Showing papers in "Indian Journal of Pediatrics in 2013"

Childhood obesity and the metabolic syndrome in developing countries.

Abstract: Rapidly changing dietary practices accompanied by an increasingly sedentary lifestyle predispose to nutrition-related non-communicable diseases, including childhood obesity. Over the last 5 y, reports from several developing countries indicate prevalence rates of obesity (inclusive of overweight) >15 % in children and adolescents aged 5–19 y; Mexico 41.8 %, Brazil 22.1 %, India 22.0 % and Argentina 19.3 %. Moreover, secular trends also indicate an alarming increase in obesity in developing countries; in Brazil from 4.1 % to 13.9 % between 1974 and 1997; in China from 6.4 % to 7.7 % between 1991 and 1997; and in India from 4.9 % to 6.6 % between 2003-04 to 2005–06. Other contributory factors to childhood obesity include: high socio-economic status, residence in metropolitan cities and female gender. Childhood obesity tracks into adulthood, thus increasing the risk for conditions like the metabolic syndrome, type 2 diabetes mellitus (T2DM), polycystic ovarian syndrome, hypertension, dyslipidemia and coronary artery disease later in life. Interestingly, prevalence of the metabolic syndrome was 35.2 % among overweight Chinese adolescents. Presence of central obesity (high waist-to-hip circumference ratio) along with hypertriglyceridemia and family history of T2DM increase the odds of T2DM by 112.1 in young Asian Indians (< 40 y). Therapeutic lifestyle changes and maintenance of regular physical activity are most important strategies for preventing childhood obesity. Effective health awareness educational programs for children should be immediately initiated in developing countries, following the successful model program in India (project ‘MARG’).

Fetal Programming and the Risk of Noncommunicable Disease

Abstract: The "developmental origins of health and disease" (DOHaD) hypothesis proposes that environmental conditions during fetal and early post-natal development influence lifelong health and capacity through permanent effects on growth, structure and metabolism. This has been called 'programming'. The hypothesis is supported by epidemiological evidence in humans linking newborn size, and infant growth and nutrition, to adult health outcomes, and by experiments in animals showing that maternal under- and over-nutrition and other interventions (e.g., glucocorticoid exposure) during pregnancy lead to abnormal metabolism and body composition in the adult offspring. Early life programming is now thought to be important in the etiology of obesity, type 2 diabetes, and cardiovascular disease, opening up the possibility that these common diseases could be prevented by achieving optimal fetal and infant development. This is likely to have additional benefits for infant survival and human capital (e.g., improved cognitive performance and physical work capacity). Fetal nutrition is influenced by the mother's diet and body size and composition, but hard evidence that the nutrition of the human mother programmes chronic disease risk in her offspring is currently limited. Recent findings from follow-up of children born after randomised nutritional interventions in pregnancy are mixed, but show some evidence of beneficial effects on vascular function, lipid concentrations, glucose tolerance and insulin resistance. Work in experimental animals suggests that epigenetic phenomena, whereby gene expression is modified by DNA methylation, and which are sensitive to the nutritional environment in early life, may be one mechanism underlying programming.

Nutrition transition and its health outcomes.

Abstract: Advances in agriculture and food systems, consequent increases in food availability, and a shift in dietary consumption patterns with economic development and urbanization of developing societies leads to adverse health outcomes. The structure of the habitual diet is altered and is characterized by increasing consumption of fats, saturated fats largely from animal sources and sugars. Lifestyle changes in an increasingly urbanized environment which occurs concurrently contributes to a reduction in physical activity levels which promotes overweight and obesity. The essence of these changes is captured by the term ‘nutrition transition’ which accompanies the demographic and epidemiologic transition in these countries with economic development. The existing burden of undernutrition in developing countries is thus compounded by the adverse effects of the nutrition transition, notably the increasing prevalence of obesity and non-communicable diseases. This double burden of malnutrition adds to the health and economic burden of developing societies.

NICU Admissions and Maternal Stress Levels

Abstract: To determine the stress levels among mothers of babies admitted in Neonatal Intensive Care Unit (NICU) and to identify demographic parameters that influence their stress levels. Stress levels were assessed using Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) questionnaire among 100 NICU mothers by doctors between 6 and 8 d of admission. Maternal stress was quantified using Likert scale as low (1–2.9), medium (3–3.9) and high (4–5). The data was analyzed using SPSS Ver.16. The mean scores for the subscales sights and sounds, looks and behaviour and alteration in the parental role were 2.55, 4.1 and 4.12 respectively. Increased maternal age, prematurity of baby, longer NICU stay and inability to directly breastfeed the baby were associated with higher stress levels. NICU mothers are under significant stress and appropriate counseling targeted towards specific stressors is required.

Kangaroo Mother Care in Reducing Pain in Preterm Neonates on Heel Prick

Abstract: To determine the effect of Kangaroo Mother Care (KMC) of small duration of 15 min in decreasing pain in preterm neonates between 32–36 wk 6 d on heel prick by a 26 gauge needle. Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score. The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO2). The difference(4.85) in PIPP score was clinically and statistically significant (p < 0.0001). The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure.

Incidence and etiology of acute kidney injury in southern India.

Abstract: To determine the incidence, etiology, short term outcome and predictors of mortality in hospitalized children aged 1 mo to 13 y with Acute Kidney Injury (AKI). This prospective observational study was conducted in the pediatric wards and the pediatric intensive care unit (PICU) of a tertiary hospital in southern India, to study the clinico-etiological profile of AKI (defined according to the Acute Kidney Injury Network criteria). From June 2010 through March 2011, 2376 children were included in the study. The incidence of AKI was 5.2 % in the pediatric wards and 25.1 % in the PICU. AKI occurred in association with infections (55.4 %), acute glomerulonephritis (16.9 %), cardiac disease (4.8 %), envenomations (4.2 %) and hemolytic uremic syndrome (3.6 %). Pneumonia constituted 26.1 % of the infections. Tropical febrile illnesses (dengue, scrub typhus, enteric fever, cholera, tuberculosis, malaria and leptospirosis) constituted 15.6 % of children with AKI. Dialysis was required in 14.5 % of patients; mortality was 17.5 %. A significant proportion of children (17.5 % of survivors) had partial renal recovery at discharge. On multivariate logistic regression, dysnatremia and meningoencephalitis were independent predictors of mortality in AKI. The incidence of AKI is high in the patient population, including the non-critically ill children. AKI continues to be associated with adverse outcomes. Presence of dysnatremia and meningoencephalitis are poor predictors of outcome in AKI.

Effect of Oil Massage on Growth in Preterm Neonates Less than 1800 g: A Randomized Control Trial

Abstract: To study the effect of oil massage on growth in preterm babies less than 1800 g. This randomised controlled trial was conducted in Neonatal intensive care unit of a level II hospital. Neonates with birth weight < 1800 g, gestation < 35 wk and < 48 h of age at enrolment were included in the studies. Eligible neonates were randomized to one of the two groups (a) Oil massage along with standard care of low birth weight (b) Standard care of low birth weight without massage. Weight, length and head circumference was measured in the two groups at 7 d intervals. Serum triglyceride levels were measured at enrolment and at completion of study. Primary outcome variable was weight gain at 28 d after enrolment. A total of forty-eight neonates were randomisd to either oil massage group (n = 25) or standard care of low birth weight without massage group (n = 23). Mean (SD) weight of babies in the two groups was 1466.4 ± 226.8 g in oil massage group and 1416.6 ± 229.9 g in the control group. At 28 d, weight gain in the oil massage group (476.76 ± 47.9 g) was higher compared to the control group (334.96 ± 46.4 g) (p < 0.05). At 7 d, less weight loss (7.80 ± 9.8 g) was observed in babies in oil massage group compared to control group (21.52 ± 19.4 g) (p = 0.003). However, there was no significant difference in serum triglycerides and other anthropometric parameters. Oil application has a potential to improve weight gain and cause less weight loss in first 7 d in low birth weight neonates

Rheumatic Heart Disease: Progress and Challenges in India

Abstract: Rheumatic heart disease, a neglected disease, continues to be a burden in India and other developing countries. It is a result of an autoimmune sequalae in response to group A beta hemolytic streptococcus (GAS) infection of the pharynx. Acute rheumatic fever (RF), a multisystem inflammatory disease, is followed by rheumatic heart disease (RHD) and has manifestations of joints, skin and central nervous system involvement. A review of epidemiological studies indicates unchanged GAS pharyngitis and carrier rates in India. The apparent decline in RHD rates in India as indicated by the epidemiological studies has to be taken with caution as methodological differences exist among studies. Use of echocardiography increases case detection rates of RHD in population surveys. However, the significance of echo based diagnosis of carditis needs further evaluation to establish the significance. Research in this area through prospective follow up studies will have to be undertaken by the developing countries as the interest of developed countries in the disease has waned due the declined burden in their populations. Prevention of RHD is possible through treatment of GAS pharyngitis (primary prophylaxis) and continued antibiotic treatment for number of years in patients with history of RF to prevent recurrences (secondary prophylaxis). The cost effectiveness and practicality of secondary prophylaxis is well documented. The challenge to any secondary prophylaxis program for prevention of RF in India will be the availability of benzathine penicillin G and dissipation of fears of allergic reactions to penicillin among practitioners, general public and policy makers. The authors review here the progress and challenges in epidemiology, diagnosis and primary and secondary prevention of RF and RHD.

Childhood Myelodysplastic Syndrome

Abstract: Myelodysplastic syndrome (MDS) comprises of a heterogeneous group of bone marrow disorders resulting from a clonal stem cell defect characterised by cytopenias despite a relatively hypercellular marrow, ineffective hematopoiesis, morphological dysplasia in the marrow elements, no response to hematinics such as iron, B12 or folic acid and risk of progression to leukemia. Myelodysplastic syndrome in childhood is extremely rare and accounts for less than 5% of all hematopoietic neoplasms in children below the age of 14 y. The primary MDS in children, also known as de novo MDS differs from secondary MDS which generally follows congenital or acquired bone marrow (BM) failure syndromes as well as from therapy related MDS, commonly resulting from cytotoxic therapy. MDS associated with Down syndrome which accounts for approximately one-fourth of cases of childhood MDS is now considered a unique biologic entity synonymous with Down syndrome-related myeloid leukemia and is biologically distinct from other cases of childhood MDS. Refractory cytopenia of childhood (RCC) is the commonest type of MDS. Genetic changes predisposing to MDS in childhood remain largely obscure. Monosomy 7 is by-far the commonest cytogenetic abnormality associated with childhood MDS; however most cases of RCC show a normal karyotype. Complex cytogenetic abnormalities and trisomy 8 and trisomy 21 are also occasionally observed. The most effective and curative treatment is Hematopoietic stem cell transplantation and this is particularly effective in children with the monosomy 7 genetic defect as well as those displaying complex karyotype abnormalities provided it is instituted early in the course of the disease.

Hyperleukocytosis: emergency management.

Abstract: Hyperleukocytosis is defined as peripheral blood leukocyte count exceeding 100,000/mm(3). Acute leukemia is the most common etiology in pediatric practice. Hyperleukocytosis is a medical emergency. The increased blood viscosity, secondary to high white cell count and leukocyte aggregates, results in stasis in the smaller blood vessels. This predisposes to neurological, pulmonary or gastrointestinal complications. In addition, patients are at risk for tumor lysis syndrome due to the increased tumor burden. Initial management includes aggressive hydration, prevention of tumor lysis syndrome, and correction of metabolic abnormalities. A red cell transfusion is not indicated in a hemodynamically stable child, as it adversely affects the blood viscosity. Leukapheresis is the treatment of choice for a very high count, or in patients with symptomatic hyperleukocytosis. The technical expertise required, a relative difficult venous access in younger children, risk of anticoagulation and possible non-availability of the procedure in emergency hours are limitations of leukapheresis. However, it is a rewarding procedure and performed with relative ease in centers that perform the procedure frequently. An exchange transfusion is often a practical option when hyperleukocytosis is complicated with severe anemia. The partial exchange aids in correcting both, without the risk of volume overload or hyperviscosity, which are the limitations of hydration and blood transfusion, respectively. Etiology and management of hyperleukocytosis in relevance to the pediatric emergency room is outlined.

Bacteriological profile and antibiogram of neonatal septicemia.

Abstract: Objectives To determine the incidence of neonatal septicemia, identify the bacterial isolates and study their antimicrobial susceptibility pattern in neonates visiting out-patient door (OPD) and admitted to the pediatric ward and neonatal intensive care unit (NICU) of the College of Medical Sciences, Teaching Hospital, Chitwan, Nepal.

Effect of Multisensory Stimulation on Neuromotor Development in Preterm Infants

Abstract: To investigate the effect of Auditory, Tactile, Visual and Vestibular stimulus (ATVV) on neuromotor development in preterm infants. Fifty preterm infants born at 28–36 wk with a birth weight ranging from 1,000–2,000 g were recruited for the study. They were block randomized into a control group (n = 25) and study group (n = 25). New Ballard score was used for the baseline measurement of neuromaturity in both groups. In neonatal intensive care unit (NICU), the study group received multisensory stimulation for 12 min per session, 5 sessions per wk along with routine NICU care either from 33 wk corrected gestational age for infants born at 28–32 wk or from 48 h of birth for infants born at 33–36 wk until discharge from the hospital. The control group received the routine NICU care. At term age the preterm infants were assessed using Infant Neurological International Battery (INFANIB) and the groups were compared using independent t test. The multisensory stimulated infants showed higher neuromotor score (p = 0.001) compared to the control group. The french angle components of INFANIB including heel to ear (p = 0.016) and popliteal angle (p = 0.001) were statistically significant between the groups. Multisensory stimulation appears to have a beneficial effect on the tonal maturation in preterm infants. However, further studies are warranted to investigate the long-term effects of multisensory stimulation on neurodevelopmental outcome in preterm infants.

Prevalence and Pattern of Congenital Heart Disease in Uttarakhand, India

Abstract: To find the prevalence and pattern of congenital heart disease (CHD) at a tertiary care hospital in Uttarakhand, India. A thorough history and clinical examination was done for all the live births and children up to 18 y of age who presented to the institute over a period of 3 y from July 2008 through June 2011. Those suspected of having a CHD, were further evaluated with ECG, chest radiography and the diagnosis was confirmed by color Doppler echocardiography. Of the 36541 children examined, 312 were identified as having congenital heart defects, thus giving a prevalence of 8.54 per 1000 children attending hospital. Only one fifth cases were diagnosed in neonatal period and the diagnosis was delayed beyond infancy in more than half of the cases. Ventricular septal defect (30.45%), atrial septal defect (17.63%), patent ductus arteriosus (9.62%), pulmonary stenosis (6.41%), tetralogy of Fallot (5.45%) and transposition of great arteries (5.13%) were the commonest defects observed. Only 9.29% of children with CHD underwent definitive treatment. The prevalence of CHD at a tertiary referral hospital in Uttarakhand India is 8.54 per 1000 children. VSD and TOF are the most common acyanotic and cyanotic congenital heart defects respectively.

Prevalence, Pattern and Outcome of Congenital Heart Disease in Bhabha Atomic Research Centre Hospital, Mumbai

Abstract: Objective To assess the prevalence, pattern and outcome of congenital heart disease (CHD) among the babies born in Bhabha Atomic Research Centre (BARC) Hospital, Mumbai and to compare the pattern of CHD with the study done in the same hospital in year 1999.

Emergency management of acute abdomen in children.

Abstract: Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle’s tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

Injury Prevention and Care : An Important Public Health Agenda for Health, Survival and Safety of Children

Abstract: Injuries affect the lives of thousands of young people and their families each year in India. With the gradual decline of communicable and nutritional diseases, injuries will be a leading cause of mortality, morbidity and disabilities and the success achieved so far in child health and survival is in jeopardy. Available data indicate that among children less than 18 y, 10–15 % of deaths, 20–30 % of hospital registrations and 20 % of disabilities are due to injuries. Based on available data, it is estimated that injuries result in death of nearly 1, 00,000 children every year in India and hospitalisations among 2 million children. Road Traffic Injuries (RTI’s), drowning, falls, burns and poisoning are leading injury causes in India. Drowning and burns are major causes of mortality in less than 5 y, while RTIs, falls and poisoning are leading causes in 5–18 y. A shift in the occurrence of suicides to younger age groups of 15–20 y is a matter of serious concern in recent years. More number of males, those in rural areas, and majority of poor income households are affected due to injuries. Child injuries are predictable and preventable. Children have limitations of size, development, vision, hearing and risk perceptions as compared to adults and hence are more susceptible and vulnerable to injuries. Thus, it is important to make products and home – road and school environments safer along with greater supervision by parents and care givers. The key approaches include vehicle and product safety, environmental modification, legislation and enforcement, education and skills development along with availability of quality trauma care. Child injury prevention and care requires good quality data, building human and financial resources, strengthening policies and programmes based on evidence and integrated implementation of countermeasures along with monitoring and evaluation. Child injury prevention and control is crucial and should be an integral part of child health and survival.

Mortality and morbidity in extremely low birth weight (ELBW) infants in a neonatal intensive care unit.

Abstract: Objective To determine the morbidity and mortality in ELBW babies till discharge from a Neonatal Intensive Care Unit (NICU).

Exploring play therapy in pediatric oncology: a preliminary endeavour.

Abstract: To discuss the benefits and feasibility of play therapy in pediatric oncology. This is highlighted through the use of a case report of non-directive play therapy with a 4 y- old girl, diagnosed with Acute Lymphoblastic Leukemia. The outcome of play therapy was examined using a combination of qualitative and quantitative assessments. The benefits of play therapy with this child were manifested in better illness adjustment and general mental well-being, enhanced coping, and normalization. Having illustrated benefits of play therapy in pediatric oncology, this paper discusses its feasibility and proposes avenues for clinical practice and research endeavours.

Hypertension in Children and Adolescents: Epidemiology and Pathogenesis

Abstract: High blood pressure is one among the leading contributors to burden of disease globally. Approximately 54 % of stroke and 47 % of ischemic heart disease events worldwide were attributable to high blood pressure in the year 2001. There is deficiency of data on the long-term outcome of hypertension in children. In spite of this, there is sufficient evidence to suspect that the health risks of hypertension in pediatric patients are substantial. Hypertension in childhood is known to result in hypertension in young adulthood. The epidemiology of hypertension in children is well represented from various studies conducted across continents. Factors like methodological issues in measurement, socio demographic differences, adiposity levels and ethnicity appear to influence the distribution of blood pressure as well as prevalence of hypertension in children. The etio-pathogenesis of essential (primary) hypertension is multi-factorial in origin. Obesity, insulin resistance, activation of sympathetic nervous system, alterations in sodium homeostasis, renin-angiotensin system changes, changes in vascular smooth muscle structure and reactivity, high serum uric acid levels, genetic factors and fetal programming have been reported to contribute to this disorder. The causes of secondary hypertension vary with age. Renal disorders and coarctation of the aorta are the most common causes of hypertension in children up to age 6 y. In older children, renal parenchymal disease remains the most frequent cause of increased blood pressure. Other causes of hypertension in children are relatively rare and include systemic arteritis and certain tumours, endocrine dysfunction, and neurologic disorders.

Communication skills to ensure patient satisfaction.

Abstract: Every pediatrician would want to satisfy their patients and their parents to sustain good practice, earn name and fame and simultaneously to avoid litigation in this era of consumer protection act. This can be achieved only by use of good communication skills. Today the patients demand time, information and want their questions to be answered. They expect politeness, empathy and human touch from doctors. Time constraints, arrogance, telephone calls, language barriers and cultural insensitivity are the important barriers to good communication. Research has shown that doctor, who undergoes training to acquire good communication skills, can better satisfy his patients. Good communication skill is an art which can be acquired or improved by putting conscious efforts in day to day practice. Such skills should also be incorporated as part of medical teaching curriculum. Asking open ended questions, effective listening, appropriate praise, providing enough information as part of advice and finally checking their understanding, are the key areas of communication during medical interview. During this process pediatrician should ensure to address the parental concerns, should empathize with parents and involve parents in decision making. This will not only ensure satisfaction of parents but also their adherence to the therapy and to the pediatrician.

Delivering Sprinkles Plus through the Integrated Child Development Services (ICDS) to reduce anemia in pre-school children in India.

Abstract: To assess the effectiveness of micronutrient powder (MNP) supplementation in reducing anemia levels in children aged 6 mo to 6 y in India. Sixty sachets of MNP (Sprinkles Plus) were administered flexibly over a 4 mo period to 17,124 children at anganwadi centers or at home through Integrated Child Development Services (ICDS). Compliance was monitored using compliance cards and an assessment of mother’s recall at post-intervention survey. Hemoglobin was measured in separate random samples of 1,786 children before and 1,782 children after MNP supplementation. Mean compliance rate was estimated at 56.4 % (based on mother’s recall) and 91.7 % (based on compliance cards) for children who received MNP at home. Mean compliance was 96.9 % (based on compliance cards) for children who received MNP at anganwadis. A significant reduction in anemia (50 % to 33 % in boys; p-value < .000; 47.4 % to 34.2 % in girls) was seen following MNP supplementation. Integration of a flexibly administered MNP supplementation into the ICDS is effective in reducing and treating anemia in children 6 mo to 6 y age.

Topiramate and propranolol for prophylaxis of migraine.

Abstract: To compare efficacy and safety of topiramate (TPM) and propranolol for migraine prophylaxis in children. In a parallel single-blinded randomized clinical trial, 5–15 y-old referred migraineurs to Pediatric Neurology Clinic of Shahid Sadoughi Medical Sciences University, Yazd, Iran from May through October 2011, were evaluated. Patients were distributed into two groups, 50 of whom were treated with 3 mg/kg/d of topiramate (TPM) and another group of 50, were treated with 1 mg/kg of propranolol for 3 mo. Primary endpoints were efficacy in reduction of monthly frequency, severity, duration and headache related disability. Secondary outcome was clinical side effects. Fifty two girls and 48 boys with mean age of 10.34 ± 2.31 y were evaluated. Monthly frequency, severity and duration of headache decreased with TPM, from 13.88 ± 8.4 to 4.13 ± 2.26 attacks, from 6.32 ± 1.93 to 2.8 ± 2.12, and from 2.36 ± 1.72 to 0.56 ± 0.5 h, respectively. Monthly frequency, severity and duration of headache also decreased with propranolol from 16.2 ± 6.74 to 8.8 ± 4.55 attacks, from 6.1 ± 1.54 to 4.8 ± 1.6 and from 2.26 ± 1.26 to 1.35 ± 1.08 h, respectively. Pediatric Migraine Disability Assessment score reduced from 31.88 ± 9.72 to 9.26 ± 7.21 with TPM and from 33.08 ± 8.98 to 23.64 ± 9.88 with propranolol. Transient mild side effects were seen in 18 % of TPM and in 10 % of propranolol (P = 0.249) groups. Topiramate is more effective than propranolol for pediatric migraine prophylaxis.

Prevalence of Monosymptomatic Nocturnal Enuresis and its Correlates in School Going Children of Lucknow

Abstract: To determine the prevalence of primary monosymptomatic nocturnal enuresis (PMNE) and its correlates in school going children of Lucknow. It is a cross-sectional school based study conducted in a random sample of 1212 school going children of Lucknow belonging to the middle socioeconomic strata. Data was collected via questionnaire designed for parents. Detailed urological history was obtained and physical examination done in the children whose parents answered the questionnaire. The chi-square test was used to compare the categorical/dichotomous indicators and backward logistic regression was used to find out the significant risk factors for monosymptomatic nocturnal enuresis. Study reports the prevalence of PMNE to be 12.6 % (95 % CI = 10.9–14.3 %) and significant association of enuresis with the presence of home conflicts(adjusted OR = 38.37, 95 % CI = 20.04–73.47), stress in children due to enuresis(adjusted OR = 10.86, 95%CI = 5.73–20.57), scolding(adjusted OR = 6.78,95%CI = 3.69–12.44), parental history of enuresis(adjusted OR = 3.57, 95%CI = 1.96–6.50), poor scholastic performance(adjusted OR = 2.88,95 % = 1.49–5.56), age 6–8 y (adjusted OR = 13.80,95%CI = 4.38–43.45) and living with single parent (adjusted OR = 0.34, 95%CI = 0.17–0.68). Prevalence of monosymptmatic nocturnal enuresis MNE was 17.9 % (p = 0.001) among children who were not exclusively breastfed till 6 mo of age in the index study. Enuresis is a pediatric health problem with high prevalence . Parental awareness needs to be created about this condition.

A comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care unit.

Abstract: To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer. This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software. Mean sodium measured on the BGA was 132.8 ± 12.2 mmol/L where as measured by AA was 141.5 ± 11.1 mmol/L. The mean difference between the two was −8.76 mmol/L (p < 0.001). The difference was statistically significant in all three subgroups of hypernatremia, isonatremia and hyponatremia (p < 0.001). Potassium level in BGA was 3.53 ± 0.81 mmol/L and AA was 4.28 ± 1.05 mmol/L. The mean difference between the BGA and AA was −0.75 mmol/L (p < 0.0001). The difference was statistically significant in patients with normokalemia and hyperkalemia (p < 0.0001). The difference was non significant in patients with hypokalemia (p = 0.051). Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman’s analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.

Consensus on Timing of Intervention for Common Congenital Heart Diseases: Part II - Cyanotic Heart Defects

Abstract: The purpose of this review/editorial is to discuss how and when to treat the most common cyanotic congenital heart defects (CHDs); the discussion of acyanotic heart defects was presented in a previous editorial. By and large, the indications and timing of intervention are decided by the severity of the lesion. While some patients with acyanotic CHD may not require surgical or transcatheter intervention because of spontaneous resolution of the defect or mildness of the defect, the majority of cyanotic CHD will require intervention, mostly surgical. Total surgical correction is the treatment of choice for tetralogy of Fallot patients although some patients may need to be palliated initially by performing a modified Blalock-Taussig shunt. For transposition of the great arteries, arterial switch (Jatene) procedure is the treatment of choice, although Rastelli procedure is required for patients who have associated ventricular septal defect (VSD) and pulmonary stenosis (PS). Some of these babies may require Prostaglandin E1 infusion and/or balloon atrial septostomy prior to corrective surgery. In tricuspid atresia patients, most babies require palliation at presentation either with a modified Blalock-Taussig shunt or pulmonary artery banding followed later by staged Fontan (bidirectional Glenn followed later by extracardiac conduit Fontan conversion usually with fenestration). Truncus arteriosus babies are treated by closure of VSD along with right ventricle to pulmonary artery conduit; palliative banding of the pulmonary artery is no longer recommended. Total anomalous pulmonary venous connection babies require anastomosis of the common pulmonary vein with the left atrium at presentation. Other defects should also be addressed by staged correction or complete repair depending upon the anatomy/physiology. Feasibility, safety and effectiveness of treatment of cyanotic CHD with currently available medical, transcatheter and surgical methods are well established and should be performed at an appropriate age in order to prevent damage to cardiovascular structures.

Development and Validation of Trivandrum Development Screening Chart for Children Aged 0-6 years [TDSC (0-6)]

Abstract: To develop and validate a simple screening tool for identifying developmental delay among children of 0–6 y of age in the community. The 51-items of Trivandrum Development Screening Chart for children of 0–6 y [TDSC (0–6 y)], were carefully prepared from the norms in various existing developmental charts/scales, by experts keeping in mind the face validity and content validity. The criterion validity was assessed in a community sample of 1,183 children of 0–6 y with a mean age of 35.38 mo (SD of 19.25) including 597 (50.46 %) boys and 586 (49.54 %) girls. TDSC (0–6 y) was validated against Denver Developmental Screening Test (DDST) as the ‘Reference Standard’. When one item delay in TDSC (0–6 y) was considered as ‘TDSC delay’ (test positive), the sensitivity and specificity of TDSC (0–6 y) was found to be 84.62 % (95 % CI: 71.92–93.12) and 90.8 % (95 % CI: 88.97–92.43) respectively with a Negative Predictive Value of 99.23 % (95 % CI: 98.48–99.67) and LR (negative) of 0.17(95 % CI: 0.09–0.32). The test-retest and inter-rater reliability [an interclass correlation (ICC) of 0.77 for test-retest and ICC of 0.97 for inter-rater] were good and acceptable. TDSC (0–6 y) is a simple, reliable and valid screening tool for use in the community to identify children between 0 and 6 y with developmental delay, enabling early intervention practices.

Use of vitamin D in various disorders.

Abstract: Approximately 1 billion people worldwide have been identified as vitamin D deficient in the 21st century, and the number is on the rise; non-classical actions of vitamin D were initially recognized around 30 y ago when receptors for vitamin D were detected in neoplastic cells lines. The aim of this review is to provide a brief overview of the non-classical actions of vitamin D. Reports describing the associations of non skeletal actions of vitamin D, especially pertaining to the immune system, inflammatory disorders, cancers and cardiovascular disease have been summarized in this paper. Reports support a role for the active form of vitamin D in mediating normal function of both the innate and adaptive immune systems. Studies also suggest a link between vitamin D deficiency and autoimmune diseases, such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus and type 1diabetes. There is believed to be an inverse association between serum 25-hydroxyvitamin D concentrations and the incidence of colorectal cancer, sporadic colorectal adenoma and breast cancer. Vitamin D deficiency has been linked with various cardiovascular diseases such as hypertension, myocardial infarction, and stroke. Several epidemiological and genetic studies suggest a strong association between vitamin D and non skeletal acute and chronic disorders. However, currently, robust clinical data are still lacking to support raising intake requirements and target vitamin D plasma levels. Nonetheless, the high prevalence of vitamin D deficiency is alarming and requires implementation of clear supplementation guidelines.

Common Childhood Poisonings and Their Outcome in a Tertiary Care Center in Delhi

Abstract: Clinical profile of children presenting with poisoning to the Pediatric emergency department of a tertiary care hospital in Delhi from 8.1.2009 to 8.10.09 was studied prospectively. Fifty two cases of accidental poisoning were reported during this period which formed 1.05 % of all pediatric admissions (5094 admissions). No case of homicidal poisoning was reported. There were 80.7 % children between 1–5 y of age with male preponderance. PICA was observed in 57.7 % children. Overall mortality was 7.7 % and 11.3 % children required pediatric intensive care unit (PICU). Kerosene oil poisoning remained the commonest accidental poisoning in this study. An interesting trend was concentrated HCL poisoning (now a common household product) as the second commonest poisoning (17.3 %). This was followed by poisoning with various drugs used by adults in the house.

Serum procalcitonin in septic meningitis.

Abstract: Objective To evaluate the role of serum procalcitonin (PCT) in diagnosis of septic meningitis in children and its efficacy in differential diagnosis.

ADad 3: the epidemiology of Anxiety Disorders among adolescents in a rural community population in India.

Abstract: Despite being the most common mental health concern, there is paucity of literature on the epidemiology of anxiety disorders among the adolescent population in India This study aimed to estimate the period prevalence of Anxiety Disorders (AD) among 11 to 19 y old adolescents in India A representative sample of adolescents (N = 500) from a rural community in Southern India was assessed for the period prevalence of all and specific Anxiety Disorders using Screen for Child Anxiety Related Emotional Disorders (SCARED), and confirmed in a subsequent interview with Schedule for Affective Disorders and Schizophrenia for School-Age Children/Present and Lifetime Version (K-SADS-PL) The prevalence for all AD using the international, Indian SCARED cut-offs and DSM-IV-TR criteria was 86 % (boys = 2 %; girls = 66 %), 258 % (boys = 66 %; girls = 192 %) and 144 % (boys = 48 %; girls = 96 %) respectively There were significant gender differences in the prevalence for all Anxiety Disorders (χ 2 = 361, df = 1; P < 005), Separation Anxiety Disorder (χ 2 = 2227, df = 1; P < 0001) and Social Anxiety Disorder (χ 2 = 429, df = 1; P < 003) Significant age difference in the prevalence of Panic Disorder (χ 2 = 1032; df = 1; P = 000) and Generalized Anxiety Disorder (χ 2 = 587; df = 1; P = 005) was noted The prevalence of Anxiety Disorders in South Indian adolescents was higher than found in the western literature Prevalence of specific AD was age and gender specific Adolescent and mental health policies must integrate anxiety disorder of public health significance