Pakistan Pediatric Journal

Comparative efficacy of Nebulized Magnesium Sulphate plus Salbutamol versus Nebulized Salbutamol plus 0.9% NaCl in Acute Exacerbation of Asthmatic in Children

Samina Batool — 2025-12-11

Objective: To To compare the effectiveness of magnesium sulphate (MgSO)₄ plus salbutamol nebulization versus salbutamol plus normal
saline nebulization in managing acute asthma exacerbations in children.

Material and Methods: 144 children with acute asthma exacerbations were randomly divided into two groups of equal size. Group Magnesium
received MgSO₄ + salbutamol; Group Saline received salbutamol + normal saline via nebulizer. Participants received up to three treatment
sessions every 20 minutes. Assessments were done by measuring the Pulmonary Index Score and peak expiratory flow rate before treatment
and at 30, 60, and 90 minutes after treatment. Data was analyzed using SPSS v.25.

Results: The mean ages of children in magnesium and saline groups were 8.26 ± 1.85 and 8.39 ± 2.15 years, respectively, with no significant
difference (p = 0.709). The mean PEFR increased and PIS decreased significantly over time in both groups. Magnesium group had
significantly higher PEFR than saline group at 60 and 90 minutes. The groups did not differ significantly from pre-intervention to 30 minutes
post-intervention. Regarding PIS, the groups differed significantly at all three post-intervention time points: magnesium group had significantly
lower PIS scores than Saline group.

Conclusion: In pediatric asthma exacerbations, nebulized MgSO₄ with salbutamol significantly improves outcomes compared to nebulized
salbutamol with normal saline.

Diagnostic Significance of Serum Vitamin D Levels in Pediatric Acute Respiratory Infections: A Comparative Study of Covid-19 and Other Acute Respiratory Infections

Ilhama Yelmar Huseynova — 2025-12-11

Objective: The article provides information about a research study conducted to investigate the diagnostic significance of vitamin D in children with acute respiratory diseases.

Place and Duration od Study: After obtaining informed consent, the study was conducted in 2021 at the educational-therapeutic Clinic of Azerbaijan Medical University and Baku City Children's Infectious Diseases Hospital No. 7

Material and Medod: The study included 95 children aged 1 to 17 years. Based on clinical symptoms, laboratory findings, and instrumental results, the study included 20 children diagnosed with ARDs, 75 children who tested positive for SARS-CoV-2 RNA in nasopharyngeal swabs and were designated as COVID-19 patients, and 15 healthy children who served as the control group. Vitamin D levels in all participants' serum were measured using the enzyme-linked immunosorbent assay (ELISA) method using the Stat Fax 4700 analyzer and reagent kits from Pishqaman (Germany).

Results: Children with COVID-19 (PCR-positive) had an average vitamin D concentration of 25.1 ng/ml (median 24.8 ng/ml) (p<0.001), while those with ARDs had an average of 20.8 ng/ml (median 21.0 +ng/ml) (p<0.001). The interquartile range (Q_1-Q₃) for vitamin D levels in the ARDs group was 18.3-23.8 ng/ml, whereas the COVID-19 group had 20.6-29.2 ng/ml. The control group had an average vitamin D level of 46.4 ng/ml (median 48.4 ng/ml), with an interquartile range (Q_1-Q₃) of 39.5-55.8 ng/ml.

Conclusion: According to the findings of this study, low levels of vitamin D in serum are a significant contributor to the development and worsening of respiratory diseases in children.

EFFICACY AND OUTCOMES OF ENDOSCOPIC BALLOON DILATATION IN CHILDREN WITH ESOPHAGEAL STRICTURE

Isbah Zaidi — 2025-12-11

Objective: To determine the efficacy and outcomes of endoscopic balloon dilatation in children with esophageal stricture.

Study Design: Prospective cross sectional study.

Place and duration of study: Study was conducted at Pediatric Gastroenterology department of Children's Hospital Lahore during time period 3-01-2024 to 29-08-2024.

Martial & Methods: Total of 47 patients with confirmed diagnosis of esophageal stricture were included in this study. The study begins with ethical approval and informed consent, followed by demographics detail collection. EBD procedures conducted under general anesthesia. Treatment efficacy will be recorded in terms of symptomatic relief and secondary outcomes as treatment response, weight gain and need for next EBD session. Data entry and analysis was done with SPSS version 26.

Results: In this study EBD found to be effective in 87% patients, 72.3% patients have shown complete response, and 87% patients reported to have weight gain. Data stratification with respect to gender, age, site, size and etiology of stricture has shown insignificant results for efficacy among stratified groups, p > 0.05. Among the patients who required only one session, majority had congenital etiology (66.7%), and those who required five and six sessions had chemical etiology (100%), p = 0.001.

Conclusion: Our study found that EBD was effective in 87% of patients in terms of symptomatic relief, complete initial treatment response was documented in 72.3% patients. Patients with chemical etiology required the highest number of EBD sessions. Therefore, EBD is beneficial intervention for symptom relief and is successful in achieving complete and long-lasting therapeutic response.

Clinical Characteristics of Wilson Disease in Children: Our Experience from a Tertiary Care Hospital

Syeda Sara Batool — 2025-12-11

Objective:

This study aimed to describe the clinical characteristics of Wilson's disease (WD) in our genetically homogenous (inbred) population.

Study design: Cross sectional observational study.

Place and duration of study: This study was conducted at the Liver unit of Children's Hospital & University of Child Health Sciences, Lahore, from January 2021 to December 2024.

Material and Methods:

Children under the age of 18 and diagnosed with Wilson’s disease were enrolled based based on Leipzig criteria. Data analyzed include demographic, clinical presentation, and diagnostic modalities especially KF rings, serum ceruloplasmin and 24-hours urinary copper estimation. Statistical analysis was carried out by using the Statistical Package for Social Sciences version 26 (SPSS Chicago, IL, USA).

Results:

A total of 50 children met the diagnostic criteria for Wilson’s disease; 27 (54%) were male, with a mean age of 9.67 ± 2.31 years. Most (88%) were symptomatic, while 12% were diagnosed via sibling screening. Consanguinity was present in 64%, and 16% had a positive family history. Acute liver failure was the most common presentation. Jaundice, edema, encephalopathy, hemolysis, and portal hypertension were frequent findings. Neurological and other rare manifestations were less common. Serum ceruloplasmin was low in 78%, and urinary copper elevated in most. Medical treatment was effective in 23 patients; 8 required transplantation, and 19 (38%) died.

Conclusion:

Pediatric Wilson disease is relatively common and often presents as chronic liver disease. In acute liver failure or hemolysis, WD should be considered. Serum ceruloplasmin, liver chemistry, urinary copper, KF rings, and family history aid in diagnosis.

Keywords: Wilson disease, clinical features, hemolysis, chronic liver disease.

Efficacy of Magnesium sulphate as an adjuvant to antenatal steroids in prevention of Intraventricular Haemorrhage in preterm infants.

Sabika Iftikhar — 2025-12-11

Abstract:

Objective: To evaluate the effect of magnesium sulphate as an adjuvant to antenatal steroids in prevention of intraventicular haemorrhage (IVH) in preterm infants.

Study Design: The present study is a prospective observational study.

Place and Duration of study: The study was conducted at Hameed Latif Hospital, Lahore from August 2022 – November 2023

Material and Methords: We enrolled 300 premature infants (26-34 weeks gestation), divided them into two groups: Group A (n = 195) with mothers receiving MgSO4 and antenatal steroids, and Group B (n = 105) with mothers receiving only antenatal steroids. The primary outcome, intraventricular hemorrhage (IVH), was assessed by cranial scans on the third day of life and at discharge. SPSS 20 software was used to analyzed the data, with a p-value ≤ 0.05.

Results: The overall prevalence of IVH was 35%, and cranial scan findings on day 3 and at discharge revealed normal results in 85.1% vs. 80.5% and 61.9% vs. 71.4% for Group A and Group B, respectively. Group A exhibited lower rates of Grade 1 and 2 IVH on day 3 (8.7% and 6.2% vs. 16.2% and 21.9% for controls, p < 0.001) and at discharge (6.2% and 10.8% vs. 7.6% and 9.5% for controls). Grade 3 and 4 IVH rates were also lower in Group A at discharge (0% and 1% vs. 2.9% and 3.8% for controls, p = 0.036).

Conclusion: Antenatal MgSO4 when used with steroids, decreases risk of IVH in premature infants.

Keywords: Magnesium sulphate, Intraventricular haemorrhage, Antenatal steroid.

Electroclinical Profile of Children with Electrical Status Epilepticus: Insights from a Tertiary Care Centre

Naveed Anjum — 2025-12-11

ABSTRACT

Objective: This study aims to explore the clinical and electroencephalographic (EEG) characteristics, treatment strategies, and associated comorbidities in children diagnosed with electrical status epilepticus (ESE) at a tertiary care center in Pakistan.

Study Design: Retrospective Chart Review study.

Place and Duration of Study: Paediatric Neurology Department, The Children’s Hospital & The ICH, Multan, from January 2020 to December 2024.

Materials and Methods: Medical records of 127 children diagnosed with ESE were retrospectively reviewed. Data were collected on seizure types, developmental history, family history of epilepsy, EEG findings, and anti-epileptic drug (AED) regimens.

Results: The majority of patients were male (66.9%, n=85), with a mean age of 6.9 years. Generalized tonic-clonic seizures were the most common type (48.8%, n=62), followed by focal tonic-clonic (12.6%, n=16) and myoclonic seizures (9.4%, n=12). Over half (54.3%) experienced daily seizures, with an average diagnostic delay of 4.8 years. Developmental delays were prevalent (67.7%, n=86), and regression was noted in 8.7% (n=11). EEG confirmed ESE in all cases, with generalized ESE (84.3%, n=107), focal ESE (10.2%, n=13), and multifocal ESE (5.5%, n=7). The leading causes were epilepsy (41.7%), developmental and epileptic encephalopathy (28.3%), and cerebral palsy with epilepsy (13.4%). Other contributing factors included metabolic disorders, brain malformations, and rare syndromes. Sodium Valproate was the most frequently prescribed AED (17.3%, n=22), though polytherapy was required in 74.8% of cases.

Conclusion: Paediatric ESE presents with diverse clinical features and significant neurodevelopmental challenges. Early EEG assessment and tailored management strategies are crucial for improving patient outcomes.

Keywords: Electrical status epilepticus, paediatric epilepsy, EEG abnormalities, neurodevelopmental delay.

IRON DEFICIENCY ANEMIA AND BREATH HOLDING SPELLS IN CHILDREN- A CORRELATION STUDY AT CHILDREN HOSPITAL FAISALABAD.

Muhammad Adil Shahzad — 2025-12-11

ABSTRACT: -

Introduction:

Breath-holding spells are common, non-epileptic episodes in children aged 6 to 60 months, often triggered by crying or pain, with a high prevalence of associated iron deficiency anemia requiring routine screening. This study aims to determine the frequency of iron deficiency anemia in children with breath-holding spells locally, providing treatment with affordable iron supplements to reduce parental anxiety and unnecessary medical visits.

Objective:

To determine the frequency of iron deficiency in children presenting with breath-holding spells.

Settings:

OPD of Pediatric Medicine unit of Children Hospital & Institute of Child Health Faisalabad.

Study Design:

Descriptive Cross sectional study design.

Duration:

Minimum of six months, after approval of synopsis.

From: December, 2023 to June 2024

Methodology:

The study commenced with approval from the Institutional Ethical Review Committee and CPSP. Informed consent was obtained from parents. Patients with breath-holding spells were evaluated through history, physical examination, and blood samples for iron deficiency diagnosis, with data recorded systematically.

Results:

The age distribution shows 59.4% of patients aged 6-36 months and 40.6% aged 37-60 months. Males comprise 63.5%, and females 36.5%. The mean weight is 13.29 kg. Mean spell duration is 37.80 seconds. Mean ferritin level is 14.42 µg/dL, and mean iron level is 54.11 µg/dL. Fifty-one percent of patients have iron deficiency anemia.

Conclusion:

Our study found a significant prevalence of iron deficiency anemia in children with breath-holding spells, highlighting the need for routine screening and iron supplementation to reduce the frequency and severity of these spells.

Keywords:

Breath-holding spells, Iron deficiency anemia, Ferritin levels, Serum iron.

Vascular complications of chronic pancreatitis and their management: Experience from Children's Hospital, University of child Health Sciences, Lahore, Pakistan

Dr. NOORUL HADI — 2025-12-11

Background: Chronic pancreatitis in children is a relatively uncommon but increasingly recognized condition, adversely affecting both exocrine and endocrine pancreatic functions, very rarely can lead to vascular complications. which are clinically significant and require a multidisciplinary approach.

Objective: To determine the frequency, management, and outcomes of vascular complications associated with chronic pancreatitis in children.

Methods: A retrospective study was conducted at the Department of Gastroenterology & Hepatology, Children’s Hospital, University of Child Health Sciences, Lahore, from April 2021 to April 2025. A total of 178 children diagnosed chronic pancreatitis based on INSPPIRE criteria were included in the study. Data were analyzed using SPSS version 25.

Results: Among 178 children (61.7% male, mean age 9.47 ± 3.5 years), vascular complications were identified in 11 (6.2%). The most affected age group was 7-12 years (46.1%). Portal vein thrombosis was the most common complication (6, 54.5%), followed by splenic artery aneurysm and splenic vein thrombosis (2, 18.2% each). Pseudoaneurysm of the gastroduodenal artery, less common and rare also diagnosed (1, 8.3%).

Conclusion: Vascular complications can occur in children with chronic pancreatitis, with portal vein thrombosis being the most common. Early detection and appropriate management are essential to reduce the associated morbidity and mortality.

Comparison of Minimal Effective Dose of Sucrose for Pain Relief in Neonates After Minor Procedures

Mehak Fatima — 2025-12-11

: Sucrose solution has been demonstrated to reduce pain in neonates following minor procedures, thereby enhancing their comfort and facilitating recovery. Despite its proven benefits, there is a lack of detailed information regarding the minimal dose of sucrose necessary for effective pain relief. Accurate identification of this minimal effective dose is crucial for optimizing pain management. The aim of this study was to establish a minimal effective dose of 24% sucrose for pain relief in neonates after minor procedures.

Objective: To compare the outcome of 0.2 ml versus 0.5 ml sucrose solution for pain relief in neonates after minor procedures

Study design: Randomized, single-blinded controlled trial

Study place and duration: Department of Pediatric Surgery, x y z Hospital, from March 2023 to February 2024.

Patients and methods: A total of 148 neonates admitted to the NICU for preoperative management were enrolled in this study. Group I (74 neonates) underwent intravenous cannulation and received 0.2 ml of sucrose solution, while Group II (74 neonates) underwent IV cannulation and received 0.5 ml of sucrose solution. Sucrose was administered 1 minute before the procedure drop-by-drop onto the anterior tongue, followed by non-nutritive sucking with a sterilized pacifier. The sucrose was intended to control pain during the procedure and provide continued pain relief after the procedure. The analgesic effect of sucrose is expected to last for approximately 3–5 minutes after administration, based on existing evidence. A group using pharmacologic agents like EMLA was not included to focus on assessing sucrose as a non-pharmacological option for neonatal pain relief. This approach ensures a clear evaluation of sucrose's effectiveness without interference from other treatments. No anesthesia was used during the procedures. Rescue analgesia refers to additional interventions such as acetaminophen or local anesthetics employed when the initial pain relief strategy is insufficient. Studies suggest that sucrose effectively reduces procedural pain in neonates during minor procedures like venipuncture or cannulation, minimizing the need for rescue analgesia. In our study, no neonates required rescue analgesia. IV fluids containing glucose were temporarily discontinued to ensure accurate measurement of sucrose's analgesic effects. All neonates with obstructive conditions, such as Hirschsprung disease and intestinal atresia, were managed with nasogastric tube decompression, ensuring their condition was not influenced by the minimal dose of sucrose. The primary outcome, pain intensity, was assessed using the Premature Infant Pain Profile (PIPP) at 1 minute post-procedure. Data were analyzed using SPSS version 25.0.

Results: A 0.5 ml dose of 24% sucrose significantly reduced PIPP scores compared to a 0.2 ml dose, with mean scores of 3.57 ± 1.61 and 8.74 ± 2.03, respectively (p < 0.0001). Additionally, a significant correlation was found between the age and weight of neonates and their PIPP scores (p < 0.05).
Conclusion: A 0.5 ml dose of 24% sucrose is more effective than 0.2 ml for managing procedural pain in neonates. The findings provide evidence for using sucrose as a safe, non-pharmacological analgesic in neonatal care.

DIAGNOSTIC ACCURACY OF C REACTIVE PROTEIN IN THE DIAGNOSIS OF NEONATAL SEPSIS KEEPING BLOOD CULTURE AS GOLD STANDARD

Maliha mehmood — 2025-12-11

ABSTRACT:
Objective: To determine the diagnostic accuracy of C-reactive protein in the diagnosis of neonatal sepsis keeping blood culture as gold standard.
Study Design: Cross-sectional study.
Place and Duration of Study: This study was carried out at the department of Pediatrics Medicine of the Balochistan Institute of Child Health Services from October 2021 to March 2022.

Methodology: A total of 194 neonates were enrolled in the study who met the inclusion criteria. Data of all the hospitalized neonatal patients were recorded including age, sex, and weight at the time of admission, cause of admission, and length of stay at the hospital.

Result: There were 194 neonates enrolled in the study. The sensitivity of the CRP test in detecting neonatal sepsis by taking blood culture as gold standard was found to be 56.75%, whereas the specificity, positive predictive value (PPV), and negative predictive value (NPV) were found to be 67.50%, 51.85%, and 71.68%. Moreover, the accuracy of CRP in diagnosing neonatal sepsis was found to be 63.40% respectively. A significant relationship was found with p-value <0.05. Our study also examined the diagnostic accuracy of CRP in relationship to gestational age, birth weight, and type of sepsis. The mean length of hospital stay of neonates was 4.78 ± 1.67 days respectively.

Conclusion: The sensitivity, specificity, and accuracy of the CRP test in diagnosing neonatal sepsis were 56.75%, 67.50%, and 63.40% respectively. With the added advantage of early availability of test results, it is highly recommendable that it should be utilized frequently in the evaluation of neonates. For a nation with poor health conditions such as Pakistan, CRP will be helpful where blood culture is not readily available and the waiting time for results is much lengthy.

Key Words: Neonatal sepsis, Early onset neonatal sepsis, Late-onset neonatal sepsis, C - reactive protein, Blood culture

Use of functional status score as a tool to evaluate morbidity and improvement in clinical status on discharge from Pediatric ICU of a tertiary care hospital in Karachi, Pakistan

Aleena — 2025-12-11

Background: Advances in pediatric intensive care have improved survival rates, yet many critically ill children experience persistent functional impairments post-discharge. The Functional Status Scale (FSS) is a validated tool for assessing functional outcomes in critically ill children, but its utility remains underexplored in Pakistani institutions. This study aimed to evaluate the FSS of pediatric patients at admission and discharge from the intensive care unit (ICU) to determine recovery trends and identify residual morbidity.

Methods: A cross-sectional study was conducted in the pediatric ICU of Civil Hospital Karachi over six months, following institutional review board approval. Using a non-probability consecutive sampling method, 84 children aged 1 to 12 years who were admitted for over 24 hours were included. Exclusion criteria encompassed congenital heart disease, neurological disorders, and ICU mortality. FSS was recorded at admission and discharge, assessing six domains: mental status, sensory functioning, communication, motor functioning, feeding, and respiratory functioning. Statistical analysis was performed using SPSS 26.0, applying paired t-tests, McNemar tests, and chi-square tests, with a significance level of p<0.05.

Results: Among 84 participants (56% female, 44% male), the median age was 3 years (IQR: 2-5). Most admissions were from the emergency department (81%). The median FSS score decreased significantly from 12 (IQR: 10-18) at admission to 6 (IQR: 6-6) at discharge (p<0.001), indicating substantial functional improvement. At admission, 45.2% had moderate dysfunction, 17.9% severe, and 19.0% very severe dysfunction, while only 1.2% had normal function. By discharge, 86.9% had normal function, with severe and very severe dysfunction nearly eliminated. Mechanical ventilation use correlated with higher dysfunction (p=0.026). Patients with CNS disorders had poorer functional recovery. Readmission was required in 16.7% of cases, and prolonged hospitalization was associated with higher readmission rates (p=0.018).

Conclusion: The study demonstrated significant functional recovery among pediatric ICU survivors, highlighting the importance of systematic functional status assessments. The FSS proved valuable in tracking morbidity and guiding early interventions, particularly for patients requiring mechanical ventilation or with CNS-related admissions. These findings support integrating FSS into routine ICU evaluations to enhance long-term patient care and rehabilitation strategies.

CHILD’S COMMUNICATIVE STATUS AND ASSOCIATED FACTORS AT PRECOCHLEAR IMPLANT ASSESSMENT.

Rimsha Shakeel — 2025-12-11

Background/aim: Language deprivation can occur during the first five years of life. Hearing impairment is one of the major causes of language deprivation and it has high prevalence in Pakistan. Cochlear implants, a neuro-prothesis is used to treat hearing impairment, prior to its implementation. Fitness from a multi-disciplinary team is recommended. Our study will highlight child’s communicative status and associated factors at the time of pre-cochlear implant speech therapy assessment.

Material and Methods: A questionnaire and informal speech therapy clinical assessment was administered to collect data from the parents and children coming for pre-cochlear implant communication fitness assessment in Speech Therapy Department, Armed Forces Institute of Rehabilitation Medicine Pakistan. Data collection took almost 15-20 mins. SPSS was used for evaluation.

Results: 93% of the children did not undergo hearing aid and speech habilitation trail before proceeding to cochlear implant .Most of the children were using distinct expressive skills to communicate and had age appropriate play skills, these skills can help design appropriate speech therapy goals post cochlear implant speech therapy. 10 % of the children had oro-motor deficits. P value was significant for Socio economic status, mother education and linguistic background.

Conclusion: Children had adapted communication skills even with hearing loss, this was compensated by strategies like lip reading and play skill. Hence, strength and deficits of hearing impaired children considering oro-motor deficit and prior adequate therapeutic trail should be considered during post and pre cochlear implant speech therapy.

Key words: Cochlear implant, speech therapy, communication patterns

A case of Ataxia Telangiectasia with normal Neuroimaging. An Atypical presentation

Muhammad Fahim — 2025-12-11

Ataxia telangiectasia (A-T) is a progressive neurodegeneration disorder inherited in an autosomal recessive pattern. It is caused by mutations in the ATM (Ataxia Telangiectasia, Mutated) gene which is responsible for cellular signaling pathways regulation in response to DNA double strand breaks, and other genotoxic stresses. Cerebellar manifestations are earliest and predominant including truncal and axial ataxia, nystagmus, and slurred speech etc. Ocular and cutaneous telangiectasia usually appears in school going age and are the pathognomonic findings. Other manifestations include immunodeficiency characterized by recurrent sinopulmonary infections, low IQ and cancer susceptibility along with sensitivity to ionizing radiations. Serum alpha-fetoprotein levels are typically elevated and MRI brain often shows cerebellar degeneration. We report a case of a 12-year-old girl with a clinical finding suggestive of A-T, but with normal MRI brain. This case highlights the clinical spectrum of A-T and underscores the importance of early diagnosis and symptomatic management to reduce morbidity.

Bilateral adrenal hemorrhage in a large for gestational age neonate due to obstructed labour and birth asphyxia

Dr Faiqa Fazal — 2025-12-11

Neonatal adrenal hemorrhage is a rare condition presenting as a unilateral or bilateral adrenal mass. Large size of the gland and increased vascularity makes it prone to hemorrhage. Ultrasound abdomen helps in confirmation of diagnosis and also differentiates it from other causes of abdominal masses. We present the case of a neonate who was large for gestational age delivered through SVD and developed adrenal hemorrhage secondary to obstructed labour and birth asphyxia. Diagnosis was confirmed by USG abdomen and he was discharged home successfully on steroids on 13^th day of life. We conclude that conservative management is important and early surgical intervention should be avoided. Our aim is to emphasize radiological and clinical features associated with NAH for early diagnosis and management.

Early Recognition and Management of Nephrogenic Diabetes Insipidus in preterm newborn: A Vital Case Study

Nida Aslam — 2025-12-11

Abstract:

Diabetes insipidus (DI) is a rare condition in neonates, caused by arginine vasopressin deficiency in the hypothalamic-neurohypophysial system or a vasopressin receptor defect at the kidney level. Recognizing DI in neonates, especially extremely low birth weight (ELBW) and preterm infants, is challenging due to subtle symptoms. This case highlights the importance of considering DI in preterm, very low birth weight (VLBW) neonates presenting with polyuria, as early diagnosis and prompt management of water and electrolyte balance in these vulnerable infants is crucial for better outcomes. Our index case underscores the importance of considering rare causes of polyuria and persistent hypernatremia, emphasizing that timely diagnosis and management can significantly improve neurodevelopmental outcomes.

Keywords: Hypernatremia , dehydration, diabetes inspidus ,nephrogenic

Trichobezoar: A rare cause of chronic abdominal pain in childhood

Aisha Sajid — 2025-12-11

A 13-years-old girl presented in the Pediatric emergency in hypotensive shock state with complaints of abdominal pain and vomiting for last 15 days, that worsened over last 2 days. She had marked abdominal distension along with tenderness. The child was resuscitated immediately with intravascular volume replacement. X-ray abdomen revealed massive air under diaphragm and whole abdomen. CRP was markedly elevated i.e., 259g/L. After initial maximum possible stabilization with IV rehydration and antibiotics, patient underwent emergency laparotomy. One liter of purulent fluid was suctioned out. A hard mass of entangled hair was found in stomach with proximal stomach wall perforation. After mass removal and gut repair, patient remained in ICU for two weeks for completion of treatment with antibiotics and she had uneventful recovery later on. On follow up, the abdominal complaints were settled, and patient was in follow up with the psychiatry department for management of behavioral disorder for trichophagia.