International Journal of Contemporary Pediatrics

Evaluating reliability and validity of the infant distress scale for distress assessment during and after intramuscular injection

Shanthi S. — 2025-09-23

The infant distress scale (IDS) was developed to assess the unpleasant feeling (distress) triggered by intramuscular injection where the child experiences pain. Numerous pain scale exists to measure pain during painful procedure, but only a few scales measuring the distress, So the investigator intended to evaluate the reliability and validity of the IDS in assessing distress both during and after intramuscular injection. The methodological research design was used to test and evaluate the research instrument. The study was conducted at an immunization clinic. Twenty infants aged between 1 to 6 months who received intramuscular vaccination were included in this study. Two observers measured the distress using separate Infant Distress Scale by observing the video recordings. In total around 120 observations were made. Face validity and content validity were established for the tool. Internal consistency of the scale was calculated using Cronbach’s alpha, with values ranging from 0.731-0.821 and the content validity index is 0.89. The study concluded that the IDS is statistically valid and reliable.

Type 1 diabetes mellitus in the pediatric age group: a case series

Pradeep Kumar Ranabijuli — 2025-09-23

Diabetic ketoacidosis is the common initial presentation of type 1 diabetes mellitus in children. In a series of five cases of Type 1 diabetes mellitus who presented in the department of Pediatrics of our hospital, four children presented in the emergency department with diabetic ketoacidosis and severe dehydration. At the time of presentation, all the cases with diabetic ketoacidosis were managed according to the Milwaukee regimen as per the department protocol. None of our children developed any complications, including cerebral edema, during the treatment of diabetic ketoacidosis. The age distribution at the onset of Type 1 diabetes mellitus in our case series ranges from 1 year to 13 years. All the cases showed low c-peptide levels, high Anti- GAD antibodies and high HbA1c levels at the time of presentation. One of our cases also has celiac disease, hypothyroidism and hypercholesterolemia. One child was diagnosed to have hepatitis A infection during the hospital stay for the management of first episode of diabetic ketoacidosis, and another child developed hepatitis A infection after 2 years of diagnosis of type 1 diabetes mellitus. The child who developed hepatitis A infection later also had multiple admissions, once for non-compliance with hyperglycemia and once for an abscess with cellulitis in the neck. In one case, despite the child being clinically well and having normal growth and development, blood sugar levels are uncontrolled despite being on the maximum dose of human actrapid and glargine. Of all these cases, two are on regular insulin in the form of human Actrapid and basal insulin in the form of glargine, two are on regular insulin in the form of glulisine and basal insulin of degludec, and one is on insulin pump therapy with insulin lispro and a continuous glucose monitoring machine. All 5 children are on regular follow-up in the hospital for monitoring of growth and development, screening for complications, and optimal glycemic control.

TNNT1-associated nemaline myopathy: a rare case report from a tertiary centre in central India

Mukesh Bhavanagare — 2025-09-23

Nemaline myopathy (NM) is a rare congenital skeletal muscle disorder characterized by generalized muscle weakness and the presence of rod-like nemaline bodies within muscle fibers. Severity varies from neonatal hypotonia and respiratory failure to milder forms with delayed motor milestones. Inheritance is autosomal dominant or recessive, with mutations commonly in ACTA1, NEB, TPM3 and TNNT1. We report a case of a 3-year-old female with global motor delay, feeding difficulties and hypotonia. Whole exome sequencing revealed a homozygous TNNT1 variant (c.33-2A>T), confirming NM. Supportive care, including nutritional and physiotherapy intervention, led to clinical improvement. This report emphasizes the importance of early clinical suspicion and genetic evaluation in NM, particularly in consanguineous populations.

When Sturge-Weber syndrome and perinatal asphyxia collide: management of intractable seizures in a neonate

Aneeka Zia — 2025-09-23

This report presents a rare and complex case of a neonate with concurrent Sturge-Weber syndrome (SWS) and hypoxic-ischemic encephalopathy (HIE), highlighting the challenges inherent in early diagnosis and effective management. A 37-week male neonate presented with intractable focal-to-bilateral tonic-clonic seizures within six hours of birth. The case was complicated by Grade 2 HIE and a facial port-wine stain in the V1 distribution. Initial anticonvulsant therapy with diazepam and phenytoin proved ineffective, necessitating escalation to quadruple therapy including levetiracetam, midazolam, and phenobarbital. Therapeutic hypothermia was initiated within the critical six-hour window. Diagnostic imaging confirmed cortical parenchymal thickening in the left parieto-occipital region, and ophthalmological examination revealed a choroidal hemangioma, despite the severity of the dual pathology, seizure-free status was achieved after 17 days of intensive management, with sustained response at the initial follow-up. This case addresses a critical gap in the current clinical knowledge by demonstrating the successful implementation of an aggressive multi-modal treatment approach in managing concurrent SWS and HIE, a combination rarely reported in the medical literature.

Self-resolving vaginal cyst in a neonate: a case report

Khurshed A. Choudhury — 2025-09-23

Interlabial cysts in newborns are rare and typically benign, with causes ranging from simple retention cysts to congenital anomalies or malignancies. We report the case of a full-term newborn girl presenting with a 10 mm × 15 mm golden-colored, thin-walled cyst located anterior to the vaginal introitus. The urethral meatus was normally positioned and the infant exhibited normal voiding patterns without urinary obstruction. Over the course of 4 weeks, the cyst regressed significantly in size without intervention. The differential diagnosis included hymenal cysts, paraurethral gland cysts, prolapsed urethra, neonatal prolapsed ectopic ureterocele, Gartner duct cysts, hydrometrocolpos, botryoid rhabdomyosarcoma and other congenital anomalies. Physical examination is often sufficient for diagnosing simple cysts, while imaging modalities such as ultrasonography or MRI are reserved for atypical cases or suspected urinary tract anomalies. This case underscores the importance of careful differentiation between benign, self-resolving cysts and more complex conditions requiring medical or surgical intervention. Clinicians should remain vigilant for signs of associated anomalies or complications, ensuring timely and appropriate management.

Alström syndrome: a rare genetic cardiomyopathy

Sheeba Thomas — 2025-09-23

With an incidence estimated at less than 1 100 000, Alstrom syndrome (AS) was first reported in 1959. AS is an autosomal recessive multi organ disorder, characterized by childhood obesity, adult short stature with initial accelerated childhood linear growth, progressive cone-rod dystrophy leading to blindness, and sensorineural hearing loss. Acanthosis nigricans, hyperinsulinemia, hypertriglyceridemia, hypothyroidism, infertility (hypergonadotrophic hypogonadism), and early-onset diabetes mellitus are the endocrinology consequences. In children dilated cardiomyopathy is the main cause of mortality, in older affected patients, renal failure is the main cause of death. We report a rare case of a 04-month-old girl with dilated cardiomyopathy, Global developmental delay, congenital nystagmus caused by ALMS1 mutation. This study demonstrates that genetic testing for cardiomyopathy without an obvious acquired cause help in determining the underlying cause, managing the condition appropriately, diagnosing syndromic forms early, and keeping an eye on and initiating pre-symptomatic treatment for related extracardiac complications.

Interesting signs in facioscapulohumeral muscular dystrophy in a child

Rahul Sinha — 2025-09-23

Facioscapulohumeral muscular dystrophy is the third most common muscular dystrophy in the world after Duchenne muscular dystrophy and myotonic dystrophy. The age of onset of FSHD varies from infancy to late adulthood. The prevalence ranges from 1:8000 to 20,000, with sixty percent of the disease population in Asian population. We report interesting signs in a genetically proven case of Facioscapulohumeral Muscular Dystrophy in a 9 years old child who had presented with facial muscle weakness, shoulder girdle weakness followed by hip girdle weakness. The clinician should be aware of this rare genetic condition especially when there is asymmetric weakness of facial and shoulder girdle muscles.

Vitamin D deficiency - a hidden culprit in dilated cardiomyopathy in children: a rare case report and review

Kapil Bainade — 2025-09-23

Vitamin D deficiency (VDD) is a significant public health concern in India, especially in infants and children. Hypocalcemia originating from VDD is a cause of dilated cardiomyopathy (DCM). Here, we reported a case of a 4-month-old infant who was diagnosed with DCM secondary to hypocalcemia-associated VDD. A 4-month-old full-term female infant presented to the emergency with three episodes of apneic spells and a feeding history of improperly prepared formula and diluted cow's milk with no other supplementation. The baby had normal vitals and no abnormal examination findings. Investigations revealed severe hypocalcemia with prolonged QTc interval on electrocardiogram. Further investigations showed VDD, and echocardiography showed DCM with mild left ventricular dysfunction. The infant was managed with calcium and mega doses of vitamin D. There was DCM resolution and ventricular function improvement. The infant was discharged with no morbiditiesn. Despite its importance, VDD persists as a significant public health challenge in Indian infants and children, resulting from a complex interplay of factors. Hypocalcemia due to VDD results in a form of reversible DCM, causing heart failure. Consistent with our case, numerous published case series have demonstrated that infants and children with VDD often present with cardiac dysfunction and DCM at various stages and show dramatic improvement following vitamin D supplementation. Dilated cardiomyopathy may be more common than previously thought as a complication of vitamin D deficiency, but early detection and timely intervention can lead to swift recovery.

Infantile hemangioma with cleft lip in a term female infant born to a mother with pregnancy-induced hypertension

Suryaram J. — 2025-09-23

Infantile hemangioma (IH) is the most common benign vascular tumor in infancy, affecting approximately 4–10% of neonates, with a higher prevalence in females and premature infants. Although typically self-limiting, IHs can lead to complications such as ulceration, disfigurement, or functional impairment—particularly when located near vital anatomical structures. This case reports a case of a 40-day-old term female infant presenting with multiple reddish raised lesions over the upper lip and right shoulder, clinically diagnosed as infantile hemangiomas. The infant was born to a mother with pregnancy-induced hypertension (PIH), managed antenatally with labetalol. Examination revealed a central ulcerated lesion on the upper lip and a smaller non-ulcerated lesion over the right shoulder. A congenital cleft lip was also noted, without cleft palate involvement. Systemic evaluations including abdominal and cranial ultrasound, echocardiography, and 12-lead electrocardiogram (ECG) were within normal limits. Topical becaplermin 0.01% gel was applied twice daily for two weeks to promote ulcer healing, followed by oral atenolol at a dose of 0.25 mg/kg/dose twice daily. The treatment was well tolerated, with no adverse effects. Significant regression of both lesions was observed over the following weeks. Although PHACE syndrome was initially suspected due to facial involvement and cleft lip, it was ruled out based on normal neuroimaging and cardiac assessments. This case highlights the successful use of atenolol as a safe and effective alternative to propranolol in the treatment of complicated IHs. Early diagnosis, comprehensive evaluation to exclude syndromic associations, and timely therapy are essential to avoid complications and ensure favorable outcomes.

Cockayne syndrome: infantile onset in two siblings and its clinical spectrum in India

Gulnaz Nadri — 2025-09-23

Cockayne syndrome (CS) is a rare autosomal recessive disorder having myriad manifestations including features of growth failure, premature ageing, photosensitivity and progressive neurological degeneration. Often, a characteristic facial phenotype is also described. Mutations in the ERCC6 or ERCC8 genes, which impair DNA repair mechanisms, are responsible for CS. Mutations in the ERCC6 gene are reported commonly. Due to its rarity and overlap with other neurodegenerative disorders, Cockayne syndrome often presents significant diagnostic challenges, especially in early life. This case report discusses a unique case of 2 two siblings with CS, challenging the typical understanding due to the absence of photosensitivity. The index child presented with growth failure, developmental delay, including motor and speech impairment, with microcephaly and progeroid appearance. Genetic testing confirmed a mutation in the ERCC8 gene, consistent with Cockayne syndrome type A. This case is unique due to the absence of photosensitivity, which is conventionally considered a hallmark feature, highlighting the variability in the phenotypic expression of Cockayne syndrome. Despite established features, Cockayne syndrome remains underdiagnosed, hence under-reported, particularly in milder or atypical cases. The rarity and marked variability in clinical presentation often leads to delayed diagnosis, impacting timely management and genetic counselling. Given its complex presentation, clinicians must maintain a high level of suspicion in children with multisystem involvement who exhibit phenotypic features of Cockayne. This report reinforces the necessity of early recognition and intervention. Timely diagnosis is essential for appropriate management and genetic counselling, potentially altering the trajectory for affected families.

Achalasia cardia in a child managed with per-oral endoscopic myotomy: a case report

Tabia Tamim — 2025-09-23

We present a case of a 12-year-old girl with progressively worsening vomiting and respiratory symptoms, eventually diagnosed with achalasia cardia. Initial imaging and endoscopy suggested esophageal motility disorder, confirmed by high-resolution manometry as type I achalasia. The child underwent per-oral endoscopic myotomy (POEM) procedure after antifungal treatment for incidental esophageal candidiasis. The procedure was successful with complete symptom resolution and weight gain on follow-up. This case highlights the diagnostic challenges in pediatric Achalasia and emphasizes the role of POEM as an effective therapeutic modality.

From prenatal diagnosis to postnatal stability: a case of isolated type II congenital pulmonary airway malformation

Swapnil Dadmal — 2025-09-23

Congenital pulmonary airway malformation (CPAM) is the most common congenital lung anomaly. CPAM is characterized by multiple cysts of varying diameter, of embryological origin. With advances in prenatal imaging, it is frequently detected antenatally. We report a male neonate with antenatal diagnosis of CPAM in the lungs at 22 weeks of gestation. The baby was delivered at 39 weeks via planned cesarean section, weighing 2425 gm, and had mild transient tachypnea after birth. Postnatal imaging confirmed multiple thin-walled cysts in the right lung, without compression of adjacent structures. No associated anomalies were found. The neonate was managed conservatively and discharged with multidisciplinary follow-up. This case highlights the possibility of a benign course in asymptomatic CPAM type II, underscores the role of prenatal and postnatal imaging, and discusses current controversies regarding conservative versus surgical management.

Psychosocial risk-factors of depression in adolescents: a cross-sectional study at tertiary hospital of southern Rajasthan

Prerna Vaishnav — 2025-09-12

Introduction: Depression in adolescent is a growing global issue in India where world largest adolescent population with 253 million individuals resides. In 2024 global prevalence of depression among adolescent’s ranges from 6% to 21.3% according to World Health Organization. Family unrest contributes to risk of depression among adolescents.

Methods: A Cross-sectional study was conducted on adolescents with non-cardiac chest pain between age 10-19 years. Research-designed questionnaire including demographic and risk factors was completed for each participant. PHQ 9 is patient health questionnaire tool of 9 items used to assess depressive symptoms. The participated adolescents who scored 15 and above were considered Depressed. Univariate analysis was performed to find out psychosocial risk factors. Adjusted odds ratio with 95% confidence intervals were derived. To test association of depression with socio-demographic factors we used PHQ-9 continuous scores as our main outcome.

Results: Total 60 adolescents were assessed for depression using PHQ 9 severity assessment tool. 26.6% were found depressed using PHQ 9 score 15 and above. On Univariate analysis female gender, elder in age, belonging to lower socioeconomic class, dropped out of school, experiencing family conflicts and experiencing domestic abuse were significantly associated with depression. Living with single parents had 3.76 times higher risk of depression. 15.7% males were experiencing academic stress. Living arrangement, chronic illness, use of social media and relationship breakdown were not found significant risk factors.

Conclusions: Depression is common in elderly female of Rajasthan belonging to lower socioeconomic class. Most common risk factors being family conflicts and domestic abuse. Academic stress in male adolescents living with parents was significant risk factor. There is urgent need to educate parents, to reduce parental pressure on academic performance and to stop early child marriage at rural level to save mental health of adolescents.

Association of cranial ultra sonography findings with intrauterine growth restriction in term neonates

Shrikant Giri — 2025-09-03

Background: Fetal growth restriction (FGR) is a condition in which a fetus does not reach its full growth potential in utero. It is a significant contributor to perinatal morbidity and mortality. Cranial ultrasound (CU) is a non-invasive imaging technique used to assess brain structure and abnormalities in neonates, particularly affected by FGR or classified as small for gestational age (SGA). Aim was to determine the association between FGR and CU abnormalities (CUAs) in term neonates.

Methods: It was a single centre, hospital-based, cross-sectional comparative observational study conducted in the level IIIA neonatal intensive care unit (NICU) of Shri Shishu Bhawan Hospital for Children and Newborn, Bilaspur, Chhattisgarh. A total of 194 neonates were selected for the study. Comparative analysis between the FGR and control groups was performed using chi-square tests for categorical variables and t-tests for continuous variables.

Results: The present study observed a higher proportion of CUAs in term neonates with FGR (11.3%) compared to appropriate for gestational age (AGA) neonates 2.06% (p>0.5). Periventricular leukomalacia (PVL) was more commonly observed among FGR neonates (14.3%) compared to AGA neonates 6.18% (p>0.05). The trend suggests that FGR may predispose neonates to a higher risk of periventricular white matter damage, even at term gestation.

Conclusions: FGR has a substantial impact on neonatal brain development and increases the risk of neurodevelopmental complications. Early detection through CU screening and long-term follow-up for neurodevelopmental assessment are essential to improve outcomes in this high-risk population.

Childhood asthma and quality of life: insights from ICMH, Dhaka

Mohammad Mahbubur Rahman — 2025-09-23

Background: Asthma is a significant global health issue affecting both children and adults, negatively impacting various aspects of quality of life. In Bangladesh, one in thirteen children suffers from asthma, which hampers their daily activities. This study aimed to assess the health-related quality of life (HRQoL) in children with asthma.

Methods: A descriptive cross-sectional study was conducted among 116 children with asthma, aged 7−17 years, at the Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh in 2020. Data were collected using the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) through direct interviews with children, supplemented with sociodemographic information and incomplete responses from parents. Statistical analysis was performed using SPSS version 26.0.

Results: The overall PAQLQ score ranged from 2.48 to 6.52, with an average of 5.2. The greatest impairment was observed in the domain of 'Activity Limitation' (mean=3.6259), followed by 'Emotional Function' and 'Symptoms.' HRQoL decreased as asthma severity increased with age (r=-0.341, p=0.001). Uncontrolled asthma was associated with the lowest HRQoL scores (p=0.001) and a longer duration of suffering further impacted the PAQLQ score negatively.

Conclusions: Childhood asthma significantly reduces quality of life, as indicated by statistical findings. PAQLQ can serve as a valuable tool for routine assessment in clinical practice. Training asthma educators at district and upazila-level hospitals could improve HRQoL evaluation and management for children with asthma in Bangladesh.

Understanding the parental contribution to antimicrobial resistance: a study of pediatric antibiotic practices in South Asian communities

Saima Ghafoor — 2025-09-23

Background: Antimicrobial resistance (AMR) is a growing public-health threat in South Asia. Because community AMR is shaped by parental knowledge, attitudes, and practices (KAP) regarding pediatric antibiotics, we assessed KAP among Pakistani parents and examined socioeconomic differences.

Methods: A cross-sectional survey was administered from January 2024 to June 2025 in pediatric and pediatric-surgery outpatient clinics of five tertiary hospitals. Using multistage stratified random sampling, 425 parents of children aged 0–12 years completed a structured questionnaire spanning knowledge, attitudes, and practice domains.

Results: Only 38.0% demonstrated appropriate knowledge of antibiotic use, while 61.9% incorrectly believed antibiotics treat viral infections. Self-medication with antibiotics was reported by 43.5%, frequently via over-the-counter purchase at pharmacies, and 45.9% stored leftover antibiotics. Lower household income (OR 1.79; 95% CI 1.26–2.55; p=0.003) and lower educational attainment (OR 2.14; 95% CI 1.52–3.00; p=0.001) independently predicted inappropriate antibiotic practices.

Conclusions: Parental awareness and behaviors surrounding pediatric antibiotics in Pakistan are suboptimal, particularly among families with lower income and education. Addressing community-level AMR will require culturally tailored education, strengthened counseling by physicians and pharmacists, and enforcement of regulations limiting non-prescription antibiotic sales. Integrating stewardship messages into routine child-health visits and media campaigns, with monitoring through KAP surveys, may help curb misuse and preserve antibiotic effectiveness.

Frequency of pressure injuries in a resource limited pediatric intensive care unit of Pakistan: a retrospective study

Faiza Rehman — 2025-09-23

Background: Pressure injuries are a significant global healthcare issue, particularly affecting children, who are identified as high-risk. This study aimed to evaluate the frequency, severity and most vulnerable sites of PIs in critically ill children admitted to the Paediatric Intensive Care Unit (PICU).

Methods: We enrolled children aged 1 month to 15 years who stayed in the PICU for over 24 hours from August 1 to December 30, 2023. Two well trained health professionals called skin champions conducted daily comprehensive skin examinations until discharge or death. Location, severity and possible cause of PIs were noted on data collection sheet as well as trend of occurrence noted.

Results: Among 1,196 patients and 3077 skin assessments, 53 (4.4%) PIs were identified. Of these, 32 injuries (60.4%) were related to medical devices MDRPI and 21 (39.6%) were due to pressure alone. The upper trunk was the most common site (75.5%), with the occiput being particularly affected (24%). Stage 1 and Stage 2 PIs accounted for 45.3% and 54.7%, respectively.

Conclusions: Occurrence of PI was lower than in earlier research, while the frequency of MDRPIs was notably higher underscoring the necessity for improved prevention strategies and ongoing risk evaluations.

Screening of tuberculosis in hospitalized severely acute malnourished children in a tertiary care hospital

Kinjal G. Patel — 2025-09-23

Background: Tuberculosis (TB) remains one of the leading causes of infectious disease-related morbidity and mortality worldwide. There is an increase susceptibility to TB due to impaired immunity in malnourished children.

Methods: This is a cross-sectional study done at a tertiary care hospital over a period of 1 year. Children aged 6 months to 5 years diagnosed with severe acute malnutrition (SAM) based on World Health Organization (WHO) criteria were enrolled in the study. Screening for tuberculosis was performed using: Monteux test, chest X-ray, sputum or gastric aspirate microscopy or cartridge-based nucleic acid amplification test (CBNAAT) for Mycobacterium tuberculosis detection.

Results: A total of 165 SAM patients were screened for TB. Prevalence of TB in SAM patient was 3.63%. Among the 6 cases, 4 were extra pulmonary and 2 were pulmonary TB. The most frequent symptoms were cough (34.56%), vomiting (26.66%), and diarrhoea (25.45%). Fever was seen in 24.24%, and weight loss in 14.54%. The Monteux test results was negative in all patients. CBNAAT testing was positive in only 2 patient (1.21%). Out of 165 children, 2.42% had elevated erythrocyte sedimentation rate (ESR) and 14.55% had an abnormal chest X-ray. Mesenteric lymphadenitis was observed in 9 patients (5.45%) in abdominal ultrasonography.

Conclusions: This study highlights that clinical features of tuberculosis were nonspecific. Diagnostic limitations were evident as the Monteux test yielded 0% positivity, and CBNAAT only in 1.21%. This study emphasizes the need for high clinical suspicion in paediatric TB, particularly in malnourished children.

Assessment of orthodontic treatment awareness among tribal cohort of adolescents: a cross-sectional questionnaire survey

Smitha V. Shetty — 2025-09-23

Background: Marginalized communities of India mostly live in isolation and have limited access to healthcare service. the aim of the study is to evaluate the level of awareness regarding orthodontic treatment among adolescents residing in tribal Bangalore, as there is very high prevalence of malocclusion.

Methods: A cross-sectional questionnaire survey was conducted among 119 adolescents aged (13-17 years) from the Soliga tribe of Bangalore rural area. With prior authorization from the panchayat development officer and the respective school authorities within the tribal community, a survey was be organized across all selected schools.

Results: Significant gaps in orthodontic awareness were identified among 118 adolescents in tribal Bangalore, with 43.2% recognizing orthodontists and 80.5% perceiving treatment as expensive, highlighting the need for education and affordability.

Conclusions: There is a significant gap in orthodontic awareness among tribal adolescents, particularly regarding the functional and long-term health benefits of treatment.

Clinical and laboratory profile of acute adenoviral infections in children in a tertiary care centre in India

Akhila Naz — 2025-09-23

Background: Adenoviral infections have very dramatic presentation with high grade fever, prolonged course and high inflammatory markers, causing much alarm among caretakers and health care workers. Being very common in pediatric age group, it leads to rampant use of antibiotics and hospitalization. This study attempts to characterize acute adenoviral infections and those related to swimming pools.

Methods: A study was conducted among children, aged 2 months to 14 years, who presented with fever and clinical features of adenoviral infection. Diagnosis was confirmed by nasopharyngeal swab and clinical and laboratory data were analyzed statistically.

Results: Fever was the commonest presentation (100%), with >80% experiencing high-grade fever and 7.3% lasting≥10 days. Respiratory symptoms were most common (75%), followed by gastrointestinal (51%), ophthalmic (41%) and neurological (19%). Multisystem involvement occurred in 78%. Elevated inflammatory markers were frequent: CRP>50 mg/L in 70%, ESR>50 mm/hour in 53% and leukocyte count>15,000/mm³ in 65%. Neither higher inflammatory markers nor fever severity correlated with longer fever duration or hospital stay. Swimming pool-related cases showed a higher incidence of conjunctivitis. Post COVID era saw in surge of adenoviral infections.

Conclusions: Adenoviral infections cause prolonged fever, multisystem involvement and high inflammatory markers despite being viral. Elevated inflammatory markers do not predict prolonged illness or hospitalization and should not alone guide antibiotic use in clinically stable children. Early diagnosis can prevent unnecessary antibiotics. A global surge in adenoviral infections has been observed post-COVID.

Study of impact of screen time in early adolescent school children

Nitya T. Hapani — 2025-09-23

Background: Excessive screen time exposure is a widespread issue among modern school children. Indian data on risk factors and the adverse consequences of screen use in healthy, school-going children is limited. This study aimed to explore types of screen exposure and evaluate associations between screen time and variables including sleep quality, academic performance, family structure, behavioural and medical problems, and outdoor activity.

Methods: This was a cross-sectional observational study conducted from 1 February 2025 to 31 March 2025 at The Galaxy School, Rajkot, Gujarat. Parents of grade 4 and 5 students were surveyed using structured questionnaires. BMI was assessed according to Indian academy of pediatrics (IAP) charts. Data was analysed using SPSS version 26.

Results: A total of 155 students (54% male) participated. The mean screen time was 3 hr 35 min (range: 40 min-8 hr 30 min). Nuclear family structure and both parents working was associated with higher screen time (4 hr 19 min and 4 hr 18 min respectively). Dry eye (27%), stubbornness (45%), and headaches (10%) were frequent complaints. Neck/shoulder pain, insomnia, and night terrors were associated with notably higher-than-average screen exposure. Academic performance was inversely related to screen time.

Conclusions: Screen exposure was reported to be universal. Risk factors for excessive screen time include nuclear family settings and dual working parents. Behavioural, sleep, and physical health indicators demonstrate measurable associations with screen use, underscoring the need for early interventions.

Effectiveness of augmentative alternative communication therapy in children with cerebral palsy with expressive speech delay

Priyanka Prasanna — 2025-09-23

Background: The objectives of the study were to determine the effectiveness of augmentative alternative communication therapy (AAC) in children with cerebral palsy (CP) and to correlate the outcome of AAC therapy with the communication function classification system (CFCS) and gross motor function system classification (GMFCS) levels.

Methods: This is a prospective interventional study. Among the children satisfying the inclusion criteria, CFCS and GMFCS scoring, and the family impact of assistive technology scale AAC scoring (FIATS AAC) were taken. AAC therapy was administered based on the patient's baseline communication skills, utilizing both aided and unaided techniques on a weekly follow-up basis. The outcome was assessed at 6 months following therapy by both the investigator and the speech therapist using the FIATS-AAC questionnaire.

Results: All cohorts (n=101) had a predominant expressive language delay. Among 101 cohorts, 43.5% belonged to level 3 GMFCS, and 42.5% belonged to level 3 CFCS classification. 93.06% (n=94) used low-tech AAC, and 6.94% (n=7) used high-tech AAC. The correlation between baseline and follow-up FIATS AAC scores showed a significant improvement in the score, with a p<0.01.

Conclusion: Children with expressive speech delay could benefit from AAC as it aids in communication with family and social interaction. Additionally, this study correlates the association between GMFCS and CFCS with AAC therapy.

Correlation between occurrence of natural phenomena and incidence of two specific cyanotic congenital heart diseases: an exploratory study

Darsita D. Jatakia — 2025-09-23

Background: Cyanotic congenital heart disease (CCHD), like transposition of the great arteries (TGA) and total anomalous pulmonary venous connection (TAPVC), arise from abnormal cardiac development during embryogenesis. While genetic and environmental factors are well-known, the influence of natural astronomical phenomena, such as the lunar cycle and eclipses, remains unexplored. This study evaluates a possible correlation between these events and the incidence of TGA and TAPVC.

Methods: Hospital records from 2020–2022 were reviewed to identify cases of TGA and TAPVC. The estimated conception period was calculated based on gestational age at birth. This period was then compared with the dates of natural astronomical events, like new moon, full moon, and eclipse (solar and lunar). The frequency of cases conceived during these events was analyzed for potential associations.

Results: Amongst 29 cases of TGA, 10 (34.4%) were conceived during an astronomical event, with 7 (24.1%) around the new moon period. Of the 49 TAPVC cases, 19 (38.7%) coincided with similar events, including 17 (34.7%) around the new moon period.

Conclusions: There is a positive correlation in the incidence of TGA and TAPVC in the offspring if conceived during the period of new moon. While preliminary, this warrants further prospective studies to explore astronomical influences on congenital heart disease.

Knowledge, attitude and practices of various feeding practices among the mothers and caregivers of infants aged 0-12 months in the Northeastern State of Nagaland, India

Angkita Mishra — 2025-09-23

Background: This study was undertaken to determine the knowledge, attitudes and practices of various feeding practices of mothers and caregivers of infants aged 0-12 months in the Northeastern state of Nagaland, India.

Methods: A cross-sectional study was conducted from January 2022 to March 2022. A total of 210 mothers and caregivers of infants aged 0-12 months from the Mon district of Nagaland were enrolled in the study. A standardised pre-tested questionnaire consisting of relevant questions on the knowledge, attitudes and practices of the mothers and caregivers regarding various feeding practices, and the most preferred homemade complementary foods provided to the infants was used. All the data collected via different parameters were statistically analysed, and the results obtained were tabulated.

Results: The results showed that out of the 210 respondents, 97.14% were mothers, and 2.86% were fathers who were either divorced or widowers and were the sole caretakers of the infants. The KAP questionnaire showed that the respondents' overall knowledge about breastfeeding and various complementary feeding practices was poor (54.0%), their overall attitude was good (38.10%), and their overall practice regarding breastfeeding and various complementary feeding practices was average (60.95%). The study also showed that rice kanji was the most preferred complementary food being used in Nagaland, and semolina porridge was the least favored item (1.90%).

Conclusion: This study showed that proper knowledge and socio-demographic profile of mothers and caregivers play an important role in choosing the right complementary foods, determining the time of initiation and following the rightful practices of complementary feeding in infants with the right attitude.

Improving duration of kangaroo mother care by using quality improvement methodology of low-birth-weight neonates

Anita Mehta — 2025-09-23

Background: Kangaroo mother care (KMC) is an evidence-based neonatal care that resulted in decreased mortality and morbidity in preterm infants. The objective of this study was to improve the duration of KMC for Low Birth Weight (LBW) neonates using a Quality Improvement (QI) methodology.

Methods: This hospital-based study was carried out among eligible low birth weight neonate-mother dyad at the Neonatal Unit of Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India. Quality Improvement methodology was used, which included counseling and sensitization of staff nurse and family members about KMC, reward and positive reinforcement of staff nurse and family members and implementation of a written hospital policy. The effect of KMC was assessed by duration of KMC in three Plan-do-study-act (PDSA) cycles, each of 3 months duration. Data was analyzed by using SPSS.

Results: The total duration of KMC was increased from 6.28 hours/day during PDSA-1cycle to12.13 hours/day during PDSA-3 cycle.

Conclusions: By applying QI methodology with existing infrastructure and staff only, there was improvement in KMC duration in preterm LBW neonates.

Early bubble continuous positive airway pressure as the initial mode of management of respiratory distress syndrome in preterm neonates

Nazish Tahreem — 2025-09-23

Background: Respiratory distress syndrome (RDS) is a common and serious condition in preterm neonates caused primarily by surfactant deficiency and immature lungs. Early application of bubble continuous positive airway pressure (bCPAP) offers a non-invasive respiratory support method that may reduce the need for mechanical ventilation and associated complications. The present study aimed to evaluate the efficacy and safety of early bubble CPAP as the initial mode of respiratory support in preterm neonates with RDS.

Methods: A prospective observational study was conducted on 100 preterm neonates between 28 and 34 weeks of gestation presenting with clinical and radiological features of RDS within 6 hours of birth. All neonates were initiated on bCPAP within 1 hour of birth or diagnosis. The primary outcome was bCPAP success, defined as avoidance of invasive mechanical ventilation within 72 hours. Secondary outcomes included the duration of bCPAP therapy, complications, incidence of bronchopulmonary dysplasia (BPD), length of stay in the neonatal intensive care unit (NICU), and survival to discharge.

Results: The mean gestational age and birth weight were 31.5±1.8 weeks and 1450±320 grams, respectively. Successful bCPAP therapy was achieved in 72% of neonates. The mean duration of bCPAP was 72.12±18.54 hours. Complications included apnea requiring intubation (12%), nasal trauma (10%), pneumothorax (5%), and BPD (8%). Neonates who failed bCPAP had significantly lower gestational ages and birth weights and higher incidences of BPD and mortality (p<0.05). Survival to discharge was 94%.

Conclusion: Early bubble CPAP is an effective and safe respiratory support strategy in preterm neonates with RDS, reducing the need for mechanical ventilation and associated complications.

Clinical, hematological, and flow cytometric correlation of acute leukemia in children: a study from a tertiary pediatric care facility in Hyderabad, Telangana

Priyadarsini Munirathinam — 2025-09-23

Background: Acute leukemia is the most common malignancy in children, accounting for approximately 30-40% of all childhood cancers. In India, pediatric acute leukemia presents a significant public health challenge due to its rising incidence, diagnostic delays, and variable access to specialized care. clinical features, hematological parameters (including smear), flow cytometry are essential for diagnosis, risk stratification and prognosis of the disease.

Methods: The study was conducted on 77 patients’ children aged 1 month to 12 years who were diagnosed with acute leukemia.

Results: The majority of participants were between 1 to 5 years (42.9%) with definite male predominance (57.1%). Common clinical features were fever (87%), Bleeding manifestations (40.3%), joint pain (15.6%). Splenomegaly and hepatosplenomegaly were observed in 29.9% and 48.1% of the participants. B-cell acute lymphoblastic leukaemia (ALL) was most common (70.1%). Among acute myeloid leukemia subtypes, AML M2 was predominant, and T-cell ALL was relatively rare (3.9%). On flow cytometry analysis of B-ALL, B-cell markers were exclusively expressed and CD34 was positive in 44.2% of the cases. CD10, CD19, and CD79 were exclusively expressed in B-ALL, while MPO, CD13, CD33, and CD117 were strongly associated with AML. T-ALL was characterized by the expression of CD3, CD2, and CD5. Distinct expression patterns of markers such as CD41 and CD61 observed in AML M7 subtype.

Conclusions: Overall, the integration of clinical, hematological, and flow cytometric findings will enable accurate diagnosis and characterization of pediatric leukemia and in further management.

Evaluating the link between antenatal care and foetal outcomes in a rural tertiary care center in North India

Rizwan Ahmad — 2025-09-23

Background: Antenatal care (ANC) is essential for safeguarding the health of both mothers and newborns. Despite policy initiatives, rural India continues to face challenges in ensuring adequate and quality ANC. This study assessed the adequacy of ANC using a structured scoring system and examined its association with foetal outcomes in a rural tertiary care center in North India.

Methods: This cross-sectional study was carried out in a hospital setting, enrolling 175 mothers and their infants between August 2023 and January 2025. ANC quality was measured using a 10-domain scoring system (maximum score 40). Adequate ANC was defined as ≥24 points. Maternal and neonatal outcomes, including birth weight, Apgar scores, preterm delivery, and neonatal intensive care unit (NICU) admission, were compared between adequate and inadequate ANC groups.

Results: The mean ANC score was 24.95±8.27; 73.7% of women received adequate ANC. Adequate ANC was significantly associated with higher socioeconomic status, booked status, and caesarean deliveries (p<0.001). Neonates of inadequately supervised pregnancies had significantly higher odds of preterm birth (OR=24.8, p<0.001), low birth weight (OR=45.8, p<0.001), low Apgar score at 1 minute (OR=6.3, p=0.012), and NICU admission (OR=0.08, p<0.001).

Conclusions: Adequate ANC, as measured by a structured scoring system, was strongly associated with favourable foetal outcomes. Strengthening maternal health programs should emphasize early registration, comprehensive ANC contacts, improved record completeness, and quality counselling. Addressing socioeconomic barriers and promoting equitable access to ANC remain essential to reduce adverse outcomes in rural populations.