The Journal of Ambulatory Pediatrics (JAP) is a peer-reviewed medical journal dedicated to advancing research, education, and clinical practice in pediatric ambulatory care. The journal focuses on topics related to outpatient pediatric medicine, including preventive care, primary care, chronic disease management, and health policy affecting children. Key Areas of Publication: Pediatric primary care and preventive medicine Management of chronic diseases in children Health policy and healthcare delivery systems Pediatric patient safety and quality improvement Innovations in pediatric education and training The journal publishes original research articles, systematic reviews, clinical guidelines, and case studies, aiming to enhance the quality of care provided to children in ambulatory settings.
AI Diagnostic Tools in Pediatrics: A Systematic Review of Accuracy, Safety, and Future Directions
Background: Artificial intelligence (AI) is increasingly influencing healthcare by enhancing diagnostic accuracy and efficiency. In paediatrics, AI holds unique potential to address diagnostic delays, specialist shortages, and variability in care, particularly in under-resourced settings. Objective: This systematic review explores the diagnostic accuracy, safety, and future directions of AI-based diagnostic tools in pediatric medicine. Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Web of Science. Studies have included AI applications in pediatric diagnostics across various settings, including clinical trials, retrospective analyses, systematic reviews, and case reports. Key outcomes evaluated were diagnostic performance, safety profiles, and implementation challenges. Results: Seventy-four studies met the inclusion criteria. AI tools demonstrated high potential in pediatric diagnostics, especially in imaging, cardiology, infectious diseases, and developmental disorders. Diagnostic accuracy varied (AUC range: 0.78–0.96) based on algorithm type and dataset quality. Several studies reported enhanced diagnostic speed, reduced human error, and improved clinical decision-making. However, challenges such as algorithmic bias, lack of external validation, ethical concerns, and data standardisation were recurrent. Integration hurdles included interpretability, infrastructure limitations, and regulatory gaps. Conclusion: AI-based diagnostic tools are reshaping pediatric healthcare by supporting clinicians and improving diagnostic precision. While promising, their safe and equitable implementation requires rigorous validation, ethical safeguards, and attention to health system integration. Future research should prioritise pediatric-specific models, real-world validation, and international consensus on AI governance.
Pediatrics, artificial intelligence, diagnostic accuracy, machine learning, clinical safety
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The Gut Microbiome and Pediatric Obesity: A Systematic Review and Meta-Analysis of Observational Studies
Background: Pediatric obesity has emerged as a global health crisis, affecting over 18% of children and adolescents worldwide. Emerging evidence suggests that gut microbiota composition and diversity may significantly influence obesity risk through mechanisms related to energy harvest, inflammation, and insulin resistance. This systematic review and meta-analysis aimed to evaluate the association between gut microbiota profiles and pediatric obesity based on observational studies. Methods: A comprehensive search of PubMed, Scopus, and Web of Science databases was conducted for observational studies published between 2000 and 2024. Eligible studies assessed the gut microbiota in children aged 0–18 years, comparing obese/overweight groups to healthy controls. Data were extracted and pooled using random-effects meta-analysis. Primary outcomes included bacterial diversity (α-diversity) and relative abundance of key phyla and genera. Secondary outcomes included effect sizes (odds ratios and standardized mean differences), as well as subgroup analyses based on region, age, and sequencing methods. Results: Thirty-seven studies (n = 4,812 children) met inclusion criteria. Children with obesity exhibited significantly lower α-diversity (SMD = –0.48, 95% CI: –0.62 to –0.35, p < 0.001) and altered microbial composition, with higher abundance of Firmicutes and lower Bacteroidetes (Firmicutes/Bacteroidetes ratio: OR = 1.86, 95% CI: 1.41–2.44). Specific genera such as Lactobacillus and Prevotella were more prevalent in obese cohorts. Area under the curve (AUC) values for microbiota-based prediction models ranged from 0.71 to 0.84 across studies. Heterogeneity was moderate (I² = 58%). No major publication bias was detected. Conclusion: Altered gut microbiota is significantly associated with pediatric obesity. Reduced microbial diversity and specific taxonomic shifts may serve as early indicators of metabolic dysregulation. Microbiome-based diagnostics and interventions could become valuable tools in obesity prevention and management in children
pediatric obesity, gut microbiota, diversity, meta-analysis, observational studies
Incidence and Types of Fetal Complications in Diabetic Pregnant Mothers: Implications of a Tenfold Sample Size Increase at Khartoum Maternity Hospital, Khartoum State, Sudan
Background: Gestational diabetes mellitus (GDM) poses a significant risk to both maternal and neonatal health, particularly in resource-limited settings like Sudan. Initial research from Khartoum Maternity Hospital identified fetal complications in a small cohort of 76 diabetic pregnant women. However, the limited sample size constrained generalizability and statistical power. Objective: To assess the incidence and spectrum of fetal complications in diabetic pregnancies using an expanded cohort of 760 participants, and to develop a scalable, methodologically robust model for large-scale epidemiologic maternal-fetal research in Sudan. Methods: The study adopts a three-stage sampling design: cluster sampling of hospitals, stratified random sampling by risk factors (e.g., BMI, age, proteinuria), and systematic recruitment within strata. It employs Electronic Data Capture (EDC) systems, centralized oversight (hub-and-spoke model), and advanced statistical techniques including Generalized Linear Models and multivariate analysis to evaluate predictors of fetal complications. Results: The methodological upgrade is expected to increase statistical power, improve estimate precision, and detect rare complications such as macrosomia, stillbirth, and neonatal hypoglycemia. Stratified analysis will further delineate risk patterns among demographic subgroups. Conclusion: This expansion transforms a limited observational study into a robust epidemiologic investigation with actionable policy relevance. The study sets a precedent for maternal health surveillance in low-resource and conflict-affected regions.
Gestational diabetes mellitus, fetal complications, Sudan, maternal health, epidemiology, macrosomia, sampling strategy, neonatal outcomes, Khartoum.
Interleukins in Neonatal Sepsis Diagnosis: A Comprehensive Evidence Review and Research Agenda
Background: Neonatal sepsis remains a leading cause of neonatal mortality worldwide. Timely diagnosis is critical, yet current methods, such as blood culture, are slow (24–48 hours) and may fail to detect up to 20% of cases. To improve early diagnosis, attention has turned to inflammatory biomarkers, particularly interleukins (IL-6, IL-8, and IL-10), which rise rapidly in response to infection. IL-6 increases within hours of onset, IL-8 promotes neutrophil recruitment and demonstrates high sensitivity, and IL-10, though anti-inflammatory, is associated with disease severity. This review evaluates the diagnostic accuracy of these interleukins compared to conventional markers like C-reactive protein (CRP) and procalcitonin (PCT) in neonatal sepsis. Methods: This systematic review adhered to PRISMA guidelines and was registered on PROSPERO (CRD42024569564). A comprehensive search was conducted in Medline, Embase, CINAHL, PsycInfo, Scopus, and Web of Science through April 23, 2024. Eligible studies reported sensitivity, specificity, or predictive values of IL-6, IL-8, or IL-10 in diagnosing neonatal sepsis and included ≥100 neonates. Observational studies from both low- and high-income countries were considered. Reviews, case reports, interventional studies, and conference abstracts were excluded. Two reviewers independently screened studies and extracted data on study design, population characteristics, diagnostic tools, and outcomes. Study quality was assessed using the JBI checklist. Meta-analysis was conducted using STATA v18 with a random-effects model and Freeman-Tukey transformation. Heterogeneity was evaluated via Cochran’s Q and I². Subgroup and sensitivity analyses were performed, along with tests for publication bias. Results: A total of 47 studies were included in the meta-analysis. IL-6 showed a pooled sensitivity of 0.81 (95% CI: 0.73–0.87), specificity of 0.77 (95% CI: 0.72–0.81), and AUC of 0.89. The diagnostic odds ratio (DOR) was 13.90. IL-6 levels typically rose within 2 hours of infection, preceding the rise in CRP and PCT. IL-8 demonstrated a pooled sensitivity of 0.78 (95% CI: 0.72–0.83), specificity of 0.84 (95% CI: 0.79–0.88), DOR of 21.64, and AUC of 0.89. IL-10 showed a pooled sensitivity of 0.82 (95% CI: 0.78–0.86), specificity of 0.79 (95% CI: 0.75–0.82), DOR of 17.52, and AUC of 0.88. Compared to CRP and PCT, interleukins—especially IL-6 and IL-8—demonstrated faster kinetic responses and superior or comparable diagnostic performance. Subgroup analysis revealed IL-8 had higher accuracy in early-onset sepsis, while IL-27 was more effective for late-onset cases. In premature infants, Serum Amyloid A (SAA) and IL-6 performed notably well. Conclusion: This review confirms that IL-6, IL-8, and IL-10 are effective early diagnostic biomarkers for neonatal sepsis, offering superior speed and comparable or better accuracy than traditional markers. Their integration into clinical protocols may improve early detection, guide timely interventions, and optimise antibiotic stewardship. Future research should focus on standardizing biomarker thresholds and validating findings across diverse neonatal populations.
Neonatal sepsis, Interleukins, IL-6, Diagnostic biomarkers, Early detection
Artificial Intelligence-Assisted Triage Accuracy in Pediatric Emergency Departments Across East Mediterranean Hospitals: A Multicenter Validation Study
Emergency departments (EDs) in the East Mediterranean region face critical challenges, including pediatric overcrowding, triage delays, and variability in clinical decision-making. This multicenter, prospective validation study evaluated the accuracy and efficiency of an AI-based pediatric triage tool implemented across six emergency departments (EDs) in Egypt, Lebanon, Jordan, and Saudi Arabia from June 2022 to March 2024. A total of 3,462 pediatric cases (ages 0–15 years) were assessed by both standard triage nurses and the AI-assisted system. The AI tool incorporated natural language processing for presenting complaints, automated vital sign interpretation, and risk score stratification into five urgency levels. Final diagnosis, time to treatment, and admission outcomes were tracked and adjudicated by independent pediatric emergency physicians. The AI triage system achieved an overall agreement rate of 87.9% with expert clinical judgment, compared to 73.5% agreement by standard nurse-led triage (p < 0.001). Sensitivity for identifying high-acuity cases (levels 1 and 2) was 92.4%, and specificity for non-urgent cases (levels 4 and 5) was 85.7%. Time to first provider contact was reduced by an average of 11.2 minutes in AI-triaged cases (p < 0.001). Over-triage was reduced by 22%, while under-triage incidents dropped from 7.4% to 2.1% following AI integration. In subgroup analysis, the tool performed exceptionally well in presentations of respiratory distress and seizures, with AUC values of 0.94 and 0.91, respectively. Triage satisfaction among staff increased by 41% according to follow-up surveys. This study provides the first regional validation of AI-supported triage in pediatric emergency settings, demonstrating its potential to enhance decision-making accuracy, reduce delays, and improve outcomes in resource-limited environments.
AI triage, pediatric emergency, emergency department, decision support, East Mediterranean
Sleep Architecture Disruption and Cognitive Performance in East Mediterranean School-Aged Children with Primary Nocturnal Enuresis: A Multicenter Neurophysiological Study
Primary nocturnal enuresis (PNE) affects 12–18% of children aged 5–12 in the East Mediterranean, yet the neurocognitive implications associated with sleep disturbances in this population remain understudied. This multicenter cross-sectional study enrolled 738 children with PNE and 402 age- and sex-matched healthy controls across pediatric clinics in Saudi Arabia, Jordan, and Tunisia between 2022 and 2024. The objective was to assess differences in sleep architecture and cognitive function between groups. All participants underwent overnight polysomnography and standardized neuropsychological assessments, including working memory (WISC-V), attention span (CPT-3), and processing speed tasks. Children with PNE demonstrated significantly lower sleep efficiency (81.2% vs. 91.7%, p < 0.001), higher arousal index (15.4 vs. 6.8 events/hour), and a 26% reduction in REM sleep duration compared to controls. Neurocognitive scores revealed that the PNE group scored lower in working memory index (mean: 84.7 ± 9.6 vs. 94.3 ± 10.2, p < 0.001) and sustained attention tasks (omission error rate: 17.1% vs. 9.6%, p < 0.001). Multivariate regression showed that reduced REM sleep duration and increased arousals were the strongest predictors of cognitive underperformance (adjusted R² = 0.41, p < 0.001). Moreover, 61.3% of PNE children with disrupted REM patterns reported school difficulties compared to 28.7% without REM disruption (p < 0.001). These findings suggest that PNE may be a neurophysiological condition with broader cognitive impact, rather than an isolated urological disorder. This is the first comprehensive sleep and cognition study in East Mediterranean children with PNE. Early screening and targeted behavioral therapy for sleep stabilization may improve both continence and learning outcomes in affected children.
nocturnal enuresis, pediatric sleep, REM sleep, cognition, East Mediterranean
Prevalence and Predictors of Post-Traumatic Stress Disorder Among Displaced Children in East Mediterranean Conflict Zones: A Multi-Nation Cross-Sectional Study
Armed conflict and forced displacement have significantly disrupted the lives of millions of children across the Eastern Mediterranean region. This cross-sectional study investigated the prevalence and key predictors of post-traumatic stress disorder (PTSD) among 1,382 displaced children aged 6–17 years residing in refugee camps across Syria, Lebanon, and Sudan between 2022 and 2024. PTSD symptoms were assessed using the Child PTSD Symptom Scale (CPSS), and trained mental health professionals conducted clinical interviews. Of the total sample, 46.3% met the criteria for probable PTSD. The prevalence was highest among children aged 10–13 (52.1%) and among females (49.6% vs. 42.7% in males, p = 0.008). Key trauma exposures included witnessing violence (71.4%), death of a family member (38.6%), and personal injury (24.9%). Children exposed to three or more traumatic events had a 4.2-fold increased risk of PTSD (OR = 4.21, 95% CI: 3.32–5.34). Those without parental presence had a significantly higher PTSD rate (62.8%) compared to those accompanied by at least one caregiver (39.5%, p < 0.001). Protective factors included participation in school (PTSD prevalence: 38.2% in school-enrolled vs. 54.6% in non-enrolled, p < 0.001) and access to psychosocial support services. Multivariate regression identified age, trauma load, parental loss, and school absence as independent predictors of PTSD (model AUC = 0.89). This study provides the largest regional dataset to date on mental health in displaced children, underscoring the urgent need for integrated psychosocial support and education access within refugee settings. Tailored mental health interventions targeting school-aged displaced children could mitigate the long-term psychological impact of war-related trauma.
pediatric PTSD, displacement, refugee mental health, conflict zones, East Mediterranean
Incidence, Genetic Risk Profiling, and Clinical Outcomes of Type 1 Diabetes Mellitus in East Mediterranean Children: A Multicenter Registry Analysis (2020–2024)
Type 1 Diabetes Mellitus (T1DM) in children is rising globally, with increasing incidence in the Eastern Mediterranean region. This multicenter, registry-based cohort study analyzed trends in T1DM, genetic risk profiles, and clinical outcomes among 2,316 pediatric patients (ages 1–15 years) diagnosed between 2020 and 2024 across five East Mediterranean countries. The overall crude incidence of pediatric T1DM increased from 19.2 to 28.7 per 100,000 person-years during the study period, with the highest rise observed in children under five (up by 63%). Ketoacidosis at diagnosis occurred in 44.1% of cases, with a significant difference by age group (≤5 years: 58.2%; 6–15 years: 38.4%; p < 0.001). HLA genotyping was performed on a subset of 784 patients. The most common risk haplotypes were DRB103:01-DQB102:01 (present in 41.3%) and DRB104:01-DQB103:02 (present in 29.6%). Patients with both haplotypes had earlier onset (mean age: 6.1 years) and higher rates of severe hypoglycemia in the first year post-diagnosis (21.4% vs. 12.3%, p = 0.004). Clinical outcome follow-up at 12 months revealed suboptimal glycemic control in 48.7% (HbA1c > 8.5%) of patients, associated with limited access to insulin pumps and structured diabetes education programs. Children receiving multidisciplinary care (n = 608) had significantly better glycemic control (HbA1c < 7.5% in 62.9%) compared to those in standard care settings (HbA1c < 7.5% in 36.2%, p < 0.001). This study confirms a concerning rise in T1DM incidence and highlights genetic risk stratification as a valuable tool for early identification and tailored follow-up. Expanding access to comprehensive care models may substantially improve pediatric diabetes outcomes in the region.
type 1 diabetes, pediatric endocrinology, HLA typing, incidence trends, East Mediterranean
Post-Vaccination Antibody Persistence and Immune Response Variability in East Mediterranean Children Following Measles-Rubella Vaccination Campaign (2022–2024)
Despite large-scale immunization efforts, periodic outbreaks of measles and rubella persist in the East Mediterranean region, raising concerns about the long-term durability of vaccine-induced immunity. This prospective study evaluated antibody persistence and immune response variability in 1,204 children (ages 9 months to 6 years) across Egypt, Jordan, and Iraq following national measles-rubella (MR) vaccination campaigns conducted between 2022 and 2024. Children were stratified into three age groups: 9–12 months (n = 408), 13–36 months (n = 412), and 37–72 months (n = 384). Serum IgG titers were measured at 6, 12, and 18 months post-vaccination. At 18 months post-vaccination, 89.3% retained protective measles IgG levels (>200 mIU/mL), while only 74.8% maintained rubella IgG above the protective threshold (>10 IU/mL). Antibody waning was significantly higher in the youngest group, with a 27.4% drop in rubella IgG levels between 6 and 18 months (p < 0.001). Host immune profiling revealed that children with HLA-DRB1*15:01 genotype had 2.1-fold higher rubella IgG decline compared to non-carriers (p = 0.004). Additionally, malnourished children had significantly lower peak antibody levels and a faster rate of waning (p < 0.001). Multivariate logistic regression identified age at vaccination, nutritional status, and genetic polymorphism as independent predictors of seroprotection at 18 months. Overall, 16.7% of participants fell below protective levels for either measles or rubella by 18 months, highlighting potential gaps in immunity. These findings support the need for age-specific booster policies and underline the importance of post-campaign immunological surveillance. This is the first longitudinal immunogenicity study in East Mediterranean children linking genetic and nutritional factors to MR vaccine antibody durability, with direct implications for improving public health immunization strategies.
measles, rubella, vaccine immunity, antibody persistence, pediatric immunization
Gut Microbiota Diversity and Its Association with Malnutrition Severity in East Mediterranean Children Under Five: A Metagenomic Analysis
Childhood malnutrition remains a critical public health concern in the East Mediterranean, affecting 14–21% of children under the age of five. This cross-sectional study evaluated the gut microbiota profiles of 684 malnourished and 312 age-matched well-nourished children across three countries (Sudan, Lebanon, and Egypt) between April 2022 and November 2024. Using 16S rRNA sequencing, we assessed microbial diversity, dominant taxa, and correlations with anthropometric indicators. Among malnourished children, 61.8% were classified as moderately malnourished (WHZ between -2 and -3), and 38.2% as severely malnourished (WHZ < -3). Shannon diversity indices were significantly lower in severely malnourished children (mean: 1.62 ± 0.21) compared to controls (2.48 ± 0.26, p < 0.001). Bifidobacterium and Faecalibacterium prausnitzii were depleted by 63% and 71%, respectively, in severe cases. Proteobacteria abundance was markedly higher in severely malnourished children (32.6% vs. 9.4%, p < 0.001), and the Firmicutes-to-Bacteroidetes ratio was inverted (0.68 in malnourished vs. 1.41 in controls). A microbial dysbiosis index (MDI) was calculated and found to correlate inversely with mid-upper arm circumference (r = -0.63, p < 0.001) and serum albumin (r = -0.58, p < 0.001). Machine learning classification using microbiota profiles yielded an AUC of 0.89 for predicting severe malnutrition, with sensitivity of 84% and specificity of 87%. These findings suggest that gut microbiota analysis could be developed into a diagnostic adjunct for early malnutrition detection and monitoring. This is the first metagenomic study in the East Mediterranean to link specific microbial patterns with malnutrition severity, providing a foundation for future microbiota-targeted interventions to improve nutritional recovery in vulnerable pediatric populations.
malnutrition, gut microbiota, microbiome diversity, child health, metagenomics
AI-Enhanced Radiomics for Early Risk Stratification of Neuroblastoma in East Mediterranean Pediatric Patients: A Multi-Center Study
Neuroblastoma accounts for approximately 8–10% of pediatric cancers in the East Mediterranean region, with delayed diagnosis contributing to poor outcomes. This multicenter prospective study recruited 476 newly diagnosed neuroblastoma patients (ages 0–14) from seven oncology centers between January 2022 and December 2024. The aim was to evaluate the performance of artificial intelligence (AI)-driven radiomics in predicting high-risk tumor profiles using initial MRI scans. Baseline demographic, clinical, and imaging data were collected. A total of 32 radiomic features were extracted per tumor, including texture, shape, and intensity metrics. High-risk disease was defined based on INRG staging, MYCN amplification, and metastatic status. Of the cohort, 182 children (38.2%) were classified as high-risk. The AI model, based on a convolutional neural network trained on 70% of the cohort and tested on 30%, demonstrated strong discriminatory power. Key predictors included entropy score > 5.8, sphericity < 0.65, and non-uniformity in the gray-level co-occurrence matrix. The final model achieved an AUC of 0.92 (95% CI: 0.89–0.95), with a sensitivity of 85.1% and a specificity of 88.3%. Notably, the model correctly predicted 91% of MYCN-amplified cases without requiring biopsy or genetic profiling. Patients flagged as high-risk by the model were referred earlier for intensive chemotherapy, with a 22% reduction in treatment delay compared to the standard diagnostic workflow (p < 0.001). Follow-up analysis revealed that early therapeutic decision-making based on AI predictions resulted in improved interim response rates (CR or PR in 76.4% of patients vs. 61.1% of controls, p = 0.02). This study provides strong evidence for integrating AI-enhanced imaging analytics into pediatric oncology workflows in low- to middle-income settings, enabling earlier intervention and improving survival potential in high-risk neuroblastoma cases.
neuroblastoma, pediatric oncology, AI radiomics, early diagnosis, East Mediterranean
Multiplex Allergen Exposure, Air Pollution, and Atopic Dermatitis Severity in East Mediterranean School-Age Children
Atopic dermatitis (AD) affects up to 20% of children in the East Mediterranean, yet the combined role of allergen sensitization and air pollution on disease severity remains underexplored. In this cross-sectional study conducted between May 2023 and November 2024, 1,128 school-age children (6–12 years) from four urban centers were evaluated for AD severity, indoor/outdoor allergen exposure, and ambient pollution levels. Of these children, 642 (56.9%) had physician-diagnosed AD. Serum IgE multiplex assays revealed that 74.6% of affected children were sensitized to at least three common allergens (house dust mite, pollen mixes, mold spores). Children with multi-sensitization experienced significantly higher Eczema Area and Severity Index (EASI) scores (median 14.2; IQR 10.1–19.8) versus monosensitized or non-sensitized peers (median 7.8; IQR 5.3–11.4, p < 0.001). Ambient particulate matter (PM₂.₅) averaged 58 µg/m³ (SD ± 12) across study sites, exceeding WHO recommendations. A multivariate regression showed that every 10 µg/m³ increase in PM₂.₅ was associated with a 1.8-point rise in EASI score (95% CI: 1.3–2.3, p < 0.001)—children with both multisensory integration difficulties and high PM2.5.₅ (>60 µg/m³) had the most severe disease, with EASI scores 2.4-fold higher than those with single/no sensitization in low pollution areas (p < 0.001). Predictive modeling combining sensitization count, PM₂.₅, indoor humidity, and family history achieved an AUC of 0.87 (95% CI: 0.84–0.90), with a sensitivity of 81% and a specificity of 78%. These findings underscore the synergistic effect of allergen exposure and pollution on AD severity, highlighting the need for integrated environmental and immunological management strategies. This study is among the first in the East Mediterranean to quantify the concurrent effects of allergen sensitization and air pollution on pediatric atopic dermatitis (AD), supporting policies for air quality control and targeted therapeutic plans.
atopic dermatitis, air pollution, allergen sensitization, PM₂.₅, pediatric dermatology
Longitudinal Electroencephalogram and Serum Neurotrophic Factor Profiling for Early Prediction of Autism Spectrum Disorder in East Mediterranean Infants
Autism Spectrum Disorder (ASD) affects approximately 1.8% of children in the East Mediterranean region, with diagnosis often delayed until after age 3 due to limited screening resources. In this prospective cohort study, 862 infants aged 6 to 24 months were enrolled across four pediatric centers from January 2023 to December 2024. Serial electroencephalogram (EEG) recordings and serum levels of brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) were measured at baseline (6 months), mid-point (12 months), and follow-up (24 months). By age 24 months, 72 infants (8.3%) met criteria for ASD based on standardized developmental assessments. Early EEG showed increased theta-band power (4–7 Hz) in 68% of later-diagnosed infants compared to 21% of neurotypical peers (p < 0.001). Median BDNF levels in the ASD group were elevated by 27% at 12 months (median: 24.9 ng/mL; IQR: 21.1–29.3) versus controls (19.6 ng/mL; IQR: 17.2–22.0). NGF levels showed a corresponding increase of 19% (p = 0.003). A combined predictive model using theta power increase ≥15%, BDNF ≥22 ng/mL, and NGF ≥18 ng/mL yielded an AUC of 0.91 (95% CI: 0.88–0.94), sensitivity 86%, and specificity 89%. Notably, this model identified ASD risk at a median age of 14.8 months—approximately 1.5 years earlier than typical clinical diagnosis (p < 0.001). Early identification enabled targeted behavioral interventions for 53 infants (73% of ASD group), who showed a 32% improvement in adaptive behavior scores (Bayley-III) at 36 months. This study demonstrates that combining EEG and serum neurotrophin profiling enables early and accurate ASD risk prediction in infants. This cost-effective, easily scalable screening protocol could transform neurodevelopmental care in the East Mediterranean by enabling earlier diagnosis, intervention, and improved long-term outcomes.
autism spectrum disorder, EEG biomarkers, BDNF, early diagnosis, neurodevelopment
Artificial Intelligence-Driven Echocardiographic Prediction Model for Early Detection of Pediatric Cardiomyopathy in East Mediterranean Populations
Pediatric cardiomyopathy is a leading cause of sudden cardiac death and heart transplantation in children, yet early detection remains limited in low-resource settings. This prospective study enrolled 1,026 children (ages 1–17 years) across six major pediatric cardiac centers in the East Mediterranean between March 2022 and December 2024 to develop and validate an AI-assisted echocardiographic prediction tool. Left ventricular strain, ejection fraction, septal wall thickness, NT-proBNP levels, and genetic risk scores were collected at baseline. Of the total cohort, 184 children (17.9%) were diagnosed with early-stage cardiomyopathy within 12 months. The AI model was trained on 70% of the dataset and validated on the remaining 30%. The final predictive model demonstrated a sensitivity of 88.7%, specificity of 91.4%, and an AUC of 0.94 (95% CI: 0.91–0.96). Among the top predictors were global longitudinal strain (GLS < -17%), NT-proBNP > 450 pg/mL, and specific MYH7 gene variants. The model flagged 92 of the 184 cardiomyopathy cases at least 4 months before clinical diagnosis, based on standard guidelines. This AI-integrated echocardiographic tool reduced diagnostic delay by an average of 3.6 months (p < 0.001), particularly improving detection in asymptomatic children. Implementation in resource-limited cardiology units could significantly enhance early intervention, reduce long-term cardiac complications, and support telecardiology programs in underserved regions. This is the first study to validate a region-specific AI model tailored to East Mediterranean pediatric populations, providing a scalable and low-cost solution for cardiomyopathy screening and triage.
cardiomyopathy, pediatric AI, echocardiography, early diagnosis, East Mediterranean
Recognition Trends in Pediatric Emergency Cases: Perspectives from Clinical Laboratory Diagnostics
N.V Authors' ORCIDs are Missing 0000-00000 N/A Background: In pediatric emergency care, accurate diagnosis is critical for the desired treatment. Systemization of clinical pathology and imaging might lead to higher accuracy of diagnoses in various diseases of children. Objective: The study aims to evaluate the feasibility of clinical pathology and imaging protocol regarding diagnostic accuracy in pediatric emergent disorders and corresponding age and condition performance. Methodology: The cross-sectional study involved a single centre excluding patients<18 years old without needing diagnostic imaging. Age group and conditions, sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV)were also determined. Patient data were extracted from patients’ charts, initial core application biomarker assays, and radiologic results and confirmed with comparison to their clinical records. Results: The protocol was 87% sensitive in general and 92% specific, although sensitivity remained constant across ages while specificity was slightly higher in the oldest children. The protocol proved especially useful in identifying crucial conditions that require immediate action; meningitis had the highest sensitivity of 93%. Conclusion: This study provides evidence for using integrated diagnostic protocols in pediatric emergency care, and newer adaptation strategies may even build the capacity for more precise diagnosis. The authors also suggest multi-centre trials and further changes to its age-dependent markers to ensure the high accuracy of the method in other clinics. Research Paper Report : 1. Introduction Pediatric emergency care requires accurate diagnostic methodologies to ensure timely and appropriate treatments. Recent advancements in clinical pathology and imaging have allowed for improved diagnostic accuracy in various pediatric conditions. This report explores the research conducted by Abubakr Elamin, Mayssaa Mamoun Yousef Ahmed, Rihab Khattab, Omer Kheir, and Doaa Mohamed Yousif Mabrouk, focusing on the integration of clinical pathology and imaging in pediatric emergencies. 2. Methodology 2.1 Study Design and Population The research, conducted as a cross-sectional study, involved pediatric emergency patients requiring diagnostic imaging. Data was collected through patient records, biomarker assays, and radiological findings, ensuring a comprehensive evaluation of diagnostic performance. The study included patients under 18 years old, with data extracted from medical charts and confirmed through clinical records. 2.2 Diagnostic Performance Metrics The study assessed sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) across various pediatric age groups. Sensitivity measured the ability to correctly identify positive cases, while specificity determined the correct classification of negative cases. 3. Results 3.1 General Diagnostic Accuracy Overall sensitivity: 87% Overall specificity: 92% Positive Predictive Value (PPV): 90% Negative Predictive Value (NPV): 89% Sensitivity for meningitis cases: 93%, showing high efficiency in identifying life-threatening conditions. 3.2 Age-Specific Diagnostic Accuracy Age Group Sensitivity (%) Specificity (%) PPV (%) NPV (%) 0 - 4 92.5 86.0 88.2 92.0 5 - 9 89.7 82.0 84.0 88.0 10 - 14 92.8 86.0 87.3 91.8 15 - 18 91.5 89.8 90.5 90.9 3.3 Disease-Specific Diagnostic Accuracy Condition Sensitivity (%) Specificity (%) PPV (%) NPV (%) Sepsis 91.0 82.0 85.5 90.0 Non-Sepsis 88.5 84.5 85.0 87.5 Meningitis 93.0 86.5 88.5 93.0 Non-Meningitis 91.8 88.5 89.5 91.0 4. Discussion 4.1 Impact of Clinical Pathology and Imaging Integration The research by Elamin et al. underscores the importance of combining biomarker analysis with imaging techniques. This integration has significantly improved diagnostic precision, particularly in severe cases like meningitis, where early intervention is crucial. 4.2 Implications for Emergency Pediatrics The high sensitivity across all age groups indicates that the diagnostic protocol is effective in pediatric settings. Specificity increases with age, suggesting that symptoms may be more distinguishable in older children, improving diagnostic accuracy. Multi-modal diagnostic approaches should be further explored to refine emergency pediatric care protocols. 5. Conclusion and Recommendations This research provides substantial evidence supporting the use of integrated diagnostic protocols in pediatric emergency care. The findings highlight the necessity for multi-center trials to validate the protocol's applicability across diverse clinical settings. Recommendations: Implement structured clinical pathology and imaging protocols in pediatric emergency departments. Conduct further studies to refine age-specific diagnostic markers. Promote the use of biomarkers to enhance early detection of severe conditions. 6. Acknowledgments and Correspondence The study was conducted by Abubakr Elamin, Mayssaa Mamoun Yousef Ahmed, Rihab Khattab, Omer Kheir, and Doaa Mohamed Yousif Mabrouk. For further information, contact the corresponding author Dr. Omer Kheir at omerokheir@gmail.com.
Diagnostic Patterns in Pediatric Emergency Cases: Insights from Clinical Pathology
The Distribution and Determinants of Immunization-Preventable Illnesses in Children: Patterns, Obstacles, and Vaccination Approaches
Author verified Abstract: Vaccine-preventable diseases (VPDs) remain a significant concern in pediatric populations, despite advancements in immunization programs worldwide. This study examines the epidemiological trends, emerging challenges, and immunization strategies for controlling VPDs among children. Using multi-country surveillance data from 2015 to 2023, we analyze the incidence, mortality, and vaccine coverage of measles, pertussis, pneumococcal infections, rotavirus, and influenza in pediatric populations across high-income, middle-income, and low-income settings. A cohort of 22,500 children from Asia, Europe, and Africa was assessed for vaccination status, infection rates, and immune response variability using national health databases and WHO surveillance reports. Key variables included vaccine hesitancy trends, socioeconomic determinants of immunization, and outbreak frequency in different regions. Results: Measles resurgence: Incidence increased by 35% globally between 2018 and 2023, with the highest surge in low-vaccine-coverage regions (sub-Saharan Africa: 82.4 cases per 100,000 children). 93.1% of hospitalized cases were in unvaccinated children (p < 0.001). Pertussis burden: Despite widespread DTaP vaccination, pertussis cases rose by 18.7%, particularly in adolescents with waning immunity. Booster vaccination reduced incidence by 68% in adolescents and 45% in infants with vaccinated mothers (p = 0.002). Pneumococcal & Rotavirus Disease: Introduction of PCV13 and rotavirus vaccines in LMICs reduced severe infections by 49.2% (p < 0.001). Non-vaccine pneumococcal serotypes increased, necessitating enhanced surveillance and updated vaccine formulations. Vaccine Hesitancy Impact: 24.6% of parents in high-income regions expressed concerns about vaccine safety, affecting MMR and HPV vaccine uptake. Community-driven awareness campaigns improved vaccination rates by 11.8% over 24 months (p = 0.004). Conclusion: This study underscores the continuing burden of vaccine-preventable diseases in pediatric populations and highlights critical gaps in immunization coverage, booster necessity, and vaccine hesitancy trends. While pneumococcal and rotavirus vaccines have demonstrated success, measles resurgence and pertussis outbreaks signal the need for targeted interventions. Strengthening routine immunization programs, addressing vaccine hesitancy, and optimizing booster strategies remain essential to achieving global pediatric health goals. Future efforts should focus on real-time surveillance, vaccine innovation, and cross-border immunization policies to mitigate disease transmission effectively.
Pediatric Vaccination, Vaccine-Preventable Diseases, Measles Resurgence, Pertussis Epidemiology, Pneumococcal Immunization, Rotavirus Control, Vaccine Hesitancy, Global Immunization Strategies
Prolonged Consequences of Early-Life Undernutrition: A Population-Based Analysis of Physical Growth, Cognitive Function, and Vulnerability to Illness
Author verified Abstract: Malnutrition during early childhood remains a significant global health concern, particularly in low- and middle-income countries, where food insecurity, inadequate healthcare, and poor sanitation contribute to high rates of undernutrition. This study investigates the long-term effects of early childhood malnutrition on physical growth, cognitive development, and disease susceptibility in pediatric populations. Utilizing a longitudinal cohort design, data were collected from 4,200 children aged 6 months to 10 years across five regions in Eastern Europe and Asia. Participants were stratified into three nutritional status categories: severely malnourished, moderately malnourished, and well-nourished controls. Key outcomes assessed include stunting prevalence (height-for-age Z-score), cognitive performance (IQ and memory tests), and immune function (frequency of infectious diseases and inflammatory markers). The study further explores the impact of nutritional interventions on long-term recovery and overall well-being. Results: Growth and Physical Development: Stunting prevalence: 38.2% in severely malnourished children vs. 12.5% in moderately malnourished (p < 0.001). Height-for-age Z-score: -2.81 in severely malnourished vs. -1.67 in moderately malnourished vs. -0.22 in well-nourished controls. Recovery rates: 57% of stunted children showed some height recovery by age 10, but 28% remained permanently stunted. Cognitive Development: IQ scores were significantly lower in children with a history of severe malnutrition (mean IQ: 82.3) compared to controls (mean IQ: 101.5, p < 0.001). Memory performance and executive function were impaired in 42.7% of severely malnourished children. Early nutritional intervention improved cognitive scores by 9.4 points over five years (p = 0.002). Disease Susceptibility and Immune Function: Infectious disease incidence: Malnourished children experienced 2.3x higher rates of respiratory infections and 1.9x higher rates of diarrheal diseases compared to controls (p < 0.001). Inflammatory markers (C-reactive protein, IL-6) remained elevated in malnourished children, suggesting long-term immune dysregulation. Childhood malnutrition was associated with a 32% increased risk of developing metabolic disorders (obesity, type 2 diabetes) in later life. Conclusion: This study highlights the profound and lasting consequences of early childhood malnutrition on physical growth, cognitive function, and immune resilience. The findings emphasize the importance of early intervention, targeted nutritional programs, and policy-driven approaches to combat childhood undernutrition. Nutritional rehabilitation can partially mitigate developmental deficits, but long-term impairments persist in severely affected individuals. Public health strategies must focus on preventative nutrition, maternal education, and improved healthcare access to reduce the global burden of malnutrition-related complications.
Childhood Malnutrition, Stunting, Cognitive Development, Nutritional Interventions, Immune Dysfunction, Pediatric Epidemiology, Global Health, Longitudinal Study
The Prevalence and Trends of Vaccine-Preventable Diseases in Pediatric Populations: Challenges, Obstacles, and Immunization Strategies
Author verified Abstract: Environmental exposures play a crucial role in shaping pediatric health outcomes, with increasing evidence linking air pollutants, heavy metals, pesticides, and endocrine-disrupting chemicals to adverse health effects in children. This study investigates the impact of various environmental contaminants on pediatric health, analyzing respiratory conditions, neurodevelopmental disorders, and metabolic alterations while emphasizing preventive measures and policy development. A multi-center cohort study was conducted in four Eastern European and Asian countries (China, India, Poland, and Kazakhstan), including 3,200 children aged 0–18 years. The study analyzed exposure to air pollution (PM2.5 and NO2 levels), heavy metals (lead, mercury, cadmium), and endocrine disruptors (bisphenol A, phthalates). Health outcomes were assessed through spirometry tests for respiratory function, neurodevelopmental assessments (IQ and attention span tests), and metabolic biomarkers (insulin resistance, obesity markers). Results: Respiratory Effects: Children exposed to high levels of PM2.5 (>35 µg/m³) had a 47% higher risk of developing asthma compared to those in lower-exposure areas (p < 0.001). NO2 exposure (>40 ppb) correlated with a 28% decline in lung function (FEV1%) compared to children in cleaner environments. Neurodevelopmental Impact: Blood lead levels above 5 µg/dL were associated with a 6.3-point decrease in IQ scores (p = 0.002). Exposure to phthalates was linked to higher rates of ADHD symptoms (32.7% vs. 14.8%) in exposed vs. non-exposed groups. Metabolic Disorders: Children with bisphenol A (BPA) levels in the highest quartile (>4.5 ng/mL) exhibited a 35% increase in insulin resistance compared to those in the lowest quartile. Higher cadmium levels correlated with an 18% increased risk of childhood obesity (p = 0.005). Conclusion: This study provides robust evidence that environmental exposures significantly contribute to pediatric health issues, including respiratory diseases, cognitive impairment, and metabolic disorders. The findings emphasize the urgent need for stricter environmental policies to reduce exposure to harmful pollutants. Preventive strategies such as air quality regulations, reduction of heavy metal exposure, and banning endocrine-disrupting chemicals in consumer products are essential to protect children’s health. Further longitudinal studies are recommended to explore long-term health outcomes of early-life exposure to environmental pollutants.
Pediatric Environmental Health, Air Pollution, Heavy Metals, Neurodevelopmental Disorders, Asthma, Endocrine Disruptors, Environmental Policy, Child Health Protection
Pediatric Inflammatory Bowel Disease Management: Evaluating Current Treatments and Outcomes in Children with Inflammatory Bowel Disease to Optimize Therapeutic Strategies
Author verified Abstract: Pediatric Inflammatory Bowel Disease (IBD) is a chronic, relapsing disorder that significantly impacts the quality of life of affected children. This study aims to evaluate current treatment modalities and their outcomes in pediatric IBD patients, providing a comprehensive analysis of therapeutic strategies to optimize disease management. A retrospective cohort study was conducted on 478 pediatric patients diagnosed with IBD (Crohn’s disease and ulcerative colitis) across three major pediatric gastroenterology centers in Eastern Europe and Asia between 2018 and 2023. Patients were stratified into three treatment groups: (1) exclusive enteral nutrition (EEN), (2) biologic therapy (anti-TNF agents such as infliximab and adalimumab), and (3) combination therapy (immunomodulators with biologics). Disease remission rates, adverse events, and long-term clinical outcomes were assessed over a follow-up period of two years. Results showed that the remission rate at 12 months was significantly higher in the biologic therapy group (78.2%) compared to the EEN group (62.5%) and the combination therapy group (82.1%) (p < 0.001). Adverse event rates were lowest in the EEN group (4.3%) compared to biologic therapy (12.7%) and combination therapy (18.9%). However, combination therapy was associated with a higher rate of sustained remission at 24 months (73.4%) compared to biologic monotherapy (68.9%) and EEN (51.2%) (p < 0.01). Biomarker analysis showed a significant reduction in fecal calprotectin levels in the combination therapy group (134.5 ± 22.8 μg/g) compared to biologic monotherapy (186.7 ± 30.4 μg/g) and EEN (240.3 ± 41.6 μg/g) (p < 0.001). Endoscopic healing rates were highest in the combination therapy group (65.8%) compared to biologic therapy (57.3%) and EEN (38.9%) (p = 0.002). This study highlights the effectiveness of biologic therapy and combination therapy in achieving long-term remission in pediatric IBD patients. While EEN remains a viable first-line therapy with the lowest adverse effects, biologic therapy—especially in combination with immunomodulators—provides superior long-term disease control. These findings support the early use of biologics in moderate to severe pediatric IBD cases to optimize patient outcomes. Further randomized controlled trials are needed to establish standardized protocols for personalized therapy.
Pediatric Inflammatory Bowel Disease, Crohn’s Disease, Ulcerative Colitis, Biologic Therapy, Enteral Nutrition, Combination Therapy, Disease Remission, Fecal Calprotectin
Gut Microbiota Dysbiosis and Its Role in Pediatric Autoimmune Disorders: A Cross-Sectional Study
Authors: ¹ Dr. Narges Hashemi, ² Dr. Shahnaz Armin, ³ Dr. Mohammad Sadegh Rezai, ⁴ Dr. Vahid Ziaee https://orcid.org/0000-0002-1767-7873 Dr. Shahnaz Armin: https://orcid.org/0000-0002-4993-482X Dr. Mohammad Rezai: https://orcid.org/0000-0003-4585-9954 Dr. Vahid Ziaee: https://orcid.org/0000-0003-4648-3573 Abstract: In this cross-sectional investigation, we examined the association between gut microbiota dysbiosis and pediatric autoimmune disorders. A total of 600 children were enrolled, including 300 diagnosed with autoimmune conditions (e.g., type 1 diabetes and juvenile idiopathic arthritis) and 300 age- and sex-matched healthy controls. Stool samples were analyzed using next-generation sequencing to determine microbial composition and diversity. Children with autoimmune disorders exhibited a dysbiosis index of 2.2 ± 0.4 compared to 1.5 ± 0.3 in controls (p < 0.001). Notably, beneficial bacteria such as Bifidobacterium were reduced by 40%, while pro-inflammatory bacterial species increased by 45% in the autoimmune group relative to controls. Logistic regression analysis revealed that a dysbiosis index greater than 2.0 was associated with a 2.8-fold increase in the odds of having an autoimmune disorder (95% CI: 1.9–4.1, p < 0.001). These data support the hypothesis that alterations in gut microbiota composition contribute significantly to the pathogenesis of pediatric autoimmune diseases and may offer novel targets for therapeutic intervention.
Keywords: Gut microbiota, Dysbiosis, Pediatric autoimmune disorders, Next-generation sequencing, Microbial diversity, Biomarkers, Inflammatory response
The Influence of Early Childhood Screen Time on Cognitive Development and Behavioral Outcomes
Author verified The increasing prevalence of screen time among young children has raised concerns regarding its potential impact on cognitive development and behavioral outcomes. This study aims to investigate the relationship between screen time exposure and the cognitive and behavioral development of children aged 2-5 years. Data were collected from a cohort of 1,200 children across various childcare centers. A structured questionnaire and direct observation were used to assess the total weekly screen time, cognitive test scores, and behavioral assessments. Descriptive statistics revealed that 72% of the children exceeded the recommended 2 hours of screen time per day. Among this group, 48% spent 3-4 hours per day on screens, while 24% reported more than 4 hours. Cognitive testing, conducted using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI-IV), showed a significant decline in IQ scores among children exposed to more than 3 hours of screen time daily. The mean IQ score for children with less than 2 hours of screen time was 108 (SD = 6), while for children with more than 3 hours, the average score dropped to 95 (SD = 7). A t-test revealed a statistically significant difference in mean IQ scores between these groups (t = 12.85, p < 0.01). Behavioral assessments, which utilized the Child Behavior Checklist (CBCL), identified higher levels of hyperactivity (25%), aggression (18%), and social withdrawal (14%) in children exposed to excessive screen time. Multivariate analysis indicated a strong association between increased screen time and negative behavioral outcomes, with a correlation coefficient of r = 0.52 (p < 0.05). Regression models controlling for socioeconomic status, parental education, and sleep duration confirmed that screen time was a significant predictor of both cognitive delays and behavioral issues (β = -0.45, p < 0.01). In conclusion, this study provides strong evidence that excessive screen time during early childhood is associated with lower cognitive performance and increased behavioral problems. The findings underscore the need for interventions to limit screen time in young children to promote healthier developmental trajectories.
Early Childhood, Screen Time, Cognitive Development, Behavioral Outcomes, IQ Scores, Child Behavior Checklist, Statistical Analysis, Pediatric Health, Developmental Delays, Hyperactivity
Exploring the Impact of Pediatric Obesity on Long-Term Cardiovascular Health Outcomes
Author Verified Pediatric obesity has emerged as a critical health concern with long-term cardiovascular consequences. This study aimed to explore the relationship between childhood obesity and its subsequent impact on cardiovascular health in adulthood. Data was collected from a cohort of 1,250 children aged 5-12 years, who were monitored over a 10-year period. Of the total participants, 32% were classified as obese based on BMI-for-age percentiles. Statistical analysis revealed a significant association between obesity and increased risk of hypertension, with 45% of obese children developing elevated blood pressure by the age of 18 compared to 20% in their non-obese peers (p<0.01). Additionally, 38% of obese children exhibited early signs of atherosclerosis, a condition only present in 15% of the non-obese group (p<0.05). Multivariate regression analysis confirmed that pediatric obesity was independently associated with a 2.3-fold increase in the risk of cardiovascular diseases in adulthood (p<0.001). These findings emphasize the urgency of early intervention strategies to combat pediatric obesity and its long-term health repercussions. Conclusion: In conclusion, the findings of this study highlight a strong and statistically significant relationship between pediatric obesity and the development of cardiovascular risk factors in later years. With 45% of obese children showing signs of elevated blood pressure and 38% developing early atherosclerosis, this study underscores the long-term health implications of childhood obesity. These results suggest that pediatric obesity is a critical precursor to cardiovascular diseases in adulthood. Therefore, early screening, prevention, and intervention measures are essential to mitigate the long-term effects of obesity on cardiovascular health, ultimately reducing the future burden of cardiovascular diseases.
Pediatric obesity, cardiovascular outcomes, hypertension, atherosclerosis, childhood health, longitudinal study, BMI-for-age, multivariate regression, early intervention.
Long-Term Neurodevelopmental Outcomes in Preterm Infants
Preterm birth remains a significant global health challenge, with increasing survival rates due to medical advancements. However, long-term neurodevelopmental impairment (NDI) remains a major concern. This study evaluates cognitive, motor, and behavioral outcomes in 1,500 preterm infants (gestational age <32 weeks) at five years of age across multiple centers in Europe and North America. Participants were classified into three groups based on birth weight: Extremely low birth weight (ELBW, <1,000g, n=500) Very low birth weight (VLBW, 1,000–1,500g, n=500) Moderate preterm (1,500–2,000g, n=500) Standardized neurodevelopmental assessments were performed, including the Bayley Scales of Infant Development-III (BSID-III) and Wechsler Preschool and Primary Scale of Intelligence (WPPSI). Key findings include: Global cognitive delay was found in 32.4% of ELBW infants, 18.6% of VLBW infants, and 9.1% of moderate preterms (p<0.001, OR=2.45, 95% CI: 1.88–3.21). Motor impairment (defined as a score <85 on the BSID-III Motor Scale) was observed in 23.8% of ELBW, 12.1% of VLBW, and 5.6% of moderate preterms (p=0.002). Attention-deficit/hyperactivity disorder (ADHD) symptoms were significantly higher in ELBW infants (19.2% vs. 7.8% in controls, p=0.004). Severe NDI (cognitive and motor disability combined) was diagnosed in 14.7% of ELBW infants, 6.9% of VLBW infants, and 2.4% of moderate preterms (p<0.001). Multivariate regression confirmed that lower gestational age, prolonged mechanical ventilation (OR=1.92, p=0.003), and neonatal sepsis (OR=2.37, p<0.001) were significant predictors of NDI. Conclusion Preterm infants, especially those with ELBW, remain at high risk for long-term neurodevelopmental deficits. Early intervention programs and long-term follow-up strategies are crucial in mitigating adverse outcomes. Future research should focus on targeted therapies to improve neurodevelopment in this vulnerable population.
Preterm birth, neurodevelopment, cognitive impairment, motor delay, very low birth weight, long-term outcomes
Current Issue OverviewThe latest issue of Ambulatory Pediatrics presents a dynamic collection of articles that reflect the cutting-edge of outpatient pediatric care. This issue is meticulously curated to provide clinicians, researchers, and healthcare professionals with in-depth analyses, innovative research, and practical insights into the evolving landscape of pediatric medicine.Key Highlights Include:Innovative Clinical Research:Explore new studies that address early nutritional interventions, telehealth advancements, and digital strategies to enhance vaccination rates. Each research article is backed by robust methodologies and compelling data, offering actionable insights for improving clinical outcomes.Contemporary Practice Guidelines:Benefit from updated recommendations and expert commentaries that delve into the management of chronic conditions, environmental influences on pediatric asthma, and preventive care strategies tailored for the outpatient setting.Pathology and Molecular Biology Insights:This issue uniquely integrates perspectives from pathology and molecular biology, shedding light on the underlying mechanisms of pediatric diseases. In-depth analyses reveal how cellular alterations, molecular markers, and histopathological findings are influencing early diagnosis and targeted treatment strategies. These contributions enhance our understanding of disease progression and support the development of precision medicine approaches in pediatrics.Emerging Technologies in Care Delivery:Learn about the latest tools and digital innovations that are reshaping patient engagement and continuity of care in ambulatory settings. Articles in this issue highlight how telemedicine and digital health platforms are bridging gaps in access and enhancing care coordination.Multidisciplinary Perspectives:Gain diverse insights from thought leaders and specialists across various fields. The issue includes contributions from renowned experts who share their experiences and future directions for research and practice in pediatric outpatient care.This issue of Ambulatory Pediatrics not only informs but also inspires its readers to integrate evidence-based practices into everyday clinical workflows. With an emphasis on practical applications and forward-thinking approaches, the content is designed to support excellence in pediatric care and improve overall health outcomes for children.
C.M.B.-S.: https://orcid.org/0000-0002-7528-1586 I.D.F.: https://orcid.org/0000-0002-0751-8932 M.P.: https://orcid.org/0000-0001-5236-6598 C.R.: https://orcid.org/0000-0001-6449-0377 L.L.D.: https://orcid.org/0000-0002-7699-1061 Abstract: This cross-sectional study compared environmental exposures and asthma outcomes in urban versus rural pediatric populations. A total of 800 children aged 6–12 years were enrolled, with 400 from urban settings and 400 from rural areas. Asthma prevalence was 25.5% in urban children compared to 15.3% in their rural counterparts (p = 0.002). Air quality assessments indicated that levels of PM2.5 and other pollutants were on average 35–40% higher in urban regions. Spirometric evaluation revealed that urban asthmatic children had an 8% lower mean forced expiratory volume in 1 second (FEV₁) than rural asthmatics (p = 0.01). Additionally, urban children experienced a 30% higher rate of emergency room visits for asthma exacerbations than rural children. Multivariate regression analysis, controlling for socioeconomic factors, confirmed that urban residence independently predicted poorer asthma control with an odds ratio of 1.8 (95% CI: 1.2–2.7). These findings underscore the critical role of environmental factors in pediatric asthma severity and highlight the need for targeted public health interventions in urban areas.
Pediatric asthma, Environmental exposure, Urban versus rural, Air pollution, Respiratory health, Cross-sectional study, Public health
Prolonged Impact of Initial Dietary Strategies on Pediatric Adiposity and Metabolic Well-Being: A Decade-Long Observational Study
https://orcid.org/0009-0001-0022-4755 https://orcid.org/0000-0003-1566-6000 https://orcid.org/0000-0002-2589-3250 https://orcid.org/0000-0002-9356-3480 This 10-year prospective cohort study evaluated the impact of early nutritional interventions on obesity and metabolic outcomes in children. A total of 1,200 children (mean age: 5.1 ± 0.8 years) were enrolled, with 600 assigned to a comprehensive nutritional intervention program and 600 receiving standard care. Annual assessments included body mass index (BMI), waist circumference, fasting glucose, and insulin levels. At baseline, obesity prevalence was 25% in both groups. By year 10, the intervention group exhibited a significant reduction in obesity prevalence to 15.3% compared to 29.7% in the control group (p < 0.001). Additionally, the incidence of metabolic syndrome was 8.5% in the intervention group versus 14.2% in controls, reflecting a 40.1% relative reduction (p = 0.002). Mean waist circumference in the intervention group decreased by 3.2 cm (a 12% reduction) while the control group experienced a 1.1 cm increase (3% rise). Fasting insulin levels decreased by 18% among intervention participants versus a 5% increase in the control group. These findings suggest that early nutritional interventions can significantly mitigate long-term obesity and metabolic risk, supporting the implementation of targeted pediatric nutrition programs.
Childhood obesity, Nutritional intervention, Metabolic health, Cohort study, Long-term outcomes, Pediatric nutrition, Prevention strategies