Objective To synthesise evidence on the effectiveness and safety of deep brain stimulation (DBS) for drug-resistant epilepsy (DRE) in children and adolescents.Methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020, we searched Scopus, PubMed, Embase and the Cochrane CENTRAL from inception to September 2026 without filters. Eligible studies reported at least five patients aged ≤18 years at implantation (or a separable paediatric subset of at least five) with DRE treated by open-loop DBS and quantitative seizure-frequency outcomes. Mixed-age cohorts without separable outcomes for those aged ≤18 years were excluded from the primary synthesis and where predominantly paediatric, retained as sensitivity evidence. Reports sharing patients were grouped into evidence clusters, with one index report per independent programme. Risk of bias was assessed using the Joanna Briggs Institute checklist and Risk Of Bias In Non-randomised Studies of Interventions. Findings were synthesised narratively (Synthesis Without Meta-analysis) with Grading of Recommendations Assessment, Development and Evaluation (GRADE)-informed certainty appraisal. PROSPERO: CRD420261433237 (registered retrospectively).Results 12 reports contributed to the synthesis, of which five independent programme-level index reports provided the primary efficacy evidence, with age-separable responder data at ≥12 months for 54 children. Stimulation predominantly targeted the centromedian nucleus. Responder proportions ranged from 14% to 92% across programmes, with very low certainty; no pooled estimate was calculated. Durable seizure freedom was infrequently documented. No meaningful age-separable comparison between stimulation targets was available. Seizure severity improved in some children without a reduction in seizure frequency, while school attendance improved across the cohort. Infection and hardware complications were the main reported harms; safety data were partly mixed-age or non-separable. Certainty was very low for efficacy and low for safety.Conclusion Reported response varied widely between programmes, certainty for efficacy is very low and current evidence supports neither a reliable expected response rate nor target superiority. Reports including children should present outcomes for those aged 18 years or younger separately and by target.PROSPERO registration number CRD420261433237.
Introduction Maternal depressive symptoms may adversely affect child growth and development, yet evidence examining both outcomes simultaneously remains limited in Pakistan. We assessed associations between maternal depressive symptoms and child growth outcomes and developmental delays among children aged 2–24 months attending selected healthcare facilities in Karachi, Pakistan.Methods A multicentre analytical cross-sectional study was conducted from September 2023 to May 2024 among mother-child dyads. Maternal depressive symptoms were assessed using the Beck Depression Inventory-II, child growth status using WHO growth standards and development using the Ages and Stages Questionnaire, Third Edition. Multivariable logistic regression examined associations after adjustment for child, maternal and household characteristics.Results Among 340 mother-child dyads, 20.8% of mothers had moderate-to-severe depressive symptoms. Stunting, underweight and wasting affected 45.9%, 33.8% and 21.2% of children, respectively. Moderate maternal depressive symptoms were associated with higher odds of stunting (adjusted OR (AOR) 3.21, 95% CI 1.59 to 6.49), while no significant associations were observed for wasting or underweight. Gross motor delay was most prevalent (34.4%). Moderate depressive symptoms were associated with gross motor delay (AOR 2.16, 95% CI 1.11 to 4.22), while severe symptoms were associated with gross motor delay (AOR 7.57, 95% CI 1.51 to 37.93) and fine motor delays (AOR 5.08, 95% CI 1.11 to 23.22). Other developmental domains showed no significant associations.Conclusion Maternal depressive symptoms were associated with child stunting and motor developmental delays, supporting integration of maternal mental health screening and support within maternal and child health and nutrition programmes.
Objective To identify factors associated with dermatology-related quality of life among Embera Dobidá children with dermatological findings and describe care practices in a displaced community.Methods Convergent mixed-methods community case study. Two rural Embera Dobidá communities in Colombia: a displaced settlement in Caldas and a riverine community in ancestral territory in Chocó. Data were collected from August 2025 to January 2026. The quantitative strand included 79 children aged 4–16 years with dermatological findings (31 in Caldas and 48 in Chocó). Qualitative activities in Caldas involved 11 family units, 12 caregivers and 12 adolescents aged 11–15 years.Results The primary outcome was the Children’s Dermatology Life Quality Index (CDLQI). Explanatory variables included psychosocial burden, food insecurity, skin symptoms, community, age and sex; qualitative analysis examined care practices. Median CDLQI was 5.0 (IQR 2.5–7.0), and 21 participants (26.6%) had scores of 7 or higher. In an ordinary least-squares model with HC3 SEs (n=79), psychosocial burden (B=0.27, 95% CI 0.11 to 0.44; p<0.001) and food insecurity (B=0.19, 95% CI 0.04 to 0.34; p=0.011) were independently associated with higher CDLQI. Community was not independently associated with CDLQI (B=0.32, 95% CI −0.51 to 1.15; p=0.446). Qualitative findings described environmental contexts, household and plant-based responses, caregiving knowledge and sequencing between household, Jaibaná and biomedical care.Conclusions Worse skin-related quality of life was associated with psychosocial burden and food insecurity. Paediatric skin care should consider household conditions, psychosocial needs, language and plural care practices. Findings are not prevalence estimates or evidence of a causal effect of displacement.
Background and objective Respiratory distress syndrome (RDS) remains a leading cause of neonatal morbidity. While continuous positive airway pressure (CPAP) is the preferred non-invasive support, early identification of infants who will fail CPAP and require mechanical ventilation (MV) is challenging. This study aimed to evaluate the predictive value of the Lung Ultrasound Score (LUS) and the Score for Oxygenation and Pressure Index (SOPI) in predicting CPAP failure in preterm neonates.Methods A retrospective cohort study was conducted at a tertiary neonatal intensive care unit in Zarqa, Jordan. Preterm infants (<37 weeks) requiring bubble CPAP immediately after birth were included. Clinical data and LUS (0–18 scale) were collected during the first 48 hours of life. Predictors were selected using Least Absolute Shrinkage and Selection Operator regression and validated via a multivariable logistic regression model with 10 000 bootstrap resamples.Results Out of 179 neonates, 71 (39.7%) failed CPAP and required MV. Infants who required MV had significantly higher median LUS (9.0 vs 5.0, p<0.001) and higher SOPI scores (3.16 vs 1.87, p<0.001). In multivariable analysis, LUS (OR 1.51, 95% CI 1.18 to 1.93, p=0.001), SOPI (OR 2.05, 95% CI 1.21 to 3.47, p=0.008) and gestational age (OR 0.79 per week, 95% CI 0.68 to 0.93, p=0.004) were identified as independent predictors of MV. The model demonstrated high discriminative ability, with an optimism-corrected C-statistic of 0.88 and excellent calibration.Conclusion Early LUS and SOPI scores are robust, non-invasive predictors of CPAP failure in preterm neonates. Integrating these bedside tools into clinical protocols can facilitate timely escalation to MV and optimise respiratory management in resource-limited settings.
