Indian pediatrics最新文献

Objective: Chemotherapeutic protocols developed in high-income countries do not produce comparable results in low- and lower-middle income countries (LMICs). This study analyzed the treatment outcomes of modified Berlin-Frankfurt-Munster (BFM)-2009 protocol in children with acute lymphoblastic leukemia (ALL) in a tertiary care referral center in Northern India.

Methods: This retrospective study evaluated the treatment outcomes of children with newly diagnosed ALL treated with the modified BFM-2009 protocol using a risk-stratified approach between July 2018 and Dec 2024 and followed-up till June 2025.

Results: One hundred sixty six children with a median (q1, q3) age 51 (31, 78) months were followed-up over a median (range) duration of 36.5 (6-84) months. Patients were categorized as standard-risk (SR, 34%), intermediate-risk (IR, 36%) and high-risk (HR, 30%). Extra-medullary disease was seen in 1 child and T-cell lineage in 27 (16%). On day 8, 13 out of 160 children (8%) had prednisolone poor response (PPR). At end of induction-I, 159 out of 160 patients were in morphological remission (marrow blasts < 5%) and measurable residual disease (MRD) was positive in 23 out of 156 (14.7%). At the end of re-intensification phase (induction-II), MRD was positive in 5 children. Relapse and overall toxic deaths were seen in 16/166 (9.6%) and 8/162 (4.9%) children. Event-free survival (EFS) and overall survival (OS) at 36-month follow-up for SR, IR and HR were 95.7% and 96.5%, 83% and 85%, 76.9% and 79%, respectively. Children with PPR and IR/HR were associated with poor EFS.

Conclusion: Adapting, rather than, adopting a protocol in LMICs, improves outcomes for childhood ALL.

'Teleconsultation Connecting ALL patients in Remote Expanses' (TeleCARE) was introduced to ensure continuity of care for children with acute lymphoblastic leukemia (ALL) during the second wave of the COVID-19 pandemic; consultations were done via phone calls, and reports and prescriptions were shared on WhatsApp. This study reviewed the data of 35 patients with ALL receiving maintenance chemotherapy during the first and second wave of pandemic. 437 telephonic consultations were done over 6 months (73/month). The mean (SD) absolute neutrophil count (ANC, per μL) during teleconsultations was lower than that during physical visits [1754 (461) vs. 2272 (644); P < 0.001], with 55% of patients achieving the target ANC compared to 26% during in-person visits.

Kidney Support Therapy (KST) is essential for addressing metabolic disturbances and enhancing outcomes in critically ill children with acute kidney injury (AKI). The comparative effectiveness of different KST modalities remains uncertain. This cross-sectional analytical study included children in a tertiary care center undergoing peritoneal dialysis (PD, n = 16), hemodialysis (HD, n = 17), or continuous renal replacement therapy (CRRT, n = 20). The urea and creatinine reduction ratios and survival were higher in CRRT compared to PD. Higher PRISM III scores and lower eGFR were found to be predictors of mortality.

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.