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International Journal of Contemporary Pediatrics
Number of Followers: 4  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2349-3283 - ISSN (Online) 2349-3291
Published by Medip Academy Homepage  [12 journals]
  • Bubble continuous positive airway pressure therapy for neonatal
           respiratory distress at birth in level III newborn unit in Chengalpattu
           Medical College Hospital: a prospective observational study

    • Authors: Diana Grace R., Suresh Kumar S., Sathya .
      Pages: 906 - 910
      Abstract: Background: Bubble continuous positive airway pressure (bCPAP), a non-invasive respiratory device provides continuous pressure that helps recruitment of more alveoli, increases the lungs, functional residual capacity and decreases the work of breathing in newborns admitted with respiratory distress. Bubble continuous positive airway pressure (bCPAP) is the most important respiratory support in different types of respiratory conditions in level III. In this observational study, author reported this research using bCPAP therapy as the primary respiratory support in level III unit in tertiary care centre in Chengalpattu, Tamil Nadu, India. Despite reporting their indications, duration of use and adverse effects we tried to search for further improvement in other areas of CPAP therapy in level III newborn unit.Methods: This prospective observational study included 250 babies delivered in obstetric unit and admitted with respiratory distress within 6 hours of birth at level III care. They were treated according to level III newborn unit protocol. Those data were collected and entered in the proforma. Newborns were followed up till discharge.Results: A total of 250 babies satisfying the inclusion criteria delivered in Chengalpattu Medical College Hospital, Tamil Nadu, India (mean gestational age 36±2 weeks, mean birth weight 2.5±1.2 kg were included. All newborns were given bCPAP as the primary support. The most common underlying cause of respiratory distress was transient tachypnea of newborn (44%), followed by respiratory distress syndrome (24%) and prolonged respiratory transition (18%). The therapy success rate was 86%. Only 35 newborns failed to respond to CPAP. The most common adverse effect was eye puffiness (19%).Conclusions: Bubble continuous positive airway pressure (b CPAP) therapy use is being well established in level III unit for various respiratory conditions with minimal failure and adverse effects. Its use in extreme preterms and initiation after 6 hours is controversial.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191992
      Issue No: Vol. 6, No. 3 (2019)
       
  • Factors associated with overcrowded pediateric emergency rooms in Northern
           India and possible solutions: a medical school setting

    • Authors: Najmus Saqib, Mahvish Qazi
      Pages: 911 - 916
      Abstract: Background: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions.Methods: A retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the Department of Pediaterics and comprised data of all the patients presenting to the emergency department between 1st January 2018 to 31st December 2018. Demographic characteristics, length of stay (LOS), revisit frequency and consultation status of the patients were determined.Results: Of the 1,17,035 patients, 25,223 (43.89%) were discharged straight away while 24,113 (41.95%) were admitted to different wards and subspecialties. Besides, 6464 (11.25%) patients left the department against medical advice, 861 (1.5%) expired, 741 (1.29%) were referred to other hospitals and 67 (0.12%) were dead on arrival. Of those who were admitted, 1,4498 (60.13%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in pediatric and neonatal intensive care units, not using checklist for proper reassessment of patients and early discharge, overburdened by patients coming in just for nebulization and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards.Conclusions: In conclusion, cooperation of the managers, relevant departments and a multidisciplinary approach are necessary to achieve the goals to reduce overcrowding in the emergency departments.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191993
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinicobacteriological profile, antibiotic sensitivity patterns and
           mortality of neonatal sepsis in a tertiary care hospital in Kashmir, Jammu
           and Kashmir, India

    • Authors: Gh Rasool Wani, Nazir Ahmed, Mohd Irshad, Mohd Ashraf, Bashir Ahmed Teli
      Pages: 917 - 921
      Abstract: Background: Neonatal sepsis refers to generalized bacterial blood stream infection in first 28 days of life documented by positive blood cultures. It is one of leading causes of neonatal mortality. Objectives was to study clinicobacteriological, antibiotic sensitivity patterns and mortality of neonatal sepsis.Methods: This prospective study was conducted in the Department of Pediatrics of Government Medical College Srinagar in collaboration with Department of Microbiology of same medical college after ethical clearance from ethical committee of Government Medical College Srinagar. One hundred (100) neonates out of 731 neonates admitted between octomber2007 and September 2008 with signs and symptoms of neonatal sepsis were included in our study by random sampling method. After history, examination and laboratory investigation blood culture results were analyzed by standard statistical methods.Results: The blood culture was positive in 40% of neonates. Fifty one (51) neonates were males while as 49 were females. Sixty three (63) neonates had late onset of sepsis while as 37 had early onset sepsis. The positive  blood culture was more common in males, late onset sepsis, babies born in rural areas, home born, vaginal births, preterm and other  low birth weight neonates .The gram negative isolates were most common followed by positive ones .The best sensitivity of gram negative isolates was to ciprofloxacin followed by amikacin and cephalosporins while as gram positive isolates were sensitive to imipenum followed by vancomycin. Pseudomonas was most responsive to pipercillin +tazobactum combination. The neonatal mortality was 35% being higher in early onset sepsis and low birth weights.Conclusions: This study depicts a high rate of neonatal sepsis, mainly caused by gram negative organisms followed by gram positive organisms with rising drug resistance that could bear far reaching implications to the times to come, mandating the implementation of sepsis preventive measures and administration of specific antibiotics.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191994
      Issue No: Vol. 6, No. 3 (2019)
       
  • Hypoalbuminemia in critically sick children

    • Authors: Sandeep T. Golhar, Hina Agrawal, Urmila M. Chauhan, Abhishek Madhura
      Pages: 922 - 926
      Abstract: Background: Hypoalbuminemia at admission is a common finding in patients admitted to the Paediatric Intensive Care Unit (PICU) and may predict morbidity and mortality.Methods: Patients of age more than 1 year and less than 12 years diagnosed with hypoalbuminemia on the grounds of the inclusion criteria who were admitted in the Paediatric Intensive Care Unit (PICU) were enrolled in the study as ‘cases’ and patients with normal levels of serum albumin and otherwise similar characteristics to cases were included in the study as ‘controls’. Detailed clinical examination and required investigations were done. Above collected information was utilized to select two groups for the study i.e., those with hypoalbuminemia and others with no hypoalbuminemia. Both these groups were further followed up till discharge or death and the outcome in terms of morbidity and mortality was noted.Results: Incidences of MODS and degree of severity of illness as judged by PRISM III score in cases and control showed that, a lower serum albumin concentration correlated well with higher rates of complications such as ventilator dependence and development of new infections leading longer stay in the critical care unit. The mean length of PICU stay in cases group was statistically longer than in the control group. Although we did not observe a difference in fatal outcome in patients managed with either Human Albumin or Fresh Frozen Plasma compared to those managed conservatively in this study, we did observe a decreased mean length of PICU stay and rate of complications in the patients treated with either Human Albumin or Fresh Frozen Plasma, thus achieving a faster rate of recovery with lesser rate of complications and thus alleviating the morbidity, though still not being able to affect the overall mortality.Conclusions: Hypoalbuminemia at admission was a predictive factor of poor outcome in critically ill children. It is associated with a higher mortality, a longer length of stay in the PICU, as well as longer ventilator use.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191995
      Issue No: Vol. 6, No. 3 (2019)
       
  • Spectrum of congenital heart disease in a tertiary care centre of Northern
           India

    • Authors: Amber B. Mir, Kaisar Ahmed, Muzafar Jan, Sitaraman Radakrishnan
      Pages: 927 - 931
      Abstract: Background: Congenital heart disease (CHD) is very common disease and it is the major cause of childhood mortality and morbidity. Not much of Indian data are available particularly from the northern part of the country. It is important to mention that this part of India is unique with respect to its demographic and geographical location. There are needs to further explicate the spectrum and epidemiology of the CHD in this part of the country.Methods: A prospective hospital-based study carried out over a period of 24 months (January 2016 to January 2018) where all suspected children (<14 years) of CHD were subjected to echocardiographic study. The age, sex, clinical presentation and echo findings were well documented.Results: Out of total 3210 cases CHD was diagnosed in 2072 cases (64.54%). Most CHDs were diagnosed between 1 month and 6 years of age in both cyanotic and a cyanotic disease group. Incidence of a cyanotic CHD was n=1529 (47.6%) and cyanotic CHD was n=543 (17%) with the ratio of acyanotic to cyanotic 2.8:1. Ventricular septal defect was commonest CHD (35.85%) among acyanotic CHD and Tetralogy of Fallot was the commonest (12.2%) among cyanotic CHD.Conclusions: Burden of CHD is highly underestimated and unrecognised, especially in this part of the country. This study can provide observed data that can help in policy making in the health sector. The contrasting result with respect to complex CHD in present study indicates need for good and effective antenatal cardiac screening in high risk mothers.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191996
      Issue No: Vol. 6, No. 3 (2019)
       
  • The study of lipid profile and other cardiovascular risk factors in
           children born to parents having premature ischemic heart disease

    • Authors: Savitha M. R., Santhosh Krishnappa, Shubha Jayaram
      Pages: 932 - 939
      Abstract: Background: Most of the studies on cardiovascular risk factors are concentrated on adults. But atherosclerotic process begins in childhood and is influenced by genetics, diet and life style. Hence, present study was undertaken. The objectives of the study were to study lipid profile and other cardiovascular risk factors like hypertensive status, BMI(Body mass index) in children aged between 5years and 18 years born to parents having premature IHD(Ischemic heart disease), to study diet and life style factors in study group having family history of IHD, to study the sociodemographic profile of dyslipidemia.Methods: A 200 Cases of premature IHD were selected. Their children(n=200) in the age group of 5 to 18 years were selected and analysed for cardiovascular risk factors. They were compared with 200 normal children without any family history of IHD.Results: On comparison of mean lipid profile between cases and controls HDL cholesterol was very low amongst cases (p=0.001). The mean values of triglycerides and VLDL were very high amongst cases (p=0.001). The mean atherogenic index (AI) was high amongst cases (p=0.001). Prehypertension or hypertension was seen amongst 8.5% cases (p=0.004). Amongst the cases 19.5% had excess junk food intake (p=0.001). 51.5% of cases had sedentary life style (p=0.001).Conclusions: Children in our area born to parents with premature IHD have significant incidence of dyslipidaemia. There is an increased incidence of other cardiovascular risk factors like hypertension, excess junk food intake, sedentary life style in these children.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191997
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study of respiratory complications and outcome in meconium stained
           deliveries

    • Authors: Omprakash S. Shukla, Swapna S. T.
      Pages: 940 - 944
      Abstract: Background: To study the development of respiratory complications in the form of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of newborn (PPHN), pulmonary hemorrhage and pneumothorax in neonates born through meconium stained liquor.Methods: It was a prospective study conducted during the period of February to October 2018. All live babies associated with meconium stained liquor were included.Results: Total 606 neonates with meconium stained amniotic fluid (MSAF) were enrolled. Chance of meconium passage was more after 37wk of gestation, in birth weight >2.5 kg and in AGA babies. The rate of LSCS was higher in MSAF group. MAS developed in 28% cases, out of which 42.9% expired. PPHN developed in 6.9% cases, out of which 80% expired. 100% mortality was there in babies with pulmonary hemorrhage. Apgar scores <7 is significantly associated with the development of respiratory complications. 22.8% of vigorous babies and all non-vigorous babies developed respiratory complications showing statistical significance with P-value of <0.00001. Mortality in MSAF was 12%. All babies who expired had severe meconium aspiration syndrome. 83.9% of the patients stayed for <7 days in the hospital. All of the expiry except one occurred within 7 days of life due to development of respiratory complications.Conclusions: MSAF is associated with the development of respiratory complications and mortality in neonates. Non-vigorous babies and the babies with Apgar scores <7 at birth are more prone to developing respiratory complications. Most of the MSAF babies were discharged and mortality was more in patients with respiratory complications.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191998
      Issue No: Vol. 6, No. 3 (2019)
       
  • Cross-sectional study of the breastfeeding practices among women
           delivering in a tertiary care hospital in Puducherry, India

    • Authors: Kalaivani A., Manasi D. Garg, Majeti Srinivasa Rao
      Pages: 945 - 948
      Abstract: Background: Global Public Health recommends that infants should receive only breastfeeding for first 6 months of life for their optimal growth and development. This study was done to find the rate of exclusive breast feeding and other feeding practices in children up to 6 months of age.Methods: A hospital based longitudinal study was conducted in a tertiary care hospital for a period of one year. Data from 158 mothers who were admitted for safe confinement was collected using structured questionnaire which was administered at every monthly follow up visit following delivery till first six months. Data included socio-demographic factors, psychosocial factors, breastfeeding details, maternal and infant factors. Data was entered in MS-Excel and analysed on SPSS version 18 software.Results: About 82.9% mothers had the knowledge about benefits of breastfeeding. Breastfeeding was initiated within one hour in 74% babies but exclusive breastfeeding for first six months was given only in 42.4% babies. Pre-lacteal feeds were given only in 3.2% babies. Early complementary feeds were started in 57.6% predominantly with cereal based diet. Perceived insufficiency of milk (30.3%) was the major reason mentioned for starting early complementary feeds.Conclusions: There is a wide gap between the knowledge and practice of exclusive breastfeeding. The importance of exclusive breastfeeding should be reinforced at every immunization visit so as to increase the rate of exclusive breastfeeding.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191436
      Issue No: Vol. 6, No. 3 (2019)
       
  • Risk factors for acute severe pneumonia in under five children

    • Authors: Neerupam Gupta, Naine Bhadrala
      Pages: 949 - 954
      Abstract: Background: Acute severe pneumonia is the leading cause of death in children below five years of age. India tops in the list amongst the 15 countries having a high incidence of childhood pneumonia with 43 million episodes of pneumonia annually. Identification of modifiable risk factors of acute severe pneumonia can help in reducing the burden of disease.Methods: A hospital-based case control study was undertaken to determine risk factors associated with acute severe pneumonia in under-five children. A case definition of acute severe pneumonia as given by world health organization (WHO) was used for cases. Healthy children attending Pediatrics outpatient Department for immunization during study period were enrolled as controls. Details of potential risk factors in cases and controls were recorded in pre-designed proforma. 732 children including 366 cases and 366 controls were enrolled in the study.Results: On stepwise logistic regression analysis it was found that low  literacy status of the mother (OR:9.46; 95%CI:7.31-19.0); inappropriate immunization for age (OR:38.04; 95%CI 14.59-110.18);cooking fuel other than liquid petroleum gas (OR:3.79; 95%CI: 2.40-6.78); low socioeconomic status (OR: 6.12; 95%CI: 2.42-35.48); overcrowding (OR:1.21; 95%CI: 1.03- 2.21) and upper respiratory infection in family (OR:5.08; 95%CI: 3.79-7.67) were the significant contributors to the occurrence of acute severe pneumonia in children under five years.Conclusions: Low literacy status of mother, incomplete immunization status, use of fuel other than LPG, low socioeconomic status, overcrowding, family history of URTI emerged as risk factors for occurrence of acute severe pneumonia in under five children.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191493
      Issue No: Vol. 6, No. 3 (2019)
       
  • How conscious are adolescent boys about their body image'

    • Authors: Ritesh Patidar, Yogendra Singh Verma, Ajay Gaur
      Pages: 955 - 958
      Abstract: Background: Perceived body image is an important determinant of nutritional status of adolescent boys. Body image misconception during adolescence is mostly unexplored field in Indian boys. The objective of this study is to assess the perceived body image and degree of dissatisfaction about it, among adolescent boys of different socioeconomic class.Methods: This multistage observational study was conducted on 200 adolescent boys of Gwalior in two different schools. Anthropometric measurements were taken. Information about socioeconomic status and perceived body image, desired body size and actual body size was collected with predesigned questionnaire.Results: Out of 200 study subjects 155 had normal BMI and 36 had high BMI, remaining were thin. Majority of adolescents (90%) desires to be neither thin nor fat and 10% (20) studied adolescent boys desires thin body. Lesser number of study subjects (63, 31.5%) adolescent boys were satisfied with their perceived body image. Satisfaction was more (34.65%) in middle adolescent age group as compared to late adolescent (28.28%). Almost two third (137, 68.6%) adolescent boys were dissatisfied with their perceived body image. Majority of adolescent boys (160, 80%) correctly estimated their body image, only 03% adolescent boys overestimated their body image whereas 17% adolescent boys underestimated their body image.Conclusions: Majority of adolescent boys are dissatisfied with their body image and almost all of them desire to have perfect body size.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191020
      Issue No: Vol. 6, No. 3 (2019)
       
  • Outcome of neonates receiving high frequency oscillation ventilation in a
           tertiary care institution

    • Authors: Kalpana M. S., Kalyani S.
      Pages: 959 - 965
      Abstract: Background: High-frequency ventilation is defined as ventilation at a frequency greater than four times normal respiratory rate. HFOV has been used as alternative to conventional ventilation and in respiratory failure of various etiologies. The aim of the study was to identify the indications of neonates receiving HFOV, following failure of conventional ventilation.Methods: Total 93 neonates were enrolled in the study who received HFOV. The criteria for starting HFOV, the ventilator settings, CBG and ABG analysis, oxygenation index (OI), duration of ventilation and complications of ventilation were recorded during CMV and subsequently when shifted over to HFOV. Outcomes such as oxygenation, lung recruitment and ventilation and survival were monitored.Results: Total 66 neonates (71%) were term babies. Among the 27 preterm 18 (18.4%) were 33-34±6 weeks of gestational age. Male were 50 in number (53.8%) and female were 43 (46.2%). The male: female ratio was 50:43. Disease specific survival analysis revealed more than 50% survival in cases of pneumonia, collapse, air leak, MAS and pulmonary hemorrhage. 16 out of 33 babies (48.5%) with PPHN survived. All 3 babies with CDH expired. Of the 93 neonates included in the study, 53 (57%) of them were discharged home. The major complications noted while on HFOV were- 38 neonates (40.8%) had air leaks. Instead of, ventilator associated pneumonia was present in 42 of them (45.1%) and none of them developed IVH or NTB (Necrotising tracheo bronchitis).Conclusions: HFOV is a safe and effective technique in the treatment of neonates with respiratory failure in whom CMV fails. The results of present study show that rescue HFOV improved oxygenation, ventilation and lung recruitment and there was no increased incidence of IVH.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191521
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prevailing pattern of feeding practices and malnutrition among infant and
           young children

    • Authors: Bharath Kumar Thirunavukkarasu, Sujay Kumar Earan
      Pages: 966 - 971
      Abstract: Background: Nutritional factors like breast feeding practices, weaning practices and diet during illness influence the growth and development of children. Recurrent   infections are other important factors that lead to malnutrition.Methods: This was a non-randomized prospective study using pretested, predesigned questionnaires. Study was done in a single centre to determine the pattern of feeding practices and malnutrition among infant and young children. This study was carried out in the Department of Paediatrics at Sri Manakula Vinayagar Medical College and hospital, Puducherry.Results: Out of the 200 babies studied, 22% of the babies were exclusively breast fed and 5% of the babies were bottle fed. The remaining 73% of the babies were on both breasts feeding and bottle feeding. A 52% of children in the age group 6-12 months, 50% children under12-24 months and 52% of children >24 months were found to be malnourished according to WHO growth standards.Conclusions: Quantity and quality of complementary feeds given is inadequate due to lake of awareness, fear and food stigmata. Hence feeding practices are far from satisfactory. Complementary feeding and weaning practice guidelines are better practiced as the age advances but their practice at a younger age would lead to a better outcome.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20190974
      Issue No: Vol. 6, No. 3 (2019)
       
  • Accuracy of lead risk assessment questionnaire in predicting elevated
           blood lead levels in children

    • Authors: Kanimozhi Sadasivam, Balaji Chinnasami, Apurva Hariharan, Balaji Ramraj, Rahul Saravanan, Saravanan Ayyavoo
      Pages: 972 - 977
      Abstract: Background: Lead toxicity in children is a serious problem affecting their neurodevelopment. Although CDC mandates screening for lead toxicity regularly in children, India doesn’t have any lead related public health program in place. In resource limited India a prescreening lead risk assessment questionnaire will be more economical than universal screening for blood lead levels (BLL).
      Authors aim to evaluate the accuracy of a validated modified CDC lead risk assessment questionnaire in predicting elevated BLL.Methods:
      Authors conducted an explorative cross-sectional study from July to August 2017 in 340 children aged 6 months to 6 years. A standardized self-administered questionnaire modified from CDC lead risk assessment questionnaire was administered in the children. Also, BLL were measured in all study subjects using lead care II analyser. Data from questionnaire were compared with BLL to test the accuracy of questionnaire.Results: Blood lead levels was high (>5ug/dl) in 57.9% of study subjects especially in children between 24-35 months. Employment in battery manufacturing companies (P=0.0001), usage of cosmetics (P=0.019), parental smoking history (P=0.001), involvement in painting, arts (P=0.0001) and malnourished children (P=0.018) were the risk factors associated with undesirable BLL. The modified questionnaire had a sensitivity of 87.9% and specificity of 66.7% for detecting elevated BLL.Conclusions: The modified CDC lead risk assessment questionnaire is a sensitive tool in identifying high risk cases of lead toxicity in children.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191040
      Issue No: Vol. 6, No. 3 (2019)
       
  • Drug utilization pattern in a neonatal intensive care unit at tertiary
           care hospital attached to a medical college in Southern Karnataka, India

    • Authors: Keerthi Budnoor Jayaram, Usha D., Prem Bhushal
      Pages: 978 - 982
      Abstract: Background: Neonates and in particular preterm neonates belongs to the most vulnerable population. A neonatal intensive Care Unit (NICU) is a highly specialized unit that provides high quality skilled care to critically ill new newborn, premature or low birth weight babies. Apart from facilities for continuous clinical and biochemical monitoring, NICU management involves the use of wide range of medications. Irrational prescription of drug is common in clinical practice, important reason being lack of knowledge about drug prescription. Developing countries have limited funds available for health care and drugs so it becomes very important to prescribe drugs rationally. The present study was done to find out the drug utilization pattern and improve the rational use which aids in the improvement of neonatal care.  Methods: The study was retrospective study in NICU of tertiary care hospital attached to MIMS, Mandya for a duration of 6 months. Data extraction sheet were used to collect the information regarding demographic details, maternal and delivery details, indication for admission, final diagnosis and medications administered. Data collected were evaluated for the category of prescribed, based on World Health Organization Anatomical Therapeutic Committee (WHO classification system and were analyzed using SPSS. WHO drug utilization core indicators were also evaluated.Results: Among 400 neonates admitted in NICU during the study period, 53.7% were males and 46.2% were females. There were 29.7% preterm born neonates. The maximum number of neonates were admitted in early neonatal period (87.25%). Neonatal sepsis (37.9%) and Birth asphyxia (11.6%) were the most common indications for admission. The total number of drugs prescribed was 1428 and the average number of drugs per neonate was 3.57. Preterm (<37weeks) and low birth weight (<2.5Kg) were exposed to significantly higher number of drugs. The most frequently prescribed therapeutic class of drugs was anti-infectives (60.36%), followed by drugs of central nervous system (7. 84%). Among the anti-infectives, the most commonly prescribed drugs were Ampicillin (59%), followed by gentamycin (42.5%). High end antibiotics like carbapenems, colistin’s and linezolid were used in less than 5% of cases.Conclusions: Drug use in neonates should be minimal and focus on the importance of therapeutic treatment guidelines establishment in hospital to control the over usage of antibiotics.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20190975
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinico etiological spectrum and antibiotic sensitivity profile of
           bacillary dysentery in a tertiary care hospital in Kashmir, India

    • Authors: Aasif Aziz Wani, Munazza Aziz Wani, Abdus Sami
      Pages: 983 - 988
      Abstract: Background: Diarrheal disorders along with dysentery constitute the second killer infections in childhood. In fact, more than half of the dysentery cases are recorded in children under 9 years of age. Shigella infection comprises well over 60% of dysentery cases in age group of 6 month to 5 years. Shigella flexneri is the commonest etiology encountered in developing nations. E. coli and campylobacter comprises the second important bacterial isolates in childhood dysentery. The objective of this study was to ascertain the clinical spectrum, etiological profile and local antibiotic sensitivity of the enteropathogens isolated.Methods: 147 serial dysentery cases admitted in GB Panth hospital Srinagar, which is an associated hospital of government medical college Srinagar from October 2014 to September 2015 were taken up for the study. A thorough and detailed history and examination was taken and recorded as per the proforma. Freshly collected stool sample was subjected to gross and microscopic examination; and after due bacteriological instructions was cultured on enrichment and selective media as per the need. Antibiotic sensitivity was done using disc diffusion method.Results: Maximum cases occurred in 1-5 years age group. Malnutrition grades II and III recorded the highest admissions. Most of cases had moderate dehydration. Although not frequent severe anemia, paralytic ileus and renal failure were the commoner complications. Shigella was grown in 12.24% of cases. Among them Shigella flexeneri serotype was encountered in 65% patients. Drug resistance was seen for many of the antibacterials like amoxycillin, ampicillin, norfloxacin, cotrimoxazole and nalidixic acid. However, they were susceptible to ceftriaxone and amikacin in well over 80% cases. E. coli isolates had similar antibiotic sensitivity profiles, with most susceptibility to amikacin and ceftriaxone.Conclusions: Drug sensitivity and resistance pattern is a variable phenomenon and changes from place to place and time to time. Hence there is a need to document the local pattern of an area so as to guide a judicious antibiotic administration. 
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20190969
      Issue No: Vol. 6, No. 3 (2019)
       
  • Most common cause of cardiomegaly without significant murmur in pediatric
           age group at tertiary care hospital, Hyderabad, India: a prospective
           observational study

    • Authors: Chandra Mohan Chekkali, Rakesh Kotha, Himabindu Singh, Narahari Bapanpalli, Sadiqua Anjum, Alimelu ., Arjun Jadhao
      Pages: 989 - 993
      Abstract: Background: Following the invention of monaural stethoscope by Laennec and X ray by Roentgen in 18th century there was spectacular advancements in cardiology. The myocardium can be affected by various disease process unrelated to abnormal pressure or volume loads. These processes may be inflammatory, metabolic, infiltrative, ischemic or primary with significant overlap. These diseases usually present as cardiomegaly. In pediatric age group cardiac diseases will present early, sometimes without any signs and symptoms like sudden death due to less cardiac reserve. Few cases of sudden death also showed huge cardiomegaly in postmortem X rays. authors want to carry out this study to find out most common cause of cardiomegaly with silent chest as authors usually miss the diagnosis and these cases may present as sudden death without giving much time to intervene. The aim of the study is to know the most common cause of cardiomegaly without significant murmur in pediatric age group above one year.Methods: Prospective observational study done at a tertiary care hospital Hyderabad over a period of one year from January 2018 to January2019.Results: Most common cause of cardiomegaly without significant murmur was cardiac beriberi. It is mostly prevalent in rural areas of Telangana, mostly occurring in breastfed babies and below six years. All cases were recovered after proper treatment. Fortunately, it is associated with nil mortality, if timely treatment was initiated.Conclusions: Cardiac beriberi which is easily preventable and if treated in proper time it will associated with nil mortality. As it was occurring commonly breastfed babies supplementation of Thiamine to mothers was very useful as a preventive strategy.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191041
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical profile of hypernatremia in exclusively breast-fed neonates

    • Authors: Sahana Devadas, Ranjitha C. R., Sarala Sabapathy, Mallesh K.
      Pages: 994 - 998
      Abstract: Background: Neonatal hypernatremia is a potentially lethal condition. This study was planned to find out the predisposing factors and outcome of hypernatremia in breast feed late preterm and term neonates.Methods: In defined study period, neonates with serum sodium level >145mmol/L, who satisfies all the inclusion criteria are included in the study.  The data was collected using a proforma which included clinical symptoms, risk factors for neonatal hypernatremia in addition to laboratory data.Results: The results demonstrated hypernatremia in 63 neonates with mean age of presentation being 4.5 days, mean sodium level of 154.2 and average weight loss was 13.2%. Neonates admitted at older age >7days had higher sodium concentration with mean of 162.5mmol/L. Serum sodium levels correlates positively with percentage of weight loss and correlates negatively with birth weight and was statistically significant with p value <0.05. 41(65%) of mothers were primipara, 37(58%) had delivered by LSCS and 39(62%) had lactation issues postnatally. Most common presenting symptom was jaundice in 44(71%), followed by fever in 38(61%).Conclusions: Hypernatremic dehydration can be prevented by counselling about importance of breast feeding for the mothers starting from antenatal period, early initiation of breast feeding, addressing lactation issues and monitoring daily weight.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191490
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study to assess the knowledge, attitude and practice of Kangaroo mother
           care among post-natal mothers in a tertiary care centre of Mangalore,
           Karnataka, India

    • Authors: Paras Gulati, Sinchana Bhat, Roshan Maben, Santhosh T. Soans
      Pages: 999 - 1002
      Abstract: Background: Kangaroo mother care (KMC) is a practical low-cost intervention which is very cost effective in developing countries for babies weighing less than 2500g. This study aimed to evaluate the knowledge, attitude and practice of post-natal mothers of LBW babies after giving a teaching session by trained personnel in a tertiary care center in Karnataka.Methods: A cross sectional descriptive study of 90 mothers whose neonates were weighing less than 2.5kg from May to October 2018.Mothers were interviewed at enrolment and were assessed about their knowledge and were oriented on its practice.Results: At recruitment (95.5%) mothers did not know about KMC.80% of mothers followed in first sitting and 86.6% of the mothers felt photo exhibition was better than verbal.96.6% of mothers thought KMC is beneficial and it was believed that other family members can even provide KMC.Conclusions: Maternal knowledge was low before now they are happily practicing KMC in hospital and thereafter at home.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191042
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study about the knowledge and attitude of antenatal women on postnatal
           care and immunisation

    • Authors: Basim Ali C. T., Fysal N., Asha S., Saleema C. V.
      Pages: 1003 - 1007
      Abstract: Background: Optimum postnatal care, exclusive breast feeding and vaccination are the most essential factors for the adequate growth and development of a child. Interventions to improve these can result in reduction in infant morbidity and mortality. The study was done to assess the knowledge level and attitude of antenatal mothers on postnatal care and immunisation.Methods: This is a cross-sectional descriptive study done in a private medical college in Kerala conducted during September 1 to 31st 2018. All pregnant ladies attending the medical college hospital for antenatal check-up during the study period and willing to participate were included. Data collection was done by interviewing the participants using pretested and edited questionnaire and analysed by applying proportions.Results: The awareness about postnatal care and breast feeding was good among participants while lacking in a few aspects. Majority of them had the right knowledge about pre-lacteal feeds, colostrum and timing of initiation of breast feeding. But there was a gap between the knowledge they possessed and what they practised when it comes to vaccination.Conclusions: There is a need to educate antenatal mothers about various aspects of vaccination and postnatal care.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191006
      Issue No: Vol. 6, No. 3 (2019)
       
  • Comparison of the effectiveness of oral sucrose solution and topical
           anaesthetics during immunization in infants between age 6 weeks-6 months

    • Authors: Ashwani Kumar, Gursharan Singh Narang, Gurmeet Singh, Jaskeen Kaur
      Pages: 1008 - 1013
      Abstract: Background: Routine childhood immunization is a proven tool for eradicating and controlling infectious diseases. Despite its key role in maintaining global public health, many individuals either refuse or delay immunization because of pain from the needle puncture. Several methods have been employed to reduce injection pain during immunization in children.Methods: Study comprised of 210 healthy infants coming for immunizations. They were divided into three groups A, B and C having equal number of infants. Group A was given oral sucrose solution, group B was given topical anaesthetic prior to immunization; whereas group C acted as controls. Response to pain was recorded among the three groups and findings were analyzed.Results: Infants enrolled in group A, i.e. those who were given 24% oral sucrose solution before immunization showed significant reduction in pain (measured by modified behaviour pain scale) as compared to control group at 15 seconds and 60 seconds of injection administration. Infants enrolled in group B, i.e. those who were sprayed topical local anaesthetics (10% lignocaine spray) before immunization showed significant reduction in pain as compared to control group at 15 seconds and 60 seconds of injection administration.Conclusions: Administration of oral sucrose solution and application of topical local anaesthetics are effective measures to reduce injection pain during immunization. Administration of oral sucrose solution before immunization showed greater reduction in pain as compared to application of topical local anaesthetics in present study.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191021
      Issue No: Vol. 6, No. 3 (2019)
       
  • Eutectic mixture of Prilocaine and Lignocaine (2.5%) versus 5% Lignocaine
           versus placebo for pain relief in new-borns undergoing venipuncture: a
           hospital based, double blind randomised case control study

    • Authors: Rakshith Reddy H. V., Aswathy Rajan, Amitha Rao Aroor
      Pages: 1014 - 1018
      Abstract: Background: Venipuncture is one of the most common cause of iatrogenic pain in neonates which is equally stressful to the parents as well as to the personnel performing the procedure. Despite an abundance of data that demonstrate the efficacy of local anesthetics for reducing venipuncture pain in neonates their use in day to day practice is not used widely used. Our objective was to evaluate the efficacy of EMLA cream and 5% Lignocaine cream versus placebo for pain relief in newborns undergoing venipuncture.Methods: Present study was a hospital based, double blind randomised, case control study. A 240 eligible new-borns were randomised into EMLA, 5%lignocaine and placebo groups after randomization. The respective creams were applied 1 hour before the procedure and pain scores were assessed using NIPS scoring during venepunture. Data was analysed using SPSS ver. 20.0 statistical package. Student’s unpaired t-test and paired t tests was used to compare continuous data, and to compare pain scores one-way ANOVA was used to compare categorical data. A p-value <0.05 was considered statistically significant.Results: Paired t-tests revealed significant lower NIPS scores in EMLA and 5% lignocaine group than the placebo group (p value=0.001).Conclusions: From present study it can be concluded that both EMLA and 5% lignocaine are equally efficacious and cost effective in reducing the pain of venepuncture in neonates.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191007
      Issue No: Vol. 6, No. 3 (2019)
       
  • A study of gross congenital malformation at birth

    • Authors: Pooja R. Gandhi, Hetal D. Vora, Halak J. Vasavada, Mehul T. Patelia, Pragneshkumar L. Popatiya, Naznin Vora
      Pages: 1019 - 1022
      Abstract: Background: A congenital anomaly is a structural anomaly of any type that is present at birth. Congenital anomalies may be induced by genetic or environmental factors. Most congenital anomalies, however, show the familial patterns expected of multi-factorial inheritance. The aims and objective of this study were to study the incidence of visible congenital malformations at birth, to study risk factors, to find associated internal malformations.Methods: It is a retrospective cross-sectional study carried out in a tertiary care hospital affiliated to a medical college. The Inclusion criteria include all new-borns delivered in the hospital with visible congenital malformations examined within 48 hours of birth. Extramural babies were included if they had presented within 48 hours after birth. The Exclusion criteria include still births were excluded from the study.Results: Percentage of congenital malformation was 1.32%. Most common systems involved were musculoskeletal system (46.34%) followed by genitourinary system (21.34%) and gastrointestinal system (14.02%).Conclusions: All Babies with gross congenital malformation should be screened for internal malformation. The incidence of CNS malformation has reduced than observed in previous studies which suggest awareness about antenatal folic acid supplementation. Other than CNS anomalies, other system anomalies were not diagnosed antenatally despite antenatal ultrasound being done in maximum number of mothers, which suggest use of 3D or 4D scan antenatally.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191022
      Issue No: Vol. 6, No. 3 (2019)
       
  • Etiology, outcomes and co-morbidities among cerebral palsy children
           attending tertiary care hospital, India: a prospective study

    • Authors: N. Dushyanth Subramaniam, Antony Jenifer, Uma Devi L., Suresh P.
      Pages: 1023 - 1026
      Abstract: Background: Cerebral palsy is the most common aetiology for motor dysfunction among children worldwide. It is associated with range of co-morbid conditions that affects the quality of life. Cerebral palsy has been studied extensively in western countries and there are only few articles available on epidemiological information in developing countries and low resource settings. This study focuses on the aetiology, risk factors, types and co-morbidities in cerebral palsy.Methods: Cerebral palsy children attending tertiary care hospital were prospectively recruited into the study. The study was conducted during January 2017 to July 2018. The cross-sectional study included complete prenatal, natal and postnatal history of the participants, BERA and Ophthalmological examinations were done.Results: One hundred and fifty children with cerebral palsy were enrolled. The mean age of participants were 36±30 months.  Male to female ratio was 2.19:1. The most common maternal risk factor among study participants was consanguinity in marriage (23.33%). 16% had prolonged labour and 10% had toxaemia during pregnancy. 47% of the children were born by institutional normal vaginal delivery. The most common neonatal risk factor was Birth Asphyxia (23%), low birth weight (20%) and neonatal sepsis (21%). 122 had spastic type of cerebral palsy. The most common morbidity associated with cerebral palsy was Gastro intestinal disturbances in 61% of the participants.Conclusions: History of prolonged labour and birth asphyxia were risk factors for cerebral palsy. Spastic CP is the most common type. Malnutrition, Gross Motor delay, Seizures, Mental retardation were the most common morbidities associated with CP. 
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191437
      Issue No: Vol. 6, No. 3 (2019)
       
  • A clinical study of hyperreactive airway disease with wheeze in children
           aged five to twelve years with special reference to pulmonary function
           test

    • Authors: Arjun Reddy, Abhishek Patel, Sanjeev Chetty
      Pages: 1027 - 1035
      Abstract: Background: Pulmonary function test is the easiest and most cost-effective method to evaluate respiratory functions. PFT can be measured by a simple instrument spirometer. Measuring PFT has been suggested as an important tool in understanding HRAD and its complications and management by all international guidelines.  The objectives of this study were to clinically diagnose the hyperreactive airway disease in children coming to Navodaya Medical College, Raichur, of age group 5 to 12 years. And to perform pulmonary function test before and after the use of a bronchodilator.Methods: PFT was measured in 100 children who came with HRAD with wheeze using Spiro lab III spirometer. The child was given then nebulization with salbutamol and PFT was performed again after 30 min.Results: A total of 100 clinically diagnosed cases of HRAD of age group 5 to 12 years of both the gender was taken into the study, of which more than 44% of the children showed more than 20% improvement in parameters FEV1, PEF, FVC and marginal improvement in EV1/FVC post bronchodilator compared to their prebronchodilator parameters. The young children of both the gender showed better improvement than elder children.Conclusions: Spirometry is the best tool to assess HRAD even in younger children, early diagnosis and regular follow up with PFT helps to understand and prevent the progression of the disease with prompt treatment.                     
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191499
      Issue No: Vol. 6, No. 3 (2019)
       
  • Mean platelet volume (MPV) as a diagnostic marker in neonatal sepsis

    • Authors: Prathyusha ., Shreekrishna G. N., Sinchana Bhat, Sahana P.
      Pages: 1036 - 1040
      Abstract: Background: Neonatal sepsis is a frequent and important cause of morbidity and mortality which accounts for one quarter of neonatal deaths. There are very few studies done in India to evaluate the role of MPV as diagnostic marker of neonatal sepsis.Methods: Prospective case control study in a tertiary care hospital. Neonates > 30 weeks gestation admitted to neonatal intensive care unit during the study period of 1 year with clinically suspected were included in the study. Neonates with Septic screen positive and culture positive sepsis were included in group A and normal neonates were included in Group B. MPV was done for all the subjects and values more than 10.2fl was considered positive. Newborns with congenital anomalies and who were already on antibiotics prior to admission were excluded from the study. Statistical analysis was done using Statistical Package of Social Sciences (SPSS) version 17.0.Results: 106 neonates were included in the study. MPV showed statistically significant difference between the study groups (mean 12.8±1.52, 10.82±1.20 respectively) at a cut of value of 10.2fl and a sensitivity of 93%, specificity of 84 % with a positive predictive value of 83% and negative predictive value of 94%.Conclusions: MPV can be used as an adjuvant marker along with established septic screen to ensure early diagnosis and treatment of neonatal sepsis with no additional expense.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191008
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prevalence of vitamin D deficiency in children with lower respiratory
           tract infection

    • Authors: Chandrashekhara ., Srinivasu Pampana
      Pages: 1041 - 1045
      Abstract: Background: Vitamin D has a role in lung growth, preserving lung function, and preventing pulmonary infection.Methods: Hospital based cross sectional prospective study was done for a period of one year from January 2017 to December 2017, at the AJ Institute of Medical Sciences, Mangalore. A total of 69 patients were admitted with LRTI during the duration of 1 year, which includes pneumonia and bronchiolitis. Out of 69 patients admitted with LRTI, 10 were excluded from the study as they were not fulfilled the criteria.Results: A total 59 children were enrolled in the study with LRTI, out of which 50 (84.7%) were vitamin D deficiency 6 (10.1%) were insufficiency and only 3 (5.08%) had normal vitamin D values, which was statistically highly significant with p value <0.05. Vitamin D deficiency is more common in less than 1 year and also in male child. Vitamin D deficiency is also common among preterm babies who were not on Vitamin D supplements, exclusively breast fed babies and among lower socio economic status especially in class 4.
      Authors found that 13 (22.03%) members were having a history of previous LRTI out of which 11 (84.6%), 2 (15.3%) had Vitamin D deficiency and insufficiency respectively. Among study group, 16 (27.11%) were diagnosed to have bronchiolitis, out of which 10 (62.5%), 4 (25%), 2 (12.5%) patients were found to have Vitamin D deficiency, insufficiency and normal values respectively. Children who diagnosed as pneumonia were 43 (72.88%), out of them 40 (93%), 2 (4.6%), 1 (2.3%) were having deficiency, insufficiency and normal values of Vitamin D respectively.Conclusions: Vitamin D deficiency is common in children with LRTI especially among exclusively breastfed, born preterm and children from lower socio economic status. Early recognition and treatment of Vitamin D deficiency can prevent morbidity associated with rickets and possibly frequent LRTI.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191043
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinico-epidemiological spectrum of early onset neonatal sepsis in
           neonates admitted in NICU of a tertiary care institute

    • Authors: Ashwani Kumar, Gursharan Singh Narang, Gurmeet Singh, Navneet Virk, Ashiana Singh
      Pages: 1046 - 1051
      Abstract: Background: Neonatal  sepsis  is  a  clinical syndrome  characterized by signs and symptoms  of  infection  with  or  without  accompanying  bacteremia  in  the  first  month  of  life. Neonatal  sepsis  may  be  classified  into  two  groups : early onset  sepsis and  late onset  sepsis . Early onset neonatal sepsis  is  generally  associated  with  the  acquisition  of  microorganisms  from  the  mother  and  usually  presents  with  respiratory  distress  and  pneumonia.Methods: The study included one hundred  term  neonates with early onset neonatal sepsis. A septic screen including total leukocyte count, absolute neutrophil count, blood smear evaluation, blood cultures and C-reactive protein (CRP) were performed in all neonates with suspected sepsis to corroborate early onset sepsis diagnosis. Epidemiological parameters including gender of the neonate, mode of delivery, rural/urban residence were recorded in addition to clinical profile.Results: Respiratory distress was the most common presentation in the form of tachypnea, seen in 63 (63.0%) neonates. In present study, Staphylococcus aureus was the most common organism isolated followed by Staphylococcus epidermidis, Staphylococcus hominis, Acinetobacter baumannii and Klebsiella pneumonae.Conclusions: Early onset neonatal sepsis  was seen more in males. Among the gram-positive Staphylococcus aureus and among gram negative Acinetobacter baumannii and Klebsiella pneumonae were most common organisms to be isolated.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191071
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prognostic value of rise in neutrophil to lymphocyte ratio (NLR) and
           platelet to lymphocyte ratio (PLR) in predicting the mortality in
           paediatric intensive care

    • Authors: Siby Mathews, Aswathy Rajan, Santosh T. Soans
      Pages: 1052 - 1058
      Abstract: Background: When the body is stressed in diverse pathological conditions, it responds by mounting an inflammatory response. Predictive biomarkers reflecting the response may serve as guide to management. Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio has been frequently used in adult patients as an indicator for mortality. However, no study has looked into their use within pediatric population. The objective of the study is to assess the prognostic value of rise in NLR and PLR in pediatric intensive care as markers of mortality.Methods: A retrospective study based on 3 year data from HIMS and G-HEALTH data systems of AJ Institute of Medical Science, of all patients admitted to PICU after excluding those in whom all the study parameters were not retrievable, were postoperative patients and/or stay was less than 5 days. NLR and PLR ratios were determined and compared to PELOD 2 using SPSS version 17.0.Results: The demographic data was matched. PELOD 2 (>20) predicted mortality in 72.2% of the patients, while NLR increase predicted in 61.1% and PLR increase in 77.8%. A decreasing trend in NLR and PLR were both closely related to better survival. Among the 3, Rise in PLR had higher sensitivity, specificity, PPV, NPV, and overall accuracy of 72.73% (p <0.001) to predict mortality.Conclusions: The study gives an insight into the fact that simple and inexpensive markers such as rise in NLR and PLR helps in predicting the mortality in the pediatric intensive care which is comparable to PELOD 2 score.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191044
      Issue No: Vol. 6, No. 3 (2019)
       
  • Association of other congenital anomalies in children with cleft lip and
           palate: a prospective hospital based observational study

    • Authors: Padmasani Venkat Ramanan, Rajesh Balan, Jyotsna Murthy, Syed Altaf Hussain
      Pages: 1059 - 1062
      Abstract: Background: Cleft lip and palate is a common congenital anomaly affecting approximately 1 in 700 live births in south Asia. It is often associated with syndromes and other malformations but the exact incidence of these in Asians is not known. The present study was carried out to determine the association of other congenital anomalies in children with cleft.Methods: The study was carried out in the patients attending the Cleft centre of our Hospital. They were examined for other major external congenital malformations and syndrome association.  Where ever relevant, appropriate investigations were done.Results: Of the total of 2367 children examined, 262 (11.06%) had congenital malformations.  Among the non-syndromic children, 9% had associated malformations.  The commonest was congenital heart disease (1.4%) following by genitourinary and skeletal anomalies.  The highest number of anomalies was seen in patients with cleft palate alone (24.89%). 1.4% patients had identifiable syndromes.Conclusions: The study emphasizes the need for a thorough examination of all children with cleft.  The overall lower incidence of syndromic clefts and associated anomalies in present study suggests that other etiological factors may be involved in our country.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191072
      Issue No: Vol. 6, No. 3 (2019)
       
  • Universal hearing screening in newborns: experience in a tertiary care
           hospital of Mangalore, Karnataka, India

    • Authors: Y. Bhanu Chandar Reddy, Sinchana Bhat, Roshan Ann Oommen, Santosh T. Soans
      Pages: 1063 - 1067
      Abstract: Background: The aim of the study was to do universal hearing screening of all newborns using otoacoustic emission (OAE), to know the incidence and risk factors of hearing loss in neonates.Methods: This was a prospective observational study done in a tertiary care hospital in Mangalore city in Karnataka. 950 neonates were screened with distortion product otoacoustic emission (DPOAE) during the study period of one year from 2017 to 2018. A repeat test was done at one and a half months of age if the first test failed. Auditory brain stem evoked response (ABER) was performed at 3 months of age if both the tests failed. Babies with hearing loss were referred to ENT specialist for further management. Comparison of the variables was done by student’s t test and Chi-square test. P-value <0.05 was considered statistically significant.Results: Out of the 950 newborns screened with DPOAE test, 204 (21.4 %) babies had abnormal screen either in single or both ears. 7 out of 204 (3.43%) babies had abnormal OAE on repeat testing at one and half months. 2 out of 7 babies (0.96 %) had significant hearing loss ABER was performed at 3 months of age.Conclusions: Early identification by screening of hearing loss prevents a significant public health concern. Early recognition and intervention prior to 6 months have a significant positive impact on development.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191073
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study of blood pressure in relation with age, sex and BMI in school going
           children of age group 5-15 years in Amalapuram, Andhra Pradesh, India

    • Authors: Rajesh Kumar Sethi, Raghava Badabagni, Padmaja Sridevi Pabbineedi, Radhika Chennupati
      Pages: 1068 - 1075
      Abstract: Background: The measurement of blood pressure is an important component of routine Pediatric physical examination. Children with higher levels of blood pressure tend to maintain higher blood pressure levels in adulthood in comparison to their peer group. The aims and objectives of this study were to define the normal pattern of blood pressure and prevalence of hypertension in urban school children between the age group of 5-15 years and to evaluate relationship of blood pressure with variables such as age, sex, height, weight and BMI in Amalapuram, Andhra Pradesh.Methods: This was a prospective cross-sectional observational study conducted from July 2016 to December 2018 in Department of Pediatrics, KIMS Amalapuram.Results: The overall prevalence of hypertension in the present study was 3.2%. Of these 16 children 11 were males amounting to 4.41% of total number of males and 5 were females amounting to 1.99% of total number of females. The prevalence of hypertension was more in the males. It was observed that there is not much increase in mean blood pressure up to 130 cms (both in males and females) and increased significantly and gradually in children above 130 cms of height. Blood pressure increases gradually and in a proportionate manner with increase in weight and BMI.Conclusions: Blood pressure is an important vital sign which reflects the integrity of the cardiovascular system, renal, endocrinal system and other systems in the body. Blood pressure of an individual varies with age, sex, height, weight and BMI. It also has a strong correlation with family history of hypertension. Thus, concluded that hypertension has its roots in childhood and early adolescence.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191438
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study of sodium and potassium changes in term neonates receiving
           phototherapy

    • Authors: Rangaswamy K. B., Dileep Yeturi, Anantha Narayana Gowda B. L., Chandana Krishna, Samyuktha .
      Pages: 1076 - 1079
      Abstract: Background: Neonatal Hyperbilirubinemia (NH) is the commonest abnormal physical finding during the first week of life and also the most common cause for readmission during the early neonatal period is a cause of concern for the parents as well as for the Pediatricians. Hence appropriate management of Neonatal Hyperbilirubinemia is of paramount importance. Phototherapy plays a significant role in prevention and treatment of hyperbilirubinemia. However, this treatment modality may itself result in inherent complications. The present study was carried out with the objective of evaluating the sodium and potassium changes in neonates receiving phototherapy for neonatal hyperbilirubinemia.Methods: A prospective hospital based observational comparative study conducted on 96 eligible term neonates admitted in the neonatal intensive care unit receiving phototherapy at a teaching Hospital from October 1st to December 31st 2018. A predesigned proforma has aided the enrolment of new-borns into the study according to AAP guidelines. Serum bilirubin, sodium and potassium were determined before and after termination of phototherapy. The first samples were considered as controls. A comparative study was made between before and after phototherapy groups to determine the incidence of sodium and potassium changes.Results: The study group included 96 term neonates that were managed with phototherapy. Incidence of low birth weight babies was 21.9%. Mean birth weight and gestational age was 2.76±0.38 kg and of 38.34±0.88 weeks respectively. Mean duration of phototherapy was 38.48±09.34 hours. The incidence of Sodium and potassium changes were found to be statistically significant after phototherapy (p<0.01) but neonates didn’t develop any signs of hyponatremia and hypokalemia.Conclusions: The study shows that neonates undergoing phototherapy are at a higher risk of sodium and potassium changes. This risk is greater in LBW babies and hence this group of babies should be closely monitored for changes in sodium, potassium and should be managed accordingly.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191439
      Issue No: Vol. 6, No. 3 (2019)
       
  • Changes in serum phosphorous level during inpatient treatment of children
           with severe acute malnutrition

    • Authors: Dakshayani B., Divyashree P., Sarala Sabapathi, Mallesh Kariyappa
      Pages: 1080 - 1084
      Abstract: Background: SAM children have increased requirements for phosphorus during recovery. If requirements are not met, they may develop refeeding hypophosphatemia leading to increased morbidity and mortality. However, no much studies known about the effect of current therapeutic diets (F-75 and F-100) on serum phosphate in SAM children.Methods: Prospective observational study, in which measuring serum phosphate at admission, at end of stabilization phase and at discharge in SAM children between 6-59 months.Results: Among 35 children enrolled, mean serum phosphate was 4.3 ±0.6 mg/dl at admission, 4.1± 0.8mg/dl at end of stabilization phase and 4.4±0.7mg/dl at discharge. 17% of children had hypophosphatemia at admission, 31% at end of stabilization phase and 17% at discharge. mean weight gain in hypophosphatemia and normophosphatemia groups are 1.3±1.46mg/kg/day and 2.51±2.63mg/kg/day (p=0.1) respectively. Mean duration of stay in hypophosphatemia and normophosphatemia groups are 11.6±1.26 and 10.26±1.54 days respectively (p=0.016).Conclusions: Hypophosphatemia was common among children with SAM at admission and increased at end of stabilization phase. Serum phosphate remains subnormal in about 1/5th of the children at discharge. This could be problematic for further recovery as phosphorus is needed for catch-up growth and bioavailability of phosphorus is low in local diets. Hence, authors suggest phosphorus supplementation in SAM children.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20181478
      Issue No: Vol. 6, No. 3 (2019)
       
  • Predictors of treatment failure in severe pneumonia treated with
           Ampicillin in tertiary care center

    • Authors: Lakshmi M., Manu M. A., Kalpana R. Y., Sarala Sabapathy, Rekha T. D.
      Pages: 1085 - 1089
      Abstract: Background: Pneumonia affects 156 million children under five years every year and is the leading cause of mortality in this age group. It emphasizes the need to identify high risk factors for Treatment Failure so as to treat them aggressively. The objective of this study was to assess factors influencing treatment failure in severe pneumonia treated with Ampicillin.Methods: Prospective observational study, in which 235 children with severe pneumonia between 2 months to 60 months were enrolled and started with intravenous Ampicillin as per WHO protocol. If no clinical improvement was seen after 48 hours, it was taken as treatment failure and managed accordingly.Results: Among 235 children, 43(18.2%) did not respond to Ampicillin. Among treatment failure cases males were 20 (46.5%) and females were 23 (53.6%). All the following parameters were statistically significant(p<0.05). Majority of 23(53.4%) were between 2 to 12 months. 13(30.2%) were incompletely immunized. MAM were 23(53.4%) and 22(51.1%) cases had signs of Rickets. 34(79.1%) had Anemia out of which 22(64%) had moderate anemia. 39(90.6%) children had fever and hypoxia at admission.Conclusions: Infancy, malnutrition, severity of anemia, rickets, lack of immunization, hypoxia at baseline were significant predictors of treatment failure in severe pneumonia. Strengthening immunization and improving nutritional status may improve the outcome. Children with above risk factors require vigilant monitoring.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20181479
      Issue No: Vol. 6, No. 3 (2019)
       
  • Response to gluten free diet in sero-positive celiac disease children
           suffering from severe acute malnutrition in age group 1-5 years

    • Authors: Mahendra Meena, Pradeep Meena, R. L. Suman, Suresh Goyal
      Pages: 1090 - 1094
      Abstract: Background: Diagnosis of celiac disease in children suffering from severe acute malnutrition without duodenal biopsy or HLA typing is a dilemma. The objective of this study was to study the response to gluten free diet in sero-positive Celiac Disease children suffering from severe acute malnutrition in age group 1-5 years.Methods: This prospective, observational, hospital-based study was conducted at MTC of tertiary care medical college hospital of southern Rajasthan from Dec. 2017 to Nov. 2018. Total 110 children with SAM were enrolled and screened for celiac disease on the basis of tissue tTg-IgA/IgG serology. Seropositive cases were kept on gluten free diet for short period of time and observed for the resolution of symptoms and improvement in growth, monitored by anthropometry on discharge and follow up visit.Results: Mean weight gain (gm/kg/day) on follow up was 3.87±3.49 in seropositive and 1.88±3.79 in seronegative cases (P-value<0.05). Mean weight gain was 6.43±3.28gm/kg/day in only tTg-IgA positive and 3.04±2.95 gm/kg/day in only tTg-IgG positive cases (P-value-<0.05). The mean weight gain in strictly gluten free adherent sero-positive cases was 4.89±2.97 gm/kg/day while in gluten free non-adherent patients it was -0.49±1.70 (P-value <0.001). Mean weight gain in probable (tTg-Ig-A <10 times ULN) and presumptive (tTg-IgA >10 times ULN) Celiac disease were 3.44±3.73 and 5.44±3.78, respectively without statically significant difference (P-value >0.05).Conclusions: In situations where facility of duodenal biopsy and or HLA DQ2/DQ8 typing is not available, resolution of symptoms and improvement in growth on gluten free diet confirms the diagnosis of celiac disease.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191440
      Issue No: Vol. 6, No. 3 (2019)
       
  • Safety of aggressive nutrition bundle-aggressive parenteral nutrition,
           standardized feeding policy, human milk fortification and probiotics in
           babies born less than 34 weeks of gestation: a prospective analytical
           cohort study

    • Authors: Mubashir H. Shah, Nitin P. Rachwani, Reashma Roshan, Gaurav Patwardhan, Tushar Parikh, Sandeep S. Kadam
      Pages: 1095 - 1101
      Abstract: Background: Despite changes in nutritional interventions in neonatal intensive care units worldwide, significant proportion of preterm babies are growth restricted at discharge.
      Authors intended to look at the feasibility of aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) in preterm neonates.Methods: This single centre prospective analytical cohort study, involving babies born before 34 weeks of gestation, was conducted in a tertiary hospital. Aggressive parenteral nutrition and enteral nutrition bundle intervention was started within 24 hours of birth. Clinical, laboratory and anthropometrical parameters were monitored longitudinally to ensure safety of this intervention.Results: Mean gestational age and birth weight of the cohort (n=107) was 30.6 weeks (SD±2.6) and 1147 grams (SD±287) respectively. Out of 107 babies, 67.3% (n=72) have extra uterine growth retardation (EUGR) at discharge and was more in small for gestational age neonates (p=0.001). With this aggressive parenteral and enteral nutrition bundle intervention, medical necrotizing enterocolitis (NEC) developed in 7.4 % (n=8) babies while surgical NEC was seen in 1.9%. (n=2). Early onset and late-onset sepsis occurred in 1.8% and 5.4% of babies respectively while mild hyperammonemia, mild hypertriglyceridemia, raised creatinine and urea developed in 12.4%, 4.6%, 7.4% and 11.7% respectively. Hyperglycemia and hypoglycemia were present in 8.8% and 5.6% babies respectively.Conclusions: Aggressive nutrition bundle (aggressive parenteral nutrition, standardized feeding policy, fortification and probiotics) can be safely employed in preterm babies. There is an urgent need to design a study to see the impact of this approach on incidence of EUGR in preterm babies.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191491
      Issue No: Vol. 6, No. 3 (2019)
       
  • Evaluation of the WHO/UNICEF algorithm for integrated management of
           childhood illness

    • Authors: Javaid Iqbal, Tarsem Lal Motten, Ashu Jamwal, Pallvi Sharma
      Pages: 1102 - 1107
      Abstract: Background: The present study was designed to evaluate the feasibility and utility of the integrated management of the childhood illness (IMCI) algorithm to diagnose the illnesses in children under the age of 2 months to 5 years.Methods: The study was conducted on 300 children, aged 2 months to 5 years, who presented with a fresh episode of any illness to the out-patient Department of the SMGS Hospital over a period of 9 months. Within these initial selection criteria, the WHO/UNICEF algorithm for management of the sick child was referred to, children were assessed and classified as per "IMCI" algorithm and treatments required were identified. The final diagnosis was made and appropriate therapy instituted served as the "Gold standard". The diagnostic and therapeutic agreements between the 'gold standard' and the IMCI and vertical (on the basis of primary presenting complaint) algorithms were computed.Results: Among all 300 subjects, more than one illness was present in 207 (69%) of subjects as per Gold standard diagnosis. The corresponding, figures for IMCI module were 141 (47%) and 222 (74%) for low and high malaria algorithms respectively. The mean illnesses per child were 2.12, 182 and 2.21, respectively. The subjects who would have been referred as per IMCI module had a greater co-existence of illnesses than those who would not have been referred (mean 2.5 versus 1.5 illnesses per child respectively). The specificity for general danger signs was 66% while the sensitivity was 71%.Conclusions: In conclusion, the performance of the IMCI algorithm is significantly better than the vertical disease specific algorithm. In addition, the IMCI algorithm incorporates an element of preventive care in the form of immunization and feeding advice.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191541
      Issue No: Vol. 6, No. 3 (2019)
       
  • Placental pathology and its correlation with immediate feto neonatal
           outcome

    • Authors: Ashoka A., Manjunatha Sarthi, Basavraj A. C., Mahesh T. K.
      Pages: 1108 - 1112
      Abstract: Background: Placenta plays a major role in growth and development of the fetus as it helps in both exchange of nutrients and removal of waste. Even though it yields a valuable information of prognostic significance for the newborn, majority of the time it will be discarded after the gross examination. Hence the present study was conducted to determine the placental pathology and its correlation with fetal outcome.Methods: The present study was carried out in Davangere for a period of 2 years. The placenta of 100 parturients, more than 28 weeks of gestation were included for the present study. The data was collected after detailed review of the obstetric case records. Placentas were examined soon after delivery. After the gross examination was complete, the placentas were put in a labelled plastic container. The placentas were re-examined macroscopically again by the pathologist. Cut-section examination was done. Then, at least 4 appropriate blocks were taken for each placenta. They were stained with hematoxylin-eosin stain and examined under the microscope. The histopathological examination was conducted as per proforma.Results: One hundred placentae belonging to one hundred babies were studied among which 80% of the maternal cases had anaemia, 68% were term infant, 37% had IUGR. Eccentric insertion of the cord was observed to be the commonest (51). Marginally inserted membranes were seen most frequently (97).Conclusions: In the present study we conclude that placental reserve is large and small alteration do not affect the pregnancy outcome. The placental changes are not specific to a particular condition affecting the pregnancy.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191999
      Issue No: Vol. 6, No. 3 (2019)
       
  • Profile of children with seizures in a tertiary care hospital at VCSGGIMS
           and R Srinagar Pauri, Gharwal, Uttarakhand, India

    • Authors: Rohit Chib, Manju Devi
      Pages: 1113 - 1118
      Abstract: Background: Seizure is one of the common causes of childhood hospitalization with significant mortality and morbidity. Current study is to find the etiology of seizure and classify seizure into various types and age groups presenting to tertiary center in Department of pediatrics VCSGGIMS and R Srinagar Pauri, Gharwal, Uttrakhand, India.Methods: This was a hospital based prospective study carried out from 1st Jan. 2014 to 31st Dec 2014. Variables collected were demographics, clinical presentations, laboratory tests, brain imaging studies, electroencephalography, diagnosis and hospital course.Results: A total of 276 patients were admitted for seizures with 172 (62.3%) males and 104 (37.7%) females. Among these patients, 148 (53.5%) presented with fever and 157 (56.8%) of children were less than 5 years of age. Generalized tonic-clonic seizure was the most common seizure type (69.2%) followed by partial (19.2%), absence (2.8%), myoclonus (1.6%) and others (6.9%). Seizure disorder (33.7%), febrile seizures (30%), CNS infections (meningitis 6.1%, encephalitis 6.5% and Tubercular meningitis 1.8%) and neurocysticercosis were other common etiologies. Abnormal brain images were noted in 55 (45.45%) out of 121 patients and most common abnormality was neurocysticercosis 33(12%).Conclusions: Acute episode of seizure is one of the causes for hospitalization. It can be concluded from present study that most of seizures caused by febrile seizures and CNS infections (meningitis and encephalitis, neurocysticercosis) can be managed better with prompt interventions. Children presenting with unprovoked seizure need prolonged follow up with neurophysiologic studies and neuroimaging (CT or MRI) for better understanding of childhood seizure.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191492
      Issue No: Vol. 6, No. 3 (2019)
       
  • The randomised prospective comparative study to see the duration of
           analgesia following intravenous or rectal acetaminophen after
           adenotonsillectomy in children

    • Authors: Neerupam Gupta, Naine Bhadrala, Jasmeen ., Saloni .
      Pages: 1119 - 1123
      Abstract: Background: The greatest advance in pediatric pain medicine is the recognition that untreated pain is a significant cause of morbidity and even mortality after surgical trauma. Author compared the analgesic efficacy and duration of analgesia of rectal acetaminophen and I.V. acetaminophen.Methods: A total of 80 children in the age group of 2-5 years were randomly selected and divided into 2 groups. Group I received 15 mg/kg I.V. paracetamol and group II received 40 mg/kg rectal acetaminophen. Post-operative pain scores were measured using Face, Legs, Activity, Cry and Consolability scale and duration of analgesia were recorded and compared.Results: The pain scores in group I was lower immediately after extubation and at 30 minutes post extubations but at one, two and four hours the pains score were comparable in both the groups. At 6 hours, the pain score was significantly more in I.V. group and also the duration of analgesia was 9-10 hours in rectal acetaminophen group where as in I.V. group, it was 5-6 hours.Conclusions: Rectal acetaminophen 40 mg/kg produces prolonged analgesia as compared to I.V. paracetamol 15 mg/kg and also is more convenient and cost effective and is devoid of side effects of I.V. cannulation.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191500
      Issue No: Vol. 6, No. 3 (2019)
       
  • Can moms give up bottle feeding': retrospective analytic study to
           promote breast feeding

    • Authors: Anil Kumar Sajjan, Ravi Kumar Baradol
      Pages: 1124 - 1129
      Abstract: Background: Bottle feeding is one of the preventable causes of morbidity and mortality in infants and young children. Children admitted in our hospital analyzed at our center and appropriate advice and guidance for cessation of bottle feeding was given. The objective of this study was to analyses the feeding pattern and the reasons for bottle feeding in children and to help mothers to try and give up bottle feeding and initiate breast feeding.Methods: Retrospective analysis of 200 children less than 2 years admitted to Shri B M Patil hospital for various illnesses was done. Children were divided into 2 groups mainly breast-fed children and bottle-fed group. Both groups were analysed with respect incidence of infection, reason for bottle feeding, age of introduction of bottle feeding, time taken by mother to give up bottle feeing and type of compatible feeding at the time of discharge.Results: All the mothers could give up bottle feeding in less than 7 days during the hospital stay. 81 mothers were able to initiate breastfeeding of which 4 mothers were able to exclusively breastfeed at the time of discharge. 66 mothers were not able to initiate breastfeeding.71% of children received help with drip-drip method of feeding. Breast refusal was the cause of bottle feeding in 40.13% (59/147) of babies.Conclusions: Bottle fed children were more prone to infections. All the mothers gave up bottle feeding within 1 week. Drip drop method was the most effective strategy for initiation of breastfeeding.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191520
      Issue No: Vol. 6, No. 3 (2019)
       
  • Screening for congenital heart disease in newborns at urban community
           health centre

    • Authors: Kalpana M. S., Vijayanthi Mala J.
      Pages: 1130 - 1135
      Abstract: Background: Congenital heart disease (CHD) is a defect in the cardiovascular structure and function and represents a heterogeneous group of defects with little known cause. Most of them are diagnosed in newborn period, yet some may be missed only to be diagnosed later. CHDs present with little or no symptoms and hence are under diagnosed in centres with inadequate facilities. So, this study was conducted to find the prevalence of CHDs in neonates delivered in our centre.Methods: The study was conducted in an urban community centre from May 2018 to January 2019. Babies delivered here were subjected to clinical examination, pulse oximetry at our centre and detailed ECHO examination was done at a nearby PHC where a trained cardiologist was available.Results: There were 783 babies delivered during the study period, of which 436 babies underwent echo and formed the study group. Totally 35 (8%) babies had some abnormality on echo. Clinically murmurs were present in 10 newborns. Critical congenital heart disease was seen in 3(0.6%) babies. These babies were diagnosed with severe PS, Bicuspid aortic valve with severe AS and pulmonary atresia. VSD was the commonest malformation followed by ASD and PDA.Conclusions: Screening of CHD helps to detect defects which otherwise would have been missed. Critical CHD could be diagnosed which enabled us to refer the babies for early surgery.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20191522
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical profile of neonates with acute renal injury in neonatal intensive
           care unit at GMERS Medical College and General Hospital, Gotri, Vadodara,
           Gujarat, India

    • Authors: Kajal Lakhubhai Katariya, Nimisha K. Pandya
      Pages: 1136 - 1142
      Abstract: Background: Acute kidney injury (AKI) is defined as an acute deterioration in ability of the kidneys to maintain homeostasis of body fluids and electrolytes leading to retention of wasted and toxic metabolic end products. It is fairly common in newborn population and is a major contributor of neonatal mortality and morbidity. The aim was to study the incidence of renal failure in high risk neonates and risk factors for renal failure.Methods: A prospective observational study was done to evaluate renal profile in high risk neonates admitted to neonatal intensive care unit, GMERS Medical College and General Hospital, Gotri, Vadodara, Gujarat, India over a 1-year period. nRifle criteria was used for classification of acute kidney injury.Results: The incidence of AKI in high risk newborns admitted in this study was 52 (37.14%). The male to female ratio in current study was 2.46:1. Majority of neonates with AKI were out born 44 (84.6%). The incidence of AKI was higher in term newborns. Mean weight in AKI group was 2048 grams. The highest incidence of AKI was found in AFD newborns (57.69%). nRifle criteria was used to diagnose AKI in this study. Out of 52 neonates who had AKI, 27 (51.9%) were in risk category, 21 (40.4%) were in injury group and 4 (7.7%) were in failure group. Mortality in these groups were 5 (18.51%), 7 (33.33%) and 3 (75%) respectively. Highest correlation of risk factors for AKI was found with birth asphyxia 18 (34.9%) followed by sepsis 12 (23.1%) and shock 15 (28.5%). 29 (55.76%) neonates had non oliguric AKI. 28 (53.8%) neonates with AKI developed dyselectrolytemia.Conclusions: Early recognition and management of risk factors can help in reducing the occurrence and improve outcomes in them.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192000
      Issue No: Vol. 6, No. 3 (2019)
       
  • Nutritional status and common morbidities among school-going adolescents
           of rural areas of Vadodara, Gujarat: a cross sectional study

    • Authors: Prashant M. Modi, Sunil Pathak, Sagar Patel, Ritika Srivastva, Reya Thomas, Niharika Khullar
      Pages: 1143 - 1148
      Abstract: Background: Abnormal nutritional status i.e. underweight, overweight and obesity is increasing rapidly amongst adolescents irrespective of socioeconomic status and geography. This study was carried out to assess prevalence of abnormal nutritional status and common associated morbidities among school going adolescent of rural areas of Vadodara, Gujarat, India.Methods: A cross sectional observational study was done among school going adolescents of rural areas of Vadodara, Gujarat. A predesigned and pretested semi-structured proforma was used to get relevant clinical details of study participants. Total 474 students aged 12-17 years participated in our study.Results: Out of 474 enrolled adolescents, 16.67% were underweight, where as 3.8% and 2.95% were obese and overweight respectively. The prevalence of overweight and obesity were almost similar in both genders. Out of total 16.24% were stunted with predominance in boys compared to girls (p value: 0.039). Hypertension was found in 5.0% of participants with 3 times more prevalent in girls than boys (p value 0.011). Similarly, anemia was affecting both genders equally.Conclusions: Although underweight is a known nutritional problem of adolescents from rural areas, overweight and obesity are also rapidly growing health issues among them now a days. With keeping in mind this increasing burden of abnormal nutritional status and associated morbidities, regular health check-up, education of parents and adolescents on healthy lifestyle and inclusion of adolescents in existing government programmes are essential measures to reduce these problems.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192001
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical profile of pediatric patients with urinary tract infection in a
           tertiary care centre in Kashmir, India

    • Authors: Khalid Kawoosa, Rahid Rasool Malla, Sheeraz Ahmad Dar, Syed Heena Kubravi
      Pages: 1149 - 1153
      Abstract: Background: The urinary tract is a common site of infection in pediatric patients. Author studied the clinical and microbiological profile along with the antibiotic resistance in children with UTI attending centre.Methods: It was a prospective study was conducted in the Department of Pediatrics, Sheri-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India over a period of one year from August 2017 to August 2018.A total of 250 children aged 1-36 months were included in the study. A proper history and examination were done in each case. A clean catch mid-stream urine sample was obtained from each child. Quantitative microscopy and urine culture were performed. Standard biochemical tests were done to identify the isolates and for determination of antibiotic sensitivity.Results: Out of the 250 children studied , a total of 216 children were diagnosed as UTI by positive urine culture.102 were males and 114 were females. Significant pyuria was detected in 85%patients. Fever with irritability was the most common presenting symptom (71%) followed by vomiting (63%) and abdominal pain (52%).The most common uropathogen detected was E. coli (57%) followed by Klebsiella spp. (20%), proteus (16%), pseudomonas (5%), and candida (2%). Majority of the patients responded to treatment with ceftriaxone followed by cefixime. Antibiotic resistance in vitro was least seen with amikacin (25%) followed by nitrofurantoin (11%). 91.3% of UTI detected was nosocomial. Vesicoureteral reflux was found in 49% of patients while 13% were diagnosed with posterior urethral valve.Conclusions: Urinary tract infection should be considered as one of the most important differential diagnosis in patients with fever attending pediatric OPD. Urine microscopy and culture should be a part of routine diagnostic evaluation in all febrile children. Early treatment of UTI is important to prevent later sequelae including pyelonephritis and renal scarring.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192002
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical study of scorpion sting envenomation

    • Authors: Manjunatha Sarthi, Ashoka A., Basavraj A. C., Mahesh T. K.
      Pages: 1154 - 1157
      Abstract: Background: Scorpion stings are common in India. Presentation of scorpion sting may vary from localised pain at the site of the sting to life threatening condition. Systemic envenomation will even result in death among one third of the subjects. The present study was conducted to determine the clinical presentation, course, complications and outcomes of scorpion sting envenomation among children as they are sensitive to scorpion envenomation.Methods: 50 cases of scorpion sting, admitted to 2 hospitals, under JJMMC, Davangere for 1 year were included. A detailed clinical history followed by examination was done. Relevant investigations were also done. All the cases were monitored for complications and managed accordingly.Results: Maximum number of cases were noted in the age group of 1-3 years and 10-12 years. 58% of them were boys, 54% of the cases had red scorpion sting. Pain at the sting site, diaphoresis and restlessness were the most common presenting symptoms. The common signs noted were restlessness, cold extremities and tachycardia. Commonest complications were peripheral circulatory failure, pulmonary oedema, myocarditis and congestive cardiac failure. Majority of cases recovered without any sequelae.Conclusions: Present study we conclude that majority of the cases were among boys belonged to 1-3year age group. Red scorpion sting was common, and commonest presentation was pain and recovered without any sequelae.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192003
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study of eosinophil count in nasal smear and peripheral blood smear in
           children with allergic rhinitis

    • Authors: Sudha Rudrappa, Rajendra Kumar, Vinay Kumar
      Pages: 1158 - 1162
      Abstract: Background: Allergic respiratory disorders are the common cases seen in Pediatrics OPD. With an appropriate history and detailed examination, the diagnosis usually may not be problematic and routine investigations may not contribute much for the final diagnosis but may help in ruling other possibilities. The objectives of this study were done to know the eosinophil counts in nasal and blood smear and to assess the feasibility of nasal cytogram which is simple, economical and reliable investigation in patients of allergic respiratory disorders.Methods: A prospective clinical correlation study conducted in outpatient visiting Mysore Medical College and Research Institute, Cheluvamba hospital Department of Pediatrics and ENT Department KR hospital. 60 children of age group between 2 to 18 years were selected to estimate the eosinophil count in nasal and peripheral smear in allergic rhinitis. All allergic rhinitis cases based on clinical signs and symptoms were selected and investigated for nasal and blood eosinophilia. The nasal and blood eosinophilia were compared with each other and the clinical findings of allergic rhinitis were studied.Results: In this study peak age incidence is between 6-10 years and there is equal gender distribution. Seasonal variation and pollen allergens were the most common risk factors for allergic rhinitis. Running nose and the nasal obstruction were the most common symptoms in children with allergic rhinitis followed by sneezing and itching. One tenth of the children with allergic rhinitis had bronchial asthma. Nasal eosinophilia contributes to the diagnosis of allergic rhinitis as compared blood eosinophilia. Mild intermittent variety of allergic rhinitis was the most common form of allergic rhinitis.Conclusions: Among various risk factors for allergic rhinitis, seasonal variation and pollen allergens have significant association with the severity of allergic rhinitis. Among various symptomology, only itching had a significant relation to the severity of allergic rhinitis.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192004
      Issue No: Vol. 6, No. 3 (2019)
       
  • Case-based learning in integrated management of neonatal and childhood
           illness

    • Authors: Sundaram Kartikeyan, Aniruddha A. Malgaonkar
      Pages: 1163 - 1167
      Abstract: Background: This complete-enumeration, before-and-after type of study (without controls) was conducted on 61 third-year medical students at Rajiv Gandhi Medical College, Thane, Maharashtra state to study the difference in cognitive domain scores after attending lecture-based learning (by a pre-test) and after attending case-based learning (by a post-test).Methods: After approval from the institutional ethics committee, the purpose of the study was explained to third-year medical students and written informed consent was obtained. After curriculum-based lectures on integrated management of neonatal and childhood Illness, a pre-test was administered wherein each student was asked to fill up case sheets for five case scenarios. The maximum marks obtainable were 10 marks per case (total 50 marks).  Case-based learning was conducted in two sub-groups comprising 31 and 30 randomly assigned students by the same faculty and students in each sub-group were exposed to identical case scenarios. The post-test was conducted using case scenarios and case sheets that were identical to that of the pre-test.Results: The overall mean score increased and the difference between the case-wise pre-test and post-test scores of both female (n=35) and male (n=26) students was highly significant (p <0.00001). However, the gender differences in pre-test score (Z=1.038; p=0.299) and post-test score were not significant (Z=0.114; p=0.909).Conclusions: Using case scenarios augmented the cognitive domain scores of participating students and the gender differences in scores were not statistically significant. The post-test scores showed higher variability. Remedial educational interventions would be required for students who obtained low scores in the post-test.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192005
      Issue No: Vol. 6, No. 3 (2019)
       
  • The study of disease pattern of various clinical classes of hemophilia in
           South Gujarat area, India

    • Authors: Vijay B. Shah, Niraj Bansal, Kirti Mehta
      Pages: 1168 - 1174
      Abstract: Background: Haemophilia is one of the most severe bleeding disorder. Seventy-five per cent of the global haemophiliacs live in developing countries, where probably only one in five cases is diagnosed, and there is little or no care available. Haemophilia as a disease and its management has a large impact on the community, including social integration and economics. Inability to be an active part of society and high cost of the medical care make this disease an important problem for all haemophilic patients.Methodology: a cross-sectional study, conducted over a period of one and half year. Institutional Ethics Committee permission was taken before starting the study. Information was gathered through personal interview of the patient’s guardian with the help of predesigned questionnaires. Special emphasis was given to past history of bleeding. For each specific symptom/ specific site a detailed history and relevant details was taken and number of episodes of each symptom or number of episodes of involvement of a specific site was written.Observations: Out of 75 patients of haemophilia; 8 (10.7%) were Mild haemophilic, 17 (22.7%) were moderate haemophilic; and 50 (66.7%) were severe haemophilic. Most common site for spontaneous bleeding was muscle where 121 (25%) episodes of bleeding were reported, followed by knee joint 97(20%), and Ankle 79 (16.3%). The commonest site for traumatic bleeding was muscle where 201 (24.7%) episodes of bleeding were reported, followed by knee joint 175 (21.5%), Ankle 143 (17.6%) and Elbow joint 83 (10.2%). Site with highest duration of bleeding was intracranial for 6 days.Conclusion: Frequency of traumatic dental and nasal bleeds was significantly higher in mild class as compared to moderate and severe classes. In severe category Knee, ankle, elbow and muscle were the commonest site where traumatic bleeding. There was no significant difference in bleeding frequencies at various sites in moderate and severe cases, whether spontaneous or traumatic bleed.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192006
      Issue No: Vol. 6, No. 3 (2019)
       
  • A study on screening of high risk children for tuberculosis infection

    • Authors: Kishore V. R. V. K., Hemasundar Rao M.
      Pages: 1175 - 1181
      Abstract: Background: Tuberculosis (TB) continues to be one of the most devastating and widespread infections in the world. Of the 9 million annual tuberculosis cases, about 1 million (11%) occur in children (under 15 years of age). Childhood tuberculosis is a neglected aspect of the tuberculosis epidemic. The objective of the study was to screen the children who are household contacts of TB, HIV and TB -HIV patients and identify the children with the type of tuberculosis (Latent and symptomatic) and treat accordingly there by reducing the transmission of disease, as these children may become open cases in the future.Methods: All the registered cases of active TB, TB-HIV and HIV were traced out from district unit of RNTCP, PHC, CHC in and around Nellimarla town (10 kms radius). These patients were interviewed for medical history, treatment history, duration of treatment and degree and duration of house hold contacts (primarily children between 1 to 14 years.Results: Out of 160 registered patients 91 patients were diagnosed as having symptomatic TB infection and 69 were diagnosed having latent TB infection, with most of the affected children being in the age group of 1 to 5 years). Majority of the symptomatic patients (46.15%) were household contacts of TB- HIV patients and majority of children (40.57%) with latent TB Infection are direct household contacts of open cases of TB alone. Of the symptomatic TB infection 74.72% had pulmonary TB and 25.28% had extra pulmonary TB.Conclusions: Tubercular lymphadenopathy is the most common manifestation of extra pulmonary TB followed by tubercular meningitis and among the tubercular lymphadenopathy the cervical lymphnodes are most commonly involved.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192007
      Issue No: Vol. 6, No. 3 (2019)
       
  • Comparative evaluation of nebulised 3% saline versus nebulised 0.9% saline
           in the treatment of acute bronchiolitis

    • Authors: Pragalatha Kumar A., Indhuja Rajarathinam, Aruna Gowdra
      Pages: 1182 - 1185
      Abstract: Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence of acute bronchiolitis, no consensus exists on the management. Studies have shown that except oxygen therapy, no other treatment found to be effective. Hence, the present study was conducted to find out the efficacy of nebulised 3% saline versus is 0.9% saline for the treatment of acute bronchiolitis.Methods: A prospective randomized controlled study of 150 children between the age group of 2 months to 24 months with signs and symptoms of Acute Bronchiolitis admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2016 to December 2016 formed the study group, they were randomized into 2 groups, one received 3% saline nebulization and the other received 0.9% saline.Results: A total of 150 children were enrolled in the study, 75 children (group A) received 0.9% saline and 75 children (group B) received 3% saline. At 24 hours, the mean clinical severity score for group A was 2.49±1.03 and group B was 2.16±0.49 (P=0.013). The duration of hospital stay was shorter (1-3 days) in 3% saline with a mean of 2.35 days and was longer (3-5 days) in 0.9% saline with mean value of 4.04 days which was statistically significant (p <0.001).Conclusions: 3% saline nebulization can be used as an effective treatment for acute bronchiolitis. It significantly reduced the clinical severity score and length of hospital stay compared to 0.9% normal saline.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192008
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prediction of the risk of mortality in paediatric intensive care unit
           using PRISM III score

    • Authors: Aashay Abhay Shah, Dileep Goyal, Devendra Sareen
      Pages: 1186 - 1189
      Abstract: Background: is the Pediatric risk of mortality (PRISM) score which has been devised by Pollock et al, to predict the mortality in hospitalized children. PRISM score is a revised form of physiologic stability index of mortality score.Methods: A observational prospective study was conducted at tertiary care hospital, Udaipur Rajasthan over period of March 2017 to September 2018. Total 207 patient were enrolled in study as per inclusion and exclusion criteria.Results: Total 29.92% had PRISM III score of 0 to 5, 25.45% had score of 6-10, 16.53% had score of 11-15, 13.12% had score of 16-20, 7.61% between 21 to 25, 4.72% between 26-30 and 2.62% had score of greater than 30. There was no mortality when the PRISM score of the child was between 0 to 5. The percentage of deaths increased progressively with increasing PRISM score.Conclusions: There was no significance difference in predicted from PRISM score and the actual death. The expected mortality was comparable to actual death, except in children who required mechanical ventilation and vasopressor drugs.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192009
      Issue No: Vol. 6, No. 3 (2019)
       
  • Thyroid function studies in children of nephrotic syndrome

    • Authors: Gurdeep Singh Dhanjal, Mani Garg
      Pages: 1190 - 1193
      Abstract: Background: Nephrotic syndrome is a condition which is characterized by proteinuria, hypoproteinemia, hypercholesterolemia and significant edema. In children with nephrotic syndrome, it is probable to determine a hypothyroid state because of significant loss of thyroxine (T4), triiodothyronine (T3) in presence of proteinuria. The objectives of this study were to evaluate the level of serum free T3, free T4, and TSH in children with nephrotic syndrome and its correlation with healthy controls.Methods: A comparative study was carried out on total of 60 children (divided into two equal groups of 30 cases and 30 controls) in the age group of 1-18 years of either sex admitted to Department of Paediatrics. Maharishi Markandeshwar institute of Medical Sciences and Research. Mullana, Ambala, Haryana over a from January 2017 to September 2018. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH) were done in all 60 children and compared.Results: Among cases 18 (60%) were males and 12 (40%) were females. 63.4% of the cases were in the age group 1-10 years and 36.6% were in age group 11-18 years. Studied patients showed lowered FT3 and FT4 and raised TSH in comparison with normal values.Conclusions: Hypothyroidism should be actively sought for in children with nephrotic syndrome as it is a treatable complication.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192010
      Issue No: Vol. 6, No. 3 (2019)
       
  • A study on the outbreak of dengue fever in a tertiary care children’s
           hospital in southern Tamil Nadu, India

    • Authors: Belgin Premkumar, Baburaj S., Margaret Hepzibah N., Misha K. P., Binu Abraham
      Pages: 1194 - 1198
      Abstract: Background: Dengue fever is the most rapidly spreading mosquito-borne viral disease in the world.Incidence has increased 230-fold with increasing geographic expansion with potential for further spread. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden. This study’s objective is to assess the outbreak of epidemic of dengue fever in a tertiary care children hospital and to describe their socio-demographic, clinical outcome and serological profile.Methods: It is an observational descriptive study conducted for a period of 1 year in less than 12 years old children in a tertiary care hospital at Southern Tamil Nadu.Results: Among the 360 children admitted with dengue fever, there were 198 boys (55%) and 162 (45%) were girls. Maximum incidence of dengue incidence was seen in infants less than 1 year (25%). The highest number of cases were admitted during September and October. The most common affected age group was less than 3 years with 179 (49%). Among the cases, 297 (82%) were of severe dengue which constitute dengue haemorrhagic fever-183(38%) and Dengue shock syndrome 114 (62%). Serological analysis showed NS1 Ag was positive in 144 children (40%), Dengue IgM was positive in 54 children (15%), both IgM and IgG positive in 126 children (35%) and IgG was positive in 36 children (10%). Out of the total children admitted with dengue fever, the case fatality was 0.5% (2 children).Conclusions: This study highlights the importance of WHO clinical criteria for early diagnosis of severe dengue. Moreover, the early and intensive management reduces the mortality significantly.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192011
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical and imaging correlation of cerebral palsy: a retrospective study
           in a tertiary care centre

    • Authors: Swathi S. Sanjee, Chandrashekhara G. Shettigar, Santosh T. Soans
      Pages: 1199 - 1203
      Abstract: Background: Cerebral Palsy is the most common chronic motor disorder of childhood. Clinical spectrum is different in developing and developed countries. Aim of the study was to evaluate the clinical profile, co-morbidities and the imaging correlate of children with CP.Methods: Data was collected retrospectively from individual case records from March 2016 to October 2018. All children aged 2 years and above with clinical signs of cerebral palsy were included in the study.Results: A total of 78 children had the diagnosis of cerebral palsy, out of which 63 cases were included which satisfied the inclusion criteria. Most of the children were born out of singleton pregnancy (90.4%). The mean gestational age was 36.94±1.48 weeks. Most common type of cerebral palsy noted in present study was spastic quadriplegic type (n=34) followed by diplegic type (n=14). Epilepsy was associated in 36.5% (n=23) of children, and most commonly associated with spastic quadriplegic type of cerebral palsy(n=16). Other associated abnormalities included mental retardation, speech, hearing, cognitive, and behavioral abnormalities. Magnetic resonance imaging was normal in 60.3% (n=38) of children and abnormal in 39.68% (n=25) of children. Diffuse cerebral atrophy was the most common abnormal finding (n=9). Other abnormal findings included periventricular leucomalacia, basal ganglia lesions, cortical/subcortical lesion, focal infarcts and miscellaneous lesions.Conclusions: MRI helps in knowing the pathological basis of the disease, but clinical findings carry utmost importance. MRI positivity was seen in only 39.68% of cases. Hearing abnormalities being the most common association, proper screening tests and regular follow up is very essential.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192012
      Issue No: Vol. 6, No. 3 (2019)
       
  • Diagnosis of paediatric tuberculosis by cartridge based nucleic acid
           amplification test and its effectiveness as compared to the other
           conventional diagnostic methods

    • Authors: Jyotiranjan Champatiray, G. Dharmaraj Patra
      Pages: 1204 - 1210
      Abstract: Background: Childhood TB constitutes 10-20% of all TB cases in high burden countries like India and accounting for 8-20% of TB related deaths. Diagnosis of TB in children is difficult. One test, CBNAAT which was recently endorsed by WHO has the potential to lead a revolution in diagnosis of active TB disease.Methods: A cross sectional study in SCB MCH and SVPPGIP, Cuttack in all the suspected TB patients admitted during the period from January 2016 to October 2017.Results: A total of 100 suspicious patients admitted to the Department of Pediatrics in SCB MCH and SVPPGIP during the study period. Of these 45 were diagnosed TB and rest others were diagnosed otherwise than TB. Diagnosis of TB was established on basis of Microscopy, CBNAAT, culture, biochemistry, cytology, clinical findings, neuroimaging, FNAC/biopsy, USG abdomen. Out of 45 TB patients 30 were CBNAAT positive taking the body fluid samples other than blood, urine and stool with a sensitivity of 66.7% and specificity of 100%. Out of 45 TB patients 14 were having ZN Smear positive taking the same fluid sample with a sensitivity of 31.1% and specificity of 100%. Whereas out of these 45 TB patients 32 were MGIT culture positive taking the same sample with a sensitivity of 71.1% and specificity of 100%. When diagnostic performances of CBNAAT and MGIT culture were compared, it was found to be statistically insignificant with a P value 0.54.Conclusions: The CBNAAT is able to confirm a diagnosis of TB with 66.7% sensitivity and 100% specificity within 2 hours. We can use CBNAAT as a diagnostic method as it provides rapid result and simultaneous better sensitive result, it can be helpful in starting ATT in sick patients and also in outdoor patients.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192013
      Issue No: Vol. 6, No. 3 (2019)
       
  • Pediatric respiratory assessment measure score in assessing the severity
           of acute asthma in children

    • Authors: R. Prasanna, Fayrouz Moidu, Sekar Pasupathy
      Pages: 1211 - 1217
      Abstract: Background: Asthma is a chronic inflammatory disease of the lung airways resulting in episodic airflow obstruction. Management of acute pediatric asthma depends on assessment of asthma severity which is difficult in children due to poor coordination. This study is to evaluate the usefulness of a simple yet effective alternative like Pediatric respiratory assessment measure (PRAM) score in assessing the severity and outcome of an acute exacerbation of wheeze in children and to identify the PRAM score predicting the need for hospitalization.Methods: A prospective cohort study was done on 127 children for a period of 2 months in 2018, admitted with acute exacerbation of wheeze using PRAM scores at admission and following each treatment modalities. Usefulness of score in assessing severity was evaluated.Results: Increasing severity was associated with increasing initial PRAM score. Initial mean PRAM score of 11 in severe persistent forms, 7 in moderate persistent, 6.73 in mild persistent and 5.37 in mild intermittent was found. 59.1% of patients had a positive family history. The most common trigger factor according to our study was viral upper respiratory tract infection (50.4%) followed by exposure to dust (13.4%). Patients who were admitted to the Pediatric Intensive Care Unit (PICU) had the maximum number of interventions.Conclusions: In our study, statistically it was proved that PRAM Score is a tool that can be used across different ages and PRAM Score is a tool that can be used to assess severity of asthma.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192014
      Issue No: Vol. 6, No. 3 (2019)
       
  • Etiology, clinical profile and outcome of first episode of seizure in
           children

    • Authors: R. Prasanna, Sekar Pasupathy, Fayrouz Moidu
      Pages: 1218 - 1222
      Abstract: Background: Seizure is a commonly encountered problem in pediatric practice. Convulsive disorder constitutes a heterogeneous group with a varied etiology. Arriving at the cause of seizure is important as it plays a vital role in managing the child. Chances of recurrence to be analyzed, after the first episode of seizure for management. The aim was to study the etiology and the causes of recurrence after a first episode seizure.Methods: A prospective observational study was done on 135 children for a period of two months admitted in tertiary care center. Proper history, complete neurological and other systemic examinations was done. Blood investigations and imaging with EEG was done when indicated. All children were classified according to International League against epilepsy and followed up for recurrence rate and history leading to recurrence. Co- relation between recurrence and risk factors was analyzed.Results: Electroencephalogram tracing was abnormal in 62 out of 105 children. 19 out of 62 had recurrence while only 2 among 43 normal EEG had recurrence. This was statistically significant (P value 0.001). Children with remote symptomatic etiology constitutes the majority in those with abnormal EEG tracings. In children with remote symptomatic etiology, only one child had normal EEG. Remote symptomatic had higher number of abnormal EEG when compared to others and was found to have more recurrence.Conclusions: Children with EEG abnormalities after the first episode of afebrile seizure have more chance of recurrence. Children with seizure secondary to remote symptomatic etiology had more recurrences.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192015
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical and laboratory predictors to differentiate severe dengue from
           scrub typhus in children

    • Authors: Bharathi Elangovan, Rajesh N. T.
      Pages: 1223 - 1227
      Abstract: Background: Objective of study was to compare the clinical features and laboratory parameters at admission and differentiate severe dengue from scrub typhus in children.Methods: Retrospective analysis of case records and comparison of clinical and laboratory parameters at admission of all children with a diagnosis of severe dengue and scrub typhus was done.Results: A total of 72 children were included (severe dengue =40; scrub typhus =32) during the study period. The mean (SD) age of children with severe dengue and scrub typhus was 7.9(3.8) and 11.8(5.8) years, respectively. Majority of children with severe dengue presented with hypotension, 21(52.5%) vs 3(9.4%) in scrub typhus. Children with severe dengue had a relatively low ANC (2.6±1.97x103/mm3 vs 3.9±2.06x103/mm3), low platelet count (50.23±35.55x103/mm3 vs 140±95.0x103/mm3) and low mean ESR at 1hour (8.1±6.82mm vs 33.88±13.79mm) than scrub typhus.Conclusions: Compared to scrub typhus, severe dengue was significantly associated with hypotension, lower ANC, ESR and platelets.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192016
      Issue No: Vol. 6, No. 3 (2019)
       
  • Incidence and risk factors of retinopathy of prematurity in Goa, India: a
           report from tertiary care centre

    • Authors: Sarvesh Kossambe, Shilpa Joglekar, Annely D'lima, M. P. Silveira
      Pages: 1228 - 1234
      Abstract: Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity (ROP) from a tertiary care center in the western Indian state of Goa, India.Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for a period of 18 months. Babies born at < 34 weeks’ gestation and having a birth weight of <1500gm were screened for ROP and laser photocoagulation was done for those who developed threshold ROP. Group differences between any ROP and threshold ROP were analysed using the chi-square test.Results: Out of the 244 preterm neonates screened, 37 developed ROP (15.16%), and 14 out of them (5.73%) developed threshold ROP requiring laser photocoagulation. Very low birth weight, prematurity, apnea, anemia, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusions, exchange transfusions and days taken to reach full enteral feeds and regain birth weight were significantly associated with the development of ROP.Conclusions: This is the first report of ROP from Goa where less than 1 in 5 babies developed ROP. This is similar to that reported across the rest of the country. Judicious oxygen use, ventilation strategies, transfusions guidelines, control of sepsis, early enteral feeds and adequate nutrition may help prevent the development of ROP in the future.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192017
      Issue No: Vol. 6, No. 3 (2019)
       
  • Impact of maternal anaemia on cord blood haemoglobin

    • Authors: Dhanasekaran Ramadoss, Sumitha Arumugam, Suguna .
      Pages: 1235 - 1238
      Abstract: Background: Anaemia during pregnancy is associated with serious maternal and fetal complications. Cord blood hemoglobin of the newborn is an important indicator of anaemia in newborn at birth. So, this study is done to assess the impact of maternal anaemia on cord blood hemoglobin levels of neonates.Methods: It is a cross sectional study done at government Kilpauk medical college and hospital in the department of paediatrics in year 2016.400 pregnant mothers attending the labour room in Kilpauk medical college were included and cord blood haemoglobin of their babies were collected. Mean cord blood haemoglobin of new-borns born to anaemic mothers (mild, moderate and severe) were compared with cord blood haemoglobin of new-borns born to non-anaemic mothers.Results: Out of 400 mothers,192 mothers were anemic, and 208 mothers were non anemic. The mean maternal hemoglobin among non-anemic mothers was 16.37±0.85 and among the anemic mothers it was 15.03±1.04. The mean cord hemoglobin of neonates born to anemic mothers among the three groups (mild moderate severe) were compared with mean cord hemoglobin of the non-anemic group. The difference between groups were statistically significant with P values <0.05,0.01 and 0.05 respectively.Conclusions: In present study maternal anaemia affects the cord blood haemoglobin of neonates. Present study infers that anaemic mothers deliver babies with lower haemoglobin compared to non-anaemic mothers.
      Authors have found a linear relationship between maternal haemoglobin and cord blood haemoglobin of the new-borns.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192018
      Issue No: Vol. 6, No. 3 (2019)
       
  • The evaluation of effectiveness of separate kangaroo mother care ward on
           implementation of kangaroo mother care in tertiary care hospital: a before
           and after study

    • Authors: Bhowmik A., Gargi G., Nandy M.
      Pages: 1239 - 1242
      Abstract: Background: Kangaroo mother care (KMC) is a standard of care for preterm and low birth weight babies. To implement KMC in institutional care it was often practiced inside intensive care unit and also in separate ward. In present study authors have tried to evaluate effect of separate kangaroo mother care ward on implementation of kangaroo mother care in tertiary care hospital.Methods: Uncontrolled study before and after establishment of separate kangaroo mother care ward comparing kangaroo mother care in sick new-born care unit versus kangaroo mother care in separate ward.Results: In separate ward, as compared to kangaroo mother care practice in sick newborn care unit, mean (SD) duration of kangaroo mother care increased from 5.3 (1.6) to 11.4 (7.4) hours/day (95%CI 5.0-7.1, p value <0.0001). Mean (SD) weight gain increased from 10.7 (7.0) g/day to 13.7 (11.1) g/day (95% CI 1.0-4.8, p value <0.0024). Incidence of sepsis diminished from 14.0% to 28.9% (95% CI 6.4-23, p value <0.0006). Exclusive breast-feeding rate at discharge (42.3% vs. 57.3%) (95% CI 4.8- 24.9, p value <0.0041) and follow up (49.4% vs. 65.0%) (95% CI 1-29.4, p value <0.0378) increased. Mortality also decreased in this group of patients (8.6% vs.2.3%) (95% CI-1.6-11.4, p value <0.0082).Conclusions: Kangaroo mother care ward is better place than sick new born care unit for providing kangaroo mother care in tertiary care hospital.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192019
      Issue No: Vol. 6, No. 3 (2019)
       
  • Renal biopsy in children with nephrotic syndrome: a study of
           histopathological pattern

    • Authors: Trupti A. Joshi, Amol K. Joshi
      Pages: 1243 - 1246
      Abstract: Background: Idiopathic nephrotic syndrome (INS) is a common childhood renal disease characterized by a remitting and relapsing course, associated with different histopathological subtypes. The true incidence of various histopathological subtypes of NS remains under estimated owing to the diversity in indication criteria for performing renal biopsies in pediatric population.Methods: This was a cross-sectional observational study in children with nephrotic syndrome at a tertiary health care centre. Total 22 children, with nephrotic syndrome, who underwent renal biopsy procedure during a period of one year, were enrolled for the study. Indications of renal biopsy were noted, and the histopathology reports were studied in detail.Results: In this study group, the most common indication for renal biopsy was “Atypical age (> 8years) of diagnosis in 45.5% (10/22) patients, followed by 22.7% (5/22) in “Children presenting with hypertension and hematuria”.The most common histopathological finding in these children was mesangial proliferative glomerulonephritis in 45.5% (10/22) patients followed by IgA nephropathy with mesangial proliferation in 22.72% (5/22) and minimal change disease in only 13.6% (3/22).Conclusions: This study highlights the occurrence of non-MCD as the common cause of INS in the children and denotes the significance of performing renal biopsies in children with INS for better prognostication.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192020
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prevalence of small for gestational age term neonates and its surrogate
           marker

    • Authors: Satyamanasa Gayatri Vinay S., Karthiga K., Abhijeet Shrivastava
      Pages: 1247 - 1250
      Abstract: Background: The incidence of low birth weight babies continues to be high in India at about 30% in contrast to 5-7% in developed countries. Perinatal, neonatal and infant mortality as well as morbidity is associated with low birth weight (LBW) neonates of which, it is the Small for Gestational Age (SGA) neonates that are at increased risk. Henceforth, it becomes important to study the prevalence of SGA babies and to compare various anthropometric measurements among term neonates for assessing as to which of these could be taken as surrogate markers of small for gestational age babies.Methods: It was a cross sectional study conducted over a period of 2 years among 100 term neonates delivered in a private medical college in Puducherry, India.Results: The prevalence of low birth weight babies and small for gestational age was found to be 40% and 30% respectively. Using mid arm circumference as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value of SGA was found to be 100%, 57.14%, 50% and 100% respectively. Using MAC/HC ratio as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value was found to be 46.67%, 100%, 100% and 81.4% respectively.Conclusions: In predicting SGA babies, mid arm circumference has the highest sensitivity whereas MAC/HC ratio has the highest specificity followed by mid arm circumference. Present study concluded that mid arm circumference and ratio of MAC/HC are very helpful in identifying SGA neonates among term neonates.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192021
      Issue No: Vol. 6, No. 3 (2019)
       
  • Immediate effects of clamping of the umbilical cord on the newborns

    • Authors: Muhammad Hassan, Adarsh E., Sahana Manjunath, Shivtej N., Archana D. V., Vidhi Meta, Spoorthi S.
      Pages: 1251 - 1254
      Abstract: Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn’t receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192022
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study on the effect of maternal anemia on birth weight of term neonates
           among rural population India

    • Authors: Sruthy Gnanasekaran, Jakanattane V., Rajendran R. R.
      Pages: 1255 - 1258
      Abstract: Background: Maternal anemia in pregnancy is common and has several deleterious effects on the health of the mother and the fetus. Maternal anemia is an important risk factor for LBW babies and preterm babies. There exists an insufficient information regarding the adverse effect of anemia during pregnancy especially among rural population. The aim of the study was to determine whether maternal anemia would affect the birth weight of the baby.Methods: The study was conducted in post-natal ward in Sri Venkateshwara Medical College Hospital and Research centre, Ariyur, Puducherry, India a tertiary care hospital in a rural area.Results: About 85% of low birth weight babies were born to mothers with severe maternal anemia with a p value of <0.001 which is statistically significant. None of the mothers who didn't have maternal anemia had low birth weight babies.Conclusions: Maternal anemia is directly proportional to fetal growth. Maternal anemia being an important risk factor for low birth weight should be prevented as early as possible thus helpful in de-creasing the incidence, mortality and morbidity of LBW babies.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192023
      Issue No: Vol. 6, No. 3 (2019)
       
  • Simplified bronchiolitis severity score for health care providers

    • Authors: Rachel P. Rudhan, Niranjan Biswal
      Pages: 1259 - 1262
      Abstract: Background: Bronchiolitis is a viral lower respiratory infection of young infants. It requires monitoring by outpatient health care providers and rarely needs hospitalization. Scoring of severity in community helps in early referral. A simplified bronchiolitis scoring for rural health care providers with no facility for measurement of oxygen saturation (SpO2) and chest X-ray (CXR) is a long-felt need. This study proposes a simplified score.Methods: The proposed bronchiolitis severity score (PSS) has to be validated against the standard bronchiolitis severity score (SSS). The PSS was administered by a physician, nurse and researcher. The reliability was measured by the comportment of internal consistency and inter-observer agreement.Results: The physicians rating of severity by SSS and PSS was similar in 97% of cases. The internal consistency of 0.72 and the kappa index of 0.86 were obtained. The inter-rater agreements between physician, nurse, researcher was 0.94, 0.94 and 0.93 respectively.Conclusions: The PSS is reliable, valid and can be administered by nurses in peripheral health care settings.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192024
      Issue No: Vol. 6, No. 3 (2019)
       
  • Morbidity and mortality pattern of very low birth weight and extremely low
           birth weight neonates in a tertiary care hospital

    • Authors: Wani Shahid Hussain, Muzafar Jan, Rahat Abbas, Zarkah Nabi
      Pages: 1263 - 1269
      Abstract: Background: Although the mortality and morbidity rates for Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) neonates have improved over last few decades, they still remain highly vulnerable groups. This study determines the neonatal morbidity and mortality within first four weeks of life in VLBW and ELBW neonates.Methods: It was a hospital based prospective study conducted in the department of paediatrics at GB Pant hospital, an associated hospital of Government Medical College Srinagar. All included neonates were evaluated in neonatology section and were followed up to 4 weeks of life. Standard protocols were used for management of these neonates.Results: A total of 116 neonates were included in the study. Among the 116 neonates 82 (70.69%) were VLBW and 34 (29.31%) were ELBW. 28 (34.14%) VLBW and 18 (52.94%) ELBW neonates died. Among the morbidities Respiratory Distress Syndrome was found in 35.37% of VLBW and 70.59% of ELBW neonates, out of which 12.20% VLBW and 20.58% ELBW neonates developed Bronchopulmonary dysplasia. Perinatal asphyxia was found in 20.73% of VLBW and 29.41% of ELBW neonates and Pathological apnea occurred in 28.04% VLBW and 85.29% ELBW neonates. 40.24% VLBW and 73.53% ELBW neonates developed clinically significant jaundice requiring treatment. Clinical sepsis was found in 43.90% VLBW and 67.65% ELBW neonates while as culture proven sepsis was found in 26.83% VLBW and 41.18% ELBW neonates. Intra ventricular haemorrhage was found in 15.85% VLBW and 52.94% ELBW neonates. Necrotizing enterocolitis developed in 18.29% VLBW and 35.29% ELBW neonates. Retinopathy of prematurity was found in 21.95% VLBW and 26.47% ELBW neonates. Patent ductus arteriosus was found in 14.63% VLBW and 32.35% ELBW neonates.Conclusions: Present study has shown Respiratory distress syndrome, perinatal asphyxia and sepsis as the predominant causes of neonatal morbidity and mortality and these are preventable with a proper health care system and policy directed to the primary prevention.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192025
      Issue No: Vol. 6, No. 3 (2019)
       
  • Study of risk factors leading to poor outcomes in severe pneumonia age
           2M-60M in a tertiary care hospital

    • Authors: Mohammed Abdul Rahman, Sowjanya Bhanu Veera, Venkata Priyanka Dandugula
      Pages: 1270 - 1275
      Abstract: Background: Childhood pneumonia is the single leading cause of mortality in children aged less than 5 years. Most cases occur in India (43 million); pneumonia is responsible for about 19% of all deaths in children aged less than 5 years. According to Child Health and Epidemiology Reference Group (CHERG) latest estimates, Pneumonia was responsible for 0.397 million of a total estimated 1.682 million under-five deaths in India.Methods: A hospital based prospective longitudinal study. In the present study 200 cases belong to age group 2 months to 5 years  fulfilling WHO criteria for pneumonia who were  attended to the department of paediatrics, Siddhartha medical college  from January 2017 to January 2018 were evaluated the risk factors in relation to their outcomes after obtaining consentResults: Out of 200 children with severe pneumonia  11 risk factors are studied for significance against outcomes like Death of the patient, mechanical ventilation oxygen supplementation, hospital stay of patient and total duration of illness, Risk factors found to be significant are maternal literacy (p =0.0002617), malnutrition (p <0.00001), exclusive  breastfeeding (p <0.05), low birth weight (p <0.05), immunisation (p=0.01).Conclusions: Severe malnutrition, maternal illiteracy, exclusive breast feeding, improper immunization and low birth weight are having a significant association with poor outcomes in children with severe pneumonia. Proper preventive strategies to decrease the incidence of these risk factors can help in increasing the survival rate of children with severe pneumonia.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192026
      Issue No: Vol. 6, No. 3 (2019)
       
  • Glycemic status in exclusively breast fed low birth weight babies In first
           72 hours of life in a teriary care hospital

    • Authors: Vithal Rao S. Natta, Deepthi Pagali, Venkata Priyanka Dandugula, Sowjanya Bhanu Veera
      Pages: 1276 - 1280
      Abstract: Background: Neonatal hypoglycaemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. It can lead to considerable mortality and morbidity with long term neurological sequelae. Adequate breast feeding play an important role in maintaining normal glucose levels. So, this study is done to assess the incidence of hypoglycaemia in exclusively breast fed low birth weight babies, both term and preterm neonates and evaluate the impact of early breast feeding on glycaemic status upto 72 hours of life.Methods: This study was conducted over 12 month period involving 236 AGA (Appropriate for gestational age), SGA (Small for gestational age) babies with birth weight between 1.6-2.49 kg. Blood glucose values were measured at birth, 3h, 6h, 12h, 24h, 48h and 72h of life after delivery which was independent of feeding time. Hypoglycaemia was assessed against age of onset, gestational age, sex of baby, mode of delivery and time of initiation of breast feeding.Results: Total 56 episodes of hypoglycaemia were recorded in 52 babies of which 46 (27%) were term SGA babies and 6(8%) were preterm AGA babies (p=0.00148). The incidence of hypoglycaemia was found to be 22%, highest during the first 24 hours of life (93%) and delayed breast feeding is the most commonly noted risk factor (p=0.00024).Conclusions: Low birth babies are more prone to develop hypoglycaemia especially in first 24 hours of life with delayed introduction of breast feeding being one of the common risk factors and asymptomatic hypoglycaemia can be managed with frequent breast feeding without any formula feeds.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192027
      Issue No: Vol. 6, No. 3 (2019)
       
  • Hepatitis B in children with leukemia: the role of primary immunization

    • Authors: P. K. Aslam, A. Riyaz, V. T. Ajith Kumar, M. G. Geeta
      Pages: 1281 - 1284
      Abstract: Background: Children with cancer have a greatly enhanced risk of contracting hepatitis B infection due to immunosuppression secondary to chemotherapy and radiotherapy, frequent blood transfusions, bone and peripheral vein punctures, tissue damage and mucositis. During the past 3 decades, multimodality therapy for childhood leukemia has resulted in markedly improved survival. Inspite of screening and immuno prophylaxis, hepatitis B infection rates in children with leukemia are high. In view of this, we decided to study the prevalence of hepatitis B among children with leukemia in our institution, and the possible risk factors.Methods: This was a cross sectional study carried out at a tertiary pediatric care center in North Kerala among 104 children between 1 and 12 years of age on treatment for leukemia.Results: Among the 104 children, only 17 (16.3%) had received primary immunization against hepatitis B. Of the 87 children who had not received primary immunization, 44.8% (n=39) developed hepatitis B, compared to 11.8% (n=2) in the vaccinated group (p=0.01).Conclusions: This study highlights the importance of primary immunization against hepatitis B in children with leukemia, and the need for universal coverage.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192028
      Issue No: Vol. 6, No. 3 (2019)
       
  • Plasma zinc levels in normal and malnourished children with lower
           respiratory tract infection from 2 months to 5 years of age

    • Authors: Dinesk Kumar E., Thumjaa Annamalai, Shafath Ahmed M., Sundari S.
      Pages: 1285 - 1288
      Abstract: Background: Acute Lower Respiratory Tract Infection (ALRI) is an important cause of morbidity and mortality in the developing world. Pneumonia is a severe form of ALRI that cause over 2 million deaths annually among children younger than 5 years of age. About 19% of all deaths, pneumonia is the leading cause of child mortality. Malnutrition is known to be associated with greater intensity of lower respiratory tract infections, higher the frequency of complications, longer episodes of infections. This study is to assess the plasma zinc levels in normal and malnourished children with LRI aged 2 months to 5 years.Methods: This is a case control study, which was carried out in the Department of Paediatrics, Sree Balaji Medical College and Hospital, the study period is one year from July 2016 to July 2017. 100 children between 2 months to 5 years of age with LRI was included in the study and children less than 2 months and more than 5 years. 50 Children with normal nutrition were taken as controls and 50 children with moderate and severe malnutrition were taken as cases. Age and sex were matched among cases and controls. Blood samples were collected for zinc estimation in both the cases and controls. All children were investigated and treated as per the department protocol for the particular condition. All statistical procedures were performed using SPSS v 21.0.Results: In present study, 66% of children had normal zinc levels, 34% of children had low zinc levels. The mean zinc level in our cases was 54.84±18.31 and in controls was 76.84±15.2, which was statistically significant (p = 0.000). Mean plasma zinc levels with respect to age and sex were not significant.Conclusions: Total 34% of children with LRI had low plasma zinc levels. Plasma zinc level were significantly low in malnourished children than normally nourished children with LRI, which is one of the most important cause of high childhood mortality in developing countries.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192029
      Issue No: Vol. 6, No. 3 (2019)
       
  • Serum ionic calcium levels and hypocalcemia in dengue fever in children
           and its correlation with its severity: case control study

    • Authors: V. G. Manjunath, Sruthi Balla, Jagadish Kumar
      Pages: 1289 - 1293
      Abstract: Background: Dengue fever (DF) is a major health problem, 90% of dengue hemorrhagic fever (DHF) occurring in children <5 years and mortality of 2.5%. Abnormalities like metabolic acidosis, hyponatremia and hypocalcemia can occur in severe dengue especially in dengue shock patients. Alterations in calcium homeostasis, may play a role in the pathogenesis of dengue shock. Objectives is to evaluate serum ionic calcium (Ca2+) levels in children aged 1-18yrs with dengue fever and correlate it with severity and outcomeMethods: The study was prospective hospital based case-control study. Case group had 75 children with dengue fever with equal number of controls. Cases were classified according to WHO classification. Serum Ca2+ levels were estimated within 24 hours of admission.Results: Majority of children with dengue were in the age-group of 6-15 years (71.4%). Out of 75 cases,16% were dengue without warning signs, 54.7% dengue with warning signs and 29.3% were severe dengue cases. Mean Ca2+ level (in mmol/l) was 1.2009 (±0.09) among controls and 1.0911 (±0.10) in dengue cases (p=0.0001). Mean Ca2+ level in dengue without warning signs was 1.0950 mmol/l, dengue with warning signs was 1.1088 mmol/l and severe dengue was 1.0559 mmol/l. Mean Ca2+ level in severe dengue was significantly lower compared to dengue with warning signs (p=0.04). Hypocalcemia was seen in 56% of dengue cases but only 14% among controls. Seven children with severe dengue who died had hypocalemia.Conclusions: Hypocalcemia is common in dengue fever. Lower levels of ionic calcium correlate with severity of dengue illness and may be considered as a prognostic indicator of poor outcome.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192030
      Issue No: Vol. 6, No. 3 (2019)
       
  • Hypomagnesemia as a predictor of mortality in critically ill pediatric
           patients in picu using prism score

    • Authors: Poornima Shankar, N. Varsha Monica Reddy, Shiva Devaraj
      Pages: 1294 - 1297
      Abstract: Background: Magnesium is the fourth most abundant cation in the human body and the second most abundant intracellular cation after potassium. A potential relationship between low magnesium levels and increased mortality has been suggested in the literature. The objectives were to detect prevalence of hypomagnesemia in critically ill children, its association with sepsis and to correlate this with mortality.Methods: This study was an observational study done on 100 children who met the inclusion criteria, admitted to the PICU of Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India. Patients under the study were managed and treated according to their clinical status and supportive traditional treatment.Results: Prevalence of hypomagnesemia in critically ill pediatric patients was 53%. In this study, majority of the cases admitted to PICU were dengue (19%) and bronchopneumonia (15%) which were significantly associated with hypomagnesemia as p value was less than 0.05. As regard prognosis, Mg had an AUC of 0.576 for prediction of mortality whereas the AUC for PRISM score was 0.811. Logistic regression analysis showed that hypomagnesemia is a significant predictor for mortality among critically ill children (p value=0.028) and OR=3.180 (0.854-7.965).Conclusions: Present study has found high prevalence of hypomagnesemia in critically ill patients. Hypomagnesemia was associated with a higher mortality rate in critically ill patients and commonly associated with infections and respiratory diseases. Hypomagnesemia indicated poor outcome and higher mortality rates in critically ill patients.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192031
      Issue No: Vol. 6, No. 3 (2019)
       
  • Comparison of the inferior vena cava index and inferior vena cava
           collapsibility index obtained by ultrasound as a measure of body fluid
           volume status in children with nephrotic syndrome

    • Authors: Deepesh Gupta, Kusum Devpura, Kamlesh Kumar Agrawal
      Pages: 1298 - 1302
      Abstract: Background: There is triad of hypoalbuminemia, edema, and hyperlipidemia in nephrotic syndrome patients. Management of nephrotic syndrome includes general measures like fluid restriction, emergency albumin transfusions and diuretics that provide symptomatic relief till steroids act. These measures require an assessment of body fluid volume to avoid circulatory failure which is very difficult in these patients because of edema. The objective of the study was to measure and compare the Inferior Vena Cava (IVC) Index and Inferior Vena Cava Collapsibility (IVCC) Index by ultrasound as a measure of body fluid volume status in children with nephrotic syndrome.Methods: The present observational study was conducted in all children of age more than 1 year up to 18 year. There were two groups; group 1 was nephrotic syndrome patients-Initial episode or in relapse and group 2 (Control) was age and sex-matched non-nephrotic children. IVC index and IVCC index were measured and compared in both the groups.Results: Mean value of minimum diameter of IVC during inspiration in cases was 5.91±1.60 mm as compared to 4.53±0.94 mm in controls which was significantly higher in case group {P ˂0.0001}. Mean value of IVC index in cases was 0.88±0.20 cm/m2 as compared to 0.93±0.19 cm/m2 in controls which was non-significant. Mean value of IVCC index in cases (35.61±13.68) was significantly less as compared to controls (52.23±2.01) {P ˂0.0001}.Conclusions: The present study concluded that IVCC index is better indicator of body fluid volume status in nephrotic patients as compare to IVC index.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192032
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prevalence, profile of malnutrition and iron deficiency anemia in children
           with cyanotic congenital heart defects: a case control observational study
           in a tertiary care hospital in North India

    • Authors: Amber B. Mir, Jehangir A. Shah, Sheikh Mushtaq, Muzafar Jan
      Pages: 1303 - 1308
      Abstract: Background: Children with congenital heart disease (CHD) are prone to malnutrition. Children with cyanotic CHD [CCHD] are specifically affected due to chronic hypoxia and iron deficiency anemia which is overlooked by pediatrician. This can have a significant effect on the outcome of surgery. Our objective was to determine the burden and determinant of malnutrition in children with several types of cyanotic congenital heart disease (CCHD).Methods: This case-control study included 80 children with symptomatic CCHD, and 40 healthy children matched for age and sex as a control group. Clinical evaluation and laboratory assessment of nutritional status were documented. Anthropometric measurements were recorded and Z scores for weight for age (WAZ), weight for height (WHZ), and height for age (HAZ) have been calculated. Haemoglobin, red cell indices and serum iron, total iron binding capacity and serum ferritin was done in cases and controls.Results: The overall prevalence of malnutrition was 72.5% in patients with CCHD and 22.5% in controls. Severe malnutrition was diagnosed in 68.9% of cases. All anthropometric measurements which markers of nutritional state are were significantly lower in the patients group compared to controls. The prevalence of iron deficiency anemia (IDA) was 47.5% in the study population. The study also showed that hemoglobin and hematocrit levels, RBC count were paradoxically higher in the cyanotic CHD as compared to the healthy controls though the iron studies revealed the iron deficiency. The mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) mean corpuscular hemoglobin concentration (MCHC), serum ferritin, serum iron, total iron binding capacity (TIBC), values were the parameters, which were found to be statistically significant to differentiate the study groups.Conclusions: Malnutrition is a very common problem in children with symptomatic CCHD, the prevalence of IDA in children with CCHD was found to be high.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192033
      Issue No: Vol. 6, No. 3 (2019)
       
  • Prevalence of stress among postgraduate junior residents in Bangalore,
           Karnataka, India

    • Authors: Ramya H. S., Nisar Ahamed A. R., Rajendra Prasad T. C., Muragesh Awati
      Pages: 1309 - 1314
      Abstract: Background: Post graduate residents in tertiary care teaching hospitals in metropolitan cities bear the overwhelming burden due to heavy workload, they are at high risk of developing burnout syndrome, which in turn may affect hospital outcomes such as the quality and safety of the provided care.  This study was conducted to assess their perceived stress, stress induced somatic symptoms and coping strategies by postgraduates in Bangalore, India.Methods: This cross-sectional study was conducted on all postgraduates willing to participate in the study, pursuing their post-graduation in various specialties in Six medical colleges in Bangalore, India. Stress was assessed by Perceived stress scale (PSS-10), Stress induced physical symptoms using selected items from self-reporting questionnaire (SRQ-20), coping strategies using selected items from BRIEF COPE. Descriptive and inferential statistical analysis has been carried out in the present study.Results: The mean PSS score in present study was found to be 22.92 (moderate stress). Stress was associated with clinical specialty, higher workload, poor sleep quality due to more working hours, marital status, harmful ideations. In present study Post graduates of OBG, pediatrics, radiology demonstrated higher perceived stress score with a mean PSS Score of 25.57, 24.25, 24.22 respectively. Dermatology postgraduates reported lowest stress levels with a mean PSS score of 16.86.Conclusions: In present study post graduates are facing moderate stress, affecting their physical and mental health resulting in dysfunctional coping strategies and harmful ideations like quitting and suicide, which has an impact on quality and safety of provided care.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192034
      Issue No: Vol. 6, No. 3 (2019)
       
  • Neuro developmental outcome of preterm babies with hypoxic ischemic
           encephalopathy

    • Authors: Ramya H. S., Rajendra Prasad T. C., Nisar Ahamed A. R., Muragesh Awati, Maria George
      Pages: 1315 - 1320
      Abstract: Background: Neonatal encephalopathy, following severe birth asphyxia or perinatal hypoxia is referred to as hypoxic ischemic encephalopathy (HIE). Cerebral ischemia occurs as a consequence of cerebral oedema and reduced cerebral perfusion due to myocardial dysfunction as a result of hypoxic cardiomyopathy. Sarnat stage I -100% recovery, HIE stage II - 80% normal and 20% mortality and HIE stage III - 50% mortality and 50% morbidity. Relatively few studies have been made on outcome in HIE affected preterm infants. The aims and objectives of this study was to find out the neurodevelopmental outcome in preterm infants with HIE.Methods: This study is an observational clinical study, undertaken in Kempegowda Institute of Medical sciences and research centre, Bangalore, India. Study was performed between November 2016 to September 2018. 31 preterm infants with HIE were included in the study. Regular follow-up was done at 3, 6, 9, 12.15, 18 months by using Trivandrum development screening chart (TDSC) to stage II HIE infants.Results: The incidence of abnormal neurological outcome was 12.9%. Out of 31 preterm babies, stage I were 24, stage II was 4 (100% morbidity) and stage III were 3 (100% mortality).Conclusions: In present study, stage II HIE had 100% morbidity and moderate disability, stage III 100% mortality. Thus at 3-5 months of age during follow-up, when authors identify developmental delay, it is an ideal time to start interventional therapy to improve long term outcome.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192035
      Issue No: Vol. 6, No. 3 (2019)
       
  • Predictors of mortality among neonates transported to tertiary care centre

    • Authors: Preeti Malhotra, Karuna Thapar, Gurpreet Kaur
      Pages: 1321 - 1324
      Abstract: Background: The neonatal transport in India has taken a giant leap in last years. For reducing the death among transported newborns, transport in well-equipped ambulance could play a vital role. As there is not much data available in Punjab on neonates being transported to tertiary care center so the present study was conducted to know the predictors of mortality in newborns transported to tertiary care center.Methods: The present study was an observational study conducted in neonatal intensive care unit of department of Pediatrics at SGRD institute of medical science and research, Amritsar, Punjab, India over a period of 18 months from 1st January 2017 to 30th June 2018. Total 121 neonates were enrolled in the study. History and clinical examination were done at the time of admission and the various study variables were statistically analysed.Results: Out of total 121 neonates, 76 were discharged, 12 expired and 33 left against medical advice. Mortality rate was 9.9%. Mortality was higher in neonates who had hypothermia, hypoglycemia, poor perfusion and bradycardia at the time of admission. Neonates with extremely low birth weight (<1 kg) and those admitted after 6 hours of age also had higher mortality.Conclusions: Predictors of mortality were hypothermia, hypoglycaemia, poor perfusion and bradycardia at the time of admission. New-borns require special care for stabilization before and during transport, which can be achieved by using specially equipped neonatal ambulances. So, these neonatal ambulances should be started in all states to decrease the neonatal mortality rate.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192036
      Issue No: Vol. 6, No. 3 (2019)
       
  • Early predictors of early onset neonatal hypocalcaemia in infants of
           diabetic mother

    • Authors: Bhavya S. O., Rachel Ranitha
      Pages: 1325 - 1329
      Abstract: Background: The objective of this study was the magnitude of hypocalcemia and to assess the predictors for early onset neonatal hypocalcemia in infants of diabetic mother.Methods: Total 100 infants of diabetic mother were followed for development of hypocalcaemia. weight length, gestational age, Apgar score, cord calcium was correlated for serum calcium at 48 hours of life.Results: In present study 91% babies were term and 9% babies were preterm, the incidence of hypocalcemia was high in preterm babies i.e.22% when compared to term babies i.e. 4.3% was not significant and incidence of hypocalcemia was high in babies with Apgar <7 at 1 min (27.27%) was significant statistically. The association of hypocalcemia with cord calcium is not significant statistically.Conclusions: The incidence of hypocalcaemia is more among preterm babies and babies with risk factors, so these babies need close monitoring for hypocalcaemia. No need of regular monitoring of calcium for healthy term babies unless they are symptomatic.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192037
      Issue No: Vol. 6, No. 3 (2019)
       
  • Meconium aspiration syndrome and neonatal outcome: a hospital based study

    • Authors: Siva Saranappa S. B., Shiva Devaraj, Nithya E.
      Pages: 1330 - 1335
      Abstract: Background: The incidence of meconium stained amniotic fluid is 8-20% among all deliveries. The Aspiration of meconium into the airway results in various short term and long term morbidities and mortality. Timely management of these neonates with meconium in amniotic fluid may prevent Meconium aspiration syndrome.Methods: This prospective cohort study was conducted at Kempegowda Institute of Medical Sciences, Bangalore. All live Term neonates born between December 2016 and July 2018 with meconium in amniotic fluid were enrolled in the study. Details of the neonate was entered in the pre-designed Proforma. The objective of this study the outcome of MAS neonates and find factors associated with Meconium aspiration syndrome when compared with Meconium stained amniotic fluid neonates as a whole. These associated factors were presented as Odds Ratio (OR) and 95% Confidence Interval. Chi-square test was done where applicable and a p-value <0.05 was taken as significant.Results: Meconium aspiration syndrome was seen in 79 out of the 188 neonates born with meconium stained amniotic fluid.Conclusions: The morbidity and mortality in a neonate with Meconium stained amniotic fluid (MSAF) to develop meconium aspiration syndrome (MAS) can be avoided with timely antenatal care. Meconium-stained babies should be aggressively managed to prevent complications like perinatal asphyxia and respiratory failure which may lead to the mortality. Those neonates with risk for adverse outcome should be managed with special focus on respiratory care with use of assisted ventilation and inhaled nitric oxide and extracorporeal membrane oxygenation, where available.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192038
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical presentations of congenital hypothyroidism in pediatric age group

    • Authors: Prasad Nayak N., Roshan Maben
      Pages: 1336 - 1338
      Abstract: Background: Hypothyroidism (HT) in pediatric age group is of prime importance because of it’s varied presentations. Missing a diagnosis of hypothyroidism is disastrous since it results in mental retardation (MR). Hence, it is mandatory to know the various types of clinical presentation in clinical practice.Methods: Study includes 30 children who were diagnosed to have hypothyroidism. Detail history were taken thorough examination carried out and thyroid function tests were obtained in all the cases. Results were statistically analyzed in Microsoft office excel 2007.Results: Majority of the children were diagnosed at the age of 1-3 month of age. Males and females were almost equally affected, 70% of the children had constipation, 26.7% of the cases presented with umbilical hernia, feeding difficulties were seen in 23.3%, abdominal distention and prolonged jaundice were seen in 20% of the cases. 10% of the cases presented with short stature and 6.6% children showed obesity.Conclusions: Detailed history and examination of each infant will help in early diagnosis of congenital hypothyroidism (CH). High index of clinical suspicion should be made when any of clinical features of hypothyroidism are present.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192039
      Issue No: Vol. 6, No. 3 (2019)
       
  • Bronchoalveolar lavage for etiological diagnosis of childhood pneumonia

    • Authors: Gouda Ankula Kartikeswar Kartikeswar, Helina Rahman, H. K. Dutta, Amit Kumar satapathy
      Pages: 1339 - 1343
      Abstract: Background: Pneumonia is the most common cause of childhood morbidity and mortality in age group less than 5 years. Identification of causative organism is a real challenge in these children though many of them are responding to the first line antibiotics therapy. Isolation of the organism is of paramount importance those who fails to respond to first line therapy. The objective of this study was to determine the relative efficacy of Bronchoalveolar Lavage (BAL) over blood culture in finding out causative organisms of childhood non responder community acquired pneumonia and to study antibiotic-sensitivity pattern of causative organisms.  Methods: BAL and blood culture was performed in 17 patients of age 2 months to 5 years with pneumonia or severe pneumonia. Lavage fluid was cultured and growth of organism 10000CFU/ml was considered positive. Blood culture was taken on the same day. Antibiotic sensitivity was tested.Results: BAL isolated the organism in 82.35% (n=14) cases out of 17 patients and in 11.76% (n=2) by blood culture (p=0.002). Streptococcus pneumoniae was the most common organism isolated (58.82% (n=10)), followed by K. pneumoniae (23.53% (n=4)). Antibiotic therapy was changed in 58.82% (n=10) cases according on culture report. Transient rise in temperature, tachycardia and tachypnea was noted after procedure but no major complication was associated with BAL.Conclusions: BAL fluid culture in childhood pneumonia has high diagnostic value and better efficacy over blood culture in isolating causative organism without increased risk of complication and decreases unwanted exposure to empiric antibiotic in children with community acquired pneumonia who did not respond to initial 1st line therapy.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192040
      Issue No: Vol. 6, No. 3 (2019)
       
  • Clinical profile and outcome of neonatal thrombocytopenia in a tertiary
           care hospital

    • Authors: Sumarth Lal Meena, Kanwar Singh, Sanjiv Jain, Anil Jain, B. S. Karnawat
      Pages: 1344 - 1348
      Abstract: Background: Thrombocytopenia (platelet count <1,50,000/µL) is one of the most common haematological problems in neonatal intensive care units. In contrast, only 2% of the normal neonates are thrombocytopenic at birth with severe thrombocytopenia (platelet count <50,000/µL) occurring in less than 3/1000 term infants. Multiple disease processes can cause thrombocytopenia in neonates. The important causes of thrombocytopenia in neonates are sepsis, birth asphyxia, prematurity, intra-uterine growth retardation, hyperbilirubinemia, respiratory distress syndrome, meconium aspiration syndrome and low birth weight. Apart from platelet count, bleeding manifestations depend on underlying ailments. The aims and objective were to study the clinical profile, etiology and outcome of neonatal thrombocytopenia in a tertiary care hospital.Methods: Prospective study involving 100 neonates with or developed neonatal thrombocytopenia in NICU.Results: In present study, 100 new-borns with thrombocytopenia 46% were mild, 35% were moderate and 19% were severe thrombocytopenia. 51 (51%) had early onset neonatal thrombocytopenia and 49 (49%) babies had late onset neonatal thrombocytopenia. Anaemia was the dominant maternal predisposing risk factor. Sepsis was the most common cause of neonatal thrombocytopenia. Most common symptom was apnoea. Sepsis, RDS and NEC had significantly contributed to mortality. Most common cause of death was sepsis followed by RDS and NEC.Conclusions: Neonatal thrombocytopenia is a treatable and reversible condition. Hence, it is important to identify neonates at risk and initiate transfusion therapy to prevent severe bleeding and potentially significant morbidity. Anaemia and PROM were the commonest maternal risk factors. Therefore, author recommended that babies born to mothers with these risk factors should be closely monitored for thrombocytopenia.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192041
      Issue No: Vol. 6, No. 3 (2019)
       
  • Correlation of maternal hemoglobin with outcome of neonatal gestational
           age and birth weight

    • Authors: H. S. Ramya, Rajendra Prasad T. C., Nisar Ahamed A. R., Muragesh Awati
      Pages: 1349 - 1353
      Abstract: Background: Anemia is the most common nutritional deficiency disorder in the world. Maternal anemia has become one of the major health concerns worldwide. It is associated with adverse maternal and fetal outcomes such as increased rates of maternal and perinatal mortality, premature delivery, low birth weight and certain anomalies. This study was done to find out the correlation between maternal hemoglobin and birth weight and gestational age of newborn at birth.Methods: This is an observational clinical study, which  included 1501 pregnant mother and their newborn babies. All singleton live born babies born were examined. The pregnant women’s lowest recorded hemoglobin measurement during pregnancy is correlated with outcomes of neonatal gestational age and birth weight.Results: Majority of the mothers belonged to lower middle class. 59.4% of the mothers were anemic. 21% of the babies born were preterm and 30% of the babies born were low birth weight.Conclusions: In India, according to WHO 2018 data, anemia in pregnancy is 65-75%. Present study outcome shows, preterm deliveries is 12.1% and low birth weight is 17.8% born to anaemic mothers who were 59.4%. The reduction in percentage of anaemic mothers in current study is due to National health programmes. In future, these programs will help to reduce the incidence of anaemia in pregnancy, which in turn will reduce low birth weight and preterm deliveries.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192042
      Issue No: Vol. 6, No. 3 (2019)
       
  • Spectrum of multi-organ system involvement in perinatal asphyxia in
           neonatal intensive care unit department of Pediatrics, King George
           hospital, Visakhapatnam, Andhra Pradesh, India

    • Authors: P. Satish Chandra, M. Surya Prasadarao
      Pages: 1354 - 1361
      Abstract: Background: The objective of the current study to find out the maternal risk factors associated and spectrum of involvement of multiorgan dysfunction in perinatal asphyxia.Methods: This is a prospective study comprises of 102 asphyxiated neonates. At the time of admission blood samples were taken for complete blood picture, random blood sugar, serum electrolytes, septic screen & blood culture. For the assessment of the central nervous system a neurosonogram would be carried out in all asphyxiated new-borns. Computed tomography scan was done who had abnormal neurosonogram. Chest x ray was done for all respiratory cases. Echocardiogram was done for cardiac assessment. Renal system evaluated by serum creatinine and urine output.Results: Of these 102 babies, 59 were males and 43 were females. Major risk factors in the study were meconium stained amniotic fluid cases, eclampsia, pregnancy induced hypertension, premature rupture of membranes and prolonged second stage of labour. central nervous system (CNS) involvement occurred in all 102 (100%) neonates. Hypoxic ischemic encephalopathy was the most common presentation of CNS involvement. Respiratory involvement was noted in 42 (41.5%). Renal involvement was seen in 27 (26.5%). Cardiovascular system involvement was observed in 26 (25.5%). Gastrointestinal involvement was observed in 16 (15.68%). Hematological abnormalities were seen in 14.7%.Conclusions: Multiorgan dysfunction is common in neonates with perinatal asphyxia. Overall mortality was 24.5%, which clearly indicates the need for early detection of maternal risk factors, better obstetric management and the prompt resuscitator measures.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192043
      Issue No: Vol. 6, No. 3 (2019)
       
  • Experience with Holter monitoring for evaluation of infant arrhythmia

    • Authors: Anita Baghel, Manoj Kumar, J. P. Soni, Mudit Agarwal, Ravi Kumar
      Pages: 1362 - 1366
      Abstract: Background: Arrhythmia is defined as abnormal heart rates. Sometimes they are intermittent and difficult to diagnose on routine ECG. Neonatologist and Pediatrician needs to rapidly establish accurate diagnosis and management for infants suspected to have arrhythmia. Hence Holter monitoring of the infants presenting with symptoms suggestive of arrhythmia is necessary as it provides a continuous record of heart’s electrical activity. The aim of this paper is to find out the role of continuous ambulatory electrocardiographic monitoring in daily clinical practice of Pediatrics.Methods: All infants including neonates, either inborn or brought to the paediatric emergency with risk factors, between January 2016 to January 2018, were included in this prospectively study. Evaluation including chest X-ray, standard 12-lead electrocardiography, 24 hours continuous ECG monitoring using Mortara holter, echocardiography, biochemical and haematological analysis.Results: A total of 73 babies were enrolled in present study. In this study arrhythmia was found in 29 (39.72%) new-borns. The most common arrhythmia observed was supraventricular tachycardia (SVT) (41.3%). Other arrhythmia observed were ventricular tachycardia (VT), AV block (34.4%), atria premature beats (3.4%) and ventricular premature beats (6.89%), tachy-bradyarrhythmia (3.4%) and junctional rhythm (3.4%). Of 29 arrhythmia patients four were diagnosed solely by Holter monitoring. None of the babies had long QT syndrome on Holter monitoring.Conclusions: Cardiac arrhythmias are important causes of infant morbidity, and mortality if undiagnosed and untreated. It is important for the neonatologist and paediatrician to be aware of these of arrhythmias and the various diagnostic modalities available for them. A Holter electrocardiogram may be of value in identification of these transient arrhythmic events.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192044
      Issue No: Vol. 6, No. 3 (2019)
       
  • Social dilemma and vitamin D deficiency: a cross-sectional study of
           nutritional rickets in children ages 6 months to 24 months

    • Authors: Sajid S., Irfan Khan, Khalid K., Khalil A., Zahid I. Marwat, Shah N.
      Pages: 1367 - 1372
      Abstract: Background: In developing countries, malnutrition's is one of the challenges that still need to be addressed. Undernutrition is usually a result of the unavailability of food and/or repeated infections in children. Countries with comparatively lower per-capita incomes as well as those with middle per-capita income have its increased prevalence in younger age. Social dilemma of mothers, like exclusively breastfeeding, heavy clothing’s and practice of keeping babies inside the doors, lead vitamin D deficiency and ultimately into nutritional rickets. The objective of this study was to determine the frequency of factors leading to nutritional rickets in children ages 6 months to 24 months.Methods: This cross-sectional study was conducted at Department of Pediatrics, Ayub Teaching Hospital, Abbottabad, Pakistan from March to December 2017. After inclusion/exclusion criteria, total 160 patients of rickets were observed. Detailed history followed by vitamin D level (<15 ng/ml) was measure. Data was analyzed by SPSS-22 and all documents were locked with principal author.Results: Present study showed that 62% children were in age ranged 6-12 months and 38% children were in age range 13-24 months. Mean age was 12 months with SD±2.16. Seventy nine percent children were male, and 21% children were females. More over 52% children had exclusive breast feeding, and 48% children did not have exclusive breast feeding. Similarly, 15% children had limited sun-light exposure and 85% children did not have limited sun-light exposure.Conclusions: Present study concluded that a lack of health education and sunlight exposure and exclusive breastfeeding were the significant risk factors contributed to nutritional rickets among children of Abbottabad, Pakistan.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192045
      Issue No: Vol. 6, No. 3 (2019)
       
  • Gilbert syndrome in a young boy with thalassemia trait: a rare association

    • Authors: Debashree Priyadarshini, Amit Kumar Satapathy, Samarendra Mahapatro
      Pages: 1373 - 1375
      Abstract: Gilbert syndrome (GS) is a mild benign disease characterized by asymptomatic unconjugated hyperbilirubinemia in absence of liver disease or hemolysis. This is the most common disorder associated with bilirubin metabolism with autosomal recessive inheritance. It usually precipitates during episodes of dehydration, fasting or stress like intercurrent illnesses. Here, we are reporting a case of Gilbert syndrome in 12 yrs old boy with thalassemia trait who presented with history of persistent jaundice for last 10 months. He had disproportionately higher concentration of unconjugated bilirubin which cannot be attributed to either disorder alone.
      Authors considered the possibility of Gilbert syndrome after ruling out hemolytic anemia. Though genetic testing is considered to be gold standard for diagnosis of Gilbert syndrome but availability is an issue. Calorie restriction test and nicotinic acid provocation test has been used to confirm GS too. Rifampicin test, another simple test which has been described in literature though not widely used in diagnosis. It has high sensitivity and specificity too.
      Authors had performed rifampicin test in our index case to confirm the diagnosis of GS. Here, authors wish to highlight the patients with both GS and thalassemia trait has higher bilirubin concentrations and is more likely to be icteric than either defect alone.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192046
      Issue No: Vol. 6, No. 3 (2019)
       
  • Hypoplastic internal carotid artery, renal artery stenosis, vertebral
           fusion anomaly: rare association-a case report

    • Authors: Venu Kulkarni, Mallesh Kariyappa, Anil Kumar H., Gangadaraiah .
      Pages: 1376 - 1379
      Abstract: Hypoplastic internal carotid artery has been reported in about 100 patients, most being incidentally diagnosed. Association with other anomalies rarely described.
      Authors report 6-year-old male presenting failure to gain weight and precordial bulge from past 6 months, past history was significant-diagnosed to have right dysplastic kidney at 8 months age. Detailed investigations revealed left hypoplastic internal carotid artery, vertebral segment anamoly, right dysplastic kidney due to right renal artery stenosis. Child was treated medically and was clinically better at latest follow up. All cases with dysplastic kidney need to be searched for vertebral and carotid anomalies, left ventricular dysfunction.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192047
      Issue No: Vol. 6, No. 3 (2019)
       
  • Benign abducens nerve palsy: diagnosis by exclusion

    • Authors: Praveen U., Sushma Save, Sanjay Singh
      Pages: 1380 - 1382
      Abstract: Of all the cranial nerves, the abducens nerve has the longest intracranial course hence is most common cranial nerve to be affected secondary to any potentially devastating intracranial cause. It can indicate significant underlying pathology. Abducens or sixth cranial nerve innervates lateral rectus muscle and pathology of this nerve results in abduction deficiency of ipsilateral eye. Most of the time it will be unilateral but bilateral involvement is also well known. It can recurrent without any underlying identifiable pathology. The 6th nerve palsy is considered as benign after ruling out all possible causes. Benign causes account for just 9 to 14% of all 6th nerve palsies in children. Most of the time benign 6th nerve palsy occurs after viral infection or vaccination as an immunological reaction. In our case patient had history of pentavalent vaccination 1 month back. After thorough investigation and ruling out all possible causes it was attributed to post vaccination immunological reaction. which resolved spontaneously over 4months.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192048
      Issue No: Vol. 6, No. 3 (2019)
       
  • Bilateral suppurative parotitis in a neonate: a case report

    • Authors: Srilakshmi M. Chordia, Arulkumaran Arunagirinathan, Karthik S. Bhandary
      Pages: 1383 - 1385
      Abstract: Acute suppurative parotitis is a very rare ailment to be encountered in the neonatal period. Here, we report a 13-day old hemodynamically stable neonate, who presented to us with bilateral tender, erythematous parotid swelling and purulent discharge exuding from stensen’s duct. He was exclusively breast fed and had no other risk factors. Provisional diagnosis of acute suppurative parotitis was made with clinical examination. On investigating, there was neutrophilic leukocytosis, elevated acute phase reactants, ultrasonogram showed hypoechoic areas and a heavy growth of Staphylococcus aureus was isolated on pus culture. Baby underwent incision and drainage on the day of admission and was started on appropriate parenteral antibiotics along with supportive management. There was a significant clinical response over next 24 hours. He was doing well throughout the hospital stay and antibiotic course was completed based on culture sensitivity pattern. He neither had any immediate complications during hospital stay nor developed any late complications on follow up. Prognosis of the condition is excellent with adequate timely management.
      Authors would like to report this case for its rarity and to emphasize on fact that though the condition is uncommon, acute neonatal parotitis should be included in the differentials of any unilateral or bilateral neonatal parotid swelling, as early diagnosis and prompt management of this entity is mandated for a favorable outcome and to limit complications drastically. 
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192049
      Issue No: Vol. 6, No. 3 (2019)
       
  • Langerhans cell histiocytosis presenting as isolated central diabetes
           insipidus in a 2-year-old child: a rare manifestation of rare disease

    • Authors: Nirmal S. R., Revathi Krishnakumar, Gayathri G. Nair, Sri Lakshmi Chordia, Arulkumaran Arunagirinathan
      Pages: 1386 - 1390
      Abstract: Central diabetes insipidus, though uncommon in children, has varied causes, the commonest ones being genetic mutations, infiltrative disorders, infections. Isolated central diabetes insipidus is not one of the often encountered conditions in the pediatric practice. Here we report a case of 2 ½ years old female child who presented to us following history of polyuria for 2 months, who was confirmed to have central diabetes insipidus which was later evaluated to be secondary to Langerhans cell histiocytosis. Magnetic resonance imaging (MRI) and histopathological studies further helped in confirmation of the diagnosis. Langerhans cell histiocytosis is a rare, multifarious, and underdiagnosed hematologic disease in which isolated diabetes insipidus can be the sole presenting feature before other manifestations. Hence, this diagnosis could strongly be considered in the work up of central diabetes insipidus in children.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192050
      Issue No: Vol. 6, No. 3 (2019)
       
  • A case report of mono-sensitization to peanut component Ara h6

    • Authors: Maria G. Bartellino, Lisa Barisciano
      Pages: 1391 - 1393
      Abstract: Peanut is the most common food allergen in the US, affecting 1-2 % of the population and studies show that it is still on the rise.  Component testing has offered better insight into the likelihood of reactivity with exposure. Extensive literature shows Arachis hypogea (Ara h) 2 as being the most clinically significant component identified to correlate with reactivity with exposure to the peanut protein, however there is minimal research on the reactivity of Ara h6. This case report describes a patient with a clinical reaction to peanut as a toddler and subsequent positivity on annual skin testing with commercial peanut extract, likely confounded by positive birch with advancing age. Immuno CAP testing revealed a negative Ara h2 and positive Ara h6, describing mono-sensitization to Ara h 6 and high probability of clinical reactivity. The importance of this case is to raise awareness of other highly allergenic components in patients with peanut allergy.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192051
      Issue No: Vol. 6, No. 3 (2019)
       
  • A rare case of Goldenhar syndrome: oculo-auriculo-vertebral spectrum

    • Authors: Pooja Pradeep, Nandhinee Umapathi, Jagadeeshwari S., Sundari S., D. Shylaja
      Pages: 1394 - 1397
      Abstract: Franceschetti-Goldenhar syndrome or Goldenhar syndrome, also known as facio-auricular-spectrum (FAV), first and second branchial arch syndrome, or Oculo-Auriculo-Vertebral (OAV) spectrum is a rare congenital malformation which encompasses various morphological and functional abnormalities. The incidence of Goldenhar syndrome has been reported between 1:3500 to 1:5600 children, with a male: female ratio of 3:23. The incidence is higher, about 1 in 1000 children with congenital deafness. The exact etiology is not known. However, it is possible that abnormal embryonic vascular supply, disrupted mesodermal migration or some other factors leads to defective formation of the brachial and vertebral system. Most of the cases have been sporadic. Autosomal dominant, autosomal recessive and multifactorial modes of inheritance have also been suggested. Chromosomal studies have not revealed any abnormality.
      Authors report a case of a neonate with hemifacial microsomia, bilateral cleft lip and cleft palate, right deformed pinna, right facial palsy, single umbilical artery and congenital heart disease.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192052
      Issue No: Vol. 6, No. 3 (2019)
       
  • Cerebral abscess as a complication of a dental abscess

    • Authors: Jeroen Regeer, Bert De Groote, Emmi van Damme
      Pages: 1398 - 1401
      Abstract: A dental abscess, most often caused by inadequate oral hygiene, can be easily treated if timely diagnosed. However, delay in treatment can lead to bacterial dissemination and serious complications, such as development of a cerebral abscess.
      Authors retrospectively analyzed a case of a 15-year-old boy admitted to our pediatrics department with a cerebral abscess due to a dental abscess. A 15-year-old patient presented with supra-orbital swelling which due to previous delay in dental treatment had caused dental, orbital and cerebral abscess formation. After extraction of the affected tooth and six weeks of IV antibiotics the size of the cerebral abscess was practically unchanged. An epidural drainage and further treatment with IV antibiotics were needed to eliminate the cerebral abscess. The urgency of dental treatment to inhibit further microbial spread is of great importance and delay can have serious consequences.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192053
      Issue No: Vol. 6, No. 3 (2019)
       
  • Intussusception associated with celiac disease in a child: case report and
           review of literature

    • Authors: Mukesh Kumar, Diwakar Bansal, Mohan Lal Parihar
      Pages: 1402 - 1405
      Abstract: Intussusception and celiac disease both are common in children.  Intussusception has been rarely associated with celiac disease in children, which mostly involved small bowel, are transient without classical symptoms, reduced spontaneously and rarely needs intervention.
      Authors are reporting a 2-year girl who presented initially as gastroenteritis and later on intestinal obstruction and on investigation revealed ileo-ileal intussusception which resolved spontaneously during laparotomy preparation. The patient had growth retardation and microcytic hypochromic anemia and on further evaluation diagnosed with celiac disease. This case report highlights the need of celiac testing in children with intussusception, and such intussusception resolved spontaneously with gluten free diet and rarely needs any active intervention, thus preventing from undue nonsurgical or surgical interventions for intussusception.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192054
      Issue No: Vol. 6, No. 3 (2019)
       
  • Neonatal chylothorax

    • Authors: Tejinder P. Kaur, Gursharan S. Narang, Ashiana S.
      Pages: 1406 - 1409
      Abstract: Chylothorax is the most common form of pleural effusion encountered in neonates. It is defined as abnormal accumulation of lymphatic fluid in the pleural space. It may be either congenital or an acquired condition. It causes respiratory and nutritional problems and significant mortality rate. Neonatal chylothorax respond to octreotide treatment. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax.   Initial management may include restriction of enteral feedings.
      Authors report a case of newborn baby born to gravida 2 mother at 32±2 weeks of gestation with left sided pleural effusion subsequently confirmed to be a congenital chylothorax with patent ductus arteriosus. USG guided tap was done, and milky fluid was aspirated.
      PubDate: 2019-04-30
      DOI: 10.18203/2349-3291.ijcp20192055
      Issue No: Vol. 6, No. 3 (2019)
       
 
 
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