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 Schools as opportunity for oral health promotion: Existing status in India <p>Childhood is a significant stage in people’s lives where they are more receptive toward behavior shaping; thus, schools have been<br>considered important foundation in addressing the health and social issues. School oral health education programs have produced<br>affirmative results in improving the overall health of the child. The aim of the current review was to explore the history of school<br>health, models of school health and existing efforts of School Oral Health Programs (SOHP) in India. The review identified<br>five existing SOHP (Indian Dental Association - Colgate’s “Young India” Bright Smiles, Bright Futures, Chacha Nehru Sehat<br>Yojna - School health scheme [Government of Delhi], Neev - SOHP, Intensive Dental Health Care Program - Punjab, Trinity Care<br>Foundation - Bengaluru, National Oral Health Program, AIIMS) which is either running or proposed. It is recommended that the<br>upcoming SOHP should be crafted on the existing evidence-based guidelines and theoretical models of school health. Prompt<br>execution of proposed programs should be the priority to target the optimum oral health of the children.</p> Puneet Chahar Meena Jain Ankur Sharma Nisha Yadav Parul Mutneja Vishal Jain ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 513 517 An electroencephalographic study in birth asphyxia and correlation of electroencephalographic pattern with neurodevelopment outcome at 6-month age <p><strong>Background:</strong> Perinatal asphyxia is one of the most common medical emergencies of newborn and important cause of neonatal morbidity and mortality. In India, about 1 million babies suffer from birth asphyxia every year, and it is responsible for nearly 28.8% of the neonatal deaths and the subsequent major sequelae. <strong>Objectives:</strong> The objective of the study was to evaluate the clinico-etiological and electrophysiological profile of neonates with birth asphyxia and its correlation with the neurodevelopment outcome at 6 months of age. <strong>Methods:</strong> In this prospective observational follow-up study, 50 neonates of &gt;35 weeks of gestation with a history of birth asphyxia were included. Electroencephalographic (EEG) was performed within the first 72 h of life or as soon as neonate was stable. Follow-up visits were scheduled as per NNF guidelines at 6, 10, and 14 weeks, 3 and 6 months of age. Detailed neurological examination, neurodevelopment and tone were assessed by Denver II and Amiel–Tison method, respectively, on every visit. <strong>Results:</strong> All neonates were on hypoxic-ischemic encephalopathy (HIE) Stage I had normal EEG recording; 36.7% with HIE Stage II had abnormal EEG recording while 100% the neonates of HIE Stage III showed abnormal EEG. All neonates, who had normal EEG recording, survived, and 96.5% (n=28) of them show normal neurodevelopment outcome. 3.7% (n=1) showed developmental delay. All the neonates who had abnormal background on EEG showed adverse outcome. 50% of them expired and rest 50% had abnormal neurodevelopment outcome on follow-up. <strong>Conclusion:</strong> The severity of encephalopathy in asphyxiated neonates correlates well with the abnormalities on EEG records.</p> Ashish Jain Jyotsna Shrivastav Jyoti Prajapati ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 518 521 Effect of routine lactation consultant support to mothers on breastfeeding efficacy <p><strong>Introduction:</strong> Studies have concluded that lactation consultant’s visit provides more face-to-face time and education than physician support alone in improving the breastfeeding efficacy and rates. <strong>Objectives:</strong> The objective is to study the effect of incorporating routine lactation consultant to daily postnatal rounds with the resident on (a) cumulative weight loss of postnatal neonates and (b) jaundice requiring phototherapy, number of breastfeedings per day, duration of hospital stay and NICU admission. <strong>Methodology:</strong> A cross-sectional study was carried out among all stable neonates admitted in postnatal wards weighing &gt;2 kg and gestation &gt;35 weeks. The babies whose mothers were trained on breastfeeding by the pediatric resident doctor, in the routine postnatal rounds, were considered as Group 1. Infants whose mothers were counseled by the lactation consultant and the resident doctor on the breastfeeding were considered as Group 2. The baseline characteristics of mother and the neonates were recorded by a structured proforma. <strong>Results:</strong> Of 158 eligible babies, during the study period, 84 babies were enrolled for the study. The mean gestation of the babies in Groups 1 and 2 was 38.1±1.9 and 38.2±1.8 weeks, and the mean weight was 2.95±0.42 and 2.87±0.04 kg, respectively. The cumulative weight loss was 5.43±2.53% and 5.59±2.35 % (p=0.75) in Groups 1 and 2, respectively. The duration of hospital stay was 5.6±1.98 and 5.1±0.81 days (p=0.09), jaundice requiring phototherapy 22 (47%) and 15 (37%) with p=0.56 and the number of breastfeedings per day was 10.2±2.98 and 10.5±1.2 times with p=0.60 between the Groups 1 and 2, respectively. <strong>Conclusion:</strong> Even though there was no difference in either the primary or secondary objective between the groups, postnatal lactation counseling is very essential for improving the breastfeeding efficacy with the support of either doctor or the lactation consultant. There was acceptable cumulative weight loss, urine output, number of breastfeedings per day, and NICU admissions.</p> Vinay Kumar Gogi Chandrakala Bada Shekharappa Sumithra Selvam ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 522 525 Nurse’s perspective on barriers in the implementation of kangaroo mother care in a tertiary care hospital from North India <p><strong>Background:</strong> Despite the established benefits of kangaroo mother care (KMC), it is not being implemented in all eligible babies. There are several barriers in its implementation including those from the nurses, mothers, and institution. <strong>Objective:</strong> The objective of the study was to determine the nurse’s perspective on various barriers in the implementation of KMC. <strong>Materials and Methods:</strong> This was a cross-sectional descriptive study in which data were collected from all the nurses of the Department of Neonatology and Obstetrics in a tertiary care hospital, from North India, over 1 week using a structured pre-tested questionnaire covering barriers in three main domains - mothers (6), nursing staff (7), and institutional (5). <strong>Results:</strong> There were a total of 40 nurses, who responded to questionnaire; among them, 70% were from neonatology and 30% were from obstetrics. Mean barrier-free score (BFS) (%) was 48.93±14.77 with a range of 29.17–76.39, while median (interquartile range) was 47.22 (44.4–52.4). Mean BFS was found to be statistically significant when compared between maternal and nursing domains (54.5±11.1 vs. 43.3±11.9 vs. 49.0±18.4, p=0.003).<strong> Conclusion:</strong> The present study shows that the most important barriers in KMC implementation were lack of support to mother, duty schedule of staff, difficulty in convincing, and a private/separate environment for KMC. Therefore, actions need to be taken to overcome these barriers to use this simple intervention with enormous benefits.</p> Anita Singh Namita Mishra Girish Gupta Prabhaker Mishra ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 526 529 Comorbidities in children hospitalized with severe acute malnutrition <p><strong>Background:</strong> As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. <strong>Objective:</strong> The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. <strong>Results:</strong> Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. <strong>Conclusion:</strong> Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes.</p> Vinnamangalam Mani Baskaran Sridevi A Naaraayan Dorairaj Priyadharishini ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 530 532 Study of echocardiography in thalassemia (major/intermedia) patients at tertiary care center <p><strong>Objective:</strong> The objective of this study is to study the cardiovascular complications and to establish the role of echocardiography (ECHO) screening in beta thalassemia major (TM) and intermedia patients, aged 2–12 years, receiving one or more transfusions per month for 2 or more years. <strong>Methods:</strong> A cross-sectional study was done at tertiary care center from June 2015 to November 2015. Hemoglobin, serum ferritin, and 2D ECHO were done before the blood transfusion. <strong>Results:</strong> Male preponderance was seen with a ratio of 1.7:1. 87% (n=47) had TM and remaining had thalassemia intermedia (TI). Serum ferritin in TM was &gt;1000 ng/ml in 80.9% (n=38) of cases and &lt;1000 ng/ml in 19% (n=9) of cases. Serum ferritin in TI was above 1000 ng/ml in 42.8% (n=3) and &lt;1000 ng/ml in 57.14% (n=4) of cases. 64% (n=35) had cardiomegaly in X-ray. 2D Echo showed increased LV mass in 71.1% (n=27) of cases and normal LV mass in 28.9% (n=11) of cases. Pulmonary hypertension was seen in 21.2% (n=10) of cases of TM and 42% (n=3) of cases with TI. <strong>Conclusion:</strong> ECHO combined with electrocardiogram should be used for regular periodic monitoring of transfusion-dependent thalassemia patients.</p> Usha B K Stalin S Ravi Chandran T Gnanasambandam S ##submission.copyrightStatement## 1970-01-01 1970-01-01 5 8 533 536 Etiological evaluation of convulsions in children from 1 month to 14 years of age <p><strong>Background:</strong> Seizures are a common problem evaluated in the pediatric emergency departments worldwide. <strong>Objective:</strong> The objective of the study was to study the etiology of convulsions in children aged 1 month–14 years. <strong>Methods:</strong> This cross-sectional study was done among 120 children admitted to the pediatric ward of a tertiary care hospital with convulsions during the period of June 2014–May 2015. Complete blood count, blood sugar, serum calcium, magnesium, and electrolytes were done for all the children. Mantoux, chest X-ray, liver biopsy, electroencephalograph, lumbar puncture and cerebrospinal fluid analysis, ultrasonography cranium, computed tomography brain, or magnetic resonance imaging brain were done based on the clinical situation. <strong>Results:</strong> We found that 46.7% of the children had febrile seizures, 19.2% had seizure disorder, 15% had cerebral palsy, 5.8% had viral encephalitis, 3.3% had pyogenic meningitis, 1.7% had neurocysticercosis, 0.8% had metabolic disorders, and 0.8% had traumatic brain injury, and the cause of seizures was unknown in 6.6% of the children. <strong>Conclusion:</strong> Children with seizures need a thorough evaluation to identify the underlying pathology causing seizures.</p> Madhan Kumar M Shanthi Ramesh Sundari S ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 537 539 Problems related to voiding pattern in patients with hypospadias repair: i̇s the problem related to only operation? <p><strong>Background:</strong> Problems related to the urine flow are rather common in hypospadias patients. As these problems are detected during follow-up of urine flow in the post-operative period, it is difficult to determine whether it is a problem emerging secondary to the surgery or it is a congenital condition. <strong>Objective:</strong> The objective of this study was to evaluate the lower urinary tract functions in hypospadias patients with pre-operative and post-operative uroflowmetric examinations and to determine whether it is a complication of the surgery or a congenital condition. <strong>Materials and Methods:</strong> A total of 63 patients who underwent hypospadias surgery and were monitored postoperatively between January 2012 and January 2013 were enrolled in the study. Data about the pre- and post-operative uroflowmetry parameters were collected and compared. <strong>Results:</strong> Of total 83 patients, only 63 (76.8%) patients, whose parent’s provided the written consent, were studied. The mean age was 6.9±2.4 years (3–14 years). The mean bladder volume estimated according to the age of the patients was 266.5±71.7 ml. The mean bladder volume before and after the surgery was 179±56 ml and 189±53 ml, respectively, and the bladder volumes were 67% and 71% of the estimated bladder volume, respectively. There was no significant difference between the bladder volumes measured before and after the surgery (p=0.159). Furthermore, no significant change in the measurements regarding the maximum flow rate, time to maximum flow rate, total time of the urine flow, mean flow rate, voided volume, voiding time, and post-void residual volume was observed. <strong>Conclusion:</strong> The uroflowmetry is an easy-to-use, non-invasive, and objective method, which can be used for the early diagnosis of the urethral stricture following the hypospadias surgery and the evaluation of the obstructions in the lower urinary tract</p> Yusuf Atakan Baltrak Ibrahim Karaman Ayşe Karaman ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 540 544 Clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients <p><strong>Objective:</strong> The objective is to study the clinico-epidemiological profile and risk factors associated with failure of conservative therapy in pediatric empyema patients and to correlate the Light’s criteria in the same. <strong>Materials and Methods:</strong> A hospital-based prospective observational study was performed in the pediatric department of a tertiary care hospital, New Delhi. A total of 74 children of ≤12 years of age having either macroscopic frank pus in pleural tap or a positive Gram-stain or positive culture in pleural fluid were enrolled in the study. Those empyema patients who fail to improve with antibiotics and chest tube drainage after 7–14 days (4 weeks for Staphylococcus aureus and 6–12 weeks for anaerobic organisms, respectively) or develop some complications in the mean time were considered as a failure of therapy. <strong>Results:</strong> Head nodding, lethargy and inability to feed/drink, prior antibiotic therapy, duration of illness (&gt;7 days) before presenting to the hospital, and growth on the cultures were the main factors associated with the failure of conservative therapy. S. aureus is the most common organism causing empyema. Considering Light’s criteria, significant results were obtained and almost all the enrolled empyema patients found to have exudative pleural fluid. In the study, failure of conservative therapy occurred in 27.03%, prolonged hospitalization was seen among 48.65 % children, 28.38% needed change in antibiotics, and 1.35% children expired.<strong> Conclusion:</strong> History of prior antibiotic therapy, long duration of illness, and clinical features at admission along with the microorganism involved affect the conservative therapy response and may predispose to complications. Light’s criteria were very well validated in the study for its use in pediatric population.</p> Vipul Gautam Ajay Kumar Balvinder Singh Arora Shyam Sunder Mina Kailash Chandra Aggarwal ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 545 548 Nodular hidradenoma: A rare tumor in children <p>Hidradenomas are the benign cutaneous tumors of sweat gland origin, with the clear cell type constituting the most frequent histologic variety. Usually, they are diagnosed in the elderly population, the peak incidence being the fifth to sixth decade. Very few cases of hidradenoma have been documented in children in their first decade of life. Here, we present a rare and interesting case of a 10-year-old boy who presented with swelling on the anterior aspect of the neck, since birth. The histological findings were consistent with the diagnosis of nodular hidradenoma.</p> Pragati A Sathe Balaji D Baste ##submission.copyrightStatement## 1970-01-01 1970-01-01 5 8 549 550 Brittle bone disease - A rare genetic disorder: A case report <p>Osteogenesis imperfecta (OI) is a group of rare inherited disorders of connective tissue with the hallmark of excessive fragility of bones caused by mutations in collagen characterized by remarkable soft and large cranium and short-curved limbs. Radiological findings, such as, under mineralization of skull, platyspondyly, severely short and deformed long bones, and small continuously beaded ribs, pathognomonic for OI, were observed. Considering the clinical/radiological manifestations, a diagnosis of OI was made.</p> Suresh Goyal Pradeep Meena Juhi Mehrotra Sunny Malvia Ravi Rawat Mahendra Meena Roshani Dodiyar ##submission.copyrightStatement## 2018-09-22 2018-09-22 5 8 551 553