Pediatric Education and Research

The recommended upper limits for long term vitamin D intake are 1000 IU for children <1 year old and 2000 IU for older children and adults. Vitamin D intoxication can occur with long term high intake or with a substantial acute ingestion. Excess 25 (OH) D causes bone resorption and intestinal absorption of calcium leading to hypercalcemia. Hypercalcemia is defined as a serum calcium concentration that is greater than two standard deviations above the normal mean. Hypercalcemia is generally considered to be mild, moderate, and severe for total serum calcium concentrations <12 mg/dL (3.00 mmol/L), between 12 and 14 mg/dL (3.00 to 3.50 mmol/L), and >14 mg/dL (3.50 mmol/L), respectively. Children with vitamin D intoxication present with symptoms of hypercalcemia, such as poor appetite, weight loss, abdominal pain, vomiting, constipation, polyuria, and polydipsia, and in severe cases, life-threatening dehydration. We report a case of hypercalcemic crisis presenting in emergency department.

Keywords: Hypercalcemia; Intoxication; Vitamin-D.

Dropsy is due to consumption of mustard oil contaminated with argemone oil. It usually occurs in epidemic outbreaks with acute manifestation of bilateral pitting edema, erythema, and local tenderness along with cardiac and respiratory problems in severe cases leading to death. We report an outbreak in a single joint family with major manifestation of bilateral pitting edema, erythema, and local tenderness in seven family members. Reported case was having serious clinical manifestation involving cardiac and respiratory systems. The diagnosis of epidemic dropsy should be strongly suspected if there is repeated clustering of bilateral pedal edema cases within a single family, especially in an area consuming mustard oil.

Keywords: Epidemic dropy; Argemone oil; Bilateral Pedal Edema; Mustard oil.

Jaundice is the yellowish discoloration of the sclera and the skin due to increased bilirubin levels in blood. It is often a normal condition in the neonates, but when the levels of the bilirubin exceed a certain range, it requires intervention because it can have serious neurological sequelae and may even cause death in those who survive. There are some factors which can put the baby at an increased risk of developing hyperbilirubinemia. These risk factors may be maternal or neonatal. Maternal risk factors can include any history of drugs, other comorbid conditions, ABO and Rh incompatibility, ethnicity and others. Neonatal risk factors include gestational age, infections, trauma during birth, etc.

Keywords: Jaundice; Neonatal Hyperbilirubinemia; Bilirubin levels.

Aims and objectives: To identify changes in the specific parameters (anthropometry, hypothermia, hypoglycaemia, sepsis) of neonates receiving ‘KMC”. To identify feeding patterns and sleep pattern in babies receiving KMC. To determine Mother’s perception during KMC. Methods and Material: It is a prospective case study, studying the outcome of Kangaroo Mother Care given to babies (32-40 weeks), weighing 1.5-2 kg born by normal vaginal delivery in Basaveshwar and Sangameshwar Teaching and General Hospital, Gulbarga. Results: Our study group of 150 neonates included males more than females, SGA more than AGA, late preterm more than early preterm and term neonates. Neonates body temperature significantly increased after KMC. A significant increase in respiratory rate, decrease in heart rate and increase in oxygen saturation was seen in neonates receiving KMC in our study. Our study recorded a higher proportion of neonates achieving transition from predominant expressed breast milk consumption (paladai or wati) to predominant direct breastfeeding during hospital kangaroo mother care. Also all infants were on exclusive breast feeding at follow up and on were on regular supplements. Behavioral state of the babies before and during KMC was studied using modified BRASELTON behavioral assessment scale and it found that there was increased deep quiet sleep state (80%) during KMC. The mean crying state was found to be less during KMC(4%). There was significant mean weight gain of 20 gm/day during hospital KMC and during follow up, also babies with KMC had better weekly length increment. Maternal acceptance of KMC was good and concurred with other studies. (85.3%) mothers in our study strongly agreed that KMC provides warmth to the babies. 88% mothers felt that their baby is secure and majority of them felt that baby sleeps better and that it improves the weight of the baby. All the mothers were able to practice KMC at home and no adverse events were reported. The response of the family and/or the father was supportive. Conclusion: KMC promoted an improvement in body temperature, thereby contributing towards improvement of thermal control, decreased heart rate, increased peripheral oxygen saturation, improvement of tissue oxygenation and improved breathing rate, which brought greater respiratory comfort to the newborns. Thus, KMC promoted beneficial physiological changes for low-weight PTNBs and contributed significantly to their physiological control. Kangaroo mother care accelerates growth pattern in LBW babies and reduces hospital stay. By promoting kangaroo mother care, exclusive breast feeding was ensured in LBW babies. Kangaroo mother care had a protective effect on morbidities like hypothermia, sepsis and apnea. It is superior alternativeto conventional method of care in institutions with limited resources.

Keywords: Kangaroo mother care; Anthropometry; Physiological changes.

Objectives: To know the incidence of neonatal complications following premature rupture of membranes more than 12 hours.To study the incidence of early onset sepsis following premature rupture of membranes more than 12 hours. To know the incidence of mortality among neonates born to mothers with PROM more than 12 hours. To know the incidence of neonatal infection in neonates born to mothers with history of PROM more than 12 hours who have not received antibiotics before labour. Methods: Total 185 neonates born to mother’s with PROM of more than 12 hours were evaluated in this study born in Sangameshwar Teaching Hospital and Basaveshwar General and Teaching Hospital attached to M.R. Medical College, Gulbarga. Clinical features like fever, feeding difficulties and respiratory distress were commonly encountered. Laboratory investigations like total count, band count, toxic granules and baby’s blood culture were used for the diagnosis of sepsis. Results: The present prospective study includes 185 cases of neonates born to mothers with PROM of more than 12 hours duration. The incidence of PROM was 4.12%, Respiratory distress syndrome was the most commonest clinical manifestation 35 (18.91%) followed by septicemia 28 cases (15.14%) and pneumonia 3 cases (1.62%). The incidence of septicemia was 15.14%. Most common organisms isolated in blood culture of neonates were Klebsiella in 13 cases (40.6%), Staphylococcus 10 cases (31.3%), E.coli 6 cases (18.8%) and Pseudomonas 3 cases (9.4%). There was strong correlation between maternal genital flora and bacterial isolates of baby’s blood culture. The incidence of neonatal deaths was 1.08% of 15.14% of early onset septicemic neonates. Conclusion: PROM is a high risk Obstetric condition, active management is needed to enable delivery within 18 hours of PROM and it offers better neonatal outcome

Keywords: Premature rupture of membranes; Early onset septicemia; Pneumonia; Respiratory distress syndrome.

Background: Hypocalcemia is a known entity in nephrotic syndrome. Does hypercalciuria contribute to this state, is investigated in our study. Aims: To study the urinary calcium excretion during nephrotic range proteinuria and during remission in nephrotic children. Design & Setting: This observational-cohort study was carried out in a tertiary care hospital in Northern India from July 2015 to June 2016. Material & Methods: Eighty consecutive nephrotic patients (aged 2-14 years) with new onset nephrotic syndrome or relapse were enrolled. Eight patients were lost to follow up and 3 were excluded due to addition of calcium to their treatment. Urinary and blood samples of the patients were sent at initial enrollment, at remission and at completion of alternate day therapy. Urinary calcium to urinary creatinine ratio (UCa/UCr) at onset (of patients with initial episode) or relapse (in known cases of nephrotic syndrome) and during remission was compared. Statistical Analysis: Analysis of variances (ANOVA) was applied for comparison among groups showing normal distribution and Kruskal-Wallis Test was used for parameters having non-Gaussian distribution. Results: No statistically significant difference in the value of UCa/UCr was observed during onset/relapse, after remission and after stopping steroid therapy. Conclusion: Urinary calcium excretion does not statistically vary during nephrotic range proteinuria and after it.

Keywords: Calciuria; Relapse; Remission; UCa/UCr ratio.