Indian Journal of Child Health <p><strong>Indian Journal of Child Health (IJCH)</strong> is a monthly, peer-reviewed, international journal, published by <strong>Atharva Scientific Publications,</strong>&nbsp;Bhopal, India. <strong>IJCH</strong> is both online and print, open access journal and it allows free access to its contents and permits authors to self-archive the final accepted version of their articles. The journal publishes articles covering various aspects of child health including basic research and clinical investigations in different fields of pediatrics covering perinatal and neonatal to adolescent age group.</p> <p>&nbsp;</p> Atharva Scientific Publications en-US Indian Journal of Child Health 2349-6118 Alterations of thyroid function in overweight and obese children: An update <p><strong>Background:</strong> Children with simple overweight and obesity may have alterations in the function of various endocrine organs. Abnormal function of the thyroid gland is seen in about one-fifth of children with obesity. The underlying mechanisms of obesity-associated thyroid dysfunction are still unclear, and hence, the specific treatment with levothyroxine (LT4) is controversial. This review discusses the causes of thyroid dysfunction and its management in pediatric obesity. <strong>Methods of Evidence Acquisitio</strong>n: The literature search for this narrative review was performed using international databases including PubMed/Medline, EMBASE, SCOPUS, and Google Scholar and relevant information was extracted from articles on thyroid dysfunction in obesity with an emphasis on the most recent studies. <strong>Results:</strong> The most common thyroid function abnormality in children with obesity is an isolated increase in thyroid-stimulating hormone (TSH) followed by minor changes in the ratios of triiodothyronine (T3) and thyroxine (T4). Several mechanisms have been proposed for the thyroid dysfunction in obesity, but none explains it fully, and hence, the clinical implications remain unclassified, and the specific treatment with levothyroxine is controversial. There are a few studies in children with obesity-related thyroid dysfunction and the effect of normalization of thyroid function on weight. However, there are limited data on the effect of normalization of thyroid function by either weight loss or levothyroxine (LT4) treatment on the various metabolic consequences closely associated with thyroid dysfunction in obesity. <strong>Conclusions:</strong> Further research is needed to elucidate the exact mechanisms of thyroid dysfunction in childhood obesity. In addition, larger studies are required to understand the beneficial effects of specific LT4 treatment on weight and on the other thyroid related metabolic derangements in childhood obesity, especially in view of the recent findings of induction of browning of white adipose tissue by thyroid hormones. Until new research establishes its benefits, specific LT4 treatment of thyroid dysfunction in childhood obesity should be avoided.</p> Jaivinder Yadav Nimisha Jain Devi Dayal ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 145 150 Medical research and ethics - Revisited <p>Ethics in the medical research is known since many years; however, there have been new developments in this area recently. A phenomenal improvement in the health-care system, leading to increased life expectancy, and thereby, newer lifestyle and other health-related diseases has opened avenues for newer drugs and health-care technology. However, these have to be tried and tested in the context of the disease epidemiology, health-care delivery and of course, medical ethics. Monitoring and evaluation of the treatment regimes of well documented effective medicines is also required. This is the core of medical research. With the ever increasing concept of evidence-based medical system, and thereby, a rapid rise in the number of clinical trials; the role of medical ethics is potentially increasing to keep the patients P Thakkar K S Shringarpure S Gupte A Agrawal ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 151 156 Assessment of health care providers’ and parents satisfaction about care decisions and care provided to the patients admitted in Pediatric Intensive Care Unit: A descriptive study <p><strong>Background:</strong> Hospitalisation is a stressful situation especially for children. Health care providers (HCPs) play an important role in caring for the sick children. <strong>Objective:</strong> To assess the health care providers</p> Amarpreet Kaur Harshdeep Kaur Nidhi Kumari Rja Kumari Suman Rani Geetanjli Kalyan Jayshree Muralidharan Sandhya Ghai ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 157 160 Association of serum Vitamin A, calcium, alkaline phosphatase, and phosphorus levels with recurrent acute lower respiratory infections among children <p><strong>Introduction:</strong> Acute lower respiratory infection (ALRI) is a leading cause of morbidity and mortality in children younger than 5 years of age all over the world especially in developing countries. Consequently, considerable research has been aimed at finding possible risk factors in ALRI; micronutrients have been considered one of them. <strong>Materials and Methods:</strong> The present study was conducted to determine any association of serum Vitamin A, beta-carotene, calcium, alkaline phosphatase, and phosphorus levels with recurrent ALRI in children &lt;5 years of age. A prospective hospital-based case-control study was planned for a period of 10 months at a tertiary care referral center in central India. <strong>Results:</strong> A total number of 85 children aged 6 months to 5 years were randomly enrolled in two groups as case, i.e., recurrent ALRI (n=40) and control (n=45). Levels of serum Vitamin A and beta-carotene were found significantly lower in children with recurrent ALRI than in the control group (p&lt;0.05). However, serum levels of calcium, alkaline phosphatase, and phosphorus did not differ significantly when compared with control group (p&gt;0.05). <strong>Conclusion:</strong> The results provide evidence for the role of Vitamin A and beta-carotene levels in recurrent ALRI in pediatric patients. Our study was not able to find a significant relationship between calcium, phosphorus, and alkaline phosphatase levels with the occurrence of recurrent ALRI.</p> Rashmi Randa Sharad Thora Nirbhay Mehta Savita Vyas ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 161 165 Comparing the effectiveness of intranasal Midazolam and intravenous Lorazepam for the treatment of acute seizures in children <p><strong>Objective:</strong> The objective of this study was to compare the safety and efficacy of intranasal midazolam with intravenous lorazepam in acute seizures in children. <strong>Methods:</strong> Children aged 6 months Kingini Bhadran Dhanya Roy Isac Mathai ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 166 169 Cerebrospinal fluid C-reactive protein - A point of care test in the diagnosis of bacterial meningitis <p><strong>Background:</strong> Bacterial meningitis is a significant life-threatening illness during infancy and childhood. Delay in distinguishing<br>bacterial from viral or other aseptic meningoencephalitis may have irrevocable consequences. A typical case of pyogenic meningitis<br>without prior antibiotics may not create any diagnostic problems, but prior treatment with inappropriate and inadequate antibiotics<br>may cause sufficient alteration in biochemistry and cytology of cerebrospinal fluid (CSF), and organisms may not get isolated from<br>blood or CSF culture. <strong>Objective:</strong> C-reactive protein in CSF (CSF-CRP) has been reported to be one of the most reliable and early<br>indices to differentiate bacterial from non-bacterial meningitis. This study was undertaken to evaluate the diagnostic significance<br>of CSF- CRP as an early indicator in the differentiation of bacterial from non-bacterial meningitis. Materials and Methods: This<br>descriptive study was done in children in the age group of 1 month to 12 years who were admitted with history and clinical features<br>suggestive of acute central nervous system infection. CSF was analyzed for macroscopic appearance, pleocytosis, proteins, and<br>sugar content, Grams and Ziehl Sivasambo Kalpana Dorairaj Priyadharishini ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 170 173 The role of magnetic resonance imaging brain in estimating the burden of preventable and potentially curable epilepsy in developmentally normal children <p><strong>Background:</strong> Epilepsy is the most common neurological condition among children. Diagnosis of epilepsy is clinical, but to find<br>the etiology we must depend on investigations such as electroencephalography (EEG) and magnetic resonance imaging (MRI)<br>of the brain. EEG is more useful to diagnose genetic epilepsies, and MRI is more useful in structural causes. <strong>Objective:</strong> The<br>objective of this study was to find the etiology of epilepsy prevalent in children of our region and to evaluate the role MRI brain<br>in diagnosis. <strong>Methods:</strong> This was a survey-based study conducted at a tertiary care hospital in central India, between April 2015<br>and August 2016. A total of 108 developmentally normal children in the age group of 1 month to 14 years who presented with<br>two or more unprovoked seizures 24 h apart or known case of epilepsy and on treatment admitted in the inpatient department for<br>seizures were included in this study. The patients were classified based on detailed history, personal observation of seizures in some<br>cases, thorough clinical examination, EEG recording, MRI findings, and other relevant investigations pertaining to the case, and<br>the data were analyzed. <strong>Results:</strong> According to the ILAE 2010 classification, 12.9% of our patients had probable genetic epilepsy,<br>32.4% belonged to the structural metabolic group, and 54%, the largest proportion had an unknown cause. Of total 42 patients<br>with abnormal MRI, 30 (71.42%) patient had underlying structural or metabolic abnormality, whereas 28.57% had a genetic cause.<br>10 patients had imaging results suggestive of neurocysticercosis, while 7 patients had mesial temporal sclerosis. Gliosis was seen in<br>nine patients, tuberculoma was seen in four patients, and finding suggestive of infarcts was seen in six patients. Remaining patients<br>had abnormalities including corpus callosal agenesis (1), cortical dysplasia (2), tuberous sclerosis (1), white matter disease (1),<br>and hippocampal hyperintensities suggestive of encephalitis (1). <strong>Conclusion:</strong> MRI brain is the most important routinely available<br>investigation and must be utilized. Neurocysticercosis is still the most common structural cause of epilepsy in children in our region.</p> Jaya Upadhyay Prachi Chaudhary S Thora ##submission.copyrightStatement## 2018-04-27 2018-04-27 5 3 174 177 Clinical profile of recurrent headache in rural children of Rajasthan: A cross-sectional study <p><strong>Context:</strong> Recurrent headache is a commonly encountered clinical entity in rural children.<strong> Aims:</strong> This study aims to record the clinical profile of recurrent headache in rural children of Rajasthan. <strong>Settings and Design:</strong> A cross-sectional, observational study in a pediatric outpatient department of a tertiary care teaching hospital. <strong>Methods and Materials:</strong> A total of 164 children of either sex, between 5 and 17 years of age, presenting with complaints of a recurrent headache were included in the study. All relevant clinical details collected from patients and their relatives were recorded in a structured pro forma. A detailed examination was performed to rule out underlying problems associated with a headache. Headache subtypes were classified according to the International Classification of Headache Disorders, 3rd edition beta, 2013. Pediatric migraine disability assessment test score and Faces pain rating scale were utilized to assess the disability and severity, respectively. Statistical analysis involved summarizing the continuous variables as mean and standard deviation while nominal/categorical variables were expressed as percentages. <strong>Results:</strong> The mean age was 11.5 years and the M:F ratio was 1:1.1. Adolescents in 13–17 years age group constituted 61.5% (n=101) of the study sample with 58.4% (n=59) female subjects. Primary headaches - tension-type headache (n=77, 46.9%), migraine (n=43, 26.2%), and new daily persistent headache (n=5, 3%) were observed in 125 (76.1%) cases. Common causes of secondary headache were somatization disorder (n=27, 16.5%), ophthalmic problems (n=7, 4.3%), medication overuse (n=3, 1.9%), intracranial tumor (n=1, 0.6), and postictal (n=1, 0.6). <strong>Conclusions:</strong> Recurrent headache in rural children has distinct etiological profile which mandates a meticulous evaluation for initiating appropriate management.</p> Jagdish Prasad Agrawal Masand Rupesh Grover Nidhi ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 178 183 Evaluation of the vision screening programs in school-age children <p><strong>Background:</strong> Visual acuity (VA) screening programs, especially during early childhood, are important for the early detection of<br>eye disorders. <strong>Objectives:</strong> The objective of this study is to evaluate the effectiveness of eye surveys conducted by guide teachers in<br>school-age children. Design: This was a cross-sectional study. <strong>Patients and Methods:</strong> Detailed eye examinations were conducted<br>by an ophthalmologist in 462 children aged 5 Seyfettin Erdem ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 184 187 Unintentional home injuries among children aged 1–9 years in slums of Burdwan Municipality, West Bengal: A cross-sectional study <p><strong>Context:</strong> Unintentional home injuries result in morbidities among children. <strong>Aims:</strong> This study aimed to find out the prevalence<br>and patterns of unintentional home injuries among children aged 1</p> Tanmoy Mukherjee Sima Roy Sutapa Mandal Dilip Kumar Das ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 188 192 Hydrocarbon poisoning in children: 1-year retrospective study <p><strong>Context:</strong> Accidental hydrocarbon poisoning continues to be a major problem in children in India. <strong>Objectives:</strong> The objectives of the study were to study the demographics, clinico-laboratory profile of hydrocarbon poisoning in children admitted to our hospital from April 2015 to March 2016. <strong>Secondary Objective:</strong> The secondary objective of the study was to determine corelation between vomiting and development of pneumonia after hydrocarbon consumption. <strong>Materials and Methods:</strong> In this retrospective descriptive study, all children with the history of hydrocarbon consumption and admitted to the hospital during the study period were included in the study. The medical records of these children were reviewed retrospectively, data were recorded in a standard pro forma and were analyzed. Chi-square test was used for comparing differences between categorical variables. For interpretation of results, significance was adopted at p&lt;0.05 at 95% confidence interval.<strong> Results:</strong> A total of 52 cases (thinner-15 and kerosene-37) were included in our study. Male: Female ratio was 1.4:1, with the mean age in years being 3.01 Sachin S Hatti Vinod Uplaonkar Charanraj Honnalli ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 193 195 Comparing the personal oral hygiene practices among Government and Private school children of Mahabubnagar, Telangana state - A cross sectional study <p><strong>Introduction:</strong> Oral health is fundamental to general health and well-being. A healthy mouth enables an individual to talk, eat, and<br>socialize without experiencing active disease, discomfort, or embarrassment. <strong>Objectives:</strong> To assess the knowledge and oral hygiene<br>practices of school children from both Government and Private schools in Mahabubnagar district. <strong>Materials and Methods:</strong> A total<br>of 150 children aged 11–15 years were randomly selected from six Private and six Government schools. A questionnaire related<br>to their personal and oral hygiene practices was distributed to the school children. <strong>Results:</strong> The results of this study showed that<br>most respondents had a good knowledge of basic hygiene measures and positive attitude towards oral hygiene. The students of both<br>schools exhibited poor oral hygiene practices but were significantly reported more in the Government school than in the Private<br>schools (p&lt;0.005). Majority of the respondents (91.3%) used a commercial toothbrush and toothpaste and half of them (50%)<br>reported brushing twice a day. Two-third of the respondents (75%), had never visited a dental clinic. <strong>Conclusion:</strong> The results of the<br>present study showed that the knowledge and oral hygiene practices of Government school children were less satisfactory in some<br>aspects when compared to private school children.</p> Kola. Srikanth Reddy N. Venugopal Reddy M. Ajay Reddy P. Niharika V. Daneswari ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 196 199 Role of perfusion index in pulse oximetry screening for critical congenital heart disease in neonates <p><strong>Introduction:</strong> Screening for critical congenital heart diseases (CCHD) with oxygen saturation (SpO2) by pulse oximeter often misses left-sided obstructive heart diseases. <strong>Objective:</strong> The role of perfusion index (PI) along with SpO2 in CCHD screening was studied. <strong>Methodology:</strong> The Masimo, RADICAL-7 pulse oximeter was used to record the SpO2 and PI in the right hand and left foot of asymptomatic babies at 24 S Ramesh J Kumutha ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 200 203 Effect of intravenous fluid supplementation in healthy term neonates with non-hemolytic hyperbilirubinemia: A randomized controlled trial <p><strong>Objective:</strong> The objective of this study was to evaluate the effect of intravenous fluid supplementation in healthy term neonates with non-hemolytic hyperbilirubinemia receiving phototherapy. <strong>Study Design:</strong> Randomized controlled trial conducted in a tertiary level neonatal care unit of a teaching institute in North Karnataka. <strong>Methods:</strong> A total of 60 healthy term neonates with non-hemolytic hyperbilirubinemia (total serum bilirubin [TSB] &gt;15 mg/dL [256 &#956;mol/L] Meenakshi Sarvi Shailesh S Patil Arunkumar Desai ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 204 207 Phototherapy induced hypocalcemia in neonates: A case <p><strong>Objective:</strong> The objective of the study was to evaluate the adverse effects of phototherapy both total and ionic calcium levels in neonates. <strong>Methods:</strong> A case Madhu Goyal Rambabu Sharma D R Dabi ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 208 212 Perinatal testicular torsion - Not an uncommon entity <p>Perinatal testicular torsion is a rare condition with an incidence of 1 in 7500 live births. 70% are prenatal and 30% postnatal. Postnatal torsion presents as an acute scrotum, whereas prenatal torsion may be usually missed as it is a non-tender hard mass. Management of prenatal torsion is controversial. We are reporting three such case series presenting within a period of 1 year. Prenatal testicular torsion is usually missed as it is asymptomatic and later presents as cryptorchid. Careful postnatal physical examination and documentation is essential, as a missed case can later present as cryptorchid and may lead to medicolegal issues. In torsion in the immediate perinatal period, the testis may be salvaged if promptly operated.</p> Muhammed Rafi P M C Nair Jemila James Anand N Mathan P George Ashrin AN ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 213 215 Association of Hirschsprung disease with Waardenburg syndrome and role of gene studies: A review of 2 cases <p><strong>Background:</strong> Waardenburg-Shah syndrome type 4 is an association of Waardenburg syndrome with Hirsch sprung disease. Three disease-causing genes have been identified so far: Endothelin receptor type B encoding the endothelia-B receptor, EDN3 encoding an endothelia receptor ligand and Sry-like HMG bOX10 (SOX10) encoding the SOX10 transcription factor. <strong>Case Report:</strong> This is a review of 2 cases with variable onset of presentation and extent of aganglionic segment. <strong>Intervention/Outcome:</strong> In case 1, primary pull-through, as definitive surgical correction was done as a single procedure, whereas in case 2, required ileostomy with a plan of definitive surgery later on. <strong>Message:</strong> Mutation studies are helpful in characterization of the syndrome and counseling to the family. Furthermore, prognosis depends on the length of the ganglionic segment.</p> Niraj Kumar Dipak Siddharth Parab Amol Nage Abnish Kumar ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 216 219 Congestive cardiac failure induced by antitubercular therapy in a child: A case report <p>Tuberculosis is a significant public health concern affecting people of all age groups in developing countries. Agranulocytosis and pancytopenia occurring in adult tuberculosis patients taking antitubercular therapy (ATT) are well known. In contrast, only a couple of reports are available in the literature documenting pancytopenia in children with tuberculosis receiving ATT. These have reported pancytopenia secondary to disseminated tuberculosis presenting as hemophagocytosis or due to drug-induced systemic lupus erythematosus. However, clinically significant pancytopenia in the absence of hemophagocytosis and secondary lupus along with concurrent hepatitis leading to congestive cardiac failure in pediatric age group as witnessed in the index patient occurring due to ATT has not been reported previously. This child developed severe anemia presenting as congestive cardiac failure requiring multiple packed red blood cell transfusions. This case reinforces the need for regular hematological and liver function test monitoring in children receiving ATT so as to prevent the development of complications such as congestive cardiac failure.</p> Roosy Aulakh Isha Kapoor ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 220 222 Scimitar syndrome - A rare cause of recurrent pneumonia <p>Scimitar syndrome is a congenital anomaly characterized by anomalous drainage of the right lung into inferior vena cava. This may be associated with other anomalies in the form of pulmonary hypoplasia, systemic arterial supply of right lung, and congenital heart diseases. We report an infant with recurrent pneumonia who turned out to be a case of scimitar syndrome on further workup. The patient was managed surgically by selective embolization of the artery from celiac trunk to sequestered lung. This case report highlights the fact that scimitar syndrome should be suspected in a patient with recurrent pneumonia with typical chest X-ray findings.</p> Bhayana Swati Singh Aaradhana Aggarwal Anju Sachan Ravi ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 223 224 Congenital hypothyroidism presenting as isolated macroglossia in a term neonate: A case report <p>Macroglossia is a clinical condition in which the tongue protrudes beyond the teeth or alveolar ridge during resting posture, or there is an impression of a tooth on the lingual border with the mouth open. True macroglossia occurs in hypothyroidism, Beckwith Laxman Basani Roja Aepala ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 225 227 Case report of multiple hepatic microabscesses in a term neonate <p>Neonatal liver abscess is a rare entity, which usually occurs in preterm infants with sepsis and certain risk factors like umbilical vein catheterization. Neonatal hepatic abscess has a non-specific clinical presentation, and a high index of suspicion for this condition is warranted in case of unresolving sepsis especially in the presence of risk factors. Ultrasonography of abdomen is an important investigation in a febrile neonate with sepsis. Here, we report a case of hepatic microabscesses in a term neonate without any significant risk factors. We want to report this case because of its rare occurrence particularly in a term neonate without significant risk factors. This case also emphasizes the utility of abdominal ultrasonography in a febrile neonate with unresolving sepsis.</p> Sanjay Bafna S B Kirthana Vibha Bafna Sagar Lad Mergu Ravikanth ##submission.copyrightStatement## 2018-03-19 2018-03-19 5 3 228 230