Moumita Samanta

Prophylactic probiotics for prevention of necrotizing enterocolitis in very low birth weight newborns.

Our study showed that enteral administration of prophylactic probiotics in neonatal intensive care setup could significantly reduce morbidity due to necrotising enterocolitis in very low birth weight newborn. It also helps in establishing early full enteral feeding and reduces hospital stay.

Patient Health Questionnaire-9 as an Effective Tool for Screening of Depression Among Indian Adolescents

PURPOSE Detection of depression among adolescents in the primary care setting is of paramount importance, especially in resource-constrained countries such as India. This article discusses the diagnostic accuracy, reliability, and validity of the Patient Health Questionnaire-9 (PHQ-9) when pediatricians use it among Indian adolescents. METHODS Pediatricians administered the PHQ-9 to 233 adolescent students aged 14-18 years, along with the Beck Depression Inventory. Our psychologist clinically diagnosed depression based on an International Classification of Diseases, 10th Revision, interview of participants. One month later, the PHQ-9 was readministered among students. We conducted appropriate analyses for validity and diagnostic accuracy. RESULTS A total of 31 students (13.3%) had a form of depression on psychiatric interview. A PHQ-9 score of ≥5 was ideal for screening (sensitivity, 87.1%; specificity, 79.7%). In addition to good content validity, PHQ-9 had good 1-month test-retest reliability (r = .875) and internal consistency (Cronbachs α = .835). There was high convergent validity with the Beck Depression Inventory (r = .76; p = .001). The concordance rate between the PHQ-9 threshold score of ≥10 and the International Classification of Diseases, 10th Revision based diagnosis was good (Cohens κ = .62). The area under the receiver operating characteristic curve for PHQ-9 was .939. CONCLUSIONS The PHQ-9 is a psychometrically sound screening tool for use by pediatricians in a primary care setting in India. Because it is a short, simple, easy to administer questionnaire, the PHQ-9 has tremendous potential in helping to tackle the growing problem of depression among adolescents in developing countries.

Food Supplementation as an Incentive to Improve Pre-antiretroviral Therapy Clinic Adherence in HIV-Positive Children—Experience from Eastern India

OBJECTIVE To evaluate the importance of food supplementation as incentive in improving preantiretroviral therapy (pre-ART) adherence, and second its impact on health of HIV-infected children by a clinic-based observational study. METHODS HIV-seropositive children aged between 2 and 12 years were followed-up sequentially for 2 years without and with food supplementation, respectively, with monitoring of disease parameters. The outcome morbidity parameters were compared and correlated. RESULT Study showed significant improvement in clinic adherence (r = 0.165, p = 0.027) along with increased mean clinic visit (6.65 ± 1.43 vs. 8.01 ± 1.52, p = 0.000) and mean CD4 count (p = 0.028) with incentive. Provision of incentive correlated well (Pearsons r = 0.345) with number of visits which in turn had strong correlation with weight gain (r = 0.548), episodes of AIDS-defining illnesses (r = -0.412), hospitalization (r = -0.279). CONCLUSION Food incentive could enhance pre-ART phase clinic adherence that decreases disease-related morbidities, setting the stage for improved treatment and care of seropositive children in future.

Unique Neurological Manifestations of Dengue Virus in Pediatric Population: a Case Series

Dengue infection is endemic in developing countries posing a major public health problem. Clinical manifestations form a broad spectrum and include uncomplicated dengue fever, dengue hemorrhagic fever and dengue shock syndrome. We report three confirmed cases of dengue infection in pediatric population with central nervous system involvement with certain unreported manifestations resulting in diagnostic dilemma. Increasing evidence of neurotropism by dengue virus emphasizes that clinician be aware of such association and consider dengue infection in cases of febrile encephalitis and myelitis in endemic areas. Early diagnosis and appropriate supportive cars can reverse this potentially fatal disease.

Pre-exchange 5% Albumin Infusion in Low Birth Weight Neonates with Intensive Phototherapy Failure—A Randomized Controlled Trial

OBJECTIVE To evaluate the role of 5% albumin infusion before exchange transfusion in reducing post-exchange unconjugated serum bilirubin (UCB) levels in low birth weight (LBW) neonates with intensive phototherapy failure. METHODS In a placebo-controlled Randomized Controlled Trial, 42 healthy LBW (birth weight between 1000 and 2499 g and gestational age ≥ 32 weeks) neonates were randomly allocated into intervention and control groups. Post-exchange UCB at 6 and 12 h were compared in the two groups along with the duration of post-exchange phototherapy, repeat-exchange requirement, adverse effects of albumin and hospital stay. RESULTS The intervention group (n = 21) with mean birth weight 1619 ± 324 g, gestational age 34.5 ± 1.65 weeks, peak UCB 19 ± 3.85 mg dl(-1), was demographically comparable with the control group (n = 21) (1660 ± 320 g, 34 ± 1.6 weeks, 19.4 ± 3.59 mg dl(-1), respectively). Significant reduction in the post-exchange UCB (10.55 ± 1.53 mg dl(-1) at 6 h; 5.86 ± 1.21 mg dl(-1) at 12 h in albumin group; 15.26 ± 1.78 mg dl(-1) at 6 h; 11.69 ± 1.52 mg dl(-1) at 12 h in control group) and phototherapy duration (23.8 ± 3.2 h vs. 40.3 ± 7.2 h) was observed in the intervention group (p < 0.0001). Repeat exchange requirement was reduced by 86% (RR = 0.14; 95%CI: 0.19-1.06). Mean duration of hospital stay was significantly lower (10.1 ± 5.8 days vs. 12.4 ± 6.6 days) (p = 0.021). No albumin transfusion-related complications were observed.

Dorfman-Chanarin syndrome: A rare neutral lipid storage disease

Dorfman-Chanarin syndrome is a rare neutral lipid storage disorder characterized by ichthyosis, lipid vacuolations in peripheral leucocytes, and multisystem involvement. It is an autosomal recessive disorder caused by mutations in the CGI-58 gene. A total of 42 cases have been reported worldwide till February 2009 out of which 4 have been previously reported from India. We report a case of a 20-month-old male with congenital ichthyosis, organomegaly, and bilateral cryptorchidism. Examination of the peripheral smear revealed lipid vacuoles in the leucocytes consistent with Jordans anomaly, which was confirmed by transmission electron microscopy. Liver biopsy revealed micronodular cirrhosis with macrovesicular steatosis while skin biopsy showed ichthyosis vulgaris. Dorfman-Chanarin syndrome was diagnosed on the basis of clinical and laboratory criteria with certain unreported manifestations. Dietary modifications were instituted and followed up after 1 year with promising results. This emphasizes the importance of neonatal screening for lipid vacuolations in peripheral blood in all cases of congenital ichthyosis.

Normative blood pressure data for Indian neonates.

ObjectivesTo establish the normative blood pressure (BP) values in healthy Indian neonates using oscillometric method, and to develop BP percentile charts.DesignProspective observational study.SettingNeonatal unit of a teaching hospital in Eastern India.Participants1617 hemodynamically stable inborn neonates without birth asphyxia, major congenital anomaly, maternal complications (e.g. preeclampsia, hypertension, diabetes) or critical neonatal illness.ProcedureQuite state measurements of systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were recorded by oscillometric method on day 4, 7 and 14 of postnatal life. The averages of three readings at 2-minute intervals were used.ResultsPercentile charts (providing 5th, 10th, 25th, 50th, 75th, 95th, and 99th percentile values) have been developed. SBP, DBP and MAP showed a steady rise from day 4 to day 14, and were comparable between males and females, but were significantly lower in preterms than in term neonatesConclusionNormative neonatal BP data along with gestational age-wise percentile charts shall be of help for decision-making and planning for sick newborns.

Animal Bites and Rabies Prophylaxis in Rural Children: Indian Perspective

A prospective observational study was conducted in a tertiary care hospital to study clinicoepidemiological profile of potentially rabid animal bite cases from rural India. Total of 308 children (median age 6 years) admitted to hospital, were recruited over 1 year and followed up till completion of antirabies vaccine course. Dog was the commonest (77.27%) offending animal. Of the exposures, 66.88% were scratches, 88.96% were unprovoked and 27.27% were categorized as Class III. The median times to wound toileting and reporting to health facility were 1 and 6 h, respectively. Majority received prompt PEP in hospital, and RIG was administered in 34.55% of Class II and 90.48% of Class III exposures. Compared with their older counterparts, children aged <5 years suffered more bites on face and trunk and more Class III exposures. The rabies prophylaxis scenario is encouraging, when compared with earlier studies, but there are gaps to be addressed.

Clitoral length and anogenital ratio in Indian newborn girls

ObjectivesTo generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns.DesignCross-sectional study.SettingNeonatal unit of a tertiary care teaching hospital in Kolkata.Participants378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities.InterventionsMeasurements were recorded using a digital vernier caliper between 24–72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured.Main outcome measuresGestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios.ResultsMean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance.ConclusionsThe normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.

Changing clinical profile of Dengue infection: A newer perspective in the pediatric population

Background: Traditionally complications of Dengue infection is limited to vascular and haematological system. The present study describes the changing clinico-epidemiological and laboratory profile of children hospitalized with dengue infec- tion. Methods: Prospective observational study of children hospitalized with a diagnosis of dengue illness from October to December, 2010 at a tertiary care centre in Kolkata. Results: Of 50 children admitted with dengue infection, 24 had dengue fever (DF), 18 dengue hemorrhagic fever (DHF) and 8 had dengue shock syndrome (DSS). The mean age of affected children was 6.25 ± 3.34 years, mostly being males from rural areas. The common clinical manifestations were fever, rash, body ache, hemorrhagic manifestations and oedema. While headache and body ache was commoner among DF cases, rash and hemorrhagic manifesta- tions were significantly more among DHF group. Incidence of altered sensorium, neck rigidity, fulminant hepatitis, and sple- nomegaly were significantly higher among the DHF/DSS group. 12% case fatality rate was found. Conclusion: Clinical mani- festations of dengue seem to be changing. Fever, rash and bodyache are not the only clinical presentations. Encephalopathy, encephalitis, 6 th cranial nerve palsy, fulminant hepatic failure, acute acalculous cholecystitis, myocarditis, myelitis, spleno- megaly are some unusual but novel presentations of dengue in pediatric population that clinician in endemic area should be aware of though they are not mentioned in conventional guidelines Dengue is no longer restricted to urban areas but has propensity to spread to rural areas also.