Reference Centile Curves for Body Fat Percentage, Fat-free Mass, Muscle Mass and Bone Mass Measured by Bioelectrical Impedance in Asian Indian Children and Adolescents.

OBJECTIVE: To create gender-specific percentile curves for percent body fat (%BF) by Bio electrical Impedance Analysis (BIA) for screening adiposity and risk of hypertension in Indian children and generate reference curves for percent fat-free mass (%FFM), muscle mass (%LM) and bone mineral content (BMC) by using bioelectrical impedance. DESIGN: Secondary analysis of data from previous multicenter cross-sectional studies. SETTING: Private schools from five regions of India. PARTICIPANTS: A random sample of 3850 healthy school children (2067 boys) (5-17 yr) from private schools in five major Indian cities. METHODS: Anthropometry, blood pressure (BP) and body composition were measured by bioelectrical impedance. Reference curves were generated by the LMS method. MAIN OUTCOME MEASURES: %BF, %FFM, %LM, BMC and BP. RESULTS: Median %BF increased by 6% from 5 to 13 years of age and declined (around 2%) up to 17 years in boys. In girls, %BF increased by 8% from 5 to 14 years and thereafter declined by 3%. Based upon the risk of hypertension, the new cut-offs of 75th and 85th percentile of %BF were proposed for detecting over fatness and excess fatness in children. Median %FFM was 90% at 5 yrs and decreased till 12 years, and then showed a slight increase to 84% at 17 yrs in boys. In girls, it was 86% at 5 yrs and decreased till 15 yrs, and plateaued at 71.8% at 17 yrs. CONCLUSIONS: Reference curves for percent body fat for Indian children would be useful to screen children for health risk in clinical set up.

Study of Parental Perceptions on Health & Social Needs of Children with Neuro-Developmental Disability and It's Impact on the Family.

INTRODUCTION: The term Neuro Developmental Disorder (NDD) is used for conditions caused by a dysfunction in any part of the brain or nervous system, resulting in physical and/or psychological symptoms as a child develops. Family of children with NDD face many problems. It is very important to find them and create awareness so that gaps in essential services and supports can be decreased. AIM: To explore parental perceptions on health & social needs of children with NDD, to understand the impact of disability on the families having children with disability, and to find out the parental perceptions on availability of services for children with NDD and its utilization by families. MATERIALS AND METHODS: The parents of 30 children with NDD were interviewed using a questionnaire and data elicited in these interviews were analysed. The questionnaire had preliminary information about parents and child with NDDs, socio-demographic profile of the family and the parental perceptions on health and social needs of their child having NDDs. RESULTS: There were total 30 patients 17 were males and 13 were females. Most of the patients suffered from Cerebral Palsy (13 cases) and were diagnosed by General Practitioner (22 cases) while Developmental Neurologist/paediatrician had diagnosed remaining cases of NDD (8 cases). Most common disability for which parents were worried was inability to walk (17 cases). Common difficulties countered in daily care by parents were feeding and bathing (10 cases). Only 2 children were given assistance with tuition & psychologist (cases of ADHD). Most of the parents knew about special schools but didn't know which place such facilities were available and none of the children were attending special schools. Twenty two parents said they have no plans for the future studies but wish that at least child learns to read & write. With help of spiritual power (doing prayers and pooja) 25 parents got courage to face the difficulties and discrimination. Two parents required antidepressants. Six Mothers had to quit their jobs so as to concentrate and give more time to their children. Experience with services provided was satisfactory in 17 cases, while 13 parents reported problem of arranging money, adjusting time for long travelling and regular follow-up. CONCLUSION: The findings can be utilized in developing supportive activities for families with disabled children. It addresses the need for new prospective of stigma reduction in our society. The study has found that the care givers of child with NDDs suffer from significant physical and mental stress, and their health should be taken into consideration. The study has found need of "care givers' support group". The professionals can help parents in establishing positive thinking towards care giving. There is need of provision of comprehensive and latest rehabilitation/ support resources & information.

Growth status of children and adolescents with type 1 diabetes mellitus.

BACKGROUND AND OBJECTIVES: Growth parameters are important indicators of a child's overall health, and they are influenced by factors like blood glucose control in diabetic children. Data on growth parameters of Indian diabetic children is scarce. This retrospective, cross-sectional, case control study was conducted at diabetes clinic for children at a tertiary care center at Pune, to study growth parameters of diabetic children in comparison with age-gender matched healthy controls and evaluate effect of different insulin regimes and age at diagnosis of diabetes on growth. MATERIALS AND METHODS: ONE TWENTY FIVE DIABETIC CHILDREN (BOYS: 50) and age gender matched healthy controls were enrolled. All subjects underwent anthropometric measurements (standing height and weight). Mean height (HAZ), weight (WAZ) and body mass index (BAZ) for age Z scores were calculated. Diabetes control was evaluated by measuring glycosylated hemoglobin (HbA1C). Statistical analysis was done by SPSS version 12. RESULTS: Mean age of diabetic children and age gender matched controls was 9.7 ± 4.4 years. Diabetic children were shorter (128.3 ± 24.3 cm vs. 133.6 ± 24.7 cm) and lighter (29.2 kg ± 15.3 vs. 31.3 ± 15.4 kg). HAZ (-1.1 ± 1.2 vs. -0.2 ± 0.8) and WAZ (-1.2 ± 1.3 vs. -0.7 ± 1.3) were significantly lower in diabetic children (P < 0.05). Children on both insulin regimes (intensive and conventional) were shorter than controls (HAZ-intensive -1.0 ± 1.0, conventional -1.3 ± 1.3, control -0.2 ± 0.8, P < 0.05). HAZ of children who were diagnosed at <3 years of age was the least (-1.6 ± 1) amongst all diabetic children while those diagnosed after puberty (>14 years) were comparable to healthy controls. CONCLUSIONS: Growth was compromised in diabetic children in comparison to controls. Children diagnosed at younger age need more attention to optimize growth.

Performance of WHO growth standards on Indian children with growth related disorders.

OBJECTIVE: To assess performance of WHO 2006 standards on anthropometric measurements of children referred for growth related disorders to a speciality pediatric clinic in Pune, India, from June 2006 through June 2010. METHODS: Data presented in this study were collected retrospectively from case records of all children from birth to 60 mo (n=1840, mean age 2.7±1.3 y) who presented with growth related disorders; healthy age and sex matched children were recruited as controls (n=824, mean age 2.8±1.2 y). Children were divided as per their clinical diagnosis into eight different groups: growth hormone deficiency, bone disorders, syndromic short stature, familial short stature, hypothyroidism, nutritional and systemic disorder, other endocrinopathies and overgrowth disorders. Anthropometric parameters for all study subjects were converted to standard deviation scores (SD scores) using the WHO Anthro 2005. RESULTS: Mean height SD scores of children with growth related disorders were significantly lower than that of the controls, while that of the tall children were significantly higher (p<0.05). All children who were clinically very short were below the 1st percentile, while none of the children with overgrowth or normal children were classified as stunted. Weight for height SD scores of children with nutritional and systemic disorders were the lowest, while those for the obese children were the highest. CONCLUSIONS: The present results suggest that the WHO 2006 growth standards classify children with growth disorders appropriately and the classification is in concordance with the clinical assessment. They provide health practitioners in a clinical setting with an effective tool to assess growth of children.

Study of blood pressure and blood sugar levels in adolescence and comparison with body mass index.

BACKGROUND: Worldwide prevalence of overweight and obesity is increasing and its consequences prompted the WHO to designate obesity as a global epidemic in 2002. Being overweight is a risk factor for significant illness, especially diabetes and hypertension in adult life. OBJECTIVES: To study the blood pressure and blood sugar levels and lifestyle parameters in adolescence and comparison with body mass index. MATERIALS AND METHODS: In a prospective case control study, out of the 1000 screened, a total of 200 adolescents were considered out of which 100 were with high body mass index (BMI) and the other 100 were with normal BMI. Height, weight, BMI, waist hip ratio (WHR), blood pressure (BP), BSL, and associated risk factors like physical activity, fast food consumption, and computer/television watching were measured and screened. RESULTS AND OBSERVATIONS: 109 (54.5%) males and 91 (45.5%) females were included. Maximum number [90 (45%)] of adolescents screened were in the age group of 17-19 years, while 54 (27%) and 56 (28%) adolescents were in the age group of 10-13 years and 14-16 years, respectively. According to CDC charts 2000, prevalence of overweight was 24% which was double when compared to WHO charts 2007. There was significant difference in prevalence of obesity; according to CDC chart it was 26%, whereas according to WHO chart it was 39%. The difference in blood pressures between cases and controls as per both CDC and WHO charts was found to be statistically significant (P < 0.0001). Positive family history of hypertension has a highly significant correlation (P < 0.001) with BMI. Blood sugar level (BSL) was significantly higher in cases (high BMI) when compared to controls (normal BMI). The comparison of WHR in the study group showed highly significant correlation ( P < 0.0001) between cases and controls. The present study shows highly significant correlation of physical activity ( P < 0.0001) and fast food ( P < 0.05) between cases and controls, whereas there was no significant correlation of computer/television watching ( P > 0.05) with BMI. CONCLUSION: The adolescents seem to have become heavier owing to environmental influences on growth patterns. So, a consideration should be given to shift the cut-offs for overweight and obesity to higher BMI percentiles if recent growth charts are to be followed. Adolescents with a BMI above the 95 th percentile (obese) are most likely to have obesity-related health risks.

Anemia as a risk factor for childhood asthma.

OBJECTIVE: This prospective-(cohort) study was conducted to evaluate whether anemia is a risk factor for childhood asthma. MATERIALS AND METHODS: Two hundred children in the age group of 2-18 years who attended the Outpatient Department with upper respiratory / lower respiratory tract infections were included in this study. One hundred children with anemia were taken as the study group and another 100, age - and sex-matched children without anemia were taken as the control.They were subjected to complete blood count (CBC) C-reactive protein (CRP) estimation, Mantoux test and chest X-ray. Pulmonary function tests (PFTs) were performed on those above six years showing evidence of asthma. Peripheral smear, serum ferritin and serum iron-binding capacity were estimated for all anemic children. RESULTS: Asthma was present in 74 (74%) children in the study group and in 33 (33%) children in the control group. Iron-deficiency anemia was present in 85 (85%) anemia of chronic infection in 20 (20%) and the other five (5%) had hemolytic anemia. Anemia was found to be a risk factor for childhood asthma. CONCLUSION: Anemic children were 5.75 times more susceptible to asthmatic attacks when compared with nonanemic children.

Characteristics of rotavirus gastroenteritis in hospitalized children in Pune.

BACKGROUND: Diarrheal diseases affect millions of people around the world and have the greatest impact on children, especially those in developing countries. Rotavirus is now known to contribute significantly to the etiology of diarrheal diseases in both developing and developed countries. OBJECTIVE: To study demographic, clinical, and laboratory characteristics of rotavirus infection in cases of acute diarrhea admitted in the hospital who were below the age 5 years. MATERIALS AND METHODS: It was a prospective study conducted from June 2009 to June 2011 to determine characteristics, clinical profile, and antigenemia of rotavirus. The study group included patients up to 5 years of age hospitalized with a diagnosis of acute gastroenteritis. Statistical analysis was done using the chi-square test. Data were analyzed using SPSS (Statistical Package for Social Sciences) version 17.0. RESULTS: From the 246 cases studied in the hospitalized patients of acute gastroenteritis, 88 cases (35.77%) were found to be positive for rotavirus infection. The occurrence of infection was found to be most common in the age group of 11-20 months (38.63%) followed by the age group of 0-10 months (23.86%). There was no association with the sex of the child. In rotavirus-positive patients, associated features were fever in 48.86%, vomiting in 29.54%, and pain in abdomen in 53.4% of cases. Seasonal variation of rotavirus infection was observed in the present study with peak in the winter season. It was found that 5.68% cases which were positive for rotavirus in their stool samples were positive for rotavirus present in their urine sample, suggesting extraintestinal manifestation of rotavirus. CONCLUSION: It is concluded that in spite of clean hygienic condition and vaccination rotavirus is still an important cause of infantile diarrhea in urban area like Pune. There is association between the occurrence of rotavirus and degree of dehydration, fever, vomiting, and pain in abdomen. Peak incidence was found in the months of December and January. There is association between the occurrence of rotavirus in stool and rotavirus in blood.

Guillain-Barré syndrome in child with prolong intubation.

Guillain-Barré syndrome (GBS) is an acute demyelinating disorder of the peripheral nervous system that results from an aberrant immune response directed at peripheral nerves. A typical GBS patient presents with rapidly ascending symmetrical weakness, which may progress to respiratory failure in 30% of patients. There are no definite criteria exists in GBS in children regarding prolonged ventilation. Here we report a child of GBS requiring prolonged intubation and ventilation for 60 days who afterward had a complete recovery. We present this case to highlight the importance that even in children prolonged intubation and ventilation of GBS case prognosis can be good.

Cardiogenic shock with hypereosinophilic syndrome.

We report a child with hypereosinophilic syndrome who presented with cardiogenic shock. In addition, she had skin and joint involvement. The clinical condition improved and eosinophil counts normalized with steroid therapy. However, the skin lesions and hypereosinophilia relapsed on stopping the steroids. The child was subsequently maintained in remission on low dose prednisolone.

Hypercalcemia and metastatic calcification in a neonate with subcutaneous fat necrosis.

We report a 30-day-old baby with subcutaneous fat necrosis and symptomatic hypercalcemia, who developed metastatic calcification in the subcutaneous tissue, kidneys, pericardium and brain. The baby also had anemia, hypertriglyceridemia and hypercholesterolemia. He was managed with intravenous saline, furosemide, oral steroids and bisphosphonates and improved with treatment.