Indian Academy of Pediatrics Revised Guidelines on School Reopening: First Revision, September 2021.

JUSTIFICATION: The COVID-19 pandemic has affected schooling for more than 24 crores students, since March 2020. Students need a respite from the long standing social isolation so that they regain their chance to develop holistically, but after the devastating effects of the second wave, the administrators as well as parents are skeptical about the decision of school reopening. PROCESS: The Indian Academy of Pediatrics constituted a task force comprising of national and international experts in the field who deliberated on the issue. OBJECTIVES: To bring out scientifically supported guidelines on the prerequisites of opening and attending the schools, in the current context of the COVID-19 pandemic. RECOMMENDATIONS: The task force recommends i) Decentralization of the school reopening decision; ii)Three epidemiological parameters, case positivity rate (<5 or steadily declining number of cases for past two weeks), number of new cases(<20 per lakh population per day for past two weeks) and vaccination coverage (>60% of the vaccine-eligible population) to be met at the local level, before the schools reopen; and iii) Criteria regarding health and vaccination to be met by the schoolattendees.

Indian Academy of Pediatrics Guidelines on School Reopening, Remote Learning and Curriculum in and After the COVID-19 Pandemic.

JUSTIFICATION: With the unprecedented COVID-19 pandemic and the resultant school closure, children all over the country are undergoing a lot of educational, psychosocial, and physical problems. There is an urgent and deep felt need to offer scientific and concrete guidance for these concerns and support children in their educational development during these testing times. OBJECTIVE: To review the guidelines and recommendations given by various international agencies and formulate guidelines in the Indian context on (a) how and when to reopen the schools; (b) ways and means of remote learning; and (c) to identify the contents of curriculum that need restructuring in context of the current situation. PROCESS: Indian Academy of Pediatrics (IAP) formed a task force of pediatricians, educationists and technological experts who connected through various video and social platforms. They gathered and exchanged information and thoughts. The writing committee drafted the guidelines and got approval of all the members of the task force. RECOMMENDATIONS: Schools can be reopened only when the local epidemiological parameters are favorable, the administration is equipped with adequate infrastructure and health care facilities, and the stakeholders (teachers, students, parents, and support staff) are prepared for the new normal. In the meanwhile, remote learning (media-based and /or otherwise) should reach to the last student to maintain uninterrupted education. The curriculum needs to be revised, with focus on revision and core contents. Informal learning of psychosocial empowerment and daily living skills should be encouraged rather than stressful formal learning.

Morbidity Patterns of Late Preterm Babies Born Small for Gestation.

OBJECTIVE: To compare hypoglycemia and the other early neonatal morbidities (from birth till hospital discharge) of late preterm babies born small for gestational age (LP SGA) with their appropriate for age (LP AGA) counterparts. METHODS: LP SGA and LP AGA, as defined by Fenton charts, were prospectively followed-up to assess development of predefined morbidities, mortality and readmission rates at one month. All live inborn late preterm babies (340/7 to 366/7 weeks, n = 238) were included. RESULTS: LP SGA babies (n = 72) as compared to LP AGA babies (n = 166) were at higher risk for developing at least one predefined neonatal morbidity before hospital discharge [RR 1.93 (1.6-2.3; p < 0.001)]. These included hypoglycemia, hypothermia, respiratory morbidity needing support, jaundice needing treatment, feeding difficulties, birth asphyxia, and sepsis; besides, significant rates of readmissions and duration of hospital stay. CONCLUSIONS: Being born small for gestation age acts an additional jeopardizing factor in late preterm babies.

When alternative female Kangaroo care is provided by other immediate postpartum mothers, it reduces postprocedural pain in preterm babies more than swaddling.

AIM: Research on alternative female Kangaroo care (KC) has been hampered by high maternal refusal rates. We assessed the efficacy of Kangaroo mother care (KMC), alternative KC provided by other postpartum mothers and swaddling for postprocedural pain relief in preterm babies. METHODS: The study was carried out in a tertiary armed forces hospital, where mothers did not have support from other female relatives and other postpartum mothers agreed to act as alternative female KC providers. We exposed 51 stable preterm neonates, with a gestational age of 30-36 weeks, to KMC, alternative female KC and swaddling for 30 minutes before heel lancing. The outcome measures included the Preterm Infant Pain Profile (PIPP) scores at 30 seconds and the time taken for the heart rate to return to baseline. RESULTS: The mean PIPP scores were lower with KMC (10.59) and alternative female KC (11.24) than swaddling (12.96) and heart rate normalisation took 111, 117 and 149 seconds respectively. The p values were <0.001 for individual groups and outcomes. KMC fared better than alternative female KC for both pain (p = 0.045) and heart rate (p = 0.013). CONCLUSION: Providing KMC and alternative female KC before heel lancing resulted in better pain relief than swaddling.