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International Journal of Contemporary Pediatrics
Number of Followers: 5  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2349-3283 - ISSN (Online) 2349-3291
Published by Medip Academy Homepage  [12 journals]
  • Retinopathy of prematurity in India: incidence, risk factors, outcome and
           the applicability of current screening criteria

    • Authors: Sujit S. Patel, Niranjan Shendurnikar
      Pages: 2235 - 2241
      Abstract: Background: To study the incidence, risk factors and outcome of retinopathy of prematurity (ROP) in at-risk newborns at tertiary care hospital in Vadodara.Methods: Preterm infants with birth weight ≤2000 gm and gestation ≤34 weeks were screened for ROP at 4 weeks of birth for first screening or if <28 week or <1200 grams then at 3 weeks after delivery. Infants with birth weight >2000 gm and gestation >34 weeks were screened only if they had additional risk factors. Those found to have high risk ROP were treated.Results: The incidence of ROP in 286 infants who were screened was 24.1%, 12 ROP positive cases were having birth weight >2000 gm. On multivariate analysis risk factors predisposing to ROP (P<0.05) were birth asphyxia, Sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and Phototherapy. Out of 69 infants who developed ROP, 6(8.7%) needed invasive management.Conclusions: Risk factors predisposing to ROP were gestational age and birth weight alone and along with the various risk factors like birth asphyxia, sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and phototherapy. The occurrence of ROP is trending towards a rise including newborns with higher birth weight and gestational age in developing countries; hence necessitating to use different guideline for Screening of Newborns in these developing countries.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194698
      Issue No: Vol. 6, No. 6 (2019)
  • Anthropometric outcome of extremely low birth weight and very low birth
           weight newborn at 12 months of corrected age associated with prenatal risk

    • Authors: Balai Ch. Karmakar, Ramesh Ch. Kalder
      Pages: 2242 - 2247
      Abstract: Background: Advancement of skill, technology and perinatal medicine has led to improve survival of low birth weight babies during the last few decades but they have reported high incidence of growth failure during infancy and early childhood. The objective of the study was to find out the influence of perinatal risk factors on anthropometric outcome.Methods: A prospective cohort study conducted on 143 ELBW and VLBW babies admitted in Sick Newborn Care Unit (SNCU and PICU) of North Bengal Medical College and Hospital (NBMC), Darjeeling, West Bengal from 2016 to 2017 and discharged babies were followed up.Results: Total 143 neonates were studied at NBMC among male 82(57.3%) and female 61(42.7%), 95 were AGA and 48 were SGA babies. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). The mean weight for age (Mean±SD) was 7.615±1.1092 kg with median 7.8 kg. The mean length for age (Mean±SD) was 72.6±3.74 cm with median 73 cm. The mean head circumference for age (Mean±SD) was 42.5±2.12 cm median 43 cm. Adverse neonatal outcome associated with CRIB II score ≥10. Total CRIB II score with parameters of growth (<-2 Z score) like weight for age, length for age, weight for length and head circumference for age shows significant correlation (p<0.001).Conclusions: Perinatal risk factors are important determinant for future anthropometric outcome in very low and extremely low birth weight babies. They should be identified, and appropriate measures should be taken to achieve good outcome.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194699
      Issue No: Vol. 6, No. 6 (2019)
  • Impact of introduction of Mini-Clinical Evaluation Exercise in formative
           assessment of undergraduate medical students in pediatrics

    • Authors: Pankaj M. Buch
      Pages: 2248 - 2253
      Abstract: Background: Student’s assessment is a systemic process of determining the extent to which the student has achieved the desired competency. Mini–Clinical Evaluation Exercise (Mini-CEX) is an assessment tool applicable in broad range of settings. Very little data is available in Indian settings about Mini-CEX in undergraduate. This study has been undertaken to understand its role in formative assessment.Methods: In this interventional study 47 students and 7 faculty of pediatrics participated. Students were assessed for two encounters of Mini-CEX. Assessment was as per Mini-CEX rating form followed by feedback.Results: Mean score range for different competency of data gathering were 1.76 to 2.5 during first mini-CEX and 4.38 to 5.14 during second Mini-CEX. Difference was significant (Cohen’s d >0.8). More than 90% of students felt that Mini-CEX is better way to assess clinical skills and would like to be assessed by Mini-CEX. One to one interaction was most important advantage felt about Mini-CEX. Though nearly all faculties felt that Mini-CEX is a better way for assessment half of them disagree to continue using it in future due to time constraints.Conclusions: In this study we found Impact of Mini-CEX in formative assessment is significant to improve clinical competency at undergraduate level. Improvement in Mini-CEX scores in consecutive encounter signifies its role even as Teaching Learning tool. Need to consider issues about its feasibility for Undergraduate level in settings with limited staff strength.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194700
      Issue No: Vol. 6, No. 6 (2019)
  • Status of neurodevelopmental impairments among children using rapid
           neurodevelopmental assessment attending a tertiary care hospital

    • Authors: Mohammad Zahir Uddin, Muhammad Mizanur Rahman, Kanij Fatema, ARM Sakhawat Hossain Khan, Mohammad Monir Hossain, Tania Saad
      Pages: 2254 - 2259
      Abstract: Background: Developmental and childhood neuropsychiatric disorders have a large burden throughout the world, including the developing countries. Many children with clinically identifiable developmental problems present late for medical help due to lack of simple measures for their early recognition. These missed opportunities increase the level of dependence and disability of an individual and decrease the productivity of the community at large. So simple measures are needed to determine NDIs at an early age where professional expertise is sparse.
      Authors objective was to estimate the proportion of children having NDIs in a tertiary care hospital, and to estimate the specific types of NDIs, and their grades of severity, within the study population.Methods: It was a cross sectional study conducted at the Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh and the duration of the study was six months. Children aged 0-2 years who were attending Pediatric OPD were included in the study. Sample was collected by lottery method and who fulfilled the inclusion criteria. A two-stage design was followed for detection of NDIs. Stage I was consisted of screening of all children in the sample by Development Screening Questionnaire (DSQ). Stage II consisted of neurodevelopmental assessment using a validated RNDA method of evaluation of all children with DSQ positive screening result.Results: 7.26% children were found to have DSQ positive for NDIs. Cognition and speech was the mostly affected domain. By RNDA, NDIs were found in all DSQ positive cases. Severe impairment was 35.29% of the affected children in speech by RNDA. Detection of NDIs was more in gross motor (52.94% vs 35.29%), fine motor (94.18% vs 17.65%), speech (76.47% vs 64.71%), cognition (94.18% vs 64.71%), behavior (58.82% vs 5.89%) respectively by RNDA than the DSQ.Conclusions: The frequency of NDIs is 7.26% of all children. In certain developmental domain (i.e. gross motor, fine motor, cognition, speech, behavior) RNDA is more effective than DSQ as found in the small-scale study.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194701
      Issue No: Vol. 6, No. 6 (2019)
  • Risk factors for mortality among Human Immuno Virus infected children on
           antiretroviral therapy

    • Authors: Sunil Bule, Minal Wade
      Pages: 2260 - 2266
      Abstract: Background: Children infected with HIV often reach the health care well after progression to severe immunosuppression which results in higher morbidity and mortality as compared to adults. They are vulnerable to faster disease progression compounded by susceptibility infections and social factors like attrition of caretakers. The present study delineates the factors for poor outcomes among HIV infected children.Methods: The records of HIV infected children from 1 to 15 years of age, started on HAART, registered at ART Centre at a tertiary hospital were reviewed in the Retrospective descriptive study. The demographic details, growth parameters, clinical features, WHO staging and investigations were assessed to study the risk factors for mortality in these children.Results: Amongst the 205 HIV infected children, enrolled in the study, the incidence of mortality was 27/205 (13.7%). The mean age of HIV infected children on ART in the no mortality and mortality group was 8.19 years and 8.25 years. The mean WHO stage of HIV infected children on ART in no mortality and mortality groups at the start of the study was 2.75 (SD=0.89) and 3.66 (SD=0.48), respectively. The mean CD4 count at start in the mortality group (195.85±105.57 cells/mm3) is significantly lower as compared to the no mortality group (306.2+355.66 cells/mm3). The mean grade of malnutrition in the no mortality and mortality groups was 1.84 and 2.88, respectively. Tuberculosis was present in 48.78% at start.Conclusions: Presence of advanced clinical stage, immunosuppression, poor nutritional state, and shorter duration of therapy are important factors deciding outcome of the children on HAART. The intense monitoring in period post starting of HAART will ensure better outcomes.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194537
      Issue No: Vol. 6, No. 6 (2019)
  • Incidence and clinico-demographic characteristics of neonatal meningitis
           in clinically suspected sepsis: an observational study

    • Authors: Rupali Jadhav, Baraturam Bhaisara, Anjali B Bhatawdekar
      Pages: 2267 - 2272
      Abstract: Background:
      Authors objective was to study the incidence and risk factors for meningitis in neonates with clinical suspicion of sepsis in Neonatal Intensive Care Unit (NICU) of tertiary care hospital of Mumbai, India.Methods: This descriptive observational study enrolled Consecutive 92 patients of either sex with suspected neonatal sepsis admitted in NICU of Tertiary Care Hospital. All neonates admitted to NICU with clinical suspicion of sepsis or developing signs of sepsis during NICU stay were included in study. Exclusion criteria were 1.Neonates with hemodynamic instability 2.major congenital malformations 3.contraindication or no willingness for Lumber puncture (LP ) 4.neonates who have received intravenous antibiotics for more than 24 hours elsewhere.Standard data collection form was used to collect all demographic data and clinical characteristics of neonates.Results: Incidence of meningitis in study population was 7.6%. Cases of meningitis in study population had mean birth weight 1.91 kg, 71.43% were preterm, 57.14% vaginaly delivered, 42.86% by LSCS, Premature rupture of membrane (PROM) observed in 28.57% cases. Meconium stained liquor in 42.86% cases and foul smelling liquor in 28.57% cases observed. 42.86% cases required resuscitation and 28.57% received surfactant therapy. Poor feeding (100%), lethargy (85.71%), weak cry (85.71%) and tachypnea (50.58%). Retractions (85.71%), Grunting (57.14%) and Nasal flaring (42.86%) were clinical presentation. Lab findings in a case of meningitis: mean Hemoglobin (Hb) 15.22 gm%, Leukopenia (28.57%), Leukocytosis 28.57%, Absolute Neutrophil count (ANC) <1800 (28.57%), Thrombocytopenia 42.85%, blood culture positive (28.57%) hypoglycemia (28.57%), CSF white cell count (124.57cells/ml.), mean CSF protein level (60 mg/dl.) Mean CSF glucose level (40.86 mg/dl.) CSF culture was positive in two cases of meningitis.Conclusions:
      Authors study highlights the diagnostic utility of routine lumbar puncture in neonates with clinically suspected sepsis.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194617
      Issue No: Vol. 6, No. 6 (2019)
  • Comparative study of cord blood lipid profile in preterm and post term

    • Authors: Pooja Pradeep, Arunkumar T., Sundari S.
      Pages: 2273 - 2276
      Abstract: Background: The fetal-origin hypothesis and fetal programming emphasize the profound and sustained impact of factors related to fetal health on the development of chronic disease in adulthood. Several studies suggested that low birth weight and preterm birth linked to abnormalities in cord lipid profile and higher prevalence of atherosclerotic cardiovascular disease.
      Authors objectives was to estimate and compare cord lipid profile in term, pre-term, and post-term neonates.Methods: In the study group, there were 200 healthy Polish newborns. Newborn characteristics included sex, gestational age at birth, Apgar score, and anthropometric data (weight and length at birth, neonatal ponderal index, head, chest and abdominal circumferences, placental weight, and placental-fetal weight ratio). Cord blood samples were collected for total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TG). Information regarding selected maternal factors was collected. Neonates were classified into preterm (<37 weeks) and term (≥37 weeks) based on new Ballard scoring.Results: The preterm had higher Total cholesterol compared to Term and post term and it was Statistically Significant with a p value of < 0.001. The preterm had higher Triglycerides compared to term and post term and it was statistically significant with a p value of <0.01. The preterm had higher HDL compared to Term and post term and it was statistically significant with a p value of <0.001. The preterm had higher LDL compared to Term and post term it was statistically significant with a p value of <0.001. The preterm had higher VLDL compared to Term and post term and it was statistically significant with a p value of <0.01.Conclusions: Abnormal intrauterine milieu created by maternal changes during gestation may bear a profound impact on lipid metabolism in neonates, which may account for their differences in lipid profile and anthropometry at birth.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194626
      Issue No: Vol. 6, No. 6 (2019)
  • Are parents and children aware of child sexual prevention education'

    • Authors: Yamini Batham, Sunita Koreti, Ajay Gaur
      Pages: 2277 - 2281
      Abstract: Background: India contains largest populations of child victim of sexual abuse. Current study aimed to find out awareness, orientation, execution of parents for child sexual abuse (CSA) prevention education and study the awareness of CSA prevention education among children attending pre-primary and primary school.Method: It was cross-sectional study carried out during 2016-2017 at government and private school of Gwalior. Total 500 parents and 500 children were selected  Proforma based assessment was done among parents and diagrammatic (picture) based assessment among children, Children are explained about diagrammatic proforma and give to color area of good touch and bad touch.Results: The study revealed that 34% of parents are unaware of various facts of child sexual abuse (p <0.005). Post graduate parents have more CSA awareness (90.3%) (p<0.001).Total36% parents have shown negative orientation towards child sexual abuse prevention education. CSA prevention awareness more in upper class parents (88.3%) as compared to lower class (43.8%) (p < 0. 001). post graduate parents have more CSA awareness as compared to illiterate and higher secondary. On assessing the knowledge of good touch and bad touch among children. It was found that only 6% of children have good knowledge, 36%children have some knowledge and 58 % no knowledge regarding good touch and bad touch .Conclusion: Majority of parents and kid are unaware of various fact of child sexual abuse. Parents education level has direct correlation, highly qualified mother father has positive attitude toward child sexual abuse prevention education. Lack of knowledge found in lower socioeconomic class.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194183
      Issue No: Vol. 6, No. 6 (2019)
  • Knowledge, attitude and practice of parents regarding antibiotic use in

    • Authors: Rasheena Shamshu, Shyam Sudhir, Haleema Nuwera
      Pages: 2282 - 2286
      Abstract: Background: Antibiotic resistance has become an emerging issue worldwide due to the rampant and excessive use of antibiotics for any and every condition. At present, antibiotics are the most commonly sold drugs in the developing countries which have been the cause for escalation of antibiotic resistance. Lack of knowledge, awareness and practice among parents regarding antibiotics use is the most important cause for antibiotic misuse.Methods: Cross sectional hospital based questionnaire study conducted among 200 parents of children attending the outpatient or inpatient department at Yenepoya Medical College Hospital, Mangalore; using personal interview method. Parents were asked to answer the statements on a 5-point Likert scale (“strongly agree”, “agree”, “uncertain”, “disagree”, “strongly disagree” or “never”, “sometimes”, “often”, “most of the time”, “always”). Statistical Package of social science (SPSS) software was used for analysis of data.Results: Out of the 200 parent’s majority of the respondents (69%) were mothers. There was very little difference in percentage of respondents that disagreed with notion that antibiotics must be administered in any case of fever (43.3%). 42.3% mentioned that antibiotics were always necessary in ARI. Most common symptoms to visit pediatrician included cough (23.4%), followed by ear pain (18.1%) and nasal discharge (12.9%). 17.5% of parents never questioned the pediatricians if antibiotic administration was necessary and more than 2/3rd of the parents declared that pediatricians provided sufficient information regarding diagnosis and therapy.Conclusions: Majority of parents admitted to self-administration of antibiotics. There is a need of intervention to increase awareness regarding judicious use of antibiotics and to check un-prescribed dispensing of antibiotics. Strategies for effective communication with patients and prudent prescription of antibiotics should be included in physician education to ensure patients’ adherence to advice and consequently to reduce self-medication with antibiotics.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194555
      Issue No: Vol. 6, No. 6 (2019)
  • A comparative study to determine intermittent versus continuous
           phototherapy for reducing neonatal hyperbilirubinemia at tertiary care
           hospital in Chennai, Tamil Nadu, India

    • Authors: Diksha Suri, Krithika A. P., R. Somasekar
      Pages: 2287 - 2291
      Abstract: Background: Phototherapy is safe and effective in neonatal hyperbilirubinemia. Despite its worldwide application, questions regarding methods of optimizing efficacy remain unanswered, turning the infant is believed to be one of the methods to improve. Severe neonatal hyperbilirubinemia is associated with kernicterus, condition characterized by athetoid spasticity, gaze and visual abnormalities, and sensory-neural hearing loss. It may also be associated with mental retardation. Aim of this study was conducted to compare the efficacy of intermittent with continuous phototherapy.Methods: Study was conducted in 100 neonates from February 2018 to July 2018 in Sree Balaji medical college and hospital. Inclusion criteria were weight >2000 grams, absence of other concomitant diseases, and hyperbilirubinemia not requiring exchange transfusion. The neonates were randomly divided into two groups. Continuous phototherapy group received phototherapy on and off for 2 hours and half an hour respectively and the intermittent phototherapy group on and then off for one hour. Serum total bilirubin levels were measured in every 36 hours.Results: Mean age of the patients was 3.89±1.83(p=.91) days, mean baseline bilirubin was 17.56mg/dl±1.42 (p=0.36), while the mean follow-up bilirubin was 12.85mg/dl±1.65 (p=.95), and the mean difference between the baseline and follow-up bilirubin was 4.7 mg/dl±1.19 (p=.32). For group A and B babies, the mean difference between the baseline and follow-up bilirubin was 4.78 mg/dl±1.20 (p=.32) and 4.63mg/dl±1.18(p=0.32) respectively. The difference between the mean age, mean baseline bilirubin, mean follow-up bilirubin, and the mean decrease in bilirubin for both the groups was statistically not significant.Conclusions: Intermittent and continuous phototherapies were found to be equally effective for reducing neonatal hyperbilirubinemia.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194536
      Issue No: Vol. 6, No. 6 (2019)
  • A clinical study of respiratory distress in neonates

    • Authors: Ramkesh Meena, Mallikarjun R. Kobal, Sharanabasappa S. Dhanwadkar, Ashwini Kumari N. B.
      Pages: 2292 - 2295
      Abstract: Background: Respiratory distress is a medical emergency responsible for most of the admissions in NICUs during neonatal period. It is a major contributor to neonatal morbidity and mortality and results from a variety of respiratory and non-respiratory etiology. It occurs in 0.96 to 12% of live births and responsible for about 20% of neonatal mortality. Aim of study to find out the proportion of patients with different etiology of respiratory distress in neonates.Methods: The present study is a prospective, descriptive study which was carried out at neonatal units attached to SMS Medical College, Jaipur. All the neonates with respiratory distress admitted in NICU admitted from April 2012 to March 2013were selected for the present study. Detailed history including antenatal history, natal history, postnatal history with thorough clinical examinations and investigations done in each case and were recorded in the performa.Results: A total of 500 neonates were admitted and among them 375 were inborn (delivered in our hospitals) and 125 out-born (referred to our hospitals from outside). In inborn group hyaline membrane disease (HMD) was the most common cause (32%) of respiratory distress and in out-born congenital pneumonia/septicaemia (34.4%). There was male preponderance in both inborn and out-born groups with male: female ratio 1.45:1 and 1.6:1 respectively.Conclusions: Majority of cases in both inborn and out-born groups were preterm (56.8% and 54.4% respectively) which emphasises the need for care of mother during antenatal period for prevention of premature delivery.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194168
      Issue No: Vol. 6, No. 6 (2019)
  • Growth outcome, feeding practices and co morbidities in follow up of
           discharged newborns from special newborn care unit Gwalior, India

    • Authors: Ajay Gaur, Prakash Petchimuthu
      Pages: 2296 - 2301
      Abstract: Background: In spite of advances in neonatal care, infant mortality is still high in India. Regular follow up of discharged newborns could bring down infant mortality and reduce long term disability by early identification and intervention. The primary objective of the study is evaluating the Special Newborn Care Unit(SNCU) graduates for Comorbidities, feeding and immunization practices, growth assessment and outcome during follow up.Methods: The discharged neonates from SNCU, GRMC were examined for their morbidity and growth monitoring done. Feeding and immunization practices were observed.Results: Among 100 neonates observed, 2 neonates were excluded and 41(41.8%) were females and 57(58.1%) were males. Major causes of indication of admission were prematurity (25.5%) and birth asphyxia (22.4%). During follow up, 23(23.4%) neonates had respiratory infections followed by 19 cases (19.3%) of diarrhea. Around 45(45.9%) infants’ weight fall between -1 to +1 SD which was around 55 infants during admission. Length monitoring showed that around 68(69.3%) infants length fall between -1 to +1 SD which was 72 during admission. Exclusive breast feeding was observed in 68(69.3%) infants, 7 infants (7.1%) were exclusively top fed, and 19 infants (19.3%) were mixed fed. Immunization was appropriately done in only 51 infants (52%). Retinopathy of prematurity was observed in 2 infants during follow up. Hearing difficulty was observed in 1 infant.Conclusions: Most common indication of admission in SNCU was prematurity. Most common comorbidity during follow up was respiratory infection. Weight monitoring of infants showed the reduction in weight during follow up than admission whereas length and head circumference was relatively static during admission and follow up.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194189
      Issue No: Vol. 6, No. 6 (2019)
  • Calf circumference to detect low birth weight babies: a comparative study

    • Authors: Pradheep Kumar Kokku, Himabindu Singh, Rakesh Kotha, Arjun Jadhavo, Alimelu Maddireddi, Nirmala Cherukuri, Sadiqua Anjum, Apoorva Tadury
      Pages: 2302 - 2308
      Abstract: Background: In developing countries 15 per cent of infants weigh less than 2,500 grams at birth .It is not possible to provide expensive weighing scales to the community members and families due to logistic (carrying a heavy scale) and operational (inability of Trained Birth Attenders to read) problems. Therefore it is essential to find out an alternative method for the estimation of birth weight. Almost 60 per cent of newborns in developing countries are not weighed. Which can lead to an underestimation of the incidence of low birth weight. That’s why  we done  present study  to know the simple indicators to detect low birth weight babies. Aim of this study to compare calf circumference with other Low birth weight indicators as a reliable predictor of low birth weight babies.Methods: It is a cross-sectional study done during period 2018 January to 2018 October done at Niloufer Hospital Hyderabad. Statistical analysis is done using SPSS (version 17) statistical software. For comparison Pearson's Correlation coefficients used.Results: The best correlation was observed with both calf circumference (r=0.818) and head circumference (r=0.744) for identifying babies with birth weight <2 kg. For babies with birth weight <2.5 kg, calf circumference had the highest order of correlation (r = 0.986) followed closely by head circumference (r=0.886).Conclusion: In the absence of a weighing machine, simple measurements like calf circumference is the best indicator in identifying low birth weight babies (<2.5kg) at birth.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194156
      Issue No: Vol. 6, No. 6 (2019)
  • A clinical, radiological and etiological study of neonatal pneumonia

    • Authors: Mallikarjun R. Kobal, Prashant S. Gadgi, Sharanabasappa S. Dhanwadkar, Ashwini Kumari N. B.
      Pages: 2309 - 2312
      Abstract: Background: Pneumonia contributes to between 7, 50,000 and 1.2 million neonatal deaths and an unknown number of stillbirths each year worldwide1. It is estimated that 3.9 million of the 10.8 million deaths in children annually worldwide occur in the first 28 days of life.2 Neonatal pneumonia can be preventable if it is diagnosed as early as possible. Early recognition and prompt management are essential for the better outcome.Aim and objective: To determine bacterial etiology of neonatal pneumonia and to study the risk factors associated with neonatal pneumonia.Methods: A prospective, descriptive study was conducted for the duration of one year from July 2014 to June 2015 in Pragna children’s Hospital, a tertiary care centre, Hyderabad, Telangana, India. A total of 100 neonates were admitted in Pragna children’s Hospital with the signs and symptoms of neonatal pneumonia. A detailed history was taken including age, obstetric history of the mother, detailed birth history including resuscitation details and gestational age assessment were evaluated.Results: Out of 100 cases, 39(39%) neonates were preterm babies and 61(61%) were term. Also found history of Prolonged Rupture of Membrane (PROM) in 22% cases, maternal fever in 18%, home deliveries in 14% and foul smelling liquor in 18%. Out of 100 cases, 51 (51%) cases had positive finding in Chest X-Ray for neonatal pneumonia and 57(57%) had pneumonia with septicemia. Out of 100 cases, 9% of cases are positive for Coagulase negative staphylococcus (CONS), 5% for Klebsiella pneumonia, 2% for Pseudomonas aeroginosa and the remaining 84% of the cases had no growth for any organism.Conclusions: Major predisposing factors included PROM, foul smelling liquor, maternal fever, and home deliveries. CONS was the commonest organism isolated in blood culture.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194614
      Issue No: Vol. 6, No. 6 (2019)
  • Effectiveness of awareness lecture in improving the knowledge about
           learning disability among primary school teachers

    • Authors: Basim Ali C. T., Fysal N., Akhila Thasneem A., Aswathy P. S.
      Pages: 2313 - 2318
      Abstract: Background: This study was done to assess the pre-existing knowledge about  Learning Disability (LD) among primary school teachers and the effect of awareness lecture on improving their skills in  early identification and remediation of LD among children having poor scholastic performance.Method: The study was conducted as a part of the IAP state President’s action plan 2018-2019 “VIBGYOR”. The study sample consisted of 709  primary school teachers of government schools in Malappuram district in Kerala. The teacher’s knowledge level on LD was assessed using a questionnaire following which an awareness class was given. Their knowledge level was assessed again at the end of the class.Results: There is a significant increase in knowledge level about learning disability among the teachers after the awareness lecture (p value<0.001).Conclusion: This study implicates the need for intensive training programmes to primary school teachers on learning disability so as to identify it at an early stage among children with poor scholastic performance.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194190
      Issue No: Vol. 6, No. 6 (2019)
  • Profile of neonatal mortality in special newborn care unit of tertiary
           care hospital

    • Authors: Ashutosh Kumar Sharma, Ajay Gaur
      Pages: 2319 - 2325
      Abstract: Background: In India presently around 8 million LBW infant are born each year. India accounts for 24% of global neonatal mortality. Improving NMR is an essential component of reducing U-5MR. The aim of this study was to determine the causes of morbidity and mortality in neonates admitted in our hospital.Methods:  This study was conducted at SNCU of Kamala Raja Hospital, Gwalior providing level III neonatal care. This is a retrospective hospital based observational study. Data from SNCU online database were taken for a period of 3 year from March 2016 to March 2019. Data obtained included sex, birth weight, Gestation age, morbidity profile, Diagnosis, and Mortality profile, Duration of stay and outcome. Categorical variables were tabulated and Statistical analysis was done.Results:  A total of 12,027 neonates were recruited, 63.07% were males and 36.92% were females. 54.87% were extramural, while 45.13% were intramural neonates. Prematurity was the most common morbidity 56.98% in the admitted neonates. Major contributors to the neonatal morbidity were Birth asphyxia (24.61%), others (21.60%), Respiratory Distress(14.06%), Sepsis(13.77%). The mortality rate in the present study is 25.45%. Major contributors for neonatal mortality includes Respiratory distress (37.76%), Birth Asphyxia (26.75%), Sepsis(13.91%). Mortality was more in out born babies 33.03% compared to inborn babies 22.03%. Conclusions:  Improving antenatal care, more deliveries at institutions with SNCU facility, improved access to health facility, early identification of danger signs,   timely referral of high risk cases, capacity building, can reduce neonatal mortality and its complications.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194205
      Issue No: Vol. 6, No. 6 (2019)
  • Thrombocytopenia in children 2 months to 12 years of age admitted in the
           paediatric intensive care unit of a tertiary care hospital

    • Authors: Jegan Murugan R., Manivannan V.
      Pages: 2326 - 2333
      Abstract: Background: To assess the etiology, clinical profile, complications, outcome and prognosis of children admitted in the paediatric ICU with thrombocytopeniaMethods: This study was done on children admitted to the paediatric ICU of Tirunelveli Medical College Hospital during the period from December 2011 to April 2012. 112 consecutive  patients aged  2 months to 12 years with platelet counts less than 1 lakh were studied.Results: One in 6.25 children admitted in the paediatric ICU developed thrombocytopenia(15.95%incidence).The commonest age group of presentation of is 6-10 years(47.3%).Infants(45.5%) died more. Dengue(58.8%) was the commonest etiology, followed by enteric fever(11.6%), acute lymphoblastic leukemia (all 4.5%), septicemia(4.5%), plasmodium vivax malaria (2.7%). Leading cause of mortality is dengue shock syndrome(DSS  44.4%). The most common presenting symptom among the study group is fever(95.5%). Abdominal distension and pedal edema were significantly associated with low platelet counts, bleeding manifestations, increased transfusion needs and a  poor outcome. The presence of Altered sensorium, tachycardia, tachypnea, shock, seizures at presentation were all associated with significant bleeding and high mortality. Gastrointestinal bleed(41.07%) was the commonest bleeding manifestation. There was no significant correlation between the exact platelet counts and the bleeding. Children with counts less than 10,000  had a poor outcome.(57.1% mortality). Gall bladder wall edema and pleural effusion in Ultrasound correlate significantly with bleeding.Conclusions:  Thrombocytopenia is common in sick children in  paediatric ICU and has a definite bearing on prognosis. Infants have poor prognosis and need intensive monitoring. Mortality predictors, if present, need aggressive management. There is no role for prophylactic transfusions, as platelet counts do not correlate with bleeding.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194157
      Issue No: Vol. 6, No. 6 (2019)
  • Quality improvement initiative: improving proportion of preterm infants on
           mothers only milk at the time of discharge

    • Authors: Sumandeep Kaur, Gurmeet Kaur, H. C. L. Rawat, Prajjwal Bansal, Amanpreet Sethi
      Pages: 2334 - 2339
      Abstract: Background: Availability of mothers only milk (MOM) for preterm infants is a boon for their growth and development.
      Authors found that in our Special Newborn Care Unit (SNCU), the availability of MOM was very less with excessive use of formula feed. So, authors planned a quality improvement (QI) study to improve availability of MOM for preterms in level 3 SNCU catering to both in-born and out-born neonates.Methods:
      Authors aimed to improve availability of MOM to preterm infants admitted in SNCU from the current 10% to 80% at day 7 of admission over a period of 8 weeks.
      Authors included preterm and mother dyads with <34 weeks of gestation or having birth weight <1800 gm. and likely to stay in SNCU for at least a week. For this initiative a QI team was formed. Baseline data was collected for a period of 3 weeks and analysis was performed of various constrains in providing MOM to preterms was later an interventional package was implemented which included counselling to mothers, Kangaroo mother care (KMC), demonstration of milk expression techniques. Intervention phase was implemented for the period of 8 weeks followed by sustenance phase for 2 months.Results: Proportion of preterm infants on MOM increased from 10% to 81% during intervention phase at day 7 of admission and remained 66% during sustenance phase.Conclusion: QI initiative has the potential to bring a tremendous change in making mothers milk available to both inborn and out-born preterms. With existing resources simple interventions can increase availability of MOM to preterm infants.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194613
      Issue No: Vol. 6, No. 6 (2019)
  • A study to assess the prevalence of hypertension in children with
           nephrotic syndrome

    • Authors: Manasa M., Anitha S. Prabhu, Santosh Pai, Kiran Raj H.
      Pages: 2340 - 2345
      Abstract: Background: Hypertension is been one of the most common co morbidity of this disease. It was mostly attributed to sodium retention, which is a major clinical feature of nephrotic syndrome. These mechanisms likely have a role in the development of hypertension in nephrotic syndrome, where hypertension may be difficult to control, and provide new therapeutic options for the management of blood pressure in the setting of nephrotic syndrome. Objective of study the prevalence of hypertension in children with NS and also the number of antihypertensive required to control it.Method: A Retrospective study of the hospital records of 100 children diagnosed with nephrotic syndrome admitted to Pediatric and Nephrology Ward at YMCH was accessed.Results: In our study 35 (35%) of them were Infrequent relapse nephrotic syndrome (IFNS) and 35(35%) were  Frequent relapse nephrotic syndrome (FRNS) ,while 30 cases (30%) were First episode nephrotic syndrome (FENS). 65 cases were steroid sensitive, while 28 and 7 of them were steroid dependent and resistant respectively. Of the 100 study population 54 of them had hypertension while 46 of them did not develop it .Of the 54 hypertensive nephrotic syndrome children, 15 of them (28.%) required three anti hypertensives to control the pressure, while 19 (35%) and 20 (37%) required single and dual anti hypertensives respectively.Conclusion: Prevalence of hypertension is increasing among the children with nephrotic syndrome. Its more prevalent among the male then female FRNS, SRNS and SDNS are more prone to develop hypertension and also they needed two or more antihypertensives to control the hypertension, whereas hypertension in SSNS could be managed with single drug.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194184
      Issue No: Vol. 6, No. 6 (2019)
  • A study on clinical profile of meconium aspiration syndrome in relation to
           gestational age and birth weight and their immediate outcome

    • Authors: Manivannan V., Jegan Murugan R., Devandiran R. S.
      Pages: 2346 - 2351
      Abstract: Background: Aim of the study was to understand the factors causing meconium aspiration syndrome (MAS) in relation to gestational age and birth weight and their immediate outcome.Methods: This study was done on babies admitted in the neonatal intensive care unit (NICU) of Thanjavur medical college hospital, who fulfilled the criteria of MAS. Babies born with meconium stained amniotic fluid (MSAF), were resuscitated as per NRP guidelines. The babies with complications of MAS were admitted to NICU and were observed for their immediate outcome in the hospital.Results: MAS occurred most commonly in babies having fetal distress and in mothers with history of PIH. It is seen more commonly in babies born through caesarean section and in term babies with mean gestational age of 38-40 weeks of gestation and mean birth weight of 2.71 kg. Most babies were depressed at birth and most common cause of mortality was hypoxic ischemic encephalopathy (HIE stage III), significantly contributing 37.5% of cases of MAS. There was significant and strong association between the birth weight and mortality. Thick MSAF was significantly associated with need for mechanical ventilation and subsequently higher mortality. Babies born through caesarean section with MAS also had significantly poor outcome.Conclusions: MAS is an entity which is commonly seen in term and post term babies with birth weight >2.5 kg. There is a significant correlation between the birth weight and outcome in MAS. When thick meconium stained liquor is noted prior to birth, anticipation is necessary and non vigorous babies need aggressive management and possibly early ventilation. Asphyxiated babies should be followed up astutely. Continuous monitoring and early intervention, followed by due resuscitation as per guidelines can reduce the morbidity, complications and the mortality in MAS.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194185
      Issue No: Vol. 6, No. 6 (2019)
  • Correlation of serum creatine phosphokinase and serum cholinesterase in
           organophosphate poisoning in children

    • Authors: Dhanalakshmi K., Febina K., Sarala Sabapathy, Chaithra R., Thileepan N.
      Pages: 2352 - 2356
      Abstract: Background: Organophosphate (OP) poisoning is one of the most common pesticide poisoning in India in adolescents because of its easy availability. Serum pseudocholinesterase levels are commonly used to assess the severity and to know the prognosis in OP compound poisoning. Serum creatine phosphokinase (CPK) levels is another lab parameter which gets deranged in OP poisoning and has been tried in adults to assess the severity and to know the prognosis. 
      Authors objective was to study the correlation of serum pseudocholinesterase and serum CPK in organophosphate poisoning at admission and to compare outcome with serum CPK levels.Methods: All the children in the age group of 1 month to 18 yrs, who were admitted with the history of suspected OP compound poisoning were enrolled for the study. Estimation of cholinesterase and CPK levels were done at admission and after 1 week. Patients were categorised in to latent, mild, moderate and severe cases based on the S. Cholinesterase levels. These values were analysed to see the correlation.Results: Among 34 OP poisoning cases,13(38%) were males and 21(62%) were females. Mean age of study population was12.6+4.25 yrs. The median CPK values in latent, mild, moderate and severe cases were 121.5 IU/L,276.5 IU/L, 308IU/L and 467IU/L respectively (p=0.015). Spearman’s rho Correlation coefficient was -0.522 between S. Cholinesterase and S CPK at admission which was significant. The median serum CPK level after 1week in non survivors was 2498.0IU/L and in survivors was 201.0IU/L (p0.014).Conclusions: There was a strong negative relationship between serum cholinesterase and serum CPK at admission in OP poisoning. Follow up values at 1 week showed that significantly high serum CPK and low cholinesterase, which was also significant and was associated with mortality.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194546
      Issue No: Vol. 6, No. 6 (2019)
  • Parental stress: a neglected entity

    • Authors: Nusrat R. Inamdar, Anvesh S. Tamboli, Anupama V. Mauskar, Suchit Tamboli
      Pages: 2357 - 2363
      Abstract: Background: Parents feel very stressed when their child is sick and in Intensive care unit. Objectives of study were to identify common parental stressors during their child’s critical illness and to examine its relationship with demographic variables.Methods: It’s a Cross-sectional questionnaire based study done in PICU & NICU of a tertiary care medical college hospital in Mumbai, 62 parents of children admitted to PICU and NICU for at least 24 hours were interviewed using the Parental Stress Scale. The demographic variables were also recorded.The data analyzed using Cluster Analysis, Kruskal Wallis test, Chi- square test and spearman correlation.Results: The main cause of parental stress was to witness the child’s sufferings (unresponsiveness/pain, procedures, tubes, monitors around child) (median of standardized score = 3.9, IQR = 0.5, p <0.005). The median of standardised stress score due to hospital environmental factors (monitor alarms, nurses, doctors around baby, other sick children) was 3.7 (IQR = 0.5) and that due to lack of intimacy with child was 3.6 (IQR =0.4). Age of parent inversely correlated with the level of stress (r = -0.638) and parents of infants were more stressed (p = 0.005). Number of children, socioeconomic status didn’t affect the stress levels.Conclusions: Young parents and parents of infants were more stressful. Socioeconomic status, residential area and parental sex didn’t affect stress. Few stress factors need remedial steps to meet parental needs. The clinician’s awareness about these stressors, may help to provide optimized family-directed care.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194539
      Issue No: Vol. 6, No. 6 (2019)
  • A cross sectional study to find incidence of clinically detectable
           congenital malformations and factors affecting it in tertiary care

    • Authors: Vikram V. Yaragatti, Shivanagouda .
      Pages: 2364 - 2368
      Abstract: Background: Congenital malformations are emerging as an important perinatal problem, contributing sizably to the perinatal mortality with considerable repercussions on the mothers and the families. Patients with multiple congenital anomalies present a relatively infrequent but tremendously difficult challenge to the pediatrician.
      Authors objective was to study the incidence of clinically detectable congenital malformations among consecutive births in hospital deliveries examined during hospital stay.Methods: A prospective cross sectional study was conducted in Department of Pediatrics at Dr R N Cooper Municipal General Hospital, Mumbai from June 2016 to June 2017. All live births from June 2016 to June 2017 were considered in the studyResults: The total number of deliveries in our hospital were 3120(100%) and the total number of babies with congenital anomaly were 43(1.4%), So the incidence of congenital anomalies amongst study population was 1.4%. The involvement of various systems was seen in our study. The involvement of CNS (9.3%), Eye (7%), ENT (28%), GIT (20.9%), Urinary Tract (2.3%), Musculoskeletal System (35%), Gentialia (7%), CVS (7%).Conclusions: Congenital malformation, one of the important causes of infant mortality and morbidity can be reduced by proper preconception care and level two anomaly scan. Congenital anomalies must be identified, as early diagnosis and surgical correction of malformed babies offer the best chance for survival.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194556
      Issue No: Vol. 6, No. 6 (2019)
  • Factors affecting compliance of drug therapy in outpatient children

    • Authors: Vikram R. Goudar, Mahantesh Matti, Vijay Kulkarni
      Pages: 2369 - 2373
      Abstract: Background: Adherence to a medical treatment regimen is an essential determinant of clinical success and professional success of doctor as well. Compared with the thousands of trials for individual drugs and treatments, there are few relatively rigorous trials of adherence interventions. Our study is a small effort towards understanding reasons for poor compliance among paediatric patients.Methods: The 256 cases that were selected for study had various clinical conditions. Compliance definition was applied only for those who received antibiotics. For other cases who received drugs other than antibiotics, we asked number of skipped doses. Data collected by paediatrician during follow-up or next visit because of some other illness and by telephone call to parents by assistant. Parents and kids were asked about the reasons for skipping the doses and also about their personal preferences towards medicines.Results: Out of 256 children 93 were prescribed antibiotics, 37.63% had good compliance and 62.36% had poor compliance.7% never skipped any medicine, 62% skipped less often (≤5 times) and 31% skipped. Very often (≥6 times), taste (67%), quantity (52%), apparent recovery (62%), school (65%), sleeping (56%), timing with food (47%) and bottle getting finished (49%) were the most common reasons for missing the dose of any medicine. Adherence was better when less number of doses were given less often. Chocolate flavor was liked by most kids.Conclusions: Prescribing medications should involve parents, children and practitioners in an open discussion around the most suitable, palatable formulations for successful treatment outcomes.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194557
      Issue No: Vol. 6, No. 6 (2019)
  • Effect of maternal age and gestational weight gain on anthropometry of the
           newborn in semi urban area of Chhattisgarh, India

    • Authors: Naresh P. Motwani, Ankit Jain, Sudhakar C.
      Pages: 2374 - 2378
      Abstract: Background: Maternal undernutrition is a known to be a major factor contributing to adverse pregnancy outcomes. Gestational weight gain and young maternal age at childbearing years is associated with an increased risk low birth weight babies and infant mortality.Methods: Prospective observational study carried out in the post-natal ward of a tertiary care hospital (CM hospital) in a semi-urban area over a period of 1 year in between March 2018 and March 2019. Total 150 mothers who satisfied the inclusion criteria were enrolled. Age of the mothers was noted and were divided into 5 groups. Last known pre-pregnancy weight was recorded on re-call basis, recorded data on first visit during first month of pregnancy and again they were weighed in the third trimester at the time of admission using standard electronic weight machine. Data collected were entered in Microsoft Excel Work sheet 2018 which was imported to SPSS (version16) for data analysis. Quantitative data has been analysed by Mean, Standard deviation, T test and Karl Pearson correlation.Results: Mean birth weight among young age  mother (<20 years) was 2068 g (95%CI,±223.99) which was significantly lower than mean birth weight of 20-30 year old mother (271.19 g±95%CI, 437.02) and >30 year old mother (2932.78, 95%CI±429.99). With increase in gestational weight gain there was a corresponding increase in mean birth weight and this increase was statistically significant (r=0.435, p=<0.001).Conclusions: Maternal age and gestational weight gain had significant impact on new-born anthropometry. Young age (<20yrs) and decreased gestational weight gain is associated with increased number of low birth weight babies.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194581
      Issue No: Vol. 6, No. 6 (2019)
  • Effectiveness of healthy eating and active lifestyle intervention program
           on physiological parameters among children with obesity

    • Authors: Ester Mary Pappiya, Sumathi Ganesan, Ibrahim Mubrak Al Baalharith
      Pages: 2379 - 2384
      Abstract: Background: The aim of the study was to investigate the effectiveness of Healthy Eating and Active Lifestyle Intervention Program (HEALIP) on physiological parameters among children with obesity.Methods: True experimental research design was adopted with 200 children between the age group of 12-18 years who met the inclusion criteria from four different schools in Chennai, Tamil Nadu, India. Samples were allocated into experimental group (n=100) and control group (n=100) by random sampling technique. Children were screened for weight, height, body mass index, and blood pressure were measured before as well as after the intervention. Healthy eating and active lifestyle intervention program were administered for the experimental group for 16 weeks, whereas the control group received routine practices. Post-test was conducted at the end of the 16th week for the both groups. Data were analysed using SPSS.Results: There was a difference in the pre-test systolic blood pressure (128.4±1.3) and post-test (118.6±0.7) and in the pre-test diastolic blood pressure (78.8±0.6) and post-test (72.8±0.6) mean value in the experimental group and found statistically significant at the level of p <0.001. It was also observed the significant difference between the experimental and control group.Conclusions: The finding of the study concluded that healthy eating and active lifestyle intervention program has proved the beneficial effect in maintaining the physiological parameters. Hence, it was concluded that there is a need to educate the children about the obesity and its complications. The study findings ensure that periodic monitoring of the basic physiological parameters among obese children will prevent the furthermore complications. 
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194702
      Issue No: Vol. 6, No. 6 (2019)
  • Effect of maternal height on neonatal outcomes in tertiary care hospital:
           a retrospective study

    • Authors: Poornima Shankar, Jayalalitha S. Marol, Muragesh Awati, Abhishek Manohar
      Pages: 2385 - 2389
      Abstract: Background: Global or regional evidence showed maternal height as a strong predictor of child survival. However, there is limited information that confirms the intergenerational effect of short maternal height on the risk of offspring mortality in Bangladesh. Therefore, this study aimed to examine the association of maternal height with neonatal morbidity and outcome.Methods: In this analysis authors took data of 100 women who delivered in Kempegowda Hospital in the year 2018 including anthropometry of the mother at admission, anthropometry of the newborn, NICU admissions. Neonatal outcome was assessed by birth weight, anthropometry and NICU admissions against maternal stature which was stratified into 4 groups.Results: Comparison of mean birth weight, head circumference and length showed significant relation with maternal height (p<0.001).Conclusions: Findings should draw the attention of the programme and policymakers to focus on improving maternal nutrition for better offspring nutrition, health and survival.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194703
      Issue No: Vol. 6, No. 6 (2019)
  • Clinical profile of Dengue fever in children of Nellore city, Andhra
           Pradesh, India

    • Authors: E. Kishore, Syam Sundar Junapudi
      Pages: 2390 - 2393
      Abstract: Background: India especially Andhra Pradesh is endemic for dengue, in dengue fever mortality and morbidity is more in children when compare to adults.
      Authors objective was to assess the clinical profile of the Dengue fever in children.Methods: Children below 14 years with serologically positive for dengue included in this study from June 2017 to June 2018, data was collected and analyzed with MS office 2016.Results: In 100 children 84 were suffering with Non Sever dengue , 16 were suffering with severe dengue. In the study population 68 were male children and 32 were female children, more children 68 were in the above 11 age group, 52 children stay in hospital for 3-6 days.Conclusions: Health education and anti-larval measures and anti-adult measures for mosquito control is effective measures.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194704
      Issue No: Vol. 6, No. 6 (2019)
  • Correlation of TOPS scoring with immediate outcome among neonates
           transported to special newborn care unit: a prospective study

    • Authors: Gargi H. Pathak, Anuya V. Chauhan, Priyanka B. Patel
      Pages: 2394 - 2397
      Abstract: Background: Several sick neonates require transfer to tertiary level care neonatal unit for treatment. The facilities of neonatal transport in India are not optimal and the newborn thus transported can become hypothermic, hypoxic and/or hypoglycemic which can affect the neonatal outcome. These parameters can be maintained during transport by adopting simple measures. The aim and objective of this study is to study impact of acute physiological parameters during transfer of neonates on their immediate outcome by using TOPS score. TOPS score - Temperature, Oxygenation, Perfusion (Assessed by capillary refill time), Blood sugar.Methods: This prospective observational study was conducted at the special newborn care unit, Civil Hospital, Ahmedabad enrolling 460 transported neonates. TOPS scoring for each neonate was done at admission, and then the parameters of the TOPS score were correlated with the outcome at 48 h of admission.Results: A total of 460 transported newborns were assessed, 47.8% newborns were hypothermic, 33.9% had poor perfusion, 27.8% were hypoxemic, and 22% were hypoglycemic. On correlating with the outcome, Hypoxemia and hypo perfusion had the highest sensitivity (92.2% and 57.3%, respectively) while hypoglycemia had the highest specificity (88%), for an adverse outcome.Conclusions: TOPS score is a useful and easy to use the method to assess the physiological status and predict early mortality in transported neonates.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194705
      Issue No: Vol. 6, No. 6 (2019)
  • Awareness of human papilloma virus vaccine among medical interns in
           tertiary health centre

    • Authors: C. Ashrita, Prasad Nayak N., Prakash Saldanha
      Pages: 2398 - 2401
      Abstract: Background: Human Papilloma virus [HPV] infection is one of the most common sexually transmitted disease[STD] in the entire world. In India, HPV infections stands as one of the first few major cause of STD among both male and female adolescents and adults. However studies done in major centers reveals that awareness about this disease among the general population is poor. Aim of this study was the awareness of HPV and its preventive measures among medical interns who have recently completed their graduation and doing medical internship in a tertiary care centre.Methods: Total 100 participants were subjected to questionnaire study which has questions on basic knowledge about HPV and its preventive measures. The data were analyzed using Microsoft excel software.Results: Statically 98% of the study population was aware of HPV, whereas 78% were having knowledge about the vaccine availability for prevention of HPV and only 55% of them knew that the vaccine is available for use in India.Conclusions: Although majority of participants are having knowledge about HPV, the awareness on vaccine and its potentials are very poor. It is very important to put more emphasis on educating medical, nursing, para medical students and interns of various discipline on HPV infection and its preventive measures.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194706
      Issue No: Vol. 6, No. 6 (2019)
  • Study of indications, complications and outcomes of neonatal transport by
           a skilled team

    • Authors: Karthik Ram Mohan, Rajesh Kumar
      Pages: 2402 - 2405
      Abstract: Background: A skilled transport team is an essential requirement for safe and effective neonatal transport. The transport team of this level III NICU in Chennai performs a considerable number of transports every year and a need was felt to study the indications, complications and outcomes of transport.Methods: Prospective Descriptive study of neonatal transports conducted 18 months Patients were divided into 2 main groups based on transport Duration: Short (≤1hr) and Long (>1hr) transport groups. TRIPS (Transport risk index of physiologic stability) score, a risk- weighted validated neonatal transport was used as a practical system for assessing infant transport careResults: During the study period 210 transports were performed from 12 cities and towns. 60% transports were of short duration. Respiratory causes were the most common indications (43.8%) followed by CNS causes (19.5%). 44.3%(93) patients required ventilation during the transport process. Overall, there was improvement in mean TRIPS 2 score compared to TRIPS 1 in all groups of patients (Short, Prolonged, Survivors and Non-survivors). Total mortality of transported group was 31 patients (14.8%). (Including 02 patients who died enroute). There were non-significant differences in 7 day mortality (7.6% vs 8.4%) and total mortality (13.9% vs 13.4%) between the groups. Complications that occurred during transport included hyperglycemia, prolonged CFT, hypothermia, accidental extubation enroute, hypoglycemia, hyperthermia, Hypotension, and persistent Hypoxia.Conclusions: It appears, that overall, duration of transport does not adversely affect outcome. Transport Team should be able to intubate and ventilate the baby and diagnose and manage complications like hypothermia, shock and hypoglycemia at referring hospital and enroute.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194707
      Issue No: Vol. 6, No. 6 (2019)
  • Audit of neonatal congenital anomalies required surgical intervention at
           tertiary care centre

    • Authors: Vinod Uplonkar, Nandkishor Shinde, Vikas Kumar
      Pages: 2406 - 2412
      Abstract: Background: Nearly 10% of neonatal deaths are due to congenital malformations requiring surgical intervention. Hence our aim is to study spectrum and outcome of the different neonatal congenital anomalies requiring surgical intervention.Methods: This prospective study was conducted over a period of 2 years. 130 cases which required surgical intervention in neonatal period were included in the study. Plain x-ray abdomen was done in all the cases of our study. Ultrasound scan was done in all the cases to rule out renal and other anomalies. Contrast radiography was also performed in selected cases. All cases underwent their respective operations depending upon the diagnoses. Complication and mortalities during hospital stay were noted.Results: During the study period total 130 neonates underwent surgical intervention. Out of 130 cases 5(3.84%) neonates had trachea-esophageal fistula, 2(1.53%) had pure esophageal atresia, 5(3.84%) had duodenal atresia, 9(6.92%) had jejunal atresia, 14(10.76%) had ileal atresia, 3 had meconium ileus(2.30%), 9(6.92%) had malrotation, 15(11.5%) had HD and 5(3.84%) had Meckel's diverticulum, 10(7.69%) had Hypertrophic Pyloric Stenosis, 2(1.53%) had gastroschisis, 3(2.30%) had omphalocele, 16(12.30%) had anorectal malformation, 4(3.07%) had Patent Vitello Intestinal Duct, 3(2.30%) had persistent patent urachus, 4(3.07%) had congenital diaphragmatic hernia, 1(0.76%) had Congenital Lobar Emphysema, 4(3.07%) had Neural Tube Defects, 8(6.15%) had Inguinal Hernia, 6(4.61%) had Posterior Urethral Valve and 2(1.53%) had Pelvi-ureteric Junction Obstruction. There were 85 males and 45 females (M: F-2:1). Septicaemia (40%) was most common complication, 21 (16.15%) cases had mortality.Conclusions: There is lack of awareness regarding dog bite and its management among the rural population.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194708
      Issue No: Vol. 6, No. 6 (2019)
  • Survey of obesity among school children in rural Kerala, India

    • Authors: Robin Joseph Abraham, Priyadarsini C. Pillai
      Pages: 2413 - 2418
      Abstract: Background: Childhood obesity is a risk factor for subsequent development of diabetes mellitus, hypertension etc. Rural children show lower levels of obesity and higher rates of malnutrion. Objectives: Study seeks to access the prevalence of obesity and overweight among higher secondary students in rural Kerala).Methods: 1577 students were selected from schools picked randomly in and around vadavukode block in Ernakulam district, Kerala, of which 761 from private and 816 from government and aided school. Their height, weight and BMI was recorded and plotted in WHO growth charts to assess stunting, wasting, overweight and obesity.Results: No difference was found among the government and private schools. The finding from the data tally with the results from other parts of rural India with overweight and obese children (around 10%). The study found 44% children were found to be undernourished. Malnutrition was noted in both private and public schools possible highlighting knowledge deficit on Nutrition may be the cause of malnutrition. Only 47% students were in the normal range.Conclusions: Rural Kerala is afflicted with a serious problem of undernutrition and lower levels of obesity. There was striking prelidiction for obesity was noted among stunted children in the study highlighting the complex nature of the nutrition problem in India where malnutrition and obesity coexist and cause double burden of diseases. The solution is to encourage the message of healthy living, equally to the over nourished and the undernourished, where balanced diet and exercise as a way of life is encouraged.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194709
      Issue No: Vol. 6, No. 6 (2019)
  • Incidence of culture proven neonatal sepsis, pattern of antibiotic
           sensitivity and clinical course in neonatal intensive care unit in
           tertiary care center in North India

    • Authors: Mohit Tayal, Abhishek Kumar Sharma, Ruchira Sharma
      Pages: 2419 - 2427
      Abstract: Background: Neonatal sepsis is a major cause of neonatal mortality, accounts for nearly half of all the neonatal deaths in our country. The incidence of neonatal septicemia ranges from 1 to 10 per 1000 live births. In our country the incidence of culture proven neonatal sepsis is 8.6 per 1000 live births, intramural data. Antibiotics are rapidly losing their effectiveness, with some early reports going so far to suggest that we are approaching a post-antibiotic era. Aims of this study was to find out the incidence of culture proven neonatal sepsis and to analyze data collected for mortality and morbidity in culture proven neonatal sepsis and antibiotic sensitivity pattern in culture proven neonatal sepsis at Neonatal Intensive Care Unit of Santokba Durlabhji Memorial Hospital (SDMH), Jaipur.Methods: The study included 129 newborn fulfilling the inclusion criteria, admitted into NICU of SDMH, Jaipur from 01st January 2013 to 31st December 2013, were investigated using various hematological and biochemical test e.g. CBC, Serum CRP, Blood culture and sensitivity, CSF examination includes cell counts, gram staining, biochemistry, culture and sensitivity etc.Results: Overall 722 cases admitted in NICU during the period of one-year 2013. Out of which 129 cases had blood culture proven neonatal sepsis (17.87%). 14.88% cases in P.C.U. and 21.79% cases in I.P.U. had positive blood culture sepsis with statistically significant difference (p value 0.016, <0.05).Conclusions: Antibiotic resistance is an emerging problem requires justified use of antibiotics.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194710
      Issue No: Vol. 6, No. 6 (2019)
  • Clinical and epidemiological profile of cleft lip/ palate deformities in
           Tamil Nadu, India

    • Authors: S. Prabakaran
      Pages: 2428 - 2432
      Abstract: Background: Cleft lip and palate deformities are commonly detected at the time of birth in most of the developing countries like India. The surgical management of cleft lip/ palate deformities involve multi-disciplinary approach with corrective measures from dental surgeon, plastic surgeon, speech pathologist and audiologist. The role of pediatricians in clinical management of cleft lip is often missed. This study was done to evaluate the clinical profile of cleft lip and palate deformities.Methods: This cross sectional study was carried out among 1077 patients diagnosed with cleft lip or cleft palate deformity for a period of 5 years between 2014 and 2019. A structured patient information schedule was prepared and data regarding the age, gender, antenatal details and parental history were recorded. A detailed clinical examination was carried out to evaluate the presence of complete and incomplete deformity in the lip, alveolus, hard palate and soft palate.Results: Complete cleft lip was present in 47.8% of the participants on the left side while on the right, complete cleft lip was present in 29.4% of the participants. Complete deformity of the alveolus on the left side was present in 45.4% of the participants while complete deformity on the right side of alveolus was present in 27.4% of the participants.Conclusions: It is important the pediatricians sensitize the parents regarding the clinical and supportive management and also initiate the surgical correction of this deformity with help of a multidisciplinary team.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194711
      Issue No: Vol. 6, No. 6 (2019)
  • A study on clinical profile and etiological agents of empyema in
           hospitalised children in Jaipur, India

    • Authors: Poonam Meena, Pankaj Kumar Jain, Abhishek Sharma, B. S. Sharma
      Pages: 2433 - 2437
      Abstract: Background: Objective is to study the clinical profile and etiological agents of empyema in hospitalised children in Jaipur.Methods: This hospital based prospective study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2016 to March 2017. Children between 1 month to 18 year of age having empyema thoracis (pleural tap showing pus cells under microscopy or on gross examination purulent exudates) were included in the study. Children with Empyema secondary to post-surgical or post-traumatic cause and with tubercular effusion were excluded from the study. Relevant history, clinical examination and investigation were done. Pleural fluid studies were done for cytology, biochemical analysis , culture and antibiotic sensitivity pattern.Results: Total 100 patients were included in study. Out of total 100 patients 62 (62%) were between 1 month to 5 years. Most common symptoms were fever (94%), breathlessness (87%) and cough (85%). 27% patients were severely malnourished as per IAP classification of PEM. Pleural fluid culture was positive in 29 (29%) patients. Most common organism isolated was Staphylococcus aureus (27%), 87.5% isolates of Staphylococcus aureus had sensitivity to vancomycin and linezolid.Conclusions: Empyema thoracis is frequently encountered complication of bacterial pneumonia. Fever, cough, and respiratory distress were the most common presenting complaints and severe acute malnutrition was an important risk factor. Staphylococcus aureus was found to be the most common organism for childhood empyema.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194712
      Issue No: Vol. 6, No. 6 (2019)
  • Non-alcoholic fatty liver disease in general paediatric population -
           associated factors and screening by Ultrasonography

    • Authors: Mounica L., Nair Bindu T., Dhagat Piyush
      Pages: 2438 - 2443
      Abstract: Background: Ultrasonography(USG) is an easily available and non-invasive method for screening the general paediatric population for prevalence of non-alcoholic fatty liver disease (NAFLD).Methods: This was a cross-sectional descriptive study conducted in the Paediatric Out Patient Department on 100 randomly selected children of school going age group (5-15 years). A detailed history regarding diet and lifestyle, anthropometric measurements of the children like height, weight , BMI and waist – hip ratio and blood pressure was correlated with USG of general paediatric population.Results: There were 4 cases of NAFLD of which one case was of normal weight. The study shows that the mean weight of normal population was 33.36 kgs. while the mean weight of children with fatty liver was 56.38 kgs. The mean value of systolic and diastolic blood pressure in normal population is 98.46 mmHg and 57.48 mmHg respectively while in that of children with NAFLD, it was 119.00 mmHg and 78.50 mmHg respectively. Among the dietary factors, increased intake of non-veg food, fast food, soft drinks and decreased intake of eggs and fish food is seen in children with NAFLD. Children with decreased physical activity also showed to have increased NAFLD.Conclusions: As NAFLD is seen even in children with normal weight, all children of general pediatric population can be screened for NAFLD by an easily available and non-invasive method like USG for an early intervention to prevent morbidity associated with NAFLD.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194713
      Issue No: Vol. 6, No. 6 (2019)
  • Correlates of picky eating behaviour in children and its effect on growth

    • Authors: Shweta Shettiwar, Minal Wade
      Pages: 2444 - 2449
      Abstract: Background: Picky eating is common in preschool-aged children. Children’s picky eating behaviour has been linked both to being overweight and underweight.
      Authors objectives was to study the factors associates of picky eating behaviour on growth and nutritional status of children.Methods: A Cross-sectional study done in 200 parents of children between 1-5 year age visiting outpatient department. Picky eating behaviours were assessed using questions from children eating behaviour questionnaire.Results: In the study, the estimated prevalence rate was 25%, maximum 38% at 49 to 60 months. 26% of subjects with picky eating behaviour had height for age <-3SD (severely stunted) 38% of subjects with picky eating behaviour had weight for height <-3SD (severely wasted) as compared to only 4% in non-picky eating behaviour subjects. Low birth weight and exclusive breast feeding for less than 6 month, were found to be significant risk factor for development of picky eating behaviour, while no significant association was seen with the time of introduction of semisolid complimentary feeds.Conclusions: Picky eating is major parental concern and impacts growth of children. The children with picky eating behaviours need to be monitored for growth.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194547
      Issue No: Vol. 6, No. 6 (2019)
  • Study of clincial profile and outcome of Klebsiella sepsis in neonates at
           a tertiary care centre

    • Authors: Sharath Chandra N., Mohamed Sajjid, Kamalrathnam C. N., Prakash V.
      Pages: 2450 - 2453
      Abstract: Background: Objective of the study is to study clinical profile and outcome of Klebsiella sepsis in neonates.Methods: A retrospective observational study from January 2018 to Sep 2018. After getting approval of institute ethics committee, admitted neonates whose blood culture showed Klebsiella growth were enrolled. A detailed history, birth weight, sex , age, APGAR, need for resuscitation at birth, distress at birth, ventilator support, CPAP, central line, blood products, species of Klebsiella and drug sensitivity and outcome-discharge or death were taken. Data were entered into Microsoft excel data sheet and was analyzed using SPSS 23 version software.Results: Out of the total 252 positive blood culture, 110 (43%) grew Klebsiella in blood culture. 92 cases were included in the study. Male to female ratio was 1.24:1. Mean age at admission was 1.22 days. 40 (43.5%) died and 52(56.5%) were discharged. Birth weight was 1.635±802 gm for babies who died and 2211±939 gm among discharged. Mean gestational age were 32.5 weeks in died and 34.8 weeks among discharged. Mortality was 23(57.5%) in males, low birth weight babies 23(59%), thrombocytopenia 28 (78%), invasive mode of ventilation 19(67%). By Univariate analysis, it was found that pregnancy induced hypertension (PIH), premature rupture of membrane (PROM), abnormal APGAR, Birth weight, shock, invasive ventilation, DIC, inotropes, blood products, abnormal total count, thrombocytopenia, umbilical venous catheterization were factors which influenced outcome. Regression analysis identified only thrombocytopenia and umbilical venous catheterization as factors that influenced outcome in Klebsiella sepsis. Klebsiella isolated was uniformly sensitive to Meropenam.Conclusions: No single risk factor was ascertained but thrombocytopenia and umbilical venous catheterization possibly influence the outcome of Klebsiella sepsis. Mortality is high in neonates.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194714
      Issue No: Vol. 6, No. 6 (2019)
  • A study of pattern of neonatal infections, socio-demographic correlates;
           clinical manifestations and bacteriological profile of neonatal infections

    • Authors: Bijayalakshmi Jena, Satyajit Behera
      Pages: 2454 - 2458
      Abstract: Background: In the newborns one of the leading causes of deaths and disease is septicemia. Classical clinical features are absent which poses a challenge for early diagnosis. Hence to prevent the deaths and diseases it is essential to go for early diagnosis and early treatment. Objective of this study pattern of neonatal infections, socio-demographic correlates; clinical manifestations and bacteriological profile of neonatal infections.Methods: A hospital based follow up study was carried out among total of 140 study subjects with age less than 28 days of life were studied over a period of one year. All these subjects were suspected to have neonatal septicaemia. Detailed history, thorough clinical examination was carried out. Samples were sent for culture and sensitivity. Subjects were followed till the outcome.Results: Among 2.02% was the incidence of the neonatal septicemia. Females were less affected than the males. Late onset septicemia was less common. Chest retraction was the most common clinical manifestation. Culture positivity rate was 44.29%. Gram-negative organisms were detected in 20 cases (64.5%). Case fatality rate was 17.14%. 41 babies (58.6%) affected by septicemia belonged to low socio economic status. 63 babies (90%) were diagnosed to have septicemia, 3 babies (4.28%) were affected by Meningitis, 2 babies were affected by pneumonia. 49 babies (50%) Belonged to Hindu both in case and control group,12 babies (42.9%) belonged to Buddhist in case group, 16 babies in control group.Conclusions: Males were more susceptible compared to the female babies as well those with higher birth weight. Late onset septicemia was less common.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194715
      Issue No: Vol. 6, No. 6 (2019)
  • Study of the prevalence of urinary tract infection in febrile children
           attending paediatric OPD in Government medical college and general
           hospital, Srikakulam, Andhra Pradesh, India

    • Authors: Pondugala Sunil Kumar, Dinendraram Ketireddi
      Pages: 2459 - 2462
      Abstract: Background: Children with fever comprise a major proportion of our practice in outpatient department of Paediatric. Among the fever cases Urinary tract infection is the third most common cause of febrile illness in children. The emphasis on identification of urinary tract infections in febrile children is minimal. Very often, children receive antibiotics empirically, without any adequate evaluation for urinary tract infection. The objective of our study is to determine the prevalence of urinary tract infection in all febrile children from 1months to 5 years of age.Methods: A prospective study was undertaken in the department of Pediatrics, Government medical college, Srikakulam. Urine was collected from enrolled febrile patients and sent for routine microscopic examination as well as for culture and sensitivity.Results: The study included 500 children. Females were 256(51.2%) and males were 244(48.8%). The total prevalence of UTI cases were 6%. The incidence in <1 year was 7.05%, 1-2 years was 5.97 % and >2 years was 5.35%. The prevalence of UTI was higher among females (7.68%) than males (4.68%). Apart from fever, the commonest symptoms were dysuria, abdominal pain, vomiting, chills and rigors and loss of appetite. Urine culture shows E. coli followed by Klebsiella were found to contribute the maximum number of cases.Conclusions: Possibility of Urinary Tract Infection must be considered in all febrile children and urine culture specimen must be collected as a part of diagnostic evaluation.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194716
      Issue No: Vol. 6, No. 6 (2019)
  • Clinico-epidemiological study of neonatal seizures from a tertiary care
           hospital of Western Rajasthan, India

    • Authors: Suresh Kumar Verma, Jagdish Chand Dabi, Sandeep Rawat, Basanti Dabi
      Pages: 2463 - 2468
      Abstract: Background: Neonatal Seizures are frequent may be either symptoms of an underlying disorder and malfunction of the developing CNS or due to a primary epileptic condition. Their varied clinical presentations, delay in recognition and treatment results in poor neurological outcome. This study attempts to find out the clinical and etiologic profile of neonatal seizures and associated biochemical abnormalities in this geographical part of India.Methods: A hospital based prospective observational study undertaken in a tertiary care pediatric hospital of Medical College Jodhpur India, on 202 consecutive neonates who presented with seizures during period of one year. A detailed antenatal history and baseline characteristics of convulsing neonate at admission and clinical details of each seizure episode reported by the mother and subsequently observed by doctors on duty were recorded. Venous blood sample was analyzed as soon as possible for blood glucose, total serum calcium levels and electrolytes, before instituting any treatment. Data were managed on Microsoft Excel spreadsheet, and analysis was performed using SPSS version.Results: The overall frequency of neonatal seizures in our set up was recorded as 4.08%. Perinatal asphyxia with subsequent HIE was the most common (40.09%) cause of neonatal seizures while hypoglycemia was the most common metabolic cause (11.38%) observed specially in VLBW babies. Subtle seizures were the most common type (34.65%) and tonic seizures were the second most common (33.66%) type of seizures encountered. Hypocalcemia was the second commonest biochemical abnormality found in primary metabolic seizures. HIE, ICH and Hypoglycemia were the common seizure etiology in preterm neonates.Conclusions: Perinatal asphyxia and subsequent HIE was the commonest etiology with subtle, tonic and multifocal seizures being the commonest clinical types encountered. Hypoglycemia and hypocalcemia were the most frequent biochemical abnormality found.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194717
      Issue No: Vol. 6, No. 6 (2019)
  • Knowledge, attitude and practice in parents of chronically transfused
           thalassemic patients regarding thalassemia in thalassemia day care unit in
           government medical college, Amritsar, Punjab, India

    • Authors: Riya Kaur Kalra, Dania Kaur, Manmeet Sodhi, Jasleen Kaur
      Pages: 2469 - 2475
      Abstract: Background: Thalassemia is a chronic debilitating disease that affects nearly 200 million people worldwide. A caregiver who has good knowledge regarding the disease can not only provide a better quality of care to his/her ward but also may spread knowledge in the society in which he/she lives which helps immensely in raising community awareness related to the disease.Methods: 50 caregivers (either mother or father) of chronically transfused thalassemic children were questioned regarding their knowledge, attitude and practice towards this disease, using a self-constructed questionnaire.Results: It was found that despite adequate knowledge regarding every aspect of this disease, there is a lack of attitude of practice towards prevention of this disease in their subsequent child or in their near and dear ones.Conclusions: There is a need to promote an attitude of practice in prevention of the birth of thalassemic children as mere knowledge regarding the disease is not enough in the present scenario where the disease burden is increasing as is the financial and emotional burden on the families. Role of Government sponsorship, a social worker and a child psychologist in the Thalassemia day care unit cannot be minimized.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194718
      Issue No: Vol. 6, No. 6 (2019)
  • A study on correlation of gall bladder wall thickness with severity of
           Dengue fever

    • Authors: Vijayalakshmi A., Sreelekha P., Kalashankar D.
      Pages: 2476 - 2479
      Abstract: Background: Dengue is an acute viral infection with potentially fatal complications. This study was done to describe the correlation of Gall bladder wall thickness with severity of Dengue fever and to predict the fatal outcome of Dengue fever at the earliest to prevent serious consequences by timely interventions.Methods: This was a hospital based prospective observational study conducted at Niloufer Hospital, a tertiary care pediatric hospital attached to Osmania Medical College, Hyderabad, Telangana, India from October 2017 to November 2018. All children between 1 year to 12 years of age that had clinical features of dengue and who were serologically confirmed were included in this study.Results: Age group most commonly affected was 5-8 years with maximum number of dengue cases without warning signs (55.7%). Majority of severe dengue cases (64.3%) had gall bladder wall thickness >5mm. The correlation between severity of dengue and gall bladder wall thickness was found to be highly significant indicating the higher the severity of dengue more the gall bladder thickness.Conclusions: This study concludes gallbladder wall thickness (GBWT) measured by ultrasonography can be used in children for early prediction of the severity of DHF in children and authors can include gall bladder wall thickness as an admission criteria during epidemics.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194719
      Issue No: Vol. 6, No. 6 (2019)
  • Comparison of hematological parameters among newborns with meconium
           stained amniotic fluid and clear amniotic fluid

    • Authors: Preeti Garg, Shruti Saxena
      Pages: 2480 - 2483
      Abstract: Background: Meconium stained amniotic fluid is an indirect marker of fetal hypoxia. Fetal hypoxia affects bone marrow and affects production of cell lines. Indirect marker of erythropoietin activity is nucleated red blood cells count. Aim of the study is to compare hematological parameter in newborn born with meconium stained liquor and clear amniotic fluid. Also, to determine cut off levels of nucleated RBC as marker of fetal hypoxia in meconium stained amniotic fluid(MSAF).Methods: The study was conducted over a period of 2 years from January 2012 to January 2014 in Department of Pediatrics, Sri Aurobindo medical college and hospital, Indore. One hundred newborns with meconium stained amniotic fluid (study group) and one hundred newborns with clear amniotic fluids (control group) were studied in this period. Cord blood samples were collected and hematological parameters were compared.Results: Hemoglobin % and WBC counts were seen in study group in comparison to control group, which is statistically significant (P<0.05). The reported NRBC/100 WBC between the two groups was statistically analyzed. The mean NRBC count in study group were 8.09±6.09 which was statistically higher than the corresponding values in control group 2.07±2.25 (P<0.05).Conclusions: Study concluded that the hemoglobin levels , WBC and NRBC counts in babies with meconium stained amniotic fluid is higher than those babies delivered with clear amniotic fluid and NRBC can be taken as a surrogate marker of hypoxia in a resource limited setting.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194720
      Issue No: Vol. 6, No. 6 (2019)
  • Development delay in children with severe acute malnutrition and its
           association with Vitamin B12 deficiency

    • Authors: Aishvarya Adhualia, Manisha Maurya, A. D. Tewari
      Pages: 2484 - 2488
      Abstract: Background: About half of the under five children are malnourished in India and so is morbidity associated with it. Malnutrition is also associated with multiple vitamin deficiency one of which is vitamin B12. Vitamin B12 is essential for DNA, RNA and protein synthesis; and for myelination of brain during the early childhood period. Deficiency of vitamin B12 can lead to megaloblastic anemia and neurological problems. So, authors aimed to look prevalence of vitamin B12 deficiency and; its hematological and neurological effects in severe acute malnourished children.Methods: it was an observational case control study, in which severe acute malnourished (SAM) children aged 0- 59 months who were admitted in Nutritional Rehabilitation Centre (NRC) were enrolled. Vitamin B12 levels were estimated and levels <200 pg/ml, 200-350 pg/ml, and >350 pg/ml were considered deficient, insufficiency and sufficient. Complete blood count was done for hematological effects and; developmental assessment was done to look for neurological effects.Results: Vitamin B12 was deficient, insufficient, normal in 15(16.3%), 25 (27.5%) and 52 (56.5%) children respectively. Vitamin B12 deficiency was significantly associated with hyperpigmentation and glossitis. Infant and young child feeding practices were not associated vitamin B12 deficiency. Macrocytic anemia was found in 23.4% SAM children and macrocytosis was not significantly associated with vitamin B12 deficiency.  Developmental delay was found in 55.3 % children and was not significantly associated with severe acute malnutrition. Conclusions: There is high prevalence of Vitamin B12 deficiency and insufficiency in children with severe acute malnourished children. Macrocytic anemia and developmental delay are not significantly associated with vitamin B12 deficiency.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194721
      Issue No: Vol. 6, No. 6 (2019)
  • Determinants of severe acute malnutrition in children between six months
           to five year of age enrolled in nutritional rehabilitation centre at a
           tertiary care level

    • Authors: Gargi H. Pathak, Anuya V. Chauhan, Sunita O. Beniwal
      Pages: 2489 - 2492
      Abstract: Background: Indicators showing levels of nutritional status in children are often regarded as representative of the health and general well-being of a society at large. Malnutrition stands as a consequence of several key social and economic factors such as lack of education, inadequate health care services and ill-informed cultural behaviors.  In order to holistically address the issues surrounding malnutrition, a comprehensive understanding of the multi-dimensional complexities at play in society is crucial. Objective was to identify determinants of severe acute malnutrition among children with severe acute malnutrition under 5 years (between 6 months to 60 months) of age. Methods: A cross sectional study design involving 64 patients with severe acute malnutrition between 6 to 60 month of age was employed to identify the risk factors of severe acute malnutrition among children admitted in pediatric wards and nutritional rehabilitation centers, Civil hospital Ahmedabad, from April 2018 to march 2019. A detailed history of all the patients were taken and data collected using structured interviewer-administered questionnaire.Results: Thus, from the above study, it is clear  that age of the child <2 years, female gender, bigger family size, poverty, illiteracy in mother, poor feeding practices, improper complementary feed introduction, poor nutritional status of mother whose child were breastfed, acute or chronic illness in child and narrow birth spacing were the chief determinants of SAM in under five children.Conclusions: Socio demographic characters, nutrition and child caring practices, infection and other childhood illness as well as obstetric history of mother are important determinants of severe acute malnutrition in children under five years of age. As a result, collaborative efforts should be organized to improve promotion of better child caring practices through appropriate age specific child and maternal feeding practices, prevention and early treatment of acute childhood illnesses and promotion of family planning.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194722
      Issue No: Vol. 6, No. 6 (2019)
  • Prognostic significance of initial management of childhood diarrhoea in
           rural areas: an observational study

    • Authors: Poorva Gohiya, Varsha Shrivastava, Rashmi Dwivedi
      Pages: 2493 - 2496
      Abstract: Background: To identify current evidence in order to guide scaling up of initial management of diarrhoea among children of age group 2-60 months in rural areas of the country.Methods: This hospital based cross sectional study included all children 2 months to 60 months of age admitted with chief complains of loose stools in the last 7 days over a period of one year. A pre-tested questionnaire was used as the data collection tool and face to face interviews were conducted on mothers of children.  All the data were analyzed using IBM SPSS version 20 software. Chi-square/Fisher Exact/ Student t-test and ANOVA test has been used. Significance was assessed at 5%.Results: Data showed the use of antibiotic in 55.9% cases, IV fluids in 50.3%, ORS in 6.7%, zinc in 2.0% and blood transfusion in 13.8% cases as an initial management of diarrhoea in peripheral health care centers. Of these, 37.6% cases were severely dehydrated, and 8.14% cases were in shock at the time of admission. 10.1% mothers did not intervene in the first 3 days of the disease whereas 45.2% consulted some health care center only in the later part. 4.5% cases expired after admission of which 69% were malnourished.Conclusions: This study summarizes the importance of initial management of a child with diarrhoea in defining the further course of the disease and also the failure of effective promotion and propagation of the most appropriate and cost-effective therapy (ORS and Zinc) for diarrhoea in this part of the country. Pre-existing malnutrition further complicates the situation.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194723
      Issue No: Vol. 6, No. 6 (2019)
  • Epidemiological analysis of central nervous system tumors in pediatric
           patients from a tertiary care centre in India

    • Authors: Rinu Dwivedi, P. Sudhapriya, P. Padmavathi, Vivek Sharma, V. V. Rameshchandra, B. C.M. Prasad, K. V.S. Sarma
      Pages: 2497 - 2503
      Abstract: Background: Tumors of the nervous system are the second most common childhood cancer after leukemia. The diagnosis of CNS tumors is challenging due to non-specific symptoms in children which mimic other less serious illness.Methods: This was a retrospective analysis of case records of patients from 0-18 years of age, who were diagnosed with CNS tumors for a period of 7 years.Results: Out of total 64 patients included in this study, 32 were females and 24 were males. The mean age was 13.2 years. The most common clinical presentation in patients with brain tumors was headache (92.3%) followed by visual symptoms in the form of blurring or loss of vision (42.3%) and swaying while walking (32.6%). The overall mean symptom interval for all patients was 274.8 days (approx. 9 months) ranging from 7-1820 days. In the present study out of total 64 patients, 54 were brain tumors (35 supratentorial and 19 infratentorial) and 10 were spinal tumors. The most common tumor location was cerebellum (21.8%) followed by cerebral cortex, spine and sellar area. Based on histopathology the most common tumor type in our study was astrocytoma. There was no significant correlation of symptom interval with age and gender but was significantly associated with location and tumor grade.Conclusions: Early referral to centers with appropriate facilities will help, as many pediatric CNS tumors are low grade with better survival.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194724
      Issue No: Vol. 6, No. 6 (2019)
  • Study on electrolyte disturbances in dengue fever in a tertiary care

    • Authors: Poornima Shankar, Nithya E., Kavya C.
      Pages: 2504 - 2508
      Abstract: Background: Dengue is a mosquito borne disease of significant morbidity and mortality. Dengue viral infection has been shown to be associated with electrolyte abnormalities and renal dysfunction. It is necessary to have a thorough understanding about electrolyte disturbances in Dengue, so as to predict, diagnose and treat them accordingly. The aim and objective of this study is to study electrolyte disturbances in dengue fever and its correlation with severity of dengue fever.Methods: This study was performed in a tertiary care centre in Bangalore , India. The study was a prosspective observational study. 200 Patients diagnosed with Dengue were enrolled for the study. Patients demographic data, clinical history, electrolyte values were recorded and analysed.Results: In our study majority of patients belonged to 5-12 years age group ie 47%. Fever was found to be the most common presentation in 196 patients (98%) followed by myalgia in 142 patients (71%), headache in 102 patients (51%), skin rash in 43 patients (21.5%). The mean value of serum sodium observed was 133.69 mEq/L and of serum potassium was 3.58 mEq/L and there was positive and significant correlation between difference in serum sodium and potassium levels with severity of dengue fever.Conclusions: Dyselectrolytemia is more common in dengue fever. Serum electrolytes testing early is very important in dengue patients during management so that if abnormalities are found, they can be appropriately managed as some of these abnormalities may lead to increased severity as well as mortality.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194725
      Issue No: Vol. 6, No. 6 (2019)
  • Pre-schoolers bronchial asthma in the primary health care centres:
           physicians' knowledge and practice in Jazan region Saudi Arabia

    • Authors: Gassem Ali Gohal, Ebtihal Elameen Eltyeb
      Pages: 2509 - 2515
      Abstract: Background: The aim of this study was to assess the knowledge and practice of primary health care (PHC) physicians in the diagnosis and management of preschoolers’ bronchial asthma in Jazan region in Saudi Arabia.Methods: A survey of 106 primary care physicians practicing in Jazan region was conducted. Domains that assessed include asthma causes, diagnosis, management, and prognosis. Item formats included self-reports through online version questionnaire during the period December 2018 to February 2019.Results: Among 72% of participants were general practitioners, with about 60% were mid-level experience (1-10 years), overall PHC physician level of knowledge and practice was moderate level, and the knowledge was significantly affected by grade of specialty, years of experience, and the number of bronchial asthma patients seen in the last three months in the center. This study showed mis concepts and mal practices of PHC physicians as 57% of them considered prescribing antibiotics during asthma attacks, while 72% agreed that anti-cough therapy is helpful in asthma like symptoms.Conclusions: This study proves that PHC physician in Jazan region are moderately aware of preschoolers’ bronchial asthma if compared to studies done in other regions of Saudi Arabia. There are certain practices and concepts regarding preschooler’s asthma that need to be revised. Raising the awareness regarding adherence to guidelines of pediatrics bronchial asthma mandates more attention and advocacy.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194726
      Issue No: Vol. 6, No. 6 (2019)
  • Hyponatremia in children with severe pneumonia and its effect on overall

    • Authors: Mampy Das, Bhupendra Narain
      Pages: 2516 - 2521
      Abstract: Background: Severe pneumonia is often associated with dyselectrolytemia, most commonly hyponatremia and the level of sodium significantly correlates to the overall outcome of the patient. The present study was conducted to identify the incidence of hyponatremia in children with Severe Pneumonia and to identify its association with Syndrome of Inappropriate secretion of Anti Diuretic Hormone (SIADH) and the effect on morbidity, mortality and duration of hospital stay.Methods: This study was conducted on 102 children between the age group of 6 months to 5 years admitted to the Upgraded Department of Pediatrics, Patna Medical College and Hospital with clinically and radiologically confirmed severe pneumonia from March 2017 to September 2018.Results: There were 33(32.4%) cases of hyponatremia out of which 26(25.5%), 5(4.9%) and 2(1.9%) had mild, moderate and severe hyponatremia respectively. 19(57.6%) cases of hyponatremia were due to SIADH out of which the duration of hospital stay was prolonged in 10(52.6%) cases, 10(52.6%) cases developed complications and 7(36.8%) patients died. The mortality of patients with hyponatremia was significantly higher (p<0.05) in the group with SIADH when compared to those without SIADH. The average duration of stay in hospital also was significantly higher (p<0.05) for the group with hyponatremia i.e. 8.2±4.5 days when compared to the group with normnatremia i.e. 7.3±1.7 days.Conclusions: Hyponatremia is commonly associated with Severe Pneumonia. Hyponatremia is usually mild and results in prolonged hospital stay, increased complications and mortality especially when associated with SIADH.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194727
      Issue No: Vol. 6, No. 6 (2019)
  • A cross-sectional study of the distribution of pediatric solid tumors at
           an Indian tertiary cancer centre

    • Authors: Monali Madhukar Patole
      Pages: 2522 - 2525
      Abstract: Background: Pediatric solid tumors include a heterogeneous group of tumors, and the burden of these tumors, especially from resource-challenged countries, is not well described. The aim of this study was to describe the distribution of solid tumors in children in an Indian tertiary cancer center.Methods: All patients under 12 years of age with histologically confirmed tumors presenting at a tertiary cancer center from January 2014 to January 2019 were identified from the hospital database. Patients with lymphomas, bone, and central nervous tumors were excluded. The demographic profile including age, sex distribution, and the treatment received were recorded for all patients. Results: The mean age of the eligible 153 patients was 5.7 years with majority (57.3%) in the 0-5 years age group. The male-to-female ratio was 1.6:1 with a male predominance in all tumors except germ cell tumors. Renal tumors were the most common tumors followed by neuroblastoma and soft tissue sarcoma, whereas germ cell and gonadal tumors formed only 8.49% of all tumors.Conclusions: Extracranial and extraosseous pediatric solid tumors include a wide range of tumors with a predilection for male sex and children below 4 years of age. Wilms tumors, neuroblastoma, and soft tissue sarcomas tumors are the most common tumors.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194728
      Issue No: Vol. 6, No. 6 (2019)
  • Awareness about thalassemia and feasibility of cascade screening in
           families of thalassemia major patients

    • Authors: Leeha Singh, Minal Wade, Mukesh Agrawal
      Pages: 2526 - 2531
      Abstract: Background: The main objective of this study is to assess knowledge and attitude of parents & extended relatives of children diagnosed with Thalassemia major and to evaluate feasibility of screening of extended families for thalassemia trait by correlating their willingness to get screened with actual screening.Methods: This was a cross sectional type of descriptive  analytical study, conducted at the thalassemia day care center at a tertiary care teaching hospital in western India among 230 study population using a pre-designed and pre-validated structured questionnaire.Results: We found the overall knowledge score of parents about thalassemia was significantly better than relatives. About 95.83% of parents and only 31.86% of the relatives amongst the study population had adequate knowledge. Majority of study population (84.61% relatives and 100% parents) had positive attitude. The significant contributing factors for knowledge and attitude towards thalassemia were age, marital status, education level, religion and per capita monthly income. 2% relatives agreed to get themselves screened for thalassemia status out of which only 20% got themselves screened.Conclusions: This study has identified key areas which need to be highlighted and emphasized in public awareness campaigns for thalassemia screening in India.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194582
      Issue No: Vol. 6, No. 6 (2019)
  • Knowledge, attitude and practice among mothers regarding common childhood

    • Authors: Muralidhar Gundluru, Harisha Gopal
      Pages: 2532 - 2537
      Abstract: Background: Since 1990 the global under-5 mortality rate has dropped from 91 deaths per 1000 live births in 1990 to 43 in 2015. But the rate of this reduction in under-5 mortality was insufficient to reach the MDG target of a two-thirds reduction of 1990 mortality levels by the year 2015. Leading causes of death in children under-5 years are preterm birth complications, pneumonia, birth asphyxia, diarrhoea and malaria.Methods: Present study is a cross sectional observational study conducted in the Department of Paediatrics, in JJM Medical College, Davanagere. Source of data was primary caregivers (mothers, fathers, grandparents, other relatives or guardians) of children between the age group of 1 month-5 years. This study is a structured questionnaire based cross-sectional observational study. Data collected was analysed using descriptive and inferential statistics.Results: Out of the 350 primary caregivers, 146(41.71%) were mothers, 97(27.71%) were fathers, 57(16.28%) were grandparents. Taboos and cultural beliefs to ward of illness were commonly practiced among this study group. 26% believed in skin branding their children during febrile episodes or convulsions. 8% believed that ear piercings would prevent diarrhoeal illnesses and infant deaths while 6% felt that amulets prevent respiratory illness and mortality. Overall knowledge among primary caregivers regarding common childhood illnesses was found to be good.Conclusions: Knowledge and attitude among primary caregivers regarding common childhood illnesses is favourable but the practices and perceptions are not satisfactory. Improving literacy rates will have a significant impact on reduction of childhood mortality. Socioeconomic development of the urban community can improve care seeking behaviour during the childhood illness.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194729
      Issue No: Vol. 6, No. 6 (2019)
  • Analysis of serum lactate levels to predict in hospital mortality in
           critically ill children admitted to pediatric intensive care unit

    • Authors: Trilok Rao Srigiri, Partha Saradhi Manyam, Uma Mahesh, Gangadhar Belavadi
      Pages: 2538 - 2543
      Abstract: Background: The predictive significance of lactate measurement at admission for mortality in critically ill children remains uncertain.
      Authors   objectives was to study evaluated the predictive value of blood lactate levels at admission and determined the cut-off values for predicting in-hospital mortality in the critically ill pediatric population.Methods: A prospective observational study was done in 100 critically ill admissions to the pediatric intensive care unit (PICU), requiring hemodynamic/respiratory support.  The chi-square test for categorical variables performs the comparison.Results:  Out of 100 patients, 22 (22%) expired. Mortality is highest in 10-16 age (7%). In the non-survivor group, the majority of patients were diagnosed as pneumonia (7.5%). Median lactate levels in non-survivors are 4.5 at admission when compared to 2.0 in survivors (p<0.001). The mortality rates left rate in the high lactate group (73%) is more when compared to intermediate (20%) and low-level groups (7%). Blood lactate was 75% sensitive and 90% specific at the optimal cut-off value of 33.7 mg/dl. The positive likelihood ratio of predicting death is more with a high lactate level (7.5) when compared to intermediate (0.8) and low levels (0.08). Sensitivity and Specificity with elevated lactate levels is the mortality 24 hrs (89%, 92%) than at admission (75%, 90%). The AUROC values with the admission lactate level are 0.86, and after 24 hrs are 0.95.Conclusions: Blood lactate levels at admission predict mortality in critically ill children requiring hemodynamic/respiratory support.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194730
      Issue No: Vol. 6, No. 6 (2019)
  • Knowledge and practices among caregivers in cases of persisitent diarrhoea
           in children of age group 6 months-12 years

    • Authors: Swetleena Mandavi, Varsha Shrivastava, Yamini Jamod
      Pages: 2544 - 2548
      Abstract: Background: Persistent diarrhoea has a variety of infectious and non-infectious etiology and it seriously affects the growth and development of children. The objective of the is to the identify the knowledge and practices prevalent amongst caregivers of children to understand environmental and behavioral risk factors and their interactions associated with the disease and its management.Methods: It is a hospital based cross-sectional study which included 70 children in the age group 6 months-12 years admitted in a tertiary care center at Bhopal over a period of one year with complaints of loose stools lasting for more than 14 days. A pre-tested questionnaire was used as a data collection tool for face-to-face interviews with the mothers or caretakers of the cases. Statistical analysis was done using Statistical Package of Social Science (SPSS Version 20; Chicago Inc., USA). Data comparison was done by applying specific statistical tests to find out the statistical significance of the comparisons.Results: Most of children’s mother were Illiterate, 27.1% were educated till primary school and only 5.7% were graduate. Out of 70 cases, most of 51(72.8%) were have understanding that drinking untreated water is a risk factor, only 11(15.7%) understands the value of filtered water and 8(11.4%) know the importance of doing boiling. Most of 46(65.7%) were using open field for sanitation and only 11(15.7%) were using toilets at home. 42(60.0%) were having the habit of hand washing before taking meal. Conclusions: Community education about the prevention and management of diarrhoea will reduce the mortality and morbidity associated with persistent diarrhoea.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194731
      Issue No: Vol. 6, No. 6 (2019)
  • Syndrome of inappropriate antidiuretic hormone secretion in neonates with
           birth asphyxia at tertiary care centre

    • Authors: Vijayalaxmi Gagandeep, Vidhya P. S.
      Pages: 2549 - 2553
      Abstract: Background: Syndrome of inappropriate antidiuretic hormone is an important metabolic complication of perinatal asphyxia. This study aims to study the occurrence of syndrome of inappropriate antidiuretic hormone in different grades of perinatal asphyxia and to find out the correlation of syndrome of inappropriate antidiuretic hormone to gestational age and birth weight in birth asphyxiated babies.Methods: It was a hospital-based cohort study. 50 neonates with different grades of asphyxia were enrolled in the study and 50 controls were taken. Syndrome of inappropriate antidiuretic hormone was diagnosed based on calculated plasma osmolality, serum and urine sodium, urine specific gravity and analyzed with different grades of birth asphyxia and birthweight and gestation age.Results: The occurrence of SIADH in birth asphyxiated babies was 26% and none of the babies in control group developed SIADH. The occurrence was more in the severely asphyxiated babies (53.8%), followed by moderate (30.8%) and then mildly asphyxiated babies (15.4%). Hyponatremia was seen in 26% of birth asphyxiated babies and can be used as a marker of SIADH. In relation to gestation age and birth weight there was no statistically significant correlation between SIADH and different grades of asphyxia. Mortality was high among the neonates who developed SIADH.Conclusions: The occurrence of SIADH was 26% in asphyxiated neonates and high in severe asphyxia and gestation age and birth weight beard no significant co relation.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194732
      Issue No: Vol. 6, No. 6 (2019)
  • Prevalence of possible depression and associated biosocial risk factors
           among adolescents in a private school in Chennai, South India

    • Authors: Aravind Sunderavel Kumaravel Kanagavelu, Vishnu Chidambaram, Subalakshmi Jayachandar
      Pages: 2554 - 2558
      Abstract: Background: Depression among adolescents is often undetected because of lack of awareness in mental health. Schools are the best place to study, analyze and report adolescent depression. The objective of this survey is to find out the prevalence of possible depression and associated bio-social risk factors among high school going adolescents aged 15 and 16 years. This can help reform school curriculum based on the prevalence of depression.Methods: A school based cross-sectional study done by randomly selecting 10 classrooms from the 11th standard high school compartment in a private school. Data was collected using a pre-designed and structured questionnaire based on Kutcher’s Adolescent Depression Scale. The results were analyzed using R Studio software with Pearson Chi-square test and a p-value of <0.05 was considered statistically significant.Results: Out of 486 students included in the study, 164(33.7%) have ‘possible depression’ and adolescents aged 16 years(39.5%) has higher proportion of possible depression than adolescents aged 15 years(29.2%), which is statistically significant(p=0.016). About 46.2% of adolescents having illiterate mothers had a possibility of depression. With regards to physical activity 28.1% who played for 3 hours and more had depressive signs and adolescents who played less had 37.2%. This difference is statistically significant (p=0.039).Conclusions: Being a dormant and hidden disease, depression is one such disease that must be probed by regular health screening. Mother’s literacy status and a modifiable factor ‘physical activity’ have shown promising statistical significance. Adequate physical activity must be included in school curriculum to reduce the risk of depression.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194733
      Issue No: Vol. 6, No. 6 (2019)
  • Volume guarantee ventilation in premature neonates with respiratory
           distress: a comparative study

    • Authors: Sudheer K. A., Sunil B., P. K. Rajiv, Mathew Kripail, E. Nithya
      Pages: 2559 - 2565
      Abstract: Background: Respiratory distress syndrome (RDS) occurs in about 50% of preterm infants born at less than 30 weeks of gestational age. Surfactant therapy and mechanical ventilation have been the standard of care in the management of RDS. Objective of this study to compare the time required to achieve successful extubation criteria in Volume guarantee mode of ventilation to that with Time cycled pressure-limited mode of ventilation and the duration of mechanical ventilation between them in preterm neonates ventilated for respiratory distress syndrome.Method: The study was done at Neonatal intensive care unit, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala over a period of 2 years. Total of 37 inborn preterm neonates between 26 weeks to 32weeks with RDS requiring mechanical ventilation were included in 2-year study period with 18 babies in 1st year study period ventilated with SIPPV mode and 19 babies in 2nd year study period on SIPPV–VG mode of ventilation. Analysis was done using SPSS v. 16 software.Results: In the present study the neonates receiving SIPPV-VG ventilation had stable and equivalent gas exchange at significantly lower MAP and PIP compared to neonates receiving SIPPV -TCPL. Also, neonates receiving SIPPV-VG had achieved significantly faster extubation criteria than SIPPV-TCPL and hence lesser duration of ventilation.Conclusion: Our study concludes that Volume Guarantee ventilation achieves near stable tidal volume delivery by auto-weaning peak inspiratory pressures thereby promoting early extubation and hence reducing volutrauma and barotrauma in contrast to TCPL mode.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194734
      Issue No: Vol. 6, No. 6 (2019)
  • Study on impact of protein energy malnutrition on development in children

    • Authors: Dhara Patel, Greeshma Issac
      Pages: 2566 - 2570
      Abstract: Background: Majority of the children in India who live below the poverty line in an environment of deprivation and starvation have physical and developmental retardation. The Objective of this study to study the impact and comparison of protein energy malnutrition on the development with normal children.Methods: This was a hospital based cross sectional study in which total 128 cases of protein energy malnutrition and 30 normal children were enrolled from nutritional rehabilitation center and in patients wards. The study population comprised of children less than 5 years of age, having weight for height/length ≤3 SD, with visible wasting, or bipedal oedema, with mid arm circumference <11.5 cm were assessed for their development in all four domains using Denver II developmental Screening Test (DDST-II).Results: The gross motor milestones are affected in 62.5% with grade4 PEM & 42.85% with grade 3, the fine motor component is affected more in grade 4 with other domains less affected, no significant relation of language delay with PEM was observed in this study, 40% of children with grade 4 PEM shows delay in social domain while 18.18% of the patients with grade 3 PEM show delay in social domain. No patients with grade 1 or grade 2 PEM showed delay in social domain. All four domains are affected in PEM with a maximum effect in gross motor, but the difference does not seem to be significant as the p value is 0.3 i.e.  >0.05 which is insignificant.Conclusions: My study on the effect of protein energy malnutrition on development proves that there in increasing delay in all the domains of development with increasing grade of malnutrition. Early detection of malnutrition in community can cause early intervention and increase the productivity of nation.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194735
      Issue No: Vol. 6, No. 6 (2019)
  • Clinical profile of pulmonary tuberculosis and MDR TB in children at
           tertiary medical institute

    • Authors: Anupama Vinayak Mauskar, Amrit Gopan
      Pages: 2571 - 2576
      Abstract: Background: India is the country with highest burden of TB. There is paucity of data as far as Pediatric TB is concern. TB in children directly reflects intensity of on-going transmission of TB in a given community. This study was done including indoor cases of Pediatric pulmonary TB in a medical college hospital, a tertiary care institute in the city of Mumbai. The aim and objectives of this study the clinical profile and outcome of Pediatric pulmonary tuberculosis/MDR TB in an indoor setting of a tertiary care center. It was a clinical observational study in a setting of medical college hospital.Methods: All admitted children with newly diagnosed pulmonary TB were included in study. A detailed clinical analysis was done. Statistical Analysis Association between two qualitative data was assessed by Chi-Square test, Fisher's exact test for all 2 X 2 tables where Chi-Square test was not valid due to small counts. Comparison of quantitative data measured between two outcomes was done using unpaired t-test. PSPP version 0.8.5 was used for statistical analysis.Results: Total of 41 patients with pulmonary TB were included in the study, making admission rate of 0.7% of total admission. Three out of 41 children had MDRTB making incidence 7% of total TB patients. Severe acute malnutrition was a major risk factor for dissemination of disease and mortality (p value 0.031and 0.0017).Conclusions: The study estimates 0.7% admission rate and 7% as incidence of MDRTB in indoor patients. Severe malnutrition was found to be risk factor for dissemination of disease [p value 0.031].
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194736
      Issue No: Vol. 6, No. 6 (2019)
  • Study on risk factors of respiratory distress syndrome in term neonates: a
           retrospective case-control study

    • Authors: Sunil B., E. Nithya, Girish N.
      Pages: 2577 - 2581
      Abstract: Background: Respiratory distress syndrome (RDS) is one of the most common causes of neonatal respiratory failure and neonatal death. It is more common in preterm neonates but also been found in term and late preterm neonates. This study aims at studying the risk  factors for developing RDS in term neonates. Objectives was to study the maternal and perinatal risk factors for RDS in term neonates.Methods: This is a retrospective case control study conducted in neonatal intensive care unit of tertiary care centre. A total of 100 term neonates with RDS were taken as cases and 150 normal term neonates were taken as control. Data were collected from the hospital NICU records, maternal and neonatal history was taken. The χ2 tests or Fisher’s exact text were used for one-way risk factor analysis. The effects of multiple factors on term neonatal RDS were analyzed using logistic regression analysis.Results: In our study RDS in term neonates  was significantly associated with following risk factors like selective cesarean section, male sex, SGA, oligohydramnios, MSAF, severe fetal distress, birth asphyxia, PROM, and maternal-fetal infection. Among the significant risk factors severe birth asphyxia, maternal-fetal infection, PROM, MSAF were showing positive association with RDS in full-term neonates.Conclusions: Several high-risk factors such as severe birth asphyxia, maternal-fetal infection, PROM, and MSAF were closely correlated with full-term neonatal RDS. Hence these could provide a significant reference for the diagnosis and treatment of term neonatal RDS.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194737
      Issue No: Vol. 6, No. 6 (2019)
  • A study on screen time use in children between 24 to 60 months of age in
           Tamilnadu, India

    • Authors: S. Alph Shirley, S. Santha Kumar
      Pages: 2582 - 2586
      Abstract: Background: This study was done with the objective of finding the average daily duration and pattern of screen time use in children in the age group of 24 to 60 months in the state of Tamilnadu, India and to find the correlation between screen time and demographic parameters.Methods: This cross-sectional observational study was conducted at the state of Tamilnadu, India from June 2019 to August 2019 among 148 children in play school and kindergarten classes in the age group of 24 to 60 months fulfilling the inclusion and exclusion criteria. Details regarding screen time use were collected from the parents using a predesigned questionnaire and analyzed using suitable statistical methods.Results: A total of 148 children (77(52.0%) male and 71(48.0%) female) were studied. The average daily screen time in the study group was 139.4 minutes (SD: 1.6). Majority of the children had a screen time duration between 61 to 120 minutes (48.6%). Only 14.2% had a screen time of ≤60 minutes as per AAP and WHO recommendations. Majority of the screen time was used to watch children’s entertainment programs and play games (67.6%). 83.1% of the children were using 2 or more screen types. Television and smart phones were the commonest screen types used by children in this age group. The percentage of children with average daily screen time ≤ 60 minutes was found to be more in joint families (16.3%) compared to nuclear families (10%). But this difference was not statistically significant. No statistically significant correlation was found between screen time duration in children and age, gender, parent’s socioeconomic status, education and occupation.Conclusions: Increasing screen time activity in early childhood is an emerging problem of the digital age which requires interventions at family, social and healthcare levels.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194738
      Issue No: Vol. 6, No. 6 (2019)
  • Referral profile of child guidance clinic of a tertiary care hospital in
           central Maharashtra: a retrospective observational study

    • Authors: Smita M. Mundada, Shilpa Y. Pawar, Amol R. Suryavanshi, Prabha Khaire, Prajit Prasad
      Pages: 2587 - 2592
      Abstract: Background: Developmental disabilities occur in approximately 5-10% of the childhood population. The paucity of data regarding the burden and risk factors slows down the programs and policymaking actions for these highly prevalent conditions in developing countries.Methods: A retrospective review of records of 264 children below 12 years referred to CGC of a Tertiary Care Hospital from November 2016 to December 2018 was done. Data was analysed using SPSS software and is described in terms of frequency and mean.    Results: 264 new cases that were referred to the CGC were enrolled. The mean age of referral was 2.54 yrs. (±1.00) with M: F ratio being 1.4:1. In religion, Hindu predominance (56.4%) was found.76.5% hailed from urban area. 39% of all cases showed Consanguinity.37% belonged to Class IV(Upper Lower) and 89% had chronic malnutrition. 46.2% of cases had NICU stay of which perinatal asphyxia(PA) was found in 40%.Majority of children (45.7%) had Global developmental delay (GDD)/Mental Retardation (MR), 37.7% had various forms of CP, Attention Deficit Hyperactivity Disorder(ADHD) was seen in 13%, 3.4% had Autism, 4.5% had specific language disorder, Learning disability  was seen in 2.7% and only 2.7% had Isolated motor delay.Conclusions: Early Intervention services for children lag behind in developing countries and the proportion of children referred to CGC with severe disabling conditions is high. This study provides baseline data for further planning of services and interventions for these children in Maharashtra.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194739
      Issue No: Vol. 6, No. 6 (2019)
  • Assessment of nutritional status of children aged 34-92 months using
           various nutritional status indices and validity of age independent indices

    • Authors: Nayantara R. Gandra, Kalavathy Jasmine Masillamoni
      Pages: 2593 - 2597
      Abstract: Background: Even though there are many programs run by Government to tackle the problem of malnutrition in India, problem of malnutrition is still there. Malnutrition leads to infections and even can lead to death of child in severe cases. The mortality rate is very high compared to other countries. The objective of the study to study validity of age independent various nutritional status indices in comparison to gold standard of weight for ageMethods: Present study was institution based cross sectional study carried out at SDA high school, from January 2019 to July 2019 among 58 school children aged 34-92 months of age. Anthropometric measurements like weight, height, head circumference, chest circumference, mid arm circumference were recorded as per the standard guidelines. Weight for height, weight of age, Kanawati Index, Jeliffe’s ratio, Rao index, and Dugdales index was calculated. Gold standard used was weight for age. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for these indices.Results: Majority of the children belonged to 48-60 months and 61-72 months i.e. 29.3% each. Males were more than females. Prevalence of malnutrition was 60.3%, 48.3%, 51.7%, 91.4%, and 56.8% based on weight for age, Kanawati index, Rao index, Jeliffe’s ratio and Dugdale’s index respectively. Dugdale’s index was found to have high sensitivity (85.7%) and specificity (86.9%) compared to all other indices.Conclusions: Among age independent indices of nutritional status available, Dugdales index can be used as it has been found that it has remarkably higher sensitivity and specificity compared to other age independent indices of nutritional status.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194740
      Issue No: Vol. 6, No. 6 (2019)
  • Assessment of overweight and obesity among urban adolescents

    • Authors: Ansh Chaudhary, Aarati Pokale, A. P. S. Narula, Bhupendra Chaudhary, Ankita Misra, Ayush Jain
      Pages: 2598 - 2604
      Abstract: Background: Obesity is defined as the abnormal growth of adipose tissue due to enlargement of fat cell size or increase in their number or a combination of both. Adolescents are nutritionally vulnerable age group considering their increased nutritional needs, eating patterns, lifestyle and susceptibility to environmental influences. The present study was conducted with aims to access the prevalence of overweight and obesity among urban adolescents and to study various factors associated with overweight and obesity.Methods: A community based cross sectional study of 872 adolescents of both sexes in urban population of Pune, Maharashtra, India was conducted to assess prevalence and various factors influencing overweight and obesity, especially type of diet, frequency of junk foods, physical activity and sleeping habits. The Body Mass Index (BMI) and Waist-Hip Ratio (WHR) were used to define overweight and obesity as per WHO growth standards.Results: The prevalence of overweight and obesity in urban adolescents according to BMI were 17.4% and 6.9% respectively with overall prevalence being 24.3% but with Waist-Hip Ratio (WHR) it was 43.1%. Risk factors in urban areas were consumption of fast/junk food, carbonated drink, physical inactivity while afternoon sleep was not a significant factor.Conclusions: This study showed an increased prevalence of overweight and obesity in urban adolescents especially in those who have more consumption of fast food, carbonated drink, those who were either inactive or engaged in physical activity for less than 30 min/day were strongly associated with overweight and obesity.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194618
      Issue No: Vol. 6, No. 6 (2019)
  • Alphabet problems linked with learning disability in children: a cross
           sectional study

    • Authors: Raghavendra K., Venkatesh Reddy A. N.
      Pages: 2605 - 2609
      Abstract: Background: Learning Disability (LD) is a frequently neglected entity in our set up, with the affected children being labeled as dull and worthless. The feeling of inadequacy and shame leads to psychological problems in approx. 30% of these children. These include low self-esteem, school phobia, anxiety, depression, oppositional-defiant behavior and conduct disorders. Early recognition of this disability in the primary school children and initiating appropriate remedial measures can significantly reduce morbidity.
      Authors objective was to study the prevalence and pattern of alphabet problems in children with learning disability.Methods: This was a cross sectional study done in the Child Guidance Clinic of a tertiary care teaching hospital in Chitradurga district, Karnataka, between January 2016 and January 2018. After obtaining informed consent from parents, children between ages 5 to 17 years, diagnosed to have learning disability, were asked to write upper and lower case alphabets in English. Alphabet problem was diagnosed if child had mixing of upper and lower case alphabets, missing of alphabets, reversals and improper sequence. Association of alphabet problems with age and sex was studied.Results: There were 293 children with learning disability, between 5-17 yr of age, attending our Child Guidance Clinic, who were assessed for alphabet problems. Alphabet problems were noted in 83.6% children. Mixing of upper and lower case alphabets was seen in 74.74%, missing of alphabets in 25.94%, reversal of alphabet in 21.50% and errors in sequencing in 12.97%. The prevalence of alphabet problems was higher in the 5-8yr age group. Prevalence of alphabet problems was more in males compared to females.Conclusions: Alphabet problems were present in a significant number of children with learning disability. Presence of alphabet problems could be used as a simple screening tool for children with learning disabilities.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194641
      Issue No: Vol. 6, No. 6 (2019)
  • Simple predictors to differentiate acute respiratory infections from acute
           asthma in children 6 months to 5 years

    • Authors: Krithika Manikumar, Pooja Pradeep, R. Somasekar
      Pages: 2610 - 2617
      Abstract: Background: Acute respiratory infections constitute one of the principal causes of morbidity and mortality in children less than five years of age in developing countries. For logistic reasons, WHO recommended case management is structured towards treatment as pneumonia in preference to acute asthma. It is warned that wheezing can occur during pneumonia and therefore, care must be taken when treating wheezing not to miss treating pneumonia with an antibiotic. Current WHO ARI CASE MANAGEMENT guidelines, in a child presenting with cough and rapid breathing, there is a predilection for over -treatment of pneumonia and under treatment of asthma.Methods: Totally 245 children were included in the study. They were classified into asthmatic and LRI prone with the help of simple predictors.Results: The combination of fever, chest indrawing and persistent tachypnoea after bronchodilator has an excellent specificity of 96.12% in predicting the presence of pulmonary infiltrate. The presence of more than two episodes of similar respiratory distress, previous H/O of nebulization and family H/O asthma, either alone or in combination may point more towards asthma as a cause of cough and respiratory distress.Conclusions: In a child presenting with cough and fast breathing with a previous similar episode, trial nebulization can be given before investigating further for pneumonia.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194741
      Issue No: Vol. 6, No. 6 (2019)
  • Pattern of changes in liver enzymes SGPT, SGOT level during Dengue
           infection in hospitalized pediatrics patients in tertiary care centre

    • Authors: Nazeer Ahmad Jeergal, Riyaz Ahmed F. K., Riyaz Ahmed F. K., Ayesha Siddiqa, Ayesha Siddiqa, Ravindra G. Naganoor, Ravindra G. Naganoor
      Pages: 2618 - 2621
      Abstract: Background: Hepatic involvement is not an uncommon in dengue viral infection, which presents with elevation in serum aminotransferases due to reactive hepatitis. The study is aimed to know the pattern of changes in hepatic enzyme levels in dengue infection in pediatric patients and to assess it with clinical presentation of dengue in particularly patients without and with shock.Methods: Pediatric patients with serologically confirmed Dengue viral infection were enrolled in the study and divided clinically into a shock group and a non-shock group. SGPT and SGOT levels were measured from day one of fever onset till 7 days and within 3 days after shock in the shock group. Student t-test was used to analyze the statistical data.Results: 100 patients with a mean age of 8±2.6 years were included in the study. The incidence of abnormal SGOT and SGPT levels were 96.9% and 51.1% in the shock group, and 92.2% and 45% in the non-shock group respectively. 30% and 17.9% of the patients in shock group and only 9.9% and 4.2% in non-shock group had the respective SGOT and SGPT levels > 200 U/L. Patients in shock group had statistically higher levels of Serum aminotransferase compared to the non-shock group. SGOT tended to increase starting from one day before shock and continued to increase within a few days whereas SGPT was less likely to be affected.Conclusions: Pediatric patients with Dengue infection have raised Aminotransferases in particular SGOT, which is higher than SGPT level. Aminotransferase levels in shock patients are significantly high and increases up to 3 days.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194742
      Issue No: Vol. 6, No. 6 (2019)
  • Syncope in children clinicoetiological correlation

    • Authors: Madhura Fadnis, Shakuntala Prabhu, Sumitra Venkatesh, Shilpa Kulkarni
      Pages: 2622 - 2627
      Abstract: Background: Syncope is the abrupt cessation of cerebral blood flow leading to temporary loss of consciousness. Identification of etiology is utmost important as any syncopal event may be life threatening. Aim was to correlate the clinical and etiological causes of syncope in children and to note their investigational profile.Methods: Among 40 patients presenting with syncope and presyncope were studied. History of the event, precipitating factors were noted. They were investigated with the help of blood pressure, Electrocardiogram (ECG), 2D Echocardiogram and Electroencephalogram (EEG).Results: Out of the 40 patients of syncope 65% were above the age of 10 years with male preponderance (60%). Vasovagal syncope (57%) was the most common cause of syncope followed by orthostatic hypotension (15%), neurological (15%), and cardiac etiology (6%). In the neurological etiology the EEG showed diffuse slow background with occasional sharp bursts in right frontal area in 2 patients while in 4 patients sharp bursts were present in the centero-temporal region. 17% were classified as presyncope, 60% as mild and 22% as having severe syncope. There was a significant correlation of etiology of syncope with duration of hospitalization of more than 4 days and with recurrence of syncope. There was significant correlation of Evaluation of Guidelines in Syncope (EGSYS) score >3 with cardiogenic syncope. On follow up, neurological syncope patients had significant decrease in the number of syncopal episodes as they were immediately started on antiepileptics.Conclusions: Electrocardiogram, 2D Echocardiogram and Electroencephalogram are important tools for the early management and treatment of cardiac and neurological etiology of syncope.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194743
      Issue No: Vol. 6, No. 6 (2019)
  • Study on acute encephalitis syndrome in children and their correlation
           with clinical parameters and etiological factors

    • Authors: Maram Nagarjuna Reddy, Gangadhar Belavadi, Vaka Hari Priyanka
      Pages: 2628 - 2633
      Abstract:  Background: Acute encephalitis is the clinical diagnosis of children with acute onset of symptoms and signs of inflammatory lesions in the brain. It must be diagnosed promptly for saving life and preserving brain functions.
      Authors objectives was to determine the profile and outcome of children admitted with Acute Encephalitis Syndrome (AES) and to identify etiological factors.Methods: Study consist of a retrospective analysis of hospital records of children up to 15 years of age admitted with a diagnosis of AES in the pediatric ward, Narayana medical college, Nellore from January 2018 to June 2019.Results: In a total of 30 patients of AES, clinical features like fever (100%), altered sensorium (100%), convulsion (40%), headache (45%) and neuro deficit (40%) and vomiting (50%). The average Glasgow coma scale at admission was 8. There are 55% of cases in the 5 to15 yr age group (p>0.05). Both Encephalitis (56.6%) and meningitis (43.3%) were documented significantly more in males as compared to females (p<0.01). Twenty-one cases are discharged, eight expired, and 1 case was referred (p<0.001). JE IgM positive cases contributed to 36.6%, of which eight males and three females recorded between 5-15 years. Male children are more likely to play outdoors where the mosquito vector of the disease is abundant.Conclusions: JE has significant morbidity and mortality, can be prevented by immunization, and reduced if supportive interventions are provided in time. Preventive measures must be taken for 5-15 years of age group those playing outdoors, going to school or agriculture fields predisposing them to vector mosquito bite.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194744
      Issue No: Vol. 6, No. 6 (2019)
  • A prospective cohort study of enteric pathogens in human immunodeficiency
           virus-infected Indian children and their relationship with diarrheal

    • Authors: Pooja Dewan, Dhano Mardi, Sunil Gomber, Rumpa Saha
      Pages: 2634 - 2641
      Abstract: Background: Opportunistic intestinal infections can increase the risk of death 11- fold in Human immunodeficiency virus (HIV) infected children presenting with diarrhea. Understanding the etiology of diarrhea and its predictors can help strategize a targeted approach to reduce child mortality due to diarrhea in this vulnerable group.
      Authors aim was  to compare the enteric pathogens in HIV-infected children with and without acute diarrhea, to assess the association between carriage of enteric pathogens in HIV-infected children and the occurrence of diarrhea within the next 3 months and to ascertain the relationship between enteric pathogens in HIV-infected children with their immunological and nutritional status.Methods: Stool samples were collected from HIV-infected children with acute diarrhea (n=41) and without diarrhea (n=52). All samples were subjected to microscopic examination, modified acid-fast and Trichrome staining, hanging drop examination, and bacterial culture. Serology for Cryptosporidium parvum was determined. Children who had received any antimicrobial therapy within the previous 2 weeks were excluded. Participants were followed up for three months for occurrence of diarrhea.Results: Intestinal pathogens were isolated in 48.8% and 42% of children in the diarrheal and non-diarrheal group respectively. The most common pathogens isolated in the diarrheal and non-diarrheal group were Cryptosporidium parvum and Escherichia coli (29.3% vs. 17.3%). During follow up, 8 children in each group had diarrheal occurrence. The pathogen isolated in subsequent episodes matched with the initial isolate in 3 children in each group.Conclusions: HIV-infected children without diarrhea also harbour enteric pathogens in comparable proportions to symptomatic children, which can predispose them to diarrheal occurrence in future, hence indicating need for assessing the need for preventive screening and prophylactic antibiotic regimens in this vulnerable group.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194745
      Issue No: Vol. 6, No. 6 (2019)
  • A study on clinical profile of typhoid fever at Government General
           Hospital, Nizamabad, Telangana, India

    • Authors: K. Gopal Singh, J. Syam Sundar
      Pages: 2642 - 2645
      Abstract: Background: The disease is most common in India. Children are most commonly affected. Typhoid fever, also known simply as typhoid, is a bacterial infection due to specific type of Salmonella that causes symptoms.Methods: Prospective observational study, 100 children with fever more than 7 days attending pediatric departed at GGH, Nizamabad were included in this study.Results: Total 100 children included in this study, male were 62, female were 38. More cases were (43) in 5-10 years age group, 53 children, belongs to middle class, 30 children belongs to lower class and 17 children belongs to upper class. Most common physical finding was toxic look (52), fallowed by coated tongue (41), hepatomegaly (32), pallor (12), spleenomegaly (11), hepatospleenomegaly (8).Conclusions: Safe drinking water, hand washing, proper sanitation, health education to children and food handlers in schools and hostels will decrease the incidence of typhoid fever in children.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194746
      Issue No: Vol. 6, No. 6 (2019)
  • Evaluate the role of endoscopy and ultrasonography in patients of portal

    • Authors: Ghanshyam Das, Shweta Gautam, Vijay Pal
      Pages: 2646 - 2649
      Abstract: Background: Aim of the study was to evaluate the role of endoscopy and ultrasonography in pediatric patients suffering from portal hypertension .subjects: children under 12 years of age hospitalized with any symptom or sign suggestive of portal hypertension.Methods: The study was conducted in 30 children with portal hypertension. They were divided into two groups on the basis of site of lesion: extrahepatic (extra hepatic portal vein obstruction) and intrahepatic (chronic liver diseases).Results: Mean age of children with EHPVO (extra hepatic portal vein obstruction) was 4 years and 4 months while that of children with CLD (chronic liver diseases) mean age was 8 years and 4 months. Endoscopic findings in patients with EHPVO have severe grade of varices as compared to those with CLD. In patients with EHPVO, the most common USG finding was nonvisualisation of the main portal vein or either branch (75-85%). Portal vein cavernoma was seen in 75% of these patients. Portosystemic collaterals were visualized in 23 patients  in which the left gastric collateral (60%) was the most common followed by short gastric collaterals in 11 children (55%).Conclusions: Endoscopy and ultrasonography are new and better modalities to assess the diagnosis and severity of portal hypertension. Extra hepatic portal vein obstruction is the commonest cause followed by intrahepatic obstruction (Chronic liver diseases).
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194747
      Issue No: Vol. 6, No. 6 (2019)
  • Pattern of clinical manifestation and antibiotics sensitivity of
           Burkholderia Cepacia sepsis in Neonatal Intensive Care Unit of tertiary
           care centre of North India

    • Authors: Sharad Bansal, Rambabu Sharma, Narendra Jangir
      Pages: 2650 - 2653
      Abstract: Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide. Now a days, neonatal sepsis due to Burkholderia cepacia is on rise. This study was conducted to delineate clinical presentation and antibiotic sensitivity pattern from blood culture proven Burkholderia sepsis. Methods: In this retrospective analytical study, thirty-six neonates admitted to Neonatal Intensive Care Unit of a tertiary care hospital with blood culture proven Burkholderia sepsis were included. Clinical manifestation, laboratory findings and antibiotic sensitivity patterns of blood culture proven Burkholderia sepsis were analyzed.Results: : All neonates were inborn and were admitted within 24 hours of birth. Difficulty in breathing was most common presenting symptom and seizure was second in number. There was no association with mode of delivery. Male to female ratio is 1.4:1. Progressive thrombocytopenia was the most consistent feature and in 6 patients also associated with anaemia. Average hospital stay was increased and more in preterm neonates. In this setup piperacillin + tazobactem was found to be most sensitive against Burkholderia cepacia and cotrimoxazole was 2nd in sensitivity.Conclusions: Proper and timely identification of Non Fermentative Gram Negative Bacilli (NFGNB) other than Pseudomonas can help confine morbidity due to such infections. High degree of suspicion helps in early recognition. Efficient housekeeping is necessary to prevent nosocomial infections due to these pathogens.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194748
      Issue No: Vol. 6, No. 6 (2019)
  • A study of bacteriological profile and outcome of babies born to mother
           with Premature rupture of membrane and its correlation with blood and
           gastric culture

    • Authors: Milind B. Kamble, Ramchandra Nagargoje, Sagar G. Chopde
      Pages: 2654 - 2660
      Abstract: Background: PROM, a condition that occurs when fetal membranes are ruptured at least one hour before onset of labor. While PROM is observed in 10% of all pregnancies, 60-80% of PROM is observed in term and 20-40% in pregnancies less than 37th gestational week. PROM is the most significant reason for preterm labor. The three causes of neonatal death associated with PROM are prematurity, sepsis and pulmonary hypoplasia. Infants born with sepsis have a mortality rate four times higher than those without sepsis. Objective of the study was correlation of blood and gastric culture positive sepsis in PROM newborns. It helps to find out the incidence of PROM in our locality.Methods: This retrospective study enrolled 90 neonates born to healthy mothers with history of PROM more than 18 hours duration, admitted in SNCU/ward at a tertiary care hospital for six months duration from 1st January 2017 to 30 June 2017. Clinical profile of these Newborn with history of PROM was noted such as birth weight, gender, gestation, duration of membrane rupture, history of maternal fever. For all newborns with PROM, sepsis screen had been sent. The neonatal outcome was also recorded, and the data was collected and analyzed by using frequency and percentages.Results: Gram negative bacilli were the commonest cause of neonatal sepsis and male neonates were more prone to infection. PROM and low birth weight especially, ELBW and VLBW are the common high-risk factors for early onset sepsis. Most common organisms isolated in blood and gastric culture were Klebsiella and Staphylococcus aureus respectively.Conclusions: PROM is a high-risk obstetric condition. Active management is needed to enable delivery within 24 hours of PROM as it offers better neonatal outcome. Morbidity and mortality increase as the duration of PROM increases. This can be reduced by early diagnosis, specific treatment and strict infection control practices in neonatal units.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194749
      Issue No: Vol. 6, No. 6 (2019)
  • Study of glucose levels in newborn with reference to hypoglycemia

    • Authors: Gaddam Zion Eluzai, K. Poojitha
      Pages: 2661 - 2665
      Abstract: Background: Hypoglycemia is one of the common metabolic problems in neonatal medicine. Early diagnosis and treatment of neonatal  hypoglycemia is important as many studies found that, hypoglycaemic episodes in neonates lead to neurodevelopmental and physical growth deficits. In this study, blood glucose levels at different time points were assessed and the influence of maternal blood glucose, mode of delivery, gestational age on neonatal blood glucose levels were studied.Methods: Blood glucose levels were low at 0 and 6th hour and maximum at 24th hour. The blood glucose levels ranged from 27 mg/dl to 140 mg/dl. Neonates with high maternal blood glucose were hypoglycaemic, showing a negative correlation.Results: The mean blood glucose levels were low in pre-term and post term babies compared to term and the range was wide in pre-term and term babies compared to post-term. The mean blood glucose levels were high and range was wide in babies delivered vaginally at all the time points compared to the babies delivered by LSCS. 17% babies were hypoglycaemic at birth but none of them had signs. The major signs noted were jitteriness (88%), high cry (88%), lethargy (55%), tremors (55%), limpness (22%), apathy (22%), weak cry (11%) and poor feeding (11%).Conclusions: 0 and 6th hour are the vulnerable time points for hypoglycaemia. Neonates with high maternal blood glucose, pre-term, post-term and babies delivered by LSCS were more prone for hypoglycaemia requiring blood glucose monitoring. There is a wide variation in signs of hypoglycaemia and babies showing signs require monitoring.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194750
      Issue No: Vol. 6, No. 6 (2019)
  • Evaluation of factors responsible for lactation failure-hospital based

    • Authors: Sravya Sree Sreekantham, Piduru Pratima, Uma Mahesh Ramisetty, Gangadhar Belavadi
      Pages: 2666 - 2670
      Abstract: Background: Exclusive breastfeeding is an essential part of early infant feeding. Promotion of EBF is the most effective way to reduce the infant mortality rate. This study was carried out to identify factors affecting EBF among mothers attending Narayana medical college hospital Nellore. Aim and objectives of the study was to know the incidence of lactation failure and to evaluate the factors responsible for lactation failure.Methods: Hospital-based cross-sectional study conducted from July 2018 to September 2018 involving a total of 100 mothers with the help of a proforma containing predesigned questionnaire. Demographic data of mother, obstetric details, mode of delivery, birth weight, details of antenatal advice about breastfeeding and practices, pre-lacteal feeds, current feeding practice, problems encountered during breastfeeding, anatomical problems were noted. The data collected were tabulated and statistically analyzed.Results: At the end of the study, among 100 mothers, 24 mothers are reported to have lactation failure and feeding babies with formula feeds. Among the variables taken into consideration pre-lacteal feeds, problems encountered during breastfeeding, breast diseases showed a statistically significant association with lactation failure. Mean weight gain in breastfeeding mothers and mothers with lactation failure is 11.3 kgs and 10.04 kgs respectively. Mean hemoglobin in breastfeeding mothers and mothers with lactation failure is 10.43 g/dl and 9.91 g/dl respectively.Conclusions: The results provide information about the relation between breastfeeding failure and its association with factors that contribute to it.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194751
      Issue No: Vol. 6, No. 6 (2019)
  • Intrauterine upper limb thrombosis: an unusual presentation

    • Authors: Baraturam B. Bhaisara, Charusheela S. Korday, Minal R. Wade, Vikram V. Yaragatti, Anjali M. Bhatawdekar, Anupama V. Mauskar
      Pages: 2671 - 2674
      Abstract: Intrauterine thrombosis with extremity ischemia presenting at birth in a newborn is a rare event. A 29 year old mother, 2nd gravida with one first trimester spontaneous abortion delivered a 33week gestation male preterm baby. On Examination, the entire left upper limb was ischemic and edematous with an absent flow on Doppler USG. Low molecular weight heparin (LMWH) was started after which gradually the limb turned pink with good volume pulsations. Thrombophilia mutation studies revealed the heterozygous state for the MTHFR (C677T) mutation only in the mother. Prompt diagnosis and early treatment has a favourable outcome in cases of intra-uterine thrombo-embolism.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194538
      Issue No: Vol. 6, No. 6 (2019)
  • Double trouble: hemophagocytic lymphohistiocytosis in a child with Dengue

    • Authors: Minal Wade, Nusrat Inamdar, Baraturam Bhaisara, Anupama Mauskar
      Pages: 2675 - 2677
      Abstract: The epidemic of Dengue is steadily increasing in more than 100 endemic countries. During critical phase, of this disease, shock with organ dysfunction and severe bleeding, can occur. Rarely, it can be further complicated by Hemophagocytic lymphohistiocytosis (HLH), which results from aberrant activation of immune mechanism. HLH is a rare, frequently fatal if untreated condition. It challenging to diagnose because initial symptoms mimic other conditions which are more common. Dengue induced Secondary Hemophagocytic lymphohistiocytosis (HLH), may be responsible for severe form of Dengue with adverse outcomes. We describe a case of an infant, with Dengue fever whose clinical situation deteriorated after being stable during initial phases of illness due to development of Secondary Hemophagocytic lymphohistiocytosis (HLH). The child had persistent fever, anemia, hepatomegaly with deranged coagulation which directed towards diagnosis of Secondary Hemophagocytic lymphohistiocytosis (HLH). We discuss the features of our case and its management to sensitize the clinicians to consider this condition in patients with severe Dengue fever.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194616
      Issue No: Vol. 6, No. 6 (2019)
  • Benign neonatal sleep myoclonus in a child

    • Authors: Imella Marcos, Darto Saharso, Prastiya Indra Gunawan
      Pages: 2678 - 2681
      Abstract: Benign neonatal sleep myoclonus (BNSM), is a disorder generally mistaken for seizures during the newborn period. Benign neonatal sleep myoclonus is featured by myoclonic "lightninglike" jerks of the extremities that exclusively occur during sleep; it is not associated with epilepsy that occur only during sleep and cease abruptly when the child is agitated. This case reported was a 50 days-old baby boy with a history suggestive of abnormal movements for limbs noted over the preceding 7 days. Diagnosis of BNSM in infant based on history taking, clinical manifestation, and with no electroencephalographic changes. BNSM is usually not associated with any other neurologic impairment and spontaneously subsides within the first year of life. Its importance lies in the differential diagnosis with the epileptic, especially myoclonic, seizures of infancy. BNSM can be misinterpreting for neonatal seizures or even neonatal status epilepticus, the recognition of benign sleep myoclonus of infancy is imperative to elude unnecessary diagnostic studies and treatments.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194752
      Issue No: Vol. 6, No. 6 (2019)
  • Childhood pneumonia: read the smear and clinch the diagnosis

    • Authors: Nandhini K., Kaveri S., Elayaraja S., Umapathy P., Latha Ravichandran
      Pages: 2682 - 2684
      Abstract: Childhood pneumonia has a myriad of disease causing organisms. Identifying the etiology often helps us predict the natural course of the illness. We would like to share an interesting child with pneumonia by the hematological manifestation of the disease. Case report of this study is a 8 year old boy who presented with high grade fever for eleven days associated with cough. History of skin rashes which worsened following therapy with penicillin. On Examination child had maculopapular rashes predominantly over the trunk with decreased air entry in the left hemithorax. Chest x-ray done showed left lower lobe consolidation hence treated with cephalosporins and macrolide. Counts revealed falling trend in haemoglobin with high MCV count. Peripheral smear done showed agglutinated RBC’S and occasional nucleated RBC’s. Direct Coombs test was positive. With these haematological manifestations child was diagnosed to have Mycoplasma pneumonia which was proven by positive antibodies against Mycoplasma. Child recovered completely and haematological manifestations became passive after four weeks. Cold agglutinin disease is poorly understood affecting 15% of patients with Autoimmune hemolytic anemia. Respiratory tract involvement and extrapulmonary complications manifest in 3-10% and 25% respectively. Antibodies (IgM) against the I antigen on human erythrocyte membranes appear during the course of M. pneumoniae infection and produce a cold agglutinin response. AIHA typically occurs during 2-3rd week after febrile illness with sudden onset of hemolysis which is self-remitting within 4-6 weeks. The conclusion of this study is extra-pulmonary manifestations in a child with pneumonia help in diagnosing the etiology. This in turn helps us like provide rationale management and Predict the natural course of the illness.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194753
      Issue No: Vol. 6, No. 6 (2019)
  • Unusual umbilical cord finding in a neonate

    • Authors: Antonieo Jude Raja, Sriambika K.
      Pages: 2685 - 2687
      Abstract: Umbilical cord cyst refers to any cystic lesion that are associated with the umbilical cord. They are classified as true cysts or pseudocysts. True cysts are small remnants of the allantois, whereas false cysts originate from liquefaction of Wharton Jelly. In present case, cyst was diagnosed at birth without any associated congenital anomalies and resolved spontaneously within a few days requiring nil surgical intervention. Umbilical cord cysts deserve special attention since 20% of them, regardless of type, are associated with structural or chromosomal anomalies. Because of this, fetal karyotyping and amniocentesis should be considered when cysts persist beyond the first trimester.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194754
      Issue No: Vol. 6, No. 6 (2019)
  • Hemolytic disease of newborn caused by multiple Rh antibodies

    • Authors: Suman Sudha Routray, Rachita Behera, Jagdish Prasad Sahoo, Devi Prasad Acharya, Bibudhendu Pati
      Pages: 2688 - 2691
      Abstract: Hemolytic disease of Fetus and Newborn (HDFN) usually results due to natural occurring antibodies or alloimmunization in mother but the presence of multiple red cell antibodies increases the risk of development of significant HDFN. Here author reported a case of hemolytic disease of fetus and newborn in a preterm baby caused by multiple maternal antibodies. Direct Antiglobulin Test (DAT) on neonate blood sample was positive (3+) with monospecific DAT showed IgG type which was confirmed by heat elution. Antibody identification of eluate was done using commercial 11-cell panel by gel method showing specificity to anti-D and anti-C antibody which was differentiated from anti-G by sequential adsorption and elution studies. Neonate was treated with double volume exchange transfusion (DVET) using leucoreduced, irradiated O Rh D and C negative PRBC suspended in AB plasma and discharged 6th day in a stable condition. So, all pregnant women should be at least advised for ICT irrespective of Rh D negative status. If ICT is positive, they should be referred to higher center for proper Immunohematological work up, so that proper blood unit for DVET could be identified.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194755
      Issue No: Vol. 6, No. 6 (2019)
  • Sirenomelia, the Mermaid syndrome: a case report

    • Authors: Charusheela Korday, Baraturam Bhaisara, Rupali Jadhav, Suraj Rathi, Ubaidulla Shaikh, Avinash Rao
      Pages: 2692 - 2696
      Abstract: Sirenomelia, also known as mermaid syndrome, is a rare congenital anomaly characterized by a single lower extremity which is associated with abnormalities in other organ systems, commonly affecting the gastrointestinal and the urogenital systems. It is sporadic with no increased risk in subsequent pregnancies. In almost all the cases of sirenomelia, a single umbilical artery (SUA) is present which arises from the abdominal aorta. The exact etiology of sirenomelia is unknown. Sirenomelia can be confidently diagnosed in the 1st trimester while the diagnosis in the 2nd and 3rd trimesters is difficult due to the lack of amniotic fluid in the later gestation. Antenatal diagnosis of this universally lethal condition is desirable so that possible termination of pregnancy can be offered at the earliest. 
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194756
      Issue No: Vol. 6, No. 6 (2019)
  • Is that a scolex' a case of clinically isolated syndrome

    • Authors: Van K. Ma, Lourdemillard Bellevue, Maria Espiritu Fuller
      Pages: 2697 - 2699
      Abstract: Clinically Isolated Syndrome is an initial demyelinating event of the central nervous system that has been associated with the future development of multiple sclerosis. Diagnostic studies include clinical and paraclinical studies. Patients with lesions on MRI of the brain at baseline will more likely develop multiple sclerosis compared to patients without findings. We report a case of a 10-year-old female of Colombian ancestry and origin, who presented with indiscernible neurological clinical signs and symptoms, with MRI brain with and without contrast showing demyelinating lesions with one lesion “suggesting” a scolex.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194757
      Issue No: Vol. 6, No. 6 (2019)
  • A case of primary immunodeficiency: hyper IgM syndrome

    • Authors: Madhura P. Fadnis, Pratibha B. Shamkuwar
      Pages: 2700 - 2701
      Abstract: Hyper IgM syndrome are group to disorders characterized by elevated serum level of IgM and low or absent serum levels of IgG, IgA and IgE the mechanism of HIGM is immunoglobulin Class-Switch Recombination (CSR) failure and Somatic Hyper Mutation (SHM). This diagnosis should be considered in any patient presenting with hypogammaglobulinemia, with low or absent IgG and IgA and normal or elevated IgM level. In the present case report, this was a 6-year-old male child who had history of recurrent respiratory tract infections who presented with otitis media and persistent fever spikes. Immunoglobulin studies revealed a pattern consistent with hyper IgM.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194758
      Issue No: Vol. 6, No. 6 (2019)
  • A case of twenty nail dystrophy affecting a 12 year old boy

    • Authors: Harshitha Shanmuganathan, Radha Kumar
      Pages: 2702 - 2704
      Abstract: Nail diseases in children may be congenital or acquired and occurs in 3 to 11% of pediatric population. Twenty nail dystrophy is a nail disorder with a classical presentation, often affecting all twenty nails. It is an idiopathic disorder in childhood but can be associated with other diseases such as lichen planus, alopecia areata, psoriasis, eczema, IgA deficiency, atopic dermatitis, ichthyosis vulgaris and vitiligo. Twenty nail dystrophy is otherwise called trachyonychia. Typically, the condition is bilateral and symmetrical affecting all the nails of hands and feet. It is cosmetically disfiguring and can be source of anxiety for children and parents, which can impact further the quality of life. Twenty nail dystrophy is of two types, based on the clinical presentation namely opaque or shiny trachyonychia. Since this nail disorder is associated with a number of dermatologic diseases, children require long term follow up. We report a case of a 12-year-old boy with a three-year history of twenty nail dystrophy with no relevant family history of skin or nail diseases. The child had isolated nail manifestation without any other dermatologic condition. Twenty nail dystrophy is a self-limiting disease, which is treated conservatively. The aim of this report is to highlight importance of a thorough physical examination to diagnose nail disorders in early stages, which will be helpful to clinicians to distinguish the different nail conditions and associated illness and decide on the correct management. It is important to counsel the family about the benign nature of the disease and good prognosis.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194759
      Issue No: Vol. 6, No. 6 (2019)
  • Pseudo hypoaldosteronism type 1B due to novel deletion mutation in SCNN1A

    • Authors: Noman Ahmad, Meshal Atiyah, Balgees Abdulhadi Al Ghamdi, Halah Faleh Al Enizi, Ali Saeed Al Zahrani
      Pages: 2705 - 2708
      Abstract: Pseudo hypoaldosteronism type 1B (PHA1B) is a systemic form of salt wasting. Children present after the first week of life with typical symptoms of an adrenal crisis. PHA1B is caused by autosomal recessive homozygous mutations in genes encoding epithelial sodium channels (ENaC) subunits α, β and γ. ENaC are widespread and present in renal tubules, airways, colon, sweat and salivary glands. Electrolyte imbalance is significant with severe hyponatremia, hyperkalemia and metabolic acidosis. In early life until approximately one year of age electrolytes remain unstable despite active management but then gradually improve. The mainstay of treatment is high dose salt replacement, sodium bicarbonate and sodium polystyrene therapy. The adequate treatment and monitoring can result in normal physical and psychomotor development. We present a case of PHA1B with severe intractable electrolyte imbalances in neonatal period. The genetic sequence revealed a novel homozygous deletion mutation in exon 4 of the SCNN1A gene (c.942delC, p.N315Tfs*16).
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194760
      Issue No: Vol. 6, No. 6 (2019)
  • A rare and interesting case of Scarabiasis

    • Authors: Sangeetha Merrin Varghese, Austoria A. J., Manju Koshy, Jithin Mathew Abraham
      Pages: 2709 - 2711
      Abstract: Scarabiasis or Canthariasis or Beetle disease is an ectoparasitic infection of the gastrointestinal tract, in which the beetles temporarily infest the digestive tract and rarely the urinary tract. Dung beetle belongs to Scarabiaediae family.  It is mostly seen in children aged between 2 to 5 years, who play outdoor for prolonged hours without undergarments. It is a temporary infestation in which early stages of development of beetle takes place in the anus and the adult beetle flies, out of the anus while defecation. A boy aged 3 years and four months presented to the pediatric OPD with complaints of peri umbilical abdominal pain, vomiting, nausea, mucus in stool along with “black insects” in his stool. The clinical examination revealed that the pulse rate, blood pressure and temperature were normal. Per rectal examination and ultrasound of the abdomen was normal. Routine examination of stool and urine was also found to be normal. The beetle was identified by the medical entomologist as dung beetle belonging to family Scarabidae. This report implies that the boy had an infestation with the larvae of dung beetle in the gastro intestine. The family belonged to the high range area of Mundakayam. Agriculture is the main source of income for people and main plantation being Rubber. Natives breed cattle for their livelihood and agriculture. During contact with mud or while playing outdoors naked, he would have come into contact with the eggs or the beetle, which hatched into larvae and caused canthariasis.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194761
      Issue No: Vol. 6, No. 6 (2019)
  • Transient leukaemia of Down syndrome in a neonate: case report

    • Authors: Baraturam Bhaisara; , Charusheela Korday, Minal Wade, Chandra Kiran Chunchu, Priyanka Modi, Dinesh Kumar Singh
      Pages: 2712 - 2715
      Abstract: Transient leukemia of Down syndrome(TL-DS)  or transient myeloproliferative disorder (TMD) or transient abnormal myelopoiesis (TAM) is a hematologic abnormality characterized by an uncontrolled proliferation of myeloblasts in peripheral blood and bone marrow which characteristically affects newborns and babies with Down syndrome. Children with Down syndrome (Trisomy 21) have a unique predisposition to develop myeloid leukemia of Down syndrome(ML-DS). In majority of cases of TL-DS, the GATA1 mutant clone goes into spontaneous remission without the need for chemotherapy. However, 10-20 % of neonates with TL-DS and silent TL-DS subsequently develop ML-DS in the first 5 years of life due to additional oncogenic mutations acquired by the persistent GATA1 mutant cells. We present here, one such case of Down syndrome with TL-DS in a neonate. 
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194615
      Issue No: Vol. 6, No. 6 (2019)
  • Neurocognitive outcome in young child with Isovaleric Acidemia

    • Authors: Nusrat R. Inamdar, Anupama V. Mauskar, Minal Wade, Ankita Shah
      Pages: 2716 - 2719
      Abstract: Isovaleric Acidemia (IVA) is inherited as an autosomal recessive trait, caused by the deficiency of the enzyme isovaleryl CoA dehydrogenase. It has the prevalence of 1 in 62,500 (in parts of Germany) to 1 in 250,000 live births (in the United States). Acute episodes of metabolic decompensations may occur, which may mimic sepsis, ketosis or shock. Early diagnosis & early initiation of treatment has been reported to correlate with a good neurocognitive outcome. This is case of child presenting in Paediatric emergency department with fever, vomiting, increased respiratory activity and lethargy. Child had GCS score of 8/15, acidotic breathing, hypotonia with hyporeflexia. Sepsis screen, metabolic work up and neuroimaging were all normal except for high anion Gap acidosis with ketosis. So further neurometabolic screening work up was done in view of persistent metabolic acidosis, developmental delay, and bad obstetric history in mother. It revealed increased excretion of isovalerylglycine 1(IVG 1), Isovalerylglycine 2 (IVG2) Lactate, 3-Hydroxypropionate (3HP) and 3-Hydroxybutyrate (3 HB).Serum lactate 358.54 (control 1.1-208.1) confirming the diagnosis of Isovaleric Acidemia. After recovery from the acute attack, the patient was advised low-protein diet (1.0-1.5 g/kg/24 hrs.) and carnitine (100 mg/kg/24 hrs. orally) supplements. On follow up child is asymptomatic & showing neurological improvement as he started achieving further developmental milestones during 6 months follow up.Early diagnosis and early treatment of IVA cases definitely results in favorable outcome and better prognosis. But chronic intermittent cases presenting late should not be neglected, proper medical management can reverse neuromotor consequences in them also.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194580
      Issue No: Vol. 6, No. 6 (2019)
  • Severe generalized dystonia in paediatric onset wilsons disease

    • Authors: Jyothi A., Subramanya N. K.
      Pages: 2720 - 2722
      Abstract: Wilson disease (WD) is a rare autosomal recessive disorder with defect in copper transport mechanism with varied clinical manifestation predominantly hepatic, neurological, ophthalmological and multi-systemic involvement. WD in paediatrics  age group manifest differently from the adults.  In this case report,
      Authors have  described the first case report presenting with neurological involvement in the form of severe generalized dystonia in a paediatric onset WD. This case report is of greater significance in detecting the most often undetected paediatric WD presenting with a usual hepatic manifestation occurring early in the course.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194762
      Issue No: Vol. 6, No. 6 (2019)
  • A rare form of domestic accident: blast abdominal injury with evisceration
           of abdominal viscus

    • Authors: Aniruddha Basak, Arindam Ghosh, Prafulla Kumar Mishra
      Pages: 2723 - 2725
      Abstract: Evisceration of abdominal viscus following “Flowerpot firecracker” (tubri) blast injury to the abdomen is a rare but dangerous form of domestic accident. Lack of knowledge and non-compliance of safety measures is the major reason for firecracker eventualities. A 10-year male child presented three hours post-injury with a wound over the upper abdomen. On examination there was evisceration of part of stomach along with colon through supraumbilical abdominal wound. Resuscitation and repair following exploratory laparotomy performed. Patient recovered well postoperatively. Public awareness and safety measures need to be taken to prevent the fatal outcomes of firecracker misuse.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194763
      Issue No: Vol. 6, No. 6 (2019)
  • Newborn with multiple congenital anomalies in newborn, intensive care unit
           suggestive of joubert syndrome and related disorder with an atypical

    • Authors: Garima Goyal, Ajay Arya
      Pages: 2726 - 2729
      Abstract: Joubert syndrome (JS) is a rare autosomal recessive disorder with key finding of cerebellar vermis hypoplasia with a complex brainstem malformation that comprises the molar tooth sign on axial magnetic resonance images. This syndrome is difficult to diagnose clinically because of its variable phenotype. Molar tooth sign is not specific for JS. Another entity is termed as Joubert syndrome and related disorders (JSRD). Although the molar tooth sign and other important clinical features of the JS may be seen in these syndromes, they usually have supplementary prominent features. Author present a case of Joubert syndrome and related disorder in a term newborn delivered in the hospital of Government Medical College, Haldwani with multiple congenital anomalies. Macrocephaly, facial dysmorphism, polydactyly left hand and bilateral ballotable lumbar lump (multicystic dysplastic kidney). MRI showed molar tooth configuration of superior cerebellar peduncles, dilatation of lateral and third ventricles with aqueductal stenosis with arachnoid cyst (unusual association).
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194764
      Issue No: Vol. 6, No. 6 (2019)
  • Severe thermal injury of larynx in a child following accidental ingestion
           of hot tea

    • Authors: Bendangienla Jamir, Senthil Kumar S. P., Md Nawed Azam, Arun Kumar, Pupun Patnayak
      Pages: 2730 - 2732
      Abstract: Thermal injury to the upper respiratory tract caused by aspiration of hot liquids resulting in laryngeal edema and subsequent obstruction of the airway is commonly not seen in the pediatric population. Unlike adults, children are more prone for subglottic injury, swelling and resulting obstruction of the airway due to the smaller size of the trachea and relatively large epiglottis. Examination of the airway with laryngoscopy hence should be recommended in all patients with inhalational and aspiration burn injury as it will help in guiding airway management and preventing development of complications.
      Authors report a case of a 3-year-old male child with accidental ingestion of just made hot tea. Upon presentation there was severe stridor and signs of respiratory distress requiring emergency intubation. Direct laryngoscopy revealed glottic edema and ulcer. Upper GI endoscopy showed erythematous arytenoids, esophagus and stomach showing few erythematous flat lesions. Chest radiographic examination showed bilateral para cardiac and perihilar inhomogeneous opacities suggestive of aspiration pneumonitis. The child was gradually weaned and extubated on day three of admission. Ingestion of hot liquids can cause airway and esophageal thermal burns. Rapid diagnosis and treatment are essential in management of inhalational and aspiration burn injury to reduce the morbidity, mortality and long-term sequelae in these patients. Children are more prone for burn accidents due to their curious and exploratory behavior and their inability to perceive the hazards. Since most of the pediatric burn accidents happen at home, parents should be offered education about prevention of burn and advised on how to manage and treat minor burn injuries and to watch for any warning signs in which case to rush to the nearest hospital.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194765
      Issue No: Vol. 6, No. 6 (2019)
  • Waardenburg syndrome: a rare genetic disorder in four generations of a

    • Authors: Charusheela Korday, Baraturam Bhaisara, Dhara Shah, Srinivas Shinde, N. S. K. Vasu, Sanjeev Kumar
      Pages: 2733 - 2737
      Abstract: Waardenburg Syndrome (WS) is a rare autosomal dominant disorder manifesting with sensorineural deafness, pigmentation defects of the skin, hair and iris and various defects of neural crest derived tissues. A primigravida mother delivered a full term, appropriate for gestational age, 2530 gm female child, by emergency LSCS. Baby was admitted in the NICU in view of features suggestive of Waardenburg syndrome, like white forelock of hair, broad nasal root and hypopigmented patches on the skin for further work up and management. Several members in the family were affected in the last 4 consecutive generations. Our baby was feeding well and discharged home after an uneventful hospital stay. Early diagnosis, detection of findings of hearing loss and the characteristic ophthalmic findings as well as regular follow up is necessary to enable the patient to lead a better quality of life.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194766
      Issue No: Vol. 6, No. 6 (2019)
  • The resurgence of Measles in 2019

    • Authors: Chaitanya Varma P. V., Samitha Rajkumar
      Pages: 2738 - 2739
      Abstract: Measles, a highly contagious infection caused by a single stranded RNA Paromyovirus is transmitted through aerosol droplets and contact with nasopharyngeal secretions of the infected patient.  The incubation period lasts between 10 and 14 days. The Prodromal phase presents with high grade fever, cough, coryza and conjunctivitis. Punctate blue-white spots on the buccal mucosa called Koplik spots are pathognomic of measles. The typical maculopapular rash appears 3-5 days after the onset of fever. It starts from the neck and spreads down to the lower limbs; it decreases in the same pattern lasting for 5-6 days. The patients are considered contagious 4 days prior to 4 days after the appearance of rash.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194767
      Issue No: Vol. 6, No. 6 (2019)
  • Sulfonamides: far from obsolete

    • Authors: Mahmoud Moussa Hassanein
      Pages: 2740 - 2745
      Abstract: Sulfa drugs or sulfonamides were introduced in 1935 by the German physician Gerhard Domagk (1895-1964). Domagk worked closely with two chemists, Fritz Mietzsch and Josef Klarer. They worked together on compounds related to synthetic dyes, testing their effects on infectious diseases. Their concerted work eventually led to the discovery of Prontosil (sulfamidochrysoidine), the first sulfa drug that showed an incredible antibacterial effect on diseased laboratory mice. Soon after the introduction of sulfonamides, penicillin was discovered and hailed as a more effective and a safer alternative. The production of sulfonamides lost its enthusiasm with the introductions of even more antibiotics. However; anti-bacterial Sulfonamides are far from being obsolete despite the introduction of newer classes of antibiotics. Interest in their use has been revived in the 1980s with AIDS epidemic, when a combination of sulfamethoxazole and trimethoprim (SMX/TMP) was recognized as the drug of choice for the treatment of Pneumocystis jirovecii (PCP) pneumonia. This review article is intended to update clinicians with the many still current recommendations for sulfonamides both as therapeutic and prophylactic agents; with mechanism of action and resistance; and with adverse side effects that clinicians need to watch for while using this class of antimicrobial.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194768
      Issue No: Vol. 6, No. 6 (2019)
  • Collodion baby-congenital ichthyosis: clinical review

    • Authors: Rahul Choudhary, Garima Sachdeva, Gaurav Katoch, Rakesh Kumar
      Pages: 2746 - 2749
      Abstract: Collodion baby is a rare form of congenital ichthyosis in which the entire body is covered by a parchment-like membrane. These neonates are at the risk of dehydration, sepsis, electrolyte disturbances, and temperature instability. It is inherited in autosomal recessive manner. We report a case of Collodion baby, born of a consanguineous marriage. Here, we present a short review of this condition and the various methods available for the prenatal diagnosis. A literature search was done using PubMed, Medline, and Google Scholar databases using the mesh terms “Ichthyosis”, “collodion baby”, “collodion membrane”, “Congenital ichthyosiform erythroderma”, and “Lamellar ichthyosis”.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194769
      Issue No: Vol. 6, No. 6 (2019)
  • Congenital tuberculosis: a review article

    • Authors: Nisha Kumari, Anuj Khatri
      Pages: 2750 - 2754
      Abstract: TB remains a leading cause of morbidity and mortality in developing countries. The incidence of congenital TB is underestimated. Current recommendations regarding the management of neonates of mothers with tuberculosis are variable and no tangible guidelines have been advised. Congenital TB is fatal if untreated, moreover the mortality and morbidity is increased if the diagnosis and treatment is delayed. Therefore, the treating clinician should be aware of the unusual presentation of congenital TB. A high suspicion and good screening of mothers and neonates is of paramount importance. Congenital tuberculosis is diagnosed by Cantwell criteria. Isoniazid prophylaxis for 6 months is recommended in neonates born to mothers with TB who are infectious. Breastfeeding should be continued, and isolation is recommended only in certain circumstances such as mother is infectious, has multidrug resistant tuberculosis or non-adherent to treatment. BCG vaccine is recommended in all neonates however, the timing of administration varies according to various guidelines. Neonate diagnosed with congenital TB should be treated with anti-tubercular drug regimen.
      PubDate: 2019-10-21
      DOI: 10.18203/2349-3291.ijcp20194770
      Issue No: Vol. 6, No. 6 (2019)
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