Indian pediatrics最新文献

Objective: To describe the genotype-phenotype characteristics of patients with 21-hydroxylase deficiency from western India and ascertain the prevalence of various phenotypes of 21-hydroxylase deficiency.

Methods: Patients with 21-hydroxylase deficiency, diagnosed clinically and biochemically, were prospectively enrolled and classified into salt wasting (SW), simple virilizing (SV), and non-classic (NC) phenotypes and were subjected to genetic testing of CYP21A2 by targeted sequencing and multiplex ligation-dependent probe amplification (MLPA).

Results: Eighty (64; 46, XX) probands with 21-hydroxylase deficiency were analyzed. 41 had SW, 34 had SV, and 5 had NC phenotype. Disease-causing mutations were identified in 158/160 alleles. The common mutations were Deletions/Large Gene Conversions (Del/LGC, 25.6%), p.293-13A/C>G (22.5%), and p.Ile173Asn(18.75%). Exon 6 cluster mutations (Ile236Asn, Val237Glu, Met238Lys) and p.Val282Leu were absent. c.-113G>A+p.Pro31Leu (6.87%) and p.Phe405Ser (2.5%) were rare recurrent mutations with a possible founder effect. Two novel variants (Exon 1, p.Leu49Arg, Exon 8, p.Leu362Ter) were identified and were estimated to have low enzyme activity (<2%).

Conclusion: Del/LGC were the most common mutations identified. The c.-113G>A+p.Pro31Leu and p.Phe405Ser were recurrent variants with possible founder effect. This study also reiterates the low prevalence of NC CAH in Indian cohorts.

Objective: To evaluate the change in the neurodevelopmental status of children (1-30-months-old) with severe acute malnutrition (SAM) following nutritional rehabilitation.

Methods: A prospective study was conducted in the Severe Malnutrition Therapeutic Unit (SMTU) of a tertiary hospital in Central India, between April 2021 and October 2022. Children with primary neurological conditions like cerebral palsy and epilepsy were excluded. Neurodevelopment was assessed using the Developmental Assessment Scale of Indian Infants (DASII) at admission and following nutritional rehabilitation as per the National Health Mission (NHM) guidelines at the time of discharge, 2 months and 4 months follow-up. Developmental quotient (DQ) ≤ 70 was considered delayed.

Results: 114 children with SAM were included; 4 were lost to follow-up. There was an increase in Motor Developmental Quotient (MoDQ) and Mental Developmental Quotient (MeDQ) at discharge, 2 months, and 4 months. The improvement in MoDQ and MeDQ was greater in children with adequate weight gain. Poor weight gain, higher age of presentation and lower MeDQ and MoDQ at admission were associated with persistent developmental delay at 4 months follow-up.

Conclusion: There was a consistent improvement in DQ with improvement in nutritional status.

The health and welfare of children and adolescents-the nation's future-must always be a priority. One would, therefore, expect this to be reflected in the manifestos of political parties. This article suggests that pediatricians and the Indian Academy of Pediatrics (IAP) should play a more proactive role in influencing political parties to commit to an inclusive manifesto that addresses key issues related to child health and welfare, by also liaisoning and collaborating with other stakeholders, such as parents, educators, and child rights organizations.

Objective: To design a specific advanced life support (ALS) tape based on recent Indian multicenter height/length and weight data to accurately estimate the weight from the recumbent length.

Methods: We designed the new ALS tape by matching the median weights to median heights/lengths from the recently published Indian multicenter growth data, maintaining the same color codes as the Broselow tape. The accuracy of weight estimation for the newly designed ALS tape was validated and compared with the Broselow estimated weights at a tertiary care hospital.

Results: The color (weight) band matched median heights (cm) from the new ALS tape were higher (53.0 vs 53.9 for grey, 63.1 vs 67.4 for pink, 70.6 vs 76.4 for red, 79 vs 85.5 for purple, 89.6 vs 95.5 for yellow, 101.9 vs 107.5 for white, 126.1 vs 130.5 for orange and 137 vs 140.5 for green) than the Broselow tape. For every color band on the newly designed ALS tape, a sizable proportion of children (27% for grey, 78% for pink, 83% for red, 38% for purple, 63% for yellow, 41% for white, 35% for blue, 54% for orange) recorded a higher Broselow color band, suggesting overestimated weights at each color band. The percentage difference in the estimated weight from the actual weight was very small (-0.5% for under-5 years and 0.2% for older children) using the new ALS tape as compared to Broselow tape.

Conclusion: This Indianized ALS tape estimated Indian children's weights more accurately. Use of the newly designed ALS tape may reduce the errors in calculating emergency medications, fluids and equipment sizes. Further studies are required to validate this tape in pediatric emergency departments in India.

Objective: To investigate the prevalence of problematic internet use (PIU) among adolescents and determine the associated factors contributing to PIU.

Methods: In April/May 2023, a cross-sectional study was conducted among adolescents studying in grades 9 to 12 in government and private non-residential schools in Western Tamil Nadu, India. Participants completed a semi-structured questionnaire assessing demographic characteristics, behavioral patterns, and internet usage. The Problematic and Risky Internet Use Screening Scale (PRIUSS) was employed to quantify PIU.

Results: Out of 1795 participants, 398 (24.5%) were identified with PIU. Prevalence rates of PIU were similar between adolescents studying in English (n = 189; 25.4%) and Tamil medium (n = 209; 23.7%), with no significant differences based on gender [boys (n = 270, 25.4%) and girls (n = 121, 22.2%)]. Students possessing personal gadgets showed higher PIU [n = 287 (27%) Vs. n = 111 (20%)]. Specific risk factors for PIU identified students in English medium and scoring below 80% [OR (95%CI) 1.5 (1.1, 2.3); P = 0.029 ] and those with multiple gadgets at home [1.3 (1.01, 1.7); P = 0.04].

Conclusion: Adolescents have a high prevalence of PIU. Implementing school-based educational programs will mitigate excessive internet usage.

Objectives: To assess the association between monocytic Human Leukocyte Antigen-DR (mHLA-DR) expression and outcome in children with severe sepsis.

Methods: Consecutive children, aged 29 days to 15 years, who were admitted with severe sepsis or septic shock in the pediatric intensive care unit (PICU) were enrolled. mHLA-DR expression [antigen bound per cell (ABC)] was assessed on two time points: between 72 to 120 hours (P1) and 121 to 168 hours (P2), of stay in PICU and the difference between the two was calculated as delta mHLA-DR. Outcomes were noted for survival, mortality and secondary infection during the hospital stay.

Results: Forty-seven children with median (IQR) age 24 (10, 96) months and a median (IQR) duration of illness of 3 (3, 5) days, were enrolled consecutively. Pediatric Logistic Organ Dysfunction (PELOD) score >10 was observed in 63.8% children. 18 children succumbed. The median mHLA-DR levels (ABC) at P1 were significantly higher in children who survived as compared with those who expired (7409 vs. 2509, P = 0.004). Similarly, the median mHLA-DR levels (ABC) at P2 were higher in those who survived than the expired group (14728 vs. 2085, P = 0.001). The median delta mHLA-DR levels (ABC) were 4574 and 309 for the survived and expired group, respectively (P = 0.012). mHLA-DR at P1 (P = 0.004), mHLA-DR at P2 (P = 0.001) and delta mHLA-DR (P = 0.012) was significantly associated with mortality but not associated with secondary infection. A negative correlation was observed between PELOD score and mHLA-DR at P1 (r = -0.25, P = 0.46), at P2 (r = -0.425, P = 0.018) and delta mHLA-DR (r = -0.27, P = 0.41). The area under curve (95%CI) of mHLA-DR expression (ABC) at P2 for a cutoff of < 6631 was 0.966 (0.907, 1.0) to predict mortality in severe sepsis.

Conclusions: mHLA-DR levels were significantly lower in children who succumbed than those who survived at both time points. mHLA-DR levels can be a useful biomarker to diagnose immune-paralysed state.

Objective: To evaluate the effects of perioperative active warming on the core body temperature, postoperative pain, shivering and agitation in pediatric patients.

Method: Children aged 2-6 years undergoing elective surgery, including orthopedic soft tissue surgeries, ear nose throat surgical procedures and general surgical interventions, all performed under general anesthesia, were randomized to receive either active warming (using the forced-air warming gowns, Bair Hugger, in the pre- and postoperative period, and a carbon fiber blanket in intraoperative period; Group A), or conventional warming using green blankets pre-and post-operatively and a carbon fiber blanket intraoperatively (Group B). Children undergoing emergency surgery, surgeries involving major body cavities (abdominal, thoracic, cranial surgery), or those with endocrinological pathologies, or baseline fever, were excluded. Core body temperature (t-core), postoperative pain, shivering and agitation scores were compared between the two groups.

Results: Seventy children were included, with 35 in each group. No significant difference was observed between the groups in t-core values at 0 and 15 minutes preoperatively (P > 0.05). However, the value at 30 minutes preoperatively and all subsequent t-core values were higher in Group A (P < 0.001). Postoperative pain and shivering scores at 0 minutes, 30 minutes and 6 hours were significantly lower in Group A compared to Group B. No significant difference was observed in agitation scores in the immediate postoperative period, although, Group A showed reduced agitation at 30 minutes (P = 0.03).

Conclusion: Active warming in the pre- and post-operative period significantly maintained higher core temperatures and reduced postoperative pain and shivering in children undergoing surgery compared to those receiving conventional passive warming measures in the pre- and post-operative period.