Indian Journal of Child Health <pre><strong>ISSN:</strong> <strong>p-ISSN</strong> - 2349-6118; <strong>e-ISSN</strong> - 2349-6126 <br /><strong>Discipline:</strong> Pediatrics and Neonatology<br /><strong>Starting Year:</strong> 2014<br /><strong>Current volume:</strong> Volume 7<br /><strong>Issue per year:</strong> 12 (monthly)<br /><strong>Editor-in-chief:</strong> Dr. Girish Chandra Bhatt, India<br /><strong>Indexing:</strong> Index Copernicus, EZB, BASE, World Cat, Journal Guide, Google Scholar<br /><strong>E-mail: <a href="" target="_blank" rel="noopener"></a> </strong></pre> en-US (Dr. Girish Chandra Bhatt) (Dr. Rashmi Agrawal) Sun, 27 Sep 2020 00:00:00 +0530 OJS 60 Managing pediatric otorhinolaryngology patients in coronavirus disease-19 pandemic – A real challenge to the clinicians <p>The novel coronavirus disease (COVID-19) pandemic is posing unprecedented challenges among the otolaryngologists during managing the pediatric patients. COVID-19 infection is caused by novel coronavirus called severe acute respiratory syndrome coronavirus-2. This infection is transmitted primarily through human contact and by droplet route. The pediatric otolaryngologists have a critical role for managing nose, paranasal sinus, ears, oral cavity, pharynx, and larynx, which are important sites for generating aerosols and virus transmission. Asymptomatic pediatric patients have high risk for viral shedding. In COVID-19 pandemic, the surgical procedure by pediatric otolaryngologists should be limited to the emergency condition. The surgical interventions should limit the viral dissemination. This review article provides an overview of common methods to limit the viral transmission to the otolaryngologists and assisting health-care staffs from COVID-19 infections during the management of the pediatric patients.</p> Santosh Kumar Swain, Ishwar Chandra Behera Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Multisystem inflammatory syndrome in children-associated with severe acute respiratory syndrome coronavirus 2: A case report and brief review of literature <p>Amid coronavirus disease (COVID-19) pandemic, recently a number of children who developed a significant systemic inflammatory response have been identified from various parts of the world. This syndrome has been described to have clinical features closely related to Kawasaki disease, toxic shock syndromes, bacterial sepsis, and macrophage activation syndromes. Clinical and laboratory manifestations of this multisystem inflammatory syndrome have been attributed to the antibodies produced against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we report a case of a previously well 4-year-old female child who presented to us with multisystem inflammatory syndrome in children (MIS-C) following exposure to SARS-CoV-2 and was successfully managed with intravenous immunoglobulin (IVIGg) and IV steroids.</p> Prashant Prakash Rajebhosale, Mohammad Mousa Aldisi, Wissam Jamal Altamr Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Macrophage activation syndrome: A fatal complication of systemic-onset juvenile idiopathic arthritis – A case report <p>Macrophage activation syndrome (MAS) is a life-threatening complication of systemic-onset juvenile idiopathic arthritis (sJIA) marked by the sudden onset of non-remitting high-grade fever, lymphadenopathy, hepatosplenomegaly, and profound depression in all three blood cell lines and elevated serum liver enzyme levels. Although MAS can occur in any systemic rheumatological disorder, it is most common in sJIA. In children with sJIA, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. Early and aggressive immunosuppression is likely to benefit these patients. Hereby, we report a case of a 6-year-old male patient who presented with high-grade fever, joint pain, and rashes and was diagnosed as systemic-onset juvenile idiopathic arthritis with MAS.</p> Amit Agrawal, Jyotsna Shrivastava, Sharmila Ramteke Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Cardiac manifestations of dengue fever in pediatrics age group <p><strong>Background:</strong> Dengue infection is a serious public health concern in tropical and subtropical regions of the world. Cardiac involvement is a known but rare complication of dengue. Electrocardiogram (ECG) and 2D echocardiogram (ECHO) are preferred non invasive instant diagnostic tool to evaluate the status of heart in dengue infection. <strong>Objectives:</strong> The present study was carried out to confirm the cardiac manifestation in dengue fever, along with its correlation with the severity of the disease. <strong>Materials and Methods:</strong> A total of 60 subjects were included over a period of 1-year time from inpatient and outpatient departments presenting with clinical features suggestive of dengue and further confirmed by positive serology test of IgM and/or NS1 antigen by rapid and/or by ELISA method. Cardiac manifestations were analyzed with the help of ECG and 2D ECHO in all serologically confirmed cases. <strong>Results:</strong> 16 out of 60 cases had cardiac findings in the form of tachycardia, bradycardia, and myocarditis. ECG showed some nonspecific findings like sinus tachycardia followed by sinus bradycardia. Myocarditis diagnosed by ECHO as ejection fractions &lt;50% was observed in four cases of dengue with warning sign and in one of severe dengue, while mild TR was seen in three cases of dengue with a warning sign, two cases of probable dengue, and one case of severe dengue. <strong>Conclusion:</strong> This study showed that cardiac involvement of dengue infections runs a benign course without any complications. Early diagnosis, strict monitoring, and prompt supportive management reduce the mortality rate in dengue.</p> Upasana Menwal, Anil Rawat, Anurag Rawat, Vipan Chandar Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Risk factors and outcome of Klebsiella sepsis in neonates <p><strong>Background:</strong> Klebsiella is the most common organism isolated in early onset sepsis and causes outbreaks in neonatal intensive care unit (NICU). No clear risk factors for Klebsiella sepsis have been documented.<strong> Objective:</strong> The objective of the study was to study the risk factors, clinical profile, and outcome of Klebsiella in neonatal sepsis. <strong>Materials and Methods:</strong> A retrospective observational study was done at an extramural tertiary care center from January to December 2017. After getting Institutional Ethics Committee approval, data were collected from hospital records of admitted neonates whose blood culture was positive for Klebsiella. Detailed antenatal and natal history including birth weight, Apgar score, sex, and age was taken. Data on ventilator support, continuous positive airway pressure, intravenous fluids, enteral and parenteral nutrition, central line, and surgical procedure were collected. <strong>Results:</strong> Of the total of 1852 blood cultures sent, 308 (16.63%) showed growth. Altogether, 63 (20.45%) cases with Klebsiella growth were included in the study, of which 40 were male and 23 were female (1.7:1). Klebsiella was isolated in 25 (62.5%) who died. Birth weight was 2.152±0.752 g for babies who died and 2.613±0.525 g among discharged. Mortality was high in males 18 (72%) as compared to females 7 (28%), in low birth weight babies 32 (63.69 %), with thrombocytopenia 18 (80%), and those on invasive mode of ventilation. By regression analysis, it was found that duration of days of NICU stay, shock, invasive ventilation, umbilical venous, and arterial catheterization were identified as the factors that influence outcome in Klebsiella sepsis. <strong>Conclusion:</strong> High index of suspicion, initiating early and appropriate antibiotic therapy, antibiotic stewardship, and environmental cleaning improve the outcome. With emerging drug resistance, prevention of sepsis by infection control measures is needed.</p> Usha B Kantharajanna, Hunsanhalli Shivanna Niranjan, Naveen Benakappa, Bandya Prathik Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Impact of COVID-19 pandemic on the pediatric services of a tertiary care hospital in North India: A retrospective review <p><strong>Background:</strong> The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected the world at large. To control the spread of the virus, the Government of India promoted simple measures such as social distancing and hand hygiene. Yet, the most prominent one was a strict nationwide lockdown on all non-essential services and complete curtailment of the public transport. <strong>Objective:</strong> Our study aims to quantify the impact of COVID-19 pandemic and lockdown measures on the pediatric services of a tertiary care center in North India. <strong>Materials and Methods:</strong> A retrospective observational study was done to analyze the change in our outpatient visits, admissions, and number of institutional deliveries, immunization services, pediatric surgeries, and mortality rates during the lockdown period when compared to the pre-lockdown period. Data of all children aged 0–12 years who presented to the pediatric medicine and pediatric surgery departments were collected. Data were divided into two groups; January 1, 2020–March 31, 2020 and April 1, 2020–June 30, 2020. <strong>Results:</strong> There was a reduction of 79.1% OPD attendance and 70.8% in immunization visits. Inpatient admission in pediatrics medicine and surgery decreased by 59.8% and 67.6%, respectively. The mortality rate increased from 11.8% to 13% and 7.6% to 19.6%, respectively. Emergency area visits decreased by 55.3% with an increase in mortality rate from 2.4% to 6.2%. Intramural births decreased by 55.4%. <strong>Conclusion:</strong> The COVID-19 pandemic has led to an unmet need of pediatric services. This requires urgent management or else it may halt the progress made in different aspects of health care.</p> Akriti Gera, Amitabh Singh, Nidhi Sungadhi, Nidhi Aggarwal, Rani Gera Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Phenotypic variance in children with chromosomal aberrations – A cohort study <p><strong>Background:</strong> Chromosomal abnormalities are the result of alterations in the number or structure of chromosomes leading to significant human morbidity and mortality. They are responsible for large proportion of miscarriages, developmental delay, disorders of sexual development, congenital malformations, and mental retardation. <strong>Objectives:</strong> The objectives of the study were to find the occurrence of chromosomal abnormalities in infants and children with various phenotypic presentations and to analyze the impact of associated risk factors for chromosomal abnormalities in children. <strong>Materials and Methods:</strong> A retrospective single-center study, based on the outcome data of chromosomal analysis of 112 children admitted to the pediatric department of our hospital over a period of 3 years, was reported. The data were collected from the electronic medical records for analysis, including maternal age, consanguinity, family history of any congenital anomalies and malformations, clinical details, and the results of chromosomal analysis. <strong>Results:</strong> A statistically significant association between the presence of dysmorphic features and chromosomal abnormalities with 3 times increased risk when compared to children with no dysmorphism (relative risk [RR] 3.06, 95% confidence interval [CI] 1.71–5.50, p=0.0002). Among the congenital anomalies, the presence of congenital heart defects had strong association and was found to be 43% higher in children with chromosomal abnormalities (RR 1.43, 95% CI 1.10–1.86, p=0.0069). Our study demonstrated a strong association for maternal age &gt;35 years and the risk for chromosomal abnormality. It was 1.75 times more than the children born to mothers ?35 years age (RR 1.75, 95% CI 1.29–2.36, p=0.0003). <strong>Conclusion:</strong> Cytogenetics has a major role in diagnosis of chromosomal abnormalities, especially in children with dysmorphic features and congenital heart defects. The early diagnosis is important for planning and resource allocation of specialized health services directed toward the families and infants.</p> Alaa Abouzaid, Jemila James, Emad Shatla Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Incidence and factors associated with early neonatal near miss in a tertiary care hospital in Bengaluru <p><strong>Background:</strong> Neonatal near miss is defined as, a neonate who has suffered a life-threatening condition but survived the first 28 days of life. As neonatal near miss is a predictor for early neonatal death, the lessons learned from near misses will be useful to help prevent early neonatal mortality. <strong>Objectives:</strong> The objectives of the study were to estimate the incidence of neonatal near miss and its associated factors in the early neonatal period in a tertiary hospital. <strong>Materials and Methods:</strong> This was a longitudinal study where all the cases of early neonatal near miss and early neonatal mortality were documented over a 1-year period. A face-validated structured questionnaire was used to collect information from mothers. The data were described using proportions, mean, and standard deviation. Regression analysis and adjusted odds ratio (aOR) were used to identify the determinants of early neonatal near miss. <strong>Results:</strong> The study was conducted among 210 neonates born to 197 mothers. The neonatal near miss rate in our study was found to be 75.43/1000 live births. The total live births during the study period were 2784. The most common cause of near miss was identified as birth weight of &lt;1750 g. The absence of antenatal ultrasound scans (aOR 6.124), anemia (aOR 3.945), preterm premature rupture of the membranes (aOR 3.136), presence of oligohydramnios (aOR 3.624), and malpresentation (aOR 5.581) was independent determinants of early neonatal near miss. <strong>Conclusion:</strong> These findings demonstrate the importance of better antenatal care including prevention of anemia, screening and management of high-risk cases, and antenatal complications to avoid the incidence of near miss.</p> Sobin Sunny, Avita Rose Johnson, Sulekha Thimmaiah, P N Suman Rao Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Rickettsial fever in tertiary care hospital in rural Bengaluru: Clinical profile and complications <p>Background: Rickettsial fever is a major health concern in different districts of Karnataka with serious complications, including morbidity and mortality, if diagnosed late. Objective: The objective of the present study was to know the clinical profile of Rickettsial fever in children. Materials and Methods: A descriptive study was conducted on all the laboratory-confirmed cases of Rickettsial fever in children admitted to a tertiary care hospital from December 2018 to November 2019. Results: Among 103 children studied, majority were males (66%) in the age group of 3–6 years. All the children presented with history of fever (100%) followed by decreased appetite (94%). The least common symptoms noticed were altered sensorium (1.9%), breathlessness (6.5%), and bleeding tendencies (6.5%). The most serious complications seen were shock (38.8%), hepatic dysfunction (7.7%), and myocarditis (3%). There were no deaths reported. The least common complication was renal failure. A single case had cranial nerve palsy with meningitis. Conclusion: It was concluded that male children in the age group of 3–6 years were more affected. The common symptoms observed were fever, decreased appetite, abdominal distension, and skin rash and the common complications were shock and myocarditis.</p> P Saravanan, M V Nagaraj, C Somashekhar Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530 Role of serial C-reactive protein measurements for determination of the duration of empirical antibiotic therapy in suspected neonatal sepsis <p><strong>Background:</strong> Neonatal sepsis (NS) is a clinical syndrome characterized by signs and symptoms of infection with or without bacteremia in neonatal age. At present, there are a variety of tests available for testing sepsis in neonates including C-reactive protein (CRP). <strong>Objective:</strong> The objective of the study was to decrease the antibiotic duration in a case of NS and to decrease the hospital stay and financial burden on the patient by measuring serial CRP levels. <strong>Materials and Methods:</strong> This case–control study was conducted in a tertiary care teaching hospital at a tertiary hospital of central India. A total of 103 neonates were considered as the study population. Estimation of serial CRP levels among neonates was assessed and correlated within two study groups. <strong>Results:</strong> CRP level at admission was able to successfully identify NS in 66.67% of the cases (sensitivity), while in 12.07% it was able to negate NS when it was absent on blood culture also (specificity). The positive predictive value (PPV) was low (37.04%) with a negative predictive value of 31.82%. The diagnostic accuracy of the CRP level at admission was 35.92% suggesting its accuracy to correctly identify the patient with NS in only 35.92% cases. The results show that CRP is having a good sensitivity, with a poor specificity, and overall low diagnostic accuracy. <strong>Conclusion:</strong> Our study showed a significant difference in the use of antibiotics in the two groups. The sensitivity of CRP was high with the low specificity and low PPV and high NPV, which makes CRP a vital screening tool, especially if used in conjunction with other screening parameters improving the overall sensitivity and specificity.</p> Virendra Mehar, Anuj Malhotra, Pulkit Mehta, Karishma Thakur, Ritu Malik Copyright (c) 2020 Sun, 27 Sep 2020 00:00:00 +0530