Indian Journal of Trauma and Emergency Pediatrics

Hypertrophic pyloric stenosis (HPS) causes a functional gastric outlet obstruction as a result of hypertrophy and hyperplasia of the muscular layers of the pylorus. In infants, HPS is the most common cause of gastric outlet obstruction and the most common surgical cause of vomiting. Hypertrophic pyloric stenosis is a condition characterised by hypertrophy of two muscle layers of pylorus,l enghthening of canal, thickening of pylorus which becomes oedematous causing functional obstruction of gastric outlet. The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. While the exact cause of the hypertrophy remains unknown, one study suggested that neonatal hyperacidity may be involved in the pathogenesis.

Keywords: Hypertrophic pyloric stenosis (HPS); Hyperplasia. 

Respiratory distress is a common presentation in pediatric emergency and pneumonia with empyema is one of the important causes requiring immediate drainage. Accurate and fast diagnosis is the key to successful management. The diagnosis is usually made by chest X ray. X rays take time to diagnose, involve radiation exposure to children and most importantly may miss the diagnosis. We present a case of pneumonia with empyema that was diagnosed using emergency point of care thoracic ultrasound. Following this intercostals chest drainage tube was put and pus was drained. Chest X ray later on showed corroborate findings. This case suggests that point of care ultrasound is feasible and useful investigation for diagnosing empyema in children in emergency and can be used to take a decision for intercostal drainage.

Keywords: Thoracic Ultrasound; Point of Care Ultrasound; Empyema; Emergency.

HSP is the most common childhood vasculitis, and is characterized by the classic tetrad of nonthrombocytopenic palpable purpura, arthritis or arthralgias, gastrointestinal and renal involvement. It is a systemic disease where antigen-antibody (IgA) complexes activate the alternate complement pathway, resulting in inflammation and small vessel vasculitis. Mild disease resolves spontaneously, and symptomatic treatment alone is sufficient. Systemic steroids are recommended for moderate to severe HSP. The prognosis depends upon the extent of renal involvement, which requires close followup. Early recognition of multiorgan involvement, especially outside of the typical age group, and appropriate intervention can mitigate the disease and limit organ damage. We describe a case of 6 year male with Henoch-Schonlein purpura (HSP), presenting with cutaneous and gastrointestinal manifestations

Keywords: Henochscolienpurpura; Palpable Purpura; Arthritis.

Dengue is a mosquito-borne viral infection. The infection causes flu-like illness, which occasionally develops into a potentially lethal complication called severe dengue. The global incidence of dengue has grown dramatically in recent decades. About half of the world’s population is now at risk. Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. Severe dengue is a leading cause of serious illness and death among children in some Asian and Latin American countries. There is no specific treatment for dengue/ severe dengue, but early detection and access to proper medical care lowers fatality rates below one percent. Dengue prevention and control depends on effective vector control measures. A dengue vaccine has been licensed by several National Regulatory Authorities for use in people 9-45 years of age living in endemic settings.

Keywords: Dengue; Viral Infection; Severe; Flu-Like; Fatal. 

Adolescence is delicate period of life when an individual passes from child to adulthood and involves a lot of physical and mental alterations. Pregnancy in adolescent girls is social hazard with serious consequences, when she herself is yet to attain her full growth. Teenage pregnancies represent a high-risk group in reproductive groups because of double burden of reproduction and growth. Adolescent pregnancies have impact on obstetric outcome. Maternal problems involves anaemia, abortions, pregnancy induced hypertension, pelvic disproportion, increase rate of caesarean section and preterm labour. Foetal problems in adolescent pregnancies are LBW, IUGR. Undernourished adolescent mothers are more likely to deliver undernourished offspring thus perpetuating the cycle of malnutrition.

Keywords: Adolescent Pregnancy; Anaemia; Cephalopelvic Disproportion; IUGR; Preterm; Low Birth Weight.

Introduction: Nutritional status plays a vital role in deciding the health status particularly in children. Nutritional deficiencies give rise to various morbidities, which in turn, may lead to increased mortality. Undernutrition is a known factor closely associated with child mortality rates. Methodology: The sample size was estimated to be 372 according to online sample size calculator at 95 percent confidence interval (CI) with 5 percent precision. Thus 500 children from each tribal and nontribal area were covered from HD Kotetaluk of Mysore district. Results: The present study shows that higher percentage of history of fever 16% among tribal children and 5.2% among non tribal children during last one month. Respiratory Infection, Diarrhoea, Measles, worm infestation, chicken pox, skin Infection, TB, Jaundice, Dengue are more prevalent in tribes. Conclusion: Clinical nutritional deficiency signs like pallor (80%),Bitots spot (15%), angular stomatitis (37%) , thyroid enlargement (6%) which indicates iron deficiency, Vitamin A deficiency ,Vitamin B complex deficiency, iodine deficiency respectively were found among tribal children while in non tribal children pallor (53.6%), Bitots spot (2.4%), angular stomatitis (4.8%), thyroid enlargement(0.6% ) were found.

Keywords: Morbidity; Children; Nutritional Deficiency. 

Introduction: Febrile seizures (FS) are a form of acute symptomatic seizures. Iron deficiency Anaemia (IDA) is one of the most common nutrition related problems in the world. Iron is important for neurological functions and development of brain. Methods: A case control study was done among 50 children at the Pediatric department, DVVPF’s Medical College & Hospital. Total of 50 children between age group of 6 months – 6 years with fever were included, out of which 25. Children with first febrile seizure were enrolled as cases. 25 children with fever without seizure were enrolled as control group. A pre designed proforma was used to collect the relevant information. Blood samples collected from all cases and control groups and estimated for hematological parameters. Results: The mean age in months was 22.4 among cases and 26.7 months in controls. 5 cases had a positive family history of febrile seizures. Respiratory tract infections were most common underlying cause of illness. The mean and standard deviation values of all the hematological parameters (HB, PCV, MCV, MCH, MCHC & serum Ferritin) showed that measurements were lower among cases compared to control and it was statistically significant. Conclusions: IDA was more frequent among children with FS than those with febrile illness alone. The result suggests that IDA may be a risk factor for FS. Screening for IDA should be considered in children with First Febrile Seizures (FFS).

Keywords: Febrile Seizures; Iron Deficiency Anaemia; Hematological Parameters; Case Control Study. 

Introduction: The wide spread poverty, illiteracy, malnutrition non-availability of safe drinking water, unhygienic living conditions, poor maternal and child health services have been reported in several studies as the possible contributing factors for dismal health conditions prevailing among the tribal communities in India. Methodology: In order to fulfill the chief objectives of the study the information on health and nutritional status of the tribal children, such as socio-demographic and child rearing conditions, anthropometric measurements, clinical examination, morbidity pattern and dietary intake are collected and described the methods followed in the present study. Children were classified based on age group i.e. 1-<2 years, 2-<3 years, 3-<4 years, 4-<5 years and 5-<5.5 years. Results: High Prevalence of Undernutrition in terms of underweight (62.1%), stunting (62% )and wasting (38.1%) was observed among tribals than non tribals. P Value is significant. Prevalence of underweight, stunting and wasting was found similar in both the sexes. Conclusion: Mean mid upper arm circumference among different age group is higher in non tribal children which indicates good muscle mass in non tribal children than tribal children.

Keywords: MUAC; BMI; Malnutrition. 

Background: The increasing existence of overweight and obesity; especially among adolescents is alarming and it becomes a serious public health challenge. Obesity among adolescents not only causes several complications in adolescence and future transformation of adulthood obesity but it also impairs the economic development of the country. Due to rapid urbanization and life style modification adolescent obesity is also a concern in developing countries like India. So an observational, cross-sectional study was conducted among adolescents in an urban community of Ahmednagar District. Material and Methods: Considering the prevalence of overweight and obesity among adolescents in the urban area as 21%, 95% confidence interval and 5% absolute error sample size was calculated as 266. Adding 10% non response, the total number came to 300. Sample was calculated as population proportion to size for each ward. Sample was collected by simple random sampling technique from house list of each ward of the municipality. Results: Prevalence of overweight/obesity among the study subjects was 30% and consumption of fast food, sedentary life style, higher socio economic status, consumption of alcohol and residing in a nuclear family were identified as risk factors of adolescent overweight and obesity. Conclusion: School based intervention like nutritional education regarding healthy eating and physical activity, increase awareness about the impact of away from home eating on weight management at family level and changes in social environment should be emphasized for the long term success of prevention of obesity.

Keywords: Adolescents; Obesity. 

Objective: To compare the effectiveness of intermittent benzodiazepine therapy with paracetamol alone in preventing the recurrence of febrile seizures and to study the clinical profile of children with recurrent febrile seizures. Method of Study: This is a prospective study on 93 neurologically normal children aged from 6 months to 4 years, admitted with a history of febrile seizures during the study period, January - September 2015. Children with history of afebrile seizures and infection of nervous system were excluded. 45 children were prescribed only paracetamol when febrile (assigned as Group 1) and age matched 48 children were given benzodiazepine prophylaxis for initial three days of fever during each febrile episodealong with paracetamol to control fever (assigned as group 2). Oral clobazam and oral diazepam at appropriate doses were used for intermittent prophylaxis. All the patients were followed up for 12 months, for recurrence of seizures during fever. Results: Among the 93 children included in the study, 48 were males and 45 were females. 43.8% had positive family history with first degree relative affected in 19.1% and second degree relative in 24.6%. Family history of epilepsy is present in 9.5%. The most common etiology for fever was viral infection (57.5%). Atypical febrile seizures occurred in 28.7%. Multiple episodes of seizure during a febrile episode was also reported (20.5%). 8.2% children had focal seizures. The recurrence of febrile seizure was found in total of 52% children. Recurrence was maximum (31.5%) in the age group of 1-2 years. Among those with recurrence all had typical febrile seizure except 4 children. A recurrence rate of 56% and 53% was noted in group 1 and group 2 respectively, which was not statistically significant. Conclusion: We conclude that administration of benzodiazepines along with paracetamol is not superior in efficacy to paracetamol alone in preventing the recurrence of febrile seizure.

Keywords: Febrile Seizure; Benzodiazepine; Prophylaxis. 

Objective: To determine normal arterial oxygen saturation (SpO2) trend during first 30 min of life and to evaluate for difference in SpO2 trends in healthy term newborns of normal delivered (NVD) and caserean section (CS) and to determine the possible relationship between the normal levels of oxygen saturation and birth weight at 0 and 5 th minute of life. Methods: This Prospective Cross-sectional Observational study was conducted in Department of Paediatric. Term neonates born by NVD and elective CS were included and readings of oxygen saturation levels were obtained at an interval of 5 minutes up to 30 minutes. Secondary objective is to determine the relation of SpO2 levels of term newborn with birth weight irrespective of mode of delivery. Results: Difference in values of NVD and CS neonates were statistically significant for 1 st and 30 th min (p- 0.001 and -0.003) respectively. SpO2 is negatively related to birth weight. Conclusions: The study defines the normal SpO2 in healthy term newborns of NVD and CS and also concludes that there is significant difference in SpO2 levels at 1 st and 30 th minute of life in NVD and CS babies. In healthy term newborns, levels of SpO2 measured at 1 st and 5 th minute of life are negatively related to birth weight.

Keywords: Oxygen Saturation; Normal Vaginal Delivery; Caesarean Section. 

Aim: The objective of this study was to correlate laboratory tests during the evolution of dengue fever, comparing frequencies between the different clinical forms in order to use test results to predict the severity of the disease. Methods: This is an observational, descriptive and retrospective study of 154 patients with clinical and serological diagnoses of dengue fever who, in the period from January 2014 to December 2015, were admitted in our hospital. The patients were allocated to two groups according to age: under 15 years old (n = 66) and 15 years or older (n = 88). The tests analyzed were blood count, platelet count, and serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations. Results: Thrombocytopenia and elevated transaminases were observed in patients with classic dengue fever. The main laboratory abnormalities found in dengue hemorrhagic fever were thrombocytopenia, hem concentration and elevated transaminases, similar to severe dengue with the exception of hem concentration. Most laboratory abnormalities started on the 3rd day but were more evident on the 5th day with restoration of values by the 11th day; this was more prominent in under 15-year-olds and with the more severe clinical forms. Conclusion: These results are relevant in assessing the disease because they can be used as markers for more severe forms and can help by enabling the adaptation of the therapeutic conduct to the needs of individual patients.

Keywords: Dengue; Dengue Hemorrhagic Fevers; Hematologic Tests; Biochemical Markers.