Abstract
BACKGROUND: The integration of artificial intelligence (AI) into early childhood health management has expanded rapidly, with applications spanning the fetal, neonatal, and pediatric periods. While numerous studies report promising results, a comprehensive synthesis of AI's performance, methodological quality, and translational readiness in child health is needed. OBJECTIVES: This systematic review aims to evaluate the current landscape of AI applications in fetal and pediatric care, assess their diagnostic accuracy and clinical utility, and identify key barriers to real-world implementation. METHODS: A systematic literature search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2021 and March 2025. Eligible studies involved AI-driven models for diagnosis, prediction, or decision support in individuals aged 0-18 years. Study selection followed the PRISMA 2020 guidelines. Data were extracted on application domain, AI methodology, performance metrics, validation strategy, and clinical integration level. RESULTS: From 4,938 screened records, 133 studies were included. AI models demonstrated high performance in prenatal anomaly detection (mean AUC: 0.91-0.95), neonatal intensive care (e.g., sepsis prediction with sensitivity up to 89%), and pediatric genetic diagnosis (accuracy: 85%-93% using facial analysis). Deep learning enhanced consistency in fetal echocardiography and ultrasound interpretation. However, 76% of studies used single-center retrospective data, and only 21% reported external validation. Performance dropped by 15%-20% in cross-institutional settings. Fewer than 5% of models have been integrated into routine clinical workflows, with limited reporting on data privacy, algorithmic bias, and clinician trust. CONCLUSION: AI holds transformative potential across the pediatric continuum of care-from fetal screening to chronic disease management. However, most applications remain in the research phase, constrained by data heterogeneity, lack of prospective validation, and insufficient regulatory alignment. To advance clinical adoption, future efforts should focus on multicenter collaboration, standardized data sharing frameworks, explainable AI, and pediatric-specific regulatory pathways. This review provides a roadmap for clinicians, researchers, and policymakers to guide the responsible translation of AI in child health.