Indian pediatrics最新文献

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.

Objective: To compare the performance of an alternate nasal-tragus length (NTL) formula for the calculation of insertional length (IL) during endotracheal intubation with the standard NTL formula (NTL + 1 cm) for optimal placement of endotracheal tube.

Methods: A randomized controlled trial was conducted in a level IIIB neonatal intensive care unit between June 2022 and December 2023. Neonates who required endotracheal intubation were randomized to either standard NTL group or alternate NTL group. In standard NTL group, the IL of ETT was calculated as NTL + 1 cm and in the alternate NTL group, IL was calculated as IL = NTL + 0.5 cm for a measured NTL ≤ 5.5 cm and IL = NTL for a measured NTL > 5.5 cm.

Results: A total of 158 neonates were randomized, 79 per group. Baseline maternal and neonatal characteristics were similar. Optimal placement of endotracheal tube was more frequent in alternate NTL group than in the standard NTL group [48 (65%) and 30 (39%), respectively, P = 0.002]. Low placement of endotracheal tube was observed more frequently in standard NTL group versus alternate NTL group [41 (54%) vs 14 (19%); P < 0.001]. There was no difference in other secondary outcomes such as rate of reintubation within 1 h, need for mechanical ventilation for > 72 h, pneumothorax or other air-leak syndromes, lung atelectasis and mortality.

Conclusion: Use of alternate NTL formula in neonates requiring endotracheal intubation leads to a higher rate of optimal placement of endotracheal tube compared to standard NTL formula.

Trial registry: CTRI/2022/09/045209.

Objectives: To develop and disseminate an innovative blended educational programme comprising of evidence-based neonatal healthcare practices across India and to identify and empower local champions who could sustain and scale quality improvement (QI) efforts regionally.

Methods: The study was conducted in two phases and engaged healthcare professionals mentored by trained facilitators (1:8 ratio). A structured methodology was adopted comprising of: (i) assessment of learning needs, (ii) identification of the target audience and local facilitators, (iii) development of content and blended learning strategy, (iv) alignment with measurable QI objectives, (v) documentation of outcomes and (vi) implementation through the support of the National Neonatology Forum. Participant and facilitator feedback guided course evaluation.

Results: The course engaged 1073 healthcare professionals (590 doctors, 483 nurses) with 2-10 years of neonatal experience mentored by 132 facilitators. Phase 1 included 250 participants from five Indian states, and 823 participants from 18 Indian states and four South-East Asia Regional Organization (SEARO) countries-Bangladesh, Bhutan, Maldives and Nepal-were enrolled in Phase 2. Overall, 57% participants completed weekly online quizzes, and the average attendance for live webinars was 50%. 43 hands-on skill workshops were held training 685 professionals.

Conclusion: This flipped-classroom, blended model promoted exploratory and self-directed learning. Its adaptability and emphasis on faculty development and QI projects offer a replicable framework for future neonatal training initiatives.

Objective: The study aimed to evaluate the effect of antiseizure medications (ASMs) on bone health in children with drug-naive epilepsy and its associated risk factors over a one-year follow-up period.

Methods: A prospective study enrolled children aged 5-15 years with drug-naïve epilepsy. At baseline and after one year of treatment with ASMs, bone mineral density (BMD) was measured by Dual energy X-ray absorptiometry (DXA), and bone metabolism markers (calcium, phosphorus, alkaline phosphatase, vitamin D, intact parathyroid hormone (i-PTH)). The primary outcome was the change in BMD after one year of treatment; secondary outcomes included BMD change in mono- and polytherapy, and changes in bone metabolism markers and risk factors for reduced BMD.

Results: Sixty-five patients (40 boys) with mean (SD) age 8.6 (2.8) years completed one-year follow-up; 50 (77%) had generalized epilepsy, and 42 (65%) had an unknown etiology. 30 (46%) and 35 (54%) children received monotherapy and polytherapy, respectively. At one-year follow-up, the median (Q1, Q3) BMD was significantly lower compared to baseline [0.623, (0.540, 0.714) vs. 0.656 (0.582, 0.745); P < 0.001]. Likewise, the median (Q1, Q3) DXA Z-score was significantly lower compared to the baseline [0.20, (- 0.50, 0.60) vs. 0.50, (0.20, 0.80); P < 0.001]. At one-year, median (Q1, Q3) serum 25-OH vitamin D levels [20, (17, 27) vs. 26, (23, 33.5); P < 0.001] and i-PTH [34, (24, 56) vs. 31, (20.50, 44); P = 0.008] had significantly reduced and increased, respectively. Both mono- and polytherapy subgroups showed significant reduction in BMD, DXA z-score, and serum 25-OH vitamin D levels. Multivariate analysis identified male gender as an independent risk factor for low BMD [adjusted odds ratio 4.46, (95% CI 1.16-17.21); P = 0.030).

Conclusion: Antiseizure medications affect the bone health adversely in children with drug-naïve epilepsy, leading to significant reductions in BMD and altered bone metabolism markers.

Objectives: To evaluate the efficacy of oral Lactobacillus rhamnosus GG (LGG) in reducing neonatal enterocolitis (NEC), sepsis and mortality in very low birth weight (VLBW) infants.

Methods: This open-label randomized controlled trial included enterally-fed VLBW infants with gestational age ≤ 32 weeks; those with gastrointestinal anomalies, severe birth asphyxia (APGAR score < 3 at 5 min), cyanotic congenital heart disease, and those not started on feeds by 14 days of life were excluded. Participants were randomized to receive either no probiotic (control) group, or probiotic (LGG; intervention) group. The intervention group received the first dose of LGG (probiotic) at feed initiation and was continued till 35 weeks of corrected gestational age. The control group received only breast milk. Clinical outcomes (mortality, NEC, sepsis) were compared in both groups during hospital stay.

Results: A total of 236 infants were enrolled. The primary composite outcome of sepsis, NEC or mortality was seen in 35 (30.4%) and 33 (27.2%) infants, respectively in the LGG and control groups (RR 0.85; 95%CI 0.48-1.50, P = 0.592). The mean (SD) time to reach full feeds was 11.9 (4.2) and 12.0 (5.5) days in the LGG and control groups, respectively; P = 0.561. The mean (SD) time to regain birth weight was 13.5 (3.9) and 13.6 (3.9) days in the LGG and control groups, respectively (P = 0.982). There was no significant difference in duration of hospital stay, duration of mechanical ventilation, or duration of antimicrobial therapy between the two groups (P > 0.05).

Conclusions: Use of LGG as single component probiotic in VLBW infants did not confer any significant benefit on the composite outcome of mortality, sepsis or NEC.

Trial registry: Clinical Trial Registry of India; Ref. No. CTRI/2021/03/031724 dated Mar 03, 2021.