Indian pediatrics最新文献

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.

Objective: To assess the serum amino acid (AA) levels among preterm infants receiving parenteral and enteral nutrition.

Methods: This cross-sectional study included very preterm neonates (≤ 32 weeks) and healthy term breastfed neonates as reference group between December 2022 and June 2024. Parenteral nutrition (PN) was commenced on day 1 of life for preterm neonates delivered at ≤ 30 weeks gestation. Neonates delivered at 31-32 weeks gestation did not receive PN. Standard feed regimens were followed for enteral nutrition with "early" commencement of human milk fortifier (HMF). AA levels were estimated by liquid chromatography tandem mass spectrometry after at least one week of full enteral nutrition for 31-32 weeks group, or parenteral followed by full enteral nutrition for ≤ 30 weeks group. AA levels in preterm infants were considered inadequate if found to be below the lowest level of corresponding AA levels in healthy term breastfed babies.

Results: A total of 84 preterm neonates delivered at ≤ 30 weeks gestation, 56 preemies at 31-32 weeks gestation, and 100 term neonates were studied. Compared to term neonates, preterm infants ≤ 30 weeks on PN and EN had inadequate levels of phenylalanine, methionine, histidine, valine, glycine, glutamine, arginine, alanine, glutamic acid, and aspartic acid. Deficiencies were noted in > 10% of this group for phenylalanine, methionine, histidine and glycine; in 5-10% for valine, leucine/isoleucine, glutamine, alanine, glutamic acid; and in < 5% for tyrosine, arginine, serine, and aspartic acid.

Conclusions: Despite use of parenteral and enteral nutrition protocols based on current science, preterm (≤ 30 weeks) infants had amino acid levels significantly lesser than in term healthy breastfed neonates.

Objective: Despite injury being a leading cause of morbidity and mortality in children, especially in low- and middle-income countries, including India, there is a lack of pediatric-specific resuscitation training programs. This study evaluates the impact of Pediatric Trauma Resuscitation Module (PTRM) training on patient outcomes in a Level 1 trauma center in Northern India.

Methods: A pre-post-intervention study was conducted at Level 1 trauma center in Northern India. The study consisted of a 12-month pre-training phase, a 3-month PTRM training period, and a 12-month post-intervention phase. All pediatric trauma patients admitted during the two 12-month periods were enrolled. Data on patient demographics, injury characteristics, time to interventions, and outcomes were collected and compared between the two phases.

Results: A total of 164 pediatric trauma patients were included (73 pre-training, 91 post-training); both groups had comparable baseline characteristics. Post-PTRM implementation, survival at 72 h improved significantly from 86. % to 94.5%; P = 0.048, and the mean hospital stay decreased from 15.5 (4.8) to 13.2 (3.9) days (P < 0.021). Mortality within the first 60 min of admission was observed in the pre-PTRM study group (%) but was absent post-PTRM (P = 0.042). Specialist consultation times showed marked improvement, with 34.2% of patients reviewed within 1-2 h post-training compared to none pre-training (P < 0.001).

Conclusion: The study reiterates the need wider implementation of PTRM in India to improve pediatric trauma care.

Objective: The Indian Society of Pediatric Nephrology (ISPN) guidelines recommend only renal ultrasound for children > 2 years with febrile urinary tract infection (UTI), but its accuracy in predicting vesicoureteral reflux (VUR) is limited. We audited a modified top-down approach (MTDA) using late-phase Tc99m-dimercaptosuccinic acid (DMSA) scintigraphy to select patients for undergoing voiding cystourethrography (VCUG).

Methods: This is a retrospective audit of consecutive children > 2 years with febrile UTI who completed the index test (late-phase DMSA for the presence/absence of cortical scarring) and the reference standard (VCUG for the absence/presence of VUR). The main outcome measures were sensitivity, specificity, positive and negative predictive values of DMSA scan and US for detecting VUR and the number needed to diagnose (NND).

Results: A total of 224 children (mean age 3.5 years) were included. Late DMSA showed sensitivity 95.45% (95% CI 84.5-99.4%) and specificity 91.11% (95% CI 86.0-94.8%) for predicting VUR (NND 1.16). The sensitivity and specificity of renal ultrasound were 18.18% (95% CI 8.2-32.7%) and 98.89% (95% CI 96.0-99.9%); NND was 6.25. MTDA avoids 5/6 VCUGs.

Conclusion: In children > 2 years with febrile UTI, late-phase DMSA had a high diagnostic accuracy and could be used to selectively perform VCUG, reducing invasive testing.

Objective: Bioelectrical impedance analysis (BIA) measures a parameter known as Phase Angle (PhA) which reflects the cellular health. This study assessed changes in PhA and association with anthropometric and body composition parameters in children with severe acute malnutrition (SAM).

Methods: A longitudinal observational follow-up study was conducted among hospitalized children aged 12-59 months with SAM, treated at a Nutrition Rehabilitation Centre. Anthropometry and BIA, including PhA data and analyses, were performed at admission, at discharge, and 11-weeks post-discharge follow-up.

Results: Of the 141 children enrolled, 136 were successfully discharged following treatment of medical complications and stabilization. Of these, 106 (75.2%) completed nutritional rehabilitation and follow-up of 11 weeks. The median (q1, q3) hospital stay was 10 (6, 14) days with mean (SD) daily weight gain of 3.50 (- 1.8) g/kg/day. Lower PhA values were observed in children aged 24-59 months, with edema, and those from low-income households. PhA positively correlated with weight-for-height (WHZ) and body-cell-mass-index, and negatively with extracellular water. There was no significant difference in PhA (at baseline or follow-up) between those who achieved complete cure (30.2%), partial cure (51.9%) or remained SAM (17.9%). A multivariable linear regression model (R² = 0.234) showed higher PhA in children aged 12-23 months (P = 0.019), those with higher WHZ (P = 0.036) and lower body mass index-Z score (P = 0.018).

Conclusion: PhA can be a complementary marker of cellular health and nutritional recovery in SAM children. Standardized reference values are needed to enable its routine clinical use, especially in resource-limited settings.

Objective: To assess the effectiveness and safety of cyclophosphamide and topotecan in children with relapsed or refractory extracranial solid tumors.

Methods: This study included children with relapsed or refractory extracranial solid tumors treated with cyclophosphamide (250 mg/m²/day) and topotecan (0.75 mg/m²/day) for 5 days, 3-weekly, between January 2012 and February 2024. Event-free-survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results: Eighteen patients with median (range) age 6 (2-13) years (72% boys) with diagnoses of neuroblastoma (61%), Ewing sarcoma (22%), and rhabdomyosarcoma (17%), were analysed. Median of 4-cycles of chemotherapy was given, mostly as second-line (78%). Among 15 evaluable patients, responses were complete-response (CR, n = 1), partial response (PR, n = 3), stable disease (SD, n = 2), and progressive disease (n = 9); disease control rate (CR + PR + SD) 40%. The median EFS and OS were 3.65 months and 9.72 months, respectively, with 1-year EFS and OS rates of 33% and 45%. There was no treatment-related mortality.

Conclusion: Cyclophosphamide-topotecan shows efficacy and acceptable safety in pediatric relapsed/refractory solid cancers, highlighting the need for better strategies to improve outcomes.

Objective: Growth patterns are influenced by gender, race, nutrition, genetics and environment and have shown secular trends as per available data from India. This study aimed to measure the growth patterns in school-going girls from Northern India.

Methods: This prospective cohort study enrolled school-going girls aged 3-18 years in year 2018 after parental consent and assent. Weight and height were recorded during school visits on six monthly intervals for a period of 30 months. Pubertal assessment was done annually. Height velocity was computed on an annual basis. The age at onset of puberty and its progression trends were also recorded.

Results: A total of 2470 girls (n = 1413 had normal body mass index) with mean (SD) age 10.17 (3.29) years were enrolled. 1354 (54.8%) and 929 (37.6%) girls completed follow-up at 12 and 30 months, respectively. The mean (SD) age at thelarche (n = 341) and menarche (n = 552) was 10.13 (0.99) and 11.94 (1.14) years, respectively. The first-year height velocity (HV) was maximum in girls at pubertal stage 2 at 6.07 (1.86) cm/year as compared to other stages; P < 0.001. The age of thelarche and menarche was earlier in overweight/obese girls than normal BMI (P < 0.001). A significant negative correlation was seen between BMI and age at thelarche (r = - 0.113; P = 0.032) and first-year HV (r = -0.303; P < 0.001). When categorized as per pubertal onset, girls who were early maturers had higher BMI and higher height velocity than normal or late maturers (P < 0.05).

Conclusion: School going girls had a maximum growth velocity at stage 2 of puberty. A secular pattern was seen across pubertal stages as compared to the last decade.

Objective: To evaluate subclinical cardiac dysfunction and its association with treatment exposure and metabolic risk factors in a cohort of asymptomatic childhood cancer survivors (CCS).

Methods: In this cross-sectional, observational, single-centre study, pediatric and young adult CCS were evaluated. Eligible participants were diagnosed before 18 years of age and had completed cancer therapy at least two years prior to enrolment. Data on cancer history, treatment exposures, and comorbidities were extracted from electronic medical records. Cardiovascular evaluation included history, physical examination, electrocardiogram, and comprehensive 2D-echocardiography with global longitudinal strain (GLS) analysis. Cumulative anthracycline-equivalent doses (CAE) and radiation exposure to the heart were documented.

Results: Out of 456 CCS, anthracycline exposure was noted in 88% [mean (SD) CAE dose: 178.1 (123.2) mg/m²], and 6.3% had received cardiac radiation. The median (Q1, Q3) age at evaluation was 15 (10, 19) years, with a median (Q1, Q3) follow-up of 6.5 (4.9, 9.3) years. Left ventricular ejection fraction was reduced in 2.8%, while abnormal GLS was detected in 41.4%. On multivariable logistic regression, abnormal GLS was independently associated with CAE dose > 250 mg/m² (P = 0.012), obesity (P = 0.004) and hypertriglyceridemia (P = 0.05).

Conclusion: Abnormal GLS was prevalent in over 40% of asymptomatic CCS. Higher anthracycline exposure and presence of obesity and dyslipidemia were linked with subclinical cardiac dysfunction. These findings underscore the need for routine cardiac surveillance using strain imaging and aggressive management of modifiable risk factors to mitigate long-term cardiovascular morbidity in CCS.

Objective: To estimate the incidence of hypertension during induction therapy in children with acute lymphoblastic leukemia (ALL), comparing a systematically monitored prospective cohort to a retrospective cohort lacking regular blood pressure monitoring.

Methods: This ambispective observational study was conducted at a pediatric hematology-oncology unit in Chandigarh, India. The prospective cohort included 46 children with B-/T-ALL or T-cell non-Hodgkin lymphoma enrolled between September 2023 and August 2024, whose blood pressure was monitored weekly during induction therapy using the auscultatory method with an aneroid sphygmomanometer. Hypertension was defined according to the 2017 American Academy of Pediatrics guidelines. The retrospective cohort comprised 160 children diagnosed between June 2022 and July 2023, whose case files were reviewed for documented hypertension or posterior reversible encephalopathy syndrome (PRES). In the retrospective cohort, blood pressure was not monitored systematically and was detected incidentally during routine care or at the time of admission for intercurrent illnesses.

Results: Hypertension was observed in 27 (58.7%) patients in the prospective cohort, compared to 20 (12.5%) in the retrospective (P < 0.001). Most (92.6%) cases of hypertension in the prospective cohort occurred within the first two weeks of induction. No case vs. two (1.3%) cases of PRES were reported in the prospective and retrospective cohorts.

Conclusion: The incidence of hypertension during induction therapy in childhood ALL was 58.7%, with most cases occurring within the first two weeks. Incorporating blood pressure monitoring into routine care is essential for children with ALL receiving induction chemotherapy.