Introduction: Respiratory Syncytial Virus (RSV) is a leading cause of lower respiratory tract infections in infants and young children worldwide, with significant morbidity and healthcare burden in Asia. In Hong Kong, RSV seasonality and hospitalization rates underscore the urgent need for effective prophylactic strategies. Recent advances in maternal vaccination and long-acting monoclonal antibodies have expanded the armamentarium for RSV prevention. However, clinical guidelines across Asia remain heterogeneous, and parental hesitancy continues to limit uptake. To address these gaps, selective national guidelines and clinical recommendations were reviewed and a simplified ABC mnemonic framework to integrate antenatal and postnatal prophylaxis with parental counselling were proposed. Methods: A narrative review of published guidelines, policy documents, and clinical recommendations from Hong Kong and selected Asian countries was conducted. Sources included pediatric society statements, Ministry of Health advisories, and World Health Organization (WHO) regional guidance. Comparative analysis focused on prophylaxis strategies, target populations, and implementation challenges. Based on this synthesis, we developed the ABC mnemonic to facilitate recall and communication among clinicians and families. Results and Discussion: Variability in RSV prophylaxis adoption across Asia, is as follows: Antenatal Vaccine: Maternal immunization during pregnancy, exemplified by Abrysvo, is recommended in several high-income settings but remains under consideration in Hong Kong and neighboring regions. Evidence supports transplacental antibody transfer, reducing RSV hospitalization in newborns. Baby after Birth: Long-acting monoclonal antibodies such as nirsevimab (Beyfortus) provide direct infant protection for up to five months, covering the peak RSV season. While approved in Europe and the United States, access in Asia is limited by cost and regulatory timelines. Counselling: Parental education emerged as a critical determinant of uptake. Misconceptions about vaccine safety and uncertainty regarding timing hinder implementation. Structured counselling strategies can bridge scientific advances with family decision-making, ensuring continuity of care from pregnancy to infancy. The ABC Mnemonic: Antenatal vaccine (e.g., Abresyvo), Baby after Birth (e.g., Beyfortus), Counselling (e.g., Clesrovimab as an alternative to Beyfortus), offers a concise, memorable framework that aligns clinical interventions with communication needs. It emphasizes the continuum of protection and highlights the indispensable role of parental engagement. Conclusion: RSV prophylaxis in Hong Kong and Asia is at a pivotal juncture, with maternal vaccination and infant monoclonal antibodies poised to transform prevention strategies. Yet, fragmented guidelines and limited awareness impede progress. The ABC mnemonic provides a practical tool for clinicians and policymakers to harmonize recommendations, improve recall, and strengthen parental counselling. By integrating antenatal and postnatal interventions within a simple communication framework, the ABC approach bridges science and public health messaging, fostering broader acceptance and uptake. This model may serve as a template for other regions seeking to balance innovation with implementation in RSV disease prevention.
Abstract: With growth in obesity and metabolic dysfunction globally, Metabolic Dysfunction- Associated Steatotic Liver Disease (MASLD) has emerged as the most common chronic liver disease with a rising trend in children and adolescents. Because of differences in frequency, risk factors, histology, disease progression, and therapy response, pediatric MASLD has emerged as a distinct clinical and histological disease, rather than a lesser variant of the adult disease. In addition to contributions from gut microbiota dysbiosis, epigenetic programming, and microRNA regulation, its pathogenesis also involves interactions among hepatic lipid accumulation, insulin resistance, dysregulated lipogenesis, mitochondrial dysfunction, oxidative stress, and inflammatory and fibrogenic pathways. Early onset of MASLD can progress to advanced fibrosis, cirrhosis, and increased long-term cardiovascular risk. Although liver biopsy remains the gold standard for diagnosis, its invasive nature restricts use in pediatric populations, underscoring the need for reliable non-invasive alternatives. This review compares pediatric and adult MASLD and highlights novel non-invasive and emerging biomarkers and imaging techniques for early diagnosis, staging, and risk assessment in the pediatric population.
Background: Outdoor play is vital for children's physical, mental, and social development, yet opportunities for such engagement have declined globally, including in Latin America and the Caribbean (LAC). Objectives: This brief narrative review aimed to synthesize the current landscape of outdoor play among children and adolescents in LAC, identify challenges and opportunities, and offer evidenceinformed recommendations for advancing policies and practices in the region. Methods: We searched PubMed/MEDLINE, Scopus, and SciELO between September and October 2024, using the term "outdoor play" in English, Portuguese, and Spanish, to identify all records available from inception through October 2024. Governmental and non-governmental documents and initiatives related to outdoor play in the region were identified through complementary Google searches. Results: The review highlights substantial disparities in access to outdoor play, influenced by income inequality, urban infrastructure, gender, environmental conditions, and cultural norms. It also documents successful interventions, including open street programs, nature-based learning initiatives, and community-led actions, primarily in urban contexts. However, child-focused outdoor play policies and evaluations remain scarce. The COVID-19 pandemic intensified existing barriers while reinforcing the importance of outdoor environments for child well-being. Prominent regional organizations have contributed to advocacy, policy development, and knowledge dissemination. Conclusion: The review underscores the need for culturally relevant, equity-oriented, and climateresilient strategies to promote outdoor play. Strengthening policies, infrastructure, research, and intersectoral collaboration is essential to ensure that all children in LAC have the right and opportunity to play outdoors safely and meaningfully.
Abstract: Pediatricians and acute care physicians caring for ill patients with respiratory failure often encounter the decision to intubate children for respiratory support and/or to protect the airway. There are several Standard Operating Procedures (SOPs) or protocols such as the 3-3-2 Rule, Mallampati Score, Modified Mallampati Test, and Lemon Criteria, to evaluate whether a difficult airway exists so that preparedness for successful intubation can be ensured. Pediatricians are particularly concerned that there are usually no tailor-made tools or protocols to follow. The authors think that there are a few issues associated with the 3-3-2, Mallampati, and LEMON approaches. The Mallampati approach is only part of the more comprehensive LEMON approach to oropharyngeal patency, and patient cooperation is often required. The LEMON approach amalgamates the 3-3-2 and Mallampati approaches, together with the intrinsic problems associated with these two methods. We present a novel NIMO approach that consolidates existing techniques for intubating difficult airways. By integrating assessments of the Neck (3-3-2), Incisors (Inter-incisor distance), Mouth (Mallampati), and Oropharynx (LEMON), this systematic framework optimizes and streamlines clinical workflow and minimizes the limitations of current tools.
