Prerna Batra

Comparison of rectal, axillary, tympanic, and temporal artery thermometry in the pediatric emergency room.

Background Accurate measurement of temperature in the emergency room is important for diagnosis as well as investigating a patient. Various noninvasive methods thermometry are available today, but there is no consensus on the most accurate method of thermometry. Study Objective The present study was conducted to compare different methods of temperature measurement available in the emergency room, that is, rectal, axillary, and temporal artery and tympanic membrane. Design This was a cross-sectional observational study Patients Fifty febrile and 50 afebrile children aged 2 to 12 years attending the pediatric emergency room of a tertiary care hospital were included. Temperatures were measured using rectal, axillary, tympanic (right and left), and temporal artery thermometers and were compared. Results All the temperatures correlated well with rectal temperature, with temporal artery temperature showing the best correlation (correlation coefficients, 0.99 in the febrile and 0.91 in the afebrile group). Conclusions Temporal artery thermometry has the potential to replace rectal thermometry in a busy emergency room setting.

Predictors of meningitis in children presenting with first febrile seizures.

No data exist on the prevalence of meningitis in a first episode of seizures with fever in the Indian population. We investigated the prevalence of bacterial meningitis in children aged 6-18 months presenting with a first episode of seizures with fever, and we assessed clinical predictors of bacterial meningitis in these patients. We analyzed clinical and investigative profiles of 497 children, aged 6-18 months, admitted to pediatric casualty wards with a diagnosis of first febrile seizures. Lumbar puncture was performed in 199 (40.04%) infants. The prevalence of meningitis was 2.4% in children with first febrile seizures, 0.86% in simple febrile seizures, and 4.81% in complex febrile seizures. Duration of seizures more than 30 minutes, the presence of postictal drowsiness, and neurologic deficits were predictive of meningitis, with neurologic deficits as the most reliable. These predictors should be assessed in larger prospective studies.

Thermometry in children

Accurate measurement of temperature is important for detection of fever and hypothermia in pediatric patients. Ideal temperature-measurement technique should be safe, easy, noninvasive, cost effective, time efficient, and should precisely reflect core body temperature. Pulmonary artery is the closest to hypothalamus and best reflects the core temperature. Other sites used are distal esophagus, urinary bladder and nasopharynx. All these methods are invasive and difficult to use in clinical practice. Amongst the noninvasive methods, rectal thermometry is considered to be the closest to core temperature, but it has its own drawbacks. With the current evidence available, tympanic artery thermometry for children more than 2 years of age and temporal artery thermometry in all age groups are taking precedence over other methods.

Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics

Point of care testing, is the term commonly applied to the bedside tests performed in sick patients. Common clinical conditions encountered in pediatric emergency rooms are respiratory, gastro-intestinal, infections and cardiac. Emergencies at most of the places, especially developing countries are overburdened. Availability of tests like arterial blood gas, lactate, electrolytes and procalcitonin, bedside tests or point of care tests can help identify sick patients quickly. Abnormalities like acid-base disturbances and dyselectrolytemias can be dealt with instantly, thus improving the overall prognosis. Lactate levels in emergency give the earliest clue to cardiovascular compromise and poor tissue perfusion. Procalcitonin has recently gained significant importance as an acute phase reactant for early identification of sepsis. Decisions for initiating or withholding antibiotic therapy can also be taken based on procalcitonin levels in emergency. Bedside estimation of serum electrolytes, blood gas analysis and procalcitonin thus facilitate the clinical evaluation and management of critical patients. An extensive literature review of current status of these investigations as point of care tests is appraised here.

Electrical injuries in urban children in New Delhi

Aim The objective of this study was to analyze the epidemiology, presentation, management, and complications of electrical burn injuries in urban children. Methods Data from records and clinical data were collected retrospectively and prospectively during 2008 to 2010. Results Of 41 children enrolled, the mean age of children enrolled was 8.1 ± 4.5 years. Low-voltage injury was seen in 28 (68.2%), and 13 (31.8%) had high-voltage injuries. Low-voltage injuries were most commonly (52.45%) secondary to direct contact with live wire, whereas high-voltage injuries in 70% were due to direct contact with broken wires lying in fields/rooftops. Fourteen children of the 41 enrolled had associated injuries. Low-voltage injuries were associated with minor burns, seizures, tibial fracture, eyelid burn, scalp hematoma, and speech and visual impairment, whereas high-voltage injuries were associated with cardiac arrest, extradural hematoma, visceral burns, pulmonary hemorrhage and hypoxic encephalopathy, and postelectrocution acute respiratory distress syndrome. Surgical interventions done included split-thickness skin grafting, fasciotomy, and amputation procedures. The mean duration of hospital stay of all the children enrolled was 9.02 days with 35 children discharged, 71.4% of them having low-voltage injuries. Four children died, 75% of them having high-voltage injury, whereas 2 children left without medical advice, both having low-voltage injuries. Conclusions Children are a major group susceptible to electrical injuries in our country. Most of the mechanisms leading to them are easily preventable, but occur because of lack or awareness among the children and their guardians. Burn prevention program should be implemented incorporating these epidemiological data.

Oral dextrose for analgesia in neonates during nasogastric tube insertion: a randomised controlled trial.

This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates.

Organochlorine pesticide exposure in mothers and neural tube defects in offsprings

We explored the association between maternal exposure to organochlorine pesticides and neural tube defects (NTDs) in the offspring. Blood was collected from 35 mothers and their offsprings with NTDs (case group) and from 35 mothers-neonate dyads without congenital anomalies (control group). The median blood levels of DDE, t-HCH and endosulphan in mothers in the case group and of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), total hexachlorocyclohexane (t-HCH) and endosulfan in the neonates with NTDs were significantly higher. Neonates with NTDs had 3.6 times more chances of having blood levels of endosulfan above the median level of the control group. Mothers delivering offsprings with NTDs had 11.3 times greater chances of having DDE levels above the median concentration in the control group. We recommend a restrained use of organochlorine pesticides like DDT, DDE, and endosulfan, while monitoring the expectant mothers closely for birth defects like NTDs.

Role of Organochlorine Pesticides in Children with Idiopathic Seizures

Background. Organochlorine pesticides (OCP) are persistent organic pollutants that have been implicated in causing several deleterious effects in humans. These are known neurotoxins in high doses, but the role of environmentally acquired OCPs in the body to induce seizures in children has not been investigated yet. Objectives. To assess the serum levels of OCPs in children aged 2–12 with idiopathic seizure and to find out any association between the two are our objectives. Methods. It was a cross-sectional pilot study. Twenty developmentally normal children aged 2–12, presenting with idiopathic generalized seizures, were recruited. Twenty age-matched controls without any history of seizures were also taken. Their serum levels of α, β, and γ hexachlorocyclohexane (HCH); and aldrin; dieldrin; p,p-dichlorodiphenyltrichloroethane (DDT), o,p-DDT, and p,p dichlorodiphenyldichloroethylene (DDE); and α and β endosulfan were analysed using gas chromatography (GC). Mann-Whitney U test was used to compare OCP levels between the groups. Spearman correlation was used to find the correlation between individual pesticide levels with age and seizure duration. Results. Levels of β, γ, and total HCH were significantly higher among cases as compared to the control group (P ≤ 0.05). Conclusion. There exists a possible association between idiopathic seizures and high serum levels of OCPs, especially HCH.

Immunogenicity and safety of early vs delayed BCG vaccination in moderately preterm (31–33 weeks) infants

Minimum gestation at which infant can be given BCG (Bacillus Calmette-Guerin) vaccine safely at birth is not clearly defined. Our objectives were the following: to compare Mantoux test after 6 months of BCG immunization in moderately preterm babies (31–33 weeks) vaccinated at birth and 34 weeks post conception age and to compare in above groups:(a) Interferon – gamma (IFN-γ) levels in BCG vaccinated infants who did not react to Mantoux test (b) Local BCG reaction at 6, 10, 14 weeks and 6 months (c) Complications of BCG vaccination. Interventional, randomized comparative trial. Moderately preterm infants (31–33 weeks), 90 in each group. At birth, 180 moderately preterm infants were recruited and randomly allocated into 2 groups. Two ml venous blood was drawn for estimation of IFN-γ levels. Infants were given BCG vaccine within 72 hours of birth and followed up after 2, 4, 6, 10, 14 weeks and 6 months (group 1). Infants were recruited at birth and held up till 34 weeks post conception age (group 2) and then given BCG vaccine and followed up similarly as group 1. At each visit, local BCG reaction, any local or unusual complication and anthropometric measurements were noted. At six months, Mantoux test was done and 2 ml venous blood sample was collected for IFN-γ levels post vaccination. Presence or absence of BCG local reaction, PPD conversion rates and complications were analyzed using Chi square or Fishers exact test. IFN-γ levels were analyzed by ANOVA. In all 117 infants could be followed till 6 months after BCG immunization in 2 groups, and Mantoux test was positive in 38.4% of them. The rate of Mantoux test positivity was similar irrespective of the age of giving BCG immunization (group 1- 39.1% vs group 2- 37.5%; p > 0.05). IFN-γ levels were significantly raised at 6 months in 60% (n = 21/41) and 65% (n = 15/27) Mantoux negative infants in group 1 and group 2 respectively. The sequence and order of local BCG reaction at 2, 4, 6, 10, 14 weeks and 6 months was in the form of papule, pustule, ulcer, scab and scar. Scar was formed in 94.2% and 89.5% infants in group 1 and group 2 respectively. One infant in group 1 showed abortive reaction (0.85%). Only 3.4% of infants developed lymphadenopathy and was similar in both the groups. Moderately preterm infants (31–33 weeks) exhibited 98.3% immunogenicity after BCG immunization at birth and can be safely vaccinated without any risk of severe complications.

Assessment of quality of life during treatment of pediatric oncology patients.

BACKGROUND The objective of this study was to assess health-related quality of life (HRQOL) of pediatric cancer patients and their parents in North India. MATERIALS AND METHODS Seventy-five cancer children were assessed for HRQOL, using Lansky play performance scale and health utility index-2 (HUI-2). Fifty-seven patients were followed-up after 4 months after therapy and reassessed. Their parents were also assessed using World Health Organisation (WHO) QOL BREF. Seventy five controls were also assessed and compared. RESULTS Lansky and HUI-2 scores of patients, as well as WHO QOL BREF of parents were significantly poor in cancer patients when compared to controls. There was significant improvement after therapy in patients with lymphomas and miscellaneous tumors. Pain and self-care were found to be maximally affected domains on HUI-2. CONCLUSIONS Large prospective multicenter studies may be undertaken and hence that need based interventions can be planned.