International Journal of Contemporary Pediatrics

Co-occurrence of SLC7A7 mutation with a novel PACS2 variant in a child with lysinuric protein intolerance: expanding the clinical spectrum

Anju Yadav — Wed, 25 Jun 2025 00:00:00 +0530

Lysinuric protein intolerance (LPI) is a rare, autosomal recessive metabolic disorder caused by mutations in the SLC7A7 gene, leading to defective transport of cationic amino acids. It typically presents with vomiting, failure to thrive, hepatosplenomegaly, protein intolerance, hyperammonaemia, pulmonary and renal systems. Separately, heterozygous pathogenic variants in the PACS2 gene have been associated with early-onset developmental and epileptic encephalopathy (DEE66), marked by hypotonia, drug-resistant seizures, and global developmental delay, encephalopathy. We report a 7-month-old male child whose initial presentation was persistent vomiting, developmental delay, poor weight gain, hypotonia, seizures, and acute encephalopathy. The patient required mechanical ventilation for a month and was subsequently discharged on syrup levetiracetam, benzoate citrulline, arginine and supportive care.

A bitter sip: fuelling the fire in the lung

Wed, 25 Jun 2025 00:00:00 +0530

The authors wish to highlight a critical public health warning prompted by a recent case we managed. A 3-year-old child was admitted with cough and respiratory distress following accidental ingestion of diesel (approximately 50 ml). The child played in the hot summer and was lured by the diesel stored in the fruit juice bottle kept in the home. The thirst during a hot summer and the familiar colour of the juice bottle made the kid accidentally drink the stored diesel.

Investigation of factors influencing timely initiation of breastfeeding and delayed exclusive breastfeeding in India

Wed, 25 Jun 2025 00:00:00 +0530

Breastfeeding is a critical component of infant health and development, providing essential nutrients, antibodies, and immune factors. Despite the recognized benefits, rates of early breastfeeding initiation and exclusive breastfeeding remain suboptimal in India. This systematic review aims to investigate the factors influencing timely initiation of breastfeeding and delayed exclusive breastfeeding in India. A comprehensive literature search was conducted, and studies meeting the inclusion criteria were analyzed. The review identified several key factors influencing breastfeeding practices, including maternal factors (age, education, parity, socioeconomic status), infant factors (birth weight, gestational age, health status), socio-cultural factors (cultural beliefs, traditions, family support), and healthcare system factors (access to skilled birth attendants, antenatal care, postnatal support). Enabling factors for timely breastfeeding initiation included high maternal education, urban residence, delivery in a healthcare facility, and receiving breastfeeding counseling. Impediments included low maternal education, rural residence, home births, lack of antenatal care, and delayed recognition of colostrum importance. Factors influencing exclusive breastfeeding included maternal education, attitudes, confidence in milk production, infant latching and suckling skills, and socio-cultural beliefs. The review highlights the need for a multi-pronged approach to address these factors, including enhancing maternal education, promoting positive attitudes, providing skilled support, addressing socio-cultural beliefs, strengthening healthcare systems, and evaluating interventions such as midwife-led care units. Future research should focus on implementing and evaluating interventions to promote and support exclusive breastfeeding, particularly among working mothers and marginalized communities.

Behind the hashtags: a review of Instagram posts on pediatric ADHD

Mon, 16 Jun 2025 00:00:00 +0530

Social media has become an influential source of mental health information in recent years, raising concerns about the spread of misinformation. This study aimed to evaluate the reliability of Instagram posts related to pediatric attention-deficit/hyperactivity disorder (ADHD). A total of 761 posts were analyzed across 10 popular hashtags, with data collected on content relevance, type, gender representation, content creators, and engagement metrics such as likes, comments, and follower counts. Relevance was assessed using criteria from the DSM-5 and CDC guidelines. Only 31% of posts were found to be relevant to ADHD, with a majority being educational in nature. ADHD coaches were identified as the most frequent content creators. Gender representation in the posts represented females more than males. The overall engagement rate was calculated to be 16%. These findings highlight the widespread presence of potentially unreliable ADHD-related content on Instagram. Physicians must recognize the influence of such platforms on public health literacy and take proactive steps to counter misinformation, as it may contribute to misdiagnosis, inappropriate management, and confusion among patients and caregivers.

Unlocking the mysteries of fulminant hepatitis: exploring diagnoses in multi-organ disease

Aashika Janwadkar, Laura Kasper, Rebecca Megchelsen, Vishakha Nanda — Wed, 25 Jun 2025 00:00:00 +0530

A male neonate was born to a mother with a history of scant prenatal care and suspected Herpes lesions in the birth canal. The infant presented after birth with severe anemia, thrombocytopenia, and acute liver failure along with multiple organ involvement. He received multiple transfusions and was treated empirically for potential sepsis and viral infection. Differential diagnoses considered included neonatal HSV infection, enterovirus infection, gestational alloimmune liver disease (GALD), hemophagocytic lymphohistiocytosis (HLH), and inborn errors of metabolism. The case underscores the complexity of diagnosing fulminant hepatitis in neonates and emphasizes the necessity of maintaining a broad differential diagnostic approach. This case report highlights the diagnostic challenges and the need for a systematic approach in managing neonates with fulminant hepatitis.

A case of neonatal lupus presenting with myocardial dysfunction with complete heart block: early identification and management results in excellent outcome

Fri, 13 Jun 2025 00:00:00 +0530

Neonatal lupus erythematosus (NLE) is an uncommon acquired autoimmune disorder that develops when maternal autoantibodies to Sjogren’s syndrome A or B (SSA-SSB) autoantigens pass through placenta and cause immune mediated destruction of targeted fetal and neonatal tissues. Among the cardiac abnormalities, congenital complete atrioventricular block (AVB) is the most common cardiovascular abnormality seen in affected fetuses and infants that also accounts for more than 80% of cases of complete AVB in newborns with structurally normal heart. Other cardiovascular manifestations may include arrhythmias, myocarditis, cardiomyopathy and structural heart defects with particular tendency toward valvular lesions. We report a case of a neonate who presented with severe ventricular dysfunction with ejection fraction 20% in the presence of complete heart block (CHB), required extracorporeal membrane oxygenation (ECMO support). After treatment with pulse steroids and IVIG, there was a dramatic improvement in ejection fraction 55%. ECMO support was successfully weaned, and a permanent pacemaker was subsequently inserted. The neonate was discharged home in good health.

Eradicated? Neonatal tetanus in Western Uganda; a case report of successful management

Nicole B. Kennard, Gyan Moorthy, Elizabeth Najjingo, Sadhana Chheda — Wed, 25 Jun 2025 00:00:00 +0530

Neonatal tetanus is a life-threatening condition with an almost 100% mortality in resource-limited settings. The standard of care ventilator support, parenteral nutrition and neuromuscular blockade is often inaccessible. Here, we present the successful workup and management of neonatal tetanus at a regional hospital in Western Uganda. Particular attention is paid to social and cost barriers to history-gathering and treatment and cross-institutional collaboration to improvise care based on pathophysiology. We reviewed records of a neonate treated for neonatal tetanus at Mbarara Regional Referral Hospital, in collaboration with physicians from TTUHSC El Paso, Texas. A term neonate was delivered at home in Western Uganda. She presented with intermittent fevers, refusal to feed and dystonia, which progressed to generalized stiffness and led to presumptive treatment for meningitis at an outside hospital. After referral with worsening symptoms, a sepsis workup was performed and she was started on intravenous antibiotics and phenobarbital. Further maternal history revealed lack of tetanus immunization and unsterile birthing practices. As symptoms progressed to trismus, opisthotonos, risus sardonicus and clinical suspicion for tetanus rose. She received tetanus immunoglobulin, diazepam, magnesium sulfate and supportive care. She was discharged after 19 days and had normal development at 19 months. This case highlights that successful management and survival from neonatal tetanus is possible without access to advanced NICU care. Mutually respectful collaboration enabled diagnosis and care improvisation using local resources to craft a protocol that can be formally evaluated for efficacy. Ongoing communication is key to making such adaptation ethical in global partnerships where resources differ.

A rare occurrence of complicated plasmodium vivax malaria in a 5-month-old infant

Kapil Bainade, Veeranna Kotrashetti, Neelu Elon, Apoorva Dhulaj — Wed, 25 Jun 2025 00:00:00 +0530

Malaria is less frequently documented in infants under six months due to a focus on older populations in research. Despite protective maternal antibodies and fetal hemoglobin, infants in this age group remain susceptible to malaria. This case highlights the importance of recognizing and diagnosing malaria in this vulnerable population. Recognition and appropriate management are crucial to preventing severe complications and improving patient outcomes. It presents a diagnostic dilemma in infants under 6 months when distinguishing malaria from sepsis, as both conditions present with similar symptoms.

“Double Whammy” - a case of nephrotic syndrome on rituximab infusion with extensive herpes zoster: a case report of an 8-year-old female child

Shamiyaz D. Nilakhawala, Rajesh Rai, Prithi Inamdar, Ravi P. Nalikha — Wed, 25 Jun 2025 00:00:00 +0530

This paper presents the case of an 8-year-old female patient, diagnosed with steroid-resistant nephrotic syndrome (SRNS), who developed herpes zoster while on Rituximab treatment. The patient presented with a vesicular rash, fever, and headache. She was started on intravenous acyclovir and managed with symptomatic treatment. The patient responded well to the treatment, with resolution of symptoms and was discharged with guidance on hygiene practices. This case highlights the potential for herpes zoster infection in immunosuppressed patients, particularly those with SRNS receiving Rituximab, and the importance of early diagnosis and antiviral treatment to prevent complications.

Moyamoya disease: a silent smoke

Kapil Bainade, V. Kotrashetti, Neelu Elon, Saylee Jagtap, Yash D. Vasagadekar — Wed, 25 Jun 2025 00:00:00 +0530

Moyamoya disease (MMD) is an isolated chronic, usually bilateral, vasculopathy of undetermined etiology characterized by progressive narrowing of the terminal intracranial portion of the internal carotid artery and circle of Willis. It is a connective tissue disorder of cerebrovascular vessels of unknown aetiology. A fragile network of abundant collateral vessels as a reaction to chronic brain ischemia develops predominantly at the base of the brain known as moyamoya vessels. This activity describes the pathophysiology, evaluation, and management of MMD and highlights the role of the interprofessional team in the management of affected patients. Here we present a case of 3-year-old female child who had frequent transient episodes of twitching of left side of her face with deviation of angle of mouth towards right side since 15 days without neurological deficit and altered sensorium. There also was a history of transient episode of left sided paresis at the age of 18 months of life. Detailed evaluation and magnetic resonance imaging (MRI) confirmed the diagnosis of MMD. In this particular case the age group of presentation for MMD is unusual. Discussion of this case will help to spread awareness about early suspicion and appropriate intervention at right time to improve the developmental and cognitive status of such cases.

Rosai Dorfman disease: a rare entity

Sweety Goyal, Chandra M. Sharma, Cheena Garg — Wed, 25 Jun 2025 00:00:00 +0530

Rosai Dorfman disease (RDD), a rare benign proliferative disorder of unknown etiology, stems from abnormal histiocyte accumulation within lymph node sinusoids and extra nodal tissues. While uncommon in paediatric population, RDD clinically simulates lymphoproliferative disorders. This report details a 4-year male patient presenting at a tertiary care centre with progressive bilateral cervical and submandibular lymphadenopathy lacking febrile symptoms. Diagnostic confirmation was achieved through excisional biopsy. RDD is an exclusion-based diagnosis which requires multidisciplinary collaboration and heightened clinical suspicion remains essential for paediatricians and oncologists to facilitate timely intervention and management of this rare entity.

Transient neonatal diabetes mellitus due to de novo mutation in KCNJ11 gene

Abhishek Kulkarni, Joewin Monteiro — Wed, 25 Jun 2025 00:00:00 +0530

Neonatal diabetes mellitus (NDM) is a rare monogenic diabetes that usually presents in first 6 months of life. Activating mutations in KCNJ11 gene encoding Kir6.2 subunit of ATP-sensitive potassium (KATP) channel cause either transient NDM (TNDM) or permanent NDM (PNDM). A month-old male presenting with diabetic ketoacidosis was managed initially with intravenous (IV) fluids and IV insulin administration and subsequently started on subcutaneous insulin therapy on resolution of ketoacidosis. C-peptide level at diagnosis was 0.51 ng/ml and sanger sequencing analysis of the ABCC8, KCNJ11, INS and EIF2AK3 genes identified a heterozygous missense mutation p.R50Q in KCNJ11 gene. Successful transition to oral sulfonylurea therapy was made with maintenance of euglycemia and remission of NDM was witnessed at 5 months of age. A diagnosis of TNDM due to mutation in Kir6.2 subunit of K-ATP channel was made, supervised discontinuation of sulfonylurea therapy performed and the 50 percent risk of relapse of DM during adolescence or adulthood was explained to the family.

Griscelli syndrome type 2: a tragic tale of two siblings

Wed, 25 Jun 2025 00:00:00 +0530

Griscelli syndrome (GS) is a rare autosomal recessive disorder classified as an inborn error of immunity. Among its three variants, GS type 2, caused by mutations in the RAB27A gene, is marked by partial albinism and recurrent episodes of hemophagocytic lymphohistiocytosis (HLH). This case report chronicles the poignant journey of two siblings tragically lost to this condition. GS type 2 carries a high mortality rate, primarily due to HLH complications. Currently, hematopoietic stem cell transplantation (HSCT) remains the sole curative treatment for this devastating syndrome.

A case of inherited thrombophilia with superior vena cava syndrome: pharmacological thrombolysis

Joshi Siddhartha, Deepali Bangalia, Hemant K. Nayak, Santanu Roy — Wed, 25 Jun 2025 00:00:00 +0530

Venous thrombosis involving vena cava is an uncommon phenomenon seen in children, even in those with inherited thrombophilia syndromes. We present a case of protein C and S deficiency with superior vena cava (SVC) thrombosis along with pyo-pericardium, treated successfully with intravenous (IV) tissue plasminogen activator (TPA) and unfractionated heparin (UFH). A 4-year, male patient presented with massive pericardial effusion (causing cardiac tamponade). Fluoroscopic and echo-guided pericardiocentesis was done. Pericardiocentesis continued for the next 2 days, after which the catheter was removed as fluid volume came down. However, the child soon showed features of SVC syndrome. Ultrasonography and CT angiogram of neck vessels showed occlusive thrombus. Systemic thrombolysis with IV alteplase was performed, followed by continuous UFH IV infusion. Blood investigations showed protein S deficiency and low protein C level. Gradually, symptoms and cardiac function improved. We discharged the patient on warfarin, aspirin and clopidogrel. On follow up, he is doing well. The development of SVC syndrome due to inherited thrombophilia syndromes like protein C and protein S deficiency is rare in children. With that, thrombolytic therapy in children has not been studied much in the past, with extrapolation of data from adult studies being made, putting into the question of its safety and efficacy. However, we successfully managed to restore blood flow in thrombus occluded areas by TPA therapy with no complication from the therapy. SVC syndrome is attached to many causes, one being protein S and C deficiency. However, it can be successfully managed with thrombolysis using TPA.

Enthesitis related arthritis with systemic features

S. Bhavana, Vijaya Prasanna Parimi, R. N. Tejaswini, G. Narsimulu — Wed, 25 Jun 2025 00:00:00 +0530

Systemic juvenile idiopathic arthritis (SJIA), classified as a form of juvenile arthritis, constitutes around 10-20% of all cases of JIA, and is the most common form of arthritis in children. It has no sex predilection and affects children as young as one year of age. Enthesitis occurs in a form of JIA known as enthesitis-related arthritis (ERA), which has a male predilection and is associated with the HLA-B27 allele. Systemic features do not characterize it. We describe a rare presentation of systemic inflammation in ERA in a female child.

Technetium-99 thyroid scan as an aid to diagnosis of congenital hypothyroidism with normal initial thyroid function test

Niharika Khullar, Sanjeev Dutta, Zainuddin Shaikh — Wed, 25 Jun 2025 00:00:00 +0530

Congenital hypothyroidism (CH) occurs in 1:2,000 to 1:4,000 newborns, is often asymptomatic at birth, due to transplacental passage of maternal thyroid hormones and some thyroid production by the infant. CH is classified into permanent and transient forms, thyroid dysgenesis accounts for 85% while dyshormonogenesis 10-15% cases. CH is diagnosed through newborn screening, confirmation by elevated serum thyroid stimulating hormone (TSH) and low T4 or free T4 levels. Thyroid radionuclide uptake, thyroid sonography, serum thyroglobulin, help identify the underlying cause, although treatment may begin prior to these tests. Early diagnosis and treatment are crucial for preventing developmental delays and ensuring optimal growth and development in affected infants.

The unseen onset: myelitis and nephritis as the first clue to juvenile lupus

Sreeja Mogiligari, Vijaya P. Parimi — Wed, 25 Jun 2025 00:00:00 +0530

Juvenile systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder that commonly affects the kidneys and central nervous system. While lupus nephritis and neuropsychiatric manifestations are well-recognized complications, the concurrent onset of lupus nephritis and acute transverse myelitis (ATM) as the initial presentation is exceptionally rare, particularly in the pediatric population. Such an atypical presentation poses significant diagnostic challenges and requires a high index of clinical suspicion to enable early recognition and timely management.

A rare and challenging case of Rasmussen’s encephalitis: a pediatric case report

Thrishnitha Dasari, M. Nisar Ahamed, Chigullapally Sai Priya, Illuri Issac — Wed, 25 Jun 2025 00:00:00 +0530

Rasmussen’s encephalitis (RE) is a rare, chronic, and progressive neurological disorder characterized by unilateral hemispheric inflammation, intractable seizures, and neurological decline, primarily affecting children under 10 years old. This case report describes a 9-year-old male child born to consanguineous parents presented with a 9-month history of progressive myoclonic jerks, generalized tonic-clonic seizures (GTCS), and right-sided hemiparesis. Despite undergoing left temporo-parieto-occipital craniotomy and aggressive pharmacological management with antiepileptics, immunosuppressants, and corticosteroids, the patient developed super-refractory status epilepticus. Diagnostic imaging revealed left hemispheric atrophy, and cerebrospinal fluid analysis ruled out infections, leading to a diagnosis of Rasmussen’sencephalitis with drug resistant epilepsy. The patient underwent left vertical thalamic functional hemispherotomy, resulting in reduced seizure frequency, improved motor function, and decreased inflammatory markers postoperatively. This case underscores the challenges in managing RE, emphasizing the importance of early diagnosis, a multidisciplinary approach, and timely surgical intervention and challenging medication management.

Pediatric systemic lupus erythematosus with macrophage activation syndrome: navigating immune dysregulation under immunosuppressive therapy

Tvesha Gandhi, Devraj Kumar, Sikha Agarwal, Sumitra Venkatesh — Wed, 25 Jun 2025 00:00:00 +0530

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that can escalate into a more dangerous situation when accompanied by macrophage activation syndrome (MAS)—a rare but potentially deadly hyperinflammatory condition. This report explores the case of a 15-year-old female patient with an established history of systemic lupus erythematosus who developed MAS while on immunosuppressive therapy for chronic immune thrombocytopenic purpura. The patient presented with persistent high-grade fever, severe anemia, pancytopenia, and profound hyperferritinemia, yet notably lacked renal involvement—a feature that challenges conventional pediatric SLE presentations. Rapid deterioration necessitated aggressive treatment with high-dose corticosteroids, intravenous immunoglobulin, cyclosporine, and Rituximab, ultimately stabilizing her condition. This case underscores the diagnostic complexity and therapeutic challenges inherent in managing MAS in pediatric SLE, particularly when traditional markers are absent. This report offers insights into the timely diagnosis and treatment of rare MAS in SLE.

Psychiatric crisis to abdominal tuberculosis

Fify Thampi, Johny Vakayil Francis, Anil Kokkat, Varghese Louis, Afeefa K. K. — Wed, 25 Jun 2025 00:00:00 +0530

We report a case of a 15-year-old female presenting with alprazolam overdose, psychiatric symptoms, and subsequent diagnosis of ileocecal tuberculosis (TB). Initial management addressed acute overdose and psychiatric illness, followed by identification of TB through imaging, colonoscopy, and histopathological confirmation. Drug-induced liver injury (DILI) complicated first-line anti-TB therapy, necessitating a modified regimen. This case highlights the diagnostic challenges in patients with overlapping psychiatric and systemic presentations, underscoring the critical role of thorough clinical and diagnostic evaluation in adolescents presenting with psychiatric symptoms and gastrointestinal complaints and the importance of monitoring for hepatotoxicity during ATT.

Beyond the blink: a case report on Jeavons syndrome

Ali Kumble, Abhishek K. Phadke, Anciline Siriac, Manju Jacob — Wed, 25 Jun 2025 00:00:00 +0530

Jeavons syndrome is a distinct syndrome characterized by the triad of eyelid myoclonia with or without absence seizures, eye closure induced generalized paroxysms, and EEG photosensitivity. We present a 5-year-old female child who was admitted for workup of high blood sugars. On evaluation child was diagnosed with type 1 diabetes mellitus (T1DM). At admission child had features of moderate diabetic ketoacidosis, requiring PICU admission for IV fluid correction and insulin infusion. Low C-peptide levels and elevated GAD antibodies confirmed the diagnosis of T1DM. Notably, the child had a 3-year history of eyelid myoclonus, prompting further evaluation. EEG revealed generalized 4-5 Hz spike-wave discharges with fixation-off phenomenon, leading to a diagnosis of Jeavons syndrome, a rare epileptic disorder. Child was started on antiepileptics. Now child is on regular follow up.

BioFlx smiles: aesthetic rehabilitation of primary anterior teeth using bioflx crowns - a case report

Wed, 25 Jun 2025 00:00:00 +0530

Restoring primary anterior teeth poses a unique challenge in pediatric dentistry, requiring a balance between function, esthetics, and durability. BioFlx crowns, an innovative alternative to traditional zirconia and composite crowns, offer enhanced flexural strength, biocompatibility, with a consistent appearance that ensures reliable esthetic outcomes. This case report presents the rehabilitation of maxillary primary central and lateral incisors (teeth 51, 52, 61, and 62) using BioFlx crowns in a young child. The treatment approach, including case selection, crown adaptation, and clinical outcomes, is discussed. The patient exhibited significant aesthetic and functional improvement, with high parental satisfaction. BioFlx crowns demonstrate promising potential as a reliable and aesthetically pleasing restorative option for anterior pediatric dental rehabilitation.

Unresolved Coronary artery aneurysms in an adolescent with multisystemic inflammatory syndrome in children associated with SARS-CoV-2 infection- What happens in the long term?- Case report

Chaitra Govardhan, Poornima Ragavaiah Naidu, Fulton D'Souza — Wed, 25 Jun 2025 00:00:00 +0530

MIS-C, a well-known association with SARS-CoV-2 infection, has been a topic of significant interest. It presents with Kawasaki-like illness along with coronary artery dilation or aneurysms. In this report, we describe a particularly intriguing case of an adolescent with MIS-C presenting with coronary artery aneurysms persisting at the end of a 6-month follow-up, underscoring the importance of this condition. An 11-years-old adolescent female presented with fever, livedoid vasculitis rash over lower limbs, abdominal pain and breathlessness. Diagnosis of MIS-C was established based on the clinical findings, elevated inflammatory markers and positive SARS-CoV-2 IgG antibodies. Echocardiogram evidenced myocardial dysfunction with moderate pericardial effusion and coronary aneurysm. She was treated with intravenous immunoglobulins, steroids and aspirin. Serial follow-up until 6 months showed persisting skin changes and coronary aneurysms with normalized inflammatory markers. MIS-C and its related long-term outcome have been well recognized; however, longer follow-up is not just essential, but urgent in understanding this known yet novel condition.

Vitamin D status of children with recurrent lower respiratory tract infection: a comparative observational study

Prabhakar Patil, Danny Alsalloum, Ravikant S. — Wed, 25 Jun 2025 00:00:00 +0530

Background: Lower respiratory tract infections (LRTIs) are one of the major causes of morbidity and mortality in children under five. Recurrent LRTIs which is defined as three or more episodes in one year or two or more in six months pose a significant health burden. Emerging evidence suggests that vitamin D deficiency in may increase susceptibility of children to such infections.

Methods: This comparative observational study was conducted over one year (January 2024 to December 2024) in the pediatric department of Bidar Institute of Medical Sciences, Karnataka, India. The study was undertaken to assess the association between vitamin D status and recurrent LRTIs in children aged 6 months to 5 years. The study included 80 children with recurrent LRTIs (group A) and 80 age matched healthy controls (group B). Detailed demographic details, clinical findings and nutritional status of cases was collected using a structured questionnaire. Serum 25-hydroxyvitamin D [25(OH)D] levels were measured using chemiluminescent immunoassay and categorized as deficient (<20 ng/ml), insufficient (20–30 ng/ml) or sufficient (>30 ng/ml). Statistical analysis was performed using statistical package for the social sciences (SPSS) version 21.0 with significance set at p<0.05.

Results: No significant differences were noted between groups regarding age and gender distribution. Bronchiolitis and pneumonia were the most common types of LRTIs observed. The mean serum vitamin D level in group A (18.7±7.3 ng/ml) was significantly lower than in group B (26.1±8.5 ng/ml) (p<0.0001). Vitamin D deficiency was observed in 47.5% of children with recurrent LRTIs compared to 27.5% in controls (p=0.0002).

Conclusions: Children with recurrent LRTIs were found to have significantly lower serum vitamin D levels compared to healthy counterparts. These findings suggest that vitamin D deficiency may be a modifiable risk factor for recurrent respiratory infections.

A clinical study to evaluate the association between clinical features, electroencephalographic changes, and neuroimaging in paediatric seizure disorders

Sanket Thakur, Dipankar Mondal, Pralhad Pode, Saurav Dey, Priyanka Mandal — Wed, 25 Jun 2025 00:00:00 +0530

Background: Seizure disorders in children are a significant cause of morbidity and present a diagnostic challenge due to varied clinical presentations and underlying aetiologies. Electroencephalography (EEG) and magnetic resonance imaging (MRI) are essential tools in evaluating these patients. This study aimed to analyse the association between clinical features, EEG findings, and MRI changes in paediatric patients presenting with seizures and to evaluate the diagnostic correlation among these modalities.

Methods: A prospective observational study was conducted on 60 paediatric patients presenting with seizures over an 18-month period at a tertiary care centre in Pune, Maharashtra. Detailed history, clinical examination, EEG, and MRI brain findings were collected and analysed for statistical significance.

Results: Generalized seizures were more common than focal seizures, with generalized tonic-clonic seizures (GTC) being the predominant type (73%). EEG abnormalities were found in 52% of cases, with generalized spike-wave discharges and focal spikes with generalization being most frequent. Temporal lobe involvement was the most common localization on EEG. MRI abnormalities were seen in 43% of cases, with periventricular white matter lesions being the most common (20%). Statistically significant associations were found between type of seizure and EEG abnormality (p<0.01), and between EEG and precipitating factors (p=0.02). However, no significant correlation was found between EEG and MRI localization (p>0.05).

Conclusions: EEG and MRI are crucial complementary tools in the evaluation of paediatric seizures. While EEG abnormalities were more common in complex partial seizures, MRI was more likely to show abnormalities in cases with focal neurological signs. Routine use of both EEG and MRI is recommended in the initial evaluation of paediatric seizure disorders to improve diagnostic accuracy.

Sick kids, smart teachers: a cross-sectional study on teachers’ knowledge of pediatric neurological diseases in Saudi Arabia

Ehssan Ashraf Basha, Ghalyah Mansour Aljowaie, Amjad Aldrees, Hamad Alkhalaf — Wed, 25 Jun 2025 00:00:00 +0530

Background: Recent medical advancements have decreased absenteeism in children with chronic illnesses, emphasizing the importance of inclusive education. Epilepsy remains a common neurological disorder worldwide, yet many teachers lack the training to manage it and other neurodevelopmental disorders such as attention deficit-hyperactivity disorder (ADHD) and Autism spectrum disorder (ASD). ADHD is prevalent among school-aged children, with studies in Riyadh and Madina showing limited teacher awareness. Similarly, increasing ASD diagnoses underscore the need for enhanced educator preparedness. This study assesses the knowledge of teachers in Riyadh regarding the management of common pediatric neurodevelopmental conditions in school environments.

Methods: A cross-sectional analytical design was used. A self-administered questionnaire was distributed to 369 teachers across various schools. It comprised two sections: demographic data and assessment of knowledge regarding epilepsy, ASD, and ADHD. Questions covered disease definitions, symptoms, educational impact, school strategies, and management practices.

Results: Among the 369 teachers, gender distribution was nearly equal. Most worked in private schools (56.9%). While 77.5% correctly identified epilepsy and 86.7% recognized its symptoms, only 54.2% felt confident managing it. Knowledge of ASD and ADHD was moderate (65% and 70.7%, respectively). The average knowledge score was 12.66/19, with 57.7% scoring above average. Male teachers showed slightly better overall knowledge, though teaching experience and school type were not significant predictors.

Conclusions: Teachers in Saudi Arabia demonstrate basic knowledge of epilepsy, ADHD, and ASD, but notable knowledge gaps remain, especially in daily management. Targeted training is crucial to enable effective educational support for children with chronic neurodevelopmental disorders.

Assessment of physical functioning domain on quality of life of children with cerebral palsy-experience in rural Bangladesh

Wed, 25 Jun 2025 00:00:00 +0530

Background: Cerebral palsy (CP) is the most prevalent health condition linked to childhood disability in Bangladesh. This study was intended to evaluate the physical functioning domain of quality of life (QoL) of children with CP using Peds QLTM inventory in a tertiary care hospital. The aim of this study was to find out physical aspects of the child’s QoL by using PedsQL^TM inventory (physical, emotional, social, schooling), to identify co-morbidities, socio demographic profile of child and parents and to find out relationship between physical functioning domains of QoL score with types, co-morbidities and of socio demographic characteristics.

Methods: To evaluate health related QoL (HRQOL), PedsQL 4.0, a generic tool, validated in Bangladesh was applied to and the questionnaire was answered by parents. Main outcome variable was physical functioning.

Results: Majority of patients (28.16%) have both speech impairment and behavior problem. Intellectual disability was found 13.79%, 14.94% had epilepsy. Overall physical functioning summary score (PFSS) was 21.65 (95% CI). Multiple regression analysis of generic scale core and the variables associated independently with QoL. No statistically significant difference was found between types, co-morbidities of CP, father’s and mother’s education, family income, place of residence with physical domains of QoL score. Among all the types of CP only quadriplegic CP had significant effect on physical functioning score with (p<0.05), but this does not explain the variations in physical functioning score well (R square=0.208).

Conclusions: The results of this study concluded that QoL pertaining to physical functioning domain in children with CP was found low which was most significant among children with quadriplegic CP. Most of the patients had speech impairment and behavior problem.

Efficacy and safety of deflazacort in children with an initial episode of idiopathic nephrotic syndrome - a randomized controlled trial

Wed, 25 Jun 2025 00:00:00 +0530

Background: Idiopathic nephrotic syndrome (INS) is the most common glomerular disease in children. Prednisolone has been the standard first-line therapy, but deflazacort, a synthetic corticosteroid, has shown promise with potentially fewer side effects. This study aimed to compare the efficacy and safety of deflazacort versus prednisolone in children with an initial episode of INS.

Methods: This randomized controlled trial was conducted in the Department of Pediatric Nephrology, National Institute of Kidney Diseases and Urology (NIKDU), Dhaka, Bangladesh, from June 2019 to January 2021. In this study, we included 83 children, aged 2 to 12 years, who had Idiopathic nephrotic syndrome and visited the outdoor department and were admitted to the pediatric nephrology department of NIKDU. Patients were divided into two treatment groups – group A patients were prescribed prednisolone, and group B patients were prescribed deflazacort.

Results: The mean age was significantly higher in the deflazacort group (4.97±2.11 years) compared to the prednisolone group (3.87±1.23 years), with a statistically significant p value of 0.007. The mean time to induce remission was significantly shorter in the deflazacort group (7.87±3.33 days) compared to the prednisolone group (9.82±3.43 days; p=0.02). Although relapse rates were higher in the prednisolone group at 3 and 6 months, the differences were not statistically significant. Complications like moon face and buffalo hump occurred more frequently in the prednisolone group, but without statistical significance. No significant differences were observed in growth parameters, blood pressure, cholesterol, or random blood sugar (RBS) levels between the two groups during follow-up.

Conclusions: This study showed that deflazacort induced remission in a shorter time compared to prednisolone in children with an initial episode of INS. While both treatments were similarly effective in achieving remission, the deflazacort group experienced fewer relapses and a lower incidence of side effects during the follow-up period.

Transient neonatal hyperthyrotropinemia: prevalence and its associated materno-fetal factors: a hospital based prospective observational study

Padmini S. Karnam, Sathiyanarayanan Sathiyamoorthi — Tue, 10 Jun 2025 00:00:00 +0530

Background: Transient neonatal hyperthyrotropinemia (TNH) should be interpreted with caution in newborns, to assess the risk of unnecessary treatment. There are very few studies reporting prevalence of TNH which ranges from 0.02 to 6.0%. Hence, this study was conducted to estimate the prevalence of TNH among neonates and factors associated with it.

Methods: A prospective observational study was conducted among neonates born for a period of one year. All neonates were subjected to thyroid hormones screening on day 3-5, and if TSH level was elevated (10-20 mIU/l), a repeat TSH and T4 after 2 weeks were done. Elevated TSH levels at 3-5 days with normal T4 levels, normalizing on re-examination at 2-4 weeks was diagnosed as TNH. Descriptive data were reported as frequencies. Chi square and unpaired ‘t’ test was used to study association. Odd’s ratio was calculated to study the strength of association using regression analysis.

Results: Out of 333 neonates studied, 17 (5.1%) had elevated TSH levels with normal fT4 on initial screening. Of 15 newborns who returned for follow up at 2 weeks, 14 (4.1%) neonates returned to normalcy, indicating the prevalence of TNH as 4.1%. Prevalence of TNH among neonates born to hypothyroid mothers (45) was 11.1%. Maternal hypothyroid status, birth weight, head circumference and gestational age were statistically significant with TNH.

Conclusions: Screening of all newborns for congenital hypothyroidism (CH) is useful, as they benefit from early initiation of treatment. However, interpretation of thyroid hormones must be done with utmost caution.

Profile of pediatric medico-legal cases admitted in Department of Pediatrics at a tertiary care hospital in Eastern Uttar Pradesh

Astitva Singh, Prachi Agarwal, Priyanka Aggarwal, Vineeta Gupta, Rahul Patel — Wed, 25 Jun 2025 00:00:00 +0530

Background: There is lack of data regarding medico-legal cases in paediatric population. To define the clinical, demographic and etiological profile of medico-legal cases admitted and managed in pediatric department of a tertiary care centre.

Methods: The prospective observational study is conducted over a period of 1 year; all children up-to age of 18 years admitted with medico-legal implications were included in study.

Results: Total 57 children were enrolled in study; mean age of study participants was 8.05±5.52 years. Majority of medicolegal cases were accidental (52.6%) followed by suicidal (28.1%), homicidal (10.5%) and intentional (8.7%). Accidental injuries are significantly associated with male sex and better outcome when compared suicidal injuries.

Conclusions: Most frequent type of injury was poisoning followed by abandoned baby. Poor outcomes are associated with poisoning in cases involving suicidal ingestion, the presence of stressors, and the need for respiratory/vasopressor support.

Weight loss of term babies in 48 hours of life as a tool to predict non-pathological neonatal hyperbilirubinemia

Lalita Wadhwa, Gudipudi Uma Divya Tejaswini, Geshmanjali Kakarala — Wed, 25 Jun 2025 00:00:00 +0530

Background: The aim of this study is to analyse the percentage of weight loss in 48 hours in term neonates as a predictor of non-pathological neonatal hyperbilirubinemia.

Methods: The study was carried out in Department of Paediatrics in GITAM Institute of Medical Sciences and Research. A total of 120 babies were studied. Babies with pathological jaundice were excluded from the study.

Results: While 45% of participants in the current study had normal bilirubin levels, 55% had hyperbilirubinemia (TSB>12). Percentage weight loss at 48 hours was positively correlated with total serum bilirubin with correlation coefficient (r) of 0.525 which was statistically significant (p value <0.001). On performing ROC analysis between percentage weight loss at 48 hours and hyperbilirubinemia, it was found that, at an optimum cut off >6.3% weight loss at 48 hours, patient will have hyperbilirubinemia.

Conclusions: According to the above study, there is a clear link between hyperbilirubinemia and weight loss in newborns. Increased levels of bilirubin are strongly correlated with notable weight loss within the first 48 hours of life. Jaundice has been demonstrated to occur if the weight loss is more than 6.3% in the first 48 hours of life.

Profile of poisoning in children and adolescents at a tertiary care centre

Wed, 25 Jun 2025 00:00:00 +0530

Background: This study examines exogenous poisoning-related hospitalizations among children and adolescents at Chengalpattu medical college hospital. It aims to identify risk factors for unintentional poisoning in individuals aged 1-18 and assess clinical outcomes. Additionally, it seeks to characterize the types and outcomes of poisonings in this demographic.

Methods: A retrospective analysis was conducted using medical records of all admissions with confirmed poisoning diagnoses from January 1, 2022, to December 31, 2022, at Chengalpattu medical college hospital. Patients aged 1 to 18 years were included. Cases involving food poisoning, adverse drug reactions, and animal-related envenomation were excluded. Data collected included demographic details, type of poisoning, time to hospitalization, treatment given, and outcomes.

Results: Out of 2,123 total poisoning cases, 389 (18.3%) involved patients under 18 years. A majority were female (58.4%), with a mean age of 11.61 years. Most cases (64%) originated from rural areas. The leading agents were corrosives (52.5%), organophosphorus compounds (14.1%), and oleander (13.6%). Corrosive poisoning was predominant among children under five, indicating accidental ingestion. The median time to hospital admission was 3.29 hours, and the Glasgow coma scale score was 12.83. Medical management was successful in 98.9% of cases, while the overall mortality rate was 1%, with organophosphorus poisoning being the most fatal.

Conclusions: Preventive strategies and public education are essential, especially in rural areas, to reduce poisoning incidents. The study also highlights the growing concern of intentional poisonings and underlines the importance of mental health support for adolescents, particularly girls.

Study of prevalence of overweight and obesity among school going adolescents in north Karnataka and its association with life style changes

Sameer Ahammad S., Apurva A. B., Roopa Mangshetty — Wed, 25 Jun 2025 00:00:00 +0530

Background: Overweight and obesity in adolescence have become major public health concerns worldwide, including in India, with prevalence rates doubling over the past two decades. Childhood obesity is strongly linked to adult obesity and increases the risk of chronic diseases such as type 2 diabetes, hypertension, cardiovascular disease, and certain cancers. It also negatively impacts bone health, reproductive health, and overall quality of life. This cross-sectional study was conducted to determine the prevalence of overweight and obesity among school-going adolescents and to assess their association with lifestyle factors.

Methods: This cross-sectional study was conducted to determine the prevalence of overweight and obesity among school-going adolescents and to assess their association with lifestyle factors. A total of 800 adolescents aged 13–17 years from various private schools in Kalaburagi were included. Data were collected using a semi-structured questionnaire. Anthropometric measurements were taken using standardized methods, and overweight/obesity was classified based on the 2015 Indian academy of paediatrics (IAP) growth chart. Statistical analysis was performed using IBM SPSS version 25.0, with the Chi-square test applied for significance (p<0.05).

Results: The study found that 34.3% of participants were either overweight or obese. A significant association was observed between overweight/obesity and various lifestyle factors including diet, screen time, physical activity, and family history. High intake of calorie-dense, processed, and fast food emerged as a major contributor.

Conclusions: Despite improvements in health education and recreational opportunities in schools, obesity remains prevalent, highlighting the need for greater awareness and behaviour change at both individual and community levels.

Clinical profile and predictors of immediate outcome in children with status epilepticus

Nitish Kumar P. Nandini, K. Varadaraj Shenoy — Wed, 25 Jun 2025 00:00:00 +0530

Background: Aim of the study was to study the clinical profile, and predictors of immediate outcome in children aged 1 month to 15 years, with status epilepticus admitted to tertiary care center.

Methods: A prospective study of 43 patients admitted in department of pediatrics in Father Muller medical college between October 2017 to April 2019. They were evaluated for their clinical presentation, treatment profile and immediate outcome.

Results: Twenty-one children (49%) were between 1 to 5 years, seven children (16%) were below 1 year and fifteen (35%) were between 5 to 15 years. Thirty children (70%) were male and thirteen (30%) were female. Twenty-six patients (60.4%) had unprovoked status epilepticus. Twelve children (28%) had pre-existing neurological abnormality. Three patients died (6%) during hospital course and six patients (13.9%) had new onset neurological deficits and rest recovered.

Conclusions: Unprovoked seizures, presence of pre-existing neurological abnormalities, significant birth history, metabolic abnormalities and need for ventilation was associated with new onset neurological deficit and mortality. Overall children with preexisting neurological abnormality presenting with status epilepticus have poorer outcome.

Prevalence of adeno virus associated diseases among pediatric population in a tertiary care teaching hospital

Wed, 25 Jun 2025 00:00:00 +0530

Background: Human adenoviruses (HAdV), can cause infections at any age but most commonly in young children and infants. Most children have experienced at least one bout of adenovirus infection by ten years old.

Methods: A prospective observational study was conducted during July 2023 to December 2023 with 100 patients. Clinical data was collected from patients diagnosed with adenovirus to study adenoviral associated diseases, clinical manifestations and treatments administered. Statistical analysis was done using statistical package for the social sciences (SPSS) version 26.0, p<0.05 was considered significant.

Results: In the current study children are between 1 month to 15 years and males (55%) outnumber females (45%). The most prevalent symptoms were high-grade persistent fever (100%), cough (79%), cold (67%), vomiting’s (34%), shortness of breath (18%) abdominal pain and noisy breathing (12%), sore throat (10%), headache (5%), conjunctivitis (3%) and ear pain (1%). Comorbidities were, gastroenteritis with dehydration (3%), enlarged adenoids (5%), enlarged tonsils (4%), sepsis (4%), sickle thalassemia (1%), pansinusitis (1%) and shock with down syndrome (1%). Support received include, nebulization (69%), high-flow nasal cannula (HNFC) (2%), oxygen (2%), both HNFC and oxygen (1%). 48% received azithromycin, of which on day of admission (12%), second day (14%), third day (13%), fourth day (9%). Notably all children were discharged successfully without encountering any complications.

Conclusions: HAdV infections are commonly associated with high-grade fever, challenging the conventional perception that respiratory infections are their predominant manifestation. Timely, precise detection of HAdV infection is essential for enhancing treatment and reducing inappropriate use of antibiotics.

Identifying the barriers to antiepileptic drug adherence among children with newly diagnosed epilepsy

Amrita Prabhat, Vijay Jaiswal, Anupama Verma — Wed, 25 Jun 2025 00:00:00 +0530

Background: Epilepsy is a common neurological disorder with significant health consequences. Adherence to antiepileptic drugs (AEDs) is vital for effective seizure control. Poor adherence is associated with increased hospitalizations, reduced quality of life and higher mortality. In children, ensuring adherence is especially challenging, involving caregivers, the child and clinicians. This study aimed to assess the prevalence and factors associated with AED non-adherence in children aged 3 months to 18 years with newly diagnosed epilepsy.

Methods: A Prospective, longitudinal observational study was conducted in 120 children with newly diagnosed epilepsy in the Department of pediatrics, LLRM Medical college, Meerut, from October 2022 to September 2023. Adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) and factors influencing non-adherence were evaluated using the Pediatric Epilepsy Medication Self- Management Questionnaire during follow-up interviews.

Results: AED non-adherence was observed in 48% of participants. Factors associated with non-adherence: Socio-demographic: Rural residence (53%), lower parental education (75%), Clinical: frequent seizures (74%), polytherapy (60.5%), Caregiver-related: Poor treatment knowledge (71%), forgetfulness (90.5%), running out of medication (80%), lack of belief in treatment (75%) and Child-related: Refusal to take medication (87.6%).

Conclusions: Nearly half of the children with epilepsy were non-adherent to AEDs. Major barriers included caregiver forgetfulness, run out of medication and child refusal. Addressing these modifiable factors is essential to improve adherence and health outcomes in pediatric epilepsy.

Hepatic masses in children: a 15-year experience at a single tertiary care center in India

Srishti Saini, Neelam Mohan, Anushka Shankar, Sailen Kumar Bana — Wed, 25 Jun 2025 00:00:00 +0530

Background: Hepatic masses are rare and challenging to diagnose and manage in pediatric populations; therefore, data on clinical presentation, management strategies, and long-term outcomes are limited. Hence, the aim of the study was to review the incidence, clinical spectrum, management, and outcome of hepatic masses in pediatrics.

Methods: This retrospective, cross-sectional study reviewed the medical records of pediatric patients (age <18 years) presenting to a pediatric hepatologist and diagnosed with hepatic masses between 2010 and 2024 at a tertiary care center.

Results: Thirty-nine patients were identified with hepatic masses, 21 (53.8%) had benign tumors and 18 (46.2%) had malignant tumors. The median age of patients was 39 months (range: 2–208 months) at presentation, and 19 (48.7%) of them were females. The most common presentation is abdominal distension (n=14, 35.8%), while the less frequent presentations were abdominal pain (n=6, 15.38%), pallor (n=6, 15.38 %) and anorexia (n=4, 10.20%). Hepatic masses were an incidental finding in 5 patients (12.80%). Patients underwent different radiologic investigations including ultrasound imaging (n=15, 38.4%), computed tomography (CT; n=26, 66.6%), magnetic resonance imaging (MRI; n=8, 20.5%), and positron emission tomography (PET; n=11, 28.2%). Histopathology was done preoperatively in 9 (23.07%) patients and post operatively in 17 (43.5%) patients. Most patients underwent surgical resection (n=16, 41%), 5 (12.8%) patients received chemotherapy for malignant tumors, and 5 (12.8%) patients underwent liver transplantation. Surgical complications occurred in 2 (5.1%) patients but were successfully managed. One patient was lost to follow up and no mortality was reported in the remaining patients with long-term follow up.

Conclusion: The immediate and long-term clinical outcomes of surgical resection and liver transplantation, with or without chemotherapy, are good without considerable morbidity or mortality. This study contributes valuable real-world data to inform clinical practice and future research in this area.

A cross-sectional survey of knowledge, attitude, and practices toward dengue fever among university students in Bengaluru

Shylaja B. S., Denny John — Wed, 25 Jun 2025 00:00:00 +0530

Background: The incidence of dengue fever (DF) has been on the rise over the past few decades, with an increasing number of outbreaks in Bengaluru. This study was conducted to assess health literacy on DF among university students through a knowledge, attitude, and practices (KAP) survey.

Methods: A cross-sectional survey among university students between the ages of 18 and 21 was carried out. Data was collected using a validated questionnaire comprising 40 questions based on KAP on dengue, to assess the KAP regarding DF, descriptive statistic; univariate and multivariate logistic regressions were performed.

Results: Among 340 students, 104 (30.6%) showed a good level of knowledge, 154 (45.3%) exhibited a good attitude level, 255 (75%) displayed good preventive practice levels, and 173 (50.9%) demonstrated good overall KAP levels. 24.4% (n=83) reported of prior dengue infection history in family. Private university attendance correlated with lower odds of positive attitudes (OR=0.562, p=0.012) and overall KAP levels (OR=0.618, p=0.032) in univariate analysis, a trend confirmed in multivariate analysis (aOR=0.393, p=0.001 for attitude; aOR=0.570, p=0.035 for KAP levels).

Conclusions: The study revealed strong awareness, positive attitudes, and preventive behaviours among Bengaluru university students regarding DF. Location and institution type influenced attitudes, emphasizing the need for targeted health literacy programs for effective dengue prevention in urban areas such as Bengaluru.

Comparison of complete IV antibiotic course versus partial IV with oral antibiotics in probable and proven early-onset sepsis in a tertiary care centre; a step toward antimicrobial stewardship in the neonatal intensive care unit: a prospective observational study

Sana Khan, Abhishek Singh, Navratan Gupta, Ravi S. Chauhan — Wed, 25 Jun 2025 00:00:00 +0530

Background: Neonatal sepsis, particularly early onset sepsis (EOS), remains a leading cause of neonatal morbidity and mortality. The standard treatment involves intravenous (IV) antibiotics; however, prolonged IV antibiotic use increases hospital stay, healthcare costs, and the risk of antimicrobial resistance. Transitioning from IV to oral antibiotics in stable neonates may be a viable alternative. Aim and objectives were to compare the clinical outcomes of neonates with EOS receiving a complete course of IV antibiotics versus those transitioning from IV to oral antibiotics following initial stabilization.

Methods: A prospective observational study was conducted at the neonatal intensive care unit (NICU) of L.L.R.M Medical College, Meerut, from April 2023 to April 2024. Neonates diagnosed with EOS were categorized into two groups: group A (complete IV antibiotic course) and group B (IV-to-oral transition). Data on neonatal demographics, clinical parameters, duration of hospital stay, readmission rates, mortality, and weight gain were analysed. Statistical comparisons were performed using Chi-square and independent t-tests, with a p value <0.05 considered significant.

Results: A total of 100 neonates were included (50 per group). The mean hospital stay was significantly shorter in group B (7.2±1.4 days) compared to group A (10.1±2.1 days; p<0.01). No significant difference in mortality was observed between the groups (group A: 4%, group B: 3%; p=0.68). Readmission rates were comparable (group A: 6%, group B: 5%; p=0.74). Weight gain was significantly higher in group B at follow-up (p=0.03). The incidence of hospital-acquired infections was lower in group B, suggesting potential benefits of early transition to oral therapy.

Conclusions: Early transition from IV to oral antibiotics in stable neonates with EOS is a safe and effective strategy that reduces hospital stay without increasing mortality or readmission rates. This approach may contribute to antimicrobial stewardship by minimizing unnecessary IV antibiotic exposure. Further large-scale studies are needed to establish standardized protocols.

Comparative evaluation of efficacy of Darolac, Arimedadi oil and chlorhexidine mouthwash on salivary pH in special children: a randomized control trial

Diganta Rava, Kalpna Chaudhry, Akriti Chauhan, Pooja Panwar — Wed, 25 Jun 2025 00:00:00 +0530

Background: Children with special healthcare needs often have trouble keeping their teeth clean because of cognitive and physical problems, increasing their risk of oral diseases. While chlorhexidine effectively maintains salivary pH, it has lot of side effects. Hence an alternative mouthwash to chlorhexidine is required. The aim of this study was to compare the efficacy of chlorhexidine, Darolac (a probiotic) and Arimedadi oil (an herbal formulation) on salivary pH in special children.

Methods: Randomized controlled trial was conducted comprising of 45 special children of age 9-12 years from a special School from Rishikesh were randomly assigned to three groups i.e., group I Chlorhexidine (n=15) group II Darolac (n=15) and group III (n=15) Arimedadi Oil. A pre intervention saliva swab was taken priorly to evaluate the salivary pH. Following a standardized oral hygiene regimen, participants were instructed to use their respective mouthwash twice daily for a duration of 7 days. Salivary pH measurements were taken at the end of the intervention period using pH paper. Statistical analysis was performed to compare the changes in salivary pH among the three groups.

Results: After 15 days of intervention, intragroup comparison showed a significant increase in salivary pH compared to baseline with p<0.05 (p=0.00). The intergroup comparison of three groups when compared to mouthwashes containing chlorhexidine and Darolac, Arimedadi oil caused a modest increase in salivary pH after 15 days.

Conclusions: Chlorhexidine, Darolac and Arimedadi oil mouthwashes were found to be effective in increasing the salivary pH in special children, indication their potential in maintaining oral health. Arimedadi Oil showed superior efficacy compared to Chlorhexidine and Darolac mouthwashes in this population.

RCT to analyse efficacy of double port extension tubing connection to peripheral IV cannula in prevention of neonatal late onset sepsis

Vinit Malik, Archana Agrawal, Abhishek Singh, Navratan Gupta, Alpha Rathi — Wed, 25 Jun 2025 00:00:00 +0530

Background: Late-onset sepsis (LOS), defined as sepsis occurring after 72 hours of age, causes substantial mortality and morbidity in neonates admitted in NICU. These neonates depend significantly on vascular access to administer fluids, nutrition, blood products and medication. This typically relies on the use of Peripheral Intravenous Cannula (PIVC) however, problems associated with IV infusion therapy include contamination of fluid with bacteria, endotoxins and particulates. Despite strict adherence to hygienic protocols, the incidence of nosocomial sepsis remains high. Incorporating an intravenous cannula with double port extension may be an effective strategy to reduce LOS. So, we did an open-label randomized controlled trial (RCT) to determine if the addition of a double port extension to an intravenous cannula can help in the prevention of LOS.

Methods: Open label randomized controlled trial was conducted in 300 newborns admitted in the Department of pediatrics, LLRM Medical college, Meerut from April 2023 to March 2024. Admitted neonates underwent a sepsis screen. Those with a negative sepsis screen were enrolled and then randomly assigned to the groups. Group A: Babies with an intravenous cannula with a double port extension; Group B: Babies with an intravenous cannula without double port extension

Results: 150 babies from each group were analysed. 13.34% and 43.34% were blood culture positive in each group respectively (p-value<0.001). 10% and 30% were sepsis screen positive in respective groups. 142 (94.67%) discharged, 1 (0.66%) expired and 133 (88.67%) discharged, 10 (6.66%) expired out of 150 babies in each group respectively.

Conclusions: The addition of a double port extension in the IV cannula shows a reduction in LOS when compared to the control.

Neurosonogram in high-risk neonates delivered in a rural tertiary care hospital

Samyukta Srinivasan, Anjali Kher, Uday Zende, Nitin Lingayat — Wed, 25 Jun 2025 00:00:00 +0530

Background: A neurosonogram can detect both congenital and acquired brain lesions in neonates. Abnormal neurosonogram findings in high-risk neonates range from 3% to 47%. The aim was to study the neurosonogram findings in high-risk neonates and to associate them with maternal and neonatal risk factors.

Methods: Seventy-nine high-risk neonates delivered in this rural tertiary care hospital were included. Maternal demographic data along with neonatal examination findings at birth, neurosonogram, investigations, treatment given and short-term follow-up till discharge were entered in a pre-validated proforma. In cases with abnormal neurosonogram findings, a repeat neurosonogram was done between the 8^th to 28^th day of life, and the findings were recorded. Statistical analysis used: The Fischer exact test was used for parameters on a categorical scale. A p≤0.05 was considered statistically significant.

Results: The overall prevalence of abnormal neurosonogram findings was 11.4% with cysts, midline shifts, intraventricular haemorrhage, germinal matrix haemorrhage and hydrocephalus being the most common intracranial abnormalities detected. Factors associated with abnormal neurosonogram in high risk neonates were premature rupture of membranes, polyhydramnios, APGAR score less than seven at five and ten minutes, positive blood culture, low platelet count, low hematocrit, hypocalcaemia, low pH and high pCO₂. These high risk neonates with abnormal neurosonogram had a longer hospital stay of more than 10 days and a mortality of 11.1%.

Conclusions: Neurosonography is an effective screening modality for early detection of intracranial abnormalities in high-risk neonates. Morbidity and mortality were more in high risk neonates with abnormal neurosonogram.

Impact of maternal sociodemographic characteristics on infant and child nutrition and growth: a cross-sectional observational study

Basundhara Mete, Shivani Randev, Vishal Guglani — Wed, 25 Jun 2025 00:00:00 +0530

Background: A high prevalence of malnutrition in infants in India may be associated with socio-demographic characteristics of mother. We wanted to find out the association between maternal socio-demographic factors, dietary diversity and growth in 12 to 24 months children.

Methods: We enrolled 12 to 24 months children over 11 months in a tertiary care centre in North India, from outpatient and inpatient wards in an observational, cross-sectional study. Maternal education, occupation and socio-economic status were noted. Dietary history was recorded to determine Minimum Meal Frequency (MMF) and Minimum Dietary Diversity (MDD) as per WHO guidelines. Child’s weight, length/height, mid upper-arm circumference (MUAC) and occipitofrontal circumference were recorded. Outcomes were proportion of underweight, stunted, wasted and severe acute malnutrition (SAM defined as MUAC <11.5 cm) in various dietary adequacy groups and as per maternal socio-demographics.

Results: Authors enrolled 246 children and mean (SD) age at assessment was 17.6(4.2). Mothers of 210 (85.4%) were unemployed, 73(29.7%) either uneducated or educated less than 10th and 31(12.6%) completed post-graduation. Complementary feeding was initiated between 6 months to 1year age in 208(84.2%) children. MMF was met in 169 (68.7%) and MDD in 74(30%). We found 79(32%) children were underweight, 51(20.7%) wasted, 83(33.7%) stunted and 20 (8.7%) SAM. Nearly 72% of unemployed mothers failed to provide MDD versus 55% (p=0.042) employed mothers. MDD increased with increasing education of mother(p=0.002). Children of less educated mothers had significantly higher underweight (p=0.029) and stunting (p=0.006).

Conclusion: Dietary diversity and growth are significantly affected by maternal sociodemographic characteristics in 12-24 months children.

Validity of screening tool for the assessment of malnutrition in paediatrics in detecting malnutrition among in-patient children aged below 12 years

Padmini S. Karnam, Garikipati Chandrika, Sathiyanarayanan Sathiyamoorthi — Wed, 25 Jun 2025 00:00:00 +0530

Background: Screening tool for the assessment of malnutrition in pediatrics (STAMP) is a reliable screening tool for the identification of malnutrition risk. This study was done to assess the validity of STAMP in detecting malnutrition as compared to World Health Organization (WHO) 2006 and Indian Academy of Pediatrics (IAP) 2015 combined growth charts.

Methods: A cross-sectional study was conducted among inpatient children aged below 12 years. STAMP assessment yields a sum to calculate the overall risk of malnutrition, which is divided into three categories: 0 to 1, low risk; 2 to 3, medium risk; ≥4, high risk. In comparison to WHO growth criteria, STAMP's sensitivity, specificity, positive and negative predictive value were computed. The sensitivity and specificity of the STAMP tool was assessed using a receiver operating characteristic (ROC) curve. To identify risk factors for malnutrition, logistic regression analyses were conducted.

Results: Out of 63 children studied, 36 (57.1%) were male and 27 (42.9%) were female. The median [interquartile range] age was 3 years [1.5, 8.0]. Children who were categorized as medium or high risk as per STAMP tool had a higher likelihood of being underweight. Regression analysis found weight for age was the most important factor associated with the risk of malnutrition with p value 0.040. The sensitivity of STAMP in detecting underweight, stunting and wasting was 95.2%, 84.6% and 81.8% respectively using ROC analysis.

Conclusions: The nutritional risk scores by STAMP are feasible and can identify children at risk of malnutrition. Future studies in outpatient settings are required to confirm these results.

Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections-presentation and challenges to care in a Nigerian community

Wed, 25 Jun 2025 00:00:00 +0530

To present a case series of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS), highlighting the clinical presentation, diagnostic process, and management strategies. PANDAS is characterized by the sudden onset of neuropsychiatric symptoms such as obsessive-compulsive disorder (OCD) or tic disorders following streptococcal infections. The condition poses diagnostic and therapeutic challenges due to its complex presentation and overlap with other neuropsychiatric disorders. This case series highlights three children in a Nigerian community diagnosed with paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Presentations included the abrupt onset of obsessive-compulsive behaviour, tics, and neuropsychiatric disturbances linked to prior streptococcal infections. A detailed clinical evaluation, laboratory testing, timely diagnosis, and individualized multidisciplinary management approach, including antibiotics, immunomodulatory therapies, and psychosocial support, resulted in significant clinical improvement and successful management of PANDAS. These cases underscore the importance of considering PANDAS in children with abrupt neuropsychiatric symptoms post-streptococcal infection and illustrate the benefits of a comprehensive management approach to optimize outcomes.