Pediatric Education and Research

Consent means voluntary agreement, compliance or permission. Consent signifies acceptance by a person of the consequences of an act that is being carried out. Informed consent is a communication process of providing the patient/parents/guardians with relevant information regarding the treatment and the diagnosis, so that they can make informed decisions. The process of informed consent in pediatric patients is not well understood. The amount of information to be disclosed in an informed consent is a matter of debate.

Keywords: Consent; Assent; Child; India; Informed Consent; Parents. 

Pediatric lupus nephritis, though rare; has significant morbidity and mortality. Often it may get undiagnosed or get diagnosed late due to lack of awareness about its intricacies of management. Hereby an effort is made to compile the recent definitions and advances in management of pediatric lupus nephritis.

Keywords: Nephritis; Lupus; Renal Hypertension. 

Combination vaccines that include multiple antigens in one vaccine are now a widely accepted as an effective means of eliciting protection against several diseases at the same time. Owing to improvement in quality and convenient mode of administration, they have become part of routine paediatric practice. Hexavalent vaccine includes diptheria, tetanus, pertussis, hepatitis B, polio and Haemophilus influenzae type b antigens. The studies until now have shown that the vaccine is highly immunogenic and well tolerated. It is now a part of various primary and booster vaccination schedule as well as it is safely given with other vaccines.

Keyword: Hexavalent; Hemophilus Influenzae; Hepatitis B.; Pertussis. 

Lower respiratory tract infections (LRTIs) are the leading cause of death among infectious diseases and responsible for large burden of avoidable morbidity and mortality in childhood. The present study was done to assess the prescribing pattern of drugs in LRTI in children aged 1 month14 years old using WHO core antibiotics drug prescribing indicators. This was a cross sectional, record based study carried out for a period of 1 year in the Department of Pharmacology in collaboration with Department of Pediatrics, PBMH, KIMS, Bhubaneswar. This study was approved by KIMS research committee and institutional ethics committee. Study states that LRTI (42%) was highest in the incidence followed by WALRI. Most commonly prescribed antibiotic was Cephalosporin group (Ceftiraxone) followed by Amikacin. Levosalbutamol with Ipratropium was the most commonly used nebulizing drug followed by combination with steroid (budesonide). Antibiotics were prescribed for 245(100%) patients followed by bronchodilators, antipyretics, cough medications, oxygen inhalation, nasal decongestants, steroids and others which include multivitamins. Admissions of males (70.6%) were more as compared to females (29.4%) indicating gender bias is still persisting in society. Antibiotics stewardship is very much needed to prevent its overuse and emergence of resistances.

Keywords: Hospital Stay; Prescription Pattern; Antibiotics; LRTI. 

Introduction: Liver disease in pediatric age group is one of the most significant causes of morbidity and mortality and includes a broad spectrum of disorders such as infections, developmental abnormalities, metabolic and neoplastic disorders that finally results in hepatic dysfunction and cirrhosis [1] and may recover fully. Objective: 1) to study the clinical profile of hepatomegaly in pediatric age group. 2)To identify etiological spectrum hepatomegaly in pediatric age group. Material and Methods: A prospective study will be carried out during 01.12.2014 to 31.05.2016 in 100 patients of pediatric age group presenting with hepatomegaly admitted in Navodaya Medical College Hospital Raichur. All the pediatric patients (birth – 18 years) admitted with hepatomegaly, (defined clinically) with span more than normal for age. The patients will be evaluated clearly based on history, clinical examination and requisite laboratory parameters to find out the cause of hepatomegaly. This study will be conducted as a prospective Clinical study, wherein written informed consent will be taken prior to the investigation after detailed information given to the guardians regarding the study. Children with hepatomegaly will be screened through history, detailed examination and correlated through lab investigations. Results: Male predominance was seen in our study.Maximum incidence of hepatomegaly was seen between 1 to 4 year age group (34%). Majority of the cases had mild hepatomegaly (64%). Commonest cause of hepatomegaly was infections. Fever was the most common symptom associated with hepatomegaly. Splenomegaly was the most common sign associated with hepatomegaly. Conclusion: Infection is the most common cause of hepatomegaly in our study. Male preponderance was seen in majority of the cases who had hepatomegaly and belonged to pre school age group.

Keywords: Hepatomegaly; Anemia. 

Neonatal septicaemia is a major cause of morbidity and mortality in new born infants. Back ground and objectives: to study the incidence, predisposing factors, clinical profile, out come, early indicators of correlation with all clinical aspects and antibiotic sensitivity pattern of neonatal septicaemia. Materials and Methods: The 50 neonates who are showing the well documented signs of septicaemia are included in this study. Results: culture was bacteriologically positive in 34% cases. Ciprofloxacin had maximum sensitivity 88.2%. Leucopoenia ï‚£5000/cmm had sensitivity of 47% specificity of 66.67% and ppa of 42.11%,toxic granulation had 70.56% sensitivity, 63.65% specificity and 50% ppa. B/n>0.2 had 88.2% sensitivity 62.4% ppa. Mesr had sensitivity of 70.56%, specificity of 84.84%, ppa of 70.5%, creactive protein had 88.2% sensitivity and 87.8% specificity and 78.95%ppa. Case fatality rate was 28%. Conclusion: Clinical features of neonatal septicaemia are non specific and vague. Sepsis screen had good sensitivity, specificity and ppa. combination of tests increase the specificity and ppa. An an individual test creactive protein has highest sensitivity.

Keywords: Neonates; Septicaemia; Outcome. 

Introduction: During the past few decades, preventive and therapeutic interventions focused primarily on low birth weight infants and deliveries occurring at less than 34 weeks. Many clinicians have become increasingly comfortable with births in late preterm gestations and many seemingly choose elective delivery well before 39 to 40 weeks of gestation, mistakenly believing that these neonates may be as physiologically and metabolically mature as term new borns. Methodology: Data were collected from infants and mothers medical records and supplemented with additional information collected at discharge using a structured form covering the variables of interest. Variables relating to the mothers and their infants were analyzed. Results: Regarding gestational age, 18 neonates were admitted between the gestational ages of 340/7 to 346/7 weeks who constitute about 18%. 16 neonates were admitted between the gestational ages of 350/7 to 356/7 weeks who constitute about 16% and 66 neonates were admitted between the gestational ages of 361/7 to 366/7 weeks who constitute 67%. Conclusion: Majority of babies were admitted within first three days of life.

Keywords: Preterm Neonates; Gestation; Low Birth Weight. 

Introduction: Factors that affect the state of lung development at birth include prematurity, maternal diabetes and genetic factors (white race, history of RDS in siblings, male sex). Thoracic malformations that cause lung hypoplasia, such as diaphragmatic hernia, may also increase the risk for surfactant deficiency. Methodology: The maternal and gestational variables studied were: Age (years), number of pregnancies, prior history of miscarriages, still births and premature deliveries; type of delivery (normal or caesarean); previous caesarean section, intercurrent clinical conditions observed during gestation – diabetes, hypertension, anemia, urinary infections at any point during pregnancy, syphilis, human immunodeficiency virus (HIV), toxoplasmosis, heart disease, hepatitis B, premature rupture of membranes (PROM) for longer than 18 hours, placental abruption Results: Maternal risk factors were present in 67% mothers which constitute about 67%. Among which Anemia (15%) and PROM (10%) has high incidence. PIH and previous history of LSCS constitute about 9% and 5% followed by Maternal Fever and younger age 9% & 4%. APH were found in 3 which constitute about 3%. BOH found in 2 mothers which accounts for about 2%. Conclusion: In the present study also PROM and anemia constitute the major maternal risk factor.

Keywords: Maternal Risk Factors; Preterm Neonates; PROM. 

Background: Obesity is an important modifiable risk factor for most chronic noncommunicable diseases. The objective of the study was to determine the prevalence of overweight/ obesity among adults in rural areas of Ahmednagar. Materials and Methods: This was a cross sectional study conducted among 150 population in rural areas of Ahmednagar. 1545 years adolscents & adultsare interviewed from the consecutive houses with the help of a pretested structured questionnaire. Height, weight, waist circumference and hip circumference were measured using standard anthropometric methodology. Results: Mean age of the study population was 30 years. Mean BMI among women was significantly higher (24.28), compared to men (23.2) with . The prevalence of overweight and obesity in the population was 24% and 40.7% respectively, as per WHO BMI guidelines for Asians. About 51% of women and 35% of men had high waist circumference. Higher proportion of women (77.7%) had high waisthipratio compared to men (48.5%). Conclusion: The prevalence of overweight and obesity is high among adults in rural areas in Ahmednagar.

Keywords: Obesity; Overweight; Prevalence; Rural; Maharashtra. 

Background: Pediatric malnutrition is a major cause of morbidity and mortality in developing countries including India. This malnutrition can be prevented by proper dietary advice to parents along with early diagnosis and management of malnutrition. The aim of this study was to find out the present nutritional status and its comorbid abnormalities in children attending primary school in rural Kanpur. Objective: To assess the prevalence of underweight, stunting, wasting and comorbid abnormalities of malnutrition in 5 to 10 years age group of school going children. Methods: This study was across sectional study conducted in rural primary schools of Mandhana Kanpur between December 2016 to May 2017 to know the nutritional status of school age children with coexisting morbidities with the help of anthropometric measurement and clinical examination. Results: A total of 400 children were studied belonging to the age group 5 to 10 years including 226 (56.5%) boys and 174 (43.5%) girls. Approximately 54% boys and 50% girls have their weight and height within normal limits. Prevalence of wasting and stunting was highest in 5 to 6 years age group in both sexes. On clinical examination highest number of children were found to be clinically anemic in both sexes but more in girls followed by presence of pharyngitis. Conclusion: In our study we found presence of all types of nutritional deficiency starting from under nutrition to stunting, wasting and associated abnormalities like anemia and pharyngitis. Need of the hour is more steps to be taken to overcome the nutrition gap and abolish the problem of malnutrition.

Keywords: Underweight; Stunting; Wasting; Anemia. 

Background: Sickle cell anemia (SCA) is a formidable problem in India, and is more prevalent in Maharashtra. Cardiovascular events and complications are the leading cause of mortality and morbidity in patients with SCA. The aim of this study was to determine the issue Doppler Imaging (TDI) changes in left ventricular function in children suffering from SCA. Methods and Results: This case controlled study comprised of 20 cases of SCA, and 20 nonanaemic controls with normal haemoglobin and electrophoresis pattern. Mmode, TwoDimensional, Doppler and Tissue Doppler Imaging (TDI) measurements of patients and controls were performed. In the study cases, age ranged from 5 years to 15 years with the mean age of 9.91 years. There were 12 males and 8 females in the study cases. Patients with SCA had significantly larger left atrial, and left ventricular dimensions. The ejection fraction and shortening fraction were lower in the cases, but the difference was not statistically significant. The LV tissue Doppler of the lateral annulus of mitral valve in SCD compared with control showed higher E’/A’ ratio and reduced S wave which was statistically insignificant (p > 0.05), similar finding were present at the level of interventricular septum and lateral annulus of tricuspid valve. Conclusions: TDI is a useful noninvasive technique to study the changes in cardiac structure and function. SCA in children results in a volumeoverloaded heart with a significant increase in left ventricular dimensions.

Keywords: Sickle Cell Anemia; Tissue Doppler Imaging; Ventricular Function. 

Asthma is one of the most common chronic diseases worldwide imposing a substantial social burden on both children and adults alike. Worldwide childhood asthma appears to be increasing in prevalence, despite considerable improvement in management of the disease. In India prevalence of asthma has been found to be around 6% in majority of survey, but it has been reported to vary from 217% in different study population, affecting on average about 311% of adults, 35% of paediatric population. The symptoms of the disease can start at any age, but in majority it starts before 10 years of age. Aims and Objectives: To study the clinical features of bronchial asthma and the peak expiratory flow rate( PEFR )in patients with acute exacerbation of bronchial asthma and to assess objective response of PEFR to bronchodilator therapy in group of 40 children visiting the department of pediatrics in a city hospital. Material and Methods: Data was collected by using pretested proforma meeting the objectives of the study. The purpose and technique of the study was carefully explained to the subjects and informed consent was taken.Age and sex matched control group of 100 was taken from the same population as the lung function tests are affected by certain variables like age, sex, stature and environmental conditions Detailed clinical history, thorough clinical examination was taken. Relevant investigations were done. Instrument used to measure PEFR was “The miniature Wright’s peak flow meter”. Results: There was significant reduction in PEFR in all the age groups of the study group as compared to the control group which was easily measured using the miniature Wright’s peak flow meter in both outdoor and admitted patients.

Keywords: Asthma; Children; Peak Expiratory Flow.