Indian pediatrics最新文献

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.

Objective: To evaluate the seasonal variation in Guillain-Barré Syndrome (GBS) subtype distribution and its association with clinical outcomes in pediatric patients requiring intensive care unit (ICU) admission.

Methods: An audit of pediatric patients with GBS admitted to the neuro-ICU of a tertiary center in Southern India between 2008 and 2018 was conducted. Seasonal distribution was defined as per meteorological classification: summer (March-May), monsoon (June-September), post-monsoon (October-November), and winter (December-February). Clinical subtypes, treatment, and outcomes, including length of mechanical ventilation (LOMV), ICU stay (LOIS), hospital stay (LOHS), and Hughes disability scores, were analyzed across seasons.

Results: Among 75 patients, the highest admissions occurred during the monsoon (n = 29). Acute motor axonal neuropathy (AMAN) was more frequent in monsoon, while acute inflammatory demyelinating polyneuropathy (AIDP) was common in winter and summer. Across the full cohort, no statistically significant seasonal differences were found in the outcomes. However, within the AMAN subtype, LOHS was significantly longer in summer compared to post-monsoon (P = 0.005). Axonal variants showed higher rates of intubation and severe disability (Hughes disability score > 3), while AIDP had milder outcomes.

Conclusion: Seasonal clustering of GBS subtypes was observed, with axonal variants more common during the monsoon. However, seasonal variation did not significantly impact the overall clinical outcomes in pediatric ICU patients.

Objective: To develop reference range for target oxygen saturation levels during the first 10 min of life in late preterm neonates born by cesarean delivery.

Methods: A prospective observational study conducted at a tertiary hospital in India between April 2022 and September 2024 included 200 late preterm neonates delivered by cesarean section following delayed cord clamping. Preductal peripheral oxygen saturation (SpO₂), heart rate, and temperature were recorded every minute at 2-10 min after birth.

Results: The mean (SD) gestational age and birth weight were 35.6 (1.3) weeks and 2260 (496) g, respectively. The median (q1, q3) preductal SpO₂ at 2, 5, and 10 min were 77 (70, 84), 88 (82, 92) and 95 (93, 96), respectively. The median (q1, q3) time taken to reach saturations of ≥ 80%, ≥ 85% and ≥ 90% were 4 (3, 5), 5 (3, 6) and 6 (4, 7) minutes, respectively. Only 73.3% late preterm neonates reached the target SpO₂ of ≥ 80% at 5 min; 98.8% reached ≥ 85% at 10 min without any intervention.

Conclusion: Nearly one-fourth of healthy late preterm neonates did not reach the thresholds laid by the Neonatal Resuscitation Program (NRP) until 5 min after birth, yet nearly all achieved the ≥ 85% threshold of SpO₂ by 10 min without intervention. This suggests a slightly delayed but adequate transition, indicating routine supplemental oxygen may be unnecessary in clinically stable late preterm neonates.