Arrhythmias in childhood are often challenging to diagnose and treat for a pediatrician. Tachyarrhythmias may or may not be associated with underlying structural heart disease or ion channel defects, and may also occur i...Arrhythmias in childhood are often challenging to diagnose and treat for a pediatrician. Tachyarrhythmias may or may not be associated with underlying structural heart disease or ion channel defects, and may also occur in the post-operative setting. Symptoms vary from excessive crying, irritability and failure to thrive, to palpitations, heart failure and syncope. Knowledge of the normal 12 lead ECG (electrocardiogram) in various stages of life and its transition to adulthood is essential in order to distinguish abnormal ECG from normal variants. Management in acute settings as well as long term medical management and interventional therapies are important. Both, cardiologists as well as pediatricians should be well-versed in the diagnosis and management of tachyarrhythmias in children.
Indian J Pediatr
· 2026 Jun · PMID 42258041
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OBJECTIVES: To evaluate serum soluble programmed death ligand-1 (sPD-L1) levels in neonatal sepsis and assess its diagnostic performance, association with disease severity, and clinical outcomes. METHODS: This prospectiv...OBJECTIVES: To evaluate serum soluble programmed death ligand-1 (sPD-L1) levels in neonatal sepsis and assess its diagnostic performance, association with disease severity, and clinical outcomes. METHODS: This prospective observational study was conducted in a tertiary-care neonatal intensive care unit. Neonates with suspected sepsis, defined according to National Neonatology Forum (NNF) 2021 guidelines, were enrolled after parental consent. Serum sPD-L1 levels were measured using enzyme-linked immunosorbent assay (ELISA). Comparisons were performed across early-onset and late-onset sepsis, culture-positive and culture-negative sepsis, presence of multi-organ dysfunction syndrome (MODS), and survival outcomes. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic accuracy. RESULTS: Serum sPD-L1 levels were significantly elevated in neonates with sepsis. Higher levels were observed in early-onset sepsis, culture-positive sepsis, neonates with MODS, and non-survivors, indicating a positive association with disease severity and adverse outcomes. ROC analysis demonstrated good diagnostic performance, with an area under the curve of 0.86. A cut-off value of 85 pg/mL showed clinically meaningful diagnostic discrimination. CONCLUSIONS: Serum sPD-L1 is significantly elevated in neonatal sepsis and correlates with severity, organ dysfunction, and mortality. It may serve as a promising adjunct biomarker for early diagnosis and risk stratification in neonatal sepsis, warranting validation in larger multicentric studies.
Yadav V, Bajpai A, Banerjee S
… +5 more, Mahapatra A, Maurya M, Maurya A, Ali S, Singh A
Indian J Pediatr
· 2026 Jun · PMID 42258039
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OBJECTIVE: To develop and validate Puberty Interpreter, a mobile application-based point-of-care clinical decision support tool for pubertal disorders. METHODS: Puberty Interpreter recommendations in 306 children with pu...OBJECTIVE: To develop and validate Puberty Interpreter, a mobile application-based point-of-care clinical decision support tool for pubertal disorders. METHODS: Puberty Interpreter recommendations in 306 children with puberty concerns (199 early and 107 delayed puberty) were compared to the gold standard, a pediatrician, a senior trainee, and a junior trainee. RESULTS: Puberty Interpreter concordance with the gold standard was 303/306 (99.0%) for diagnosis, 303/306 (99.0%) for management, and 606/612 (99.0%) overall. This was higher than the pediatrician (476/612, 77.8%), the senior trainee (330/612, 53.9%), and the junior trainee (305/612, 49.8%). The relative risk of error compared with the Puberty Interpreter was 21 for the pediatrician (95% CI 6.7-66), 41 for the senior trainee (95% CI 13-127), and 44 for the junior trainee (95% CI 14-136). Agreement beyond chance for management was highest for the application (κ = 0.978; overall agreement 0.990) and lowest for the junior trainee (κ = 0.233; overall agreement 0.683). Adopting the Puberty Interpreter outputs would have reduced diagnostic discordance by 96 cases (96.9%) for the pediatrician, 197 (98.5%) for the senior trainee, and 212 (98.6%) for the junior trainee. Estimated economic benefit of adhering to Puberty Interpreter guidance was ₹56,700 for the pediatrician ($683; ₹185 [$2.2] per case), ₹236,250 for the senior trainee ($2,846; ₹772 [$9.3] per case), and ₹220,500 for the junior trainee ($2,657; ₹721 [$8.7] per case). CONCLUSIONS: The Puberty Interpreter delivers accurate guidance, substantially reducing both over- and under-investigation compared to pediatricians and trainees. These findings support implementation and multi-center prospective evaluation.
Indian J Pediatr
· 2026 Jun · PMID 42250093
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Artificial intelligence (AI) technologies such as machine learning (ML), deep learning (DL), predictive analytics and other tools are rapidly changing pediatric health care, using large amounts of health data. AI tools a...Artificial intelligence (AI) technologies such as machine learning (ML), deep learning (DL), predictive analytics and other tools are rapidly changing pediatric health care, using large amounts of health data. AI tools aid in triage, real-time monitoring and risk stratification in acute care settings, towards improving overall outcomes and fewer complications. During newborn resuscitation, AI analyses real-time data, can guide decisions and enhance training. Computer vision systems with AI tools can generate reliable neonatal bilirubin estimates without the need for blood sampling. AI technology is also being used in the management of necrotising enterocolitis, respiratory distress syndrome, and screening and early diagnosis of retinopathy of prematurity. ML models assist in detecting brain injuries on MRI for conditions such as hypoxic-ischemic encephalopathy, intraventricular hemorrhage; MRI biomarkers can be analyzed using AI to predict neurodevelopmental outcomes. AI-based clinical decision support systems have been deployed to enhance workflows and outcomes by early detection of disease, reducing medication errors and help clinicians improve decision-making. However, there remain ethical and practical challenges in the use of AI including data privacy, the need for high-quality pediatric datasets, rigorous clinical validation and transparency, to ensure that AI strengthens clinical judgement and is trustworthy.
Percutaneous cardiac interventions in neonates and young infants have fundamentally altered the management paradigm of critical congenital heart disease, offering minimally invasive alternatives to surgery as definitive...Percutaneous cardiac interventions in neonates and young infants have fundamentally altered the management paradigm of critical congenital heart disease, offering minimally invasive alternatives to surgery as definitive therapies or as bridges to later repair. Advances in catheter technology, device miniaturization, and imaging have enabled increasingly complex interventions to be performed safely in this highly vulnerable population. This review provides a comprehensive overview of commonly performed neonatal cardiac interventions, including balloon atrial septostomy, balloon dilatation of the aortic and pulmonary valves, ductal stenting, transcatheter patent ductus arteriosus closure in preterm infants, coarctation interventions, pulmonary valve perforation, right ventricular outflow tract stenting, pulmonary vein interventions, and emerging techniques such as percutaneous pulmonary artery banding. For each intervention, the authors outline indications, technical considerations, procedural outcomes, and limitations, with emphasis on neonatal-specific anatomical and physiological challenges. Neonatal cardiac interventions are inherently unforgiving, mandating meticulous patient selection and a structured multidisciplinary heart team approach to ensure ethical, evidence-based decision-making. The review also addresses unique challenges relevant to low- and middle-income settings, particularly India, including disparities in access to specialized care, affordability, reliance on off-label device use, and the critical role of fetal diagnosis. In conclusion, neonatal transcatheter interventions continue to expand in scope and efficacy, driven by technological innovation and collaborative care models. Addressing systemic barriers and strengthening fetal and neonatal cardiac services are essential to optimizing outcomes and ensuring equitable access to these life-saving therapies in resource-limited settings.