Indian Journal of Pediatrics最新文献

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.

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.