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> en-US (Dr. Girish Chandra Bhatt) (Rashmi Agrawal) Wed, 10 Apr 2019 17:17:19 +0530 OJS 60 Pediatric injuries: The etiology and associated factors as seen at a Mission Hospital in Aba, Southeast Nigeria <p><strong>Background:</strong> Pediatric injuries constitute a significant health burden, particularly in developing countries, including Nigeria. Comprehensive and case-specific management including a good database is largely unavailable in these countries.<strong> Aim:</strong> This study aims to determine the causes and associated factors of pediatric injury (PI) in Aba, Southeast Nigeria. <strong>Materials and Methods:</strong> This was a retrospective study conducted for a period of 3 years (January 1, 2015–December 31, 2017) in a Mission Hospital in Aba. Data were obtained from the case notes of children aged 16 years and below, who were seen for injuries at the accident and emergency department (AED). Information extracted from the case files included the sex, age, nature of injury, venue of injury, body areas involved, and outcome of treatment. <strong>Results:</strong> PI constituted 13% of all trauma cases seen in the AED during the study period. There were 54 males and 39 females, giving a male:female ratio of 1.4:1. The leading mechanisms of injury were road traffic accident (RTA), 36 (38.7%) and domestic accidents, 27 (29%), while gunshot wounds 3 (3.3%) constitute the least. RTA occurred most frequently in the age groups of 6–15 years, 24 (25.8%). Again, 91.7% of RTA occurred in the urban area and involved mostly pedestrians crossing the road (55.6%). Children aged 0–5 years, 34 (36.6%) were the most frequently involved in PI. Leading mechanisms of injury in this age group were domestic accidents, falls, and burns. There was a statistically significant association between age and mechanism of injury (p=0.000). Mortality rate was 2%.<strong> Conclusion:</strong> Pediatric injuries constituted 13% of all trauma cases in this study. Children aged 0–5 years were the most frequently involved in PI. RTA and domestic accidents were the leading causes of PI. Very young children at home and older children crossing the road were vulnerable to pediatric injuries.</p> Chukwuemeka Ngozi Onyarugha, Nneka Chioma Okoronkwo, Chioma Akunnaya Ohanenye ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Endovascular management of pediatric neurovascular malformations – A single‑center experience from South India <p><strong>Background:</strong> Neurovascular malformations (NVMs) in pediatric population are highly challenging to manage and treatment options include open surgery, endovascular therapy, and radiosurgery or combined. Recently, there has been a gradual shift from conventional surgical approach toward endovascular therapies with increasing availability of technical expertise and gadgetry. <strong>Objective:</strong> We aimed to study the clinical profile and immediate outcome of children with NVMs, who underwent endovascular therapy. <strong>Materials and Methods:</strong> This retrospective observational study was conducted in a tertiary care center in South India between February 2017 and August 2018. We included children admitted in pediatric intensive care unit (PICU) with NVM and needed neuroradiological intervention. Children with thromboembolism or other NVMs who did not require intervention were excluded from the study. Data on clinical profile, endovascular procedure done, supportive therapy given, and immediate outcome were collected and analyzed. <strong>Results:</strong> Of 1615 children admitted in PICU, 13 had NVM (0.8%), of which five had arteriovenous malformation (AVM), three had vein of Galen arteriovenous malformation (VGAM), one had VGAM with dural AVM, one had acquired carotid-cavernous fistula, two had berry aneurysm, and one had mycotic aneurysm. VGAM presented as hydrocephalus, whereas AVM and aneurysm as intracranial hemorrhage. Endovascular embolization was done using platinum detachable coils, onyx, N-butyl cyanoacrylate glue, and coil assist stents. One child needed decompressive craniectomy and another child needed extraventricular drainage. Four children needed pre-procedure ventilation and seven children needed prolonged post-procedure ventilation. Mortality was 15%; and among the survivors, 72% had an uneventful recovery. One child had seizures and two had hemiparesis at discharge. <strong>Conclusion:</strong> Endovascular management is an effective intervention for pediatric NVM. Multidisciplinary team approach and good pediatric intensive care are important for successful outcome. Further studies with long-term follow-up are needed to assess the durability of endovascular therapy.</p> Abhinav Kalvala, Rajakumar Padur Sivaraman, Shruthi Tarikare, Shuba Sankaranarayanan, Santhosh Joseph ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Radiological screening for neurocysticercosis in asymptomatic siblings of children with neurocysticercosis: An observational cohort study <p><strong>Introduction:</strong> Neurocysticercosis (NCC) is the most common helminthic infection of the central nervous system and a leading cause of acquired epilepsy worldwide. Tuberculosis (TB) is transmitted through droplet infection to index pediatric case from only sputum acid-fast bacilli -positive patients while NCC in an index child can result from fecal–oral route from other family members who are Taenia carriers or through autoinfection as well. <strong>Objective:</strong> Similar to universal practice of TB screening of asymptomatic family members with chest X-ray which poses radiation hazard, radiation-free radiological screening by magnetic resonance imaging (MRI) brain of asymptomatic siblings of children with NCC was carried out in the present study in addition to evaluation of family members for taeniasis.<strong> Methods:</strong> Siblings (between 1 and 18 years of age) of children attending the pediatric NCC clinic at a tertiary care hospital in Chandigarh, India, with clinically suspected and radiologically confirmed the diagnosis of NCC, were enrolled. Contrast-enhanced MRI brain was obtained free of cost to detect the presence of asymptomatic NCC in siblings enrolled in the study. Stool analysis of family members of children with NCC was carried out to detect Taenia solium carriers. <strong>Results:</strong> Of 39 enrolled asymptomatic siblings, 4 (10.3%) children were detected to have solitary intraparenchymal NCC lesion. Of the aforementioned four siblings, 3 (75%) had viable lesions, while 1 (25%) had calcified lesion. Only 2 (1.7%) of 118 stool samples of family members tested were positive for T. solium eggs. <strong>Conclusions:</strong> The results from the present study suggest clustering of NCC cases in the family and that majority of children with NCC may continue to remain asymptomatic. Targeted family screening for NCC in asymptomatic family members of children with NCC may prove more cost effective than routine mass screening. Based on the results of this study, targeted deworming of community food handlers and caution in conducting routine deworming of children are suggested.</p> Roosy Aulakh, Suman Kochhar ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Seroprevalence of celiac diseases in children suffering from severe acute malnutrition in age group of 1–5 years <p><strong>Introduction:</strong> Celiac disease (CD) may be an underlying cause of malnutrition. <strong>Aim:</strong> The objective of this study was&nbsp;to find out the seroprevalence of CD in children suffering from severe acute malnutrition (SAM) in age group of 1–5 years.&nbsp;<strong>Materials and Methods:</strong> This was a prospective, observational, hospital-based study carried out at Malnutrition Treatment Centre&nbsp;attached with tertiary care pediatric hospital associated with the medical college of southern Rajasthan, from December 2017&nbsp;to November 2018. A total of 110 children with SAM were enrolled and screened for CD on the basis of celiac serology (tissue<br>transglutaminase [tTg]-immunoglobulin A/G [IgA/IgG]). <strong>Results:</strong> Celiac serology was positivity in 30 (27.28%) cases; out of&nbsp;total 30 seropositive cases, 14 (46.66%) cases were seropositive for both tTg-IgA and IgG, while only tTg-IgA and only tTg-IgG&nbsp;were positive in 9 (30%) and 7 (23.33%) cases, respectively. Mean serotiter of serum tTg-IgA and IgG in seropositive cases was&nbsp;134.01±198.74 and 49.05±25.74 unit/ml. Conclusions: High seroprevalence of CD in SAM should be taken as alert as CD may&nbsp;be an underlying cause and responsible for malnutrition. These children should be screened by celiac serology (tTg-IgA/IgG) to&nbsp;rule out CD.</p> Pradeep Meena, Mahendra Meena, Namir Khan, Priyanka Meena ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Profile of acute childhood poisoning at a tertiary care teaching hospital in North India <p><strong>Objective:</strong> The objective of the study was to determine the profile and outcome of children under the age of 12 years admitted with acute poisoning at a tertiary care teaching hospital in Delhi. <strong>Materials and Methods:</strong> We retrospectively reviewed case files of all patients &lt;12 years of age admitted with poisoning at pediatric emergency from January 2016 to December 2016. All cases with definite history of poisoning were included in the study. Exclusion criteria included chronic poisonings such as lead poisoning, food poisoning, foreign body ingestion, and homeopathic drug ingestion. Baseline characteristics of patients, type of poison, signs and symptoms of poisoning, investigations, treatment, and outcome were recorded from the case files and analyzed. <strong>Results:</strong> A total of 91 patients were presented with poisoning during the study period. Almost all cases (n=89, 97.8%) were accidental, only 2.2% (n=2) cases were suicidal, and none was homicidal. The mean age of presentation of these patients was 4.08±3.11 years with males outnumbering females (M: F=1.6:1). Corrosives (n=20, 21.9%), kerosene (n=17, 18.7%), prallethrin (n=11, 12.1%), and drugs (n=7, 7.7%) were the most frequently implicated agents. 11 patients (12.1%) were completely asymptomatic, while 30.7% (n=28) patients developed serious symptoms such as breathing difficulty, altered sensorium, seizures, abnormal speech, hematemesis, nasal bleeding, and hypotonia. Gastric lavage was done in 15 cases, three patients received activated charcoal, and three patients required intubation, and one patient required an emergency tracheostomy. One patient expired and rest all survived.<strong> Conclusion:</strong> The trends of pediatric poisoning noted in our center were different from those observed in other hospital based studies. Corrosives (particularly acids) being the most common agents. Prallethrin, kerosene, and drugs were other common agents.</p> Abhishek Kumar, Aaradhana Singh, Anju Aggarwal ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Death clustering in India: Levels, trends, and differentials, 1992–2016 <p><strong>Background:</strong> India and many of its bigger states could not achieve the national goal related with child health based on 4th UN Millennium Development Goal. There is a need to look for different approaches which deal with infant mortality. Literature emphasizes clustering of infant deaths in families has implications on infant mortality. <strong>Objective:</strong> The present study attempts to examine the levels, trends, and differentials of clustering of infant deaths in families in India using National Family Health Survey (NFHS) dataset and how they changed over the years. <strong>Materials and Methods:</strong> Study used bivariate analysis and multilevel random effects logit model based intraclass correlation coefficient and median odds ratio to examine the clustering of deaths in families, in India. <strong>Results:</strong> There has been a consistent decline in both infant mortality rate (IMR) and clustering of infant deaths in families in India between 1992 and 2016. However, the pace of decline was faster after 2005. States such as Uttar Pradesh, Madhya Pradesh, and Bihar are the major contributors in clustering of infant deaths in families. In Kerala, clustering of infant deaths has been disappeared in families while among relatively more developed states such as Maharashtra and Tamil Nadu have experienced a reduction in clustering of infant deaths in families by an amount of &lt;1%. <strong>Conclusion:</strong> Between NFHS-3 and NFHS-4 there has been an increase in clustering of infant deaths among mothers with age at first birth &gt;30 years and for mothers who have received higher education. IMR can be reduced to a greater extent if government policies and health resources are directed toward the families experiencing the clustering of infant deaths.</p> Mukesh Ranjan, Laxmi Kant Dwivedi ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Assessment of knowledge of mothers from migrant population regarding use of oral rehydration solution in diarrheal illness in under-five children from rural Pune <p><strong>Background:</strong> Diarrhea is one of the important causes of morbidity and mortality among under-five children in India. Lack of knowledge of mothers about the management of diarrheal diseases is a common problem in many developing countries. Use of oral rehydration solution (ORS) largely depends, on the level of mother’s knowledge.<strong> Objective:</strong> The objective of the study was to assess the knowledge of the mothers, from rural migrant population regarding the use of ORS in under-five children with diarrhea. <strong>Materials and Methods:</strong> A cross-sectional study was carried out from December 2016 to March 2017, among mothers of the migrant population residing and working at brick kilns and construction site in the field practice area of the rural health training center, Lavale, Pune. We included the mothers whose children were under five years of age. Those mothers, who had serious illness and had hearing and speech problems, were excluded from the study. Data were collected by interview method from mothers with the help of a pre-structured and pre-tested questionnaire. <strong>Results:</strong> A total of 54 (93.1%) mothers from brick kiln sites were included among whom, 43.10% were aware of ORS. Only 37.93% of mothers knew the use of homemade sugar salt solution for diarrhea in children. In this study, 25 (43.10%) mothers were illiterate and the study showed that knowledge regarding ORS was lower in illiterate mothers. <strong>Conclusion:</strong> Majority of the mothers were not aware regarding ORS, and as per the study, knowledge regarding ORS was lower in less educated mothers. Government schemes would help these mothers to increase the awareness which will result in a decrease in mortality rate.</p> Neeta Hanumante, Sujata Murarkar, Shrivallabh Sane, Sumati Sancheti ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Correlation of lipid profile and anthropometry with aortic intima-media thickness in newborns of diabetic and non-diabetic mothers <p><strong>Background:</strong> Exposure to diabetes in utero has been established as a significant factor for certain component of the clinical syndrome. Although complications of atherosclerosis occur in adult life, the process begins in early childhood. Hence, measuring aortic intima-media thickness (AIMT) in the newborn is a feasible, accurate, and sensitive marker of atherosclerotic risk. <strong>Objective:</strong> The objective of the study was to find an association of AIMT with cord blood lipid levels and anthropometric factors. <strong>Methods:</strong> Babies born to diabetic mothers (gestational diabetes mellitus/type 2 diabetes mellitus (34 weeks–42 weeks) who were taken as one group and babies born to non-diabetic mothers (34 weeks–42 weeks) who were taken as the other group were enrolled in this study. Lipid values were measured of umbilical cord blood, collected immediately after delivery. Atherogenic-indices were calculated; neonatal anthropometric measurements were taken within 24 h after delivery. Abdominal AIMT (aAIMT) was measured within 4 days of delivery using a high-resolution ultrasound B mode by a trained radiologist. Maternal age, parity, height, pre-pregnancy weight, gestational age, and other investigations were taken from maternal records. <strong>Results:</strong> In this study, birth weight (BW) was positively correlated with triglycerides (TG), cholesterol, high-density lipoprotein (HDL), very low-density lipoprotein (VLDL), and atherogenic-indices, whereas, it was negatively correlated with low-density lipoprotein (LDL) (p&lt;0.01). A positive correlation was found between aAIMT and BW, abdominal circumference, TG, cholesterol, HDL, LDL, VLDL, and atherogenic-indices (p&lt;0.001). <strong>Conclusions:</strong> In this study, infants born to diabetic mothers had higher anthropometry, lipid values, aAIMT compared to babies born to non-diabetic mothers without risk factors.</p> Syeda Kausar Anjum, Shiva Devaraj, Yashoda H T ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Early neonatal outcome in late preterms compared with term neonates <p><strong>Introduction:</strong> Neonates born between 34 weeks and 36 weeks 6 days of gestational age (GA) are known as late preterm neonates. These late preterm neonates are the largest subgroup of preterm neonates. There have been few studies regarding the early morbidity in this cohort of neonates when compared to neonates born at term. <strong>Objectives:</strong> The objectives of the study were to study the incidence and various causes of early morbidities and mortality in late preterm neonates and to compare with term neonates. <strong>Materials and Methods:</strong> This prospective cohort study was conducted at a tertiary care teaching institution of Bengaluru. All late preterm and term neonates born between December 2016 and July 2018 were enrolled in the study. Data regarding parity, mode of delivery, sex, GA, birth weight, predefined neonatal morbidities, and maternal risk factors were all entered in the pre-designed pro forma. The morbidities and mortality of these late preterm neonates were compared with the term neonates. <strong>Results:</strong> A total of 408 late preterms and 1660 term neonates were enrolled in this study. These late preterm neonates were at significantly higher risk of overall morbidity due to any cause (85.3%, p&lt;0.001, adjusted odds ratio [OR]: 1.4, 95% confident interval [CI]=0.8–2.4). They were also at higher risk of developing respiratory distress (23.5%, p&lt;0.001, adjusted OR: 1.5, 95% CI: 1.1–2.2), need for ventilation ([Nasal continuous positive airway pressure – 8.6%] [synchronized intermittent mandatory ventilation [SIMV] – 3.7%], p&lt;0.001), and neonatal sepsis (9.1%, p=0.003, adjusted OR: 1.3, 95% CI=0.3–3.3) when compared with term neonates. <strong>Conclusion:</strong> Gestational maturity is the most important determinant of the outcome in newborns. Late preterm neonates are not the same as term neonates as evidenced by the high incidence of complications in late preterm compared to term infants.</p> Siva Saranappa S B, Shiva Devaraj, Madhu G N ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Duration of cord clamping and physiological jaundice in newborn: A case–control study <p><strong>Introduction:</strong> Delayed cord clamping (DCC) in term newborns improves iron stores in infancy, and the most international&nbsp;guidelines now recommend at least 30–60 s of DCC in term and preterm newborns. <strong>Objective:</strong> The objective of this study was&nbsp;to find out the association between neonatal jaundice (physiological) and duration of cord clamping. <strong>Methods:</strong> An observational&nbsp;matched case–control study was conducted from June 1, 2017, to May 31, 2018, in the neonatal unit of a tertiary care hospital in&nbsp;Odisha after getting approval from the institutional ethics committee. Of 3367 neonates, 784 were included in the study (392:392)<br>after satisfying the pre-defined inclusion and exclusion criteria. All the relevant data were collected and validated, and the results&nbsp;were analyzed. Fisher exact test was performed to find out the association. For all statistical purpose, p&lt;0.05 was considered to&nbsp;be statistically significant.<strong> Results:</strong> A significant association was found between neonatal jaundice and DCC as evidenced by&nbsp;Chi-square value: 15.62; p=0.0001, relative risk (95% confidence interval [CI]): 1.68 (1.29, 2.18), absolute risk reduction: −0.12&nbsp;(−0.18, −0.06), and number need to treat (95% CI): −8 (−6, −17). <strong>Conclusion:</strong> Neonatal jaundice appears to be more commonly<br>associated among babies with DCC.</p> Samira Bhoi, Nihar Ranjan Mishra, Sradhananda Rout ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Optimizing use of empirical antibiotics in late preterm neonates at risk of early-onset sepsis <p><strong>Background:</strong> In sick neonates, we are posed to treat suspected or proven infection. However, the vast majority of newborn babies who are given antibiotics do not have any infection. <strong>Objective:</strong> The objective of this study was to optimize the use of empirical antibiotic therapy in late preterms who are asymptomatic with maternal risk and symptomatic neonates without maternal risk for early-onset sepsis (EOS) and to estimate the rate of risk increase in onset of symptoms in neonates exposed to maternal risk factor for EOS. <strong>Methods:</strong> In this descriptive study, late preterm neonates (34+0–36+6 weeks) who are asymptomatic at birth with and without maternal risk factor for EOS at birth were subjected to clinical assessment of sensorium, temperature, oxygenation status, perfusion, and skin color, starting after 1 h of initial stabilization till discharge from hospital. Sepsis screen (C-reactive protein and absolute neutrophil count) was obtained at 24 h and 48 h of age from these asymptomatic late preterms. <strong>Results:</strong> A total of 135 late preterm neonates (34+0–36+6 weeks) recruited during the study period were included for analysis. The presence of maternal risk factor for EOS has shown no statistical significance in relation to the presence of symptoms at birth odds ratio 0.66, 95% confident interval (0.24–1.8) p=0.42. <strong>Conclusion:</strong> In our study, as maternal risk factor for sepsis has shown no statistical significance in relation to the presence of symptoms at birth, antibiotic use can be restricted to only those babies who have clinical worsening over 24–48 h of observation and/or along with supportive evidence of positive sepsis screen and/or blood culture, irrespective of the presence or absence of maternal risk for EOS.</p> Jemila James, Lalitha Kailas, P M C Nair, M Shaji ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Hidden hazard in appendix in children: Carcinoid tumors <p><strong>Introduction:</strong> Carcinoid tumors (CT) are the most common tumors of the appendix. The incidence of CT of the appendix is generally 1–2 in every 1000 appendectomy material. <strong>Objectives:</strong> The objectives of the study were to discuss the follow-up and treatment of CT of the appendix in the specimen of patients who underwent an appendectomy. <strong>Materials and Methods:</strong> This retrospective study enrolled the patients who were diagnosed with CT of the appendix as a result of an examination of the appendix specimen after the patients underwent an appendectomy. All the patients, who underwent appendectomy in the pediatric surgery clinic of our hospital between November 2015 and November 2018, were included in the study. Patients’ demographic characteristics, clinical findings, pre-operative laboratory and imaging results, location, diameter and size of the tumor, mesoappendix invasion status, mitotic index and Ki-67 elevation, hospital stay duration, surgical types and complications, and results of laboratory and imaging tests were evaluated. <strong>Findings:</strong> Eight of the 621 patients (1.2%) who underwent an appendectomy were diagnosed with CT of the appendix. The median age of the patients was 13 years (range, 11–16 years). Of the eight patients, five (62.5%) were female and three (37.5%) were male. All patients presented to our clinic with abdominal pain. No surgical complications were observed during the operation and in the early post-operative period. The mean hospital stay was 2.7 days (2–5 days). In all the patients, the tumor size was &lt;2 cm, the surgical margins were clean, the mitotic index was &lt;2%, the Ki-67 index was below 1%, and the tumor had not spread to the mesoappendix. Only in one of the patients, the CT was located in the appendix radix; in the other seven patients, the tumor was in the middle and end of the appendix. <strong>Conclusion:</strong> CT of the appendix are clinically similar to acute appendicitis but may be found incidentally during other surgical procedures other than an appendectomy. Diagnosis is made after the pathological specimen diagnosed with CT is histopathologically evaluated. The size, diameter, and depth of the tumor, mesoappendix invasion, mitotic index, and Ki-67 elevation are used in the evaluation and treatment of the tumor.</p> Yusuf Atakan Baltrak, Onursal Varlikli ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Pierre Robin sequence in association with tracheoesophageal fistula and esophageal atresia <p>The first symptom of esophageal atresia and tracheoesophageal fistula is the inability to eat and respiratory distress after feeding. The coexistence of Pierre Robin Sequence (PRS) with esophageal atresia and tracheoesophageal fistula is a rare clinical condition. In infants with PRS, evaluation of respiratory and nutritional problems is important. The coexistence of esophageal atresia and tracheoesophageal fistula leads to increased nutritional and respiratory problems. Problems that may occur in the airways may occur late. In this case report, we aimed to present a case of neonatal infant with rare esophageal atresia, tracheoesophageal fistula, and PRS.</p> Yusuf Atakan Baltrak, Onursal Varlikli ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530 Rare isolation of Leclercia adecarboxylata in a child with pneumonia: Case report and review of literature <p>Leclercia adecarboxylata is a Gram-negative flagellated bacilli named after Leclerc, who first described it in 1962. Isolation of this<br>organism from body fluids is rare. Although it has been reported in immunocompromised individuals and nosocomial infections,<br>pneumonia due to this organism is still rare. We report a case of 13 months old, previously healthy immunocompetent child, with<br>community-acquired pneumonia due to L. adecarboxylata.</p> Vipul Gupta, Arpita Chauhan, Arun Kumar, Anuj Dhyani, J. P. S. Mazumdar ##submission.copyrightStatement## Wed, 01 May 2019 00:00:00 +0530