bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinical study of retinopathy of prematurity in neonates in a tertiary care hospital
Authors: V. Srinivasa , Yadav Vijay , G. V. Kumar
Published: February 2019

Background: Retinopathy of prematurity (ROP) is a disease process mostly reported in preterm neonates with a wide spectrum, ranging from mild, transient changes in the retina with regression to severe progressive vasoproliferation, scarring, detachment of retina and blindness. India shares 20% of the world childhood blindness. Besides congenital cataract, congenital glaucoma and ocular injuries, ROP is emerging as one of the important causes of childhood blindness in India.Methods: A cross sectional study was undertaken among all neonates born between 28-34 weeks of gestation admitted in NICU, who are under oxygen, screened for ROP. Babies with ocular disorder which interfere with fundus examination, babies who did not complete follow up till complete vascularisation of retina and babies with congenital retinal abnormalities were excluded from the study.Results: About 13.3% of male children and 18.0% of the female children had retinopathy of prematurity. Among the infants born before 30 weeks, 46.7% had retinopathy of prematurity. In the children with gestational age between 30- 32 weeks, 15.4%, 8.5% in the 32-35 weeks and none among those born between more than 35 weeks. About 27.9% of the newborns with birth weight of less than 1.5kgs and 5.8% of those who had birth weight of 1.5-2.5kgs had retinopathy of prematurity.Conclusions: This study had shown a significant association of retinopathy of prematurity with the low gestational age, birth weight and oxygen therapy. Reducing subsequent post-natal risk factors depends on optimal perinatal and postnatal care, as well as adhering to strict ROP screening guidelines. Recognizing and treating ROP in a timely fashion is critical for achieving the best visual outcome.
A study on prevalence of minor physical anomalies in mentally retarded children in a tertiary care centre of India
Authors: Konar Mithun C. , Karmakar Kushal , Islam Kamirul , Nayek Kaustav , Sil Archan
Published: February 2019

Background: Paucity of studies in world literature and lack of any Indian study assessing the frequency, prevalence and severity of minor physical anomalies (MPAs) in children with mental retardation (MR) as well as their importance for prediction and timely recognition of mental insufficiency, if any.Methods: A cross-sectional observational study involving 273 mentally retarded children aged 5-18 years was conducted over a period of one year and were compared with their age and sex matched controls. Waldrop and Halverson (1971) physical anomaly scale was used to assess those MPAs.Results: In the study group, higher percentage (79.85% vs. 40.29%) of children had MPAs with a predominance of multiple MPAs in comparison to healthy children (40.29% and 0%, respectively). Higher average frequency of MPAs per child was noted in the study group (1.42) than control group (0.40). Mean Waldrop weighting score was significantly higher among mentally retarded children than their controls (3.7±0.8 versus 0.8±0.2, P<0.0001). Authors noticed a gradual and significant decrease in Waldrop score with increase in intelligence quotient (IQ) [F=175.72, P<0.001]. A significant strong negative correlation between Waldrop score and IQ level (r=-0.89, P<0.001) was also observed. Out of eighteen variables of Waldrop score, seven were found as significant in binary logistic regression model for MR. Our model can explain 37.6% to 50.1% variability of the MR.Conclusions: MPAs are more prevalent in mentally retarded children than healthy children.  A clear-cut demarcation between these two groups is possible by the frequency of anomalies and the increased strength of their expression (i.e. their weighting scores).
Clinical profile and outcome of respiratory distress in newborns admitted in rural tertiary health care centre of Maharashtra, India
Authors: Kshirsagar Vinayak Y. , Kshirsagar Ashok Y. , Mohite Rajsinh V.
Published: February 2019

Background: Respiratory distress is most common symptom complexes seen in newborn infants lead to high mortality. The objectives were to study various etiological factors, maternal and neonatal risk factors for development of respiratory distress along with need for CPAP, mechanical ventilation and surfactant to assess the immediate clinical outcome in newborns.Methods: The study was conducted at Krishna Hospital and Medical Research Centre, Karad in period of January to August 2018. A total of 100 neonates who were admitted in NICU within 72 hours of life were studied by clinical examination and relevant investigations. The severity of distress was assessed by Silverman-Anderson scoring, Downe’s scoring and APGAR scoring respectively for neonates.Results: It was observed that max, 90% of the distress cases were of respiratory in origin and high severity of distress was observed among 27% newborns. The proportion of respiratory distress was higher, 51% in males and low APGAR score was reported in 14% cases. Among respiratory etiology of respiratory distress, high proportion was of TTNB 35.55%. The maternal and new born factors like maternal age >30 years (32%), gestational age 28-30 weeks (87.5%), gravid 2 and 3 mothers (35%), female gender (32.6%), low birth weight (70%) developed severe distress respectively. The recovery rate of respiratory distress due to respiratory etiology was of 88.8%.Conclusions: Transient tachypnoea of new-born is the most common cause among new-borns with respiratory distress. New-borns with low gestational age, low birth weight baby, low APGAR score is more prone to develop severe respiratory distress.
Clinical profile of dehydration fever in neonates in a tertiary care hospital
Authors: Hassan Muhammad , E. Adarsh , K. V. Rajanish
Published: February 2019

Background: The aim of this study was to determine the clinical profile of neonates admitted with dehydration fever and ascertain the maternal and neonatal factors affecting it.Methods: A observational descriptive study was conducted at Rajarajeswari Medical College and hospital, population included neonates who were admitted in NICU with dehydration fever.Results: The study were conducted among 50 neonates admitted with dehydration fever. Majority of neonates (72%) were diagnosed with dehydration fever on day 3 of life. 84 % neonates were born to primiparous mothers. In the study there was significant difference in mean birth weight, weight at admission and percentage of weight loss between birth weight and weight at admission with respect to symptoms on presentation. Mean % of weight loss was 12.06 when dehydration fever was presented with fever, 11.29 when dehydration fever presented with decreased urine output, 18.44 when presented with both fever and decreased urine output and 12.73 when presented with jaundice these values were statistically significant.Conclusions: Dehydration fever occurs most commonly on day 3 or after, effective measures should be initiated for early diagnosis and prevention of complications like effective breast-feeding counselling, proper techniques, good latching and supplementation of artificial feeds if required and monitoring of daily weight and daily urine output.
Niemann-Pick disease type C-presenting as persistent neonatal jaundice: a rare case report
Authors: Narayana Jinka L. , Rafi Shaik M. , Ramisetti Uma M. , Tumati Kedarnath R. , Belavadi Gangadhar B.
Published: February 2019

Neimann-Pick disease (NPD) is an autosomal recessive lysosomal storage disorder caused by inherited deficiency of acid sphingomyelinase enzyme or its transport which leads to deposition of sphingomylin and cholesterol in the lysosomes of reticuloendothelial system. It is characterized by failure to thrive, hepatospleenomeagaly and neurodegenerative changes. There are four subgroups of neimann pick disease, type A, B, C and D. Here authors are reporting a case of 5 months old female child presenting with persistent jaundice since neonatal period, progressive abdominal distention and failure to thrive. On examination patient had significant abdominal distension with moderate hepatosplenomegaly. On laboratory evaluation child diagnosed to have NPD type C. This case emphasizes the need to keep NPD in differential diagnosis of children presenting with persistent neonatal jaundice, hepatosplenomegaly, failure to thrive.
A study of zinc level in cord blood of neonates and its relationship with antropometric measurements in the neonates: a descriptive cross-sectional study
Authors: Mohamed Syed , Kumar Santosh , Kumutha J.
Published: February 2019

Background: During pregnancy, fast growth and cell differentiation takes place in both mother and foetus. Maternal nutritional factors play an important role in the growth of the neonate. Among the micronutrient zinc is an important micronutrient whose deficiency is associated with poor pregnancy outcomes. The objective the current study was to evaluate the relationship of serum zinc concentration of the maternal blood and the neonatal cord blood with that of the infant’s anthropometric measurements.Methods: A descriptive cross-sectional study was performed under the Department of Neonatology, Saveetha medical college. Duration of the study was from April 2017 to June 2018. The study included 82 singleton mother baby dyads born in Saveetha medical college. Anthropometric measurements such as birth weight, head circumference, neonate length apart from other clinical features of both the mother and neonates were recorded for statistical analysis. Serum zinc levels were estimated using 2-(5-bromo-2-pyridylazo)-5-(N-Propyl-N-sulfopropylamino)-phenol (5-Br-PAPS) protocol.Results: The mean maternal age of the study population is 25.3±2.3 years. Majority of the mother had natural mode of delivery (57%). The mean cord serum zinc level was found to be 94.0±1.6microgram /dl and the mother’s serum zinc level was 93.8±30.7microgram /dl (range from 49 to 171microgram /dl) which was not found to be statistically significant. Serum zinc levels of the cord was compared with the child anthropometrics and mother’s serum zinc levels to assess for the significance, but there was no correlation observed between the umbilical cord, and the birth weight (r=0.03), length of the child (r=-0.02), head circumference (r=-0.07) and mothers serum zinc levels (r=-0.002).Conclusions: According to our results authors were unable to establish a relationship between Neonates growth parameters and zinc levels in neonates cord blood and zinc levels in the mother. Further studies with a larger sample size and prospective design would establish a causal relationship between zinc and growth parameters in the neonate.
Antibiotic resistance pattern of Staphylococcus aureus infections in children
Authors: Kumar K. Senthil , Kumar C. Ajith Brabhu
Published: February 2019

Background: Methicillin resistant Staphylococcus aureus (MRSA) is endemic in India and is a dangerous pathogen for hospital acquired infections. Analysing antibiotic susceptibility pattern of Staphylococcus helps us to overcome the therapeutic difficulties created by the rising anti-microbial resistant bacteria and guide us in choosing appropriate antibiotics. Hence, this study was conducted.Methods: Children with confirmed S. aureus infection between the age group of 0-12 years were classified into MSSA and MRSA subgroups. Isolates were identified as S. aureus using standard microbiological methodologies at diagnostic bacteriology laboratory, in the Microbiology department. Basic demographic variables and antibiotic resistance patterns were compared between MRSA and MSSA subgroups.Results: Majority of S. aureus were isolated from pus followed by blood culture. Prevalence of community acquired MRSA in present study (80%, with 95% CI from 68.56% to 91.44%) was significantly higher when compared to another studies (p value=0.004). Resistance to gentamicin and ciprofloxacin among the MRSA isolates was more than that in methicillin sensitive S. aureus (MSSA) (P<0.001).Conclusions: It is prudent to include MRSA coverage in empirical antibiotic regimens in settings where a significant proportion of patients hospitalized for S. aureus infection have MRSA.
Intermittent clobazam prophylaxis in simple febrile convulsions: a randomised controlled trial
Authors: Kumar Vinod , Gupta Ashish
Published: February 2019

Background: Febrile seizure (FS) is the most common type of childhood seizure disorder with a prevalence of 2-5% in children less than 5 years. Although the prognosis of febrile seizure is usually good, however, the possibility of recurrence keeps many parents and families in a state of anxiety and concerned, for years after the first seizure. Thus, intermittent prophylactic treatment might be advised in children with high risk of recurrence.Methods: The study was a prospective randomized, double blind, placebo-controlled trial conducted at Department of Pediatrics, Umaid Hospital, Dr S N Medical College, Jodhpur on neurologically normal children aged from 6 months to 5 years with a history of simple febrile seizures and normal electroencephalogram without any evidence of acute central nervous system infection. Subjects were randomly prescribed oral clobazam according to weight of child and placebo when they developed a febrile disease during the first 48 h of the onset of fever.  Temperature reduction measures with paracetamol and tepid sponging were also advised. Patients were followed up for the frequency and time of febrile seizure recurrence, febrile episodes and side effects of drugs for 12 months.Results: Ten (3.8%) of 257 episodes in clobazam group and 38 (14.07%) episodes in placebo group had seizure recurrence (p value <0.001). The two groups were not significantly different in terms of side effects. (p >0.05).Conclusions: Intermittent oral clobazam therapy is a very effective measure in preventing recurrence of febrile seizures.
Outcome of pre-term babies born in tertiary care institute
Authors: M. V. Nagaraj , P. Saravanan
Published: February 2019

Background: Preterm babies’ survival has improved with advances in neonatology care in this era. Even with advances in treatments, there is still morbidity and mortality among preterm. The objective of this study was to know the incidence of prematurity and complications seen in them.Methods: A cross sectional study was conducted on all preterm babies born in Sapthagiri Institute of Medical Sciences, Bangalore, over period of one year from 1st August 2017 to July 2018.Results: Out of 500 babies born, 110 babies had RDS, among 110 babies 85 cases were preterm RDS babies included in study. Majority were males 55 (64.5%) and females 30 (35.2%). The gestational age group was maximum in the 28-32weeks,the most common morbidity noted was sepsis (77.7%) and RDS (22%). Death was 9(10.5%) only 4(4.7%) needed intervention in the form of CPAP.Conclusions: The study concluded that males were commonly affected by respiratory distress syndrome, sepsis was a common cause for morbidity and mortality. Inspite of advances in neonatology sepsis continues to be a leading cause of death. Proper hand cleansing has to be emphasized and reinforced to prevent sepsis in NICU. The best possible attempts to delay preterm delivery have to be followed. One should have a high index of suspicion and low threshold to treat sepsis in preterm.
Levetiracetam versus phenytoin for treatment of convulsive status epilepticus in pediatric population: a randomized controlled trial
Authors: Sharma Pooja , Mandot Sanjay , Bamnawat Subhash
Published: February 2019

Background: Status epilepticus is a major medical and neurological emergency. Despite advances in treatment, it is still associated with significant morbidity and mortality. The objective of the study was to compare the efficacy of levetiracetam versus phenytoin in treatment of convulsive status epilepticus.Methods: A Randomized control trial, was conducted at tertiary care hospital, Udaipur, Rajasthan, over a period of March 2017 to September 2018. Total 250 patients (age group 6 months to 18 years) who were presented with status epilepticus in PICU, were enrolled. These patients were divided into two groups by simple randomization. Levetiracetam was given to one group, while phenytoin was given to another group. Efficacy was decided by cessation of clinical seizure activity within 30 minutes of starting of drug infusion and patient was observed for recurrence of seizure within 24 hours.Results: A total of 250 patients were enrolled in this study. Seizure terminated in 107 patients in phenytoin group (85.6%) and in 114 patients in levetiracetam group (91.2%). The difference was significant. Recurrence of seizure (with in 24 hour) was high in phenytoin group (14.4%) in comparison with levetiracetam group (8.8%). Most common adverse effect in both the groups on treatment was hypotension, though in phenytoin group it was significantly higher than patients on levetiracetam group (7.2% v/v 2.4%).Conclusions: Levetiracetam may be an effective alternative to phenytoin as a second line drug in the management of benzodiazepine resistant convulsive status epilepticus in children.
Prevalence of attention deficit hyperactivity disorder, gender difference and its co morbidity among urban school children in a city of southern Rajasthan, India
Authors: Bhardwaj Anubhuti , Mandot Sanjay , Jain Hemant
Published: February 2019

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed disorders of childhood (3-5%). The main characteristics of attention deficit hyperactivity disorder are inattention, hyperactivity, and impulsivity.  The Objective of this study was to study prevalence of ADHD in school aged children.Methods: A cross sectional descriptive school-based study was conducted in a private school of Udaipur from January 2017 to September 2018.  All eligible students were included. Total 1200 students were enrolled. They were assessed for the presence of ADHD using INCLEN diagnostic tool and those found positive were further assessed for the presence of co-morbid conditions using child behavior checklist (CBCL).Results: In present study out of total 1200 students 730(60.83%) were male and 470(39.17%) were female. 76 (6.3%) students out of 1200 were ADHD Positive. ADHD was more common in male students (73.7%), urban locality (57.89%), in age group 6 to 9 years (44.7%) and higher economic class (46.1%). Hyperactivity-Impulsivity type was most common type (51.32%). Male students had predominance of hyperactivity (60.7%) whereas in female student’s inattention type was predominant (45%). Aggressive Behavior (19.6%) and rule breaking behavior (80.4%) was more common in male. Somatic complaints were more common in females (60%). Oppositional defiant disorder was observed in male (21.4%) and female (10%) students. 15.8% of ADHD students had learning disorder.Conclusions: Present study shows 6.3% prevalence of ADHD. Hyperactivity type of ADHD was more common in boys, while Inattention type was more common in girls. Among associated co morbid conditions - aggressive behavior, rule breaking behavior and oppositional defiant disorder (ODD) was found to be more prevalent in boys while anxious behavior, somatic complaints and social problems were more commonly found in girls. Thought problems, learning disorders and conduct disorders are also observed in ADHD students.
A study on clinical profile and outcome of patients in PICU (paediatric intensive care unit) at tertiary care unit
Authors: Jyothi K. Aruna , Ankireddy Korisipati
Published: February 2019

Background: This study was carried out with the objectives to study the clinical profile and to find the outcome of children admitted to pediatric intensive care unit (PICU) of Kurnool medical college and hospital, Andhra Pradesh.Methods: A retrospective study was carried in children aged more than 28 days to 12 years admitted in PICU from 1st January 2016 to 31st December 2016 when a total of 600 patients were admitted.Results: Out of these, 400 (66.66%) cases were males and 200 (33.33%) cases were females. Maximum numbers of patients were in the age group of more than 28 days to 1 year which constituted 325 (54.16%) cases. This was followed by 1 year to less than 5 years age group which constituted 150 (i.e. 25%) cases. Under 5 years aged children constituted 500 (83.33%) cases. Next most common age group admitted was 5 years to 10 years with 85 (i.e. 14.16%) cases and 10 to 12 years age group constituted 40 (6.66%) cases. In this study, central nervous system was the commonest system involved (n=195, 32.5%). Other systems involved were: respiratory system (n=122, 20.33%), cardiovascular system (n=65, 10.83%), gastro-intestinal system (n=32, 5.33%), hematological (n=35, 5.83%) and renal system (n=23, 3.83%).   Other causes include infections (n=97, 16.16%), metabolic (n=17, 2.83%), down syndrome (n=7, 1.16%) and poisoning (n=7, 1.16%) etc.Conclusions: Out of the 600 patients admitted to PICU, 168 (28%) patients died. 315 (52.5%) cases improved.  117 (19.5%) cases constituted those who were shifted to higher centre or another department or were taken against medical advice.
Clinical profile of dengue fever in children presented at a tertiary care hospital
Authors: K. M. Senthilkumar , Harini R. Hema
Published: February 2019

Background: Dengue fever is a benign syndrome caused by an arthropod-borne virus and is characterized by Biphasic fever, myalgia, and arthralgia, rash, leucopenia, and lymphadenopathy. Dengue hemorrhagic fever and dengue shock syndrome are a severe, often fatal febrile disease caused by 1 of 4 dengue virus. It is characterized by increased capillary permeability, abnormalities of hemostasis and protein-losing shock syndrome. The aim of this study was to assess the clinical profile, complications and outcome of dengue infection in children.Methods: All children attending the hospital with symptoms and signs suggestive of dengue fever were tested for NS1 antigen and IgM/ IgG dengue antibody serology (depending on the day of fever) by enzyme-linked immunosorbent assay (ELISA) technique.Results: Of the 174-dengue serology positive children, fever was the most common major symptom (97.7%) followed by vomiting (85.6%), loss of appetite (81.6%), abdominal pain (77%), body pain/leg pain (62.6%). Severe dengue as per WHO criteria was seen in 29 (16.7%) children. Thrombocytopenia (platelet count less 1,00,000) was observed in 82 children (47%), Platelet count less than 20,000 in 8 children (4.5%). Dengue shock syndrome was seen it 26 children (15%). Mortality was nil.Conclusions: In children, if symptoms like fever, vomiting, loss of appetite, abdominal pain and body pain are present, a strong possibility of dengue fever is present especially in an epidemic setting. Early suspicion and effective management can reduce the severity.
A clinical study of new onset seizures in children aged 3-12 years
Authors: Dwivedi Rinu , Sudha Priya P. , Padmavathi P.
Published: February 2019

Background: Seizures are common in pediatric age group and less than 1/3rd of seizures in children are caused by epilepsy. Aim of present study was to analyze the etiological factors and clinical profile of new onset seizures in children aged 3-12 years.Methods: This was a prospective study done at a tertiary care center of south India. Authors analyzed 98 children aged 3-12 years presenting with new onset seizures. Proper history and investigations including EEG, and CT brain were done to confirm the etiology.Results: Out of 98 children 51 were 3-5 yrs of age and 47 were 6-12 years. 66.3% had generalized seizure and 33.6% had partial seizure. Partial seizure were more common in 5-12 years of age. Intracranial infections were the leading cause (73/98) which included neurotuberculosis (26/73), NCC (20), bacterial meningitis (12), cerebral malaria (8) and viral encephalitis (7). Intracranial infections  were the  leading cause in both age groups. Space occupying lesions were more common in 6-12 years (46.8%) as compared to 3-5 years (19.6%). NCC and Tuberculoma were the leading CT findings in both age groups. There was significantly high incidence of focal EEG changes in partial seizure group compared to generalized seizure group.Conclusions: Intracranial infections were leading cause of new onset seizures especially GTCS. Good clinical evaluation and judicious use of investigations should be ensured. CT brain and EEG are more likely to be informative in partial seizures than in generalized seizures.
Rational use of blood components in children with dengue by using WHO and NVBDC guidelines
Authors: Tambekar Harish , Sharma Sujata
Published: February 2019

Background: Dengue fever has become a major public health concern. The disease is now endemic in more than 100 countries with very high case fatality rate and children are the most affected age group worldwide. During explosive outbreaks, there is sudden surge in demands of blood components. Hence the aim of present research was to study the rational use of blood components in children with dengue by using WHO 2012 and NVBDCP 2015 (GOI) guidelines.Methods: Total 219 children of age ˂12 years, who has been diagnosed to have dengue and received blood component therapy during 12 months of study period, were included in the study. The transfusions of blood components [packed red cells (PRC), platelets and fresh frozen plasma (FFP)] were being given to the cases accordance to the WHO and NVBDCP guidelines. The patients’ demographic data, diagnosis, details of blood component therapy used the reason for transfusion was recorded.Results: Out of 219 children, 12(5.4%) children received platelet transfusion, 4(1.8%) children received PRC transfusion and 5(2.2%) children received FFP transfusion. One transfusion (4.7%) out of 12 platelet transfusion was inappropriate and all PRC and FFP transfusions were appropriate according to WHO and National Vector Born Disease Control Programme (GOI) guidelines.Conclusions: The need for platelet transfusion is often overemphasized and the fact is that the platelet count alone is not a predictor of bleeding. Unnecessary and empirical use of platelets should be completely avoided.
Effect of Kangaroo mother care on physiological parameters in low birth weight neonates
Authors: Ranjan Ankit , Malik Sushma
Published: February 2019

Background: Low birth weight (LBW) babies require special care as they suffer from several handicaps, including maintenance of temperature, feeding, adequate weight gain and optimum neurobehavioral adaptation to the external environment. Kangaroo mother care (KMC) is an important modality that helps in the easy transition of the newborn infant to the outside world and overcomes the above problems. This study was planned to assess the effect of KMC on physiological parameters of low birth weight neonates, in a tertiary care hospital.Methods: This was a single-centered prospective observational quasi-experimental study conducted over a period of 18 months on 70 eligible LBW neonates. The arterial oxygen saturation, blood pressure (systolic, diastolic and mean), heart rate and respiratory rate of the neonates were noted. The readings at 1 hour and 2 hours after KMC were compared with that of the reading at 10 minutes prior to initiating KMC to assess the changes in the mentioned physiological parameters.Results: Analysis suggested statistically significant improvement in the arterial oxygen saturation and stabilization of the systolic, diastolic and mean blood pressure, heart rate and respiratory rate with institution of KMC. There was better improvement in the physiological parameters on increasing the duration of KMC from one hour to two hours and these changes were statistically significant.Conclusions: LBW neonates receiving KMC showed significant improvement in oxygen saturation and blood pressure, heart rate and respiratory rate.
Clinico-bacteriological profile of neonatal sepsis
Authors: P. Rashmi , B. K. Praveen
Published: February 2019

Background: Neonatal sepsis is the commonest cause of neonatal mortality responsible for about 30-50% of total neonatal deaths in developing countries. Surveillance of causative organisms and their antibiotic sensitivity pattern promotes rational use of antibiotics and antibiotic stewardship.Methods: A retrospective study, relevant data regarding the neonates diagnosed with culture positive sepsis was obtained from the case records during the period from July 2014 to June 2017. Culture positive sepsis was defined as isolation of bacterial pathogen from blood in neonates with clinical suspicion of sepsis.Results: Of the 414 neonates with clinical suspicion of sepsis, 110 neonates had blood culture positive sepsis. Sepsis was predominant in males (64.5%). Low birth weight (47.2%) and prematurity (40.9 %) were important neonatal risk factors for sepsis. Early onset sepsis occurred in 58.1% of the cases and late onset sepsis in 41.9% of the neonates. Gram-positive cocci constituted 67.52% of all isolates and gram negative 30.76%. The most frequently isolated organism in blood was methicillin resistant coagulase negative staphylococcus(MRCONS) (32.47%). Gram positive organisms included MRCONS, methicillin resistant Staphylococci aureus (MRSA), group B Streptococci (GBS), Staphylococcus aureus and Enterococci. Among Gram-negative organisms, Acinetobacter was most frequently isolated followed by Klebsiella, Escherichia coli, Pseudomonas, Citrobacter and Burkholderia species. The mortality in the study group was 13.5%. Gram negative organisms were most resistant to ampicillin and cephalosporins. Gram positive isolates were least resistant to vancomycin and linezolid.Conclusions: Gram positive sepsis was the most common type of sepsis among the neonates, although mortality was more in gram negative sepsis.
Prognostic value of laboratory and radiological parameters in kerosene poisoning
Authors: Kulkarni Venu , K. Dhanalakshmi , K. Raju , P. Megha
Published: February 2019

Background: Kerosene poisoning, a commonly encountered situation in pediatric emergencies, caused varied systemic manifestations ranging from asymptomatic state to altered sensorium and cardiac arrhythmias. Gupta score has been traditionally used to prognosticate such cases. Limited number of studies have been done previously despite high incidence rates pertaining to laboratory and radiological features. Present study aimed to determine association between these features and outcome in terms of duration of stay.Methods: A retrospective study consisted of all children presented with kerosene poisoning from May 2017 to May 2018. CBC was done within 12 hours of presentation and CXR was taken after 6 hours of exposure. These values were compared against duration of stay to predict prognosis.Results: Most children were in age group of 1-3 years, male predominance 62.9%. Quantity of consumption didn’t have any effect on outcome. Large proportion of children were asymptomatic 60%, followed by hurried breathing 31.5% - most frequent presenting complaint. Peak duration of consumption was 4 pm to 8 pm. CBC parameters- Hemoglobin status and WBC counts failed to have correlation with outcome in terms of duration of stay. CXR taken after 6 hours exposure- was imperative to predict outcome.Conclusions: Radiological features on CXR in addition to clinical symptoms could be used to decide likely outcome after kerosene consumption.
Comparative study between serum and transcutaneous bilirubin measurements in new-borns
Authors: Tiwari Manish Mahadeo , Pise Harshal N.
Published: February 2019

Background: Hyperbilirubinemia is one of the common problems in neonates. The transcutaneous bilirubin (TCB) measurement is non-invasive, easy and rapid not requiring expertise and manpower. Fewer studies have been carried out to whether newer TCB measurements can correlate with serum bilirubin measurements using newer generation of transcutaneous bilirubinometer in our region.Methods: An observational cross-sectional study to compare serum and transcutaneous bilirubin measurements in newborns admitted to a neonatal intensive care unit, conducted from December 2015 to November 2017. Blood samples were obtained from neonates collected from venous sample into plain bulb and sent for analysis. For transcutaneous bilirubin measurement, the reading from forehead and sternum were taken using bilirubinometer and an average reading was taken for comparison.Results: Total 172 neonates were admitted during study period and enrolled in the study. It was observed that out of 172 patients, studied 102(59%) patients were male and 70(41%) patients were female. Out of 172 patients maximum 89(51.74%) mother have O positive blood group and only 2(1.1%) have O negative blood group. Common cause of neonatal hyperbilirubinemia was ABO incompatibility 81(48%), Rh incompatibility 11(6%), and other causes 80(46%). The mean and standard deviation of TSB for first, second and third reading were 19.21±3.44, 15.76±2.79 and 12.89±2.44 respectively. While mean and standard deviation of TCB for first, second and third reading were 18.34±2.99, 15.48±2.36 and 12.31±2.28 respectively with correlation coefficient of r=0.806513, r=0.694273, r=0.785471 respectively indicating linear relationship between two.Conclusions: There was a strong correlation between serum and transcutaneous bilirubin levels before and even after the phototherapy. As transcutaneous bilirubin estimation is non-invasive, gives quick and reproducible results. So, by using this method has potential screening value especially in the high-risk neonates to start early intervention.
A study of echocardiographic changes in patients of thalassemia major
Authors: Chanpura Vaishali R. , Modi Daxay
Published: February 2019

Background: Thalassemia major is a chronic hematological disorder. Regular blood transfusion is the only modality of long-term survival for these patients. This leads to iron overload, the heart being the most severely affected organ. The gold standard for detecting myocardial iron deposition is cardiac MRI. However, very few patients can afford this investigation. Hence, authors carried out this study to find out whether early iron overload can be detected by echocardiography which is a simple and less expensive tool. The objective of this study was to document echocardiographic changes of cardiac iron overload in patients of thalassemia major even before appearance of symptoms.Methods: A comparative cohort study conducted from January 2018 to October 2018 in the Department of Paediatrics of SSG Hospital, and Government Medical College, Vadodara. The case group consisted of 35 patients of Thalassemia major. 35 age and sex matched normal children were selected as controls. Relevant blood investigations were performed in cases. 2-Dimensional M-Mode Echocardiography was performed in both patients and controls. Thalassemia major patients were compared to normal healthy children for various parameters in echocardiography indicating the systolic and diastolic function. Proportion and percentage were calculated for descriptive analysis. Independent t-Test was applied between two groups to find out significance level.Results: For all parameters except End systolic volume and fractional shortening, p values were less than 0.05 which is significant. 85% (30/35) had increase in interventricular septal dimensions (IVSD), 97%(34/35) had increase in posterior wall dimensions (PWD),  82%(29/35) had  increased left ventricular internal diameter diastole(LVIDD), 88%(31/35) had increased left ventricular internal diameter systole (LVIDS), 80%(28/35) had increased E/A RATIO .Ejection fraction was affected in 77%(27/35).This shows that patients of thalassemia major have significant cardiac dysfunction; possibly because of cardiac iron overload.Conclusions: Echocardiography is an effective tool for screening cardiac iron overload in patients of thalassemia major and should be done periodically in all patients.
Epidemiological profile of acute poisoning in children admitted to a tertiary care hospital
Authors: M. Mathivanan , K. Vignesh
Published: February 2019

Background: Acute poisoning in children is most commonly encountered in day to day practice which contributes a major part of admissions in pediatric intensive units and ward. It is a preventable public health problem. There are limited community based data available because of several reasons including lack of standard case definition, regional variability, poor functioning regulatory and surveillance system. Therefore, authors carried out this study in present set-up.Methods: A prospective observational study carried out at a tertiary care hospital which included all children within the age of 12 years presenting with history and symptoms and signs suggestive of acute poisoning over a period of 1 year after getting consent from parents.Results: Incidence of acute poisoning among children was 4.7%. Maximum cases were in the age group of 1-5 years (79.85%). Among the 278 cases, male children were 154(55.4%) and female were 124(44.6%). Majority of cases were observed in upper lower (43.1%) socio-economic group of Modified Kuppusamy scale. Based on locality, majority of cases were from rural area (66.9%). Accidental poisoning was the most common cause including 88.5% cases. In our study, we found that hydrocarbons were the most common substance of poisoning (58%). The most common clinical presentation in our study was vomiting (24.5%).Conclusions: Incidence of acute poisoning among children is high in our set-up. Lower socio-economic class, rural populations are important epidemiological factors which influences the poisoning event in children.
Aetiological profile of fever in neonatal and paediatric population in hospital setting
Authors: Dwivedi Amitabh
Published: February 2019

Background: Febrile illness in children is a common cause of admission to hospital globally, with significant associated morbidity and mortality. Dengue, malaria, scrub typhus, typhoid and leptospirosis have been identified as major causes of acute undifferentiated febrile illness in Thailand, Malaysia, and Nepal. Climate variation, over population and urbanization may all contribute to the emergence and reemergence of infections in tropical regions like Tamil Nadu. The objectives of this study were to describe the aetiology of fever in hospitalized neonatal and Pediatric population. A descriptive study was designed.Methods: A prospective observational study was conducted. All children from 0 to 18 years admitted as in-patients. Sample size was calculated to be 650. Basic laboratory tests were done in all cases.Results: Out of a total of 650 children maximum number (40.7% n=265) of patients had short duration of fever between 1 to 3 days. Majority (56%) of patients had temperature between 100.4 to 101F. Only 5 children were confirmed to have malaria. Maximum number of pus cells found was 80 to 100 in 3 children in urine examination. Total Infectious cases were 631 (97.07%).Conclusions: Infectious aetiology was more common than non-infectious aetiology. Among all aetiologies, viral fever particularly dengue was the most common aetiology. Enteric fever was the second most common infectious cause of fever after viral fever.  Short febrile illness (1 to 5 days) was the most common type of fever in children admitted in hospital. In neonates, the most common cause of fever was probable sepsis followed by dehydration fever.
Evaluation of immunization coverage and its determinants in children aged 12-24 months from rural and urban areas of Udaipur, Rajasthan, India
Authors: Pahwa Hartesh Singh , Goyal Dileep , Sareen Devendra
Published: February 2019

Background: Infectious diseases are now the world’s biggest killer of children and young adults. Over the last three decades a lot of progress has been made globally as far as protection against six important vaccine preventable diseases is concerned. The major cause of non-immunization and partial immunization in most of the studies conducted in India and abroad suggest lack of knowledge and awareness about vaccination in the community.Methods: 400 children aged 12-24 months from urban and rural areas (200 each) of Udaipur in a randomized manner were included in this study. For coverage and evaluation of vaccination in this study, informants preferably mothers were interviewed using pre-coded and pretested questionnaire by door to door visit from 1st April 2017 to 31st March 2018, in urban and rural areas of Udaipur and if mother was not available then father or any other person >18 years belonging to the household was asked to respond to questionnaire.Results: The present study was undertaken to find out the vaccination coverage in eligible population in rural and urban blocks of Udaipur. Out of 400 children evaluated. More than half (60.25%) of children were completely immunized. 29.5% children were partially immunized and 10.25% were not immunized at all.Conclusions: Lack of knowledge and awareness were the main reason for non-immunization (44.4%) and partial immunization (29.4%) respectively.
Prevalence of anemia in under five-year-old children: a hospital-based study
Authors: Singh Swatantar , Parihar Sangeeta
Published: February 2019

Background: Anemia affects individuals of both gender and all ages, there is a need for localized and age- and context-specific studies to improve our knowledge of prevalence patterns and associated risk factors of Indian population. The present study was done to determine the prevalence of and associated risk factors for anemia in under five-year-old children in a tertiary care teaching hospital.Methods: A prospective observational study was carried out among under five-year-old children suffering from anemia. For the diagnosis of anemia, WHO criteria for haemoglobin (Hb) threshold in different age group were used. The growth and development statuses of children were evaluated by WHO's Child Growth Standards 2006.Results: Total 240 anaemic children were enrolled into the study. Children of age group of between 2-5 years was more affected. A majority of the mother of anaemic children had primary level of school education. More than half of the children belong to lower socioeconomic classes (Class IV + Class V). Nutritional deficiency was the single most important causative factor in the development of anemia. Infectious diseases found to be more prevalent.Conclusions: Nutritional deficiency, particularly, iron deficiency is the leading cause of anemia in the present study. In addition to nutritional deficiency, socioeconomic factors like, gender, maternal education and SE class also play an important role in development of anemia.
Ventilator associated pneumonia: incidence and risk factors in a tertiary care hospital
Authors: Rathor Manish , Sharma Neetu
Published: February 2019

Background: The objective of this study is to find the occurrence and contributing risk factor of ventilator associated pneumonia (VAP) in 2 months-5 years age group.Methods: This was a prospective, observational, hospital-based study carried out in a tertiary care setting hospital. All patients between 2 months-5 years age admitted in the ICU who had undergone MV were included in the study. Inclusion criteria includes patients who developed pneumonia after the 48 hours of mechanical ventilation and those patients were excluded who developed pneumonia within 48 hours of mechanical ventilation and having respiratory system findings /involvement prior to the MV. After recruiting patients baseline clinical characteristics (age, sex, diagnosis, duration of MV) were taken, monitored and diagnosed VAP using CDC guidelines until they were discharged or deceased. The parameters such as fever, oxygenation, leucocytosis, other risk factors. chest X-ray and ETA>105CFU/ML or microscopy (grain stain>l bacteria/>10 polymorphonuclear cells) were collected every 48 hours.Results: This study was done in 133 patients while 42 patients (31.58%) developed VAP during their ICU stay. Early onset VAP occurred in 34 (80.9%) while late onset VAP was observed in the remaining 8 (19.1%) patients. In ETA culture CFU>105 Klebsiella (38%) was the predominant isolate followed by Pseudomonas (23%), Acinetobacter (17%), Staphylococcus (13%) and Citrobacter (10%) are offending organism responsible for VAP in MV patient in present study. On analysis (univariate) reintubation, altered sensorium at intubation and use of antacid are found significantly associated risk factors with the development of VAP.  Multivariate analysis revealed that reintubation was an important risk factor for the development of the VAP.Conclusions: The various risk factors can be minimized for better outcome of patients undergoing mechanical ventilation. Risk factors such as reintubation, altered sensorium at intubation and use of antacid are associated with VAP and also the physician treating must have knowledge and awareness about prevention of these risk factor to improve the outcome of patients.
Acute kidney injury in paediatric intensive care: need for extended vigil
Authors: P. J. Saritha , M. P. Jayakrishnan , T. P. Ashraf , G. Geeta M.
Published: February 2019

Background: Acute kidney injury (AKI) is an important contributor towards morbidity and mortality among critically ill children. The objective of this study was to ascertain the etiological factors, categorize the severity and determine the immediate outcome of AKI among children admitted to the pediatric intensive care unit (PICU) of a tertiary referral hospital in south India.Methods: A prospective study was conducted from January to December 2012 in the PICU, Government medical college, kozhikode, a major referral hospital in north Kerala. The institutional ethics committee approved the study. Children in the age group of 1 month to 12 years admitted to the PICU for at least 48 hours were included if they had no previous renal disease/AKI at the time of admission. Serum creatinine levels of the children were measured at the time of admission, at 48 hours, and one month later. Outcome measures included normalization of serum creatinine or persistence of impaired renal function. Mortality was assessed both immediately and after one month.Results: A total of 1716 children were included in the study, of which 107 children developed AKI (6.2%). Among the 107 children, 56 children (52.3%) were boys. Majority of children were infants 75(70.1%). Infection was the commonest underlying condition   associated with AKI. Most of the children with acute kidney injury were in the earliest phase (Stage 1). Twenty-six children (24.29%) died. Among the survivors, 10% were found to have impaired renal function when followed up a month later.Conclusions: There is a high incidence of AKI in critically ill infants admitted in PICU. Residual renal impairment can persist even after discharge from hospital and these children need follow up for a longer time.