Indian pediatrics最新文献

Objectives: To correlate the inferior vena cava/aorta diameter (IVC/Ao index) in children with nephrotic syndrome with clinical indicators of volume status, and to compare the IVC/Ao index between children in relapse and in remission.

Methods: This prospective longitudinal study included children aged 2-18 years presenting with relapsed nephrotic syndrome. Low intravascular volume status was diagnosed if two of the three criteria (tachycardia, hypotension, prolonged capillary filling time) were present. Sonographic measurements of the IVC and aorta diameter were obtained by a single observer at recruitment and after achieving remission.

Results: One hundred and three children (73 boys) with a median (Q1, Q3) age 72 (24, 216) months were recruited. 26 (25%) children had low intravascular volume at recruitment. The mean (SD) IVC/Ao index was lower in low volume status compared to normal volume status [0.74 (0.2) vs 0.83 (0.1); P = 0.090]. The correlation between IVC/Ao index and heart rate (r = -0.29, P = 0.003) and mean arterial pressure (r = 0.23, P = 0.018) was weak. IVC/Ao index was not an independent predictor of volume status (OR = 0.04, P = 0.331). The mean (SD) IVC/Ao index increased significantly from when in relapse to remission [0.94 (0.1) vs 1.05 (0.2), respectively; P = 0.001].

Conclusions: The IVC/Ao index was lower in relapse than in remission, and did not predict low intravascular volume status independently.

An observational hospital-based study included 50 children aged 1-18 years with chronic kidney disease (CKD) to ascertain the prevalence of hypothyroidism. Out of 50 enrolled cases 13 had hypothyroidism (serum free thyroxine < 0.93 ng/dL and thyroid stimulating hormone > 5.2 mIU/L). The incidence of hypothyroidism was 23% (3/13) in CKD stage 2/3, 27% (10/37) in CKD stage ≥ 4. Hypothyroidism was present in 20% patients having spot urinary protein to creatinine ratio (UP:UC) between 0.2 and < 2, and 39.1% with UP:UC > 2. Hypothyroidism was more common in children with advanced CKD and those with greater proteinuria. No child had detectable thyroid peroxidase antibodies.

Objective: To assess the behavioral adverse effects associated with the use of levetiracetam in drug-naïve children with epilepsy, either as monotherapy or as part of anti-seizure medications polytherapy.

Methods: This prospective cohort study was conducted in the pediatrics department of a public hospital from October 3, 2024, to July 26, 2025. Typically developing children aged 4-12 years with epilepsy were consecutively enrolled, if they were being planned to be initiated on levetiracetam therapy, either as monotherapy or as an add-on therapy. Behavioral problems were assessed prior to starting levetiracetam using Strength and Difficulties Questionnaire (SDQ) and Child Behavior Checklist (CBCL) and repeated at 14 (+ 3) days and 6 (+ 1) weeks of follow-up.

Results: The study included 60 children with mean (SD) age of 7.75 (2.48) years. At enrollment, behavioral problems were not observed in any child (scores in the normal range). Proportion of those with behavioral problems in any sub-domain in either of the tools at follow-up was 3.3% at 14 days and 11.7% (95% CI 5.77-22.18%) at 6 weeks. Behavioral problems based on total scores, of either tool, were present in 6.7% (95% CI 2.6-16.0%) at 6-week follow-up. Behavioral adverse effects were found to be statistically associated with use of higher doses of levetiracetam (> 30 mg/kg/day), with dose and total CBCL scores [r (95% CI) = 0.542 (0.33-0.70); P < 0.001] and total SDQ scores [r (95% CI) = 0.515 (0.30-0.68); P < 0.001] showing significant correlation. The discontinuation rate was 1.7% (n = 1).

Conclusion: There is a need of close surveillance for neurobehavioral morbidity in children with epilepsy receiving levetiracetam, especially those receiving high doses.

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.