Indian Journal of Child Health 2018-06-04T12:20:46+00:00 Dr Amit Agrawal Open Journal Systems <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> Effect of valproic acid monotherapy on thyroid function on short-term follow-up in children with newly diagnosed epilepsy 2018-06-04T11:01:48+00:00 Sudhir D Malwade Shiji S Chalipat Kinisha Patel Sharad R Agarkhedkar Geeta R Karambelkar <p><strong>Background:</strong> The effect of valproic acid (VPA) monotherapy on thyroid function test is controversial. <strong>Objective:</strong> The aim of this study is to assess the effect of VPA monotherapy on thyroid function on short-term follow-up in children with newly diagnosed epilepsy. <strong>Methods:</strong> In this prospective case 2018-03-19T00:00:00+00:00 ##submission.copyrightStatement## Effect of Vitamin D supplementation in under-5 children with pneumonia: A randomized controlled trial 2018-06-04T12:20:46+00:00 Jagadish Krishna Jingi Shailesh Shivajirao Patil Arunkumar Desai <p><strong>Objective:</strong> The objective of the study was to study whether Vitamin D supplementation in under-5 children presenting with pneumonia and severe pneumonia reduces its duration and recurrences. <strong>Study Design:</strong> This study was designed as a double-blind, randomized, placebo-controlled trial. <strong>Setting:</strong> Pediatric unit of a teaching institute. <strong>Methods:</strong> A total of 80 children aged between 2 months and 5 years with the diagnosis of pneumonia and severe pneumonia (as per the WHO definition) admitted over a period of 1 year were included in the study. Children with features of rickets, severe malnutrition, asthma, any underlying medical disorders, and if received Vitamin D supplementation over the past 12 months were excluded from the study. Children were randomized into two groups. Intervention group received 300,000 IU (international units) of Vitamin D (1 ml), and the control group received 1 ml of sterile water as a placebo along with antibiotics and supportive care. Children were monitored for the resolution of symptoms. The two groups were comparable for baseline demographic, socioeconomic, clinical, and laboratory parameters. All the children were followed up for 3 months after discharge for any repeat episodes of pneumonia. <strong>Results:</strong> Time to resolution of symptoms (fever, tachypnea, and chest retractions) was not significant (3.63 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Prevalence, clinical profile, and laboratory features of hospitalized under-five children with rotavirus-induced diarrhea 2018-06-04T10:58:26+00:00 P Jyothirmayi D Dnyanesh Kamble V D Patil <p><strong>Background:</strong> Rotavirus is considered as an important causative agent for pediatric diarrhea. Despite recent studies, data available<br>on the prevalence of diarrhea due to rotavirus, among under-five children, are scarce. <strong>Objective:</strong> The objective of this study<br>is to estimate the prevalence, clinical profile, and laboratory features among hospitalized under-five children with rotavirusinduced<br>diarrhea. <strong>Materials and Methods:</strong> A total of 145 under-five children with diarrhea were included in the study. The<br>sociodemographic characteristics, clinical profile, and laboratory investigations of all the children were recorded. Stool samples<br>collected were tested for rotavirus antigen using enzyme immunoassay.<strong> Results:</strong> Of 145 stool samples processed, rotavirus antigen<br>was positive in 33.10% of cases, and male-to-female ratio was 1.1:1. The majority (62.76%) of the children with diarrhea were<br>aged &#8804;12 months. Rotavirus infection was significantly associated with socioeconomic status of the parents (p=0.023), maternal<br>education (p=0.028), fever (p=0.029), vomiting (p=0.001), restlessness (p=0.001), perianal excoriation (p=0.045), bottle feeding<br>(p=0.014), hypernatremia (p&lt;0.001), and presence of reducing substances (p 0.001). <strong>Conclusion:</strong> Rotavirus-induced diarrhea was<br>diagnosed in one-third of the study children. Maternal education, symptoms of fever, vomiting, presence of reducing substances,<br>and age &#8804;12 months were found to be predisposing factors for rotavirus infection in under-five children. However, periodic review<br>on rotavirus and other co-pathogenic infections are required to validate the current findings.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Spectrum of esophagitis in children with cerebral palsy - A clinical, endoscopic, and histopathological correlation 2018-06-04T11:05:00+00:00 Manjari Tiwari Shrish Bhatnagar Savitri Thakur Nishi Tandon <p><strong>Background:</strong> Gastrointestinal disease is frequent in children with severe neurological impairment and developmental disability. Dysphagia may worsen due to concurrent gastroesophageal reflux disease (GERD) and non-GERD esophagitis in children. <strong>Objective:</strong> The aim of our study was to study the spectrum of causes of esophagitis in cerebral palsy (CP) children with feeding difficulty. <strong>Methods:</strong> Children of CP with feeding difficulties in the age group of 1 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Are we still misdiagnosing clubfoot? A study of non-clubfoot cases labeled or referred as clubfoot from primary care centers in Uttarakhand 2018-06-04T11:06:47+00:00 Ganesh Singh Dharmshaktu Alamgir Jhan Dar Shailendra Singh Bhandari <p><strong>Background:</strong> Clubfoot is a congenital disorder identifiable with the clinical assessment itself, provided the knowledge of key features is sound. Several disorders affecting the foot and lower limb that present with crooked or bent anatomy may be confused with it. Knowledge of common disorders that mimic clubfoot in a particular region is thus important to adequately distinguish, manage or refer the case to specialist opinion. <strong>Objectives:</strong> The current study attempts to provide an overview and documentation of the conditions referred and labeled as clubfoot from primary care facilities, the knowledge of which is important so that appropriate treatment is given to each. The findings will reflect lacunae in the knowledge and perception of primary healthcare workers regarding the deformity. <strong>Materials and Methods:</strong> A retrospective assessment of all cases referred to our dedicated clubfoot clinic with a diagnosis of clubfoot by peripheral health-care facility was done from September 2016 to October 2017. Relevant demographic details including that of parents, type of deformity, nature, laterality, and treatment received were noted for each case. Conditions requiring non-operative treatment and those requiring further evaluation were noted separately with a detailed description. <strong>Results</strong>: Out of total 97 cases labeled as clubfoot, 32 (33.68%) cases with 64 feet were part of the study after excluding true clubfoot cases. The common condition noted was calcaneovalgus, postural clubfoot, equinus deformity secondary to cerebral palsy, metatarsus adductus, in-toeing, and posteromedial bowing of tibia. <strong>Conclusion:</strong> The knowledge of common foot disorders in primary care settings should be strengthened by refresher practical training so that these disorders are diagnosed and managed there an appropriate referral is made thus leading to decrease the burden on higher centers.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Clinical profile of severe acute malnutrition among children under five years of age living in Bundelkhand region of Uttar Pradesh 2018-06-04T11:08:28+00:00 Om Shankar Chaurasiya Ram Kumar Pathak Sapna Gupta Kawalpreet Chhabra <p><strong>Introduction:</strong> Malnutrition is a general term and often refers to undernutrition resulting from inadequate consumption, poor absorption, or excessive loss of nutrients, but the term also encompasses overnutrition. <strong>Objective:</strong> The objective is to study the clinical profile of children with severe acute malnutrition (SAM) and also to assess the effectiveness of Nutrition Rehabilitation Center in providing therapeutic care for children with SAM. <strong>Materials and Methods:</strong> This prospective study was conducted at the department of pediatrics of a tertiary care center at Jhansi for a period of 12 months among 152 children with SAM. A detailed history and physical examination finding were recorded in pretested pro forma at the time of admission using the standard methodology and anthropometric measurement expressed in standard deviation from the median of the reference population (WHO). <strong>Results:</strong> Majority of the patients (96, 63.15%) belonged to age group of 6 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Indications and outcome of ventilated children in a Pediatric Intensive Care Unit of tertiary care hospital: A retrospective study 2018-06-04T11:10:16+00:00 Sachins Hatti Vinod Uplaonkar Charanraj Hunnalli <p><strong>Introduction:</strong> Mechanical ventilation (MV) is frequently used as one of the most frequent life-supportive technology in Pediatric Intensive Care Units (PICUs).<strong> Objectives:</strong> The objectives of this study are to assess the frequency, indications, and immediate outcomes in mechanically ventilated pediatric patients in the tertiary care center of developing country. <strong>Materials and Methods: A</strong> retrospective observational study was conducted among critically ill pediatric patients admitted in PICU of our institute, who required MV over the 2-year period. SPSS Software Version 22.0 was used for the statistical analysis. Quantitative data were analyzed using mean and standard deviation, and Chi-square test was used for comparing differences between categorical variables. <strong>Results:</strong> A total of 1735 patients were admitted to PICU, and 9.11% of them required MV support. The mean age in years was 1 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Role of urinary tract infection in development of neonatal pathological unconjugated hyperbilirubinemia 2018-06-04T11:11:38+00:00 Ajay Kumar Mohammed Uvaise Batcha <p><strong>Introduction:</strong> American Academy of Pediatrics recommends investigating for urinary tract infection (UTI) in neonates with conjugated hyperbilirubinemia, but UTI may be associated with unconjugated hyperbilirubinemia also. <strong>Objective:</strong> The objective of this study was to evaluate the frequency of UTI in initial 4 weeks of life in pathological unconjugated hyperbilirubinemia and to study the effect of treatment of UTI on the course of hyperbilirubinemia in these neonates. <strong>Methods:</strong> This hospital-based prospective cohort study included 100 consecutive neonates with a gestational age more than or equal to 35 weeks and &lt;42 weeks with unconjugated hyperbilirubinemia in pathological range. Babies were treated with phototherapy (and exchange transfusion), and neonates with UTI were treated with antibiotics also. The primary outcome was the frequency of UTI, confirmed by a positive urine culture and secondary outcomes included positive leukocyte esterase (LE) and nitrite reactions, significant pyuria, and rate of fall of bilirubin levels. <strong>Results:</strong> Seven neonates had a positive urine culture growth (UTI group) while remaining 93 babies constituted non-UTI group. In the UTI group, six and five babies had positive LE and nitrite reactions, respectively, and four babies had significant pyuria also. Exchange transfusion was done in 23 neonates in the non-UTI group. The median (range) duration of phototherapy in the remaining 70 neonates in the non-UTI group was 39 (15 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## The incidence and outcome of respiratory distress syndrome in preterm babies in relation to administration of antenatal corticosteroids 2018-06-04T11:13:03+00:00 Shermin Nasreen Abdul Jaleel Bindu Sarojum Bindusha Sasidharan Priya Gopala Krishnan <p><strong>Background:</strong> Premature infants have a higher incidence of respiratory distress syndrome (RDS), which is one of the main causes of early neonatal mortality. <strong>Objectives:</strong> The objective is to study the incidence and outcome of RDS in preterm babies &lt;34 weeks of gestation born to mothers who had received antenatal corticosteroids (ACS). <strong>Methodology:</strong> A prospective observational study was conducted among preterm babies from January 2015 to December 2015 in a tertiary care hospital of South India. Details of the mothers with a period of gestation 34 weeks or less who had received ACS were recorded. <strong>Results:</strong> The study population included 749 preterm babies (&lt;34 weeks) delivered in our hospital. Among them, 698 (93.2%) mothers received two doses of ACS and 51 (6.8%) received only a single dose of ACS. Neonates whose mothers received two doses of ACS had a significantly lower incidence of RDS (27.6% vs. 100%, p&lt;0.001), lower rate of mechanical ventilation (45% vs. 72.5%, p&lt;0.001), and higher survival rate (87% vs. 68.6%, p=0.001) than neonates whose mothers received a single dose of ACS. The occurrence of RDS is highest in 26 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Clinical profile and neuroimaging of neonates with influenza encephalopathy 2018-06-04T11:14:58+00:00 Jemila James Roshan Joseph John Arun Edwin Lalitha Kailas PMC Nair <p><strong>Background:</strong> Pediatric influenza is found primarily in children under 5 years of age, and it is very difficult to distinguish the<br>illness caused by influenza, a virus infection based on the signs alone. <strong>Objective:</strong> The objective of this study is to analyze the<br>clinical profile and neuroimaging of neonates admitted with seizures followed by encephalopathy. <strong>Methods:</strong> A descriptive study<br>was conducted among neonates admitted to our neonatal intensive care unit, with neurological manifestations such as poor feeding,<br>lethargy followed by seizures and poor sensorium in the 1st week of life. During the study period, 14 neonates were included<br>with similar neurological manifestations. <strong>Results:</strong> Our study neonates had poor feeding and lethargy (57.1%) before the onset of<br>seizures. The mean day of the onset of seizure was day 4, and the mean duration of encephalopathy lasted for 63 h. We could detect<br>influenza A in cerebrospinal fluid-polymerase chain reaction only in two neonates and H1N1 influenza in one neonate, but all<br>our study neonates had consistent findings on the magnetic resonance imaging (MRI) brain suggestive of viral infection probably<br>influenza A as its circulation in the community is considered common. The mean day of discharge from the hospital was 11.5 days.<br>At discharge, all neonates were on breastfeeds and had no focal neurological deficit. <strong>Conclusions:</strong> The possibility of influenza<br>A-related encephalopathy should be considered as a differential diagnosis if a neonate presents with poor feeding, lethargy followed<br>by seizures and encephalopathy in the 1st week of life and their brain MRI 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Impact of hand hygiene training module among healthcare providers working in neonatal intensive care unit: A before and after trial 2018-06-04T11:16:20+00:00 Abhishek Madhura Sandeep Golhar Urmila Chauhan Suresh Ughade Samadhan Dhakne <p><strong>Background:</strong> Healthcare-associated infections (HAI) include central line-associated bloodstream infections, catheter-associated<br>urinary tract infections, and ventilator-associated pneumonia. Maintaining strict hand hygiene (HH) compliance and asepsis is<br>pivotal in reducing the HAI. <strong>Objective:</strong> The objective of this study is to evaluate the impact of a training module on HH practices<br>of healthcare providers (HCPs) working in neonatal intensive care unit (NICU).<strong> Methods:</strong> An uncontrolled before and after study<br>was conducted in a tertiary level NICU of a government hospital. All HCPs working in the NICU were eligible and included in<br>the analyses. In the pre-intervention Phase I (November 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Correlation of acute physiological parameters with immediate outcome among neonates transported to special care newborn unit: A prospective study 2018-06-04T11:18:10+00:00 Nirbhay Mehta Manish Kumar Sharma <p><strong>Background:</strong> Several sick neonates require transfer to tertiary level care neonatal unit for treatment. The facilities of neonatal<br>transport in India are not optimal and the newborn thus transported can become hypothermic, hypoxic, and/or hypoglycemic<br>which can affect the neonatal outcome. These parameters can be maintained during transport by adopting simple measures. <strong>Aim:</strong><br>Study impact of acute physiological parameters during transfer of neonates on their immediate outcome by using TOPS score.<br>TOPS Score -temperature, oxygensaturation, perfusion (assessed by capillary refill time), blood Sugar. <strong>Materials and Methods:</strong><br>This prospective observational study was conducted at the special care newborn unit, Indore enrolling 513 transported neonates.<br>TOPS scoring for each neonate was done at admission, and then the parameters of the TOPS score were correlated with the<br>outcome at 48 h of admission.<strong> Results:</strong> A total of 513 transported newborns were assessed, 48.73% newborns were hypothermic,<br>33.91% had poor perfusion, 28.46% were hypoxemic, and 22.22% were hypoglycemic. Hypoxemia and hypoglycemia had the<br>highest sensitivity (93.39% and 80.18%, respectively) while hypoglycemia had the highest specificity (92.87%). <strong>Conclusion:</strong><br>TOPS score is a useful and easy to use the method to assess the physiological status and predict early mortality in transported<br>neonates.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## A study of serum-ionized calcium in neonates with unconjugated hyperbilirubinemia on phototherapy 2018-06-04T11:20:04+00:00 Swasti Pal Braham Prakash Kalra Vinita Kalra <p><strong>Objectives:</strong> The objective is to study the occurrence of phototherapy-induced hypocalcemia in neonates with unconjugated hyperbilirubinemia and to compare the occurrence between pre-term and full-term neonates. <strong>Materials and Methods:</strong> The study was conducted in the Neonatology Unit of Department of Pediatrics, at a tertiary care teaching hospital for 12 months. A total of 230 full-term and pre-term neonates with jaundice were recruited. Of 230 neonates, 150 were given phototherapy (cases), while 80 did not receive phototherapy and were used as control. Serum-ionized calcium levels were measured at initiation, after 24 h and after 48 h, or at the end of phototherapy in the case duration of phototherapy was &lt;48 h. Serum-ionized calcium was repeated at 24 h after the completion of phototherapy. In the control group, ionized calcium levels were measured at the time of development of jaundice and 24 h after the initial measurement.<strong> Results:</strong> Of 150 cases who received phototherapy, 105 were term and 45 were preterm. 69 babies (46%) developed hypocalcemia after 24 h of phototherapy. Of these, 28 (40.5%) were preterm and 41 were term (59.5%). 4 patients developed symptoms, which included jitteriness and seizures. 62.2% of the total pre-term and 39% of term neonates developed hypocalcemia after phototherapy. <strong>Conclusion:</strong> This study suggests that neonates exposed to phototherapy are at the risk of developing hypocalcemia. There is a significant decline in the ionized calcium levels after exposure to phototherapy, and this level can even fall to hypocalcemic levels. As the duration of phototherapy increases, the serum levels of calcium may decline further. The risk of developing hypocalcemia is higher in pre-term neonates.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Predictive value of cord blood bilirubin in development of neonatal hyperbilirubinemia 2018-06-04T11:21:42+00:00 Bharati P Choubey Aditi Kakodia Pankaj Pal Amit Agrawal <p><strong>Introduction:</strong> The early detection of neonatal hyperbilirubinemia (NNH) can be done by various methods; however, the most reliable is cord blood bilirubin (CBB). <strong>Objective:</strong> The objective of this study is to evaluate the predictive value of the CBB levels for the subsequent hyperbilirubinemia in healthy term newborns and its association with various maternal and neonatal factors. <strong>Materials and Methods:</strong> Two hundred healthy term-neonates between 37 and 42 weeks of gestation were included in the study. A thorough antenatal, perinatal, and natal history was obtained. Cord blood was collected from all newborns, and the samples were sent for the estimation of serum bilirubin, blood grouping, and Rh typing.<strong> Results:</strong> Various risk factors such as gender difference (p&lt;0.05), development of jaundice (p=0.00), extent of jaundice (p=0.00), number of cases requiring referral (p&lt;0.05), and jaundice in siblings (p=0.01) were found statistically significant. Several maternal and neonatal factors such as maternal history of jaundice (p=0.009), gestational hypertension (p=0.01), antepartum hemorrhage (p&lt;0.05), obstructed labor (p=0.009), use of oxytocin (p=0.008), ABO, and Rh incompatibility (p&lt;0.001) were also found statistically significant in relation to CBB &gt;2.5 mg/dl. At a cutoff of 2.5 mg/dl, sensitivity and specificity came out to be 33.33% and 96.25%, respectively. <strong>Conclusion:</strong> NNH and CBB level were found to be associated with several maternal and neonatal risk factors. Hence, total serum bilirubin in cord blood was indicative of the jaundice severity among neonates.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## A clinical study to assess the patterns of muco-cutaneous changes in newborns during the first five days after birth 2018-06-04T11:23:17+00:00 Anu Kurian Ritesh Patidar G V Kumar G Narendra <p>Background: Skin is the largest organ in the human body accounting for approximately 13% of the neonatal body weight as compared to 3% of the adult weight. It is the most visible and easily accessible organ of the body. <strong>Objective:</strong> To study the patterns of muco-cutaneous changes in newborns during the first 5 days after birth. <strong>Materials and Methods:</strong> This prospective study was conducted in postnatal wards of department of Obstetrics and gynaecology and neonatal unit of department of Paediatrics of a tertiary care teaching hospital. All the newborns within first 5 days after birth, irrespective of gender, underlying disease and general condition of the baby were included in the study. All the newborns were examined within 24 h of birth and followed up till 4 days after birth and the findings were noted in the preformed case-study proforma. <strong>Results</strong>: The present study was conducted on 200 newborns with cutaneous lesions. The muco-cutaneous diseases were divided into physiological, transient and pathological diseases. Among these newborns 114 (57%) were males, and 86 (43%) were females. The most common manifestations observed were Mongolian spots 156 (78%), sebaceous gland hyperplasia 81 (40.5%), Epstein pearls 79 (39.5%), milia 43 (21.5%), physiological jaundice 16 (8%), vernix caseosa 14 (7%), erythema toxicum 13(6.5%), salmon patch 5 (2.5%), hypertrichosis/lanugo 2 (1%), sucking blisters 1 (0.5%) and bacterial infection of Staphylococcal scalded skin syndrome 1 (0.5%). <strong>Conclusion:</strong> Muco-cutaneous manifestations are very common in neonates but as these are the transient conditions, so no intervention is required. Early recognition of these lesions is important to distinguish them from more serious skin disorders.</p> 2018-03-19T00:00:00+00:00 ##submission.copyrightStatement## To study the morbidity and mortality pattern of outborn neonates admitted in neonatal intensive care unit of Indore 2018-06-04T11:24:58+00:00 Preeti Malpani Manju Biswas Ravi Shankar Uikey <p><strong>Introduction:</strong> About 50% of infant deaths occur within the 1st month (neonatal period) of life; of these, more than half die during the first 24 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Profile of boys with posterior urethral valves from a tertiary care center in a developing country 2018-06-04T11:26:19+00:00 Ashish Jain Mukta Manthan Nisha Kumari Srijan Singh <p><strong>Introduction:</strong> Posterior urethral valves (PUVs) are the most common cause of obstructive uropathy in boys. While most patients<br>in developed countries are diagnosed in the antenatal period, our patients often present late which adversely affects their outcome.<br>This retrospective study was aimed to study the clinical profile of boys with PUV at follow-up. <strong>Methods:</strong> Records of 45 boys<br>with PUV who were in follow-up for at least 1-year were retrieved between February and December 2015. Age of presentation,<br>signs and symptoms, anthropometry, radiological findings, surgical interventions, and biochemical investigations were recorded<br>in a pre-structured pro forma. The data were later analyzed on an Excel spreadsheet.<strong> Results:</strong> The mean age at the diagnosis<br>of PUV was 16 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Evaluation of predisposing factors, etiology, and clinical manifestations of childhood empyema thoracis at a tertiary care center of Odisha 2018-06-04T11:27:41+00:00 Sitanshu Kumar Meher Sanjay Kumar Mahapatra Sapan Kumar Murmu Purnima Meher <p><strong>Background:</strong> Empyema thoracis (ET) is a life-threatening disease often encountered in pediatric patients. In spite of all modern sophistication of medical sciences, this disease is chargeable for a high proportion of hospital admission and continues to require an important tool against them. <strong>Objective:</strong> The objective of this study is to evaluate the age-sex profile, predisposing factors, etiology, seasonal variation, and clinical manifestations of ET in children. <strong>Methods:</strong> A cross-sectional study was conducted in the department of pediatrics in Western Odisha. A total of 80 children, aged 0 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Pseudomembranous colitis in a child 2018-06-04T12:12:46+00:00 Rajani Hassan Sreenivasamurthy Narayanappa Doddaiah Doddaiah Rashmi Nagaraj <p>A 7-year-old male child with a history of fever of 1-month duration, treated with ceftriaxone for 10 days, developed foul-smelling bloody loose stools associated with severe abdominal cramps. Colonoscopy revealed yellowish-white pseudomembranes suggestive of pseudomembranous colitis which is uncommon in pediatric age group.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Acute hemorrhagic edema in a nursing infant - An unusual diagnosis 2018-06-04T12:15:34+00:00 Neha Agarwal Sunil Taneja Saket Bihari Ashish Verma <p>Acute hemorrhagic edema of infancy is a rare, small vessel vasculitis of young children with characteristic skin findings. We<br>have described an 8-month-old male infant who presented with upper respiratory infection followed by acute onset of generalized<br>swelling of both lower limbs and appearance of erythematous, purpuric, and ecchymotic lesions on the lower limbs, face, and ear<br>lobules. There were no systemic complications and the lesions resolved completely.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement## Idiopathic congenital lymphedema involving the upper limb: A case report 2018-06-04T12:17:15+00:00 Pearl Mary Varughese <p>Congenital lymphedema is the rarest form of primary lymphedema. The best line of investigation is lymphoscintigram. The management of primary lymphedema is usually conservative with bed rest and skin care. The prognosis is usually good if there are no other complications. We report a case of 10-year-old boy presented with a complaint of swelling in left upper limb and scrotal edema soon after birth. Investigations were performed and it turned out to be a case of congenital lymphedema involving the upper limb. Although there are many cases of lower limb involvement, upper limb lymphedema has not been documented often, so we are presenting this case.</p> 2018-04-27T00:00:00+00:00 ##submission.copyrightStatement##