World journal of clinical pediatrics最新文献

{"title":"Use of nailfold capillaroscopy for evaluation of disease activity in juvenile dermatomyositis: Results of a two-center retrospective study.","authors":"Vera Podzolkova, Ilia S Avrusin, Maria Nikolaeva, Elena Afonina, Siuzanna Davtian, Asel Nurseitova, Kira Kravtsova, Aleksandra Malahova, Alexandr A Yakovlev, Sergey L Avrusin, Olga V Kalashnikova, Vyacheslav G Chasnyk, Mikhail M Kostik","doi":"10.5409/wjcp.v15.i2.114270","DOIUrl":"10.5409/wjcp.v15.i2.114270","url":null,"abstract":"<p><strong>Background: </strong>Juvenile dermatomyositis (JDM) is a rare, immune-mediated children disease that affects both skeletal muscles and skin. Inflammatory vasculopathy is a key part of the JDM pathogenesis. Nailfold capillaroscopy (NFC) is a non-invasive method for microvasculature assessment. Despite the pathogenic relevance of microangiopathy in JDM, the diagnostic utility of NFC in JDM remains insufficiently defined.</p><p><strong>Aim: </strong>To quantitatively assess capillaroscopic dynamics and their association with clinical and laboratory activity markers in JDM.</p><p><strong>Methods: </strong>This retrospective double-center cohort study included 52 children with confirmed JDM, who were followed at the clinics of Sechenov University and Saint Petersburg State Pediatric Medical University. Patients were divided into active and inactive JDM groups based on the modified disease activity score. Demographic, clinical, laboratory, and instrumental data were analyzed. NFC evaluation was performed using standardized criteria developed initially for adult patients with systemic sclerosis and Raynaud's phenomenon. Statistical analysis was conducted using Windows v.13 (StatSoft).</p><p><strong>Results: </strong>Active and inactive JDM groups were demographically comparable (predominantly female, median onset age 6 years). NFC revealed marked differences: Active patients showed higher rates of reduced capillary density (96.2% <i>vs</i> 60.9%, <i>P =</i> 0.003), giant capillaries (73.1% <i>vs</i> 13.0%, <i>P</i> < 0.001), perivascular edema (73.1% <i>vs</i> 17.4%, <i>P</i> < 0.001), and greater maximal apical loop width. Disease activity positively correlated with giant capillaries (<i>r</i> = 0.65), perivascular edema (<i>r</i> = 0.60), and reduced capillary density (<i>r</i> = 0.46). These findings confirm that specific NFC features are strongly associated with clinical disease activity, as measured by the disease activity score.</p><p><strong>Conclusion: </strong>Children with active JDM demonstrated more frequent NFC changes, indicating that NFC may play a potential role in monitoring disease activity. Further studies are needed to determine the diagnostic accuracy and prognostic relevance of this approach.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"114270"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140230","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":"Imaging of pediatric musculoskeletal trauma: Age-specific considerations and challenges.","authors":"Arosh S Perera Molligoda Arachchige, Bianca Schmiliver, Helly A Patel","doi":"10.5409/wjcp.v15.i2.113603","DOIUrl":"10.5409/wjcp.v15.i2.113603","url":null,"abstract":"<p><p>Pediatric musculoskeletal trauma differs significantly from adult injuries due to the dynamic and evolving nature of the growing skeleton. The presence of open growth plates (physes), secondary ossification centers, and a more elastic bone structure contributes to unique injury patterns and imaging findings in children. Proper interpretation of pediatric imaging requires an in-depth understanding of age-specific anatomy, biomechanics, and normal developmental variants. This review provides a comprehensive overview of pediatric bone physiology and fracture types, including the Salter-Harris classification, special pediatric fractures, elbow ossification, avulsion injuries, and conditions related to repetitive stress. Additionally, we address the critical topic of non-accidental trauma, underscoring the radiologist's role in early detection. Through an anatomical and pathophysiological lens, this paper explores the challenges and strategies for accurate diagnosis in pediatric trauma imaging.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"113603"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140172","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":"Study of the gut microbiome profile in full-term infants with necrotizing enterocolits.","authors":"Eman Hamza Hassan, Wessam Zaghloul, Shwikar Mahmoud Ahmed, Ahmed M Ghozi, Ibrahim A Abdelwahab","doi":"10.5409/wjcp.v15.i2.112551","DOIUrl":"10.5409/wjcp.v15.i2.112551","url":null,"abstract":"<p><strong>Background: </strong>Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease that primarily affects preterm. Recently, cases with similar clinical manifestations have been observed in full-term infants without Hirschsprung's disease. Dysbiosis suggested to have role in development of NEC.</p><p><strong>Aim: </strong>To compare the gut microbiome composition between full term infants with NEC and healthy controls and to evaluate the impact of feeding sources on microbial diversity.</p><p><strong>Methods: </strong>Ten full term infants with NEC and six matched healthy breastfed control infants were enrolled in the study. Triplicate stool samples were collected from the enrolled infants. Genomic DNA was isolated and subjected to polymerase chain reaction analysis.</p><p><strong>Results: </strong><i>Bacteroidetes</i> and <i>Bacteroides</i> were more abundant in control infants than in NEC cases, although the differences were statistically insignificant (<i>P</i> = 0.118 and <i>P</i> = 0.147, respectively), with large and moderate effect sizes. <i>Bifidobacteria</i> levels were significantly greater when a relaxed threshold (<i>P</i> ≤ 0.1) was used in both the control and NEC breastfed groups than in the NEC formula-fed group (<i>P</i> = 0.098). Additionally, alpha diversity was significantly reduced at the 0.1 level in NEC patients, especially among formula-fed infants (<i>P</i> = 0.094).</p><p><strong>Conclusion: </strong>Full-term Egyptian infants with NEC exhibit reduced microbial diversity and alterations in bacterial abundance, supporting a potential link between dysbiosis and NEC. Feeding practices, particularly breastfeeding, appear to influence the gut microbiome profile regardless of NEC status. Although <i>Bacteroidetes</i> and <i>Bacteroides</i> did not reach statistical significance, their effect sizes suggest a need for further investigation into their roles in NEC pathogenesis in full-term infants.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"112551"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140249","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":"Epidemiological trends and neurological outcomes of pediatric central nervous system infections in rural part of western India.","authors":"Pushparaj Nilkanth Patil, Zubair Khan, Darshankumar K Mahyavanshi","doi":"10.5409/wjcp.v15.i2.114986","DOIUrl":"10.5409/wjcp.v15.i2.114986","url":null,"abstract":"<p><strong>Background: </strong>Central nervous system (CNS) infections remain a leading cause of morbidity, mortality, and disability among children in low-income and middle-income countries. In India, regional variations in etiology and outcomes are influenced by vaccination uptake, environmental conditions, and healthcare access. Data from rural western India remains limited.</p><p><strong>Aim: </strong>To evaluate the epidemiological trends, clinical spectrum, etiological distribution, and short-term outcomes of pediatric CNS infections, and to identify factors associated with adverse neurological outcomes.</p><p><strong>Methods: </strong>This retrospective study included 278 children (1 month to 12 years) admitted with CNS infections between January 2021 and April 2025. Cases were classified as bacterial meningitis, viral encephalitis, tuberculous meningitis (TBM), brain abscess, or undetermined etiology, based on clinical, laboratory, and neuroimaging criteria. Outcomes were categorized as recovery, neurological sequelae, or death. Data were analyzed for demographic distribution, seasonal patterns, and temporal trends.</p><p><strong>Results: </strong>The mean age was 5.8 years; 51.1% were < 5 years old, and males accounted for 58.3%. Viral encephalitis was the leading etiology (39.9%), followed by bacterial meningitis (30.9%), TBM (15.1%), brain abscess (2.2%), and undetermined (11.9%). Seasonal clustering occurred during monsoon/post-monsoon months (41.7%). Mortality was 9.4% overall, highest in TBM (21.4%) and bacterial meningitis (12.8%), while viral encephalitis had the lowest (2.7%). Neurological sequelae affected 14.0% of children, predominantly after TBM and bacterial meningitis. Over time, bacterial meningitis declined (31%-21%), while viral encephalitis increased (34%-42%). Children aged < 5 years were more likely to have poor outcomes (<i>P</i> = 0.03). Mortality was highest in TBM (21.4%, <i>P</i> = 0.01), followed by bacterial meningitis (11.4%).</p><p><strong>Conclusion: </strong>Pediatric CNS infections in rural India show shifting trends, with viral encephalitis surpassing bacterial meningitis. Strengthening vaccination coverage, early diagnosis, and hospital preparedness can reduce morbidity and mortality associated with pediatric CNS infection.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"114986"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217206/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140127","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":"Lifelong cognitive and motor outcomes after being born small for gestational age or with fetal growth restriction.","authors":"Gemma Chavarria Ventura, Harrigan Ryan, Hai-Nian Yu, Kirat Kishore Chand, Paul Bernard Colditz, Julie Anne Wixey","doi":"10.5409/wjcp.v15.i2.115027","DOIUrl":"10.5409/wjcp.v15.i2.115027","url":null,"abstract":"<p><p>Children born with fetal growth restriction (FGR) or small for gestational age (SGA) face an increased risk of motor and cognitive impairments, although prevalence and severity vary across studies due to differences in definitions, assessment methods, and population characteristics. In recent years, advances in technology and clinical awareness have led to a growing body of research on the relationship between fetal growth and neurodevelopmental outcomes. This mini-review synthesises recent findings on the impact of SGA and FGR on neurodevelopment in preterm and term infants across the lifespan. Three databases were screened to identify original studies published between 2020 and 2025 with 40 studies meeting the selection criteria. Evidence suggests that children born SGA or with FGR are at higher risk of cognitive impairments, which may persist into later life; however, results from some preterm cohorts do not show significant associations. Findings on sensory and behavioural outcomes are limited and heterogeneous, reflecting the fewer studies that have addressed these domains. Regarding motor outcomes, reports on cerebral palsy remain inconsistent, with some studies suggesting no increased risk. In contrast, broader evaluations of motor function consistently indicate a higher prevalence, particularly among term-born cohorts. Together, these findings highlight the need for refined definitions, standardised assessment tools, and longitudinal studies to clarify the developmental trajectories of children born with growth complications and to guide early interventions.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"115027"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140187","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":"Novel <i>TMEM63A</i> mutation associated with transient hypomyelination of infancy - lessons from a previously negative whole-exome sequencing case: Three case reports.","authors":"Mongkol Chanvanichtrakool, Pimchanok Kulsirichawaroj, Watanawan Jaito, Theerapong Pho-Iam, Wuttichart Kamolvisit, Surachai Likasitwattanakul","doi":"10.5409/wjcp.v15.i2.117629","DOIUrl":"10.5409/wjcp.v15.i2.117629","url":null,"abstract":"<p><strong>Background: </strong>Hypomyelinating leukodystrophies are rare neurodevelopmental disorders characterized by impaired myelin development and early motor delay. Hypomyelinating leukodystrophy type 19 (HLD-19), also termed transient hypomyelination of infancy, is caused by <i>TMEM63A</i> variants. It can clinically resemble other hypomyelinating leukodystrophies but is distinguished by developmental improvement. However, its phenotypic spectrum remains incompletely defined.</p><p><strong>Case summary: </strong>We describe 3 related individuals presenting in early infancy with nystagmus, hypotonia, and delayed motor milestones. Brain magnetic resonance imaging demonstrated diffuse hypomyelination, followed by progressive clinical improvement and normalization of myelination on serial imaging. Initial trio whole-exome sequencing was nondiagnostic. Reanalysis-prompted by recognition of additional affected relatives and refinement of human phenotype ontology (HPO) annotation-identified a novel heterozygous <i>TMEM63A</i> variant (c.146G>T; p.Gly49Val). The variant segregated with disease in multiple affected family members.</p><p><strong>Conclusion: </strong>This familial series expands the clinical and genetic spectrum of <i>TMEM63A</i>-related HLD-19. It emphasizes that whole-exome sequencing reanalysis-particularly when family structure or phenotype evolves and when broader HPO terms are applied-can secure a diagnosis and improve counseling and prognostic guidance.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"117629"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140167","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":"Study on intravenous immunoglobulin use in a pediatric intensive care unit of a tertiary care center.","authors":"Poovazhagi Varadarajan, Seenivasan Subramani, Vasanth Jeyaram, Lakshmi S Velmurugan, Raghul Jayaseelan, Gomathy Srividya Venugopal","doi":"10.5409/wjcp.v15.i2.118421","DOIUrl":"10.5409/wjcp.v15.i2.118421","url":null,"abstract":"<p><strong>Background: </strong>Intravenous immunoglobulin (IVIG), an immunomodulatory therapy/agent has been increasingly used and its off label use is on the rise in critical care units. We planned to analyze the indications of IVIG in different disease conditions in pediatric intensive care unit (PICU). This is a single- center ambispective audit on IVIG use.</p><p><strong>Aim: </strong>To study the usage pattern of IVIG among children admitted at a pediatric tertiary care unit.</p><p><strong>Methods: </strong>This was an ambispective study in which data was collected retrospectively from January 2021 to February 2025 and prospectively from March 2025 to November 2025 in a PICU of a tertiary care center. Details of age, sex, indications, strength of recommendation and survival in each disease group were documented.</p><p><strong>Results: </strong>Four hundred and fifty five children received IVIG during the study period. The commonest indication was immunological diseases (42.4%, <i>n</i> = 193), followed by neurological illness (33.6%, <i>n</i> = 153), infections (13.19%, <i>n</i> = 60), hematological diseases (9.2%, <i>n</i> = 42) and cardiac diseases (all acute myocarditis) (1.5%, <i>n</i> = 7). Use of IVIG as per strength of recommendation A, B, C, D were 89 (19.5%), 176 (38.5%), 92 (20.2%) and 98 (21.5%) respectively. Overall mortality was 22.42% (<i>n</i> = 102). The off label usage of IVIG in the unit was 21.5%.</p><p><strong>Conclusion: </strong>IVIG was commonly used in immunological and neurological diseases in our cohort. 78.5% received IVIG as per strength of recommendation A, B, C. Off label use was 21.5%.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"118421"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140286","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":"Letter to the Editor: 100-day window: Reframing early follow-up and parental guidance in recurrent wheezing.","authors":"Mudasir Maqbool, Zulfkar Qadrie","doi":"10.5409/wjcp.v15.i2.117381","DOIUrl":"10.5409/wjcp.v15.i2.117381","url":null,"abstract":"<p><p>In paediatric treatment, persistent wheeze in babies continues to pose significant challenges for identification and management. The forthcoming retrospective cohort study recently published in <i>World Journal of Clinical Pediatrics,</i> entitled \"Understanding recurrent wheezing: A parent's Guide\" by Kiatvitchukul <i>et al</i> offers essential insights by pinpointing independent factors linked to recurrence, such as age 12-24 months, preterm birth, allergic rhinitis, eosinophilia, and previous lower respiratory tract infections. The median time to recurrence of about 100 days is important since it shows that there is a good potential for quick treatment and comprehensive follow-up. This comment makes it clear how crucial it is to use this kind of proof in both community and clinical settings. By checking for clinical signs and chatting to their parents, you can find kids who are at high risk early on. This makes it easier to give them customized counselling, reduce their exposure to allergens, and start them on controller medicines when they need them. The study's results show that pediatricians, allergists, and carers need to work together to stop the same problems from happening again and cut down on hospital readmissions. By changing how they see the \"100-day window\" as an important time for monitoring and putting preventive measures into action, pediatricians can improve outcomes and give families more control over their child's respiratory health. We need more multicenter prospective research to learn more about the biological, environmental, and socioeconomic factors that lead to recurrence. This will help us turn these findings into standard approaches to care for people.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"117381"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140124","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":"Evaluation of heart rate variability in pediatric patients with beta thalassemia major: Cross-sectional study.","authors":"Esraa A Sorour, Eman M Elaskary, Shimaa Basyoni Elnemr, Adel A Hagag, Nesma Ahmed Kassab, Mohammed Al-Beltagi","doi":"10.5409/wjcp.v15.i2.116098","DOIUrl":"10.5409/wjcp.v15.i2.116098","url":null,"abstract":"<p><strong>Background: </strong>Cardiac complications are a significant cause of morbidity and mortality in patients with β-thalassemia major (TM). Early detection of subclinical cardiac involvement remains challenging, as conventional echocardiography and electrocardiography often fail to identify early dysfunction. Heart rate variability (HRV) reflects autonomic regulation of the heart and may serve as a sensitive marker for early cardiac impairment.</p><p><strong>Aim: </strong>To evaluate HRV in children with β-TM without clinical cardiac manifestations.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on 40 children with β-TM and 40 age- and sex-matched healthy controls. All participants underwent full clinical assessment, laboratory investigations, and 24-hour ambulatory Holter monitoring. HRV parameters were analyzed in both time and frequency domains using Cardioscan CS12 software. Statistical comparisons between groups and correlations with hemoglobin and serum ferritin levels were performed using SPSS version 27.</p><p><strong>Results: </strong>Children with β-TM showed significantly higher minimum and maximum heart rates and markedly lower HRV indices, including standard deviation of all normal-to-normal intervals (SDNN), standard deviation of the 5-minutes average normal-to-normal intervals, SDNN index, root mean square of successive differences, and percentage of normal-to-normal intervals differing by > 50 ms, compared with controls (<i>P</i> < 0.001). High-frequency (HF) power was significantly decreased, whereas the low-frequency/HF ratio was elevated (<i>P</i> < 0.001), indicating sympathetic predominance. Arrhythmias were recorded in 47.5% of patients, though HRV parameters did not differ significantly between those with and without arrhythmia. No correlation was found between HRV indices and hemoglobin or serum ferritin levels.</p><p><strong>Conclusion: </strong>Children with β-TM demonstrate significant autonomic imbalance, reflecting early cardiac involvement even before the onset of clinical symptoms. Routine HRV assessment could provide a valuable, non-invasive tool for early detection and risk stratification in pediatric thalassemia management.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"116098"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140112","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":"Enigma of autism regression mechanistic pathways, clinical phenotypes, and early intervention implications.","authors":"Mohammed Al-Beltagi","doi":"10.5409/wjcp.v15.i2.118495","DOIUrl":"10.5409/wjcp.v15.i2.118495","url":null,"abstract":"<p><p>Autism regression, defined by the loss of previously acquired social, communicative, and language skills, affects approximately 25%-30% of children on the autism spectrum, most commonly emerging between 12 months and 30 months of age. Once debated as a potential artifact of parental recall or observation bias, contemporary evidence-including home-video analyses and prospective sibling studies-establishes regression as a biologically grounded neurodevelopmental deviation rather than a psychogenic phenomenon. This review presents an integrated model of regression, conceptualizing it as a \"neurobiological crisis\" in which the convergence of physiological stressors unmasks latent genetic vulnerabilities during a critical period of brain reorganization. Central mechanistic pathways include excessive synaptic pruning, excitatory-inhibitory imbalance, neuroinflammation, mitochondrial dysfunction, and dysbiosis of the gut-brain axis. From a clinical perspective, the period immediately following skill loss represents a window of heightened neuroplasticity. Pediatricians are urged to move beyond a \"wait-and-see\" approach, adopting a dual-track strategy that combines rapid medical and genetic evaluation to exclude pathological mimics (<i>e.g.</i>, Landau-Kleffner syndrome, metabolic disorders) and to initiate immediate intensive behavioral and developmental interventions. Leveraging naturalistic developmental and behavioral interventions, as well as and parent-mediated strategies, many children achieve a meaningful functional reacquisition of lost skills. Ultimately, this review advocates empowered realism, framing regression as a dynamic, modifiable process in which early identification, precision-guided assessment, and evidence-based intervention can optimize long-term developmental and adaptive outcomes.</p>","PeriodicalId":75338,"journal":{"name":"World journal of clinical pediatrics","volume":"15 2","pages":"118495"},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148140136","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}