Pediatric Education and Research

Autism and ADHD are wide spectrum neurodevelopmental disorders of children with uncertain aetiology. Early neonatal or fetal acute brain insult is one of the suspected aetiologies. In this case of Autism and ADHD history of neonatal head injury is suspected as an aetiological possibility. No such case is reported yet.

Keywords: Autism; ADHD; Head Injury; Neonatal; Subependymal Hemorrhage.

 

Rotavirus is the most common cause of diarrhoeal disease among infants and young children. It is a genus of double -stranded RNA viruses in the family Reoviridae. Nearly every child in the world is infected with rotavirus at least once by the age of five. Immunity develops with each infection, so subsequent infections are less severe; adults are rarely affected. There are eight species of this virus, referred to as A, B, C, D, E, F, G and H. Rotavirus A, the most common species, causes more than 90% of rotavirus infections in humans. Rotavirus vaccine is a vaccine used to protect against rotavirus infections.

Keywords: Rotavirus; Vaccine.

 

This prospective study was conducted in tertiary care hospital attached to Department of pediatrics, Mahadevappa Rampure Medical college Kalburgi.

Aims: To determine the incidence of post phototherapy rebound hyperbilirubenemia in neonates subjected to phototherapy.

Materials and Methods: All babies with hyperbilirubinemia admitted to nicu were included in the study . A total of 200 neonates among which 122 were males and 78 were females. Repeat serum bilirubin was measured 24 hours after stopping phototherapy.

Statistical analysis: Data entry analysis were done using SPSS.

Results: The general incidence of significant rebound hyperbilirubinemia requiring reinitiation of phototherapy was 9.5%. Birth weight and gestation age has significant impact on rebound hyperbilirubinemia.

Conclusion: it is necessary to measure rebound bilirubin levels after 24 hrs of stoppage of phototherapy in high risk neonates like premature babies, birth weight <2kg.

Keywords: Bilirubin; Phototherapy; Significant Rebound.

 

Objective: To screen the school children aged 10-14 years for Attention Deficit Hyperactivity Disorder using Vanderbilt ADHD Diagnostic Teacher Rating Scale.

Method: This was a cross-sectional observational study. Total 2114 students of three schools between the age group of 10-14 yrs studying in 5th-9th standard were surveyed. Pre-study, the class teachers were trained in a half day workshop about ADHD disease and how to fill up forms. From each class suspected students of ADHD were selected by the teachers and then ADHD symptom scale self report form was filled by the teachers for these students. The filled up forms were analyzed by us.

Result: Prevalence of ADHD in present study was 65/2114 (3.07%), out of which 27.27% and 14.54% were of hyperactive and inattentive ADHD type respectively, while 58.16% were suffering from mixed ADHD type. Most affected age was 12 years, and male to female ratio was 5.5. Most common symptom of ADHD was, excessive talking (96.62%); most common behavioral problem was, not following rules (70.7%); and most common affected area was, mathematics.

Conclusion: The self report tool filled up by teachers after training them is able to detect cases of suspected ADHD in 10 to 14 year studying in 5 to 9 standard. There is a 3% predicted prevalence of ADHD by this survey tool in upper-middle class schools.

Keywords: ADHD; Vanderbilt Scale; School Children; Screen; Teacher Rating Scale; Prevalence.

 

Introduction: A lecture is the most widely used teaching method. Learning by lecture is a passive practice. Many pioneering techniques have been used to motivate students to have active attitude toward learning. In our method we are using museum as an innovative teaching-learning method.

Material and Method: 96 undergraduate students were evaluated by dividing into 2 groups. Group 1 (48 students) was taught through the traditional blackboard-chalk and Power Point presentation method and Group 2 (48 students) was sent to the Paediatric Museum for the same period of time. The knowledge and understanding of the subject was then assessed through a test at the end of the 1 month posting. After both the groups were taught by both methods of teaching, feedback was taken.

Result: Most of the students accepted that the newer, innovative method of teaching was more interesting and appealing to them. Group 1 scored 68% average and in that group 54% students got above 50%. While the average of Group 2 was 84% and 68 % scored a over 50% marks. The feedback showed that 99% of the students agreed or strongly agreed that learning and clearing their concepts was easier after visiting museum. Students also strongly agreed that this method was time saving and helped them in memory retention.

Conclusion: Students who had attended the museum had a better understanding of the Paediatric subject and could reproduce the knowledge gained by them in a better way as compared to the students taught through the traditional method.

Keywords: Museum; Teaching; Medical Students.

 

Introduction: The face is important part of many syndromes of dysmorphogenesis. Main aim of anthropometric studies are to obtain the characteristics of ethnic groups and provide the basis for a comparison among different races. Our study is being conducted totake craniofacial measurements in newborn of rural India and to find corelation between different parameters. It also adds normograms for all the craniofacial anthropometric measurements studied.

Method: 97 normal neonates comprising 49 male and 48 female were measured 48 hours after birth. The measurement for different cranio-facial dimensions were obtained using verniercalliper and non-stretchable measuring tape. Unpaired ‘t’test was utilized to compare the parameters.

Result: The mean value and range for all the parameters was determined.Mean birth weight of studied neonate was 2.52±0.318 and gestational age being 37.95 ±1.27. A statistically significant sexual dimorphism was noted to exist in ear length (p<0.05). The mean intercanthal distance was 17.55±3.00 in male and 17.64±2.73 in female, philtrum width were 5.06±1.72 in male and 5.02±1.48 in female and commissural distance were 23.44±4.50 in male and 22.95±3.97 in female. Ear length measurements were 32.46±3.79 in male and 31.25±2.24 in female.

Conclusion: We here present a reference data set for the newborn population of rural area in India.

Keywords: Newborn; Anthropometric; Craniofacial; Dysmorphogenesis.

 

Both working memory and attention-deficit/hyperactivity disorder (ADHD) have been associated with educational deficits. Since working memory deficits are prevalent in children with ADHD, the main aim of the present study was to examine whether educational deficits are driven by working memory deficits or driven by the effect of ADHD itself. Participants were referred children with (N=100) and without (N=100) ADHD ascertained from pediatric and psychiatric sources. Education deficits were defined as grade retention or placement in special classes, and were assessed using interviews and written rating scales. Working memory was assessed using the WISC-R Freedom from Distractibility (FFD) factor based on digit span, arithmetic and coding. Results were significantly more youth with ADHD had working memory deficits than controls (31.9% vs. 13.7%, p< 0.05). In ADHD children, working memory deficits were significantly (p no other differences were noted in other areas of functioning. Although working memory deficits also had some adverse impact on educational and cognitive correlates in non ADHD controls, these differences failed to attain statistical significance. Conclusion was that working memory deficits significantly and selectively increase the risk for academic deficits and cognitive dysfunction in children with ADHD beyond those conferred by ADHD. Screening for working memory deficits may help identify children with ADHD at high risk for academic and cognitive dysfunction.

Keywords: Attention Deficient Hyperkinetic Disorder; Working Memory.

 

Background: Posterior urethral valve is one of the most common causes of bladder outlet obstruction. It’scongenital defects which most commonly affect male children.

Aim: The aim of this study is to evaluate the Long term outcome of treated posterior urethral valve patients at a tertiary care center.

Materials and Methods: The Present study was conducted in SMS Medical College & Hospital, Jaipur, Rajasthan, India.A total of 40 patients with mean age of 2 years were selected for the study. Parameters like, including age at presentation, serum creatinine, initial creatinine clearance, renal ultrasound findings and ascites were studied. Long-term renal outcome was assessed.

Results: Of the 40 patients 18 were aged below 2 years i.e. 45%, 21 were aged between 2 to 4 years i.e. 52.5% and 9 of the were aged between 5 to 7 years i.e. 22.5%. Primary fulguration was carried in 77.5% cases and fulguration diversion in 22.5%.

Conclusion: Posterior urethral disease is very common though its rate has declined for past few years. Urethral valve ablation is safe and easy procedure to be carried out. 

Keywords: Urethral Valve; Tertiary Care Unit; Creatinine; Renal Dysfunction.

 

Objectives: To assess the morbidity pattern and mortality among preterm infants admitted in Level – 3 NICU of a teaching hospital of a backward district of Kerala and to analyze the quality neonatal survival and cause of death in such preterm neonates.

Methods: A retrospective study of all preterm infants admitted in the level – 3 NICU of a teaching hospital for a period of one year from 01/01/2017 based on hospital records. This includes both inborn and out born babies. Gestational age at delivery, mode of delivery, birth weight, major congenital anomalies, number of deaths and causes of deaths are recorded. Data are entered in Microsoft excel and data are correlated for any significance. 

Results: A total of 141 infants born below completion of 34 weeks of gestation were includedin the study. 8 infants (6%) were of extremely low birth weight out of which only one died in the hospital. Six infants (4.25%) died during NICU
stay. Major morbidities were present in 84% of all infants, and multiple morbidities were present in 66% infants. 

Conclusions: In a level 3 NICU of a teaching hospital 6% of babies were of extremely low birth weight and all except one survived. Death and morbidity are directly related to gestational age.

Keywords: Preterm Infants; Gestational Age; Neonatal Asphyxia.

 

Objective: To determine incidence, risk factors, and outcome of acute kidney injury (AKI) in Pediatric Intensive Care Unit (PICU).

Materials and Methods: This prospective observational study was conducted over period of 1½ years. All patients within the age group of 1 month to 18 years admitted in the PICU (Pediatric Intensive Care Unit) at Basaveshwar teaching and general hospital and Sangameshwar hospital attached to Mahadevappa Rampure Medical College during a period from December 2015 to August 2017.

Results: Out of 1007 patient screened 7 patient were excluded, out of which 2 where congenital dysplastic kidney, 2 were known case of nephrotic syndrome, 3 where known case of chronic kidney disease. Out of 1000 patients 69 children had AKI, giving incidence of 6.9%. The median age of boys and girls were 4.56±3.84 and 4.49±4.01 respectively. 58% of the patients were boys. The median admission serum creatinine value in AKI patients was 2.91±2.48 mg/dL. In the present study, pre-renal causes accounted for (54) 78.3% of AKI. AKI Stage 1, 2, 3 was diagnosed in 11 (15.9%), 14 (20.3%) and 44 (63.8%) respectively.

Conclusions: AKI continues to be associated with adverse outcomes, including high mortality , morbidity and prolonged hospital stay. Mechanical ventilation & Hypovolemia were independent risk factors. Higher the stage of AKI mortality increases. Early diagnosis of AKI using new defined criteria (AKIN, RIFLE, pRIFLE) [4,5,6] along with early and appropriate management of risk factors will prevent the progression of AKI and decrease the mortality and morbidity of AKI patients.

Keywords: Acute Kidney Injury; Critically Ill Children; Pediatric Intensive Care Unit; pRIFLE.

 

Background and Aim: Jaundice is the frequent irregular physical finding in the first week of life Jaundice is the noticeable form of hyperbilirubinemia. The present study was performed with an aim to evaluate the predictive value of TSB=6 mg/dl at 24±6 hours of age in identifying infants.

Material and Methods: The present forthcoming study was performed at Department of Pediatrics, at a tertiary care hospital, Bhuj. All fit neonates were to be examining for TSB levels at 24 hours and over again at 5 days. Serum bilirubin was expected for all registered cases within 18 to 30 hour of life spectrophotometrically utilizing twin Beam method. Children after that followed up clinically for the manifestation and development of jaundice every 12 hour till discharge from the department. TSB estimation was repeated if the clinical assessment of jaundice was more than 10 mg/dl by any observer using Kramers Rule.

Results: A total of 199 neonates were originally enrolled. 37 of 199 cases did not follow up. Significant Hyperbilirubinemia was present in 20.9% cases of those babies who developed jaundice. A TSB of <6mg/dl at 24+6 hours was there in 99 infants. In the due 49 cases the TSB at 24+6 hours was >6 mg/dl. 20 cases out of this eventually went on to develop a positive study outcome. Sensitivity of TSB at 24+6 hours >6mg/dl in recognizing those who will have hyperbilirubinemia =90.9%, Specificity was 76.12%, Positive predictive value was 41.6% and Negative predictive value was 97.9%.

Conclusion: The current research establishes that a TSB at 24+6 hours <6mg/dl has a elevated predictive value in recognizing those infants who are doubtful to build up consequent hyperbilirubinemia and these neonates can be released before time from the hospital.

Keywords: Infants; Hyperbilirubinemia; Jaundice; Sensitivity; Specificity.

Context- Perinatal asphyxia and Postasphyxial hypoxic-ischemic encephalopathy (HIE) is a major cause of early neonatal mortality in India accounting for 24.3% of neonatal deaths.

Aim- To study risk factors, clinical, biochemical, Neurosonography parameters and short term outcome of neonates with HIE.

Setting and Design- Study conducted at AVBRH, Sawangi (M) after seeking IEC approval. It was a prospective observational study.

Material and method-All neonates delivered in AVBRH and admitted to NICU with birth asphyxia and HIE were included in the study. A detailed history, examination, HIE staging, cord blood ABG, Neurosonography, other investigations and short term outcome were recorded in prevalidated proforma and data was statistically analyzed using SPSS 22.0.

Results- Incidence of Birth asphyxia was 2.97%, incidence of HIE was 1.76%. Of all neonates with HIE (study group n=50) 26% were in HIE stage I, 54% were in stage II and 20% were in stage III. On umbilical cord ABG 20% neonates had severe acidemia and 80% had moderate acidemia. Neurosonography changes were seen in 4% neonates, mortality rate was 18%. All 9 neonates who died were in HIE stage III.

Conclusion-Birth asphyxia and HIE are still a major cause of neonatal morbidity and mortality. HIE stage III, severe acidemia are associated with high mortality. Preclampsia, oligohydramnios and MSAF are risk factors associated with HIE.

Keywords: Birth Asphyxia; HIE; Incidence; Mortality and Risk Factors.

 

Introduction: The Quality of Life in Children with Chronic diseases is a crucial, yet often neglected part of child’s overall health. Chronic diseases and their treatment present children and their parents with significant chronic stress that lead to emotional and behavioural problems compromising adherence to treatment. WHO defines Quality of life as an individual perception of their position in life in context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns [1].

Method: Cross-Sectional Study conducted in the Department of Paediatrics, JSS Hospital Mysuru from 1-10-2014 to1-8-2016.60 Children aged 7 to 18 years, suffering from chronic disease since at least 3 months were selected at random. Interviewing was done using 2 Questionnairres namely EQ-5DY administered to children and CPMS Questionnairre given to Parents/Gaurdians, after obtaining valid consent from authorities and Parents. Data was entered in Excel and analysed using SPSS Software.

Results: There was no association between the Socio-Demographic factors and Quality of Life or Psychological issues in the children. In the EQ-5DY Questionnaire, the children who had some pain and discomfort also had significant Psychopathology and P Value being 0.03 was significant. 95% of our population had possible Psychopathology indicating that Mental Health is affected in children suffering from various chronic diseases. Children with seizure disorder had problems in daily activities, had some pain and discomfort and all were worried/sad.

Conclusions: All children with chronic disease, irrespective of age, gender and socio-economic class have high risk for impaired Quality of Life and Mental Health problems.

Keywords: Quality of Life; Chronic Diseases; EQ-5D-Y IS A; Childhood Psychopathology Measurement Schedule (CPMS).

Phototherapy is a simple treatment for neonatal hyperbilirubinemia. During phototherapy, the bilirubin in the neonatal body is changed into another form that can be easily excreted in the stool and urine. Phototherapy devices include halogen lamp, fluorescent, light emitting diode light sources. It is important that phototherapy is applied correctly to combat increased bilirubin production. Light in the wavelength range of 450–475 nm (blue) is the most effective because it overlaps the peak absorption spectrum of bilirubin. The effectiveness of phototherapy is dependent upon four major factors: Color of the light, Intensity of the light, Exposed body surface area and Duration of exposure. It is a safe and easily available treatment worldwide and the side effects of phototherapy are discussed.

Keywords: Phototherapy; Hyperbilirubinemia; Neonate; Irradiance.

Context: Malnourished children are at increased risk of many common infections and their complications. In those hospitalized with Severe Acute Malnutrition (SAM), concomitant infections and diarrhoea are frequent complications resulting in adverse outcome. Metabolic acidosis is a consequence of dehydration in diarrhoea, and the diagnosis of dehydration is based on history of fluid loss. Present study carried out to find the predictors of metabolic acidosis among children hospitalized with SAM.

Aims: To study the predictors of metabolic acidosis among children hospitalized
with severe acute malnutrition.

Settings and Design: Department of Paediatrics Shyam Shah Medical College Rewa, Prospective cross sectional study.

Methods and Material: Children between 6-60 months fulfilling the WHO criteria of SAM were enrolled. Variables recorded were sociodemograghic, anthropometry, history, clinical sign and laboratory results. Study population was grouped in children with (case) and without metabolic acidosis as (control). WHO guidelines for management of SAM was used to treat the morbidities.

Statistical analysis used: Data was analyzed by using SPSS 16, variables were initially analyzed in univariate model, and then independently associated factors with metabolic acidosis were identify using logistic regression analysis. A probability of less than 0.05 was considered statistically significant (p<0.05).

Results: Out of total 202 children, 91 (45%) children developed metabolic acidosis, 110 (54%) out of 202  children were presented with either acute watery diarrhoea or vomiting or both; out of which 69 (62%) developed metabolic acidosis and association of fluid loss was significant (p<0.001). Septic shock, watery diarrhoea and vomiting were independently associated with metabolic acidosis in SAM children.

Conclusions: History of fluid loss either in form of loose motion or loose motion with vomiting and septic shock were independently predict metabolic acidosis
in SAM children.

Keywords: Metabolic Acidosis; Severe Acute Malnutrition; Dehydration; Shock.

 

Serious malnutrition is all around us and yet it is not obvious, for it exhibits the Iceberg phenomenon”. By Anthropometric assessment one can detect the sub-clinical malnutrition very easily. Anthropometric measurements obtained in children are usually compared with that of a “reference standard”. In developing countries anthropometry despite its inherent limitations still remains the most practical tool for assessing the nutritional status of the children. Biological, epidemiological and statistical evidence suggests that wasting and stunting represent different processes of malnutrition. Low height-for-age (stunting) is a principal indicator of long term growth impairment caused by malnutrition in the past. The present study aims at comparing the prevalence of malnutrition in WHO Z Score classification and IAP classification. 

Method: About 400 children in the age group of 1-5 years were studied for their Anthropometric indices. The anthropometric measurements were performed using the standard WHO anthropometric measuring tools. Standardized methods were used in all measurements and were compared with standard HARVARD classification of IAP and WHO Z Score classification.

Result: Overall prevalence of malnutrition was found to be 67.5% according to IAP. Among 67.5% malnourished children the prevalence of underweight was more in girls (51.8%) than boys (48.1%). According to WHO classification prevalence of malnutrition was 68.7% of which 27.5% had severe malnutrition. Among 68.7% of underweight children about 25.7% were found to be below -3SD. Among 59.2% of stunted children about 26.5% below -3SD were observed. Among 13.5% of wasted children about 2.6% below -3SD were observed. According to IAP criteria among underweight (67.5%), preschool children, Grade I were 55.9%, Grade II 23.7%, Grade III- 16.2% and Grade IV were 4.07%.

Conclusion: In the current study it was observed that the Z Score system obtained the result with 1.2% precision as compared to that of IAP classification. Thus it can be concluded that Z Score system is more accurate in early diagnosis of malnutrition. 

Keywords: Malnutrition; IAP; Anthropometric; Anemia.

Background: Role of Highly Active Retro Viral Therapy (HAART) in improving the nutritional status and immunity in poorly accessible areas of developing countries has been inadequately documented.This study aims to assess the effect of HAART on weight, height and CD4 counts of Human Immune Deficiency Virus (HIV) infected children and analyze factors associated with the effect.

Methods: Anthropometric measurements and CD4 counts were taken on registration and follow up and duly recorded.

Results: 107 children were studied for one year out of these 63 received ART on the basis of CD4 counts or symptoms. The mean weight improved from 16.67±7.64kg to 19.63±9.15kg in boys and from 18.45±9.77kg to 21.7±10.89kg in girls. The mean height increased from 105.82±21.5cm to 108.75±23.18cm in boys and from 107.7cm to 108.58±24.54cm in girls. The percentage of underweight, stunted and wasted children decreased after the start of HAART from 58.7% to 32.6%, 69.8% to 60.5% and 21.7% to 11.4% respectively. Weight for age and weight for height z scores improved significantly while height for age showed a small increase. No effect on CD4 countswas seen.

Conclusions: HAART has a positive effect on growthin HIV1 infected children irrespective of nutritional supplementation. The change is more significant in severe forms of malnutrition. We strongly recommend viral load estimation for better monitoring and prompt and universal initiation of HAART in children with HIV infection to prevent growth failure.

Keywords: Malnutrition; Children with HIV/AIDS; HAART; CD4 Count.