Pushpa Chaturvedi

Congenital malformations at birth in Central India: A rural medical college hospital based data.

OBJECTIVE: To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra. MATERIALS AND METHODS: All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable. RESULTS: Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies. CONCLUSION: Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers’ babies is the important factor to be considered.

Poisoning in children: Indian scenario

The retrospective data on childhood poisoning from eight regional hospitals in India has been reviewed. The demographic features and types of poisonings encountered have been compared. The analysis of the data indicated that pediatric poisonings constituted 0.23–3.3% of the total poisoning. The mortality ranged from 0.64–11.6% with highest being from Shimla. Accidental poisoning was common involving 50–90% of children below 5 years of age and males outnumbered the females. Suicidal poisoning was seen after 13 years of age and was due to drugs and household chemicals. One of the hospitals in Delhi recorded a very high incidence (66.6%) of drug poisoning in children. The drugs consumed belonged to phenothiazines, antiepileptics and antipyretics. Iron poisoning was seen in younger children. Kerosene was one of the causes of accidental poisoning at all hospitals except Shimla and rural Maharashtra where probably wood charcoal is widely used. Pesticide poisoning was more prevalent in Punjab and West Bengal whereas plant poisoning was very common in Shimla. Significant number of snake envenomation has been recorded from rural Maharashtra. Other less common accidental poisonings in children included alcohol, corrosives, heavy metals, rodenticides, detergents and disinfectants. Thus various regions in the country showed some variation in types and frequency of childhood poisoning which could be attributed to different geographical and socio-economic background.

Microalbuminuria as a predictor of early glomerular injury in children with sickle cell disease.

Objective : A cross sectional study was carried out to determine the prevalence of microalbuminuria in the pediatric patients with sickle cell disease.Methods : The study was carried out on 64 pediatric patients aged less than 14 years with documented HbSS, HbAS and HbS beta thalassemia, Microalbuminuria was estimated using single radial immuno diffusion technique. Majority of the study subjects were of HbSS type. 38.5% had symptoms for >2 years. 18.8% of the study population had significant microalbuminuria (19.2% of SS types and 18.8% of Hb AS types).Result : Microalbuminuria excretion was significantly more in patients >9 years of age as compared to young patients (p<0.05). Mean serum creatinine levels did not show any significant difference in the various study groups.Conclusion : Microalbuminuria estimation is a very important clinical marker of preclinical glomerular damage in patients with sickle cell disease. Its estimation would help in the early detection of such patients and prompt initiation of therapy.

Distribution of blood pressure in school going children in rural area of Wardha district, Maharashatra, India.

Objectives: To study the blood pressure of school going children in a rural area and its relationship with the anthropometric indices. Methods: A prospective, cross-sectional study was carried out from November 2006 to December 2007 in the school going children between the ages of 6–17 years from eight different schools in the rural areas of Wardha district. The height, weight, systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded in both sexes followed by complete clinical examination with special emphasis on cardiovascular system. Hypertension (HT) was defined as SBP or DBP exceeding the 95th percentile for age, gender, and height on at least three separate occasions, 1–3 weeks apart. SPSS software was used to analyze the data. Coefficient correlation tests were employed to assess the relation between BP and anthropometric variables. Results: Of 2643 school children, 1227 were boys and 1416 girls with a male to female ratio of 1:1.16. In boys, SBP and DBP increased with age except a marginal decline in SBP at the age of 17 years (−0.09) and decrease in the DBP (−1.29) at 16 years of age. In girls, SBP and DBP also increased with age except at 11 years, wherein there was a mild decrease in SBP (−0.09) as well as the DBP (−0.24). Correlation coefficient analysis showed highly significant positive correlation of height with SBP and DBP. There was a significant correlation of SBP and DBP with the weight, and body mass index (BMI). The prevalence of HT was 5.75% (i.e., 3.25% for systolic HT and 2.49% for diastolic HT). Conclusion: We recommend that there is a need for checking BP to detect HT in children, so that remedial measures can be initiated as early as possible.

CANDIDA COLONIZATION IN PRETERM BABIES ADMITTED TO NEONATAL INTENSIVE CARE UNIT IN THE RURAL SETTING

PURPOSE Candida colonization in neonates results in significant morbidity and mortality. The purpose of this study was to determine colonization of Candida spp. in preterm babies and identify the risk factors. METHODS Swabs from oral, rectum, groin and umblicus of 103 preterm and 100 term neonates were obtained within 24 hours of birth, day three, day five, day seven and thereafter every week till the neonate was admitted in the neonatal intensive care unit (NICU). Swabs were also collected from the mothers vagina prior to delivery. Twice every month, air of the NICU was sampled by settle plate and swabs were collected from the hands of health care workers and inanimate objects of NICU. Identification and speciation was done by standard methods. Antibiotic sensitivity was studied against amphotericin B, ketoconazole and fluconazole by disk diffusion method. RESULTS Colonization with Candida was significantly higher in preterms. Earliest colonization was of oral mucosa and 77.1% of the preterms had colonised at various sites by the first week of life. Significant risk factors in colonized versus non-colonized preterms were male sex, longer duration of rupture of membranes (DROM), administration of steroids and antibiotics and vaginal colonization of mothers, whereas those in preterms versus terms were low birth weight and gestational age. C. albicans was the commonest species, both in the colonized preterms (45.9%) and vagina of mothers. Resistance was seen to fluconazole and ketoconazole only. No Candida spp. was isolated from health care personnel or environment. CONCLUSIONS Colonization of preterms by Candida is a significant problem in NICU and the significant risk factors observed in colonized preterms were male sex, longer DROM, administration of steroids and antibiotics and vaginal colonization of mothers.

Spectrum of Congenital Malformations in the Newborns from Rural Maharashtra

Congenital malformations comprise 8% of the perinatal mortality after asphyxia (25%), respiratory problems (15%), infections (12%) and cerebral birth trauma (10%)) With advances in perinatal and neonatal care these factors are slowly being controlled. Hence the time is not far when in India also congenital defects will rank among the foremost causes of early death, as the pattern is changing rapidly. Incidence of birth defects differ from country to country and from one region to another within the same country. This could probably be due to different environ: mental factors and also due to variability in the nature of study (retrospective or prospective), in the selection of the population sample (hospital or community, live or total births) and inclusion or exclusion of certain defects (major or minor defects). It was felt that the problem of malformations in the rural area of Maharashtra is more than anticipated and no study has been reported earlier from this area, hence a study was undertaken to find out the magnitude of this problem and the pattern of malformation prevalent in this area.

Perforated acute appendicitis in a term neonate.

Acute appendicitis is rare in term neonates. In most of the reported cases, it is seen as a complication of necrotizing enterocolitis, Hirschsprung’s disease, cystic fibrosis, meconium plug, inguinal hernia, umbilical hernia, Group B Streptococcal septicemia and chorioamnionitis. A surviving term male newborn with isolated acute appendicitis with perforation is reported. A high index of suspicion of acute appendicitis, early surgery and the importance of a thorough search for a perforation in cases of neonatal acute abdominal distention is stressed. Literature of this rare condition is reviewed briefly

Fast Breathing in the Diagnosis of Pneumonia—A Reassessment

In this hospital-based prospective study, a total of 222 children presenting with cough and/or breathlessness were screened for presence of lower respiratory infection. All clinically-detected cases of LRI and every fifth case of URI were investigated. Pneumonia was defined as presence of abnormal shadows on chest roentgenograms, against which the clinical symptoms and signs were assessed for their utility in the diagnosis of pneumonia. Fast breathing was found to be the most useful sign predicting pneumonia in all age groups. Cut-off points at 50 breaths/min for infants including neonates, 40 breaths/min for children aged 12-35 months, and 30 breaths/min for children aged 36-60 months indicated presence of pneumonia. Crepitations on auscultation of chest was found to have good correlation with presence of radiological pneumonia. Other signs like chest indrawing and cyanosis were found to be highly specific signs in detecting pneumonia, but had low sensitivity.

Yale Observation Scale for Prediction of Bacteremia in Febrile Children

ObjectiveTo assess the accuracy and reliability of yale observation scale (YOS) predicting bacteremia.Methods219 consecutive febrile inpatients aged 3–36 months were the subjects. Before giving antipyretics, rectal temperature was recorded. YOS scores were assessed by 2 independent blinded residents. History, clinical examination and investigations followed. Blood cultures were taken in all children before antibiotics. Point estimates and 95% confidence intervals were calculated for sensitivity, specificity, positive & negative predictive values and likelihood ratios for use of YOS as a diagnostic test in prediction of bacteremia. The best cut off value for a positive YOS test was established by calculating these statistical values separately for a cut off YOS score of 8, 10 and 12 and plotting ROC curve. Reliability of YOS was assessed by the inter-observer agreement through kappa statistics.ResultsStudy population (n=219) had 59.36% males and a mean age of 15.24 months. 28.16% subjects had bacteremia. Mean YOS scores were significantly higher in bacteremic children (14.9 vs 8.78 in non-bacteremic, p=0.00001) Sensitivity, specificity, PPV, NPV, LR+ and LR− of YOS score >10 to predict bacteremia were 87.93%, 83.78%, 68.00%, 94.66%, 5.42 and 0.14 respectively. Those of YOS score >8 were 96.55%, 65.54%, 52.34%, 97.98%, 2.80 and 0.05 respectively and of a YOS score >12 were 48.28%, 91.22%, 68.29%, 81.82%, 5.5 and 0.5 respectively. ROC curve showed YOS score >10 to be the best cut off for prediction of bacteremia. Area under ROC curve was 0.9001. The chance corrected inter-observer agreement (kappa) was 0.7919.ConclusionYOS is a simple, easy to administer, cost-effective and useful test to predict bacteremia in a febrile child aged 3–36 months due to its high sensitivity and reproducibility.

Immunodiagnosis of childhood pulmonary and extrapulmonary tuberculosis using Mycobacterium tuberculosis ES antigen by penicillinase ELISA

The diagnostic potential for detection of IgG to Mycobacterium tuberculosis excretory secretory (ES) antigen in childhood pulmonary and extrapulmonary tuberculosis was explored. IgG antibody to M. tuberculosis ES antigen was detected by indirect penicillinase ELISA. Twenty (80%) out of 25 pulmonary tuberculosis cases (clinically diagnosed and/or AFB-positive), five of nine tuberculous pleural effusion cases and only six of 69 cases in the control group were positive for IgG antibody to M. tuberculosis ES antigen. All CSF and sera were positive for IgG antibody in 12 cases of clinically diagnosed tuberculous meningitis (TBM). Out of 35 cases in the control group for TBM, all five cases of pyogenic meningitis but none of the 13 cases of viral encephalitis, five cases of enteric encephalopathy and 12 cases with no CNS infection were positive for anti-tubercular IgG antibody in CSF samples. Only two of them, i.e. one case of pyogenic meningitis and the other with no CNS infection, were positive for antibody in sera. The study demonstrated the potential of this assay in the diagnosis of tuberculosis in children where bacteriological confirmation is very difficult.