Indian Journal of Child Health 2018-07-31T16:11:20+0530 Dr Amit Agrawal Open Journal Systems <p align="justify"><strong>Indian Journal of Child Health (IJCH)</strong> is a monthly, peer-reviewed, international journal, published by <strong>Atharva Scientific Publications,</strong>&nbsp;Bhopal, India. <strong>IJCH</strong> is both online and print, open access journal and it allows free access to its contents and permits authors to self-archive the final accepted version of their articles. The journal publishes articles covering various aspects of child health including basic research and clinical investigations in different fields of pediatrics covering perinatal and neonatal to adolescent age group.</p> Attention-deficit/hyperactivity disorder management: A biopsychosocial model 2018-07-28T16:50:39+0530 Reeba Ann Daniel <p>Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. It represents a complex problem because it appears at an early age, affects the daily lives of children from all areas of development, and is likely to persist throughout the life. The main management interventions in ADHD include pharmacotherapy, behavioral management, and family therapy which vary in their precedence according to age of the child and degree of impairment in the child. The biopsychosocial model tries to elucidate the interactions between biological, psychological, and social factors which determine the cause, manifestation, and outcome of any disease. In this article, we discuss how the biopsychosocial model of disease can be applied to ADHD to explain the symptoms as well as how it can help in planning of management at individual level.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Iron status among under-five children with first febrile convulsion and subsequent febrile convulsion 2018-07-28T16:54:52+0530 Rekha Krishnan Geetha S Elizabeth K E Anisha A N <p><strong>Objective:</strong> The objective of this study is to estimate the iron status using hemoglobin (Hb), red cell indices, serum iron, plasma ferritin, total iron binding capacity (TIBC), and transferrin saturation (TSAT) in children with first febrile convulsion (FFC) and subsequent FC (SFC). <strong>Methods:</strong> The study was conducted in a tertiary care teaching hospital among children aged 6 months–5 years with first and subsequent episodes of the simple FC taking cases and controls in a ratio of 2:2:1. Consecutive cases and concurrent controls were selected for the study. Controls were children of the same age group with short febrile illness but without any seizures. After informed consent from parents, detailed history was taken; clinical examination and blood investigations were done to estimate iron status in both cases and controls. Laboratory tests included Hb, hematocrit( Hct), red cell indices, peripheral smear, red cell distribution width (RDW), serum iron concentration, plasma ferritin, TIBC, and TSAT. The data were then analyzed statistically using SPSS software. <strong>Results:</strong> 44 cases with FFC, 44 with SFC, and 22 controls were included in the study. The mean Hb, Hct, red cell indices, and RDW between the three groups did not show any significant difference. The mean serum ferritin was significantly lower in the SFC group compared to the control group (p=0.005). The mean serum TIBC was significantly higher in the SFC group compared to the control group (p=0.004) and also the SFC group compared to the FFC group (p=0.022). <strong>Conclusions:</strong> Poor iron status in subsequent febrile seizures indicates that iron deficiency is associated with subsequent seizures. Hence, screening for iron status rather than Hb level estimation should be considered for children presenting with or at high risk for febrile seizures.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Awareness and impact of educational intervention regarding kangaroo mother care among pediatricians of Marathwada region of Maharashtra 2018-07-28T16:57:03+0530 Manish Tiwari Harshal N Pise <p><strong>Objective:</strong> The objective of the study was to compare knowledge and attitudes toward kangaroo mother care (KMC) among pediatric practitioners in Marathwada region before and after a workshop on KMC. <strong>Material and Methods:</strong> A prospective comparative study was conducted among 40 pediatricians practising in the rural area of Marathwada region. Clinicians having at least Level 2 neonatal intensive care unit setup at their place were enrolled in the study. Every pediatrician satisfying the selection criteria and willing to participate was enrolled in the study. They were given a questionnaire, consisting 25 questions, which were supposed to be answered at the time of enrolment, i.e., pre-test. After that, the participant was given a short booklet on KMC to read, and then after a gap of 7 days, the participant attended a workshop on KMC for 4 h, in which details regarding KMC, advantages of KMC, and videos showing actual practice of KMC were shown to participants. After completion of workshop, participants were given the same questionnaire and pre- and post-test scores were calculated. <strong>Results:</strong> The mean score in basic knowledge was 20 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## A study to assess the factors associated with developmental delay and nutritional status among the children with cleft lip and/or cleft palate 2018-07-28T17:10:53+0530 Abhilasha Sampagar Bhavana Lakhkar Tanvi Bafna Niranjana S Mahantashetti <p><strong>Background:</strong> Cleft lip with or without cleft palate is one of the most common congenital anomalies. Development is often affected in these children. It may be due to other associated defects, syndromic status, or malnutrition. <strong>Objective:</strong> The objective of this study was to assess the factors associated with developmental delay and nutritional status among the children with cleft lip and/or cleft palate. <strong>Materials and Methods:</strong> A cross-sectional study was conducted at the Department of Pediatrics of a Medical College in Sawangi (Meghe), Wardha, for 2 years from August 2010 to March 2012. All children below 15 years with cleft lip and/or palate admitted in the pediatric ward, the neonatal intensive care unit, or postnatal ward were included in the study. A total of 200 children were included in the study and were analyzed for developmental delay and growth lag. <strong>Results:</strong> Cleft clip was seen in 51 (25.5%) of the children, 25 (12.5%) had cleft palate, and 124 (62%) had both cleft lip and palate. Developmental delay was more common in cleft palate category; however, it was not statistically significant (χ2=0.90, p=0.34). Unilateral form of defects had more number of delays as compared to bilateral defects, and it was statistically significant (χ2=7.32, p=0.006). Delay was more common when both the defects were present together as compared to isolated defects; however, it was not statistically significant. Gross motor and language delay were the most common type followed by global and personal social. 12.5% of children were syndromic. Most of the syndromic children (64%) had global developmental delay (χ2=7.84, significant). 69.6% of children below the age group of 5 years were malnourished (χ2=16, significant). Faulty feeding (73.5%), recurrent respiratory infections (21.4%), and repeated hospitalization (17.1%) were the statistically significant factors for poor growth. <strong>Conclusion:</strong> Global developmental delay was more common in syndromic children. Overall, delay was more commonly seen in children with unilateral defect. Factors, which contributed to growth lag, were faulty feeding, recurrent respiratory infections, and repeated hospitalization.</p> 2018-07-25T00:00:00+0530 ##submission.copyrightStatement## Role of oral erythromycin for feed intolerance in neonates - A randomized controlled trial 2018-07-28T17:12:28+0530 Chandrakala Bada Shekharappa Swarnarekha Bhat Ashok Chandrasekaran <p><strong>Objective:</strong> The objective of this study was to compare the effect of high and low dose of erythromycin with placebo and to determine the efficacy and safety of oral erythromycin for feed intolerance in neonates admitted to the neonatal intensive care unit. <strong>Methodology:</strong> The study was a double-blind, randomized, and placebo-controlled trial. Term and preterm babies having feed intolerance were included in the study, and babies with congenital malformations, necrotizing enterocolitis, and sepsis were excluded from the study. After parental consent, the subjects were randomized into Groups 1, 2, or 3 to receive low-dose (3 mg/kg/dose) or high-dose (10 mg/kg/dose) oral erythromycin estolate or the placebo (equal volume of 5% dextrose). Feeding of all the study neonates was managed as per the unit protocol and babies were monitored for the complications. The primary outcome was the time to reach full feeds of 150 ml/kg/day, without significant gastric residuals. <strong>Results:</strong> Of 58 eligible babies, 84.5% were preterm babies. The median time for reaching full feeds with placebo was 6 days with interquartile range 3 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Prognostic value of hyponatremia in critically ill children admitted to the pediatric intensive care unit 2018-07-28T17:13:55+0530 Arpana Hanchinmani Dnyanesh Duryodhan Kamble Vishwanath Dundappa Patil <p><strong>Background:</strong> Hyponatremia is the most common electrolyte disturbance in critically ill children. Although hyponatremia in hospitalized children is associated with adverse outcomes, the risk can be reduced by early diagnosis and intervention. <strong>Objective:</strong> The objective of this study is to identify the outcome of hyponatremia in critically ill children seeking emergency care in the pediatric intensive care unit (PICU). <strong>Methods:</strong> Demographic data, detailed history, systemic examinations, and routine blood and urine investigations were conducted if required for 100 critically ill children aged 1 month 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## A study on neonatal hyperbilirubinemia due to ABO incompatibility in sick newborn care unit, Telangana 2018-07-28T17:15:22+0530 Snehalatha Gopu Ayesha Begum <p><strong>Background:</strong> Hyperbilirubinemia is one of the most common clinical signs encountered in neonates which if untreated is potentially neurotoxic. The neonates at higher risk of jaundice should be identified at birth and kept under enhanced surveillance for occurrence and progression of jaundice and promptly intervened. <strong>Aim:</strong> This study aims to study and analyze the neonatal hyperbilirubinemia in the babies born to O positive mother. <strong>Subjects and Methods:</strong> A prospective observational cohort study of healthy term neonates born to O positive mothers with clinical jaundice was conducted in a sick newborn care unit (SNCU) attached to a tertiary level government maternity hospital. SPSS version 19 was used for statistical analysis. Descriptive statistics such as mean, median, standard deviation, and Chi-square test were calculated. p&lt;0.05 was taken as statistically significant. <strong>Results:</strong> A total of 100 babies, born to O positive mothers brought to SNCU with clinical jaundice of &lt;120 h of age, were studied. 72 babies had ABO incompatibility, of which 52 (72%) babies required phototherapy and 1 (1.3%) required exchange transfusion. There was no significant difference in the severity and outcome in both O-A and O-B incompatibility, although O-B incompatibility was more (65%).<strong> Conclusion:</strong> Blood group of mother should always be noted and babies born to O positive mothers must be followed for early identification and prompt intervention.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Clinical and laboratory profile of children admitted with measles in a tertiary care teaching hospital 2018-07-28T17:17:25+0530 Leela Kumari P Ranjith Kumar T <p><strong>Background:</strong> Measles is a vaccine-preventable viral illness associated with substantial childhood morbidity and mortality. Recently, changing trends in the occurrence of measles are noted like incidence in younger infants and in those who have received measles vaccine.<strong> Objectives:</strong> The objective was to study the clinical profile of children with measles and to study the usefulness of polymerase chain reaction (PCR) in diagnosing measles and to study the measles-specific immunoglobulin M (IgM) response in children with measles. <strong>Materials and Methods:</strong> This study was done in the Pediatrics Department of a Tertiary Care Center, and the study population was children up to 12 years of age admitted in the setting with a clinical diagnosis of measles during the study period and who were laboratory confirmed by PCR/IgM ELISA or both. <strong>Results:</strong> Of 173 clinically diagnosed cases, 149 laboratory confirmed cases were taken for analysis and studied. Of these, 47% of cases were below 9 months. Newborns constituted 2.01% of the total cases. The mean age was 13 months and the male:female ratio was 1.13:1. A total of 24.8% children were unimmunized, 16.77% had a single dose, and 8.72% had 2 doses of measles vaccine. Overall mortality was 0.67% and bronchopneumonia was the major complication (76.5%). Among immunized children with measles confirmed by PCR, measles-specific IgM response was reactive in 36.4% of cases. In the early phase of measles (within 3 days) confirmed by PCR, IgM response was inconclusive in 60% of cases. <strong>Conclusion:</strong> In our study, 47% of the cases of measles were below 9 months; therefore, the age of measles vaccination may be reconsidered. Among eligible cases (&gt;9 months), 24.83% were not immunized for measles which indicates that measles immunization coverage should be increased. Among the measles cases, 25% had measles vaccination which highlights the need to check for the determinants of vaccine failure. In our study, the RT-PCR was found to be useful for early diagnosis of measles and for diagnosis in immunized children.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Neonatal sepsis: Risk factors, clinical and bacteriological profile, and antibiotic sensitivity 2018-07-31T16:11:20+0530 Anitha B Sethi Vedavyasa Srigade Guntur Dharmateja <p><strong>Background:</strong> Neonatal sepsis (NS) is a cause of very high morbidity and mortality. Reviews of bacterial spectrum and antimicrobial susceptibility help to treat NS and to develop strategies to lower neonatal mortality. <strong>Objectives:</strong> The objectives were to study organisms causing NS, their antimicrobial susceptibility pattern, predisposing factors of NS, and the presentations of NS. <strong>Methods:</strong> This prospective study was done for 1 year from August 2016 to July 2017 at a tertiary care hospital, Hyderabad with C-reactive protein (CRP), aerobic blood cultures, and sensitivities in 300 neonates with clinical sepsis. Risk factors for NS and clinical features were recorded. Significances for sex, gestational age, birth weight, and age of onset of sepsis differences were assessed. <strong>Results:</strong> Male to female ratio was 1.65:1, 39% were preterm, 40% were &lt;2500 g in weight, and 54% had sepsis in &lt;72 h (early onset sepsis - EOS) (p&lt;0.05). Prolonged labor and rupture of membranes, maternal fever within 2 weeks, foul-smelling liquor, birth asphyxia, and iatrogenic factors were the risk factors in decreasing order of frequency. Refusal to feed was the most common presentation. CRP showed good sensitivity and negative predictive value while 117 (39%) cases were blood culture positive. Organisms in decreasing order of frequency were Klebsiella pneumoniae, coagulase-negative staphylococci, enterococcus, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter, Escherichia coli, and Group-B streptococci. Gram-negative isolates (44%) were sensitive to meropenem, amikacin, and piperacillin-tazobactam while Gram-positive isolates (56%) were sensitive to vancomycin and netilmicin and both were least sensitive to cefotaxime and ampicillin. <strong>Conclusion:</strong> Obstetric and neonatal care practices around birth need to be reviewed as EOS proportion in India is very high. Most of the isolates were resistant to cefotaxime and ampicillin, underscoring the need for the addition of penicillinase inhibitors. Timely review of antibiotics is necessary in view of widespread resistance. Focus on prevention of NS and the improvement of health systems to effectively manage it is very much needed in India.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Unwanted penile engorgement in pediatric patients under anesthesia: The role of anesthetic technique and other contributing factors 2018-07-28T17:22:34+0530 Muazzam Hasan Abu Nadeem Nadeem Raza Syed Moied Ahmed <p><strong>Background:</strong> The mechanism behind intraoperative penile engorgement (PE) is complex. One common myth is that PE occurs more frequently during spinal anesthesia than the general anesthesia. <strong>Objective:</strong> The objective of this study was to report the incidence and management of intraoperative PE in pediatric patients undergoing urogenital operations under spinal anesthesia with or without sedation over a period of 1 year. <strong>Methods:</strong> Patients aged between 2 and 12 years, posted for elective urogenital surgery of expected duration &lt;1 h, were given spinal anesthesia with or without supplemental sedation as per child’s cooperation. Incidence of unwanted intraoperative PE, time of onset of the SA, length of surgery, attempts of successful lumbar puncture, need for supplemental systemic sedation, conversion to general anesthesia, and perioperative complications were recorded. <strong>Results:</strong> A total of 348 patients were included in the study. Only two (0.005%) cases developed PE intraoperatively. 225 (64.6%) children required systemic sedation along with spinal blockade. 123 (35.3%) cases were successfully operated under spinal alone without any sedation. None of the cases required conversion into general anesthesia. The mean time of onset of spinal blockade was 100±54 s. First attempt success rate of lumbar puncture was 83% while 16.9% of patients required the second attempt. There were no major complications in any child in the perioperative period. <strong>Conclusion:</strong> Spinal anesthesia is associated with very less incidence of PE and can be practiced safely in the pediatric patients. Just the fear of development of PE should not bias the choice of an esthetic technique toward general anesthesia.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Burden of late-preterm infant at a tertiary care neonatal intensive care unit - A prospective observational study 2018-07-28T17:24:28+0530 Saikiran Deshabhotla Aafaque Hussain Baswaraj Tandur <p><strong>Background:</strong> Infants born at 340⁄7 through 366⁄7 weeks’ gestation are called as “late-preterm” infants. Even though physically resembling infants born at term gestation (370⁄7–416⁄7 weeks) they are developmentally immature and are at higher risk of morbidity and mortality. <strong>Objective:</strong> The objective of the study was to study the etiology and burden of late-preterm infant (340/7–366/7 weeks) birth. <strong>Material and Methods:</strong> This prospective observational study was conducted over 11 months in a tertiary care Level III neonatal intensive care unit in an urban city of India to elucidate the burden and etiology of late-preterm infant birth. <strong>Results:</strong> In our study, 17.5% (160, n=916) of total admissions were late-preterm infants. The most common underlying cause of late-preterm infant birth in this cohort was a previous lower segment caesarian section (LSCS) 27.5% (44, n=160) and pregnancy-induced hypertension 25% (40, n=160) followed by preterm labor 15.6% (25, n=160). Median gestation was 35 weeks with IQR (34–36 weeks). The median birth weight was 2100 grams with IQR (1900–2400 g). <strong>Conclusion:</strong> Late-preterm infants account for a significant proportion of preterm births and major burden on the neonatal intensive care workload. The most common reason of late-preterm births was an elective LSCS, done due to an earlier LSCS delivery.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Congenital syphilis: How long do we have to deal? 2018-07-28T17:27:44+0530 Vivek Gupta Gitanjali Jain Rakesh Gupta <p>Congenital syphilis is a preventable disease and its presence reflects a failure of prenatal care delivery system, as well as syphilis control programs. Adequate antenatal screening is a boon to prevent cases of congenital syphilis. There have been sporadic case reports of congenital syphilis in our country, but the exact disease burden is not very clear. We present a neonate born to a mother, who was venereal disease research laboratory (VDRL) reactive and treated before delivery. This neonate was asymptomatic after birth, but serum VDRL was reactive with a 4-fold rise in titer and cerebrospinal fluid (CSF) VDRL was also reactive. Treponema pallidum hemagglutination assay was detected for both the mother and baby. Neonate was treated with intravenous sodium benzylpenicillin G for 10 days. During follow-up, the patient was asymptomatic and CSF and serum VDRL were non-reactive after 6 months.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Second malignant neoplasm in a treated Ewing sarcoma patient: A case report 2018-07-28T17:31:36+0530 Kakoti Lopa Mudra Choudhury Zachariya Sharma Jagannath <p>Ewing sarcoma (ES) is an aggressive tumor commonly seen in children and young adults. Late effects of ES therapy include the second cancers, a tragic outcome for survivors of such young age. We report a case of a 3-year-old male child who presented with a right maxillary mass extending to the orbit. Fine-needle aspiration cytology and tru-cut biopsy showed features suggestive of a small round cell tumor. Immunohistochemistry confirmed the diagnosis of ES/primitive neuroectodermal tumor. The patient was started on non-metastatic Ewing family tumor protocol with intensity-modulated radiotherapy and responded well to therapy. He was followed up regularly, but after 5 months of initial diagnosis, his peripheral blood smear showed atypical cells resembling blasts. His bone marrow aspiration (BMA) and biopsy showed marrow infiltrated by hematolymphoid malignancy. Based on the positivity of the blasts for myeloperoxidase and non-specific enolase in cytochemistry on the BMA and flow cytometric analysis, a diagnosis of acute myeloid leukemia with monocytoid differentiation was made. We report this case to emphasize the role of the pathologist in differentiating the second malignancies from recurrence of the first malignancy or therapy-related changes, especially in the case of an equivocal morphological picture.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Atypical skin manifestations of dengue fever 2018-07-28T17:34:23+0530 Dhanya Soodhana Mohan Kuldeep Singh Yogesh N Parikh <p>Dengue fever is a severe flu-like illness that affects infants, children, adolescents, and adults and can have a wide variety of manifestations. Dengue fever can have varied skin manifestations including petechiae, purpura, and bleeding. We report the case of a child who presented with atypical skin manifestations to us and which was confused to be staphylococcal scalded skin syndrome initially. The manifestations later turned out to be the skin manifestations of dengue fever, and the child got better with fluid resuscitation, skin care, and supportive management. This case report draws light toward the various other dermatological manifestations of dengue fever.</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement## Physical health perspective and mental subnormality of a child with Hunter 2018-07-28T17:37:11+0530 Gowhar Iqbal Wani Ayesha Imran Vyas Rathore Anumodan Gupta <p>Hunter</p> 2018-08-17T05:37:02+0530 ##submission.copyrightStatement##