Hypoglycaemia in high-risk neonates on exclusive breastfeeding.

Background: Neonates at risk of hypoglycemia are often roomed in with mothers, but there is paucity of literature on the occurrence of hypoglycemia in these exclusively breastfed high-risk neonates. The primary objective was to estimate the incidence of hypoglycaemia in high-risk neonates on exclusive breastfeeding. The secondary objectives were to study the time of presentation, symptoms of hypoglycaemia, and the various maternal and neonatal risk factors. Methods: This prospective observational study was carried out in a tertiary care teaching hospital of eastern India between January 2017 and June 2018. All neonates roomed in with mothers with high-risk factors such as low birth weight, preterm, small for gestational age, large for gestational age and infants of diabetic mothers were included. All included neonates were exclusive breastfed and underwent blood glucose monitoring at 2, 6, 12, 24, 48 and 72 h of life using glucometer strips and also whenever clinical features suggested hypoglycaemia. Hypoglycemia was defined as the blood glucose level ≤46 mg/dL. Results: Of a total of 250 neonates studied, 52 (20.8%) developed hypoglycaemia in first 72 h. Hypoglycaemia was detected in most at 2 h with the second peak at 48 h of age. Only 8 (3.2%) neonates had symptomatic hypoglycaemia with jitteriness being the commonest symptom, followed by lethargy and poor feeding. Conclusion: There is a need to closely monitor the blood glucose levels for at least first 48 h in high-risk neonates roomed in with mothers on exclusive breastfeeding.

Two Novel Compound Heterozygous ADGRG1/GPR56 Mutations Associated with Diffuse Cerebral Polymicrogyria.

Background Polymicrogyria (PMG) has environmental or genetic etiologies. We report a 8-year-old boy with diffuse PMG and two novel adhesion G protein-coupled receptor G1 ( ADGRG1 ) / G protein-coupled receptor 56 ( GPR56 ) mutations. Case Report The proband has intellectual disability, spastic quadriparesis, and intractable epilepsy without antenatal or perinatal insults. Brain magnetic resonance imaging revealed PMG involving fronto-polar, parietal and occipital lobes with decreasing antero-posterior gradient, and a thinned-out brain stem. Targeted exome sequencing identified two novel compound heterozygote ADGRG1/GPR56 mutations (c.C209T and c.1010dupT), and each parent carries one of these mutations. Subsequent pregnancy was terminated because the fetus had the same mutations. Conclusion The detected mutations expanded the genetic etiology of PMG and helped the family to avoid another child with this devastating condition.

The Association of Breastfeeding With Childhood Asthma: A Case-Control Study From India.

Background The role of breastfeeding in childhood asthma has long been controversial. The majority of research pertains to developed countries with scant literature available in a developing country like India, where a different asthma phenotype is prevalent. This study examined the association of breastfeeding duration and exclusiveness with childhood asthma and its severity, as measured by peak expiratory flow rate (PEFR) in India. Methodology We conducted a matched case-control study in Pune, India. A total of 180 children with asthma (cases) and 180 without the disease (controls) were included. A standardized questionnaire recorded demographics and medical and breastfeeding history. PEFR readings were obtained from each child. Conditional logistic regression and linear regression were used to explore the association of breastfeeding with asthma and PEFR, respectively. Results The median duration of breastfeeding among cases was [5 (2.5-10)] months as compared to controls [9 (3.5-16.8)] months. The prevalence of exclusive breastfeeding among mothers was 60% (50% among cases and 69% among controls). Exclusive breastfeeding was associated with a 46% lower likelihood of having asthma with a probability (p-value) of 0.025 where the odds ratio (OR) was 1.85, with a 95% confidence interval (CI) of 1.08 to 3.16. Breastfeeding duration was significantly associated with a lower likelihood of having asthma (p = 0.001) (OR 0.87; 95% CI 0.79-0.94). One-month increase in the duration of breastfeeding was associated with a 23% reduced risk of the disease. The odds of maternal asthma [21.4 (4.22-109.36)], paternal smoking [1.44 (0.22-0.86)], and maternal smoking [5.14 (1.78-14.80)] were higher among children with asthma as compared to children without asthma. The weight of the child and duration of breastfeeding were negatively associated with PEFR. Maternal asthmatic history, associated allergies, paternal smoking, and parents' education were positively associated with PEFR for the overall sample. Conclusion Prolonged and exclusive breastfeeding was found to be a protective factor against the development of asthma. Promotion of breastfeeding and smoking cessation should be a priority in the control of childhood asthma. Further research should be conducted to explore the negative correlation between duration and frequency of breastfeeding and PEFR.

Maternal Ability to Correctly Detect Significant Jaundice in Indian Neonates.

BACKGROUND: The ability of mothers to correctly detect jaundice in their newborns is largely unknown. The objective was to ascertain the ability of mother to correctly detect the presence of significant jaundice in her newborn. MATERIALS AND METHODS: This cross-sectional study was conducted in a tertiary care hospital in eastern India from February 2015 to July 2016. All inborn neonates more than 34 weeks' gestation were included. Congenital malformations, perinatal asphyxia, neonatal sepsis, readmission after discharge, and isoimmunization were excluded. A total of 505 inborn newborns were independently assessed by the mother and the treating pediatrician for significant jaundice every day till discharge. Each newborn underwent total serum bilirubin estimation on suspicion of significant jaundice by either of the two or at discharge, whichever was earlier. RESULTS: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of maternal detection of significant jaundice was 51.47%, 88.33%, 39.29%, and 92.12%, respectively. CONCLUSION: Mothers have poor sensitivity and PPV to detect significant neonatal jaundice in the Indian population.

Knowledge of breastfeeding practices in doctors and nurses: A questionnaire-based survey.

BACKGROUND: As the primary physicians and nurses in hospitals are the first contact with the mothers, we carried out a questionnaire-based survey to assess the knowledge of the MBBS nonspecialist doctors and general duty nurses regarding breastfeeding of normal newborns. METHODS: Thirty-four MBBS, nonspecialist doctors and ninety-seven general duty nurses were enrolled in the study between August 2016 and September 2016 in a tertiary care teaching hospital, and a questionnaire comprising of 10 questions on breastfeeding was provided to each. RESULTS: All doctors (100%) and nurses (100%) agreed that breastfeeding must be started within 1 h of birth and all nurses (100%) agreed that breastfeeding alone is sufficient for a newborn baby during the first 2-3 days of life. However, 58.8% of the doctors and 25.7% of the nurses believed that after 6 months of life, the mother must give her infant cow's milk or formula for better growth. Only 52.9% of doctors and 40.2% of nurses agreed that breastfeeding should be advised to be continued for 2 years and beyond. Among doctors only 67.6% believed that breastfeeding for a normal newborn should be on demand only and not by clock. CONCLUSION: There is scope of improvement regarding knowledge of breastfeeding in both doctors and nurses. All healthcare providers must provide correct information to mothers to help them in successful breastfeeding.

Iron deficiency anemia in children with cyanotic congenital heart disease and effect on cyanotic spells.

BACKGROUND: Iron deficiency anemia (IDA) in cyanotic congenital heart disease (CCHD) and its association with cyanotic spells has been documented in literature. However, Indian data especially in the pediatric age group is scarce. This study was conducted to find out the prevalence of IDA in this population. METHODS: An observational study was conducted in a tertiary care hospital. Children with CCHD in the age group of birth-12 years were included in the study. Hematological parameters of these patients were determined and compared. An assessment of the incidence of cyanotic spells in the iron-deficient and iron non-deficient children was also done. Data analysis was done using Fischer's exact test. RESULTS: The prevalence of IDA was 47.06% in the study population. The study also showed that hemoglobin and hematocrit levels were paradoxically higher in the iron-deficient group as compared to the non-deficient, though the iron studies revealed the iron deficiency. The incidence of cyanotic spells was higher in the iron-deficient group. The mean corpuscular volume (MCV), red cell distribution width (RDW), serum ferritin, serum iron, total iron binding capacity (TIBC), and transferrin saturation (TS) values were the parameters, which were found to be statistically significant to differentiate the study groups. CONCLUSION: The prevalence of IDA in children with CCHD was found to be high. Iron-deficient group had an increased frequency of cyanotic spells as compared to the non-deficient group, which was statistically significant.

Use of Plan-Do-Study-Act cycles to decrease incidence of neonatal hypothermia in the labor room.

BACKGROUND: Body temperature of a neonate continues to be under-documented, under-recognized, and under-managed, even though studies have shown that neonatal hypothermia increases mortality and morbidity. We aimed to reduce neonatal hypothermia (body temperature <36.5 °C) at 1 h following normal vaginal delivery in term and late preterm neonates in delivery room from 50% at baseline to less than 10% by 6 weeks. METHODS: We implemented a quality improvement (QI) initiative using the rapid-cycle Plan-Do-Study-Act approach (PDSA) improvement model and the project was conducted from 15 Jan 2017 to 25 Feb 2017. All singleton neonates with gestational ages above 34 completed weeks born by vaginal delivery were targeted. Exclusion criteria included neonates needing any form of resuscitation, those developing respiratory distress after birth needing any form of respiratory support or observation in NICU. We ran PDSA cycles (including pre-warmed cloths, skin to skin care with mother, early breast feeding, delaying weight check by 1 h and checklist of planned steps), every week, after taking the baseline data in the first week. RESULTS: A total of 46 neonates were studied. After 4 PDSA cycles, incidence of neonatal hypothermia at 1 h of birth dropped to zero from 50% at baseline and we were able to sustain 100% normal temperature (36.5-37.5 °C) since then. CONCLUSION: This QI project has significantly reduced the incidence of hypothermia in term and late preterm neonates born by vaginal delivery in our institute.

Parameatal urethral cyst.

Parameatal urethral cyst is a rare clinical entity, resulting in asymptomatic cosmetic concerns, distortion of urinary stream or difficulty in urination. Though they cause considerable parental concerns, natural history is to resolve spontaneously or rarely surgical excision is needed. We report a neonate with asymptomatic parameatal urethral cyst.

Effects of maternal epidural analgesia on the neonate--a prospective cohort study.

BACKGROUND: Epidural analgesia is one of the most popular modes of analgesia for child birth. There are controversies regarding adverse effects and safety of epidural analgesia. This study was conducted to study the immediate effects of the maternal epidural analgesia on the neonate during early neonatal phase. METHODS: A prospective cohort study of 100 neonates born to mothers administered epidural analgesia were compared with 100 neonates born to mothers not administered epidural analgesia in terms of passage of urine, initiation of breast feeding, birth asphyxia and incidence of instrumentation. RESULTS: There was significant difference among the two groups in the passage of urine (P value 0.002) and incidence of instrumentation (P value 0.010) but there was no significant difference in regards to initiation of breast feeding and birth asphyxia. CONCLUSIONS: Epidural analgesia does not have any effect on the newborns in regards to breast feeding and birth asphyxia but did have effects like delayed passage of urine and increased incidence of instrumentation.

Prevalence of rotavirus infection in children below two years presenting with diarrhea.

BACKGROUND: Rotavirus is a common cause of diarrhea in children. There is a need for data on prevalence of rotavirus diarrhea especially in our setting. This study was carried out to determine the prevalence of rotavirus infection in children upto two years presenting with diarrhea and to ascertain factors associated with rotavirus infection in them. METHODS: A cross sectional observational study was carried out to determine the prevalence of rotavirus infection amongst children less than 2 years presenting with diarrhea. The clinical profile of the children was analyzed along with detection of rotavirus antigen in stool. RESULTS: A total of 250 children with diarrhea were included in the study. The Male: Female ratio was 0.97:1. We found 24% children presenting with diarrhea to be positive for rotavirus antigen. 78.3% of children with rotaviral diarrhea were in the age group of 6-15 months. There was a significant association between type of feeding and rotavirus diarrhea with reduced prevalence while on exclusive breast-feeding. Though only 10.4% of children with rotavirus diarrhea had severe dehydration, 61.5% of children with severe dehydration were positive for rotavirus. CONCLUSION: Rotavirus diarrhea caused substantial morbidity in our study population. The rotavirus positivity in these children was 24% and there was a significant association of rotavirus infection with type of feeding and severity of dehydration.

Translating technology into patient care: Smartphone applications in pediatric health care.

The latest generations of smartphones are increasingly viewed as handheld computers rather than as phones and the applications on these phones are becoming increasingly popular among the medical professionals. A large number of health care applications are available across various smartphone platforms. At times it may be difficult to identify most appropriate and reliable application for use at the point of care. In this review, we have tried to identify the applications relevant to Pediatrics and Childcare which when used at the point of care might be helpful in improving patient care.

A study to determine the prevalence of pulmonary arterial hypertension in children with Down syndrome and congenital heart disease.

BACKGROUND: Down syndrome (DS) is a common chromosomal abnormality associated with congenital heart disease (CHD). These cardiac abnormalities are known to be associated with pulmonary arterial hypertension (PAH). METHODS: The aim of this study was to assess the prevalence of PAH in DS children with CHD and to compare it with PAH prevalence in non-syndromic children with CHD. It was a cross-sectional study including all children presenting to Cardiology Department at a tertiary care center between Jan 2007 and Dec 2010. RESULTS: Thirty-five DS children with CHD were compared with 38 non-syndromic children with CHD. Atrioventricular septal defect (AVSD, 13/35) was the commonest CHD among DS children while isolated VSD (26/38) accounted for maximum cases in non-syndromic CHD. PAH was more prevalent among DS children with CHD (18/42) than among the control group (7/38, p = 0.038). In addition, 14/19 patients with AVSD in the entire cohort developed PAH. CONCLUSION: DS children with CHD have a higher predisposition to develop PAH, and the likelihood is highest with underlying AVSD.

Gaucher's disease: rare presentation of a rare disease.

Gaucher's disease is a rare lysosymal storage disorder characterized by deposition of glucocerebroside in cells of the macrophage monocyte system. Gaucher's disease has 3 types-non-neuronopathic (type I), acute neuronopathic (type II), and chronic neuronopathic (type III). It generally presents with delayed milestones, seizures, bony deformities, or massive organomegaly. The acute neuronoapthic variety is the rarer type that predominantly presents with neurological features. The authors present a case of the acute neuronopathic variety of Gaucher's disease where the child presented with only abnormal head position.

Daily immunization services: A moral duty, not an empty slogan.

BACKGROUND: Immunization services in Armed Forces hospitals are provided once or twice a week leading to children missing important vaccines. Vaccines offered are restricted to vaccines provided under the Universal Immunization Programme (UIP). This system is inadequate to meet the challenge of providing 100% immunization to children in a station. Two large service hospitals were selected for provision of daily immunizations under the 'CHOICE' banner (Comprehensive child Healthcare, OPD services and Immunization Clinic Everyday), which was conducted under the supervision of the Pediatrician. The immunization delivery before and after institution of the daily immunization program was compared. METHOD: This retrospective study compares the vaccine delivery rate of two systems, namely a restricted approach providing UIP vaccines on a weekly basis and a comprehensive approach providing both UIP as well as optional vaccines on a daily basis. RESULTS: There was a significant increase in attendance at the immunization clinic, which was progressive over the years with the comprehensive approach. The delivery rates of all vaccines increased, in particular the combination vaccines. The workload per immunization session showed a concomitant decrease. CONCLUSION: Daily immunization is a better method of vaccine delivery to children, leading to a marked increase in attendance at the immunization clinic and utilization of hospital services.