Indian Journal of Child Health <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> Atharva Scientific Publications en-US Indian Journal of Child Health 2349-6118 Central venous pressure versus inferior vena cava collapsibility index measurement to assess the intravascular status <p>-</p> Michael Keenaghan Amit Agrawal ##submission.copyrightStatement## 2018-11-16 2018-11-16 554 555 Newborn screening for hemoglobinopathies <p>-</p> Suksham Jain Amit Agrawal ##submission.copyrightStatement## 1970-01-01 1970-01-01 556 556 Tracheostomy among pediatric patients: A review <p>Tracheostomy is a surgical procedure which has been performed since ancient time. Tracheostomy is a life-saving surgical procedure done among critically sick patients. Children with airway compromise often require tracheostomy. The indication of the tracheostomy among children ranges from airway obstruction to prolonged mechanical ventilator support. There are numerous research papers published for adult tracheostomy with its indications, operative technique, and complications, but the literature on pediatric tracheostomy is scarce. Advanced technique of pediatric anesthesia and increased awareness for vaccination for serious diseases such as polio, measles, diphtheria, tetanus, and Haemophilus influenzae type b (Hib) among children increased the changing indication for tracheostomy from emergency to more elective procedure. Standardization of the procedure, timing, and exact indications is helping to reduce the mortality related to the tracheostomy among the pediatric patients. Here, we attempt to discuss the indications, techniques, selection of the tracheostomy tube complications, and outcome of the tracheostomy among pediatric patients.</p> Santosh Kumar Swain Alok Das Ishwar Chandra Behera Biplob Bhattacharyya ##submission.copyrightStatement## 2018-11-16 2018-11-16 557 561 To evaluate the relation between central venous pressure and inferior vena cava collapsibility in cases of pediatric shock <p><strong>Background:</strong> Invasive hemodynamic monitoring of central venous pressure (CVP) is a useful guide in directing early resuscitative efforts and assists in reducing the morbidity and mortality of the patients with septic shock. Dynamic parameters like ultrasonographic evaluation of the inferior vena cava (IVC) diameters are becoming increasingly popular method to assess the intravascular volume status. <strong>Objectives:</strong> The objective of this study was to evaluate the relation between CVP and IVC collapsibility in cases of fluid refractory shock. <strong>Methods and Materials:</strong> This was a prospective observational study. Pediatric patients between 1 and 14 years with fluid refractory shock were evaluated. Their CVP was recorded and IVC diameter was measured by ultrasonography during inspiration and expiration. This was calculated as IVC collapsibility index (IVC-CI). Data analysis was done with descriptive statistics, coefficient of correlation, and analysis of variance, as appropriate using SPSS for Windows software (SPSS Inc. Version 20). <strong>Results:</strong> A total of 107 patients with shock were included in the study with the mean age of 7.6 years. Septic shock (93%) was the most common cause of shock and the maximum patients (63%) were in cold shock. Most of these patients had acidosis (mean pH 7.22±0.2), high lactate levels (mean 6.3±3.50 mmol/l), and decreased bicarbonate levels (mean 16.98±5.95 mmol/l). When CVP range was ≤8 mmHg, the mean IVCCI value was &gt;40% and when the CVP range was ≥12 mmHg, the mean IVCCI value was around 20%. Inverse relation between CVP and IVCCI was observed (r=−0.690, p&lt;0.01). <strong>Conclusions:</strong> There was a strong negative correlation between CVP and IVC collapsibility.</p> Mohd Kashif Ali Aditi Das Eeman Naim ##submission.copyrightStatement## 2018-11-16 2018-11-16 562 565 Comparative analysis of the role of isoelectric focusing and high-performance liquid chromatography in newborn screening in hemoglobinopathies <p><strong>Introduction:</strong> Hemoglobinopathies are the common genetic disorders and are considered as the emerging health burden. To reduce the childhood and infant mortality and morbidity, early recognition by newborn screening and timely intervention is necessary. <strong>Objectives:</strong> The objectives of this study are to evaluate the prevalence of different hemoglobinopathies in the study population and to compare the efficacy of isoelectric focusing (IEF) and high-performance liquid chromatography (HPLC) tests in the neonatal screening for hemoglobinopathies. We have also assessed the predominant mutations for all β-thalassemia variants. <strong>Materials and Methods:</strong> The prospective observational study was conducted in the Department of Pathology in collaboration with the Department of Neonatology over 1½ years including 4200 neonates. Both IEF and HPLC diagnoses were attempted and compared with recall HPLC and parent HPLC. DNA analysis was also done further confirmation in all thalassemia cases. <strong>Results:</strong> A total of 213 cases with 11 Hb variants were detected; among them, HbE trait was the most prevalent type. Overall sensitivity, specificity, and negative and positive predictive values were noted. The results of IEF were comparable with HPLC with a statistically significant measure of agreement of κ=0.928 between the two. DNA analysis of 37 β-thalassemia variants revealed three common mutations, i.e., cd26 (G&gt;A), IVS1-5 (G&gt;C), and cd15 (G&gt;A).<strong> Conclusion:</strong> In IEF, the hemoglobin separation is very precise with little band overlap, but the process and interpretation need a high expertise. Due to more sensitivity, IEF should be the initial screening test followed by recall HPLC for confirmation of the diagnosis.</p> Nikhil Kumar Moumita Sengupta Mousumi Kar Chhanda Datta Suchandra Mukherjee Uttara Chatterjee Dhrubaneel Biswas ##submission.copyrightStatement## 2018-11-16 2018-11-16 566 570 Clinico-demographic Profile and coinfections among hospitalized children with chikungunya in a tertiary care hospital of North India: lessons learnt <p><strong>Background:</strong> Chikungunya is a vector-borne arboviral disease. Children are known to have atypical manifestations. Overlapping features with other infections can make the diagnosis difficult. <strong>Objective:</strong> The objective was to study the clinicodemographic and laboratory profile of chikungunya and the impact of coinfections on the course and outcome among hospitalized children. We conducted the study during a large outbreak of chikungunya in the national capital. <strong>Materials and Methods:</strong> A retrospective analytical study was conducted on children admitted from July to November 2016 at a tertiary care hospital in North India. Case records of all hospitalized children (1 month–14 years) with immunoglobulin M positive chikungunya serology were reviewed. Children were categorized into Group A (isolated chikungunya infection) or Group B (coinfection) after entering baseline data, clinical, laboratory, and management details in a pre-designed case record pro forma. Groups A and B were compared to see any statistically significant difference in the clinical and laboratory parameters using appropriate statistical tests.<strong> Results:</strong> Of 102 children, 45 (44.1%) had isolated chikungunya and 57 (55.9%) had chikungunya with other coinfections. In the coinfection group, 37 (36.3%) had dengue, 7 (6.8%) enteric, 6 (5.9%) malaria, 5 (4.9%) pyomeningitis, and 2 (2%) viral hepatitis-A. Vomiting and splenomegaly (p&lt;0.05) were significantly more in the coinfection group. The classic triad of chikungunya was present in only three cases of isolated chikungunya. <strong>Conclusion:</strong> Children lack the classical triad of chikungunya and coinfections are very common in children.</p> Shivani Deswal Ajeet Kumar Yadav Soumya Dey Tribhuvan Pal Yadav Chander Prakash Yadav ##submission.copyrightStatement## 2018-11-16 2018-11-16 571 575 A study to assess the outcome of critically ill children with hypoalbuminemia admitted in a tertiary care center <p><strong>Introduction:</strong> Albumin is a major plasma protein, constituting around 55% of total protein load of the plasma. Hypoalbuminemia is commonly found in patients with heart failure, cirrhosis, nephrotic syndrome, severe malnutrition, thermal injuries, and protein-losing enteropathy. <strong>Objectives:</strong> The objectives of the study were to assess the outcome of critically ill children with hypoalbuminemia admitted in a tertiary care center. <strong>Materials and Methods:</strong> A total of 80 patients, who were diagnosed to be having hypoalbuminemia, were admitted in the pediatric intensive care unit (PICU) in Bengaluru. 80 patients with similar characteristics to cases and with normal levels of serum albumin were included in the study as “controls.” The study was undertaken over the duration of 1 year. <strong>Results:</strong> The mean serum albumin in cases at admission was 2.5±0.5 mg/dl and in controls was 4.3±0.6 mg/dl. Mean length of PICU stay among cases was 7.8±5.1 days and among controls was 5.1±3.2 days (p&lt;0.001). Among cases 32.5% died and 67.5% survived, similarly among controls 35% died and 65% survived (p=0.73). <strong>Conclusion:</strong> The level of albumin in the children plays a very important role in determining the treatment options and the outcome of the treatment in the form of an increased rate of mortality and morbidity.</p> Lakshmi Lakkappa V Bharathi Tulasi Penta ##submission.copyrightStatement## 2018-11-16 2018-11-16 576 578 Evaluation of vaccination status of children attending a private tertiary paediatric hospital in urban Hyderabad <p><strong>Objectives:</strong> The objectives of this study were to understand the vaccination status and reasons for missed vaccination in the catchment of a tertiary private paediatric hospital in a densely populated area in urban Hyderabad. <strong>Study Design:</strong> This was a questionnaire-based cross-sectional survey. <strong>Methods:</strong> Data regarding the vaccinations for all the vaccines included in the guidelines provided by the Indian Academy of Pediatrics were collected from eligible parents attending the outpatient department after informed consent. <strong>Results:</strong> Vaccination coverage was almost 90% with private health facilities being used by both timely and missed vaccine groups. Factors such as gender bias, large families, or low educational status were absent in both groups in this urban population unlike rural populations. Vaccines perceived by the parents as optional and booster doses were most often missed and an unwell child was the most common reason for the missed vaccines. <strong>Conclusion:</strong> Even in urban areas like our densely populated catchment, specified dates for next vaccine at each visit to the pediatrician will improve timely vaccination. Awareness also needs to be raised regarding the importance of what are perceived to be optional vaccines.</p> Rajasri Seethamraju Neelima Kharidehal Chandrashekhar Koyalakonda Pallavi Maddukuri Vamsi Kiran Rayudu ##submission.copyrightStatement## 2018-11-16 2018-11-16 579 583 Serum zinc levels in children with simple febrile seizure <p><strong>Background:</strong> It has been postulated that children with low serum zinc level are more prone to febrile seizures. <strong>Objectives:</strong> The objectives of this study were to compare the serum zinc levels in children suffering from febrile seizures with the children with febrile illness without seizures and children with no seizure and fever. <strong>Materials and Methods:</strong> A prospective case–control study was conducted in the Department of Pediatrics, in a Medical Institution of Meerut, over a period of 2 years (March 2015–May 2017). A total of 150 candidates of age 6 months–60 months were recruited from the pediatric wards and were divided into three subgroups. Group A consisted of 50 children who neither had fever nor seizures. Group B consisted of 50 children who had fever but no seizures. Group C consisted of 50 children who suffered from simple febrile seizure. Here, the Groups A and B served as control while Group C was taken as case. Serum zinc level was assessed in each child after taking written consent from parents. Further, the value of serum zinc was compared among the group. The results were statistically analyzed using the Statistical Package for the Social Sciences Version 21.0 statistical analysis Software. <strong>Results:</strong> Of 50 children with febrile seizures, 29 (58%) were male. Mean serum zinc levels of all the children included in the study were low (55.42 μg/dl) as compared to the reference values. There was no significant difference in the serum zinc levels in the febrile seizure group and control groups. <strong>Conclusion:</strong> We found that the serum zinc level was not associated with febrile seizures.</p> Vandana Singh Daksh Yadav ##submission.copyrightStatement## 2018-11-16 2018-11-16 584 587 Determination of cord blood lipid profile in neonates and its correlation with birth weight and maternal anthropometry <p><strong>Introduction:</strong> Serum lipid disorders have their roots in childhood and atherogenic changes are postulated to originate early in life. Cord lipid profile is a useful tool in the earlier detection of babies at a higher risk. <strong>Objectives:</strong> The objectives of the study were to assess the early onset dyslipidemia by determining cord blood lipid profile in healthy term newborns and to compare the cord blood lipid profile between terms small for gestational age (SGA) and appropriate for gestational age (AGA) newborns. <strong>Materials and Methods:</strong> This prospective observational study was conducted from October 2013 to October 2014 in the Department of Pediatrics of a Tertiary Care Institution of Central India. All normal term newborns with gestational age between 37 and 42 weeks were included in the study. After thorough examination, their weight, length, and ponderal index (PI) were recorded. Cord blood was collected immediately after the delivery and cord lipid profile was measured. Data were recorded and correlated statistically. <strong>Results:</strong> Of 114 neonates, 71 were AGA, 40 were SGA, and three were large for gestational age. There were 59 (51.8%) female and 55 (48.2%) male neonates. Birth weight, length, gestational age, head circumference, and PI were significantly higher in AGA neonates than SGA neonates (p&lt;0.001, 0.013, 0.022, 0.02, and &lt;0.001, respectively). Total cholesterol (TC), triglycerides (TGs), low-density cholesterol (LDL), and very low-density cholesterol (VLDL) levels were significantly higher in term SGA than term AGA neonates. <strong>Conclusion:</strong> Birth weight correlated negatively with LDL, VLDL, TC, and TG. Lipid profile parameters were also higher in babies with maternal body mass index ≥25 kg/m2.</p> Shipra Mandraha Avyact Agrawal Vikas Talware ##submission.copyrightStatement## 2018-11-16 2018-11-16 588 591 Outcome of large- and small-for-gestational-age babies born to mothers with pre-pregnancy and gestational diabetes mellitus versus without diabetes mellitus <p><strong>Introduction:</strong> The prevalence of diabetes mellitus (DM) is on the increase among general population and prenatal mothers. The feto-maternal outcome of mothers with DM varies with the type of DM, pre-pregnancy or gestational (PPDM and GDM), and glycemic control. <strong>Objective:</strong> The objective of this study is to assess the outcome of small- and large-for gestational-age (SGA and LGA) babies born to a cohort of mothers with PPDM and GDM and without DM. <strong>Materials and Methods:</strong> This cohort study was conducted in a tertiary care teaching hospital. A total of 480 mothers and their newborn babies were enrolled before 6 weeks of gestation and were categorized into PPDM, GDM, and no DM subgroups. Mothers were managed as per the standard protocols. Parameters observed were optimum/suboptimum glycemic control, neonatal weight, GA, morbidity, mortality, and neonatal intensive care unit (NICU) stay. <strong>Results:</strong> A total of 19.5% mothers had PPDM, including 70 mothers already diagnosed as DM, while 39% had GDM and 41.5% had no DM. The detection rate of PPDM was 5.6% and GDM was 17.5%. Majority of the mothers with PPDM and GDM required insulin and two-third had optimum glycemic control. Good glycemic control resulted in more appropriate-for-GA babies. SGA babies were more in PPDM group (54%), followed by GDM (26%) and non-DM (21%) subgroups, while LGA babies were less in these groups, i.e., 9.6%, 5.9%, and 0.5%, respectively. The following observations were statistically significant among PPDM compared to GDM: SGA (relative risk [RR] 2.1, 95% confidence interval [CI] 2.9–3.6), congenital anomalies (RR 3.3, 95% CI 5.1–8.8), and neonatal mortality (RR 4, 95% CI 2.1–3.2). Prematurity and NICU admission with longer stay were also more in PPDM. Macrosomia and birth injury were more in GDM. Hypoglycemia, longer NICU stay, and macrosomia were more with poor glycemic control.<strong> Conclusions:</strong> A change in profile with more SGA and less LGA babies was noted in this study. Differential short-term outcomes were noted, based on the onset of DM and glycemic control. Pre-pregnancy/early first-trimester screen followed by second and third trimester screens and optimum glycemic control, throughout pregnancy, is recommended.</p> Elizabeth K E David Ashok Ashwin Sobhakumar S Sujatha T L ##submission.copyrightStatement## 2018-11-16 2018-11-16 592 596 Cord blood Vitamin D levels in newborns and its correlation with anthropometric indices of baby: A cross-sectional study <p><strong>Objectives:</strong> The objectives were to study the cord blood Vitamin D levels in term neonates and the association of Vitamin D deficiency with birth weight and crown-heel length. <strong>Materials and Methods:</strong> This cross-sectional study was performed in the department of pediatrics at the tertiary care center. All term singleton infants were included in the study. A detailed history from the mothers was taken, and complete anthropometric assessment of babies was done. Cord blood was collected, transported, and analyzed for Vitamin D levels. Data were analyzed using SPSS software. <strong>Results:</strong> A total of 202 children were enrolled. The median cord Vitamin D level was 16.0 ng/dl (interquartile range 13–18.8 ng/dl). Deficiency of Vitamin D was noted in 162 babies (80.6%) and insufficiency in 26 (13%) neonates. A total of 92.6% (151) of Vitamin D-deficient babies were low birth weight (LBW) (p&lt;0.001) and 96.5% (157) of babies of the Vitamin D-deficient babies had crown-heel length &lt;50 cm (p&lt;0.001). <strong>Conclusion:</strong> Majority of the studied newborns were deficient in Vitamin D, and a positive correlation was found between Vitamin D deficiency and LBW and decreased crown-heel length.</p> Jagan Nath Mohapatra T Sheten Doga Sherpa Nidhi Bedi ##submission.copyrightStatement## 2018-11-16 2018-11-16 597 599 Risk factors for complicated appendicitis among pediatric population <p><strong>Context:</strong> Appendicitis is the most common surgical emergency in children. In children, it is difficult to diagnose appendicitis due to atypical presentation. Various risk factors have been mentioned in literature leading to complicated appendicitis. <strong>Aims:</strong> Our study was to determine the risk factors for complicated appendicitis in children. <strong>Methodology:</strong> The children who underwent appendectomy with a clinical diagnosis of acute appendicitis from 2015 to 2018 were studied retrospectively at Kempegowda Institute of Medical Sciences and Hospital, Bengaluru. The pre-operative, operative, and post-operative data were analyzed. Statistical analysis was performed and variables analyzed were age, sex, location of patient, duration of symptoms, total leukocyte count, and fecolith. S<strong>tatistical Analysis Used:</strong> Categorical variables were analyzed by applying Chi-square test and continuous variables were analyzed by applying independent t-test. <strong>Results:</strong> A total of 220 children presented with appendicitis during the study period, of which 60 children had complicated appendicitis. Mean age of presentation was 10.38±2.84 years. On statistical analysis, patients having pain of duration &gt;48 h (p=0.017), patients with leukocyte count &gt;15000/mm3 (p&lt;0.0001), and patients with fecolith (p=0.00075) were more likely to have complicated appendicitis. However, the age, rural location, and sex of the patient were not associated with complicated appendicitis. <strong>Conclusion:</strong> Appendicitis is a common cause of abdominal pain in children. High leukocyte count, delayed presentation, and appendicolith are possible markers of complicated appendicitis. Sex, rural location, and age did not have any association with complicated appendicitis.</p> Pramod Sreekanta Murthy Amrit Preetam Panda ##submission.copyrightStatement## 2018-11-16 2018-11-16 600 603 Profile and outcomes of children presenting with infection-related glomerulonephritis <p>Poststreptococcal acute glomerulonephritis (PSGN) was reported as the most common cause of GN in children. There has been, however, a marked shift in epidemiology in recent years with the decline in poststreptococcal cases. Various other bacteria and rarely viral and fungal infections are associated with GN. More cases are now being reported with ongoing infection at the time GN is diagnosed. Therefore, the term infection-related GN (IRGN) is now being used increasingly. We describe the clinical profile and outcomes of children presenting with IRGN at a tertiary care center in the past 1 year. 5 children presented with features of GN. Only 1 of the 5 had the course typically described in PSGN. Two patients also had a post-infectious course but with some unusual features. Another patient had an ongoing systemic infection in the form of pneumonia at the time of onset of features GN, while our fifth patient developed an infection-related GN with dengue illness.</p> Lt Col Suprita Kalra Maj Gitanjali Jain Lt Col Sanjay Kumar Panda Col Venkat K Narayan ##submission.copyrightStatement## 2018-11-16 2018-11-16 604 606