Indian pediatrics最新文献

Objective: To estimate the prevalence of various hemoglobinopathies among newborns, women in antenatal clinic and children presenting with signs and symptoms suggestive of sickle cell disease (SCD).

Methods: A hospital-based prospective study was conducted at a Centre of Excellence for SCD (COESCD). Dried blood spot (DBS) samples were collected for newborn screening using heel-prick and venous samples were used in the post-neonatal age group. Hemoglobin variant analysis was performed using high-performance liquid chromatography (HPLC).

Results: Out of 26,642 neonates screened, 1.87% (n = 498) were found to have abnormal hemoglobin patterns. The prevalence of hemoglobin variants detected among women screened during antenatal check-up and children with signs and symptoms of SCD were found to be 6.11% and 22.69%, respectively.

Conclusion: Intensive screening programs have led to detection of a large number of cases with hemoglobinopathies including rare hemoglobin variants.

Objective: To compare Clinical Risk Index for Babies (CRIB) II score and Extended Sick Neonatal Score (ESNS) for predicting in-hospital mortality in premature neonates with gestational age ≤ 32 weeks.

Method: This prospective observational study included 110 preterm neonates less than equal to 32 weeks of gestation. Clinical parameters of CRIB II score and ESNS were documented at time of admission and laboratory parameter were obtained with 24 h. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio of the two scores as a predictor of mortality were compared.

Result: The sensitivity, specificity, PPV, NPV and the Area under the Receiver Operating Characteristic (ROC) curve of CRIB II score at a cut-off value of ≥ 10 were 85.2%, 96.4%, 88.5%, 95.2%, ands 0.91 (95%CI 0.83, 0.98) respectively. The corresponding values for ESNS at a cut-off value of ≤ 11, were 77.8%, 71.1%, 46.7%, 90.8% and 0.85 (95%CI 0.78, 0.92) respectively. CRIB II score had better predictive accuracy for in-hospital mortality among premature neonates compared to ESNS (0.93 v 0.73).

Conclusion: Both CRIB II and ESNS are useful tools to predict the risk of mortality during hospital stay in premature neonates. However, CRIB II score has a better predictive ability for in-hospital mortality in comparison with ESNS.

Context: Early identification and treatment of meningitis in early infancy is crucial for improved outcomes. However, the commonly used cerebrospinal fluid (CSF) markers for diagnosing meningitis have poor diagnostic accuracy.

Objective: To assess the diagnostic utility of CSF procalcitonin for diagnosing meningitis in infants with postnatal age less than 90 days.

Evidence acquisition: We searched databases, including MEDLINE, Embase, and Scopus, from inception to 15 March 2025. We included observational studies that used CSF procalcitonin as a marker for diagnosing meningitis in infants with a postnatal age of less than 90 days. The risk of bias was assessed using the QUADAS-2, and the certainty of evidence was ascertained using GRADE approach. The bivariate random effect model and hierarchical summary receiver operating characteristic meta-analysis were used to pool data with multiple thresholds.

Results: Out of 815 retrieved records, seven studies involving 963 infants were included in the meta-analysis. We obtained diagnostic accuracy measures at commonly used threshold cut-offs of 0.20 ng/mL and 0.33 ng/mL. At a CSF procalcitonin threshold cut-off of 0.20 ng/mL, the pooled sensitivity (95%CI) was 77.1% (49.2%, 92.1%), and the pooled specificity (95%CI) was 68.9% (49.2%, 83.5%). At a cut-off of 0.33 ng/mL, sensitivity was 75.8% (50.1%, 90.7%) and specificity was 75.1% (58.5%, 86.6%). The certainty of evidence remained very low for both sensitivity and specificity.

Conclusion: CSF procalcitonin has moderate sensitivity and specificity for diagnosing meningitis in infants with postnatal age < 90 days. However, wide confidence intervals and very low certainty of evidence limit the reliability of these findings.

Fifteen sick neonates were transported to higher-level neonatal intensive care units (NICUs) using specially equipped aircraft with trained medical teams. The median (Q1, Q3) one-way distance traveled (km) was 710 (689, 1224.5), and the median (Q1, Q3) transit time and airborne time were 6 (5.5, 7) and 1.25 (1.22, 2.15) hours, respectively. Thirteen neonates needed mechanical ventilation and five needed inotrope support during transit. The median (Q1, Q3) NICU stay was 20 (13.5, 35) days. Twelve neonates (80%) were discharged, two (13.3%) left against medical advice, and one died. Air ambulance is a feasible, effective, and safe mode of transportation of critically ill neonates in India.

Objective: To evaluate the effect of biologic therapy, school success, parental education and socioeconomic status on transition readiness of adolescent patients with juvenile idiopathic arthritis (JIA) and their parents.

Methods: This cross-sectional study enrolled adolescent patients with JIA from two pediatric clinics. Juvenile Arthritis Disease Activity Score was calculated, and Transition Readiness Assessment Questionnaire (TRAQ) was administered to the patients and their parents. Demographic and clinical data were collected.

Results: The study included 91 JIA patients (median age 15.32 years, range 11.58-18 years) and their parents; 36 had active disease. Biologic usage was significantly associated with transition readiness of children (P = 0.038) and their parents (P = 0.035). School success was associated with higher levels of transition readiness; TRAQ was significantly lower in observed groups with "good" school success compared to "very good" (P = 0.024; P = 0.002) and "excellent" (P = 0.010; P = 0.012). Parents' education or socioeconomic status has no influence on transition readiness.

Conclusion: Biologic usage and better school performance have a positive impact on the patients and their parents' transition readiness.

Objective: India has the highest number of stillbirths worldwide. However, the disease and economic burdens of stillbirths in India remain missing. This study aimed to estimate the disease and economic burden associated with stillbirths in India and its states for 2019.

Methods: A retrospective analysis was conducted using stillbirth data from the health management information system (HMIS) and civil and sample registration systems (CRS and SRS) for India and its states. Disease burden was calculated as disability-adjusted life years (DALYs) and economic burden as value of life years (VLYs). A sensitivity analysis for disease burden estimation was performed using a framework that estimated DALYs using a stillbirth-adjusted life expectancy.

Results: Indian HMIS reported 263,342 stillbirths in 2019. Nationally, stillbirths led to 18.3 million DALYs and a monetary loss of INR 7.80 trillion. Uttar Pradesh, Maharashtra, Rajasthan, Madhya Pradesh, Gujarat, and West Bengal contributed to more than 40% of the burden. The sensitivity analysis showed consistent findings.

Conclusion: Stillbirths should be prioritized in the public health agenda as they contribute to a high burden of disease and disability.

Objective: This study assessed the psychological distress, depression, and burden among primary caregivers of children with steroid-sensitive nephrotic syndrome (SSNS) and explored its association with disease severity and patient/caregiver demographics.

Methods: Psychological assessment of primary caregivers of children aged 6 months to 15 years with SSNS was performed using General Health Questionnaire-12 for psychological distress, Beck Depression Inventory for depression, and Zarit Burden Interview-6 for caregiver burden.

Results: Out of 72 eligible caregivers, 60 were included. Severe depression, severe psychological distress, and significant caregiver burden were observed in 38.3%, 30%, and 61.7% of primary caregivers, respectively. Steroid-dependent nephrotic syndrome (SDNS) and disease duration over 24 months increased severe psychological distress. Risk factors for caregiver depression included child < 7 years, female gender, frequently relapsing nephrotic syndrome (FRNS)/SDNS, steroid use > 6 months, > 4 relapses, and prior hospitalization. Caregiver burden was higher in younger age, FRNS/SDNS, hospitalization, and lower middle socio-economic status.

Conclusion: Caregivers of children with SSNS experience significant psychological distress, depression, and financial burden.

Objectives: Survivors of childhood cancer are at risk of sleep disturbances, an often, neglected aspect of holistic health. This study was carried out to determine the prevalence of sleep disturbances in survivors of pediatric acute lymphoblastic leukemia (ALL) and to identify any risk factors for the same.

Methods: Survivors of ALL aged 6-18 years, who had completed their treatment, at least two or more years ago, were enrolled. The Child Sleep Habits Questionnaire (CSHQ) was used to assess the sleep problems.

Results: Out of 89 childhood survivors of ALL, 42.7% had sleep disturbances. Fears during treatment, painful memories during treatment, younger age at enrolment, and shorter interval from treatment completion were significantly more in patients having sleep problems.

Conclusions: Approximately half of childhood ALL survivors had sleep problems. Fears during chemotherapy and shorter post-completion interval were significant risk factors for sleep problems in childhood cancer survivors.