Indian pediatrics最新文献

We report a cluster of acute gastrointestinal illness in seven preterm neonates temporally associated with a single batch of powdered human milk fortifier (HMF). Symptoms developed within 3-4 h of ingestion and included profuse diarrhea, dehydration, hypoglycemia, and shock. Blood and stool cultures were sterile. Microbiological analysis of unopened HMF sachets revealed contamination with Bacillus cereus and other spore-forming organisms. Withdrawal of the implicated batch and reinforcement of infection-control measures resulted in no further cases. This outbreak highlights the risk of pathogenic contamination of powdered HMF in neonatal intensive care units.

Objective: To assess the safety, efficacy and outcomes of therapeutic plasma exchange (TPE) in children at a tertiary care hospital.

Methods: Data of children who underwent TPE between January 2020 and July 2024 at a tertiary care hospital in Eastern part of India, were collected from the hospital records and analyzed.

Results: Forty children with mean (SD) age of 7.5 (3) years underwent 184 cycles of TPE during the study period. Liver disease was the commonest indication (n=14, 35%) followed by renal diseases (n=11, 27.5%) and secondary hemophagocytic lymphohistiocytosis (HLH, n=9, 22.5%). Out of 40 children,16 were discharged, 21 succumbed to the illness and 3 left against medical advice. Children with autoimmune encephalitis and renal diseases with American Society for Apheresis (ASFA) category I indication for TPE had an excellent outcome as compared to others. However, a high mortality was observed in view of delayed presentation with organ failure and lack of liver transplant facility.

Conclusion: TPE is an effective treatment in hemolytic uremic syndrome (HUS) and anti-N-methyl-D-aspartate receptor encephalitis. TPE can be performed safely and effectively for renal and non-renal indications.

Objective: To describe the clinical profile and the predictors of outcome in children with viral pneumonia.

Methods: This retrospective study included children (1 to 120 months) admitted to the pediatric intensive care unit with severe acute respiratory illness (SARI) of viral etiology confirmed by polymerase chain reaction (PCR) testing of nasopharyngeal swabs or endotracheal aspirates.

Results: Out of 180 children admitted with SARI, 160 were screened by PCR testing; 112 had a proven viral etiology; respiratory syncytial virus (RSV) being the commonest (40.2%), followed by rhinovirus (25.9%), and adenovirus (19.6%). 96 required high-flow oxygen support, and 23 needed mechanical ventilation. Adenoviral infections accounted for all five deaths (4.5%) and were significantly associated with need for mechanical ventilation [aOR 9.3 (95%CI 3.1, 30.5)], shock [aOR 12.8 (95%CI 3.9, 47.2)], and multi-organ dysfunction [aOR 15.3 (95%CI 4.4, 60.8)].

Conclusion: The broad impact of adenovirus infections on various organ systems in children underscores the need for thorough surveillance, high suspicion, early detection, and effective management of potential complications.

Objective: To assess the effectiveness and safety of cyclophosphamide and topotecan in children with relapsed or refractory extracranial solid tumors.

Methods: This study included children with relapsed or refractory extracranial solid tumors treated with cyclophosphamide (250 mg/m²/day) and topotecan (0.75 mg/m²/day) for 5 days, 3-weekly, between January 2012 and February 2024. Event-free-survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method.

Results: Eighteen patients with median (range) age 6 (2-13) years (72% boys) with diagnoses of neuroblastoma (61%), Ewing sarcoma (22%), and rhabdomyosarcoma (17%), were analysed. Median of 4-cycles of chemotherapy was given, mostly as second-line (78%). Among 15 evaluable patients, responses were complete-response (CR, n = 1), partial response (PR, n = 3), stable disease (SD, n = 2), and progressive disease (n = 9); disease control rate (CR + PR + SD) 40%. The median EFS and OS were 3.65 months and 9.72 months, respectively, with 1-year EFS and OS rates of 33% and 45%. There was no treatment-related mortality.

Conclusion: Cyclophosphamide-topotecan shows efficacy and acceptable safety in pediatric relapsed/refractory solid cancers, highlighting the need for better strategies to improve outcomes.

Since its inception in 1987, the Pediatric Hematology Oncology (PHO) chapter of the Indian Academy of Pediatrics (IAP) has emerged as one of its most active and impactful chapters. The chapter has played a pivotal role in improving the care of children with cancer and various hematological disorders in India over the past four decades. It has contributed significantly to the development of the subspecialty in India through capacity-building initiatives, national training programs, guideline development, academic teaching, and conferences. The chapter has also fostered global collaborations and multicentric research, resulting in evidence-based, context-specific improvements in clinical practice. Alongside its sister organization-the research foundation-Indian Pediatric Hematology Oncology Group (INPHOG)-the PHO chapter has elevated pediatric hematology oncology care in India to standards comparable with leading international centers.

Objective: To determine the diagnostic accuracy of Hindi version of Trivandrum Development Screening Chart (TDSC) for developmental screening of children aged 1 - 30 months.

Methods: Children aged 1 to 30 months who were accompanied by their mothers were recruited from the pediatrics department. Children with acute illnesses which could interfere with developmental assessment, unavailable birth records and from families unable to understand Hindi language were excluded. After translation into Hindi, TDSC was piloted initially on 25 children and later on 224 participants by a researcher who was trained in application and interpretation of TDSC. The results were interpreted as item 'Pass' or 'Fail'; 'TDSC delay' or screen positive was considered even with one item fail. Subsequently, Developmental Assessment Scale for Indian Infants (DASII) was administered to all by a trained clinical psychologist as reference tool and the final diagnosis was made based on developmental quotient (DQ) as: 'any delay' (DQ < 85), 'developmental delay' (DQ < 70), 'borderline delay' (DQ 71-84) or 'no delay' (DQ ≥ 85).

Results: The sensitivity and specificity of Hindi version of TDSC for 'Developmental delay' and for 'Any delay' was 92.3% and 83.6%, and 70.5% and 90.2%, respectively. The test-retest and inter-observer validity was good (Cohen's Kappa 0.720).

Conclusion: The Hindi version of TDSC had acceptable psychometric properties and excellent test-retest and inter-rater reliability. Trial registration CTRI/2021/06/033957.