Showing papers in "Indian Journal of Pediatrics in 2006"

Influence of infant-feeding practices on nutritional status of under-five children.

Abstract: Objectives: To study the nutritional status of under-five children and to assess whether infant feeding practices are associated with the undernutrition in anganwari (AW) areas of urban Allahabad.Methods: Under-five-years children and their mothers in selected four anganwari areas of urban Allahbad (UP) participated in the study. Nutritional assessment by WHO criterion (SD- classification) using summary indices of nutritional status: weight-for-age, height-for-age and weight-for-height was done. Normal test of proportions, Chi-square test for testing association of nutritional status with different characteristics and risk analysis using odds ratios with 95% confidence intervals was also done.Results: Among all under five children surveyed, 36.4% underweight ( 0.10) with any infant feeding practice studied. ICDS benefits received by children failed to improve the nutritional status of children.Conclusion: Delayed initiation of breast-feeding, deprivation from colostrum, and improper weaning are significant risk factors for undernutrition among under-fives. There is need for promotion and protection of optimal infant feeding practices for improving nutritional status of children.

Clinical features, complications and atypical manifestations of children with severe forms of dengue hemorrhagic fever in South India.

Abstract: The objective was to review clinical features and outcome of children with severe forms of dengue hemorrhagic fever (DHF) presenting to a pediatric intensive care unit (PICU) with particular focus on clinical presentation and outcome. Retrospective chart review of patients admitted to the Pediatric Intensive Care Unit (PICU) of a referral childrens hospital in South India with DHF over 1.5 years (2001-January 2003). Of 858 patients with dengue fever/DHF admitted to the hospital during the study period 109 cases with severe forms of disease required PICU admission of which 9 patients died. 77 were under 5 years of age. The commonest indication for PICU admission was persistent shock (39 patients) followed by requirement for positive pressure ventilation in 29 patients (10 of whom had Acute Respiratory Distress Syndrome [ARDS]) and neurological symptoms in 24 patients. An important finding was the presence of diastolic dysfunction in 3 children. Six deaths of refractory shock included 4 who had ARDS and DIC and 2 who had shock with DIC 3 patients had abdominal compartment syndrome (ACS) has not been previously described in children with DSS and may lead to fluid refractory shock if not corrected. All patients had thrombocytopenia which was a defining feature of the syndrome while 74 were also coagulopathic and 6 had severe fatal DIC. Hepatic dysfunction was more severe in children with prolonged shock however only a fifth of cases (5/24) with neurological manifestations were in shock. Other significant reasons for neurological presentation included cerebral edema and encephalopathy secondary to hepatic dysfunction. 2 children had features of Acute Disseminated Encephalomyelitis (ADEM) previously only described in adults with dengue. It was found that complications such as DIC diastolic dysfunction abdominal compartment syndrome ARDS and hepatic dysfunction were more frequent in severe established shock. However most neurological events were unrelated to the perfusion status. Children referred late were harder to resuscitate. There were 9 PICU deaths (case fatality rate of 8.35%). Severe refractory shock DIC ARDS hepatic failure and neurological manifestations singly or in combination were the commonest causes of death in the present study. (authors)

Lifestyle associated risk factors in adolescents.

Abstract: The data on these risk factors in school age population is deficient in India. The present study was conducted to evaluate the prevalence of lifestyle associated risk factors for non-communicable diseases in apparently healthy school children in an urban school in Delhi using standard criteria. The study was carried out among 510 students of classes 9th–12th of a school in New Delhi and in the age group of 12 to 18 years. The students were surveyed through an age appropriate modified GSHS (Global School Based Student Health Survey) self administered questionnaire. Height and Weight were measured using standardized equipment and procedure. The blood pressure was measured using OMRON electronic B.P apparatus which were standardized daily against a mercury sphygmomanometer. The statistical analysis was done using Epinfo ver. 3.3 and SPSS ver11.5. The study documents the inappropriate dietary practices (fast food consumption, low fruit consumption), low physical activity, higher level of experimentation with alcohol and to a lesser extent smoking, high prevalence of obesity and hypertension in the school children. The study also showed an association between BMI, systolic and diastolic blood pressures amongst children and other lifestyle factors. School based interventions are required to reduce the morbidity associated with non-communicable diseases.

Acute Renal Failure in Neonatal Sepsis

Abstract: To evaluate the occurrence of acute renalfailure (ARF) and the factors associated with it in cases of neonatal sepsis. The case control study was conducted in the referral neonatal intensive care unit of a tertiary teaching hospital. 200 out born neonates with sepsis admitted to the nursery from January to July 2003 were evaluated for presence of ARF (cases) or not (controls). Sepsis was diagnosed on the basis of either a positive sepsis screen (immature: total (I:T) neutrophil ratio >0.2, μ-ESR> age in days + 2mm or>15 mm, CRP>6mg/dl, TLC 20mg/dl on two separate occasions at least 24 hours apart. Oliguria was defined as urine output <1ml/Kg/hr. 52 out of 200 (26%) neonates with sepsis had ARF; only 15% of ARF was oliguric. The mean gestation of neonates with ARF was similar to those without ARF (36.1±4.1 wks vs. 36.6±3.5 wk; p=0.41). A significantly higher number of babies with ARF weighed less than 2500 gm as compared to those without ARF (86.5%vs 67.6%; p=0.008). The association of meningitis, disseminated intravascular coagulation (DIC) and shock was also significantly higher in neonates with ARF (46.8%vs 26.2%, p=0.01; 65.4%vs 20.3%, p<0.001; 71.2%vs 27.0%, p<0.001 respectively). Mortality in neonates who developed ARF was significantly higher (70.2%vs 25%, p<0.001). Factors including gestational age, weight, onset of sepsis, culture positivity, associated meningitis, asphyxia, shock, prior administration of nephrotoxic drugs were subjected to univariate analysis for prediction of fatality in neonates with sepsis and ARF; only shock was found to be a significant predictor of fatality (p<0.001). ARF had recovered in 22 out of 49 neonates in whom data was available; three patients had left against medical advice. The mean duration of recovery in these 22 neonates was 5.5 days (range 1–14 days). Presence of co-existing morbidities (perinatal asphyxia/congestive heart failure (CHF)/necrotising enterocolitis (NEC) or nephrotoxic drugs did not alter the frequency of recovery of ARF in septic neonates (45.5%vs 44.4%, p=0.944; 41%vs 52%, p=0.308 respectively). Renal failure occurred in 26% neonates with sepsis. Although ARF in neonates has been reported to be predominantly oliguric, it was observed that ARF secondary to neonatal sepsis was predominantly non oliguric. Low birth weight was an important risk factor for the development of ARF. The mortality being three times higher in neonates with ARF demands a greater awareness of this entity among practitioners and better management of this condition.

Nutritional status of adolescents in rural Wardha.

Abstract: Objective| The objective of the study was to study the nutritional status of adolescents in rural area of Wardha.Methods: The cross-sectional study was carried out in two PHC areas of Wardha district with two stage sampling method. In the first stage, cluster-sampling method was used to identify 30-clusters in each Rural Health Training Centre (RHTC) area separately. In the second stage, systematic random sampling method was used to identify 10 households per cluster. All adolescents in the household thus selected were included in the study. The mean body mass index (BMI) for age was used for classifying the nutritional status with CDC 2000 reference. Data thus generated was entered and analyzed using epi_info 2000.Results: Overall, 53.8% of the adolescents were thin, 44% were normal and 2.2% were overweight. The mean body mass index (BMI) for boys and girls was 16.88 and 15.54 respectively. The difference was statistically significant (p<0.05). The prevalence of thinness was significantly (p<0.05) higher in early adolescence, girls, lower education (<8th standard) and lower economic status.Conclusion: Majority (53.8%) of the adolescents in this study area are thin and only 2.2% were overweight.

Suicidal behaviors in adolescents.

Abstract: Objective. Suicidal ideation and suicide attempt are generally considered as non-fatal suicidal behaviors (NFSB) by most researchers. Across different cultures, the prevalence of NFSB has been found to be alarmingly high among adolescents. As there is no published study estimating prevalence rates in India, we conducted a study on adolescents in Delhi to find prevalence of NFSB and other related behaviors and to identify risk factors for NFSB.Methods: We collected data from 1205 adolescents in the age group from 12 to 19 years from 2 schools through semi-structured questionnaire on demographic variables, NFSB, death wish, deliberate self harm (DSH), Adjustment Inventory for School Students (AISS) by Sinha et al. & BDI.Results: Prevalence of suicidal ideation (lifetime), suicidal ideation (last year), suicide attempt (lifetime), suicide attempt (last year) were 21.7%, 11.7%, 8% and 3.5%, respectively. All the significant variables were entered into a logistic regression analysis model, and the adjusted odds ratios, with 95% confidence intervals, were obtained for them. Hindu religion, female sex, older adolescent, physical abuse by parents, feeling neglected by parents, history of running away from school, history of suicide by a friend, death wish and DSH were found to be significant risk factors for NFSB.Conclusions: There is high prevalence of suicidal ideation, suicide attempt, death wish and deliberate self-harm in adolescent population of two schools in Delhi. Clinical implications of these findings are discussed.

Psychosocial burden in thalassemia.

Abstract: To study the psychosocial life aspects of Indian adolescents suffering from transfusion dependent β-thalassemia major. Earlier studies done in Italy, Greece and United Kingdom reported the presence of psychosocial burden associated with the disease. We aimed to determine the presence of disease burden in the psychosocial life aspects of Indian adolescents affected with thalassemia. Structured interviews were carried out with each of the subjects using a schedule which contained questions relating to perceived burden of thalassemia in the various psychosocial life aspects of affected adolescents. Adverse impact of thalassemia was perceived in the domains of education (70%) and sports (72%). Most thalassemics were not satisfied with their body image. Almost all the study subjects felt that the disease did not affect their family or social relationships. The adolescents were anxious about their future health and education. Majority of the subjects (80%) did not discuss about their disease and its related problems with their friends. They mainly depended on their parents for monetary and emotional support. There is tremendous psychosocial disease burden perceived by the affected adolescents, and hence it is imperative to ameliorate it by promoting a clear understanding of the disease and initiating intervention programs.

Hemoglobin level as a risk factor for lower respiratory tract infections.

Abstract: This prospective study was conducted to evaluate the role of hemoglobin level, as a risk factor for Lower Respiratory Tract Infections in children (LRTI). 100 children who came to the outpatient department for LRTI were included in the study. Age and sex-matched 100 children, not having any respiratory illness, were taken as control. They were subjected to complete blood count (CBC) C-reactive protein estimation (CRP), Mantoux test, and X-ray chest. Peripheral smear, serum ferritin and serum iron binding capacity were done for all anemic children. Radiological evidence of pneumonia was present in 63 children (63%). Hyper inflated lungs were seen in 27 (27%). Mantoux was positive in 22 children (22%) of study group and none among control group. CRP>6mg/L was noted in 45 children (45%) of study group and 14 (14%) of control group. Seventy four of study group (74%) and 33 of control group (33%) had anemia. Of the anemic children, 60 (60%) had iron deficiency, 10 (10%) chronic inflammation and 4 (4%) had hemolytic anemia. These values were 30(30%), 2(2%) and 1(1%) respectively for control group. Low hemoglobin level due to whatever etiology, was a risk factor (p=0.000). Anemic children were 5.75 times more susceptible to LRTI compared to the control group. Prevention of anemia, due to whatever etiology, will reduce the incidence of LRTI.

Maternal antenatal profile and immediate neonatal outcome in VLBW and ELBW babies.

Abstract: Objective To evaluate the antenatal profile of the mother and the immediate neonatal morbidity and mortality till discharge.

Effect of counseling on nutritional status during pregnancy

Abstract: Objective To assess the nutritional status and dietary practices among underprivileged pregnant women, identify the lacune, outline implement and assess the effect of nutritional counseling on their dietary intake, anthropometric status and anemia status.

Liver involvement in celiac disease

Abstract: Celiac disease may present as a cryptogenic liver disorder being found in 5-10 % of patients with a persistent and cryptogenetic elevation of serum aminotransferase activity. In fact, a wide spectrum of liver injuries in children and adults may be related to CD and in particular: (1) a mild parenchymal damage characterised by absence of any clinical sign or symptom suggesting a chronic liver disease and by non-specific histological changes reversible on a gluten-free diet; (2) a chronic inflammatory liver injury of autoimmune mechanism, including autoimmune hepatitis, primary sclerosing cholangitis and primary biliary cirrhosis, that may lead to fibrosis and cirrhosis, generally unaffected by gluten withdrawal and necessitating an immunosuppressive treatment; (3) a severe liver failure potentially treatable by a gluten-free diet. Such different types of liver injuries may represent a spectrum of a same disorder where individual factors, such as genetic predisposition, precocity and duration of exposure to gluten may influence the reversibility of liver damage. A rigorous cross-checking for a asymptomatic liver damage in CD individuals and conversely, for CD in any cryptogenic liver disorder including end-stage liver failure is recommended.

Reproductive health problems and help seeking behavior among adolescents in urban India.

Abstract: Objective To assess their reproductive health problems and help seeking behaviour among urban school going adolescents.

Neonatal Morbidity and Placental Pathology

Abstract: Objective: To investigate the association between gestational age, placental pathology and outcome among preterm births.Methods: Medical records and placental pathology results of 165 preterm infants (gestational age ≤34 weeks) were used to analyze the development of intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) and sepsis, in association with placental findings in the gestational age categories of 22–27 (n=71) and 28–33 (n=93) weeks.Results: Significant differences were found in placental findings based on gestational age and neonatal morbidity. Lower gestational age was associated with increased infection-related lesions such as chorionic vasculitis (47.9%, P<0.001) and acute chorioamnionitis (67.6%, P<0.001). Placental lesions reflecting disturbances of fetal-placental blood flow (infarction, chorionic plate thrombi and basal perivillous fibrin) were predominantly seen in the 28–33 week gestational age category (P<0.05–0.01). Despite the high prevalence of chorioamnionitis (38.8%), no significant association was found between this lesion and the tested preterm morbidity after controlling for gestational age. Only, villous edema and chorionic vasculitis were identified as independent predictors for the development of IVH (49.2%, ORA 2.57, 95% CI 1.01, 6.58 and 39.3%, ORA 1.95, 95% CI 1.01, 4.21, respectively).Conclusion: Villous edema and chorionic vasculitis are significant risk factors for the development of the IVH among neonates born at gestational age ≤34 weeks.

Hypoxemia in children with pneumonia and its clinical predictors.

Abstract: To assess the prevalence of hypoxemia in children, 2 months to 5 years of age, with pneumonia and to identify its clinical predictors. Children between 2–60 months of age presenting with a complaint of cough or difficulty breathing were assessed. Hypoxemia was defined as an arterial oxygen saturation of <90% recorded by a portable pulse oximeter. Patients were categorized into groups: cough and cold, pneumonia, severe pneumonia and very severe pneumonia. The prevalence of hypoxemia (SpO2 of <90%) in 150 children with pneumonia was 38.7%. Of them 100% of very severe pneumonia, 80% of severe and 17% of pneumonia patients were hypoxic. Number of infants with respiratory illness (p value=0.03) and hypoxemia (Odds ratio=2.21, 95% Cl 1.03, 4.76) was significantly higher. Clinical predictors significantly associated with hypoxemia on univariate analysis were lethargy, grunting, nasal flaring, cyanosis, and complaint of inability to breastfeed/drink. Chest indrawing with 68.9% sensitivity and 82.6% specificity was the best predictor of hypoxemia. The prevalence and clinical predictors of hypoxemia identified validate the WHO classification of pneumonia based on severity. Age <1 year in children with ARI is an important risk factor for hypoxemia.

Complementary foods associated diarrhea

Abstract: The World Health Organization regards illness due to contaminated food as one of the most widespread health problems in the contemporary world. Food safety especially in the weaning groups is one of the major concerns that have posed a threat to health of the children. Millions of children in the world die each year from diarrheal diseases; hundreds of millions suffer from frequent episodes of diarrhea and consequent impairment of nutritional status. Contaminated foods play a major role in the occurrence of diarrheal diseases. Apart from food contamination, transmission of infection occurs by direct contact, highly favored by the habits and customs of the people. Improper storage and handling of cooked food is equally responsible for food-borne illnesses, as during storage especially at ambient temperature (28-38 degrees C) there is the risks of multiplication of pathogenic organisms increase. Food safety education is a critical prerequisite and is an essential element in control and prevention of diarrheal diseases. However, no preventive measures can ever be successful without the acute involvement of the caretakers, other family members and the community. To sensitize the community in a catalytic manner, health workers, community leaders and community volunteers can act as effective change agent, to bring about a behavior that can lead to improvement in their real life practices, thereby reducing the prevalence of diarrheal episodes in young children. Food Safety Education Programs that involve volunteers are cost effective as they can be reached to a maximum number of people through limited health personnels, and by this, the community can be made responsible for its own health problems.

Grandmothers' influence on child care.

Abstract: Objective: This paper compares child care-giving and child's nutritional status among rural families where grandmothers were present and those where grandmothers were absent. Methods: From 27 villages in rural Vadodara, four were randomly selected and all the families (n=31) with children (3–24 months) where grandmothers were present (GMP) were compared with 39 families where grandmothers were absent (GMA). Semi structured questionnaires were used to assess beliefs-practices of mothers and grandmothers regarding breastfeeding and complementary feeding (BF-CF). Nutrient intake of the children and nutritional status were measured using standard procedures.Results: Some deleterious practices were present in a similar proportion of both GMP and GMA groups: giving prelacteals, delaying initiation of BF, exclusive breastfeeding <3 months and delaying initiation of CF. Favorable practices present in significantly more GMP were: active feeding and use of anganwadi services. Grandmother’s help enabled mother to practice more care-giving behaviors. However, children in both the groups had low calorie intake (<40% RDA) and a high prevalence of under nutrition: 56–64% (Weight-for-Age z score <−2).Conclusion: Role of family members in childcare and the benefits of including them in interventions to improve child survival, health and nutrition status need to be further researched.

Parasitic etiology of childhood diarrhea.

Abstract: The objective was to determine the prevalence of parasitic agents among under-five children with diarrhea in Ilesa, Nigeria and the clinical correlates of diarrhea associated with parasitic infestation. All under-five children presenting with diarrhea in the hospital had stool microscopic examination. Children with parasites in diarrheic stools (cases) were compared with those without (controls) for clinical features. Out of 300 under-five children with diarrhea, 70 (23.3%) had parasites. There were 18 (6%) helminthes and 52 (17.3%) protozoas. These included the ova ofAscaris lumbricoides (13; 18.6%), cysts and trophozoites ofEntamoeba. histolytica (46; 65.7%), cysts ofEntamoeba coli (1; 1.4%),Giardia Lamblia (5; 7.1%),Necator american us (1; 1.4%) andTrichuris trichiuria (4; 5.7%). As against the controls, the cases were older (t=4.88; p=0:0000017), more undernourished (OR=2.04; 95% Cl=1.14 to 3.63; p=0.009) and belonged to the lower socio-economic classes (OR=7.15; 95% Cl=3.83 to 13.43; p=0.0000). It is concluded that parasitic infestations are commonly associated with childhood diarrhoea in Nigeria. Malnutrition and low socio-conomic status are risk factors.

Congenital CMV infection in symptomatic infants in Delhi and surrounding areas.

Abstract: Many viral infections are associated with significant maternal and fetal consequences during pregnancy among which cytomegalovirus is one of the most important agent, globally. Both primary and recurrent infection due to this virus can result in fetal infection. Samples from Congenital Anoammaled babies are referred to NICD from Delhi based Government hospitals and surrounding areas for diagnosis of congenital infections like Toxoplasm, Rubella, CMV and Herpes. In the present study, accumulated data is presented for the most common teratogenic virus—Cytomegalovirus prevalence as a causative agent for congenital infection in New Born babies at Delhi and surrounding areas. 96 samples from symptomatic babies in the age group of few days to 6 months exhibiting different congenital anomalies, were reported between 1 st Jan 04 to 30 th April/05. All the blood samples were tested for the detection of CMV (IgM) antibodies using μ-capture ELISA technique. 18(18.75%) samples from babies showed positive titres for CMV-IgM antibodies. None of the mothers of positive babies were found positive for CMV-IgM antibodies but all were serologically exposed to CMV virus previously as their serum samples were positive for CMV-IgG antibodies indicating primary infection in the past or reactivation/reinfection with a different strain of CMV in the early pregnancy.

Liver abscess in children.

Abstract: Liver abscesses are frequently observed in pediatric clinical practice in tropics and subtropics especially in developing countries. Children have unique set of predisposing factors which have been highlighted. Expected microbiology and setting for unusual organisms are mentioned. Clinical presentations’, including importance of location and number of abscesses has been discussed. Role of each modality of treatment clarified. Importance and limitations of investigations and imaging explained, and complications and mortality discussed.

Retroperitoneal teratomas in children.

Abstract: Objective: This paper aims to highlight the clinical features, investigations and treatment of retroperitoneal teratomas conditionMethods: 12 patients (8 females and 4 males, age range-2 months to 14 yrs) of retroperitoneal teratoma admitted to the department of Pediatric Surgery, King George Medical University, Lucknow between 1980 and 2004 were studied Investigations included hematology, plain X-ray of the abdomen, intravenous urography, ultrasound, computerised tomography (CT) of the abdomen (after 1990, 8 patients), and serum alpha-fetoprotein assay (after 1991, 6 patients, preoperatively) All patients underwent surgery Serum alpha-fetoprotein assay was used during follow-up to detect recurrenceResults: Majority of the tumors were left pararenal in location In two patients there was bilateral involvement In all except one, the tumor could be excised easily preserving the kidneys In one child with a massive cystic tumor with bilateral involvement, the tumor was marsupialised in the first stage and excised subsequently One child died postoperatively, the other 11 children are well and there has been no tumor recurrence on follow-upConclusions: Retroperitoneal teratomas are uncommon lesions in children mostly arising in close relation to the kidneys The majority are benign but complete excision is necessary for cure Even large tumors with bilateral involvement of the retroperitoneum can be excised while preserving adjacent organs Serum alphafetoprotein assay is a reliable method of detecting recurrence

Comparative study of intranasal midazolam and intravenous diazepam sedation for procedures and seizures.

Abstract: Objective To evaluate the safety and efficacy of intranasal midazolam for seizures and various procedures.

Transient evoked otoacoustic emissions

Abstract: Objective: The purpose of this study was to collect parametric measures of TEOAEs in normal hearing children of various age-groups and to establish a normative baseline for Transient Evoked Otoacoustic Emissions (TEOAEs).Methods: Sixty subjects were investigated in three age-groups: neonates, 0–1 month; infants, 1 month-1 year; and children, 1–6 years. Each group comprised of 20 subjects. All the subjects underwent medical examination by a pediatrician and an ENT surgeon. Screening for hearing was done by immittance testing, behavior observation and conditioned play audiometry. The TEOAEs were analyzed for the parameters of amplitude, cross-correlation (wave reproducibility) and signal-to-noise ratio (SNR).Results: There was no difference between the mean amplitudes of the right and left ears in the groups. The females in the neonates group had higher emission amplitudes than the males. The mean amplitude of the subjects in the neonates group was significantly higher than the subjects in the infants, or children groups. The cross correlation (wave reproducibility) was constant across the age. The mean SNR for all the subjects were well above 3 dB at frequencies 1.5 k, 2k, 3k and 4kHz. The neonates group showed the lowest SNR ranging between 3.47 to 9.62 dB. The infants group showed the highest SNR ranging between 6.13 to 13.11 dB.Conclusion: The TEOAEs response measures of SNR and cross correlation, at frequency bands 1.5, 2, 3 and 4 kHz, may provide more reliable outcomes than TEOAEs amplitude. Subjects in the age range of 0–1 month show lower SNRs than those in higher age ranges. The values can be used as normative data for screening and diagnostic purposes in the pediatric population.

Length of postnatal stay in healthy newborns and re-hospitalization following their early discharge.

Abstract: Objective The present study was conducted prospectively to determine i) the length of postnatal hospital stay of healthy newborns and determine the factors facilitating their early discharge (<48 h) and ii) the frequency and causes of re-hospitalization following early discharge, in a tertiary care hospital.

Iodine nutritional status of children in North East India.

Abstract: Objective To assess the iodine nutritional status of school children in selected areas of Imphal West District of Manipur where endemic goitre and associated iodine deficiency disorders (IDD) are prevalent in the post-salt iodization period.

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

Abstract: Objective: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels.Methods: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follw-up visit at 2–4 months of age.Results: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group.Conclusion: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Early onset conjugated hyperbilirubinemia in newborn infants

Abstract: Objectives: To determine the causes and related outcomes of early onset conjugated hyperbilirubinemia in a group of newborn infants, and to determine the incidence of sepsis in these neonates.Methods: The charts of 42 babies with conjugated hyperbilirubinemia were retrospectively reviewed.Results: The mean gestational age was 37 weeks, and the mean postnatal age at presentation was 10 days. Culture-proven sepsis was identified in 15 babies (35.7% of total). Gramnegative bacteria were isolated in 10 cases and E. coli was the most common of these agents (7 cases). Perinatal hypoxiaischemia was the second most frequent etiology (7 patients; 16.7% of total). The other diagnoses were blood group incompatibility (n=5), Down syndrome (n=3), cholestasis associated with parenteral nutrition (n=3), neonatal hepatitis (n=2), metabolic liver disease (n=1), biliary atresia (n=1), portal venous thrombosis (n=1), and unknown (n=4). Thirteen babies with sepsis recovered completely with treatment, whereas the prognosis for those with perinatal hypoxia-ischemia was grave (six of seven died).Conclusions: The findings suggest that early onset cholestatic jaundice in newborn infants is more commonly from non-hepatic causes, so it is reasonable to monitor these infants carefully for a period of time before undertaking time-consuming or invasive investigations towards a primary liver disease.

Maternal genital bacteria and surface colonization in early neonatal sepsis

Abstract: Objective: The study was intended to evaluate the role of maternal genital bacteria and baby's surface colonization in early onset neonatal sepsis.Methods: Babies (born in the hospital of Jawaharlal Institute of Postgraduate Medical Education and Research) who developed clinical signs of sepsis were studied. Swabs were collected for culture from baby's umbilicus, ear, throat in addition to gastric aspirate and blood culture. The genital tract of the mother was also studied for bacterial colonization. The organisms isolated from the maternal genital tract and baby's surface colonization were correlated with those isolated from blood culture by calculating Phi correlation coefficient.Results:Esch coli was the most common organism isolated from maternal genital tract and surface cultures of babies, but Klebseilla-Spp was the most common organism isolated from blood. There was a significant correlation between surface colonization of babies and matermal genital bacteria, so also was baby's surface culture and blood culture. However, correlation between maternal genital bacteria and baby's blood culture was not significant.Conclusion: Surface colonizing bacteria and not maternal genital bacteria are important in early onset neonatal sepsis.

Vincristine induced cranial polyneuropathy.

Abstract: We describe a 5-year-old girl showed recovery of vincristine induced cranial polyneuropathy with pyridoxine and pyridostigmine treatment. A 5-year-old girl was diagnosed preB cell Acute Lymphoblastic Leukemia (ALL). She received chemotherapy according to the previously described modified St. Jude total therapy studies XIII. Five days after the fourth dose of vincristine, she presented with bilateral ptosis. Neurological examination revealed bilateral ptosis, and complete external opthalmoplegia with normal pupillary and corneal reflexes. She received 3.8 mg cumulative dose of vincristin before development of ptosis. A neuroprotective and neuroregenerative treatment attempt with pyridoxine and pyridostigmine was initiated. The bilateral ptosis markedly improved after 7 days of pyridoxine and pyridostigmine treatment and completely resolved after two weeks. The both agents were given for 3 weeks and were well tolerated without any side effects. During the follow up period we did not observe residue or recurrence of the ptosis.

Current status of anti-diarrheal and anti-secretory drugs in the management of acute childhood diarrhea.

Abstract: Each year 1.8 million children die due to diarrheal diseases. Indiscriminate use of antibiotics has resulted in increasing resistance to commonly used antibiotics. Moreover the recent outbreaks of shigella and cholera have revealed multi-drug resistance strains. There is a need for review of recommended antibiotics for shigellosis. From recent data it emerges that fluoroquinolones should be the first line of therapy and cephalosporins to be used as the second line. Among the anti-cholera antibiotics, tetracyclines which were the drug of choice for adults, has the advantage of high sensitivity and low cost. Single dose doxycycline would have minimal side effects, hence can be the drug of choice even in children. We should not allow the business pressures to force usage of probiotics and racecadotril as their role in the management of acute diarrhea is yet to be established. Nitazoxanide has high efficacy against Cryptosporodial diarrhea only. Strict adherence to the recommendations for the management of acute childhood diarrhea is needed or else we dilute the effect of standard management.

Outcome of scorpion sting envenomation after a protocol guided therapy

Abstract: Objective Scorpion sting (SS) envenomation is a life threatening emergency in children, though not so severe in adults. Attempt to develop protocol using prazosin and dobutamine and few other drugs to treat SS.