ISSN: p-ISSN - 2349-6118; e-ISSN - 2349-6126 Discipline: Pediatrics and Neonatology Starting Year: 2014 Current volume: Volume 10 Issue per year: 13 (monthly) Editor-in-chief: Dr. Nihar Ranjan Mishra, India Indexing: Index Copernicus, EZB, BASE, World Cat, Journal Guide, Google Scholar E-mail: editor.ijch@mansapublishers.com
Artificial Intelligence in Pediatric Healthcare - Part II: AI in Ambulatory Preventive Pediatrics
Artificial intelligence (AI) is increasingly being incorporated into ambulatory and preventive pediatric practice through advances in machine learning, deep learning, computer vision, natural language processing, and mobile health technologies. The growing availability of electronic health records, wearable devices, telemedicine platforms, and digital health applications has created new opportunities for AI-assisted screening, risk prediction, preventive care, and outpatient clinical decision support. In pediatric healthcare, AI has emerging applications in developmental and autism screening, vision and hearing assessment, growth and nutrition monitoring, vaccination programs, infectious disease surveillance, symptom triage, prescribing support, remote patient monitoring, and parent-facing digital health tools. These technologies have the potential to improve early diagnosis, enhance preventive interventions, expand access to care, and support more personalized management of pediatric patients in outpatient settings. However, significant challenges remain, including limited pediatric-specific validation, algorithmic bias, data privacy concerns, regulatory uncertainties, workflow integration barriers, and the need to maintain trust among clinicians and caregivers. This narrative review summarizes current evidence regarding AI applications in ambulatory pediatrics, preventive pediatrics, and pediatric outpatient care, highlighting their clinical utility, limitations, implementation challenges, and future directions. This article is the second in a four-part series on AI in pediatrics; subsequent articles will discuss AI applications in pediatric inpatient and critical care settings, as well as the ethical, regulatory, and future implications of AI in child healthcare
Copyright (c) 2026 Amit Agrawal, Rashmi Agrawal https://creativecommons.org/licenses/by-nc-nd/4.0
Blue Babies with a Red Flag: Methemoglobinemia as a Sentinel Sign of Cow's Milk Protein Intolerance in Infants - A retrospective Case Series
Background: Cow's milk protein intolerance (CMPI), often referred to as cow's milk protein allergy (CMPA), is among the most prevalent food hypersensitivities in children, typically manifesting with gastrointestinal symptoms, including diarrhea and vomiting. Methemoglobinemia is an exceedingly rare complication of CMPI, a life-threatening illness marked by the pathological oxidation of hemoglobin, resulting in impaired tissue oxygen transport and clinically observable cyanosis. Since the precise pathophysiologic mechanism linking intestinal inflammation to methemoglobin accumulation remains unclear, this uncommon association poses diagnostic and therapeutic challenges. This study was done to describe the clinical presentation, diagnostic evaluation, and outcomes of infants with methemoglobinemia due to CMPI, to facilitate early identification and prompt dietary intervention. Materials and Methods: A retrospective case series of 6 infants with methemoglobinemia associated with CMPI is presented here. All patients were either term or late preterm infants with a history of formula or combination feeding. Clinical and laboratory data, encompassing symptomatology, acid-base status, and sequential methemoglobin levels, were systematically evaluated. Results: All six newborns exhibited diarrhea, metabolic acidosis, and elevated methemoglobin levels, with a median methemoglobin concentration of 26% (range 11–30.7%). The therapeutic intervention involved transitioning to extensively hydrolyzed or amino acid-based elemental formulations, together with pharmaceutical treatment of methylene blue and/or ascorbic acid (vitamin C). All patients had full clinical and biochemical remission within 2-3 days of initiating medication. Conclusion: CMPI must be included in the differential diagnosis of unexplained infantile methemoglobinemia. Timely recognition and removal of cow's milk protein from the diet, along with appropriate pharmacological treatment, can lead to rapid and lasting recovery.
Copyright (c) 2026 Nilesh Ranjan, Nitasha Bagga, Vijayanad Jamalpuri, Nalinikanta Panigrahy https://creativecommons.org/licenses/by-nc-nd/4.0
Sphingomonas paucimobilis: An unusual cause of meningitis in a preterm neonate
Copyright (c) 2026 Bhagyashree PR, Varsha Kolachena, Poonam Singh, Suman Chaurasia, Mayank Priyadarshi, Sriparna Basu https://creativecommons.org/licenses/by-nc-nd/4.0
Rare cause of pulmonary hypertension and elevated lactate in a neonate: Scimitar Syndrome Case Report
Scimitar syndrome, a rare congenital anomaly with an incidence of 1-3/100,000 live births, is commonly associated with hypoplasia of the right lung, pulmonary sequestration, and persisting superior vena cava (SVC). The other features are a partial anomalous pulmonary venous connection (PAPVC) with a curvilinear pattern on chest radiograph, with the pulmonary veins draining to the Inferior Vena Cava (IVC). This case report presents a two-week-old female, presented with escalating respiratory distress. Serum lactate gradually increased despite sildenafil and diuretics. Scimitar syndrome with large aortopulmonary collaterals from the celiac trunk was confirmed by contrast CT. Multiple abnormal systemic arteries (4-6 mm in diameter) were discovered during a one-month cardiac catheterization. Transcatheter embolization with Piccolo coils, PDA occlusion devices, and microvascular plugs worked well. Transcatheter embolization of aortopulmonary collateral vessels in neonatal Scimitar syndrome leads to a rapid resolution of high-output cardiac failure and pulmonary hypertension. Transient persistent hyperlactemia (resolving by 6 months of age) is likely due to ischemic changes in the embolized lung. Neonates with hyperlactemia should be screened for Scimitar syndrome.
Copyright (c) 2026 Dalwinder Janjua, Munira AlMaazmi, Shiva Shankar, Suresh Kotinatot https://creativecommons.org/licenses/by-nc-nd/4.0
Development of language in children after cochlear implantation: A narrative review
Background: For newborns and young children with congenital bilateral severe to profound sensorineural hearing loss who benefit little from properly fitting hearing aids, pediatric cochlear implantation (CI) is the recommended course of treatment. Pediatric CI significantly improves speech and language development. The development of speech and language is often faster than pre-CI rates. Materials and Methods: A narrative review of published literature was conducted by using databases like Google Scholar, Scopus, PubMed, and Medline. Key references were identified through searching the database and manual screening of reference lists from seminal papers. There were 45 out of the 70 publications (24 case reports, 20 case series, and 26 original studies) received from different databases included in this PRISMA Flow diagram for study selection. Results: The outcomes of CI in pediatric patients are highly variable. The consistent speech therapy, involvement of family, and early intervention are vital for maximizing language skills. For young children with severe-to-profound sensorineural hearing loss (SNHL), CI is a surgical substitute for conventional amplification (hearing aids) that can promote spoken language development. Post-implant spoken language outcomes are still very diverse, ranging from strong speech recognition and age-appropriate language to little improvement in sound detection with limited speech perception and language delays, despite notable advancements in cochlear implant device technology and surgical safety. By considering post-implant language development predictions into intrinsic and extrinsic elements and emphasizing clinically useful tactics to maximize therapies, this narrative review incorporates data from the literature. Conclusion: Early CI in children followed by early auditory verbal therapy (AVT) is helpful for optimum speech and language development. Regular follow-up and active participation by parents are required to optimize the outcomes. The duration of AVT after pediatric cochlear implantation has an impact on the hearing and language development of a child.
Copyright (c) 2026 Santosh Kumar Swain, MS(ORL), DNB(ORL), MNAMS https://creativecommons.org/licenses/by-nc-nd/4.0
Artificial Intelligence in Pediatric Healthcare Part I: Foundations and Basic Concepts
Artificial intelligence (AI) is rapidly transforming healthcare by enabling machines to analyze complex datasets, recognize patterns, and support clinical decision-making. Advances in machine learning (ML), deep learning (DL), and computational technologies, along with the widespread digitization of health records, have accelerated the integration of AI into medical research and clinical practice. In pediatric healthcare, AI has emerging applications in developmental screening, growth and nutrition monitoring, early disease detection, medical imaging interpretation, and prediction of clinical deterioration, particularly in neonatal and pediatric intensive care settings. However, the safe and effective use of AI in pediatric practice requires a clear understanding of its fundamental concepts, methodologies, data sources, and evaluation processes. This narrative review summarizes the foundational concepts of AI relevant to medicine and pediatrics, including the historical evolution of AI in healthcare, core methodologies, types of machine learning models, major clinical data sources, and the development pipeline of medical AI systems. This article is the first in a four-part series on AI in pediatrics; subsequent articles will discuss AI applications in ambulatory pediatrics, hospital and critical care settings, and the ethical and regulatory considerations related to the use of AI in child health.
Copyright (c) 2026 Amit Agrawal , Rashmi Agrawal https://creativecommons.org/licenses/by-nc-nd/4.0
Supra-Cardiac Bronchogenic Cyst Masquerading as lower respiratory tract infection in a Young Infant: A Case Report
Bronchogenic cysts are rare congenital malformations of the foregut that may present with nonspecific respiratory symptoms, often leading to misdiagnosis. We report a case of a 4-month-old boy with recurrent episodes of cough, fever, and respiratory distress, initially managed as bronchopneumonia during previous hospitalizations. Despite partial clinical improvement, the child developed oxygen dependency and intermittent stridor during weaning attempts. Radiological evaluation revealed left lung hyperinflation with a mediastinal shift, raising suspicion of an underlying mass. Point-of-care ultrasound identified a cystic lesion above the left atrium, which was further characterized by computed tomography (CT) as a well-defined mediastinal cyst compressing the tracheobronchial tree. The patient underwent successful surgical excision through thoracotomy. Histopathological examination confirmed the diagnosis of bronchogenic cyst. The postoperative recovery was uneventful. This case highlights the importance of maintaining a high index of suspicion for congenital cystic lesions in infants with recurrent or atypical respiratory symptoms. Early use of bedside ultrasound and advanced imaging can facilitate prompt diagnosis and management, preventing complications associated with airway compression.
Copyright (c) 2026 Avinash Kumar, Rajan Kumar, Soumi Kundu, Nishat Ahmed Sheikh, Md Ehtesham Ansari https://creativecommons.org/licenses/by-nc-nd/4.0
A Storm in the Cradle: Fulminant Neisseria meningitidis Infection with Multifocal CNS Complications in a 3-Month-Old Infant
Bacterial meningitis in early infancy is a life-threatening condition associated with high morbidity and mortality. Neisseria meningitidis infection is uncommon in infants younger than three months but may present with a rapidly progressive and fulminant clinical course. A case of a 3-month-old male infant presenting with fever and refractory generalized seizures requiring mechanical ventilation is presented here. Cerebrospinal fluid (CSF) analysis revealed elevated protein with minimal pleocytosis, while culture confirmed Neisseria meningitidis. Neuroimaging demonstrated diffuse cerebral edema with extensive central nervous system (CNS) involvement, including subdural empyema, subdural effusion, encephalitis, cerebral abscess formation, and subarachnoid hemorrhage. Despite aggressive antimicrobial therapy and multiple antiepileptic drugs, the patient developed focal seizures. Neurosurgical intervention was advised but declined by caregivers. This case highlights the aggressive nature of meningococcal infection in early infancy, atypical CSF findings, and the importance of early neuroimaging and multidisciplinary management. Prompt diagnosis and timely intervention are critical to improving outcomes.
Copyright (c) 2026 N Satya Sravani, S Velusamy, Sakthi Velayutham, PR Sowmini, Kannan V https://creativecommons.org/licenses/by-nc-nd/4.0
Feasibility study for use of an educational program on essential newborn care practices for mothers in selected urban communities of Delhi: A pilot study
Background: The first month of life (neonatal period) represents the most critical period for child survival. Although neonatal mortality has declined by 44% since 2000, nearly half (47%) of all deaths in children under five years of age in 2022 occurred during the neonatal period. This phase remains one of the most vulnerable stages and necessitates enhanced quality newborn care. Therefore, implementing strategies to strengthen mothers' capacity to provide essential newborn care is imperative. This study was done to assess the feasibility of using a developed educational program on essential newborn care practices among mothers. Methodology: A pre-experimental study design was employed for the present research. Study participants were initially approached during the antenatal period, and the same mothers were subsequently contacted within 3 to 7 days postpartum for the first pre-test assessing essential newborn care practices. Following this, an intervention was administered. Two post-tests were conducted: the first on the 7th day after the intervention and the second on the 28th day of the postnatal period to evaluate essential newborn care practices. Results: Study findings proved there was an improvement in essential newborn care practices among mothers as compared to essential newborn care practices from pre-test 10(10.34) to post-test I 65.86(7.93) and post-test II 79.86(1.99). The mean (SD) practice scores were enhanced, respectively. Conclusion: The educational intervention was found to be effective in improving essential newborn care practices among mothers.
Copyright (c) 2026 Prerna Sharma, Dr Laxmi https://creativecommons.org/licenses/by-nc-nd/4.0
A Rare Case of Homozygous δβ-Thalassemia in Childhood: Molecular Diagnosis and Comprehensive Family Analysis
Delta- Beta (δβ)-Thalassemia is a rare autosomal recessive hemoglobinopathy caused by deletions in the δ- and β-globin genes, leading to prolonged fetal hemoglobin (HbF) production. δβ-Thalassemia can resemble β-thalassemia major due to anemia and increased HbF. A step-by-step method is required for accurate diagnosis, which includes initial HPLC screening, family hemoglobin studies, and molecular tests. A four-year-old female presented with anemia. Initial HPLC results showed HbF 99.2%, HbA 0.8%, and no HbA₂, indicating a rare hemoglobinopathy. Subsequent family HPLC tests revealed inheritance patterns, but conclusive carrier status was not identified until molecular testing. Molecular investigation verified a homozygous loss of HBB, HBD, and HBG1. Pedigree analysis indicated autosomal recessive inheritance in which both parents and siblings were identified as heterozygous carriers. The identification of unique laboratory and molecular features facilitates genetic counselling and family screening, thereby aiding in the prevention of misdiagnosis and the avoidance of unwarranted transfusions.
Copyright (c) 2026 Pavan Ganesh Dave, Prashant Mahendrabhai Parikh, Bhavini Sandip Shah, Sandip Chandrakant Shah, Ankita Girish Murnal https://creativecommons.org/licenses/by-nc-nd/4.0
Isolated Ectrodactyly in a Late Preterm Neonate: A Case Report
Ectrodactyly, also known as Split Hand Foot Malformation (SHFM), is a rare congenital limb defect characterized by the partial or complete absence of the central rays of the hands and feet, resulting in a varied spectrum of anomalies ranging from mild digital deficiencies to the classic “split” appearance of the affected limb. It may involve a single or multiple extremities, and its presentation can vary widely even within the same family. Ectrodactyly may occur as an isolated malformation or as part of a broader syndrome, often associated with additional craniofacial, auditory, or neurodevelopmental abnormalities. Although the exact etiology is heterogeneous, genetic factors play a significant role, with several chromosomal regions and genetic mutations implicated in their pathogenesis. Early recognition of SHFM is important for timely evaluation, genetic counselling, planning functional and reconstructive interventions, and rehabilitation. In this report, we present a case of SHFM, outlining its clinical presentation and discussing the diagnostic and therapeutic considerations relevant to its management.
Copyright (c) 2026 Gaurav Gautam, Manish Choudhary, Mayank Priyadarshi, Suman Chaurasia, Poonam Singh, Sriparna Basu https://creativecommons.org/licenses/by-nc-nd/4.0
Neurodevelopmental status of Severe Acute Malnutrition children of 6 months to 59 months and its follow-up at 6 months using Trivandrum Developmental Screening Chart (TDSC)
Background: Malnutrition has a significant impact on the neurodevelopment of Children. Toddlers, especially those below 24 months, are more prone to malnutrition and neurodevelopmental delay. Once neurodevelopmental delay develops, there will not be much improvement even after treatment or rehabilitation. The nutritional status of severe acute malnutrition (SAM) children can be reverted to normal by proper management, rehabilitation, following advice, and with regular follow-up. This study was done to assess the neuro-developmental delay in SAM children at the time of diagnosis and their follow-up after six months to assess the level of recovery, if any, after the treatment using the Trivandrum Developmental Screening Chart (TDSC). Materials and Methods: A total of 103 children were assessed for any delay in development using TDSC at the time of diagnosis and after 6 months from the diagnosis, post-rehabilitation and treatment. The chronological and developmental ages were measured and marked at both intervals, which, on analysis, gave the developmental delay for that corresponding age if present. Results: Of 103 children, 47 (45.6%) identified as having developmental delay using the TDS chart. The highest number of children with neurodevelopmental delay (38 out of 47, i.e., 80.9%) was observed in the 6-24-month age group, which decreased to 32 (82.1%) at the 6-month follow-up. Among children aged > 24 months, 9 (19.1%) participants had Neurodevelopmental delay, while at follow-up, only 2 recovered, and 7 (17.9%) were found to have neurodevelopmental delay even after treatment and rehabilitation. Conclusion: The results show that once neurodevelopmental delay develops due to malnutrition during a vulnerable period, it will not improve even after treatment or rehabilitation.
Copyright (c) 2026 Ravi Teja Satyala, Arun Kumar, Adarsh Soman, Saswath Ranjan Raul https://creativecommons.org/licenses/by-nc-nd/4.0
Not All Infantile Air Leaks Tell the Same Story: A Case Series from South India
Spontaneous pneumothorax (SP) in infancy is uncommon and often secondary to underlying infectious, congenital, or neoplastic lung pathology. Clinical presentation may be subtle, and pediatric management strategies are largely extrapolated from adult guidelines. In this case series, five infants aged 2–8 months with spontaneous pneumothorax are presented. Etiologies included viral lower respiratory tract infection in three infants, congenital bullous disease in one, and pleuropulmonary blastoma in the last infant. Two infants were managed successfully with intercostal chest drainage. Three of them required surgical intervention due to persistent air leak or structural lung abnormality, including bullectomy and lobectomy. One infant was diagnosed with Type I pleuropulmonary blastoma on histopathology. From these cases, it can be inferred that infantile spontaneous pneumothorax represents a heterogeneous clinical entity. Persistent or recurrent air leak warrants advanced imaging and early surgical evaluation to identify underlying structural or neoplastic causes.
Copyright (c) 2026 Krishna Chaitanya Dharmavarapu, Yeluri Vidyasree, Ramya Keerthy, Ravula Satyanarayana https://creativecommons.org/licenses/by-nc-nd/4.0
When Electrolytes Shocks You: Classical Bartter Syndrome (Type III) Presenting with Refractory Shock and Recurrent Extubation Failure in a 9Month-Old Infant.
Bartter syndrome (BS) is a rare inherited renal tubular disorder characterized by hypokalemia, metabolic alkalosis, renal salt wasting, and secondary hyperreninemic hyperaldosteronism with normal or low blood pressure. The classical form (type III) is commonly present in infancy or early childhood but may demonstrate variable clinical features, leading to delayed diagnosis. A 9-month-old male infant was admitted with severe pneumonia and septic shock requiring mechanical ventilation. The child developed persistent hypokalemia, hyponatremia, and metabolic alkalosis despite appropriate correction, resulting in four episodes of extubation failure. Persistent dyselectrolytemia in the presence of normotension and inappropriate renal electrolyte losses raised suspicion of an underlying renal tubular disorder. Elevated plasma renin and aldosterone levels supported the diagnosis of classical BS. Stabilization of serum electrolytes resulted in successful extubation and clinical improvement. This case highlights the importance of considering BS in infants with refractory electrolyte imbalance and unexplained ventilator dependence, particularly when renal salt wasting is evident.
Copyright (c) 2026 Animesh Gandhi, Aachal Sadani, Narendra Gandhi, Hemraj Dewangan https://creativecommons.org/licenses/by-nc-nd/4.0
Respiratory Distress Syndrome in Preterm Neonates: A Comprehensive Narrative Review
Background: Respiratory distress syndrome (RDS) is a leading cause of respiratory morbidity and mortality in preterm neonates, primarily resulting from surfactant deficiency and structural lung immaturity. Despite advances in perinatal care, RDS continues to contribute to substantial early neonatal mortality and long-term complications such as bronchopulmonary dysplasia (BPD), especially in extremely preterm infants. Materials and Methods: A narrative review of published literature was conducted using standard neonatology textbooks, international guidelines (European 2022 and Indian 2022), and peer-reviewed articles from PubMed, Cochrane Library, and Google Scholar. The search covered publications from 1959 to 2023. Key references were identified through targeted database searches and manual screening of reference lists from seminal papers. A total of 35 key references were selected based on their scientific rigor, clinical relevance and contribution to understanding fetal lung development, surfactant biology, epidemiology, pathophysiology, diagnostic approaches, and management strategies for RDS in preterm neonates. Results: Advances in antenatal care, respiratory support, and surfactant therapy have significantly improved outcomes in preterm infants with RDS. Improved understanding of lung development and surfactant biology has guided preventive strategies such as antenatal corticosteroids. Diagnostic modalities have evolved from chest radiography to lung ultrasound, which allows reliable bedside assessment and prediction of CPAP failure and surfactant requirement. Management has shifted toward early CPAP, caffeine therapy, volume-targeted ventilation, and minimally invasive surfactant administration techniques such as LISA/MIST, reducing ventilatorinduced lung injury and improving survival without BPD. Conclusion: Integration of modern diagnostic tools, minimally invasive respiratory support, and guideline-based management has transformed outcomes in RDS OF preterm infants. Adapting global recommendations to local resource settings is essential for further improving survival and long-term respiratory outcomes.
Copyright (c) 2026 Fathima Ahana, Agnes Harmath https://creativecommons.org/licenses/by-nc-nd/4.0
Big Feelings in a Small Syringe: Exploring Parental Distress in Type 1 Diabetes and the Buffering Role of Child Life Specialists
Background: Caring for a child or adolescent with Type 1 Diabetes (T1D) requires sustained emotional, relational, and behavioural involvement from parents and may lead to psychological distress. Although parental diabetes-related distress has gained increasing recognition globally, evidence from Indian paediatric care settings remains limited, where psychosocial services are not routinely integrated into diabetes management. A clearer understanding of the psychological dimensions of parental distress is essential for developing family-centred interventions. Materials and methods: This pilot cross-sectional exploratory study was conducted during a Diabetes Awareness Camp at Aster CMI Hospital, Bangalore. Thirteen parents (eight fathers and five mothers) of children and adolescents with T1D attending a multidisciplinary clinic participated. Parental distress was assessed using the Parent Diabetes Distress Scale (Parent-DDS), a validated psychological instrument evaluating four domains: Teen Management Distress, Parent–Teen Relationship Distress, Personal Distress, and Healthcare Team Distress. Data were analysed using descriptive and exploratory statistical methods. Results: Parents reported a moderate level of overall psychological distress (mean score = 2.60). Distress related to parent–teen interactions was the most prominent domain (mean = 2.73), indicating substantial relational strain associated with diabetes management. The Healthcare Team Distress domain demonstrated the greatest variability (SD = 1.09), reflecting differences in perceived quality of medical communication and support. Approximately 25% of participants had distress scores in the high range (≥ 3.20), indicating clinically meaningful emotional burden. Fathers tended to report higher distress levels than mothers across several domains; however, these differences were not statistically significant. Conclusion: A considerable proportion of parents of children with T1D experience elevated psychological distress, primarily influenced by relational challenges and perceptions of professional support rather than medical factors alone.
Copyright (c) 2026 Preeti Singh, Sushma Gopalan, Shruti Sastry, N Kavitha Bhat, Chetan Ginigeri https://creativecommons.org/licenses/by-nc-nd/4.0
Study of the Prevalence of Obesity and Its Association with Selected School Performance Measures Among School-age Children in Mosul, Iraq
Background: Childhood obesity is a growing public health concern worldwide, with implications for both physical health and cognitive development. Limited data exist in Mosul, Iraq, regarding the prevalence of obesity among primary school children and its potential impact on academic performance. Materials and Methods: An analytical cross-sectional study was conducted from January to June 2025 among 2,310 primary-school children aged 6–12 years in Mosul. Anthropometric measurements (height, weight, BMI) were obtained and classified using CDC growth charts. A structured questionnaire assessed sociodemographic and lifestyle factors. Academic performance was evaluated using standardized Stage 6 mathematics examination scores. Logistic regression identified predictors of overweight/obesity, while multiple linear regression examined associations between obesity and mathematics scores, adjusting for confounders. Results: The prevalence of overweight and obesity was 6.1%, with boys (7.8%) more affected than girls (4.3%). Significant predictors included age (11–12 years), male gender, higher household income, urban residence, parental obesity, prolonged screen time, reduced physical activity, and frequent fast-food consumption. Mathematics scores were negatively associated with obesity, male gender, screen time ≥3 hours/day, and fast-food intake, while positively associated with parental education, higher parental income, urban residence, and daily physical activity ≥30 minutes. Conclusion: Childhood overweight and obesity in Mosul are relatively common and significantly associated with lower mathematics performance. Early interventions involving schools, families, and healthcare providers are essential to promote healthier lifestyles and academic achievement.
Copyright (c) 2025 Riyadh Abdulatif Al-Obeidi, Mahdi Mustafa khder, Hamad Jandari Jumaa https://creativecommons.org/licenses/by-nc-nd/4.0
Safety and Tolerability of Intravenous Bisphosphonate Infusion to Improve Bone Mineral Density in Children with Spinal Muscular Atrophy at a Tertiary Care Hospital in India: An Observational Retrospective Study
Background: Children with spinal muscular atrophy (SMA) have significantly reduced bone mineral density (BMD) compared to other neuromuscular disorders, predisposing them to frequent fractures. Despite this, bone health is frequently under-researched and under-managed in SMA care. Intravenous (IV) bisphosphonates, particularly zoledronate, reportedly improve BMD and reduce fracture risk in other disorders, with a favorable safety profile. This study aimed to evaluate the safety and tolerability of IV zoledronate in SMA type 2 pediatric patients in a tertiary care hospital. Materials and Methods: An observational retrospective study was conducted between June 2022 and July 2024. Twenty-two patients with SMA type 2 had their case notes from the SMA clinic retrospectively reviewed; of these, 8 patients (aged 5-17 years) with SMA type 2 had low BMD (Z <-2.5 on DEXA scan) who met the fitted inclusion criteria and received 0.05 mg/kg body weight of IV zoledronate every 6 months. Patients were monitored for adverse events (AEs), fractures, and clinical outcomes. Results: Fifteen infusions were administered in total; no serious Adverse Events (AEs) or adverse drug reactions (ADR) were observed. Grade I fever in 50% (3/6) of the females and infusion-related grade II pain in 87.5% (7/8) of the patients were observed, which resolved within 24 h with paracetamol. No patient required re-admission. Laboratory parameters and motor scales remained stable and no fractures occurred during the study period. Conclusion: IV zoledronate is safe and well-tolerated in children with SMA type 2 in their multidisciplinary management.
Copyright (c) 2025 Sanjukta De, Shreya De, Subhrojyoti Bhowmik https://creativecommons.org/licenses/by-nc-nd/4.0
Urological Anomalies in Early Childhood UTI: MCU Detects What Ultrasound Misses
Background: Urinary tract infection (UTI) is a common serious bacterial infection in young children and may be associated with underlying congenital anomalies of the kidney and urinary tract (CAKUT). Early identification of these anomalies is essential to prevent renal scarring and long-term renal morbidity. However, the optimal imaging strategy following UTI in young children remains debated. This study aimed to determine the prevalence and pattern of urinary tract anomalies in children and to evaluate the diagnostic yield of renal–bladder ultrasonography (RBUS) and micturating cystourethrogram (MCU). Methods: This prospective observational study was conducted in a tertiary care hospital over 1.5 years. Children aged 1 month to 5 years admitted with UTI were included. All participants underwent RBUS and MCU following treatment of the acute infection. Additional imaging was performed when indicated. Vesicoureteral reflux (VUR) was graded according to standard criteria. Results: Ninety-six children were included in the final analysis. RBUS was abnormal in 61.4% of children, most commonly showing hydronephrosis. MCU detected abnormalities in 33.3%, with vesicoureteral reflux identified in 28.1%. High-grade reflux (Grades IV–V) constituted the majority of VUR cases. Notably, 70.3% of children with VUR had a normal RBUS. Renal scarring was detected in a substantial proportion of children with VUR who underwent DMSA scanning. Conclusions: MCU demonstrated a superior diagnostic yield in children with UTI who have underlying urological anomalies compared to ultrasonography, supporting the inclusion of MCU in the initial evaluation of young children with culture-proven UTI, especially in settings with a high burden of congenital uropathies.
Copyright (c) 2026 Aishwarya Venugopal, Prasanth Soundararajan, Nikhil Kumar, Anjana S.R.Krishnan, Ramesh Bhat Y https://creativecommons.org/licenses/by-nc-nd/4.0
Harlequin Ichthyosis in a Term Neonate with Consanguineous Parents: A Fatal Case Report
Background: Harlequin Ichthyosis (HI) is a rare, severe autosomal recessive keratinization disorder caused by mutations in the lipid-transporter gene ABCA12. The mutation leads to defective lipid transport, impaired ceramide formation, and failure of epidermal barrier development, predisposing neonates to infection, dehydration, and respiratory compromise. Case Presentation: A 38–39-week gestational age male neonate, born via lower-segment cesarean section to second-degree consanguineous parents, presented at birth with generalized rigid hyperkeratotic yellow skin plates separated by deep erythematous fissures, bilateral ectropion, eclabium, malformed ears, and limb contractures. Supportive care, including emollients, sterile non-adherent dressings with topical antibiotic over fissures, and graded enteral feeding, was provided. On day 3, the neonate developed progressive respiratory insufficiency with oxygen desaturation, requiring endotracheal intubation; however, he succumbed to death within hours due to respiratory failure. Postmortem genetic sequencing could not be performed. Conclusion: This case highlights the fulminant clinical course of severe HI phenotype, persistent mortality risk in resource-limited settings, and the importance of early clinical suspicion, multidisciplinary supportive care, informed consent-based photo documentation, and parental genetic counseling.
Copyright (c) 2025 Sunilkumar Pargi, Rishi Patel, Pankti Desai, Sunil Chand, Halak Chauhan https://creativecommons.org/licenses/by-nc-nd/4.0
A Rare Cause of Unilateral Nasal Cavity Mass
Nasal cavity masses in children pose a diagnostic challenge due to varied etiology and potential intracranial extension. Among these, frontoethmoidal meningoceles are rare congenital lesions, typically present in infancy with external nasal swelling or craniofacial abnormalities. Post-traumatic meningoceles are even rarer and may present as an intranasal mass, delaying diagnosis. Case: A case of a three-year-old girl with a progressively enlarging right nasal mass first noted at seven months of age following trauma is presented here. The lesion eventually protruded externally and caused periorbital swelling, noisy breathing, and mouth breathing, without cerebrospinal fluid (CSF) rhinorrhea or neurological deficits. Examination revealed a soft, pale-yellow mass with hypertelorism. Magnetic Resonance Imaging (MRI) revealed a cystic lesion in the right ethmoid region with a defect in the cribriform plate, consistent with a frontoethmoidal meningocele. The patient underwent right frontal craniotomy with trans nasal repair of the skull base defect with optimum postoperative recovery. Conclusion: Frontoethmoidal meningocele can present as a nasal mass in children, particularly after trauma, even without CSF leak or neurological deficits. Radiological evaluation is essential for diagnosis, and early surgical repair provides definitive management with a favorable outcome.
Copyright (c) 2026 Hamsika V, Prerna Batra, Vikram Bhaskar https://creativecommons.org/licenses/by-nc-nd/4.0
Blurred Vision, Clear Clue: The Cascade Sign in a Child with Recurrent Optic Neuritis
Neuro-Behçet’s disease (NBD) refers to a constellation of neurological signs and symptoms occurring in patients with Behçet's disease (BD). Pediatric NBD (PNBD) is extremely rare and can present with headache, meningitis, stroke, cerebral venous sinus thrombosis (CVST), psychiatric symptoms, and recurrent fever. Optic nerve involvement in BD has been reported. However, it almost always occurs alongside other features of BD or NBD, which either precede or follow ocular symptoms. Isolated ocular manifestations of PNBD are extremely rare. NBD can be associated with characteristic abnormalities in neuroimaging. We present an unusual PNBD case with recurrent unilateral (left) optic neuritis (ON) without any systemic features or neurological manifestations. The diagnosis was made based on the Cascade sign visualized on Brain Magnetic Resonance Imaging (MRI), highlighting the importance of recognizing neuroimaging patterns. A differential diagnosis of PNBD should be considered in such unusual cases in which other causes of ON have been ruled out, and there are supporting diagnostic markers, such as human leukocyte antigen B51 (HLA-B51) positivity, with or without neuroimaging features of NBD. Early diagnosis ensures disease remission and prevents PNBD-associated morbidity.
Copyright (c) 2025 Minal V Kekatpure, Jyoti H Matalia, Aruna Bhat, Vidya Lakshmi BK, Vikram Huded https://creativecommons.org/licenses/by-nc-nd/4.0
Quality of life of caregivers of children with cerebral palsy in Assam, India
Background: Cerebral palsy (CP) is a common childhood disability worldwide that places significant demands on caregivers. Empirical evidence on caregiver strain is scarce in India. This cross-sectional study assessed the quality of life (QOL) of 140 purposively chosen caregivers of children aged 4-12 with CP in Assam, India, using the WHOQOL-BREF questionnaire. Methods: Subscale scores were computed with reliability confirmed using Cronbach's α. Spearman's rank correlation and chi-square tests were performed to investigate the associations of caregiver and child characteristics with the QOL of caregivers. Results: The overall QOL score was 48.46 ±11.49, with 82% of caregivers reporting poor QOL. Significant variations in QOL were associated with parental education, father’s occupation, perceived parental physical and mental health, social isolation, awareness of social services, child’s GMFCS levels, special school enrolment, associated conditions, and social support. Spearman’s rank correlation revealed that the father’s age, mother’s years of schooling, GMFCS levels, and associated conditions of the child were correlated with the QOL of caregivers. Conclusions: Community-level awareness generation programs, establishment of an affordable special school, and increased enrolment, along with a disability-friendly health system, will enhance the QOL of the caregivers.
Copyright (c) 2025 Daisy Saikia, Manas Ranjan Pradhan https://creativecommons.org/licenses/by-nc-nd/4.0
Child Protection and Maltreatment in India: Understanding the Burden, Legal Framework, and the Role of Paediatricians
Child maltreatment remains a major public health concern in India. Child abuse includes physical, emotional, sexual, and neglect-related harm. Risk factors operate across individual, family, community, and societal levels. Legal protections are extensive but unevenly implemented, despite comprehensive legislation, including the Protection of Children from Sexual Offences Act and the Juvenile Justice Act; the burden of abuse remains high with persistent underreporting. National health programs support early identification. Persistent clinical challenges include limited training, unclear pathways, and rising digital threats. Strengthened training, structured screening tools, multidisciplinary collaboration, and enhanced community awareness are essential to improve child protection. This review summarises the epidemiology, types of abuse, risk factors, legal frameworks, national health programs, and current management approaches. Gaps in paediatric awareness, challenges in reporting, inconsistent enforcement, and emerging threats such as cyber abuse are also highlighted.
Copyright (c) 2025 Aditi Sinha, Sanjana Hansoge Somanath, Raj Prakash https://creativecommons.org/licenses/by-nc-nd/4.0
What is new in the management of distal VP shunt catheter extrusion through the anus: A brief review of recently published literature
The objectives of the current study were to briefly review the demographics, clinical characteristics, and outcomes of the surgical procedures performed for the cases managed for the trans-anal extrusion of the distal ventriculo-peritoneal (VP) shunt catheter. The current literature review focused on cases published between January 1, 2021, to December 31, 2024. The relevant literature/articles were retrieved through an online database search. This literature review included n=50 cases (males n=27 and females n=23) of distal VP shunt catheter extrusion through the anus. In approximately four-fifths (n=40) of cases, the indication for primary VP shunt insertion was congenital hydrocephalus. Approximately two-thirds (n=31) of cases involved were ≤ 24 months at the extrusion of the distal VP shunt catheter. Approximately two-thirds (n=32) of extrusions of distal VP shunt catheter occurred within 12 months of the initial VP shunt catheter insertion or last shunt revision. The main complaint reported was the extrusion of the distal shunt catheter through the anal canal. For 96% (n=48) of the cases, the entire shunt system or the distal shunt catheters were removed with or without external ventricular drainage (EVD). Most cases recovered well, but this review also noted one death. Distal ventriculo-peritoneal shunt catheter extrusion through the anus, primarily reported in children ≤ 5 years, though cases have also been reported in older children, adults, and older individuals. For management, the preferred approach was the removal of the entire or distal shunt catheter with or without external ventricular drainage and delayed re-VP shunt catheter insertion.
Copyright (c) 2025 Rajendra K Ghritlaharey https://creativecommons.org/licenses/by-nc-nd/4.0
Extubation failure in PICU: The Preventive Strategies and Lessons Learnt
Mechanical ventilation has always played a pivotal role in saving lives in pediatric critical care. But as indications for the same have been elaborated in literature, weaning is still a challenging task. A structured weaning protocol is required to prevent extubation failure in a critical care setting. Prolonged mechanical ventilation, extended sedative use, post-extubation stridor (PES), and diminished respiratory muscle strength are major causes of failed extubation. To tackle its impact, many new techniques, indices, and modalities are being developed. Using non-invasive ventilation for weaning, peri-extubation steroids, minimal sedation, and nutrition maintenance are some of the strategies that have been shown to improve the ventilation outcomes. Diaphragmatic ultrasonography has emerged as a new non-invasive technique to test diaphragm strength and can be used to assess readiness for successful extubation. Integrating knowledge about risk factors, applying defined tests and maneuvers, and using different parameters and ultrasonography to monitor diaphragm function can improve the chances of successful extubation.
Copyright (c) 2025 Vaishali Sharma, Abhishek Navik, Vikram Bhaskar, Prerna Batra https://creativecommons.org/licenses/by-nc-nd/4.0
Fibrovascular Polyp of the Esophagus in an Infant: A Rare Case Emerging from a Tribal Healthcare Setting.
Fibrovascular polyp is a rare benign intraluminal submucosal lesion of the esophagus that usually arises from the proximal portion and, despite its non-malignant nature, can enlarge significantly and lead to life threatening complications, particularly in children where cases are exceedingly uncommon. We report a 7-month-old female infant who presented with progressive dysphagia, intermittent respiratory distress, and protrusion of a soft mass from the mouth during coughing. Imaging revealed a fat-attenuated lesion in the upper cervicothoracic esophagus, while endoscopy demonstrated a large pedunculated mass. Surgical excision was performed via left lateral pharyngo-esophagostomy, and histopathology confirmed fibrovascular polyp composed of myxoid, fibrofatty, and collagenous tissue with dilated vascular channels beneath squamous epithelium. The postoperative course was uneventful, with resolution of dysphagia and respiratory symptoms, and at three-month follow-up no recurrence was detected. This case underlines the importance of considering fibrovascular polyp in the differential diagnosis of infants presenting with unexplained dysphagia, recurrent respiratory compromise, or visible oropharyngeal masses. Although benign, delayed recognition may result in aspiration or fatal airway obstruction, making early diagnosis and prompt surgical intervention crucial. Reporting such rare pediatric cases enhances clinical awareness and contributes to timely recognition and management in future practice. Written informed parental consent was obtained for publication.
Copyright (c) 2025 Rajan Kumar, Akanksha Raj, Soumi Kundu, Nishat Ahmed Sheikh, Md Ehtesham Ansari https://creativecommons.org/licenses/by-nc-nd/4.0
Rare Yet Reversible: CA5A Deficiency Presenting as Neonatal Metabolic Crisis
Carbonic anhydrase 5A (CA5A) deficiency (OMIM 615751) is a rare autosomal recessive metabolic disorder caused by mutations in the CA5A gene on chromosome 16q24.2. Deficiency of this mitochondrial enzyme disrupts bicarbonate production, impairing ureagenesis and energy metabolism, and typically presents in neonates with hyperammonemic encephalopathy, lactic acidosis, and hypoglycemia. We report a term neonate who developed severe hyperammonemia with encephalopathy on day 4 of life, requiring peritoneal dialysis, nitrogen scavengers, and ventilatory support. Tandem mass spectrometry and urinary GCMS were non-diagnostic, but singleton exome sequencing identified a homozygous CA5A variant, c.721G>A (p.Glu241Lys), classified as likely pathogenic. With early intervention, the infant recovered fully and remains metabolically stable with normal growth and neurodevelopment at 5 years of age. This case underscores the diagnostic challenge of CA5A deficiency, highlights the role of exome sequencing, and demonstrates the potential for excellent long-term outcomes with timely recognition and management.
Copyright (c) 2025 Abhishek K Phadke, Ali Kumble, Arun Varghese, Manju Jacob, Anciline Siriac https://creativecommons.org/licenses/by-nc-nd/4.0
Multisystem Inflammatory Syndrome in Children (MIS-C) with Kawasaki Disease (KD) phenotype – A case report
The coronavirus pandemic has led to the emergence of a new entity in children called Multisystem Inflammatory Syndrome in Children (MIS-C), which has different phenotypes. Coronavirus disease 2019 (COVID-19) has affected all age groups, with the emergence of MIS-C, having features overlapping with Kawasaki Disease (KD). A case with a variant of MIS-C showing overlapping features of KD occurring in a child post-COVID infection is presented in this report. A 2-year-old male was presented with complaints of fever and rash for the past 6 days. Examination showed maculopapular rash, conjunctival congestion, and unilateral cervical lymphadenopathy. Routine investigations were suggestive of thrombocytopenia, transaminitis, hyponatremia, and positive Creactive protein (CRP). The fever panel sent was negative. The patient was started on antibiotics provisionally. But in view of the persisting fever and clinical assessment, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) IgG antibody and D dimer levels were elevated, which distinguished it from KD. The patient was diagnosed with a case of MIS-C with KD phenotype and managed accordingly. This case highlights that thorough clinical examination with necessary investigations helps in early diagnosis and timely treatment, since delay in diagnosis can lead to both short and long-term complications in MIS-C.
Copyright (c) 2026 Vyas Kumar Rathaur, Monica Jassal, Meenakshi Rawat https://creativecommons.org/licenses/by-nc-nd/4.0
Emergency Endotracheal Intubation in a Pediatric Intensive Care Unit: A Quality Improvement Study
Background: Emergency Endotracheal Intubation (EEI) is a high-risk procedure with complications such as hypoxemia and hypotension. Despite these risks, EEI is routinely performed in Pediatric Intensive Care Unit (PICUs), which are complex and hazard-prone environments. Suboptimal intubation can lead to adverse outcomes, including brain injury, cardiac arrest, and death. Quality improvement (QI) measures, including system changes and standardized protocols, have been shown to improve first-pass success rates and reduce adverse events. This study describes a QI project aimed at enhancing safety EEI. Objective: To improve the first pass success rate of emergency endotracheal intubation in children in the PICU and reduce procedure related adverse events through QI interventions. Method: The study was conducted in the PICU over three months. A multidisciplinary QI team was formed. Baseline data were collected from 50 intubations using a structured checklist. Root cause analysis was performed using fishbone methodology. Based on identified deficits, interventions were developed and tested through Plan-Do-Study-Act (PDSA) cycles. Post-Intervention data were collected using the same checklist. Interventions were accepted, rejected, or modified based on results. Intubation parameters were reassessed one year later to evaluate sustainability. Results: Following interventions, the first-pass success rate improved from 62% to 88% (p = 0.0004). Preoxygenation compliance increased from 3% to 88% (p = 0.00004). Equipment checks improved from 55% to 90% (p = 0.0005). Complications decreased from 38% to 12%, reflecting better patient safety. One year later, the improvements remained sustainable: first-pass success rate 79%, preoxygenation 75%, and equipment checks 89%. Conclusion: The first-pass success rate should be adopted as a standard quality metric for auditing intubation care. Mandatory simulation-based training for all staff is essential.
Copyright (c) 2025 Abhishek Navik, Vaishali Sharma, Prerna Batra, Vikram Bhaskar https://creativecommons.org/licenses/by-nc-nd/4.0