Artificial intelligence (AI) is increasingly integrated into pediatric healthcare, supported by the expansion of electronic health records, continuous physiological monitoring, digital imaging, and computational methods capable of analyzing complex, time-dependent clinical data. This article is the third in a four-part series examining the evolving role of AI in pediatric medicine. The first article introduced the fundamental concepts, methodologies, data sources, and model development processes underlying AI in medicine, while the second reviewed its applications in ambulatory and preventive pediatrics. Building on these foundations, the present review examines AI applications in hospital-based pediatric care, with emphasis on pediatric emergency medicine, pediatric and neonatal intensive care, diagnostic imaging, pediatric subspecialties, and hospital workflow optimization. Current evidence indicates that machine learning and deep learning approaches may support emergency triage, early sepsis detection, prediction of clinical deterioration, physiological monitoring, ventilator management, diagnostic assessment, risk stratification, and treatment-response prediction. AI-based systems have also demonstrated potential applications in pediatric radiology, cardiology, oncology, and neurology. However, despite substantial technological progress, translation into routine clinical practice remains limited. Major challenges include small, heterogeneous pediatric datasets; age-dependent physiological variation; inadequate external validation; limited model interpretability; algorithmic bias; false-positive alerts; and difficulty integrating AI tools into established clinical workflows. Overall, AI has the potential to augment clinical decision-making and support the timely identification and management of critically ill children. However, prospective validation, external evaluation, transparency, and demonstration of clinically meaningful benefit are essential before widespread implementation.
Pharyngoconjunctival fever (PCF) is a distinct clinical syndrome characterized by high fever, pharyngitis, and non-purulent conjunctivitis, typically following human adenovirus (HAdV) infection. While adenovirus is generally a self-limiting condition in immunocompetent patients, it can present as a "Pandora’s box" of atypical systemic complications. This report describes a 10-year-old male presenting with the classic PCF triad alongside significant hematemesis and a widespread maculopapular rash. The clinical course was complicated by respiratory distress requiring supplemental oxygen and two episodes of gastrointestinal hemorrhage (~500 mL) followed by melena. Diagnostic confirmation was achieved via polymerase chain reaction (PCR) of throat and conjunctival swabs, which were positive for Adenovirus. Laboratory investigations ruled out common differentials including Dengue, Kawasaki disease, and Scarlet fever. Following supportive management with intravenous proton pump inhibitors, ophthalmic steroids, and respiratory support, the patient achieved full clinical resolution without sequelae. This case highlights the necessity for clinicians to recognize gastrointestinal and cutaneous manifestations as rare but possible components of the PCF spectrum to avoid diagnostic delays and ensure appropriate supportive intervention.
Background: Adolescence is a critical developmental period marked by significant physical, psychological, and social changes, making individuals particularly vulnerable to stress. Stress during this phase is associated with adverse lifestyle behaviors and long-term health consequences. This study was done to assess perceived stress among adolescents and its association with sleep duration, physical activity, and nutritional status among school-going adolescents. Methods: This school-based cross-sectional analytical study included 180 adolescents aged 12–15 years from private schools of Bhopal, selected using multistage random sampling. Perceived stress was assessed using the Perceived Stress Scale (PSS-10). Anthropometric measurements were recorded, and nutritional status was determined using BMI categories. Sleep duration and physical activity were assessed using a structured questionnaire. Statistical analysis was performed using SPSS version 22, applying the Chi-square test and ANOVA, with p < 0.05 considered statistically significant. Results: Among participants, 40.6% had low stress, 39.4% had moderate stress, and 20.0% had high stress. The mean PSS score was 18.6 ± 6.4. Mean sleep duration was 6.9 ± 1.1 hours, and mean BMI was 17.85 ± 1.77 kg/m². Perceived stress showed a statistically significant association with nutritional status, sleep duration, and physical activity (p < 0.001). Most adolescents reported suboptimal sleep duration, and moderate physical activity was the most common pattern. Conclusion: Perceived stress is common among adolescents and is significantly associated with sleep duration, physical activity, and nutritional status. Early identification and school-based lifestyle interventions may improve adolescent well-being.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
