Pediatric Review: International Journal of Pediatric Research <p><em><strong>ISSN: <a href="" target="_blank" rel="noopener">2349-3267 (Online)</a>, <a href="" target="_blank" rel="noopener">2349-5499 (Print)</a></strong></em></p> en-US (Dr Ram Gopal Verma, MOB: +91-9977225727 (Mon-Sat)) (Mr Mandeep Kapoor, Mob: 9977225727 (10 AM to 5 PM, Mon- Sat)) Fri, 28 Aug 2020 08:22:34 +0000 OJS 60 Maternal Risk factors, morbidity, and mortality pattern of LBW babies admitted in NICU: A Retrospective study done in Banas Medical College and Research Centre, Palanpur, Gujarat, India <p>Background: This study was undertaken to know about the maternal risk factors, morbidity, and mortality of low birth weight (LBW) babies admitted to NICU in a tertiary care hospital.</p> <p>Methods: This is a hospital-based, retrospective, descriptive study, done on LBW babies admitted to the NICU of Banas Medical College and Research Institute, Palanpur from January 2019- March 2020.</p> <p>Results: Out of the 1018 newborns admitted to NICU, 735 were LBW babies and 700 LBW babies were analyzed because 35 cases did not fit in inclusion criteria. The magnitude of LBW babies was 68.7 %.Out of 700 LBW babies, 530 (75.7%) had weight between 1.5kg to 2.49 kg,138 (19.7%) babies were of VLBW ( 1kg -1.5kg) and 32(4.57%) babies were of ELBW (weight &lt;1 kg).Out of 700 LBW babies, 450 (64.3%)were males and 250(35.7%) were females and 60 (8.57%) were term babies and 640 (91.42%)were preterm babies. Among the maternal risk factors most common was maternal undernutrition (30%), followed by maternal anemia in 180 cases (25.7%), inadequate ANC visits in 170 cases (24.2%), maternal age &lt;20 years in 110 cases (15.7%). Less common causes were bad obstetric history (1.14%), Twins delivery (1%), acute infections, and elderly primi (0.85%) respectively and the least common was PROM in 0.42%. Out of 700 babies, morbidity was seen in 590 LBW babies (84.28%).</p> <p>Conclusion: Identification of maternal risk factors and providing proper care and appropriate management to LBW can reduce neonatal morbidity and mortality</p> Dr. Neha Sharma, Dr. Ajit K. Shrivastava, Dr. Santosh K. Roy, Dr. Heenaben R. Desai, Dr. Anjum A. Hasan Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 28 Aug 2020 08:42:06 +0000 Assessment of prevalence of risk factors for non-communicable diseases in early adolescent age group using Global School Health Survey in Ujjain, Madhya Pradesh, India <p>Introduction: There has been a global rise in non-communicable diseases and a shift in trends from infectious to chronic lifestyle-related diseases, roots of which are behaviourally acquired and begin during adolescence. Adolescence constitutes a natural partner for their prevention.</p> <p>Objective: To determine the prevalence of risk factors for non-communicable diseases in the early adolescent age group using a global school-based health survey among students of Ujjain.</p> <p>Method: Cross-sectional study was done for 24 months from August 2017 to August 2019 in schools of Ujjain, Madhya Pradesh. Sampling was done using a cluster sampling technique. Students who participated were administered a questionnaire based on the GLOBAL SCHOOL HEALTH SURVEY. Appropriate statistical methods were used to find the odds ratio for the prevalence of the risk factors and differences among sex, residence (urban or rural), and type of school (government or private).</p> <p>Result: This study documents that among 400 students lack exercise, consumption of junk food =44.5%, high alcohol consumption 16.8 %, smoking cigarettes was found to be prevalent risk factors of NCDs. There was a statistically significant difference noted among types of school, residence, and sex.</p> <p>Conclusion: This is the first study done in this region and emphasizes individual health interventions along with the implementation of national health policies targeting the adolescent age group to lower the financial and health care burden of the region.</p> Dr. Priyanka Sharma, Dr. Jagdish Chandra Mandliya, Dr. Mamta Dhaneria, Dr. Vishal Diwan Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 28 Aug 2020 11:28:51 +0000 Clinical profile and outcome of suspect pediatric COVID-19 patients: Experience from a COVID hospital <p>Introduction: The Indian Council of Medical Research (ICMR) has given clinical criteria for suspecting COVID-19 in the Indian population and admissions to hospitals have been based on the above criteria. Aim - To study the clinical profile and outcomes of children suspected to have COVID-19 infection (based on ICMR criteria) admitted to a designated COVID hospital of North India.</p> <p>Methods: This was an observational study done in a COVID hospital of North India from April to June 2020. All children &lt;/= 18 years of age (including newborns), fulfilling the ICMR criteria and suspected to be COVID infected, from the screening area, were enrolled in the study. Demographic, clinical, laboratory, treatment details, and the final outcome were recorded on a pre-designed data collection proforma. Data was later entered into an MS-EXCEL 2013 spreadsheet and was analyzed using the Epi-info software version 7.2.2.</p> <p>Results: Of the 21 admissions (7 newborns and 14 children&gt;1 month of age) occurring in the COVID suspect ward during the study period, only 1 patient with a positive history of contact, was found to be COVID positive. The mean age of presentation was 10.27 years (Range 0.8-17; SD 7.83). Four children (4/14 = 28.5%) children were admitted on the basis of having symptoms of SARI (Severe Acute Respiratory infection). One patient took leave against medical advice (LAMA) after his RT-PCR report came negative.</p> <p>Conclusion: The majority of children admitted as per the testing criteria were found to be COVID negative.</p> Dr. Surabhi Chandra, Dr. Gunjan Kochar, Dr. Lahar Sahai, Dr. Rahul Jaiswal, Dr. Akansha Bajwa Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 28 Aug 2020 13:10:19 +0000 Study of serum vitamin d levels and its association with neonatal sepsis among newborns <p>Introduction: Vitamin D plays an important role in immune function. It plays an important role in the neonatal period in fetal skeletal growth, prevention of rickets, neonatal sepsis, respiratory tract infections, cardiovascular diseases, diabetes, and other endocrine disorders. It has been found that newborns' low level of cholecalciferol is closely related to neonatal sepsis.</p> <p>Aims and Objectives: To determine the neonatal plasma cholecalciferol levels and severity of vitamin D deficiency in neonatal sepsis.</p> <p>Material and Methods: This was a prospective, observational study conducted at Neonatal Care Intensive Unit of R. D. Gardi Medical College, Ujjain. The cases included all babies &gt;34 weeks of gestational age having postnatal age of 0-28 days with clinical signs and laboratory findings of neonatal sepsis. Statistical analysis was performed using STATA 10.0.</p> <p>Results: Total 70 newborns with sepsis were included in the study among which n=47 (67%) had deficient (less than 20ng/ml), n=16 (22.86%) had insufficient (between 20-30ng/ml) and n=7 (10.00%) of newborns had sufficient levels of cholecalciferol (more than 30ng/ml). The mean cholecalciferol levels among term were 18.53ng/ml (±4.8) and in preterm is 15.7ng/ml (±2.6) and this finding was statistically significant (p=0.04). The mean cholecalciferol in newborns with culture-positive sepsis was 14.8ng/ml (±6.04) and in culture-negative sepsis was 16.4ng/ml (±5.2) and this finding was statistically significant (p=0.02).</p> <p>Conclusions: More than 65% of newborns were deficient in 25-OH cholecalciferol and the mean 25-OH cholecalciferol levels were lower in preterm than in term newborns and lower in newborns with culture-positive sepsis than in newborns with culture-negative sepsis.</p> Dr. Vijay Kumar Gupta, Dr. (Mrs) Mamta Dhaneria Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 28 Aug 2020 14:49:06 +0000 Benefits of 100% human milk diet in preterm infants: NICU Nurses Survey <p>Background: Hundred percent human milk diet plays a vital part in the nutritional management of preterm infants in the Neonatal Intensive Care Unit (NICU). NICU nurses play an important role in the management of nutrition and growth of preterm infants, who will also oversee the implementation of an exclusive human milk diet (EHMD) in the NICU.</p> <p>Objective: To understand the NICU nurses' perspectives on the benefits of 100% human milk diet through human milk-derived nutritional products in preterm infants.</p> <p>Material and Methods: Online survey was conducted through Google Forms which had nine questions on the benefits of human milk-based nutrition finalized by expert neonatologists. An online survey link was shared with the NICU nurses through emails and text messages. A request was made to the neonatologists and head nurses to disseminate the survey link with their counterparts and colleagues.</p> <p>Results: All the participants rated that exclusive breastfeeding or using 100% Human Milk Diet is very important for preterm babies in NICU [n=152 (100%)]. 46.7% (n=71) participants reported that seventy calories pasteurized human breast milk, (PHBM – 70 Cal) is the best option for preterm infants when the mother’s own milk (MOM) is unavailable. 84.9% (n=129) of the participants stated that the Human milk-based fortifier (HMDF) – Mother’s Milk Fortifier (MMF) is the best option for fortification. 96% (n=146) participants were satisfied with the safety and tolerance of 100% human milk-based products like PHBM - 70 calories and MMF.</p> <p>Conclusion: The majority of the NICU nurses in India are aware of the benefits of human milk and 100% human milk diet in preterm infants. Human milk-derived nutritional products; HMDF (MMF) and 70 Calories are reported to be having good tolerance and safety in preterm infants by most of the NICU nurses. Having regular training sessions about EHMD for NICU nurses would be impactful.</p> Mohit Sahni, Prathap Chandra, Deepa Mohan Sharma, Ranjan Kumar Pejaver, Betty Thomas, Flavia Cardoza, Vikram Reddy K. Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 28 Aug 2020 17:25:10 +0000 To study renal parameters and serum calcium levels in birth asphyxia <p>Background: Birth asphyxia is a common neonatal problem and contributes significantly to neonatal mortality and long term morbidity. Any organ can be affected but the brain, heart, kidneys are more sensitive to hypoxic injury.</p> <p>Aim and Objective: To study renal parameters and serum calcium levels in birth asphyxia, to determine the incidence of renal failure in asphyxiated newborns, and to correlate the renal parameters with different severity of birth asphyxia and with different stages of hypoxic-ischemic encephalopathy.</p> <p>Method and material: A comparative study of 69 term newborns, appropriate for gestational age born/admitted to tertiary care Centre RDGMC Ujjain with birth asphyxia and 69 normal newborns without birth asphyxia was done. Perinatal history, physical examinations, New Ballard score, Apgar score was done. Data collected and entered in the master chart for results and analysis.</p> <p>Result: The study included 69 cases and 69 controls with the majority of boys. Mild, moderate, and severe birth asphyxia was7%, 29%, and 64% of all cases respectively. The incidence of acute renal failure was 57% among cases of birth asphyxia. The incidence of acute renal failure was 53% and 50% in hypoxic-ischemic encephalopathy stages III and II respectively. Incidence of renal failure with mild, moderate, and severe asphyxia was 40%, 50%, and 39% respectively</p> <p>Conclusion: Perinatal asphyxia is an important cause of neonatal renal failure. Monitoring of urea, creatinine and urine output helps in the early diagnosis and management of acute renal failure</p> Dr. Amit Patidar, Dr. Jagdish Chandra Mandliya, Dr. Pavan Sonker, Dr. Mamta Dhaneria Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Sat, 29 Aug 2020 12:20:22 +0000 Study of morbidity and mortality profile among low birth weight neonates in sick newborn care unit of a rural medical college and hospital. <p>Introduction: Low birth weight is one of the major health problems in children both in developed and developing countries. Birth asphyxia, neonatal sepsis, hypothermia, hypoglycemia, hyperbilirubinemia, hypocalcemia, MAS, NEC, polycythemia, IVH, meningitis, apnea, BPD, etc are the major risk factors for LBW babies morbidity and mortality. This study was conducted in a tertiary care center to find out morbidity and mortality profiles among low birth weight neonates and short-term neurodevelopmental outcome. A cross-sectional observational study. 404 low birth weight babies admitted from 1st June 2016 to 31st May 2017.</p> <p>Methods: Both clinical and laboratory data of all the patients were retrieved, compiled, and analyzed.</p> <p>Results: Out of 404 LBW 38 (9.4%) were ELBW,134 (33.2%) were VLBW and rest 232 (57.4%) were between 1500-&lt;2500gm weight, 88 (21.8%) were preterm and IUGR, 219 (54.2%) were male and rest 185 (45.8%) were female. Major cause of morbidity includes hypoglycemia (17.6%), RDS (13.1%), HIE (29.5%), NEC (5.7%), Sepsis (47.8%), hyperbilirubinemia (31.9%), PDA (2.5%), Apnea (5.9%), IVH (1.25%), congenital anomalies (5.9%) etc.</p> <p>Conclusion: In the present series the mortality rate was (23.5%) was high. Sepsis, RDS, Birth Asphyxia, and Apnea were the main causes of morbidity and mortality among low birth weight babies. Proper asepsis, judicious use of antibiotics, timely intervention like CPAP, etc reduce the mortality. Proper counseling while discharge regarding feeding, warmth care, asepsis, danger sign and need for follow up plays a pivotal role in the neurodevelopmental outcome.</p> Dr. Sudipta Bandyopadhyay, Dr. Abhay Charan Pal, Dr. Snehansu Chakraborti Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Sat, 29 Aug 2020 16:43:29 +0000 Assessment of parents’ understanding of pediatric medical prescriptions <p>Objective: To assess the accuracy of the parent understanding of pediatric prescription and prescribed medications and examine factors associated.</p> <p>Methods: Cross-sectional, observational questionnaire-based study involving 354 eligible parents was carried out in the pediatric department of a tertiary care teaching hospital. Parent's sociodemographic details and their understanding of prescription including medication name, indication, dose, frequency, and duration were assessed by a self-administered questionnaire and their association analyzed statistically.</p> <p>Results: Mean age of parents was 33 ± 1.2 with the majority of females 57.06%. Out of 354 parents, 22.32% had low literacy and 37.74% were working as farmers. Overall understanding of prescription was present in only 25.14% of parents. The majority of parents were having a better understanding of the frequency of drug administration (79.09), while poor understanding was observed with respect to dosage calculation of medication (45.76%) and adverse drug reactions (25.14%) and the difference in the understanding was statistically significant (P&lt;0.05). Factors like the age of parents, Child’s age, parent occupation, education of parent, experience in administering medicine, number of medicines prescribed, and type of dosage form were significantly impacting parent’s understanding regarding medication (P&lt;0.05).</p> <p>Conclusion: Unperceived medication instruction understanding gaps exist at all literacy levels for pediatric patients among all parents. Communication and care delivery practices need further evaluation.</p> <p>Practice implications: Clinicians should be aware of the frequency of parent medication misunderstanding and give more attention to parents’ counseling.</p> Dr Jatin Dhanani, Dr. Rameshkumar Dihora, Dr. Ashish Goti, Dr. Rima Shah Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Sun, 30 Aug 2020 07:19:07 +0000 A pattern of poisoning in children- an experience from a teaching hospital in southern India <p>Introduction: Poisoning in children is an important Paediatric emergency and is a worldwide problem. It is a common and preventable cause of morbidity and mortality in children.</p> <p>Objectives: The aim of this study was to determine the profile and outcome of children less than 13 years admitted to the Paediatric department presenting with acute poisoning at a Teaching district hospital in southern Karnataka.</p> <p>Methods: Prospectively, 134 acute poisoning cases, admitted to Paediatric intensive care, SIMS Shivamogga from November 2018 to May 2019 were included in this study.</p> <p>Results: During the study period, 134 patients presented with acute poisoning. The incidence of poisoning in Paediatric patients was 2.84%. The median age of our patients was 5.2 years (range 0.75-12 years). The male to female ratio was 1.58:1. Animal bites (27.61%), Petroleum products (26.87%), Household chemicals (15.67%), Drugs (11.19%), Poisonous plant derivatives (8.96%) and Insecticides (6.72%) were the agents most frequently implicated. Almost all (98.41%) cases in 1 to 5 years age group were accidental in nature, whereas in the &gt;10 years age group, the majority (71.43%) were suicidal. Thirteen patients (9.7%) remained asymptomatic. The specific antidote was given to 19 (14.18%) patients. Three patients (2 snake bite and 1 rodenticide child) died. The mean duration of hospital stay was 4.49 days (range was 1 day to 22 days).</p> <p>Conclusions: Accidental poisoning was common in children below 5 years of age. Minimal age of suicidal poisoning was 8 years. The most common agent implicated was a snake bite.</p> Dr. Vijayalakshmi P, Dr. Shreeshail V. Benakanal, Dr. Ravindra B. Patil, Dr. Manoj GM, Dr. R. Vikram S. Kumar Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Sun, 30 Aug 2020 00:00:00 +0000 Clinical profile and cerebrospinal fluid indices in children with complex febrile seizures <p>Introduction: Fever with seizure is the most common type of seizure occurring in children. A seizure is a common presentation for which a child may come to the emergency and may occur in up to 10% of children presenting to the emergency. Among all these seizures, Febrile seizures (FS) are the most common type of childhood seizures, affecting 2–5% of children older than 1 month and most commonly from 6 months–5 years old. The differential diagnosis of febrile seizure includes non-epileptic events or movements, provoked seizures following a central nervous system infection, and rare forms of genetic epilepsy in which seizures typically present with fever.</p> <p>Material and Methods: A hospital-based, prospective study conducted at the Department of Pediatrics, Government Medical College, and Hospital Aurangabad conducted from November 2018 to February 2020.</p> <p>Results: A total of 120 cases that presented with Complex Febrile Seizures (CFS) between six months to five years of age were included. Among them, 83 (69.1%) were male and 47 (30.9%) were female children. There were a total of 63 children in 6-12 months age, 32 in 12-24 months, and 25 in the above 12 months age group.</p> <p>Conclusion: In conclusion, it was found that age less than 1 year and male gender were the most significant risk factors for Complex Febrile Seizure in our area.</p> Dr. Amol Ramrao Suryavanshi, Dr. Sachin Bapurao Bodhgire, Dr. Rahul Digambarrao Anerao, Dr. Shilpa Pawar, Dr. Amit Tukaram Patil, Dr. Mugdha Paranjape Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Mon, 31 Aug 2020 00:00:00 +0000 Study of association of pancreatitis with enteric fever of age group 1 to 15 years <p>Introduction: Enteric fever is endemic in India. 1% of children up to 17 years of age suffer from Enteric fever. Enteric fever is a systemic disease characterized by fever and abdominal pain caused by the dissemination of Salmonella typhi or S. paratyphi. The term enteric fever includes both typhoid fever and paratyphoid fever. Many case reports of severe acute pancreatitis during salmonellosis have been reported, suggesting that serious pancreatic disease may represent a complication of Salmonella infection.</p> <p>Aim and objective: To find out the frequency of acute pancreatitis considering clinical features, biochemical changes (serum amylase and lipase), and ultra-sonographic evidence of pancreatic involvement in the pediatric population by estimating serum amylase and lipase level in the pediatric population who were admitted with the diagnosis of Enteric fever.</p> <p>Material and Method: The present prospective study was conducted in the S V P PG Institute of pediatrics and SCB Medical College, Cuttack, Odisha, India which is a premier referral institute of eastern India.</p> <p>Result: Overall the proportion of patients with raised levels of serum amylase and lipase in the Enteric fever group was 44.68% (n=21). Comparing these values with the control group shows that the rise in serum amylase and serum lipase levels were statistically more significant (‘p’ value &lt;0.05).</p> <p>Conclusion: Hence, salmonella may be considered as a causative agent of subclinical pancreatitis with biochemical and radiological changes.</p> Dr. Dillip Kumar Das, Dr. Suprabha Shukla, Dr. Mangal Charan Murmu Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Mon, 31 Aug 2020 00:00:00 +0000 Cranial ultrasound in high-risk neonates and their neurodevelopmental outcome <p>Introduction: With the advancement in neonatal care over the last two decades, neonatal mortality is decreased but simultaneously there is an increase in the adverse outcomes including neurodevelopmental abnormalities in the high-risk neonates.</p> <p>Purpose: To evaluate the association between cranial ultrasound findings and the clinical neurodevelopmental outcome among high-risk neonates at 12 months (corrected gestational age in preterm infants) and to assess the various perinatal risk factors associated with neurodevelopmental outcome.</p> <p>Material and Methods: 123 high-risk neonates admitted in NICU were enrolled. Cranial ultrasound was performed and morphology was noted. The neurodevelopmental assessment was done using DDST Test II at 12 months age and these neonates were labeled as normal or abnormal based on the findings. Association between the two non-parametric variables was seen using the Pearson Chi-square test.</p> <p>Results: There was a statistically significant association between clinical neurodevelopmental outcome and gestational age at birth; birth weight; Apgar score &lt;5 at 5 minutes; neonatal seizures; and abnormal cranial ultrasound findings (p&lt;0.05), while the association with all other studied parameters were found to be statistically not significant (p&gt;0.05). The sensitivity of CUS was 89.2%, specificity 47.3%, positive predictive value 89.2%, and negative predictive value 47.3%.</p> <p>Conclusions: The neurodevelopmental outcome in high-risk neonates was associated with gestational age at birth; birth weight; Apgar score at 5 minutes; neonatal seizures and abnormal cranial ultrasound findings. The current study recommend the use of cranial ultrasound for the prediction of neurodevelopmental abnormalities especially in neonates with above risk factors.</p> Dr. Ruby Singh, Dr. Chandan Shaw, Dr. Shachi Jain Taran, Dr. Veerendra Mehar, Dr. Aman Gupta Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Mon, 31 Aug 2020 00:00:00 +0000 Congenital unilateral absence of facial nerve with hypoplastic abducens nerve: A case report of rare Moebius syndrome <p>Moebius syndrome is a rare congenital neurological disorder characterized by bilateral facial and abducens nerve paralysis. The syndrome may also include involvement of the other cranial nerves and various other congenital deformities and malformations. A one-month-old male infant presented with facial asymmetry, inability to close eye, and drooling of saliva from one side of the mouth, diagnosed to have Moebius syndrome. Early diagnosis of the cases by experienced clinicians and a supportive multidisciplinary approach can help children with Moebius syndrome and prevent associated complications.</p> Dr. Ankur Dharmani, Dr. Sonia Kashyap, Dr. Swati Thakur, Dr. Sandesh Guleria Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Mon, 31 Aug 2020 00:00:00 +0000 Compressive myelopathy presenting with paraparesis in pediatric age <p>Compressive myelopathy is a common presentation of the adult age group secondary to degenerating etiologies. Trauma is a rare cause of compressive myelopathy, especially in the pediatric age group as the pediatric spine is more elastic than that of adults, especially below 8 years of age. Boys are more commonly injured as compared to girls. The present study reports a case of a six-year-old female patient of compressive myelopathy presenting with jerks with progressive paraparesis. MRI shows posterior subluxation of dens (C2) attached to C2 vertebral effacing anterior – subarachnoid space and indenting spinal cord.</p> Dr. V. A. Kotrashetti, Dr. Vijay Baburao Sonawane, Dr. Shweta Ravindran Nair, Dr. Kapil Bainade, Dr. Amit Vatkar, Dr. Samarth Gupta Copyright (c) 2020 Author (s). Published by Siddharth Health Research and Social Welfare Society Fri, 04 Sep 2020 10:30:44 +0000