ISSN: p-ISSN - 2349-6118; e-ISSN - 2349-6126 Discipline: Pediatrics and Neonatology Starting Year: 2014 Current volume: Volume 10 Issue per year: 12 (monthly) Editor-in-chief: Dr. Nihar Ranjan Mishra, India Indexing: Index Copernicus, EZB, BASE, World Cat, Journal Guide, Google Scholar E-mail: editor.ijch@mansapublishers.com
Quality of life of caregivers of children with cerebral palsy in Assam, India
Background: Cerebral palsy (CP) is a common childhood disability worldwide that places significant demands on caregivers. Empirical evidence on caregiver strain is scarce in India. This cross-sectional study assessed the quality of life (QOL) of 140 purposively chosen caregivers of children aged 4-12 with CP in Assam, India, using the WHOQOL-BREF questionnaire. Methods: Subscale scores were computed with reliability confirmed using Cronbach's α. Spearman's rank correlation and chi-square tests were performed to investigate the associations of caregiver and child characteristics with the QOL of caregivers. Results: The overall QOL score was 48.46 ±11.49, with 82% of caregivers reporting poor QOL. Significant variations in QOL were associated with parental education, father’s occupation, perceived parental physical and mental health, social isolation, awareness of social services, child’s GMFCS levels, special school enrolment, associated conditions, and social support. Spearman’s rank correlation revealed that the father’s age, mother’s years of schooling, GMFCS levels, and associated conditions of the child were correlated with the QOL of caregivers. Conclusions: Community-level awareness generation programs, establishment of an affordable special school, and increased enrolment, along with a disability-friendly health system, will enhance the QOL of the caregivers.
Copyright (c) 2025 Daisy Saikia, Manas Ranjan Pradhan https://creativecommons.org/licenses/by-nc-nd/4.0
What is new in the management of distal VP shunt catheter extrusion through the anus: A brief review of recently published literature
The objectives of the current study were to briefly review the demographics, clinical characteristics, and outcomes of the surgical procedures performed for the cases managed for the trans-anal extrusion of the distal ventriculo-peritoneal (VP) shunt catheter. The current literature review focused on cases published between January 1, 2021, to December 31, 2024. The relevant literature/articles were retrieved through an online database search. This literature review included n=50 cases (males n=27 and females n=23) of distal VP shunt catheter extrusion through the anus. In approximately four-fifths (n=40) of cases, the indication for primary VP shunt insertion was congenital hydrocephalus. Approximately two-thirds (n=31) of cases involved were ≤ 24 months at the extrusion of the distal VP shunt catheter. Approximately two-thirds (n=32) of extrusions of distal VP shunt catheter occurred within 12 months of the initial VP shunt catheter insertion or last shunt revision. The main complaint reported was the extrusion of the distal shunt catheter through the anal canal. For 96% (n=48) of the cases, the entire shunt system or the distal shunt catheters were removed with or without external ventricular drainage (EVD). Most cases recovered well, but this review also noted one death. Distal ventriculo-peritoneal shunt catheter extrusion through the anus, primarily reported in children ≤ 5 years, though cases have also been reported in older children, adults, and older individuals. For management, the preferred approach was the removal of the entire or distal shunt catheter with or without external ventricular drainage and delayed re-VP shunt catheter insertion.
Copyright (c) 2025 Rajendra K Ghritlaharey https://creativecommons.org/licenses/by-nc-nd/4.0
Extubation failure in PICU: The Preventive Strategies and Lessons Learnt
Mechanical ventilation has always played a pivotal role in saving lives in pediatric critical care. But as indications for the same have been elaborated in literature, weaning is still a challenging task. A structured weaning protocol is required to prevent extubation failure in a critical care setting. Prolonged mechanical ventilation, extended sedative use, post-extubation stridor (PES), and diminished respiratory muscle strength are major causes of failed extubation. To tackle its impact, many new techniques, indices, and modalities are being developed. Using non-invasive ventilation for weaning, peri-extubation steroids, minimal sedation, and nutrition maintenance are some of the strategies that have been shown to improve the ventilation outcomes. Diaphragmatic ultrasonography has emerged as a new non-invasive technique to test diaphragm strength and can be used to assess readiness for successful extubation. Integrating knowledge about risk factors, applying defined tests and maneuvers, and using different parameters and ultrasonography to monitor diaphragm function can improve the chances of successful extubation.
Copyright (c) 2025 Vaishali Sharma, Abhishek Navik, Vikram Bhaskar, Prerna Batra https://creativecommons.org/licenses/by-nc-nd/4.0
Fibrovascular Polyp of the Esophagus in an Infant: A Rare Case Emerging from a Tribal Healthcare Setting.
Fibrovascular polyp is a rare benign intraluminal submucosal lesion of the esophagus that usually arises from the proximal portion and, despite its non-malignant nature, can enlarge significantly and lead to life threatening complications, particularly in children where cases are exceedingly uncommon. We report a 7-month-old female infant who presented with progressive dysphagia, intermittent respiratory distress, and protrusion of a soft mass from the mouth during coughing. Imaging revealed a fat-attenuated lesion in the upper cervicothoracic esophagus, while endoscopy demonstrated a large pedunculated mass. Surgical excision was performed via left lateral pharyngo-esophagostomy, and histopathology confirmed fibrovascular polyp composed of myxoid, fibrofatty, and collagenous tissue with dilated vascular channels beneath squamous epithelium. The postoperative course was uneventful, with resolution of dysphagia and respiratory symptoms, and at three-month follow-up no recurrence was detected. This case underlines the importance of considering fibrovascular polyp in the differential diagnosis of infants presenting with unexplained dysphagia, recurrent respiratory compromise, or visible oropharyngeal masses. Although benign, delayed recognition may result in aspiration or fatal airway obstruction, making early diagnosis and prompt surgical intervention crucial. Reporting such rare pediatric cases enhances clinical awareness and contributes to timely recognition and management in future practice. Written informed parental consent was obtained for publication.
Copyright (c) 2025 Rajan Kumar, Akanksha Raj, Soumi Kundu, Nishat Ahmed Sheikh, Md Ehtesham Ansari https://creativecommons.org/licenses/by-nc-nd/4.0
Rare Yet Reversible: CA5A Deficiency Presenting as Neonatal Metabolic Crisis
Carbonic anhydrase 5A (CA5A) deficiency (OMIM 615751) is a rare autosomal recessive metabolic disorder caused by mutations in the CA5A gene on chromosome 16q24.2. Deficiency of this mitochondrial enzyme disrupts bicarbonate production, impairing ureagenesis and energy metabolism, and typically presents in neonates with hyperammonemic encephalopathy, lactic acidosis, and hypoglycemia. We report a term neonate who developed severe hyperammonemia with encephalopathy on day 4 of life, requiring peritoneal dialysis, nitrogen scavengers, and ventilatory support. Tandem mass spectrometry and urinary GCMS were non-diagnostic, but singleton exome sequencing identified a homozygous CA5A variant, c.721G>A (p.Glu241Lys), classified as likely pathogenic. With early intervention, the infant recovered fully and remains metabolically stable with normal growth and neurodevelopment at 5 years of age. This case underscores the diagnostic challenge of CA5A deficiency, highlights the role of exome sequencing, and demonstrates the potential for excellent long-term outcomes with timely recognition and management.
Copyright (c) 2025 Abhishek K Phadke, Ali Kumble, Arun Varghese, Manju Jacob, Anciline Siriac https://creativecommons.org/licenses/by-nc-nd/4.0
Emergency Endotracheal Intubation in a Pediatric Intensive Care Unit: A Quality Improvement Study
Background: Emergency Endotracheal Intubation (EEI) is a high-risk procedure with complications such as hypoxemia and hypotension. Despite these risks, EEI is routinely performed in Pediatric Intensive Care Unit (PICUs), which are complex and hazard-prone environments. Suboptimal intubation can lead to adverse outcomes, including brain injury, cardiac arrest, and death. Quality improvement (QI) measures, including system changes and standardized protocols, have been shown to improve first-pass success rates and reduce adverse events. This study describes a QI project aimed at enhancing safety EEI. Objective: To improve the first pass success rate of emergency endotracheal intubation in children in the PICU and reduce procedure related adverse events through QI interventions. Method: The study was conducted in the PICU over three months. A multidisciplinary QI team was formed. Baseline data were collected from 50 intubations using a structured checklist. Root cause analysis was performed using fishbone methodology. Based on identified deficits, interventions were developed and tested through Plan-Do-Study-Act (PDSA) cycles. Post-Intervention data were collected using the same checklist. Interventions were accepted, rejected, or modified based on results. Intubation parameters were reassessed one year later to evaluate sustainability. Results: Following interventions, the first-pass success rate improved from 62% to 88% (p = 0.0004). Preoxygenation compliance increased from 3% to 88% (p = 0.00004). Equipment checks improved from 55% to 90% (p = 0.0005). Complications decreased from 38% to 12%, reflecting better patient safety. One year later, the improvements remained sustainable: first-pass success rate 79%, preoxygenation 75%, and equipment checks 89%. Conclusion: The first-pass success rate should be adopted as a standard quality metric for auditing intubation care. Mandatory simulation-based training for all staff is essential.
Copyright (c) 2025 Abhishek Navik, Vaishali Sharma, Prerna Batra, Vikram Bhaskar https://creativecommons.org/licenses/by-nc-nd/4.0
Accidental poisoning in children: An eight-year experience from a tertiary care institute of north India
Introduction: Accidental poisoning is an important Paediatric emergency worldwide resulting in high mortality and morbidity. As no recent data is available from our region regarding the substance responsible for accidental poisoning. So, the present study was planned to describe the profile of accidental poisoning in children. Methodology: A retrospective analysis was conducted on records of children (up to 18 years of age) admitted to Paediatric Emergency from January 2015 to December 2022 with a diagnosis of poisoning was done and information recorded on a data collection form. Results: Two-third of the children (68.4%) belonged to the age group of 1-3 years, were males (62.1%), and from rural background (70%). The mean age was 3.2 + 2.73 years. Highest number of admissions were due to the consumption of hydrocarbons 26.8% followed by mosquito repellent (18%) and prescription drugs (17.3%). In children less than 5 years of age, hydrocarbons were the main reason of poisoning, in those aged 5-10 years, it was insecticides which led to maximum poisoning cases and children over 10 years, pesticides were the leading cause. Mechanical ventilation was required by 9% children with mean duration 0.14 + 0.5 (0-3) days. Mean duration of ICU stay was 0.19 + 0.78 (0-5) days. Mean number of days of hospital stay was 2.91 +2.74 (1-19). Mortality was 3.3%. Conclusion: Hydrocarbons were the leading cause of accidental poisoning. Poisoning in children was caused by the common household chemicals which should not be accessible to the children. So community mass awareness programs can be initiated to educate the parents regarding storage of such poisonous substances.
Copyright (c) 2025 Poonam Verma, Shivani Randev, Amanvir Kaur, Nikhil Mehta https://creativecommons.org/licenses/by-nc-nd/4.0
Satoyoshi Syndrome: Difficult to find or treat?
Satoyoshi Syndrome, also known as Komuragaeri disease, is a rare multisystemic autoimmune disorder characterised by alopecia, intermittent painful muscle spasms, diarrhoea, endocrinopathies, skeletal deformities, and positivity for antinuclear antibodies (ANA). The etiology of this condition remains unclear. This case report discusses Satoyoshi Syndrome in a 10-year-old girl, emphasising the diagnostic challenge, clinical course, treatments, and outcomes.
Copyright (c) 2025 Ashik Majumder, Aditi Das, Rohit Bhowmick, Niladri Sekhar Bhunia, Subhankar Sarkar, Rimjhim Sonowal https://creativecommons.org/licenses/by-nc-nd/4.0
Pediatric Arterial Ischemic Stroke: Current Insights and Challenges
Paediatric arterial ischemic stroke (AIS) is a significant cause of acquired brain injury in children, leading to considerable morbidity and mortality. The incidence of AIS in children ranges from 1.2 to 8 cases per 100,000, with diverse etiologies that differ from adults, including congenital abnormalities and lifestyle factors. Recent studies highlight the exacerbating role of infections, such as influenza, and the importance of vaccination in prevention. Diagnosis remains challenging due to nonspecific symptoms and the need for rapid imaging techniques, with vascular imaging being crucial for accurate etiological diagnosis. The management of pediatric AIS requires tailored strategies, including the use of thrombolysis and mechanical thrombectomy, although evidence for these treatments in children is limited. Recovery outcomes are influenced by early intervention, access to rehabilitation services, and parental involvement. The establishment of dedicated pediatric stroke centres and standardized protocols are essential for improving diagnosis and treatment outcomes. Additionally, ongoing research is necessary to develop evidence-based guidelines specifically for pediatric stroke management, addressing the unique needs of this vulnerable population to enhance recovery prospects and quality of life for affected children.
Copyright (c) 2025 Rahul Binu, Mohammed Arslaan Musthaq Ahamed, Arsha Priya K, Mohamed shafee Abdul Hameed, Muhammed Ajas, Chaminda Padmaraju, Lakshmi Teja Pemmasani, Priyashruthi Lakshmi Raja, Jhancy Malay https://creativecommons.org/licenses/by-nc-nd/4.0
Estimation of Serum Iron Status in Patients with Cyanotic Congenital Heart Disease – A Cross-Sectional Study
Background: Cyanotic congenital heart disease (CCHD) is associated with chronic hypoxia, leading to compensatory erythrocytosis and paradoxically elevated hematological indices, which can mask underlying iron deficiency anemia (IDA). Objective: To assess the serum iron levels and prevalence of IDA in patients with CCHD. Methods: This cross-sectional study was conducted from July 1, 2021, to December 31, 2022, at All India Institute of Medical Sciences (AIIMS) Rishikesh for 18 months, enrolling 127 children aged 6 months to 18 years with unrepaired CCHD. Serum iron, ferritin, total blood count, and erythrocyte indices were assessed. Nutritional assessment, anthropometric measures, and socioeconomic data were collected. Different erythrocytic indices were compared between iron-deficient and non-iron-deficient groups. Results: A total of 127 children, with a mean age of 5.6±4.7 years, were included in the study. The most frequent CCHD was Tetralogy of Fallot (55.1%). Based on serum iron and ferritin levels, 25 participants (19.7%; 95% CI: 12.7%–26.7%) had iron deficiency. Comparison of hematological indices showed no significant difference in mean hemoglobin (16.7 g/dL in both groups; p = 0.99) and hematocrit (52.6 vs 53.2; p = 0.86) between iron-deficient and non-iron-deficient groups. Similarly, mean corpuscular volume (77.3 vs 80.5 fL), mean corpuscular hemoglobin (25 vs 24.4 pg), and mean corpuscular hemoglobin concentration (28.4 vs 28.9 g/dL) differences were also not statistically significant. Conclusion: The study revealed that 19.7% of children with CCHD have iron deficiency. Neither the clinical predictors of iron deficiency nor the erythrocytic parameters varied between the two groups, underscoring the importance of routine iron status evaluation.
Copyright (c) 2025 Sanchit Agarwal, Yash Shrivastava, Anish Gupta, Vinod Kumar, Bela Goyal, N.K Bhat https://creativecommons.org/licenses/by-nc-nd/4.0
The Lifeline of Donor Human Milk: Understanding Human Milk Banking in India and Future Prospects
Human milk banking, also known as breast milk banking or lactarium, is a vital service that collects, screens, processes, pasteurizes, and dispenses donated human milk to infants who cannot receive their mother's milk. When a mother’s milk is unavailable, donor human milk is the best alternative for babies who are born premature and low birth weight. Donor human milk acts as a lifeline for infants who can’t receive their mother’s milk. This practice plays a crucial role in providing optimal nutrition and crucial health benefits, particularly for premature, sick, and vulnerable newborns. Growing recognition of the benefits of donor human milk has led to increasing global interest in creating and sustaining human milk banks to fulfill the need for donor human milk. This article will focus on the basics of Human Milk Banking and it’s continuously evolving areas of interest.
Copyright (c) 2025 Neelam Belekar https://creativecommons.org/licenses/by-nc-nd/4.0
Short-term Effect of Sensitization Workshop on “Giving Effective Feedback” among PG teachers of Pediatrics
Background: Postgraduate educators are key to developing physician leaders and specialists who shape community healthcare. To prepare them as effective teachers, imparting knowledge, skills, and professionalism through effective feedback on professional conduct and disposition is vital. This study aimed to ascertain postgraduate teachers' perceptions of effective feedback delivery. Methodology: This prospective intervention study was implemented over a 3-month duration, employing a convenience sampling method. All postgraduate teachers in the department were included, except for those on leave exceeding 4 weeks. A validated proforma (by a member of the Medical Education Unit [MEU]) was utilised for data collection, with pre-test and post-test assessments administered before and after the workshop. The short-term effects were assessed through a Google Form distributed 8 weeks following the intervention. Results: In feedback awareness and attitude, 75% of participants were giving feedback, 68.75% were giving it individually, and 56.25% believed that it should be given immediately. Only 37.5% had an understanding of feedback before the sensitization session. Post-intervention changes highlighted a general positive attitude towards feedback, and they realized the aspects of time constraints. The participants felt it should be given in all sessions, such as didactic lectures, clinical case discussions, ward rounds, and extracurricular work. Feedback had a positive impact on student performance and higher engagement in clinical case discussions. Later, after 8 weeks. Around 41.2% of the participants felt that giving feedback had become a routine, and 52.9% felt that it was only sometimes. Conclusion: The results indicate a positive shift in the practices and perceptions regarding effective feedback among post-graduate teachers in pediatrics, demonstrating the impact of sensitization workshops on improving feedback strategies and their implementation.
Copyright (c) 2025 Jyotsna Shrivastava, Padma Bhatia, Amit Agrawal https://creativecommons.org/licenses/by-nc-nd/4.0/
Two year old adults: Clinical Navigation through Precocious Puberty
Precocious puberty is defined as the onset of puberty below the age of eight years in girls and nine years in boys. It is etiologically classified as central and peripheral depending on the source of hormone production. We present a couple of cases of two year old males who presented with increased penile length, pubic hair and height spurt along with testicular volume enlargement. Thus, a clinical diagnosis of isosexual central precocious puberty was made. Central precocious puberty was confirmed by pubertal levels of gonadotropins. MRI brain showed the presence of hypothalamic hamartoma. Both the children were started on Gonadotropin releasing hormone (GnRH) analogs. We use these cases to highlight the paramount importance of a thorough clinical examination including genital examination in all children and emphasize on physical measurement of testicular volume by accurately using an orchidometer as an important step to decide the further line of evaluation and management.
Copyright (c) 2025 Simran Syal, Prakash George Mathew, Anil Kumar Goel https://creativecommons.org/licenses/by-nc-nd/4.0
Hyponatremia of children of two months to five years of age with community-acquired pneumonia and its correlation with severity of illness and its outcome.
Background: Pneumonia is an acute respiratory infection of the lungs where alveoli become inflamed and are filled with pus and fluid, leading to impaired oxygen exchange, respiratory distress, and painful breathing. Community-acquired pneumonia (CAP) remains the leading single cause of mortality in the pediatric age group worldwide. This study aims to study hyponatremia in community-acquired pneumonia among children of 2 months to 5 years of age and its correlation with severity of illness, course, outcome and length of stay in hospital. Material and Methods: This was a prospective observational study conducted in the pediatric inpatient ward & pediatric intensive care unit (PICU) of North Bengal Medical College. The study was conducted from July 2023 to December 2024 with a duration of 18 months. Children admitted to the pediatric inpatient ward or PICU with a clinical diagnosis of CAP according to the WHO criteria were included in the present study. Results and Conclusion: The present study highlights that hyponatremia is a common finding in children with CAP. This study also highlights the significant association of hyponatremia with severe pneumonia, the association of severe hyponatremia with severe pneumonia, increased need for ventilation, prolonged hospital stays, and higher mortality in children with CAP.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Copyright (c) 2025 Arnab Roy, Rahul Majumdar, Divya Mahajan, Mridula Chatterjee https://creativecommons.org/licenses/by-nc-nd/4.0/
Effects of Amino-acids based fortifier in preterm infants – An open label, observational study
Background: Preterm infants have elevated protein needs for optimal growth and development; However, current bovine milk-based fortifiers are associated with feed intolerance and necrotising enterocolitis (NEC). An amino acid-based fortifier (AABF) can enhance protein absorption and tolerance in preterm infants. This study evaluates the safety and efficacy of an amino-acid-based fortifier in improving growth outcomes in preterm neonates. Methods: Preterm infants with a birth weight < 2000 g and/or gestational age < 32 weeks were prospectively observed in this single-centre, open-label study. Following the establishment of enteral feeds at 100 ml/kg/day, an amino acids-based forifier (Human Milk Fortifier (HMF) -ADVANCE) was introduced and maintained until neonatal intensive care unit (NICU) discharge. The primary outcome was assessment of daily weight gain, with secondary outcomes including weekly gains in length and head circumference and the occurrence of feed intolerance was also considered for assessment. Results: A total of 25 preterm infants (12 males and 13 females) with an average birth weight of 1204.62 ± 48.9 grams and a mean gestational age of 31.33 ± 3.4 weeks were enrolled in the study. At the end of the study period, the observed growth outcomes included a mean weight gain of 21.34 ± 3.41 grams per day, a mean head circumference increase of 0.92 ± 0.32 cm per week, and a mean length increase of 0.9 ± 0.13 cm per week. There were no instances of feed intolerance or NEC during the study, and none of the infants required discontinuation of fortification before discharge from the NICU. Conclusion: Fortification with an amino-acid-based fortifier in preterm infants demonstrated positive growth outcomes with optimal weight gain, length gain, and head circumference growth. No infants exhibited feeding intolerance, indicating good safety and tolerance. These findings suggest that AABF is an effective fortification strategy for preterm neonates.
Copyright (c) 2025 Sagar A Karotkar, Mahaveer Lakra, Ravi , Aditi , Akanksha https://creativecommons.org/licenses/by-nc-nd/4.0/
Emerging Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Tertiary Care Perspective
Background: Urinary tract infections (UTIs) are a common pediatric concern that can lead to significant morbidity if improperly managed. The objective of this study is to determine the etiological profile and antimicrobial resistance patterns of uropathogens in children aged 1 month to 5 years. Methodology: A prospective observational study was conducted in a tertiary care government medical college involving 96 children between 1 month to 5 years of age presenting with UTI. Aetiology was confirmed using standard microbiological methods, and antimicrobial susceptibility testing was conducted [1]. Results: Of the 96 children, 50 showed significant bacterial growth. Escherichia coli (66%) and Klebsiella pneumoniae (18%) were the predominant pathogens. Multi-drug resistance was observed in 75% of E. coli and 66% of Klebsiella isolates. Sensitivity remained high for Amikacin and Imipenem. Conclusion: The high prevalence of multidrug-resistant uropathogens underscores the importance of antibiotic stewardship and region-specific antibiogram-based empirical therapy in children [2, 3].
Copyright (c) 2025 Aishwarya Venugopal, Anjana S R Krishnan, Ramesh Bhat Y, Niranjan Kumbara H O https://creativecommons.org/licenses/by-nc-nd/4.0/
Evolving Antibiotic Resistance in Neonatal Sepsis in a Tertiary Neonatal Care Unit in Eastern India: A Prospective Study
Introduction: The Indian National Neonatology Forum (NNF) advises using ampicillin and gentamicin as the initial empirical antibiotics for treating neonatal sepsis. However, with the ongoing rise in antibiotic resistance among pathogens, there is a pressing need to update and review the current antibiotic protocols. Aims and Objectives: This study aims to describe the spectrum of antibiotic sensitivity pattern of common pathogens causing blood culture-positive neonatal sepsis and propose a uniform first-line empirical antibiotic against them. Methodology: The study was conducted in the Neonatal Intensive Care Unit (NICU) over a period of 2 years. A total of 100 inborn neonates, who had blood culture proven sepsis, were included in the study. The antibiotic susceptibility pattern against commonly used antibiotics like Ampicillin, Gentamicin, Piperacillin-tazobactam, Amikacin and Meropenem were analysed. Results: The most common organism to be isolated from blood culture was Klebsiella pneumoniae (32%). None of them were sensitive to Ampicillin, and only 43.75% were sensitive to Gentamicin. Instead, Piperacillin tazobactam had 50% sensitivity, and Amikacin had 81.25% sensitivity. Conclusion: The study highlights the changing trends of antibiotic sensitivity patterns and the high degree of resistance to the conventional Ampicillin–Gentamicin combination. Instead, Piperacillin tazobactam - Amikacin can be a better alternative choice of empirical antibiotic.
Copyright (c) 2025 Turiyo Adhikary, Tapabrata Chatterjee https://creativecommons.org/licenses/by-nc-nd/4.0/
A Hospital-Based Study to Assess the Effect on Mental Health of Mothers providing Kangaroo Mother Care (KMC) to Newborns
Background: Many mothers with low-birth-weight babies and sick babies present with mental health issues. Kangaroo mother care (KMC) aims at skin-to-skin contact between the care provider and newborn babies. KMC provides psychological support to the mother and helps her positively interact with the baby. Method: This present cross-sectional observational study assessed the mental health of 40 KMC mothers according to the DASS-21 questionnaire. Mothers filled the questionnaire before the start of KMC and after 7 days of continuing Kangaroo care sessions. The questionnaire assessed the mental health on three different parameters: stress, anxiety and depression. Both the baseline and follow-up scores were computed, and the data were analysed. Results: There was a significant reduction in scores of stress, anxiety and depression over 7 days of KMC sessions. Conclusion: Kangaroo Mother Care supports bonding and interaction between mothers and babies. The mental health of mothers improves after KMC sessions.
Copyright (c) 2025 Harshita Vidhwani, Shweta Anand, Pritesh Goutam https://creativecommons.org/licenses/by-nc-nd/4.0
Childhood Obesity: Examining New Approaches to Tackle This Growing Health Concern
The escalating prevalence and severity of obesity-related comorbidities in the pediatric population globally underscore the critical importance of addressing childhood obesity. Effective treatment strategies necessitate a thorough assessment of predisposing risk factors, which are characterized by a complex interplay between physical and environmental determinants. While extensive literature addresses adult obesity, a notable paucity exists regarding childhood obesity, highlighting an urgent research imperative. This review aims to comprehensively examine childhood obesity by identifying its underlying causes, exploring current diagnostic methodologies, and outlining effective management approaches. Given the increasing prevalence of this condition, the development and implementation of both individual and community-based interventions are crucial for achieving optimal prevention and management outcomes.
Copyright (c) 2025 Amit Agrawal , Rashmi Agrawal, Jyotsna Shrivastava https://creativecommons.org/licenses/by-nc-nd/4.0/
Parental knowledge of nephrotic syndrome: A questionnaire based study
Introduction: When parents lack adequate knowledge about nephrotic syndrome, it can delay them from seeking timely medical attention. Unfortunately, many parents demonstrate insufficient understanding of effectively managing their children's nephrotic syndrome at home. Aim: The purpose of the present study was to examine the parental knowledge of relapsing nephrotic syndrome and the effects of the gaps in this knowledge on the outcome of the nephrotic syndrome. Materials and methods: The present study was a prospective, questionnaire-based descriptive study that examined the parental knowledge of a paediatric patient with nephrotic syndrome. A second questionnaire study was conducted after parents received a pamphlet and an educational film in the vernacular language with information about nephrotic syndrome. Results: None of the parents had heard the diagnosis of nephrotic syndrome before it disturbed their child. The risk of one relapse was known to 85% of parents, but only 17.2 % of parents were informed that the child might have more than one relapse. The home monitoring for the urine albumin was not informed to 75% of parents. Accordingly, the majority did not perform home monitoring. The scholastic status of the mother emerged as the only significant risk factor (p = 0.035) that could influence the parental knowledge of relapsing nephrotic syndrome. Conclusion: Following this study, the department began disseminating educational materials (film on social media, booklet, fact sheet) in the local vernacular language for parents of children with nephrotic syndrome to improve accessibility.
Copyright (c) 2025 Yashaswi Guntupalli, Darshini Kattula, Aruna Mangipudi, Snehitha Tiruvalli, Poojitha Obulreddy, Chandana Sree Madala, Sri Lakshmi Gaddam, Viswaeswar Rao G , Aishwarya Lakshmi Pavuluri, Koti Reddy Kandula Venkata, Ram Rapur https://creativecommons.org/licenses/by-nc-nd/4.0/
Protracted Bacterial Bronchitis in children- shedding light on lingering cough
Protracted Bacterial Bronchitis [PBB] in children, as the name suggests, is a prolonged wet cough of bronchial origin for more than four weeks. The affected children will be otherwise hale and healthy except for the disturbing diurnal cough. Unlike asthma, the cough is characteristically wet or productive, and there is no specific nocturnal variation of symptoms. It usually affects preschool children. The diagnosis is clinical in experienced hands without going in for an extensive workup. Responding to the treatment is one of the criteria to diagnose PBB as per consensus guidelines. Most patients respond to appropriate antibiotic therapy of 2-4 weeks duration, usually amoxicillin-clavulanate. Few children may go in for recurrence of symptoms; in such cases, bronchoscopic workup of the airway is warranted. Thus, clinicians should always have a high index of suspicion of this condition in otherwise healthy young children who have a chronic wet cough of more than four weeks duration. Timely management of such cases would prevent the development of chronic suppurative lung disease and long-term morbidity.
Amoxicillin-Potassium Clavulanate Combination
Copyright (c) 2025 Nithya Parasuraman, Raju Palanigounder, Karthikeyan Raju https://creativecommons.org/licenses/by-nc-nd/4.0/
A rare cause of pneumothorax in a neonate: A case report
Congenital pulmonary airway malformation (CPAM) is a rare developmental lung malformation, typically presenting with respiratory distress in the neonatal period. It is typically diagnosed by fetal ultrasound. We describe a baby boy (22 days old) presenting with respiratory distress. He was admitted at birth for perinatal asphyxia and respiratory distress and was discharged on the 10th day of life. Examination showed severe subcostal retraction with tracheal shift towards the left and reduced breath sounds on the right side of the chest. X-rays of the chest revealed a hyperlucent right lung with a significant mediastinal shift towards the left and compression of the left lung. High-resolution computed tomography (HRCT) of the chest demonstrated a large multicystic lesion almost replacing the right upper and middle lobes, suggestive of CPAM. A lobectomy was planned, but the baby succumbed before surgical intervention. A pathological diagnosis could not be made. CPAM is a rare but significant cause of neonatal respiratory distress, often mimicking conditions like pneumothorax, which can lead to diagnostic challenges. This case underscores the importance of considering CPAM in neonates with persistent respiratory distress and highlights the role of imaging in early diagnosis. Timely recognition and surgical intervention remain crucial to improving outcomes and preventing fatal complications.
Congenital Pulmonary Airway Malformation
Copyright (c) 2025 Anjum Hussain, Poorva Gohiya, Nitesh Upadhyay, Mohammed Shahid https://creativecommons.org/licenses/by-nc-nd/4.0/
Assessment of electrolyte imbalance and its predictors in children admitted with Acute Gastroenteritis-Cross Sectional study
Background: Acute Gastroenteritis is considered to be a major cause of morbidity and mortality among children all around the globe. Annually, 3 to 5 billion cases of Acute Gastroenteritis are reported from all over the world and it is estimated to be responsible for 2 million deaths among children below 5 years of age. Methods: An observational descriptive study with a cross-sectional design was conducted at the pediatric department of North Bengal Medical College and Hospital. The sample size was calculated using the Cochrane formula using the prevalence of the outcome in the population. The patients admitted to the study institution with clinically diagnosed acute gastroenteritis were selected by a consecutive sampling technique till the required sample size was reached. At the time of admission, the sociodemographic details of the patients were obtained from their parents using a predesigned questionnaire. After that, blood was drawn from the patients to measure serum haemoglobin, sodium, potassium, and calcium. Results: Out of 160 children, most of the children were between 49-60 months with male predominance born out of Spontaneous Vaginal Delivery; mothers were young and resided in rural areas. Exclusive breastfeeding was not practised, improper administration or lack of Oral Rehydration Solution contributed to the high prevalence of electrolyte abnormality. Conclusions: The study concludes that there is an urgent need for effective educational interventions to improve ORS administration and breastfeeding practices, especially in rural areas. Enhancing caregiver knowledge and public health strategies could substantially reduce the incidence of electrolyte disturbances and improve clinical outcomes for children with acute gastroenteritis.
Copyright (c) 2025 Sabyasachi Kazi, Rahul Majumdar, Divya Mahajan https://creativecommons.org/licenses/by-nc-nd/4.0/
Myocardial Infarction in Adolescents: A Growing Concern – A Narrative Review
Background: Myocardial infarction is the leading cause of mortality worldwide. Although it is believed to be uncommon in teenagers, current research indicates that the prevalence of myocardial infarction and its associated consequences is rising in this age group, potentially linked to increasingly hazardous eating and lifestyle choices. Objective: To evaluate and include several recent studies that identify the key differences in risk factors, causes, and clinical manifestations of myocardial infarction in older adults and adolescents, highlighting the growing prevalence of myocardial infarction in adolescents and its unique management strategies. Methodology: Data was collected and analysed following a review of relevant studies published in journals indexed in PubMed, Google Scholar, and Science Direct. Results: Clinical presentation of myocardial infarction is similar in adolescents and older adults. While a positive history of angina, diabetes, and hypertension have a greater impact on adults, a positive smoking history and family history of myocardial infarction are more directly linked to myocardial infarction in younger individuals. Most adolescents present with ischemic discomfort related to congenital abnormalities or acquired changes due to Kawasaki disease, improper medication, and substance use. Primarily, many may have a family history of early coronary heart disease or a history of arterial or venous thrombotic events, which may contribute to their presenting condition. Adolescents and young adults are more likely than middle-aged and older individuals to experience ventricular tachycardias and peak creatine kinase levels. Additionally, adolescents tend to have a better prognosis. Conclusion: There is a higher prevalence of myocardial infarction in adolescents, and notable distinctions exist between adolescents and older individuals regarding their presentation, investigation results, and risk factors for myocardial infarction.
Copyright (c) 2025 Johi Reaninsam samjoey, Yumna Mushrmita Almas, Malavika Santhosh, Sara mohideen, Subhranshu Sekhar Kar, Rajani Dube https://creativecommons.org/licenses/by-nc-nd/4.0/
Effect of Various Perinatal Factors on Cord Blood TSH Levels: A Cross-Sectional Study
Background: Congenital hypothyroidism (CH) is one of the most common preventable causes of mental retardation (MR). Due to the typically asymptomatic nature of congenital hypothyroidism (CH) in newborns, universal screening is necessary. Cord blood TSH (CB-TSH) levels have good sensitivity. However, many maternal and perinatal factors cause variations in Cord blood TSH levels, which can interfere with interpreting its levels and diagnosis. Aim: This study was done to determine various maternal and perinatal factors affecting CB-TSH levels. Materials and Methods: A cross-sectional study was conducted in the Department of Paediatrics and Neonatology in a Tertiary care centre. Cord blood TSH level was estimated, and the results were statistically analysed concerning various maternal and perinatal factors. A TSH cut-off of >20microIU/ml was considered as high. Results: The median Cord blood-TSH was 7.945microIU/L (Interquartile range = 6.475 – 12.82) with 10% (n=13) of newborns had elevated cord blood TSH levels (>20 microIU/ml). Among them, 2.3%(n=3) of newborns had subclinical hypothyroidism (serum TSH 10-20 microIU/ml, normal FT4). No babies were found to have overt hypothyroidism—requirement of resuscitation, low birth weight, birth asphyxia, and low Appearance, Pulse rate, Grimace, Activity, and Respiratory effort (APGAR) score, maternal (add a comma after APGAR score) diabetes and antenatal complications (other than hypertension/Diabetes (DM)/ hypothyroidism) showed a significant association even on multivariate analysis. Preterm gestation, male gender, and maternal hypothyroidism were significant in univariate analysis. The mean TSH levels found in our study were 11.96 ± 15.01. The correlation between cord blood TSH and 72-hour thyroid profile was found insignificant because of a low number of babies with high cord TSH. Conclusions: Since various maternal and perinatal factors affect the levels of TSH in cord blood, any increase in cord TSH should be interpreted in the context of these circumstances.
Copyright (c) 2025 Noonety Navya Sree, Akash Bang, Nishant Banait, Meenakshi Girish, Urmila Chauhan, Abhijit Choudhary, Shikha Jain https://creativecommons.org/licenses/by-nc-nd/4.0/
Lingual Thyroid with Right Internal Jugular Vein Phlebectasia : A Rare Case Report
Lingual thyroid gland is a rare entity which occurs due to the failure of the thyroid gland to descend into its usual pretracheal position during embryogenesis. The reported incidence of lingual thyroid is more common in females. When located at the base of the tongue, ectopic thyroid gland is often asymptomatic but may cause local symptoms such as difficulty in swallowing, hoarseness and a foreign body sensation in the throat, hemorrhage and often presents with hypothyroidism. The diagnosis of lingual thyroid is usually made clinically along with imaging studies and radionuclide scanning is used to confirm diagnosis. A case of lingual thyroid with right internal jugular vein phlebectasia in a 4-year-old male is presented for its rarity and for differential diagnosis of midline base of the tongue lesions.
Copyright (c) 2025 Soumik Chatterjee, Mayukh Bhattacharya, Koushik Mandal, Papiya Majumdar https://creativecommons.org/licenses/by-nc-nd/4.0/
Lipid Profile of Under-5 Years Children from a Tertiary Care Centre
Introduction: There is a considerable lack of study estimating lipid profile levels in children below 5 years of age. We therefore carried out this cross-sectional study to evaluate the lipid profile level of healthy Indian children under five years of age from a tertiary level hospital in India. Methodology: This observational cross-sectional study was conducted in a tertiary care center. We randomly enrolled 119 healthy children aged 1 month to 5 years, in whom Total cholesterol, triglyceride, HDL, LDL, and VLDL were measured in a random venous blood sample via a BA400 automatic analyzer by BioSystems using Glycerol Phosphate Oxidase/Peroxidase method using the principle of spectrophotometry. Total cholesterol was calculated as the sum of all the lipids detected. Results: Median age was 16 months (9.5 months - 28 months), and 59.6% were male. The overall mean reference range for Total cholesterol was 132.6±38.3 mg/dL, Triglycerides was 98.5±46.2 mg/dL, LDL was 71.5±25.0 mg/dL, HDL was 42.6±15.8mg/dL and VLDL was 19.6±9.3mg/dL. There was no significant difference in lipid profiles between the sexes. HDL level was significantly higher in those above 24 months (p=0.02), while the other components were similar between various age groups. Conclusion: There was no significant difference between the lipid profile of children in our cohort, and previously published studies. Levels of HDL cholesterol increased with age after 24 months of age.
Copyright (c) 2024 Dr Manisha Ghosh Roy, Dr Jyotsna Shrivastava, Dr Deepanjan Bhattacharya, Dr Amit Agrawal https://creativecommons.org/licenses/by-nc-nd/4.0/
Impact of Delivery Mode on Breastfeeding Practices: A Prospective Cohort Study
Background: Breastfeeding is crucial for infant health, providing optimal nutrition and immunity. The mode of delivery significantly influences breastfeeding practices, with Normal Vaginal Delivery (NVD) often enabling earlier initiation and exclusivity than Lower Segment Cesarean Section (LSCS). This study examines differences in breastfeeding initiation, exclusivity, and associated challenges between NVD and LSCS mothers at a tertiary healthcare facility. Methods: A prospective observational study was conducted at Government Medical College (GMC) Jalaun over seven months, including 623 mothers (320 NVD, 303 LSCS). Data were collected using a questionnaire on breastfeeding initiation, breastfeeding practices, and challenges at six weeks, 14 weeks, and six months postpartum. Results: Early breastfeeding initiation (in 1st hour) was significantly higher among NVD mothers (81.88%) compared to LSCS mothers (9.24%) (p < 0.01). LSCS mothers exhibited higher pre-lacteal feeding rates (73.60% vs. 12.19%) and reported more breastfeeding challenges, such as latching difficulties (42.24% vs. 24.06%) and low milk supply (43.23% vs. 22.81%) (p < 0.01). Exclusive breastfeeding rates remained consistently higher among NVD mothers across all follow-up points, with significant differences at six weeks, 14 weeks, and six months. Conclusions: The mode of delivery significantly impacts breastfeeding practices, with LSCS presenting greater challenges to early initiation and exclusivity. Tailored breastfeeding support for LSCS mothers, including immediate skin-to-skin contact and early lactation consultations, may help bridge these gaps, ultimately enhancing maternal and infant health outcomes.
Copyright (c) 2025 Meenal Goel, Chhavi Jaiswal, Harsh Maheshwari, G.S. Chaudhary, Janhavi Tripathi https://creativecommons.org/licenses/by-nc-nd/4.0/
Milky Blood and Bloody Stools: A Twist Of Fate Spotting Of Neonatal Hyperlipoproteinemia
Hyperlipoproteinemia is a very rare condition in a neonate and its mechanism includes lipoprotein molecular defect, lipoprotein lipase deficiency, or lipoprotein receptor defect. The common ones are familial combined hyperlipidemias, familial & polygenic hypercholesterolemia and familial hypertriglyceridemia. Usually, the detection is by accidental observation of milky blood while sampling for non-specific symptoms. Hyperlipoproteinemia can cause acute pancreatitis and early-onset cardiovascular disease if left untreated. Here we are reporting the case of a 25-day-old baby who presented with blood in stools. Physical examination was normal. Incidentally, it was found that the blood was highly viscous and milky. Complete lipid profile done suggested familial combined hyperlipidemia. The baby was started on Gemfibrozil (20 mg/kg twice daily) and continued on exclusive breast feeds along with the addition of medium chain triglyceride oil and multivitamins. Lipoprotein levels normalized within 5 months. This condition requires lifelong follow up.
Copyright (c) 2025 Aishwarya Venugopal, Aswathy Rahul, Radhika Sujatha, Prakash Duraisamy, A V Anupriya, Nikhil Kumar, Meghna Nema https://creativecommons.org/licenses/by-nc-nd/4.0/
Pyloric web : Management of a neglected case of Gastric Outlet Obstruction
Pyloric atresia is an extremely rare cause of gastric outlet obstruction, constituting approximately 1% of all gastrointestinal atresias and occurring in about 1 in 100,000 live births. It is equally prevalent in males and females and may exhibit autosomal recessive inheritance. Clinically, it presents during infancy with non-bilious vomiting, abdominal distension, and failure to thrive. Type 1 pyloric atresia, characterized by a pyloric membrane with an opening, is exceptionally rare and may present later in childhood. We reported the case of a 5-year-old male with the history of recurrent non-bilious vomiting since the age of one year, which worsened over the preceding four months. Examination revealed visible peristalsis and upper abdominal fullness. Radiological findings suggested gastric outlet obstruction, and exploratory laparotomy confirmed Type 1 pyloric atresia. Surgical management involved excision of the pyloric web and Heineke-Mikulicz pyloroplasty. The child had an uneventful recovery and demonstrated significant improvement in weight and nutritional status at a 6-month follow-up. The diagnosis of pyloric atresia is challenging due to its rarity and similarity to other conditions like duodenal atresia or hypertrophic pyloric stenosis. Early diagnosis through clinical suspicion, radiological evaluation, and definitive surgical intervention is crucial to prevent complications such as aspiration pneumonia and metabolic imbalances. This case highlights the importance of considering pyloric atresia in children with recurrent vomiting and failure to thrive, even beyond infancy, and emphasizes the significance of prompt surgical management for favorable outcomes.
Copyright (c) 2024 Nishant Agarwal, Tarun Kumar, Pujana Kanneganti, Anju Verma, Basant Kumar https://creativecommons.org/licenses/by-nc-nd/4.0/