Indian Journal of Trauma and Emergency Pediatrics

Objective: To evaluate the tolerance of rapid advancement of enteral feeds in VLBW babies. Setting: Tertiary teaching hospital. Design: Randomized controlled trial. Methods: All stable neonates with birth weight <1250 grams were included in the study. The primary outcome variable was the time taken to achieve full enteral feeds (defined as 180 ml/kg/day). The secondary outcome variables were incidence of Necrotizing enterocolitis (NNEC) and incidence of apnea. At 48 hours, the infants were randomized into the slow advancement group (enteral feeds advanced by increments of 15 ml/kg/day) or fast advancement group (enteral feeds advanced by increments of 30 ml/kg/day). The monitoring during feeding included daily weight record, two hourly abdominal girth charting, gastric aspirates, apnea, time taken to reach full enteral feedings and for NNEC. Results: There were 53 infants who were enrolled for the study ( 27 in the fast advancement group and 26 in the slow advancement group). In the fast advancement group, 20 (74%) completed the trial; whereas 14 (53.8%) in the slow advancement group completed the study. The two groups were comparable for birth weights, gestational age, sex, intrauterine growth status, Apgar and CRIB scores. The infants in the fast group reached full enteral intake of 180ml/kg/day significantly earlier (10 ± 1.8 days) than in the slow group (14.8 ± 1.5 days). The two groups were comparable for episodes of feed intolerance, apnea, NNEC. Infants in the fast group regained birth weight significantly earlier (median 18 days) than in the slow advancement group (median 23 days). Conclusions: Stable VLBW neonates can tolerate rapid advancements of enteral feeding without increased risk of adverse effects.

 Wautersiella Falsenii is an unusual organism isolated from human samples. Its clinical relevance needs to be defined. Solitary identification of this microorganism in a clinical sample explains an etiological link between it and the disease. We present such a case that came to us with respiratory distress and later on diagnosed to have pneumonia, mediastinal abscess and bacteremia. Aetiological work up isolated Wautersiella Falsenii from the blood which was sensitive to ofloxacin. No any other organism was isolated. The patient responded well to the ofloxacin treatment and was discharged in good general condition. Solitary identification and clinical improvement on effective antibiotic; supports that it is a clinically significant infection. In this case report we discuss the clinical spectrum of diseases caused by this organism and its antibiotic sensitivity pattern.

Keywords: Wautersiella Falsenii; CHROM Agar; Pneumonia; Mediastinal Abscess; Bacteremia

Hirayama’s disease is a rare focal motor neuron disease that is reported mainly in young Asian males (15-25 years old). Hirayama disease also known as juvenile non-progressive cervical myotrophy or monomelic amyotrophy. Insidious onset and slow progression of weakness followed by a spontaneous arrest within several years are classical symptoms described with disease. MRI cervical spine in flexion is mainstay for diagnosis.

Keywords: Hirayama Disease (Hd); Cervical Myelopathy; Juvenile Non-Progressive Cervical Myotrophy

 Septic arthritis (SA) in children is considered as a medical emergency. If untread, it may destroy the joint in a period of days. The infection may also spread to other parts of the body. SA results from bacterial invasion of the joint space through the blood stream, from adjacent osteomyelitis, or through direct inoculation of the wound. Staphylococcus aureus is the most common cause of SA in all age group. Among those aged 15-50 years, Neisseria gonorrhoea runs a close second. Pain with an infected joint typically present with triad of fever (40-60% of cases) pain (75%of cases), and impaired range of motion. SA is a challenging clinical problem because: (1) signs and symptoms may be subtle and overlap with those found in other condition, (2) screening laboratory studies and synovial fluid cultures are relatively insensitive, and (3) optimal management, including duration of antibiotics therapy and surgical approach is not evidence based. Diagnosis of SA is based on a combination of clinical findings and results of synovial fluid analysis. Imaging studies is insensitive in the diagnosis of SA. All children presumed to have SA should be hospitalized for empiric intravenous antibiotic therapy. In general, 3-4 weeks to treat staphylococcus aureus, H. influenzae type B, or Strep. Pneumoniae infections, while gonococcal infections are treated for 7-10 days. Close follow up with physical examinations and laboratory tests must be done to make sure that patients remain afebrile, pain resolved, improved range of motion, and normalize laboratory values.

Keyword: Septic Arthritis; Microorganism; Synovial Fluid.

 Adolescence is a transitional journey from childhood to adult life along with physical development and sexual maturation. This may be considered as physical, psychological and emotional rebirth. The phenomenal growth that occurs in adolescence, second only to that in the first year of life, creates increased demands for energy and nutrients. Total nutrient needs are higher during adolescence than any other time in the life cycle. Nutrition is also important this time to help prevent Adult diet related chronic diseases such as cardiovascular disease, cancer and osteoporosis. Poor nutrition starts before birth, and generally continues into adolescence and adult life and can span generations. By improving the nutrition of adolescent girls and women, nations can reduce health care costs, increase intellectual capacity, and improve adult productivity.

Keywords: Adolescence; Nutrition; Energy; Intergeneration Cycle.

 Introduction: In India, ARI is one of the major reasons for which children are brought to the hospital and health facilities. According to WHO estimates, respiratory infections cause about 9.87 lakh deaths in India of which 9.69 lakh deaths were due to ALRTI. Methodology: This was a prospective clinical study of severe pneumonia conducted on 150 children who were admitted to pediatric wards in medical college hospital. Epidemiological factors affecting the same were studied and bronchoscopy was done whenever it was needed.Children in the age group of one month to 5 years with clinical features of severe pneumonia as per WHO recommendations for the control ARI were included. Results: In the present study, according to WHO ARI programme,83.33% had severe pneumonia and 16.67% has very severe pneumonia. Conclusion: Symptoms and signs mentioned in the WHO ARI control programme were very sensitive and can be applied to hospitalized children.

Keywords: ARI; Clinical Profile; Pneumonia.

 Introduction: Acute respiratory infections (ARI) are one of the commonest causes of death in children in developing countries. It is responsible for an estimated 4 million deaths worldwide. Almost all ARI deaths in young children are due to acute lower respiratory tract infections (ALRTI), mostly pneumonia. Methodology: Children in the age group of one month to 5 years with clinical features of severe pneumonia as per WHO recommendations for the control ARI were included. A detailed examination of each child including anthropometry was carried out. During the general physical examination, emphasis was laid on assessing general condition of the child, respiratory rate (counted over 1 minute), presence of fever and other signs such as cyanosis and pallor. Results: In the present study, radiological findings were present in 80.66% of cases. Bacterial pneumonia was detected in 62.67%, viral pneumonia in 14%. Among bacterial pneumonia, consolidation was seen in 18%, alveolar infiltrate in 24.67% and complications of pneumonia in Complications include empyema, pleural effusion, collapse, and pneumothorax. Chest X –ray was normal in 8 cases. Conclusion: Routine hematological investigations and blood culture will not give much information regarding severity or etiology of illness.

Keywords: Acute Respiratory Infections; Pneumonia; Bacteriology

 Objective: Both pulmonary and extra pulmonary causes could present as tachypnea and respiratory distress. We have planned a study to evaluate acid base status and outcome of neonatal respiratory distress. Methods: A prospective study carried on neonates admitted in intensive care unit from 1 st August 2015 to 31 st August 2016 in Department of Paediatrics. Ethical Clearance was taken by Ethics Committee of the college. Newborns brought to our NICU with respiratory distress were included in study randomly. After detailed clinical history, examination, arterial blood was taken in all the babies for ABG analysis with necessary precautions along with other routine investigation and stabilization of the baby. Results: A total of 115 neonates with respiratory distress were selected for study, out of these about 24.34% had normal pH, 45.21% had metabolic acidosis, 21.73% neonates had respiratory acidosis and 8.69% had mixed pH disorder. Neonates having respiratory distress with normal pH 85.71% were discharged from the hospital, 7.14% went LAMA and 7.14% expired during the treatment. Neonates having respiratory distress with abnormal pH 77.01% were discharged from the hospital, 2.29% went LAMA and 20.68% expired during the treatment. Conclusion: The expiry rate was significantly higher in neonates having abnormal pH with respiratory distress than in neonates with normal pH with respiratory distress (p<0.05).

Keywords: Neonatal Respiratory Distress; Acid Base Abnormality; Meconium Aspiration Syndrome; Transient Tachypnea of Newborn.

 Background: Low backache is one of the common condition encountered in day to day practice. 85% of general population experience backache in their lifetime. The incidence is common next only to headache. Limiting activity levels, recurrence of symptoms, psychological stress, loss of wages are of primary concern. Methods: This is a prospective study on 100 low back ache patients who underwent epidural steroid injection . Painscaling was done before performing the procedure, and on 2nd day, after 2 weeks, after 2 months and after 6 months of the procedure and compared with the previous results. Results and Conclusion: Patients had a good relief from the pain immediately following the injection.But the pain gradually worsened on subsequent follow ups. The effect of epiduralsteroid injection decreases with time. The epidural steroid injections is simple, safe, minimally invasive, economical and effective mode of early pain relief of low-back and radicular pain. It improves the functional status and decreases the severity of pain.

Keywords: Low Back Pain; Conservative Management; Epidural Steroid Injection.

 Duct dependant circulations needs high degree of suspicion, early stabilisation with prostaglandin and early diagnosis and treatment. Early PGE1 infusion is an economically viable option in the management of these sick neonates. Majority of them present in the first week of life and do well with prompt and proper approach to the problem. Prostaglandin plays important role as a palliation before undergoing any palliative or definitive surgery. Titration with low effective dose regimen of prostaglandin definitely helps to maintain adequate response without increased complications. Mortality remains high in duct dependent circulation even with use of prostaglandins and interventions.

Keywords: Duct Dependent Circulation; Congenital Heart Disease; Prostaglandins.

 Objective: To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant’s neurodevelopmental outcomes at 6-8 weeks of age in healthy term neonates. Design: A hospital based prospective, observational study. Setting: Lady Harding Medical College and Smt. Sucheta Kriplani Hospital, Delhi. Participants: 238 full term singleton infants born through normal vaginal delivery. Intervention:Infants were divided in two groups delayed umbilical cord clamping (60 seconds after delivery) or early umbilical cord clamping (60 seconds after delivery) from the data collected. Outcome Measures: To study the effects of delayed umbilical cord clamping, compared with early clamping on neurodevelopmental outcomes at 6-8 weeks of age in healthy term neonates. Results: At 6- 8 weeks of age, there were no significant differences between the neurodevelopmental outcome of babies in the delayed and early umbilical cord clamping groups. Conclusions: Delayed cord clamping did not result in any difference in neurodevelopmental outcome compared with early umbilical cord clamping.

Keywords: Umbilical Cord Clamping; Neuro-Development.

 Introduction: Febrile seizures are a benign condition of childhood and most common cause of seizures in children less than 5 years. Many risk factors predisposing the children to febrile seizures have been identified and studied. Among those many studies have found a significant association with anaemia. Objective: To study the clinical profile of children admitted with febrile convulsion and its relation with anaemia. Materials and Methods: Retrospective case series study of children admitted with first episode of febrile convulsion in the Pediatric department of a tertiary care teaching hospital over period of 15 months. Detailed history was taken and blood investigations were done to diagnose anaemia as per WHO criteria. Results: Higher incidence of FS was found in males (63.4%) and children between 6-24 months (71%) with male: female ratio of 1.7:1. 78% had simple FS, 82.5% had fever of less than 24 hours and 20.6% with h/o FS in first degree relatives. 76% of cases had anaemia with 55.5% having iron deficiency features and 36 (57.1%) cases had leucocytosis. Conclusions: Iron deficiency is a possible risk factor for febrile seizures in children of age group 6 months to 5 years. Early detection and timely correction of iron deficiency may help in preventing and reducing the incidence febrile seizures in children of this age group.

Keywords: Febrile Seizures; Hemoglobin; Iron Deficiency Anaemia; ILAE; WHO