Serum Zinc Levels as a Predictor of Severity of Acute Diarrhea.

OBJECTIVE: To determine relationship between serum zinc levels and severity of diarrhea as determined by hydration status, duration of diarrhea and requirement for hospitalization. Also, to compare serum zinc levels in relation to rotavirus status. METHODS: A prospective observational study which included 254 children aged 6 mo to 5 y with diarrhea was conducted. RESULTS: Serum zinc levels could be estimated in 198 children. Median (IQR) serum zinc levels of study population were 73.5 (59.11-92.86)µg/dl. Median (IQR) of serum zinc levels in children with dehydration and without dehydration were 69.64 (54.57-81.62) and 82.86 (64.1-103.48) µg/dl respectively (p < 0.001). Median (IQR) of serum zinc levels in hospitalised and non-hospitalished children were 63.28 (51.81-85.37) and 74.86 (61.75-95.78) µg/dl, respectively (p 0.013). Median (IQR) of total duration of diarrhea was 4.8 (3.5-6.0) d and it did not correlate with serum zinc levels. Median (IQR) of serum zinc levels in children, with rotavirus diarrhea was 66.8 (49.7-82.48) and non-rotavirus diarrhea was 80.0 (62.42-100.12) µg/dl (p < 0.001). CONCLUSIONS: Children with dehydration and those with rotavirus diarrhea tend to have significantly lower serum zinc levels. Hospitalized children also have lower serum zinc levels than non-hospitalized children. Duration of diarrhea does not relate with serum zinc levels.

Simultaneous Two-site Blood Culture for Diagnosis of Neonatal Sepsis.

OBJECTIVE: To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis. STUDY DESIGN: Prospective cohort study. SETTING: A tertiary-care center at a public hospital. PARTICIPANTS: 475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015. INTERVENTION: Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis. MAIN OUTCOME MEASURES: Increase in culture-positivity rate with use of two blood cultures. RESULTS: 475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) (n=10) and Candida spp. (n=15) in either of the two cultures. CONCLUSION: Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture.

Randomized controlled trial of topical EMLA and vapocoolant spray for reducing pain during wDPT vaccination.

BACKGROUND: Intramuscular vaccination is among the most common source of iatrogenic pain in infants. Vapocoolant sprays are rapid-acting alternative to topical anesthetics. They provide transient anesthesia via evaporation induced skin cooling, and reduce pain due to vaccine injection in children and adults. The objective was to compare the synergistic analgesic effect of eutectic mixture of local anesthetics (EMLA) with breastfeeding (EB group) and vapocoolant spay with breastfeeding (VB group) to that of only breastfeeding (BO group) during whole cell diptheria, pertussis and tetanus (wDPT) vaccination. METHODS: A double blind randomized controlled trial was done to include infants up to 3 months of age who came for their first wDPT vaccination. The primary outcome variable was the duration of cry after vaccination. Secondary outcome variables were Modified Facial Coding Score, Neonatal Infant Pain Scale and latency of onset of cry. RESULTS: Of the 201 eligible participants, 111 babies were excluded and remaining 90 babies were randomized into three groups of thirty each. The groups did not differ significantly in baseline characteristics. Median (interquartile range, IQR) of duration of cry was lesser [35.86 (21.07-107.75) seconds] in babies receiving EMLA cream with breast feeding (EB group) and in babies receiving vapocoolant spray with breast feeding (VB group) [32.58 (21.25-106.21) seconds] as compared to babies receiving only breast feeding (BO group) [67.5 (27.6-180) seconds] (P=0.147). Difference in median (IQR) of latency of cry was not statistically significant. Modified Facial Coding Score and Neonatal Infant Pain Scale at 1 minute and 3 minutes was significantly lower in the EB and VB group, as compared to the BO group (P<0.05). CONCLUSION: Addition of topical EMLA application or vapocoolant spray to breastfeeding during wDPT vaccination does not reduce duration of cry in infants up to 3 months of age. However, they are able to show reduction in pain score and further studies are warranted to assess their efficacy as pain relief measures in infants and children.

Effect of change in sequence of administration of DTwP and Hepatitis B vaccines on perception of pain in infants: A randomized control trial.

OBJECTIVE: This study was designed with objective to study pain response of infants to change in sequence of administration of Hepatitis B and DTwP vaccines. METHODS: This was a randomized parallel control trial. The study was carried out in the immunization clinic of the Department of Pediatrics, LLRM Medical College, Meerut. One hundred and thirty healthy term infants up to 4 months of age were injected either DTwP vaccine first or Hepatitis B vaccine first, followed one minute later by the other vaccine. RESULT: Baseline characteristics did not differ between the groups. The mean (SD) of AUC of MFCS and NIPS was significantly more in DF group as compared to HF group (for MFCS 25.5 ± 5.4 versus 22.5 ± 5.5, p<0.01; for NIPS 31.77 ± 5.5 versus 27.64 ± 6.9, p < 0.01). Similarly mean (SD) of AUC of Heart rate and saturation of oxygen showed significant variation in DF group as compared to HF group (for heart rate 591.6 ± 55 versus 559.6 ± 49, p< 0.01; for SpO2 326.4 ± 12 versus 335 ± 8, p < 0.01). CONCLUSION: These results showed that infant experienced lesser pain when Hepatitis B was administered first than when DTwP vaccine was given first.

Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during wDPT vaccination.

UNLABELLED: The primary objective was to evaluate the analgesic effect of a eutectic mixture of local anesthetics (EMLA) during whole cell DPT vaccination. The secondary objective was to evaluate if the analgesic effect of EMLA was synergistic to breastfeeding. A randomized, placebo-controlled trial was done to include infants of up to 3 months of age who came for their first DPT vaccination. The outcome variables were duration of cry, latency of onset of cry, and Modified Facial Coding Score. Thirty babies were enrolled in each of three groups. The groups did not differ significantly in baseline characteristics. Median (interquartile range) of duration of cry was least [34.6 (24.1-72.2) s] in babies receiving EMLA cream with breastfeeding (EB group), followed by 94.2 (46.1-180) s in babies receiving EMLA cream with oral distilled water (EW group), as compared to 180.0 (180-180) s in babies receiving placebo cream with oral distilled water (PCW group) (p < 0.05). Mean (SD) of latency of cry was significantly greater in EB group [2.4 (1.14) s] and EW group [1.9 (0.62) s] as compared to babies in PCW group [1.5 (0.47) s] (p < 0.05), but the difference between EB and EW groups was not significant. Modified Facial Coding Score was significantly lower in EB group as compared to the other groups (p < 0.05). CONCLUSIONS: Topical EMLA is effective in reducing pain and has a synergistic effect in analgesia when combined with breastfeeding during vaccination in infants.

Comparison of analgesic effect of direct breastfeeding, oral 25% dextrose solution and placebo during 1st DPT vaccination in healthy term infants: a randomized, placebo controlled trial.

OBJECTIVE: To compare analgesic effect of direct breast feeding, 25% dextrose solution and placebo as we give 1st intramuscular whole cell DPT injection to 6week - 3month old infants. DESIGN: Randomized, placebo controlled trial. SETTINGS: Immunization clinic of Department of Pediatrics, LLRM Medical College. PARTICIPANTS: Infants coming for their 1st DPT vaccination were randomized in to three groups of 40 each. OUTCOME MEASURES: The primary outcome variable was the duration of cry after vaccination. Secondary outcome variables were Modified Facial Coding Score (MFCS) and latency of onset of cry. RESULTS: 120 babies were equally enrolled in breast feed group, 25% dextrose fed group and distilled water fed group. Median (interquartile range) of duration of cry was significantly lower in breast fed (33.5 (17-54) seconds) and 25% dextrose fed babies (47.5 (31-67.5) seconds) as compared to babies given distilled water (80.5 (33.5-119.5) seconds) (P<0.001). MFCS at 1 min and 3 min was significantly lower in direct breast fed and dextrose fed babies. CONCLUSION: Direct breastfeeding and 25% dextrose act as analgesic in young infants undergoing DPT vaccination in young infants less than 3 month of age.