Indian Journal of Child Health <p><strong>Indian Journal of Child Health (IJCH)</strong> is a quarterly, peer-reviewed, international journal, published by Atharva Scientific Publications on behalf of Atharva Scientific Society, 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> Atharva Scientific Publications en-US Indian Journal of Child Health 2349-6118 Neonatal screening for congenital hypothyroidism in India R Kishore Kumar Amit Agrawal ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 462 462 Safety and efficacy of intravenous pulse cyclophosphamide therapy in children with steroid-dependent nephrotic syndrome <p><strong>Background:</strong> Cyclophosphamide (Cyp) is a well-known alternative agent to spare the use of steroids and avoid the side effects that result from long-term steroid therapy in children with idiopathic nephrotic syndrome (NS). Use of Cyp typically reduces the risk of relapse in comparison with prednisolone by about 50%. <strong>Objective:</strong> To study the safety and efficacy of intravenous pulse Cyp (IV Cyp) therapy in children with steroid-dependent NS (SDNS). <strong>Materials and Methods:</strong> This was a retrospective single-center analysis from a large government hospital in South India. The data were retrieved from the records of children attending the pediatric nephrology clinic between 2005 and 2016. Children with SDNS who received the complete schedule of IV Cyp were included in the study. Children who received other alternate drugs were excluded. <strong>Results:</strong> Fifty patients with SDNS were treated with IV Cyp, seven patients did not complete the treatment and were excluded from the analysis. 24 (56%) of the 43 patients stayed in remission throughout the course of Cyp treatment and prednisolone could be stopped and were considered as Cyp responsive. The remaining 19 (44%) children had relapsed while on Cyp therapy (Cyp resistant) and required treatment with alternate immunosuppressant drugs. 19 of the 24 Cyp responsive patients were in remission 6 months after stopping Cyp treatment (Cyp sensitive) while the remaining five patients relapsed within 6 months of stopping Cyp treatment (Cyp dependent). 9 children (20.9%) were relapse-free till the time of last follow-up with a median follow-up of 2.1 years. Among 24 children, 13 (30.23%) who responded were infrequently relapsing NS and 2 (4.5%) children were frequently relapsing NS.</p> H Anil Kumar R Premalatha B M Nagabhushan ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 463 466 Students’ perspective of a competent medical teacher: A qualitative study <p><strong>Background:</strong> Current experience shows that at the end of the medical education process, there is relative lack of knowledge, skills, communication, and attitude which are necessary for an effective young doctor. It is the gap in medical teaching. Competency of medical teacher plays an important role in transforming the young medical student into an efficient young doctor to meet this gap.<strong> Objectives:</strong> To formulate the students’ perspective of a competent medical teacher. <strong>Materials and Methods:</strong> Qualitative descriptive study was conducted using focus group discussions. The study participants were consented medical students. <strong>Results:</strong> The transcribed text data were subjected to conventional content analysis and identified 278 meaning units. These codes were categorized and eight themes were generated regarding the students’ perspective of a competent medical teacher. They are good communication skill, adequate knowledge, attitude to demonstrate, concern for students, teaching skill, professional development, personal qualities, and interpersonal skill. <strong>Conclusion:</strong> The findings of this study can be discussed in teachers training activities under medical education units which may help to bring out attitudinal change and skill development among the medical teachers.</p> R Jayaprakash S Sharija ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 467 470 Follow-up assessment of pulmonary functions in mechanically ventilated children after discharge from pediatric intensive care unit: A developing country perspective <p><strong>Background:</strong> There is a paucity of data on the pulmonary function tests (PFTs) in pediatric mechanically ventilated patients, especially in a developing country setting.<strong> Materials and Methods:</strong> This prospective study was carried out in the pediatric intensive care unit over 15 months. The PFTs were measured using spirometry at discharge, at 3 and 6 months. <strong>Results:</strong> Of 32 eligible children, 20 (mean age 9 ± 2.62 years) completed the 6-month follow-up. The most common indications for mechanical ventilation were respiratory (45%) and neurological (35%) causes. At the end of 6 months, 65% children had abnormal lung function (restrictive pattern). Patients with longer duration of ventilation, high peak pressures, and high fractional inhaled oxygen had a trend toward more abnormality in the lung function.<strong> Conclusions:</strong> Pediatric mechanically ventilated patients developed restrictive pulmonary defects after discharge that gradually improved over time. The majority was asymptomatic and reported no lifestyle limitations. There is a need for longer follow-up studies to assess the lung function and clinical condition postdischarge.</p> Meenal Garg Siddharth Bhargava Puneet A Pooni Rashmi Ranjan Das Nihar Ranjan Mishra ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 471 477 Nutrient intakes from solid/semisolid foods and body fat of children 12-36 months of age in Mumbai city, India <p><strong>Background:</strong> Few reports are available on the association between feeding practices and body fat of young Asian Indian children.<br>Indian children have “thin-fat” syndrome, i.e., they tend to have higher body fat at lower body mass index, placing them at risk<br>of non-communicable diseases. <strong>Objectives:</strong> The objective of this study is to examine whether young children’s nutrient intakes<br>are associated with body fat. <strong>Materials and Methods:</strong> Percent body fat measured by bioelectric impedance and nutrient intakes<br>estimated from three 24-h diet recalls were studied in 1200 children, aged 12-36 months. Average intakes of macronutrients and<br>micronutrients were calculated. Nutrient intakes were compared by quintiles of body fat.<strong> Results:</strong> Mean body fat was 20.13±2.37%,<br>with older children having more body fat than younger children. Males had more body fat than females. Percent body fat was not<br>only correlated with macronutrient intakes but also was positively correlated with iron, zinc intakes, and thiamine. Body fat was<br>negatively associated with calcium, fiber, and Vitamin A intakes but was positively associated with intakes of animal protein<br>and from milk and milk products. Children in the highest quintile of body fat had lower calcium intakes those in lower quintiles.<br>Animal protein intakes increased from Quintile 1 to Quintile 4 of body fat. Male children aged 12-24 months in the second and third<br>quintile had higher mean protein intakes than in the other quintiles. Female children in the highest quintile of body fat had lower<br>mean animal protein intakes. Breastfed children aged 24-36 months old in Quintile 1 had lower protein intakes from milk and milk<br>products than in the other four quintiles. Among non-breastfed male children, those in the fifth quintile had lowest intake of milk<br>protein. <strong>Conclusion:</strong> Diets given to young children should be adequate in micronutrients and fiber, and there should not be too<br>much emphasis on dairy protein only.</p> Namrata Nitin Bagle Shobha Anand Udipi ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 478 487 Use of furosemide stress test for edema control and predicting acute kidney injury in children with nephrotic syndrome <p><strong>Background:</strong> Furosemide stress test (FST) involves measurement of 2‑h urine output after giving 1 mg/kg of furosemide in clinically<br>euvolemic patients and has been shown to identify those with severe and progressive acute kidney injury (AKI). <strong>Objectives:</strong> To<br>assess whether using FST could help in deciding whether to give diuretics only, or combination of diuretics with albumin infusion,<br>in children with nephrotic syndrome with edema to prevent AKI. <strong>Materials and Methods:</strong> This prospective, pilot cohort study was<br>conducted on the use of FST to manage edema in children with nephrotic syndrome. Consecutive patients 1–14 years were enrolled<br>from October 2016 to April 2017 from the pediatric nephrology outpatient department of a tertiary care center. They were assessed for<br>fluid overload using their present and baseline weight. Patients with fluid overload of ≥10% were screened for AKI by measurement<br>of serum urea and creatinine and monitoring of urine output in the next 24 h. Systemic infections were excluded using clinical and<br>laboratory criteria. AKI was defined using the pediatric RIFLE score. Children with fluid overload of ≥10% were given intravenous<br>furosemide 1 mg/kg provided; they had no clinical signs of intravascular dehydration or shock. Urine output was measured over the<br>next 2 h. Children with urine output &lt;1 ml/kg/h after FST were presumed to be at risk for progressive AKI. Differences between<br>the average heart rate, serum albumin, and urea/creatinine ratio were analyzed by independent t‑test. <strong>Results:</strong> A total of 67 children<br>with nephrotic syndrome were reviewed, and 34 with fluid overload of &gt;10% were analyzed for inclusion in the study. Of them,<br>11 were excluded and 23 were finally analyzed. 19/23 had urine output &gt;1 mg/kg/h in next 2 h and none had serum creatinine<br>increase &gt;0.3 mg/dl or &gt;150% of the baseline value. 4 had urine output &lt; 1 ml/kg/h. Significant difference was found in the post‑FST<br>heart rate and urea/creatinine ratio between the children who had urine output &gt;1 ml/kg/h and which had &lt; 1 ml/kg/h after furosemide.<br>These children were assumed to be at risk for severe and progressive AKI as per FST and were thereafter given furosemide with<br>albumin to prevent further intravascular dehydration. <strong>Conclusion:</strong> FST may be used as a bedside test to help identify the children<br>with nephrotic syndrome with intravascular dehydration who are at high risk for AKI and helps rational use of diuretics.</p> Suprita Kalra Amit Sood K Venkat Narayan R K Gupta ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 488 491 Effectiveness of video-assisted teaching program on dental hygiene among children <p><strong>Introduction:</strong> Worldwide, dental problems affect children’s health, causing millions of school hours to be lost each year. An<br>effective community prevention program as a planned procedure prevents the onset of a disease among a group of individuals<br>and the most cost-effective method is health education. <strong>Objectives:</strong> Assess the effectiveness of video-assisted teaching program<br>on dental hygiene among primary schoolchildren. <strong>Methods and Materials:</strong> An experimental study was carried out in 60 primary<br>schoolchildren between the age group of 5 and 10 years by dividing them into experimental and waitlisted control group. Pretest-<br>post-test waitlisted control group design and simple random sampling were used. Standardized plaque index score and semistructured<br>knowledge questionnaire used as tool. <strong>Results:</strong> The experimental group pre-test means rank (30.23) was significantly<br>lower than the overall post-test rank (44.00) according to Mann–Whitney U-test. The control group pre-test means rank (30.77) was<br>significantly higher than the post-test means rank (17.00) U = 442 (Z = −0.118), p &lt; 0.01. The difference between the experimental<br>and waitlisted control group was large (μ = 0.906). <strong>Conclusion:</strong> The level of awareness among schoolchildren regarding correct<br>dental hygiene practices is low. The video-assisted teaching program was found to be effective in improving the dental hygiene of<br>the schoolchildren as measured by plaque index score. The knowledge regarding the importance of maintaining dental hygiene will<br>help more and more schoolchildren to follow the correct dental hygiene practices.</p> Lt. Col. Keka Chatterjee Lt. Col. Mary Selvadhas Lt. Col Rajanimole R Major Sarita Sharma Capt. Mahima Shukla ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 492 495 Infant feeding practices in an urban tertiary care hospital: A descriptive longitudinal study <p><strong>Background:</strong> Infant and young child feeding are the corner stone for child development. More than a third of the world’s<br>undernourished children reside in India. Inadequate infant and young child feeding practices with inadequate care and management<br>of common illnesses contributes to malnutrition. <strong>Objective:</strong> To study the prevailing infant feeding practices and determine influence<br>of factors on infant feeding in a tertiary care hospital. <strong>Materials and Methods:</strong> A descriptive longitudinal follow-up study was<br>conducted in a tertiary care hospital between November 2010 and April 2012. Maternal and baby’s profiles were obtained using<br>oral questionnaire after birth by personal one-to-one interview. These cases were followed up for their infant feeding practices till<br>1 year of age in outpatient department and also by telephonic conversation. Continous variables were analysed by mean and SD. For<br>categorical variable frequency and percentage were determined.<strong> Results:</strong> 61.25% mothers had initiated breastfeeding within 1 h.<br>Prelacteal feed was given to 28.6% babies. 61.5% had initiated complementary feed at 6 months. Bottle feeding was preferred mode<br>of feeding. There was a statistically significant association between initiation of breastfeeding and parity (p=0.022) and type of<br>delivery (p&lt;0.0001), religion and complementary feeding introduction (p&lt;0.001), religion and duration of exclusive breastfeeding<br>(EBF) (p=0.003), occupation and EBF duration (p=0.005), education (p=0.015), and religion (p=0.001) were associated with<br>prelacteal feeds. <strong>Conclusions:</strong> Infant feeding practices observed from the study include early initiation of breastfeeding, appropriate<br>duration of EBF, and timely introduction of complementary feed. Practice of prelacteal and bottle feeding was seen. Infant feeding<br>practices are found to be influenced by several socio-demographic factors.</p> Jayashree Hegde L Manjula K R Venkatesha ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 496 502 Clinico-epidemiological profile of snake bite in children - A descriptive study <p><strong>Background:</strong> Snakebite is one of the important causes of occupational hazard in our country. The state of Bihar has the third largest number of snakebite deaths in India. <strong>Objective:</strong> Our aim was to study the clinical profile, seasonal pattern, complications and outcome in patients of snake bite in pediatric age group. <strong>Materials and Methods:</strong> This was a record-based retrospective study conducted at Sri Krishna Medical College, Muzaffarpur. Data were collected for patients admitted between 1 July 2015 and 30 June 2016. Patients were included if they had a history of snakebite or unknown bites. <strong>Results:</strong> There were 51 males (60%) and 34 females (40%) out of 85 patients studied. Among them, 50 patients had krait bite, 25 patients had Cobra bite, 2 patients had viper bite, and in 8 patients snake was not identified. Majority of the snake bites were in the lower limbs (80.0%). The highest number of cases occurred during June-October month (42%). Mortality in our study was 6%. The most common symptom detected was pain abdomen (80%), ptosis/ophthalmoplegia (82.35%), altered sensorium (29.41%), and respiratory difficulty (35.29%). <strong>Conclusions:</strong> Common krait (Bungarus caeruleus) accounted for the highest number of venomous bites. Lower limb was the most common bitten site. Victims were from a rural background, and most of them were bitten indoors and during the night time. Identification, timely diagnosis and early administration of anti-snake venom will certainly aid to curb mortality in snake bite.</p> Gopal Shankar Sahni ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 503 506 Prevalence of childhood asthma and its immediate outcome - At tertiary care rural hospital <p><strong>Introduction:</strong> Asthma is a chronic inflammatory disorder of the airways resulting in episodic airway obstruction. Globally, childhood asthma is increasing in the prevalence, despite improvements in investigation and treatment. Childhood asthma seemed more prevalent in urban population and now even in rural areas of India. <strong>Objectives:</strong> To know the prevalence, assess the risk factors, severity, and immediate outcome of the treatment offered to asthmatic children in a tertiary rural hospital. <strong>Materials and Methods:</strong> All the diagnosed asthmatic children up to 18 years were enrolled in the study. All the patients of pulmonary Koch’s, congenital heart disease and chronic lung disease were excluded from the study. Clinical profile was noted in recruited patients. <strong>Results:</strong> The prevalence of childhood asthma among children visiting to our department was 3.93%. 58 (48.33%) had age of onset before the age of 6 years. Asthma was more prevalent in boys. 116 (96.66%) children presented with complain of cough, and 118 (98.33%) children had associated breathlessness. Common precipitating factors were change in season (71.66%), pollen allergy (58.33%), air pollutieon (45.00%), and passive smoking (23.33%). Exercise-induced asthma was seen in 55% cases, diurnal variation in 60% and 28.33% children had family history of atopic disease. Majority of the patient was undernourished. The average duration of stay in persistent asthma is 1.8 times more than in intermittent asthma. <strong>Conclusion:</strong> Significant number of patient becomes symptomatic before the 6 years of age. Prevention of child from exposure to passive smoking, environmental improvement, and allergen avoidance are major aspects for prevention of asthma exacerbations.</p> Prasad Muley Hemal Dave Maitrey Patel Unnati Shah Jigar Dosi Ankur Mehta ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 507 510 Clinicopsychological profile of children with bleeding disorders from a tertiary center in Karnataka <p><strong>Objectives:</strong> The aim of this study is to observe the clinical spectrum of presentation of hemophilia and other bleeding disorders in children. <strong>Material and Methods:</strong> This observational study was carried out in the Comprehensive Hemophilia Center at Bangalore Medical College and Research Institute from December 2015 to August 2016. Clinical profile of 126 diagnosed children of hemophilia and other bleeding disorders &lt;18 years of age was analyzed. <strong>Results:</strong> Among the 126 cases of bleeding disorders, 123 were male and 3 were female. 101 (80.2%) cases were of hemophilia A, 15 (11.9%) cases were hemophilia B, and 3 (2.4%) were of Von Willebrand disease. Other rare deficiencies were seen in 7 (5.5%) cases. Mean age at diagnosis was 2.5 years (range-1 month to 8 years). Only 45.2% of cases had a family history of bleeding. Inhibitors were seen in 9 (7.14%) cases with hemophilia A. Joint bleeding (52.9%) either spontaneous or after trauma was the main forms of bleeds with hemarthrosis of knee joint being most common. Psoas muscle bleeds in 10 (33.3%) followed by hematemesis and melena in 7 (23.3%) were the most common critical bleed seen in our patients. Numerous psychosocial issues such as school absenteeism (68.25%), family dysfunction (50.8%), depression, low self-esteem, parental separation (21.4%), and divorce (2.4%) were noticed. Mothers were blamed for the disease and victimized in 10 (7.9%) cases. <strong>Conclusion:</strong> Joint bleeding was the most common bleed with hemarthrosis of knee joint being the major presentation. Psoas muscle bleeds were the most common critical bleed. Major life-threatening bleeds such as intracranial bleed and liver bleeds were seen only in patients with severe hemophilia A. Numerous psychosocial issues were noticed quite often and need equal attention as a medical treatment to optimize hemophilia care.</p> Meera Varadarajan S R Rakesh Premalatha Ramaswamy Raj Mohammed Smita Ramiah ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 511 514 Mean platelet volume as short-term follow-up biomarker in children with celiac disease <p><strong>Objective:</strong> To assess the mean platelet volume (MPV) as a short-term follow-up biomarker in celiac disease (CD) and to compare it with anti-tissue transglutaminase antibody (TTGA) assay in Indian children. <strong>Material and Methods:</strong> Newly diagnosed 35 children aged &lt;12 years who were positive for TTGA and further confirmed by intestinal biopsy with histological Grade 2 and 3 based on modified Marsh Classification were enrolled. TTGA, MPV, and clinical parameters were assessed at enrollment and after 3 months of gluten free diet (GFD). <strong>Results:</strong> Short stature (94.3%) and diarrhea (80%) were the most common presenting features. 33 (94.3%) children were found to have anemia. MPV reduced significantly from 9.28±1.88 fl to 8.55±1.10 fl after 3 months of GFD, (p&lt;0.001). The mean TTG level reduced from 166.80±59.23 U/ml to 86.45±39.67 U/ml (p&lt;0.001) after 3 months of GFD. <strong>Conclusion:</strong> MPV is one of the biomarkers that can be used to monitor dietary transgressions in CD in short term.</p> Mohanaraj Ramachandran Anurag Agarwal R N Mandal Ravi K Rajeshwari Avinash Lomash Seema Kapoor ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 515 517 Hygiene and health: Effects, experiences, and expertise of “Clean India Campaign” from a tertiary care hospital <p><strong>Background:</strong> The current happenings in the country for the good should be of importance in the crucial places and the critical<br>phases of life, i.e., hospitals and during hospitalization, even for normal life processes. The current “Clean India Campaign” is<br>a catalyst for hospitals for improvements in hygiene. <strong>Objective:</strong> The objective of this study is to define and describe the impact<br>of multifaceted infection control and hygienic practices by all on hospital-acquired infections (HAIs) in the pediatric age group.<br><strong>Materials and Methods:</strong> Implementation of multifaceted infection control policies was ensured along with the health education<br>for hygienic practices by all, including attendants of patients and patients when possible. These were rigorously enforced with<br>the renewed enthusiasm since the launch of “Clean India Campaign” from January 2015. The setting was “Paediatric Wing” of a<br>tertiary care hospital catering to a large army cantonment, and also, referred cases. The outcome measures were the incidence of<br>HAIs. <strong>Results:</strong> The incidence rate of HAIs was 2.91% (July 2013-December 2014) and declined to 1.59% (January 2015-June<br>2016) (relative risk: 0.547, 95% confidence interval: 0.409-0.733; p=0.0001). The most significant decline in HAI in our study<br>has been in that of gastrointestinal infections (RR: 0.428%, 95% CI: 0.241-0.761; p=0.0034). Overall, the results of preventive<br>actions were rewarding (RR: 0.547, 95% CI: 0.409-0.733; p=0.0001). <strong>Conclusion:</strong> The mission “Clean India Campaign” and the<br>WHO’s vision “clean care is safer care” lead to prevention and reduction of HAIs. Implementation of multifaceted infection control<br>interventions is impactful. Hygienic practices teaching should be for both caregivers and caretakers.</p> Col. Sunil Jain Col. Rajeev Kumar Thapar ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 518 522 Feeding practices among tribal mothers of malnutrition prevalent region of Amravati District in India <p><strong>Introduction:</strong> Due to lack of intra- and post-natal care, the feeding practices can lead to a number of morbidities in the infancy period. Infant care in the community is influenced by cultural practices prevalent in the specific area apart from medical and economic reasons. <strong>Objectives:</strong> The objectives of this study were to understand prevalent feeding practices among tribal mothers having children &lt;3 years of age and to explore reasons behind these practices. <strong>Methods:</strong> This community-based cross-sectional descriptive study was done in the northern tribal region of Amravati district. A total of 312 mothers were selected randomly for the study. Data were collected through face-to-face interviews of mothers who had a child of age &lt;3 years using the structured interview. <strong>Results:</strong> Nearly 35% of mothers gave colostrum to the baby after 1 h of birth. While 39% of mothers were not found to be feed colostrum to the baby due to family tradition or advice of the elders, and 68% rejected colostrum feeding because they thought it was not clean. As high as 90% of the mothers initiated complementary feeding to the baby between 6 and 8 months of age, whereas 59% of children suffered from illness during 6 months immediately preceding the study. <strong>Conclusion:</strong> Inappropriate feeding practices need to be corrected to ameliorate the nutritional and health status of infants in a tribal region in India.</p> Pankaj Mahure Yashashree Gurjar Jitendra Sawkar ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 523 526 A study of frequency of occurrence and severity of thrombocytopenia in malaria in 2 months to 18-year-old children in a tertiary care centre at rural Haryana <p><strong>Objective:</strong> To study the frequency and severity of thrombocytopenia in children between age groups of 2 months and 18 years with malaria. <strong>Materials and Methods:</strong> It was a prospective study conducted at tertiary care centre of rural Haryana. Data of confirmed cases of malaria with regard to age, sex, and platelet count were recorded in pre-defined pro forma. <strong>Results:</strong> Out of total 79 confirmed cases of malaria, 67 (84.81%) cases of Plasmodium vivax, 10 (12.65%) cases of Plasmodium falciparum, and 2 (2.53%) cases of mixed type were observed. Total 58 (73.41%) cases had thrombocytopenia. A total of 50 (74.62%) and 6 (60%) cases had thrombocytopenia in P. vivax and P. falciparum, respectively. Total 17 patients (P. vivax - 14, P. falciparum - 2, and mixed - 1) had severe thrombocytopenia (platelet count &lt;50,000/μl). Maximum number of the patients belonged to the adolescent age group and was found to statistically significant. <strong>Conclusion:</strong> Thrombocytopenia is a sensitive indicator for diagnosis of malaria. In a febrile patient with thrombocytopenia, malaria should always be suspected.</p> Raghvendra Narayan Shivani Singh ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 527 529 Clinical profile of different type of tuberculosis in hospitalized children in tertiary care center <p><strong>Background:</strong> Since the implementation of directly observed treatment short (DOTS) program, the prevalence, clinical profile,<br>and risk factors of pulmonary and non-pulmonary tuberculosis (TB) necessitating hospitalization in pediatric patients are not<br>evaluated extensively. <strong>Materials and Methods:</strong> We designed a prospective observational study to evaluate the clinical profile of<br>different types of TB in hospitalized children &lt;12 years old. Different types of TB in children hospitalized from 1st January 2013<br>to 30th June 2014 were recorded. Detailed clinical history, clinical examination findings, diagnostic methods, and treatment of<br>these cases were analyzed by age groups and types of TB. <strong>Results:</strong> During the study period, 150 (2.8% of total admission) patients<br>with TB were admitted in our institute. 87 (58%) patients were &lt;5 years old, and 92 (61.33%) children were male. 140 (93.33%)<br>children were malnourished. The clinical profile of TB included neuro TB in 78 (37.32%), pulmonary in 67 (32.05), abdominal<br>in 27 (12.91%), and disseminated in 27 (12.91%) patients. Less than half of children with neuro TB and disseminated TB were<br>immunized with Bacillus calmette-guerin (BCG).<strong> Conclusion:</strong> Despite aggressive DOTS implementation, the prevalence of TB,<br>particularly, non-pulmonary TB in children is quite alarming. All the variants of TB are prevalent in the children. The neuro TB and<br>the pulmonary TB dominate in the hospitalized cases. Younger age, lack of protection of BCG vaccination, and malnutrition are<br>the main risk factors in childhood TB.</p> Rashmi S Thanvi Ashish Jain Shital M Patel Nehal H Patel Geet Gunjana Krina Patel ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 530 534 Predisposing factors and clinical profile of acute severe asthma <p><strong>Background:</strong> Asthma is a chronic inflammatory condition of the lung airways resulting in episodic airflow obstruction. It is also one of the leading causes of morbidity in children and hospital admissions. Current treatments, although helpful, are still unable to prevent childhood asthma exacerbations completely. <strong>Objectives:</strong> To study the clinical profile and predisposing factors for acute severe asthma in children. <strong>Methods:</strong> This prospective study was conducted between January 2015 and December 2015 in a tertiary care teaching hospital. Children between the age group of 5 and 18 years admitted with symptoms and signs of acute severe asthma formed the study group. Detailed history and examination were recorded in a systematically designed pro forma, and these patients were evaluated for the predisposing factors. <strong>Results:</strong> Out of 100 children with acute severe asthma, the predominant age group was between 5 and 10 years (68%). Boys are more commonly affected than girls in the ratio of 1:1.2. The most common predisposing factors were family history of asthma (60%), atopy (32%), and dermatitis (23%). The common risk factors responsible for acute exacerbations were viral infections (83%), poor drug compliance (68%), and exposure to house dust (61%). 55% of the children had acute exacerbation during the winter season. The common comorbid conditions were rhinosinusitis (35%), obesity (23%), and gastroesophageal reflux (9%). Eosinophilia was seen in 62% of the children with acute severe asthma. <strong>Conclusion:</strong> In the present study, majority of the asthmatics were males and belonged to urban area. Viral infections were the predominant factor for exacerbations and others like family, and previous history of atopy/allergic rhinitis/dermatitis, food allergy, indoor and outdoor pollution, seasonal variations, and comorbid conditions like obesity and rhinosinusitis were the common predisposing risk factors.</p> S K Sreenivas K Anjana Murthy T Renuka ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 535 538 Role of lactation educators in urban India: A comparative study <p><strong>Objective:</strong> To study the impact of postnatal lactation counseling by certified lactation educator on the establishment of breastfeeding in urban areas.<strong> Design:</strong> Retrospective observational study<strong> Setting:</strong> Maternity ward of a multispecialty Private Hospital in Thane City of Maharashtra. <strong>Materials and Methods:</strong> During March 2014 to February 2015, data were collected retrospectively from the hospital records of 283 mothers (study group) who had delivered healthy newborns at full term with birth weight of &gt;2.5 kg and had received structured lactational counseling from the lactation educator. This was compared with the data from March 2013 to February 2014 when 235 mothers (control group) received lactational counseling from the maternity staff after delivery. <strong>Main Outcome Measures:</strong> Reduction in the volume of supplemental formula feed during the hospital stay and number of babies discharged on exclusive breastfeeding (i.e., no supplemental formula feed given in the 24 h before discharge). <strong>Results:</strong> The mean volume of supplemental formula consumed was significantly lesser (p&lt;0.001) in the study group (median 50 mL, interquartile range [IQR] 0-130) than control group (median 110 mL, IQR 20-190). The study group had 205 out of 283 babies (72.4%) who were discharged on exclusive breastfeeding as compared to 113 out of 235 babies (48%) in the control group, which was significantly higher (p&lt;0.001, relative risk [RR] 1.6, 95% confidence interval - 1.4, 2.0). <strong>Conclusion:</strong> Lactation educators are more effective than maternity staff for the improvement in breastfeeding practices; especially, in the private sector hospitals of urban areas.</p> Mamata Rajadhyax Neeta Saboo Jaju Lukmita Pawaskar Satish Mali ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 539 541 Neonatal screening for hypothyroidism by time - Resolved fluoroimmunoassay in Jharkhand <p><strong>Objective:</strong> To screen newborns for congenital hypothyroidism by time resolved fluoroimmunoassay (TRFIA) (TRFIA meter by<br>Perkin Elmer). <strong>Methods:</strong> Participants were randomly selected from the Department of Paediatrics/Obstetrics and Gynaecology,<br>Rajendra Institute of Medical Sciences and Maternity Hospitals around 20 km of Rajendra Institute of Medical Sciences, Ranchi.<br>Blood samples were obtained by heel prick for thyroid-stimulating hormone (TSH) estimation from newborns selected from abovementioned<br>hospitals. Samples were collected from 3rd day of life to 7th day of life on a filter paper card and analyzed by TRFIAbased<br>method.<strong> Results:</strong> 60% of the newborns were male and 40% were female among 150 newborns selected for study. Out of<br>them, 65.33% were term, 28% were pre-term, and 6.67% were post-term. 92% newborns had TSH level &lt;10 mIU/L, 8% had TSH<br>between 10 and 20 mIU/L and none had TSH value &gt;20 mIU/L. <strong>Conclusion:</strong> The prevalence of borderline TSH assay was 80/1000<br>newborns, which is significant. Screening studies for such conditions need larger sample size, stronger logistics to cover a larger<br>area.</p> Rameshwar Prasad Amar Verma Anita Verma ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 542 544 Role of learning material delivered by short message service in addressing to the gaps in the knowledge of nursing personnel related to newborn care by one of the reviewers in a selected neonatal intensive care unit of tertiary care facility <p><strong>Objectives:</strong> The present study was undertaken (i) to evaluate the role of short message service (SMS) in improving the knowledge scores of nurses in the key areas of newborn care (NBC) and (ii) to explore the perception of nurses regarding the delivery of SMS on NBC. <strong>Methods:</strong> This pre-experimental (one group pre-test post-test) study was conducted on 30 nurses working in a tertiary level neonatal intensive care unit (NICU). The effectiveness of SMS delivery in reducing the gaps in the knowledge of nurses related to NBC was measured in terms of gain in knowledge scores using a structured knowledge questionnaire. The perception of nurses toward the delivery of information on NBC using SMS was also assessed on 5 point likert scale. <strong>Results:</strong> The knowledge scores of nurses improved significantly after the SMS delivery on NBC (pre and post, 9.6±2.2, 17.13±1.2; p&lt;0.005). The nurses’ overall perception about SMS delivery on NBC was good. <strong>Conclusion:</strong> SMS delivery on NBC has a potential role in updating and refreshing the knowledge of nurses working in NICU.</p> Poonam Joshi Meena Joshi Anu Thukra Ashok K Deorari ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 545 548 Validity of transcutaneous bilirubin in the first few days of life <p><strong>Objective:</strong> To study the validity of transcutaneous bilirubin (TCB) at different time points between 24 and 96 h of life. <strong>Materials and Methods:</strong> The study was conducted in a tertiary newborn center from November 2014 to June 2016. We have included all babies above 34 weeks of gestation while babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/gastrointestinal malformations and those on phototherapy were excluded from the study. After taking into consideration the inclusion and exclusion criteria, 396 babies were recruited. The correlation was analyzed using the ROC curves, and r values and plots of agreement were done using Bland Altman charts. <strong>Results:</strong> A total of 662 paired TCB and serum bilirubin readings were performed in 396 healthy neonates, at designated time points between 24 and 96 h of life. Mean TCB was found to be uniformly higher than total serum bilirubin (TSB) for all variables such as sex, birth weight, gestational age, and growth of the baby with an excellent correlation (r=0.698-0.932). The correlation between TCB and serum bilirubin improved as age increased with maximum correlation at 96 h (r=0.981). Test of agreement showed that at 24 h the TCB overestimated serum bilirubin by 1.5±0.7 mg/dl which decreased to 0.8±0.6 mg/dl by 96 h. <strong>Conclusion:</strong> TCB and TSB correlated significantly between 24 and 96 h of age. However, there is overestimation by TCB initially which decreases at 96 h.</p> Pearl Mary Varughese Peter Prasanth Kumar Kommu K Ravichandran Lalitha Krishnan ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 549 553 Comparative study of cord blood hematological profile of neonates born to mothers with and without pregnancy-induced hypertension: A prospective case–control study <p><strong>Background:</strong> The neonates born to mothers with pregnancy-induced hypertension (PIH) are prone to have abnormalities in their<br>umbilical cord blood hematology. However, the exact pattern of the derangements and their clinical correlations has not been<br>defined. <strong>Objectives:</strong> The purpose of this study is to compare the hematological profile of cord blood of neonates born to mothers<br>with and without PIH (gestational hypertension, pre-eclampsia, and eclampsia), and to evaluate short-term clinical outcomes in<br>the two groups.<strong> Methods:</strong> A prospective case–control study was done on cord blood of 155 neonates born to mothers with PIH<br>(cases) and compared with that of 155 neonates born to normotensive mothers (controls). 2 ml cord blood was collected at birth<br>and was analyzed for - hemoglobin (Hb), various red cell indices including nucleated red blood cell (NRBC), reticulocyte count,<br>total leukocyte count (TLC), differential leukocyte count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC),<br>platelet count, and cord blood smear examination. The cases and controls were followed up during their hospital stay for the clinical<br>outcome. <strong>Results:</strong> The mean red cell distribution width, NRBC, and reticulocyte count in cases were 14.64±2.14%, 11.18±2.33/100<br>white blood cells (WBCs) and 5.18±0.49% as compared with 11.84±0.78%, 4.32±1.32/100 WBCs, and 3.83±3.59% in controls<br>(p&lt;0.05). The mean TLC, ANC, and ALC in cases were 11642.70±6049.96/μL, 5682.30±2936.56/μL, 4955.91±2735.42/μL as<br>compared with 13677.56±5711.14/μL, 6905.12±2932.99/μL, 6276.89±2649.98/μL in controls (p&lt;0.05). The mean platelet count<br>in cases was 164660.65±73817.05/μL as compared with 181148.39±60921.05/μL in controls (p&lt;0.05). Erythrocyte changes were<br>found in 78 (50.32%) cases and 44 (28.38%) controls (p&lt;0.05).The relative risk (RR) of sepsis in PIH with respect to controls was<br>&gt;1 (1.64), with a significant increase in mortality as compared to controls.<strong> Conclusions:</strong> PIH increased the RR of sepsis (although<br>not significantly) and mortality rate in the neonate, which can be related to cord blood hematological profile findings of leukopenia,<br>absolute neutropenia, and thrombocytopenia, and increased NRBC count.</p> Naim Eman Ali Syed Manazir Firdaus Uzma Noor Nasreen ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 554 560 Predisposing factors and outcome of hypernatremia in breastfed late preterm and term neonates <p><strong>Background:</strong> Inadequate breastfeeding results in hypernatremia in otherwise healthy neonates. <strong>Objective:</strong> This study finds out the predisposing factors and clinical outcome of hypernatremia in breastfed late preterm and term neonates. <strong>Materials and Methods:</strong> A descriptive study was conducted in a tertiary hospital with retrospective data from July 2013 to June 2016. Babies with serum sodium ≥ 150 mEq/L were identified. Breastfed babies with little or no formula feeds, gestational age ≥ 34 weeks, and birth weight ≥ 2000 g were included. Babies with congenital anomalies, sepsis, prior parenteral fluid therapy and renal or endocrine diseases causing fluid and electrolyte disturbances were excluded. Total weight loss &gt; 10% or daily weight loss &gt; 5% from the birth weight were considered as excess weight loss. <strong>Results:</strong> A total of 201 babies were studied. Hypernatremia was significantly more common in babies of primiparous mothers (p &lt; 0.01). There was no difference in incidence between vaginal born and cesarean‑born babies. Positive correlation was seen between age at presentation, percentage of weight loss (p = 0.001) and serum sodium (p = 0.01). Significantly more cases were seen in summer season (p &lt; 0.01). Excess weight loss, jaundice, fever, and dehydration were the common symptoms. Complications observed were acute kidney injury, seizures, intracranial bleed, apnea, and bradycardia. Babies with complications mostly presented after 7 days of age, had &gt; 25% weight loss and had serum sodium ≥ 170 mEq/L. There was no death. Three babies had neurodevelopmental problems on follow‑up. <strong>Conclusion:</strong> Breastfed babies of primiparous mothers and born in summer are predisposed to hypernatremia. Babies presenting at a later age had severe weight loss, severe hypernatremia, and complications.</p> S Ramesh K Suvetha ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 561 565 Prevalence and presentation of cutaneous lesions in healthy neonates: A single-center study from Eastern India <p><strong>Background:</strong> Skin lesions are much common and specific to neonates. They vary according to age, sex, and geographic<br>region. <strong>Objectives:</strong> The objective of this study was to determine the prevalence of different cutaneous lesions in newborns and<br>their association with the type of delivery, age, sex, and maturity. <strong>Materials and Methods:</strong> This study was done in neonatal<br>follow-up clinic of department of Pediatrics, Maharaja Krushna Chandra Gajapati Medical College, Berhampur, Odisha. All<br>the healthy newborns coming to the OPD from January 2015 to December 2016 were included in this prospective study, and<br>their details were recorded in case recording format after taking informed consent from their guardians. Admitted patients were<br>excluded from the study. Statistical assessments were the done by SPSS software. <strong>Results:</strong> Out of 500 neonates, skin lesions<br>were found in 366 (73.2%) patients. Physiological cutaneous lesions were most common, consisting 259 (70.7%) neonates. Out<br>of the physiological lesions, benign transient lesions were seen in 163 (44.6%), out of which 95 (25.9%) had papulopustular<br>dermatoses followed by erythema toxicum in 48 (13.1%) cases. Birthmarks were seen in 138 (37.8%) cases; pigmentary<br>birthmarks 89 (24.5%) being the most common birthmarks followed by Mongolian spots in 71 (19.4%) cases. Pathological<br>lesions were seen in 107 (29.3%) cases, of which nappy rash was detected in 65 (18.01%) cases. Term and male babies had a<br>higher incidence of skin lesions. <strong>Conclusion:</strong> Benign lesions are the most common group of neonatal cutaneous manifestations<br>which is followed by birthmarks. Conditions such as nappy rash and contact dermatitis are common pathological lesions and<br>majority of them are preventable. Differentiation of the physiologic skin lesions from the pathologic ones is essential to avoid<br>unnecessary therapeutic interventions.</p> Mishra Shubhankar Mishra Pravakar Bhol Deepak Ranjan Agarwalla Sunil K Panigrahy Sambedana Mishra Swayamsiddha ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 566 570 Cord bilirubin levels as a predictive marker for neonatal hyperbilirubinemia: A prospective study <p><strong>Background:</strong> Hyperbilirubinemia is the most common medical problem in newborn infants. Early discharge is recommended but hospital readmission is a cause of concern among clinicians. This in turn carries a risk of delayed recognition of significant hyperbilirubinemia. <strong>Objective:</strong> A cross-sectional analytical study was done to evaluate the predictive value of cord bilirubin level for identifying term and near-term neonates for subsequent hyperbilirubinemia. <strong>Materials and Methods:</strong> Cord bilirubin levels at birth and subsequently serum bilirubin levels at 72 h were assessed in 100 neonates. The cutoff value was estimated beyond which there was significant hyperbilirubinemia. <strong>Results:</strong> The cutoff value of cord bilirubin &gt;2.02 mg/dl had sensitivity and specificity of 87.5-70.8%, respectively, with positive predictive value of 0.39 and negative predictive value of 0.965 for subsequent hyperbilirubinemia. <strong>Conclusion:</strong> The cutoff value of cord bilirubin level estimated is 2.02 mg/dl can be used to predict significant neonatal hyperbilirubinemia.</p> Parul Sehgal Sanober Wasim Vipan Chandar Alpa Gupta Anil Rawat Vinita Kalra N K Bhat, Neerul Pandita ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 571 574 To study the incidence of retinopathy of prematurity in high-risk neonates and the risk factors associated with the disease <p><strong>Background:</strong> Retinopathy of prematurity (ROP) is a complex disease of the developing retinal vasculature in premature infant. The challenge in India is that a large number of neonatal intensive care units (NICUs) don’t have an effective ROP screening strategy. <strong>Objective:</strong> To measure the incidence of ROP in neonates with gestational age (≤32 weeks) or weighing &lt;2000 g with risk factors and evaluation of risk factor associated with ROP. <strong>Materials and Methods:</strong> This prospective study was conducted in the Department of Pediatrics and Ophthalmology from January to July 2016. Neonates with gestational age ≤32 weeks, birth weight (BW) ≤1500 g, and selected preterm infants with a BW between 1501 and 2000 g with risk factors admitted in NICU/special new-born care unit were included in the study and screened for ROP by trained ophthalmologist under supervision of the pediatrician. All data were analyzed using SPSS or MedCalc. Univariate and multivariate logistic regression was done to determine the risk factors for the development of any ROP. <strong>Result:</strong> The incidence of ROP in our study was 19%. 4% of the neonates have severe (early treatment for ROP [ETROP] Type 1) ROP while 15% have non-severe (ETROP Type 2) ROP. 8 neonates developed Stage 1 ROP (42.11%), 7 developed Stage 2 (36.84%), and 4 neonates developed Stage 3 ROP (21.05%). <strong>Conclusion:</strong> The current study revealed that the incidence of ROP in sick neonates was 19%. Significant risk factors were found to be low BW, low gestational age, supplemental oxygen, and mechanical ventilation, culture proven sepsis, anemia, apnea, and respiratory distress syndrome (RDS).</p> Kanwar Singh Shrey Gupta Sanjeev Jain B S Karnawat Shruti Sharma Mahendra Nimel ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 575 579 Diagnostic value of superficial cultures for late-onset sepsis <p><strong>Background:</strong> Late-onset sepsis (LOS) is associated with poor outcome and one of the prevalent causes of death in preterm<br>population; hence, there is always a need for early prediction of sepsis. The performance of routine superficial swab culture is one<br>of the strategies for the early prediction and may help in the selection of appropriate empirical antibiotics. <strong>Objective:</strong> The purpose<br>of the study is to evaluate the diagnostic value of superficial swab cultures for LOS. <strong>Methods:</strong> We conducted a retrospective cohort<br>study (November 2015-October 2016) in a tertiary neonatal intensive care. Inclusion criteria were preterm infants with gestational<br>age ≤34 weeks with a diagnosis of sepsis (culture-positive and culture-negative clinical sepsis). In our unit, weekly surveillance<br>swab cultures (skin swab, mouth swab, nasopharyngeal aspirate, and umbilical surface swab) are taken from all admitted neonates,<br>and usually, no interventions are carried out based on these culture results. We excluded infants with surgical diagnosis/congenital<br>anomalies and infants with early-onset sepsis.<strong> Results:</strong> After exclusion, there were 38 preterm infants fulfilling our inclusion criteria;<br>among them, there were 108 LOS episodes. Blood culture was positive in 33 episodes, and Staphylococcus epidermidis (21%) was<br>the most common organism cultured. In our study, superficial swab cultures had a very low diagnostic value, as sensitivity (42.9%),<br>specificity (28.7%), predictive values, and likelihood ratio that all the estimations were low.<strong> Conclusions:</strong> Superficial swab cultures<br>are associated with low diagnostic value for LOS. Superficial swab culture may be used surveillance of colonizing organism in the<br>neonatal unit and provides antibiotic sensitivity pattern.</p> Babatunde Kayode- Adedeji V Nair K Harvey- Wood Prakash Loganathan ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 580 583 Comparison of feeding methods in neonates - A retrospective cohort study from India <p><strong>Background:</strong> Preterm babies who are unable to breastfeed but are able to swallow are commenced on cup or paladai or bottle as<br>alternative feeding methods. Although the World Health Organization recommends the use of cup owing to reduced infection risk,<br>many neonatal units use the bottle for feeding. <strong>Objectives:</strong> The aim was to compare the two groups with regard to time taken to<br>commence oral feeds, breastfeeds, achieve full oral feeds, complications, gestational age at discharge, discharge weight, and infant<br>formula use at discharge.<strong> Material and Methods:</strong> This retrospective observational study was performed to compare two cohorts of<br>preterm babies who were fed either by bottle or paladai (small feeding cup with a long spout traditionally used in India) during their<br>transition from tube to breastfeeding. <strong>Results:</strong> During the study period, there were 68 babies in Center 1 where paladai was used<br>and 71 in Center 2 where bottle was used. The gestational age at which oral feeding was commenced, full oral feeds, gestational<br>age at discharge, and discharge weight were similar in both the groups. Breastfeeding was commenced significantly earlier in the<br>bottle-fed group (p&lt;0.05). The use of infant formula was also significantly more in this group. One baby aspirated in the paladai<br>group. <strong>Conclusion:</strong> With adequate training and attention to hygiene, paladai or feeding bottles could be equally safe methods of<br>feeding in hospitalized preterm neonates.</p> P C Nayana Prabha R Kishore Kumar Arvind Shenoi ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 584 586 Clinicoetiological profile of neonatal seizures in a tertiary care hospital <p><strong>Background:</strong> Seizure is one of the most frequently observed clinical sign in neonatal period and may be the only sign of a central nervous system disorder. Its recognition is of paramount importance and a newborn with seizures is in a true medical emergency requiring prompt intervention. <strong>Objective:</strong> To determine the clinical and etiological profile of seizures among neonates admitted to neonatal unit in a tertiary care hospital. <strong>Materials and Methods:</strong> It was a prospective, observational, hospital-based study conducted over a period of 1 year (December 2014-November 2015). Nearly, 63 babies either admitted with neonatal seizures or who developed seizures after admission were studied to find the clinical and etiological profile. Detailed history including gestational age, mode of delivery, birth events, Apgar scores and antenatal problems, age of onset, and frequency of seizures was also noted. Seizures were classified on the basis of detailed description by pediatric resident on duty in a predesigned pro forma. Informed written consent of parents was taken before enrolling a baby in study. <strong>Results:</strong> Sepsis was the most common cause of neonatal seizures (64.9%), followed by birth asphyxia, i.e., hypoxic ischemic encephalopathy (HIE) (48.3%). Hypoglycemia was seen in 21.6% and hypocalcemia in 18.3% cases. Subtle seizures were the most common type of seizures seen in 65% babies, followed by tonic (31.6%), myoclonic (16.6%%), and clonic (6.67%) type. Subtle seizures were commonly seen in cases of HIE. <strong>Conclusion:</strong> The recognition of clinicoetiology of neonatal seizures is often helpful with respect to prognosis and treatment. The most common etiology for neonatal seizure is sepsis. Onset of seizures during first 3 days of life has significant correlation with HIE as etiology. Subtle seizures are the most common type of clinical seizures, which is difficult to identify; therefore, careful observation of at risk newborns is necessary.</p> S Rastogi Preeti Lata Rai P L Prasad ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 587 590 Correlation of amplitude electroencephalography in first 24 h after birth in perinatal asphyxiated neonates with short-term clinical outcome <p><strong>Objective:</strong> To correlate amplitude electroencephalography (aEEG) (in first 24 h after birth) in perinatal asphyxiated neonates with clinical outcome. <strong>Materials and Methods:</strong> This prospective cohort study was conducted in Jay Kay Lon Mother and Child Hospital, Government Medical College, Kota. All term asphyxiated neonates born with Apgar score of ≤7 at 5 min, admitted within 24 h of birth were included in this study. In each case, aEEG was recorded, and neurological examination was done at the time of admission and discharge. <strong>Results:</strong> Out of 72 cases, 39 neonates of hypoxic-ischemic encephalopathy (HIE) I had normal aEEG. Out of 24 neonates of HIE II, aEEG was normal in 7 and moderately abnormal in 17 neonates. All 9 neonates with HIE III had abnormal aEEG. Sensitivity of aEEG to identify seizures was 76.67%, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 92.86%, 88.46%, and 84.78%, respectively. There were 41 neonates, who were neurologically normal at the time of discharge had normal aEEG. Out of 22 neonates, who were neurologically abnormal at discharge, aEEG was normal in 5 neonates and moderately abnormal in rest 17 neonates. Out of 9 neonates whose death occurred during treatment, aEEG was moderately abnormal in 2 neonates and severely abnormal in 7 neonates. Sensitivity of aEEG (normal pattern) for good outcome was 100% and specificity, PPV, and NPV were 83.87%, 89.13%, and 100%, respectively. Sensitivity of aEEG (abnormal pattern) for poor outcome was 83.87% and specificity, PPV, and NPV were 100%, 100%, and 89.13%, respectively. <strong>Conclusion:</strong> It is concluded that if aEEG is done within 24 h of birth in asphyxiated neonates, we can predict outcome of the baby. If early aEEG is normal then outcome tends to be favorable. On the other hand, if early aEEG is abnormal, then outcome tends to be unfavorable.</p> Himanshu Goyal Gopikishan Sharma R K Gulati ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 591 594 Relationship between maternal iron and cord blood iron status: A prospective study <p><strong>Background:</strong> Iron sufficiency is of paramount importance in the neonatal period. Controversy exists whether the transfer of iron to the fetus from the mother is determined by fetal demands or by maternal iron stores. Numerous studies correlating maternal and neonatal iron stores revealed conflicting results. <strong>Aims:</strong> To study the relationship between maternal and neonatal iron indices at birth and to observe the impact of gestational age on iron stores in neonates. <strong>Methods and Materials:</strong> This prospective study was conducted in neonatal care unit of the tertiary hospital. Total 195 mother and newborn pairs are enrolled in the study. Neonates were divided into groups based on gestational age. The maternal venous samples were collected 1 h ± 15 min before the delivery. Cord blood sample and venous samples were drawn from a peripheral vein in neonates who came for follow-up at 4 weeks. Samples were analyzed for hemoglobin (Hb), serum ferritin, serum iron, and total iron-binding capacity. <strong>Results:</strong> Significant positive correlation was found between maternal Hb and neonatal ferritin (Pearson’s correlation coefficient =0.26, p=0.002) and maternal iron and neonatal iron (Pearson’s correlation coefficient =0.294, p=0.000). Ferritin concentration of cord blood samples in neonates born to mothers with ferritin levels &lt;12 μg/L showed significant correlation. Mean ferritin in preterm neonates (128.9±80.7 μg/dl) was significantly lower than in term neonates (156.9±78.6 μg/dl) (p=0.040). Mean Hb in preterm neonates (14.5±2.1 g/dl) was significantly lower than in term neonates (15.0±2.1 g/dl) (p=0.028). 4-week samples showed significantly lower serum iron concentrations in preterm when compared to term group. Serum ferritin levels at birth showed positive correlation at 4 weeks. (Pearson’s correlation coefficient =0.211, p=0.028). <strong>Conclusions:</strong> Neonatal iron stores are affected in case of severe maternal iron deficiency indicated by ferritin levels &lt;12 μg/L. Gestational age has a significant impact on neonatal iron stores. Neonates with a deficient iron store at birth likely to have low iron stores at 4 weeks.</p> K Swetha P Tarakeswararao M Saisunilkishore ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 595 598 Pattern of congenital abnormalities in a tertiary hospital and its impact on neonatal mortality <p><strong>Background:</strong> Congenital abnormalities are major contributors of neonatal mortality and stillbirths. However, there is not sufficient data in our country on the prevalence of various congenital malformations and their impact on neonatal mortality. <strong>Objectives:</strong> To study the prevalence and pattern of congenital anomalies among neonates delivered in a tertiary hospital setting in 3 years and its impact on perinatal and neonatal mortality. <strong>Materials and Methods:</strong> This hospital based prospective descriptive study was undertaken at tertiary care hospital in Kerala. All babies born in the hospital from January 2013 to December 2015 (3 years) were included in the study. The baby was examined by a pediatrician during the first 24 h to identify any birth defects. A detailed history including familial and gestational factors was taken in babies with birth defects. Photographs, radiographs, ultrasound examination, echocardiography, and chromosomal studies were undertaken as required. The details were entered in a pro forma. The anomalies are classified as per ICD-10 criteria. Results were analyzed by simple statistical techniques recording number and percentage of cases. <strong>Results:</strong> The prevalence of birth defects in live born newborn was 1.9% whereas, in stillbirths, it was 15.3%. Congenital anomalies also contributed a major risk factor for neonatal death as 22% of the newborns, died in the immediate neonatal period, had some form of congenital anomaly. The major maternal risk factor found to be associated with congenital anomalies was gestational diabetes (21.3%). The patterns of congenital anomalies were musculoskeletal anomalies (25%), central nervous system (18%), genitourinary system (14%), congenital diaphragmatic hernia (12%), cardiovascular system (10%), gastrointestinal (7%), syndromes (6%), non-immune hydrops (5%), and others (3%). <strong>Conclusion:</strong> Prevalence of birth defects in this birth cohort was 1.9% comparable to other Indian data. In Kerala, one of the major causes of perinatal and neonatal mortality is congenital malformations.</p> Vaikom Hariharan Sankar Thankam Uma Sabu George Anu K Vasu Sobha Kumar A Santhoshkumar Nirmala Chellamma ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 599 602 Neonatal Jaundice: Knowledge, attitude beliefs, and practices of postnatal mothers in a tertiary care hospital in Uttarakhand, India <p><strong>Background:</strong> Neonatal jaundice (NNJ), a preventable cause of brain damage, is the most common cause of admission in the 1st week of life in neonatal intensive care unit. <strong>Objective:</strong> To determine the knowledge attitude and practices of postnatal mothers toward NNJ in tertiary care hospital. <strong>Materials and Methods:</strong> In this descriptive analytical study, 350 mothers who underwent delivery in our institute were interviewed within first 72 h of delivery using a structured questionnaire. Data were entered in Microsoft Excel 13 and analyzed with SPSS 23. <strong>Results:</strong> Mean knowledge score was 6.48±3.93 (0-21). 73% of the mothers knew the site of recognition in NNJ. However, inadequate knowledge regarding causes, danger signs of severity, complications and treatment were seen among respondents. At least one correct answer for cause, danger sign and complication of NNJ was reported by 28%, 54%, and 33% mothers, respectively. Only 8% mothers attributed it as a risk factor for death in the baby. Phototherapy and exchange transfusion as treatment modality was answered by 15% mothers only. Their knowledge score was significantly associated with parity, education level, residence, religion and previously affected babies but not with age. Regarding attitude, 20% mothers were willing to take the baby to the hospital within 24 h on recognition of jaundice, and almost 91% of those seeking medical advice were ready to follow it. <strong>Conclusion:</strong> Although awareness of NNJ was seen in the majority of mothers, there was a paucity of knowledge regarding causes, danger signs, and effective treatment available. Cultural beliefs and traditional infant care practices do have a significant impact on mothers. Special educational programs and involvement of electronic media are needed to increase the awareness of mothers regarding NNJ.</p> Bindu Aggarwal Archana Agrawal Piyush Chaudhary Girish Gupta Sudhir Rana Sourabh Gupta ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 603 608 Comparison of breastfeeding practices among different social groups: Experience from North India <p><strong>Background:</strong> Breastfeeding is one of the most important determinants for neonatal survival, and the prevention of childhood infections. Breastfeeding practices vary among different professional and non-professional working mothers and also among different strata of society. <strong>Objectives:</strong> To assess the comparative prevalence of exclusive breastfeeding in various health professionals (Group 1), other professional women (Group 2), non-working housewives (Group 3), and laborer women (Group 4). <strong>Materials and Methods:</strong> This prospective study was conducted in the form of an interview of all above mentioned four groups of mothers using preplanned questionnaires. The mothers attending to our routine outpatient department and immunization section were randomly interviewed after taking proper informed consent. The study was conducted over a period of 1 year from January 2016 to December 2016. A total of 800 women (200 in each group) who had delivered within the past 1 year were interviewed. <strong>Results:</strong> Breastfeeding was delayed by more than 4 h in only 26% (52/200) in Group 1 (doctors/nurses/other health professionals) in comparison to 47.5%, 54.5%, and 43% of infants in Group 2, Group 3 and Group 4, respectively. Exclusive breastfeeding for ≥6 months as per the WHO recommendation was not given to any of the baby among health professional group (Group 1) where it was given to only 4.5% of Group 2 mothers, 3.5% of mothers in Group 3 and around 34.5% of laborer mothers. All mothers in Group 1 started with top/formula feeds before 6 months in comparison to 95.5%, 76.5%, and 66.5% of infants in Groups 2–4, respectively. <strong>Conclusion:</strong> Despite higher rates of early initiation of breastfeeding among all the groups and particularly in health professionals, awareness of exclusive breastfeeding (EBF), the benefits of EBF was the low depicted biyearly introduction of supplementary feeding. Maternal employment was observed as a major factor for early initiation of supplementary feeding, among health and other professionals whereas hungry baby and excessive crying were major contributory factors in early initiation of supplementary feeding in urban housewives and laborer mothers. This indicates the need to further promote and create awareness about the advantages of EBF and avoid early introduction of complementary foods.</p> Koushal Kumar Khajuria Kishour Kumar Digra Aakash Pandita ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 609 613 Towards an ideal neonatal sepsis screen panel - A review <p>Neonatal sepsis is an important determinant of survival in the neonatal units. Early recognition and institution of<br>antibiotic therapy is the key for successful treatment. Complete blood count and C-reactive protein are the ritualistic<br>commonly used tests that aid the clinician in the initiation and stopping of antibiotic therapy. Procalcitonin at 24 h<br>is useful in diagnosing early-onset neonatal sepsis (EOS). Interleukin 6 and CD 11β for EOS and CD 64 for late-onset<br>sepsis are promising candidates for future sepsis screen panel as logistical issues like the cost factor rule out their routine<br>use currently. We summarize the current available evidence on the use of these laboratory markers and the clinical sepsis<br>score and suggest a practical guide for antibiotic therapy (initiation and duration of treatment) for the benefit of practicing<br>pediatricians.</p> Karthikeyan Gengaimuthu Vaishni Karthikeyan ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 614 618 Unintentional injuries in children at pediatric emergency center: A developing country perspective <p><strong>Background:</strong> Unintentional injuries are important cause for childhood mortality and long-term morbidity. Developing countries accounts for majority of the childhood deaths due to unintentional injuries. <strong>Methods:</strong> This was a retrospective descriptive study done at a tertiary care center. Data were obtained from the records of patients. <strong>Result:</strong> A total of 180 children presented to pediatric emergency during the study period with male-to-female ratio of 2.1:1. The injuries were more common in 1-5-year age group. The most common mechanism of injuries were fall (49.4%) and hit by object (11.1%). Most of the injuries occurred at home. Median duration of arrival to hospital was 60 minutes. Out of 180 children, 19 (10.5%) required hospital admission. Injuries over the head and face were significantly associated with hospital admissions (adjusted odds ratio: 6.45, 95% confidence interval: 1.96-21.93, p=0.002).Background: Unintentional injuries are important cause for childhood mortality and long-term morbidity. Developing countries accounts for majority of the childhood deaths due to unintentional injuries. Methods: This was a retrospective descriptive study done at a tertiary care center. Data were obtained from the records of patients. Result: A total of 180 children presented to pediatric emergency during the study period with male-to-female ratio of 2.1:1. The injuries were more common in 1-5-year age group. The most common mechanism of injuries were fall (49.4%) and hit by object (11.1%). Most of the injuries occurred at home. Median duration of arrival to hospital was 60 minutes. Out of 180 children, 19 (10.5%) required hospital admission. Injuries over the head and face were significantly associated with hospital admissions (adjusted odds ratio: 6.45, 95% confidence interval: 1.96-21.93, p=0.002). Conclusion: Pediatric injuries are common in India. Male children are at higher risk. Injuries over the head and face are associated with higher rates of hospitalization in children. Pediatric injuries are common in India. Male children are at higher risk. Injuries over the head and face are associated with higher rates of hospitalization in children.</p> Bharat Choudhary Yachana Choudhary Suresh Gupta ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 619 622 A rare case of hemophilia with Ewing’s sarcoma - A case report <p>Malignancies are rare in children with inherited coagulation disorders like hemophilia except for non-Hodgkin’s lymphoma and liver malignancies in hepatitis C positive hemophiliacs. Ewing sarcoma of bone is the second most common primary malignant bone cancer in children and adolescents; particularly, the extra skeletal variety. There is limited data available in the literature reporting hemophilia with Ewing’s sarcoma. The authors report a case of 16-year-old boy with hemophilia A, who was diagnosed to have pelvic Ewing’s sarcoma, which is a rare occurrence. This case could have been mistaken for hemophilic pseudotumor because of the non-specific clinical presentation. Magnetic resonance imaging and open biopsy helped to arrive at a diagnosis. The patient is now being treated with chemotherapy and radiotherapy.</p> Urmila KV Sanad Saifu ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 623 625 Dyke-Davidoff-Masson syndrome: A case report <p>A 7 years girl presented with seizures, intellectual disability, right sided spastic cerebral palsy, and strabismus of right eye. Magnetic<br>resonance imaging (MRI) brain was suggestive of severe volume loss of brain parenchyma with dilatation of ipsilateral lateral<br>ventricle, and other MRI features diagnostic of infantile type Dyke-Davidoff-Masson syndrome also termed as cerebral hemiatrophy.<br>Seizures can be refractory to medical treatment and surgical treatment may become necessary. Greater awareness about the disease<br>is required to diagnose the condition timely and refer to neurosurgery in the case of refractory seizures as hemispherectomy is the<br>treatment of choice with high success rate.</p> Piyush Chaudhary Archana Agrawal Ankur Malhotra Akhil Bangari ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 626 628 Naphthalene induced hemolysis in a glucose 6 phosphate dehydrogenase deficient neonate - A case report <p>Glucose-6-phosphate dehydrogenase (G6PD), a critical enzyme in the hexose monophosphate pathway, is a key component in the antioxidant mechanism of all cells, particularly erythrocytes. Its deficiency may manifest in the neonatal period in the form of severe hyperbilirubinemia. Hemolysis in neonate may occur de novo or be precipitated by stressors such as oxidant drugs or naphthalene. We report a case of 3 days old, G6PD deficient neonate, with naphthalene induced hemolysis, requiring exchange transfusion.</p> Murtaza Kamal Sugandha Arya Rhea Shriyan Harish Chellani ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 629 630 Neonatal lupus erythematous – A report of three cases <p>Neonatal lupus erythematosus (NLE) is a rare acquired autoimmune disorder clinically characterized by skin lesions that resemble those of subacute or discoid lupus erythematosus and/or congenital heart bock. Skin and cardiac manifestations coexist only in 10% of the patients. It is caused by transplacental passage of maternal autoantibodies, usually anti-Ro/SS-A and /or anti-La/SS-B and less commonly anti-U1 ribonucleoprotein. Mothers of the infants with NLE are either asymptomatic or diagnosed with autoimmune disease. We describe 3 neonates with clinical and immunological findings compatible with NLE, their progress and outcome.</p> Punit S Chhajed S V Savaskar N S Bhori S T Bandichhode ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 631 634 Macrosomia due to maternal obesity: A case report <p>Macrosomia, birth weight &gt;4000 g is said to occur in &lt;10% of the pregnancies and is associated with morbidity and mortality in both mother and baby. Although it is more common in diabetic mother, it is also associated with maternal obesity and high-body mass index. We describe the case of near-term male neonate who was delivered by cesarean section and birth weight was 5000 g who developed hypoglycemia and hyperbilirubinemia which was treated successfully.</p> Rajkumar M Meshram Poonam Thakur Balaji Bhise Amruta Phatak ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 635 636 A case of Canavan disease with normocephaly - A rare entity <p>Canavan disease (CD) is an autosomal recessive disorder with spongy degeneration of white matter of the brain. It typically presents with developmental delay, visual problems, and macrocephaly. Our patient presented with these features along with normocephaly. Brain magnetic resonance spectroscopy showed typical findings for CD (peaks of N-acetylaspartic acid). This case illustrates the fact that the presence of normocephaly should not be used in isolation to rule out the possibility of CD.</p> Shamsuddin Hassan Srilatha Bajaj Sangeeta Meena Shyam Sundar Mina ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 637 638 A rare case of beta-ketothiolase deficiency in identical twins <p>Betaketothiolase deficiency is a rare defect of isoleucine and ketone body metabolism which manifests as severe metabolic acidosis following common viral illnesses. A set of 1 year, 8 month-old identical male twins presented with similar symptoms in different time frames. Both of them had severe metabolic acidosis, hypoglycemia, and altered sensorium. Both twins tested positive for beta-ketothiolase deficiency by urine gas chromatography-mass spectrometry. The children responded to symptomatic treatment and are now growing well on a protein-restricted diet. Beta-ketothiolase deficiency is a rare disorder of amino acid metabolism with a favorable outcome if preventive measures are taken early.</p> Kavya Kurkal D Narayanappa H V Prajwala ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 639 640 Varicella-associated immune thrombocytopenic purpura in a child with bleeding manifestations with review of literature <p>Chickenpox is a benign and self-limiting viral exanthematous infection, but sometimes it may be associated with complications. Mild thrombocytopenia occurs in 1-2% of children with varicella, but severe immune-mediated thrombocytopenia associated with bleeding is a rare complication. Various other mechanisms for thrombocytopenia have been implicated-decreased bone marrow production of platelets, disseminated intravascular coagulation, virally-induced platelet aggregation followed by phagocytosis or lysis, direct viral invasion of platelet precursors and viral-derived neuraminidase causing enzymatic desialylation of platelets followed by removal of abnormal platelets by reticuloendothelial system. We report a case of severe thrombocytopenia, possibly immune-mediated with bleeding in the form of petechiae and epistaxis in a child recovering from chickenpox, who is successfully treated with steroids. This may at least in part guide clinicians to recognize this rare but potentially dangerous complication of chickenpox.</p> Mukesh Kumar ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 641 643 Parietal wall post-traumatic hernia with multiple injuries: A rare case report <p>Traumatic abdominal wall hernia (TAWH) is a rare entity. Most of the cases occur in children, following an injury from the bicycle<br>handlebar. In adults, it usually results from road traffic accidents (RTA). The diagnosis may often be established with physical<br>examination alone. Conventional radiology, computerized tomography, and ultrasound have also proven useful. Due to the high<br>incidence of other associated intra-abdominal injuries, early exploration and repair through a midline incision are advocated.<br>Adequate debridement and solid repair of fascial planes with non-absorbable sutures are required to prevent recurrence. We present<br>a case of TAWH following RTA managed by delayed repair without mesh.</p> Ashwin Apte Chirag Shanti Dausage ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 644 646 Hairpin impacted in the duodenum of a 4-month-old child - a rarity <p>Foreign body ingestion is common in children. The accidental ingestion is usually seen in children due to lingual curiosity. Most of the foreign body passes spontaneously through gastrointestinal (GI) tract; hence, requiring no removal. This is a case of impacted hairpin in the duodenum of a 4-month-old female child who accidentally ingested hairpin and was asymptomatic initially for 1 month and later presented with melena requiring surgical removal of hairpin. We failed to find in literature impacted hairpin in the duodenum associated with GI bleeding.</p> Kamal Nain Rattan Priyadarashani - Omkarmanik Baridabad Kuldeep Kumar Yadav Bhavna Chopra ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 647 648 McCune-Albright syndrome without endocrine dysfunction: Case report in a young boy <p>The McCune-Albright syndrome (MAS) is a sporadic rare disease characterized by a triad of physical signs: Café-au lait spots, polyostotic fibrous dysplasia, and autonomous endocrine hyperfunction. Based on the studies, it can be concluded that this syndrome is caused by mutations that happen in the gene: GNAS1. A small number, but not all, of the patient’s cells contain this faulty gene (mosaicism). MAS is predominantly observed in girls and is rarely reported in males. We report a 5-year-old boy with café-au-lait spots, polyostotic fibrous dysplasia, and without any endocrine dysfunction.</p> Elkashif Sami Agrawal Pankaj ##submission.copyrightStatement## 2017-11-22 2017-11-22 4 4 649 651