International Journal of Contemporary Pediatrics

Clinical characteristics and short-term outcomes of children with severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome treated with methylprednisolone and/or intravenous immunoglobulin

2024-09-04T15:51:24+0530

In this case series, we evaluated the clinical profiles and short-term outcomes of four pediatric patients diagnosed with SARS-CoV-2-associated multisystem inflammatory syndrome (MIS-C), treated with Methylprednisolone and/or intravenous immunoglobulin (IVIg). All cases were managed at a tertiary care hospital in the Rohilkhand region and met the WHO diagnostic criteria for MIS-C. The study period spanned from May to December 2021, with the primary outcome being the resolution of fever. Secondary outcomes included the length of hospital stay, mortality, duration of respiratory or inotropic support (if applicable), and the time to normalization of inflammatory markers. The four cases presented with varying degrees of MIS-C involvement: two patients had significant cardiac involvement, one displayed neurological symptom, and another had systemic inflammatory manifestations. All patients received IVIg (2 g/kg) and Methylprednisolone (2 mg/kg/day). Fever resolved within 3-5 days of treatment, and inflammatory markers normalized within a median of 5 days. Two cases required inotropic support for shock, and one required high-flow nasal cannula (HFNC) oxygen for respiratory distress. No mortality was observed in this cohort. In conclusion, treatment with IVIg and Methylprednisolone was associated with favorable outcomes in these MIS-C cases.

Mycoplasma pneumoniae-associated severe autoimmune haemolytic anaemia in children: a case report from a resource limited setting

2024-11-05T15:31:17+0530

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia and respiratory tract infection in children. While traditionally known for its respiratory manifestations, extrapulmonary manifestations of Mycoplasma pneumoniae infections are rare, particularly autoimmune hemolytic anemia (AIHA). Emerging evidence suggests its association with AIHA in pediatric patients, especially with severe respiratory involvement. Here, we present a case of a child with cold AIHA secondary to Mycoplasma pneumoniae infection without marked pulmonary manifestations, from a resource limited setting, highlighting the importance of considering atypical presentations of this pathogen in pediatric patients. Understanding this association is crucial for timely diagnosis, appropriate management, and improved outcomes in affected children.

Rare association - type I caudal regression syndrome associated with congenital spinal dermal sinus tract: a multimodality evaluation

2024-10-28T14:05:41+0530

Caudal regression syndrome (CRS) and congenital spinal dermal sinus tract (CSDST) are two complex closed spinal dysraphism without subcutaneous mass. Embryo-pathogenesis behind CRS is deemed to be a fault during gastrulation, however CSDST is a result of defective focal disjunction during primary neurulation. While many associated congenital anomalies have been described with both of these entities, only a few literatures have ever described CRS and CSDST in unison. We present a case with both type 1 CRS with an intramedullary syringohydromyelia and a congenital spinal dermal sinus tract, with their multimodality imaging findings. Prompt identification and accurate diagnosis of CRS is cardinal for initiation of early and appropriate management, before the herald of dreadful complications. CSDST is a remnant tract arising superficially from the skin or subcutaneous plane, extending deep and terminating variably at the spinal cord, meninges or myofascial plane. A newborn’s neural system is usually preserved, with usual presentation being with skin stigmata. Nevertheless, this apparently benign sounding entity is associated with various other spinal dysraphisms and predispose the patient to multiple dreadful complications. Thus, a complete evaluation of a dorsal opening is cardinal and a conservative management is discouraged.

Schmid metaphyseal chondrodysplasia: consideration in differential diagnosis of rickets

2024-11-08T01:30:47+0530

Schmid metaphyseal chondrodysplasia is a rare inherited cause of skeletal dysplasia caused by COL10A1 gene mutation, characterized by skeletal abnormalities and progressive short stature not usually associated with any other major anomalies or cognitive disability. We report a case of a 3-year-old girl with short stature, genu varum, and motor developmental delay, who was initially misdiagnosed and treated as rickets. Blood investigations and radiographic findings were crucial to guide the diagnosis. Genetic testing allows definitive molecular diagnosis leading to proper treatment and counselling.

Isolated unilateral medial rectus palsy: a rare presentation of midbrain infarction in a child

2024-11-18T12:23:22+0530

This case study describes a rare instance of isolated unilateral medial rectus palsy in a young patient with Fabry disease, an X-linked lysosomal storage disease. A five-and-a-half-year-old child did not exhibit any other symptoms associated with a stroke, other than abrupt onset diplopia and a pronounced left-eye squint. Isolated medial rectus palsy as a sole presentation of midbrain infarct is a rare entity. Fabry disease is associated with an increased risk of ischemic strokes in patients because of the build-up of glycosphingolipids in the vascular endothelium. This case emphasizes how crucial it is to conduct early neuroimaging and to have a high index of suspicion when dealing with uncommon neurological presentations, particularly in individuals who have underlying genetic conditions like Fabry disease.

The evolution of rickets through the ages

2024-11-19T17:21:29+0530

Rickets is an ancient disease and for centuries different conceptions were adopted regarding its type, causes, and treatment options. The discovery of vitamin D transformed the landscape of rickets and was followed by the discovery of several new therapies that improved treatment out-comes. In parallel, the development of rickets detection technology and new workup for vitamin D improved rickets management. Remarkably a century later, vitamin D remains the cornerstone of rickets treatment. In this review, we aim to highlight the lessons learned from the limitations of vitamin D knowledge over the past century. Finally, progress continues in the field of bu-rosumab, a human monoclonal antibody to FGF23, which is approved for the treatment of X-linked hypophosphatemia among children 1 year and older, perhaps the ultimate frontier in rickets management.

Efficacy of intermittent peritoneal dialysis in renal causes of acute kidney injury in children

2024-11-12T12:50:32+0530

Background: In low-resource settings like Bangladesh, intermittent peritoneal dialysis (IPD) has been identified as the preferred modality for the management of AKI. PD is a safe, simple and inexpensive procedure and has been used in pediatric AKI patients. However, its effectiveness in treatment of renal AKI warrants further exploration. To evaluate the efficacy of IPD in treating pediatric renal AKI patients.

Method: This prospective and interventional study conducted in the Department of Paediatric Nephrology at Bangladesh Shishu Hospital and Institute from January 2020 to December 2021. Children aged 1 month to 12 years of either sexes with renal AKI stages 2 or 3 who required PD were included. Each patient had IPD for 72 hours. Every day, the clinical and laboratory markers were measured; on the third day, or 72 hours later, the results were compared.

Results: Majority of patients were from 1-5 years age group and predominantly male. Following 3 days of IPD, clinical parameters (tachycardia, tachypnea and edema) improved significantly. Oedema found in 23 patients before PD, however, 5 patients got a relief from it (p=0.016) after PD. The urea reduction ratio in renal AKI patients increased from 19.3 to 40.7 ml/kg/hr days, with urinary output increasing from 0.02 to 0.50 ml/kg/hr at day 3 (p<0.001). After PD, there was a significant decrease in creatinine, urea, and potassium levels (p<0.001). Besides, a noteworthy improvement of 40.7%, 36.5% and 47.7% were observed in creatinine, urea and bicarbonate levels respectively.

Conclusion: IPD is well-effective in treating renal AKI in children by observing a greater improvement in clinical and laboratory parameters in the patients.

Endocrine impact of transfusion therapy: parathyroid status in pediatric thalassemia major

2024-11-19T11:22:24+0530

Background: Thalassemia major, a severe form of inherited anemia, requires lifelong blood transfusions to manage the condition and sustain hemoglobin levels. However, these repeated transfusions often lead to iron overload, which can deposit in various organs, including endocrine glands and disrupt normal hormone production. One such affected gland is the parathyroid, responsible for regulating calcium and phosphate balance through parathyroid hormone (PTH) secretion. This study aimed to assess the parathyroid status in children with thalassemia major.

Methods: This case-control analytical study design was considered to assess the parathyroid status in children with thalassemia major. The study was carried out at the Department of Pediatric Hematology and Oncology, Dhaka Medical College Hospital, Dhaka, from July 2012 to June 2013. A total of 40 children with thalassemia major (termed as case) and another 32 normal children (termed as control) were included in the study. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 16.

Results: The study found that children with thalassemia major had significantly lower parathyroid hormone (PTH) levels and higher phosphate levels compared to healthy controls, though calcium levels were similar between groups. Thalassemia patients, primarily receiving blood from professional donors, underwent transfusions for an average of six years, with limited use of chelation therapy (15%). Hypoparathyroidism was significantly more common in thalassemia patients (10%) compared to controls, with 25% also showing hyperphosphatemia. No significant differences were observed in age or sex distribution between the groups.

Conclusions: It can be concluded children with thalassemia possess significantly low serum PTH and high phosphate levels. The serum calcium level does not alter significantly compared to healthy children of similar age and sex. The findings call attention to the critical need for early intervention, regular endocrine screening and diligent chelation therapy in managing thalassemia major.

Evaluating clinical opinions on the efficacy and tolerability of a novel human milk oligosaccharide-based human milk fortifier containing lactoferrin, docosahexaenoic acid and arachidonic acid

2024-11-19T13:59:30+0530

Background: To gather and analyse the opinions of healthcare professionals regarding the effectiveness and tolerability of a novel human milk oligosaccharide (HMO)-based fortifier containing lactoferrin, docosahexaenoic acid (DHA) and arachidonic acid (ARA) in neonatal nutrition.

Methods: A cross-sectional survey was conducted among neonatologists and paediatricians who have utilised the novel HMO-based human milk fortifier (HMoF) in their clinical practice. Participants were asked to provide their feedback on various parameters including nutritional adequacy, growth outcomes, tolerance, and overall clinical efficacy.

Results: Majority of respondents reported positive outcomes in terms of enhanced growth parameters, improved gastrointestinal tolerance, and overall health of the infants. The fortifier was particularly noted for its role in supporting the overall growth of the infants including weight gain, length gain and head circumference gain due to the presence of HMOs, lactoferrin, DHA, and ARA.

Conclusions: The novel HMO-based human milk fortifier containing lactoferrin, DHA, and ARA has garnered a favourable and positive opinion by healthcare professionals and demonstrates potential benefits in enhancing neonatal nutrition and health outcomes.

Effectiveness and safety of appetite-stimulating syrup in the management of pediatric patients with loss of appetite due to acute or chronic illness: results of a prospective, single-arm, multi-center and open-label study

2024-12-03T11:52:03+0530

Background: We evaluated the effectiveness and safety of appetite-stimulating syrup (AST) for managing loss of appetite (LOA) due to acute or chronic illness in Indian children and adolescents.

Methods: This was a prospective, multicenter, single-arm, open-label, observational study. Pediatric patients aged ≥6 to ≤15 years, with LOA due to acute or chronic illness were prescribed AST containing multivitamins (vitamins B12, B3, and B6), lysine, and zinc at a dose of 5 ml BID along with standard-of-care for 14 days.

Results: In all, 380 patients with a mean (SD) age of 10.0 (2.4) years were enrolled. Mean (SD) duration of LOA symptoms was 1.7 (1.2) months. Overall, 79.6% of patients reported improved appetite on day 14. Correspondingly, 25.7% and 79.6% patients reported statistically significant improvement in food consumption on days 7 and 14, respectively. The mean (SD) no. of meals per day improved significantly (p<0.001) to 2.9 (0.7) on day 7 and to 3.6 (0.8) on day 14, compared to 2.5 (0.5) meals per day at baseline. Investigators ranked the effectiveness of AST from very good to excellent in 73.2% and good in 26.5% of patients. No severe treatment-emergent adverse events were reported.

Conclusions: Two weeks of treatment with AST showed clinically relevant improvements in appetite and increased food consumption in children and adolescents with LOA due to acute or chronic illness. The syrup was ranked good to excellent for efficacy by investigators. These findings suggest that AST containing multivitamins, lysine, and zinc is effective for treating LOA in children and adolescents without any significant safety concerns.

Clinical and sociodemographic profile of asthma and attitude of parents towards inhaled corticosteroid use in children

2024-09-09T11:25:58+0530

Background: To find out the clinical and socio demographic profile of asthma in 6–12-year-old children and also to understand the knowledge, attitude and practices of parents regarding the ICS use in a tertiary care centre, Alappuzha Kerala.

Methods: Hospital based cross-sectional study, over a period of 1 year. Ethical committee clearance obtained. 141 children were selected from the asthma clinic, based on Inclusion and exclusion criteria. Questionnaire was given to parents, and methods of using MDI checked and corrected.

Results: Most common reason for exacerbation of asthma are exposure to indoor air pollutants and viral infections. A major share of parents showing reluctance for using ICS due to fear of side effects. So usually using for a short course only, not as prescribed.

Conclusions: The adherence of using ICS can be improved by parent-doctor communication and demonstrating the use of inhaler and its importance in asthma.

A study of body fat distribution-in childhood obesity and its associated metabolic risk factors

2024-10-18T12:49:51+0530

Background: The Objective of the present study was to find out fat distribution pattern in obese children between 6 to 12 years of age as compared to non-obese children of same age.

Methods: A case control study was done between 1st July 2023 to 1st July 2024 on 138 children between 6 to 12 years of age group in Deccan College of Medical Sciences, Hyderabad, Telangana state. Ultra-sonographic measurement of fat thickness including maximum and minimum preperitoneal fat thickness, maximum and minimum abdominal subcutaneous fat, thickness at triceps and subscapular regions were determined in all participants. Fasting blood glucose was measured using enzymatic assay. Total cholesterol was measured by enzymatic assays.

Results: Total 138 children were enrolled in the study. Out of 138 children included in study, the study population included 69 obese (35 females and 34 males) and 69 non-obese children (33 females and 36 males). When both groups were compared, weight, Body mass Index (BMI) and ultra-sonographic measurement of body fat thickness differed significantly.

Conclusions: Obese children have high serum cholesterol, high serum triglyceride and high serum LDL levels as compared to non-obese children. In obese children, higher the fasting serum insulin level, more is the preperitoneal fat layer 5cm above the umbilicus with p-value of <0.05 which is significant.

Beyond undernutrition: tracking the surge of obesity among younger population in Bihar, India

2024-12-18T01:03:28+0530

Background: The increasing prevalence of overweight and obesity among children and adolescents in Bihar has become a critical public health concern, coexisting with the state’s long-standing challenge of undernutrition. This study aimed to investigate the prevalence trends, key determinants, and demographic disparities of overweight and obesity among children and adolescents in Bihar to identify actionable insights for public health strategies.

Methods: Data from the National Family Health Surveys (NFHS-4, 2015–16, and NFHS-5, 2019–21) were analyzed along with supplementary reports from WHO and UNICEF. The study included children aged 5–9 years and adolescents aged 10–19 years, with overweight and obesity classified using WHO growth standards (BMI-for-age > +1 SD and > +2 SD, respectively). Descriptive statistics were employed to assess prevalence trends, while multivariate logistic regression identified behavioral and environmental risk factors, including screen time, physical activity, and dietary habits.

Results: Overweight prevalence doubled among children aged 5–9 years (1.2% to 2.4%) and increased among adolescents (3.2% to 4.5%). Obesity among adolescents also doubled, rising from 1.1% to 2.3%. Urban children exhibited higher rates of overweight (6.2%) compared to rural children (2.8%). Behavioral factors such as physical inactivity (<30 minutes/day; OR=3.2) and prolonged screen time (>4 hours/day; OR=2.5) were significant predictors. Frequent consumption of fast food and sugary beverages further increased the risk.

Conclusions: The findings highlight the urgent need for targeted interventions, including promoting physical activity, regulating unhealthy food environments, and embedding nutrition education in schools. A multisectoral approach is critical to addressing the dual burden of malnutrition in Bihar’s children and adolescents.

Prevalence of depression and its associated risk factors among children and adolescent screened at a tertiary care hospital

2024-10-23T12:06:28+0530

Background: Depression in children and adolescents has been increasing worldwide especially in the adolescence. Despite its high prevalence and its substantial impact, the detection and its treatment in primary care setting have been suboptimal. To estimate the prevalence of depression among 8-17 years attending OPD at a tertiary care hospital and the risk factors associated with it.

Methods: A cross-sectional study done among 400 participants of 08 to 17 years of age presenting to Pediatric and Medicine Outpatient departments of a Tertiary Care Hospital at Puducherry. A three-step process on diagnosis was involved. Step 1 included screening for psychiatric morbidities using Tamil and English version of Strengths and Difficulties Standardized Questionnaire. Those scoring above 19 were subjected to a second screening test for depression using Centre for Epidemiological Studies Depression scale for Children. All these participants were referred for psychiatric assessment irrespective of their CES-DC score for diagnosis. The data was analysed by descriptive statistics.

Results: Among the study population, 49 (12.25%) participants had depression. Among the participants with 8 to 12 years of age, 10 (5%) participants had depression. Among the participants with aged 13 to 17 years, 39 (19.5%) participants had depression. The risk factors significantly associated with depression include age group, friends, sickness, constant fidgeting/squirming, temper tantrum, bullying, addiction in parents, parent education.

Conclusion: Owing to the prevalence of depression in our study especially in the late adolescent, the importance is to be given for early diagnosis and appropriate management.

Role of maternal and neonatal plasma vitamin D levels on development of neonatal sepsis in term infants

2024-10-24T11:35:13+0530

Background: Neonatal sepsis is characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life and is an important cause of morbidity and mortality. There is overwhelming experimental evidence that vitamin D has an important role in the regulation of both the innate and acquired immune systems. Therefore, low vitamin D status is expected to be one of the risk factors for neonatal sepsis.

Methods: Between September 2016 and July 2018 term infants with clinical and laboratory findings of Neonatal Sepsis who were>37weeks of gestational age and were admitted to Neonatal Intensive Care Unit of Sheri-Kashmir Institute of Medical Sciences Soura, Srinagar and healthy infants (controls) who presented to our out-patient clinic for routine evaluation with no signs of clinical and laboratory infection were taken up for study. Blood for neonatal and maternal vitamin D levels was obtained from all infants and their mothers at the postpartum period at the time of hospital admission.

Results: A total of 92 mother-neonatal pairs (46 cases and 46 controls) were enrolled in the study. In the study group the mean neonatal vitamin D level was 12.90 ng/ml and the mean maternal vitamin D level was 22.90 ng/ml. In the control group the mean neonatal vitamin D level was 25.99 ng/ml and the mean maternal vitamin D level was 37 ng/ml. Mean maternal and neonatal vitamin D levels were significantly lower in the study group than in the control group.

Conclusions: There was a highly significant correlation between neonatal and maternal vitamin D levels in both study and control groups in our study. Thus, it was concluded that babies born to mothers with inadequate vitamin D levels have inadequate vitamin D levels.

Profile of congenital heart disease and its mode of presentation in children admitted in a tertiary care hospital: a cross-sectional study

2024-10-28T20:31:08+0530

Background: Congenital heart disease (CHD) is contributing more to the infant mortality rate these days. Therefore, we must investigate the profiles of CHD, it's presenting clinical features, and its consequences to assist pediatricians and cardiologists in taking the necessary actions as soon as possible to reduce infant mortality further.

Methods: This cross-sectional study was carried out on 111 infants with CHD who were admitted to the Bankura Sammilani Medical College and Hospital's pediatric medicine department in Bankura, India. The children ranged in age from one month to five years. Following approval by the Institutional Ethics Committee and parental/guardian consent, we used a case record proforma to gather data on enrolled children over ten months. To analyze the data, EpiInfo (version 3.5.1) software was used. This study received approval from the Institutional Ethics Committee.

Result: Male children contributed 53.15%, while female children contributed 46.85%. Children between the ages of one and six months made up 55.86% of the total. Among cardiac lesions, acyanotic CHD was more prevalent than cyanotic CHD (81.08% vs. 18.92%). In all cases of CHD, the most prevalent lesion type was ventricular septal defect (VSD) (43.24%). The most prevalent form of cyanotic CHD, however, was the tetralogy of Fallot's (9.9%). Most of the children with atrial septal defects presented in late infancy. Inadequate weight gain (85.59%) and malnutrition (84.68%) were the most prevalent clinical characteristics and complications of CHD.

Conclusion: The most common complication of CHD in children under five is malnutrition, a risk factor for infant death. Hence, a community-based case-control study is essential to determine the precise extent of these burdens.

Study of the clinical profile and outcome of the neonates born to COVID-19 positive mothers: a tertiary care centre experience from western Uttar Pradesh

2024-11-03T19:59:59+0530

Background: A major concern of SARS-CoV-2 infection in pregnancy is its possible effects on newborns. In the context of mother-to-child transmission, some studies have reported that there were no SARS-CoV-2-positive infants born to a cohort of mothers with COVID-19 while others have reported an incidence of as high as 10%. The study is conducted to describe the clinical profile of neonates born to mothers who tested positive for COVID- 19 infection and to determine the association of neonatal COVID 19 status.

Methods: This cross sectional study includes neonates born to COVID 19 positive mothers. Neonates born to mothers who were diagnosed before delivery were tested by RT-PCR within 24 h of birth.

Results: Out of 120 babies born to COVID positive mothers, 5 newborns (4.2%) were found to be COVID positive, diagnosed through RT-PCR. Among COVID positive babies four out of five were symptomatic (p<0.001) and required respiratory support in any form (p=0.001). All of the COVID positive neonates were discharged, while there was one mortality noted among covid negative babies (0.9%), however there was no statistically significant association between mortality and COVID infection in the neonates (p=0.498).

Conclusions: The proportion of covid positive neonates born to COVID-19-positive women were very low (p=4.2). The study supports milder manifestation in COVID-19 infected neonates and risk of transmission of COVID-19 infection from mother to neonate by rooming in and breastfeeding is low.

A study on differences in peak expiratory flow rate among school children of age 7-12 years at different altitudes of Darjeeling and Purulia district of West Bengal

2024-11-04T00:16:18+0530

Background: The peak expiratory flow rate (PEFR) is an effort-dependent parameter, which reflects large airway flow, voluntary and muscle strength. High altitudes may have an impact on peak expiratory flow rate, owing to hypoxia, low air density and increased muscular activity, The study was conducted to find out the variance of PEFR among healthy school children of high and low altitude region.

Methods: This cross-sectional study was conducted at different altitudes and schools of Darjeeling and Purulia district, taking a total of 400 healthy school going children aged between 7-12 years. The age, weight and height of the children were calculated and the PEFR was recorded in standing position. The data was entered in MS Excel and analyzed using the SPSS version 20.0 software.

Results: The mean height, body mass index (BMI) and SpO2 was lower among high altitude children, while their PEFR values were higher. These findings were observed to be statistically significant. Further, females were observed to have a lower PEFR value than their male counterparts.

Conclusion: The PEFR values of low altitude children were significantly lower than the high altitude children.

Study of clinical profile and laboratory markers in early diagnosis of severe dengue in children

2024-11-05T11:22:18+0530

Background: Dengue fever is a mosquito-borne viral disease that presents as asymptomatic or can clinically manifest with symptoms like hemorrhagic fever and shock. Alteration of various other hematological parameters includes leukopenia, thrombocytopenia, hematocrit changes, and liver enzyme alteration. this study aimed to investigate dengue patients' clinical profiles, laboratory parameters, and outcomes across different severity levels.

Methods: This is a prospective hospital-based study of 125 patients conducted at S. Nijalingappa medical college, Bagalkot over 18 months from August 2022 to February 2024. the study included 125 cases with serologically confirmed (NS1ag and/ IgM) between 1 to 14 years and categorized according to WHO classification.

Results: Out of 125 patients, 62 and 33 had dengue with and without warning signs, and 30 had severe dengue, 52% of cases had leucopenia, and thrombocytopenia was present in 105 (84%) cases with significantly higher in severity groups. Elevated SGOT 108 (86.4%) and SGPT 72 (57.6%) were commonly seen in disease severity groups. Liver dysfunction was observed in 86.4% of patients. All patients survived and improved with appropriate treatment.

Conclusions: This study highlights the importance of clinical and hematological parameters in the early recognition and management of severe dengue cases. Liver dysfunction was common in severe cases. Despite the varying severity, all patients in this cohort had favorable outcomes, emphasizing the effectiveness of proper management strategies.

Hearing screening in neonates admitted in neonatal intensive care unit at tertiary care centre of Southern Rajasthan

2024-11-05T13:44:13+0530

Background: Hearing impairment is a common congenital condition, significantly impacting speech and social development in children. Early detection and intervention are crucial for improving outcomes, yet many cases go undiagnosed. This study aims to identify hearing impairment among neonates in a tertiary care centre using otoacoustic emission (OAE) and auditory brainstem evoked response (ABER) screening methods.

Methods: A prospective observational study was conducted in the paediatric department of RNT medical college, Udaipur, over six months. Newborns admitted to the neonatal intensive care unit were screened based on risk factors as per the joint committee on infant hearing guidelines. Inclusion criteria included high-risk factors such as low birth weight, mechanical ventilation (>5 days), APGAR score etc. Descriptive analysis was performed, with statistical significance assessed using the Chi-square test.

Results: Of the 750 newborns screened, 64.67% passed bilaterally in first OAE screening, remaining were referred. Among referred babies, second OAE screening showed a referral rate of 16.9%. Significant associations were found between hearing impairment and risk factors such as low birth weight, low APGAR scores, and prolonged mechanical ventilation. ABER testing confirmed hearing impairment in 9 /140 tested infants, resulting in an incidence of 55.11 per 1,000 in high-risk infants and 3.2 per 1,000 in low-risk infants. The overall incidence was 12 per 1,000 infants.

Conclusions: In high-risk group hearing impairment primarily associated with low birth weight and prolonged mechanical ventilation (>5 days), low Apgar score, ototoxic drug. In high-risk group hearing impairment (5.5%) was more than low risk group (0.32%).

Rubix cube and kaleidoscope-an interesting tool for anxiety management in children

2024-11-06T09:57:49+0530

Background: Dental anxiety is a common fear for children undergoing dental treatments. Distraction involves diverting children's attention away from painful stimuli during invasive dental procedures and is the most effective when tailored to child's developmental level. Parents prefer non-invasive techniques over general anaesthesia, sedation, restraint, and hand over mouth. Introducing distraction aids using Rubix cube or kaleidoscope can help in the reduction of dental anxiety during the dental visits. The objective of this study was to compare Rubix cube and kaleidoscope as tools for reducing dental anxiety during the treatment.

Methods: Randomized clinical trial was conducted among 60 children (5-12 years old). They were randomly divided into three groups (20 each): Group A (control group-did not receive anything), group B (received Rubix cube during treatment) and group C (received kaleidoscope during treatment). Chotta Bheem-Chutki scale was recorded prior to the appointment and after the dental treatment. This study demonstrated that patients subjected to Rubix cube and kaleidoscope therapy had a statistically significant reduction in anxiety compared to the control group after the dental treatment.

Results: This study demonstrated that patients subjected to Rubix cube and kaleidoscope therapy had a statistically significant reduction in anxiety compared to the control group after the dental treatment.

Conclusions: Distraction aids like Rubix cube and kaleidoscope during the dental procedure plays an important role in managing dental anxiety in children and can be effectively incorporated into routine clinical practice.

Variations in physiological responses to painful stimuli in preterm and term neonates: an observational study

2024-11-09T01:42:43+0530

Background: Appropriate neonatal pain assessment and management is a key component of quality medical care. Assessment of pain, however, is a challenge due to their inability to verbalize this subjective sensation. Preterms are hyper-sensitive to pain and experience it for prolonged periods but it is postulated that they may not express it as robustly and reliably as term neonates. This paper aims to assess and compare the behavioral and physiological pain responses in these groups.

Methods: This prospective observational study was conducted in the outpatient and post-natal wards of a tertiary care teaching hospital. 90 clinically stable term and late preterm neonates requiring IV cannulation, IV blood sampling or heel prick were included. NIPS Pain Scale Scores and physiological parameters (heart rate, respiratory rate, SpO2, mean arterial pressure, total crying time) were recorded before and after the procedure.

Results: 90 neonates were analysed. Significant pain response was noted in both groups post-procedure. In response to the same procedures, preterm neonates demonstrated lower NIPS Scores (4.00 vs. 4.93, P=0.003) and shorter cry times (64.30s vs. 87.35s, P=<0.05). Also noted were higher heart rates and respiratory rates with a prolonged fall in SpO2 and Mean Arterial Pressures in this group.

Conclusions: Preterms, compared to term neonates demonstrate a blunted behavioral response to pain but a heightened and prolonged physiological response. This potential underestimation of pain in preterms indicate the need for incorporation of behavioral cues, physiological parameters and gestational age in the assessment of pain in newborns.

Comparison of effect of suctioning first or drying first on the outcome of hypothermia and respiratory distress at 6 hours of age: a hospital based prospective cohort study

2024-11-11T14:04:27+0530

Background: Around 10% of newborns need assistance to start and maintain effective breathing at birth, and perinatal asphyxia contributes to 23% of the 4 million annual neonatal deaths worldwide. Skilled resuscitation in the delivery room can help prevent many of these fatalities and reduce neurodevelopmental disabilities in survivors. Objectives were to compare the effect of suctioning first or drying first on the composite outcome of hypothermia and respiratory distress at 6 hours of age in depressed newborn requiring delivery room resuscitation.

Methods: The study was an institution-based prospective cohort study, conducted in tertiary care institute. The 380 depressed newborn requiring resuscitation were included in study and those who have major congenital malformation and preterm and meconium-stained liquor were excluded. All the enrolled newborn were randomised into 2 groups, based on block randomisation done by staff nurse. Those who were in suctioning group, were resuscitated by doing suctioning first and those who were in drying group were resuscitated by doing drying first remaining steps were done as per NRP protocol, all the newborn were admitted to NICU. Temperature, respiratory distress and blood sugar at 0, 1, 6 hour of age is recorded in predesigned proforma.

Results: Both the groups were comparable in term of maternal and neonatal characteristics. Incidence of hypothermia at admission was 26.8% for group D and 23.2% for group S (p=0.407). The 7.4% participants required intubation in group D and 4.7% in group S. Respiratory distress at admission was present in 62.1% for group D and 64.7% for group S patients (p value 0.368). At 6 hours of observation, it was seen that the presence of hypothermia in group D was 6.8% in group D and 2.6% in group S (p=0.091). During the same time period respiratory distress was present in 38.4% of group D infants and 38.8% of group S infants respectively (p=0.708).

Conclusions: As long as the neonatal resuscitation is performed properly, any one of the two can be done as the first step of the protocol, it can be said that the order of either drying first or suctioning first in the protocol of neonatal resuscitation provide comparable results in terms of neonatal respiratory distress, hypothermia, and other adverse outcomes.

Clinical and laboratory characteristics of paediatric systemic lupus erythematosus at secondary level hospital among local population in North East India

2024-11-14T22:22:37+0530

Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by multisystem inflammation and the presence of circulating auto antibodies directed against self-antigens with flare-ups and remissions. Childhood-onset SLE (cSLE) is a rare disease with an incidence of 0.3-0.9 per 100.000 children-years. The study among paediatric population of north east India were few and hence this study from north east India was undertaken. Objective of this study was to study the clinical and immunological profile of children with systemic lupus erythematosus (SLE). To study the distribution of Renal Lesions according to ISN/RPS Classification of Lupus Nephritis.

Methods: Retrospective observational single centre study at secondary care hospital in North East India. Medical records of children with SLE admitted in Paediatric department from the period of 2018-2024 through the hospital information management were analysed. Clinico pathological features and immunological profile were compared with other studies.

Results: Among 20 patients studied female to male ratio was 3:1. The mean patient’s age at the time of presentation was 12.4 years. The mean duration of illness was 8.5 months. Most common systems involved were hematological (85%), followed by kidney (75%) and mucocutaneous (75%). All (100%) cases were ANA positive. 45% were anti smith antibody positive, 20% were anti- dsDNA positive. Focal and segmental proliferative glomerulonephritis (ISN/RPS class III) was the most commonly seen histological pattern, seen in 5 (83%) patients who underwent biopsy. Diffuse proliferative glomerulonephritis (ISN/RPS class IV) was seen in 1 (16%) patient.

Conclusions: Childhood onset SLE is still a challenge to diagnose and manage due to unpredictable clinical manifestations with variable disease activity at different age.

Efficiency of organized teaching programme on knowledge regarding low glycaemic index diet among the diabetes mellitus patients admitted in selected hospitals at Bellary

2024-11-19T18:40:43+0530

Background: India leads the world with largest number of diabetic subjects earning the dubious distinction of being as “diabetic capital of world”. Diabetes is leading cause of death, disability and economic loss through the world. Prevalence of diabetes in the adults worldwide was estimated to be 4% in 1995 and is expected to be 5.4% by the year 2025.

Methods: The study conceptual frame work based on Kings Goal attainment theory. The approach used for this study was evaluative one. Pre experimental study one group pretest and posttest design is used to collect the data. The independent variable of the study is organized teaching programme on knowledge regarding low glycaemic index diet among diabetes mellitus patients and dependent variable is knowledge on low glycaemic index diet in the management of diabetes mellitus patients the tool used to collect data was structured knowledge questionnaire.

Results: The results of the study showed that the overall mean pretest knowledge of diabetes mellitus patients was 55.25% with the standard deviation of 2.77. The mean knowledge gain by the diabetes mellitus patients was 73.62% with the standard deviation of 1.89. The association was determined by using Pearson chi square test. The obtained "t" value 14.989 is greater than the table value at 0.01 level of significance. Therefore, "t" value is found to be significant. It means there is gain in knowledge level of diabetes mellitus patients. This supports that organized teaching programme on low glycaemic index diet is effective in increasing the knowledge level of diabetes mellitus patients.

Conclusions: The present study attempted to assess effectiveness of organized teaching programme on knowledge regarding low glycaemic index diet among the diabetes mellitus patients admitted in selected hospitals at Bellary and concluded that there was a significant improvement in the knowledge after organized teaching programme. Thus, organized teaching programme is effective in improving the knowledge of the diabetes mellitus patients.

A study of hypertension and obesity in school-going children age 10-16 years

2024-11-19T22:23:28+0530

Background: The rising prevalence of hypertension and obesity among the current generation of children has become a significant public health concern. This alarming trend highlights the urgent need to study the occurrence of these conditions in school-going children aged 10 to 16 years. Accurate estimates of the prevalence of pediatric hypertension and obesity, particularly in the post-COVID era, are essential for designing effective prevention and treatment strategies. The study aims to determine the occurrence of hypertension and obesity in school going children and the risk factors associated with it.

Methods: In this cross-sectional study included 402 school going children of Kalaburagi city of age group 10 -16 years. After selecting the school, informed consent from school Principal and Parents of children was obtained. A predesigned, pre tested questionnaire proforma was administered to each child to collect data (intake of fatty food, dietary pattern, duration of screen time, duration of sleep, hours of physical activity). Parameters of height, weight and blood pressure were measured and recorded. Ethical approval was obtained.

Results: The prevalence of hypertension was 2.5% and pre-hypertension was 2.5%. Prevalence of obesity was 1.7%, over weight was 5.2%. Significant association was found between obesity and mixed type of diet (p value=0.016). It was found that obesity was significantly associated with increased risk of hypertension (p value= 0.000). Significant association was found between hypertension and increased screen time (p value=0.001). It was observed that there is a statistically significant association between female gender and overweight (p=0.027).

Conclusions: The prevalence of hypertension in obese children was high. Hypertension was positively associated with increased screen time. Prevalence and early detection of childhood obesity and high BP should be strengthened to prevent the risk of cardiovascular diseases.

A study on mumps infection in children aged 1-12 years in a tertiary care hospital, South India: a cross-sectional study

2024-11-22T14:36:53+0530

Background: Mumps is a highly contagious disease effecting children globally with disease presentation varying from being asymptomatic to unilateral or bilateral parotid gland enlargement. It causes serious complications like orchitis, aseptic meningitis, pancreatitis etc. During introduction of MR vaccine in NIS by the Government of India, Mumps vaccine was not included due to lack of enough data representing actual burden of the disease in our country.

Methods: This study was done from January 2024 to August 2024 following a surge in Mumps cases in children aged 1 to 12 years attending paediatrics department, Rangaraya Medical College, Kakinada.

Results: A total of 76 children were included in the study. Children were mostly in the age group 6-10 years (44). Both male (37) and female (36) children were equally affected. Most of the children were from rural areas (67%). 75 (98.7%) children were completely vaccinated with the majority being vaccinated in the Government sector (86.85%). Only 9 (11.85%) children received mumps vaccine. Contact with an individual with mumps was seen in 51 children (67.11%). The majority of the cases were reported during the months of March-April (89.47%). All 76 children presented with parotid swelling either unilateral (22) or bilateral (52) with 2 children having both parotid and submandibular gland swellings. Mumps-related complications like pancreatitis, aseptic meningitis and both were seen in 6 cases,4 cases and 2 cases respectively.

Conclusions: The government of India is to take necessary action to include the mumps vaccine in the UIP along with the MR vaccine to prevent mumps and its complications.