Background: Acute abdomen in children, arising from diverse surgical conditions, can be treated by open laparotomy or by laparoscopic intervention. This study aimed to assess the demographics, underlying etiologies, and outcomes of different surgical procedures performed to treat pediatric patients with acute abdomen. Methods: This retrospective, single-institution study was conducted in the Department of Pediatric Surgery at a tertiary care centre in central India. This study spanned from January 1, 2000, to December 31, 2022. This study included children from infancy to 12 years of age who underwent surgery for abdominal pathologies leading to acute intestinal obstruction or perforation peritonitis. Results: Over a 23-year study period, 704 children aged 0 to 12 years underwent surgery for intestinal obstruction or perforation peritonitis. The primary abdominal pathologies managed via laparotomy included intussusception (32.38%), bowel (ileal) perforation with peritonitis (26.13%), symptomatic Meckel’s diverticulum (12.21%), Koch’s abdomen (5.68%), congenital bands, cysts, and malrotation of the gut (7.95%), patent vitelline duct (3.97%), and a few others. Surgical interventions included segmental resection of the ileum with ileo-ileal anastomosis (180; 25.56%), wedge resection or repair of bowel perforation (166; 23.57%), ileostomy creation, adhesiolysis, and a few other procedures. Seventeen percent of children required creation of a diverting ileostomy, and seven percent required a relaparotomy for management of their postoperative complications. Despite management, 62 (8.8%) children died during the study period. Conclusions: Mortality was especially higher in children undergoing surgery for bowel perforation peritonitis, those requiring ileostomy, and those needing relaparotomy to manage postoperative complications.
Intussusception is a common pediatric gastrointestinal emergency that typically presents with abdominal pain, vomiting, and blood-stained stools. Severe hypertension is an uncommon and potentially overlooked manifestation of intussusception. We report a 6-month-old female infant who presented with lethargy, poor feeding, blood-stained stools, and severe hypertension of 130/80 mmHg, exceeding the 95th percentile for age, sex, and length. Serial blood pressure measurements were obtained during quiet, non-distressed periods using an appropriately sized cuff to minimize the possibility of pain- or agitation-related elevation. Initial management included oral nifedipine, followed by intravenous labetalol infusion because of persistent hypertension. Abdominal ultrasonography demonstrated the characteristic target sign of intussusception, which was successfully treated with fluoroscopy-guided pneumatic reduction. Following successful reduction, blood pressure progressively normalized. Evaluation for secondary causes of hypertension, including serum electrolytes, renal function tests, urinalysis, screening echocardiography, and dedicated renal Doppler ultrasonography, revealed no evidence of renal parenchymal disease, renovascular pathology, including renal artery stenosis, or structural cardiovascular abnormalities. Antihypertensive therapy was subsequently tapered and completely discontinued within 5 days after discharge. At 3-month follow-up, the infant remained asymptomatic and normotensive, with no evidence of recurrence. Intussusception may therefore be considered in the differential diagnosis of acute severe hypertension in infants, particularly when gastrointestinal manifestations are present.
The serine peptidase inhibitor Kazal-type 1 (SPINK1) p.Asn34Ser variant is a pancreatitis risk factor often linked to a c.-4141G>T upstream enhancer mutation that reduces protective enzyme expression. Symptoms usually begin in late adolescence or early adulthood and typically require environmental triggers. Early pediatric presentation is exceptionally rare. A six-year-old male presented with recurrent periumbilical and epigastric abdominal pain. Investigations revealed elevated serum amylase and lipase levels and a mildly enlarged pancreas. Fecal elastase-1 testing indicated severe exocrine pancreatic insufficiency. There was a positive paternal history of early-adulthood pancreatitis. Confirmatory whole-exome sequencing identified a heterozygous c.101A>G (p.Asn34Ser) SPINK1 mutation. Initial management included bowel rest, analgesics, and intravenous hydration, followed by pancreatic enzyme replacement therapy. Parents were counseled to strictly avoid environmental triggers, such as high-fat meals. At the six-month follow-up, the patient remained asymptomatic and pain-free, with successful weight gain. Identifying SPINK1 variants in early-childhood recurrent pancreatitis is critical. Understanding its pathogenic mechanism, potentially driven by linked upstream regulatory mutations, guides targeted interventions. Early enzyme replacement and strict trigger avoidance are essential to prevent future attacks and to optimize pediatric growth.
Background: Few studies have compared use of procalcitonin (PCT) and C-reactive protein (CRP) in diagnosis of sepsis in preterm very low birth weight neonates (VLBW). This study aimed to compare sensitivity and specificity of PCT and CRP in predicting sepsis in preterm VLBW neonates and also to compare their levels in gram positive and negative sepsis, as well as in early and late onset sepsis. Methods: This prospective comparative study included 50 preterm very low birth weight neonates (gestational age <37 weeks and birth weight <1500 grams) with suspected neonatal sepsis. After enrollment, 1 ml of blood was collected for blood culture in Brain Heart Infusion (BHI) broth medium, and another 1 ml was collected for PCT and CRP quantitative determination with Boditech IchromaTM kits in Biochemistry lab using fluorescence Immunoassay. Other sepsis screen parameters, including Total Leucocyte Count (TLC), Absolute Neutrophil count (ANC), Immature-to-Total (I:T) Neutrophil ratio were also assessed. Cut-off values for CRP and PCT was taken as 10 mg/l and 2 ng/ml respectively. We considered blood culture as gold standard. Results: Sensitivity and specificity of PCT was 68.40% and 3.20 % respectively whereas for CRP it was 57.89% and 64.52% respectively. Positive predictive value and negative predictive value of PCT was only 30.2% and 14.30% respectively as compared to 50% and 71.43% with CRP. Median value of PCT and CRP was higher in gram negative sepsis [4.00(1.51-23.25) ng/ml] and [12.70(4.60-49.10) mg/l] respectively as compared to gram positive sepsis [2.25(1.38-3.98) and 5.60(1.70-20.30) ng/ml respectively], but it was not statistically significant. Median of PCT was higher in LONS group as compared to EONS group [15.00(7.3-6.67) vs 4.60(2.01-8.50) ng/ml], but the difference was not statistically significant (p=0.178). Conclusions: PCT is not a better marker as compared to CRP for diagnosis of sepsis in preterm VLBW neonates.
Immune system development during early childhood is closely modulated by the colonization of the gut microbiota. Early interaction between commensal bacteria and the gut-associated lymphoid tissue (GALT) is essential for the maturation of both innate and adaptive immune responses, as well as for the establishment of immunological tolerance. Objective of the study was to analyze the current clinical evidence on the influence of probiotic supplementation on the development, maturation, and modulation of the immune system during early childhood, as well as its impact on preventing immune-based pathologies. Systematic review of scientific literature published between 2020 and 2026 in PubMed, Scopus, and Cochrane Library databases. Randomized controlled trials and cohort studies evaluating probiotic administration in infants and children (0-5 years) and measuring immunological biomarkers (e.g., secretory IgA, Th1/Th2/Th17 cytokine profiles) or immune-mediated clinical outcomes were included. The administration of specific strains, predominantly Lactobacillus rhamnosus GG, Bifidobacterium animalis subsp. lactis, and Lactobacillus reuteri, demonstrated a significant induction in intestinal secretory IgA (sIgA) synthesis and a favorable modulation of the Th1/Th2 ratio, thereby reducing pro-allergic polarization. Clinically, a consistent reduction in the incidence and severity of atopic dermatitis was observed in high-risk infants, alongside a significant decrease in the frequency and duration of upper respiratory and gastrointestinal infectious episodes. Probiotic supplementation during early childhood plays a key immunomodulatory role that supports the maturation of the infantile immune system. These findings support its use as a promising therapeutic and preventive strategy against highly prevalent allergic and infectious diseases, though greater standardization regarding strain specificity, dosage, and critical intervention windows is still required.
