Indian pediatrics最新文献

Objectives: To analyze the profile and outcomes of Indian children with hereditary tyrosinemia type 1 (HT-1).

Methods: In this retrospective study, the data of children with a confirmed diagnosis of HT-1 from 2013 to 2024 admitted in the pediatric hepatology unit of a tertiary care referral center were analyzed.

Results: Eighteen children with HT-1 with a median (Q1, Q3) age of diagnosis of 15.5 (6, 44) months were included. All children had established cirrhosis. Hepatocellular carcinoma (HCC) was noted in 4 patients at baseline, while HCC developed in 4 children on follow-up. Only 7 (38.9%) children could be initiated on nitisinone or 2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cyclohexanedione (NTBC). In the NTBC group (n = 7), one child survived with native liver, 3 children underwent liver transplant (LT) and 3 died. In the non-NTBC group (n = 11), 4 underwent LT (rest died). Post-LT survival was 100% without new-onset/recurrent HCC.

Conclusion: Native liver outcomes for HT-1 in the Indian subcontinent remain dismal with a high proportion developing HCC and requiring LT for optimum outcomes.

Objective: To investigate the impact of macrolide resistance and Mycoplasma pneumoniae DNA (MP-DNA) load in bronchoalveolar lavage fluid (BALF) on immune and inflammatory responses in children with Mycoplasma pneumoniae pneumonia (MPP).

Methods: This retrospective study included 190 hospitalized children with MPP who underwent bronchoscopy. Patients were classified as macrolide-resistant or macrolide-sensitive based on 23S rRNA mutation analysis. MP-DNA load and cytokines in BALF and inflammatory markers in blood were measured. MRMP patients were further stratified by MP-DNA load for subgroup analysis.

Results: Of 1029 children screened, 474 had MPP, and 190 who underwent bronchoscopy were analyzed. Macrolide-resistant mycoplasma pneumonia (MRMP) accounted for 73.2% of cases and was associated with longer fever duration and hospital stay, lower lymphocyte counts, higher BALF total cell counts and neutrophil proportions, and increased inflammatory cytokines. Among MRMP patients, those with high MP-DNA loads had greater BALF cytokine levels than those with low loads. MP-DNA load positively correlated with IL‑1β and IL‑6 levels.

Conclusions: Macrolide resistance and high pathogen load are associated with enhanced airway inflammation and immune dysregulation in children with MPP. Early detection of resistance and quantification of pathogen load may guide timely antibiotic adjustment and improve clinical outcomes.

Objective: This study aimed to determine whether using videoconferencing for pediatric intensive care unit (PICU) rounds with the help of a tele-PICU kiosk in addition to standard care impacts survival outcomes and duration of hospital stay.

Methods: An open-label randomized controlled trial was conducted in the PICU of a tertiary care center in India on a sample size of 120 children, randomized into two groups using computer-generated randomization tables. Patients with a PICU stay of < 24 h were excluded. The intervention group received tele-rounds using the tele-PICU kiosk daily for the first 3 days or discharge, whichever was earlier, in addition to standard care, while the control group received standard care. Consultation feedback was given to the treating team. Both groups were followed-up for survival outcome at the time of hospital discharge and 60 days after discharge.

Results: The intervention group had better patient survival at the time of discharge [51 (85%) vs. 41 (68.3%), P = 0.031; RR 2.63 (95%CI 1.07-6.42)] and at 60 days after hospital discharge [49 (81.7%) vs. 38 (63.3%), P = 0.025; RR 2.58 (95% CI 1.11-5.96)]. The intervention group had a significantly shorter duration of hospital stay [8 (5, 13) vs. 13 (7, 21) days, P = 0.044) and PICU stay [1.5 (1, 8) vs. 4 (1, 15) days; P = 0.045). The median cost difference shows a reduction in direct cost, but it could not achieve statistical significance.

Conclusion: Tele-rounds using tele-PICU kiosk as an adjunct to standard care showed better survival, reduced duration of hospital and PICU stay, and reduced cost trends for children admitted to the PICU.

Objectives: To compare the levels of organochlorine pesticide (OCP) residues in sera and bone marrow of children with malignant and non-malignant hematological disorders (HDs) with those in healthy controls.

Methods: This case-control study was conducted among children aged ≤ 12 years with malignant and non-malignant HDs and non-anemic healthy controls. Children with gross congenital malformations, neurodevelopmental disorders, and chronic systemic diseases were excluded. OCPs were estimated in sera and bone marrow aspirate using gas-liquid chromatography/⁶³Ni electron capture detection.

Results: Thirty children, each, with malignant HDs, non-malignant HDs, and controls, were included. The median (Q1, Q3) serum total OCPs (ng/mL) were significantly higher in children with malignant and non-malignant HDs compared to controls [38.67 (33.64, 42.51); 32.72 (17.26, 41.60); and 14.11 (12.82, 16.40)]; levels were significantly higher in the malignant versus non-malignant HD group. The median (Q1, Q3) serum levels of total hexachlorocyclohexane [3.30 (2.23, 4.28) vs. 2.16 (1.31, 3.31) ng/mL] and β-hexachlorocyclohexane [0.98 (0.67, 1.68) vs. 0.54 (0.10, 0.77) ng/mL] levels were significantly higher in children with non-malignant HDs compared to malignant HD, respectively. The median (Q1, Q3) total bone marrow OCPs (ng/mL) were significantly higher in the malignant HD group [23.53 (20.83, 26.91)] compared to the non-malignant HD group [17.41 (0, 25.63)]; bone marrow endosulfan II (ng/mL) was significantly higher in the non-malignant HD group [1.56 (0.56, 3.89)] compared to malignant HD group [0.45 (0.35, 1.72)].

Conclusion: Children with HDs had significantly higher OCP residues in sera compared to controls. The cumulative OCP residues in sera and bone marrow were significantly higher in children with malignant versus non-malignant HDs.

Context: Pediatric feeding disorder (PFD) is characterized by age-inappropriate oral intake associated with dysfunction in feeding skills, medical, nutritional, or psychosocial domains. Children with developmental disabilities (DD), such as cerebral palsy (CP), often meet the criteria for PFD due to underlying neurological, motor, and sensory impairments, compounded by psychosocial stressors. These challenges contribute to undernutrition, poor growth, and adverse developmental outcomes, but remain undiagnosed. This review evaluates the burden and spectrum of feeding problems in children with developmental disabilities and aims to bridge gaps in clinical awareness, assessment, and intervention. Evidence acquisition A literature search was conducted using PubMed, Scopus, and Google Scholar for studies published between January 2015 and January 2025. Keywords included: "children" OR "childhood" AND "feeding problems" OR "feeding disorders" OR "malnutrition" OR "dysphagia" OR "drooling" OR "food aversion" OR "oral sensory processing disorders" AND "cerebral palsy" OR "developmental disabilities" OR "neurological impairment."

Results: Forty studies were included wherein feeding disorders were observed in 33-80% of these children. Physical anomalies, swallowing dysfunction, restricted diets, and socio-cultural factors were observed to be responsible for feeding difficulties which ranged from dysphagia, swallowing dysfunction, gastroesophageal reflux disease, constipation, sensory issues and food aversions. A systematic approach-objective assessment of nutritional status, calculating dietary needs, evaluating safety and efficiency of oral feeding, optimizing intake, considering enteral nutrition when indicated-can improve outcomes.

Conclusion: Feeding disorders are a significant yet modifiable source of morbidity in children with DD. Early recognition and multidisciplinary, evidence-based approach are critical to improving their quality of life.

Objectives: To establish age-specific normative reference values for mean testicular volume and serum testosterone levels in apparently healthy north Indian boys aged 5-20 years (with centile curves extended to 4-20 years), and to evaluate their associations with anthropometric, biochemical, and pubertal indicators.

Methods: In this observational cross sectional study, apparently healthy boys aged 5-20 years were recruited from schools and community centers in northern India (2019-2023). Testicular volume was measured using Prader's orchidometer, and serum testosterone via chemiluminescence immunoassay. Secondary measures included anthropometry, biochemical markers [luteinizing hormone (LH), follicle-stimulating hormone (FSH), vitamin D, albumin], and body composition by bioelectrical impedance analysis (BIA).

Results: In a total of 1,022 boys, both testicular volume and serum testosterone levels exhibited significant age-related increases (most marked progression between 11 and 15 years. After adjusting for age, higher testicular volume was significantly associated with increased BMI, LH, FSH, muscle mass, and bone mass (P < 0.001), while no significant association was found with vitamin D or albumin levels. Age-specific centile curves for both parameters were generated using the LMS method.

Conclusions: This large-scale study provides age-specific normative reference values for testicular volume and serum testosterone in apparently healthy boys from a single center in northern India. These values are clinically valuable for assessing pubertal progression and managing growth and endocrine disorders in Indian populations.

Ultra long-acting beta-agonists (ULABAs) have emerged as key therapeutic agents in the management of chronic obstructive pulmonary disease (COPD) and asthma, offering prolonged bronchodilation and symptom control in adults. Their extended duration of action, often exceeding 24 h, reduces the need for frequent dosing, enhancing adherence and simplifying treatment regimens. However, the use of ULABAs in children presents unique challenges, including age-specific pharmacodynamics, safety concerns, and the need for appropriate combination therapies with inhaled corticosteroids. Current research suggests potential benefits in improving lung function and the quality of life, yet robust evidence remains limited. Regulatory guidelines vary, emphasizing the cautious application of ULABAs in children, particularly under 12 years, due to concerns about adverse effects and optimal dosing. Future research should address these gaps, focusing on long-term safety, efficacy, and the role of personalized approaches to optimize asthma outcomes in this vulnerable population.