Indian pediatrics最新文献

We analyzed the records of 869 children who underwent flexible bronchoscopy. We found procedural complications in 6.7% (n = 59), with severe events in 3.2% (n = 28). Age < 1 y, recurrent respiratory papillomatosis, and finding lower airway malacia on bronchoscopy were identified as independent risk factors for developing complications with adjusted odds ratio (95% CI) of 2.6 (1.3, 4.9); P = 0.004; 5.4 (1.7, 17.6); P = 0.005 and 2.1 (1.1, 4.0); P = 0.031, respectively.

Adoption provides a unique opportunity to establish stable family relationships and enhance the social safety net. In India, adoptions are governed by the Hindu Adoption and Maintenance Act, 1956, and the Juvenile Justice (Care and Protection of Children) Act, 2015, each with distinct eligibility criteria. Currently, approximately 33,870 Indian couples are registered as prospective adoptive parents (PAPs), and this number is rising. The Central Adoption Resource Authority (CARA) website lists 2,140 children available for adoption, with 731 being categorized as normal and 1,409 as special needs. CARA, under the Ministry of Women and Child Development, oversees both domestic and international adoptions of legally free orphaned, abandoned, and surrendered children. The scope of adoption has expanded from primarily young infants to include older children, children with special needs, and foster care, in line with the National Child Policy. Pediatricians play a crucial role in the adoption process, understanding medical aspects within the legislative framework and acting in the child's best interests. This involves collaborating with multiple stakeholders, conducting comprehensive pre-adoption medical examinations, and providing ongoing medical and behavioral support post-adoption. This review emphasizes recent changes in adoption practices in India and highlights the evolving role of pediatricians as champions for these children and their adoptive families.

Over investigations contribute to escalating health costs driven by multiple factors including physician decisions, patient requests, information overload, technological advances, marketing, hospital management policies, insurance requirements and defensive practices. The reconciliation between knowledge and clinical wisdom while dealing with uncertainties in medicine is the primary way forward through this ethical maze. A case scenario illustrates what pediatricians need to reflect upon while facing decisions on rational investigations to maximize beneficence while being aware of economics of healthcare delivery.

Context

Heel prick is one among the common painful procedures in neonates. We performed a systematic review and network metaanalysis (NMA) to compare the efficacy of different interventions for analgesia during heel prick in neonates.

Evidence acquisition

Medline, Cochrane, Embase and CINAHL databases were searched from inception until February 2023. Randomized and quasi-randomized trials that evaluated different pharmacological and non-pharmacological interventions for analgesia during heel prick for neonates were included. Data from the included trials were extracted in duplicate. A NMA with a frequentist random-effects model was used for data synthesis. Certainty of evidence (CoE) was assessed using GRADE. We adhered to the PRISMA-NMA guidelines.

Results

One-hundred-and-three trials comparing 51 different analgesic measures were included. Among the 38 interventions, for pain “during” heel prick, non-nutritive suckling (NNS) plus sucrose [SMD Ȓ3.15 (Ȓ2.62, Ȓ3.69)], followed by breastfeeding, glucose, expressed breast milk (EBM), sucrose, NNS and touch massage, had a high certainty of evidence (CoE) to reduce pain scores when compared to no intervention. Among the 23 interventions for pain at 30 seconds after heel-prick, moderate CoE was noted for facilitated tucking plus NNS plus music, glucose, NNS plus sucrose, sucrose plus swaddling, mother holding, EBM, sucrose and NNS.

Conclusions

Oral sucrose 2 minutes before combined with NNS during the procedure, was the best intervention for reducing pain during heel prick. It also effectively reduced pain scores 30 seconds and 1 minute after the procedure. Other interventions with moderate to high CoE for a significant reduction in pain during and at 30 seconds after heel prick are oral sucrose, oral glucose, EBM and NNS. All these are low-cost and feasible interventions for most of the settings.

Asthma poses significant challenges in pediatric care, particularly in resource-limited settings. The Global Initiative for Asthma (GINA) 2024 guidelines represents a crucial step forward in addressing these challenges. This review critically evaluates the guidelines, focusing on their implementation and impact in developing countries like India. There have been certain key updates including a revised diagnostic flow chart and emphasis on alternative tools like peak flow meters. Challenges related to bronchodilator reversibility and interpreting FEV1/FVC are also explored. The article further addresses the implications of bronchial provocation testing in pediatric asthma. Detailed insights into cough-variant asthma highlight its rising recognition and management strategies. The GINA 2024 guidelines reflect updated criteria for commencing a particular step of therapy, aiming to optimize management and outcomes in pediatric asthma care. The guidelines have updated the role of allergen immunotherapy in pediatric asthma based on emerging evidence of efficacy and safety. Overall, the GINA 2024 guidelines offer a realistic approach to pediatric asthma care, with a potential for broader applications pending further research and adaptation.

Objective: To study the prevalence of macrophage activation syndrome (MAS) in children with Kawasaki disease (KD) and to devise a classification tree for predicting MAS in early KD based on easily available clinical and laboratory information using artificial intelligence (AI) technology.

Methods: A cross-sectional observational study was conducted (March 2020 - October 2021) during which hospitalized children aged 1-18 years with KD were consecutively enrolled. Those with a positive RTPCR test or IgM/IgG serology for COVID-19 were excluded. The clinical and laboratory profiles of children with and without MAS were studied. A multivariable logistic regression (LR) model was developed utilizing backward elimination method to determine the relationship between select candidate predictor variables and MAS in patients with KD. A classification tree was created based on these using artificial intelligence algorithms.

Results: Sixty-two children were diagnosed with KD during the study period, of these, 42 children with KD were included; 14 (33.3 %) were diagnosed with MAS. The median (IQR) duration of fever (days) was significantly more in MAS than those without MAS [7 (5, 15) vs 5 (5, 9), P < 0.05]. Serum albumin (g/dL) was significantly lower in those with MAS [2.3 (2.2, 2.7) vs 2.8 (2.3, 3.1), P = 0.03]. The classification tree constructed using the AI-based algorithm predicted that in children with KD who had myocardial dysfunction, serum albumin < 2.8 g/dL and fever > 6 days duration at admission had an increased likelihood of developing MAS. In children without myocardial dysfunction, alanine transaminase (ALT) levels > 70 U/L and fever > 5 days were equally predictive of MAS.

Conclusion: Nearly one-third of the children with KD had MAS. Clinicians should consider screening all children with KD for MAS at admission. A classification tree based on the presence of myocardial dysfunction, duration of fever > 6 days, ALT levels and hypoalbuminemia can identify MAS in the course of KD.

Objective: To study the differences in allergen sensitization of parents and their offspring with respiratory allergic diseases.

Methods: We included parents and their children who were both diagnosed with allergic asthma and/or allergic rhinitis, between January 2018 and December 2022. Parent-child dyads were evaluated for sensitization to six categories of allergens viz, dust mite, fungus, animal dander, weed pollen, tree pollen and food allergen, by measuring the allergen-specific immunoglobulin E levels (sIgE). Data of gender, age, feeding history, serum total IgE (tIgE), and absolute eosinophil counts (AEC) were collected and analyzed for differences in allergen sensitization of parents and children.

Results: Overall, the AEC in children were significantly higher than that of parents. The sensitivity to fungal allergens in children was significantly higher than that in fathers (33.3% vs 6.7%, P = 0.01) as well as mothers (29.3% vs 8.3%, P = 0.03). Sensitization to food allergens was also higher in children compared to fathers (25.4% vs 7.9%, P = 0.01). Fathers with tree pollen allergen sensitivity, and mothers with weed pollen allergen sensitivity had a significantly increased risk (aOR, 95% CI) of having increased sensitivity to these allergens in their offspring; 24.01 (1.08, 53.99; P = 0.04) and 3.27 (1.08, 9.92; P = 0.04), respectively.

Conclusion: Children had greater sensitivity for fungal allergens compared to both parents, as well as food allergy compared to fathers. Fathers with tree pollen allergen sensitivity, and mothers with weed pollen allergen sensitivity had an increased risk of having their children sensitive to these types of allergens.