Indian Journal of Pediatrics最新文献

Objectives: To compare the efficacy, safety and cost of Single Maintenance and Reliever Therapy (SMART) with low dose inhaled budesonide-formoterol combination vs. conventional budesonide plus as-needed levo-salbutamol, in 6-11-y-old children with asthma.

Methods: In this randomised controlled trial (RCT), 84 children (6-11 y) with treatment-naïve asthma were randomised to either SMART with inhaled budesonide-formoterol combination, or budesonide plus as-needed levo-salbutamol. Peak expiratory flow (PEF), asthma symptom score, number of rescue doses, exacerbations, adherence, inhalation technique, adverse events and cost were recorded over the first 12 wk of follow-up.

Results: Baseline PEF, asthma symptom score, and other characteristics were comparable. At the end of 12 wk, the median (IQR) improvement in PEF was 16% (10, 20) vs. 11% (8.5, 15.5), p = 0.01. The median (IQR) weekly asthma symptom score was 3 (2, 4.5) vs. 4 (3, 7), p = 0.02. The median (IQR) number of rescue doses were 0 (0, 0) vs. 4 (3, 6), p = 0.02. Only 9/37 (24.3%) vs. 16/37 (43.2%) children had exacerbations, p = 0.05. There were no adverse effects considered significant in either group. The total cost of treatment was lower with SMART.

Conclusions: SMART showed greater short-term efficacy and was less expensive compared to conventional therapy in 6-11 y-old asthmatic children, with no additional safety concerns.

Objectives: To validate the disease-specific quality of life (QoL) instrument for pediatric inflammatory bowel disease (PIBD) patients in three Indian languages (Hindi, Tamil and Bengali). Additionally, also to reveal the significant factors which effect QoL of PIBD patients in India.

Methods: One hundred and two (102) PIBD patients (mean age 13 ± 2.59 y) across 6 centres were enrolled. Each child completed two questionnaires - the IMPACT-III and Paediatric Quality of Life Inventory Version 4.0 Generic Core Scale (PedsQL™) - in one of the three languages. A uniform clinico-demographic proforma was completed for each recruit to reveal factors which determine QoL. During analysis authors used Cronbach's alpha for internal consistency, principal component analysis for factor analysis, Spearman's correlation between the questionnaires for concurrent validity and ANOVA analysis between IMPACT-III health-related quality of life (HRQoL) scores and disease severity to establish discriminant validity.

Results: A five-domain structure was most suitable: 'Concerns', 'Social acceptance', 'Mental disposition', 'Disease adjustment' & 'Self-confidence', with good internal reliability (Cronbach's α = 0.73-0.94). Concurrent and discriminant validity of the new questionnaire was also statistically significant (p < 0.001). Higher monthly family income led to better QoL scores in the 'Concerns' (p = 0.04) and 'Disease adjustment' (p = 0.03) domains while children with ulcerative colitis (UC) had better 'Social acceptance' scores than children with Crohn's disease (CD) (p = 0.02).

Conclusions: Modified IMPACT-III questionnaire with a five-domain structure demonstrated good validity and reliability for Indian population. 'Social acceptance' was higher in patients with ulcerative colitis. There is a favourable impact of higher family income on 'Concerns' and 'Disease adjustment' in PIBD.

Objectives: To develop and validate Diabetes Interpreter, a mobile application-based tool for point-of-care guidance for classifying pediatric and adolescent diabetes.

Methods: The Diabetes Interpreter recommends diagnosis and evaluation based on clinical parameters (age at diagnosis, disease duration, presentation, and insulin requirements). The validation involved comparing the guidance given by the Diabetes Interpreter, two pediatric endocrinologists, one adult endocrinologist, a pediatrician, and a pediatric trainee with the clinical diagnoses of 302 children and adolescents with diabetes treated at authors' Endocrinology Clinic.

Results: The Diabetes Interpreter agreed highly with clinical diagnoses and guidance (596 out of 604, 98.6%). The concordance rates for Pediatric Endocrinologist I (546; 90.4%) and Pediatric Endocrinologist II (491; 81.3%) exceeded those of the adult endocrinologist (405; 67.1%), pediatrician (287; 47.5%), and pediatric trainee (258; 42.7%). The adult endocrinologist missed the diagnosis of Type 1 diabetes without a suggestion for autoimmune assessment in 15 subjects (6%), while the pediatrician missed it in 16 subjects (6.4%), and the pediatric trainee in 33 (13.2%). Following the guidance of the Diabetes Interpreter could have potentially reduced 31.5%, 51.1%, and 55.9% of the discordances observed in the adult endocrinologist, pediatrician, and pediatric trainee, respectively. The pediatric trainee (250, 100%), the pediatrician (245, 98%), and the adult endocrinologist (124, 49.6%) recommended workups for a more significant proportion of subjects who did not require investigations compared to the Diabetes Interpreter (3, 1.2%).

Conclusions: The high concordance score of the Diabetes Interpreter underscores its importance in point-of-care guidance for assessing children and adolescents with diabetes.