Uncovering the future of pediatric research in India by addressing challenges and revealing opportunities

This study examined the present state of pediatric research in India, highlighting challenges like insufficient funding, lack of research facilities, complex regulatory systems, and the increasing prevalence of childhood obesity. Despite these challenges, there are many opportunities for improving child health outcomes through technological advancements. This study was published in the IP International Journal of Medical Paediatrics and Oncology.

This paper provides several applications for improving pediatric health outcomes. Artificial Intelligence (AI) holds very good scope in pediatric research to analyze data, predict disease conditions, and develop individualized treatment plans. It can be beneficial to analyze larger datasets to find out patterns associated with pediatric diseases for early detection and the development of personalized treatment strategies. Integrating AI into general pediatric research and its application can immensely improve healthcare accessibility in India, irrespective of dynamic social and economic scenarios.

Proteomics research allows us to better understand the structure and function of proteins in various diseases; hence, proteomics research is important for investigating disease mechanisms. Similarly, it can be used for monitoring disease susceptibility and progression, monitoring treatment effectiveness, and assessing the likelihood of exacerbations.

Microbiome research can help us to understand the impact of the microbiome on child health and shed light on the relationship between gut bacteria, the immune system, the central nervous system, and metabolic processes.

Nanotechnology opens new possibilities for targeted drug delivery and precision medicine among children. Engineered nanoparticles with increased efficacy and minimal systemic toxicity can be potentially used in the treatment of pediatric cancer and viral infectious diseases.

The use of advanced fetal imaging technology and early treatment can prevent congenital abnormalities. Adolescent health research can help to deal with mental health problems, nutrition deficiency problems, and lifestyle diseases that Indian teenagers are facing today.

Pediatric interventional radiology includes advanced imaging technologies to diagnose and treat various conditions by utilizing minimally invasive procedures with less recovery time and complications. Improving access to interventional radiology in India has the potential to widen treatment options for pediatric cardiac defects, birth defects, and cancer-related issues.

To conclude, pediatric research in India can be transformed by navigating current challenges and seizing emerging opportunities. The integration of AI, microbiome research, nanotechnology, interventional radiology, and the progress in fetal as well as adolescent health will cater for precise diagnosis and personalized treatment plans, leading to improved health outcomes in children and adolescents.

The efficacy of lubiprostone in the treatment of functional constipation in adolescents and children

A recent study has shown that lubiprostone is effective and has good tolerability as a pharmacotherapy for children and adolescents, offering a potential shift in the treatment approach for pediatric functional constipation (FC). This study’s findings were published in the Journal of Pediatric Gastroenterology and Nutrition.

This single-blinded, randomized controlled trial included 280 patients (aged 8-18 years) with FC. These patients were randomly assigned to receive either a weight-based lubiprostone dose (n = 140) or conventional laxatives (n = 140), which included bisacodyl, lactulose, or sodium picosulfate, for a duration of 12 weeks. Subsequently, a 4-week posttreatment follow-up was carried out.

The lubiprostone group demonstrated an improvement in constipation in 91.4% (128 patients) when compared to 34.3% (48 patients) in the conventional therapy group and persisted even after treatment discontinuation. Additionally, within 48 hours of starting the medication, one quarter of the lubiprostone group experienced their first spontaneous bowel movement. Throughout the last 4 weeks of therapy and the subsequent 4 weeks of follow-up, 75.7% of the lubiprostone group maintained a Bristol stool form of 3 or 4 compared to 35.7% (50 patients) in the conventional therapy group. No life-threatening adverse drug reactions were reported, and no patients discontinued treatment due to adverse effects.

Thus, it can be concluded that lubiprostone may be a well-tolerated and effective pharmacotherapy for children and adolescents, presenting a promising alternative in the management of pediatric functional constipation (FC).

The combination of lung ultrasound and procalcitonin has the potential to enhance pneumonia management

A recent study demonstrated that the combination of lung ultrasound (LUS) and procalcitonin (PCT) proved to be a safe approach for treating bacterial pneumonia (BP), as it avoided the use of radiation and did not result in any additional costs. This study’s findings were published in the European Journal of Medical Research.

In this blinded, randomized clinical trial, a total of 194 children under the age of 18 with suspected bacterial pneumonia (BP) were enrolled. Among them, 96 children were randomly assigned to the experimental group (EG) and 98 children to the control group (CG). The randomization was based on whether lung ultrasound (LUS) or chest X-ray (CXR) was performed as the initial imaging test. The patients were then classified into three groups: 1) those with LUS/CXR results not suggestive of BP and PCT levels below 1 ng/mL, for whom no antibiotics were recommended; 2) those with LUS/CXR results suggestive of BP, inspite of the PCT value, for whom antibiotics were recommended; and 3) those with LUS/CXR results not suggestive of BP but with PCT levels above 1 ng/mL, for whom antibiotics were also recommended.

Out of the 194 patients, the image test did not suggest the presence of BP in 75 individuals with a PCT level below 1 ng/ml. 29/52 in the experimental group and 11/23 in the control group did not receive antibiotics. The image test indicated the presence of BP in 101 patients. 34/34 patients in the experimental group and 57/67 patients in the control group were prescribed antibiotics. Notably, there were statistically significant differences between the groups when the PCT level was below 1 ng/ml (p = 0.01). In 18 patients, the image test did not suggest BP, but their PCT level was above 1 ng/ml, and all of them were administered antibiotics. Additionally, a total of 0.035 mSv radiation per patient was avoided, and there was a 77% reduction in CXR per patient. The use of LUS did not result in a significant increase in costs.

Thus, it can be concluded that the utilization of LUS in conjunction with PCT was demonstrated to be a reliable strategy in the treatment of BP, without the necessity of radiation exposure or incurring additional costs.

Dexmedetomidine and magnesium sulfate effective in preventing junctional ectopic tachycardia after cardiac surgery in pediatric patients

A recent study showed that dexmedetomidine, either on its own or combined with magnesium sulfate (MgSO4), played a therapeutic role in preventing junctional ectopic tachycardia (JET) in pediatric patients following congenital heart surgery. This study’s findings were published in the Paediatric Anaesthesia journal.

A total of 120 children under the age of 5, who were scheduled for corrective acyanotic cardiac surgeries, were randomly divided into three groups. The first group, Group MD (Dexmedetomidine-MgSO4 group), received dexmedetomidine 0.5 μg/kg intravenously over a period of 20 minutes after induction. This was followed by an infusion of 0.5 μg/kg/h for 72 hours, along with a 50 mg/kg bolus of MgSO4 upon aortic cross-clamp release. The administration of MgSO4 continued for 72 hours postoperatively at a dose of 30 mg/kg/day. The second group, Group D (the dexmedetomidine group), received the same dexmedetomidine as the MD group, but instead of MgSO4, they were given normal saline. The third group, Group C (control group), received normal saline instead of dexmedetomidine and MgSO4. The primary outcome of the study was the incidence of JET, while the secondary outcomes included monitoring hemodynamic parameters, extubation time, ionized Mg levels, vasoactive-inotropic score, duration of stay in the post-cardiac care unit (PCCU) and hospital, as well as perioperative complications.

Group MD and Group D demonstrated a significant reduction in the incidence of JET when compared to Group C. During rewarming and in the ICU, Group MD exhibited significantly higher levels of ionized Mg compared to Groups D and C. Throughout the surgery and in the ICU, Group MD displayed a better hemodynamic profile in comparison to Group D and Group C. The predictive indexes were significantly more favorable in Group MD than in Groups D and C including factors such as extubation time, PCCU, and hospital stay.

The above study demonstrated that dexmedetomidine, whether administered alone or in conjunction with MgSO4, demonstrated efficacy in preventing JET in pediatric patients who underwent congenital heart surgery.