World journal of clinical pediatrics最新文献

{"title":"Efficacy and safety of dual-targeted therapy in children with inflammatory bowel disease: Retrospective cohort study.","authors":"Tatiana Gabrusskaya, Natalia Ulanova, Elena Shilova, Natalia Volkova, Sofia Kilina, Elena Kornienko, Mikhail Kostik","doi":"10.5409/wjcp.v15.i1.111093","DOIUrl":"10.5409/wjcp.v15.i1.111093","url":null,"abstract":"<p><strong>Background: </strong>There is a limited number of studies on the efficacy and safety of dual-targeted therapy (DTT) in children with inflammatory bowel diseases (IBD); the latest reports focus on the combination of biological drugs with Janus kinase inhibitors (JAKI).</p><p><strong>Aim: </strong>To evaluate the efficacy and safety of DTT in children with IBD.</p><p><strong>Methods: </strong>This retrospective cohort study included 18 IBD patients, aged 2-17 years, with 13 (72%) having Crohn's disease (CD) and 5 (28%) having ulcerative colitis, who were treated with DTT. In two children, two different combinations of DTT were used sequentially. The data on clinical and laboratory changes were assessed at the beginning of DTT and at three months (M3) and six months (M6). Fecal calprotectin and endoscopy were evaluated at baseline and M6.</p><p><strong>Results: </strong>A total of 20 courses of DTT in 18 patients were included in the analysis: (1) 12 (60%) were treated with JAKI and vedolizumab; (2) 6 (30%) with JAKI and ustekinumab; and (3) 2 (10%) with JAKI and adalimumab. Clinical remission was achieved in 9/20 (45%) and 13/20 (68%) DTT courses in patients within M3 and M6, respectively. In contrast, laboratory and endoscopic remission (ER) were achieved in 8/20 (40%) and 9/17 (53%) patients, respectively, within M6. Perianal lesions and upper gastrointestinal tract involvement were negatively associated with the efficacy of the DTT in CD patients. Children with early onset of the disease are more likely to achieve ER compared with those with later onset: 8/11 (73%) <i>vs</i> 1/6 (17%), respectively. Side effects were reported in 6/20 (30%) of cases, and 5/6 (83.3%) were considered non-serious.</p><p><strong>Conclusion: </strong>A DTT may be considered for children with refractory IBD. This strategy was shown to be most effective among children with a very early onset of the disease.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"111093"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cow's milk protein allergy in infants: Clinical presentations and outcomes.","authors":"Fareed Khdair Ahmad, Mohammad R Alkayid, Tahani M Ahmad, Reem H Hadidi, Riad M Rahhal","doi":"10.5409/wjcp.v15.i1.109301","DOIUrl":"10.5409/wjcp.v15.i1.109301","url":null,"abstract":"<p><strong>Background: </strong>Cow's milk protein allergy (CMPA) is the most common food allergy in infants, with significant clinical, nutritional, and economic consequences. In Jordan, the Ministry of Health (MoH) provides specialized formulas for affected infants; however, local data on clinical presentation, treatment duration, costs, and breastfeeding barriers are scarce.</p><p><strong>Aim: </strong>To evaluate the clinical manifestations and outcomes of infants diagnosed with CMPA in a public hospital in Jordan and to assess treatment costs and maternal breastfeeding barriers.</p><p><strong>Methods: </strong>This retrospective cross-sectional study included 38 infants aged < 1 year diagnosed with CMPA at a MoH tertiary hospital in Salt, Jordan, between 2020 and 2023. Data were collected from medical records and caregiver phone interviews. Infants who were exclusively breastfed or received mixed formulas (extensively hydrolyzed formula and amino acid-based formula) were excluded. Statistical analysis included descriptive statistics and Fisher's exact test to determine associations between breastfeeding barriers and maternal factors.</p><p><strong>Results: </strong>Constipation (47.4%) and diarrhea (44.7%) were among the most frequent symptoms. One-third of the infants had coexisting food allergies, and elevated liver enzyme levels or isolated jaundice was noted in 21%. The average treatment duration was 13.89 months, with a mean cost of JD 1802 ($2523) per child. Maternal perception of milk insufficiency (36.8%) was the most reported breastfeeding barrier. Maternal employment, but not education (<i>P</i> = 0.22), was significantly associated with breastfeeding challenges (OR = 7.20, <i>P</i> = 0.03).</p><p><strong>Conclusion: </strong>CMPA in Jordanian infants was associated with delayed diagnosis, high treatment costs, and significant breastfeeding barriers, particularly among employed mothers. These findings highlight the need for improved awareness, earlier diagnosis, and supportive policies to promote breastfeeding and reduce the disease burden.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"109301"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional constipation in Thai infants and toddlers: The role of genetic-gut-brain interaction and fiber supplementation.","authors":"Kanticha Chatpermporn, Thitima Ngoenmak, Busara Charoenwat, Atchariya Chanpong, Hansa Sriphongphankul, Nipaporn Hanpitakpong, Palittiya Sintusek","doi":"10.5409/wjcp.v15.i1.111828","DOIUrl":"10.5409/wjcp.v15.i1.111828","url":null,"abstract":"<p><strong>Background: </strong>Functional constipation (FC) is a global burden, and data on its prevalence based on Rome IV diagnostic criteria in young children, particularly after the coronavirus disease 2019 era, are limited.</p><p><strong>Aim: </strong>To determine the prevalence of FC in Thai infants and toddlers using the Rome IV criteria and identify associated factors.</p><p><strong>Methods: </strong>The Thai version of the Rome IV Diagnostic Questionnaire for Pediatric Functional Gastrointestinal Disorder (R4PDQ-Toddler) was developed and then officially approved by the Rome Foundation. Guardians of children aged 6-48 months from six hospitals in five regions in Thailand were surveyed between August 2023 and September 2024. The questionnaire collected demographic data, the R4PDQ-Toddler gathered defecation data, and factors potentially associated with FC were recorded.</p><p><strong>Results: </strong>A total of 1874 guardians participated, yielding a high response rate of 98.1%. The mean age of the children was 20.3 months ± 11.4 months, and 53.5% were male. The prevalence of FC was 16.1% [95% confidence interval (CI), 14.5%-17.8%]. Painful or hard bowel movements (81.5%), large-diameter stools (77.5%), and excessive stool retention (72.2%) were the most common symptoms. Factors independently associated with FC were age > 1 year [adjusted odds ratio (aOR), 3.36; 95%CI: 2.29-4.94], a first-degree relative with a history of constipation (aOR: 2.48; 95%CI: 1.85-3.35), fiber supplementation (aOR: 7.85; 95%CI: 3.56-17.30), and exposure to stressful family events (aOR: 1.41; 95%CI: 1.03-1.92).</p><p><strong>Conclusion: </strong>FC is prevalent in Thai infants and toddlers. Older age, family history, fiber supplementation, and stress are key factors, highlighting genetic, dietary, and gut-brain influences that need further investigations.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"111828"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal and neonatal determinants of newborn sepsis: A case-control study in resource-limited settings.","authors":"Mohd Asif Qureshi, Mangla Sood, Pratima Thakur, Ishaan Sood","doi":"10.5409/wjcp.v15.i1.111423","DOIUrl":"10.5409/wjcp.v15.i1.111423","url":null,"abstract":"<p><strong>Background: </strong>Neonatal sepsis continues to remain a serious threat, with multiple maternal and neonatal risk factors. Understanding these determinants will empower clinicians in comparable settings to apply targeted interventions, ultimately reducing newborn morbidity and mortality.</p><p><strong>Aim: </strong>To assess maternal and infant risk factors, the aim is to develop evidence-based strategies for preventing neonatal sepsis.</p><p><strong>Methods: </strong>A total of 453 neonates and their mothers were enrolled, of which 146 were cases. Clinical, demographic, and obstetric data were analyzed including maternal infection history, delivery conditions, neonatal characteristics, and respiratory support requirements. Statistical associations were assessed using multivariable logistic regression analysis to determine independent risk factors.</p><p><strong>Results: </strong>Male sex (adjusted odd ratio [AOR] = 1.9; 95% confidence interval [CI]: 1.03-3.5), forceps-assisted vaginal delivery (AOR = 3.4; 95%CI: 1.1-14.9), fewer than four antenatal care visits (AOR = 2.9; 95%CI: 1.4-6.5), prolonged labor > 24 hours (AOR = 6.2; 95%CI: 2.8-17), rupture of membranes > 18 hours (AOR = 3.0; 95%CI: 1.6-6.8), and maternal urinary tract infection (AOR = 3.5; 95%CI: 2.4-29.4) significantly increased neonatal sepsis risk. Unclean vaginal examinations (AOR = 4.2; 95%CI: 1.6-11) and foul-smelling amniotic fluid (AOR = 10.3; 95%CI: 1.9-56.4) were among the strongest risk factors. Among neonatal factors prematurity (AOR = 4.3; 95%CI: 2.8-6.6), low birth weight ≤ 1500 g (AOR = 3.6; 95%CI: 2.2-5.7), birth asphyxia (AOR = 4.3; 95%CI: 2.4-7.6), and small-for-gestational-age status (AOR = 2.1; 95%CI: 1.1-4) were significant predictors. Respiratory support showed a strong correlation, with surfactant administration (AOR = 9.7; 95%CI: 4.1-22.9), continuous positive airway pressure) (AOR = 15.4; 95%CI: 9.4-25.1), and invasive ventilation (AOR = 53; 95%CI: 12.7-89) as the highest risk factors. Extended newborn intensive care unit stays (> 7 days: AOR = 38.9; > 15 days: AOR = 30) further elevated the likelihood of sepsis, likely due to nosocomial exposure.</p><p><strong>Conclusion: </strong>The findings highlight the importance of enhanced prenatal care, timely labor management, strict hygiene protocols, and focused neonatal monitoring to reduce neonatal sepsis incidence. Addressing modifiable risk factors, including maternal infections and respiratory interventions, could significantly improve neonatal outcomes in resource-limited settings.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"111423"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010789/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of biomarkers in pediatric sepsis: What evidence says?","authors":"Amit Agrawal, Dalwinder Janjua, Gaurav Jadon","doi":"10.5409/wjcp.v15.i1.111999","DOIUrl":"10.5409/wjcp.v15.i1.111999","url":null,"abstract":"<p><p>Sepsis is common in hospitalized pediatric patients, leading to increased morbidity, including multiple organ dysfunction and mortality. Fluid resuscitation and antibiotic administration are the primary protective mechanisms for sepsis. However, not all infections are bacterial, and unnecessary antibiotic use increases the risk of developing multidrug resistance; therefore, it is essential to distinguish bacterial from viral or other infections. Routine laboratory investigations cannot always identify the cause of diseases, but assessing different biomarker levels can help identify these infections and treat sepsis accordingly. This mini-review aims to critically analyze the available evidence supporting the use of biomarkers in pediatric sepsis. We have used the search engines PubMed, Cochrane Library, and Google Scholar to retrieve relevant information. We reviewed studies evaluating various biomarkers used for sepsis diagnoses, like C-reactive protein, ferritin, lactate, procalcitonin, tumor necrosis factor-alpha, <i>etc.</i> Apart from the diagnosis, trials are being conducted to assess the role of these biomarkers in monitoring and guiding antibiotic therapy to promote early recovery. The sensitivity of each biological marker varied in different studies, and no single biomarker can identify all types of infections. More robust studies are necessary to compare the roles of various biomarkers in diagnosing and guiding the appropriate therapy.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"111999"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Not all that drains is gut - umbilical venous catheter extravasation masquerading as intestinal perforation: A case report.","authors":"Ayush Kumar, Sanju Sidaraddi, Prashali Patil, Amit Padmakar Ghawade, Prashant Moralwar, Anish Pillai","doi":"10.5409/wjcp.v15.i1.114242","DOIUrl":"10.5409/wjcp.v15.i1.114242","url":null,"abstract":"<p><strong>Background: </strong>Umbilical venous catheterisation (UVC) is frequently used in neonates but may be complicated by malposition or migration. Extravasation is rare and can mimic other abdominal pathologies.</p><p><strong>Case summary: </strong>We report a preterm infant, born at 27 weeks' gestation, who developed bilateral pneumothorax and spontaneous intestinal perforation requiring drainage. On day 8, the infant clinically deteriorated with persistent high-volume clear peritoneal drain output and worsening dehydration despite fluid escalation. Abdominal radiography confirmed UVC migration into the liver with possible extravasation. Following catheter removal, peritoneal drainage reduced dramatically, and the infant improved rapidly. He was discharged at 38 weeks' corrected age and remained well with age-appropriate development.</p><p><strong>Conclusion: </strong>UVC extravasation can masquerade as high-output peritoneal drainage in the setting of intestinal perforation, thereby delaying diagnosis. Persistent, unusually high peritoneal drainage should prompt consideration of catheter leakage. This rare presentation expands the spectrum of UVC-related complications described in the literature and emphasizes the importance of prompt recognition and management.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"114242"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vaping during pregnancy and its impact on neonatal outcomes: A systematic review and meta-analysis.","authors":"Maneeth Mylavarapu, Sree Mahathi Chavali, Ananya D Buddharaju, Sruthi Veldurthy, Pratyusha Cheruvu, Abhinav G Parikh","doi":"10.5409/wjcp.v15.i1.108069","DOIUrl":"10.5409/wjcp.v15.i1.108069","url":null,"abstract":"<p><strong>Background: </strong>Vaping during pregnancy is becoming more prevalent, with nearly 7% of individuals using e-cigarettes. This increase may result from tobacco companies targeting younger users with e-cigarette marketing, similar to their strategies with traditional tobacco. While e-cigarette use continues to rise, evidence regarding its effects on neonatal outcomes remains inconsistent.</p><p><strong>Aim: </strong>To examine research on the connection between vaping during pregnancy and negative neonatal outcomes, exploring the potential adverse effects.</p><p><strong>Methods: </strong>According to PRISMA guidelines, we conducted a thorough review of studies from PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and Web of Science for eligible studies that reported on vaping during pregnancy and its effects on neonatal outcomes, including low birth weight (LBW), preterm birth (PTB), and small for gestational age (SGA). We utilized binary random-effects models to estimate pooled odds ratios (OR) and 95% confidence intervals (CI). A <i>P</i> value of ≤ 0.05 was deemed statistically significant.</p><p><strong>Results: </strong>A total of 14 studies with 523273 pregnant women were included in the analysis. Of them, 3840 (0.7%) vaped during pregnancy. In comparison to pregnant women who did not vape, neonates born to those who vaped had significantly higher odds of LBW (OR: 1.60; 95%CI: 1.23-2.09; <i>P</i> = 0.0005) and SGA (OR: 1.73; 95%CI: 1.34-2.22; <i>P</i> < 0.0001), as well as higher odds of PTB (OR: 1.95; 95%CI: 0.74-5.14; <i>P</i> = 0.17).</p><p><strong>Conclusion: </strong>Vaping during pregnancy is significantly associated with adverse neonatal outcomes, LBW, and SGA, emphasizing the potential risks of vaping during pregnancy and highlighting the necessity for public health initiatives to increase awareness and develop preventive strategies.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"108069"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of omega-3 fatty acid supplementation on heart rate variability.","authors":"Hoda Atef Abdelsattar Ibrahim, Kamal Gouda Kamal, Mohamed Khaled Ali Mohamed Ali Zid, Albraa Ashraf Hamad, Ayesha Kuraishi, Marwa Taha","doi":"10.5409/wjcp.v15.i1.116331","DOIUrl":"10.5409/wjcp.v15.i1.116331","url":null,"abstract":"<p><strong>Background: </strong>Obesity and overweight are major public health challenges and are associated with autonomic imbalance and decreased heart rate variability (HRV), a non-invasive indicator of cardiovascular risk. Omega-3 polyunsaturated fatty acids have shown cardioprotective effects and may modulate autonomic function. Nevertheless, the effect of omega-3 supplementation on HRV in individuals who are overweight or obese remains unclear.</p><p><strong>Aim: </strong>To study the effect of omega-3 supplementation on HRV in overweight and obese individuals and to explore the heterogeneity across different study designs.</p><p><strong>Methods: </strong>In accordance with PRISMA guidelines, a systematic review and meta-analysis were conducted. PubMed, Science Citation Index, and Scopus were searched for randomized controlled trials (RCTs) assessing the impact of oral omega-3 supplementation on HRV in overweight or obese participants. Primary outcomes were the impacts of omega-3 supplementation on time-domain HRV indices [root mean square of successive differences (RMSSD), standard deviation of normal-to-normal intervals (SDNN), and percentage of successive normal-to-normal intervals differing by more than 50 milliseconds (pNN50%)], and frequency-domain indices [high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio].</p><p><strong>Results: </strong>Four RCTs (<i>n</i> = 134 participants) met the inclusion criteria. Two trials compared pre- <i>vs</i> post- omega-3 supplementation, and two compared omega-3 with placebo on HRV in overweight and obese children and adults. In the within-subject analyses, omega-3 supplementation was associated with a significant increase in RMSSD [mean difference (MD) = -11.69 milliseconds, 95%CI: -18.50 to -4.87, <i>P</i> = 0.0008), SDNN (MD = -26.13 milliseconds, 95%CI: -35.84 to -16.42, <i>P</i> < 0.00001), and pNN50% (MD = -9.45, 95%CI: -14.27 to -4.64, <i>P</i> = 0.0001). Between-group comparisons showed that omega-3 supplementation had no significant effect on HF power, LF power, or the LF/HF ratio.</p><p><strong>Conclusion: </strong>Omega-3 supplementation represents a promising and low-cost strategy for enhancing autonomic balance and potentially reducing cardiovascular risk in overweight and obese populations, as it improves time-domain HRV measures.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"116331"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Paediatric urolithiasis: Medical & surgical management & sophistication.","authors":"Sunil Jain, Prem Kamal Jain","doi":"10.5409/wjcp.v15.i1.119008","DOIUrl":"10.5409/wjcp.v15.i1.119008","url":null,"abstract":"<p><p>Success and safety of endoscopic ureterolithotripsy (EUL) in pediatric patients has been studied by Khudaybergenov <i>et al</i> in a recent retrospective study<i>.</i> The findings support EUL as a first-line treatment, with careful planning needed for younger children. Urolithiasis is a well-known condition. It can affect any part of the urinary tract. It is quite rare in children (1%-7% of all urinary stones occur during childhood). However, its increasing incidence over last several decades is a cause of concern. Childhood urinary lithiasis is related to genetic, climatic, dietary, and socioeconomic factors. Advancing holistic approach is hope for health for all. Evaluation for aetiopathogenesis to expert management, and energetic prevention requires excellence conceptually. Conceptual frameworks present perspectives about a problem systematically and simplify understanding usefully about how complex things work. We discuss advancements as '5Ds' framework: (1) Diligent assessment: Clinically comprehensive. Investigation should be correct and comprehensive with attention to radiation risks. Results guide rationale methodical management; (2) Dedicated management: Correct intervention guided by best evidence; (3) Devoted monitoring: Immediate and long term; (4) Distinctive prevention: With attention to aetiologies; and (5) Developing professionalism: Expertise development with simulation. Special centres/clinics expertise can guide further refinements. In conclusion, early energetic management ensures cure lifelong.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"119008"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal cholestasis is associated with cytochrome P450 1A2 detoxification defect: A single center pilot study.","authors":"Magd A Kotb, Manal M Wilson, Amani N Shafik, Noura A Ahmed, Veronia F Fahim, Nabil A Lotfi, Yasmin Mr Eissawy","doi":"10.5409/wjcp.v15.i1.113478","DOIUrl":"10.5409/wjcp.v15.i1.113478","url":null,"abstract":"<p><strong>Background: </strong>Evidence supports that biliary atresia (BA) in Egyptian infants is an aflatoxin-induced cholangiopathy acquired perinatally in infants with glutathione S-transferase M1 deficiency: The Kotb disease BA variant. This inability to detoxify aflatoxins leads to progressive inflammatory adhesions and obliterative cholangiopathy early in life.</p><p><strong>Aim: </strong>To investigate the cytochrome P450 1A2 (CYP1A2) detoxification enzyme levels in neonates with confirmed BA.</p><p><strong>Methods: </strong>This prospective descriptive analytical study estimated CYP1A2 detoxification enzyme levels using enzyme-linked immunosorbent assay in 20 neonates with confirmed BA. The level CYP1A2 was also estimated in a control group of 20 infants with neonatal hepatitis (NH) and 20 age- and sex-matched healthy infants.</p><p><strong>Results: </strong>The mean age at enrollment in the study was 2.16 ± 0.58 months, 2.51 ± 1.05 months and 1.9 ± 0.81 months for the BA, NH and control group (<i>P</i> = 0.42). The mean ± SD of CYP1A2 among BA, NH and control group was 13.58 ± 9.73, 9.59 ± 9.95 and 31.68 ± 12.33 (<i>P</i> = 0.001). Within 3 months of follow up, of those with BA who underwent portoenterostomy 12 (60%) had successful outcome and cleared the jaundice, 5 (25%) had a stationary course and did not clear the jaundice while 3 (15%) died. The cholestasis resolved in 5 (25%) of the NH group, and improved in 15 (75%). CYP1A2 level did not correlate with age (<i>r</i> = 0.1559, <i>P</i> = 0.336), or total bilirubin level (<i>r</i> = 0.156, <i>P</i> = 0.336), alanine aminotransferase (<i>r</i> = -0.166, <i>P</i> = 0.305), aspartate aminotransferase (<i>r</i> = 0.091, <i>P</i> = 0.576), gamma glutamyl transferase (<i>r</i> = -0.0027, <i>P</i> = 0.99), alkaline phosphatase (<i>r</i> = 0.1059, <i>P</i> = 0.515), or outcome (<i>r</i> = 1.565, <i>P</i> = 0.23). A low CYP1A2 predicted a susceptibility to cholestasis by logistic regression (<i>P</i> = 0.000, 95% confidence interval: 0.8224-0.9327).</p><p><strong>Conclusion: </strong>Significantly low serum CYP1A2 was frequent among infants with BA and NH compared to the control group. The low serum CYP1A2 compromises the detoxification ability of neonates with cholestasis and may alter the pharmacokinetics of commonly used drugs. Careful consideration to drug dosing and toxicity risk should be given to those neonates. Further research on drug pharmacokinetics and detoxification in neonates with cholestasis is recommended.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 1","pages":"113478"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13010806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147517413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}