mental domain.

Conclusion: These findings highlight the significant impact of early-life neurological and bilirubin-related insults on child development and underscore the importance of early identification and targeted intervention using culturally appropriate tools such as DASII.

Efficacy of triclofos versus melatonin on sleep electroencephalography recording in children: a randomised controlled trial

Rahul Sinha — 2026-09-23

Background: EEG is an essential investigation for suspected epilepsy in children. As sleep EEG recordings are often difficult to obtain because of anxiety and poor cooperation, sedatives that safely induce physiological sleep without altering EEG findings are needed. The objective of this study was to compare the efficacy and safety of triclofos and melatonin for sleep induction during EEG recording in children aged 1-10 years.

Methods: In this randomized study, 100 children requiring medication for sleep EEG were assigned by block randomization to receive either oral triclofos (50 mg/kg) or melatonin (3-6 mg). Parents were instructed to wake their children at 4:00 a.m. and ensure at least 4 hours of sleep deprivation before EEG recording. The sedative was administered 30 minutes before the procedure, and EEG recording was initiated once the child fell asleep.

Results: Fifty children were enrolled in each group. Baseline characteristics were comparable, with mean ages of 4.92 ± 2.17 years in the triclofos group and 5.87 ± 1.77 years in the melatonin group. Mean sleep onset latency was significantly shorter with triclofos than melatonin (45.72 ± 14.90 vs. 59.70 ± 12.34 minutes; p < 0.001). Sleep duration and need for a second dose were similar between groups. Abnormal EEG findings were detected in 62% of children receiving triclofos and 54% receiving melatonin (p = 0.41). Excessive beta activity was more frequent with triclofos (62% vs. 24%). Adverse effects occurred in 16% and 10% of children in the triclofos and melatonin groups, respectively.

Conclusion: Both triclofos and melatonin are safe and effective for sleep EEG recording in children. Triclofos achieves significantly faster sleep induction, although it is associated with increased beta activity that does not affect EEG interpretation.

Use of ultrasonography in determining the type of imperforate anus: a case series

Alaa Yasir Hussein — 2026-09-23

Preoperative differentiation between low type and high type imperforate anus (anorectal malformation, ARM) is very important to prevent the performing of inappropriate surgical procedures. Traditional invertogram is time dependent, difficult and may be harmful in neonates whose presentation is delayed and with abdominal distention. The present study assesses the diagnostic value of transperineal ultrasonography (T-PUS) in comparison with the invertogram, with the surgical diagnosis as the "gold standard", in a late-referred cohort. A prospective, interventional case series of consecutive neonates with imperforate anus seen at a tertiary referral center in the south of Iraq was performed. The typical referral was delayed (mean age >48 hours). A standard invertogram was performed (where clinically possible) and a T-PUS in the physiological supine position with a 7.5-12 MHz linear transducer for each patient. The P-P distance was recorded and the ARMs were categorized as low-type (<2.0 cm) or high-type (≥2.0 cm) ARMs. Diagnostic accuracy with respect to the intraoperative findings was the primary outcome. Secondary outcomes were feasibility and safety of each modality. Ten neonates (6 males, 4 females) were recruited. Mean age at presentation was 2.4±0.7 days (range: 1-3). In 40% (4/10) of patients, positioning the patient on the invertogram was impossible due to abdominal distension. Of the 6 patients who had both modalities, T-PUS correctly classified 10/10 (accuracy 100% (95% CI: 69.2%-100%)), while the invertogram did so in 4/6 cases (accuracy 66.7% (95% CI: 22.3%-95.7%)). In total, T-PUS was able to correctly identify 7 low-type (mean P-P distance 1.24±0.19 cm) and 3 high-type (mean P-P distance 2.63±0.15 cm) ARMs, with a 100% concordance with surgery. This difference between low and high groups was extremely significant (p<0.001, independent samples t-test). In 2 cases, the gas shadow was obscured by fluid-filled bowel loops making the invertogram unsuccessful. Transperineal ultrasonography is a safe, feasible and highly accurate tool for the diagnosis of imperforate anus, especially in cases presenting to the neonate late. This is better than the invertogram and allows for a correct and definitive surgical decision making. In all neonates with ARM we recommend that T-PUS is the primary, standalone imaging test and that the invertogram would be of no value in this setting.

Pharmacogenetic based precision therapy in childhood epilepsy: a case series

Prerna Choudhury — 2026-09-23

Childhood epilepsy poses a significant burden for parents as well as healthcare systems. Drug refractory epilepsy (DRE) is predominantly caused by structural brain lesions or gene mutations affecting ion channels or neurotransmitter function affecting the brain networks. Precision medicine in childhood epilepsies has revolutionised the approach to children with DRE/DEE by tailoring medications based on clinical and molecular aspects. We present a case series of four paediatric patients with drug-resistant epilepsy who demonstrated inadequate seizure control with conventional antiseizure medications but showed significant clinical improvement following precision therapy guided by proposed mechanisms based on the gene defect.

Effect of oral 25% dextrose on early post-procedural pain following lumbar puncture in neonates assessed using the neonatal infant pain scale: a prospective case series

Saugat Ghosh — 2026-09-23

Lumbar puncture is a painful but essential diagnostic procedure in neonates. Although oral sweet solutions are established non-pharmacological analgesics for neonatal procedural pain, evidence specifically addressing oral 25% dextrose during lumbar puncture is limited. This prospective case series included 15 term neonates undergoing diagnostic lumbar puncture. Each infant received 2 ml of oral 25% dextrose 2 minutes before the procedure, with facilitated tucking maintained throughout. Behavioural pain was assessed using the neonatal infant pain scale (NIPS) at baseline, 1 minute, and 2 minutes after completion of the procedure. The mean NIPS score was 0.40±0.63 at baseline, increased to 2.73±0.70 at 1 minute after lumbar puncture, and decreased to 1.33±0.62 at 2 minutes. At 1 minute, 10 neonates (66.7%) had NIPS scores of 0–2 and 5 (33.3%) had scores of 3–4; no neonate had a score ≥5. At 2 minutes, all 15 neonates (100%) had NIPS scores of 0–2. These findings indicate a transient early post-procedural behavioural pain response followed by a reduction in NIPS scores within 2 minutes among neonates who received oral 25% dextrose with facilitated tucking. Because there was no control group, the observed response cannot be attributed to dextrose alone. Nevertheless, the findings provide preliminary procedure-specific evidence supporting the feasibility of oral 25% dextrose as a simple adjunct to comfort measures during neonatal lumbar puncture and support further controlled evaluation.

A novel pathogenic heterozygous mutation in the CDC42BPB gene: a case report of global developmental delay potentially associated with Chilton-Okur-Chung syndrome

Catarina Barros Azevedo — 2026-09-23

Terminal deletions involving chromosome 14q32 are exceptionally rare and associated with variable neurodevelopmental phenotypes. We report a female child with fetal growth restriction, axial hypotonia, global developmental delay, delayed motor acquisition, and characteristic craniofacial dysmorphisms, including high forehead, downslanting palpebral fissures, retrognathia, sparse scalp hair, sparse eyebrows, and bilateral instep edema. Additional findings included patent ductus arteriosus, mild valvular insufficiency, and a globally thin corpus callosum on brain magnetic resonance imaging. Chromosomal microarray analysis identified a de novo 4.21Mb terminal heterozygous deletion at 14q32.31q32.33 encompassing multiple clinically relevant genes, including CDC42BPB, a gene associated with Chilton-Okur-Chung neurodevelopmental syndrome (CHOCNS). The deletion was classified as pathogenic according to ACMG/AMP criteria and supported by previously reported pathogenic alterations in DECIPHER. The patient demonstrated a relatively favorable developmental trajectory following early multidisciplinary intervention, achieving independent ambulation by 36 months with progressive cognitive and language acquisition. This report expands the phenotypic spectrum associated with distal 14q32 deletions involving CDC42BPB and highlights the importance of early diagnosis, longitudinal follow-up, and multidisciplinary intervention in rare neurodevelopmental disorders.

Familial natal teeth across three generations – the genetic implication

Jebashini Angelin — 2026-09-23

Natal teeth, defined as teeth present at birth, are rare, with an estimated incidence of 1 in 2,000-3,500 live births. While often sporadic, familial cases suggest a genetic predisposition. We present a case of a neonate with natal teeth and a strong positive family history spanning three generations, highlighting potential genetic and clinical implications. A full-term neonate presented with two lower central incisors at birth. The teeth were firmly attached, non-mobile, and did not interfere with feeding. Family history revealed multiple relatives across three generations with natal teeth. The child had no dysmorphic features or systemic anomalies. No syndromic associations were identified. This case highlights the heritable nature of natal teeth and the need for genetic consideration in such presentations. Family history plays a crucial role in differentiating isolated cases from syndromic conditions.

Congenital epidermolysis bullosa presenting with extensive bullous lesions at birth: a rare neonatal case report

Yusra Qureshi — 2026-09-23

Epidermolysis bullosa (EB) is a rare inherited genodermatosis characterized by marked skin fragility and blister formation after minimal mechanical trauma. It includes a spectrum of disorders such as EB simplex, junctional EB, dystrophic EB, and Kindler syndrome, with variable severity ranging from localized to life-threatening disease. A 28-year-old gravida 2 para 1 woman at 40+3 weeks of gestation with oligohydramnios underwent emergency lower segment cesarean section following failed induction and fetal bradycardia, delivering a live male neonate. At birth, the infant had extensive erythematous raw areas, skin peeling, and hemorrhagic bullous lesions over the extremities. A clinical diagnosis of epidermolysis bullosa simplex was made. The neonate developed progressive widespread blistering with mucosal involvement, fever, and worsening clinical condition was referred to a tertiary centre despite intensive supportive care succumbed at 42 days of life. This case highlights severe neonatal EB with poor outcome, emphasizing early recognition, supportive care, and genetic counselling.

Subtle signs, serious consequences: pediatric moyamoya disease presenting with seizures and behavioural regression

Ansh Sethi — 2026-09-23

Moyamoya disease (MMD) is a rare, progressive cerebrovascular arteriopathy characterized by chronic stenosis or occlusion of the terminal internal carotid arteries with compensatory development of a fragile basal collateral network. Although classically described with well-recognized presentations such as stroke, transient ischemic attacks, or seizures, its clinical spectrum in young children is remarkably varied, and early manifestations are often subtle, nonspecific, and easily overlooked or misattributed to more common childhood conditions. This diagnostic ambiguity is compounded in resource-limited settings, where ready access to vascular neuroimaging is not always available, and where a low index of suspicion for a rare cerebrovascular disorder can result in children being managed symptomatically for weeks or months before the underlying diagnosis is considered. We report a 2-year-2-month-old female who presented with a three-month history of behavioural change and regression of previously attained expressive language, followed by transient right-sided weakness, recurrent right-sided focal motor seizures, and progressive hemiparesis. Her early symptoms of irritability and language regression were initially unrecognized as neurological in origin, and even her first episode of transient limb weakness resolved without further evaluation, illustrating how easily the earliest, subtlest features of this disease can be missed. It was only with the onset of recurrent seizures and persistent motor deficits that neuroimaging was pursued. Magnetic resonance imaging demonstrated an acute infarct in the left inferior frontal and parietal regions, while magnetic resonance angiography revealed marked bilateral narrowing of the terminal internal carotid, anterior, and middle cerebral arteries with extensive basal collaterals producing the classical "puff-of-smoke" appearance. Non-contrast computed tomography additionally revealed chronic left hemispheric encephalomalacia with gyriform calcification, indicating an earlier, clinically silent ischemic insult that had gone unrecognized. Digital subtraction angiography confirmed bilateral terminal internal carotid artery stenosis, graded predominantly as Suzuki stage III. The child underwent left-sided encephaloduroarteriosynangiosis (EDAS) with good postoperative recovery of hemiparesis. This case emphasizes that Moyamoya disease must be considered even in the presence of subtle, seemingly unrelated symptoms such as behavioural change or language regression, particularly in settings where diagnostic delay due to varied age-specific presentation and limited imaging access can allow silent, cumulative ischemic injury before diagnosis, underscoring the need for heightened clinical vigilance across all pediatric age groups.

The eye, ear and the kidney: a diagnostic triad in a child with progressive sensory deficits

Deepak Gande — 2026-09-23

Progressive hearing loss and visual impairment in childhood are often evaluated as isolated sensory disorders; however, their coexistence may indicate an underlying multisystem disease. We report a 13-year-old boy who presented with a three- to four-year history of gradually progressive bilateral hearing impairment and diminution of vision. Audiological assessment demonstrated bilateral moderate sensorineural hearing loss, while ophthalmological examination revealed bilateral anterior lenticonus with associated refractive abnormalities. Further evaluation uncovered persistent microscopic hematuria and proteinuria of glomerular origin. The combination of renal, auditory, and ocular abnormalities pointed to a hereditary basement membrane disorder affecting multiple organ systems. Based on the characteristic clinical triad, a diagnosis of Alport syndrome was established. Molecular confirmation was advised but could not be performed because of financial constraints. The patient was initiated on enalapril for renoprotection, fitted with bilateral hearing aids, and referred for ophthalmological surgical evaluation. This case highlights the importance of considering an underlying systemic disorder in children presenting with concurrent sensory deficits. It also emphasizes the value of simple urinalysis as an inexpensive screening tool capable of revealing occult renal involvement and facilitating early diagnosis before the onset of advanced kidney disease.

All rashes in the neonatal period are not benign: a rare case of congenital cutaneous candidiasis in a neonate with cholestasis

Bhavin Bhoraniya — 2026-09-23

Neonatal rashes manifest in various forms-papular, pustular, vesicular, or bullous lesions-and both their morphology and the day of onset provide key diagnostic clues. Benign causes include erythema toxicum neonatorum, transient pustular melanosis, miliaria. It is important to distinguish them from pathological causes like bullous impetigo, neonatal herpes, neonatal varicella or genetic conditions. In this report, we describe a case of congenital candidiasis, presenting with generalized rash with varied morphology and had systemic involvement in form of cholestasis. A systematic approach with proper history, general examination and investigations leads to early diagnosis and reduces morbidity in these babies.

Pediatric myelin oligodendrocyte glycoprotein antibody associated disease following incomplete Kawasaki – a case report with varied association

Kavya Rajanna — 2026-09-23

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has emerged as a distinct inflammatory demyelinating disorder of the central nervous system. Although relatively rare, growing recognition of this entity has highlighted important differences from multiple sclerosis and neuromyelitis optica spectrum disorder, particularly with respect to clinical phenotype, neuroimaging features, and long-term prognosis. We report a 5-year-old girl who presented with acute, painful, and progressive diminution of vision in the right eye, accompanied by impaired color perception for 3 days. Cerebrospinal fluid analysis was unremarkable, with antibody testing negative for neuromyelitis optica spectrum disorder (NMOSD) and positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. She had a recent history of incomplete Kawasaki disease treated with intravenous immunoglobulin one month prior. While systemic corticosteroids led to partial visual improvement, complete recovery was achieved following intravenous immunoglobulin therapy. This case highlights the importance of assessing MOG-IgG antibodies in pediatric patients presenting with optic neuritis. Precise differentiation from other demyelinating disorders is essential for accurate diagnosis and appropriate management. The overall prognosis is generally favorable.

Paediatric paraquat poisoning – two case reports from a quaternary care centre

Thomas Vechukunnel Thomas — 2026-09-23

Paraquat (PQ), or N, N′-dimethyl-4,4′-bipyridinium dichloride, is a widely used herbicide. It is highly toxic and enters the human body mainly by swallowing or through damaged skin but may also be inhaled. Due to its properties being corrosive, it can easily damage the skin, thereby making it easy to absorb. Paraquat poisoning has no known cure and is still a serious toxicological emergency with significant death rates. When paraquat enters into the body, it causes redox cycling and generation of reactive oxygen species (ROS). Once inside the cells, paraquat accepts an electron from nicotinamide adenine dinucleotide phosphate (NADPH) forming the paraquat radical which later becomes a superoxide radical by donating its electron to molecular oxygen. During this process, paraquat is regenerated, thereby continuing the vicious cycle. The mechanism of death is usually respiratory failure and may occur within a few days after poisoning or as long as a month later. The mainstay in the management of paraquat poisoning is supportive care with primary importance given to preventing absorption and promoting the excretion of the toxic compounds all whilst mitigating organ damage. This case series of a 14-year-old and a 17-year-old with paraquat ingestion examines the classic clinical presentation, management challenges and high mortality of paraquat toxicity.

Seizures and isolated motor delay in two siblings: looking beyond cerebral palsy

Lakshmi Aparna Devi V. V. — 2026-09-23

Rickets is a metabolic bone disorder resulting from impaired mineralization of the growing skeleton and may present with nonspecific features such as motor delay, muscle weakness, and seizures. In some children, particularly when skeletal manifestations are subtle, the underlying metabolic cause may be overlooked and the presentation may initially be attributed to nutritional deficiency or a primary neurological disorder. We report two siblings born to consanguineous parents who presented with delayed gross motor milestones and features of rickets. The elder child additionally had hypocalcemic seizures. Both children demonstrated hypocalcemia, markedly elevated alkaline phosphatase and parathyroid hormone levels, normal-to-elevated serum 25-hydroxyvitamin D concentrations, and without renal phosphate wasting. They failed to respond to conventional vitamin D supplementation. Genetic analysis revealed a homozygous pathogenic duplication in exon 8 of the CYP27B1 gene, confirming the diagnosis of VDDR-IA. Treatment with calcitriol and calcium led to rapid biochemical normalisation and significant clinical improvement, culminating in independent ambulation on follow-up. This report emphasizes the importance of considering vitamin D dependent rickets in children with early-onset rickets and poor response to standard therapy, particularly in the presence of consanguinity or sibling involvement. Early genetic diagnosis enables targeted treatment and prevents prolonged morbidity.

Succinyl-CoA:3-ketoacid CoA transferase deficiency presenting as recurrent refractory ketoacidosis in an infant

Noopur Kulkarni — 2026-09-23

Succinyl-CoA:3-ketoacid CoA transferase (SCOT) deficiency is a rare disorder of ketone body utilization caused by impairment of the OXCT1 gene, leading to recurrent life-threatening ketoacidosis despite preserved glycemia. We report an 8-month-old female infant with recurrent episodes of severe high anion gap metabolic acidosis with marked ketosis and preserved blood glucose requiring peritoneal dialysis and mechanical ventilation. Metabolic investigations demonstrated isolated ketone body accumulation and whole exome sequencing identified a homozygous variant of uncertain significance (VUS) in OXCT1, ultimately confirming SCOT deficiency in the appropriate biochemical and clinical context. This case highlights the importance of considering ketolysis defects in infants with recurrent ketoacidosis and preserved glycemia, and demonstrates the utility of extracorporeal therapy in refractory metabolic crises.