Scientific Journal of Pediatrics

Oropharyngeal Colostrum Administration for the Prevention of Necrotising Enterocolitis in Preterm Infants: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2026-09-22T04:24:38+00:00

Background: Necrotising enterocolitis is a major gastrointestinal emergency of prematurity. Oropharyngeal colostrum may provide mucosal immune protection when enteral feeding is delayed, but its clinical effect remains uncertain.

Objective: To determine whether oropharyngeal colostrum reduces necrotising enterocolitis at Bell stage 2 or above and whether the effect varies by administration regimen.

Methods: PubMed/MEDLINE, Europe PMC, CENTRAL, and ClinicalTrials.gov were searched through September 9 2026, with citation searching, for randomised trials in infants born before 37 weeks. Two reviewers independently screened records, extracted data, and assessed risk of bias using RoB 2. Random-effects models with Hartung–Knapp intervals were used.

Results: Nineteen trials were included; fifteen trials involving 1,541 infants entered the primary analysis. Colostrum reduced necrotising enterocolitis (36/786 vs 73/755; risk ratio 0.50, 95% confidence interval 0.33–0.76; p=0.003; I²=0.0%), with a number needed to treat of 21 (15–43). Late-onset sepsis, mortality, and ventilator-associated pneumonia were also reduced. Estimates did not differ significantly between administration protocols, and no intervention-related adverse events were reported.

Conclusion: Oropharyngeal colostrum approximately halved necrotising enterocolitis without evidence of harm. Its low cost and feasibility support use in preterm infants who cannot yet be fed enterally, while adequately powered trials define the optimal regimen.

Asymmetric Reactivation of Aggressive Retinopathy of Prematurity Following Bilateral Intravitreal Bevacizumab in an Extremely Low Birth Weight Infant: A Case Report

2026-09-25T02:46:19+00:00

Background: Aggressive retinopathy of prematurity (A-ROP) in Zone I carries a high risk of blindness in extremely low birth weight infants. Anti-vascular endothelial growth factor treatment induces rapid regression, but persistent avascular retina may cause delayed reactivation.

Objective: To describe interocular asymmetry, longitudinal retinal changes, and the response to rescue laser photocoagulation after bilateral intravitreal bevacizumab.

Methods: This CARE-guided longitudinal case report followed a female infant born at 26 weeks (birth weight, 930 g) across eight clinical epochs from postmenstrual age (PMA) 31 to 55 weeks. Serial RetCam imaging and quantitative vascular tortuosity measurements were reviewed.

Results: Bilateral intravitreal bevacizumab (0.625 mg/0.025 mL) was administered at PMA 34 weeks for Zone I stage 2 ROP with plus disease in the right eye and A-ROP in the left eye. Bilateral regression occurred within 1 week. At 7 weeks after injection (PMA 41 weeks), the left eye alone developed recurrent hemorrhages and a 1,700% increase in arterial tortuosity index (0.2 to 3.6); the right eye remained quiescent. Rescue diode laser photocoagulation (100 mW, 153 spots) was applied to the anterior avascular retina. By PMA 55 weeks, both eyes remained anatomically quiescent.

Conclusion: Early regression after anti-VEGF therapy does not preclude delayed, asymmetric reactivation. Extended eye-specific surveillance and timely laser treatment of persistent avascular retina may achieve durable anatomical stability.

Conservative versus Liberal Oxygenation Targets in Acutely Ill Children Across the Continuum of Care: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

2026-09-28T03:37:21+00:00

Background: Supplemental oxygen is common in paediatric care, but target saturation is not standardised and excessive exposure has been associated with organ dysfunction and death.

Objective: To compare conservative and liberal oxygenation targets for mortality, serious adverse events, length of stay, and treatment failure in acutely ill children.

Methods: PubMed/MEDLINE, trial registers, and citation networks were searched to July 15, 2026 for randomised trials of lower versus higher oxygen saturation targets in children aged over 38 weeks corrected gestational age to 18 years. Risk of bias was assessed with RoB 2, certainty with GRADE, and outcomes with random-effects models.

Results: Ten trials involving 5,171 children were included. Death occurred in 69/2,114 children managed conservatively and 71/2,121 managed liberally (risk ratio 0.99, 95% CI 0.72 to 1.37; risk difference −0.4 percentage points, 95% CI −1.2 to 0.4). Serious adverse events were similar (risk ratio 0.86, 95% CI 0.65 to 1.14). Hospital stay was shorter with conservative targets (standardised mean difference −0.28, 95% CI −0.52 to −0.04), with benefit confined to ward and emergency settings. Intensive care stay showed no clear difference. Treatment failure was more frequent with conservative care (risk ratio 2.63, 95% CI 1.43 to 4.84) without excess deaths.

Conclusion: Conservative targets did not increase mortality or serious adverse events and shortened hospital stay outside intensive care. Their higher treatment-failure rate supports use only with close monitoring and prompt escalation.

Very Early-Onset Ulcerative Colitis Manifesting as Acute Rectal Prolapse and Persistent Hematochezia in a Three-Year-Old Child: An Observational Analytic Case Study of Diagnostic Trajectory and Multimodal Intervention

2026-10-22T05:31:19+00:00

Background: Very early-onset ulcerative colitis (VEO-UC), diagnosed before six years of age, is uncommon and often presents atypically. In toddlers, severe proctitis with tenesmus can weaken pelvic floor support and cause full-thickness rectal prolapse, which can mimic solitary rectal ulcer syndrome, cow's milk protein allergy or primary rectal prolapse.

Objective: To describe the diagnostic course, treatment and six-month outcome of a toddler with VEO-UC presenting with full-thickness rectal prolapse.

Methods: A boy aged 3 years 3 months presented to K.R.M.T. Wongsonegoro Regional Hospital with persistent mucoid hematochezia, a 1-kg weight loss and full-thickness rectal mucosal prolapse. He was followed over seven epochs from baseline (T0) to month 6 (T6). Work-up comprised colonoscopy with biopsy, abdominal ultrasonography and serial inflammatory biomarkers. Treatment was a Thiersch anal cerclage with oral mesalazine induction (60–80 mg/kg/day).

Results: Colonoscopy showed continuous hyperemia and multiple 2–6 mm ulcers with fibrinous exudate in the rectosigmoid and descending colon; ultrasonography found no mass or lymphadenopathy. After cerclage on hospital day 2 and mesalazine induction, the Pediatric Ulcerative Colitis Activity Index (PUCAI) fell from 45 at T0 to 0 at T5–T6 . Hematochezia had resolved by week 4. Fecal calprotectin declined from 880 to 35 μg/g (−96.0%), and weight rose from 13.0 to 14.6 kg (+12.3%). The prolapse did not recur.

Conclusion: Full-thickness rectal prolapse in early childhood can be the first sign of VEO-UC. Prompt colonoscopy and combined medical and surgical management were followed by anatomical stabilization and mucosal healing in this patient.