Growth and Development Assessment of Children (1-5 Years) Operated for Tracheoesophageal Fistula/Esophageal Atresia: A Case Control study.

INTRODUCTION: Among children, esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is one of the major and common congenital anomalies. It is a life-threatening emergency and at birth may be associated with three C's coughing, choking, and cyanosis. It requires surgical interventions in the early neonatal period. The postsurgical period is associated with poor growth which can be developmental outcomes particularly in the first 5 years of life and attributed to postsurgical complications. The aim of the study is to assess and compare the growth and development of the children (1-5 years) operated for TEF/EA attending Pediatric Surgery OPD/admitted inwards at APC, PGIMER, Chandigarh versus healthy controls. MATERIALS AND METHODS: A case-control study was conducted on age-matched 40 children aged between 1 and 5 years operated for TEF/EA and healthy controls. The sampling technique for cases was total enumeration and for controls was purposive sampling. Tools used were socio-demographic sheets of children, clinical profile of children, Trivandrum Development Screening chart, and Vineland Social Maturity Scale for Indian adaptation. RESULTS: Majority 33 (82.5%) of children had distal TEF and more than two-third 28 (70%) have undergone primary repair. More than one-third 14 (35%) had a respiratory infection, 12 (30%) anastomosis leakage and 6 (15%) had Gastroesophageal reflux (GER) as one of the early and late postoperative complications. More than one-fourth 11 (27.5%) of TEF/EA operated children had less weight, 11 (30%) had less height and 16 (40%) had less weight for height for their reference age. A significant difference was found for height for age, weight for height, and social maturity among children who had TEF repair as compared to their healthy counterparts. CONCLUSION: Growth monitoring reflected (more than one-fourth of children were underweight and stunted while more than one-third were wasted) and showed development delay in TEF/EA operated children as compared to healthy controls.

A Quality Improvement Initiative to Increase the Opportunity of Play Activities and Reduce the Screen Time Among Children Admitted in Hospital Setting of a Tertiary Care Centre, North India.

OBJECTIVE: To increase the time spent by children on play activities and reduce screen time on daily basis from baseline to 25% over the period of 10 wks in hospital setting of a tertiary care centre, North India. METHODS: The quality improvement design was chosen and the study was conducted in the pediatric surgery and medicine wards of a tertiary care centre in North India. The participants of the study were children admitted in the medical and surgical wards, their caregivers and health care personnel (both nurses and physicians) working in the respective wards. The study was conducted in three phases: planning, development and implementation phase. In planning phase, the baseline assessment of outcome and process measures was performed and the root cause analysis was done which revealed that there was problem with the procedure and policy. This is why day-to-day play implementation procedure protocol development and implementation was chosen as a change based on Eisenhower's matrix. In development phase, day-to-day play implementation procedure protocol was developed and was implemented in the units by using PDSA (Plan, Do, Study and Act) model. Three PDSA cycles were conducted. The outcome measures were 'the time spent by the child on play activities on daily basis' (calculated by the time spent by child in play/total time the child was awake in a day) and 'the reduction in screen time' (calculated by the average time spend by the child on android based phone in a day). The process measures were day-to-day play implementation score, time spent by child on play activities and screen time on daily basis during hospitalization. The data was collected by the team members and the investigator. RESULTS: At the end of all PDSAs, the day-to-day play implementation score and time spent on play activities increased by 50% and 20% respectively and the screen time reduced to 73%. Though the outcome measures were nearly achieved, the continuous efforts are still required to ensure sustainability and future incorporation of play in day-to-day routine of hospital care. CONCLUSION: This QI initiative helped in increasing the play opportunities and reducing the screen time in wards. Hence, both the process and outcome measure were nearly achieved, whereas sustainability remained an issue.

Plasma Hepcidin Levels in Healthy Children: Review of Current Literature Highlights Limited Studies.

BACKGROUND: There are few studies that highlight pediatric hepcidin reference ranges especially from Asian subcontinent. In current study, plasma from 131 children (72 boys and 59 girls; 1 to 12 y) was analyzed for hepcidin-25 by enzyme-linked immunosorbent assay. OBSERVATIONS: The median (interquartile range) plasma hepcidin in boys was 21.89 ng/mL (16.50 to 51.70 ng/mL) and girls was 21.95 ng/mL (19.20 to 47.70 ng/mL). No statistically significant difference (P=0.937) of plasma hepcidin levels in sex was noted. However, multiple regression analysis revealed a significant correlation between plasma hepcidin levels and ferritin (P=0.000). CONCLUSIONS: Our study results highlight relatively lower median hepcidin values in children 1 to 12 years of age as compared with western data. This may be attributed to either lack of a harmonized and standard enzyme-linked immunosorbent assay detection methodology or to presence of clinically significant polymorphisms in hepcidin gene in our population.

Iron Deficiency and Iron Deficiency Anemia in 3-5 months-old, Breastfed Healthy Infants.

OBJECTIVE: To assess the prevalence of iron deficiency (ID) and iron deficiency anemia (IDA) in predominantly breastfed, 3-5-mo-old infants, born at term, with a birth weight ≥ 2.5 kg. METHODS: The cross-sectional study was conducted in the outpatient department of a tertiary care center from January 2013 through December 2014. INCLUSION CRITERIA: Age: 90-180 d, exclusively/predominantly breastfed, birth weight ≥ 2.5 kg and term gestation. EXCLUSION CRITERIA: systemic illness, leucocytosis, leucopenia, thrombocytopenia, peripheral smear abnormality or iron supplementation. Blood sample was collected for complete blood count and ferritin assay. ID was defined as serum ferritin <12 µg/L. IDA was defined as ID plus Hb ≤ 10.5 g/dl. RESULTS: Two hundred ninety six infants were initially recruited; 29 declined consent; 22 had leukocytosis, leucopenia or eosinophilia; 15 had thrombocytopenia; 15 samples were hemolyzed or insufficient. Finally, 215 infants were evaluated. The male-female ratio was 1.8:1. The mean birth weight was 2.9 (0.4) kg. The mean Hb was 10.8 (1.2) g/dl. The median serum ferritin was 44 µg/L (18, 120). The prevalence of ID at 3, 4 and 5 mo of age was 5.4%, 21.4% and 36.4%, while that of IDA was 4.6%, 16.7% and 11.4%, respectively. CONCLUSIONS: The prevalence of ID at 4 and 5 mo of age in predominantly breastfed, term infants was 21.4% and 36.4%, respectively. The study generates evidence for considering iron supplementation for well-babies from 4 mo of age, instead of the currently recommended 6 mo by National Iron plus Initiative in India.

A community-based cluster randomized controlled trial of "directly observed home-based daily iron therapy" in lowering prevalence of anemia in rural women and adolescent girls.

In a community-based cluster randomized controlled trial, we randomly assigned clusters of anemic women and adolescent girls to either "directly observed home-based daily iron therapy" (DOHBIT; n = 524 in 16 villages) or unsupervised self-treatment at home (n = 535 in 16 villages) for a period of 90 days. Those in the DOHBIT group, when compared with those in the unsupervised self-treatment group, had significantly lower relative risk (RR) of anemia (16.8% vs 35.3%, RR = 0.47 [95% confidence interval (CI) = 0.33-0.65]; P < .0001), higher hemoglobin (Hb) rise of ≥2 g/dL (70.2% vs 42.2%, RR = 1.56 [95% CI = 1.31-1.87]; P <.0001), and nonsignificant trend for lower side effects (3.5% vs 6.7%, RR = 0.49 [95% CI = 0.22-1.08; P < .08) on intention-to-treat analyses. On linear mixed model analysis, the subjects in the intervention group demonstrated higher mean Hb levels (13.01 vs 12.32 g/dL; P < .0001) and higher adherence to iron therapy (93% vs 60%; P < .0001). DOHBIT is effective in lowering the prevalence of anemia in rural women and adolescent girls.

Prevalence and treatment gap in childhood epilepsy in a north Indian city: a community-based study.

BACKGROUND: Epilepsy is one of the most common neurological disorders prevalent in childhood period. There is scarcity of epidemiological data, required to plan services in resource constrained developing nations. OBJECTIVE: To study the prevalence and treatment gap in childhood epilepsy in north Indian city, in the age group of 1-18 years. METHODS: A two stage stratified cluster sampling; probability proportionate to size (PPS) was employed. A ten question screening questionnaire was employed to identify the presence of epilepsy. Definitions provided by International League against Epilepsy (ILAE) were used to classify screen positive subjects as epilepsy and to calculate the treatment gap. RESULTS: The prevalence rate for epilepsy was 6.24/1000 population. Febrile seizures and neurocysticercosis were most common causes of symptomatic seizures in childhood. CONCLUSION: This study of epidemiology of epilepsy provides valuable aid in optimizing effective community approach, thereby improving outcomes of childhood epilepsy.

Ependymal brain cyst with posterior cerebral artery infarct.

Primary intracranial ependymal cysts are congenital, benign, ependyma-lined cysts rarely seen in the pediatric age group. The authors report such a case of intracranial fronto-parietal ependymal cyst in a 3 y-old girl. Computed tomography showed a large cystic lesion which was not in communication with the ventricular system and was associated with ipsilateral posterior cerebral artery infarct and raised intracranial pressure causing midline shift. A differential diagnosis of the commoner arachnoid, hydatid or porencephalic cyst was considered. Surgical removal to decompress the brain was done; histopathology revealed an ependymal cyst. Identification of this rare pathology in the pediatric age group is emphasized with a review of the literature.

Severe pneumonia in a remote hilly area: integrated management of childhood illness.

OBJECTIVE: This study aims to profile children with severe pneumonia in the perspective of Integrated Management of Childhood Illness (IMCI) strategy in a resource-constrained environment. METHODS: 115 consecutive children, aged 2 months to 10 yr, hospitalized with severe pneumonia were prospectively evaluated between May 1997 and June 1998 at a civil hospital in the northern hilly state of India. RESULTS: All children had tachypnea and lower chest wall indrawing. Grunting was observed in 39.7%, inability to drink in 16.5%, and cyanosis in 1.7% cases. Radiological investigation was carried out only in 90 children that included abnormal chest radiographs (CXRs) in 76.6% cases. Feeding malpractices, vaccination inconsistencies, exposure hazards to smoking, micronutrient as well as macronutrient deficiencies, treatment from unqualified practitioners, inconsequential involvement of health care workers, predominant burden on mothers in the care of sick children, failure to recognize signs and symptoms of pneumonia by parents at home, lack of oxygen facilities, problems of accessibility and less faith on primary health care services were widely prevalent bottlenecks for effective implementation of 3 components of IMCI. CONCLUSION: Our study offers practical insights that can be useful in customizing IMCI to needs of children with pneumonia in a resource-constrained environment.