Research Article
Current Evidence and Clinical Controversies in the Management of Complicated Pneumonia in Children
Issue:
Volume 12, Issue 3, September 2026
Pages:
87-102
Received:
15 June 2026
Accepted:
27 June 2026
Published:
22 July 2026
Abstract: Background: Parapneumonic effusion (PPE) and empyema remain serious complications of childhood pneumonia associated with significant morbidity despite advances in antimicrobial therapy and surgical techniques. Accurate disease staging and timely stage-directed intervention are fundamental to optimal outcomes. Objective: To provide a current, evidence-based synthesis of the definition, etiology, diagnosis, and management of complicated pneumonia in children, with particular focus on areas of ongoing clinical controversy. Methods: A narrative review incorporating randomized controlled trials, systematic reviews, meta-analyses, Cochrane reviews, and international clinical guidelines published between 2016 and 2026 was conducted. PubMed was searched through May 2026 using terms including pneumonia, complicated pneumonia, parapneumonic effusion, empyema, VATS, fibrinolysis, decortication, and pediatric. Results: Chest radiography remains the initial imaging modality for suspected complicated pneumonia, with lateral decubitus views needed to assess pleural fluid mobility. However, chest ultrasonography is the preferred imaging modality for evaluating parapneumonic effusions and empyema because of its superior diagnostic accuracy, ability to characterize pleural collections, and absence of ionizing radiation. Management is stage-dependent, combining targeted antibiotic therapy with procedural intervention when indicated. Image-guided pigtail catheter drainage with intrapleural fibrinolytic therapy is effective for most patients. VATS demonstrates particular utility during the fibrinopurulent stage. No single fibrinolytic agent has demonstrated clear superiority; however, tissue plasminogen activator is most widely employed. Open decortication remains reserved for refractory or advanced-stage disease. Conclusion: Early diagnosis, appropriate antibiotics, and prompt intervention or surgery are all important for optimal care. The optimal outcomes require a multidisciplinary, individualized, stage-directed approach. Interventional radiology is appropriate for single loculations, while early VATS is favored for thick pleural rind or multiple loculations. Further high-quality prospective research is needed to establish definitive treatment algorithms.
Abstract: Background: Parapneumonic effusion (PPE) and empyema remain serious complications of childhood pneumonia associated with significant morbidity despite advances in antimicrobial therapy and surgical techniques. Accurate disease staging and timely stage-directed intervention are fundamental to optimal outcomes. Objective: To provide a current, eviden...
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Review Article
The Science Behind the Body-Brain-Behavior Axis:
How Early-Life Nutrition and Micronutrients Shape Neurodevelopment and Behavioral Regulation of Children
Issue:
Volume 12, Issue 3, September 2026
Pages:
103-110
Received:
22 August 2026
Accepted:
2 September 2026
Published:
20 September 2026
Abstract: Early childhood represents a critical developmental period during which nutrition provides the biological foundation for physical growth, brain maturation, cognitive development, and behavioral regulation. The traditional assessment of child development has largely focused on physical indicators such as weight and height; however, emerging scientific evidence emphasizes that complete growth requires a multidimensional approach integrating Body, Brain, and Behavior (3B) outcomes. The Body-Brain-Behavior Axis describes the interconnected relationship between nutritional intake, physiological growth, neurodevelopmental processes, and behavioral outcomes, highlighting nutrition as a fundamental regulator of lifelong health trajectories. During early life, rapid cellular proliferation, synapse formation, myelination, neurotransmitter synthesis, and immune development create a high demand for essential nutrients. Micronutrients including iron, zinc, iodine, DHA, B-vitamins, vitamin D, calcium, and magnesium act through multiple biological pathways to support these processes. Iron contributes to oxygen transport, energy metabolism, neurotransmitter synthesis, and myelination; iodine supports thyroid hormone production and neurological development; zinc regulates neuronal signaling, immune function, and synaptic plasticity; while DHA plays a critical role in neuronal membrane formation, synapse development, and cognitive function. B-vitamins participate in energy metabolism and neurotransmitter pathways, whereas vitamin D, calcium, and magnesium contribute to skeletal development, cellular signaling, and neurological regulation. The relationship between nutrition and development is bidirectional. Nutritional inadequacy can impair growth, reduce neuroplasticity, disrupt neurotransmitter balance, and influence emotional regulation, attention, learning ability, and social interaction. Conversely, adequate nutrient intake during critical developmental windows, particularly the first 1,000 days of life, supports optimal body growth, brain architecture, and behavioral competence. Nutrient deficiencies rarely affect a single developmental domain; rather, they create interconnected consequences across physical, cognitive, and emotional systems. This review explores the scientific mechanisms underlying the Body-Brain-Behavior Axis and examines how early-life nutrition and micronutrients influence neurodevelopment and behavioral regulation. Understanding these biological connections provides an integrated framework for healthcare professionals to promote holistic child development through evidence-based nutritional strategies.
Abstract: Early childhood represents a critical developmental period during which nutrition provides the biological foundation for physical growth, brain maturation, cognitive development, and behavioral regulation. The traditional assessment of child development has largely focused on physical indicators such as weight and height; however, emerging scientif...
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,
Khalid Al-Shamrani
