Identifying and managing pediatric sepsis is a major research focus, yet early detection and risk assessment remain challenging. In its early stages, sepsis symptoms often mimic those of mild infections or chronic conditions, complicating timely diagnosis. Although various early warning scores exist, their effectiveness is limited, particularly in prehospital settings where accurate, rapid assessment is crucial. This review examines the roles of clinical prediction tools and biomarkers in pediatric sepsis. Traditional biomarkers, like procalcitonin (PCT), have improved diagnostic accuracy but are insufficient alone, often resulting in overprescription of antibiotics or delayed treatment. Combining multiple biomarkers has shown promise for early screening, though this approach can be resource-intensive and less feasible outside hospitals. Predicting sepsis outcomes to tailor therapy remains underexplored. While serial measurements of traditional biomarkers offer some prognostic insight, their reliability is limited, with therapeutic decisions often relying on clinical judgment. Novel biomarkers, particularly those identifying early organ dysfunction, hold potential for improved prognostic accuracy, but significant barriers remain. Many are only available in hospitals, require further validation, or need specialized assays not commonly available, limiting broader clinical use. Further research is needed to establish reliable protocols and enhance the clinical applicability of these tools. Meanwhile, a multifaceted approach that combines clinical judgment with existing tools and biomarkers remains essential to optimize pediatric sepsis management, improving outcomes and minimizing risks.

Effective management of pain and anxiety in pediatric emergency room is crucial for ensuring both the physical and emotional well-being of young patients. Analgosedation, a combination of analgesia and sedation, is commonly used to facilitate various procedures in children. However, selecting the optimal agent and administration route remains challenging due to the unique pharmacological profiles and side effects of available drugs. This scoping review aims to provide a comprehensive analysis of the pharmacological agents used for procedural analgosedation in pediatric emergency settings, focusing on their efficacy, safety, administration routes, and potential side effects. A systematic review of the literature was conducted, focusing on key agents such as ketamine, midazolam, dexmedetomidine, fentanyl, and nitrous oxide. Studies were included based on their relevance to pediatric procedural sedation, particularly in emergency settings. Literature analysis showed that ketamine and fentanyl are effective for managing moderate to severe pain, with a rapid onset of action. Fentanyl is preferred for acute pain management following fractures and burns, while ketamine and midazolam are commonly used for emergency analgosedation. Dexmedetomidine, which induces sedation similar to natural sleep, is particularly effective in preventing pain and agitation during procedures and is well tolerated in children, especially those with developmental disorders. Nitrous oxide, when used in a 50% oxygen mixture, offers a valuable option for conscious sedation during mildly to moderately painful procedures, maintaining respiratory and airway reflexes. No single drug is ideal for all pediatric patients and procedures and the choice of agent should be tailored to the specific clinical scenario, considering both the sensory and affective components of pain. Future research should prioritize large-scale comparative studies, the exploration of combination therapies, and the development of non-pharmacological adjuncts to enhance the safety and efficacy of pediatric analgosedation.

Background: The management of pediatric inflammatory bowel disease (PIBD) has evolved significantly over the past two decades, transitioning from corticosteroids and immunomodulators to biologic and small-molecule therapies. These advances have aimed not only to control inflammation but also to promote mucosal healing, improve growth, and enhance long-term quality of life. Objectives: This narrative review summarizes current evidence on the efficacy, safety, and clinical applications of biologic and novel small-molecule therapies in PIBD, highlighting emerging trends in personalized and precision-based management. Methods: A literature search was performed across PubMed, Embase, and the Cochrane Library, focusing on studies published within the last five years. Additional data were retrieved from key guidelines and position papers issued by ECCO–ESPGHAN, SIGENP, the FDA, and the EMA. Results: Anti–tumor necrosis factor (TNF) agents such as infliximab and adalimumab remain first-line biologics with proven efficacy in remission induction and maintenance. Newer biologics—vedolizumab, ustekinumab, risankizumab, and mirikizumab—offer alternatives for anti-TNF-refractory cases, showing encouraging short-term results and favorable safety profiles. Although many are approved only for adults with limited pediatric evidence, emerging small molecules—including Janus kinase (JAK) inhibitors (tofacitinib, upadacitinib) and sphingosine-1-phosphate (S1P) modulators (etrasimod)—provide oral, rapidly acting, and non-immunogenic treatment options for refractory disease. Furthermore, the gut microbiome is increasingly recognized as an emerging therapeutic target in PIBD, with growing evidence that host–microbiome interactions can influence both the efficacy and safety of biologics and small-molecule therapies. Conclusions: While biologics and small molecules have transformed PIBD management, challenges remain, including high treatment costs, limited pediatric trial data, and variable access worldwide. Future directions include multicenter pediatric studies, integration of pharmacogenomics, and biomarker-guided precision medicine to optimize early, individualized treatment and improve long-term outcomes.

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal dysfunction and eosinophil-predominant inflammation. Its increasing recognition in children and risk of progressive remodeling demand effective, sustainable treatment. Methods: We conducted a narrative review of PubMed/MEDLINE, Embase, and Cochrane Library publications through 2026. Pediatric clinical studies, systematic reviews, meta-analyses, and international guidelines addressing dietary, pharmacological, and biologic therapies were qualitatively synthe-sized, with selected adult evidence included when pediatric data were unavailable. Results: Empiric elimination diets remain effective first-line options, with step-up strategies reducing unnecessary restriction and treatment burden. Elemental diets achieve histological remission in more than 90% of patients but are limited by palatability, cost, and adherence. Allergy test-directed diets have low predictive value and are not routinely recommended. Proton pump inhibitors and swallowed top-ical corticosteroids are established first-line therapies with favorable safety profiles. Real-world evidence suggests that treatment choice depends on age, phenotype, local practice, and family preference, whereas comparative effectiveness data remain limited. Dupilumab, the first biologic approved for EoE, produces substantial histological and endoscopic improvement across pediatric age groups and is particularly relevant for difficult-to-control disease or coexisting type 2 conditions. Other targeted agents reduce eosinophilia, but symptomatic benefit and pediatric evidence remain inconsistent. Conclusion: Pediatric EoE management should combine shared decision-making with objective histological monitoring and attention to growth, nutrition, adherence, and quality of life. Future research should define optimal treatment sequencing and maintenance, validate noninvasive biomarkers, and establish the long-term safety and effectiveness of emerging therapies in diverse pediatric populations and clinical settings.

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal dysfunction and eosinophil-predominant inflammation. Its increasing recognition in children and risk of progressive remodeling demand effective, sustainable treatment. Methods: We conducted a narrative review of PubMed/MEDLINE, Embase, and Cochrane Library publications through 2026. Pediatric clinical studies, systematic reviews, meta-analyses, and international guidelines addressing dietary, pharmacological, and biologic therapies were qualitatively synthesized, with selected adult evidence included when pediatric data were unavailable. Results: Empiric elimination diets remain effective first-line options, with step-up strategies reducing unnecessary restriction and treatment burden. Elemental diets achieve histological remission in more than 90% of patients but are limited by palatability, cost, and adherence. Allergy test-directed diets have low predictive value and are not routinely recommended. Proton pump inhibitors and swallowed topical corticosteroids are established first-line therapies with favorable safety profiles. Real-world evidence suggests that treatment choice depends on age, phenotype, local practice, and family preference, whereas comparative effectiveness data remain limited. Dupilumab, the first biologic approved for EoE, produces substantial histological and endoscopic improvement across pediatric age groups and is particularly relevant for difficult-to-control disease or coexisting type 2 conditions. Other targeted agents reduce eosinophilia, but symptomatic benefit and pediatric evidence remain inconsistent. Conclusions: Pediatric EoE management should combine shared decision-making with objective histological monitoring and attention to growth, nutrition, adherence, and quality of life. Future research should define optimal treatment sequencing and maintenance, validate noninvasive biomarkers, and establish the long-term safety and effectiveness of emerging therapies in diverse pediatric populations and clinical settings.