Pub Date : 2025-02-04DOI: 10.1007/s12098-025-05439-4
Satya Prakash, Deepika Kainth, Ankit Verma, Ramesh Agarwal, Anu Thukral, M Jeeva Sankar
Managing fluid and electrolytes in extremely low gestational age neonates (ELGANs) is often challenging because of their distinctive fluid physiology. Most of the fluid loss in the first week of life is trans-epidermal due to the immature barrier function of the skin. ELGANs also have a developmental tendency for exaggerated diuresis and natriuresis. Allowing an initial weight loss of 6-12% promotes physiological extracellular contraction. Also, restricted fluid intake in the first week of life may decrease the incidence of bronchopulmonary dysplasia, patent ductus arteriosus, and necrotizing enterocolitis. A protocol-based approach for fluid management in ELGANs, developed based on physiology and available evidence, is the best strategy. Based on the estimated dermal and renal losses and desired weight change, the authors recommend initiating total fluids on the first day of life at 100 mL/kg/d in neonates at 26-27 wk gestation and 110 mL/kg/d at 24-25 wk gestation. The subsequent fluid rate is determined based on rigorous monitoring of weight, urine output, and serum sodium, with a typical daily increment in fluids of 10-20 mL/kg and a maximum fluid rate of 150-160 mL/kg/d in 26-27 wk and 160-180 mL/kg/d in 24-25 wk gestation neonates by day 7 of life. Fluid strategy should ideally be revised every 12 h in the first few days of life. A humidified incubator is the ideal care environment to minimize trans-epidermal losses. Since most of these recommendations are not based on concrete evidence from trials, it is advisable to periodically audit the outcomes and devise a unit-specific fluid strategy.
{"title":"Fluid Management in ELGANs: Striking the Perfect Balance!","authors":"Satya Prakash, Deepika Kainth, Ankit Verma, Ramesh Agarwal, Anu Thukral, M Jeeva Sankar","doi":"10.1007/s12098-025-05439-4","DOIUrl":"https://doi.org/10.1007/s12098-025-05439-4","url":null,"abstract":"<p><p>Managing fluid and electrolytes in extremely low gestational age neonates (ELGANs) is often challenging because of their distinctive fluid physiology. Most of the fluid loss in the first week of life is trans-epidermal due to the immature barrier function of the skin. ELGANs also have a developmental tendency for exaggerated diuresis and natriuresis. Allowing an initial weight loss of 6-12% promotes physiological extracellular contraction. Also, restricted fluid intake in the first week of life may decrease the incidence of bronchopulmonary dysplasia, patent ductus arteriosus, and necrotizing enterocolitis. A protocol-based approach for fluid management in ELGANs, developed based on physiology and available evidence, is the best strategy. Based on the estimated dermal and renal losses and desired weight change, the authors recommend initiating total fluids on the first day of life at 100 mL/kg/d in neonates at 26-27 wk gestation and 110 mL/kg/d at 24-25 wk gestation. The subsequent fluid rate is determined based on rigorous monitoring of weight, urine output, and serum sodium, with a typical daily increment in fluids of 10-20 mL/kg and a maximum fluid rate of 150-160 mL/kg/d in 26-27 wk and 160-180 mL/kg/d in 24-25 wk gestation neonates by day 7 of life. Fluid strategy should ideally be revised every 12 h in the first few days of life. A humidified incubator is the ideal care environment to minimize trans-epidermal losses. Since most of these recommendations are not based on concrete evidence from trials, it is advisable to periodically audit the outcomes and devise a unit-specific fluid strategy.</p>","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: To assesses the coverage, adherence, reasons for non-initiation and non-completion of tuberculosis preventive treatment (TPT) among household child contacts (HHCC) of pulmonary tuberculosis (TB).
Methods: This cross-sectional study was conducted across eight sites in India. Estimated sample size was 200 per site. Information was collected through record review and house-to-house visits of HHCCs of notified pulmonary TB cases during January to March 2022. Coverage and adherence was assessed by proportion of eligible HHCC initiated and completed TPT, respectively.
Results: Of 2554 HHCCs eligible for TPT, initiation and completion rate was 34% and 22%, respectively. Across the sites the median time to conduct home visit was 14 d (IQR 9, 22) and TPT initiation was 7 d (IQR 1, 21). Reasons for the non-initiation were no information provided by paramedical workers (82%), information provided by paramedical workers but TPT was not given (19%), parents felt it's not important (9%), and fear of side-effects (3%). Reasons for non-completion were: TPT received for less than six months (from healthcare providers) (54%), advised for the lesser duration TPT by the doctors (4%), parents felt completion was not important (32%), parents' fear of side-effects or myth (5%), and HHCC complained of side-effect (0.7%).
Conclusions: Inadequate emphasis on home visits leads to TPT initiation in only one-third and completion in less than one-fourth of eligible HHCCs. This poor coverage was primarily due to the health system related issues. Rarely reported TPT side-effects highlighted its safety.
{"title":"A Situational Analysis and an Untapped Opportunity for Tackling Challenges Associated with Coverage of Tuberculosis Preventive Treatment: A Multi-Centric Study in India.","authors":"Amber Kumar, Akash Ranjan Singh, Praveen Anand, Dhruvendra Pandey, Sarika Gupta, Lalitha K, Inder Puri, BrajRaj S Gosh, Manjeet Singh Chalga, Manjula Singh","doi":"10.1007/s12098-024-05364-y","DOIUrl":"https://doi.org/10.1007/s12098-024-05364-y","url":null,"abstract":"<p><strong>Objectives: </strong>To assesses the coverage, adherence, reasons for non-initiation and non-completion of tuberculosis preventive treatment (TPT) among household child contacts (HHCC) of pulmonary tuberculosis (TB).</p><p><strong>Methods: </strong>This cross-sectional study was conducted across eight sites in India. Estimated sample size was 200 per site. Information was collected through record review and house-to-house visits of HHCCs of notified pulmonary TB cases during January to March 2022. Coverage and adherence was assessed by proportion of eligible HHCC initiated and completed TPT, respectively.</p><p><strong>Results: </strong>Of 2554 HHCCs eligible for TPT, initiation and completion rate was 34% and 22%, respectively. Across the sites the median time to conduct home visit was 14 d (IQR 9, 22) and TPT initiation was 7 d (IQR 1, 21). Reasons for the non-initiation were no information provided by paramedical workers (82%), information provided by paramedical workers but TPT was not given (19%), parents felt it's not important (9%), and fear of side-effects (3%). Reasons for non-completion were: TPT received for less than six months (from healthcare providers) (54%), advised for the lesser duration TPT by the doctors (4%), parents felt completion was not important (32%), parents' fear of side-effects or myth (5%), and HHCC complained of side-effect (0.7%).</p><p><strong>Conclusions: </strong>Inadequate emphasis on home visits leads to TPT initiation in only one-third and completion in less than one-fourth of eligible HHCCs. This poor coverage was primarily due to the health system related issues. Rarely reported TPT side-effects highlighted its safety.</p>","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-09-26DOI: 10.1007/s12098-024-05268-x
Neerja Gupta, Devi Saranya S
{"title":"Digging Out Metabolic Causes in Global Developmental Delay.","authors":"Neerja Gupta, Devi Saranya S","doi":"10.1007/s12098-024-05268-x","DOIUrl":"10.1007/s12098-024-05268-x","url":null,"abstract":"","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":"111"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Surge of Respiratory Syncytial Virus Infection in Male Infants and Children Between the Second and Third Waves of the COVID-19 Pandemic.","authors":"Bhaskar Narayan Chaudhuri, Anushka Talukdar, Doyel Chatterjee, Partha Guchhait, Anupam Das, Arup Kumar Dawn, Satadal Das","doi":"10.1007/s12098-024-05348-y","DOIUrl":"10.1007/s12098-024-05348-y","url":null,"abstract":"","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":"218"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-12-17DOI: 10.1007/s12098-024-05344-2
Sarvesh Ramanathan Rajakumar, S Subhaschandra Singh, Ch Shyamsunder Singh, Kavitha B, Sanjay Rai, Tamphasana Maimom, Gyanmar Taba
{"title":"Magnetic Resonance Spectroscopy in Assessment of Perinatal Hypoxic Ischemic Encephalopathy: A Case Control Study.","authors":"Sarvesh Ramanathan Rajakumar, S Subhaschandra Singh, Ch Shyamsunder Singh, Kavitha B, Sanjay Rai, Tamphasana Maimom, Gyanmar Taba","doi":"10.1007/s12098-024-05344-2","DOIUrl":"10.1007/s12098-024-05344-2","url":null,"abstract":"","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":"202"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142835557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01Epub Date: 2024-11-30DOI: 10.1007/s12098-024-05338-0
Aman Elwadhi, Konpal Paharia, Shamsheer Alam, Shikha Sagar, Kanwaljeet Kaur
{"title":"Proximal Muscle Weakness in a Toddler Due to Vitamin D Deficiency Rickets.","authors":"Aman Elwadhi, Konpal Paharia, Shamsheer Alam, Shikha Sagar, Kanwaljeet Kaur","doi":"10.1007/s12098-024-05338-0","DOIUrl":"10.1007/s12098-024-05338-0","url":null,"abstract":"","PeriodicalId":13320,"journal":{"name":"Indian Journal of Pediatrics","volume":" ","pages":"215"},"PeriodicalIF":2.1,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号