Indian pediatrics最新文献

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.

An observational hospital-based study included 50 children aged 1-18 years with chronic kidney disease (CKD) to ascertain the prevalence of hypothyroidism. Out of 50 enrolled cases 13 had hypothyroidism (serum free thyroxine < 0.93 ng/dL and thyroid stimulating hormone > 5.2 mIU/L). The incidence of hypothyroidism was 23% (3/13) in CKD stage 2/3, 27% (10/37) in CKD stage ≥ 4. Hypothyroidism was present in 20% patients having spot urinary protein to creatinine ratio (UP:UC) between 0.2 and < 2, and 39.1% with UP:UC > 2. Hypothyroidism was more common in children with advanced CKD and those with greater proteinuria. No child had detectable thyroid peroxidase antibodies.

The 2025 Consensus on Science with Treatment Recommendations summary developed by the Neonatal Life Support Task Force of the International Liaison Committee on Resuscitation includes recommendations on neonatal resuscitation issued between 2021 and 2025. Major updates address umbilical cord management at birth, thermoregulation and other initial steps of resuscitation, interfaces and devices for providing positive pressure ventilation, oxygen therapy during neonatal resuscitation, the use of video laryngoscopy for endotracheal intubation, and the application of monitoring devices in the delivery room. Several good practice statements have been added, while certain previous recommendations such as the use of sodium bicarbonate in the delivery room have been withdrawn.

Objective: To assess the behavioral adverse effects associated with the use of levetiracetam in drug-naïve children with epilepsy, either as monotherapy or as part of anti-seizure medications polytherapy.

Methods: This prospective cohort study was conducted in the pediatrics department of a public hospital from October 3, 2024, to July 26, 2025. Typically developing children aged 4-12 years with epilepsy were consecutively enrolled, if they were being planned to be initiated on levetiracetam therapy, either as monotherapy or as an add-on therapy. Behavioral problems were assessed prior to starting levetiracetam using Strength and Difficulties Questionnaire (SDQ) and Child Behavior Checklist (CBCL) and repeated at 14 (+ 3) days and 6 (+ 1) weeks of follow-up.

Results: The study included 60 children with mean (SD) age of 7.75 (2.48) years. At enrollment, behavioral problems were not observed in any child (scores in the normal range). Proportion of those with behavioral problems in any sub-domain in either of the tools at follow-up was 3.3% at 14 days and 11.7% (95% CI 5.77-22.18%) at 6 weeks. Behavioral problems based on total scores, of either tool, were present in 6.7% (95% CI 2.6-16.0%) at 6-week follow-up. Behavioral adverse effects were found to be statistically associated with use of higher doses of levetiracetam (> 30 mg/kg/day), with dose and total CBCL scores [r (95% CI) = 0.542 (0.33-0.70); P < 0.001] and total SDQ scores [r (95% CI) = 0.515 (0.30-0.68); P < 0.001] showing significant correlation. The discontinuation rate was 1.7% (n = 1).

Conclusion: There is a need of close surveillance for neurobehavioral morbidity in children with epilepsy receiving levetiracetam, especially those receiving high doses.