Indian pediatrics最新文献

Objective: To determine the cyclosporine trough (C₀) and two-hour post-dose concentrations (C₂) in children with nephrotic syndrome (NS) and study the factors influencing them.

Methods: In this ambispective cohort study, children with NS (including frequently relapsing, steroid-dependent and steroid-resistant nephrotic syndrome) on cyclosporine therapy were enrolled. Clinical and laboratory data were recorded. C₀ and C₂ were estimated using liquid chromatography mass spectrometry.

Results: Among 27 patients with a mean (SD) age of 6.4 (4.1) years, the median (Q1, Q3) of C₀ and C₂ were 114.8 (86.1, 186.3) ng/mL and 661.6 (442.1, 884.6) ng/mL, respectively. At a mean (SD) cyclosporine dose of 4.1 (0.8) mg/kg/day, 12 (44%) patients had C₀ above and 4 (15%) below the therapeutic range (80-120 ng/mL). C₂ levels were outside the recommended ranges in 17 (63%) children, within range in 7 (26%), and below in 3 (11%). Capsule users had higher C₀ than syrup users. Amlodipine therapy was associated with higher C₀ levels.

Conclusion: Nearly half the children had C₀ and C₂ levels outside the therapeutic range. Dosage form and amlodipine influenced C₀, not C₂ concentrations.

Objective: To estimate the incidence of hypertension during induction therapy in children with acute lymphoblastic leukemia (ALL), comparing a systematically monitored prospective cohort to a retrospective cohort lacking regular blood pressure monitoring.

Methods: This ambispective observational study was conducted at a pediatric hematology-oncology unit in Chandigarh, India. The prospective cohort included 46 children with B-/T-ALL or T-cell non-Hodgkin lymphoma enrolled between September 2023 and August 2024, whose blood pressure was monitored weekly during induction therapy using the auscultatory method with an aneroid sphygmomanometer. Hypertension was defined according to the 2017 American Academy of Pediatrics guidelines. The retrospective cohort comprised 160 children diagnosed between June 2022 and July 2023, whose case files were reviewed for documented hypertension or posterior reversible encephalopathy syndrome (PRES). In the retrospective cohort, blood pressure was not monitored systematically and was detected incidentally during routine care or at the time of admission for intercurrent illnesses.

Results: Hypertension was observed in 27 (58.7%) patients in the prospective cohort, compared to 20 (12.5%) in the retrospective (P < 0.001). Most (92.6%) cases of hypertension in the prospective cohort occurred within the first two weeks of induction. No case vs. two (1.3%) cases of PRES were reported in the prospective and retrospective cohorts.

Conclusion: The incidence of hypertension during induction therapy in childhood ALL was 58.7%, with most cases occurring within the first two weeks. Incorporating blood pressure monitoring into routine care is essential for children with ALL receiving induction chemotherapy.

Objective: To evaluate the effectiveness of a context-specific, nurse-driven medication errors bundle in reducing the incidence of medication errors (MEs) by ≥ 50% in a pediatric intensive care unit (PICU).

Methods: We conducted a prospective, before-and-after quality improvement study, between February and November 2023, in a 15-bedded multidisciplinary PICU of a tertiary public hospital in northern India. Prescriptions advised to children hospitalized during the study period were analyzed. The intervention comprised of a structured prescription format, nursing observation and administration charts, and drug incompatibility charts. The bundle was implemented through four sequential Plan-Do-Study-Act (PDSA) cycles. Medication errors were categorized into prescription, dispensing, administration, and monitoring errors and assessed for severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index. The primary outcome was change in the overall ME rate. The secondary outcomes included category-specific error rates and improvement in staff awareness of quality improvement principles.

Results: A total of 968 prescriptions were evaluated during the pre-assessment phase and 1,386 during the intervention. The overall ME rate declined from 8.5% to 2.9%, prescription errors dropped from 13.1% to 3.8%, dispensing errors from 12.2% to 5.2%, administration errors from 3.8% to 1.9%, and monitoring errors from 1.7% to 0%. Most errors were intercepted and corrected before reaching the patient (NCC MERP Category B). Quality improvement awareness among staff improved from 55.5% to 84%.

Conclusion: A low-cost, nurse-led, multidisciplinary medication errors bundle led to a sustained reduction in MEs, demonstrating its potential for use in comparable PICU settings.

Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness in India. We examined the progress, current status, and challenges related to ROP in India. Despite national guidelines and initiatives, the coverage of ROP screening remains highly variable across regions. Key challenges include lack of screening facilities, trained personnel, inadequate awareness, and delayed referrals. Successful strategies include capacity building, quality improvement approaches, and telescreening. We recommend policy actions, including mandatory ROP screening arrangements by neonatal care facilities, raising community awareness, and the inclusion of ROP indicators in health system monitoring. Leveraging digital technologies and focusing on primary prevention through improved quality of neonatal care are crucial. With sustained commitment and intersectoral collaboration, India can create a comprehensive model for neonatal eye care for low- and middle-income countries, preventing ROP-related visual impairment and ensuring the right to sight for all infants.

Over the past 25 years, the Indian Academy of Pediatrics-Intensive Care Chapter has transformed pediatric critical care in India from scattered efforts into a structured national system for training, accreditation, and policy. After its establishment in 1999, IAP-Intensive Care Chapter has bridged key gaps in training, evidence, and systems through competency-based fellowships, accreditation of teaching units, and the development of national guidelines. Its educational ecosystem now includes training programs for physicians and nurses, simulation-based learning, and quality improvement initiatives. The Journal of Pediatric Critical Care and PediCritiCon, the annual national conference of the Chapter, has fostered scholarship and collaboration, while research and innovation at individual and institutional levels are strengthening national evidence base. Despite major gains, challenges persist in ensuring equitable access, workforce sustainability, and outcome measurement. Future priorities include digital integration, simulation expansion, multicenter research, and national quality dashboards. The IAP-Intensive Care Chapter's journey illustrates how a professional society can drive systemic improvement in pediatric intensive care across a diverse, resource-limited nation.

Data on the use of infliximab (IFX) in infants with Kawasaki disease (KD) are scant. We retrospectively analyzed data of 35 infants with KD who received IFX. Effectiveness of IFX was assessed in the presence of intravenous immunoglobulin (IVIG) resistance and coronary artery aneurysm (CAA) regression. Fifteen of thirty-five received IFX in the presence of IVIG resistance; nineteen of thirty-five for CAA; and one for persistently high c-reactive protein. Thirteen out of fifteen with IVIG resistance became afebrile by 24 h. Twelve medium CAA regressed over 3 months, four of ten giant CAA normalized, and three regressed to small CAA, median time being 7.5 (3.5, 18) months. IFX was well-tolerated, safe, and effective in infants with KD.

Objective: To assess the cognitive and behavioral outcomes of very low birth weight (VLBW) as compared to normal birth weight (NBW) neonates in middle childhood.

Methods: In this observational study, the first 50 VLBW (≤ 1250 g) children from an original cohort of 2009-2011, who agreed to participate, and 50 age and sex-matched NBW children were assessed at 6-11 years age. Cognitive function, behavior, psychopathology, self-concept, adjustment and memory parameters were assessed by a certified psychologist using Malin's Intelligence Scale for Indian Children (MISIC), Childhood Psychopathology Measurement Schedule, Children's Self-concept Scale, Preadolescent Adjustment Inventory, and PGI Memory Scale for Children (PGIMC), respectively.

Results: Compared to NBW, the VLBW children had significantly lower Verbal Intelligence Quotient (IQ) (P = 0.008), Performance IQ (P < 0.001), and Full-Scale IQ (FSIQ) (P < 0.001). VLBW cohort had significantly lower scores in remote memory (P < 0.001), mental balance (P = 0.001), attention (P = 0.005), visual retention (P < 0.001), and recognition (P = 0.003). VLBW cohort exhibited significantly higher scores on psychopathology (P = 0.036), anxiety (P = 0.034), significantly lower self-concept (P < 0.001) and adjustment scores (P < 0.001) than NBW.

Conclusions: VLBW children have significant cognitive, behavioral and adjustment issues as compared to NBW children.

This case-control study assessed the inflammatory response and oxidative stress associated with snakebites in 116 children in comparison with 116 age-matched healthy controls. The median (Q1, Q3) levels of serum C-reactive protein [11.1 (4.2, 14.4) vs 2.6 (1.9, 3.3) mg/L, P < 0.001], interleukin-6 [84.8 (75.0, 95.0) vs 15.2 (12.2, 18.0) pg/mL, P < 0.001], and malondialdehyde [1.4 (1.1, 1.5) vs 1.0 (0.9, 1.1) nmol/mL, P < 0.001] were significantly higher in children with snakebites compared to the control group. Snakebite was associated with significant inflammation and oxidative stress in children.