Pediatric Sciences Journal

Comparison of tolerance of peptide-based formula versus standard formula on outcome of critically ill children: an evidence-based case report

2025-12-30T04:03:05+00:00

Introduction. The clinical benefit of peptide-based formulas remains controversial in critically ill children.

Objective. To conduct a critical review to compare the effects of peptide-based versus standard polymeric formulas on feeding tolerance and whether this would affect outcomes in critically ill children.

Methods. An online search was conducted using PubMed, Cochrane, and the New England Journal of Medicine (NEJM) databases using the keywords “Peptide-based Formula,” “Standard Formula,” “Critically ill Children,” and “Enteral Feeding.”

Results. Three articles were found: a case-control study and two prospective cohort studies. The results of the case-control study suggested that critically ill patients receiving peptide-based formulas showed significant reductions in feeding disturbances and abdominal distension and achieved full enteral feedings sooner compared with patients receiving standard formulas. The results of the first prospective cohort study showed that the peptide-based formula was better tolerated than the standard formula in children after bowel surgery, and the second study stated that choosing the peptide-based formula as the first prescription for enteral nutrition was associated with higher severity of clinical conditions in patients.

Conclusion. The peptide-based formula was better tolerated than the standard polymeric formula in critically ill pediatric patients.

A case of oligoarthritis juvenile idiopathic arthritis in a 3-year-old male child: challenges in early diagnosis and management

2026-01-14T00:56:50+00:00

Introduction: Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children, characterized by persistent joint inflammation. However, early diagnosis is often challenging due to heterogeneous clinical manifestations. Among its subtypes, oligoarthritis is the most common, involving up to four joints within six months of symptom onset. This case is distinctive due to its very early onset at the age of 3 years, prolonged diagnostic delay despite multiple healthcare visits, and diagnostic challenges related to nonspecific initial symptoms. Delayed diagnosis can result in joint deformity, growth retardation, and long-term disability, highlighting the importance of early recognition and timely management.

Case Presentation: A 3-year-old male child presented with progressive joint pain, morning stiffness, and recurrent joint swelling that was initially associated with a history of trauma. Symptoms had been present since the age of 1.5 years, leading to a significant delay in definitive diagnosis. Based on clinical evaluation, imaging findings, and laboratory investigations, a diagnosis of oligoarticular Juvenile Idiopathic Arthritis was established according to the International League of Associations for Rheumatology (ILAR) criteria. The diagnostic process was further complicated by trauma-associated symptom onset and involvement of the temporomandibular joint (TMJ), which underscores the need for heightened clinical suspicion. The patient received multidisciplinary management, including pharmacological therapy, physical rehabilitation, and nutritional support.

Conclusion: This case illustrates the complexity of diagnosing and managing oligoarticular JIA in pediatric patients, particularly in cases with very early onset, delayed diagnosis, and TMJ involvement. A comprehensive multidisciplinary approach, along with increased clinical awareness and early diagnosis, is essential to control inflammation, preserve joint function, and prevent long-term complications in children with JIA.

Management of refeeding syndrome in a severely wasted complex case pediatric patient in a limited facilities hospital: a case report

2025-11-03T02:59:43+00:00

Backgrounds: Refeeding syndrome is a life-threatening metabolic complication that may occur during nutritional rehabilitation in patients with severe malnutrition. Diagnosing this condition is particularly challenging in resource-limited settings due to the lack of comprehensive laboratory facilities, although prompt recognition and treatment are essential to prevent serious outcomes.

Case Presentation: We report an 11-month-old boy presenting with pallor, generalized weakness, severe wasting, a senile facial appearance, prominent ribs, abdominal distention, phimosis, pedal edema, and global developmental delay. Pulmonary auscultation revealed fine crackles bilaterally. Laboratory investigations demonstrated very severe anemia (hemoglobin 2.7 g/dL), leukocytosis, hypoalbuminemia, and the presence of Ascaris lumbricoides ova. Chest radiography suggested pulmonary tuberculosis. The patient was treated with packed red cell transfusions, broad-spectrum intravenous antibiotics, multivitamins, folic acid, and first-line anti-tuberculosis drugs. Nutritional support was initiated cautiously following stabilization, but on day five, the patient developed recurrent pedal edema, hypokalemia, hypernatremia, and a further decline in serum albumin. Based on the consensus criteria of the American Society for Parenteral and Enteral Nutrition (ASPEN), a diagnosis of refeeding syndrome was established. Electrolyte abnormalities were corrected, and nutritional support was restarted from the stabilization phase with close monitoring. Anthelmintic and iron therapy were administered during the rehabilitation phase. The patient showed gradual clinical improvement and was discharged on day 26.

Conclusion: Early diagnosis of refeeding syndrome is feasible in resource-limited hospitals using the updated diagnostic criteria provided by ASPEN. Careful nutritional repletion, timely administration of thiamine and multivitamins, correction and monitoring of electrolytes, and vigilant clinical observation are essential for the effective management of pediatric refeeding syndrome.

Dengue Shock Syndrome (DSS) complicated by severe hyponatremia and seizure in a pediatric patient: a rare case report

2025-11-02T13:39:49+00:00

Background: Dengue Shock Syndrome (DSS) represents the most severe form of dengue virus infection, driven by massive plasma leakage and profound hemodynamic instability. Severe hyponatremia in this context is uncommon and may precipitate neurological manifestations, including seizure, compounding disease complexity and mortality risk. This study aims to describe the clinical course, management, and outcome of a pediatric DSS case complicated by severe symptomatic hyponatremia and seizure.

Case Presentation: We report the case of an 8-year-11-month-old boy presenting with fever, abdominal pain, diarrhea, and a generalized tonic–clonic seizure at home. Laboratory findings confirmed secondary dengue infection, hemoconcentration, thrombocytopenia, and severe hyponatremia (Na⁺ 100–122 mEq/L). The patient developed DSS with large-volume ascites and bilateral pleural effusions during the critical phase. Management included fluid resuscitation per WHO protocol, hypertonic saline correction of sodium, albumin infusion, and close hemodynamic and neurological monitoring. Seizure activity resolved with gradual sodium normalization. Conservative management of effusions avoided invasive intervention. The patient was discharged in stable condition on day six with no recurrent neurological events. This case illustrates the diagnostic and therapeutic challenges of managing DSS complicated by severe hyponatremia and seizure. Management requires balancing volume restoration with prevention of sodium dilution and fluid overload, alongside multidisciplinary coordination.

Conclusion: Severe hyponatremia with seizure in DSS is rare but life-threatening. Early electrolyte evaluation in dengue patients with neurological symptoms is essential, and individualized management can optimize survival.

Packed red cell transfusions in preterm neonates: a retrospective study

2025-11-24T09:09:45+00:00

Introduction: Preterm neonates are highly vulnerable to anemia. Packed red cell (PRC) transfusions are often necessary but must be carefully considered due to associated risks. This study aims to assess the characteristics of preterm infants who received PRC transfusions to guide safer and effective transfusion practices.

Methods: This study was conducted using a retrospective descriptive approach. It included preterm neonates who received PRC transfusions, as documented in the medical records from July 2022 to March 2025. Patient characteristics, hemoglobin level, transfusion profile, and comorbidities in preterm neonates receiving PRC transfusions were evaluated.

Results: The sample consisted of 52 neonates, 37 boys, and 15 girls. The gestational age of infants was mainly between 28 and <32 weeks (64,5%). Most neonates were very low birth weight, which is 53,8%. The mode of delivery was relatively similar between spontaneously and cesarean section. The average length of hospital stay was 35.27 ± 16.62 days. The initial hemoglobin level of preterm infants receiving PRC transfusions averaged 10.88 ± 1.33 g/dL. The first transfusion was typically administered at 18.10 ± 9.69 days of life. Notably, most infants (59.6%) required three or fewer transfusions. The most common comorbidity among preterm infants receiving PRC transfusions was respiratory distress syndrome (RDS) at 78.8%, followed by neonatal jaundice (53.8%) and asphyxia (40.4%). Most RDS cases (69.2%) were caused by hyaline membrane disease (HMD).

Conclusion: Preterm neonates receiving PRC transfusions had a high-risk profile, underscoring the importance of individualized transfusion thresholds and close post-transfusion monitoring to improve clinical outcomes.