Asian Journal of Pediatric Research

Afebrile Convulsive Status Epilepticus Associated with Suspected Accidental 3,4-Methylenedioxymethamphetamine (MDMA) Intoxication in A 20-Month-Old Boy: A Case Report

2026-10-08T10:51:24+00:00

Aims: To report an unusual presentation of suspected accidental 3,4-methylenedioxymethamphetamine (MDMA) intoxication as afebrile convulsive status epilepticus (CSE) in a toddler and to emphasise the importance of considering toxicological causes when conventional investigations are unrevealing.

Presentation of Case: A previously healthy 20-month-old boy presented with generalised afebrile CSE lasting approximately 30 minutes. Seizures were terminated with intravenous midazolam. Notably, the child had none of the classical sympathomimetic manifestations commonly associated with MDMA intoxication, including hyperthermia, tachycardia, hypertension, mydriasis, or agitation. Routine laboratory investigations, brain computed tomography, electroencephalography, and magnetic resonance imaging were unremarkable. Urine toxicological screening performed at the Moroccan Poison Control and Pharmacovigilance Center using a qualitative immunochromatographic assay was positive exclusively for MDMA. The history subsequently confirmed accidental ingestion of the contents of a bottle found in a public garden. The child received supportive management, remained seizure-free, and was discharged after three days with complete neurological recovery.

Conclusion: This case highlights the atypical possibility of isolated afebrile CSE as a presenting manifestation of suspected accidental MDMA intoxication in a toddler, even in the complete absence of a sympathomimetic toxidrome. In cases of unexplained afebrile seizures, early toxicological screening may provide an important diagnostic clue. Because qualitative immunochromatographic assays are screening tests, positive results should be interpreted cautiously and, whenever available, confirmed using specific chromatographic methods.

Kasabach-Merritt Phenomenon in a Neonate with a Rapidly Enlarging Vascular Tumor of the Foot and Hypercalcemia: A Case Report

2026-10-12T11:24:07+00:00

Kasabach-Merritt phenomenon (KMP) is a potentially life-threatening consumptive coagulopathy characterised by severe thrombocytopenia and coagulation abnormalities associated with aggressive vascular tumours, particularly kaposiform hemangioendothelioma (KHE) and tufted angioma.

We report the case of a 10-day-old term male neonate who presented with a rapidly enlarging vascular mass of the right foot. The lesion had been present since birth and had rapidly increased in size, reaching 7 cm in diameter, with a violaceous nodular surface, multiple telangiectasias, focal ulceration, and a palpable thrill. Laboratory investigations revealed profound thrombocytopenia (platelet count ~4,000/mm³), elevated D-dimer levels, hypofibrinogenemia, prolonged prothrombin time, and prolonged activated partial thromboplastin time, consistent with consumptive coagulopathy.

Despite high-dose intravenous methylprednisolone, the coagulation abnormalities initially improved, but the vascular mass continued to enlarge, reaching 10 cm. Doppler ultrasonography demonstrated marked arterial and venous proliferation with peripheral arteriovenous microfistulas, while magnetic resonance imaging showed extension into the leg and deep tissues, reaching the underlying bone without bone lysis. The clinical course was additionally complicated by hypercalcaemia associated with suppressed parathyroid hormone and increased urinary calcium excretion.

Because of progressive tumour enlargement despite corticosteroid therapy, vincristine was introduced at 0.05 mg/kg intravenously once weekly, resulting in rapid platelet recovery and marked regression of the vascular mass. This case highlights the severity of KMP in the neonatal period and the importance of early recognition, multidisciplinary management, and timely escalation of therapy in patients with progressive vascular tumours.

Trisomy 18 with Oesophageal Atresia and Distal Tracheo-oesophageal Fistula: Navigating Surgical Decision-making and Palliative Care in a Preterm Neonate

2026-10-22T12:35:13+00:00

Trisomy 18 (Edwards syndrome) is associated with multiple congenital anomalies and substantial neonatal mortality. Oesophageal atresia with a distal tracheoesophageal fistula presents an additional therapeutic challenge in affected infants with complex comorbidities. We describe a female neonate born vaginally at 34 weeks of gestation with a birth weight of 1,105 g and clinical features suggestive of trisomy 18, including micrognathia, low-set ears and clenched fists with overlapping fingers. Hypersalivation and an inability to pass a nasogastric tube prompted radiological assessment, which demonstrated a tube coiled in the proximal oesophageal pouch and air within the stomach, consistent with oesophageal atresia and a distal tracheoesophageal fistula. Karyotype analysis confirmed 47,XX,+18, and echocardiography identified a ventricular septal defect with pulmonary hypertension. Initial neonatal intensive care included continuous suction of the proximal pouch, continuous positive airway pressure, head elevation and intravenous fluids. Following multidisciplinary discussions involving neonatologists, paediatric surgeons and the family, palliative care was prioritised over surgical repair after consideration of the infant’s clinical condition and anticipated prognosis. Progressive respiratory distress and recurrent aspiration developed despite supportive measures, and the infant died on the fifth day of life. This case illustrates the complexity of decisions about potentially corrective surgery in neonates with trisomy 18 and emphasises individualised assessment, multidisciplinary counselling and the integration of parental values into care planning.

Application Effect of Refined Nursing in Nasal Negative Pressure Replacement Therapy for Children with Chronic Sinusitis

2026-10-22T12:15:01+00:00

Objective: To explore the clinical effect of refined nursing intervention during nasal negative pressure replacement therapy in children with chronic sinusitis.

Methods: A total of 156 children diagnosed with chronic sinusitis and admitted to our hospital from June 2025 to April 2026 were enrolled. All children received nasal negative pressure replacement therapy. A single-centre randomised controlled trial was conducted. Participants were allocated to a control group and an observation group using a random-number table, with 78 children in each group. The control group received routine nursing, whereas the observation group received whole-process refined nursing. The total clinical effectiveness rate, total treatment compliance rate, incidence of complications, family members’ satisfaction with nursing, and comfort scores were compared between the two groups.

Results: The total clinical effectiveness rate in the observation group was 93.59%, significantly higher than the 82.05% observed in the control group (P<0.05). The total treatment compliance rate in the observation group was 96.15%, significantly higher than the 83.33% observed in the control group (P<0.05). The complication incidence in the observation group was 7.69%, lower than the 23.08% recorded in the control group (P<0.05). Family members’ nursing satisfaction rate in the observation group was 93.59%, higher than the 78.21% recorded in the control group (P<0.05). Scores for all comfort dimensions were higher in the observation group than in the control group, and all between-group differences were statistically significant (P<0.05).

Conclusion: The application of refined nursing during nasal negative pressure replacement therapy for children with chronic sinusitis may relieve clinical symptoms, improve treatment compliance, reduce complications such as epistaxis, ear fullness, nausea and vomiting, and choking, alleviate negative emotions among children and their families, and improve children’s comfort and family satisfaction. These findings support further clinical evaluation of this nursing approach.