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Prevalence and risk factors of hearing loss in high-risk neonates at a tertiary care hospital in Mumbai 孟买一家三级医院高危新生儿听力损失的发生率和风险因素
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233960
Monalisa Pradhan, B. Bhaisara, S. Shinde
Background: The present study was conducted to assess the prevalence of hearing loss using measurements of otoacoustic emission (OAE) in newborns admitted to NICU and to determine the risk factors predictive of hearing impairment in these newborns. Methods: This was a Prospective observational study conducted among 220 newborns admitted to the NICU over 18 months. Ethical clearance was obtained from the IEC. The sample size was obtained by the universal sampling technique. All candidates underwent hearing assessment in a sound-treated room in the department using a distortion product OAEs (DPOAE) test at the time of discharge.  Babies who did not pass the initial screening underwent another OAE test within one month after being discharged. If they failed the test again, they were referred to an otologist for BERA. Results: Of the 226 neonates included in the study, 40 cases (17.7%) failed the initial screening. 29 cases (12.8%) failed the second OAE screening and were subjected to BERA. Risk factors included asphyxia (p≤0.001), mechanical ventilation (p<0.0004), history of ototoxic medication (p=0.004), neonates with hyperbilirubinemia requiring exchange transfusion (p=0.005), low Apgar scores (p≤0.001). Conclusions: A two-stage OAE hearing screening can be a suitable method for early detection of hearing impairment in newborns. This method has shown high prevalence of hearing loss among high-risk neonates but needs to be confirmed with diagnostic BERA. It is crucial to have universal hearing screening to detect the large number of hearing-impaired neonates in the newborn population of our country, including those who are not considered at risk.
研究背景本研究旨在通过测量新生儿重症监护室(NICU)新生儿的耳声发射(OAE)来评估听力损失的发生率,并确定预测这些新生儿听力受损的风险因素。研究方法这是一项前瞻性观察研究,研究对象是新生儿重症监护室在 18 个月内收治的 220 名新生儿。研究获得了 IEC 的伦理许可。样本量通过普遍抽样技术获得。所有候选者在出院时都在科室的声音处理室中接受了听力评估,使用的是失真产物 OAEs(DPOAE)测试。 未通过初筛的婴儿在出院后一个月内再次接受 OAE 测试。如果再次未能通过测试,则转诊至耳科医生进行 BERA 检查。结果:在纳入研究的 226 名新生儿中,有 40 例(17.7%)未能通过初筛。29例(12.8%)未能通过第二次OAE筛查,并接受了BERA检查。风险因素包括窒息(p≤0.001)、机械通气(p<0.0004)、耳毒性药物史(p=0.004)、需要交换输血的高胆红素血症新生儿(p=0.005)、低Apgar评分(p≤0.001)。结论两阶段 OAE 听力筛查是早期发现新生儿听力障碍的合适方法。这种方法在高危新生儿中显示出听力损失的高患病率,但需要通过诊断性 BERA 加以确认。在我国的新生儿群体中,包括那些不被认为是高危人群的新生儿在内,要发现大量听力受损的新生儿,就必须普及听力筛查。
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引用次数: 0
Pattern of transcatheter interventional procedure have done in Cath lab and their immediate outcome: one year experience at Bangladesh Shishu hospital and institute 孟加拉 Shishu 医院和研究所一年来在阴道实验室进行的经导管介入手术模式及其即时结果
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233954
M. A. S. Munsi, Maher Akther, M. K. E. S. Khan, Chandan Saha
Background: Congenital heart disease (CHD) is defined by structural and functional malformations of the heart. If CHD not managed through appropriate interventions, it affects quality of life of the individual and potential premature death. Objectives were assessing the frequency and pattern of interventional procedure done in Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute and their immediate outcome. Methods: It was a cross sectional retrospective study. Total 56 patients of ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), pulmonary stenosis (PS), aortic stenosis (AS), coarctation of aorta, pulmonary atresia, TGA from January 2019 to December 2019 who underwent trans-catheter interventional procedure by author at Cath lab of paediatric cardiology department, Bangladesh Shishu Hospital and Institute were enrolled in this study. Results: Among 56 patients, PDA device closure done in 19, balloon pulmonary valvuloplasty (BPV) in 13 patients, device closure of ASD in 3 patients, device closure of VSD in 2 patients and balloon aortic valvuloplasty (BAV) in 1 patient. Two patients died; one is pulmonary atresia with PDA dependent pulmonary circulation following ductal stenting another is d-TGA intact IVS with PFO following BAS. One PDA device embolized and retrieved surgically from main and right pulmonary artery. Mean fluoroscopy time=17.29 and mean total procedure time=38.52 min. Conclusions: Trans-catheter interventional procedure for PS, coarctation of aorta, PDA, ASD, VSD, AS, d-TGA, Pulmonary atresia is a safe and some procedure such as BAS for d- TGA, BPV for critical PS, Ductal stenting for pulmonary atresia, Balloon angioplasty for severe coarctation of aorta with LV dysfunction is lifesaving with a low adverse event rate.
背景:先天性心脏病(CHD)是指心脏结构和功能畸形。如果不通过适当的干预措施控制先天性心脏病,就会影响患者的生活质量,并有可能导致过早死亡。目的:评估孟加拉 Shishu 医院和研究所儿科心脏科阴道实验室进行介入手术的频率和模式及其即时结果。方法:这是一项横断面回顾性研究。从2019年1月至2019年12月,共有56名室间隔缺损(VSD)、房间隔缺损(ASD)、动脉导管未闭(PDA)、肺动脉狭窄(PS)、主动脉狭窄(AS)、主动脉共动脉瘤、肺动脉闭锁、TGA患者在孟加拉Shishu医院和研究所儿科心脏科阴道实验室接受了作者的经导管介入手术。结果:在 56 名患者中,19 名患者进行了 PDA 装置关闭术,13 名患者进行了球囊肺动脉瓣成形术 (BPV),3 名患者进行了 ASD 装置关闭术,2 名患者进行了 VSD 装置关闭术,1 名患者进行了球囊主动脉瓣成形术 (BAV)。两名患者死亡,其中一名是肺动脉闭锁伴 PDA 依赖性肺循环,经导管支架术后死亡;另一名是 d-TGA 完整 IVS 伴 PFO,经 BAS 术后死亡。一名 PDA 装置栓塞,通过手术从主肺动脉和右肺动脉取出。平均透视时间=17.29分钟,平均手术总时间=38.52分钟。结论经导管介入手术治疗PS、主动脉共动脉瘤、PDA、ASD、VSD、AS、d-TGA、肺动脉闭锁是一种安全的手术,一些手术,如BAS治疗d-TGA、BPV治疗危重PS、管道支架治疗肺动脉闭锁、球囊血管成形术治疗伴有左心室功能障碍的严重主动脉共动脉瘤可挽救生命,且不良事件发生率较低。
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引用次数: 0
A case of persistent left superior vena cava: an anatomical rarity with clinical implications 一例持续存在的左上腔静脉:解剖学上的罕见病例与临床意义
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233963
Pawan Saraswat, R. Prasad, Ankur Singh, Sandeep Kumar Baranwal, Nitish Kumar, Abhishek Abhinay
Persistent left superior vena cava (PLSVC) is a rare congenital anomaly characterised by the presence of a persistent left-sided SVC in addition to the normal right-sided SVC. This case report presents a unique instance of PLSVC in a 13-year-old male patient who was incidentally diagnosed during routine cardiac imaging for an unrelated condition. The diagnostic journey, including imaging modalities such as echocardiography and computed tomography, revealed the presence of this anatomical variation. Despite being asymptomatic, the case highlights the importance of recognising PLSVC, as it can have clinical implications in various medical and surgical scenarios, particularly in cardiac catheterization, pacemaker implantation, and central venous access procedures. This report discusses the clinical significance, diagnostic challenges, and management considerations associated with PLSVC, emphasising the need for increased awareness among healthcare professionals to ensure safe and effective patient care.
持续性左上腔静脉(PLSVC)是一种罕见的先天性异常,其特点是除了正常的右侧上腔静脉外,还存在持续性左侧上腔静脉。本病例报告介绍了一名 13 岁男性患者的独特的 PLSVC 病例,该患者是在一次无关疾病的常规心脏成像检查中偶然被诊断出的。诊断过程包括超声心动图和计算机断层扫描等成像方式,结果显示存在这种解剖变异。尽管无症状,但该病例强调了识别 PLSVC 的重要性,因为它可能在各种内外科情况下产生临床影响,尤其是在心导管检查、起搏器植入和中心静脉通路手术中。本报告讨论了与 PLSVC 相关的临床意义、诊断难题和管理注意事项,强调需要提高医护人员的认识,以确保安全有效地护理患者。
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引用次数: 0
Recurrent abdominal pain in children: a review 儿童反复腹痛:综述
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233965
Manisha Verma, Rajeev Verma
Recurrent tummy (abdominal) pain (RAP) is among the most prevalent symptoms where children experience frequent stomach pain over an extended period. RAP is prevalent in children, affecting 10-20% of school aged children. There is no consensus regarding this widespread issue's genesis, investigation, and management. This review touches on a few concerns about children's recurrent abdominal pain.
反复腹痛(RAP)是儿童最常见的症状之一,儿童会在较长时间内经常感到胃痛。反复腹痛在儿童中很普遍,10%-20% 的学龄儿童都会受到影响。关于这一普遍问题的起因、调查和管理,目前还没有达成共识。本综述涉及有关儿童反复腹痛的几个问题。
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引用次数: 0
Phlebotomy loss in sick newborns admitted in neonatal intensive care unit 新生儿重症监护室患病新生儿的抽血损失
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233969
Neha Tyagi, R. Rai, Dharmendra Kumar Singh, B. Bhakhri
Improved neonatal care has resulted in increased survival of neonates and duration of hospital stay. These sick neonates are subjected to frequent diagnostic blood sampling. Phlebotomy loss (PL) is acknowledged as one of the primary factors leading to anaemia in critically ill infants.
新生儿护理的改善提高了新生儿的存活率和住院时间。这些患病的新生儿需要经常进行诊断性抽血。抽血损失(PL)被认为是导致重症婴儿贫血的主要因素之一。
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引用次数: 0
Neutrophil lymphocyte ratio and platelet lymphocyte ratio as a marker for disease severity in children with COVID-19 中性粒细胞淋巴细胞比值和血小板淋巴细胞比值作为 COVID-19 儿童疾病严重程度的标志物
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233953
Attia Bari, Tooba Fateen, Aimen Ch
Background: It had been observed that there is relationship of neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) with disease severity in children with COVID-19 and post-COVID, multisystem inflammatory disease in children (MIS-C).  Study conducted to determine NLR and PLR correlation with this disease severity. Methods: Prospective descriptive analytical study conducted at the children’s hospital and university of child health sciences, Lahore. Consecutive confirmed cases of COVID-19 infection and post-COVID, MIS-C diagnosed on the basis of RT-PCR from nasopharyngeal swab and antibody test admitted from March 2020 to October 2021 were included through consecutive sampling. Complete blood (CBC) was done and NLR and PLR was determined Results: Majority 198 (74.2%) of the 267 patients had a diagnosis of COVID-19 and 69 (25.8%) were post-COVID MIS-C. There was a male preponderance 177 (66.3%) and the mean age was 6.1±4.7 years (95% CI: 5.62-6.74). Majority children had mild disease 80 (30%), 34 (12.7%) were critical and there were 37 (13.8%) deaths. Underlying comorbidity was present in 55 (20.6%). As the severity of symptoms changed from asymptomatic to severe disease, there was a significant rise of mean NLR from 1.88±1.40 to 5.47±4.77 respectively (p<0.001). PLR however, failed to show any kind of association with severity of the symptoms (p=0.922). Conclusions: NLR served as a marker of disease severity among pediatric patients suffering from COVID-19 and MIS-C. However, PLR failed to show any relation with disease severity.
背景:据观察,中性粒细胞淋巴细胞比值(NLR)和血小板淋巴细胞比值(PLR)与 COVID-19 和 COVID 后儿童多系统炎症性疾病(MIS-C)患儿的疾病严重程度有关。 研究旨在确定 NLR 和 PLR 与该疾病严重程度的相关性。研究方法在拉合尔儿童医院和儿童健康科学大学进行的前瞻性描述性分析研究。通过连续采样,纳入了 2020 年 3 月至 2021 年 10 月期间收治的 COVID-19 感染确诊病例以及根据鼻咽拭子 RT-PCR 和抗体检测确诊的后 COVID 和 MIS-C 病例。进行全血细胞计数(CBC),并测定 NLR 和 PLR 结果:267 名患者中有 198 人(74.2%)确诊为 COVID-19,69 人(25.8%)为 COVID MIS-C 后患者。男性占多数,177 人(66.3%),平均年龄为 6.1±4.7 岁(95% CI:5.62-6.74)。大多数患儿病情较轻,为 80 例(30%),34 例(12.7%)病情危重,37 例(13.8%)死亡。55名患儿(20.6%)有并发症。随着症状严重程度从无症状到重症的变化,平均 NLR 分别从 1.88±1.40 显著上升至 5.47±4.77(P<0.001)。然而,PLR 与症状严重程度没有任何关联(P=0.922)。结论NLR是COVID-19和MIS-C儿科患者疾病严重程度的标志物。然而,PLR 与疾病严重程度没有任何关系。
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引用次数: 0
Interesting case of subglottic hemangioma presented with stridor 有趣的声门下血管瘤病例,伴有喘鸣
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233962
Bhavya Patel, B. Shah, Ashish Mehta, Abhijit Mehta, Vaidehi Shah
Subglottic hemangioma is a very rare infantile form of hemangioma as compared to cutaneous hemangioma but if left undiagnosed or untreated can be life-threatening. Here we report one case of preterm who presented with sudden onset of inspiratory stridor and respiratory distress in OPD in a previously normal child. The patient was initially misdiagnosed as croup which did not improve after nebulized adrenaline and steroids later on direct laryngobrochoscopy showed subglottic stenosis.  A CT scan was done later which revealed subglottic hemangioma which showed complete remission in symptoms after starting oral propranolol. A careful approach towards diagnosing and managing the sudden onset of stridor with probable structural cause is necessary for a favorable outcome.
与皮肤血管瘤相比,声门下血管瘤是一种非常罕见的婴儿血管瘤,但如果不及时诊断或治疗,可能会危及生命。在此,我们报告了一例早产儿病例,患者在门诊中突然出现吸气性喘息和呼吸困难,而之前他是一名正常儿童。患者起初被误诊为咳嗽,在雾化吸入肾上腺素和类固醇后病情未见好转,后来直接喉镜检查显示声门下狭窄。 后来做了 CT 扫描,发现声门下血管瘤,开始口服普萘洛尔后症状完全缓解。为了获得良好的治疗效果,有必要采取谨慎的方法来诊断和处理可能由结构性原因引起的突发性呼吸困难。
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引用次数: 0
Clinical profile and laboratory parameters of confirmed pediatric scrub typhus cases in a tertiary health care institute 一家三级医疗机构小儿恙虫病确诊病例的临床概况和实验室参数
Pub Date : 2023-12-28 DOI: 10.18203/2349-3291.ijcp20233959
Nidhi Chadha, R. Aulakh
Background: Scrub typhus is one of the vector borne tropical infectious disease, caused by O. Tsutsugamushi. Because of nonspecific signs and symptoms and variable prevalence of pathognomic sign (eschar), diagnosis is very difficult in early stage. The purpose of present research was to differentiate that whether case presenting at our institution are different from previously conducted research in various regions. Methods: Hospital record of all reported cases of scrub typhus admitted to department of pediatrics at tertiary health care institute in North India over last two years (2018-2019) was retrieved and reviewed. Results: More cases were reported in male. Maximum number of cases were in 5-10 years i.e. 32 (50.0%) and only one case in less than 12 months. Maximum number cases were reported in August to October 53 (82.8%) as shown. Most common presenting complaint was fever. Most of cases reported with fever of duration of 7-14 days in (51.6%). Rash was present in 7 (10.5%) and eschar in 1 (1.5%). In lab parameters reported abnormalities severe hypoalbuminemia, hyperbilirubinemia, elevated transaminases, anemia, thrombocytopenia leucopenia and leucocytosis. Hepatitis in 48 (75%) was most common complication followed by pneumonia. Other reported complications were myocarditis, acute kidney injury, pneumonia, bleeding, meningitis, enchepalopathy , papilledema, ARDS and hemophagocytosis. Conclusions: Pediatrician should keep high index of suspicion for suspect scrub typhus in a child presents with febrile illness and early treat should be started. Hepatitis is most common complication. As Scrub typhus is associated with multisystem involvement, thorough assessment of patient should be done to look for these complications and appropriate management of complications should be provided to prevent mortality.
背景:恙虫病是由恙虫卵引起的病媒传播的热带传染病之一。由于恙虫病没有特异性症状和体征,病征(炭疽)的发生率也不尽相同,因此早期诊断非常困难。本研究的目的是区分本院的病例是否与之前在不同地区进行的研究有所不同。方法:检索并审查了过去两年(2018-2019 年)北印度三级医疗保健机构儿科收治的所有恙虫病病例的医院记录。结果:男性病例较多。5-10岁的病例最多,有32例(50.0%),12个月以下的只有1例。如图所示,8 月至 10 月报告的病例最多,有 53 例(82.8%)。最常见的主诉是发烧。大多数病例(51.6%)的发热持续时间为 7-14 天。7例(10.5%)病例出现皮疹,1例(1.5%)病例出现焦痂。实验室指标报告的异常情况包括严重的低白蛋白血症、高胆红素血症、转氨酶升高、贫血、血小板减少和白细胞减少。最常见的并发症是肝炎(48 例,占 75%),其次是肺炎。报告的其他并发症包括心肌炎、急性肾损伤、肺炎、出血、脑膜炎、包虫病、乳头水肿、急性呼吸系统综合症和嗜血细胞增多症。结论儿科医生应高度怀疑发热患儿感染了恙虫病,并应及早开始治疗。肝炎是最常见的并发症。由于恙虫病会累及多个系统,因此应对患者进行全面评估,以寻找这些并发症,并对并发症进行适当处理,以防止死亡。
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引用次数: 0
Kangaroo mother care verses oral sucrose for pain control in premature neonates on heel prick: a randomized control trial 袋鼠妈妈护理与口服蔗糖控制早产新生儿足跟刺痛:随机对照试验
Pub Date : 2023-12-16 DOI: 10.18203/2349-3291.ijcp20233840
Savitri G. Hugar, Kavitha Lakshmi S., Jagadish A. S., Premalatha R., R. B.
Background: Preterm Neonates receiving intensive care are subjected to multiple painful procedures as part of their intensive care management. Pain leads to abnormal neurodevelopment, so it is extremely important to treat and reduce pain. Multiple studies have shown to be beneficial in pain control. Objective was to compare the efficacy of Kangaroo Mother Care with oral sucrose for pain management in premature neonates on heel prick.Methods: A total of 100 preterm neonates (28-36 weeks) who fulfill the inclusion and exclusion criteria were recruited for the study. Randomization was done and fifty participants per study arm were randomly assigned to the KMC and oral sucrose group. Preterm babies in the KMC group were given KMC for 15 minutes uninterrupted prior to heel prick. In oral sucrose group, two minutes prior to the procedure, baby received 0.5ml of 24% oral sucrose solution by syringe onto the tongue. The remainder of the total recommended dose was given as needed in small increments during the procedure. Assessment of pain done using PIPP. The post-procedural PIPP score was compared between KMC and oral sucrose groups.Results: Analysis of 100 preterm neonates (50 KMC and 50 oral sucrose) were done. Baseline variables were mean±SD gestational age 34.25±1.42 weeks, age 7.15±4.9 days, birth weight 1.72±0.32 kg. Post procedural PIPP score was less in KMC 5.16±1.58 group compared to oral sucrose 5.48±1.81 group but could not achieve statistical significance p=0.35, 95% CI=−0.99,0.35.Conclusions: KMC and oral sucrose are equally effective for pain management in premature neonates on heel prick but KMC is considered better compared to oral sucrose.
背景:接受重症监护的早产新生儿在重症监护过程中会遭受多种疼痛。疼痛会导致神经发育异常,因此治疗和减轻疼痛极为重要。多项研究表明,镇痛药对控制疼痛有益。目的是比较袋鼠妈妈护理和口服蔗糖对早产新生儿足跟刺痛治疗的疗效:研究共招募了 100 名符合纳入和排除标准的早产新生儿(28-36 周)。研究采用随机分配法,每组 50 名参与者被随机分配到 KMC 组和口服蔗糖组。KMC组的早产儿在足跟点刺前不间断服用KMC 15分钟。口服蔗糖组则在刺跟前两分钟,用注射器将 0.5 毫升 24% 的蔗糖口服液注入婴儿舌头。总推荐剂量的其余部分则在手术过程中根据需要小剂量给药。使用 PIPP 评估疼痛。比较了 KMC 组和口服蔗糖组的术后 PIPP 评分:结果:对 100 名早产新生儿(50 名 KMC 组和 50 名口服蔗糖组)进行了分析。基线变量为平均(±SD)胎龄(34.25±1.42 周)、胎龄(7.15±4.9 天)、出生体重(1.72±0.32 千克)。与口服蔗糖 5.48±1.81 组相比,KMC 5.16±1.58 组的术后 PIPP 评分较低,但未达到统计学意义 p=0.35,95% CI=-0.99,0.35:KMC 和口服蔗糖对早产新生儿足跟刺痛的止痛效果相同,但 KMC 的止痛效果优于口服蔗糖。
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引用次数: 0
Congenital complete heart block in a neonate-not always maternal lupus 新生儿先天性完全性心脏传导阻滞--不一定是母体狼疮
Pub Date : 2023-12-12 DOI: 10.18203/2349-3291.ijcp20233834
Sujata Sankhyan, Ashok Garg, Dinesh Bisht, Pancham Kumar, A. Sood, Sudhir Mehta
Congenital complete heart block (CCHB) is a rare cardiac disorder in neonates and maternal lupus is the most common cause. More rarely, CCHB can be associated with congenitally corrected transposition of the great arteries. In this case, the neonate was born via emergency caesarean section due to bradycardia. Post-natal electrocardiogram and echocardiography confirmed the diagnosis. A pacemaker was inserted and the baby was kept under follow-up.
先天性完全性心脏传导阻滞(CCHB)是一种罕见的新生儿心脏疾病,最常见的病因是母体狼疮。更罕见的是,先天性完全性心脏传导阻滞可能与先天性大动脉转位有关。在本病例中,新生儿因心动过缓而通过紧急剖腹产出生。出生后的心电图和超声心动图证实了诊断结果。医生为其安装了心脏起搏器,并对其进行了随访。
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引用次数: 0
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International Journal of Contemporary Pediatrics
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