Indian Journal of Pediatrics最新文献

Necrotizing enterocolitis (NEC) is a major gastrointestinal emergency in preterm infants, often associated with sepsis that worsens the outcomes. Data from low- and middle-income settings are limited. This retrospective study described the clinical spectrum and short-term outcomes of NEC and compared sepsis-associated NEC (SA-NEC) with non-sepsis-associated NEC (non-SA NEC). Preterm infants with ≥ stage 2 NEC admitted between March 2022 and February 2025 were included. SA-NEC was defined as NEC with culture-proven sepsis at onset of illness. Of 55 infants with NEC (median gestational age 31 wk 1 d; birth weight 1,195 g), 54.5% had SA-NEC. Compared with non-SA NEC, SA-NEC had higher rates of acute kidney injury [OR 9.75; 95% CI 2.6-36.6, p < 0.001], perforation [OR 4.6; 1.3-16.6, p = 0.02] and mortality [OR 8.9; 2.52-31.4, p < 0.001]. SA-NEC represents a more severe clinical phenotype with significantly poorer outcomes. Strengthening infection control practices and adopting comprehensive NEC prevention strategies are crucial to improving outcomes in preterm infants.

An 8-y-old boy presented with premature virilization and was found to have peripheral precocious puberty due to a unilateral Leydig cell tumor. The mass was surgically excised, and histopathology confirmed the diagnosis. Postoperatively, androgen levels normalized; however, within months, he developed accelerated growth, testicular enlargement, and rising gonadotropins, consistent with central precocious puberty. Treatment with a gonadotropin releasing hormone analogue stabilized pubertal progression. This case underscores the need to consider Leydig cell tumors in boys with early virilization and highlights the risk of central activation even after curative surgery. Vigilant long-term follow-up is crucial for timely recognition and management to optimize growth and psychosocial outcomes.

Objectives: To evaluate the impact of asthma on hospitalizations for acute vaso-occlusive pain episodes in children with sickle cell disease (SCD).

Methods: A multicenter nested case-control study was conducted over a period from January 1, 2012, to December 31, 2022.

Results: The mean age of the study population was 8.41 ± 5.04 y, with an equal distribution of males and females. Among the 600 children with SCD included in the study, 35 were diagnosed with asthma, yielding a prevalence of 5.8%. Children with both SCD and asthma had a median of 6 hospitalizations (Range: 2-20), compared to 2 (Range: 1-4) in those without asthma (p < 0.001). In 90% of these cases, asthma exacerbation coincided with a sickle cell crisis. Besides vaso-occlusive episodes, other leading causes of hospitalization included pulmonary infections and acute chest syndrome. The incidence of acute chest syndrome was found to be 18 times higher in children with both asthma and sickle cell disease. Furthermore, children with both conditions were 3.99 times more likely to experience a vaso-occlusive crisis requiring hospitalization than those without asthma.

Conclusions: Children with sickle cell disease and asthma co-morbidity experience a significantly higher number of vaso-occlusive crises requiring hospitalization.

Over my 55 y career in pediatrics, I have witnessed the field evolve from its early stages to maturity in India. The persistent challenges of high infant and neonatal mortality, morbidity, and disability directed my focus toward neonatology and infectious diseases. This oration highlights my key contributions to understanding hypoxic-ischemic encephalopathy and advancing polio eradication efforts in India.