AI-driven triage presents a transformative opportunity to address persistent challenges in pediatric emergency care, from overcrowding and waiting times to human error and outcome disparities. This narrative review demonstrates that AI systems can achieve high accuracy in predicting critical outcomes, with pooled AUROCs of 0.87 for hospital admission, 0.93 for ICU admission, and 0.93 for mortality, significantly outperforming traditional triage scales, while observational studies report associations with improved efficiency, reduced triage errors, and enhanced resource allocation. However, publication bias favoring positive results affects the available evidence, and studies reporting no benefit or performance degradation exist. The promise of AI is tempered by significant challenges: performance varies across pediatric subgroups, the risks of perpetuating and amplifying bias remain inadequately addressed, and workflow integration and medico-legal liability require careful navigation. AI augments clinical judgment, guided by robust governance frameworks, fairness auditing, and human oversight for more equitable emergency care.

Refractory shock in children carries persistently high mortality, particularly in low-resource settings. It occurs when circulatory failure persists despite adequate fluid resuscitation and vasoactive medications. This review summarizes pathophysiology, recognition, and escalation strategies for pediatric refractory shock, emphasizing early identification in the emergency department. It examines evidence for fluid management, vasoactive therapy, and point-of-care ultrasound in optimizing decision-making, along with second-line options such as corticosteroids, vasopressin, and milrinone. Special attention is given to resource-constrained settings, describing evidence-based adaptations including conservative fluid strategies from the FEAST trial, simplified algorithms, simulation-based training, and telemedicine. Improving outcomes requires rapid recognition, precise hemodynamic phenotyping, and timely evidence-based interventions.

Purpose of Review: Pediatric hemorrhagic shock is a primary driver of preventable trauma mortality, often due to failures in early recognition and intervention. This review aims to define an actionable, pediatric-specific clinical framework for managing hemorrhagic shock by synthesizing pivotal advancements over the last decade into an evidence-to-practice guide for clinicians and policymakers. Recent Findings: Management has evolved significantly, with a shift away from crystalloid-based resuscitation toward early, blood-first strategies using whole blood or balanced component therapy. Advances in predictive analytics, including machine-learning-enhanced shock indices, have improved early detection. Furthermore, viscoelastic hemostatic assays are increasingly used to guide goal-directed therapy, particularly for fibrinogen replacement, while comprehensive care bundles and simulation-based training are being implemented to improve system-level performance and reduce mortality. Summary: Effective management of pediatric hemorrhagic shock requires a proactive, integrated approach. This includes early MTP activation guided by age-adjusted metrics, rapid hemostasis with blood-based resuscitation, targeted correction of coagulopathy using viscoelastic guidance, and diligent management of the "lethal triad." Critical knowledge gaps remain, particularly in prehospital prediction and defining optimal transfusion strategies, highlighting the need for high-quality, pediatric-specific clinical trials.

Spinal dysraphisms are a heterogeneous group of congenital spinal cord anomalies resulting from defective neurulation. They include both open and closed forms, with spina bifida (SB) being the most clinically recognized. These conditions frequently coexist with other anomalies, such as syringomyelia and diastematomyelia, significantly complicating clinical presentation and management. We report the case of a male neonate born at term with a lumbar spinal defect consistent with SB occulta. Initial evaluation revealed a closed, skin-colored lesion with preserved neurological function. Early spinal magnetic resonance imaging (MRI) showed vertebral arch defects, a dorsal cystocele and syringomyelia at the L1-L2 level. The patient underwent early neurosurgical repair of SB at 5 days of age, followed by cyst drainage at 1 year of age when lower extremity weakness developed. Subsequent imaging revealed persistent syringomyelia and diastematomyelia, necessitating additional surgical intervention for spinal cord mobilization. The coexistence of these complex anomalies required multiple staged interventions and close longitudinal monitoring. Complex spinal dysraphism demands a multidisciplinary approach with early surgical management and long-term follow-up to prevent neurological deterioration. This case reinforces the importance of timely diagnosis and staged surgical intervention in improving patient outcomes.

Purpose of Review: Malnutrition is a significant and global threat in pediatric emergency departments (PEDs), associated with nearly half of all deaths in children under the age of 5. While low and middle-income countries (LMICs) face life-threatening severe acute malnutrition (SAM), high- income countries (HICs) increasingly deal with obesity related complications. This review describes the epidemiology and clinical profiles of nutritional emergencies (NEs) in PEDs, summarizes evidence-based management strategies, including the WHO 10- step protocol and discusses the systemic approaches to strengthen the global PED response. Recent Findings: Globally, an estimated 13.6 million children under 5 suffer from SAM, with hospital case fatality rates ranging from 10 to 30% in many LMICs. Early recognition through visible wasting and anthropometry (MUAC < 11.5 cm) is essential for survival. Immediate PED priorities include treating hypoglycemia, active warming, and providing empiric antibiotics. Regarding fluid resuscitation, evidence from the FEAST trial (which did not specifically enroll children with SAM) showed that aggressive IV boluses increased mortality in febrile children with impaired perfusion, raising concerns about extrapolation to SAM populations who have fragile cardiac function. Current conservative WHO protocols are being re-examined as emerging data suggest liberal rehydration may not consistently increase fluid overload risk. Additionally, electrolyte imbalances and the risk of refeeding syndrome (though more commonly managed in inpatient or ICU settings after initial PED stabilization) require specialized, low-sodium rehydration solutions like ReSoMal. Emerging innovations include point-of-care ultrasound, machine learning risk prediction (AUROC 0.86–0.92), task-shifting to community health workers (improving recovery from 50% to 73%), and simplified protocols reducing RUTF use by 43 sachets per child. Summary: Pediatric emergency departments (PEDs) serve as a critical frontline in the effective management of nutritional emergencies. The success of our intervention hinges on the prompt identification of cases, adherence to tailored stabilization protocols, and a strategic balance between cautious rehydration and the immediate correction of critical metabolic imbalances. By embracing these practices, we can significantly improve outcomes and save lives in vulnerable populations.