This article details a rare instance of congenital pleural effusion, the cause of which was chylothorax. Congenital pleural effusions have several potential causes. To determine the cause, a variety of prenatal and postnatal tests can be performed. The range of presentations and the seriousness of the case’s complications determine the management strategy. A case of chylothorax is presented in this article, which was treated conservatively after postnatal confirmation through pleural fluid analysis.
{"title":"A nuanced presentation of congenital pleural effusion: The chylothorax","authors":"Santhwana Vimal, Sudha Rudrappa, S. S. Sundar","doi":"10.25259/kpj_2_2024","DOIUrl":"https://doi.org/10.25259/kpj_2_2024","url":null,"abstract":"This article details a rare instance of congenital pleural effusion, the cause of which was chylothorax. Congenital pleural effusions have several potential causes. To determine the cause, a variety of prenatal and postnatal tests can be performed. The range of presentations and the seriousness of the case’s complications determine the management strategy. A case of chylothorax is presented in this article, which was treated conservatively after postnatal confirmation through pleural fluid analysis.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"36 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140663209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A defect in the oesophageal hiatus can result in the herniation of the stomach or other abdominal organs into the thoracic cavity, known as a hiatal hernia. These hernias are uncommon in infants and children, and their symptoms can be vague and non-specific, posing challenges for even experienced clinicians to make a diagnosis. Regardless of the case, surgical intervention is necessary due to the potentially life-threatening complications associated with this condition. We present a rare case of a 2-month-old infant with congenital paraesophageal hernia (PEH) who initially came to our hospital with a diagnosis of pneumonia with pneumatocele. Based on clinical presentation and radiological examinations, the infant was correctly diagnosed with PEH and gastric volvulus. The patient underwent emergency surgical correction and was discharged in a stable condition. It is crucial to have a thorough understanding of the clinical presentation and maintain a high level of suspicion to ensure timely diagnosis and appropriate management in these cases.
{"title":"Paraesophageal hernia mimicking pneumatocele in an infant: A diagnostic dilemma","authors":"Ravi Chirag, T. Babu","doi":"10.25259/kpj_3_2024","DOIUrl":"https://doi.org/10.25259/kpj_3_2024","url":null,"abstract":"A defect in the oesophageal hiatus can result in the herniation of the stomach or other abdominal organs into the thoracic cavity, known as a hiatal hernia. These hernias are uncommon in infants and children, and their symptoms can be vague and non-specific, posing challenges for even experienced clinicians to make a diagnosis. Regardless of the case, surgical intervention is necessary due to the potentially life-threatening complications associated with this condition. We present a rare case of a 2-month-old infant with congenital paraesophageal hernia (PEH) who initially came to our hospital with a diagnosis of pneumonia with pneumatocele. Based on clinical presentation and radiological examinations, the infant was correctly diagnosed with PEH and gastric volvulus. The patient underwent emergency surgical correction and was discharged in a stable condition. It is crucial to have a thorough understanding of the clinical presentation and maintain a high level of suspicion to ensure timely diagnosis and appropriate management in these cases.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"77 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140665537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prostaglandin E1 (PGE1) is an emergency drug used in neonates with critical congenital heart diseases (CHDs) to maintain the ductal patency. There are many adverse effects of this drug explained – cutaneous side effects being one of them, of which limited literature is available. In this case report, we describe a term neonate with critical CHD, started on PGE1 infusion to maintain ductal patency. Baby developed erythematous migratory annular rashes to harlequin colour change in a dose-dependent manner. The severity of rashes decreased, and there was a complete resolution with tapering down of drug doses to a minimum level to maintain a ductal patency. No antihistamines or steroids were administered for the treatment. The PGE1 should be tapered to a minimum dose to maintain the required saturation in case of severe cutaneous reaction and should not be stopped abruptly as it is a lifesaving drug in critical CHD.
{"title":"Prostaglandin E1-induced urticaria with harlequin change in a neonate with transposition of great vessels: A case report","authors":"Nikita Kumari Panigrahi, H. A. Venkatesh","doi":"10.25259/kpj_62_2023","DOIUrl":"https://doi.org/10.25259/kpj_62_2023","url":null,"abstract":"Prostaglandin E1 (PGE1) is an emergency drug used in neonates with critical congenital heart diseases (CHDs) to maintain the ductal patency. There are many adverse effects of this drug explained – cutaneous side effects being one of them, of which limited literature is available. In this case report, we describe a term neonate with critical CHD, started on PGE1 infusion to maintain ductal patency. Baby developed erythematous migratory annular rashes to harlequin colour change in a dose-dependent manner. The severity of rashes decreased, and there was a complete resolution with tapering down of drug doses to a minimum level to maintain a ductal patency. No antihistamines or steroids were administered for the treatment. The PGE1 should be tapered to a minimum dose to maintain the required saturation in case of severe cutaneous reaction and should not be stopped abruptly as it is a lifesaving drug in critical CHD.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"8 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140660544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The impact of war on children","authors":"Bhaskar Shenoy","doi":"10.25259/kpj_6_2024","DOIUrl":"https://doi.org/10.25259/kpj_6_2024","url":null,"abstract":"","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"246 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. A. Venkatesh, H. V. Shubha, Krishna Shama Rao, Swathi Venkatesh
A 15-day female neonate term small for gestational age with Pierre Robin Sequence was presented with respiratory distress, requiring respiratory care. The mandibular distraction surgery was performed for micrognathia and progressive respiratory distress. Gradually, she improved and was discharged home on gastrostomy tube feeding. This case underscores the importance of dentistry in the neonatal management of complicated Pierre Robin Sequence successfully.
{"title":"The mandibular distraction osteogenesis; the key dental technique to success in a neonate with Pierre Robin’s sequence – A case report","authors":"H. A. Venkatesh, H. V. Shubha, Krishna Shama Rao, Swathi Venkatesh","doi":"10.25259/kpj_61_2023","DOIUrl":"https://doi.org/10.25259/kpj_61_2023","url":null,"abstract":"A 15-day female neonate term small for gestational age with Pierre Robin Sequence was presented with respiratory distress, requiring respiratory care. The mandibular distraction surgery was performed for micrognathia and progressive respiratory distress. Gradually, she improved and was discharged home on gastrostomy tube feeding. This case underscores the importance of dentistry in the neonatal management of complicated Pierre Robin Sequence successfully.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"299 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Anetekhai, O. Lasebikan, J. Asuquo, Chinenye Anetekhai, B. Asuquo
Neglected clubfoot is common in our environment, for multifactorial reasons. It could cause pain and psychological distress to the patient and parents. We assessed the efficacy of the Ponseti method in the treatment of neglected clubfoot in a Nigerian Hospital. This was a 15-month prospective and interventional study. Patients at least one-year-old with untreated idiopathic talipes equino varus (ITEV) or inadequately nonoperatively treated ITEV were the study population. The number of castings required for correction, tenotomy rate, dorsiflexion angle before and after tenotomy, and abduction angle after treatment were obtained. The chi-square test of independence was used to test the relationship between categorical variables. Logistic regression was used to assess if the Pirani score at the presentation predicted a successful correction at the end of the study. The level of significance was set at P < 0.05. Forty-two children with 69 club feet were treated in this study. The mean age of presentation was 27.45 months (standard deviation [SD] = 19.22). The mean number of casting sessions required to achieve correction was 6.35 (SD = 1.95). The mean Pirani score at presentation was 4.27 (SD = 1.33) which reduced to 0.30 (SD = 0.35) after correction. The Pirani score at presentation had a positive correlation with the number of casts required for correction (r = 0.505, P < 0.001) but did not predict a successful correction after treatment. The success rate was 85.5%. The Ponseti method of treatment showed a high success rate in the treatment of neglected ITEV.
{"title":"Efficacy of the Ponseti method in the treatment of neglected idiopathic talipes equinovarus at a tertiary hospital in Nigeria","authors":"W. Anetekhai, O. Lasebikan, J. Asuquo, Chinenye Anetekhai, B. Asuquo","doi":"10.25259/kpj_1_2024","DOIUrl":"https://doi.org/10.25259/kpj_1_2024","url":null,"abstract":"\u0000\u0000Neglected clubfoot is common in our environment, for multifactorial reasons. It could cause pain and psychological distress to the patient and parents. We assessed the efficacy of the Ponseti method in the treatment of neglected clubfoot in a Nigerian Hospital.\u0000\u0000\u0000\u0000This was a 15-month prospective and interventional study. Patients at least one-year-old with untreated idiopathic talipes equino varus (ITEV) or inadequately nonoperatively treated ITEV were the study population. The number of castings required for correction, tenotomy rate, dorsiflexion angle before and after tenotomy, and abduction angle after treatment were obtained. The chi-square test of independence was used to test the relationship between categorical variables. Logistic regression was used to assess if the Pirani score at the presentation predicted a successful correction at the end of the study. The level of significance was set at P < 0.05.\u0000\u0000\u0000\u0000Forty-two children with 69 club feet were treated in this study. The mean age of presentation was 27.45 months (standard deviation [SD] = 19.22). The mean number of casting sessions required to achieve correction was 6.35 (SD = 1.95). The mean Pirani score at presentation was 4.27 (SD = 1.33) which reduced to 0.30 (SD = 0.35) after correction. The Pirani score at presentation had a positive correlation with the number of casts required for correction (r = 0.505, P < 0.001) but did not predict a successful correction after treatment. The success rate was 85.5%.\u0000\u0000\u0000\u0000The Ponseti method of treatment showed a high success rate in the treatment of neglected ITEV.\u0000","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"16 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140232727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Badiginchala Naga Jyothi, C. P. R. Kumar, Ravindra B. Kamble, Shanthi Manivannan
Acute leukoencephalopathy with restricted diffusion (ALERD) is a clinicopathological diagnosis that is characterized by severe encephalopathy and seizures with extensive areas of restricted diffusion in cerebral parenchyma. Case 1: Apparently healthy 13-month-old male child presented with acute febrile encephalopathy with a flurry of seizures with raised intracranial pressure. Investigations were consistent with multiorgan dysfunction along with severe metabolic acidosis, ketosis, and hyperammonemia. Initial magnetic resonance imaging (MRI) Brain was normal. However subsequent MRI brain suggested features of diffuse ALERD. With immunotherapy and supportive management, he improved and was discharged without sequelae. Case 2: A 9-month-old male child who was premorbidly normal presented with fever, status epilepticus, and encephalopathy. MRI Brain was suggestive of central sparing ALERD. He was discharged with sequelae with the advice of rehabilitation. Unfortunately, he got succumbed due to aspiration. Case 3: A 10-day-old neonate presented with the refusal of feeds, multiple seizures, and encephalopathy. MRI Brain revealed central sparing ALERD. Improved with immunotherapy and was developmentally normal at five months of age. ALERD is a clinic-radiological syndrome characterized by acute encephalopathy with restricted areas of diffusion in subcortical white matter on MRI. Reported two categories are Diffuse and Central sparing ALERD. Diffuse ALERD has severe manifestations. However, Case 1 had a good outcome, suggesting a variable prognosis. Central sparing ALERD is a milder form, but when basal ganglia are involved, it may have a worsened outcome, as seen in Case 2. Case 3 had central sparing ALERD, and had a good prognosis as described in literature. This study highlights the varied signs and symptoms of ALERD, including neonatal age of onset. Diagnosis is based on the restricted diffusion in white matter on diffusion-weighted imaging and the apparent diffusion coefficient in MRI of the brain. MRI may be normal in the initial course; hence, it’s important to repeat if strongly suspected. Prompt immunotherapy and supportive care are emphasised.
{"title":"Acute leukoencephalopathy with restricted diffusion – Case Series","authors":"Badiginchala Naga Jyothi, C. P. R. Kumar, Ravindra B. Kamble, Shanthi Manivannan","doi":"10.25259/kpj_59_2023","DOIUrl":"https://doi.org/10.25259/kpj_59_2023","url":null,"abstract":"Acute leukoencephalopathy with restricted diffusion (ALERD) is a clinicopathological diagnosis that is characterized by severe encephalopathy and seizures with extensive areas of restricted diffusion in cerebral parenchyma. Case 1: Apparently healthy 13-month-old male child presented with acute febrile encephalopathy with a flurry of seizures with raised intracranial pressure. Investigations were consistent with multiorgan dysfunction along with severe metabolic acidosis, ketosis, and hyperammonemia. Initial magnetic resonance imaging (MRI) Brain was normal. However subsequent MRI brain suggested features of diffuse ALERD. With immunotherapy and supportive management, he improved and was discharged without sequelae. Case 2: A 9-month-old male child who was premorbidly normal presented with fever, status epilepticus, and encephalopathy. MRI Brain was suggestive of central sparing ALERD. He was discharged with sequelae with the advice of rehabilitation. Unfortunately, he got succumbed due to aspiration. Case 3: A 10-day-old neonate presented with the refusal of feeds, multiple seizures, and encephalopathy. MRI Brain revealed central sparing ALERD. Improved with immunotherapy and was developmentally normal at five months of age. ALERD is a clinic-radiological syndrome characterized by acute encephalopathy with restricted areas of diffusion in subcortical white matter on MRI. Reported two categories are Diffuse and Central sparing ALERD. Diffuse ALERD has severe manifestations. However, Case 1 had a good outcome, suggesting a variable prognosis. Central sparing ALERD is a milder form, but when basal ganglia are involved, it may have a worsened outcome, as seen in Case 2. Case 3 had central sparing ALERD, and had a good prognosis as described in literature. This study highlights the varied signs and symptoms of ALERD, including neonatal age of onset. Diagnosis is based on the restricted diffusion in white matter on diffusion-weighted imaging and the apparent diffusion coefficient in MRI of the brain. MRI may be normal in the initial course; hence, it’s important to repeat if strongly suspected. Prompt immunotherapy and supportive care are emphasised.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"97 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140234071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kawthar Fakhri Al-Bayati, Semaa Mohammed Al-Hasnawi, Omar Ajaj
Congenital pancreatic cysts are rare in the paediatric age group; they can be isolated or associated with other malformations. Prompt diagnosis and appropriate management are crucial to prevent complications. One and a half year old female presented with an abdominal mass. Surgical exploration revealed multiple cystic lesions occupying most of the abdominal and pelvic cavities originating from the pancreas. A complete surgical excision was done, and the histopathological examination confirmed the presence of islands of well-defined pancreatic tissue with scattered dilated ducts. True congenital pancreatic cysts are rare anomalies to occur, and there is female predominance for such conditions; early diagnosis and treatment are essential to prevent complications.
{"title":"A case of congenital multiple pancreatic cysts in a female child: Case report","authors":"Kawthar Fakhri Al-Bayati, Semaa Mohammed Al-Hasnawi, Omar Ajaj","doi":"10.25259/kpj_56_2023","DOIUrl":"https://doi.org/10.25259/kpj_56_2023","url":null,"abstract":"Congenital pancreatic cysts are rare in the paediatric age group; they can be isolated or associated with other malformations. Prompt diagnosis and appropriate management are crucial to prevent complications. One and a half year old female presented with an abdominal mass. Surgical exploration revealed multiple cystic lesions occupying most of the abdominal and pelvic cavities originating from the pancreas. A complete surgical excision was done, and the histopathological examination confirmed the presence of islands of well-defined pancreatic tissue with scattered dilated ducts. True congenital pancreatic cysts are rare anomalies to occur, and there is female predominance for such conditions; early diagnosis and treatment are essential to prevent complications.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"36 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139385114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shruthi Bagambila, Beena Antony, Jane Grace Dsouza, Santhosha Devadiga, K. Praseena, Sanjeev B. Rai
The gastrointestinal tract of newborns is colonised immediately after birth with microbes from the environment, mainly from the mother. According to studies, the early neonatal microbiota is crucial for developing the postnatal immune system. The objective of this study was to investigate the relationship between neonatal gut flora and the mode of delivery during gut microbiota colonisation. A total of 30 neonates – 16 born vaginally and 14 by caesarean section – participated in this study of the intestinal bacterial composition at 3 days of age. Stool cultures and matrix-assisted laser desorption ionisation time-of-flight analyses determine aerobic and anaerobic bacterial species. Neonates delivered by caesarean section appeared to have a less diverse gut microbiota regarding bacterial species than vaginally delivered neonates. Bifidobacterium species are absent from the gut microbiota after caesarean delivery. Even though every newborn vaginally born had a unique microbial profile, the most prevalent bacterial species were Streptococcus spp., Veillonella atypica, Bacteroides vulgatus and Bifidobacterium spp. Our results suggest that the mode of birth significantly influences the gut microbiota composition in the 1st year of human life. This study opens the path to further investigations to confirm the link between microbiota composition and enterotypes of the gut microbiome of breastfed neonates. In addition, we underline the importance of MALDI-TOF for species-level identification of organisms within a fraction of a second.
{"title":"Analysis of the gut microbiota using MALDI-TOF and cultural techniques in breastfed infants delivered vaginally and through caesarean section","authors":"Shruthi Bagambila, Beena Antony, Jane Grace Dsouza, Santhosha Devadiga, K. Praseena, Sanjeev B. Rai","doi":"10.25259/kpj_43_2023","DOIUrl":"https://doi.org/10.25259/kpj_43_2023","url":null,"abstract":"The gastrointestinal tract of newborns is colonised immediately after birth with microbes from the environment, mainly from the mother. According to studies, the early neonatal microbiota is crucial for developing the postnatal immune system. The objective of this study was to investigate the relationship between neonatal gut flora and the mode of delivery during gut microbiota colonisation. A total of 30 neonates – 16 born vaginally and 14 by caesarean section – participated in this study of the intestinal bacterial composition at 3 days of age. Stool cultures and matrix-assisted laser desorption ionisation time-of-flight analyses determine aerobic and anaerobic bacterial species. Neonates delivered by caesarean section appeared to have a less diverse gut microbiota regarding bacterial species than vaginally delivered neonates. Bifidobacterium species are absent from the gut microbiota after caesarean delivery. Even though every newborn vaginally born had a unique microbial profile, the most prevalent bacterial species were Streptococcus spp., Veillonella atypica, Bacteroides vulgatus and Bifidobacterium spp. Our results suggest that the mode of birth significantly influences the gut microbiota composition in the 1st year of human life. This study opens the path to further investigations to confirm the link between microbiota composition and enterotypes of the gut microbiome of breastfed neonates. In addition, we underline the importance of MALDI-TOF for species-level identification of organisms within a fraction of a second.","PeriodicalId":503027,"journal":{"name":"Karnataka Paediatric Journal","volume":"216 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139289456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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