Explore the vast range of titles available.

Montelukast is a leukotriene receptor antagonist (LTRA) commonly prescribed for asthma, allergic rhinitis and sleep-related breathing disorders. Recently, some studies have reported several adverse events, such as neuropsychiatric disorders and sleep disturbances, among children. Objective: To obtain more insight into the safety profile of montelukast for children with asthma, allergic rhinitis and sleep-related breathing disorders. Method and results: We retrospectively studied all adverse drug reactions to montelukast among 385 children 6 months or older in six tertiary centers over a two-year period. A total of 89.6% were asthmatic, 50% had allergic rhinitis and 13.6% had sleep-related breathing disorders; Singulair was the most common type of montelukast used (67.9%). This study reported a high prevalence of adverse drug reactions among 123 patients (31.9%), predominantly in those aged 4–9 years (52.8%), followed by adolescents (24.4%) and toddlers (22.8%). Two (ADRs) were reported in 9.8% of the children, while three or more were reported in 5.5%. Sleep disturbance was the most common (ADRs), affecting 15.1% of participants (overlap was common; 5.5% of children experienced sleep difficulties, 4.4% experienced sleep interruption and decreased sleep, and 1.82% experienced nightmares), followed by agitation (10.4%), pain (9.4%) and hyperactivity (6.8%). No serious (ADRs) were reported. Eleven percent of families faced difficulties in purchasing montelukast, and only 57% of families had insurance. Misconceptions were common (9.8% reported it to be a steroid, while 30.6% believed it to be a bronchodilator). Although 81% of the families believed it was an effective and preventive medication, 5.3% stopped the drug due to concern about side effects, especially agitation (3%) and nightmares (0.6%). Conclusion: These data demonstrate that montelukast is effective, but the associated adverse neuropsychiatric drug reactions are more prevalent than those reported in the literature. In particular, sleep disturbance, agitation, pain and hyperactivity were observed. Pediatricians should be aware of such (ADRs). Misconceptions about montelukast are still common, and parental counseling and urgent epidemiological studies are needed to quantify the risk for management plans.

Bronchiolitis is the leading cause of admissions in children less than two years of age. It has been recognized as highly debated for many decades. Despite the abundance of literature and the well-recognized importance of palivizumab in the high risk groups, and despite the existence of numerous, high-quality, recent guidelines on bronchiolitis, the number of admissions continues to increase. Only supportive therapy and few therapeutic interventions are evidence based and proved to be effective. Since Respiratory Syncytial Virus (RSV) is the major cause of bronchiolitis, we will focus on this virus mostly in high risk groups like the premature babies and children with chronic lung disease and cardiac abnormalities. Further, the prevention of RSV with palivizumab in the high risk groups is effective and well known since 1998; we will discuss the updated criteria for allocating infants to this treatment, as this medication is expensive and should be utilized in the best condition. Usually, diagnosis of bronchiolitis is not challenging, however there has been historically no universally accepted and validated scoring system to assess the severity of the condition. Severe RSV, especially in high risk children, is unique because it can cause serious respiratory sequelae. Currently there is no effective curative treatment for bronchiolitis. The utility of different therapeutic interventions is worth a discussion.

Pediatric asthma is a chronic inflammatory respiratory condition characterized by recurrent wheezing, chest tightness, breathlessness, and coughing, which can significantly impact quality of life and lead to hospitalization or long-term lung impairment. The prevalence of asthma has increased globally, with higher rates in urban areas and developing countries. Current management strategies emphasize inhaled corticosteroids (ICS) as the cornerstone of treatment, with long-acting beta 2-agonists (LABAs) introduced for patients requiring additional symptom control. ICS-LABA combinations have demonstrated efficacy in reducing exacerbations, improving lung function, and lowering health care utilization. However, concerns persist regarding adherence, potential masking of airway inflammation, and optimal dosing. The emerging maintenance and reliever therapy (MART) approach integrates ICS and formoterol into a single inhaler for both maintenance and symptom relief, aiming to enhance adherence and optimize treatment outcomes. This review examines the current evidence supporting ICS-LABA therapy and introduces MART as a potential alternative for pediatric asthma management.

The Saudi Pediatric Pulmonology Association (SPPA) is a subsidiary of the Saudi Thoracic Society (STS), which consists of a group of Saudi experts with well-respected academic and clinical backgrounds in the fields of asthma and other respiratory diseases. The SPPA Expert Panel realized the need to draw up a clear, simple to understand, and easy to use guidance regarding the application of different aerosol therapies in respiratory diseases in children, due to the high prevalence and high economic burden of these diseases in Saudi Arabia. This statement was developed based on the available literature, new evidence, and experts' practice to come up with such consensuses about the usage of different aerosol therapies for the management of respiratory diseases in children (asthma and nonasthma) in different patient settings, including outpatient, emergency room, intensive care unit, and inpatient settings. For this purpose, SPPA has initiated and formed a national committee which consists of experts from concerned specialties (pediatric pulmonology, pediatric emergency, clinical pharmacology, pediatric respiratory therapy, as well as pediatric and neonatal intensive care). These committee members are from different healthcare sectors in Saudi Arabia (Ministry of Health, Ministry of Defence, Ministry of Education, and private healthcare sector). In addition to that, this committee is representing different regions in Saudi Arabia (Eastern, Central, and Western region). The subject was divided into several topics which were then assigned to at least two experts. The authors searched the literature according to their own strategies without central literature review. To achieve consensus, draft reports and recommendations were reviewed and voted on by the whole panel.

INTRODUCTION Respiratory syncytial virus (RSV) is the leading cause of severe acute lower respiratory tract infection (LRTI) in infants and young children, resulting in an estimated 33 million infections annually, >3 million hospitalizations, and >100 000 deaths in children under 5 years globally, with a mortality rate of up to 9% in low-resource countries, which have 99% of the global RSV mortality.1 RSV infection is associated with an increased risk of respiratory failure, admission to the ICU, mechanical ventilation, use of oxygen therapy, and death.2,3 Severe RSV-LRTI in early childhood increases the risk of long-term respiratory disorders such as repeated wheezing or asthma.4–6 Most children have had serologically proven RSV infection by age 2 years, representing a major healthcare burden.7,8 RSV epidemics increase health resource utilization (HRU). [...]the early arrivals of the RSV epidemic seasons during 2022 and 2023 overlapped with the coronavirus disease 2019 (COVID-19) and influenza epidemics and resulted in severe pressure and impact on the healthcare systems of multiple countries.9–12 Risk factors such as socio-economic status influence morbidity and mortality from acute RSV infection, with low- and middle-income countries being disproportionately impacted.13 Young age at time of infection is a key risk factor. A systematic analysis of the global burden of RSV mortality found that 45% of the 101 400 RSV-caused deaths in children under 5 years of age occurred in infants during the first 6 months of life and that 3.6% of all deaths among infants 2–6 months of age were caused by RSV.1 Premature infants and infants with underlying disease are at high risk for severe RSV infection; however, most of the RSV burden occurs in previously healthy infants.14,15 There is therefore a need to protect all infants from RSV infection, which can greatly reduce HRU, thereby reducing pressure on the healthcare system, especially during the RSV epidemic season. Countries will conduct evaluations in their immunization programs to ensure the accessibility of prophylactic mAbs for all infants and some young children.23–36 In view of the global burden of RSV disease among infants, in September 2024, the World Health Organization and its Strategic Advisory Group of Experts on Immunization (SAGE) recommended that “all countries introduce passive immunization for the prevention of severe RSV disease in young infants.”

Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children’s sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.

Artificial intelligence (AI) is transforming pediatric dentistry by enhancing diagnostic accuracy, streamlining treatment planning, and improving behavior management. This review explores current AI applications in detecting dental anomalies, categorizing fissure sealants, assessing chronological age, and managing patient behavior. The review also identifies emerging trends and future directions in AI technology that promise to further revolutionize pediatric dental care. By synthesizing recent research and clinical studies, this review aimed to inform dental professionals and researchers about the potential of AI to address traditional challenges and improve oral health outcomes for children.

Sleep-disordered breathing (SDB) includes disorders of breathing that affect airway patency, which impair children's sleep and lead to negative consequences. Obstructive sleep apnea, hypoventilation and upper airway resistance syndrome are common causes of morbidity and mortality in childhood. These clinical practice guidelines, intended for use by pediatricians and primary care clinicians, provide a clear recommendation for the diagnosis and management of sleep-disordered breathing, focusing on the most serious disorder, obstructive sleep apnea syndrome (OSAS). These clinical guidelines formulate clear recommendations to identify patients with suspected OSAS. Further, the manuscript will highlight the potential consequences of SBD in children, and how to overcome such difficulties, what could be the therapeutic options, a 12 recommendations and what are the future direction for pediatric sleep medicine.

To measure the Saudi population's sleep quality during the lockdown of COVID-19. An internet-based questionnaire that was performed during the lockdown of the COVID-19 pandemic among the Saudi population over 2 weeks from April 1 to April 15, 2020. We used the instant messaging application WhatsApp and Twitter to reach the targeted population. Saudi citizens and non-Saudi residents who can read and understand the questionnaire were recruited. Data were analyzed using Stata and SPSS. A total of 790 responses were included. The majority of participants were the Saudi population 735 (92.9%). The prevalence of insomnia and poor sleep quality were 54.4% and 55.5%, respectively. Saudi citizenship was associated with longer sleep duration ( =0.031). Female gender and being married were associated with worse global PSQI, sleep quality, sleep distribution, sleep latency, and daytime dysfunction. Our findings showed that during the COVID-19 pandemic, the Saudi population had a high prevalence of insomnia and poor sleep quality. Routine monitoring of the psychological impact of life-threatening outbreaks and the adoption of effective early mental health actions should be considered.

Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and viral pneumonia in pediatrics worldwide. In the Kingdom of Saudi Arabia (KSA), the prevalence of RSV is 23.5% in pediatric patients with acute lower respiratory tract illness. Coronavirus disease (COVID-19) poses critical public health and socioeconomic challenges in KSA. The Saudi Pediatric Pulmonology Association (SPPA), a subsidiary of the Saudi Thoracic Society (STS), developed a task force to determine the potential challenges and barriers to the RSV immunoprophylaxis program during the era of COVID-19 and to compose a practical, nationwide, and multidisciplinary approach to address these challenges. Some of the recommendations to manage these challenges include increasing the number of RSV immunoprophylaxis clinics, drive-thru visits, home-care services, and swift referrals to the RSV immunoprophylaxis program specialists. Additional training is required for healthcare personnel to add RSV immunoprophylaxis to the regular immunization schedule.