Prabhjot Malhi

Child maltreatment in India

Abstract Child maltreatment is a global problem but is more difficult to assess and manage in developing countries such as India where one-fifth of the world’s total child population resides. Certain forms of maltreatment such as feticide, infanticide, abandonment, child labour, street-begging, corporal punishment and battered babies are particularly prevalent in India. Most physicians still need to be sensitized in order to suspect child abuse on the basis of unexplained trauma, multiple fractures, parental conflict and other corroborative evidence. This article summarizes the various aspects of this major problem in resource-poor settings in the hope that it will assist in the planning of services addressing child physical and sexual abuse and neglect in India and in other developing countries. A culture of non-violence towards children needs to be built into communities in order to provide an environment conducive to the overall development of the child. Rehabilitation of abused children and their families requires a multi-disciplinary service including paediatricians, child psychologists and social workers, and the training of police forces in how to tackle the problem.

Shaken baby syndrome masquerading as apparent life threatening event

A variety of diseases and disorders can present as an acute life-threatening event among which shaken baby syndrome has been recently recognized. A high index of suspicion along with an ophthalmologic evaluation and cranial imaging helps to identify this form of child abuse, which needs multidisciplinary management.

Evaluation of quality of life in indian children with bronchial asthma using a disease-specific and locally appropriate questionnaire.

Aim: To evaluate quality of life (QOL) in Indian children with bronchial asthma. Methods: A disease‐specific, locally appropriate QOL questionnaire was administered in asthmatic children and compared with FEV1, FVC, PEFR and asthma symptom score, on three occasions. Results: QOL score had strong negative correlation with symptom score and weaker positive correlation with pulmonary function tests.

Long-term Clinical and Radiologic Outcome in 500 Children With Parenchymal Neurocysticercosis

Background: Our aim was to study long-term clinical and radiologic outcome in children with parenchymal neurocysticercosis (NCC) and its predictors. Method: Five hundred children with NCC registered in the pediatric NCC clinic between January 1996 and December 2002 and followed till December 2009 were enrolled. Demographic details, clinical presentations and therapy received were recorded. Outcome was evaluated in terms of seizure recurrence and resolution of lesions on neuroimaging. Various factors that could influence outcome were studied. Results: Mean age at presentation was 8 ± 2.7 years, and the mean duration of follow-up was 8.8 ± 2.03 years; 79.6% (398) had single lesion, and 20.4% (102) had multiple lesions at presentation; 14.5% (58) of children with single lesion, and 28.4% (29) of children with multiple lesions had recurrent seizures (P < 0.001) during follow-up. At 6-month follow-up neuroimaging, resolution was seen in 52.7% (210) and 31.3% (32) of children with single and multiple lesions, respectively (P < 0.001). On prolonged follow-up, 94.6% (384) of single-lesion NCC and 88% (90) of multiple-lesion NCC (P < 0.001) had radiologic resolution. Single-lesion NCC, radiologic resolution and cysticidal therapy were associated with better seizure outcome (P < 0.05). Children with multiple lesions had significantly higher percentage of calcified lesions on long-term follow-up compared with those with a single lesion (11.7% vs. 3.6%, P < 0.05). Conclusions: Children with a single-lesion NCC have favorable outcome with resolution of most of the lesions and few seizure recurrences. Cysticidal therapy leads to better seizure control and increased resolution of lesions on short-term follow-up.

Clinical profile and neurodevelopmental outcome of new-onset acute symptomatic seizures in children

PURPOSE To study clinical profile, neurodevelopmental outcome and its predictors in children with acute symptomatic seizures (ASS). METHODS Short-term neurodevelopmental outcome and predictors of poor outcomes were prospectively assessed in 105 consecutive children with ASS aged 3 months-12 years RESULTS: Mean age was 51.2+42.2months (3-144 months); 67.2% were males. Central nervous system (CNS) infection in 82%, status epilepticus in 15.2%, abnormal neuroimaging in 62.8% and abnormal electroencephalography in 22.3% were noted. At discharge, 27.6% had poor outcome including death (13%); CNS infections were significantly associated with poor outcome compared to ASS of other aetiologies (32.6% vs 5.2%, p=0.02). Low GCS (OR 4.9, 95%CI 1.2-20.7), abnormal electroencephalograph (OR 4.3, 95%CI 1-16.9) and neuroimaging (OR 12.1, 95%CI 1.4-105.2) were independent predictors of poor outcome. After 6 months, 16% children had delayed neurodevelopment and cognition; 6% had seizure recurrences. Abnormal electroencephalograph (p=0.002; OR 6.8, 95%CI 2.0-23.1), abnormal neuroimaging (p=0.015; OR 9.47, 95%CI 1.18-75.8),>1 anti-epileptic (p=0.00; OR 9.9, 95%CI 2.88-33.9), intubation (p=0.004; OR 6.25, 95%CI 1.79-21.7) and poor outcome at discharge (p=0.02; OR 4.44, 95%CI1.38-14.2) predicted abnormal neurodevelopment. CONCLUSIONS CNS infections are the most common cause of ASS in children from developing countries. Abnormal neurodevelopment and seizure recurrences on short-term follow-up are seen in a minority of children.

Long-term Cognitive Outcome of Children With Parenchymal Neurocysticercosis: A Prospective Observation Study

To study the cognitive profile and scholastic performance of children with parenchymal neurocysticercosis. A total of 500 children with a diagnosis of neurocysticercosis and epilepsy registered in our pediatric neurocysticercosis clinic between January 1996 and December 2002 were enrolled. Patients were evaluated for their scholastic performance using their school grades. Cognitive assessment was done using Parental interview and the “Draw-a-Man” test. Poor scholastic performance was seen in 22.2% (111) children. Draw-a-Man test was done in 148 children; 18.2% (27/148) had scores equivalent to IQ <70. Intermittent headache, behavior problems, and poor memory were reported in 40% (201) children. Multiple lesions, lower socioeconomic status, and calcified lesions on follow-up were associated with academic underachievement (P < .05). About a fourth of children with neurocysticercosis had cognitive impairment during follow-up. This was mostly seen in children from lower socioeconomic status and in those with multiple-lesion neurocysticercosis.

PP11.1 – 2971: Pattern of co-morbidities and health related quality of life in children with dyskinetic cerebral palsy – A developing country perspective

Objective To study pattern of co-morbidities and health-related quality-of-life in children with dyskinetic cerebral palsy (CP) from a developing country using standardized evaluation tools. Methods We evaluated 65 children with dyskinetic CP aged 1–14 years over 1 year by Developmental Profile-3, Developmental-Behaviour-Parent-Checklist, Modified Teachers drooling scale, Sleep-Behaviour Rating Scale and Caregiver Questionnaire, and for presence of epilepsy, visual and hearing impairment and gastro-esophageal reflux. Results Mean age at presentation was 37.5+32.5 months; 91% had dystonia and 83% were in GMFCS-level IV-V. General developmental score was Conclusion Our study highlights co-morbidities and impaired health-related quality-of-life in dyskinetic children especially from developing countries, emphasizing early intervention and multidisciplinary care.

Efficacy of an individualized written home-management plan in the control of moderate persistent asthma: A randomized, controlled trial: Individualized written home-management plan in asthma

Background: The management of childhood asthma necessitates a comprehensive approach including pharmacological treatment as well as education about self‐evaluation and home management of the condition. Aim: To evaluate the efficacy of adding an individualized written home‐management plan in the control of moderate persistent asthma. Methods: Children with moderate persistent asthma were randomized to receive either an individualized written home‐management plan or no plan, in addition to standard asthma therapy including education. They were followed up with serial measurement of outcome variables. Results: Children receiving an individualized written home‐management plan had fewer acute asthma events, fewer lost school days, lower symptom score and less nocturnal awakening than those who did not receive a written plan.