Dhingra D, Srivastava S, Agarwal S
… +2 more, Singh N, Singh A
Indian J Pediatr
· 2026 Jun · PMID 42348048
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OBJECTIVES: To assess the utility of Lung ultrasound (LUS) in predicting clinical outcomes and disease severity in infants with acute bronchiolitis. METHODS: Infants with acute bronchiolitis underwent clinical assessment...OBJECTIVES: To assess the utility of Lung ultrasound (LUS) in predicting clinical outcomes and disease severity in infants with acute bronchiolitis. METHODS: Infants with acute bronchiolitis underwent clinical assessment using the ReSVinet score and LUS to assess B-lines, intercostal space involvement, and sub-pleural consolidations. Nasopharyngeal swabs identified the viral etiology. Outcomes including ICU admission, length of hospital stay, and oxygen/advanced respiratory support were recorded and analyzed. RESULTS: One hundred (100) infants were enrolled with a mean age of 8.04±6.5 mo. On admission, the clinical severity score (ReSVinet) classified 64 infants as having moderate and 36 as having severe bronchiolitis. RSV was the viral pathogen detected in 23% of infants. LUS assessment categorized 28 infants as mild, 41 as moderate, and 31 as severe, showing a strong correlation with clinical severity scores (r = 0.8, p <0.001). Among severe LUS cases, 75% required ICU admission (p <0.001). Hospital stay increased with LUS severity (5.79 ± 1.4 vs. 7.80 ± 2.8 vs. 10.87 ± 2.8 d for mild, moderate, and severe; p <0.01), as did oxygen/advanced respiratory support needs (χ², p <0.001). LUS showed predictive ability for ICU admission (AUC 0.906; CI 0.851-0.961; p <0.001) 77.6% sensitivity, 95.8% specificity, 98.3% PPV and 57.5% NPV. Clinical severity (ReSVinet score) was comparable; its AUC was 0.891 (CI: 0.831-0.952), 75% sensitivity and 100% specificity, 100% PPV and 55.8% NPV. CONCLUSIONS: LUS is a useful tool for early risk stratification in acute bronchiolitis.
Ranganath P, Vh S, Mandal K
… +5 more, Agarwal M, Ranganath P, Saranya S D, Arora V, Executive Committee of the Society for Indian Academy of Medical Genetics (SIAMG)
Indian J Pediatr
· 2026 Jun · PMID 42340586
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The genetic diagnostic armamentarium includes a host of different genetic tests, each with their own set of indications, resolution, coverage, diagnostic utility and limitations. It is essential for all medical practitio...The genetic diagnostic armamentarium includes a host of different genetic tests, each with their own set of indications, resolution, coverage, diagnostic utility and limitations. It is essential for all medical practitioners to have some basic knowledge about the principles, indications and interpretation of these tests. This position statement of the Society for Indian Academy of Medical Genetics (SIAMG) provides guidelines and recommendations regarding the use of cytogenetic and molecular cytogenetic tests in clinical practice.
Indian J Pediatr
· 2026 Jun · PMID 42340585
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Sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental impairment remain major challenges in preterm care. Increasing evidence suggests that immune immaturity an...Sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, retinopathy of prematurity, and neurodevelopmental impairment remain major challenges in preterm care. Increasing evidence suggests that immune immaturity and dysregulated inflammatory responses play central roles in determining vulnerability and outcomes in this high-risk group. This narrative review emphasizes the role of intrinsic deviations in immune development and its impact on disease. It is quite evident that there is a "host/patient factor" that determines clinical presentation, severity, response to standard therapy, and outcomes for any disease. The manuscript synthesizes current literature on key alterations in innate, adaptive, and humoral immunity in preterm neonates and discusses their contribution to morbidity. There is emerging information on immune ontogeny in preterm infants, including interactions with cytokine dysregulation and oxidative stress. Evidence linking immune alterations with clinical outcomes such as sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and neurodevelopmental injury is highlighted, with attention to the dearth of data relevant to low- and middle-income settings. Interpretation of immune-based screening tools, such as T-cell receptor excision circle-based newborn screening for primary immunodeficiency, is further complicated by physiological immune immaturity in preterm neonates. The review suggests areas that need further research and the potential role of precision medicine in this regard.
James A, Varanasi SV, Jain S
… +7 more, Meshram H, Madhura A, Mishra MR, Mani RS, Ashwini MA, Girish M, Bang A
Indian J Pediatr
· 2026 Jun · PMID 42332189
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Rabies encephalitis, caused by rabies virus, is an almost uniformly fatal neurotropic infection once clinical disease develops. Classical presentations of furious rabies, typically associated with a definitive history of...Rabies encephalitis, caused by rabies virus, is an almost uniformly fatal neurotropic infection once clinical disease develops. Classical presentations of furious rabies, typically associated with a definitive history of dog bite and characteristic features such as hydrophobia and aerophobia, progress rapidly to death. In contrast, atypical presentations, particularly paralytic rabies, often lack classical clinical features posing significant diagnostic challenges. Diagnostic confirmation may be further complicated by recent post-exposure vaccination, confounding antibody assays, while molecular detection remains technically demanding and limited in availability. With advances in intensive care, rare instances of survival have been reported, especially in children. The authors report the case of a 2-y-old toddler with history of dog bite, who presented with rapidly progressive quadriparesis, where the diagnosis of paralytic rabies was supported by rising CSF and serum rabies virus neutralising antibodies. The child survived following comprehensive intensive care and was successfully discharged after a six-week hospital stay.
Indian J Pediatr
· 2026 Jun · PMID 42319746
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OBJECTIVES: To investigate the multi-dimensional determinants of child mortality in India, focusing on subnational burden, socioeconomic inequalities, maternal care, and environmental factors. METHODS: Age-specific morta...OBJECTIVES: To investigate the multi-dimensional determinants of child mortality in India, focusing on subnational burden, socioeconomic inequalities, maternal care, and environmental factors. METHODS: Age-specific mortality indicators were estimated at the state and district levels using normalised survey weights. Under-Five Mortality (U5M) determinants were evaluated using Logistic Regression (LR) and the Cox Proportional Hazard (CPH) model, incorporating the complex survey design to characterise mortality risk over time. RESULTS: The highest mortality burden is concentrated in socioeconomically deprived regions. Maternal age, education, higher birth order, low birth weight or size, place of delivery, and multiple births were crucially associated with higher mortality. The Survival and Regression (SAR) model findings demonstrate that maternal healthcare utilisation, continuity of antenatal and intrapartum care, early postnatal practices, and overall socio-demographic factors remained as independent predictors. CONCLUSIONS: Enhancing maternal and neonatal care, accessible and quality healthcare, improving household conditions, and prioritising high-burden and high-risk states and districts are crucial to achieve Sustainable Development Goal (SDG 3.2). This analysis provides a robust and scalable analytical framework for determining child mortality disparities. It provides evidence-based recommendations for precisely targeted interventions and policy implications to reduce child mortality.
OBJECTIVES: To evaluate diagnostic utility of reticulocyte hemoglobin equivalent (Ret-He) in identifying iron deficiency anemia (IDA) in acutely ill hospitalized children in comparison to serum ferritin. METHODS: After e...OBJECTIVES: To evaluate diagnostic utility of reticulocyte hemoglobin equivalent (Ret-He) in identifying iron deficiency anemia (IDA) in acutely ill hospitalized children in comparison to serum ferritin. METHODS: After excluding chronic inflammatory and anemic conditions unrelated to iron deficiency (ID), patients were categorized as (1) IDA: low hemoglobin+ microcytosis+ red-cell-distribution-width (RDW) index >220, (2) Non-anemia-iron-deficiency (NAID): normal haemoglobin+ microcytosis+ RDW index >220 and (3) Normal-group: normal hemoglobin+ normocytosis. Diagnostic utility indices for IDA were calculated using low hemoglobin+ microcytosis + RDW index >220 as surrogate standard. Correlation coefficients and receiver-operating-characteristic (ROC) curve cut-offs for Ret-He and ferritin were calculated. RESULTS: Anemic (n = 180) and non-anemic (n = 66) acutely ill children, after exclusion criteria, were classified into IDA (n = 102), NAID (n = 14) and normal (n = 21). IDA group had significantly lower Ret-He levels (p <0.001). Ferritin levels showed no significant difference (p = 0.062). For IDA detection, Ret-He cut-off of 27.7 pg yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 87.2%, 80.9%, 95.7%, 56.7% and 86.2% whereas ferritin at cut-off of 147.0 ng/ml showed values of 58.8%, 66.7%, 89.5%, 25.0% and 60.2% respectively. For NAID detection, Ret-He cut-off of 29.1 pg showed sensitivity, specificity, PPV, NPV and accuracy of 71.4%, 57.1%, 52.6%, 75.0% and 62.9%, while ferritin at cut-off of 153 ng/ml showed values of 57.1%, 61.9%, 50.0%, 68.4%, and 60.0% respectively. CONCLUSIONS: Ret-He demonstrated superior diagnostic utility compared to serum ferritin for IDA in acutely ill hospitalized children. Optimal cut-off for serum ferritin for IDA was significantly higher than WHO reference standard.
Indian J Pediatr
· 2026 Jun · PMID 42319740
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Artificial intelligence (AI) is reshaping healthcare, and radiology is at the forefront for adoption. Increasing demand for imaging, complex protocols, quantitative image analysis, and workforce shortages drive AI develo...Artificial intelligence (AI) is reshaping healthcare, and radiology is at the forefront for adoption. Increasing demand for imaging, complex protocols, quantitative image analysis, and workforce shortages drive AI development. However, clinical translation in pediatric imaging still lags its use in general radiology. Only a small number of approved tools carry explicit pediatric indications, and these focus on narrow tasks. In chest imaging, deep learning models can detect pneumonia, tuberculosis, and misplaced lines or tubes, though performance depends on pediatric-specific training and local validation. Automated bone age assessment is among the earliest and most widely adopted applications. Neuroimaging benefits include reduced acquisition times, lower contrast doses, and rapid triage of critical findings. Cardiovascular applications support congenital heart disease detection and functional assessment, while oncology applications are being explored for tumor characterization and segmentation for therapy planning. Beyond interpretation, AI can enhance workflow triage, structured reporting, and patient communication. Despite these advances, barriers remain for AI adoption. These include scarcity of pediatric datasets, limited prospective validation, workflow integration challenges, interpretability concerns, and complex ethical and legal issues unique to children. Integration with hospital systems is uneven, and routine monitoring and support are often missing. Pediatricians and surgeons should work with radiologists and data scientists to define use cases, curate datasets, validate performance, and set ethical guardrails. Future progress will depend on collaborative data sharing, robust validation, clinician engagement, child-centred guidelines, and human-centred design to ensure safe, equitable, and meaningful adoption.
S L, Ratageri VH, Illalu S
… +1 more, Khanappanavar K
Indian J Pediatr
· 2026 Jun · PMID 42319739
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Pediatric deaths occurring before hospital arrival reflect critical gaps in health systems, particularly in low- and middle-income settings. The authors conducted a retrospective observational study at a tertiary care ho...Pediatric deaths occurring before hospital arrival reflect critical gaps in health systems, particularly in low- and middle-income settings. The authors conducted a retrospective observational study at a tertiary care hospital in Karnataka, India, including children aged 1 mo to 12 y brought dead between July 2024 and June 2025. Fifty-two cases were analyzed. Infants constituted 42.3%, and respiratory illnesses were the leading causes of death (57.7%). Although 94.2% of caregivers sought prior medical care, only 42.3% used ambulance services, and nearly half of the children received no pre-referral treatment. Delay in care was identified in 11.5% of cases, often related to caregiver decision-making. Chronic illness was significantly associated with both cause of death and delay in care. These findings highlight cumulative delays across the continuum of care. Strengthening early illness recognition, referral systems, and pre-hospital emergency services is essential to reduce preventable pediatric mortality.