Indian pediatrics最新文献

As the complexities of children getting admitted to the pediatric intensive care unit (PICU) are increasing, so is the incidence of acute kidney injury (AKI) as well as the need for performing kidney replacement therapy (KRT). This necessitates special infrastructure as the standard extracorporeal therapy like haemodialysis is often not feasible in these children. Continuous kidney replacement therapy (CKRT) has become the KRT modality of choice in PICUs across high-income countries. Even in emerging economies like India, its use is increasing because of its advantages in critically sick children. This review article summarises the practical aspects of CKRT and serves as a concise guide for postgraduate trainees and intensivists working in the PICU.

Objectives: To determine the proportion of exclusive breastfeeding in the study population. To determine the effect of various infant feeding patterns on anthropometric measurements, incidence of infectious diseases, antibiotic exposure and developmental milestones in infancy. The study also assessed the overall gut microbial abundance, alpha and beta diversity, by preliminary gut microbiome analysis.

Methods: A prospective cohort study was conducted by collecting feeding pattern data from mothers of healthy newborns (n = 374) who were assessed at birth, 1.5, 3.5, 6, 9 and 12 months. The gut microbiome analysis was done using stool samples collected at birth, 1.5, 3.5 and 9 months.

Results: Weight-for-height Z-scores indicated a higher prevalence of overweight in 'mixed milk feeding' and 'mixed complementary feeding' at 6 months (P = 0.907) with a significant association at 12 months (P = 0.019). A significant association was seen between 'mixed complementary feeding' and episodes of antibiotic exposure at 6 months (P = 0.007) and 12 months (P = 0.002), and episodes of fever (P = 0.009), cold (P = 0.007) and diarrhea (P = 0.024) after 9 months of age. Predominant phyla observed in the gut microbiome were Firmicutes; genera Bifidobacterium and Streptococcus were in abundance with increasing age.

Conclusions: Breastfeeding promotes beneficial bacteria in the gut microbiome with microbial diversity increasing during complementary feeding. Home-based complementary feeding contributes to improved nutritional status and reduced infectious diseases.

Objective: To reduce the ventilator-associated pneumonia (VAP) rate by improving the compliance of components of the VAP prevention bundle to > 90% over a period of 35 weeks.

Methods: This quality improvement study was conducted in the neonatal intensive care unit (NICU) of a tertiary care public hospital from May 2023 to March 2025. Baseline VAP rate was determined, and a team of all the stakeholders was formed. The problem was analyzed using various tools, and the main contributing factors for poor compliance with VAP bundle care were identified with the corresponding solution framed using the mnemonic H-ER-O-S: hand hygiene/head-end elevation, education/extubation readiness, oral care, suction care. Multiple plan-do-study-act (PDSA) cycles were done using point-of-care quality improvement (POCQI) methodology. The data were collected prospectively and analyzed regularly with the team members, and actions were planned accordingly.

Results: The VAP rate (per 1000 ventilator days) decreased significantly from 49.5 at baseline (May 2023) to 32.51 (95% CI 18.66-46.37) in the intervention phase and sustained at 6.40 (95% CI 4.58-8.93) for a consecutive 14 months (February 2024 till March 2025). The baseline compliance for components of VAP care bundle increased from 57.9% (95% CI 54.5-61.2) to 88.3% (95% CI 86.9-89.7) and was sustained for 14 months at 94.0% (95% CI 93.3-94.8, P < 0.001).

Conclusion: POCQI principles targeting the H-ER-O-S protocol help reduce VAP rates by increasing the compliance with the VAP care bundle.

Child deaths related to consumption of adulterated cough syrups in India and other low- and middle-income countries highlight an ongoing public health crisis. Recent tragedies linked to diethylene glycol adulteration of cough syrups expose weaknesses in drug regulation, supply chain oversight, and market transparency, and need to be viewed through the lens of commercial determinants of health (CDoH)-the conditions, actions, and omissions by commercial actors that affect health. These incidents reflect intersections of high demand for cough syrups, irrational fixed-dose combinations, widespread over-the-counter sales, and limited public awareness on the one hand, and rising prices of pharmaceutical-grade glycerin and adulteration on the other hand. Addressing CDoH requires strict enforcement of regulatory system, alongside generating relevant evidence, advocacy and partnerships and dialogue with the commercial actors.

Objectives: Preterm neonates are at risk of symptomatic postnatal cytomegalovirus (pCMV) acquired from CMV-positive breast milk intake. This study ascertained the proportion of mothers delivering at ≤ 32 weeks' gestation with CMV lactatia.

Methods: This prospective study included mother-infant dyads delivered at ≤ 32 weeks' gestation. CMV was detected in breast milk by quantitative DNA PCR. For the proportion of neonates who tested positive for CMV DNA (urine or blood) at 4-6 weeks of age, clinical outcomes were also measured. CMV load > 42.5 copies/mL was considered positive. Virologic (breast milk and infant blood/urine CMV PCR) and clinical correlates were evaluated.

Results: Out of the 93 mothers whose fresh breast milk was tested, 50 (53.7%, 95%CI 42.3, 55.9%) were positive for CMV. Out of 43 infants who were tested for CMV in blood or urine at 4-6 weeks of postnatal age, 10 (23%, 95%CI 18.1, 28.6%) turned positive. Significant differences were noted in the duration of respiratory support [47.5 (30, 73) vs 7 (3, 30) days; P = 0.002] and hospital stay [86.5 (80, 98) vs 51 (31, 65) days, P < 0.001] between CMV positive and negative infants. CMV-positive status was not an independent risk factor for bronchopulmonary dysplasia [aOR 5.3 (95%CI 0.9-31.0)] and retinopathy of prematurity requiring therapy [aOR 17.3 (95%CI 0.9-194.2)].

Conclusion: 53.7% of mothers delivering prematurely had CMV lactatia; 23% of their infants were positive for CMV at 4-6 weeks of age.

Objective: To compare module-based versus conventional lectures for undergraduate teaching in pediatrics.

Methods: This quasi-experimental study was conducted among phase III part II MBBS students during their pediatric posting at a tertiary care teaching center in Southern India. Fifty students each in the experimental and control group were taught using module-based and conventional lectures, respectively. The learning outcome was evaluated by pre-, and post-test scores and analyzed by 'paired t test', 'unpaired t test' and 'repeated measure ANOVA'. Perception was assessed using five-point Likert scale.

Results: The gain of marks for module-based teaching was statistically significant compared to conventional lecture (P < 0.001). Regarding perception, 72% of students 'strongly agreed' (40%) and 'agreed' (32%) to the different characteristics of modular teaching whereas in conventional lecture, 34% were neutral, 32% disagreed, and 12% strongly disagreed.

Conclusion: The knowledge outcome and perception level in module-based teaching are superior to that of conventional lectures.

For neonates with congenital diaphragmatic hernia (CDH), the challenges start immediately after birth. Respiratory distress and hemodynamic compromise set in with the herniation of the contents of the abdomen into the thoracic cavity. Though definitive surgical correction and long-term follow-up are required, the immediate postnatal stabilization is of paramount importance. Depending on the extent of herniation, the associated physiological impairment is variable. With extensive research over the past few decades and a better understanding of the disease physiology, coupled with newer modalities in management, various multi-institutional bodies have proposed clinical practice guidelines. This study aims to compare these guidelines for the management of CDH neonates and to understand their implications for resource-poor settings.

Objectives: To correlate the inferior vena cava/aorta diameter (IVC/Ao index) in children with nephrotic syndrome with clinical indicators of volume status, and to compare the IVC/Ao index between children in relapse and in remission.

Methods: This prospective longitudinal study included children aged 2-18 years presenting with relapsed nephrotic syndrome. Low intravascular volume status was diagnosed if two of the three criteria (tachycardia, hypotension, prolonged capillary filling time) were present. Sonographic measurements of the IVC and aorta diameter were obtained by a single observer at recruitment and after achieving remission.

Results: One hundred and three children (73 boys) with a median (Q1, Q3) age 72 (24, 216) months were recruited. 26 (25%) children had low intravascular volume at recruitment. The mean (SD) IVC/Ao index was lower in low volume status compared to normal volume status [0.74 (0.2) vs 0.83 (0.1); P = 0.090]. The correlation between IVC/Ao index and heart rate (r = -0.29, P = 0.003) and mean arterial pressure (r = 0.23, P = 0.018) was weak. IVC/Ao index was not an independent predictor of volume status (OR = 0.04, P = 0.331). The mean (SD) IVC/Ao index increased significantly from when in relapse to remission [0.94 (0.1) vs 1.05 (0.2), respectively; P = 0.001].

Conclusions: The IVC/Ao index was lower in relapse than in remission, and did not predict low intravascular volume status independently.