Showing papers in "Indian Pediatrics in 1990"

Evaluation of beneficial effects of nonnutritive sucking in preterm infants.

Abstract: The effects of nonnutritive sucking (NNS) were studied in 40 preterm infants weighing less than or equal to 1800 g and of less than or equal to 35 weeks gestation by using a pacifier. The provision of NNS accelerated the maturation of sucking resulting in a faster transition from gavage to oral feedings. Treated infants (20) were ready for bottle feeds 1.54 days earlier, took their bottle feeds 1.5 min/30 ml faster and were transferred out of the nursery on an average .5 days earlier than the control infants. No adverse effects due to NNS were observed throughout the period of study. This resulted in an earlier union with their mother, less maternal deprivation and decreased work load on the nursery staff. Used judiciously this simple and safe modality of providing a pacifier for NNS during tube feeding may be useful in the management of preterm infants.

Intrauterine growth curves in north Indian babies: weight, length, head circumference and ponderal index.

Abstract: Intrauterine growth (weight, length, head circumference, Ponderal index) was studied in 2875 consecutive live born babies. Weight, length and head circumference growth curves did not show any significant difference when compared to previous growth curves made 20 years back from this centre. Norms and curves for ponderal index are provided for the Indian babies and were comparable with figures from Western studies. However, the 90th centile values were found to be low between 32-38 weeks of gestation.

Normal blood pressures and the evaluation of sustained blood pressure elevation in childhood.

Abstract: A total of 3,861 school children in the age group 5-15 years were examined to establish the normative values for auscultatory blood pressure and to study the prevalence of sustained elevation of blood pressure in Indian children. Age-sex specific norms of systolic and diastolic blood pressure in the right upper limb were worked out. When the influence of age was minimised, the systolic and diastolic pressure still showed a positive correlation with height and weight. Two hundred and fifty five (6.60%) of the children screened were detected to have blood pressure level in excess of +2 SD of the mean for age and sex on first contact. The number declined to only 16 (0.41%) on re-evaluation 2 months after the initial contact. These 16 children continued to remain hypertensive during monthly follow up for 5 months. Family history of obesity, hypertension, or myocardial-infarction and/or stroke was met with in significantly higher (p less than 0.001) number of children with sustained hypertension as compared to normotensive students.

Childhood obesity and hypertension.

Abstract: Using the criteria of weight(g)/height(cm)2 greater than or equal to 2.26 as cut off point, 292 (7.56%) of the 3,861 school children in the age group 5-15 years were identified as obese. The mean blood pressure levels, both systolic and diastolic, were found to be significantly higher in the obese subjects compared to the controls (p less than 0.001). Further, 10 (3.4%) of the 292 obese subjects were detected to have sustained elevations in BP levels (BP greater than mean + 2 SD for age-sex) on monthly follow-up for 6 months. On the contrary, persistent hypertension was detected in only six (0.16%) of the 3,569 controls. None of these hypertensive children had any symptoms attributable to raised blood pressures and all had only mild elevations in BP levels. Baseline investigations, carried out in 9/16 subjects, failed to document any underlying cause for hypertension. Serum cholesterol levels, however, were elevated in six subjects. This suggests a close association between childhood obesity and essential hypertension.

Reliability of subjective assessment of fever by mothers.

Abstract: To evaluate reliability of mother's subjective assessment of fever, we measured actual body temperature of 301 children and correlated these with assessment of fever (presence or absence) by the mother. Mothers could identify 88.9% (104/117) of febrile children and 88.6% (163/184) afebrile children correctly (positive and negative predictive values 83.2 and 87.6%, respectively). Palpation of more than one anatomical site for subjective assessment had a sensitivity of 100% and a specificity of 92.2%. The accuracy of the assessment was maximum in infants, and was not influenced by sex of the child, mother's educational status and the use of thermometer at home. In the situation where accurate measurement of temperature by thermometer is not available, mother's assessment about presence or absence of fever in her child can be relied upon by health-workers and physicians.

Breath holding spells : an analysis of 50 cases

Abstract: Of 50 preschool children having breath holding spells (M:F::3:1) (BHS), 80.0% were less than 18 months of age (mean age 16 +/- 5 mo). More children came from a lower social class (70.0%) and a nuclear family (64.0%). Seventy four per cent cases had onset of BHS within 12 months of age (mean 9.6 mo) and the commonest frequency was 1 to 3 spells per week (56.0%). Cyanosis and tonic-clonic spasms were seen in 96.0 and 84.0% cases, respectively. Anger and frustration were the common triggering factors in 90.0% cases. No ante-, peri- and postnatal factors were significantly associated with the study group as compared to the control cases. The mean scores on Behaviour Screening Questionnaire measuring child's habits related to feeding, toilet and sleep were not significantly different in the study and control groups but the difference was significant (p less than 0.05) for behaviour measuring child's social habits. Parental attitudes, measured on Attitude Screening Questionnaires, were also not significantly different in the study and control groups. Mean hemoglobin and percentage transferrin saturation were significantly lower in the study group as compared to the controls (p less than 0.001). There was a significant decrease in severity and frequency of spells with oral iron therapy.

Neonatal morbidity and mortality in ICDS urban slums.

Abstract: A communitywide prospective survey was conducted in the urban slums of Gorakhpur to elicit information on factors contributing to Indias high rate of neonatal mortality. Neonatal mortality accounts for more than 50% of total infant mortality in India. To successfully reduce infant mortality to 60/1000 live births more information is needed on the contribution of prematurity low birth weight infections respiratory distress birth asphyxia hyperbilirubinemia birth injury congenital malformation and other determinant factors of neonatal morbidity and mortality especially in urban slums. Compared with the standards of more developed countries high levels of neonatal morbidity and mortality were found with the main causes being infections and respiratory distress. Neonatal mortality was found to bear an inverse relationship with birth weight and gestational age. Higher mortality rates were observed in institutional deliveries despite the fact that the overall majority of mortality occurred in the home. Neonatal mortality was found to be significantly higher (p<.001) in home deliveries conducted by untrained dais. Proper training of traditional dais and paramedical workers would minimize the extent of these deaths.

Typhoid fever below five years.

Abstract: During a seven year period (1981-87), 53 cases of typhoid fever in children below five years were seen. This accounted for 13.5% of all typhoid admission in pediatrics during the above period. Predominant symptoms were fever (100%), vomiting (52.8%), diarrhea (30.2%) and anorexia (24.5%). Chills and rigor associated with fever was noticed in 38% of the children. Salmonella typhi was isolated from blood in 22 of 53 (41.7%) cases. A significant finding on peripheral smear was eosinopenia (86.8%). Complications like endotoxic shock, enteric encephalopathy and gastrointestinal hemorrhage were noticed in only few cases (7.6%). There were no deaths.

Coagulase negative staphylococcal septicemia in newborns.

Abstract: A retrospective analysis of 254 newborns having blood cultures positive for coagulase negative staphylococci (CONS), and admitted in the neonatal unit of a Rural Medical College Hospital over a period of five years, was done for various clinical and perinatal characteristics as well as antimicrobial sensitivity profile of isolates. Of them, 118 (46.5%) neonates had clinical evidence of sepsis with CONS as the only growth in blood culture, and were designated as having CONS septicemia. Majority of them were delivered in this hospital itself and by normal vaginal delivery. Preterms and LBW babies constituted 23.7 and 59.4% of total cases, respectively. Other high risk perinatal factors for infection were present in 66.1% cases. Approximately two third of these cases developed sepsis within first three days of life. Early onset sepsis was more frequently seen in neonates with history of assisted delivery or perinatal asphyxia. Overall mortality in these cases was 15.6%, being significantly higher in offspring of outside deliveries and normal vaginal deliveries, in preterm and LBW babies and slightly higher in presence of birth asphyxia. Only 15.3% CONS isolates were resistant to all routinely used antibiotics and sensitivity was maximum with gentamicin followed by ampicillin. A difference in sensitivity pattern of CONS causing EOS and LOS was also recorded.

Infant feeding practices in educated mothers from upper socio-economic status.

Abstract: 120 mothers from upper socioeconomic status and education to the graduate level were assessed for infant feeding practices using a pretested questionnaire. Prelacteal feed of honey was administered by 51.7% and initiation of breastfeeding was delayed by more than 24 hours in 68.3% of the mothers. Colostrum was discarded by 53% of the mothers 83% introduced bottlefeeding in the 1st month of life and poor bottle hygiene was seen in 54% of the cases. The addition of semisolids was delayed by almost 50% of the mothers the reason being fear of liver disorders. These observations highlight ignorance about infant feeding practices among the educated elite in India. Health education in schools colleges nonformal gatherings and during the antenatal period are suggested as means to change this situation. (authors modified)

Maternal beliefs regarding diet during common childhood illnesses

Abstract: Maternal beliefs regarding diet during common childhood illnesses--diarrhea, fever, measles, cough and marasmus were determined in 143 rural mothers by using the interview technique. Some foods were preferred while others were restricted during episode of each illness, depending upon their 'hot' and 'cold', 'light' and 'heavy' and other characteristics, as determined by locally prevalent traditional dietary beliefs. 'Cold' foods like curd, butter milk were restricted during an episode of cough while 'hot' foods like tea, ginger with honey, were preferred. During diarrhea, 'light' foods like khichri, diluted milk and 'easy to digest' were preferred while 'heavy' foods like undiluted milk, roti and 'difficult to digest' were restricted. The study revealed that for a successful health education, it is important to identify local cultural practices and beliefs. The useful practices should be encouraged and reinforced while the harmful ones should be discouraged.

Comparative evaluation of the antipyretic efficacy of ibuprofen and paracetamol.

Abstract: An open multicentric trial was conducted on 175 patients to compare the antipyretic efficacy of ibuprofen (7 mg/kg) and paracetamol (8 mg/kg). Children between the age of 4 months and 12 years with fever were admitted to the study, 85 in the ibuprofen group and 90 in the paracetamol group. The axillary temperatures were recorded at half hourly intervals for 2 hours. The mean fall in temperature at 1, 1.5 and 2 hours was similar in both groups and the differences were not statistically significant (p greater than 0.05). At half hour, the fall in temperature (mean +/- SEM) for ibuprofen was 0.1975 +/- 0.0409 and for paracetamol was 0.3843 +/- 0.0490. This absolute difference of 0.19 degrees C was statistically significant (p less than 0.05). We conclude that ibuprofen has antipyretic activity comparable to that of paracetamol and that it could be a valuable alternative antipyretic in clinical practice. There is a need to repeat this trial with higher doses of ibuprofen, to establish a dose response of the drug, if any, and to find an optimally effective dose.

Liver dysfunction in severe birth asphyxia.

Abstract: A total of 46 full term, appropriate for gestational age neonates were included in this study. Out of this, 31 infants had suffered severe birth asphyxia, while 15 normal babies formed the control group. The liver function tests of the asphyxiated group was deranged in 64.52% babies. There was 60% mortality in asphyxiated babies with deranged liver function. The serum levels of transaminases (SGOT, SGPT) and alkaline phosphatase in non-survivors were significantly higher than those of survivors.

Identification of a child with short stature.

Abstract: The objective of this study was to determine the utility of Indian Council of Medical Research's (ICMR) height percentile standards in comparison to Tanner's, in the evaluation of children with short stature. The study consisted of an initial survey of the heights of 500 consecutive new cases brought to the Out Patient Department. The heights were assessed by both ICMR and Tanner's standards. Only 10% were below the 5th percentile of ICMR standards while as many as 32% were below the 3rd percentile of Tanner's standards. Two hundred children who were referred to the endocrine clinic primarily for short stature and who were below the 3rd percentile of Tanner's standards were then evaluated. Of these 200 short children 132 (66%) were also below the 5th percentile of ICMR standards. The major causes of short stature in those below the 5th percentile of ICMR standards were endocrine (56.8%). In the group between the 5th percentile of ICMR standards and 3rd percentile of Tanner standards the major cause of growth retardation was normal variant short stature (67.8% of cases in this group). Correlation of the child's height with the mid-parental height was seen in 90.4% in this group but in only 16.6% of those below the 5th percentile of ICMR standards. The ICMR standards may, therefore, be more suitable than Tanner's standards for the identification of a short child from the lower socio-economic groups.

Non-nutritive suckling and use of pacifiers.

Abstract: One hundred and sixteen infants and children with normal development were studied for their non-nutritive suckling habit with special reference to pacifier suckling. The use of pacifier was more common among the lower socio-economic group (83.6%) and those residing in slums (58.6%). In 88.7% of cases it was the mother, family member, friend or relative who was responsible for introduction of pacifier to the baby with the aim to soothe the child. The other indications for use of pacifier were to facilitate dentition (60.0%) and nutritive function (18.1%). The use of pacifier in most of the cases was associated with chronic diarrhea (86.2%), respiratory illnesses (52.5%) and pica (10.2%). Defective dentition was noted only in 5.1% of children. The medical/paramedical staff were against the use of pacifiers.

Salmonella senftenberg outbreak in a neonatal unit.

Abstract: Salmonella senftenberg was isolated from the stools of 35 newborns between June, 1987 and September, 1988. Twenty nine (82.8%) babies were preterms and twenty six (74%) babies were less than 2,000 grams in weight. All of them were symptomatic within 6 days of life, 74.3% (26) within 4 days. All of them had loose stools and weight loss. Other features were sclerema, jaundice and paralytic ileus. The organism was sensitive to nalidixic acid (100%), amikacin (94.6%), gentamicin (72.9%), cephaloridine (56.7%), and chloramphenicol (29.8%) and resistant to benzyl penicillin and ampicillin. Babies showed good response to a combination of cephaloridine and amikacin along with supportive care. Five babies died, 4 of septicemic shock and one of pulmonary hemorrhage.

The first attack of acute rheumatic fever in childhood--clinical and laboratory profile.

Abstract: One hundred consecutive cases of 'first attack' of acute rheumatic fever were studied. There were 52 males and 48 females, constituting 1.12% of total hospital admissions. Nearly 10% of children were below the age of 5 years, stressing the early onset of rheumatic fever in tropics. Only 47% gave a definite history of overcrowding at home. Sore throat was present in 67%, overt arthritis in 66%, carditis in 57%, arthralgia alone in 22% of which 45.45% had carditis. Small joint involvement was noticed in 23% of cases of which 73.91% had carditis. Only 33.33% had congestive cardiac failure. Ten per cent of children had chorea, while subcutaneous nodules were seen in 4% of cases, all of whom had associated carditis. Erythrocyte sedimentation rate (ESR) showed good correlation with clinical profile. Throat cultures were positive for beta hemolytic streptococci only in 12% of cases. Anti-streptolysin 'O' (ASO) titre showed significant titres on 68% of cases, anti-deoxyribonuclease "B" (ADN-B) in 69.32%, antibody to group A carbohydrate (ACHO) in 70.65%. ASO, ADN-B, and ACHO titres together gave 87.5% positivity while estimations in paired sera showed ASO 79.54%, ADN-B 82.27% and ASO, ADN-B together 99.92% significant titres. Study of blood groups showed A group children to be more vulnerable to rheumatic fever (37.5%) and rheumatic carditis (47.37%). Mortality in the present study was nil.

Neonatal osteomyelitis and septic arthritis.

Abstract: The records of seventeen neonates (13 males and 4 females) with osteomyelitis and septic arthritis, who were admitted over a 3 year period, were reviewed. Neither prematurity nor low birth weight seemed to be a predisposing factor. The majority of the neonates (88.2%) had some antecedent illness or were subjected to certain procedures in the neonatal period. Paucity of movement of limb, fever and local swelling of the joint were the most frequent presenting symptoms. Deep soft tissue swelling was the frequently noted radiographic change (58.8%). Bone scintigraphy was abnormal in 7 out of 11 cases. Of the 21 sites involved, femur and humerus accounted for 76.1% of cases. Four of seventeen neonates had multiple bone involvement. Arthritis was present in fifteen neonates. Of the organisms isolated, Staphylococcus aureus was the commonest.

Evaluation of steam therapy in acute lower respiratory tract infections: a pilot study.

Abstract: In a prospective controlled evaluation of steam therapy, in severe acute lower respiratory tract infection (ALRI) requiring hospitalization, 16 cases of bronchiolitis and 20 cases of pneumonia were assigned alternately to receive steam therapy in a cloth tent (Study Group); others served as controls. Respiratory status was assessed at the time of admission and subsequently at 6 hourly interval for 48 hours. No advantage of steam therapy could be identified in children with pneumonia. Bronchiolitis patients on steam therapy, as compared to the controls, showed a significant decrease in respiratory distress within first 24 hours after hospitalization and took significantly shorter time for recovery from the distress. The study patients also showed a tendency for rapid improvement in hypoxemia. Further critically controlled studies with a larger sample size are warranted.

Cesarean section and delayed contact: effect on baby's behaviour.

Abstract: Fifty two babies were assessed by the Brazelton Neonatal Behaviour Assessment Scale (BNBAS) first at 24-48 hours after birth and next at 28 days of age. Of these 26 belonged to the normal vaginal delivery (NVD) group where the babies were roomed in with their mothers immediately after birth. The other 26 were delivered by Cesarean Section (CS) and had a mean separation of 2.8 +/- 1.0 day from their mothers. Babies in the NVD group performed better for the interactive processes at both the initial and follow-up assessment. They were more active initially and on follow up. Although no differences were obtained at the initial assessment for organisational processes (physiological response to stress and state control) the follow up revealed that the NVD babies smiled more, cried less and were less irritable.

Anemia and physical fitness of school children of rural Hyderabad.

Abstract: Physical fitness status of 119 school children was assessed by administering a simple field level 'running test' without any sophisticated equipment. Moderately anemic children had taken significantly longer time (6.25 min) to complete the 'running test' distance of 1.6 Km. Children with normal hemoglobin (Hb) values and those with higher level normal Hb values took shorter times (7.42 and 7.06 min) to complete the test distance. Deficits of weight for age, height for age and weight for height did not exert independent influence on the 'running time'. Anemic children in the sub-groups of each category of nutritional anthropometric indicator, performed poorly. Anemia proved to be a handicap either in the presence or absence of anthropometric deficits. Mild and moderate anemia imposed handicaps on physical endurance and fitness of school children irrespective of other nutritional deficits.

Physical growth in school girls: relationship to socio-economic status and dietary intake--II.

Abstract: Growth of 955 healthy normal girls between ages 5-16 years was measured with a mixed-longitudinal design to observe variations due to socio-economic status and the dietary intake. Five hundred and thirteen girls belonged to upper socio-economic status (USES) and 442 girls to lower SES. The 24 hours diet-intake of each girl was recorded by 24 hour-recall method. The LSES girls were significantly smaller in every physical measurements compared to USES girls. Annual mean increments for the linear and circumferential measurements were also lower among LSES girls till the peak velocity was attained. The mean increments for triceps were also lower in LSES for all ages. The girls on inadequate calories were significantly smaller in their growth than who consumed adequate or more than adequate calories. The effect of protein was less evident. A higher percentage of LSES girls (91.2%) consumed inadequate calories than those of USES girls 38.2%). The present study thus established that SES and dietary intake had significant bearing on the physical growth of the pre-adolescent and adolescent girls.

Psychological adjustment of physically sick children: relationship with temperament.

Abstract: The contribution of temperament and duration of illness in the variability in the psychological adjustment of children with chronic physical illness was studied. The temperament and psychological adjustment of a group of 50 children with chronic physical illnesses not involving the brain and a matched control group of 50 physically healthy children were assessed through Temperament Schedule and Childhood Psychopathology Measurement Schedule developed and standardized by the first author. Results indicated that sick children were less psychologically adjusted than the healthy controls and more adjusted than children referred for psychiatric concerns. Twice as many physically sick children (32%) showed maladjustment than did healthy children (16%). Temperament, particularly low distractibility, made a significant contribution to predicted variance (23%) in maladjustment whereas duration of illness did not.