Pediatric Education and Research

Spondyloepiphyseal dysplasia congenita is an autosomal dominant inherentdisorder characterized with abnormal growth of epiphyseal center,spine and disproportionate dwarfism. Here we report a child presents with short stature evaluated for short stature and abnormal gait turned out as skeletal dysplasia.

Keywords: Spondyloepiphyseal Dysplasia; Skeletal dysplasia. 

Immune thrombocytopenic purpura (ITP) is a clinical syndrome in which a decreased number of circulating platelets (thrombocytopenia) manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into skin and mucous membranes (petechiae). Although most cases of acute ITP, particularly in children, are mild and selflimited, intracranial hemorrhage may occur when the platelet count drops below 10 × 109/L (<10 × 103/µL); this occurs in 0.51% of children, and half of these cases are fatal. Intracranial haemorrhage is a rare but life threatening complication of childhood Immune Thrombocytopenic Purpura. Aggressive multi – modality treatment is warranted in such cases.

Keyword: Immune thrombocytopenic purpura (ITP); Intracranial Haemorrhage. 

Hepatic malignant neoplasms comprise the third most common cause of intraabdominal malignancies. Apart from the constellation of clinical findings associated with malignancies; liver malignancies have also been associated with perilous paraneoplastic syndromes. This report is about a 10 years old boy presenting with abdominal distension since 1 month with firm massive hepatosplenomegaly. Investigations revealed deranged liver enzymes with HBsAg positive status. CT abdomen was suggestive of heterogenous hepatic lesions. Serum alphafetoprotein level came as >90000 ng/ml. Liver biopsy revealed the diagnosis of Hepatoblastoma. Patient subsequently developed paraneoplastic symptoms in the form of hypertensive urgencies and resistant hypoglycaemic episodes manifesting as seizures requiring Nitroprusside drip ultimately and Glucose infusion Rate as high as 12mg /Kg/minute. On PRETEXT staging the tumour was classified as Stage 4 which is the nonresectable variety. The child was started on Cisplatin and Doxorubicin. However, he deteriorated, proceeding to liver failure with deranged liver function tests, raised PT/INR and active bleeding. The parents took a discharge against medical advicedue to financial constraints. As hepatoblastoma is extremely rare in this age group with the disease predominantly presenting as Paraneoplastic syndromes,Doctors should be ready for uncommon and rare possibilities.

Keywords: Abdominal Lump; Hepatoblastoma; Hypertension; Hypoglycemia.

 A congenital heart defect (CHD) is a structural or functional abnormality of heart that is present at birth. CHD accounts for nearly onethird of all major congenital anomalies. Screening infant with noninvasive measurement ofoxygen saturation bypulse oximetry has been proposed as an aid for early detection of duct dependent circulation. Critical congenital heart defect (CCHD) is associated with hypoxemia among infants during the newborn period, and hypoxemia represents 1731 percent of all CHDs. The CCHD screening include: hypoplastic left heart syndrome, pulmonary atresia (with intact ventricular septum), tetralogy of Fallot, total anomalous pulmonary venous return, and transposition of the great arteries with Intact Ventricular Septum. The risk of morbidity and mortality in CCHD increases when there is a delay in diagnosis and referral to a tertiary center. Babies with CCHDs usually require surgery or catheter intervention in the first year of life and represent more than one third of all CHD.

Keywords: Critical congenital heart defect; Hypoxemia; Neonates.

Introduction: The tribal population in India is 74.6 million (8.2% to the total population). The largest number of tribal are in undivided Madhya Pradesh (16.40 million), followed by Orissa (7 million) and Jharkhand (6.6 million). There are 573 Scheduled Tribes living in different parts of the country, having their own languages, which are different from the one mostly spoken in the state where they live. There are more than 270 such languages in India. Methodology: A questionnaire was developed for collecting the detailed information about the child (name, age, gender, and birth order), parental consanguinity, child rearing health practices and socio economic status .The ages of the children were obtained from birth record and also interviewing mother with the help of local event calendar. Socioeconomic status of the study subjects was classified into Class I ( 3239), Class II (16203239), Class III (9721620), Class IV (486972) and Class V (< 486) by using modified B.G. Prasad Classification based on Consumer Price Index of December 2009 of 657 (Correction Factor = 32.39) Results: According to this study 61.8% of tribal children were exclusively breast fed for less than 6 months, 20.4% for 6 months and 17.8% for more than 6 months. Among nontribal children 46.6% were exclusively breast fed for less than 6 months, 49% for 6 months and only 4.4% for more than 6 months. Conclusion: Parental consanguinity were observed in 62.6% of children in tribal population and 20.8% of children in non tribal population.

Keywords: Tribal; Non Tribal; Socio Demographic Characters. 

Introduction: Hepatic encephalopathy is a common neuropsychiatric syndrome seen in patients with significant hepatic dysfunction and liver failure, in the absence of neurological disorders. Common causes of hepatic encephalopathy includes, viral hepatitis, Wilson disease, autoimmune hepatitis and idiopathic. Very few studies have been conducted in India on causes and prognostic factors of hepatic encephalopathy. Methods: The present observational study was done in children aged 1 to 18 years of age, of either sex admitted in pediatric ward as a case of hepatic encephalopathy. Fifty two children, who fulfilled the inclusion criteria were enrolled and subjected to detailed laboratory investigations to find out the etiology. All enrolled children were managed as per standard hospital protocol. Basic parameters, investigations and outcome were recorded in pretested proforma. Children were further divided into two groups: Group Ithose who improved and discharged and Group IIchildren who died to find out prognostic factors in such children. Results: The mean age of the study population was 81.54 ± 42.4 months with a range of 1 18 years. Male to female ratio in study was 2.5:1.Wilson’s disease was found to be the most common cause of hepatic encephalopathy (42.3%) followed by Idiopathic (26.9%), Hepatitis A (21.1%), Hepatitis B (7.6%) and autoimmune hepatitis (5.7%). Out of 52 patients, 35 improved and were discharged and 17 had died. All the patients in group II had INR more than 4 while the corresponding figure was 34 % in the group I. Conclusion: Wilson disease was the most common cause of hepatic encephalopathy and INR and stage of encephalopathy were major determinant of outcome. Children in hyperacute liver failure and acute liver failure had also poor outcome.

Keywords: Hepatic Encephalopathy; Wilson Disease; Hepatitis; INR. 

Introduction: Nutritional status refers to the health of an individual as it is determined by the intake of nutrients and their utilization. Food consumption is one of the major factors determining nutritional status of any community, which is also influenced by the environmental changes. Methodology: A questionnaire was developed for collecting the detailed information about the child (name, age, gender, birth order), parental consanguinity, child rearing health practices and socio economic status. The ages of the children were obtained from birth record and also interviewing mother with the help of local event calendar. Results: The average intake of energy consumed by both tribal and non tribal children was below the RDA except non tribal 3< 4 and 55.5 years age group children where as the consumption of protein among tribal and non tribal were more than the RDA of India. Conclusion: The consumption of energy and protein were low among tribal than non tribal children.

Keywords: Trbal Children; RDA; Nutritional Deficiency. 

Background: Meconium stained amniotic fluid (MSAF) is a common occurrence at birth and birth of non– vigorous baby born through MSAF is associated with more nicu admissions, Respiratory distress, Meconium aspiration syndrome (MAS) and various complications of MAS. Hence this study was undertaken to contribute to the existing knowledge about clinical profile of babies born through MSAF and to study various factors associated with the birth of nonvigorous babies and their final outcome. Study Setting: This was aprospective study, conducted in the Department of Pediatrics, MGIMS Sevagram, a rural based hospital in Central India, from June 2015 to May 2016. Materials and Methods: All the babies born through MSAF with singleton pregnancy and with cephalic presentation in the absence of any congenital anomalies were included in the study and history of various maternal risk factors was enquired. Babies were either grouped as vigorous or nonvigorous at birth and both the groups were followed for their final outcome. Statistical Analysis: The analysis was done using software used in the analysis were SPSS17.0 version and Graph Pad Prism 5.0 version. Total incidence was analyzed with respect to total meconium stained amniotic fluid deliveries. All complications were observed and an outcome of the babies was studied with respect to morbidity and mortality. Data was processed and analysis was done using chi square test. Results: No significant association was observed between various maternal risk factors and birth of Non vigorous babies .It was observed that birth of nonvigorous at birth was associated with development of respiratory distress, MAS and other complications associated with MAS. Conclusion: This study was aimed at improving the knowledge related to risk factors associated with the birth of babies with MSAF and also to study the clinical profile and final outcome of the babies born through MSAF. The information obtained can be utilised for proper management and resuscitation of nonvigorous babies at birth and also during nicu stay.

Keywords: Meconium Aspiration Syndrome; Meconium stained amniotic fluid (MSAF); Meconium Stained Liquor 

Introduction: Febrile seizures (FS) occur in 25% of children aged 6 months to 5 years. Several studies have confirmed that between 2 to 7% of children with FS, develop epilepsy later in life. This study was performed to evaluate the clinical aspects of patients with febrile seizure in Dhaka Shishu (Children) Hospital, a tertiary care pediatric hospital. Materials and Methods: This was a retrospective descriptive crosssectional study that was performed from September 2014 to December 2015 in which 74 patients aged 6 months to 5 years were evaluated. Results: Most patients were male and aged between 1 to 3 years. 22.7% had a past history of febrile seizures. Upper respiratory tract infections and gastroenteritis were among the most common causes of febrile seizures. Simple febrile seizures were seen in 64.8% of the cases. Most of such patients had body temperature above 38.5 c at the time of seizure occurrence. Conclusion: Febrile seizures were more frequently seen in boys aged 1 to 3 years. It most commonly occurred following an upper respiratory tract infection and due to rise in body temperature above 38.50C.

Keywords: Children; Convulsion; Fever; Infections. 

Aim: To evaluate the effect of intrathecal vs. intramuscular tetanus immunoglobulin therapy on hospital stay and mortality in pediatric tetanus patients admitted to a tertiary care hospital. Methods and Material: Retrospective analysis of hospital records of tetanus cases to the pediatric ward during two year period between 2012 and 2014 was done. All patients were managed as per preexisting unit protocol. Group A received Human tetanus immunoglobulin (TIG) 250 unit a via the Intrathecal route preceded by IV ketamine (1 mg/kg) for proper relaxation to ease the procedure and the group B was given TIG 750 unit via intramuscular route. Whether to give TIG by Intrathecal or intramuscular route was decided according to the treating unit’s protocol. Information regarding sex, age, immunization status, mode of infection, grade of tetanus, outcome and hospital stay was recorded in the two groups. Statistical Analysis: Fisher’s exact test, Chi square test, Unpaired t test. Results: There were total 40 patients with tetanus aged between 1 to 12 years during the two year study period. Neonatal tetanus cases were excluded. Out of 40, 15 patients were included in group A (intrathecal route) and 25 in group B (intramuscular route). Mortality and hospital stay was found to be less in group A (26.67%; 12.4 ±2.25days) as compared to group B (28%:15.4 ± 1.69 days). Conclusion: We found no significant difference between intrathecal immunoglobulin and intramuscular immunoglobulin therapy in management of pediatric tetanus in terms of mortality and hospital stay.

Keywords: Tetanus; Immunoglobulin; Intrathecal. 

Background and Aim: Dengue fever is one of the most important emerging vectorborne viral diseases. There are four serotypes of dengue viruses, each of which is capable of causing selflimited dengue fever or even lifethreatening dengue hemorrhagic fever and dengue shock syndrome. The aim of this study was to evaluate the clinical and sonographic findings of dengue fever. Methods: This crosssectional observational study was carried out in the Department of Pediatrics, Gujarat Adani institute of medical science, Bhuj. The participants were clinically and serologically evaluated against NS1 antigen, IgM and IgG antibody. These patients also underwent USG abdomen and chest within the first week of the illness. Results: Out of the 200 confirmed dengue cases, 53% cases were males and the 47% were females. The most common age group was school going children (42%) and adolescents (36%). All the cases had fever (100%). Other features were vomiting in 71.9%, abdominal pain in 45.9 %, 33.2% had hepatomegaly, bradycardia in 12.9%, and rashes in 10.4%. Investigations revealed thrombocytopenia in 96.9%, hemoconcentration in 94.2%, leucopenia (< 4000/mm3) in 62.9% and raised liver enzymes in 43.1%. The ultrasonographic findings were hepatomegaly in 84 cases, gall bladder thickening in 61 and splenomegaly in 16.5% of cases. Pleural effusion was noticed in 46.5% and 37% had ascites. Conclusion: Dengue fever should be suspected among children in endemic areas like India when they present with fever, vomiting, myalgia along with hepatomegaly, low platelet count with elevated liver enzymes.

Keywords: Bhuj; Dengue Fever; Hepatomegaly; VectorBorne.

Background and Aim: Hyponatremia is supposed to be the most common electrolyte abnormality in the paediatric intensive care unit (PICU), and is associated with increased morbidity and mortality. Present study was carried out with an aim to study on hyponatremia in children admitted in Pediatric intensive care unit. Material and Methods: Present study was carried out in the Department of Pediatrics, Gujarat Adani institute of medical science, Bhuj for over a period of March 2015 to June 2016. Using aseptic technique, 2ml of blood was introverted from the antecubital fossa of each patient and put in a vacationer. Samples were stored at 280 C. Samples were sent for serum electrolytes to the Department of Biochemistry. Results: In this study incidence of hyponatremia in bronchopneumonia was 22.88%. Incidence of hyponatremia in bronchiolitis was 27.99%. Incidence of hyponatremia in seizures was 17.52%. Incidence of hyponatremia in meningitis was 59.01%. Incidence of hyponatremia in fevers was 13.90%. Incidence of hyponatremia in other diseases was 08.99%. Conclusion: There is a high prevalence of hyponatremia in children admitted in PICU. Meningitis, Acute gastroenteritis/acute diarrhoeal illness, Bronchopneumonia and Bronchiolitis patients were having hyponatremia in the majority of them. Premature recognition of hyponatremia is obligatory to start proper fluid management, or else additional hyponatremia causes permanent brain damage and death.

Keywords: Bhuj; Children; Electrolyte; Hyponatremia; Incidence.

Aim: The aim of the present study was to find out out the function of parental smoking in severe bronchiolitis. Material and Methods: The Present Casecontrol study was conducted in the Department of Department of Pediatrics, Gujarat Adani institute of medical science, Bhuj. Sixtyfour patients admitted into the hospital with severe bronchiolitis were registered as cases and sixtyfour properly coordinated looking fit attending Department of Pediatrics with nonrespiratory disease were tag as controls. Results: The mean age of the patients was 7.54 months. Sixty two point six patients were male and 37.4% patients were female. Nearly every one of the cases arrives from low economic setting. Least amount of hospital reside was 3 days and maximum was 10 days. Thirty nine cases and twenty one controls were exposed to parental smoking which was evident by highly significant results (p = 0.005). Conclusion: Exposure to parental smoking, chiefly paternal smoking, reason a statistically significant lift in the jeopardy of mounting severe bronchiolitis in the primary year of life.

Keywords: Bhuj; Bronchiolitis; Children; Smoking. 

The purpose of the study is this study is to assess the effectiveness of dose of intratracheal surfactant administered during the progression of RDS followed by rapid extubation and institution of CPAP without mechanical ventilation as a cost effective treatment. Parental informed consent was obtained prior to the procedure. Arterial blood gas analysis was performed before the procedure.Its is a descriptive case control study .Infants with surfactant therapy and NCPAP were taken as (surfactant group) and infants to whom parental consent was not given and who came late to hospital were taken as (control group). The total length of duration in the hospital is almost similar in both the groups. The reason being other than the respiratory problem in the surfactant group like NEC, and feeding problems. But the patients requiring the intensive care is less which may lessen the cost for the treatment and make it as a cost effective treatment. There is a significant decrease in the need for MV in the surfactant group compared to control group.The reduction in the need for MV decreased the risk of airleak syndrome and is advantageous in medical settings where resources are limited like in our country. There is a significant decrease in the need for MV in the surfactant group compared to control group.The reduction in the need for MV decreased the risk of airleak syndrome and is advantageous in medical settings where resources are limited like in our country.

Keywords: Pulomonary; Intubation; Surfactant.

Background: Every year 10,000 children with thalassemia major are born in India, which constitutes 10% of the total numbers in the world. The current management of thalassemia major (TM) includes regular transfusion programs and chelation therapy. The combination of transfusion and chelation therapy has dramatically extended the life expectancy of thalassaemic patients but is complicated by citrate toxicity and subsequent iron overload. Excessive iron is deposited in most tissues primarily in the liver, heart and the endocrine glands Disorders of growth, sexual development & fertility, abnormal bone mineralisation, diabetes mellitus, hypothyroidism and hypoadrenalism are the main endocrine complications found in thalassaemic patients. Aims And Objectives: To determine the incidence of thyroid dysfunction by estimating T3, T4 and TSH, hypoparathyroidism by estimating serum calcium, phosphorus and alkaline phosphatase levels,diabetes mellitus by estimating fasting and postprandial blood suger, to see for pubertal delay in these patients according to sexual maturity rating and finally to determine if there is any correlation between increased serum ferritin and these abnormalities. Material and Methods: This study was conducted in the department of Paediatrics, Thalassemia Unit, Government Medical College, and Jammu. All thalassemic children below the age of 19 years who had received more than 20 transfusions and whose ferritin levels were more than 1000mg/ng and were coming regularly for transfusion in the thalassemia unit of department of paediatrics were included in the study. Results: The height and weight of these children were significantly less (>2.5 SD) as compared to normal children. Hypothyroidism was detected in 12.82% of the patients,hypocalcemia was detected in 20 cases, hypoparathyroidism in 8 patients, impaired glucose tolerance was detected in 25.7%, Conclusion: Increasing awareness of endocrinological problems in thalassemic patients is essential not only because such patients are living longer now, but also because much of the morbidity and mortality from these complications can be reduced with regular surveillance, early treatment and followup.

Keywords: Thalassemia Major; Blood Transfusion; Serum Ferritin; Delayed Growth; Puberty; Hyopothyroidism; Hypoparathyroidism; Diabetes. 

Bronchial asthma is a chronic inflammatory disease of respiratory tract in which episodes of bronchospasm which are seen as life threatening events are potent stressors affecting quality of life. 400 children with asthma were studied divided equally into study and control group. Children in the study group after comparing with an age, sex and socioeconomic status of control group were evaluated using Childhood Psychopathology Measurement Schedule( CPMS) Questionnaire. Those who were considered positive for psychopathological disorders were assessed further and interviewed clinically and were diagnosed according to International Classification of Diseases10 (ICD10) criteria. 27% cases compared to 7% controls were diagnosed to have psychiatric disorders on basis of CPMS cut off level. Maximum proportion among ICD10 classified psychiatric disorders was of Anxiety depression followed by moderate mental retardation, anxiety and nocturnal enuresis.

Keywords: Asthma; Psychological Problems; ICD10 Classification.

Kerosene poisoning being an important and preventable cause of morbidity and mortality in the india. Kerosene aspiration may be associated with chemical interstitial pneumonitis and rarely death. Material and Methods: A 6 year retrospective study of Children admitted with kerosene poisoning at GMC & H Nagpur during the years 2011 to 2016. Demographic and clinical data were collected and analysed from the case records.51 children were admitted with kerosene poisoning. Male preponderance (62%) was noted. There wasalso seasonal (October to December) andurban preponderance. The peak age group was from 1 to 3 years. Cough,vomiting Drowsiness were the main symptoms. There was no death due to kerosene poisoning in this study. Kerosene poisoning happens largely due to ignorance of parents. Kerosene should be dispensed in child proof bottles with pictorial warnings to deter children.

Keywords: Kerosene; Aspiration; Children; Vomiting; Drowsiness.

Deficient in the production of thyroid hormone or any defect in thyroid hormone receptor activity can lead on to hypothyroidism. Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation in children. In our study all the babies were screened by intravenous blood samples collected between 4896 hours of age and identified 3 babies with CH. Along with CH screening, necessary investigationsdone were blood grouping and serum bilirubin as a standard hospital policy. The TSH was measured by Electrochemiluminescence immuneassay method. Newborn screening for congenital hypothyroidism (CH) by intravenous blood TSH screening in our institute has been effective as a screening tool. From our study, there is no doubt that CH screening fits into the criteria of the diseases that needs to be screened in India, as the incidence in our study of nearly 1:1050 is high and should not be ignored.

Keywords: Thyroid; Hormone; Infant; Congenital.

Introduction: Kerosene Poisoning is an important & preventable cause of morbidity and mortality in the developing world. Kerosene aspiration may be associated with pulmonary complications and sometimes death. Objectives: To study the clinical profile of children with kerosene poisoning.Material and Methods: This is a 5 year retrospective study of children admitted with kerosene poisoning in SBHGMC & Hospital, Dhule between the years 2012 to 2016. Demographic and clinical data were recorded from the case records. Result: 88 children were admitted with kerosene poisoning. Male preponderance (60%) was noted. There was seasonal preponderance in the months of Feb to May. There was also an urban preponderance. The peak age group was from 1 to 5 years. Cough (56%), dyspnea (20%) and vomiting (42%) were the dominant symptoms. Radiologicaly Right lower lobe infiltration seen in 30% of children and bilateral lower lobe infiltration was seen in 15% of children. There was 1 death due to aspiration Pneumonia &encephalopathy. Conclusion: Kerosene poisoning happens largely due to ignorance of parents. Further research is needed in Kerosene encephalopathy to ascertain whether it is primarily due to direct toxic effect of the hydrocarbon or secondarily due to hypoxia of pneumonitis. Kerosene should be dispensed in child proof bottles with pictorial warnings to deter children.

Keywords: Kerosene; Aspiration; Children; Vomiting; Pneumonitis.

Retrospective study of MLC cases admitted in paediatric ward during period of 3 years (Jan 2014Jan 2017). All cases were accidental MLC. Major share was poisoning and animal bite and most of cases were under 5 years. Mortality was about 11%.

Keywords: Accidental Cases; Poisoning; Snake Bite & Parental Education for Prevention.