Indian Journal of Child Health 2018-12-10T20:48:00+0530 Dr Amit Agrawal Open Journal Systems <p align="justify"><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> Investigation of serum surfactant protein a and d levels in children exposed to cigarette smoke 2018-12-10T20:48:00+0530 Gumus Huseyin Kazanasmaz Halil Cemalettin Dost Zeyrek <p><strong>Background:</strong> Depending on the degree of exposure to cigarette smoke, various health problems can emerge in children. It is needed to have biochemical data of passive smoking to define the risks and to count the benefits of anti-smoking responses. <strong>Objective:</strong> The objective of the study was to evaluate the effect of smoke exposure on the surfactant protein (SP) A and D by measuring the cotinine level in the lungs of the children who are exposed to passive cigarette smoke. <strong>Methods:</strong> This case–control study was conducted between December 2012 and September 2013. İn this study, total 79 children were included who were admitted to the general pediatric outpatient clinic of a medical university. Out of them, 51 children were exposed to cigarette smoke and 28 children were not exposed to cigarette smoke. In a survey was applied to evaluate the smoke exposure, and urinary cotinine levels were measured. Cotinine level was measured by chemiluminescence method (children’s urines are used), and serum SP-D and SP-A levels were measured by ELISA method (peripheral venous blood is used). <strong>Results:</strong> The average urinary cotinine level of the children who were exposed to smoking was 622.27±600.66 ng/ml and 4.25±7.50 ng/ml of the children who were not exposed. The mean serum SP-A level was high (2.64±0.78 U/L) in children exposed to smoking than that in non-exposed children (2.2±0.76 U/L) and this difference was statistically significant (p&lt;0.001). The serum SP-D level was high in children who were exposed to smoking, but it was not statistically significant. It was verified that there was a correlation between the average urinary cotinine level and serum SP-A level (r=0.257, p=0.02) but it was not true for SP-D level. <strong>Conclusion:</strong> We found that the serum SP-A level, which has a big role on lungs’ natural immune system, is higher in the children who are exposed to smoking when compared to the non-exposed children. This indicates that cigarette’s inflammatory effect increases as a response to its anti-inflammatory effect in the serum level.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Recovery pattern in severely malnourished children fed with World Health Organization F-75 diet and homogenized toned milk 2018-12-10T18:06:20+0530 Dinesh Kumar Singh Durgesh Kumar Satvir Singh Rajesh Kumar Yadav Mukeshvir Singh <p><strong>Background:</strong> An average 8 million Indian children younger than 5 years (under-fives) are severely wasted. Each year approximately<br>2.3 million deaths among 6–60 months aged children in developing countries are associated with malnutrition, which is about<br>41% of the total deaths in this age group. <strong>Objective:</strong> The objective of the study was to compare the efficacy of cereal-based<br>the World Health Organization (WHO) F-75 diet and homogenized toned milk with added sugar in the recovery of presenting<br>complaints and weight gain in severe acute malnutrition (SAM) children in the stabilization phase. <strong>Materials and Methods:</strong> This<br>clinical effectiveness trial was conducted between March 2016 and August 2017 in the Department of Pediatrics, in a Medical<br>University, Saifai, Uttar Pradesh. A total of 77 children aged 6–59 months with SAM who were admitted in the pediatric ward for<br>various reasons were included in the study. Patients were randomly allocated to receive either cereal-based F-75 diet (Group I) or<br>homogenized toned milk (Group II). Each child was monitored during the early stabilization phase for improvement in terms of the<br>return of appetite, the start of edema reduction as well as the complete disappearance of edema, vomiting, loose stool, weight gain,<br>clinical duration of hospital stay, and mortality. Data collected from each group were analyzed. <strong>Results:</strong> No statistically significant<br>difference was found in the onset of edema reduction, complete disappearance of edema and return of appetite in both groups.<br>Number of vomiting and loose stools per day, on day 4 and day 10, was significantly lower in children fed with homogenized<br>toned milk (Group II). Mean weight gain among patients fed with the WHO F-75 diet (Group I) was higher (8.29±2.77 g/kg/day)<br>as compared to that of Group II (7.31±2.87 g/kg/day) but difference in weight gain among patients of Group I and Group II on day<br>10 was not statistically significant (p=0.133). <strong>Conclusions:</strong> As homogenized toned milk avoids problems of quality control and<br>microbial contamination, it may be considered for evaluation in difficult circumstances where standard protocols are not feasible<br>for management of severe malnutrition, especially in developing countries.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## What should be the criteria of renal pelvic dilatation in fetal anomaly screening? 2018-12-10T18:08:57+0530 Yusuf Atakan Baltrak <p><strong>Background:</strong> Different classification systems are used for diagnosing the renal pelvic dilatation in the fetus using imaging techniques<br>in the antenatal period. The most commonly used parameter for the diagnosis of renal pelvic dilatation is the anteroposterior diameter<br>(APD) of the renal pelvis in the transverse plane. <strong>Objectives:</strong> The objectives of this study are to compare the measurements of the<br>renal pelvic dilatation in fetuses with the measurements reported in the literature together with their short-term follow-up results<br>in the postnatal period. <strong>Materials and Methods:</strong> The infants were included in the study if they were consulted with the pediatric<br>surgery clinic due to the diagnosis of renal pelvic dilatation detected by measuring the APD of the renal pelvis in the transverse plane<br>during an ultrasound examination when their mothers were screened for detecting fetal anomalies between July 2017 and February<br>2018 at the perinatology clinic.<strong> Results:</strong> The postnatal ultrasound examination, conducted for monitoring purposes, revealed that<br>82.7% (n=57) of the infants diagnosed with a dilatation of the renal pelvis had regression or resolution of the renal pelvic dilatation;<br>however, it was observed that it persisted in the postnatal period in 17.3% (n=12) of the patients. The classification of the renal<br>pelvic dilatation in 47 fetuses diagnosed during the screening for fetal anomalies in the second trimester of pregnancy showed that<br>41 (87.2%) of them were classified as mild, 5 (7.2%) of them were classified as moderate, and 1 (1.4%) of them was classified as<br>severe. <strong>Conclusion:</strong> Based on the findings of measurements performed in the pregnant women screened at our hospital, this study<br>reported the measurements of the renal pelvic dilatation in fetuses and compared the results reported in the literature together with<br>their short-term follow-up results in the postnatal period.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Antiepileptic drug compliance among caregivers of children with epilepsy: An observational cohort study 2018-11-23T17:40:16+0530 Roosy Aulakh <p><strong>Background:</strong> Poor compliance with antiepileptic drugs (AEDs) not only increases morbidity and mortality rates among the children with epilepsy but it also leads to multiple hospital emergency room visits and enhanced health-care costs. <strong>Objective:</strong> The objective of the study was to delineate the prevalence and causes of antiepileptic drug non-compliance among caregivers of children with epilepsy in a tertiary care hospital in North India. <strong>Materials and Methods</strong>: Basic demographic data along with details of AED compliance (method of dispensing, exact dose being dispensed, frequency of administration, missing out on doses, and any side effects noted) were taken from primary caretaker dispensing the medication to the enrolled children with epilepsy on monotherapy with AEDs. <strong>Results:</strong> Wrong dosage of AED dispensed was reported in 20% (overdosing reported in 8% and underdosing in 12%) of the enrolled children. One child among the study participants receiving an overdose of the prescribed AED had emergency room admission with phenytoin toxicity. One child among the study participants was receiving wrong AED while another was receiving the AED in wrong frequency.<strong> Conclusions:</strong> The results from the present study highlight the high level of antiepileptic drug noncompliance among caregivers of children with epilepsy and also the various reasons leading to the wrong administration of AEDs to children with epilepsy. These ground level issues related to poor AED compliance, among caregivers of children with epilepsy, can help devise various methods to address these so as to improve the compliance to AEDs by caregivers of children with epilepsy.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Prevalence of obesity in students with specific learning disorder in a metropolitan city of India 2018-11-23T17:41:07+0530 Santosh Kondekar Varun Anand Pawan Mundada Surbhi Pravin Rathi Heenal Shah <p><strong>Background:</strong> Obesity is common in urban school children. Learning disability (LD) prevalence is also growing, primarily<br>in cities.<strong> Objective:</strong> The objective of this study is to find the prevalence of obesity in students with specific LD (SLD).<br><strong>Materials and Methods:</strong> This observational cross-sectional study carried out at a tertiary care center attached to a medical college<br>in Maharashtra, after obtaining permission from the institutional ethics committee. Consecutive 150 students with SLD between<br>the ages of 8 and 18 years were studied over 18 months. Obesity was classified as per body mass index. Descriptive statistics and<br>subgroup analysis were done by unpaired t-test. <strong>Results:</strong> Prevalence of obesity in students with SLD was 22.7% without gender<br>predisposition and family history correlation. Of total students with SLD, 44 (29.3%) had attention-deficit hyperactivity disorder<br>(ADHD) without any association with the obesity. <strong>Conclusions:</strong> Family history, ADHD, gender, other medical conditions, and drug<br>history have no correlation with regard to obesity in SLD. There is a further requirement of research with large population control<br>size.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Assessment of phototherapy-induced hypocalcemia and its correlation with urinary calcium excretion in term and preterm newborns with neonatal hyperbilirubinemia: A cross-sectional study with controls 2018-11-23T17:42:28+0530 Raksha Gupta Davinder Singh Meetu Yadav Prateek Kumar Panda Niranjan Nagaraj Sailen Kumar Bana <p><strong>Introduction:</strong> Although hypocalcemia is often proposed to be associated with phototherapy in both term and preterm newborns,<br>its exact incidence, clinical significance, and underlying mechanism still remain to be elucidated. <strong>Objective:</strong> The objective<br>of this study was to determine the prevalence of hypocalcemia and its etiopathogenesis in terms of urinary calcium excretion.<br><strong>Methods:</strong> This study was carried out in a tertiary care center in North India with 50 neonates (29 term and 21 preterm) in the<br>test group receiving single surface phototherapy. The other 50 age, sex, and gestational age-matched neonates were taken as<br>controls who did not receive phototherapy. Serum calcium levels at 0 and 48 h and urinary calcium/creatinine ratio (mg/mg) at<br>0 and 24 h of starting phototherapy were determined in both the groups and compared. <strong>Results:</strong> Total 12 preterm (57.1%) and<br>9 term newborns (31%) developed hypocalcemia after 48 h of phototherapy. The mean difference of serum ionized calcium<br>between two groups was statistically significant at 48 h (4.58 mg/dl in the test group vs. 4.94 mg/dl in the control group,<br>p&lt;0.001). Percentage change in mean of urinary calcium/creatinine ratio at 24 h from baseline was 1.39% in the control<br>group while it was 60.7% in the test group with statistically significant difference (p&lt;0.001) between two groups. Only a<br>weak negative correlation between serum ionized calcium and urinary calcium/creatinine ratio with correlation coefficient<br>r=−0.316 could be established in the study among both term and preterm neonates. <strong>Conclusion:</strong> Both preterm and term<br>neonates undergoing phototherapy are at increased risk for hypocalcemia and increased urinary calcium excretion. A universal<br>recommendation regarding calcium supplementation in neonates undergoing phototherapy is yet to be established but seems<br>like a reasonable intervention.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Ambient noise and neonatal hemodynamics - An observational cross-sectional study 2018-11-23T17:43:19+0530 Geeta R Karambelkar Sudhir D Malwade Disha Kewalramani Sharad R Agarkhedkar Shiji S Chalipat <p><strong>Background:</strong> Previous studies reported numerous adverse effects of noise in the newborns such as increase in the heart rate (HR) and respiratory frequency and drop in the oxygen saturation. <strong>Objective:</strong> The objective of this study was to study the effect of ambient noise levels in neonatal intensive care unit (NICU) on the hemodynamics of neonates. <strong>Materials and Methods:</strong> This was a hospital-based cross-sectional observational study which aimed at assessing the ambient noise levels in the NICU with a digital decibel meter and its effect on HR, respiratory rate (RR), and oxygen saturation. A total of 105 neonates (both preterm and term) having stable cardiorespiratory status were enrolled in the study. <strong>Results:</strong> The mean noise level recorded in the NICU was 56.2 dB. The lowest noise level was recorded at 8 am, that is, 46 dB while the highest recorded level was at 2 pm, that is, 65 dB in different areas of the NICU. There was a statistically significant increase in the HR in relation to the noise levels at all times (p&lt;0.0001). The RR also showed a significant rise in relation to the increase in noise level (p&lt;0.0001 at 2 pm with maximum noise level). The oxygen saturation showed a negative correlation and a statistically significant drop at 2 pm when maximum noise level was recorded (p&lt;0.0001). Changing shifts and more number of healthcare personnel were important factors contributing to increased noise levels at 2 pm. <strong>Conclusion:</strong> Noise levels of &gt;56 dB affected the hemodynamics of the newborn. The maximum increase in the mean HR, RR, and drop in saturation was observed at 2 pm. Staff sensitization and attitude change are needed to decrease the noise pollution in NICU.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Knowledge, attitude, and practice of kangaroo mother care among doctors in a tertiary care hospital from North India 2018-11-23T17:44:16+0530 Anita Singh Namita Mishra Girish Gupta <p><strong>Introduction:</strong> Kangaroo mother care (KMC) has been established as having an important role in the care of all the babies; especially, the preterm and low birth weight babies. Successful implementation of KMC depends on knowledge, attitude, and practice (KAP) of healthcare workers, mothers, fathers, and other family members.<strong> Objectives:</strong> The objectives of the study ws to determine the KAP of KMC among the faculty and residents of the departments of neonatology and obstetrics in a tertiary care hospital. <strong>Methods:</strong> The study was a cross-sectional descriptive study in which data were collected from departments of neonatology, maternal health, and reproductive health. The study subjects were faculty and residents from both the departments. They were interviewed using a structured pre-tested questionnaire in three domains, knowledge (11), attitude (8), and practice (4). The responses were tested against standard predefined answers and were expressed in percentages. <strong>Results:</strong> A total number of 25 doctors were interviewed; among knowledge domain, approximately 60% doctors responded correctly for the need of KMC, duration of KMC, feeding during KMC and type of baby’s clothes during KMC. In the domain of attitude, response of KMC for who can give, when to start/stop, position of mother, and feasibility of KMC during non-invasive ventilation was correct for all subjects. For practice aspect, there was a lack of counseling and re-checking, though almost everyone felt the need of separate KMC room and counselor. <strong>Conclusions:</strong> From the above results, it is apparent that knowledge and attitude, among health-care professionals, is optimum. However, there is lots of scope for filling a few gaps to improve practices and training workshops are required to bring in behavior change among doctors.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## The role of gastric aspirates cytology and micro-erythrocyte sedimentation rate in predicting the early septicemia in newborn babies 2018-11-23T17:45:00+0530 Meetu Yadav Raksha Gupta Jasbir Singh Sameer Saraswath Niranjan Nagaraj Sailen Kumar Bana <p><strong>Background:</strong> Sepsis is an important cause of neonatal morbidity and mortality. The magnitude of problem may be reduced by early detection of amniotic fluid infections and appropriate treatment of the neonate. <strong>Objective:</strong> The objective of this study was to know the role of gastric aspirates cytology and micro-erythrocyte sedimentation rate (m-ESR) in predicting the early-onset septicemia in newborn babies. <strong>Materials and Methods:</strong> The study was conducted on 100 neonates with suspected septicemia and 50 normal neonates admitted to neonatology section of a tertiary care hospital. Blood sample and gastric aspirate sample were collected for sepsis screening of the neonates. All the collected data were tabulated and statistically analyzed using SPSS 2.0 software. <strong>Results:</strong> About 55% of neonates had positive cytology and m-ESR and 22.2% had subsequent sepsis. Combined sensitivity was 50%, specificity was 81.25%, positive predictive value (PPV) was 62.5%, and negative predictive value (NPV) was 72.2%. Of the 45% of cases with positive cytology and micro-ESR, 13.3% had septicemia, 6.6% had pneumonia, and 2.2% had meningitis. The other 55% of cases had negative cytology and m-ESR, and out of them, 9.09% had septicemia, 7.2% had pneumonia, and 1.8% had meningitis. The sensitivity of m-ESR was 60%, specificity was 62.5%, PPV was 50%, and NPV was 71.5%. The combined sensitivity was 50%, specificity was 81.25%, PPV was 62.5%, and NPV was 72.2%. <strong>Conclusion:</strong> Combined gastric aspirate and m-ESR had high percentage of specificity and NPV. No specific and significant correlation between positive gastric aspirate cytology and rural/urban area, birth weight, sex, gestation, prolong labor, meconium-stained amniotic fluid, and mode of delivery was found.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Waardenburg syndrome-associated focal segmental glomerulosclerosis: A rare presentation 2018-11-23T17:45:53+0530 Murugu Sarasu J Anju Aggarwal Swati Bhayana Aaradhana Singh <p>Waardenburg syndrome (WS) is characterized by auditory and pigmentary disorders with an incidence of 1:40,000. Renal involvement is rare in WS. A 10-year-old male, diagnosed as nephrotic syndrome at 4 years, was presented in relapse. A renal biopsy performed at 6 years revealed evidence of focal segmental glomerulosclerosis. The child had morphological findings which were suggestive of WS. Hence, a diagnosis of WS type 1, with frequently relapsing nephrotic syndrome, was made. The possible genetic basis of renal involvement in WS needs to be evaluated.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## A case of elephantiasis neuromatosa 2018-11-23T18:27:28+0530 Gunasekaran K Sivakumar S Thiruvarutchelvan K <p>Elephantiasis neuromatosa (EN) is a rare and unique complication of plexiform neurofibroma, a type of neurofibromatosis type 1, and manifests as hypertrophy of an extremity (either lower limb or upper limb). EN can be seen in individuals of any age group including children and young adults where males and females are affected equally. Diagnosis is done primarily by magnetic resonance imaging of the affected region along with a history and clinical examination. EN may lead to severe functional impairment of the involved limb with cosmetic disfigurement. Treatment is mainly surgical with less satisfactory results. Here, we present a 6-year-old child with EN.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement## Equity: A maternal and neonatal problem 2018-11-23T18:28:14+0530 Mst Nahid Farha Abdul Kuddus <p>This paper highlights the maternal and neonatal mortality within the developing countries in Asia and South Africa to include a discussion on how maternal and neonatal mortality is a serious problem in developing nations. The study also draws strategies to reduce maternal and neonatal problem.</p> 2018-12-12T05:05:11+0530 ##submission.copyrightStatement##