Pediatric Education and Research

 Fetus in Fetu is a rare congenital developmental anomaly, occurs in monozygotic diamniotic twin.It is due to the presence of one of the twin in the body of the other. Most frequently located in the retroperitoneal area, however it has been reported in other locations as well. Hence we report a case of Fetus in Fetu with unusual location. It is the first case in our institution among 323 twin pregnancy during january 2014 to june 2016

Keywords: Fetus in Fetu; Teratoma; Twin Pregnancy

 Jacobsen syndrome is a rare syndrome caused due to deletion of long arm of chromosome 11. Typical clinical manifestations include physical growth retardation, mental retardation, facial dysmorphism, congenital heart disease, thrombocytopenia. The patient admitted with us at one and a half year had facial anomalies including flat occiput, prominent forehead, trigonocephaly, blue sclera, downslanting palpebral fissure, broad nose, hypertelorism, low set ears, high arched palate with bilateral eversion of foot and thrombocytopenia. Karyotyping confirmed deletion of chromosome 11q.

Keywords: Jacobsen Syndrome; Trigonocephaly; Thrombocytopenia; Heart Defects; 11q Deletion.

 Breastfeeding is one of the important aspects of a woman’s life. Asymmetry and/or small size of the breast(s) have important psychological consequences for the mother about her capacity for milk production and ability to breastfeed her baby. Adequate counseling in these cases helps allay anxiety of mothers regarding adequate milk production. Most authors have studied breast size for aesthetic purposes and most studies are on small number of subjects including few adolescents to 125 women and age ranging from 16 to 83 years. ‘Aesthetically pleasing breast’ have been studied by many authors and defined as size and fullness proportional to the body, have minimal ptosis and no axillary tail, be conical to teardrop in shape, and have the nipple at the anterior most position [12]. Results from aesthetically perfect breasts as well as breast size of the adolescent nulliparous women cannot be extrapolated to the lactating women, hence the requirement of developing nomograms for use during lactation councelling. Breast measurements can be used for counseling mothers for successful breastfeeding and for aesthetic and plastic surgery for re-shaping of the breast. Lactation promotion clinics require such data for adequate counseling of breastfeeding mothers and this decreases the likelihood of discontinuation of lactation. Breast measurements can be used for counseling and aesthetic and plastic surgery for shaping of the breast. Developing nomograms of breast measurements & breast mass/volume estimations can help to counsel lactating mothers regarding adequacy of breast volume.

Keywords: Breast size; Lactation; Lactation counseling

 Background: Accidental corrosive ingestion is common in the paediatric age group. Severity may vary from no injury to a fatal outcome [1]. However, isolated gastric outlet obstruction (GOO), though rare, is a wellknown complication of corrosive ingestion. We present five such cases. Cases’ Summary: The mean age of presentation was 5.4 years. There were 4 males and 1 female. The average time duration between ingestion of the corrosive and presentation was 40 days. The common presenting symptoms were abdominal pain and non-bilious vomiting mixed with food particles seen in all five patients. Endoscopy was done in four patients - all four patients had antral and pyloric thickening. The scope could be negotiated across the pylorus only in one patient with difficulty. It could not be negotiated in the other three patients. Retrocolic, isoperistaltic gastrojejunostomy was done in four patients and pyloroplasty was done in one patient. Post-operative recovery was uneventful in all patients. Conclusion: Corrosive ingestion is an important cause of significant morbidity, especially in developing countries. Early diagnosis and appropriate endoscopic and/or surgical intervention usually lead to a good outcome.

Keywords: Ingestion; Corrosives; Gastric Outlet Obstruction; Total; Partial; Children.

 Objectives: Decline of platelets with or without thrombocytopenia is observed in critically ill preterm newborns. Prognostic signifi cance of platelets count in Neonatal Intensive Care Unit focused on outcome after thrombocytopenia. We aimed to estimate the changes in platelets count within the first 7 days of life in preterm newborns and its relation to fi nal outcomes. Methods: Retrospectively, the platelets count during the first 7 days of life, and its association with mortality, length of stay among survivors (LOS), and later severe morbidities were determined. Appropriate regression analyses were used to examine possible relations between studied variables. Results: Platelets drop that did not reach thrombocytopenia level in the first 7 days of life happened in 61.7%. Platelets count drop in the first 7 days of life was a predictor of mortality, LOS, and major morbidities such as intraventricular hemorrhage and necrotizing enterocolitis. Conclusions: Platelets count drop within the first 7 days of life independent of thrombocytopenia can be used to predict increased mortality, LOS, and the development of later severe morbidities in critically ill preterm neonates.

Keywords: Intraventricular Hemorrhage; Thrombocytopenia.

 Background: Epilepsy, a chronic neurological disorder is common in children. The global decline in intellectual functioning may occur in children with seizure disorder. Objectives: The present study was undertaken to assess cognitive function in children with epilepsy. Method: This was a hospital based observational study on 60 children aged 2-5 years and 68; 6-14 years suffering from idiopathic epilepsy. 74 and 64 normal age and gender matched healthy children were also selected as control. Sixty six children suffering from epilepsy aged 6-14 years were also assessed for their memory functioning with healthy control (n=71). Binet-Kulsrestha intelligence scale and PGI memory scale were used for cognitive assessment. Result: Epileptic children had significantly lower scores on cognitive functioning in domains of visual-perception (p<0.001), motorcoordination (p<0.001), language development (p<0.001), and immediate recall (p<0.001) as compared to control. In children aged 6-14 years with epilepsy, significantly lower values were observed for analysis, synthesis and reasoning (p<0.001) and memory (p<0.001) as compared to control. Epileptic children also had significantly lower overall IQ. Conclusion: Parent should be counseled about decline in cognitive functions and IQ in epileptic children for early intervention and appropriate measures.

Keywords: Epilepsy; Cognition; Memory; Intelligence Quotient(IQ).

 Background: Febrile convulsion (FC) is the most common type of seizure that occurs in children aged 6-60 months. It occurs in two forms including simple and complex febrile seizure. Objectives: The purpose of this study was to determine the clinical, epidemiologic and laboratory features of patients admitted to our hospital with febrile seizure in 2014-2015. Methods: In this cross-sectional study, the patients with diagnosis of febrile seizure were the target population. We obtained patient’s data based on clinical examination, history and information registered in hospital medical files including demographic, clinical and laboratory findings. Results: During the study period, 60 children with febrile seizures and mean age of 26.2 ± 19.5 months were studied. Male to female ratio was 1.2:1. 37 (61.9%) children had simple seizures and 23 (38.1%) children had complex seizures. 12 (19.4%) of the patients had family history of febrile seizures and family history of epilepsy was positive in 6.3% of cases. Ninety one percent of cases were born with normal vaginal delivery. Also, only 2 patients (3.1%) had less than 37 weeks of gestational age at birth. The mean rectal temperature of the patients was 38.5 ± 0.67 ºC. Gastroenteritis was the most common cause of fever in our patients. Conclusion: The highest frequency of Febrile Convulsion was seen in younger than 20-month-old children. Except for the lower incidence of positive history of prematurity and higher prevalence of gastroenteritis, results of the present study are relatively similar to other studies.

Keywords: Seizures; Febrile; Children.

 Context: Clinical presentation of HIV infected children is different than adults. Disease progression is rapid. About 30% HIV infected children under one year of age die undiagnosed. Clinical scenario is changing with time and with available treatment. Aims: To study the profile of clinical presentation in HIV infected children. Settings and Design: Study was conducted in a government medical college of north India. It was hospital based observational study. Methods and Material: 140 HIV infected children between the age of 18 months to 15 years diagnosed as per guide lines of NACO were included in study. Clinical and immunological staging was done according to WHO staging criteria. Written consent was taken and counselling was done. Statistical Analysis Used: To describe nominal data simple percentages were used. Mean and Standard Deviations were used to describe normally distributed data. Results: Common age of presentation was between five to ten years. Perinatal transmission was the commonest mode of transmission (97.8%). Fever (60.7), Recurrent loose stools (45.7%), Chronic cough (27.8%), Itching and rashes over body (25%) were the common complaints. Anaemia (85%), Lymphadenopathy(59.2%), Skin lesions(47%), Chronic Supporative Otitis Media(12%) were the common clinical findings. Central Nervous System involvement was seen in six and Cardio Vascular System involvement in four children was noted. One child presented with joint involvement and one had Non Hodgekin’s Lymphoma. Conclusions: Vertical transmission was the commonest route of infection in children. Prolong fever, recurrent diarrhoea, frequent respiratory infections associated with under nutrition, anaemia and skin lesions were common clinical presentations. One third children were orphan and they were worst sufferer.

Keywords: Clinical Profile; HIV Infection; Children