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Iron deficiency anaemia (IDA) is unusual in sickle cell disease (SCD). However, excessive urinary iron loss and mucosal/submucosal infarcts may result in poor absorption of iron in SCD. During the first decade of the disease, environmental factors and poor nutrition may also affect iron metabolism and contribute to iron deficiency in SCD. The present study assessed iron status and haematological profile of young children with SCD using serum Iron, Ferritin and Total Iron Binding Capacity (TIBC) to establish early diagnosis of IDA.Results showed that out of 6276 newborns screened, 33(0.52%) were detected to have SCD. Amongst 33,14(14.28%) children were suspected to have IDA. Iron studies revealed 42.4% of coexistent IDA with low serum Iron among 3 children, whereas high normal or raised TIBC was seen in 14 children. The findings emphasize that raised TIBC with normal serum iron may indicate early onset of IDA in the early decade of SCD, highlighting the need of timely initiation of iron therapy to prevent further severe events. [ABSTRACT FROM AUTHOR]

We present updated, evidence-based clinical practice guidelines from the Indian Society of Pediatric Nephrology (ISPN) for the management of urinary tract infection (UTI) and primary vesicoureteric reflux (VUR) in children. These guidelines conform to international standards; Institute of Medicine and AGREE checklists were used to ensure transparency, rigor, and thoroughness in the guideline development. In view of the robust methodology, these guidelines are applicable globally for the management of UTI and VUR. Seventeen recommendations and 18 clinical practice points have been formulated. Some of the key recommendations and practice points are as follows. Urine culture with > 104 colony forming units/mL is considered significant for the diagnosis of UTI in an infant if the clinical suspicion is strong. Urine leukocyte esterase and nitrite can be used as an alternative screening test to urine microscopy in a child with suspected UTI. Acute pyelonephritis can be treated with oral antibiotics in a non-toxic infant for 7–10 days. An acute-phase DMSA scan is not recommended in the evaluation of UTI. Micturating cystourethrography (MCU) is indicated in children with recurrent UTI, abnormal kidney ultrasound, and in patients below 2 years of age with non-E. coli UTI. Dimercaptosuccinic acid scan (DMSA scan) is indicated only in children with recurrent UTI and high-grade (3–5) VUR. Antibiotic prophylaxis is not indicated in children with a normal urinary tract after UTI. Prophylaxis is recommended to prevent UTI in children with bladder bowel dysfunction (BBD) and those with high-grade VUR. In children with VUR, prophylaxis should be stopped if the child is toilet trained, free of BBD, and has not had a UTI in the last 1 year. Surgical intervention in high-grade VUR can be considered for parental preference over antibiotic prophylaxis or in children developing recurrent breakthrough febrile UTIs on antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Acid-base disorders are common in critically ill patients and contribute significantly to mortality and morbidity. Metabolic acidosis (MA) can be measured by pH, base deficit, serum bicarbonate, and anion gap. A study was conducted to determine the incidence and type of MA among children admitted to the pediatric intensive care unit (PICU) and to assess its roles as a predictor of outcomes in them. Subjects and Methods: Over 1 year, 100 children between 1 month and 12 years of age who presented to the PICU with an MA or developed it within 24 h of admission were prospectively enrolled. Clinicodemographic data, pediatric sequential organ failure assessment score at admission, clinical outcome, and serial measurements of anion gap, serum lactate, and bicarbonate level were recorded. Results: The incidence of MA was 60.2% with a majority (52%) being high anion gap metabolic acidosis(HAGMA). The predominant condition (39%) leading to MA was catecholamine-resistant shock with organ dysfunction. Peak lactate value and bicarbonate nadir had a significant positive correlation with the duration of mechanical ventilation and inotropic support, but only peak lactate value was significantly associated with mortality. A peak lactate value of 2.19 mmol/L yielded the highest sensitivity and specificity for predicting mortality. There was no association was found between peak anion gap and morbidity or mortality. Conclusions: MA was observed in 60% of children in PICU, with HAGMA being the most common type. Peak lactate value and bicarbonate nadir were correlated with high morbidity, but only peak lactate value was significantly associated with mortality [ABSTRACT FROM AUTHOR]

Summary: Immune thrombocytopenia (ITP) resolves in most children within 3–12 months of diagnosis. Chronic ITP affects 10%–20% of patients, some of whom require treatment. Several second‐line agents are efficacious in this group of patients. This paper describes our experience of using dapsone as a single second‐line agent in children with chronic ITP. One hundred and three children with chronic ITP were seen at our centre from January 2012 to December 2016. Forty‐five children met the inclusion criteria and received dapsone; 17 (37.8%) were boys; and 28 (62.2%) were girls. Early response to dapsone was seen in 37.8% of patients. The median duration of long‐term follow‐up was 50 months, and at least a partial response was seen in 64.4% of the patients. Dapsone offers good initial response rates and sustained remission in paediatric chronic ITP, comparable to other therapeutic agents available. [ABSTRACT FROM AUTHOR]

Background: Invasive fungal disease is common in immunocompromised children, although rare in children suffering from viral pneumonia. Recently, it was our observation that a large number of children who were otherwise normal were suffering from invasive fungal disease along with viral pneumonia. The aim of our study is to determine the epidemiological and clinical profile of fungal infection in children suffering from viral pneumonia. Subjects and Methods: It was a retrospective study of medical records of children between January 2023 and March 2023 from pediatric intensive care unit (PICU) tertiary care hospital from Eastern India. Children with suspected fungal disease as per inclusion criteria were included in the study. A total of 27 patients were enrolled in this study. The serum galactomannan and beta-D-glucan (BDG) were measured. Clinical profile and outcome were compared between children with and without invasive fungal disease. Results: Out of 27 subjects, 16 (59%) had invasive fungal disease. All had adenovirus pneumonia. Seven (4.44%) had acute respiratory distress syndrome while four (25%) had shock and multiple organ dysfunction syndrome each. The duration of mechanical ventilation (P = 0.01), duration of PICU stay (P = 0.02), and duration of hospital stay (P = 0.004) were significantly higher in children with invasive fungal disease. These children had significantly higher rates of complications (P = 0.001) and higher mortality (P = 0.04). Conclusions: The serum galactomannan and BDG can diagnose invasive fungal disease in patients of viral pneumonia with persistent symptoms for more than 2 weeks. The invasive fungal disease is associated with higher morbidity and mortality in these children. [ABSTRACT FROM AUTHOR]

Background: The overall cost of managing chronic diseases is a significant barrier to accessing complete and timely healthcare, especially in rural and geographically isolated areas. This cost disparity becomes more pronounced in the case of children and more so in under-resourced regions of the world. In the era of COVID-19, as the need for physical distancing increased, there was a transition in approach to healthcare provision to telemedicine consultations. This study evaluates the cost saving using teleconsultations in a paediatric nephrology clinic. Methods: This prospective cohort study was conducted at AIIMS Jodhpur, a tertiary care centre in western Rajasthan from March 2021 to October 2022. All consecutive paediatric (29 days–18 years) patients attending telemedicine services for kidney-related illness were enrolled. Basic demographic details were collected. Cost analysis was done after 6 months, regarding perceived cost savings for the patient and family by using telehealth for follow-up during 6 months starting from enrolment. Results: A total of 112 patients were enrolled; 266 teleconsultations attended; 109 patients who could be followed up saved INR 457,900 during 6 months of follow-up. The average cost saving was INR − 1577/patient/visit. Patients saved 4.99% of the family income (median 2.16% (IQR 0.66–5.5)). The highest expenditure per visit was incurred for food and transport. The median distance from the residence to the clinic was 122.5 km (IQR 30–250). Over the 6-month study period, patients saved a travel distance of 83,274 km (743 km/patient). Conclusions: The use of telemedicine as a follow-up method helps save significant costs and distances travelled by patients. A higher-resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Introduction: Public awareness of the COVID-19 pandemic has resulted in a reduction in healthcare utilisation for other diseases. Understanding how the COVID-19 pandemic affects hospital admissions and the disease patterns is crucial for proper triaging and planning of health resources in future pandemics. Aim: To compare the clinical spectrum of paediatric inpatients in the post-COVID-19, pre-COVID-19 and during COVID-19 pandemic periods in a tertiary level teaching centre. Materials and Methods: This ambispective study was conducted at the Paediatrics Department of SAT, Govt. Medical College, Thiruvananthapuram, Kerala, India. The analysis included all cases hospitalised from April 2019 to March 2022, with the data divided into three time periods. The discharge diagnoses of all cases admitted during the study period were coded according to the ICD-10 criteria and included in the analysis. Differences in admissions, disease patterns, and ICU admissions during the three time periods (pre-COVID-19, post-COVID-19, and during COVID-19) were compared using oneway ANOVA and Tukey's post-hoc test. Results: In the present study, ward admissions (p-value <0.001), respiratory infections (p-value 0.031), asthma (p-value 0.009), and chronic systemic diseases (p-value 0.018) decreased in the post-COVID-19 period compared to the pre-COVID-19 period, whereas ICU admissions (p-value 0.010) and Diabetic Ketoacidosis (DKA) (p-value 0.002) increased. When comparing COVID-19 and post-COVID-19 periods, there was an increase in ward admissions (p-value 0.01), respiratory infections (p-value 0.018), and diarrhoea (p-value 0.029), but a decrease in the proportion of ICU admissions (p-value 0.01). There was no significant difference in mortality among the three time periods. Conclusion: There was a significant difference in the clinical spectrum of paediatric inpatients. The significant decrease in admissions of chronic systemic diseases, which require regular follow-up for management changes, raises concerns about the potential impact on patient care. [ABSTRACT FROM AUTHOR]

Introduction: The success of root canal procedures depends on cleaning and shaping of canals. There are several instrumentation techniques available for root canal preparation. Recently, exclusive rotary file systems called Kedo-SG Blue and Prime-Pedo have been introduced for root canal preparation in primary teeth. The inherent flexibility of these files allows them to preserve the anatomy of curved canals in primary molars. Aim: To compare the instrumentation time, obturation time, and quality of obturation using two paediatric rotary file systems, Kedo-SG BlueTM and Prime-PedoTM, in mandibular primary molars. Materials and Methods: A randomised clinical trial was conducted in the outpatient Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore Andhra Pradesh, India, from February 1, 2019 to January 20, 2020. Fifty primary molars with necrotic pulp were included and randomly divided into two groups, with 25 teeth in each group. Group 1 and Group 2 were instrumented with Kedo-SG BlueTM and Prime-PedoTM, respectively. The time taken for instrumentation and obturation was noted in minutes, and the quality of root canal filling was recorded as optimal, underfilled, or overfilled. The data were statistically analysed using an independent Student's t-test for time measurements and a Chi-square test for the quality of obturation. Results: There was a statistically significant difference in instrumentation time and obturation time between the two groups (p-value=0.009; 0.011). The Kedo-SG BlueTM rotary system showed a better quality of obturation compared to the Prime-PedoTM rotary system, although the difference was not statistically significant (p-value=0.22). Conclusion: The Kedo-SG BlueTM rotary system demonstrated shorter instrumentation and obturation times, as well as a higher number of optimally filled canals compared to the Prime-PedoTM rotary system. Therefore, the Kedo-SG BlueTM rotary system exhibited better clinical performance in primary molars than the Prime-PedoTM rotary system. [ABSTRACT FROM AUTHOR]

Background: Epidemiology of maxillofacial injuries vary depending on geographic location, culture and socioeconomic condition. This study assessed etiology and pattern of facial fractures in children reported at Burdwan Dental College and Hospital, Burdwan, West Bengal, India. Method: Clinical files of 206 children with facial fractures were evaluated retrospectively. Diagnosis of fractures were confirmed by radiographic examination. Study period was from July 2018 to June 2022. Data collected were age and sex of the patient, site of fracture, and etiology of trauma. Descriptive statistics were used for statistical analysis with a P-value less than 0.05. Results: There were 127 (61.7%) males and 79 (38.3%) females with a male to female ratio of 1.6:1. Within the study sample, the majority of facial fractures (n = 146, 70.9%) belonged to 6-to-9-year age group. Overall, falls (44.2%) and motor vehicles accidents (31.5%) were the two leading causes of trauma. Mandible fracture was the most common, accounting for 72.8% of cases. 74 patients (35.9%) with facial fracture had dental injuries. Conclusion: Male predominance in facial fracture is seen. With age, frequency of facial fractures tends to increase. Falls are the main cause of facial fracture and mandible is the most common anatomic location. [ABSTRACT FROM AUTHOR]

Spice consumption, along with other environmental factors, can contribute to pediatric lead poisoning. Although public health efforts have increased awareness of contamination of spices, false assumptions regarding the safety of home-prepared spices have emerged. Here, we present the clinical features, family beliefs, and environmental toxicology of 3 spice-associated pediatric lead poisoning cases. [ABSTRACT FROM AUTHOR]

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children. [ABSTRACT FROM AUTHOR]

Background: The Pediatric Sequential Organ Failure Assessment (pSOFA) score is a scoring system used to assess the severity of organ dysfunction in critically ill children. The aim of this study was to evaluate the effectiveness of the pSOFA lactate (pSOFA-L) score in predicting the clinical outcome of critically ill children. Subjects and Methods: This hospital-based, prospective, observational study was conducted in the pediatric intensive care unit of medical college from North India. A total of 100 children were included. Parameters pertaining to the various organ systems as designated in the pSOFA-L score were studied and compared the score with the clinical outcome. Results: In this study, there were 56 survivors and 44 nonsurvivors. On receiver operating characteristics curve analysis, the cutoff value of the pSOFA-L score in predicting mortality was 10 with a sensitivity of 81.8% and specificity of 85.7% and area under the curve: 0.882, which is statistically significant (P < 0.001). In the present study, the mortality rate was 11.3%, 18.2%, and 70.5% in children with pSOFA-L score <9, 9-11, and >11, respectively. On bivariate analysis of the survivor and nonsurvivor group, nonsurvivors had a significantly higher pSOFA-L score (P = 0.000). The mean lactate level was significantly higher among nonsurvivor group (3.02 ± 1.59 vs. 1.75 ± 1.19, P = 0.000). Conclusions: pSOFA-L score is accurate in predicting mortality, with a higher score indicating a poor outcome. The study also found a significant relationship between serum lactate levels and the pSOFA-L score, with higher lactate levels indicating a poor prognosis. [ABSTRACT FROM AUTHOR]

Respected Chief Guest, guests from overseas, esteemed colleagues, dear students, and friends, I am deeply honoured to address you at this prestigious gathering at the Indian Association of Paediatric Surgeons (IAPS) Conference. I take this opportunity to remind all members that our responsibility extends far beyond our operating theatres. The Incidence of congenital anomalies in India is still 18.2/1000 live births with a high mortality of about 6.78/1000 live births, with a vast majority of these children with congenital anomalies being born into poor families, resulting in a large proportion of children being left untreated or incompletely treated. To address these problems, the IAPS makes the following suggestions: (1) Urgent instructions from the government to insurance providers to launch affordable and easily accessible insurance policies that address the needs of newborns, infants, and children. (2) To ensure the appointment of at least one pediatric surgeon for every pediatric intensive care unit/neonatal intensive care unit being set up in district hospitals. (3) To make pediatric surgery an essential subject in the undergraduate curriculum at MBBS level and ensure that medical colleges and district hospitals have at least one full time pediatric surgeon on their faculty. (4) To ensure that newborns and children (up to the age of 18 years) have access to a pediatric surgeon or specialist who is well trained in surgery on children, much like medical problems in this age group are treated by pediatricians, surgical problems should be entrusted to pediatric surgeons. Someday, a pediatric surgeon for every child's operation may become a reality. Hope that day is not too far away. [ABSTRACT FROM AUTHOR]

Objective Our objective was to describe the clinicodemographic, laboratory, and outcome profiles of a rare phenotype of pediatric acute encephalitis syndrome (AES) with acute fulminant cerebral edema (AFCE) and compare them with that of AES without AFCE. Methods We retrospectively analyzed medical records of a cluster of children hospitalized with encephalitis between June 1, 2021 and December 31, 2021. Their clinical and demographic features, laboratory investigations (hematological, biochemical, serological, microbiological, radiological, and electrophysiological tests), and follow-up data up to 3 months postdischarge were recorded. Patients with AFCE and those without it were divided into groups A and B, respectively, and their characteristics were compared. Results There were 11 and 15 patients in groups A and B, respectively. There were no significant differences between the two groups in terms of sex, neurological status at admission, hematological and cerebrospinal fluid values, pediatric intensive care unit (PICU) course, and management, etiological identification, and mortality and disabilities at discharge. Patients having reversal or having white cerebellar signs did not significantly differ in their outcomes. However, the patients in group A had significantly lower age, higher incidence of abnormal findings on head computed tomography scans at admission, longer duration of hospitalization, and neurological sequelae at 3 months. The numbers of patients with identified etiologies were zero in group A but five in group B (two Japanese encephalitis, two scrub typhus, and one dengue). Patients of group A had bilateral asymmetric temporal-parieto-occipital T2 hyperintense lesions in magnetic resonance imaging, whereas patients of group B had bifrontal predominant or thalamo-mesencephalic lesions. Multifocal epileptiform discharges were seen in electroencephalogram in both groups, which reverted to normal in 9 and 46% in groups A and B at 3 months, respectively. Conclusion Younger age is a significant risk factor for the development of AFCE in pediatric AES. AFCE patients have worse outcomes at 3 months, although they do not significantly differ from their non-AFCE counterparts at discharge. When occurring in clusters, AFCE patients exhibit the same radiological and electroencephalographic features. [ABSTRACT FROM AUTHOR]

Introduction: Multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 caused significant health concerns worldwide. In our center, we had encountered the first wave of MIS-C from June 2020 to January 2021, whereas the second wave surged up from April 2021 to August 2021. In this study, we have done a comparative analysis of different phenotypes of MIS-C seen during these two waves. Subjects and Methods: This was a single-center observational study where the children fulfilled the WHO criteria for MIS-C were included in the study. Clinical and laboratory findings, course of the illness, treatment, and outcome were noted down, and the patients were followed up. Depending on the presentations, cases were classified in four different phenotypes (Type 1: MIS-C overlapping with acute COVID-19, Type 2: MIS-C with shock/MIS-C with multiple organ dysfunction syndrome (MODS), Type 3: MIS-C Kawasaki disease phenotype, Type 4: Mild MIS-C/Febrile inflammatory state), and a comparative analysis of these phenotypes in the two waves was done. Results: There were 86 cases in 7 months during the first wave, whereas 102 cases in 5-month duration during the second wave. The clinical manifestations and laboratory findings were compared, type 2 phenotypes increased in proportion requiring more pediatric intensive care unit admissions. Mortality was seen during the 2nd wave which was absent in our cohort during the first wave. Conclusions: MIS-C typically showed a spectrum of disease manifestations starting from a mild febrile inflammatory state to full-blown MODS. Early phenotypic differentiation and targeted immunomodulatory therapy depending on the phenotype had shown to be useful. [ABSTRACT FROM AUTHOR]

Background: To evaluate the role of ultrasound during initial fluid resuscitation along with clinical guidance in reducing the incidence of fluid overload on day 3 in children with septic shock. Materials and methods: It was a prospective, parallel limb open-labeled randomized controlled superiority trial done in the PICU of a government- aided tertiary care hospital in Eastern India. Patient enrolment took place between June 2021 and March 2022. Fifty-six children aged between 1 month and 12 years, with proven or suspected septic shock, were randomized to receive either ultrasound-guided or clinically guided fluid boluses (1:1 ratio) and subsequently followed up for various outcomes. The primary outcome was frequency of fluid overload on day 3 of admission. The treatment group received ultrasound-guided fluid boluses along with the clinical guidance and the control group received the same but without ultrasound guidance upto 60 mL/kg of fluid boluses. Results: The frequency of fluid overload on day 3 of admission was significantly lower in the ultrasound group (25% vs 62%, p = 0.012) as was the median (IQR) cumulative fluid balance percentage on day 3 [6.5 (3.3--10.3) vs 11.3 (5.4--17.5), p = 0.02]. The amount of fluid bolus administered was also significantly lower by ultrasound [median 40 (30--50) vs 50 (40--80) mL/kg, p = 0.003]. Resuscitation time was shorter in the ultrasound group (13.4 ± 5.6 vs 20.5 ± 8 h, p = 0.002). Conclusion: Ultrasound-guided fluid boluses were found to be significantly better than clinically guided therapy, in preventing fluid overload and its associated complications in children with septic shock. These factors make ultrasound a potentially useful tool for resuscitation of children with septic shock in the PICU. [ABSTRACT FROM AUTHOR]

Background: Glomerular diseases vary with age, and it is important to investigate the spectrum of glomerular diseases in pediatric patients to help in a more precise clinical diagnosis and optimize the management of patients. We aimed to study the clinicopathologic pattern of pediatric glomerular diseases in North India. Methods: This is a 5-year retrospective, single-center cohort study. The database was searched to identify all pediatric patients with glomerular diseases in their native kidney biopsies. Results: About 2890 native renal biopsies were studied, of which 409 were pediatric glomerular diseases. The median age was 15 years with a male preponderance. Nephrotic syndrome was the most common presentation (60.8%), followed by non-nephrotic proteinuria with hematuria (18.5%), rapidly proliferative glomerulonephritis (7%), isolated hematuria (5.3%), acute nephritic syndrome (3.4%), non-nephrotic proteinuria (1.9%), and advanced renal failure (0.7%). Minimal change disease (MCD) was the most common histological diagnosis, followed by focal segmental glomerulosclerosis (17.4%), IgA nephropathy (IgAN; 10%), membranous nephropathy (6.6%), lupus nephritis (5.9%), crescentic glomerulonephritis (2.9%), and C3 glomerulopathy (2.9%). Diffuse proliferative glomerulonephritis (DPGN) was the most common histological diagnosis in patients with hematuria and non-nephrotic as well as nephrotic range proteinuria. The most common histological diagnoses for isolated hematuria and acute nephritic syndrome were IgAN and postinfectious glomerulonephritis (PIGN), respectively. Conclusions: MCD and lupus nephritis are the most common pediatric primary and secondary histopathologic diagnoses, respectively. The adolescent-onset glomerular diseases have a higher frequency of IgAN, membranous nephropathy, and DPGN. PIGN is still an important differential in our pediatric patients presenting with acute nephritic syndrome. [ABSTRACT FROM AUTHOR]

Introduction: Planned or unplanned hospitalization increases the family's stress and anxiety level. Hospitalization creates stress, as it interrupts normal routines and places increased demands on parents who must further divide their time between normal responsibilities and their hospitalized child. Many parents feel a lack of control and a sense of powerlessness when their child is hospitalized. Objectives: The objectives of the study were to identify the level of stress and coping among mothers of children admitted to the paediatric intensive care unit (PICU) and to determine the correlation between stress and coping among mothers of children admitted to the PICU. Methods: The setting chosen for the present study was the Paediatric Intensive Care Unit of Sree Gokulam Medical College and Hospital. By employing techniques for consecutive sampling, 100 mothers were selected. The Modified Parental Stressor Scale (PSS) and Modified Coping Health Inventory for Parents (CHIP) were used to collect the data from mothers. Results: The present study found that most 94% of mothers had severe stress because of stressors, and only 6% had moderate stress. No one had mild stress. The present study found that 50% of mothers cope well with the stressors from their child's PICU admission, and the remaining 50% cope moderately with stressors. The results show that stressors had a significant association with the age of the mother, religion of the mother, mode of payment, development stage, history of previous admission, occupation of the mother and income. There was a weak positive correlation between stressors and coping strategies. Conclusion: Therefore, the study concluded that stressors influence the stress level of mothers of children admitted to the PICU. [ABSTRACT FROM AUTHOR]

Background: Renal Angina Index (RAI) is a bedside tool for risk stratification of patients to predict acute kidney injury (AKI). Kidney biomarkers are better indicators of real-time injury and give us lead time for diagnosing impending AKI. Methods: We enrolled consecutive children aged 2 months–14 years admitted to a tertiary hospital in northern India over 2 years. RAI was calculated on day 0 (D0) and urinary (u) and plasma (p) neutrophil gelatinase-associated lipocalin (NGAL) were measured within 6 h of admission. Children were followed for the development of severe AKI on day 3 (D3) using Kidney Disease Improving Global Outcomes criteria to define and stage AKI. Results: Of the 253 children enrolled and analysed, 44 (17.4%) developed D3-AKI (stage 1 in 52.2%, stage 2 in 20.5% and stage 3 in 27.3%). Renal angina (RAI ≥ 8) on D0 was present in 66.7% children who developed stage 2/3 D3-AKI vs. 43.5% in children who did not develop D3-AKI /stage 1 AKI (p = 0.065). Area under ROC (AUROC) curve for D0-RAI to predict D3-severe-AKI was 0.66 (95% CI, 0.55–0.77). AUROC curve for uNGAL and pNGAL to predict D3-severe-AKI was 0.62 (95% CI, 0.50–0.74) and 0.48 (95% CI, 0.35–0.61), respectively. The severe AKI group had greater requirement of ventilation and inotropic support with mortality being thrice higher compared to the non-AKI group. Conclusion: RAI ≥ 8 and uNGAL had a high negative predictive value but low sensitivity for predicting D3-severe-AKI. pNGAL had a poor predictive value for D3-severe-AKI. A higher resolution version of the Graphical abstract is available as Supplementary information [ABSTRACT FROM AUTHOR]

Background: Children with multisystem inflammatory syndrome in children (MIS-C) often develop shock and require vasoactive agents. The vasoactive-inotropic score (VIS) is a potential scoring system to assess the amount of vasoactive agent support required. The study was conducted to correlate VIS at 6 and 12 h with the length of intensive care unit (ICU) stay and with COVID immunoglobulin G (IgG) antibody titers in cases of MIS-C with shock. Subjects and Methods: Demographic and clinical details were collected from patients with the diagnosis of MIS-C with shock requiring vasoactive agents. VIS was calculated at 6 and 12 h following initiation of the first inotropic/vasoactive agent. Results: Twenty-nine children admitted with the diagnosis of MIS-C who presented with shock or developed shock during hospital stay were the study population. On performing Spearman's correlation, a positive correlation was observed between COVID IgG titers and VIS at 6 h. There was no significant association between VIS and length of ICU stay. Conclusions: VIS had limited significance in predicting the length of ICU stay and the need for vasoactive agents required. [ABSTRACT FROM AUTHOR]

Introduction: The overall incidence of cholecystitis in children appears to be increasing although the exact frequency of acute and chronic cholecystitis among children in India or worldwide remains unknown. The frequency of paediatric cholecystitis has proportionally increased with the childhood obesity and intake of habitual fatty food. Aim: To present the histopathological concordance of Laparoscopic Cholecystectomy (LC) performed among children for a clinical diagnosis of Gallbladder (GB) disease. Materials and Methods: A single centre retrospective study was performed including histopathological and relevant clinical data of all paediatric LC performed at Career Institute Of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, between January 2019 to January 2022. Paediatric patients who had undergone LC in the designated time period for a clinical diagnosis of cholelithiasis and/or inflammatory GB disease with classical signs of inflammation were included. Study population with LC procedure submitted for histological evaluation were identified by performing an electronic search through the archives of Department of Pathology, Career Institute of Medical Sciences and Hospital, Lucknow, Uttar Pradesh, India, followed by a manual review of GB specimens, histopathology slides and reports. Results: Among 265 patients who underwent LC during this period, there were 62 (23.4%) children. The average age of presentation was 13 years (range 5-18 years), Forty nine (79%) were girls and 13 (21%) were boys. The clinical diagnosis for which paediatric LCs were performed were cholelithiasis among 51% and cholecystitis among 48%. On histopathological concordance these turned out to be chronic cholecystitis among 98.4% children among which 51% were associated with cholelithiasis. Calculous cholecystitis was more frequent than acalculous cholecystitis. Chronic cholecystitis with cholelithiasis and cholesterolosis was more frequent among adolescent girls. Conclusion: This study suggests that chronic cholecystitis accounts for the majority of inflammatory diseases among children undergoing LC for a GB disease and may or may not be associated with cholelithiasis. Chronic cholecystitis with cholelithiasis and cholesterolosis seem more frequent among adolescent girls. [ABSTRACT FROM AUTHOR]

Objective: Persistent shock (PS) or recurrent shock (RS) after initial fluids and vasoactives can be secondary to myriad complex mechanisms, and these patients can have a high mortality. We developed a noninvasive tiered hemodynamic monitoring approach which included, in addition to basic echocardiography, cardiac output monitoring and advanced Doppler studies to determine the etiology and provide targeted therapy of PS/RS. Design: Prospective observational study. Setting: Tertiary Care Pediatric Intensive Care Unit, India. Methods: A pilot conceptual report describing the clinical presentation of 10 children with PS/RS using advanced ultrasound and noninvasive cardiac output monitoring. Children with PS/RS after initial fluids and vasoactive agents despite basic echocardiography underwent BESTFIT + T3 (Basic Echocardiography in Shock Therapy for Fluid and Inotrope Titration) with lung ultrasound and advanced 3-tiered monitoring (T1-3). Results: Among 10/53 children with septic shock and PS/RS over a 24-month study period, BESTFIT + T3 revealed combinations of right ventricular dysfunction, diastolic dysfunction (DD), altered vascular tone, and venous congestion (VC). By integrating information obtained by BESTFIT + T1-3 and the clinical context, we were able to modify the therapeutic regimen and successfully reverse shock in 8/10 patients. Conclusion: We present our pilot results with BESTFIT + T3, a novel approach that can noninvasively interrogate major cardiac, arterial, and venous systems that may be particularly useful in regions where expensive rescue therapies are out of reach. We suggest that, with practice, intensivists already experienced in bedside POCUS can use the information obtained by BESTFIT + T3 to direct time-sensitive precision cardiovascular therapy in persistent/recurrent pediatric septic shock. [ABSTRACT FROM AUTHOR]

There is limited information on the feeding practices of 9.42 million children living within institution‐based care (IBC) worldwide. Poor feeding practices can predispose or exacerbate malnutrition, illness and disability. Here we describe the feeding practices of children living within IBC based on a retrospective analysis of records from 3335 children, 0–18 years old, participating in Holt International's Child Nutrition Program (CNP), from 36 sites in six countries. Data analysed included demographic information on age, sex, feeding practices, disabilities and feeding difficulties. Descriptive statistics were produced. A generalised linear model explored associations between feeding difficulties and disability and 2 × 2 tables examined feeding difficulties over time. An additional set of feeding observations with qualitative and quantitative data was analysed. At baseline, the median age of children was 16 months (0.66–68 months) with 1650/3335 (49.5%) females. There were 757/3335 (22.7%) children with disabilities; 550/984 (55.9%) were low birth weight; 311/784 (39.7%) were premature; 447/3113 (14.4%) had low body mass index and 378/3335 (11.3%) had feeding difficulties. The adjusted risk of having a feeding difficulty was 5.08 ([95% confidence interval: 2.65–9.7], p ≤ 0.001) times greater in children with disabilities than those without. Many children saw their feeding difficulties resolve after 1‐year in CNP, 54/163 (33.1%) for children with disabilities and 57/106 (53.8%) for those without disabilities. Suboptimal hygiene, dietary and feeding practices were reported. In conclusion, feeding difficulties were common in IBC, especially among children with disabilities. Supporting safe interactive mealtimes for children living within IBC should be prioritised, to ensure overall health and development. Key points: Feeding difficulties are common among children living in institution‐based care (IBC), particularly but not exclusively among those children with disabilities.Suboptimal feeding practices were common in IBC and encompassed inadequate hygiene, limited support for self‐feeding, reading children's feeding cues (especially around pacing and satiety), addressing feeding difficulties, such as difficulty chewing or swallowing. These should be prioritised in training and supervision for caregivers.Addressing the needs of this vulnerable group should include support for safe feeding techniques. These should be prioritised to help ease the transition into eventual family‐based care if we are to move towards deinstitutionalizing children and strengthening families. [ABSTRACT FROM AUTHOR]

Background and Aim: Psychological and biochemical factors are responsible for the behavioral problems in children with epilepsy. A study was conducted to find the prevalence of behavioral problems in children with epilepsy and also to identify the relation among socioeconomic status, age of onset of seizure, and frequency of seizure attacks with the prevalence of behavioral problems. Materials and Methods: It was a prospective observational study conducted in the Department of Pediatrics, Kakatiya Medical College, Warangal. Convenient sampling was considered; the study was conducted for 2 years. Children aged 1–12 years, admitted with epilepsy to pediatric intensive care unit and pediatric wards, were included in this study. Those were having intellectual problems, cerebral palsy, developmental delay, and metabolic and neurodegenerative disorder were excluded from the study. Sociodemographic information was collected from the parents in a standard pro forma. Diagnostic and Statistical Manual of Mental Disorders-oriented scales for different ages were used for the assessment of behavior by translating into regional language. Chi-square test was used; P < 0.05 was considered statistically significant. Results: A total of 112 children were included; male: female ratio was 1.39; 41 (36.6%) children had behavioral problems; age-wise, there was significant difference; gender-wise, there was no significant difference. Attention-deficit/hyperactivity problems were identified to be the predominant. Statistically, there was no significant difference between behavioral problems either with mother education or with parent's socioeconomic status, respectively. When brain imaging was done, normal studies were revealed in 32% of children with behavior problem. Conclusion: Each and every child with epilepsy aged <5 years and frequency of seizure attack >1 time/year needs thorough screening for behavioral problems irrespective of gender and family characteristics. [ABSTRACT FROM AUTHOR]

Background: Adenovirus affects mainly the respiratory system, leading to life-threatening pneumonia. This study was aimed to describe the epidemiological, clinical, biochemical, and radiological profile and respiratory sequelae during follow-up among children with severe adenoviral pneumonia (ADVP) admitted in a tertiary care pediatric intensive care unit (PICU). Subjects and Methods: This is a single-center, prospective study conducted in PICU from eastern India from December 2018 to August 2021. Children less than 10 years of age, admitted with features suggestive of lower respiratory tract infection (LRTI)/pneumonia and positive for adenovirus by respiratory polymerase chain reaction during the study period were included. All children were managed symptomatically. Antibiotics were used in all children and respiratory support was given according to the severity as per standard management protocol. Results: Among 96 children with adenoviral pneumonia, 33 (34.4%) had severe ADVP and required PICU care. Among them, 28 (84.8%) were males and 24 (72.7%) had SPO2 <90% at the time of admission. Twenty (60%) children needed some respiratory support beyond simple oxygen therapy. Among 33 children, 9 (27.3%) died, 2 left against medical advice, and 22 (66.7%) survived and were discharged. Among discharged, 2 (9%) were lost in follow-up and 20 (91%) children were followed up for the next 2.5 years. During the follow-up, 18 (90%) had recurrent symptoms, and high-resolution computed tomography showed features suggestive of postinfective bronchiolitis obliterans in most of them. Conclusions: Unlike other respiratory viruses, ADVP had a longer course of illness, seemed to be more severe, and had more long-term sequelae. [ABSTRACT FROM AUTHOR]

Background: To describe the clinical profile, risk factors, and outcomes that are associated with candida infection among critically ill children. Patients and methods: A retrospective case-control study wherein 109 children admitted to the pediatric intensive care unit (PICU) in the years between 2015 and 2017 with the growth of candida from blood, urine, endotracheal (ET) aspirate, and pus swabs were included and compared to 97 age and sex-matched controls chosen from the same time period. Results: Of the 124 candida isolates from 109 children, 37% were from blood, 24% from urine, and 14% in pus; 40% of the isolates were from ET aspirate. Candida non-albicans types (70%) predominated with Candida tropicalis causing 50% of the infections. Risk factors for candida infection were neutropenia [OR 20.01, 95% CI (0.94-422.32)], mechanical ventilation [OR 5.97, 95% CI (2.44-14.62)], peritoneal dialysis [OR 5.81, 95% CI (1.27-26.50)], institution of amino acids [OR 5.41, 95% CI (0.85-34.13)], presence of central venous catheter [OR 3.83, 95% CI (1.59-9.19)], antibiotic use >5 days [OR 3.58, 95% CI (1.38-9.29)]. Candida Cases (95.4%) had a septic shock with acute kidney injury in 34% and had significantly lower survival than controls [72 (66%) of 109 vs. 74 (80%) of 92] (p = 0.023). Conclusions: The rate of candida infection in our PICU was 4.2% of PICU admissions. The most common species was C. tropicalis. The independent risk factors for candida infection were neutropenia, antibiotic duration >5 days, peritoneal dialysis, amino acid administration, mechanical ventilation, and presence of a central venous catheter (CVC). [ABSTRACT FROM AUTHOR]

Altered consciousness is a common problem encountered in the pediatric emergency department. Modified Glasgow coma scale (MGCS) has been widely used in pediatric intensive care units (PICUs) for assessing the level of consciousness in children with various illnesses. To compare utility of alert verbal painful unresponsive (AVPU) scale and MGCS for assessing level of consciousness of critically ill patients admitted to PICU. A prospective observational study was conducted at Acharya Vinoba Bhave Rural Hospital in Maharashtra, India on children above the age of 30 days admitted to the PICU from September 2018 to August 2019, fulfilling the inclusion criteria, after obtaining informed consent from the parents. Level of consciousness of the enrolled patients was assessed using the AVPU scale and MGCS. One-way analysis of variance technique was used for data analysis. A total of 74 children were included in the study. A good correlation was observed between the two scales and mean MGCS score of 13.8 (13–15), 11.3 (11–12), 8.09 (7–9), and 3 corresponded to A, V, P, and U, respectively. AVPU scale was comparable to MGCS in assessing level of consciousness in children admitted to PICU. AVPU can be used for initial evaluation of level of consciousness in children presenting with altered consciousness. More detailed MGCS can be used to assess the improvement over time and to decide further treatment strategy. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) associated with COVID-19 in children is not well described in the literature, so this study was designed to assess the severity, clinical course, different treatment measures, and outcome of this group of patients. Patients and methods: This descriptive study was performed by retrospective chart review of children admitted in pediatric intensive care unit (PICU) in the age-group of 1 month to 12 years over the period of 6 months (July--December 2020) in a tertiary care pediatric COVID facility in eastern India. Severity of ARDS, ventilator settings, oxygenation and laboratory parameters, and outcomes were documented. Predictors associated with severe ARDS were evaluated. Results: Among 128 laboratory-confirmed pediatric COVID-19 cases admitted in PICU, 18 (14%) developed ARDS, 6 (33.3%) had severe ARDS, and 3 (16.6%) succumbed to death. Outcome was measured by median hospital stay [20 days (IQR 19, 21)], PICU stay [13 days (IQR 10, 16)], and 28-day ventilator-free days [14 days (IQR 13, 22)]. Half (n = 9) of our study cohort had different comorbidities and congenital heart disease being the most common (4, 22.2%). Median positive end-expiratory pressure requirement was 10 cm H2O (9, 11) for invasively ventilated children (n = 13, 72.2%) along with peak inspiratory pressure of 24 cm H2O (20, 29) and mean airway pressure of 17 cm H2O (14, 20). Median oxygenation index was 13.3 (10.5, 18.6). Nine (69.2%) out of 13 intubated children had undergone prone ventilation. C-reactive protein (CRP) and D-dimer levels were significantly high in children with severe ARDS alongside pSOFA and lung USG score. Conclusion: Incidence of ARDS in pediatric COVID-19 though less but is not rare. Elevated CRP, D-dimer values, and high lung USG scores were associated with severe ARDS. Those who died had significant comorbidity. [ABSTRACT FROM AUTHOR]

A pandemic leads to disruption and stretching of an existing health care system and its resources. Coronavirus disease 2019 (COVID-19) data show distinct and severe manifestations in children necessitating critical care. Children need prioritization as they are susceptible to COVID-19 as part of the family cluster, varied presentations, and mortality. The purpose of this report is to discuss the optimization of the health care system for pediatric care. The key initiatives were to identify our objectives, bring out changes to the organizational processes, and integrate the same into the existing system. A systems approach to health care delivery by optimizing infrastructure, human resources, materials, funding, leadership, and governance was undertaken. This resulted in creation of distinct COVID-19 and non-COVID-19 service areas, management protocols, and trained health care workers. Partnership was forged with the public health system. This preparedness and continued responses to the demands of the health care system helped us manage children ranging from neonates to adolescents efficiently. Though the health care system is mostly open, acting upon the modifiable factors gave better preparedness in a short time. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to describe the clinico-virological profile, treatment details, intensive care needs, and outcome of infants with acute viral bronchiolitis (AVB). Methodology: In this prospective observational study, 173 infants with AVB admitted to the pediatric emergency room and pediatric intensive care unit (PICU) of a tertiary care teaching hospital in North India during November 2019 to February 2020 were enrolled. The data collection included clinical features, viruses detected [respiratory syncytial virus (RSV), rhinovirus, influenza A virus, parainfluenza virus (PIV) 2 and 3, and human metapneumovirus (hMPV)], complications, intensive care needs, treatment, and outcomes. Multivariate analysis was performed to determine independent predictors for PICU admission. Results: Most common symptoms were rapid breathing (98.8%), cough (98.3%), and fever (74%). On examination, tachypnea (98.8%), chest retractions (93.6%), respiratory failure (84.4%), wheezing (49.7%), and crepitations (23.1%) were observed. RSV and rhinovirus were the predominant isolates. Complications were noted in 25% of cases as encephalopathy (17.3%), transaminitis (14.3%), shock (13.9%), acute kidney injury (AKI) (7.5%), myocarditis (6.4%), multiple organ dysfunction syndrome (MODS) (5.8%), and acute respiratory distress syndrome (ARDS) (4.6%). More than one-third of cases required PICU admission. The treatment details included nasal cannula oxygen (11%), continuous positive airway pressure (51.4%), high-flow nasal cannula (14.5%), mechanical ventilation (23.1%), nebulization (74%), antibiotics (35.9%), and vasoactive drugs (13.9%). The mortality was 8.1%. Underlying comorbidity, chest retractions, respiratory failure at admission, presence of shock, and need for mechanical ventilation were independent predictors of PICU admission. Isolation of virus or coinfection was not associated with disease severity, intensive care needs, and outcomes. Conclusion: Among infants with AVB, RSV and rhinovirus were predominant. One-third infants with AVB needed PICU admission. The presence of comorbidity, chest retractions, respiratory failure, shock, and need for mechanical ventilation independently predicted PICU admission. [ABSTRACT FROM AUTHOR]

A case study of 3‑year‑old Indian boy, born at term to nonconsanguineous parentage is presented with high‑grade fever for several month. Topics include examines he used to be irritable during the febrile period and frequented the bathroom to pour cold water over his body and a specific pattern of fever could be elicited as it appeared and resolved spontaneously after sundown.

Back Ground:- Audit of transfusion practices in pediatric patients was performed to study indications, clinical profile and whether transfusions were in accordance to guidelines. Objective:- to perform audit of transfusion practices, in order to study appropriate and inappropriate usage of different blood components in pediatric population. Results:- In present study it was observed that out of 62 packed red cells transfusions 35(56.45%) transfusions were found to be inappropriate. Among FFP transfusions out of 55 transfusions 11(20%) transfusions were observed as inappropriate . Most of inappropriate transfusions had bleeds but normal coagulogram. Among Platelet transfusions, three (16.6%) platelet transfusions, out of 18 transfusions were inappropriate and transfused mainly to raise the platelet count. Conclusion:-Most frequently transfused blood components are red cells in pediatrics . Inappropriate transfusion of blood components hinders the utility of this valuable resource, Thus it becomes necessary to conduct regular audit of blood component transfusion for optimum utilization. [ABSTRACT FROM AUTHOR]

The article informs about Essentials of Pediatric Neurology has sections on clinical evaluation and investigations, which deals with clinical examination, imaging, stroke, electroencephalography, nerve conduction, evoked potential study with neonatal neurophysiology. Topics include developmental disorders which deal with congenital malformation and intellectual disability disorders with neurodevelopment delay; and interest in pediatric neurology to take the standard of care to a higher level.