International Journal of Contemporary Pediatrics

Successful biventricular assist device Berlin heart implantation leading to heart transplant in a complicated pediatric case: an experience from a single center

Kashif Rizvi, Felix W. Tsai, Emad Hakami, Ghada Aldabaan, Majid Ali — Mon, 25 Nov 2024 00:00:00 +0530

The use of the Berlin heart EXCOR ventricular assist device (VAD) as a bridge to heart transplantation in pediatric patients has become increasingly widespread. This case report presents a detailed account of the successful implantation of a biventricular assist device (BIVAD) Berlin heart device in a complex pediatric case at the esteemed King Faisal Specialist Hospital and Research Center. The patient, diagnosed with dilated cardiomyopathy (DCM) and Kawasaki disease, underwent a series of interventions and treatments before requiring extracorporeal membrane oxygenation (ECMO) support and subsequently receiving the Berlin heart device. The post-implantation period was marked by significant challenges, including instances of bleeding and clot formation, necessitating multiple interventions and careful management. Ultimately, a heart transplant was performed; however, the patient encountered humoral rejection, leading to additional targeted treatment. Despite these intricate complications, the patient exhibited substantial improvement in left ventricular ejection fraction (LVEF) following the transplant, indicating a positive outcome. This case underscores the successful use of a BIVAD Berlin heart device as a viable bridge to heart transplantation in a complicated pediatric case, highlighting the crucial role of a multidisciplinary approach and meticulous management of complications throughout the entire treatment process.

Extreme essential thrombocytosis in a healthy asymptomatic 6-month-old child

Faraj A. Harbi, Altaf A. Bhat, Murtada H. Alsultan — Mon, 25 Nov 2024 00:00:00 +0530

In healthy child essential thrombocytosis is always an incidental finding during routine check. Essential thrombocytosis (primary thrombocythemia) is a non-reactive, chronic myeloproliferative disorder in which sustained megakaryocyte proliferation leads to an increase in the number of circulating platelets, on the other hand reactive or secondary thrombocytosis is the more common form, with infectious diseases being the most common cause. Mutations in Janus kinase 2 (JAK2), calreticulin (CALR), or myeloproliferative leukemia (MPL) are found in approximately 90% of patients with essential thrombocytosis. We describe a case of extreme thrombocytosis in a healthy 6-month child. She required admission for workup (maximum number of platelets 1900,000/mm³). With this case, we reviewed the different causes of thrombocytosis in childhood, differential diagnosis, World Health Organization (WHO) criteria for diagnosis of essential thrombocytosis, and the available treatments in case of extreme thrombocytosis.

Management of hemifacial microsoma with ear tags: a case report and three years follow-up

Pawan Kumar K., Harshitha N., Syed Moqthadeer Ahamed — Mon, 25 Nov 2024 00:00:00 +0530

Hemifacial microsomia is a congenital disorder characterized by asymmetric facial development, affecting the ear, eye, and facial nerves. The etiology is multifactorial, involving genetic and environmental factors. Clinical manifestations can range from mild facial asymmetry to severe craniofacial deformities, often requiring multidisciplinary intervention. Physical examination for facial asymmetry and ear abnormalities. Imaging studies (CT, MRI) to assess craniofacial structures. Detailed medical history to identify any familial patterns or associated syndromes. This case underscores the importance of approach in managing Hemifacial microsomia. Multidisciplinary Long-term follow-up and staged surgical interventions are crucial for achieving optimal functional and aesthetic outcomes. Further research is needed to refine treatment protocols and improve patient quality of life.

Congenital diarrhoea due to microvillus inclusion disease: a case report

Pooja N. Patel, Chinmayee Ratha, Suresh Kumar Panuganti — Mon, 25 Nov 2024 00:00:00 +0530

Inherited diarrheal diseases are group of disorders which cause significant morbidity with dependence on parental nutrition. Microvillus inclusion disease (MVID) is a secretory enteropathy with autosomal recessive inheritance associated with bi allelic mutations in MYO5B gene or more rarely STX3 gene. We report a newborn, which developed diarrhea since birth and whose exome sequencing showed the rare mutation of biallelic STX3. There is a possibility of familial involvement (two other siblings having similar symptoms involved, but not evaluated and died) in this particular case. All three had antenatal polyhydramnios and dilated bowel loops. This case report describes an infant diagnosed with congenital diarrhea due to a genetic mutation, explores the diagnostic process, and outlines the management strategies and outcomes. The report emphasizes the importance of early diagnosis and tailored treatment in improving patient outcomes.

Histological variation of natal and primary teeth: a mini-review with a case report

Noopur Kaushik, Nikhil Srivastava, Vivek Rana, Kanishka Gautam — Mon, 25 Nov 2024 00:00:00 +0530

Many changes occur during a child's growth from conception to his or her early years of life. Tooth eruption has a chronology that corresponds to the date the tooth emerges into the mouth cavity. These dates have been established in the literature and are vulnerable to minor variations based on genetic, endocrine, and environmental variables. However, the timing of tooth eruption can vary significantly, with the first teeth appearing at birth or throughout the first month of life. The objective of the present study was to present a review with a case report on important aspects of natal and neonatal teeth.

Uncommon association of tuberculosis with deep vein thrombosis in a child: a case report

Dishu Agrawal, Archana Agrawal, Shashwat Misra, Puneet Kumar — Mon, 25 Nov 2024 00:00:00 +0530

Tuberculosis (TB) is a major global health issue, particularly in developing countries. While TB commonly affects the lungs, it can spread to nearly any organ system, leading to a range of complications. One rare extrapulmonary manifestation of TB is deep vein thrombosis (DVT), which is even more rarely reported in children. We report a case of a 13-year-old girl with progressive, painful swelling in right lower limb, accompanied by fever, cough and lymphadenopathy. Diagnostic imaging identified DVT in the right external iliac vein. Further investigation confirmed Mycobacterium tuberculosis infection. She was treated with anti-tubercular medication and therapeutic anticoagulation. Although uncommon, this case underscores the importance of recognizing this serious complication and need for timely diagnosis and treatment.

Dengue fever with atypical manifestations in a child with beta thalassemia major post splenectomy

Fri, 08 Nov 2024 00:00:00 +0530

Dengue is one of the significant public health concerns in endemic countries. With plasma leakage as the primary pathophysiology in the process of severe dengue infection with hemoconcentration and thrombocytopenia being the significant laboratory diagnostic features in children, the presentation in children with underlying hemato-oncological conditions is atypical and often, anemia is found in these children, instead of hemoconcentration. We describe a young boy with beta thalassemia major who underwent splenectomy for hypersplenism 5-months ago with dengue illness, characterized by features mimicking a severe post splenectomy opportunistic infection with fever, loose stools and abdomen tenderness. Leucopenia, thrombocytopenia, minimal pleural effusion, ascites and gall bladder wall edema prompted us to think of dengue and was found to be positive. Child improved with appropriate supportive care measures. Pediatricians should be aware of the differences in the presentation of tropical infections in children with hemato-oncological disorders. Tropical infections should be kept in mind even in children with underlying hemato-oncological conditions, to ensure diagnosis and appropriate management.

Limbal dermoid in right eye in an infant: a case report

Syed Moqthadeer Ahamed, Harshitha N., Pawan Kumar — Mon, 25 Nov 2024 00:00:00 +0530

Limbal dermoids are congenital, benign tumors located at the corneoscleral junction, often associated with ocular surface abnormalities and potential facial disfigurement. They can vary in size and impact visual development depending on their location and extent. This case report describes an infant presenting with a mass growth in the right eye (RE) accompanied by facial disfigurement. The infant underwent a clinical examination, which confirmed the presence of a limbal dermoid in the right eye. The physician's management plan included initiating patching therapy for the left eye (LE) for 2 hours daily to stimulate visual development in the affected eye and to prevent amblyopia. A review was scheduled for 6 months later to monitor the dermoid's growth and assess visual acuity. Conservative management with regular monitoring was deemed appropriate due to the benign nature of the limbal dermoid and the absence of significant refractive error.

Siblings with nemaline myopathy: a case of rare genetic mutation

Zainali N. Merchant, Mehul M. Gosai, Jay H. Kaklotar, Akshat P. Shah — Mon, 25 Nov 2024 00:00:00 +0530

Nemaline myopathy (NM) is a rare, congenital myopathy with varied clinical presentation. This case report talks about varied manifestation of this condition among siblings from same couple with a rare specific mutation at molecular level among the known mutations reported for NM. The subsequently mentioned patient had severe respiratory distress and recurrent respiratory tract infections since infant, which led to meticulous investigations and relevant family history charting. Such methods proved to be fruitful for suspecting and subsequently led to successful diagnosis of NM in the patient and aforementioned siblings. The diagnosis of NM was made with proper genetic testing, and patient was put on ventilatory support and appropriate physiotherapy for muscle weakness. Lower respiratory tract infections were treated with appropriate antibiotics and medications as and when required. To conclude this case report, advising adequate pre-conceptional genetic counselling to the couple having affected siblings with dire outcomes, which helps avoid the psychological, financial and medical demands of managing such conditions.

Unusual association of limbic encephalitis in pediatric pulmonary tuberculosis-a rare case report

Dhanraj Selvamani, Tamanna Veer Singh, Rahul Middha, Shibani Mehra — Mon, 25 Nov 2024 00:00:00 +0530

Limbic encephalitis is an inflammatory condition that is rarely associated with tuberculosis. The literature shows only three cases, and all of them were seen in adults. We reported a case of an 11-year-old female child who came for fever with altered sensorium and on evaluation, the diagnosis of limbic encephalitis associated with tuberculosis was made. The thought of tuberculosis infection has to be given while making the diagnosis of limbic encephalitis.

A case report of idiopathic intussusception in four-month-old female infant

Mon, 25 Nov 2024 00:00:00 +0530

Intussusception stands as one of the primary etiologies of intestinal obstruction during the initial two years of life. In majority of instances, an underlying cause remains elusive. While barium enema remains the conventional diagnostic and therapeutic modality, the introduction of innovative techniques, such as the utilization of air enema in conjunction with ultrasound-guided hydrostatic reduction, has yielded promising results. A 4-month-old female infant was brought to our department with the symptoms like limb stiffness, upward rolling of the eyes and a single episode of vomiting accompanied by sensation of dullness. The infant did not show any signs of fever, cold, cough or diarrhoea. After performing an abdominal ultrasound, a small segment of telescoping in the epigastric region, along with telescoping of the mesentery and the small bowel was observed, which is indicative of intussusception. An endoscopic hydrostatic reduction procedure was performed, which the infant tolerated well and was discharged from the hospital in a stable condition. An early diagnosis of intussusception and ruling out other possible options, is crucial to prevent further complications and the need for surgical interventions.

Bolted in the nasopharynx: case report of an unusual foreign body in a child

Poonam Sagar, Viny Bhardwaj, Sangay Choden Lepcha, Arun E. J. — Mon, 25 Nov 2024 00:00:00 +0530

Foreign bodies of the aerodigestive tract can lead otolaryngologists in a tough spot. The complexity of the situation increases even more in paediatric patients where a satisfactory examination is often difficult to achieve. Of all the location in upper airway, nasopharynx is deemed as an uncommon spot for lodgement of foreign bodies, especially when ingestion is the route of entry of foreign substance. The role of imaging and nasopharyngoscopy is often undermined. We present the case of a 2-year-old child who presented with an alleged history of ingestion of a foreign body. Clinical examination showed mucoid discharge in bilateral nasal cavities. The examination performed was limited since the child was irritable. Based on the suspicious history given by the child’s guardian, a plain radiograph was ordered. On radiological evaluation, a radio-opaque object was seen lying at the nasopharynx. A controlled setting with secured airway was chosen as the plan and the child was taken up in emergency for foreign body removal under general anaesthesia. The retrieved object was a metallic nutbolt which presumably got lodged in the nasopharynx by digital manipulation done by the guardian or during a bout of vomiting. Ingested foreign bodies being found in the nasopharyngeal is a rare occurrence altogether. However, whenever feasible, a nasopharyngoscopy should be given due consideration. Radiology is an excellent supplemental tool in cases where a thorough examination is not possible.

Overcoming critical aortic stenosis: a rare case report on successful balloon valvotomy at 16 hours of life

Ali Kumble, Abhishek K. Phadke, Poonam Raikar, Manju Jacob — Mon, 25 Nov 2024 00:00:00 +0530

Congenital aortic stenosis is a significant cardiac malformation, comprising 5% of cardiac disorders in childhood, and is more prevalent in males. The most common type is bicuspid aortic valve and the stenosis can lead to a mortality rate of 40-50% if left untreated. Initial presentations often require urgent hemodynamic, respiratory, and metabolic resuscitation. Effective management aims to maintain systemic blood flow, typically through balloon dilation or surgical valvotomy. In this case, we present a neonate born to a 39-year-old G6P5L5 mother via normal vaginal delivery, with a birth weight of 2.7 kg. Although the mother had no antenatal risk factors, an anomaly scan revealed aortic stenosis with left ventricular hypertrophy. The infant cried immediately after birth, but an ejection systolic murmur was detected in the right second and third intercostal spaces on auscultation. Postnatal echocardiography confirmed severe aortic stenosis, significant left ventricular systolic dysfunction, mild to moderate mitral regurgitation. At 16 hours of life, the neonate underwent successful percutaneous balloon aortic valvotomy via right femoral access, leading to improved hemodynamics. The infant was discharged on day 5 and is now thriving at one year of age on anti-failure medications. This case underscores the vital role of early detection and intervention in congenital heart disease. Timely management significantly improves outcomes and mitigates the risks associated with congenital aortic stenosis. The integration of prenatal screening and immediate postnatal evaluation is crucial for optimizing care in affected infants, highlighting advancements in paediatric cardiology that enhance prognoses for these conditions.

Multiple hereditary osteochondroma presenting as spastic paraplegia

Mon, 25 Nov 2024 00:00:00 +0530

Osteochondromas are benign bony tumours with only 1–4% being located in the spine. Compressive myelopathy as a presentation of vertebral osteochondroma in a child is a rare entity. Our case being 6-year-old female with multiple osteochondroma involving spine presenting as spastic paraplegia is itself rare as males of 2nd decade are mostly affected. Father of the patient also had osteochondroma like lesion over knee showing its autosomal dominant inheritance. Appropriate imaging followed by surgical decompression is key to minimize further complications.

Tuberculosis presenting with multiple osteolytic lesions in an adolescent boy with fanconi anemia

Mon, 25 Nov 2024 00:00:00 +0530

Tuberculosis (TB) is well known to present with varied clinical and radiological features. Multifocal bone involvement in tuberculosis is rare. Multiple lytic lesions raise the possibility of malignancy usually, especially, in children with predisposing conditions like Fanconi anemia. However, a thorough evaluation with repeated attempts at histopathological confirmation and microbiological evaluation is mandatory in children with unique presentations with inconclusive initial diagnostic tests. We report an adolescent boy with an underlying Fanconi anemia who presented with fever, cough and respiratory distress. On evaluation, he had pallor, wasting, features of right upper lobe consolidation and multiple lytic lesions. Initial diagnostic evaluation including bone marrow evaluation and a diagnostic biopsy from ribs and bronchoalveolar lavage failed to yield a conclusive diagnosis. After nearly 5 weeks of broad-spectrum antibiotics and antifungals, as the clinical signs were progressing, a complete re-evaluation including biopsy from the rib lesion was done and further, he was diagnosed to have skeletal tuberculosis based on the Mycobacterium Growth Indicator Tube (MGIT) culture for Acid Fast bacilli (AFB). Child was empirically started on anti-tuberculous therapy pending cultures, which have led to significant clinical improvement in 2 weeks of therapy. Low bacterial load in skeletal TB reduces the chance to diagnosis, hence making clinical judgment imperative in diagnosis; and repeated testing is mandatory when there is high index of suspicion.

Outcome of single-ventricle patients supported with extracorporeal membrane oxygenation

Sat, 16 Nov 2024 00:00:00 +0530

Background: Single ventricle heart disease can be left or right ventricle dominant congenital heart disease mostly associated with other risk factors like low birth weight, Preterm, chromosomal abnormality and all these risk factor associated with increase mortality.

Methods: A retrospective chart review of paediatric patients from neonatal age to 14 years since 2012 to 2021, with supported by extracorporeal membrane oxygenation (ECMO) including both single ventricle heart physiology and biventricular heart, admitted in paediatric cardiac surgical intensive care unit in our hospital was conducted. All data were compared between single ventricle heart physiology and biventricular heart. Data was performed using commercially available software (SPSS), with statistical significance set p<0.05.

Results: We enrolled total 124 patients who underwent ECMO cannulation. 68 children had single ventricle, while 56 being biventricular heart. Most children acquired ECMO cannulation in CICU 63 (50.8%). Male to female ratio was 74:50. 70.2% children got the ECMO cannulation when they had already been operated for surgical repair.

Conclusions: Paediatric ECMO utilization in SV is valuable and recently its utilization has been increased in it with improve survival.

Risk factors of asparaginase-associated pancreatitis in children with acute lymphoblastic leukaemia

Mon, 25 Nov 2024 00:00:00 +0530

Background: Acute lymphoblastic leukaemia (ALL) is the top childhood cancer, with survival rates of 80–85%. Attention now focuses on treatment complications. Pancreatitis, linked to Asparaginase in ALL therapy, remains poorly understood despite its recognition. The main objective of the study was to identify the risk factors of pancreatitis in children with acute lymphoblastic leukemia receiving L-Asparaginase during induction chemotherapy.

Methods: A prospective observational study was conducted at BSMMU's Paediatric Haematology and Oncology Department from March 2018 to February 2019. Newly diagnosed ALL cases in children aged 1 to 17.9 years were included, excluding those <1 or >18 years, with prior pancreatitis, or relapsed cases. Informed consent was obtained from parents/legal guardians. Diagnosis relied on clinical, CBC, bone marrow and immunophenotyping. Induction chemotherapy followed the UK ALL 2003 protocol for 35 days, with regular follow-ups monitoring abdominal symptoms and laboratory markers. USG of the abdomen was performed if pancreatitis symptoms or elevated serum amylase/lipase occurred post-L-asparaginase administration.

Results: Among 80 patients, pancreatitis affected 3 (3.8%) after the 2nd, 3rd and 7th doses of L-asparaginase, independent of individual or cumulative dosing, induction phase or concomitant medications. Age, sex, initial WBC count, ALL lineage, treatment regimen and CNS status were not statistically linked to pancreatitis incidence. Clinical manifestations included abdominal pain, tenderness, nausea, vomiting and fever, alongside elevated serum amylase and lipase levels, supported by consistent ultrasonographic findings. Despite these symptoms, no pancreatitis-related mortalities were observed, however, overall mortality during induction therapy reached 20%, unrelated to pancreatic complications.

Conclusions: In this study no significant risk factor could be identified for developing pancreatitis in ALL patients treated with asparaginase. Further studies with large sample size are required to predict who will develop pancreatic toxicity from asparaginase.

Epidemiological profile of severe malaria and sickle cell disease in children at the mother and child university hospital center Jeanne Ebori foundation of libreville from 2020 to 2021

Fri, 01 Nov 2024 00:00:00 +0530

Background: Hemoglobinopathies represent the most common genetic diseases worldwide. In Gabon, the clinico-biological profile of patients with homozygous hemoglobin S or those with AS sickle cell traits, faced with this prevalence of serious malaria, remains unknown today. The objective was to evaluate the complications of severe malaria in SS homozygous sickle cell patients and those carrying AS sickle cell traits.

Methods: This is an observational, retrospective study, with descriptive and analytical aims which took place from January 2020 to October 2021. The parameters studied were socio-demographic, clinical and paraclinical data, the diagnosis chosen, therapeutic data and evolution.

Results: severe neurological form of malaria was the most common criterion with a frequency of 41.7%, followed by parasitic forms 35.8% and anemic forms 21.8%. Among AS heterozygotes, the most widespread severe form was the neurological form with a frequency of 63.2%, the anemic form 26.3% and parasitic at 10.5%. In homozygous SS subjects, the most widespread severe form was the anemic form with a frequency of 68.1% followed by neurological forms 27.7% and parasitic forms 4.2%. Abdominal pain, prostration, respiratory distress were the main signs in SS homozygotes. In heterozygotes, prostration, convulsion and clinical jaundice were the main signs. A total of 99.8% of our patients were cured.

Conclusions: All the electrophoretic profiles identified were subject to this infection which mainly affects heterozygous AS subjects and subjects with the AA electrophoretic profile in its severe neurological form and homozygous SS subjects in its anemic form.

Impact of Kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge

Mon, 25 Nov 2024 00:00:00 +0530

Background: To assess the impact of kangaroo mother care plus massage therapy on growth of preterm low birth weight infants at discharge.

Methods: This randomized controlled trial was conducted in Department of Neonatology in Bangabandhu Sheikh Mujib Medical University over a period of 15 months from March 2022 to June 2023. Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to <2000g and gestational age 28 weeks to <34 weeks were enrolled in the study after getting informed written consent from parents or caregiver. Infants with major congenital anomalies were excluded from this study. All data were analyzed by statistical package for social sciences (SPSS) version 25 (IBM, USA).

Results: Total 122 newborns were admitted in neonatal intensive care unit (NICU) of BSMMU during the study period with birth weight 800g to <2000 g. Among them, 80 infants fulfilled inclusion criteria. Growth was significantly better in KMC plus massage therapy group. Mean weight gain per kg per day in KMC plus massage therapy group was 13.34±10.20 g and it was nearly half in KMC group 6.18±11.84 g only (p-value-0.01). Increase in length was 0.95±0.62 cm in KMC plus massage therapy group vs KMC group 0.66±0.49 cm (p-value-0.04). Increase in OFC was 0.59±0.29 cm in KMC plus massage therapy group vs KMC group 0.42±0.33 cm at discharge (p-value-0.03). Hospital stay in KMC group was 6.36±3.52 days, alternatively it was more 8.33±2.39 days in KMC plus massage therapy group. The dissimilarity was statistically significant (p-value-0.01) Study implication: Massage therapy potentiates benefits of kangaroo mother care in respect to better growth, so massage can be added along with KMC for better outcome.

Conclusions: Massage therapy added to KMC is more effective than KMC alone in improving growth, although it did not affect the hospital stay.

Prevalence of stunting, thinness and anaemia among adolescents and their association with demographics and dietary habits

Mon, 25 Nov 2024 00:00:00 +0530

Background: Adolescence marks the pinnacle of the nutritional need, therefore, it's crucial to detect undernutrition and anemia in adolescents before they exhibit adverse effects. To assess the prevalence of undernutrition and anemia among adolescents and their association with demographic factors and dietary habits.

Methods: A cross-sectional study was conducted over 18 months at the Hind Institute of Medical Sciences, involving 250 adolescents aged 10-19 years. Data collection included anthropometric measurements, hemoglobin assessment, and a structured questionnaire capturing demographic characteristics and dietary habits. Statistical analysis (Descriptive statistics, Chi-square test) was performed using SPSS version 23.0. A p value <0.05 was considered significant.

Results: The study found that 29.6% of adolescents were stunted, 27.6% were thin and 48% had anemia, with 11.6% classified as mild, 30% as moderate and 6.4% as severe anemia. No significant association was reported of stunting with demographic parameters. A significant association was found between thinness and joint family (p=0.044) but not with any other demographic parameter. An inverse relationship of Junk food intake with stunting (p<0.0001) and thinness (p<0.0001) was inferred. Anemia was found to be significantly associated with advancing adolescent age (p<0.0001), female gender (p<0.0001), nuclear family (p<0.0001), lower socioeconomic status (p=0.041), and vegetarian diet (p=0.009).

Conclusions: The high prevalence of undernutrition and anemia among adolescents highlights the urgent need for targeted nutritional interventions. Regular anthropometric assessments and nutritional education programs are essential to address these health issues.

Risk factors and outcomes in paediatric acute febrile encephalopathy: a cross-sectional study from a tertiary care centre in North India

Sonam Tsomu, Kaikho Lajeo — Mon, 25 Nov 2024 00:00:00 +0530

Background: Acute Febrile Encephalopathy (AFE) is a frequent cause of emergency admissions in children, particularly in India, where it poses a significant public health challenge due to high morbidity and mortality rates. This study aims to bridge some of these gaps by analyzing the clinical features, incidence, and mortality-associated risk factors in pediatric AFE cases in a hospital-based setting in North India.

Methods: This hospital-based cross-sectional study was conducted over one year (January 2020 to December 2020) in the Pediatric Intensive Care Unit (PICU) of Indira Gandhi Medical College and Hospital, Shimla. The study included all pediatric patients aged 1 to 18 years admitted to the PICU with clinical evidence of AFE, fulfilling specific inclusion criteria. Data were collected on patient demographics, clinical presentation, and relevant investigations. Key risk factors, such as shock, need for ventilatory support, Glasgow Coma Scale (GCS) scores, and Multiple Organ Dysfunction Syndrome (MODS), were assessed for their association with mortality.

Results: Out of 2,832 pediatric admissions, 550 children were admitted to the PICU, and 69 met the inclusion criteria for AFE, resulting in an AFE incidence of 12.5% in the PICU and 2.4% of total hospital admissions. The study observed a slight male preponderance (56.5% male, 43.4% female) and found that the most affected age group was 10 to 18 years (43%). The overall mortality rate among AFE patients was 26%, contributing to 13.7% of the total PICU mortality. Significant risk factors associated with mortality included late hospital presentation (mortality rate of 50% in patients presenting after 7 days of symptom onset), ventilatory support (69.6% mortality), shock (44.4% mortality), MODS (47.6% mortality), Disseminated Intravascular Coagulation (DIC) (100% mortality), and GCS <8 (56.5% mortality).

Conclusion: AFE remains a significant contributor to pediatric morbidity and mortality, particularly in resource-limited settings. The study identifies key risk factors such as shock, ventilatory support, DIC, MODS, and low GCS, which are strongly associated with increased mortality. Early recognition and timely intervention are critical to improving outcomes.

Assessment of level and source of stress in mothers of newborns admitted to neonatal intensive care unit in tertiary care hospital

Basamma, Basavaraj M. Patil, Nayanatalli Meenakshi, Rudrakshi Itagi — Mon, 25 Nov 2024 00:00:00 +0530

Background: The hospitalization of a neonate is stressful for the mother and all family members Severe stress can affect mother–baby relationship and thus affect newborn development subsequently. The parent-infant bonding process during the newborn period establishes the foundation a lifelong relationship. This process is affected when the newborn spends the first several weeks in NICU. Quantifying stress levels of parents and identifying environmental stressor is useful in assisting the health personnel in improving the quality of medical care. To study the level and source of stress in mothers of Newborns admitted in the Neonatal intensive care unit and to quantify the stress levels by parental stressor scale.

Methods: In this cross-sectional study included 400 mothers of newborn babies admitted in NICU of Basaveshwar Hospital and Sangameshwar hospital attached to Mahadevappa Rampure Medical College, Kalaburgi with semi structured validated interview-based questionnaire consisting of parenteral stressor scale: NICU (PSS: NICU) comprising three subscales and questions related to maternal and neonatal characteristics will be used.

Results: Among the study population the mean stress score was maximum in parental role domain of PSS: NICU stress scale. The maternal stress was higher among preterm and non-breast-fed babies in looks and behaviour and parental role. Maternal stress was statistically significant among rural, illiterate and home maker participants in all 3 domains.

Conclusions: NICU mothers are under significant stress and appropriate counselling targeted towards specific stressors is required and before designing remediation programs for parents, local demography and the predominant NICU stressors need to be kept in mind. maternal stress, neonatal intensive care unit environment, baby looks and behaves.

Study of clinical profile and outcome of viral hepatitis in children with reference to liver function test during covid pandemic admitted at tertiary care hospital

Pathik U. Patel, Chirag D. Shah, Abhishek M. B. — Mon, 25 Nov 2024 00:00:00 +0530

Background: Viral hepatitis is major health problem in both developing and developed country affecting millions of children worldwide. Viral hepatitis defined as inflammation of liver due to hepatotropic and/or non-hepatotropic viruses. Extent of disease vary from acute to chronic which ranges from asymptomatic to fatal acute and on other side from subclinical persistent to rapid progressive chronic disease. Aim of study was proportion and etiology with clinical profile and outcome relation to liver function test (LFT).

Methods: This is retrospective observation study done at civil hospital, Ahmedabad during June 2019 to May 2021 during covid era in admitted patients from age of 6 month to 12 year diagnosed as viral hepatitis. Data collected from medical records and investigation from laboratory data.

Results: In my study, Viral hepatitis was m/c seen in age group of 5 to 10 year in lower socioeconomic class with most common hepatotropic virus was hepatitis A (51.79%) and non-hepatotropic virus was dengue virus (17.86%). Most common presenting complain was fever (93.75%) and sign was jaundice (87.5%). Altered liver function seen in 96.57% patients. Outcome with 4.46% death due to covid19 virus.

Conclusions: In my study during covid19 pandemic, still most common cause for viral hepatitis was hepatotropic virus–HEPATITIS A in admitted patients at tertiary care hospital. But case fatality rate was noted highest in COVID-19 virus among total death.

Clinical and bacteriological profile and antibiotic sensitivity pattern in spontaneous bacterial peritonitis among children with idiopathic nephrotic syndrome

Romana Akbar, Ranjit Ranjan Roy, Shanjida Sharmim, M. Asif Ali — Mon, 25 Nov 2024 00:00:00 +0530

Background: Spontaneous bacterial peritonitis is a serious complication of childhood nephrotic syndrome (NS). A precise knowledge of organism causing peritonitis is important primarily to treat infection and decrease morbidity, prevent antibiotic resistance and finally to reduce mortality. Objectives were to observe the clinical and bacteriological profile and antibiotic sensitivity pattern of peritonitis in childhood NS.

Methods: This cross-sectional observational study was conducted in pediatric nephrology department of Bangabandhu Sheikh Mujib medical university (BSMMU). The 44 diagnosed patient of spontaneous bacterial peritonitis among childhood idiopathic NS were enrolled as cases. The peritoneal fluid was obtained following standard procedure and examined for gross appearance, cytogical and biochemical analysis, microscopic examination with gram stain and peritoneal fluid culture along with antibiotic sensitivity.

Results: All patients had complaints of abdominal pain followed by fever, vomiting, lethargy and anorexia. All cases had edema and ascites followed by abdominal tenderness, abdominal wall rigidity, rebound tenderness and cellulitis in areas other than abdominal wall. Peritoneal fluid showed neutrophilic pleocytosis and exudative fluid. We observed 27.27% gram + cocci, 6.82% gram-bacilli in gram stain examination. Here, only 6.9% cases showed positive growth including 2.3% E. coli, 2.3% Pseudomonas, 2.3% Acinetobacter and remaining 93.1% cases showed no growth. We also described the antibiotic sensitivity pattern in this study.

Conclusions: In our study, patients predominantly had abdominal pain, fever, edema, ascites and abdominal tenderness. We found only 6.9% cases showed positive growth which included E. coli, Pseudomonas and Acinetobacter and demonstrated the antibiotic sensitivity and resistance pattern for these organisms.

Translating and validating the modified checklist for autism in toddlers (M-CHAT-R/F) into Malayalam for effective utilization of it in the clinical setting

Mon, 25 Nov 2024 00:00:00 +0530

Background: Early intervention strategies significantly improve developmental outcomes for children with autism spectrum disorders. In this background, this study was conducted to translate and validate Malayalam version of Modified Checklist for Autism in Toddlers (M-CHAT-R/F).

Methods: This cross-sectional study was conducted in four steps. The original version of MCHAT-R/F was translated into Malayalam, and back translated by bilingual experts followed by pilot testing. Finally, the translated tool was administered to 100 children for evaluation of psychometric properties which included reliability and validity assessment. The statistical analysis was conducted using IBM SPSS version 25.

Results: The internal consistency of the items as per parent confirmed stage of screening and flow chart interview stage of screening was 0.539 and 0.731 respectively. The level of agreement in categorizing the children according to the risk of ASD by two raters during first and second screening stage was 0.647 and 0.432 respectively. The test-retest reliability analysis showed that all the items had a moderate level of agreement between test and retest. All the items had an I-CVI more than 0.90. There was strong positive correlation between the score obtained during first stage (r: 0.562) and second stage (r: 0.529) with CARS score which indicates high convergent validity.

Conclusions: The newly translated tool with high reliability and validity could enable in screening symptoms of autism among children belonging to lower age group, which would facilitate in providing appropriate intervention as early as possible.

Clinico-etiological profile of seizures in the pediatric age group

Mon, 25 Nov 2024 00:00:00 +0530

Background: The etiologies of pediatric seizures are multifaceted, involving infections, structural brain abnormalities, or genetic factors. The objective of this study was to find the clinico-etiological profile of seizures in children and to estimate the association of different seizure etiology with demographic factors

Methods: This cross-sectional study was conducted over 18 months on 400 children aged between 1 month and 18 years presenting with their first episode of seizures at Hind Institute of Medical Sciences, Sitapur. Data was collected on predesigned Performa which included history, clinical examination, and laboratory investigations. The data was analyzed using SPSS-22 software. A p-value<0.05 was considered significant.

Results: The mean age of children was 5.51 (4.43) years. The majority of children were from the age group 3-6 years (164, 41%). Males were 242 (60.5%). Most were birth order >3 (153, 38.2%). Most were from joint families (259, 64.8%), from rural livelihood (349, 87.3%), and from lower socioeconomic status (134, 33.5%). Family history of seizures was positive in 78 (19.5%). Generalized tonic-clonic seizures were the most common type (159, 39.8%). The leading causes of seizures were febrile seizures (153, 38.2%), and CNS infections like meningitis (97, 24.2%). Fever was the most common symptom (282, 70.5%). A significant association of etiology of seizures was seen with lower age groups, lower socioeconomic status, rural livelihood, and positive family history.

Conclusions: Seizures are common in <6 years of age with male preponderance and febrile seizure is the most common cause. Most of these seizures are generalized in nature.

Comparative study of micro ESR with CRP and blood culture sensitivity

Bhavana M. Angadi, Shalini S. Rangaswamy — Mon, 25 Nov 2024 00:00:00 +0530

Background: Neonatal sepsis is one of the leading causes of morbidity and mortality among neonates in India. Indian association of paediatrics has developed sepsis screen which is useful for early diagnosis. To test the reliability of micro ESR as bedside tool in early diagnosis of neonatal sepsis we conducted this study. Comparison of Micro-erythrocyte sedimentation rate (micro ESR) with C-reactive protein (CRP) and blood culture sensitivity in neonatal sepsis. To establish a relation between severity of sepsis and Micro-erythrocyte sedimentation rate.

Methods: This is a cross sectional study done at neonatal intensive care unit (NICU), at our institute over a period of six months. Fifty neonates with risk factors for sepsis and who had a positive sepsis screen were enrolled prospectively into the study.

Results: Out of 50 samples collected, micro ESR (>15 mm/hour) was positive in 12 cases (24%) and CRP was positive in 18 cases (36%). After procuring the blood culture report, 48 cases had neonatal sepsis (84%). Our study showed that micro-ESR as a bedside test had a positive correlation with mortality (p value <0.001) when compared with CRP values (p value=0.546) in neonatal sepsis. As expected, elevated micro ESR and high CRP value had 100% correlation but was not statistically significant (p=0.319). In all the 12 cases with raised micro ESR had 100% blood culture positivity but significance could not be established.

Conclusions: Micro-ESR had a significant correlation with mortality in neonatal sepsis.

Efficacy of exclusive human milk diet in preterm infants weighing ≤1500 g: a single-center COHORT study

Mon, 25 Nov 2024 00:00:00 +0530

Background: Preterm infants have high nutrition needs for growth and survival as they are at high risk of mortality and morbidity. An exclusive human milk diet (EHMD) that comprises human milk (HM) either expressed breast milk (EBM) or pasteurized donor human milk (PDHM), fortified with a 100% human milk-based fortifier (HMBF) could provide with safe nutritional strategy in preterm infants.

Methods: This single-center, prospective cohort study included a cohort of 25 preterm infants ≤34 weeks of gestation weighing ≤1500 g at birth who were fed with EHMD when the feed volume reached 100 ml/kg/day until the infant was fit for discharge.

Results: Of the 25 infants enrolled in the study the mean gestational age was 29.6±1.6 weeks and birth weight was 1171±230.7 g. The mean weight gain was 25.5±5.5 g/day and the mean growth velocity was 17.8±3.4 g/kg/day. Feeding intolerance was observed in 4 infants (16%), the average days to reach full feeds was 12.4±4.9 days and there was no necrotizing enterocolitis (NEC) observed.

Conclusions: EHMD was well tolerated by the infants with better weight gain. These findings demonstrate that EHMD is a safe and effective nutritional strategy in the management of preterm infants. However, a large RCT (randomized clinical trial) is required to evaluate the efficacy of EHMD.

Paediatric brain lesions: a study of space-occupying conditions

Poonam Pandit Pawar, Girish Shakuntal — Mon, 25 Nov 2024 00:00:00 +0530

Background: Intracranial space-occupying lesions (ICSOL) in children, encompassing neoplastic and inflammatory origins, pose significant diagnostic and therapeutic challenges. Modern imaging techniques like CT and MRI have revolutionized the understanding and management of ICSOL, altering their clinical presentation. This study aimed to investigate the epidemiology, clinical presentation, etiology, treatment modalities and outcomes of ICSOL in pediatric patients.

Methods: A prospective analysis was conducted on pediatric patients diagnosed with ICSOL, utilizing medical records from a tertiary care hospital. Data regarding demographics, clinical symptoms, imaging findings, treatment modalities, and outcomes were collected and analyzed.

Results: In this study on space-occupying lesions (SOL) in pediatric patients, revealing a diverse distribution across different age groups. Arachnoid cysts were the most prevalent, followed by hydrocephalus, hematomas, and tuberculomas. Clinical presentations varied widely, with Headache, Seizures and altered sensorium in limbs being the most common symptoms. Treatment approaches ranged from surgical resection or fenestration for arachnoid cysts to specific therapies such as ventriculoperitoneal shunt placement for hydrocephalus and antitubercular therapy for tuberculomas. Outcomes varied by lesion type, with some cases showing improvement, stability or worsening post-treatment.

Conclusions: The study provides valuable insights into the epidemiology, clinical presentation, treatment, and outcomes of space-occupying lesions in children. Arachnoid cysts emerged as the predominant lesion type, while hydrocephalus, hematomas and tuberculomas were also notable. Understanding these factors is crucial for early diagnosis, effective management and improved outcomes in pediatric patients with brain lesions.

Demographic profile of diarrhoea in malnourished children

Anirudh Mahajan, Sharvil Dhar, Abhijay Mehta, Harsh V. Sharma, Ravinder K. Gupta — Mon, 25 Nov 2024 00:00:00 +0530

Background: Diarrhoeal illnesses impair both weight and height gains, with the most pronounced impacts observed in cases of recurrent episodes. Malnutrition can exacerbate diminished human performance, hinder physical growth, and retard cognitive development, and it is concomitant with increased frequency, duration, and severity of diarrhoeal events. The interrelationship between diarrhoea and malnutrition is intricately linked to factors related to water, sanitation, and hygiene, albeit through distinct pathophysiological mechanisms. Recurrent diarrhoeal episodes, infections, and inadequate hygiene practices can exacerbate these outcomes. Essentially, each diarrhoeal episode exacerbates nutritional deficits and fluid loss, thereby intensifying the severity of both malnutrition and dehydration. Aims and objectives were to identify and describe the demographic profile of malnourished children who experience diarrhoea, including age, sex, birth order and immunization status and to evaluate the impact of demographic variables on the severity of diarrhoea in malnourished children.

Methods: The present observational study was carried out in Outpatient department as well as inpatient department in department of pediatrics at Acharya Shri Chander College of Medical Sciences and Hospitals after obtaining ethical permission from institution with reference no. ASCOMS/IEC/2024/Meeting-II/FM/15, over a period of six months, w.e.f. 01 January 2024 to 31 June 2024. A total of 260 malnourished children were included in the study after obtaining the informed consent from their parents/guardians.

Results: In our study out of 260 malnourished children of age group 6 months to 5 years, 125 had diarrhoeal disease in which 76 (60.8%) were male and 49 (39.2%) were females with male to female ratio was 1.55:1 and majority of the study subjects were in the age group of 1-2 years (60%), followed by 6-12 months (24%), followed by 2-5 years (16%) and out of 76 male malnourished children who had diarrhoea, 52.6% were found to have grade II Indian Academy of Pediatrics (IAP) classification of malnutrition followed by 21%, 18.4% and 8% have grade III, grade I and grade IV respectively whereas out of 49 malnourished female child who had diarrhoea, 34.7% were having grade I IAP classification of malnutrition whereas grade II and grade III were found almost similar numbers 26.5% and 24.5% respectively and 14.3% had grade IV IAP classification of malnutrition.

Conclusions: The present study concluded that the malnutrition engenders diarrhoeal manifestations through a variety of mechanisms, while diarrhoea, in turn, exacerbates the degradation of nutritional status. Moreover, 13.6% of cases of diarrhoea becomes chronic has significant implication and highlights the need of early intervention and effective management strategies to prevent acute cases from developing into chronic.

Impact of maternal anemia on neonatal outcomes

Mon, 25 Nov 2024 00:00:00 +0530

Background: Maternal anemia can have adverse neonatal outcomes like low birth weight, prematurity, lower APGAR scores, lower cord blood hemoglobin, and neonatal mortality. This study aims to estimate the association of maternal anemia with demographics and the outcomes of newborns. i.e. birthweight, gestational age, APGAR score, and cord blood hemoglobin.

Methods: A cross-sectional study on 384 pregnant women and their newborns was done at Hind Institute of Medical Sciences, Sitapur over 18 months. A complete blood count sample of the pregnant women followed by a cord blood hemoglobin sample of the newborn was collected. Neonates' gestational age, birth weight, length, and APGAR score were noted. Data analysis (descriptive statistics, Chi-square test, Pearson’s correlation) was done using statistical package for the social sciences (SPSS) software. P value <0.05 was considered significant.

Results: Working mothers had lower chances of being anemic (p<0.00001) while mothers with vegetarian diets had higher chances of anemia (p<0.00001). A significant association of maternal anemia was found with lower educational status (p=0.003), alcohol abuse (p=0.003), and smoking/tobacco abuse (p=0.021). Babies born to non-anemic mothers had higher birth weights than those born to anemic mothers (p<0.0001) but maternal anemia did not significantly impact the gestational age outcome (p=0.404). A positive correlation was established between maternal and cord blood hemoglobin levels (r=0.230).

Conclusions: Monitoring and addressing maternal hemoglobin levels are essential strategies for preventing anemia in the newborn and promoting healthy development in neonatal life.

Evaluation of the safety and efficacy of herby angel tummy roll-on in managing infantile colic: a case series

Ajay Bajpai, Swathi Ramamurthy, Arpitha C. Rao — Mon, 25 Nov 2024 00:00:00 +0530

Infantile colic is a benign condition of the second or third week of life characterized by abdominal discomfort. Infantile colic is characterized by persistent and unconsolable crying in an otherwise healthy and well-fed infant. About 20% of the newborn babies and infants are affected by this condition. This condition distress and challenges caregivers, leading to 10% to 20% of paediatric provider visits during the first few weeks of their lives. Current management options are limited and often involve oral administration which can be challenging for the caregivers. This study evaluated the safety and efficacy of the Herby Angel Tummy Roll-On, a topical treatment containing natural ingredients like Asafoetida, Ajwain, Rock salt, etc., designed to alleviate colic symptoms through a non-invasive approach. Four infants with recurrent colic episodes were monitored over one month, assessing improvements using the FLACC scale and other parameters such as frequency of interruptions, episodes of colic, and skin reactions. Significant improvements in symptoms were observed within a short duration, with no adverse skin reactions. The findings of this study suggest that the product effectively alleviated abdominal distension and pain, leading to a marked reduction in sleep disturbances in infants. It has a positive short-term effect on infantile colic.