Indian pediatrics最新文献

The prevalence of childhood metabolic syndrome is rising with an increase in obesity. The current confirmatory diagnostic methods for metabolic syndrome are invasive. Triceps Skinfold Thickness (TSFT) measurement is a non-invasive alternative. This cross-sectional study evaluated the performance of TSFT for screening overweight and obese adolescents aged 10-16 years for metabolic syndrome. Out of 60 participants, 17 (28%) had metabolic syndrome. The mean (SD) TSFT measurements were significantly higher in adolescents with metabolic syndrome compared to those without metabolic syndrome [29.4 (6.0) vs. 24.3 (7.6); P = 0.018]. A cutoff of 26.7 mm for TSFT demonstrated 88% sensitivity and 72% specificity in predicting metabolic syndrome. TSFT was found as promising non-invasive screening tool for metabolic syndrome.

Objective: To assess the parental stress, coping mechanism and quality of life of caregivers of children with Differences of Sex Development (DSD).

Methods: Mothers of children (6 months - 12 years) with DSD were enrolled after excluding mothers of children with syndromic diagnosis, developmental delay, cognitive impairments, chronic diseases, or if the duration of DSD diagnosis was less than six months, and mothers with psychiatric illnesses (n = 35). Mothers of age and gender-matched children with congenital hypothyroidism served as controls (n = 35). Psychological assessments were performed using structured questionnaires: the Parent Stress Scale, PRIME MD PHQ-9 Scale, and Ways of Coping Questionnaire.

Results: Mothers of children with DSD exhibited significantly higher mean (SD) stress levels [24.34 (4.25) vs 19.57 (1.89); P < 0.001]. Prevalence of depression prevalence was higher in mothers in the DSD group than in the hypothyroidism group (71% vs 42.9%, P < 0.001). Mothers of children with DSD also had poorer quality of life, and both high negative coping behavior and low positive coping behavior (P < 0.001) compared to controls, and stigma related to social exclusion was more pronounced.

Conclusion: Beyond medical interventions, addressing family members' psychological well-being is essential in effectively managing DSD in the Indian context.

Objective: To determine the proportion of latent iron deficiency (LID) in neonates delivered at more than 34 weeks gestation with and without risk factors for in-utero iron deficiency.

Method: This observational study enrolled neonates delivered at more than 34 weeks gestation. Maternal antenatal history, risk factors for placental insufficiency, hemoglobin, and serum ferritin levels were collected upon admission for confinement. Neonates were categorized based on the presence of risk factors, and further categorized based on ferritin concentrations (cord blood or venous blood < 72 hours) into those with ferritin > 75 ng/mL (normal iron status) and those with ferritin between 11-75 ng/mL (LID).

Results: Among 559 neonates, 295 had underlying risk factors for poor in-utero iron status. Overall, 45 (9.8%) neonates had LID with an incidence of 10.5% in those with risk factors and 5.3% in those without risk factors [Odds Ratio (95% CI) 2.09 (1.08, 4.03); P value = 0.02]. Maternal anemia and gestational hypertension were found to be significant independent risk factors for LID.

Conclusion: This study highlights the higher LID in at-risk neonates, emphasizing the need for targeted interventions to prevent iron deficiency.

Objectives: To compare the incidence of central line associated blood stream infections (CLABSI) with the use of umbilical venous catheters (UVC) or peripherally inserted central cathethers (PICC) as primary vascular access in preterm neonates.

Method: This was an open-label, two parallel-arm, randomized controlled trial which included hospitalized neonates with birth weight <1250g who required a central venous access on day 1 of life. The neonates were randomized to either UVC or PICC groups and evaluated for the incidence of CLABSI.

Results: Of the total 238 eligible neonates, 128 and 110 neonates were randomized to the UVC and PICC groups, respectively. The baseline characteristics were comparable in both groups. There was no significant difference in the incidence of CLABSI among the UVC and PICC groups (21.1% vs 18.2%; P = 0.57). Neonates in the PICC group needed multiple attempts at insertion compared to those in the UVC group (43% vs 12%, P = 0.01); more time was needed for PICC line insertion [median (IQR) 20 (15, 40) vs 10 (5, 15) minutes], but had longer duration of the primary line [7 (4, 10) vs 5 (3, 7) days]. Early removal of the line for leakage was higher in the UVC group and local signs of inflammation were higher in the PICC group. The overall incidence of complications was similar between the groups (53% vs 45%, P = 1.00).

Conclusion: In preterm infants with a birth weight of less than 1250g, the incidence of CLABSI was similar in the UVC and PICC groups when used as a primary central line. The overall complication rates were comparable in the UVC and PICC groups.

Cardiopulmonary exercise testing (CPET) is a noninvasive test that provides a comprehensive assessment of the integrative exercise responses by measuring parameters calculated on a breath-by-breath basis. It can provide insight into the fitness level, cause of exercise limitation, and safe parameters for exercise prescription in children 6 years and older. Common indications for CPET include undiagnosed exercise-induced dyspnea, exercise intolerance in pediatric chronic conditions and for monitoring response after therapy/intervention. It can be utilized to assess the overall fitness, pre-operative risk, and prognosis in chronic conditions. CPET is accessible and dependable in pediatrics, yet challenges like a lack of standardized protocols are noted. With continued development and technological advancements in CPET, there is potential for revolutionizing pediatric diagnostic health care.

Graduate medical education is pivotal in shaping a physician's professional identity, an aspect that is often overshadowed by the emphasis on clinical skills. This manuscript addresses the critical role of medical educators as role models in developing professional identity among students using the ABC: Authenticity, Behavior, and Commitment. Authenticity demands consistency between personal beliefs and professional actions which fosters trust. Behavior involves consistently displaying professional and ethical conduct and providing a live curriculum that is professional. Commitment signifies a dedication to lifelong learning and patient care, demonstrating resilience and innovation. By embodying these principles, educators can significantly influence students, ensuring they acquire essential clinical skills and adopt core professional values, thereby preparing them for the ethical, interpersonal, and technical challenges in the medical field.

Objective: To explore the clinical profile and outcomes in neonates hospitalized with respiratory syncytial virus (RSV) infection.

Methods: Clinical features, respiratory support, pharmacological treatment, complications and outcomes of neonates admitted to the neonatal intensive care unit with RSV infection between January 2018 and March 2023 were recorded. Descriptive statistics were employed for analysis.

Results: Thirty-seven neonates with RSV infection were analyzed. The most common presenting features were cough (n = 29, 74.4%), refusal to feed (n = 29, 74.4%) and apnea (n = 7, 17.9%). 19 (48.7%) neonates were mechanically ventilated, 28 (71.8%) required non-invasive respiratory support and 13 (35.1%) required bronchodilator therapy. All neonates were discharged after a median (IQR) duration of 14 (9, 23.5) days.

Conclusion: Neonates with RSV infection requiring hospitalization have considerable respiratory morbidity requiring prolonged respiratory support and pharmacological therapy.