International Journal of Contemporary Pediatrics

Factors associated with maternal knowledge, perception and practice of oral rehydration solution for diarrhoea in a health facility in Port Harcourt

Tamunoiyowuna G. Okari, Boma A. West — Thu, 06 Mar 2025 00:00:00 +0530

Background: Oral rehydration solution (ORS) is an effective, inexpensive intervention for preventing dehydration and mortality among children with diarrhoea. However, this benefit can only be achieved, if caregivers have appropriate knowledge and right perceptions to make them use it when needed in diarrhoeal illness. This study was carried out to assess the level of knowledge, perception and the practice of ORS by mothers attending the paediatric outpatient clinic in Rivers State University Teaching Hospital and determine factors associated with it.

Methods: A cross-sectional study was carried out among mothers of under-five children attending the clinic. Specific questions on knowledge, perception and practice of ORS were answered, correct responses collated and converted to percentages, with 50% used as cut-off for good knowledge, perception and practice of ORS. Data analysis was done using SPPS version 23.

Results: A total of 143 mothers aged 22-50 (32.1±5.4) years, participated in the study. The ORS awareness among them was high with corresponding high level of knowledge (71.6%), perception (77.6%) and practice (69.4%) of ORS. However, there was poor knowledge and practice regarding when to start and duration of administering ORS to children with diarrhoea. Middle socioeconomic class and higher parity were significantly associated with good knowledge of ORS and being married with good perception. Good knowledge of ORS was significantly associated with good perception and good practice.

Conclusions: Though the knowledge, perception and practice of ORS in this study were good, public enlightenment is needed to address the gaps in knowledge and practice.

Clinical profile of hepatitis A virus infection in children in a tertiary care hospital

Tue, 25 Mar 2025 00:00:00 +0530

Background: Hepatitis A virus (HAV) infection is a frequent form of hepatitis primarily affects the liver and is commonly observed in children particularly in areas with limited access to clean water and sanitation. The disease is characterized by a variety of clinical manifestations including jaundice, fever, and abdominal pain. This study aims to evaluate the clinical, and biochemical of HAV infection in children in a tertiary care hospital.

Methods: This prospective observational study was conducted at Bangladesh Shishu hospital and institute, Dhaka, Bangladesh from January 2023 to December 2023. The study aimed to investigate the clinical and biochemical spectrum of HAV infection in children at the department of paediatric gastroenterology, hepatology and nutrition. A total of 200 children with confirmed HAV infection were enrolled in the study. Data were analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Descriptive statistics were used to summarize the clinical and biochemical characteristics of the study population.

Results: Clinical features were dominated by jaundice and hepatomegaly (100%), followed by fever (98.5%), nausea (98%), anorexia (98%), and abdominal pain (92.5%). Cholestasis was the most common complication (9.5%), followed by acute liver failure (4.5%). Laboratory findings showed that 86.5% had total serum bilirubin levels ≤10 mg/dl, 67.5% had serum ALT levels between 500-1500 IU/L, and 4.5% had an INR >1.5.

Conclusions: This study provides a comprehensive analysis of the clinical and biochemical spectrum of HAV infection in children at a tertiary care hospital. The findings highlight the typical presentation of HAV in children, including symptoms such as jaundice, fever, vomiting, and abdominal pain, alongside elevated serum ALT and bilirubin levels. Despite the generally self-limiting nature of the disease, complications such as cholestasis and acute liver failure were observed, underlining the importance of early diagnosis and appropriate management and emphasize the necessity of including hepatitis A vaccination in routine immunization programme.

Comparison of the efficacy of hypertonic saline (3%) with salbutamol nebulization for treatment of acute bronchiolitis: a randomized clinical trail

Rita Das, Monish Saha Roy, Humayra Akter, Tanjina Hoq — Tue, 25 Mar 2025 00:00:00 +0530

Background: Acute bronchiolitis is a common respiratory condition in infants and nebulized solutions are often used as part of its management. This study compares the efficacy and safety of nebulized 3% hypertonic saline (HS) versus salbutamol with normal saline (NS) in treating bronchiolitis.

Methods: This was a Randomized controlled trial conducted in the Department of Pediatrics of Chattogram Medical College Hospital and Chattogram Maa- O- Shishu Hospital, Chattogram, Bangladesh, during the period from February 2018 to February 2019. We included 204 children and divided them into two groups – Group A (Children who were given nebulized 3% HS (4 ml) with an oxygen flow rate of 6-8 l/min) and group B (Children who were given nebulized salbutamol in a dose of 0.15 mg/kg body weight in normal saline).

Results: The mean age of patients was comparable between groups (8.54±4.41 vs. 8.25±4.46 months, p=0.644). Both groups had a male predominance (63.7% vs. 62.7%, p=0.885). Baseline clinical characteristics, including respiratory rate, heart rate, temperature and oxygen saturation, were similar across groups. At 72 hours, CSS showed significant improvement in both groups (p<0.001), with a greater reduction in the HS group (Group A) compared to the salbutamol group (Group B) (p=0.034). LOS was significantly shorter in the HS group, with 82.35% discharged within 72 hours compared to 55.9% in the salbutamol group (p=0.013). No adverse events were reported in either group.

Conclusions: Nebulized 3% hypertonic saline demonstrated greater efficacy in reducing clinical severity scores and shortening hospital stays compared to salbutamol with normal saline, with no adverse events reported. This suggests that 3% HS is a safe and effective option for the management of acute bronchiolitis in infants.

A comparative study on preterm birth in elderly mothers and young mothers

Malavika P. S., Kumar Guruprasad G. A., Vinaykumar S., Bhavya S. O. — Tue, 25 Mar 2025 00:00:00 +0530

Background: In the present-day scenario women are career oriented and ambitious. They might not want to spoil their focus by getting pregnant. Late motherhood helps them sort their career, and when they do have children, it allows them to spend more time and money on their kids. In order to achieve this woman are choosing to embrace the motherhood in later age. Most of them not understanding the consequences of delayed marriage and late pregnancy. Advanced maternal age at birth has been found to be associated with preterm delivery, low birth weight, intrauterine foetal death and increased perinatal morbidity and mortality The aim of our study was to know the preterm birth in elderly mothers and young mothers, and to compare preterm births in these two groups.

Methods: Our study was a cross sectional, analytical case control study, done in babies delivered to mothers >35 years and <35 years. Information like age of the mother, gestational age, period of gestation at birth etc were recorded in a proforma. Collected data was analysed using frequency, percentage, chi square test and odds ratio

Results: In our study, total sample size was 460 (230 cases and 230 controls). Incidence of preterm deliveries were significantly more in case group (babies born to mothers >35 years) than the control group (babies born to mothers between 19 to 35 years).

Conclusions: It was observed that premature births were more common in babies born to elderly mothers than young mothers.

Evaluation of health-related quality of life among transfusion dependent thalassemia major children aged 6-18 years

Tue, 25 Mar 2025 00:00:00 +0530

Background: Children with transfusion-dependent thalassemia major (TDTM) are vulnerable to issues in various aspects of psychological, physical, social, emotional, communication and educational which results in diminished health-related quality of life (HRQOL). Aim was to evaluate HRQOL and corelation with sociodemographic factors among TDTM children between the aged 6-18 years.

Methods: This cross-sectional study involved 69 children with TDTM aged 6-18 years by using validated paediatric QOL inventory version 4.0 (Peds QL) to assess HRQOL, which includes four domains 1) physical functioning (8 items) 2) emotional functioning (5 items), 3) social functioning (5 items) and 4) school functioning (5 items) and were rated on a five-point Likert scale 0 to 4. The items on the Peds QoL were reverse scored and converted to a 0-100 scale. Higher scores signify better HRQOL. The data were analysed statistically.

Results: The mean age of the cohort was 11.58±3.71 years while the majority were male (72.46%). Physical and school functioning scores were significantly lower in the 16-18 years group (p=0.0094) and (p=0.0413). There was no statistically significant difference in HRQOL between sexes. Educational status showed significantly higher total HRQOL scores in 7^th 9^th grade (p=0.0481). The frequency of blood transfusion did not significantly impact HRQOL. Deferasirox users reported higher total HRQOL scores.

Conclusions: HRQOL was significantly impacted among TDTM children. Patients not receiving chelation therapy had recorded the lowest HRQOL scores, highlighting the importance of effective chelation in managing iron overload and improving HRQOL.

Paediatric assessment score as predictor of mortality in pediatric intensive care units

Mitesh Chaudhari, Mansi Bhavsar, Sonal P. Shah, Aditya Parmar, Dhruvi Dhamsaniya — Tue, 25 Mar 2025 00:00:00 +0530

Background: To study paediatric assessment score (pSOFA) as predictor of mortality in PICU.

Methods: This prospective study is conducted in children of age group one month to 12 yrs, who were admitted in the PICU of a tertiary care hospital, G.G Hospital, Jamnagar in 1 year time period of around 150 patients. The variables include SpO2: FiO2 ratio, platelet counts, Total S. bilirubin (mg/dl), mean blood pressure by age group with use of vasoactive, Glasgow Coma Scale and S. creatinine (mg/dl). Observed values were noted in case record form, scores were given for individual components according to p-SOFA score assessment chart. A total score was calculated for each patient.

Results: The use of a scoring system and audit of ICUs has not been widely reported in India. In our study, The pSOFA score demonstrated good performance in predicting mortality, with an area under the ROC curve of 0.86 (95% CI: 0.79-0.93). A score ≥6 had a sensitivity of 84.6%, specificity of 69.4%, positive predictive value of 50.7% and negative predictive value of 92.2% for mortality.

Conclusions: Pediatric SOFA score (pSOFA) score can be used as a reliable prognostic predictor of mortality among PICU patients. pSOFA score provides an objective assessment of severity of illness. Earlier assessment of disease severity based on pSOFA score helps in vigorous management and better patient treatment, which helps in patient survival. Factors such as need for mechanical ventilation and inotrope use were significantly associated with mortality.

Blood culture positive sepsis and sensitivity pattern in NICU at a tertiary care neonatal centre

Manila Singhvi, Poonam Singh — Tue, 25 Mar 2025 00:00:00 +0530

Background: This study aims to study blood culture positive neonatal sepsis and the sensitivity pattern of pathogenic organisms in a tertiary neonatal care hospital.

Methods: This retrospective observational cohort study was done in a tertiary care hospital. All the blood culture positive neonatal sepsis cases, excluding neonates with multiple congenital malformations, diagnosed during March 2023 to August 2023 (6 months) were analyzed.

Results: A total of 73 neonatal sepsis cases were diagnosed, among them 40 (54.7%) cases of gram-positive sepsis. In present study 61.6% cases were early onset sepsis, 41 (56%) babies were preterm and 49 (67%) babies were inborn. Staphylococcus aureus and Acinetobacter were the most common organisms in early onset and late onset sepsis respectively. The sensitivity of Gram-negative bacilli to colistin, minocycline and levofloxacin was 90%, 84% and 78% respectively. The sensitivity of gram-positive organisms to linezolid, vancomycin and teicoplanin were 92%, 73% and 70% respectively. Mortality rate among culture positive sepsis was 16.4%.

Conclusions: In the practice of modern neonatal care, multidrug organisms are emerging. By practicing antibiotic stewardship, infants can be protected from future multidrug resistance organisms.

Radiological evaluation of children with developmental delay using magnetic resonance imaging and proton MR spectroscopy

Tue, 25 Mar 2025 00:00:00 +0530

Background: Several factors like environmental, genetic, nutritional and chronic diseases affect the process as well as can have adverse effects on it in the form of delays in developmental milestones. The milestone delay can be evaluated using four domains of gross motor, fine motor, social and language skills. Developmental delay is defined as significant delay (more than two standard deviations below the mean) in one or more developmental domains. Global developmental delay is defined as significant delay in two or more developmental domains. Brain MRI is one of the major investigations of these patients. MRI is also used to examine the usual brain myelination patterns. Investigators have also used proton MR spectroscopy, an emerging MR imaging modality, in children to study neurodegenerative disorders, epilepsy, metabolic disorders, and pediatric neuropsychiatric disorders.

Methods: This prospective observational study involved 100 children aged 6 months to 10 years with developmental delay, referred for brain MRI at a tertiary care center. MRI was performed on a 1.5-T system, and proton MRS was used to calculate N-acetyl aspartate (NAA), choline (Cho), and creatine (Cr) ratios in children with normal MRI findings. Children with progressive neurodevelopmental disorders, recognized syndromes, and CNS infections were excluded.

Results: MRI findings were abnormal in 81% of the children, with neurovascular/traumatic lesions accounting for 59% and congenital/developmental anomalies for 15%. The most common findings involved white matter abnormalities (63%). MRS revealed abnormal neuro-metabolite ratios in 68% of children with normal MRI, indicating metabolic changes.

Conclusions: MRI, combined with proton MRS, significantly improves diagnostic accuracy in children with developmental delay. While structural abnormalities were observed in 81% of children, MRS added value by detecting metabolic abnormalities in children with normal MRI findings.

A study of the relationship between hypertension, blood sugar, lipid profile, subcutaneous and visceral fat thickness in obese and overweight children

Rohith Reddy Munagala, Pranam G. M., Usha Hirevenkangoudar, Sanjeev Chetty — Tue, 25 Mar 2025 00:00:00 +0530

Background: Childhood obesity has become a significant global public health concern, with rising prevalence contributing to increased risks of metabolic disorders, including hypertension, dysglycemia, and dyslipidemia. These conditions predispose affected children to cardiovascular diseases (CVDs) and type 2 diabetes in adulthood. Understanding these associations is critical for early intervention.

Methods: A prospective study was conducted among 64 children aged 5-15 years, categorized as normal, overweight, or obese based on body mass index (BMI) according to IAP growth charts. Anthropometric measurements, blood glucose, lipid profiles, and fat thickness (via USG) were analyzed. Statistical significance was determined at p<0.05 using the R statistical package.

Results: Blood pressure: stage 1 hypertension was observed in 50% of obese children and 20% of overweight children, while all normal-weight children had normal BP (p<0.05). Blood glucose: Mean fasting blood glucose was 88.94 mg/dl (normal), 117.06 mg/dl (overweight), and 157 mg/dl (obese) (p<0.05). Lipid profile: Obese children exhibited elevated triglycerides (TG) (165 mg/dl), lower high-density lipoprotein (HDL) (30 mg/dl), and higher low-density lipoprotein (LDL) (108 mg/dl), with significant differences compared to other groups (p<0.05). Fat thickness: Mean subcutaneous and visceral fat thickness (VFT) increased progressively with BMI (p<0.05).

Conclusions: Childhood overweight and obesity are linked to significant cardiometabolic risks, including hypertension, hyperglycemia, and dyslipidemia. Early detection and targeted interventions are essential to prevent long-term complications. Future studies should involve larger cohorts and incorporate detailed dietary assessments to better address the ongoing childhood obesity epidemic.

A study of hearing evaluation for neonate with hyperbilirubinemia using otoacoustic emission and brainstem auditory evoked response

Sangamesh V. Pansale, Ajay J., Sanjeev Chetty — Tue, 25 Mar 2025 00:00:00 +0530

Background: Jaundice is a common condition in newborns, and while most cases are benign, high serum bilirubin levels can lead to kernicterus, causing severe complications like bilirubin encephalopathy and hearing loss. Early detection through routine screening is essential to prevent such complications. One effective screening method is otoacoustic emission (OAE), followed by brain stem auditory evoked response (BERA), to assess hearing loss in neonates with hyperbilirubinemia. This study aimed to determine the incidence of hearing abnormalities in neonates with hyperbilirubinemia, correlate high bilirubin levels with OAE and BERA abnormalities, and evaluate OAE as a mass screening tool for sensorineural hearing loss.

Methods: After institutional ethics approval, 105 neonates meeting inclusion criteria were enrolled. A standard case record was maintained, and OAE testing was conducted before hospital discharge. Infants who failed OAE screening underwent BERA, which was considered the gold standard for diagnosis.

Results: Results showed abnormal OAE in 6 infants and abnormal BERA in 9 infants out of 105 tested.

Conclusions: These findings indicate that OAE is a useful, cost-effective, and quick screening tool for detecting hearing loss in neonates. Since OAE is non-invasive and less time-consuming than BERA, it can be used as an initial screening method. Infants failing OAE screening can then undergo BERA for further evaluation. This study supports the use of OAE for mass screening, ensuring early intervention through hearing aids and infant stimulation, thereby promoting normal language development in affected infants.

Comparison between PEG 3350 and PEG 4000 for treatment of functional constipation in children aged 4 to 18 years

Shrish Bhatnagar, Lily Singh, Snigdha, Sumaiya Shamsi — Tue, 25 Mar 2025 00:00:00 +0530

Background: Two molecular weight variants of PEG, viz. PEG 3350 and PEG 4000 are available commercially for treatment of functional constipation in children, however, relative efficacy of these two formulations has not yet been established. Hence, we compared the efficacy of PEG 3350 and PEG 4000 for treatment of functional constipation in children aged 4 to 18 years.

Methods: A total of 90 children were enrolled in the study. The patients were randomized either to receive PEG 3350 (Group A) or PEG 4000 (Group B). Stool frequency and other associated outcomes were noted at baseline and at 4-, 12- and 24-weeks follow-up.

Results: At baseline there was no significant difference between the two groups for patient and disease characteristics. Mean stool frequency was 2.98±0.50 and 2.96±0.47 respectively in Groups A and B at baseline; 5.04±0.56 and 5.18±0.75 at 4 weeks, 6.53±0.81 and 7.00±0.00 at 12 weeks and 7.00±0.00 and 7.00±0.00 respectively at 8 weeks in the corresponding groups. Statistically, there was no significant difference between the two groups at any time interval. For other outcomes too, there was no significant difference between the two groups at any follow-up interval except for stool consistency which attained significantly higher score in Group B as compared to Group A at week 4 follow-up (p=0.006). Incidence of diarrhea was also comparable between the two groups.

Conclusions: Both PEG3350 and PEG4000 were equally safe and effective measures for treatment of functional constipation in children aged 4-18 years.

A study of clinical spectrum of vitamin B12 deficiency in pediatric age group in a tertiary care hospital

Shradha Mangshetty, Arundhati Patil, Roopa Mangshetty — Tue, 25 Mar 2025 00:00:00 +0530

Background: Vitamin B12 deficiency is a major preventable issue in children, often leading to severe neurological and hematological problems. In regions with high vegetarianism and malnutrition, it remains underreported. This study aims to examine the clinical manifestations and contributing factors of vitamin B12 deficiency in affected children.

Methods: This cross-sectional survey at Basaveshwar Teaching and General Hospital and Sangameshwar Teaching and General Hospital, attached to Mahadevappa Rampure Medical College and Private Hospitals in Kalaburagi, from August 2022 to January 2024 included 75 children (0-18 years) with vitamin B12 deficiency. Data collection involved dietary patterns, appetite, neurological symptoms, and co-morbid conditions. Laboratory investigations assessed hemoglobin, peripheral smear, vitamin B12 levels, and platelet count. Informed consent was obtained from all participants' guardians.

Results: The study of 75 cases revealed a mean age of 6.16 years, with 37.3% under 1 year, 36% adolescents, and 20% aged 1-4 years. Vitamin B12 deficiency was widespread, affecting 85.3% with levels ≤200 pmol/l. A vegetarian diet was significantly associated with higher deficiency rates (p<0.05). Significant nutritional deficiencies and comorbidities were observed, including developmental delays and anemia. Lower vitamin B12 levels correlated with increased malnutrition severity (p=0.001).

Conclusions: This study highlights the critical role of vitamin B12 in maintaining health among children and adolescents. It reveals high deficiency rates, particularly in infants, those with delayed complementary feeding, and vegetarians. Maternal vitamin B12 levels significantly impact breastfed infants' health. An inverse correlation between vitamin B12 levels and nutritional status emphasizes the need for early detection, monitoring, and intervention.

The utility value of SpO2/FiO2 (S/F) and PaO2/FiO2 (P/F) ratios for predicting initiation and efficiency of HFNC in children with respiratory distress admitted in PICU

Tue, 25 Mar 2025 00:00:00 +0530

Background: The PaO₂/FiO₂ (P/F) ratio, defined as the partial pressure of oxygen (PaO₂) divided by the fraction of inspired oxygen (FiO₂), and the SpO₂/FiO₂ (S/F) ratio, defined as pulse oximetric saturation (SpO₂) divided by FiO₂, are key indicators of oxygenation status. This study aimed to evaluate the utility of S/F and P/F ratios in predicting the initiation and effectiveness of HFNC in children with respiratory distress.

Methods: A prospective observational study of 133 children (1 month–14 years) with respiratory distress receiving HFNC was conducted. S/F and P/F ratios were measured at 0, 1, 12, and 24 hours after HFNC initiation. Outcomes assessed included ICU stay, hospital stay, and HFNC duration.

Results: Among 133 children (35.34% females, 64.66% males; mean age 0.9 years, weight 7.8 kg), 62.42% had moderate respiratory distress per P/F ratio, while 76.69% had mild respiratory failure per S/F ratio. Both ratios improved significantly over time (p <0.05). A higher S/F ratio at initiation correlated with shorter ICU and hospital stays. The S/F ratio was a superior predictor of HFNC requirement (sensitivity: 85.29%, accuracy: 88.5%) compared to the P/F ratio (sensitivity: 41.91%, accuracy: 56.67%). ROC analysis confirmed strong predictive power for S/F (AUC 0.966).

Conclusion: The S/F ratio is a reliable, non-invasive surrogate for the P/F ratio in identifying respiratory distress and HFNC need, reducing the necessity for arterial blood sampling.

A comparative study on the efficacy and safety of intravenous levetiracetam and phenobarbitone in the treatment of neonatal seizures

Deergha Bhasin, Anuj Sethi, Om Shankar Chaurasiya, Kawalpreet Chhabra — Tue, 25 Mar 2025 00:00:00 +0530

Background: Seizures are the most common manifestation of neurological insult during the neonatal period with a significant risk of mortality and subsequent neurological disability. Phenobarbitone has been the mainstay of treatment for decades despite its limited efficacy and potential adverse effects. Levetiracetam being a newer antiepileptic with favourable pharmacological and clinical profile and better neurodevelopmental outcomes may be used as an alternative first line antiepileptic. This study compares the efficacy and safety of intravenous levetiracetam and phenobarbitone in the treatment of neonatal seizures.

Methods: Prospective randomized controlled trial conducted at level 3 Neonatal Intensive Care Unit including 150 neonates 0-28 days with clinical seizures randomized to receive either intravenous Levetiracetam or Phenobarbitone as first line antiepileptic. Cessation of seizures for 24 hours duration after drug administration is considered as primary outcome measure.

Results: Seizure control was noted in 53.3% neonates in phenobarbitone group, which was significantly higher as compared levetiracetam (21.3%, p<0.05) after first loading. A significantly higher percentage of neonates in levetiracetam group required further doses and another drug (25.3%). Adverse effects and requirement of mechanical ventilation was significantly higher in patients of phenobarbitone group (22.7%) (p<0.05). However neurological outcomes measured by HINE score did not show significant difference between the groups(p>0.05).

Conclusions: Phenobarbitone is found to be more efficacious than levetiracetam as a first line antiepileptic in terms of seizure control while levetiracetam requires more frequent dosing but with better safety profile and survival rates. Thus, levetiracetam can be considered as an alternative in treatment of neonatal seizures.

Factors contributing to inappropriate timing, quantity and consistency in complementary feeding

Vedavyas Karjol, Sanjeev Chetty — Tue, 25 Mar 2025 00:00:00 +0530

Background: An appropriate diet is critical in growth and development of children especially in the first two year of life. World Health Organization (WHO) recommends exclusive breast-feeding (BF) for the first 6-month, addition of complementary feeds at 6 months with continued BF till at least 2 years. These feeding recommendations if followed appropriately can decrease infant mortality by 19% and prevent malnutrition especially in developing countries as ours.

Methods: A hospital-based cross-sectional study was conducted at Navodaya Medical College, Raichur, over 6 months. A total of 200 children aged 6 months to 2 years attending Paediatrics OPD of our hospital for minor illness and children who came for immunization, were interviewed after a informed consent.

Results: Among 200 children studied, 32 (16%) were not started on CF at all, and only 35 (17.5%) received CF from 6 months. Of 168 who were started on CF, the mean age was 13.37 months, with adequate quantity in 25% and thick consistency in 38%. Only 3.5% of mothers met all criteria for CF. Knowledge of CF was linked to maternal education (P < 0.05). Most common reason for inappropriate practice in 154 mothers who delayed feeds was “tried but did not eat, vomits everything” (52%).

Conclusions: The study reveals a “practice gap” and “knowledge gap” in complementary feeding among mothers, emphasizing the need for education. Addressing these gaps through targeted interventions, during immunization sessions, and enhancing maternal education can significantly improve complementary feeding practices and outcomes in children.

Improving peripheral vein cannulation in neonates with skin transillumination: a prospective observational study by a neonatal fellow at a tertiary care centre

Priyanka C. Parmar, Binoy Shah, Ashish Mehta — Tue, 25 Mar 2025 00:00:00 +0530

Background: Peripheral vein cannulation (PIVC) is a common but challenging procedure in neonates, often requiring multiple attempts. Successful venous access is critical to ensure timely medical interventions while minimizing delay and complications. Skin transillumination has emerged as a potential tool to assist in visualizing veins, but its efficacy in improving procedural outcomes remains uncertain. This study evaluates the use of skin transillumination compared to the standard method, in improving the success rate of PIVC insertions. Objective was to assess the efficacy of skin transillumination in improving the procedural outcomes (success rates and time) of peripheral vein cannulation in neonates when performed by neonatal fellows.

Methods: A prospective observational study was conducted in a level 3 NICU, with neonates stratified by weight (≤1500 g and >1500 g). The intervention group used a transillumination device, while the control group used the standard procedure for cannulation. Data on success rates and time to successful cannulation were collected and analyzed using statistical methods.

Results: The use of transillumination led to significantly improved first-attempt success rates in neonates >1500 g (p=0.03). However, no significant improvement was observed in neonates ≤1500 g (p=0.72). Time to successful cannulation was significantly less in the control group for neonates >1500 g (p=0.003).

Conclusions: Transillumination significantly enhances first-attempt success rates for peripheral vein cannulation in neonates weighing over 1500 grams but does not show a substantial impact on neonates ≤1500 grams.

Spectral pattern of cough sounds as an aid to diagnosis in children with common respiratory diseases

Tue, 25 Mar 2025 00:00:00 +0530

Background: Objectives were to identify discriminatory spectral patterns of cough consistent with common respiratory sounds, through machine learning, to assist diagnosis.

Methods: Spectral analysis of cough recordings of 50 children each with crackles alone, wheezing alone and absence of crackles and wheezing. Identification of unique features through machine learning by dividing them into training (75%) and testing (25%) datasets. Feature extraction was done using R python and Librosa programming language. Two class classifications of the features extracted from the training dataset were done using classifier models like support vector machine, random forest, K nearest neighbor and classification and regression tree. Identification of the most suited classifier model that could accurately differentiate between the studied respiratory sounds in terms of sensitivity and specificity.

Results: Random forest classifier model using Mel-frequency cepstral coefficient (MFCC) gave the best results in differentiating crackles from wheezing with sensitivity and specificity of 66.67% and 66.67%. Classifier model performance improved when augmented with clinical features (Respiratory rate, history of recurrent nebulization and family history of atopy); providing sensitivity and specificity of 83.33% and 91.67%.

Conclusions: Cough features extracted and classified by machine learning can be used for non-auscultatory diagnosis of crackles and wheeze. This raises the possibility to develop smart applications for possible use by non-medical personnel to enhance their capability.

Clinical profile of ventilator-associated pneumonia and its correlation between risk factor, morbidity and mortality in children

Syeda Sadiya Siddiqui, A. N. Thobbi, Nazeer Ahmad Jeergal, Love Kumar — Tue, 25 Mar 2025 00:00:00 +0530

Background: Mechanical ventilation (MV) is often necessary to manage critically ill pediatric patients admitted in the ICU. Nonetheless, it presents certain complications, including the potential risk of developing ventilator-associated pneumonia (VAP). The main objective of the present study was to evaluate the clinical profile and risk factor associated with the morbidity and mortality in children with VAP.

Methods: This was a cross-sectional observational study conducted on 120 children aged 1 month 12 years who were mechanically ventilated. All enrolled children were evaluated daily for the onset of ventilator-associated pneumonia (VAP). Chest radiography and microbiological sampling was performed in children suspected with VAP. Duration of hospital stays, ventilator days and reintubation were also recorded.

Results: Out of 120 children, 35 (29.2%) had developed VAP and the prevalence of VAP is estimated to be 29.2%. The most prevalent pathogen associated with VAP was K. pneumonia in 18 (51.4%) of the children. The duration of MV (28.65±12.76 vs 9.87±6.87, p<0.001 and hospital stay (35.87±8.15 vs 15.76±4.12; p=0.001) was higher in VAP as compared to no VAP and it was significant. Bivariate analysis revealed that use of steroids (p=0.004), sedative (p=0.01) and reintubation (p=0.003) was found to be significant risk factor for the development of VAP. The incidence of mortality in VAP was 4/35, i.e., 11.4%.

Conclusions: About one-third of the children developed VAP. Klebsiella was the most predominate isolate and duration of MV and hospital stay were important predictors for VAP.

Unusual presentation of immunoglobulin A vasculitis with acute scrotal swelling and epididymo orchitis in a 5-year-old boy

Sahithi Putcha, Maheswari Katakamsetty — Tue, 25 Mar 2025 00:00:00 +0530

Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura (HSP), is a small vessel vasculitis primarily affecting children. It commonly presents with palpable purpura, arthralgia, abdominal pain, and renal involvement. However, atypical presentations can occur, posing diagnostic challenges. Here, we present a case of IgA vasculitis in a 5-year-old boy with a unique manifestation of epididymitis as the primary presenting symptom. Scrotal ultrasound demonstrated Epididymo-orchitis with funiculitis. Skin examination revealed scattered palpable purpura over the lower extremities. Thus, a clinical diagnosis of IgA Vasculitis is made. The patient recovered with corticosteroids and supportive care.

Management of aortic dilatation in Marfan syndrome associated with lung fibrosis

Tue, 25 Mar 2025 00:00:00 +0530

Marfan syndrome (MFS) is an autosomal dominant disorder caused by the mutation in the fibrillin-1 (FBN-1) on chromosome 15q21. The predominant clinical manifestations mainly in ocular, cardiovascular and skeletal system. MFS can also lead to deterioration of lungs progressively over time. In case of lung fibrosis or may be spontaneous in case of spontaneous pneumothorax. Physical examination of this patient revealed the following significant phenotypic manifestations of MFS like scoliosis and skin triae, wrist sign, displaced nasal septum, myopic astigmatism of both eyes pectus carinatum. Furthermore; the computed tomography (CT) scan depicted the fibrotic changes in the lung parenchyma and the echocardiogram depicted the dilation of the aortic root, mitral regurgitation, tricuspid regurgitation. Both X-ray and CT results revealed bilateral lung fibrosis. And the patient was monitored by performing spirometry tests series annually, to detect the evaluation of the prognosis of the patients’ condition. According to the latest publications in MS with interstitial lung disease, this article further reveals the necessity of taking into account the diagnosis of pulmonary manifestations in MS patients with vascular complications. This case illustrates the importance of reviewing the timely management of aortic root dilatation in MFS with lung fibrosis.

A case report of thrombotic thrombocytopenic purpura with positive ANA activity

Neha Goel, Aman Chawla, Prashant Prabhakar — Tue, 25 Mar 2025 00:00:00 +0530

Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder, characterized by: consumptive thrombocytopenia, microangiopathic hemolytic anemia with the presence of schistocytes, renal impairment, neurological dysfunction and fever. A 12-years-old girl presented with TTP and had ADAMTS13 activity deficiency along with positive ANA activity. The child was planned for plasmapheresis but developed refractory seizures and pulmonary bleeding and succumbed to death. TTP with ANA positivity has a very fulminant course. ⁠Pulmonary involvement can be asymptomatic but has a poor prognosis with rapid clinical deterioration. A high index of suspicion is of utmost importance in low to middle-income countries settings as the facility of plasmapheresis is available at very few centers

A surprise cause of recurrent pneumonia in an infant

Rashika Thakur, Yash Pal Sharma, Shruti Sharma — Tue, 25 Mar 2025 00:00:00 +0530

Foreign body (FB) ingestion is a common pediatric emergency seen among children between 6 months to 5 years. Most of the ingested FBs are accidentally taken and are passed in stools uneventfully, however they may lead to complications in some children. We present an infant with recurrent pneumonia attributed to gastroesophageal reflux due to a large Tik-Tak hair pin accidentally discovered on X-ray abdomen. The child symptomatically improved following endoscopic removal of the FB with complete resolution of respiratory symptoms and gastrointestinal reflux disease. Impacted FBs in fundus of stomach can irritate the mucosal lining, resulting in inflammation or increased acid secretions which may eventually lead to reflux of stomach contents into oesophagus (Gastro-oesophageal reflux). Aspiration of these reflux particles can cause recurrent aspiration pneumonia. After endoscopic removal of FB infant improved symptomatically and had no complains on follow up, which further proved that his symptoms were due to this large impacted FB. Thus, awareness among parents regarding ingested FBs and their complications is extremely important.

Bronchopulmonary dysplasia in low-birth-weight infant: a case study

Primi Kumar — Tue, 25 Mar 2025 00:00:00 +0530

Bronchopulmonary dysplasia is one the most common causes of mortality and morbidity specially in the low birth weight or preterm infants. Though it is the most common but with prompt treatment can be treated at the earliest without any permanent damage to the newborn. The aim of this case study is to present a report of a low-birth-weight infants with bronchopulmonary dysplasia overviewing its management including developmentally supportive care given to the baby.

Midline epidermal inclusion cyst of neck in children: a diagnostic dilemma: case report and review of literature

Keerthana Bachala, Amit Kumar Sinha, Shreyas Dudhani, Sourav Jana, Prajakta Vaze — Tue, 25 Mar 2025 00:00:00 +0530

Painless midline neck swellings have been a challenging confrontation for any surgeon, mostly due to numerous diagnostic possibilities at this location. Common ones include thyroglossal cyst, epidermoid cyst, dermoid cyst, enlarged lymph nodes, vascular anomaly etc. Due to a different treatment modality for each entity, proper diagnosis is necessary. We are presenting two cases of midline epidermal inclusion cyst having unique clinical and radiological features, creating a diagnostic query.

Fetoception: fetus within a fetus: a rare case presentation in a neonate

Sandeep Garg, Anurag Yenkar, Sana Agrawal — Tue, 25 Mar 2025 00:00:00 +0530

Fetus in fetu (FIF) is a rare congenital anomaly where a malformed parasitic twin is found within a living host. It is often confused with mature teratoma due to overlapping features, but the presence of organized fetal structures and vertebrae helps differentiate FIF. A female neonate born at 37 weeks of gestation presented with a large sacrococcygeal mass. Prenatal anomaly scans suggested a sacral mass, and postnatal imaging, including radiographs and MRI, indicated a teratoma-like lesion. Surgical resection was performed on day four of life. Pathological analysis revealed a mass partially covered with skin and containing well-organized fetal tissues, including limbs, intestinal loops, and other organs, with no evidence of malignancy. The presence of vertebrae confirmed the diagnosis of FIF. Complete surgical excision was achieved, and the infant recovered uneventfully. The baby remained stable throughout the post-operative period and was discharged on day 11. This case highlights the diagnostic and clinical challenges in distinguishing FIF from a mature teratoma. FIF typically presents with recognizable fetal parts and vertebrae, unlike teratomas, which lack organized structures. Accurate diagnosis and early surgical intervention are crucial to manage FIF and prevent complications. While FIF is benign, mature teratomas carry a risk of malignancy, emphasizing the need for comprehensive evaluation. Further studies are essential to refine diagnostic criteria and improve differentiation between these conditions.

Thinking beyond sepsis to unmask a metabolic mystery: a rare case of neonatal maple syrup urine disease

Dinkar Raut, Sagar Yamnaji Walhekar, Anjini Misra, Rachna Singh — Tue, 25 Mar 2025 00:00:00 +0530

Maple syrup urine disease (MSUD) was first reported by paediatrician Menkes in 1954, as the α-ketoacid excreted in urine smells like maple syrup. MSUD is a rare genetic disorder which manifested as impaired branched-chain amino acid (BCAA) metabolism caused by branched-chain α-ketoacid dehydrogenase (BCKD) complex deficiency. Early diagnosis and treatment of MSUD is important for better outcomes. Feed intolerance, history of consanguinity between parents and that peculiar odour of maple syrup in urine should raise suspicion of the above. Timely referral, especially by clinicians practising in rural areas, is essential for early diagnosis and treatment. We present a case of MSUD with poor prognosis probably due to advanced disease at the time of presentation. The case highlights the importance of suspicion and early diagnosis of MSUD, as well as thinking beyond sepsis as the root of all problems.

Prolonged jaundice evaluation opens a can of worms

Karishmah Senthil Kumar, Sahana Muthusamy, Radhalakshmi Senthil — Tue, 25 Mar 2025 00:00:00 +0530

We present a case of a second-born male from a non-consanguineous marriage who exhibited prolonged jaundice. Upon clinical evaluation, he was found to have bilateral cryptorchidism and a micropenis. Further investigation revealed the presence of hypothyroidism. Due to the presence of abnormal genitalia and hypothyroidism, a comprehensive endocrine assessment was conducted, which identified deficiencies in multiple pituitary hormones. Genetic testing, prompted by persistent growth failure, confirmed a diagnosis of Culler-Jones syndrome (CJS) - a rare autosomal dominant disorder characterized by hypopituitarism, postaxial polydactyly and distinct facial abnormalities, including hypotelorism, cleft lip and palate, a flat nose and midfacial hypoplasia. This condition is caused by a heterozygous mutation in the GLI2 gene on chromosome 2q14.2. The phenotype of CJS is highly variable, demonstrating both incomplete penetrance and variable expressivity. In our case, the infant presented with combined pituitary hormone deficiency, an absent anterior pituitary gland, an ectopic posterior pituitary, significant growth retardation and underdeveloped genitalia. GLI2 mutations should be suspected in patients with congenital hypopituitarism, persistent growth failure (with or without abnormal facies) and polydactyly. Genetic testing is crucial for early diagnosis, as it facilitates better management, improves outcomes and helps anticipate the disease course.

A novel mutation of Niemann-pick disease: a case report

Mohammad Amir Ali, Braja Kishore Behera, Ipsita Sahoo, Mamata Devi Mohanty — Tue, 25 Mar 2025 00:00:00 +0530

Niemann-Pick Disease (NPD) is a well-known entity among the rare causes of lysosomal storage disorders (LSD) and constitutes a significant public health burden globally. The incidence of NPD is 1 in 250,000 individuals with a high prevalence in Ashkenazi Jewish descent, affecting 1 in 40,000 individuals. We report a novel and hitherto unreported. Here we report a case of NPD in a 6 months old male child presented to our hospital with unexplained hepatosplenomegaly with cherry red spots on fundoscopy and with history of death of previous two siblings. The diagnosis of NPD was proven by whole exome sequencing (WES) with identification of novel mutation, homozygote missense variant c.500G>C in exon 2 of sphingomyelin phosphodiesterase 1 (SMPD1) gene that results in the amino acid substitution pCys167Ser. The patient was kept under management of multidisciplinary team. Age of presentation, hepatosplenomegaly, presence of cherry red spots was typical for NPD type A. We report a rare homozygote mutation in the SMPD1 gene.

Ureteropelvic junction obstruction does not spare even the ectopic kidney

Shorya Katiyar, Intezar Ahmed, Bijay Kumar Suman, Jagdish B., Rohan Saini — Tue, 25 Mar 2025 00:00:00 +0530

Robotic pyeloplasty for ureteropelvic junction obstruction is widely being done, but for anomalous kidneys, it is a bit challenging due to abnormal anatomy. The ectopic kidney lies outside renal fossa so the operative challenges it poses are a malrotation kidney, associated vascular anomalies, and short ureter complicating not only access but also the reconstruction. We present a case of right ectopic kidney with gross hydronephrosis due to pelvic ureteric junction obstruction. We further discuss the surgical challenges faced during its management and further outcome.

Pediatric hypertensive emergency: a rare case report of metanephrines negative pheochromocytoma

Neha Goel, Hardeep Khatri, Sandeep Kumar, Ratan Gupta — Tue, 25 Mar 2025 00:00:00 +0530

Pheochromocytomas are catecholamine-secreting paragangliomas (PPGL) arising from chromaffin cells in the body. It is a rare cause of secondary hypertension in adults but is even rarer in children. Ten percent occur in children, in whom they present most frequently in the age group 6-14 years. The annual incidence among children is approximately 0.8/1000000 person-years. A 7-years-old child presented with hypertensive emergency and differences in blood pressure between the upper and lower limbs > 10 mmHg. Contrast-enhanced computed tomography of the abdomen suggested the diagnosis of right-sided pheochromocytoma. Urine and plasma metanephrines were within normal limits. The hypertensive emergency was managed with anti- hypertensives and the mass was surgically resected which was confirmed as malignant Pheochromocytoma on histopathology. Pheochromocytoma can be diagnosed by measurement of 24-hour urinary or plasma metanephrines which has sensitivity and specificity of nearly 95% and 85%. However, in our case these levels were normal. It could be because of rarest dopamine-producing PPGL which produces more dopamine than the combined concentration of epinephrine and nor-epinephrine. Dopamine secreting PPGL are rare entities. This case has changed our approach to the long-term follow-up and observation of this patient, which consists of more regular clinical review and imaging with positron emission tomography – computed tomography (PET/CT) as opposed to follow up of a benign tumor and earlier discharge into the community.

Neonatal metabolic crisis: a case report of HMG-CoA lyase deficiency

Tue, 25 Mar 2025 00:00:00 +0530

3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) lyase deficiency is a rare autosomal recessive metabolic disorder characterized by impaired ketogenesis and leucine catabolism, leading to nonketotic hypoglycemia, hyperammonemia, and metabolic acidosis. We present a case of a three-day-old male neonate who exhibited poor feeding, lethargy, and respiratory distress, progressing to clonic seizures and severe metabolic decompensation. Initial laboratory findings revealed hypoglycemia, hyperlactatemia, hyperammonemia, and metabolic acidosis with absent ketones. A comprehensive metabolic workup, including urinary organic acid analysis and tandem mass spectrometry, confirmed the diagnosis of HMG-CoA lyase deficiency. The neonate was managed with intravenous dextrose, sodium bicarbonate, and L-carnitine supplementation, leading to gradual clinical improvement. This case highlights the importance of early recognition and prompt management of inborn errors of metabolism, particularly in neonates presenting with acute metabolic crises. The report underscores the need for comprehensive newborn screening to facilitate early diagnosis and prevent life-threatening complications.

Subcutaneous nodules: a rare and only presentation of acute rheumatic fever

Suguna S., Lakshmi L., Sushrutha K. P., Vasanthkumar N., Meghashree — Tue, 25 Mar 2025 00:00:00 +0530

Acute rheumatic fever (ARF) is a most common sequelae of group a beta hemolytic streptococcus (GABHS). 11yr old adolescent male presented with subcutaneous nodules, which is being rarest manifestation, diagnosed to have ARF- mitral regurgitation with active carditis based on revised Jones criteria. Treated with Injection benzathine penicillin, aspirin and steroids according to IAP protocol. Patient become asymptomatic with resolution of subcutaneous nodules. Here we describe the successful diagnosis and management of a patient with ARF

Pediatric cutaneous tuberculosis: insights from a case series

Nidhi, Rupinder Kaur, Rachna Verma, Usha Chhillar — Tue, 25 Mar 2025 00:00:00 +0530

Cutaneous tuberculosis (CTB) is the rare manifestation of tuberculosis, accounting for approximately 1-2% of extrapulmonary tuberculosis cases. Cutaneous tuberculosis in pediatric patients is often misleading and very difficult to diagnose, as it can mimic various other skin diseases. Here, we present a case series of CTB in children with atypical presentation and location. This case series highlights the rare and varied clinical presentations of cutaneous tuberculosis.