Pediatric Review: International Journal of Pediatric Research https://pediatrics.medresearch.in/index.php/ijpr <p><em><strong>ISSN: <a href="https://portal.issn.org/resource/ISSN/2349-3267" target="_blank" rel="noopener">2349-3267 (Online)</a>, <a href="https://portal.issn.org/resource/ISSN/2349-5499" target="_blank" rel="noopener">2349-5499 (Print)</a></strong></em></p> Siddharth Health Research and Social Welfare Society en-US Pediatric Review: International Journal of Pediatric Research 2349-5499 Nasal intermittent positive pressure ventilation in neonates with meconium aspiration syndrome https://pediatrics.medresearch.in/index.php/ijpr/article/view/633 <p>Background: Nasal intermittent positive pressure ventilation ( NIPPV) as primary respiratory support in neonates with meconium aspiration syndrome (MAS) has not been studied. The present study applied the use of NIPPV as a treatment modality in MAS and tried to identify factors predicting NIPPV failure.</p> <p>Objective: The aim was to identify failure rates of MAS on NIPPV and potential predictors of NIPPV failure.</p> <p>Design: Observational analytical study.</p> <p>Methods: 86 neonates were admitted during the study period of 2 years of which 60 were included and NIPPV was applied as the primary modality of respiratory support with available ventilators. Outcome variables were compared between the MAS infants who failed NIPPV and those who were successfully managed with NIPPV.</p> <p>Results: 7 neonates (11.7%) out of 60 enrolled neonates failed on NIPPV. There was a significant decrease in Downe score, respiratory rate, heart rate, fio2 requirement after 6 hours compared to a baseline measurement (p&lt;0.01). On univariate analysis factors associated with NIPPV failure were high Fio2, high PEEP, at one hour of starting NIPPV (p&lt;0.05). However, on logistic regression none of the factors were predicting failure independently.</p> <p>Conclusion: NIPPV applied early may reduce the need for mechanical ventilation in neonates with moderate to severe MAS.</p> Dr. Jagadish. A.S. Dr. Vikranth Dr. Ravichander B. Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-19 2020-12-19 7 8 395 400 10.17511/ijpr.2020.i08.01 Thyroid profile in patients of thalassemia with multiple blood transfusions and high serum ferritin: a cross-sectional study https://pediatrics.medresearch.in/index.php/ijpr/article/view/646 <p>Introduction: Beta-thalassemia major patients undergo regular blood transfusion resulting in growth faltering and various endocrine problems including thyroid dysfunction due to iron overload in the body. This study was conducted to determine the frequency of thyroid dysfunction in children presenting with Beta-thalassemia major on regular blood transfusions.</p> <p>Materials and methods: Sixty children were included with proven beta-thalassemia major who reported to the Department of Pediatrics, VIMS, and RC, Bangalore. Inclusion criteria: 1.Children 4 to 18 years age group .2.The child received transfusions for more than 2 years. 3.Children with serum ferritin level &gt;700.</p> <p>Results: In this study, four patients(6.8%) had overt hypothyroidism, eight patients(13.6%) had subclinical hypothyroidism and 47 patients(79.7%) had euthyroid status. There was a positive correlation between Ferritin and T4, TSH levels. i.e., with an increase in Ferritin level, there was an increase in T4, TSH levels, and vice versa. However, the correlation was significant with TSH. There was a significant negative correlation between Ferritin and T3 levels. i.e with an increase in Ferritin level, there was a decrease in T3 levels and vice versa.</p> <p>Conclusion: Thyroid dysfunction can exist in thalassemia patients on multiple transfusions and chelation therapy with high serum ferritin levels. Detection of hypothyroidism is important as inexpensive oral replacement therapy is readily available. Hence regular screening of beta-thalassemia major patients for Serum T3, Serum T4, Serum TSH for early detection and timely treatment could improve the life expectancy and quality of life of these patients.</p> Dr. Rohit Khandelwal Dr. Muralidhar Gundluru Dr. Leeni Mehta K. Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 401 408 10.17511/ijpr.2020.i08.02 Study of hypoglycemia in neonates with low birth weight https://pediatrics.medresearch.in/index.php/ijpr/article/view/636 <p>Background and Aim: The maintenance of normoglycemia in newborns depends upon the adequacy of glycogen stores, maturation of glycogenolytic and gluconeogenic pathways, and integrated endocrine response. The current study, therefore, proposes to observe the clinical profile of low-birth-weight babies concerning the occurrence of hypoglycemia.</p> <p>Materials and Methods: The neonates with a weight of fewer than 2500 grams were included in the study. A total of 100 infants were included in the study. They were divided into two groups with infants with hypoglycemia in one group and infants with normoglycemic in another group. The aseptic condition was maintained and with the help of heel prick, the capillary blood was collected. The capillary blood was screened with the help of reagent strips.</p> <p>Results: Out of the total 100 neonates, a total of 76 neonates were normoglycemic and 24 neonates had hypoglycaemic episodes. Overall 22 episodes of hypoglycemia were recorded. There was no significant association between birth weight and episodes of hypoglycemia. The majority of hypoglycaemic infants were male.</p> <p>Conclusion: Hypoglycemia associated with abnormal clinical signs (symptomatic hypoglycemia) has a poor short- and long-term outcome but evidence of risk in the absence of clinical signs (asymptomatic hypoglycemia) is inconclusive. Small for gestational age is a significant determinant for hypoglycemia. Hypoglycaemic episodes were significantly noticed in the first 24 hours as compared to another time interval.</p> Dr. Ekta Acharya Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 409 413 10.17511/ijpr.2020.i08.03 A cross-sectional study on the correlation between postnatal foot length and various other anthropometric parameters along with the gestational age https://pediatrics.medresearch.in/index.php/ijpr/article/view/638 <p>Introduction: This study was done to assess the utility of foot length in determining the anthropometric parameters of a newborn in a tertiary care teaching hospital.</p> <p>Materials and Methods: This cross-sectional study among 270 newborns were done at Sri Venkateswaraa medical college hospital and research centre, from Nov 2018 to May 2020. All the healthy live newborns were taken into the study and newborns with congenital lower limb anomalies were excluded.</p> <p>Results: The mean birth weight of the neonate 2.948+0.344 kg which ranged from 2.050 kg to 3.750kg. The mean foot length, head circumference and chest circumference of the foot length was 8.113+0.468 cm, 48.989+1.093 cm, 34.437+0.659 cm and 32.372+0.734 cm respectively. The foot length had a maximum correlation with birth weight (r-value=0.905) followed by gestational age (r-value=0.809), length (r-value=0.786), head circumference (r-value=0.719) and chest circumference (r-value=0.603).</p> <p>Conclusion: Foot length had a significant correlation with birth weight and gestational age of the neonates. Foot length also correlated significantly with other anthropometric variables like length, head circumference and chest circumference.</p> Dr. Abhinaya Arun Raj Dr. K. Maheswari Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 414 419 10.17511/ijpr.2020.i08.04 Screening for fecal occult blood loss in severely malnourished children https://pediatrics.medresearch.in/index.php/ijpr/article/view/640 <p>Introduction: PEM is the most important and basic hurdle in the triple-M complex of malnutrition, morbidity, and mortality. Very high mortality has been reported in severe PEM. PEM is found to account for about 4 million deaths in children. The study aimed to perform a fecal occult blood test in patients in the age group of six months to five years and also to identify the conditions associated with fecal occult blood loss in pem patients.</p> <p>Materials and Methods: A total of 100 indoor patients of PEM admitted in our pediatric ward were taken as subjects in this study. According to WHO and IAP classification of PEM, severe malnutrition (marasmus, kwashiorkor, and marasmic kwashiorkor) were taken as study group; and mild grades of PEM (grade I and grade II) were taken as a control group.</p> <p>Results: In severe PEM, marasmus (83%) was more common followed by kwashiorkor (14%) and marasmic kwashiorkor (3%); however in mild grades of PEM, grade I PEM was found in 58% and grade II PEM was found in 42%. In severe PEM, pallor (64%), hair changes (38%), and tachypnoea(31%) were major clinical signs; while tachypnoea(36%), dehydration (26%), and pallor (20%} were major clinical signs in patients with mild grades of PEM.</p> <p>Conclusion: A positive fecal occult blood test (FOBT) is strongly associated with moderate to severe anemia in severe PEM patients. So all patients having a positive FOBT should have a hemogram profile done and then appropriately treated for anemia.</p> Dr. Triya Malde Dr. Gaurang Pabani Dr. Mohmmad Shahid M Mirza Dr. Om Prakash Shukla Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 420 424 10.17511/ijpr.2020.i08.05 The value of urinary uric acid and creatinine ratio in neonatal asphyxia https://pediatrics.medresearch.in/index.php/ijpr/article/view/641 <p>Objective: The value of urinary uric acid and creatinine ratio in neonatal asphyxia.</p> <p>Method: This was a prospective observational study conducted over one year, on 45 newborns admitted in NICU with perinatal asphyxia. Cord blood from the umbilical artery was sent for pH analysis and urinary uric acid and creatinine levels were estimated in spot urine samples.</p> <p>Results: The urinary uric acid and creatinine ratio had a positive correlation with low APGAR scores at the 1st and 5th minute. Also, urinary uric acid to creatinine ratios was significantly higher in infants with severe HIE (3.180.61) when compared with infants of moderate HIE (2.190.32). It showed a significant negative correlation with pH of cord blood in neonates with perinatal asphyxia.</p> <p>Conclusion: The urinary uric acid and creatinine ratio can be used as a supportive diagnostic test for early diagnosis of perinatal asphyxia.</p> Dr. Nikhil Gupta Dr. Alka Bhambri Dr. Vedika A Bhat Dr. Rashmi Katyal Dr. Shikha Saxena Dr. Shashank Mishra Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 425 429 10.17511/ijpr.2020.i08.06 Mid-upper arm circumference cut-off for detection of severe acute malnutrition in infants aged between one and six months https://pediatrics.medresearch.in/index.php/ijpr/article/view/643 <p>Objective: To find the MUAC cut-off for detection of severe acute malnutrition in infants between 1 to 6 months of age.</p> <p>Material and Methods: A prospective observational study at IPD and OPD of a tertiary care hospital. 303 infants between one and six months of age above the length of 45cms were included in the study. In infants between one and six months of age, the length, weight, and MUAC were measured. SAM infants were identified using the WHO definition. Sensitivity, specificity, and Youden index for a particular MUAC was calculated in SAM infants.</p> <p>Results: 11cms was found to have a sensitivity of 85.1% and specificity of 65.9%. It had the maximum Youden index of 0.55 with a positive likelihood ratio of 2.79 and a negative likelihood ratio of 0.21.</p> <p>Conclusions: MUAC of 11cms can be used as a cut-off for SAM infants between 1 to 6 months of age. MUAC does not vary with gender. Weight and MUAC are significantly lower in SAM infants. But there is no difference when it comes to length as in acute malnutrition, the weight and MUAC are affected but length is not.</p> Dr. Jyothi S.D. Dr. Spoorthi L. Bendre Dr. Arunkumar S. Desai Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 430 436 10.17511/ijpr.2020.i08.07 A novel RET gene mutation in a neonate with total colonic aganglionosis and renal agenesis: a case report https://pediatrics.medresearch.in/index.php/ijpr/article/view/635 <p>Hirschsprung’s disease (HSCR) is functional lower intestinal obstruction, due to the congenital absence of the intramural plexuses of ganglion cells in the distal bowel. Total colonic aganglionosis (TCA) is a rare and severe form of HSCR and accounts for 5-10% of all the diagnosed cases of HSCR. TCA is a diagnostic and therapeutic challenge as clinical and radiological findings are not pathognomonic. The RET gene signaling system is generally acknowledged as being the most important in TCA pathogenesis, with RET gene variations being present in 70% of cases. The present study is reporting a case of TCA and right renal agenesis with a novel mutation in the RET gene.</p> Dr. Ravi Teja Goud M Dr. K. Lalatendu Kumar Dr. S. Nasreen Banu Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 437 441 10.17511/ijpr.2020.i08.08 A Forkhead box G1 (FOXG1) gene mutation in an Indian patient with a congenital variant of Rett syndrome. https://pediatrics.medresearch.in/index.php/ijpr/article/view/647 <p>A congenital variant of rett syndrome or Forkhead box G1 (FOXG1) syndrome is a rare neurodevelopmental disorder characterized by global developmental delay, microcephaly, autistic features, early-onset dyskinesia, and seizures. Once it was described as one atypical variant of rett syndrome but now considered as a separate entity. The current study found one girl carrying the de novo c.500-501incG frameshift mutation in the FOXG1 gene by genetic analysis during the evaluation for severe chronic encephalopathy. In literature, only one case was reported from India with FOXG1 mutation. The FOXG1 mutation should be considered in children with a history of global developmental delay, dyskinesia, and microcephaly with characteristic brain neuroimaging findings.</p> Dr. Sai Chandar Dudipala Dr. Naveen Reddy Cheruku Dr. Krishna Chaithanya Battu Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 442 445 10.17511/ijpr.2020.i08.09 Mild cases of Covid-19 in children. is it really true or a mirage? https://pediatrics.medresearch.in/index.php/ijpr/article/view/644 <p>To date, very few data on pediatric COVID 19 cases have been published, and most reports originate from China. There is an urgent need to understand why the course of the coronavirus that started in late 2019 is affecting different groups of individuals with varying severity during the ongoing global pandemic. Globally, the greatest burden of most infectious diseases, especially infections of the respiratory system are borne by children, hence the low burden of COVID 19 in children has been viewed by many as surprising. This article will provide insights regarding the role of constitutional higher trained immunity in children, physiological advantages of children, higher insulin secretion, higher ACE2 levels, better antioxidant potential, and absence of high-risk factors in protecting children against severe COVID 19 infections.</p> Abhishek Mandal Dr. Santosh Kondekar Rishi Bothara Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 446 451 10.17511/ijpr.2020.i08.10 Evaluation of integrated teaching among undergraduate medical students: A step towards competency-based medical education. https://pediatrics.medresearch.in/index.php/ijpr/article/view/648 <p>Background: Didactic lectures are one of the most widely used teaching methods in Indian Medical Colleges.</p> <p>Aim &amp; Objective: To evaluate integrated teaching in medical education assessing existing knowledge of medical students' inappropriate breastfeeding practices.</p> <p>Methodology: This was an observational cross-sectional study. Participants were second phase medical students.</p> <p>Results: A total of 63 students were assessed for the topic with pretest and post-test.</p> <p>Conclusion: Statistically significant absolute learning gain was observed for integrated teaching. Integrated teaching has been appreciated and accepted by undergraduate medical students to improve their learning.</p> Dr. Rajesh Gupta Dr. Sameer Sathe Dr. Mukesh Pandey Dr. Abhishek Mehta Copyright (c) 2021 Author (s). Published by Siddharth Health Research and Social Welfare Society https://creativecommons.org/licenses/by/4.0 2020-12-31 2020-12-31 7 8 452 455 10.17511/ijpr.2020.i08.11