Indian pediatrics最新文献

Diagnosing pediatric rheumatic diseases can be challenging, as they often mimic common conditions such as infections and, less commonly, malignancies. Characteristic pattern recognition, guided by a detailed history and clinical examination, often helps in making the correct diagnosis. A delay in diagnosing these disorders can lead to disease-related damage, such as joint disabilities in juvenile idiopathic arthritis, and life-threatening organ involvement in conditions like childhood vasculitis and lupus. Easily accessible laboratory investigations can guide towards the underlying diagnosis. In the current era, early diagnosis helps achieve favorable outcomes with the use of effective therapeutic options. This article aims to highlight important clinical and laboratory features that would assist the primary care pediatricians in the early diagnosis of rheumatic disorders.

Objective: To describe the autonomic nervous system abnormalities including frequency of orthostatic symptoms, orthostatic response to the active standing test and analysis of heart rate variability (HRV) parameters in children with Nutcracker syndrome (NCS).

Methods: A case-control study was conducted between May and November 2023. We included children with NCS and healthy age- and sex-matched healthy controls. Children were evaluated for autonomic system disturbances by history for orthostatic symptoms, performance in an active standing test, 24-hour holter monitoring to determine the heart rate variability (HRV), maximum and minimum heart rates, and the average heart rate and urine analysis for orthostatic proteinuria and hematuria.

Results: 45 children with NCS and 47 age-matched healthy controls were included. Orthostatic symptoms were observed in 55.5% of the NCS patients, with dizziness being the predominant complaint (37%), followed by fatigue (20%), palpitations (13%), headache (11%), vision disturbances (11%), syncope (6%), chest discomfort (4%), and diaphoresis (2%). In the 24-h holter monitoring of 24 patients, a decrease in the standard deviation of the NN intervals (SDNN), root mean square of successive R-wave peak to R-wave peak (RR) interval differences (rMSSD) was observed. SDNN was significantly lower in NCS compared to the control group; 135.5 (42.3) vs 155.9 (35.2), P = 0.039. rMSDD was also significantly lower in the NCS compared to control group; 46.2 (19.7) vs 61.3 (26.6), P = 0.020. The mean (SD) maximum heart rate was higher in NCS compared to control group; 172.3 (28.4) vs 159.4 (14.6), P = 0.015.

Conclusion: Autonomic nervous system dysfunction and orthostatic disturbances may be seen in children with NCS.

Objective: To investigate the role of plasma copeptin in predicting mortality in children with heart failure (HF) in addition to poor outcomes, including sepsis, multiorgan dysfunction syndrome, need for mechanical ventilation, and duration of stay in the pediatric intensive care unit.

Methods: This diagnostic study included 76 children aged 1 month to 16 years who were hospitalized with congenital or acquired heart disease with HF, and an age- and gender-matched control group of 65 healthy children. Plasma copeptin level was evaluated within 24 hours of admission. Patient with HF were classified into quartiles according to copeptin levels.

Results: The median plasma copeptin level (pmol/L) was significantly higher in children with HF compared to the healthy children (16.8 vs 8.0; P = 0.001). Patients were classified into quartiles according to their plasma copeptin level as follows; Q1, plasma copeptin level < 7.60 pmol/L; Q2, plasma copeptin level 7.60-10.75 pmol/L; Q3, plasma copeptin level 10.76-17.70 pmol/L; Q4, plasma copeptin level >17.70 pmol/L. The Pediatric Risk of Mortality III (PRISM III) score and inotropic scores were significantly different among the quartiles of copeptin levels in HF (P = 0.001 and 0.003, respectively). A higher proportion of patients who developed sepsis and MODS were in the fourth quartile (P = 0.001 and 0.022, respectively). All mechanically ventilated children were also in the fourth quartile. Plasma copeptin level of 35.5 pmol/L had a sensitivity of 72% and a specificity of 92.5% to predict mortality in children with HF (AUC = 0.72, P = 0.046).

Conclusion: Plasma copeptin is a novel biomarker for the early prediction of mortality and poor outcomes in children with HF.

Objectives: This study aims to investigate the correlation between perfusion index (PI) and Clinical Risk Index for Babies (CRIB) II score in sick preterm neonates < 37-week gestation admitted to neonatal intensive care unit (NICU).

Method: This observational study was conducted over period of 18 months in a tertiary care centre. All eligible preterm neonates admitted to NICU were examined. The PI and CRIB II score for each neonate were documented. The primary outcome of the study was correlation between PI and CRIB II scores at admission.

Results: 383 neonates were enrolled in the study. Mean gestation of neonates was 32 weeks. A strong correlation between PI and CRIB II scores at admission was noted (P = 0.01). We demonstrated a strong association between PI at admission and predischarge mortality of neonates with 92.9% sensitivity and 70% specificity. Lower PI was associated with need of inotropes and invasive ventilation and longer duration of hospital stay. Combined use of PI and CRIB II predicted mortality with 83.3% sensitivity and 80.5% specificity.

Conclusion: The perfusion index is a potential bedside measure that correlated well with the CRIB II score, which is a validated tool to assess sick preterm neonates. Preductal PI at admission was associated with predischarge mortality, length of hospital stay, inotrope requirement and need for ventilator support in preterm neonates.

The immunopathogenesis of dengue severity remains an enigma. There is a growing body of evidence pointing towards a transient hyperinflammatory hypercytokinemic state responsible for the development of severe dengue including dengue hemorrhagic fever that coincides with the onset of thrombocytopenia, capillary leak, multiorgan dysfunction and hyperferritinemia. There are several reports of dengue associated hemophagocytic lymphohistiocytosis (HLH). However, the cytokine storm in dengue as well as in other infections may not conform to the classic HLH 2004 diagnostic criteria. Following the recent COVID-19 pandemic, there has been a paradigm shift in the understanding of infection-associated cytokine storms. There is a need to explore timely short-course immunotherapy for the management of selected patients with dengue spiraling into the critical phase.

Objective: To assess the effectiveness of the Basic Neonatal Resuscitation Program (NRP) course and to evaluate the perceived utility of the skills acquired during the course.

Methods: This cross-sectional survey aimed to assess the perceptions of participants who attended the Basic NRP course, comprising online video modules and offline workshops, across India. Data were collected between October 2023 and November 2023 for the courses held from May 2022 to April 2023, using a semi-structured questionnaire distributed electronically or via telecommunication.

Results: Out of 10,000 participants approached, 6,066 responded which included nurses (60.4%), pediatricians (20%), and medical officers (19.7%). Majority were females (76.4%), in private healthcare (62.1%), with the highest participation from West Bengal (14.72%) among the different states. Satisfaction with online videos was reported as very high by 48.5% and reasonable by 51.5% and one participant reported dissatisfaction. Compared to private healthcare settings, exposure to labor room experience was lesser in government facilities (48.8% vs. 42.5%, P < 0.001). The overall functional equipment was greater in government set-ups compared to private facilities (49.8% vs. 45.2%, P = 0.001).

Conclusion: Participants reported improved neonatal resuscitation skills as well as opportunities and facilities to practice after Basic NRP course.