Recurrent wheezing is common in infants, most often triggered by respiratory viral infections. When wheezing begins early and persists without symptom-free intervals, it is crucial to first exclude common underlying conditions such as gastroesophageal reflux disease, bronchopulmonary or vascular malformations, and decompensated cardiac disease. Once these etiologies have been ruled out, less frequent disorders—most notably cystic fibrosis—should be considered. Through this case report, we aim to highlight the diagnostic and management challenges of cystic fibrosis in our setting. A 4-month-old infant was hospitalized for recurrent wheezing and dyspnea without symptom-free intervals. Clinical examination revealed severe respiratory distress with diffuse wheezing, along with growth faltering (–3 SD). Chest X-ray demonstrated perihilar atelectasis, bronchial wall thickening in the left lower lobe and the right apical basal segment, and left-sided thoracic hyperinflation and chest CT angiography showed bilateral pneumonia. Immunological investigations were unremarkable. A sweat chloride test, performed twice, confirmed markedly elevated chloride concentrations. The patient showed a favorable clinical evolution following treatment with antibiotic therapy, pancreatic enzyme replacement, vitamin supplementation, and respiratory physiotherapy. In the absence of systematic neonatal screening in our context and to prevent severe and fatal complications, cystic fibrosis should be considered in any case of persistent wheezing in an infant.
Background : Acute neonatal seizures are among the most common neurological emergencies during the neonatal period and are associated with increased mortality and long-term neurodevelopmental impairment. Phenobarbital has remained the conventional first-line antiseizure medication because of its rapid onset of action, intravenous availability, extensive clinical experience, and low cost. However, concerns regarding incomplete seizure control, adverse effects, and potential neurodevelopmental toxicity have raised questions regarding its position as the universal first-line therapy. Objectives: This analytical study aimed to evaluate the efficacy, safety limitations, and clinical outcomes associated with phenobarbital use in acute neonatal seizures and to compare its therapeutic profile with newer antiseizure medications, including levetiracetam, fosphenytoin, and lacosamide. Methods: A structured comparative analysis was performed using published clinical studies, randomized controlled trials, and evidence-based neonatal seizure management data. The analysis focused on seizure-control efficacy, adverse effects, pharmacological characteristics, neurodevelopmental concerns, and suitability of different antiseizure medications for individualized neonatal treatment strategies. Results: Phenobarbital demonstrated superior acute seizure-control efficacy, achieving complete seizure freedom in approximately 80% of neonates within 24 hours compared with approximately 28% with levetiracetam. However, 20–40% of neonates continued to experience seizures despite appropriate phenobarbital administration, particularly those with severe hypoxic-ischaemic encephalopathy, prematurity, structural brain injury, or refractory epilepsy. Higher cumulative phenobarbital exposure was associated with concerns regarding neuronal apoptosis, sedation, respiratory depression, hypotension, and adverse neurodevelopmental outcomes. Levetiracetam showed improved tolerability with fewer respiratory effects and less sedation but demonstrated lower immediate seizure-control efficacy. Fosphenytoin remained useful for refractory seizures but required cardiovascular monitoring, while lacosamide showed potential benefit with limited neonatal evidence. Conclusion: Phenobarbital remains an effective medication for rapid seizure termination in acute neonatal seizures; however, its limitations highlight the need for individualized treatment approaches. Future neonatal seizure management should balance rapid seizure suppression with neuroprotection and long-term developmental outcomes through integration of EEG monitoring, patient-specific characteristics, and emerging therapeutic options.
Early childhood represents a critical developmental period during which nutrition provides the biological foundation for physical growth, brain maturation, cognitive development, and behavioral regulation. The traditional assessment of child development has largely focused on physical indicators such as weight and height; however, emerging scientific evidence emphasizes that complete growth requires a multidimensional approach integrating Body, Brain, and Behavior (3B) outcomes. The Body-Brain-Behavior Axis describes the interconnected relationship between nutritional intake, physiological growth, neurodevelopmental processes, and behavioral outcomes, highlighting nutrition as a fundamental regulator of lifelong health trajectories. During early life, rapid cellular proliferation, synapse formation, myelination, neurotransmitter synthesis, and immune development create a high demand for essential nutrients. Micronutrients including iron, zinc, iodine, DHA, B-vitamins, vitamin D, calcium, and magnesium act through multiple biological pathways to support these processes. Iron contributes to oxygen transport, energy metabolism, neurotransmitter synthesis, and myelination; iodine supports thyroid hormone production and neurological development; zinc regulates neuronal signaling, immune function, and synaptic plasticity; while DHA plays a critical role in neuronal membrane formation, synapse development, and cognitive function. B-vitamins participate in energy metabolism and neurotransmitter pathways, whereas vitamin D, calcium, and magnesium contribute to skeletal development, cellular signaling, and neurological regulation. The relationship between nutrition and development is bidirectional. Nutritional inadequacy can impair growth, reduce neuroplasticity, disrupt neurotransmitter balance, and influence emotional regulation, attention, learning ability, and social interaction. Conversely, adequate nutrient intake during critical developmental windows, particularly the first 1,000 days of life, supports optimal body growth, brain architecture, and behavioral competence. Nutrient deficiencies rarely affect a single developmental domain; rather, they create interconnected consequences across physical, cognitive, and emotional systems. This review explores the scientific mechanisms underlying the Body-Brain-Behavior Axis and examines how early-life nutrition and micronutrients influence neurodevelopment and behavioral regulation. Understanding these biological connections provides an integrated framework for healthcare professionals to promote holistic child development through evidence-based nutritional strategies.
Background: Parapneumonic effusion (PPE) and empyema remain serious complications of childhood pneumonia associated with significant morbidity despite advances in antimicrobial therapy and surgical techniques. Accurate disease staging and timely stage-directed intervention are fundamental to optimal outcomes. Objective: To provide a current, evidence-based synthesis of the definition, etiology, diagnosis, and management of complicated pneumonia in children, with particular focus on areas of ongoing clinical controversy. Methods: A narrative review incorporating randomized controlled trials, systematic reviews, meta-analyses, Cochrane reviews, and international clinical guidelines published between 2016 and 2026 was conducted. PubMed was searched through May 2026 using terms including pneumonia, complicated pneumonia, parapneumonic effusion, empyema, VATS, fibrinolysis, decortication, and pediatric. Results: Chest radiography remains the initial imaging modality for suspected complicated pneumonia, with lateral decubitus views needed to assess pleural fluid mobility. However, chest ultrasonography is the preferred imaging modality for evaluating parapneumonic effusions and empyema because of its superior diagnostic accuracy, ability to characterize pleural collections, and absence of ionizing radiation. Management is stage-dependent, combining targeted antibiotic therapy with procedural intervention when indicated. Image-guided pigtail catheter drainage with intrapleural fibrinolytic therapy is effective for most patients. VATS demonstrates particular utility during the fibrinopurulent stage. No single fibrinolytic agent has demonstrated clear superiority; however, tissue plasminogen activator is most widely employed. Open decortication remains reserved for refractory or advanced-stage disease. Conclusion: Early diagnosis, appropriate antibiotics, and prompt intervention or surgery are all important for optimal care. The optimal outcomes require a multidisciplinary, individualized, stage-directed approach. Interventional radiology is appropriate for single loculations, while early VATS is favored for thick pleural rind or multiple loculations. Further high-quality prospective research is needed to establish definitive treatment algorithms.
Docosahexaenoic acid (DHA), a long-chain omega-3 polyunsaturated fatty acid, is a vital structural component of the brain and retina and plays an essential role during the first 1,000 days of life, including toddlerhood. This developmental period is marked by rapid brain growth, synaptogenesis, myelination, and neural circuit refinement, all of which require an adequate supply of essential nutrients. Among these, DHA is especially important because it is highly concentrated in neuronal membranes, where it helps maintain membrane fluidity, supports synaptic signaling, and promotes efficient communication between nerve cells. DHA contributes significantly to neurodevelopment by supporting neurite outgrowth, neuronal differentiation, and cell survival. These processes are critical during toddlerhood, when children experience major advances in language, memory, learning, motor skills, and emotional regulation. Because DHA influences the structural and functional maturation of the brain, it is often associated with improved visual and cognitive development. Experimental studies strongly support its biological importance in brain development, showing that DHA enhances synaptic plasticity and protects neurons from injury. Human studies also suggest benefits, particularly in visual acuity, attention, and certain cognitive functions, although the outcomes of DHA supplementation trials are not always consistent. In addition to its effects on cognition, DHA may also influence behavioral outcomes. Adequate DHA status has been linked with better attention, emotional balance, and adaptive behavior, likely because it supports the maturation of brain regions involved in self-regulation and social functioning. However, clinical evidence in this area remains mixed, and more toddler-specific research is needed to confirm these effects. DHA also has an important immunomodulatory role. It serves as a precursor for bioactive lipid mediators such as resolvins, protectins, and maresins, which help reduce excessive inflammation and promote immune homeostasis. By modulating cytokine production and inflammatory signaling pathways, DHA may support immune maturation during early life. Overall, DHA is functionally significant during toddlerhood because of its combined roles in brain development, cognitive performance, behavioral regulation, and immune function. However, the magnitude of its benefits may vary depending on dietary intake, baseline nutritional status, timing, and dose of supplementation. Thus, DHA should be considered a key nutrient for supporting healthy early childhood development.
