Search

Objectives: The present study examined the clinical profile of COVID-19, related morbidity and mortality in children at a tertiary care hospital in Uttarakhand. Understanding the clinical profile of the disease in this specific population is vital for better preparedness and targeted interventions to safeguard the health of children during future outbreaks. This is the first study from this region in this Methods: The present study was a hospital based observational study carried out on patients aged 1 month-18 years who tested covid-19 positive and were admitted to Department of Pediatrics at a tertiary care center in Garhwal region of Uttarakhand during study period July 2020 to May 2023 after getting ethical clearance from Institutional Review Committee and informed consent from patient or patient relatives. Statistical testing has been conducted using R Studio Software version 4. Results: A total of 51 patients with Covid-19 infection, tested positive by either rapid antigen test (RAT) or reverse transcriptase polymerase chain reaction (RTPCR) were admitted to our hospital during the study period. History of covid contact was positive in 11% patients. Comorbidities were seen in 10% patients. Respiratory system (41%) was most commonly involved followed by central nervous system (febrile seizures). Fever (70%) followed by cough (33%) were the most common symptoms. Raised ESR levels was the most common laboratory finding. Conclusions: The infection in children is usually mild, with low mortality rate (2%). Respiratory system was most commonly involved and fever and cough were the most common symptoms. [ABSTRACT FROM AUTHOR]

Context: In India, pneumonia deaths in the past decade show a decreasing trend in the child mortality rate from 74.6 to 45.4. However, NFHS-5 records an increase in prevalence to 2.8% from 2.7% in NFHS-4. The childhood pneumonia control strategies focus on strengthening the health system, skill-building health workers, counseling, and creating awareness about promoting healthy behaviors regarding the management of sick children. Aims: The study attempts to understand "caregivers" care-seeking behavior and the management of childhood pneumonia. Setting and Design: The study was conducted in the Akkalkuwa block of Nandurbar district, Maharashtra, India. We used episodic interviews, asking caregivers to recollect specific events linked to the need for treatment. Methods and Material: A total of 11 in-depth interviews of mothers were conducted whose under-five children had pneumonia in the past year. These interviews used vignettes from real pneumonia cases to discuss community priorities for health care and actions taken to improve child's health. In addition, the qualitative data from the in-depth interviews were thematically analyzed. Result: Cough, breathlessness, and disturbance in the routine schedule of the child were the major symptoms to identify pneumonia (vavlya) among children. Branding on the stomach, oil massage, and jadi-buti were commonly observed phenomena to seek help. Low priority, the influence of traditional healers and herbal medicines, and the inaccessibility of quality healthcare services were the main factors that led to the child's treatment. Conclusion: Culturally appropriate activities are to be imparted on recognition of symptoms and appropriate care seeking, and community health workers need capacity building. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to delineate the clinico-epidemiological characteristics of hospitalized children with respiratory syncytial virus (RSV)-associated acute lower respiratory tract infection (RSV-ALRI) during its recent outbreak and to find out the independent predictors of pediatric intensive care unit (PICU) admission. Materials and methods: Children aged between 1 month and 12 years who tested positive for RSV were included. Multivariate analysis was performed to identify the independent predictors and predictive scores were developed from the β-coefficients. Receiver operating characteristic curve (ROC) was generated and the area under the curve (AUC) was calculated to assess the overall precision. The performance of sum scores in predicting PICU need, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LR+ and LR-) were calculated for each cutoff value. Results: The proportion of RSV positivity was 72.58%. A total of 127 children were included with a median [interquartile range (IQR)] age of 6 (2-12) months, of whom 61.42% were males and 33.07% had underlying comorbidity. Tachypnea, cough, rhinorrhea, and fever were predominant clinical presentations while hypoxia and extrapulmonary manifestations were present in 30.71% and 14.96% of children, respectively. About 30% required PICU admission, and 24.41% developed complications. Premature birth, age below 1 year, presence of underlying CHD, and hypoxia were independent predictors. The AUC [95% confidence interval (CI)] was 0.869 (0.843-0.935). Sum score below 4 had 97.3% sensitivity and 97.1% NPV whereas sum score above 6 had 98.9% specificity, 89.7% PPV, 81.3% NPV, 46.2 LR+, and 0.83 LR- to predict PICU needs. Conclusion: Awareness of these independent predictors and application of the novel scoring system will be beneficial for busy clinicians in planning the level of care needed, thereby optimizing PICU resource utilization. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic affected millions of people across India. COVID-19 cases are fewer in children with less severity and better outcomes than in adults. However, a small proportion develop severe illness and succumb to the disease. Clinical manifestations and optimal management of COVID-19 in immunocompromised children are not clearly known. Remdesivir was shown to be efficient in reducing the recovery time in COVID-19 patients requiring supplemental oxygen. Remdesivir is approved for use in children with severe COVID-19, but there are no guidelines in patients with risk factors like recent solid organ transplantation. We report a case of a 10-year-old kidney transplant recipient (KTR) infected with severe acute respiratory syndrome corona virus-2, 2.5 months after the transplantation. Unlike most children, he presented with high fever, cough, and vomiting. His inflammatory markers were elevated. In this case report, we discussed management and clinical outcomes of this patient. In view of recent kidney transplantation and the severity of infection with emergent oxygen requirement, we gave him remdesivir. We continued prednisolone and tacrolimus and stopped mycophenolate. He recovered completely in 7 days. We feel that severely immunosuppressed KTR children with COVID-19 will benefit with remdesivir administration. Monitoring tacrolimus trough levels is essential for maintaining adequate immunosuppression. [ABSTRACT FROM AUTHOR]

Background It is thought that there is a high risk of zinc deficiency in India, but there are no representative national estimates. Objectives We aimed to evaluate the national and state-level prevalence of low serum zinc concentrations (SZCs) in Indian children from the nationally representative Comprehensive National Nutrition Survey. Methods Prevalence of low SZC, adjusted for C-reactive protein, was estimated among preschool (1–4 y; n  = 7874) and school-age children (5–9 y; n  = 10,430) and adolescents (10–19 y; n  = 10,140), using SZC cutoffs defined by the International Zinc Nutrition Consultative Group. Results Prevalence of low SZC was high among adolescents (31.1%; 95% CI: 29.8%, 32.4%), compared with school-age (15.8%; 95% CI: 15.3%, 16.3%) or preschool children (17.4%; 95% CI: 16.7%, 18.0%). However, stratification of prevalence by fasting status or using an alternative lower SZC cutoff independent of fasting status led to a reduction in prevalence by 3.7% or 7.8% in children <10 y, respectively. The prevalence of low SZC was higher among rural preschool children, those belonging to households with poor socioeconomic status, and those with severe stunting or underweight. Preschool children with diarrhea (22.6%; 95% CI: 20.8%, 24.4%), productive cough (22.7%; 95% CI: 18.5%, 27.5%), or malaria/dengue (38.5%; 95% CI: 29.4%, 48.2%) in the 2 wk preceding the survey had a higher prevalence of low SZC than those without morbidity (16.5%; 95% CI: 15.9%, 17.2%; 17.6%; 95% CI: 16.9%, 18.2%; and 17.5%; 95% CI: 16.8%, 18.1%, respectively). Conclusions The national prevalence of low SZC among preschool (17%) or school-age children (16%) was <20%, which is considered the cutoff indicating a problem of public health significance; but there were variations by state and socioeconomic status. In adolescents, however, the prevalence of low SZC was 31%, which warrants further investigation. The association of low SZC with diarrhea in preschool children necessitates better coverage of Zn administration in the management of diarrhea. [ABSTRACT FROM AUTHOR]