ADOL/01(P)
WEANING
(SUPPLEMENTARY
FEEDING)
OF
CHILDREN:
KNOWLEDGE OF URBAN ADOLESCENT GIRLS OF UDAIPUR
Abhishek Ojha, Srishti Sareen, Dharam Singh
C/o: Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, UDAIPUR-313 001
drsareen@yahoo.com
Weaning is vital for the growth and development of infants and children. Any delay or fault of this
feeding will lead to malnutrition. Hence, the present study had been undertaken to assess
knowledge of urban adolescent girls of Udaipur regarding supplementary feeding of infants. 200
urban adolescent girls studying in Sr. Secondary Schools of Udaipur between age group of 14-18
yrs. were selected for the present study. They were briefly introduced about the aim of the study
and were asked simple questions regarding weaning of the infants and children. The observations
were recorded in printed protocol and data analysis was done. We observed that only 26.5 % of
urban adolescent girls had correct knowledge regarding age of starting weaning foods exactly at 6
months of age. Majority were of opinion to start it after 6 months (49.6%), while 24% were of
opinion to start weaning prematurely (before 6 months of age). Only 38.5% preferred giving house
made things while majority (61.5%) were of opinion to offer tinned commercially available
market preparations. Feeding with Katori and spoon was supported by 41.5% while 58.5%
preferred bottle feeding for weaning. The girls belonging to joint family (71%) with science as
optional subject (64%) and educated parents (60.5%) had better knowledge of supplementary food
in comparison to those who lived in nuclear families (29%) had art or commerce as optional
subject (36%) and uneducated parents (39.5%). Hence, these adolescent girls must be imparted the
knowledge of supplementary feeding as they are the future mothers. The school curriculum must
include supplementary feeding in their studies. This would improve the knowledge of these
adolescent girls regarding infant feeding and would help our nation to bring down incidence of
malnutrition in our country.
ADOL/02(P) KNOWLEDGE OF URBAN ADOLESCENT BOYS REGARDING FAMILY
WELFARE AND HUMAN REPRODUCTION
Abhishek Ojha, Srishti Sareen, B. Bhandari
C/o Dr. Srishti Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Summary: Adolescence is a period of hormonal changes as well as changes in psychology of the
child. These children are keen to know about natural processes in life like human reproduction and
family welfare. The present study was planned to assess the knowledge of urban adolescent male
school children regarding family welfare and human reproduction. For this 500 adolescent school
boys between 12 - 18 years of age studying in Alok Sr. Secondary School, Udaipur were studied.
All of them had English medium of education. After briefing them the subject a questionnaire was
distributed to them. They were asked to fill it up. After recording the observations data analysis
was done. Correct knowledge regarding duration of pregnancy was observed in 72.6% of boys.
43.6% of them were aware of various contraceptive methods while 72.0% were well aware about
sexual transmitted diseases. Most of them (62.2%) were of opinion that age of marriage should be
18-21years. 56% of boys believed that decision of their marriage should be taken by their parents.
On the other hand 46.2% were in favour of self decision of marriage. 57% of the boys believed
that sex was a natural act. While only 20.2% were of opinion that it was a sinful act. It was
interesting to note that 58% of boys did not justify segregation of sex during play and in the
school. 47.6% of these boys were attracted by opposite sex while only 8.4% had intimated the
relationship with opposite sex. Only 26.2% had teased opposite sex. Hence, there is immediate
need to impart sex education to this vulnerable age of adolescence.
ADOL/03(P) TRIBAL ADOLESCENT SCHOOL GIRLS OF UDAIPUR : THEIR
KNOWLEDGE REGARDING SECONDARY SEXUAL GROWTH
Abhishek Ojha, Srishti Sareen, B. Bhandari
C/o Dr. Srishti Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Summary: At puberty secondary sexual development creates an anxiety and curiosity in the mind
of adolescents. The present study was planned to assess the knowledge and attitude of adolescent
school female children regarding secondary sexual growth. For this 500 adolescent school girls
between 12-18 years of age studying in Mahila Mandal Sr. Secondary School, Udaipur were
studied. All of them belonged to Hindi medium. After briefing them the subject a questionnaire
was distributed and all of them were asked to fill the performa. Data collection and analysis was
done. It was observed that only 14% of these girls had correct knowledge regarding female
secondary sexual growth. Majority of them responded in affirmative regarding presence of
pubertal changes in them (genital hair 38.6%, axillary hair 35.4% and genital growth 9.8%). Only
18% of the girls had correct knowledge regarding menstruation. The source of information was
mother (58.8%), father (14.2%), teacher (8.6%), friends (7%) and books & magazines (5.2%).
38% among them wanted to get more knowledge about pubertal changes.Knowledge of these girls
from the tender age group can be improved by including sex education in the school curriculum
and educating them through media and various social agencies.
ADOL/04(O) CONTRIBUTION OF HPA ACTIVITY AND ENVIRONMENTAL STRESS
TO VULNERABILITY FOR SMOKING IN ADOLESCENTS
Uma Rao
The University of Texas Southwestern Medical Center, Dallas, Texas, USA
uma.rao@utsouthwestern.edu
Objective: The study examined whether hypothalamic-pituitary-adrenal (HPA) activity and
stressful life experiences are related to smoking behavior in depressed and non-depressed
adolescents, and whether smoking predicts a worsening course of depression. Methods: Smoking
history and stressful experiences were assessed in 151 adolescents (48 with no personal or family
history of psychiatric disorder, 48 with no psychiatric history including depression, but at highrisk for depression by virtue of parental depression, and 55 with current major depressive
disorder). Evening salivary cortisol and nocturnal urinary free cortisol were measured for three
consecutive evenings. The participants then were followed at regular intervals for up to 5 years to
assess smoking history, clinical course of depression and stressful experiences during the followup period. Results: Increased evening/night-time cortisol levels were associated with both
initiation and persistence of smoking during follow-up. Stressful life experiences further
increased the risk for smoking in depressed as well as non-depressed youth. Smoking also was
associated with a higher frequency of depressive episodes during follow-up. A model that
included stressful experiences and cortisol levels reduced the contribution of smoking per se to
depression. Conclusions: High evening/night-time cortisol level appears to be a vulnerability
marker for smoking in adolescents, with stressful experiences further increasing the risk for
smoking in vulnerable youth. High evening/night-time cortisol levels and stressful experiences
accounted, at least partially, for the association between depressive illness and smoking behavior.
ADOL/05(O) PREDICTORS OF PERPETRATORS IN ADOLESCENT VIOLENCE
Anand K. Agarwal, Partha Nandi, Anurag Srivastava, Bhavana Papnai, Nitin Verma
Associate Professor, Dept. of Pediatrics, Saraswathi Institute of Medical Science, NH-24, Hapur,
Ghaziabad
anand.agarwal960@gmail.com
Introduction: Perpetration of violent acts by adolescents is a prevalent and a serious problem all
over the world. With rising commitments to violence prevention, there is commensurate need to
identify theory-driven, mutable contributors to violence etiology. Although adolescent violence
occurs within the context of developmental risk factors, including low social cohesion,
psychological problems, family conflict, poor school engagement, and violence victimization. Few
studies examine adolescent violence within a multi-risk framework. We present a detailed drill of
adolescent violence perpetration by examining the contributors at different health horizons, with a
special attention to the role of victimization. Aims & Objectives: This high school-based,
prospective study sought to identify early predictors of adolescent violence and to assess whether
they vary by other risk factors and across different modes and severity of violence. Material &
Methods: 1470 high school children aged 12-16 years was surveyed by using an anonymous pretested self-report questionnaire in one academic session and it was endeavored to know the
prevalence and the early predictors of the perpetrator component in the violent act. The mode and
the nature of severity of violence were also examined. Prior the interaction psychosocial
adjustment of the student was done. Results:Prevalence and the male involvement is not way
behind from the other studies. The low middle SES, parental education of less than high school
level, nuclear family, staying with parents, academic failure, alcoholism and the TV watch of more
than 2 hours per day were shown the indirect relationship to the perpetration of violence. The
school was the place where it happened the most and the next was the neighouberhood. For
perpetrators the money was every thing in life and they had witnessed the violence previously.
Bullying was found maximum among all the other modes of violence. Conclusions: These
findings support a multi-risk perspective that includes social disadvantages, psychological and
interpersonal risk factors in the early intervention and prevention efforts, particularly regarding
processes of cumulative stress and support. Key findings speak to prevention potential through
targeting mutable contributors as well as the promotive factors to ameliorate the effects of factors
such as social disadvantage and victimization in altering perpetration etiology. Peer victimization
remains one of the strongest unique contributors to violence perpetration, highlighting the need for
early intervention to disrupt the victim perpetrator link. Similarly, unmanaged anger is a
particularly important target for intervention for at-risk adolescent.
ADOL/06(P) PREVALENCE OF HYPERTENSION IN URBAN SCHOOL GOING
ADOLESCENTS OF BANGALORE
Sangamesh, Vedavathy, Niranjan H S, Shivananda
Department: Indira Gandhi Institute of Child Health, Bangalore.
vedadoc4u@yahoo.com
Objectives:To study the prevalence and risk factors of hypertension in urban school going
adolescents of different socioeconomic status. Methods: 748 adolescents of three different schools
of different socioeconomic status enrolled in study between October 2006 and September 2007
.History, Examination and relevant investigations done. SPSS soft ware and t test are used for
statistical analysis. Results: M: F= 62.4:37.6, most common age group is 14 years (38.2%).48.8%
belonged to lower middle socioeconomic status. Prehypertension and stage 1 hypertension was
noted in 3.6% each. Hypertension was significant in upper middle class (18.6%).BMI>23, birth
weight 2.5 - 3 kg, family h/o hypertension and obesity, increased waist-hip ratio, increasing
weight and height were the risk factors found statistically significant. Decrease in distribution of
hypertension noted across three screenings, that of SBP from 17.1% to 4.9% and that of DBP from
12.2% to 5.08%. SBP-16, DBP-17, combined-21. Summary and Conclusion. Prevalence of
Hypertension and Prehypertension was 7.2%. The distribution of hypertension across three
screenings, showed drastic reduction in prevalence of high SBP from 17.1% to 4.9% and DBP
from 12.2% to 5.08%. Obesity, increased body mass index are the significant anthropometric risk
factors. Family histories of hypertension and obesity are significant risk factors.
ADOL/07(O) OVARIAN TUMORS IN ADOLESCENT GIRLS
Nupur Hooja, Sanjiv Hooja, Premlata Mital, Mridul Gehlot
A-29, Lal Bahadur Nagar, Opp.Hotel Clarks Amer,Malviya Nagar, Jaipur-302017
hoojasjaipur@gmail.com
Introduction: Ovarian cancer is the most common gynaecological cancer in adolescent
girls.Treatment depends on the stage, extent of residual tumour and histology. Aims : Our aim was
to profile the ovarian tumors with analysis of age, presentation and stage of disease. Material and
Method: The study was conducted in the Department of Obstetrics and Gynaecology, S.M.S.
Medical College, Jaipur (Rajasthan) over a period of one year.All patients of ovarian tumors under
20 years were included in the study.Detailed history,clinical,surgical and histopathological
findings were analysed.Further management was planned accordingly.WHO classification was
employed Results:17 % of the <20 years patients were of ovarian tumors.The most common
presentation was pelvic pain and lump abdomen. of which 66% were germ cell and 25% were of
epithelial in origin. 50% were malignant. 83% pts. had early stage cancer.Surgery was followed by
chemotherapy in most cases. Conclusion : Young girls with ovarian tumors often complain of
vague abdominal discomfort and recurrent pain.They are treated with antispasmodics and
antiflatulents or as appendicitis. Complete evaluation along with use of imaging modalities such as
X-Ray and ultrasound should be used to increase the diagnostic accuracy.Ovarian tumors need to
be treated with great caution.Care is taken for preservation of reproductive functions along with
complete excision of the tumour.Surgery and effective chemotherapy have markedly improved
the outcome of treatment of ovarian tumors in these girls.
ADOL/08(P) A COMPARATIVE STUDY ON “AWARENESS LEVELS IN ADOLESCENT
GIRLS ON HEALTH AND HYGIENE PRACTICES
T Nalini, Shradha
Bhagwan Mahavir Hospital &Research Centre, Hyderabad.
shradhakanodia@rediffmail.com
Introduction: Under NICE Foundation School Health Programme, 1905 adolescents’ girls of 6th and 7th std from 18 government High
Aims And Objectives:-1) Assess
the food and health hygienic practices after conduction of the health education programme in the
schools.2) Assess the health education programme impact among the adolescent girls in between
intervention schools and non- intervention schools. Materials and Methods:- Sample Design- This
is quasi experimental study, having intervention and Non intervention group of schools of girl
child. Sample Size: 100 girl child respondents from each in intervention and non-intervention
schools, total 200 members. Results: 1) Girl child receive information on puberty changes from?
Intervention schools - 64 percent from mothers, 16 percent from friends and 12 percent from the
teachers. Non Intervention schools- 44 percent from mother, 20 percent from friends and 16
percent from sisters.2) Consuming enough water per day? Intervention schools - After educating consuming “8 & above” glasses of water is 36 percent (increased by 24 %). Before educating- 12
% are consuming “8 & above” glasses of water daily. Non intervention schools- 32 percent
consume “8 & above” glasses of water daily. 3) Discuss about menstrual problems with others?
Intervention schools - After educating- 80 percent said yes. Before educating- 20 percent of girl
discussed. Non intervention schools- 20 percent of girls discuss about the menstrual problems with
others. 4) Having daily Breakfast Intervention schools - After educating- 72 (Increase of 44%)
take breakfast daily. Before educating- 28 percent said yes, Non Intervention school- 56 % girls
said they take breakfast daily. 5) Attending school during Menstrual period? Intervention schools
After educating-88 percent (Increase of 28%) attend school during menstrual period Before
educating- only 60 percent used to attend the school during the menstrual period. Non intervention
schools- 52 percent attend the school during menstrual period 6) Avoiding Food Intake during
menstrual period? Intervention schools - Before educating- 60 percent avoided - After educating came down to 40 percent. Non Intervention schools- 56 percent are avoiding. Conclusion - This
study proved adolescent education programs can be the tool for prevention of many illnesses and
can enrich their knowledge levels regarding puberty.
schools were given Adolescent Health Education and its effects are assessed and compared.
ADOL/09(P) MYTHS AND PROBLEMS REGARDING MENSTRUATION AND
MENSTRUAL HYGIENE STILL PREVAIL AMONG RURAL ADOLESCENT GIRLS IN
THE 21ST CENTURY-AN EYE OPENER.
N.L.Phuljhele, Anumeha Nanda
Dept. of Pediatrics, Pt.J.N.M.Medical College , Raipur
drkumararun_1982@yahoo.com
Objective- To study various beliefs and problems regarding menstruation among rural adolescent
girls. Design- Prospective study. Settings- Pediatric Camp in Khartuli village of Dhamtari dist.. of
Chhattisgarh. Materials/Methods- 500 adolescent girls(10-18 years) were enrolled for the
study.These girls were asked about menarche,any knowledge before it,duration of cycle and
amount of blood loss and various menstrual problems.They were also asked about different
myths/beliefs regarding menstruation.The family size, socio-economic and education status were
assessed. The girls who were having any illness affecting menstrual cycle or suffering from
neuropsychiatric disorder were excluded from the study. Results-Only 12% girls were attending
schools. Mean age of menarche was 12.75 years(12-14 years) while duration of cycle varied from
21 to 38 days. The menstrual phase varied from 3 to 7 days. About 84% girls were ignorant of
menstruation prior to menarche while 10% had been told by mothers and rest 6% by
friends/relatives.Regarding the concept of menstruation, 22% believed it to be a physiological
process, 42% girls thought it as a curse of God, 30% considered it as a disease and 6% girls did
not know obvious cause. About 57% girls had irregular cycles initially. Premenstrual problems
included sudden mood changes(63%), swelling or pain in breasts(38%), anger(31%),
headache(24%), tiredness/lethargy(24%), lower abdominal pain(23%). Abdominal pain was the
most common problem observed(62%) during menstruation. Various restrictions practiced during
menstruation were- avoiding temples/social functions/kitchen 92%, avoiding spicy as well as other
food items 76%, 9% avoided schools, 45% did not do routine work/playing.Only 6% girls did not
apply any restrictions on them. Only 12% girls knew that once she becomes pregnant the menses
temporarily stops till delivery. 68% girls used old cloth piece during menses, 10% used new cloth
pieces , 18% used both old and new cloth pieces and only 6% girls used readymade sanitary
napkins. Out of the 96% girls using cloth pieces, 80% reused the same cloth piece for every cycle
after washing and drying the cloth piece in dark , damp and dirty places. Out of these, 37% shared
cloth pieces among mother and sisters. Cleaning of external genetalia was satisfactory in only 49%
of the girls during menstruation(Satisfactory cleaning includes cleaning more than 3 times a day
with soap and water). Conclusion-There is a dire need to educate rural adolescent girls regarding
menstruation and menstrual hygiene prior to menarche. This will ultimately lead to a decrease in
the incidence of RTI among women which will ultimately reduce the incidence of neonatal sepsis,
neonatal morbidity and neonatal mortality. The traditional beliefs, misconceptions and restrictions
regarding menstruation should be brought out of the minds of adolescent girls.
ADOL/10(P) DEPRESSION IN ADOLESCENTS
Samarendra Mahapatro, S.S .Kar, R.Tripathy
Dept of Pediatrics, Hi-Tech Medical College, Bhubaneswar, Orissa
samarendramahapatro@yahoo.com
Aim - To know the prevalence, etiology, sign and symptoms of depression on adolescents
students.Material method -50 male and 50 female students of Class XI of a College of Science
stream of Bhubaneswar, Orissa were included in the study. BDI questionnaire was given to the
students. History and BDI questionnaire score were taken into consideration while conducting the
study. Observation -70% male and 76% of female students have same form of depression. Out of
the depressed female students 14% and 6% were severely depressed and extremely depressed
respectively. Out of depressed male students 26% and 0% were severely and extremely depressed
respectively. 5% of depressed male and 7% of depressed female students are prone for suicide.
Depression was noticed in all types of family, but mostly in broken family. Conclusion-The
prevalence of depression in adolescent students was quite high and alarming. So it needs special
attention to diagnose early and treat early. Special plans regarding mental health of adolescent
should be implemented in our health programme to get healthy adolescent for the society.
ADOL/11(P) BLOOD PRESSURE PROFILE AMONG RURAL ADOLESCENTS
R.A.Sankarasubramanian, P.Thirumalaikolundusubramanian, P.Amutharajeswari, G.Madevan,.
Nandini Kuppusamy. M.Balasubramaniam, Sathish Kumar.
Institute of Peadiatrics & Research centre, Madurai Medical College, Madurai -625020
bkchand123@rediffmail.com
Blood pressure is rarely recorded in school children during school health programme. Objective :
The assess the blood pressure profile of boys and girls and to identify the prevalence of
hypertension. Material and Methods :
During school health programme, blood pressure was
recorded using standard methods for both boys and girls. If the systolic was more than110 and
diastolic more than 80, these children were evaluated at weekly interval for 3 readings. The study
was carried out after the institutional ethical clearance. The data were analysed statistically.
Results :There were 625 boys and 271 girls. The syllabic blood pressure (SBP) and diastolic blood
pressure (DBP) of boys ranged from 98 to 160 and 60 to 110 respectively, and those were 100 to
130 and 60 to 90 respectively among girls. High normal BP and hypertension were noticed in 11
and 13 boys as well as 13 and 9 girls respectively. When the prevalence was compared with
reference to gender, both were significantly more among boys (P<0.01). However, the under lying
cause for elevated BP in these children could not be established. Comments :The prevalence of
high normal BP among boys & girls was 1.7 and 5% respectively; and hypertension among them
was 2 and 3.3% respectively. So it is suggested that meticulous care should be taken to record BP
of children using appropriate BP cuff during school health programme. If any abnormalities were
detected, they have to be followed up and / or treated.
ADOL/12(P) BODY MAN INDEX OF RURAL SCHOOL GOING TEENAGES
R.A.Sankarasubramanian, P.Thirumalaikolundusubramanian, S. Rajasekaran. S.Balasankar
J.Balasubramanian V.K.Vijaymohan.
Institute of Peadiatrics & Research centre, Madurai Medical College, Madurai -625020
bkchand123@rediffmail.com
Studies on body man index (BMI) of urban children were reported frequently in iterature.
However, data on rural children are lacking. Objective : To find out the BMI of healthy rural
school going teenagers and find out the variation among boys and girls. Material and Methods :
After institutional ethical clearance and with the permission of school administrators, this study
was carried out. The school teachers were trained and assessed to record weight and height of
children without controversy. Those children who did not have any illness during period of
consecutive six months were considered for the study. Each children was examined by the first
another individually. BMI was calculated. Data were analysed statistically. Results :There were
503 boys and 436 girls. Their ages varied from 13 to 19 with a median of 14 years for boys and
girls. They lived in rural areas and their family members were supported by various welfare
programmes of the government. The BMI of boys and girls ranged from 14.5 to 30 and 15 to 26
respectively. The median was 16 for both. Over weight was noticed in 3 boys and one girl, and
obesity in only one boy. Comments : Over weight and obesity was rare in rural teenage school
going children in contrast to their counterpart in urban areas. This variation is attributable to low
socioeconomic status of their parents and chronic malnutrition. Despite welfare programmes
nutritional status continues to be sub-optimal. Hence, nutritional programmes need close
monitoring and rural children require sregular evaluation
ADOL/13(P) CLINICAL PROFILE OF ADOLESCENT FRIENDLY HEALTH CENTRE:
AN 8 YEAR PROSPECTIVE STUDY
Vidushi Mahajan, Veena Parmar, Srikanta Basu, Chandrika Azad, Manju Singla
Department of Pediatrics, Government Medical College, Chandigarh
vidushimahajan2003@yahoo.co.in
Introduction: Adolescents comprise 33% of our total population. There is a dearth of specific and
targeted adolescent health services. Hence this study aims to gain an insight into their health needs
and problems which are widely unmet. Methods: A questionnaire based cross sectional study was
carried out at adolescent friendly health centre (AFHC), Government Medical College,
Chandigarh (May 2001 to June 2009). All children aged 10-19 years visiting the AFHC over study
duration, were enrolled. Parental consent was obtained wherever necessary. The questionnaire
consisted of items related to their medical, nutritional, psychosexual, reproductive health problems
and health risk behaviors. The children and their parents were allowed to interact with the
interviewer freely during the interview, ensuring confidentiality. Results: A total of 582
adolescents were enrolled over study duration (males=355, females=223). Their mean age, height
and weight was 12.4  2.0 years, 146.0  11.7 cm and 36.8  12.0 kg, respectively. Their mean
body mass index was 16.9  3.7 kg/cm2. Of all attendees, 348 (59.8%) visited because of medical
reasons. Seizure disorder was the commonest medical problem (N=73) followed by headache
(N=48) and fever (N=29). Under-weight (N=23) was more common reason for AFHC visit than
overweight (N=12). However, BMI of >25 kg/cm2 was recorded in 17 adolescents. Ninety five
(16.3%) had psychological or psychosexual problems. Substance abuse (drinking, smoking etc)
was reported by 3 adolescents. Conclusion: Medical reasons were the most common cause of
AFHC visit by adolescents.
CAR/01(P) PYOPERICARDIUM-CASE REPORTS
Pradeep Debata, Shivani Deswal, Anuj Dhama, D.K Taneja
Deptt. of Pediatrics, Safdarjung Hospital, New Delhi.
pkdebata66@yahoo.co.in
Pyopericardium is a rare serious form of pericarditis where pus is accumulated within the
pericardial cavity. If untreated, this may be a fatal condition leading to cardiac tamponade . It
often begins with bacterial infections, such as pneumonia, meningitis or osteomyelitis. We report
here 2 cases aged 2 years and 6 years, presenting in the same emergency with h/o cough and fever
for 7 days and difficulty in breathing-2 days. Physical examination revealed high grade fever,
tachycardia, dyspnea and hepatomegaly. The apex beat was non palpable and the heart sounds
muffled. A provisional diagnosis of pericardial effusion was made. Chest x-ray and
echocardiography revealed massive pericardial effusion. Pericardiocentesis was done by subxiphoid approach, and 60 ml and 250 ml thick pus drained respectively. Culture of pus in 1 st case
showed the growth of Staphylococcus aureus. Both children were treated with anti staphylococcal
antibiotics for 4 weeks and required repeated drainage. Despite these measures, younger child
developed tamponade necessitating open drainage (Pericarditotomy). Post treatment echo showed
successful evacuation of pus and normal ejection fraction in both the children. The recurrence rate
of pericardial tamponade following aspiration is quite high and necessitates the open drainage as
the choice of treatment. Therefore, close monitoring and timely intervention with a team approach
is the key to managing such cases.Our cases were unique as they did not have evidence of any
other systemic illness and presented as isolated Pyopericarditis which is even rarer.
CAR/02(P) SILDENAFIL FOR PULMONARY HYPERTENSION ASSOCIATED WITH
CONGENITAL HEART DISEASE IN CHILDREN
Vinayak patki, Subodh Dhanawade, Satish Patil
Dept. of Pediatrics, Wanless Hospital, Miraj – 416410
vkp31073@rediffmail.com
Objective: To study the clinical presentation of pulmonary hypertension (PH) in children with
congenital heart disease and to study the efficacy of sildenafil for pulmonary hypertension in
children with congenital heart disease. Method: The study was a prospective observational study
carried out at Neonatal Intensive Care Unit and Pediatric Intensive Care Unit Wanless hospital,
Miraj, Maharashtra for a period of 1 year. The subjects were 10 neonates, 13 infants and 2 children
(1 between age 2-5 yr and 1 of age > 5 yr). Their mode of presentation was studied.
Echocardiography was performed before and after the sildenafil at regular intervals. Results:
Pulmonary hypertension observed more in female patients (64%). Majority (88%) of children had
moderate to severe pulmonary hypertension. All children were malnourished, severity of
malnutrition was more with severe Pulmonary hypertension. Respiratory distress, congestive
cardiac failure in 76% of each, pneumonia in 52% and upper respiratory tract infection was noted
in 100% of patient during study period. Anemia (84%) and cardiomegaly (94) % were significant
findings. Mean + S.D. of pulmonary pressure at admission was 63.53+17.48,at 2 weeks
53.95+16.17,at 1 month 50.32+19.62,at 3 month 37.92+21.28 and at 6 month 29.0+19.48
suggesting reduction in pulmonary pressures. Sildenafil has reduced the pulmonary pressures in all
grades of pulmonary Hypertension. Episodes of congestive cardiac failure and pneumonia were
reduced after sildenafil treatment during study period .Sildenafil at dose of 1mg/kg /day in divided
doses tolerated well in patients of all grades of pulmonary hypertension with diarrhea in 16%,
flushing in 12% and tachycardia in 8% patients as fewer side effects. Conclusion: Sildenafil not
only reduces pulmonary hypertension(PH) in patients of all grades of PH but also reduces
episodes of congestive cardiac failure and pneumonia. Sildenafil is an easily available,
inexpensive, well tolerated drug for patients of pulmonary hypertension.
CAR/03(P) BALLOON DILATATION OF COARCTATION IN NEONATES : A SERIES
Prabhat Kumar
Head , Department of Pediatric cardiology, Military hospital ( CTC ) Pune
drprabhat_cardio@yahoo.co.in
Introduction: Coarctation in newborns presents with a diagnostic and management challenge
where surgery used to be mainstay of the treatment. With progress in Interventional Pediatric
cardiology these patients can now be managed with catheter based interventions. We present a
series of eight neonates with coarctation managed at our centre successfully with balloon
dilatation. Aims & Objectives: To evaluate the efficacy of balloon dilatation of coarctation of
aorta in neonates. Material & Methods: Since April 2007 neonates with coarctation of aorta were
managed with balloon dilatation and followed 3 monthly minimum for 6 months. Results: Eight
neonates amongst 900 neonates who attended Pediatric Cardiology outdoor were diagnosed to be
having Coarctation of aorta. Six ( 75%) out of 8 neonates had simple coarctation while two (
25%) had associated large ventricular septal defect ( VSD ). All these neonates underwent balloon
dilatation of aorta. Two patients with associated VSD were later operated for VSD. All patients
completed at least 6 months follow up and seven ( 87% ) out of 8 had no residual gradient. One
patient ( 13% ) otherwise asymptomatic had residual gradient of 18 mm due to associated mild
hypoplasia of aorta. Conclusions: Balloon dilatation of coarctation in neonates is the treatment of
choice. Though technically challenging it is effective and certainly obviates morbidity and
mortality associated with surgery. Neonates with other associated congenital heart diseases,
balloon dilatation of coarctation should be first undertaken and if possible planned surgery should
be delayed till general condition is stabilized.
CAR/04(P) CHILD WITH VENTRICULAR SEPTAL DEFECT AND ABSENT LEFT
UPPER LIMB PULSES
Midhun Ramesh, Rakesh Gupta, Prabhat Kumar
Department of Pediatrics, Armed Forces Medical College, Pune
drprabhat_cardio@yahoo.co.in
A 5 year old child presented with a cardiac murmur and recurrent respiratory infections.
Examination revealed following interesting findings:Shortening of neck on left side Shortening
of left arm by 2 cms Left scapular deformity with prominent spine and under developed wing
Absent left brachial and radial pulses Systolic thrill in upper left para sternal region Ejection
systolic murmur in left 3rd space Radiograph of both Upper limbs Length of left humerus shorter
by 2 cms compared to right humerus ECHOCARDIOGRAPHY Large malaligned VSD with
40% aortic override Mid cavity muscle bundle in Right ventricle with 80 mm gradient
Infundibulum and pulmonary valve normal Right aortic arch Cardiac Catheterisation Anomalous
Left brachicephalic artery originating from descending aorta at level of 4 th thoracic vertebrae,
formed a tortuous loop before taking course as normal left subclavian and carotid arteries. Mid
cavity gradient of 80 mm was demonstrated in right ventricle Barium swallow did not show any
indentation over oesophagus by anomalous artery..Impression: Child with Congenital heart
disease Ventricular septal defect and double chambered right ventricle with severe mid cavity
obstruction is having features similar to VSD/ PS ( TOF) physiology with right aortic arch.
Abnormal body features as shortening of neck , left humerus, deformed scapula and absent left
upper limb pulsations were probably due to anomalous origin of left brachiocephalic and its
course. Such combination of features have not been found reported in searched literature.
CAR/05(O) A CASE OF VACTERL ASSOCIATION
DIAGNOSED CONGENITAL HEART DISEASE
Lt Col Karthik Ram Mohan,
Maj Sawant MB, Radiologist, MH Allahabad
drkram@rediffmail.com; rnr4u@rediffmail.com
WITH
ANTENATALLY
A 29yr G4P3L2A1 lady presented for antenatal USG which showed a single intrauterine live fetus
with composite gestational age of 36 to 37 weeks, gross polyhydramnios, two-vesseled umbilical
cord with single umbilical artery and fetal heart showed a large VSD. Lady did not follow advice
to report to gynecologist and two weeks later, she delivered a female neonate by simple vaginal
delivery (Birth weight 3 kg). Baby soon developed grunting, tachypnea and copious frothy oral
secretions. Feeding tube could not be passed into stomach. Chest radiograph revealed curled up
feeding tube in the upper esophagus, presence of air in stomach, boot shaped heart and mildly
oligemic lung fields suggestive of Esophageal Artesia with distal Tracheoesophageal fistula and
Tetralogy of Fallot. Radiograph of spine revealed hemivertebra at L5 level. USG Abdomen was
normal. Baby was kept nil oral in head-elevated prone position, esophageal suctioning done, given
IV fluids and oxygen and transferred to pediatric surgery centre where she was operated. Postnatal
echocardiography confirmed presence of Tetralogy of Fallot. The VACTERL (Vertebral
anomalies, Anal Artesia, Cardiovascular malformations, Tracheoesophageal fistula, Renal and
Limb [Radial] anomalies) association (OMIM 192350) is a nonrandom pattern of defects
occurring together and includes at least 3 of the above cardinal features. To conclude, infants with
antenatally diagnosed single umbilical artery and congenital heart disease must be screened at
birth for VACTERL association and delivery must be preferably be arranged at a centre with
cardiothoracic and pediatric surgical facilities.
CAR/06(O) VALVE SURGERIES IN LESS THAN 18 YR OLD RHEUMATIC PATIENTS.
-NARAYANA HRUDAYALAYA EXPERIENCE.
Amit Kumar, Prashant Patil, Raghunath C.N., Rajesh Hegde
3rd floor PITU, Narayana Hrudhayalaya, Banglore-560099
drprashant1981@gmail.com
Introduction: Rheumatic heart disease is the leading cause of acquired cardiac morbidity in
adolescence & young adults. As the age advances deterioration in valve functions requiring
surgical interventions increases. In Narayana Hrudayalaya the number of Rheumatic valve
surgeries exceeds seven times in patients of age> 18yrs as compared to patients of age <18yrs.
However the burden of surgery especially valve replacement is more in younger patients.
Objective: To assess the various types of valve surgeries done in rheumatic patients, younger than
18yrs of age. Method: A retrospective study done between October 2001 & September 2008. All
rheumatic heart disease patients who had undergone cardiac surgery in Narayana Hrudayalaya
were included in the study. Type of surgery done, number of valves repaired or replaced, outcome
and age profile were documented. Result: 105 patients of age <18yrs had undergone cardiac
surgery in Narayana hrudayalaya. Of which most common valve operated was Mitral valve (90%)
– alone or in combination. Mitral valve replacement was more common than repair (62 vs. 26).
Aortic valve replacement outnumbered repair significantly (30 vs. 4). Dual valve replacement
(MVR +AVR) were 13 (12%). Tricuspid valve was repaired in 12 patients although they were
repaired along with other valve surgery. There were 3 triple valve surgeries with 1 death. 2
patients had undergone ROSS procedures. There were altogether 3 deaths (2.8%). Youngest age to
undergo valve surgery was 7 years of age. Conclusion: Even in patients younger than 18 yrs of
age, valve replacement is more common than repair. Unfortunately they will be exposed to risk of
anticoagulant for longer period.
CAR/07(P) CARDIAC TAMPONADE CAUSED BY TUBERCULOUS PERICARDITIS IN
INFANT
Amar Taksande, V.Gautami, Sumanta Padhi, Kinjal Bakshi, K.S.Murthy
Tarnaka, Near White House, Moula Ali Road, Secunderabad, Hyderabad
amar_bharti2000@yahoo.co.uk; amar.taksande@gmail.com
Case Report: Tuberculosis usually affects lung but extra pulmonary TB is also common. Cardiac
tamponade is a common complication of TB pericarditis. It is due to accumulation of fluid in the
pericardial space, resulting in reduced ventricular filling and subsequent haemodynamic
compromise. TB pericarditis accounts for only 4% of the cases in the developed countries but
constitutes about 70% of the cases of acute pericarditis in the under-developed or developing
countries. A 5 month old male child, weighing 4.7kg was admitted with history of breathlessness.
Child was afebrile, pallor, no cyanosis or clubbing. Sign of respiratory distress was present. BCG
scar was present. CVS examination revealed normal heart sounds & other systemic examination
were normal. Laboratory investigations revealed haemoglobin of 6.7 gm/dl, RBC:4.72 million/mm
3
; WBC: 11,000/mm 3 (53% neutrophils; 38% lymphocytes) and platelets :1.6 lakhs /mm 3 and
ESR was 5mm in 1st hour. CRP, HBsAg, HIV were negative. Mantoux text was non-reactive.
Chest radiograph revealed cardiomegaly and ECG showed low voltage complexes.
Echocardiography revealed pericardial effusion s/o cardiac tamponade. Surgical pericardiostomy
was done. The pericardial fluid was whitish in color with TLC: 6,000/mm3(Leukocyte 98% and
Neutrophil 2%), proteins:7.3mg%, glucose:214mg/dl and chloride was 113mg/dl. The AFB and
gram stain revealed no organism growth. Pericardial fluid ADA was 56 (10-35). 4ATT drugs and
short course of steroid was started. On follow up, child is responding well to the treatment. In
Conclusion, pericardial effusion due to TB in an infant is very rare and ADA is the useful indirect
marker of tuberculous pericarditis
CAR/08(P) UHL’S ANOMALY IN AN INFANT: CASE REPORT
Amar Taksande, V. Gautami, Sumanta Padhi, Kinjal Bakshi, K.S.Murthy
Tarnaka, Near White House, Moula Ali Road, Secunderabad, Hyderabad
amar_bharti2000@yahoo.co.uk; amar.taksande@gmail.com
Uhl’s anomaly is characterized by partial or complete absence of the myocardium of the right
ventricle. A review in 1993 found only 84 reported cases in the world literature since the
beginning of 20th century. Congestive cardiac failure is the most frequent symptoms. Uhl’s
anomaly may be associated with tricuspid valve anomalies, pulmonary atresia, and Ebstein’s
anomaly. An unguarded tricuspid valve is a rare congenital anomaly described in only a few
antemortem case reports. Here we reported a rare case of Uhl’s anomaly. A 2month-old male
infant weighing 3.15kg, presented with history of breathlessness. He was a full-term normal
vaginal delivery at home. On general examination, afebrile, tachypneic, cyanosis and clubbing was
present and all peripheral pulses were present. His vitals were HR: 122/m, RR: 52/m, BP:
108/88mmHg and SpO2: 80%. On auscultation, ejection systolic murmur was best heard in the
upper left parasternal area. No third heart sound or diastolic murmur was heard. There was mild
hepatomegaly. Chest X-ray showed an enlarged cardiac silhouette (CT>0.5) and decreased
pulmonary vasculature. Electrocardiography showed sinus rhythm, normal QRS axis with right
atrial hypertrophy. Transthoracic 2D-echocardiography revealed situs solitus, enlarged right
atrium and right ventricle, No definitive right ventricular wall and small diverticulum of right
ventricular outflow tract. Absent tricuspid valve with free tricuspid regurgitation. Small
perimembranous ventricular septal defect with left to right shunt and peak intraventricular gradient
of 60 mmHg. Large atrial septal defect with right to left shunt and paradoxical septal motion was
present
CAR/09(P) DEXTROCARDIA: A STUDY OF PATIENTS IN A REFERRAL CENTRE
Col Mukti Sharma, Col Vipul K Sharma, Brig Manoj Luthra
Depts of Pediatrics & Cardiothorasic Surgery, Army Hospital (R&R), Delhi Cantt – 110010
akms@vsnl.com
Introduction: Dextocardia is defined as a right-sided heart with a base-apex axis directed rightward
resulting from a variation in cardiac development. Dextrocardia occurs in 0.01% of live births and
without associated situs inversus (situs solitus), often have complex cardiac malformations.
Dextrocardia with situs inversus and normally related great arteries mostly have a structurally
normal heart. Aims and objectives: To look for prognostic markers in children with
dextrocardia. Material and methods: We retrospectively analysed data of 23 children diagnosed to
have dextrocardia in our hospital over the last 2 years. All children with a clinical suspicion of
dextrocardia underwent a CXR (AP), ECG, USS abdomen and an Echocardiogram. Their outcome
after surgery, was recorded and are being followed up three monthly.
Results: Age ranged from newborn to 12 yrs (mean 3.56 SD + 6.2). The male:female ratio was
2.3:1. Twelve children had dextrocardia with situs inversus, of which 4 required repair of
ventricular septal defect. Of the 11 remaining with dextrocardia and situs solitus 4 had AV canal
defect, 1 had DORV, 3 had cTGA and 2 had single ventricle. Of these, 7 were inoperable due to
severe pulmonary arterial hypertension or AV valve regurgitation and their mean age at diagnosis
was 2.5 years. Four underwent univenticular repair, whose mean age at diagnosis was 6.1 months.
Overall only 8 of 15 (53%) children with dextrocardia who required surgery could be operated and
are doing well at a mean follow up of 11 manths. Conclusion: Delay in diagnosis leads to poor
outcome in dextrocardia with situs solitus and complex stuctural heart disease, as pulmonary
pressures rise making children inoperable.
CAR/10(P) A CASE OF AORTICO LEFT VENTRICULAR TUNNEL
Renjini, M.Vinod, Sujatha Sritharan, Moorthy, M.L.Vasanthakumari.
Institute of Social Paediatrics, Govt. Stanley Hospital, Chennai
vvsankar@rediffmail.com
11 yr old boy with complaints of palpitations revealed past history of being diagnosed as a case of
congenital heart disease at 4 months of age for which he was put on anti failure medications till
the age of 5 yrs. The child was lost to follow up after five years of age. O/E was found to have
high volume collapsing pulse and features of AR and a systolo diastolic murmur at the second
aortic area on auscultation. Clinically suspected to be a case of Ventricular Septal Defect with
Aortic Regurgitation and was investigated .Echocardiography showed non valvular AR with no
evidence of VSD. Further investigations with 64 slice CT scan showed AORTO LEFT
VENTRICULAR TUNNEL, a rare diagnosis. So far only less than 200 cases have been reported.
Child referred to cardio thoracic surgery and underwent patch closure of the aortic end of the
tunnel, direct closure of left ventricular end and external plication of the external canal.
CAR/11(O) PERI-CONCEPTIONAL FOLIC ACID IN PREVENTION OF CONGENITAL
HEART DISEASES
Praveen. S. Lal, K.E Elizabeth, Zulfikar Ahamed, N.R Preethi, M.R Pillai
PNRA B-3, Sreepatham, Pongummoodu Medical College, Post Thiruvananthapuram-695011
mallu99@rediffmail.com; praveenslal99@gmail.com
Introduction: Congenital heart disease (CHD) occurs in 0.5-0.8% of live births. Peri-conceptional
intake of folic acid reduces the incidence of neural tube defects (NTD), one of the most common
birth defects, by more than 50%. Recent studies suggest that impaired serum folate, vitamin B12
status and elevated homocysteine may also be associated with CHD. Aims & Objectives: To study
nutritional status and the serum levels of vitamin B12, folic acid and homocysteine in children
with CHD and their mothers and compare with control children and their mothers.To determine
the frequency of known polymorphisms of folate metabolizing enzymes (MTHFR , MTR ,
MTRR) in children with CHD and their mothers and compare with controls and to correlate the
results with risk of CHD. Materials & Methods: This case-control study included 100 subjects;
25 children with congenital heart disease and their mothers as cases and 25 normal children and
their mothers as controls. Blood samples collected from subjects were used for analysis of serum
folate, vitamin B12, homocysteine and DNA polymorphisms (MTHFR,MTR,MTRR) of folate
metabolizing enzymes. The statistical analysis was done by using SPSS 10.0 package. Results:
Majority (72%) of children with CHD had varying degrees of malnutrition and their dietary intake
was inadequate. Serum folate was found to be low in 44% of children with CHD whereas serum
vitamin B12 levels were low in 8% of children. Serum homocysteine levels were high in 48% of
children with CHD. Similar patterns were observed in mothers of these children. Among the
controls 20% had low serum folate, 12% had low serum vitamin B12 and 68% had high serum
homocysteine. Presence of MTHFR 677 polymorphism was statistically significant in children
with CHD and their mothers whereas polymorphisms of MTHFR 1298, MTR, MTRR was not
statistically significant. Significant polymorphisms were not observed in controls.
Supplementation of folic acid is known to overcome the polymorphisms of folate metabolizing
enzymes and prevents its sequelae. Conclusions: There is a need for assessment of nutritional
status of children with CHD and special nutritional intervention appropriate for age should be
instituted for these children. In view of the higher incidence of low folate, high homocysteine and
MTHFR 677 polymorphism in children with CHD and their mothers, peri-conceptional folic acid
supplementation may be recommended for primary prevention of CHD along with NTD.
CAR/12(P) A CASE OF AORTICO LV TUNNEL
Pragadeeswari, Ranjini
Institute of Social Paediatrics, Govt. Stanley Hospital, Chennai
dr_appu25@yahoo.co.in
11 yr old boy with complaints of palpitations revealed past history of being diagnosed as a case of
congenital heart disease at 4 months of age for which he was put on anti failure medications till 5
yrs of age .The child lost followup after five years of age. O/E was found to have high volume
collapsing pulse and features of AR and a systolo diastolic murmur at the second aortic area on
auscultation. Clinically suspected to be a case of VentricularSeptalDefect with
AorticRegurgitation and was investigated .Echocardiography showed non valvular AR with no
evidence of VSD. Further investigated with 64 slice CT Scan which showed AORTO LEFT
VENTRICULAR TUNNEL,a rare diagnosis. Child referred to cardio thoracic surgery and
underwent patch closure of the aortic end of the tunnel,direct closure of left ventricular end and
external plication of the external canal.
CAR/13(P) TO STUDY COMPLIANCE AND FACTORS AFFECTING COVERAGE OF
SECONDARY PENICILLINE PROPHYLAXIS AMONG RHEUMATIC HEART
DISEASE CHILDREN.
S. Phuljhele, N. L. Phuljhele, Atul Dutt, Shashi Kapoor
A-59 Parshuram Nagar, Behind Mining Office, Telibandha Ring Road, Raipur 492001
drkumararun_1982@yahoo.com
Introduction ;- Acute rheumatic fever is autoimmune consequence of infection with group A
streptococcus . it causes acute generalized inflammatory response and illness that selectively
affects the joints heart, joint, brain and skin. secondary prevention requires identification of those
who had rheumatic fever or have RHD. Once identified the patient needs injection of benzathin
penicilline given once in 2-3 weeks. Aims and objectives.- To study compliance and factors
affecting coverage of secondary prevention strategy of penicilline prophylaxis among rheumatic
heart disease children. Material and methods Prospective cohort study conducted in department of
pediatrics, Pt. J.N.M Medical College & Dr B R Ambedkar Memorial Hospital Raipur(CG) during
period from 1st September 2006-31st august 2008. Selection of cases . new & follow up cases of
RHD. Exclusion criterion ;- Inadequate data, patient expired during follow up. Total 120 patients
were randomly enrolled. Data regarding penicilline prophylaxis and different environmental and
social factors affecting the preventive strategy were collected from hospital records in follow up
cases and history in case of new cases. Results .;- We found that only 7% children were taking
regular penicilline prophylaxis after every 3 weeks while 9% children took penicilline prophylaxis
erratically and missed doses during follow up period. About 84% of RHD children never taken
penicillin prophylaxis . Conclusion ;- The most common reason cited for not taking penicilline
prophylaxis was long distances patient had to travel every 3 weeks for receiving penicilline
prophylaxis. Moreover low level of eduction and reluctance of periphery doctors to inject
penicilline for risk of sever anaphylactic reaction.
CAR/14(P)
ELECTROCARDIOGRAPHIC
AND
ECHOCARDIOGRAPHIC
EVALUATION OF CARDIAC STATUS IN MALNOURISHED CHILDREN.
S.Phuljhele, N.L. Phuljhele, Y. Saratiya, V Kurrey, S Suryvanshi, R Sheohare.
A-59 Parshuram Nagar, Behind Mining Office, Telibandha Ring Road, Raipur 492001
drkumararun_1982@yahoo.com
Introduction ;- Earlier concept that heart is spared in malnutrition have been shown to incorrect.
The present study was undertaken to know functioning of heart in severely malnourished children
as reflected by electrocardiographic and echocardiographic changes. Aims and objectives.- To
study various ECG and ECHO changes in severely malnourished children of PEM III & IV(15yrs age). Cardiac factors leading to morbidity and mortality in malnourished children. Material
and methods;- study is conducted in department od pediatrics Pt J N M Medical College and Dr
B R A M hospital Raipur. C.G. Inclusion criterion -children with grade III & IV malnutrition
were taken for study.cases Exclusion criterion - children with hemodynamic instability, preexisting cardiac lesions and severe anemia. In all patients complete physical examination and
anthropometry were assessed. ECG and echo were analyzed by standard percentile unit. Results
.;- Out of 94 cases 68% belong to grade III and 32% belongs to grade IV PEM. In ECG changes
decrease PR interval with prolongation of QTc, decreased amplitude of QRS and flattening of T
waves were observed. These changes were more in grade III than grade IV PEM. On echo left
ventricular end diastolic and inter ventricular end diastolic dimensions, left ventricular wall
thickness and ejection fraction were significantly reduced below 3rd percentile (p<0.001) in
relation to body surface area. Cardiac output is reduced to 0.8L/min Conclusion ;- In this study
we concluded that in malnutrition there is definite alteration in cardiac dimension, contractility,
ejection fraction. Therefore prior to management of malnutrition one should evaluate cardiac
status to avoid further management of related cardiac complication.
CAR/15(O) POLYSPLENIA SYNDROME: A LEFT ATRIAL ISOMERISM
Payal Shah, Manish K Arya, A.D. Rathod, Yogeeswari
Dept. of Paediatrics, Grant Medical College And Sir J.J. Hospital, Mumbai - 8
manjioo7@yahoo.co.in
Introduction: Polysplenia is a heterogeneous disease that is characterised by complex congenital
heart disease, multiple splenic tissues, bilateral bilobed lungs, symmetrical liver,intestinal
malrotation and billiary atresia. Case Report: , 3 ½ month old infant , BONCM, admitted for
increased respiratory activity, increased precordial activity and suck rest suck cycle since 1 ½
months. He also had bluish discolouration of lips and nails since 20 days. Birth and family
history was normal. On examination child was conscious, afebrile, tachycardic and tachypnic with
central cyanosis. CVS exaination showed apex beat in 5th left ICS lat to MCL with Epigastric
pulsation, Parasternal heave and Diastolic shock were present. S1 was normal and S2 was loud
and without split with pansystolic murmur grade 3/6 in left 3rd parasternal area. Liver and
spleen were not palpable. So diagnosis of congenital cyanotic heart disease was considered. Chest
x-ray showed cardiomegaly with biventricular hypertrophy. ECG showed biventricular
hypertrophy with right axis deviation with p- axis in superior quadrant. USG abdomen was not
able to visualise spleen on left side. 2- D ECHO was suggestive of LEFT ISOMERISATION with
bilateral SVC, DORV and SUBAORTIC VSD. CT ANGIO showed systemic venous drainage
into left atrium, pulmonary Vein drainage into right atrium, bilateral SVC with left sided aortic
arch. It also showed Heterotaxia of abdominal organs like polysplenia on right side, central liver ,
gall bladder and stomach on right side. So patient was managed for congestive heart failure and
referred for cardiac surgery.
CAR/16(P) BILATERAL ATRIAL MYXOMA –CAUSE OF RECURRENT CARDIAC
ARREST
Manish Arya, Payal Shah, A.D. Rathod, Ganesh Jewlikar
Dept.of Pediatrics, Grant Medical College And Sir J.J. Hospital, Mumbai-8
manjioo7@yahoo.co.in
Case Report: 5 months old boy ,BONCM, admitted with complaints of increased precordial
activity and increased respiratory activity since birth. Patient had repeated episodes of lower
respiratory rract infection and failure to gain weight since two and half months of age requiring
hospital admission thrice for the same. Patient had no history of cyanosis and cyanotic spell. Birth
history was normal. On examination child had wasted and stunted growth. He had microcephaly
but no dysmorphic features. He had tachycardia and tachypnoea with chest indrawing. Child had
pallor but no cyanosis. On CVS examination heart sounds were normal with middiastolic murmur
in mitral area. He had bilateral crepts. Child was treated for lower respiratory tract infection. In
the picu child developed sudden cardiac arrest three times in a span of 15 days requiring
adrenaline and mechanical ventilation. Episodes were transient and child was fine after the
episodes.CXR showed cardiomegaly with ECG showed biventricular hypertrophy with no rythm
disturbances. 2D ECHO showed 3.3 * 1.9 cm pedunculated tumor attached to IAS near attachment
of septal mitral leaflet, popping in and out of left ventricle inflow s/o Myxoma. There is another
sessile mass in right atrium arising from IAS S/O Myxoma. Excision of left atrial myxoma done
for the patient and child is doing well. So bilateral atrial myxoma was considered as a cause of
recurrent cardiac arrest. Atrial myxoma causes symptoms by mechanical obstruction which may
result in syncope and sudden cardiac arrest.
CAR/17(O) COMBINED INFLUENCE OF BODY MASS INDEX (BMI) AND WAIST
CIRCUMFERENCE (WC) ON CORONARY ARTERY DISEASE (CAD) RISK FACTORS
AMONG CHILDREN AND ADOLESCENTS.
Srivastava P, Tripathi V.N., Singh Rupa .D, Verma CM
Department of pediatrics L.L.R. & Associated Hospital,GSVM Medical College, Kanpur
coolprit1982@gmail.com
Objective : To assess the Clinical utility of using BMI in combination with WC to identify CAD
risk factors(lipid profile) amongst the overweight/ obese children and adolescent. Methods : A
cross sectional survey of CAD risk factors was done in children and adolescents between 4-18yrs
of age attending out patient department in LLR and Associated Hospital and from public schools
in Kanpur city. A total of 2570 subjects were screened,out of which 610 children of both sex were
selected for the study.BMI & WC were used as continuous variables to predict CAD risk factors
independently.Then the combined effect of BMI & WC were used to detect CAD risk factors in
the same group. Total study population were divided in three groups :(A)with high BMI & WC
both,(B)with high BMI alone and (C) with high WC. Result :.CAD risk factors were compared
with each groups.For example, for serum cholesterol, in gr A 74 out of 185, in gr B 90 out of 410
& in gr C 63 out of 185 had increased cholesterol. Applying Fisher Z test for testing the
proportion difference between two groups ,we had found that there were significance relation
between gr A &B (p<0.001)and between gr A&C(p<0.001). Conclusion : These findings provide
some evidence that a combination of BMI and WC may be used in clinical settings to evaluate the
presence of elevated CAD risk factors amongst children and adolescents.
CAR/18(P) SCREENING OF LIPID PROFILE IN HIGH RISK CHILDREN
Somashekhar Chikkanna
somashekharc123@gmail.com
Introduction: Cardiovascular disease is the leading cause of death and morbidity in the
world.Most of the clinical burden of CVD occurs in adulthood and there is an important genetic
component to the disease process . Aims and Objectives: To screen cholesterol in high risk
children aged 2-10 years whose parents had premature coronary heart disease, diabetes,
overweight, obesity and high blood pressure. Materials and Methods: Case- Child with family
history of premature coronary heart diseases, diabetes, hypertension,overweight & obesity.
Controls- The next child (age and sex matched) with no family history of premature coronary
heart diseases, diabetes, hypertension, overweight & obesity. Sample Size- A pilot study was
done in 80 children in each group Method of Study- Group A includes cases and group B includes
age and sex matched controls in the age group of 2 to 10 years. Difference between the two groups
will be compared and tabulated using unpaired student t test Results- Mean total cholesterol levels
(TC) and low density lipoprotein cholesterol (LDL) were significantly higher in Group A as
compared to Group B. The absolute values of HDL,TG`s and VLDL in Group A children were
within the normal range for age.The most common being elevated combined total cholesterol and
LDL. Abnormal Total Cholesterol level and LDL were present in 20% and 14%, respectively in
the children of this group. Conclusions- We conclude that high risk children have significant
incidence of dyslipidemia compared to age matched controls.All high risk children should be
screened for dyslipidemia
CAR/19(P) PERCUTANEOUS DEVICE CLOSURE OF ATRIAL SEPTAL DEFECTS IN
CHILDREN <5 YEARS.
Krishnamoorthy KM, Sivasankaran S, Titus T, Bijulal S, Ajithkumar VK, Harikrishnan S,
Namboodiri KKN, Tharakan JA.
Dept. of Pediatrics, Sree Chitra Tirunal Institute for Medical Sciences and Technology,
Trivandrum
kmkm@sctimst.ac.in
Introduction: To study the feasibility and results of percutaneous device closure (DC) of secundum
atrial septal defects (ASD) in children <5 years. Objectives: Patients with ASD were accepted for
DC after transthoracic echocardiography. During DC, ASD was assessed by balloon sizing in the
earlier period and later by transesophageal echocardiography. Morphology and haemodynamics of
ASD, success and complications were assessed. Results: Among 605 patients who had DC in the
last 10 years, 95 were <5 years (15.7%). 59 were girls (62%). Mean age was 4.49+1.5 years (range
1.5-5, including the youngest in literature). Mean weight was 13.7+5.6 kg (range 6-22). Multiple
ASD was noted in 6 patients prior to and 3 others during DC. DC was successful in 86 (91.6%).
Defect size was 13.4+4.6 mm (range 7-20). Mean pulmonary artery pressure was 22.1+7.9 mm Hg
(range 12-46). Mean left to right shunt was 1.94+0.64 l/min (range 1.4-3.5). Mean device size was
14.7+5.2 mm (range 8-22). Associated patent ductus arteriosus was closed by coil in 2 and device
in another. Elective surgery was required in 9 patients (9.4%) due to improper device position
(n=4), inadequate rims (n=2) and multiple defects (n=3). There were no major complications. 82
patients (95.3%) had immediate closure. Abolition of residual shunt and right ventricular
regression was seen on follow-up of 3.2+4.1 years (range 6 months-9 years). None developed
atrioventricular block. Conclusion: Percutaneous DC of ASD is a safe and effective option in
carefully selected children <5 years. Size of the child is not a contraindication.
CP/01(P) KNOWLEDGE AND ATTITUDE OF FATHER TOWARDS INFANT FEEDING
Ritu Gupta, Ravinder K. Gupta
136, Child Care Centre, Nai Basti Jammu Cantt. (J&K) 180003
riturgjammu@indiatimes.com
Objective: To asses knowledge and attitude of father towards infant feeding at the time of birth of
first child. Design: Prospective study Setting:Pediatric Clinic Methods : About 200 fathers were
interviewed using a pre structured questionnaire within 48 hours of delivery of their first child.
The education status, occupation, type of family type of delivery and details and antenatal care
were recorded. The fathers were asked about the knowledge regarding type of first feed, timing of
first feed, frequency of feeds required, duration of breastfeeding, time of introduction of solid
foods and contraindications of breastfeeding. Results : There were 95 (47.5%) fathers who had
education upto matric while 70 (35%) were graduates and 35 (17.5%) were postgraduates. About
36% fathers belonged to nuclear families. The majority of mothers (93%) had adequate and
regular antenatal check ups and about 84% fathers had accompanied their wives. About 36%
fathers were aware that colostrum should be given to the babies’ immediately after birth and they
tried for it despite resistance from elders. When asked about the knowledge of time of first feed
i.e. within 1st hour of birth, only 41% had correct knowledge. The timing of first feed varied from
2 hours to 3 days. The reasons cited were: mother’s comfort, concept that milk production is
delayed or the baby is unable to suck immediately after birth. About 32% fathers believed in
scheduled feeding and 28% knew about demand feeding while rest did not have any knowledge.
Maternal illness was considered to be a relative contraindication of breastfeeding by 27% fathers.
Formula milk and diluted animal milk were considered to be given to babies along with
breastfeeding by 27% and 39% fathers respectively. Only 23% fathers had knowledge that
adequacy of breast feeding in judged by weight gain and passage of adequate urine. The mean
duration for breast feeding was 16 months (3m – 30 months) with correct duration of 24 months
revealed by only 31% fathers. Timing of complementary feeds ranged from 4 months to 2 years
with only 32% saying that they should start semisolid feeds by 6 months. The knowledge of type
of supplementary feeds were –home made (26%), formula (28%), both (30%), and no knowledge
(16%). The knowledge and attitude regarding breastfeeding and complimentary feeding did not
correlate with education, type of family, antenatal checkup or type of delivery. Conclusion: The
father’s knowledge regarding infant feeding in many aspects and efforts is lacking. They need to
improve their knowledge through education and counseling for successful implementation of
exclusive breastfeeding for 6 months and introduction of complimentary feeding after 6 month.
This will definitely go a long way in decreasing malnutrition, morbidity and mortality in children.
CP/02(P) DOMESTIC INJURIES DURING INFANCY
Ravinder K. Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences and Hospital
(ASCOMS), Sidhra, Jammu. (J&K) 180017
drrk_gupta2000@yahoo.com
Objective: To study various types of injuries encountered during infancy at home.Design:
Prospective study Setting: Pediatric Clinic Methods and Subjects: The study was conducted at a
Pediatric Clinic from Jan. 2008 to Dec.2008. Two hundred infants who had sustained different
types of injuries at home were considered for the study. The mothers were interviewed thoroughly
regarding age, sex, family size, educational status etc. Detailed information in respect of
circumstances (time and place), activity of infant at the time of injury, nature of injury and its
immediate consequence were obtained. Health education regarding preventive aspect was
imparted. Results: There was significant male preponderance (M: F=1.5:1). There were 10
neonates. Sixty percent of infants belonged to nuclear families. About 35% mothers were
graduates, while rest had education up to higher secondary. Fifty four percent were working
mothers. The most common injury was due to fall (60%). The fall was from walker (37.5%),
furniture / bed (27.5%), stairs (20%), tricycle (7.5%), attendant’s lap (7.5%) etc. Toys, sharp
edged instruments like knife, scissors, safety pins, pen / pencil etc were responsible for about 29%
injuries. Burns / scalds and electric burns were seen in 11% of children. Out of 120 children who
had history of fall, 55% had sustained trauma on scalp in form of hematoma, 25% had lacerated or
incised wounds on various parts of the body, 15% had fractures of bone at various sites. Out of the
58 child who had suffered injuries because of sharp edges instruments, majority (80%) had incised
or lacerated wounds on various sites, while rest had puncturing wound or hematoma. Out of 10
neonates 3 babies had scalds because of steam inhalation, 3 had fallen from the lap of attendant, in
2 neonates hot oil was instilled in the ears and rest 2 had eye injury because of application of
surma. About 34% parents consulted the treating doctor within first hour, while 44 % took about 3
to 12 hours and rest took their babies for treatment after 12 hours. Local wound treatment included
washing the wound with water, application of ice/ warm object, application of turmeric, mustard
oil and facial creams. Majority of injuries occurred between 9:00 AM to 9:00 PM especially when
infants were busy in playing. Conclusion: Home related injuries during infancy are quiet common.
Short family size and working parents are major contributing factors in causation of injuries. Fall
is quiet common. Toys too can cause problems. Health education regarding preventive aspect
should be imparted by the pediatricians.
CP/03(P) MORBIDITY PATTERN OF UNDER FIVE CHILDREN LIVING IN SLUMS
Ritu Gupta, Ravinder K Gupta
Child Care Centre, 136, Nai Basti, Jammu Cantt. Jammu, (J&K) 180003
riturgjammu@indiatimes
Objective: - To find out the morbidity pattern in under five children living in slum areas.
Design: - Prospective study Subjects and methods: - This study was conducted over a period of
two months (June –July 2009) . About 300 under five children living in different slum areas were
examined in detail. After obtaining detailed history, a thorough general physical and systemic
examination was conducted. Necessary base line investigations were also performed and specific
treatment was given. Health education to the parents was also given. Results: - Sixty two percent
of the subjects had grade I and II malnutrition as per IAP Classification, while 12% had grade III
and 7 % had grade IV malnutrition. Two percent children had features of kwashiorkor. About
19% children had normal nutritional status. Vitamin D deficiency features were seen in 46%
children followed by Vitamin B deficiency (17%) and Vitamin A deficiency (11%). Moderate type
of anemia (Hb—7-10 gram %) was evident in 28% children, while severe anemia (Hb<7 grams
%) was seen in 13% children. Dental caries was seen in 24.3% children. Among various
respiratory disorders, upper respiratory tract infection (adenoids, tonsillitis, phrayngitis, etc.),
bronchitis, bronchial asthma and pneumonia were seen in 39%, 21%, 13.3% and 3.3% children
respectively. Pyoderma (21%), scabies (13%), ring worm infestation (6%) and eczematoid
dermatitis (3.3%) were skin ailments. Acute diarrhea (29.3%), pain abdomen (18.3%), vomiting
(10.3%) and chronic diarrhea (3.3%) were common GIT ailments. There was history of passage of
worms in stools in 23% children. Five percent children showed features of UTI while 2.3 % had
seizure disorder. Immunization was incomplete in majority (61%) of the children; however BCG
scar was present in all the children. Conclusions: - Proper health facilities should be provided to
the children living in slums. Parents should be imparted health education so that early intervention
in the management of childhood illnesses can be done in order to reduce the morbidity load in the
slum areas.
CP/04(P) DEMOGRAPHIC PROFILE OF THE CHILDREN SUFFERING FROM
TUBERCULAR DISEASE
Devendra Sareen, K.K. Agarwal, Dharam Singh, Nitin Goyal, Jitendra Jain, Umang Upadhyay,
Mahesh Upadhyay
C/o: Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, UDAIPUR-313 001
drsareen@yahoo.com
A major fraction of our population is constituted by infants and children. Tuberculosis is still a
major health hazard in them. The present study was planned to determine the demographic profile
of the tubercular disease in children. For this study 100 children suffering from tuberculosis were
selected and were subjected to detailed physical examination and were asked in details about their
environmental surroundings, socio economic status and conditions of housing. All the
observations were recorded in printed performa and data analysis was done. We observed that
(74%) of them were tribal and (58%) were males. Most of them were below the age of 5 yrs.
(82%). Regarding their nutritional status 74% of them were malnourished and only 26% were
healthy 48% of them were suffering from severe grade of malnutrition. Regarding literacy of the
parents only 29% had literate parents and majority 71% of the parents were illiterate. It was
interesting that 76% of them belong to socio-economic class and 68% of them were living in over
crowded areas. The environmental condition were unsatisfactory in vast majority (78%) of them.
The poor disposal of sewage was in 72% of them. They hygienic conditions were poor in majority
(76%) of them.Hence, we must improve the environmental conditions and surroundings of the
tribal population specially the lower income group, because they are more prone to develop a
killer disease like tuberculosis. This will help us to bring down the morbidity and mortality of
children because of tuberculosis.
CP/05(P) BOTTLE FEEDING: OPINION OF GRAND MOTHERS OF THE UDAIPUR
CITY
Srishti Sareen, Abhishek Ojha, Dharam Singh
C/o: Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, UDAIPUR-313 001
drsareen@yahoo.com
The bottle feeding has been hazardous to the child health. Still it is being used in most of the part
of the community. The grand mothers are the key persons as regards the feeding of the infants and
the children. The present study had been aimed to assess the views of the grand mothers of the
children of Udaipur city. For this study a door to door survey of 100 families was done who were
living in the joint families and had alive grand parents. The grand mothers were taken into
confidence and were asked about the concept of the bottle feeding. Their views were recorded and
data analysis was done. It revealed that 63.0% of them were in favour of bottle feeding. Majority
of them were of view that it leads to more milk consumptions by the child (49%). Child gets
satiety (41%) it is helpful for the working mothers (38%), mothers do not get weak (33%) and
that it is less time consuming and mother gets more spare time for the family (30%). They over
weighed its use over its disadvantages. Only 37% were of opinion that bottle feeding is harmful to
the child as it may cause diarrhoea (31%), habit forming (29%), other infections (23%), costly
(21%), would decreased the lactation in the mother (19%) and is difficult to sterilize (18%).
Hence, we must educate the target group of the family that is grand mothers about ill effects of the
bottle feeding and beneficial effects of the breast feeding. Than only we shall be able to
strengthen our motive of exclusive breast feeding.
CP/06(O) KNOWLEDGE, ATTITUDE & PRACTICE OF MOTHERS OF UNDER 5
CHILDREN WITH DIARRHOEA WITH SPECIAL EMPHASIS ON IRRATIONAL
DRUG USE
S. Kundagrami, P. Mishra, L. Das, N. Mohanty
sumana_kundagrami@yahoo.com
Introduction: Diarrhoea being among the top three killers of under 5 children, the current study is
an effort to find out the knowledge, attitude and practice (KAP) of mothers of such children with
diarrhoea so that misconceptions could be clarified and correct practices encouraged. Aims &
Objectives: To study the KAP of mothers of under 5 children in this region regarding diarrhoea
and socio-epidemiological factors affecting them with special emphasis on irrational drug use.
Materials & Methods: 300 mothers of under 5 children admitted to SVPPGIP were subjects of
study and were interviewed by direct questionnaire method. Design of Study: It’s an observational
hospital based study over a period of 6 months i.e. April to September, 2008. Results &
Observations: Although 100% of mothers had knowledge about ORS, 50% had correct idea about
its preparation. 10% of mothers wrongly believed that glucose water etc are ORS equivalents.
While 60% of mothers felt that ORS is the cornerstone in diarrhoea management, 40% still
practised use of over the counter drugs. 62% of mothers were aware of some danger signals while
38% couldn’t comment at all and none mentioned about decreased urination as an important
parameter. 36% of mothers only knew about protective role of breast feeding, 44% knew that
measles vaccine is protective while only 10% knew about rota-virus vaccine. Although 60% of
mothers were aware of the beneficial role of proper sanitation, 38% of rural mothers practised
open field defecation and 6% used community toilets. Proper hand washing by mothers and
children was practiced by 28% of rural mothers as against 98% of urban mothers. 60% were
against bottle feeding while 40% supported it. Review of the prescriptions available with the
mothers revealed irrational use of antibiotics (Parenteral/oral) (90%), antisecretory (40%) and
antimotility (20%) drugs. Conclusion: Urban literate mothers were better informed and had better
KAP than their rural counterparts. Despite 70% of mothers being educated, only 50% knew about
correct preparation and usage of ORS, few knew about protective role of breast feeding and none
knew about post-diarrhoeal nutritional rehabilitation and decreased urination as an important
danger sign. Since irrational use of various drugs in diarrhoea is highly prevalent in clinical
practice, judicious approach from health personnels is warranted. Therefore, female literacy,
sanitation, health education system should be improved and strengthened and our injudicious
malpractices stopped to decrease the burden of diarrhoea and reach goal of “child survival –
nation revival” !
CP/07(P) A STUDY OF FACTORS PREDISPOSING YOUNG CHILDREN TO BECOME
A STREET CHILD
Abhishek Ojha, Srishti Sareen, Dharam Singh
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
Street children are a burning problem of our country. This study had been planned to study the
role of various factors responsible for making the children to become a street child. For this study
200 child labourers were selected in and around Udaipur city. After obtaining a detailed history
regarding family, environmental factors and schooling. a detailed physical examination of each
child was done. All factors compelling the child to adopt child labour were studied in detail and
data analysis was done. We observed that the factors which were responsible to predispose a child
to adopt child labour being poverty (53%), illiteracy of parents (51%), large families (39.5%), lack
of interest in studies (20.5%), no schooling or delayed schooling (17.5%), maltreatment by parents
(14.5%) or teacher in school (12%), dispute among parents (8%), wrong advise by friends (7.5%),
dispute with other family members (7%) and step parents (6%). We must take care of these factors
and try to provide a healthy environment to the young children so that they are not prone to
become a street child in subsequent life.
CP/08(P) BEHAVIOURAL PROBLEMS IN DESTITUTE CHILDREN OF UDAIPUR
Nitin Goyal, Abhishek Ojha, Devendra Sareen
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
Behavioural problems are being encountered in growing children. Present study had been planned
to screen 200 destitute children of Udaipur between 6-18 yrs. of age living in hostel for
orphanages. All the children were interviewed with the help of pre-set questionnaire. Behavioural
problems were assessed in details with the help of warden of the hostel. The data analysis was
done. We observed that disobedience was the commonest behavioural problem (24%) followed by
lying (21%), temper tentrum (20%). 15% of them had problem of nocturnal enuresis. Other
common behavioural problems being stuttering (13.5%), poor appetite (12%), pica (11%), teeth
grinding (10.5%), thumb sucking (9.5%), night terror (8%) and school phobia (7.5%).
Disobedience was more common in 12-18 yrs. age group. Lying and night terrors were more
commonly observed in female children. Boys were commonly suffering from nocturnal enuresis
and school phobia. It is recommended that steps should be taken for regular screening of these
children for behavioural problems. They should be provided a feeling of security, formal
education and proper guidance. Early management will enable us to overcome these problems of
destitute children.
CP/09(O) KNOWLEDGE AND PRACTICES REGARDING UMBILICAL CORD CARE
IN RURAL WOMEN IN JAMMU.
Sanjeev kumar Digra, Varun Kaul, Rajesh Kaul, Sandesh Ganjoo
Lecturer. Deptt of Pediatrics, SMGS Hospital, Govt. Medical College, Jammu
sanjeevahsaas@yahoo.co.in
Introduction:- The umbilical cord is the lifeline of the fetus and neonate in the first few minutes
after birth. Care of the cord and stump in the immediate neonatal period varies according to social,
cultural, economic and geographical factors. Disseminating the knowledge regarding sterile
cutting, tying and post natal care of the umbilical cord may prevent serious diseases such as
tetanus neonatorum, umbilical sepsis and portal hypertension as a long term sequelae. Care of the
umbilical cord may be poor in babies born at home in rural area where most of the deliveries
happen unsupervised. Aims and Objectives:- To assess the Knowledge and Practices regarding
umbilical cord care in rural women in Jammu. Material and Methods:- 300 women in the age
group of 20- 40 years were interviewed at two medical camps organized by a local NGO in
Bhalwal block of Jammu region, J&K state between March 2009 and June 2009 and information
was obtained regarding their knowledge and practices regarding umbilical cord care and was
recorded on a pre-tested proforma. Results: Out of 300 women interviewed 50% of women did
not know what to use to cut the cord while 30% of them advocated the use of blade and the rest
suggested a knife or a scissor for the same. For tying the cord a cotton thread, bandage and a cord
clamp were suggested by 65%,5% and 5% women respectively while rest of the 25% did not
know what to use. As regarding the post natal care of the umbilical stump, 50% women advocated
the use of blue dye (triple dye) while 20% advocated ghee or oil application and 15%,10% and
5% suggested the application of crushed clove/Jaiphal, some antiseptic ointment and spirit
respectively.60% mothers favoured the daily cord painting till the cord falls while another 20%
advocated the same for two weeks and the rest favoured for three to four days. 80% mothers
believed that the cord is a painful structure and were afraid of handling it. Conclusion: The present
study shows that the knowledge and practices regarding cutting, tying and post natal care of
umbilical cord is markedly poor in the rural women of Jammu region and efforts are needed to
educate them regarding the proper and safe umbilical cord care.
CP/10(O) EFFECT OF PSYCHO-SOCIAL FACTORS ON JUVENILE DELINQUENCY :
STUDY FROM AN OBSERVATION HOME OF SOUTHERN ORISSA.
Ipsita Mishra, Lalat Barun Patra, Niranjan Mohanty
Department of Paediatrics, SCB Medical College & SVPPGIP, Cuttack.
ipsita_mishra1981@yahoo.co.in
Introduction : Juvenile delinquency is a social malady as it leads to established criminality in
adulthood. The factors for their causation are many and varied, starting from bad family
influences, broken family, poverty etc. Nevertheless care of these children shall reduce the daring
criminal adults in the society. Aims & Objectives : Present study was done to find out prevalent
sex and age group of juvenile delinquents, categorise their offences and correlate different factors
influencing their crime. Materials & Methods : A retrospective study of 3 years was done in an
observation home of Southern Orissa, taking the juvenile delinquents in the age group of 10-18
years. Results : Present study included 916 juvenile delinquents. Male : female ratio was 13:1.
Highest number of cases (36.5%) occurred in the age group of 12-14 years. Theft contributed to
53.7% followed by, burglary (23.4%), dacoity (15.7%), murder (3.5%), rape (2.4%) and drug
trafficking (1.09%). Poor socio-economic status, lack of parental care, broken homes and illiterate
parents contributed as major social provoking factors. Poor performance in own life, low level of
education, bad company were the major self provoking factors. Candidates(8.1%) committing
serious offences seemed to have no regrets for their crime. Conclusion : Increasing trend of serious
offences like rape, murder, drug trafficking amongst adolescents warrants emphasis on
sensitization and reformation of their thought and attitudes by behavioural and psychotherapy.
Environmental conditions and level of basic education standards need to be improved for
decreasing juvenile crime in society.
CP/11(P) PSYCHOSOCIAL IMPACT OF ONE CHILD NORM FAMILY
K. Trimal Subudhi, Bibhu Prasad Nayak, N.Mohanty
PG Dept. of pediatrics.SCB medical College, Cuttack
ktsubudhi_scb@yahoo.co.in
Intrduction : In India population explosion has become the major problem endangering all
infrastructure and socioeconomic development day by day. There should be coordinated and
integrated approach reaching the target couples to adopt small family norm.
Objectives: To analyse psychosocial impact and the perceptions of the parents adopting one child
norm family. Material & Methods: Cross sectional Community based house to house study taking
160 families who have one child either 1)with adoption of permanent method of family planning
or 2) temporary methods for >10 years without any intention for second child. Standard
questionnaire method was used for father,mother & child independently. Results: Out of all
families (n=160) ,74 % parents were minimum graduate or post graduate or professionals. In 148
families(92%) adopted temporary methods for birth control & only 8% adopted permanent
methods.Self motivation was observed for adopting single child in 86(53.75%) fathers and
majority of females are motivated by their husbands. 63% parents opined that literacy is the main
factor to control population growth. Adopting single child norm, the no. of boys and girls were
92(57.5%) & 68(42.5%) respectively showing that sex selection was probably not a major
concern.70% children had very good academic performance.55% of children responded that their
loneliness could have been solved by joint family and 57.5% children wanted another sibling to
give company. Conclusion: If we consider population explosion is the major determinant
impeding the progress of our country it is high time for us adopting either two children family
norm strictly by law or one child family by choice. Then our slogan should be “HAVE ONE,
ADOPT ONE” so that the problems related to orphan, unwanted and street children can be better
solved.
CP/12(O) HOW MUCH AWARE ARE OUR TRIBAL MOTHERS REGARDING
BENEFICIAL EFFECTS OF COLOSTRUM?
Devendra Sareen, D.K. Sharma, Dharam Singh, Umang Upadhyay, Mahesh Upadhyay
Jitendra Jain, Deepak Tak
27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Udaipur is surrounded by tribal belt all around. The tribal have different customs and habits. The
present study had been planned to assess the knowledge of the tribal lactating mothers regarding
beneficial effects of colostrums. For this study 200 tribal lactating mothers were selected living
around Udaipur city. They were taken into confidence and were asked about their attitude towards
colostrum in form of simple question-answers. The observations were recorded and were
subjected to data analysis. It was observed that only 29.5% of mothers were using colostrum with
the belief that it keep child healthy (14.5%), provide satisfaction to mother and child (9.5%)
increases resistance power of the child (4%) and opinion of the elders (1.5%). On contrary, 70.5%
of the mothers were in favour of discarding colostrum with the belief that it is dirty (17%), causes
sickness in new born (14%), harmful to mother (12.5%), traditional view (11%), not easily
digestible by the new borne (10%) can cause diarrhoea (3.5%) and opinion of relatives (2.5%).
Hence, we must impart the knowledge of beneficial effects of colostrum to the tribal population so
that they do not discard it colustrum and their children are not deprived of the beneficial effects of
colostrum so called the 'natural immunization' of children. This would help us in bringing down
the childhood morbidity and mortality
CP/13(P) REHABILITATION OF STREET CHILDREN NEW DELHI, INDIA
Seth R, Qaiyum Y, Keshav R, Mody RC, Gurumani VS & Srivastava RN.
E/10 Green Park (Main), New Delhi - 110016
sethrajeev@gmail.com
Objectives (a) To understand social and psychological aspects of street children in urban slums in
Delhi, (b) How they are impacted by rehabilitation in a shelter home. Material and Methods The
survey used qualitative research methodology. Data was collected during volunteer work at shelter
homes run by Project Concern International (PCI), an NGO, working for marginalized children in
Delhi, over a 9 year period. Rehabilitation shelter homes provide basic needs such as food,
clothes, shelter, education, health and provide protection from exploitation The medical doctor
performed assessment of growth, nutrition, anemia, dental caries, infections and immunizations
once a month for five years. Counseling for substance abuse, sexual/HIV/AIDS and mental health
was done. Street children were selected through purposive sampling in three focal areas of New
Delhi. Criteria for selection to shelter home: (a) Children motivated to leave street, (b) children
little exposure to street (c) commitment to stay free of drugs.Results: 347 street children in the age
groups of 6-18 years, taken off streets. All are attending formal school with extra remedial English
tuition. Major Achievements of the program home- repatriation of 71; vocational training in 64. 34
children are trained in computer skills while 30 acquired competence in job skills like plumbing,
printing, etc. Provision of basic medical healthcare and counseling demonstrated a 50% reduction
in health problems. Conclusion: Poverty is the major cause of the phenomenon of street children.
Pyramid of needs for street children begins with food, shelter, health, immunization, educationformal and/or vocational skills.
CP/14(O) MULTIPLE SOCIAL FACTORS AND THEIR RELATION WITH JUVENILE
DELINQUENCY.
N.L.Phuljheley, Vikas, Shashikapoor Singh.
Dept. of Pediatrics, Pt.J.N.M.Medical College , Raipur
drkumararun_1982@yahoo.com
Introduction;-As soon as the child is born, he takes shelter in home. He lives in a family which
provides a best ground for training in social life to develop himself physically mentally and
culturally. Any faulty, familial environmental, socio-cultural condition could maladjusted the child
and that children are more prone for admission in remand home. Aim and Objectives;- To assess
the multiple social factors and their relation with Juvenile delinquency. Material and Methods;Study setting;- in remand home MANA RAIPUR [CG]. Study design;- cross sectional study.
Inclusion criteria;-All juvenile admitted in remand home MANA RAIPUR. From age groups
between 6-18 years. Study variables;-Prim cause for admission to remand home, Parents status,
Parents occupation, socio-economic status, Sibling position, Parents education, Family size, and
detailed underlying conditions. Out come variables;-Details of family background $ reasons for
admission to remand home. Statistical analysis;-Proportions. Observation & Results;-Out of 40
juvenile 35[87.5%] are delinquent and 5[12.5%] are non delinquent.95% of admitted juvenile are
belong to grade V and VI socio-economic status.70% juvenile had both parents are illiterate. The
incidence of juvenile delinquency was found higher in first, second and third sibling position.70%
juvenile delinquents belong from joint family.30% juvenile delinquents had only single parents.
Conclusion;-Three main reasons responsible for juvenile delinquency Low socio-economic status
Illiterate parents Single parents.
CP/15(P) DERMATOLOGICAL AND DENTAL DISORDERS AMONG RURAL SCHOOL
CHILDREN.
R.A.Sankarasubramanian, T. Nagarajan, G. Madevan. K. Mathiarasan S. Natrajarathinam,
M.Krithiga
Institute of Peadiatrics & Research centre, Madurai Medical College, Madurai -625020
Tamilnadu.
bkchand123@rediffmail.com
Dermatological and dental disorders may be asymptomatic, and hence, need attention. Objective :
To find out the pattern and prevalence of dermatological and dental disorders among rural school
children. Material and methods :Rural school children studying sixth to 12th standard were
evaluated individually by pediatricians and confirmed subsequently by respective specialists.
These children were evaluated to rule out any underlying chronic and immuno-suppressive
disorders. The work was carried out as a part of community out reach programme. The data were
analysed statistically. Results :There were 485 boys and 406 girls. Their age ranged from 10 to 19
for boys and 10 to 18 for girls. The lesions noticed among boys/girls were pustular lesions (5/5),
fungus infection (4/1), hypopigmented patches (4/8), acne (4/2) and allergic rash (3/5). Leprosy
was not detected in any of them. Dental disorders observed among them were carries teeth
(53/45), dental fluorosis (38/22), and bleeding gums (1/1). Some of them had multiple
manifestations.Comments :The over all prevalence of dermatological and dental disorders were
4.6 and 18% in boys, and 5 and 15% in girls respectively, and were independent of gender.
Contrary to one’s expectation, dental disorders were far less among rural children than urban.
Dermatological disorders were more among rural children and could be attributed to their socioenvironmental factors. It is suggested that teachers may be trained to detect abnormalities and
refer to primary care centres.
CP/16(P) MORBIDITY PATTERN IN INFANTS IN TRIBAL BLOCK OF SUKINDA
P. K.Saboth, J. Tripathy
SCM Hospital, Tata Steel, Orissa
psaboth@gmail.com
Introduction: Orissa state has been improving its IMR in the last decades with help of NRHM
program. We have taken this study in sukinda block of Jajpur district. This block has the
advantage of getting health services from NRHM through the block Health department as well
from TATA steel Rural Development society under CSR activity. Aims and Objective : The
present study had been done to find out the morbidity pattern among the infants of the tribal block
of Jajpur district of Orissa. Orissa state has already implemented NRHM and there are ASHA,
AWW and ANM posted in the villages. In addition there are many NGOs working for up -liftment
of health of Mother and children. Materials and Methods: We have done this study based on outreach health camps/mobile clinics in 15 villages and the infants reporting to SCM hospital &
Immunisation clinic. A total number of 735 infants were covered during the period. The infants
were thoroughly examined with recording of their weight and length. The data were entered in
excel sheet and analysis was done. The study period is from May 2009 to 25th September,2009.
Results : It was observed that 70% of the infants reported were older than 6 months of age. Out of
the total infants reported with some ailment, only 30% were exclusively breast fed for 6 months. It
was further observed the 40 % of infants reported with complains of lose motion and fever, 30%
mother came with complain of running nose and fever, about 10% came with complain of
breathless, fever and running nose. About 20% of mother came with complains of only high grade
fever. 5% of infants reported with history of generalized convulsion. The association of skin
infection was observed in 60% of infants and history of worms in stool was observed in 20% of
infants. Only 5 cases of severe malnutrition (IAP Grade IV) were seen. 16 cases were in Grade III
and 240 cases were in Grade II. Rest all the infants were in Grade I. During this period of study
only one case of AFP has been reported and one case of congenital hydrocephalus has reported.
Conclusion: This small study indicates that most of the illness could have been prevented with
only health and hygiene education to the mothers and care takers. We need to put our maximum
efforts for health communication and target the expected mothers in each village for improved
health and hygiene practices.
CP/17(P) TRAINING OF UNTRAINED PARAMEDICAL PEDIATRIC STAFF – AN
INNOVATIVE APPROACH FOR IMPROVING PRIVATE SECTOR PEDIATRIC CARE
BY IAP GUJARAT.
Digant D. Shastri, Nilesh L. Banker, Abhay K. Shah, Satish Pandya
Consultant Pediatrician, Killol Children Hospital, 303, Takshashila Apartment, Majuragate, Surat
-395002, Gujarat
Email: drdigant@hotmail.com
Introduction: Neonates and paediatric patients need highly specialized nursing skills. In India 46%
of inpatients and 81% of outpatients seek medical care in private sector. Majority of private set
ups run with unqualified and untrained paramedic staff, and this can affect the overall quality of
care. Shortage of qualified paramedic personnel in the country and it’s disproportionate
distribution amongst the government and private sectors needs entrusting limited public health
functions to paramedics from the extended health sector after imparting adequate training. Indian
Academy Of paediatrics,( IAP) Gujarat in partnership with the state health authority launched a
innovative project TRUMPPS (Training of Untrained Medical & Paramedical Staff )to impart
structured , curriculum based training in vernacular language to vast pool of unqualified
manpower working in private sector hospitals. Aims and Objectives: Aim and objective of the
project is to orient and equip the unqualified paramedic staff with pediatric nursing skills, overall
improvement in health of children, to consolidate efforts in reduction of infant mortality rate and
under 5 mortality rates through public private partnership. Material and Method: Adhering to
evidence based National program guidelines manual in vernacular language and based on it set of
slides were prepared for paramedic training. In the 1st phase, through 5 Trainers Advocacy
workshops pool of 250 trainers was formed. In 2nd phase district level paramedic training sessions
are conducted by the trained trainers with the help of local network of IAP. Pre and post training
assessments are conducted as a method of evaluation. Results: Total 1200 unqualified paramedics
underwent the training. 82% paramedics had educational level up to higher secondary, 8% partial
college and 10% were graduate or more. Unqualified paramedic support do not have any formal
training in child care, they usually learn by assisting and likely to have several basic gaps in their
knowledge same is evident in pre-test analysis. Test assessment revealed that basic knowledge of
importance of hand washing in neonatal care(32%), signs of dehydration(26%) and universal
precautions(13%) were the poorest and showed significant improvement in post test. Knowledge
about IYCF practices was fairly good( 87-92%) and improved further (94-96%) after training.
Comments: TRUMPPS experience endorses the need of training, the scope of knowledge level
correction, the feasibility of contribution of the professional body and public private partnership in
improving healthy child care practices.
ENDO/01(O) CASE SERIES: ACUTE RENAL FAILURE IN PEDIATRIC DIABETIC
KETOACIDOSIS – A RARE BUT IMPORTANT COMPLICATION
Gautam Ray, Indira Agarwal, Anna Simon, Ebor Jacob, Rajiv Sinha.
Department of Child Health, Christian Medical College, Vellore.
child2@cmcvellore.ac.in ; raygautam_jsr@yahoo.com;
Introduction: Acute Renal Failure (ARF) is an uncommon complication of diabetic ketoacidosis
(DKA), when present it is associated with a much higher mortality. Early recognition and
management of complications (with hemodialysis) is the mainstay of treatment. Recovery
however may be prolonged. We report three children who presented with DKA and subsequently
developed ARF. Case Reports: A 12-year-old girl presented with DKA. In spite of protocol based
management, she developed oliguric ARF (creatinine 4.8 mg/dl) with hypokalemia (2.7 mg/dl),
hypophosphatemia (0.3 mg/dl), and anemia (6 gm/dl). She needed peritoneal dialysis for five days
and recovered completely. Another 10-year-old boy presented with DKA in shock. During his 18-
day survival, he developed similar features of oliguric ARF (creatinine 4.9 mg/dl) with
hypokalemia (1.7 mg/dl), hypophosphatemia (1 mg/dl), hypermagnesemia (4.4 mg/dl), anemia
(4.4 gm/dl) and elevated CPK (295 u/L). He was initiated on hemodialysis but succumbed to
multiorgan dysfunction secondary to sepsis. A 14-year-old boy presented with DKA and altered
sensorium. He developed oliguric ARF (creatinine 9.1 mg/dl) with investigations showing
hypokalemia (2.9 mg/dl), hypophosphatemia (0.9 mg/dl) and elevated CPK (9995 u/L). He is at
present on alternate day hemodialysis. Discussion: ARF in DKA is thought to be multi-factorial
with hypovolemia usually secondary to hyperosmolality, hypophosphatemia and hypokalemia.
Both hypophosphatemia and hypokalemia can result in rhabdomyolysis which further aggravates
the ARF. Widespread awareness of this entity might lead to better monitoring and early detection
of this rare but serious complication.
ENDO/02(P) UNSUAL CAUSE FOR POLYURIA AND OBESITY
Anu gangadharan,Ananda kesavan, Purushothaman, Sujatha
Dept. of Pediatrics, Meical College Thrissur
anu_gangadharan@yahoo.com
Tuberculous meningitis is not very common nowadays with improved socio economic status and
health facilities. We are presenting a rare case of drug resistant TBM with unusual complications.
9 yr old girl who was treated as a case of tuberculous meningitis with DOTS, while on
maintenance therapy , developed seizures along with sudden weight gain (4 kg in a month),
prolonged sleepiness and lethargy. Though conscious in time and place, she had irrelevant talk and
increased food craving. Bilateral optic atrophy markedly reduced her vision. Right sided ptosis
and squint too noted. She had normal power and tone on all limbs but bilateral plantars were
extensor with brisk DTR. MRI showed a mass of tuberculomas in the sellar, suprasellar and basal
ganglia extending to the midbrain disturbing 3rd ventricular morphology. Since the onset of
tuberculoma was late during the course of ATT, drug resistance considered and MDR TB regime
was started. Her ptosis and cranial nerve palsy improved and so did her abnormal behavior. She
however developed polyuria after a week. Investigations revealed diabetes insipidus and she was
put on oral desmopressin. Symptomatic improvement noted. Damage to the venteromedial
nucleus of hypothalamus produces increased appetite and obesity while damage to the supra optic
nuclei produced polyuria. This case report is presented to show how a disease like TBM can have
varied complications and the importance of early diagnosis and intervention.
ENDO/03(P) KOCHER-DEBRE-SEMELAIGNE SYNDROME
Richa Arora, Sushant Bhanja, M.S.Prasad
VMMC and Safdarjung Hospital, Delhi
richa80arora@yahoo.com
Kocher-Debre-Semelaigne syndrome is a rare association of muscular pseudo hypertrophy and
hypothyroidism in children. Early clinical recognition is important as it may be confused with
primary muscular dystrophy and thyroxin supplementation may be delayed. A six-year-old female,
fourth in birth order, born out of a non consanguineous marriage resident of Delhi, presented with
difficulty in walking and getting up from sitting position. Also had short stature, mental
retardation, hypothermia with bradycardia, lethargy, dry lusterless skin and a large umbilical
hernia. There was prominent hypertrophy of bilateral calves and thighs. CPK levels were normal.
Thyroid profile revealed TSH 122.1mIU/ml. EMG and muscle biopsy were suggestive of thyroid
myopathy. Patient was started on oral thyroxin, is under close follow and showing significant
improvement in all aspects.
ENDO/04(P) SOTOS SYNDROME – A RARE CAUSE OF CHILDHOOD
OVERGROWTH WITH DEVELOPMENTAL DELAY – A CASE REPORT
D. S. Chhajta, Harmeet Singh Arora
Dept of Pediatrics, Military Hospital, Roorkee, Uttarakhand – 247667
vicky_arora18@rediffmail.com
Introduction : Sotos syndrome (Cerebral gigantism) is a rare autosomal dominant genetic disorder
characterized by a distinctive facial appearance, overgrowth in childhood, learning disabilities and
delayed development, and specific genetic mutation. Case report : Nine months male infant, 3rd
product of NCM presented with delayed milestones, abnormal shape of head and upward looking
gaze of eyes. He was born full term through LSCS with birth wt – 3.4 Kg, with no birth asphyxia.
Detailed birth history not available. There was no significant family history. Primary dentition
began at five months of age. He had history of six episodes of seizures (three episodes associated
with fever) since 5 months of age, well controlled with single AED. On examination – Oriented,
older looking, slightly acromegalic, dolicocephaly, closed AF, prominent forehead, receding
hairline, , sparse hairs, downslant of eyes (Lt>Rt), Hypertelorism, prominent jaw, high arched
palate, large chubby hands & feet, pes planus, mild scoliosis Ht- 87 cm(> 90th percentile for age),
OFC – 48 cm , Wt – 13 Kg, Neurologically - hypotonia and impaired speech; Rest of systemic
examination – NAD; DQ- 71-75; ENT evaluation – Mild bilatreral SNHL; Eye evaluation – 6/19
(Rt) and 6/24 (Lt). Bone age (Radiologically) – 4 to 5 years; Thyroid profile – WNL; EEG –
Abnormal record with possible focus on rt side; MRI Brain – Dolicocephalic skull, prominent
ventricular system and sulci and bilateral ethmoidal & maxillary sinusitis; Karyotype_ 46XY;
DNA banding molecular study MLPA & NSD-I gene mutation analysis s/o SOTOS syndrome..
Managed with anti seizures medication, infant stimulation, physiotherapy, speech therapy and
genetic counseling. Presently, seizures under control, developmental delay persisting. Discussion:
The case reported by us had most of the phenotypical features of SOTOS syndrome as described
in literature, with few distinct ones.
ENDO/05(O) EVALUATION OF GROWTH HORMONE AND THYROID HORMONE
STATUS IN CHILDREN WITH TBM AT ONE YEAR FOLLOW UP AND ITS
CORRELATION WITH HEIGHT SDS AND WEIGHT SDS .
Gaurav Mishra, V. K . Bhardwaj
Dept. of paediatrics, NSCB Medical College , Jabalpur
gaurav_cc_doc77@yahoo.com
Introduction: In tubercular meningitis inflammation of meninges leads to formation of exudates at
the base of brain. This exudative reaction is responsible inflammatory reaction at the base of brain
which may directly affect hypothalmopituitary axis . Since hypothalamus and pituitary gland
control physical growth through the secretion of GH and TSH (which stimulate thyroid gland to
secrete T4 , T3) its involvement is likely to affect physical growth. Aims and Objectives : To
assess Pituitary function with reference to Thyroid Hormone and Growth Hormone status (Post
Clonidine) To assess correlation between Pituitary Function and Height SDS & Weight SDS .
Material and Methods : Children diagnosed to be suffering from Tuberculous meningitis who had
been taking ATT without default and who were coming to the department for regular follow up for
one year and who gave consent to participate in the study were included in this study . At the time
of there discharge from the department there Height and Weight were recorded along with brief
clinical history . After the end of one year of regular follow up , they were again readmitted for
recording their height , weight . Also they were examined for presence of any sequelae which was
noted , history of convulsions and the use of anti-convulsant was entered in the prescribed format .
Children were fasted overnight and next morning they were administered Tablet . Clonidine
4mcg/kg body weight , after that serial blood samples were taken after 30 min , 60 min, 90 min
intervals for estimation of Growth hormone level and FT4 / TSH level were estimated in the first
sample. Results: A improvement in mean Z-score of weight was observed at one year followup
(P > 0.05). There was deterioration in SDS of height of patients at one year followup (P > 0.05). In
our study sequelae were present in 70% of cases but no significant correlation could be established
with growth hormone or FT4/TSH levels(P >0.05). In our study severe growth hormone
deficiency was observed in 60% of the cases and out of these 50% of the cases had accompanying
secondry hypothyroidism .There was improvement in the weight SDS at one year follow up but
deterioration in height SDS in the same period. Conclusion : Out of 10 cases 6 cases (60%) had
severe growth hormone deficiency so growth hormone is the major hormone deficiency in the
cases of TBM. Also 3 cases out of the 6 cases having severe growth hormone deficiency had
associated secondry hypothyroidism.
ENDO/06(P) ESTIMATION OF SERUM THYROID HORMONE LEVELS IN CHILDREN
HAVING CELIAC DISEASE WITH SHORT STATURE
Parveen Mittal, Sukhmani Sangha
House No. 37, Khalsa College Colony, Near Saket Hospital, Patiala
doc_parveen@yahoo.co.in
Introduction: Celiac disease is now considered a multisystem autoimmune disorder. Short stature
is being reported as a sole manifestation of celiac disease without any gastrointestinal symptoms,
but it has been seen that some of the children having celiac disease are presenting with short
stature while others are having a normal stature. So present study was designed so as to find
whether some degree of hypothyroidism is co-existing with celiac disease in children having short
stature. Aims and Objectives:To estimate the serum thyroid hormone levels in children having
celiac disease with short stature and to compare it with that of children having celiac disease
without short stature. Material and Methods: Twelve children in age group 5-12 years having
celiac disease with short stature were the subjects of the study. Ten children (age and sex matched)
having celiac disease without short stature were taken as control. Celiac disease in these patients
was diagnosed on the basis of anti TTG antibodies test having a specificity of 95-100% and
sensitivity of 98-100%. Children having short stature were having height more than two SD below
the mean for their age and sex. Serum thyroid hormone levels (serum T3, serum T4 and Thyroid
Stimulating Hormone) were estimated in study group as well as control group and data obtained
was statistically analysed. Results: Mean serum T3 levels in study group were 1.32±0.17ng/ml
while in control group serum T3 levels were 1.41±0.20ng/ml. The values in both the groups were
within the normal reference values (0.80 to 2.1ng/ml). The difference between the two groups was
statistically not significant (p<0.05). Mean serum T4 levels in children having short stature were
7.71±1.50g/dl while in children without short stature, the levels were 8.26±1.52g/dl. Again the
values in both the groups were within the normal range (4.00 to 12.00g/dl). But there was a
difference in the two groups. The values being slightly lower in children having short stature and
the difference was statistically just significant (p=0.05). Mean serum thyroid stimulating hormones
in study group were 2.89±1.36IU/ml while in the control group mean TSH values were
2.00±1.03IU/ml. The difference between the 2 groups was statistically significant (p>0.05)
although values in both the groups were within the normal reference range (0.3-6IU/ml).
Conclusion: Although the serum thyroid hormone levels are within the normal reference range in
children having celiac disease with short stature, but the difference in serum TSH levels from the
children having normal stature is statistically significant. More studies are required to establish
whether there is some association between celiac disease and hypothyroidism.
ENDO/07(O) STUDY OF ORAL GLUCOSE TOLERANCE TEST IN OVER WEIGHT
AND OBESE URBAN SCHOOL CHILDREN BETWEEN 5 TO 15 YEARS OF AGE.
Kotyal B. Mahendrappa, Purushotham D. R.
No 93 fourth main 10th Cross, Vidyaranyapuram, Mysore - 570008
–kotyalmahendrappa@yahoo.co.in
Introduction: Childhood obesity is a single marker of the child at risk for development of various
non-communicable diseases later in life. Obese children have a high prevalence of type 2 diabetes
mellitus ,which can be prevented by early recognition with the help of measuring fasting blood
glucose and oral glucose tolerance test.With this background a study was conducted on obese &
overweight children belonging to affluent society of mysore city. Aims & Objectives:1) To know
the prevalence of impaired glucose tolerance(IGT) in over weight & obese children between 5-15
years. 2)To correlate impared glucose tolerance with BMI. 3)And also to correlate IGT in children
with family history of diabetis mellitus. Materials and Methods: A cross sectional study was
conducted in 452 children belonging to affluent society of mysore city. Schools were selected
based on simple random sampling method. out of 450 children 100 overweight and obese urban
school children who had BMI > 85 % corresponding to the age and sex were included in the study.
Fasting blood sugar & oral GTT was done on overweight and obese children. Prevalence of IGT
was calculated & also a correlation of IGT with family history of DM was done. Results: The
overall prevalence of IGT was found to be 13% in obese & overweigt children. The prevalence of
IGT in overweight & obese children was 16.6% & 7.5% respectively. The prevalence of diabetes
mellites in overweight children is 1.66% (using impaired fasting glucose as a criteria). A
significant number of children, 8 out of 13 (61.5%) born to diabetic father had abnormal IGT.
Conclusion: IGT is more prevalent in overweight than obese children. Childhood obesity is a
single marker of the child at risk for development of various diseases including type 2 DM.
Obesity is a risk factor for the development of impaired glucose tolerance & larer type 2 DM &
its associated complications, thus timely screening of IGT in over weight and obese children, life
style and behavior modifications will result in decreased morbidity and mortality later in life .
ENDO/08(P) SCURVY
J. Senthil Kumar, S. Karthi
Govt Stanley Medical College, Chennai.
dr_appu25@yahoo.co.in
A ten month old, developmentally appropriate for age male child presented with inability to move
both lower limbs, refusal of feeds, irritability and low grade fever for twenty days duration.
History of intra muscular injections present. Poor nutrition and incomplete immunization history
were present.child was on bottle feeds with cow’s milk. With traumatic neuritis, Guillian Barrie
syndrome, scurvy and paralytic polio in mind we worked up the case. On examination child has
pallor, semi flexed lower limbs, conjunctival xerosis and costochondral beading and edema of
lower limbs. Tenderness over both lower limbs present with normally elicitable deep tendon
reflexes. Investigations revealed hemoglobin 8.5 gram percent, reticulocyte count 2 percent,
microcytic hypochromic anemia. X ray both lower limbs showed white line of Frenkel, pelikan
spur and ring epiphysis( Wimburger’s sign). With plasma ascorbate levels 0.08 milligrams per
deciliter and in view of clinical and radiological picture, the diagnosis of scurvy was made. The
child treated with vitamin C 100 milligram per day orally. Child improved , discharged and was
on follow up.
ENDO/09(P) CAMURATI ENGELMANN DISEASE- A RARE BONY DYSPLASIA
A.T. Appuraj, S.Karthi
Government Stanley Medical College, Chennai.
dr_appu25@yahoo.co.in
A three year old male, third born of third degree consanguineous marriage presented with chronic
swelling of legs and arms with fatiguability. Child was normal at birth and had developmental
delay predominantly motor. He was pale. Bony thickening with loss of subcutaneous fat present in
all four limbs with widening of shaft of fingers and toes. Central nervous system examination
showed subnormal intelligence with grade four power.Blood investigations showed hemoglobin
9.5 gram percent with normal serum calcium, phosphorus and alkaline phosphatase.X ray of all
four limbs showed diaphyseal widening and cortical thickening.X ray skull and spine normal.
Similar X ray findings were present in parents, two siblings and grand mother. Metaphysis and
epiphysis spared. This features suggested Camurati Engelmann disease in this child which is a rare
autosomal dominant bony dysplasia.
GE/01(O) ACUTE VIRAL HEPATITIS IN CHILDREN EXPERIENCE FROM NORTH
EAST REGION.
Sujay Chowdhury
C/o. Mr. Arun Gautam, Newtown Durgabari, P.O. Alipurduar Court, Alipurduar, Dist. Jalpaiguri,
West Bengal
kingkdd@gmail.com
Background: Acute Viral Hepatitis is a common problem in North East Region. Lack of safe water
supply, defective sanitation lack of immunization coverage are important causes of this problem.
Aims and objective: To note incidence, clinical and investigational profile of the problem, the
following study was conducted. Subjects and Methods: The children (age < 12 yrs) who attended
Alipurduar Sub-Divisional Hospital , OPD with feature of acute viral hepatitis from May 2004 to
May 2005 were enrolled for this study. Name, age, sex, family history, immunization status, socio
economic condition literacy of parents, clinical signs and symptoms, LFT, PTI, viral serology,
USG abdomen were all noted Remarks: Fifty children (Age 6-12 Yrs) with average 10 yrs were
included in the study. Male was 40(80%) and female was 10 (20%). All 50 children were school
students. They all belonged to community having lack of safe water supply, defective sanitation.
None was immunised against Hepatitis A and B. Only of 50 children 40 (80%) belonged to below
poverty line. Thirty (60%) parents were illiterate. Fever, anorexia, nausea, vomiting followed by
jaundice was present in 45(90%) children. Five children had anicteric hepatitis with transaminities
and seroporitivity. Only 5 (10%) children developed fulminant hepatitis. All had SGOT, SGPT
raised more than 2 times with 10 had blood level more than 1000 I.U. Forty five (90%) children
had raised bilirubin All had hypatomegaly on Usg while 20(40%) had edema on GB wall. Five
(10%) had minimal ascities while 10 (20%) had mild splenomegaly. Five (10%) developed
coagulopathy. All recovered completely in course of time. None of them had background of
chronic liver disease. Forty five (90%) had seropositivity for Hepatitis A while 4 (8%) had
Hepatitis E and 1 (2%) had Hepatitis B. Conclusion: Hepatitis A, E, B are etiological agents of
acute viral hepatitis in children in North Eastern Region though Hepatitis A is majority (90%).
Immunization against hepatitis A, B improved sanitation and safe water supply are major
preventive measures against this health problem.
GE/02(P) EFFICACY OF INDIAN DAHI AS PROBIOTIC IN ACUTE DIARRHEA
Dabi DR, Beniwal M, Verma S, Jora R
Department of Pediatrics, RIMCH, Umaid Hopital, Dr. S.N. Medical College, Jodhpur
jorarakesh@rediffmail.com
Objective: To find out the efficacy of Indian dahi used in the treatment of diarrhea as a probiotic.
Design: A perspective case control descriptive study. Setting: Tertiary level teaching hospital.
Department of pediatrics; Umaid Hospital, Regional Institute of Maternal and Child Health, Dr. S.
N. Medical College, Jodhpur. Method: 100 children aged between 3 month to 5 years admitted
with some dehydration due to acute diarrhea of duration five days or less. These children were
randomized in two groups A & B. all the patients in the study received low osmolarity ORS with
normal Diet .The Group A patients additionally received Indian Dahi (curd) in the amount of 15
gm/kg of body wt./day or more for 3days, while patients of GroupB received commercially
available probiotic sachet (sachet of 1gm.containing not less then 150 million spores of lactic acid
bacillus given thrice a day for 3 days. Every case was followed for next 72 hrs. for clinical signs of
dehydration, stool volume & frequency, acceptance of the fluids & for the episodes of vomiting at
the end of 6hrs, 24hrs,2nd & 3rd day. Results: The mean weight gain on completion of 72 hrs was
better in the group of Indian dahi i.e. 121.94±94.21 gms .as compare to probiotic
group.[113.28±73.85gms]p>0.7. The Indian dahi was more acceptable (96%) as compare to
market preparation of probiotic (76%) the time of appearance of first semisolid stool was earlier in
probiotic group [46.70±14.40 hrs] then Indian Dahi group [50.64±13.4 hrs]but was not found
significant statistically[p>0.2].By the end of 72 hrs mean no of stool were 1.95±1.21 as compare
to1.80±1.70 in Group B. The treatment cost with Indian dahi was almost half [Approx.
3.60Rs/pt/day] as compare to probiotic [7.80Rs/pt./day]. Conclusions: Indian Dahi is as effective
as commercially available probiotic in the case of acute childhood diarrhea as there was no
statistically significant difference observed in the various outcome variables. But the Indian Dahi
has several advantages over the probiotics such as better acceptance; easy availability especially in
the villages & rural area &cheaper then commercial probiotics. In addition to these it is a part of
Indian ancestral diet & it has nutritive value also.
GE/03(P) UNCOMMON COMPLICATIONS OF COMMON ILLNESS: GASTRO
ENTERITIS
Ashish Simalti
ashishsimalti@rediffmail.com
Acute gastroenteritis, a common illness is usually self limiting and is not a cause of diagnostic
dilemmas. Two cases relatively uncommon presentations are discussed. Case 1 (pseudotumor
cerebri) 1-year old female infant was brought with complaints of excessive cry, refusal of feeds
and gradually increasing drowsiness for past 3 hrs. Baby had diarrhea for last 24hrs for which she
was prescribed nalidixic acid. On examination, she had abnormal staring appearance, bulging
anterior fontanelle, bradycardia (pulse 60/min) and hypertension (BP 110/90 mm Hg). There were
no focal neurological deficits. Baby was diagnosed as a case of pseudotumor cerebri. Child was
given IV mannitol (1g/kg) and response was dramatic and within 30 minutes child became playful
and AF was no longer bulging. Nalidixic acid was discontinued and child was kept under
observation for 48 hrs with regular BP monitoring and AF size. Recovery was uneventful land
child was discharged after 2 days. Follow-up ophthalmolog ical exams showed no visual deficit
Case2 (hypokalemic paralysiss) 5-year-old girl child was brought to MI room with history of
vomiting, loose motions for 5 days and weakness for last one hour. Serum potassium came towas
2meq/l and child was given slow bolus of 15meq of Kcl in 50 ml of 5% mannitol and the response
was dramatic improvement. Once child was better she was given syp kesol 10 meq every hr for 24
hrs. Mother was counseled about nutritional management and currently child is under follow up
and gaining weight adequately.
GE/04(P) CYCLICAL VOMITING SYNDROME – CASE REPORT
A K Sarma
Oil India Hospital, Duliajan, Assam
ajoy4781@rediffmail.com
Cyclical vomiting syndrome (CVS) is an idiopathic disorder characterized by recurrent,
stereotypical bouts of vomiting with intervening period of normal health. CVS was first described
in France in 1861. The three essential clinical features of the disorder, which still hold true today
are 1) Three or more recurrent discrete episodes of vomiting, 2) Varying intervals of completely
normal health between episodes 3) Episodes are stereotypical with regards to timing of onset,
symptoms and duration. A clinical fourth criteria that has been added subsequently includes – the
absence of an organic cause of vomiting. Case report: A 7 year old male child presented with
repeated with repeated vomiting since three days. The frequency of vomiting was maximum i.e.
30 – 40 episodes per day, than it gradually reduced on subsequent days. The vomiting has no
relation with food and is projectile in nature and non-bilious. He also complained of some
discomfort during period of vomiting. The patient has similar such history since he was 2 years of
age. The episodes of vomiting occur 2 – 3 times in a year and in between he becomes completely
free of symptoms. He passed normal stools during the period of vomiting. On examination he has
dehydration, shows a scaphoid abdomen and there is increased peristalsis all over the abdomen.
No tenderness was elicited. During the last three years almost all investigations like blood RE,
urine RE, C/S, LFT, KFT, metabolic screening, electrolyte study, EEG, Barium study, esophageal
PH monitoring, Ultrasound abdomen, CT abdomen and brain, esophago-gastro-duodenoscopy,
colonoscopy were done and all reports were normal. Majority of the investigations were repeated
on different centers on various occasions. Every time the patient was treated with IV dip and IV
ondansetron and patient became alright after 3-4 days.
GE/05(P) COMPLETE CONGENITAL POUCH COLON WITH ANORECTAL
AGENESIS WITH PERSISTENT CLOACA AND UTERINE DIDELPHYS
Sreeja Kothapally, J.Harish, Sreedhara Murthy, R. Nisarga
# 414,Ladies Hostel, KIMS, Banashankari 2nd Stage, Near BDA Complex, Bangalore-70
drsreeja09@gmail.com
Introduction:Congenital pouch colon is an unusual abnormality in which whole or part of the
colon is replaced by a pouch like dilatation which communicates with the Urogenital tract distally
by a fistula. The severity of the condition varies from a Complete CPC in which most of the colon
has involved in the pouch formation to an Incomplete variety where only the recto-sigmoid colon
affected. In India there is a marked regional variation with almost all cases originating from North;
which is difficult to explain. It is associated with other urogenital anomalies like Hydronephrosis ,
VUR, Bicornuate uterus and Gastrointestinal anomalies like Absent Appendix , Malrotation and
meckels diverticulum. We report a case of complete CPC with anorectal malformation and uterine
anomaly. Case Report: A term ,3.5 kg female baby born by a normal vaginal delivery to a nonconsanguineously married couple through an uneventful pregnancy presented to a private hospital
on Day 3 of life with the complaints of not passed stools since birth and abdominal distension. On
examination child was found to have a persistent cloaca and small amount of meconium was seen
being passed through that abnormal opening. On the fourth postnatal day, a laparotomy was
performed which showed total absence of transverse colon with distended caecum and pouch
colon. Window colostomy was done. Baby was brought to our hospital at one year of age for
further management. Distal cologram was done which showed Pouch colon with colo-cloacal
fistula. Exploratory laparotomy done that showed complete pouch colon with colo-cloacal fistula
and uterine didelphys. Colo-cloacal fistula was opening into the cloaca between the two vaginal
openings. Pouch excised(the length was too small for coloplasty). Sacroabdominoperineal pull
through of the ileum done. Grossly the pouch was short ,thick ,distended with absent taenia and
haustrations. On histopathological examination, there was decussation of muscular fibres and
incomplete circular muscle.After the surgery, the short term postoperative complications like
loose-stools was explained to the mother and the baby is being followed up and doing well.
Imperforate anus with single abnormal opening. Pouch colon with colo-cloacal fistula and uterine
didelphys. Distal cologram showing pouch colon with colo-cloacal fistula. Discussion: Congenital
pouch colon syndrome was first described in 1912 by Spriggs in a London hospital museum
specimen with absence of the left half of colon and rectum. The incidence of pouch colon varies in
different parts of the world. Apart from north India where almost all cases originate
from(?deficiency of iodine or vitamin B), there are only sporadic case reports from other parts. In
India, males are more affected than females with a ratio of 7:1. The exact embryogenesis is not
known. Accepted theory is aborted hindgut development following obliteration of the inferior
mesenteric artery early in fetal life. Also a genetic predisposition needs to be ruled out. In the past
short colon has been used to describe pouch colon which is misleading. Short colon with
imperforate anus can be described as CPC. In India till 1985,complete CPC was more commonly
seen accounting for 70% of cases. In the past 2 decades incomplete CPC has become more
common. CPC should have the following anatomical criteria: 1) Anorectal agenesis 2) Total
length of the colon is short 3) Colon has a pouch formation for a varying length-saccular or
diverticular with the collection of meconium. 4) Abnormal blood supply 5) Colon wall thick and
muscular with hypertrophied mucosa. 6) Fistula with genitourinary tract is large, muscular and
long. 7) No transitional zone between the pouch colon and the normal bowel. Associated
genitourinary anomalies (cloacal anomalies, double vagina, exstrophy) are common in girls. At
present single stage surgery for CPC is not advocated as its associated with high mortality.
Excision of the pouch with end colostomy is the procedure of choice followed by coloplasty.
Mortality reduced to less than 5% with the staged surgery. Prognosis depends on the weight of the
child, age at presentation, presence of sepsis and perforation, associated congenital anomalies and
mostly the type of pouch colon; incomplete with better prognosis.
GE/06(P) UNUSUAL ASSOCIATIONS OF KAYSER-FLEISCHER RING IN TWO
CHILDREN
Sunil Gomber, Jaya Shankar Kaushik, Pooja Dewan, Mukesh Yadav, Deepika Harit
Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur
Hospital, Delhi 110095
poojadewan@hotmail.com
Kayser-Fleischer (KF) rings are brownish pigment deposits seen at the periphery of cornea. They
result from deposition of copper in descemet’s membrane of the cornea; Wilson’s disease being
the commonest underlying disorder and others being chronic cholestasis, biliary and cryptogenic
cirrhosis. We report bilateral KF rings in two children, the first had wilson’s disease and
cholelithiasis and in the second a diagnosis of cryptogenic cirrhosis was made. Our case series
highlight two uncommon associations of KF ring. Cholelithiasis is a rare clinical presentation of
Wilson’s disease, and the presence of KF ring in a child diagnosed with non-Wilson’s chronic
liver disease.
GE/07(O) A CLINICO-ETIOLOGICAL PROFILE OF DYSENTERY IN CHILDREN.
Madhumita Mishra; K Rajeshwari; Beena Uppal; A P Dubey
Department of Pediatrics, Maulana Azad Medical College and associated hospitals, New Delhi
dr_madhumishra@yahoo.co.in
Introduction- Dysentery accounts for significant morbidity in pediatric population with a high case
fatality rate if left untreated. Further, the easy availability of antibiotics has led to widespread
emergence of resistant strains. Aims and Objectives- (1) To study the clinical spectrum of
dysentery in children. (2) To determine various enteropathogens causing dysentery in children..
Materials and Methods- 60 children in the age group 1 month -12 year presenting with dysentery
(defined as loose stools with visible blood) were enrolled. The stool samples were cultured to
determine various enteropathogens and their antibiotic sensitivity pattern. Results- 61.7% of
children were in the age group 6 months – 2 years. 71.7% had no dehydration at presentation. . No
complication was documented in our study. 80% of stool samples were grossly bloody and 58.3%
were grossly mucoid. Enteropathogens were identified in 44 cases ( 73.3% ). Leading isolates
were shigella in 23 cases( 38.3 %) , E coli in 18 ( 30 %). Salmonella were seen in 2 patients
accounting for 3.3%, aeromonas in one patient. Among the shigella, S flexneri was the most
frequent isolate-73.9%. Majority of shigella were resistant to nalidixic acid ( 95.7%) , norfloxacin
(87%) , amoxicillin ( 56.5 %). Most isolates were sensitive to cefotaxime, gentamycin and
amikacin ( 95.6% each). Among the E coli, EHEC were seen in 9 out of 18 ( 50%) cases, followed
by ETEC and EPEC in 22.2 % patients each. EIEC were seen in 5.6% of cases. Majority of E coli
were resistant to amoxicillin (95%), nalidixic acid (88.9%), norfloxacin (66.7%), cefotaxime
(56%). However most strains were sensitive to gentamycin (88.8%) and Amikacin (100%).
Conclusions- Enteropathogen resistance to extended spectrum cephalosporins is still rare. Thus
local susceptibility patterns should be assessed periodically to guide antimicrobial therapy.
GE/08(P) CHRONIC PANCREATITIS IN A 5 YEAR OLD – A RARE CASE REPORT
Karuna Thapar, Shashikiran Singh, Ira Dhawan, Rachna Kapoor
Department of Pediatrics, Government Medical College, Amritsar
kthapar2000@yahoo.com
Introduction: Chronic, relapsing pancreatitis in children is frequently hereditary or due to
congenital anomalies of the pancreatic or biliary ductal system. Hereditary pancreatitis is most
often transmitted as an autosomal dominant trait with incomplete penetrance. Although
spontaneous recovery from each attack occurs in 4-7 days, episodes become progressively severe.
Chronic pancreatitis is a risk factor for future development of pancreatic cancer. Other conditions
associated with chronic, relapsing pancreatitis are hyperlipidemias (Type 1, 4 & 5),
hyperparathyroidism. Case Report: A 5 year old female presented with pain abdomen for 5 days.
Pain was mild initially but gradually worsened to spasmodic at the time of presentation, location
was periumbilical with no radiation, relieved by itself and was aggravated after meals. Each
episode lasting 2 to 5 minutes with 2-3 episodes occurring per day. Child never had any vomiting,
loose stools, fever or alteration of urinary habits. There was history of similar complaints 1year
back .Child was 3rd in birth order born by full term normal vaginal delivery with uneventful
perinatal events. Developmental history was normal. No family history of pancreatic disease was
present. General physical examination was unremarkable except for pallor. Vitals were heart rate 122/min, respiratory rate - 32/min, blood pressure - 80/60 mm of Hg, Anthropometry was normal
for age. On systemic examination, abdomen was soft, liver was palpable 1.5 cm below right costal
margin with a span of 6cm, and spleen was just palpable below left costal margin. Rest of the
systemic examination was normal. On investigations: Hemoglobin - 10 gm%, Total Leukocyte
Count - 8700/cumm, Differential Leukocyte Count – polymorphs 58%, lymphocytes 40%,
monocytes 01 & eosinophils 01. Blood film showed normocytic normochromic anemia and Blood
culture showed growth of staphylococcus aureus sensitive to amikacin, erythromycin, linezolide,
gatifloxacin. Urine analysis revealed 2-3 pus cells, Urine culture was sterile. Serum amylase was
136.6 IU/L, Serum cholesterol was 152.2 mg%, Triglycerides 113 mg%, HDL 34.3 mg%, RBS 95.8 mg%, Serum calcium 9.40 mg%, Serum phosphorus - 3.97 mg/dl. Ultrasound abdomen
revealed chronic pancreatitis which was further confirmed by CT scan abdomen which showed
findings suggestive of chronic pancreatitis. Child was managed conservatively with intravenous
fluids, Injection amikacin and synthetic pancreatic enzymes. Child improved gradually with this
treatment and remained asymptomatic on follow-up visits.
IMPACT OF GLUTEN FREE DIET ON CLINICAL
PROFILES AND ANTHROPOMETRY IN
DIFFERENT AGE
GROUPS OF CHILDREN WITH CELIAC DISEASE
GE/09(O)
Navdeep Goyal, Praveen S Sobti, B K Jain, Gurdeep S. Dhooria
Department of Pediatrics, Dayanand Medical College, Ludhiana , Punjab
gurdeep2005_123@sify.com
The objective of this study was to evaluate impact of gluten free diet in children with celiac
disease in different age groups with regard to clinical profile and anthropometric measurements.
Design: A prospective interventional study. Methods: Twenty five of the 32 children diagnosed as
having celiac disease on the basis of positive anti-tissue transglutaminase IgA (tTG) and
duodenal biopsy were included. Patients underwent a clinical examination and anthropometry
measurements at diagnosis, 3 months and 6 months of strict gluten free diet. Results: There
was a dramatic clinical improvement in symptomology in all cases on institution of gluten free
diet at 6 months of follow up. Loose motions, abdominal pain , irritability disappeared in all
patients except two children had anemia (8%) and one child had abdominal distension(4%).
Significant weight and height gain was noted in these children after initiation of gluten free diet.
The mean weight and height increased significantly after 3 and 6 months of gluten free diet
(p<0.0001). Also at 6 months of gluten free diet 86% of the children <5 years and 50% of the
children between 5-10 years of age gained weight upto > 80% of expected weight whereas none
of the children >10 years of age reached that level. Similarly, all the children <5 years achieved
normal height while only 33% of the other children attained normal height after 6 months of
gluten free diet. Conclusion: Early diagnosis and institution of strict gluten free diet is required
to gain maximum growth potential in children with celiac disease.
GE/10(P) ALAGILLE SYNDROME- A RARE CAUSE OF CHRONIC LIVER DISEASE
Sushanta Bhanja, Richa Arora, S.Bajaj
VMMC and Safdarjung hospital, New Delhi
richa80arora@yahoo.com
Alagille Syndrome is a rare disorder with an incidence rate of approximately 1 case per 100,000
live births. Usual age of presentation is less than 6 months. Patients, who are less affected, such as
family members, are often diagnosed after an index case. A 8 yr old boy came with jaundice,
upper gastrointestinal bleed ,not growing well .He had history of recurrent episodes of jaundice
since infancy .On examination child was poorly built , malnourished had triangular facies,
prominent forehead, deep set eyes, elongated nose , synphorys .Child was icteric, pale, clinical
features of chronic liver disease with portal hypertension, with a systolic murmur. Multisystem
evaluation revealed posterior embryotoxon and axenfeld anomaly in eye, peripheral pulmonary
stenosis on echo, spinal bifida of L4, L5, S1 on skeletal survey. Liver biopsy had features of
intrahepatic paucity of bile ducts compatible with Alagille syndrome. Viral markers were negative.
Child was managed as a case of chronic liver disease, is presently in follow up and doing well.
Other siblings and parents were found to be normal.
GE/11(P) GASTRO-OESOPHAGEAL REFLUX -WHICH POSITION IS BEST
K.K. Locham, Manpreet Sodhi, Harshvardhan Gupta
Department of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala-147001
kklocham@hotmail.com
Some of the most distressing problems of the newborn revolve around their feeding behaviour.
Gastro-oesophageal reflux (GER) is the predominant one. Different positions have been
advocated to reduce GER. Aims & Objectives: To assess which position after feeding is the best to
reduce GER. Material & Methods: The study was conducted on 30 newborns. Age, sex, gestation,
chief complaints, antenatal risk factors were recorded on a predesigned proforma. Four different
positions after feeding were advocated: Right lateral, left lateral, supine, upright for 20-30 min
after feeding. The complaints were reassessed after 7-10 days. The final outcome was recorded.
Results: Majority of babies (17) were of early neonatal period. 12 were between 1-2 weeks and
only 1 baby was between 2-3 weeks of age. Regurgitation was predominant symptom in 73.3% of
babies. Vomiting was present in 13.3%. Additional 13.3% had both. 6.67% babies presented with
failure to gain weight. 5 babies had complication in early neonatal period in the form of septicemia
and pneumonia. Right lateral and left lateral position was advocated in 10 babies each, Supine and
upright for 20-30 min was advocated in 5 babies each. Improvement was observed in 40% in right
lateral, 30% in left lateral, 20% in supine and 80% in upright position. Conclusion: Upright
position for 20-30 min after feeding is best to reduce GER.
GE/12(P) GAUCHER’S DISEASE –KNOWN CASE PRESENTING WITH PORTAL
HYPERTENSION AND RECURRENT VARICEAL BLEEDING
K M Mehariya, Chirag D. Shah, Keludeppa, Amitabh
dramit_amy@yahoo.co.in
Introduction :Portal hypertension in gaucher disease is unusual.we report a known case of
gaucher disease ,presenting with lower gi bleed,6 months after ligation of oesophageal varices.
Gaucher disease ,a multisystemic
lipidosis characterised by haematological problems,
organomegaly, skeletal involvement.Occurs due to deficient activity of -acid beta glucosidase
.Type 1. Non –nueropathic form (Adult) most common type. Type 2. Acute neuropathic form
(Infantile)Type 3. Norrbottnian form (Juvenile). CASE REPORT-A 9 year old patient presented
with c/o heamtochezia with abdominal distension. Pt was diagnosed as gaucher disease at the age
of 4 year,when he presented with hypersplenism with pancytopenia.Bone marrow showed gaucher
cells, PAS stain: Macrophages show diffuse positivity .Splenectomy was done at that time.At
present pt has grossly enlarged liver with span of 16 cm,firm with sharp borders.Pt had severe
hematemesis 6 month back for which variceal banding was done.Now pt has bleeding per rectum
with abdominal distension.USG shows hepatomegaly with surface irregularity s/o liver
parenchymal disease,with presence of collaterals.portal Doppler showed increased flow in a
dilated portal vein. Liver function test was also s/o of CLD.Ascitic tap was done ,which was
transudative,SAAG was 2.0. But pt had intractable massive ascites causing respiratory
compromise,needing
repeated tapping.patient is on symptomatic treatment at
present.Colonoscopy confirmed presence of rectal varices needing ligation. At last patient is left
with only one option that is—liver transplantation.
GE/13(P) ACHALASIA CARDIA – A RARE CHILDHOOD PRESENTATION
Alpana Somale, Surekha Joshi, Sunil sanap, Sushma Malik, Sushma Save, Himakshee Shah,
Sudhir Singhavi
Lecturer, Dept. of Pediatrics, Bld-1/flat-11, Haji Ali government Qrts, K.Khadye road,
Mahalkshmi, Mumbai-400 034
dralpanakondekar@gmail.com; nairpediatric@hotmail.com
Achalasia Cardia is an esophageal motility disorder, rarely encountered in infants and young
children. Case report: A 14 month old female child presented with history of persistent nonbilious
vomiting and failure to thrive since the age of 6 months. She would regurgitate uncurdled milk,
soon after every feed. Other than malnutrition (grade IV, 4.8 Kg) her examination was normal.
Plain radiograph showed absence of fundic air bubble. A “bird beak” sign suggesting achalasia
cardia was noted on barium swallow. GI Endoscopy & Manometry confirmed the
diagnosis.Gastroesophageal reflux (GER) was ruled out on Endoscopy & Milk Scan. A modified
Heller’s esophagomyotomy with Dor’s fundoplication was done. Post-operatively normal feeding
could be resumed on D-4 & normal barium studies documented on D-7 .Patient had satisfactory
weight gain on follow up. Discussion: Achalasia is an esophageal motility disorder charecterised
by aperistalsis of esophageal body and failure of relaxation of lower esophageal sphincter resulting
in a functional obstruction. Achalasia commonly presents after 3rd decade & less than 5% are
symptomatic in childhood. Presenting symptoms are Dysphagia (90%), spontaneous regurgitation
(80-90%), retrosternal chest pain (25-50%). & malnutrition in advanced cases. Barium swallow
with fluroscopy is the investigation of choice; gastrointestinal endoscopy and esophageal
manometry being the other modalities. Heller's myotomy is the surgical procedure of choice with a
success rate of more than 80%. Pharmacotherapy & pneumatic dilatation are advocated when
surgically nonfeasible cases. Conclusion: Achalasia being surgically correctable condition a high
index of suspicion is warranted specially while managing children with intractable regurgitation
and dysphagia.
GE/14(P) A RARE CASE OF MULTIPLE DUPLICATION
CYSTS OF ILEUM &
MESENTRY
Bikas Bihari Tripathy, Samarendra Mahapatro, S.S .Kar, Rajib Ray, Swarupa Panda, D.Rath,
R.Tripathy
Dept of Pediatrics and Pediatric surgery, Hi-Tech Medical College, Bhubaneswar
samarendramahapatro@yahoo.com
A newborn baby with antenatal Ultrasonographic diagnosis of intestinal obstruction was admitted
in our hospital with complaints of abdominal distension since birth. On examination a mobile
cystic nontender mass of size 10cm X 5cm extending from right flank to left flank was found.
Postnatal Ultrasonography detected a duplication cyst of gut. Since postnataly there was no
symptoms of intestinal obstruction, the baby was advised for elective surgery after 1 month of age.
On laparotomy a duplication cyst of terminal ileum & a pedunculated mesenteric cyst with
intracystic hemorrhage detected. Both the cysts were excised & sent for histopathological study.
Ectopic gastric mucosa was detected in the pedunculated mesenteric cyst. The patient was doing
well on follow-up. Uncomplicated duplication cysts should be operated on elective basis at around
1 month of age. Ectopic gastric mucosa in a mesenteric cyst is of very rare occurrence.
GE/15(O) ROLE OF ABDOMINAL SONOGRAPHY IN DIAGNOSIS OF BILIARY
ATRESIA
V Mittal, BR Thapa, AK Saxena, Ravi Angara, N Khandelwal, KLN Rao, Kartar Singh
Dept of Radio-diagnosis and Imaging, PGIMER, Chandigarh
drraviangara@yahoo.co.in
Introduction: Biliary atresia (BA) must be excluded in an infant with conjugated
hyperbilurubinemia as the prognosis is improved by early diagnosis and surgery. Several
sonogarphic parameters have been used with variable success for pre-operative diagnois of BA.
Aims & Objectives: To assess the role of abdominal sonography in the pre-operative diagnosis of
BA. Material & Methods: The diagnosis of BA could be established in 30 (30%) cases. One
hundred and one consecutive children of age < 90 days and having conjugated hyperbilurubinemia
were subjected to abdominal ultrasonography. Liver size and echotexture, Triangular cord sign,
gall bladder for any abnormalities and post-feeding contractility as primary findings and presence
or absence of CBD at porta hepatis, size of hepatic artery and portal vein for any dilatation and
splenomegaly as secondary findings,were assessed sonographically. Results: Abnormal GB had
sensitivity and specificity 83.3% and 82.6% respectively. Non visualized CBD had sensitivity and
specificity 93.3% and 47.8% respectively. TC sign was always associated with abnormal GB
morphology and contractility. Negative TC sign with normal GB morphology had 91.9% negative
predictive value. When TC was negative abnormal GB morphology did not have good diagnostic
yield. Increased ratio of right hepatic artery diameter to right branch of portal vein diameter had
sensitivity and specificity 76.7% and 46.4% respectively. Conclusion: Non visualization of gall
bladder is always associated with BA. TC sign is highly specific but poorly sensitive. Negative TC
sign with normal GB morphology has 91.1% NPV and with negative TC abnormal GB
morphology did not have good diagnostic yield. Secondary findings of BA may provide
supportive evidence but, by themselves, they cannot be relied upon for diagnosis of BA.
GE/16(P) REYE’S SYNDROME: A CLINICAL DILEMMA
Payal Shah, Manish K. Arya, A.D.Rathod, Yogeeswari
Dept. of Paediatrics, Grant Medical College And Sir J.J.Group of Hospitals, Mumbai 8.
manjioo7@yahoo.co.in
Introduction: An acute self limiting metabolic insult of diverse etiology resulting in generalised
mitochondrial dysfunction due to inhibition of beta fatty acid oxidation. Case report: 1yr old girl,
4th BOB, born of non consanguineous marriage admitted with c/o cough,cold,fever - 7 days
increased respiratory activity and black coloured vomiting 2 episodes since evening and altered
sensorium in the form of irritability and lethargy since last 2 to 3 hours. On examination child was
febrile with tachycardic, tachypnic and hypotensive. On systemic examination there was bilateral
Crepitations and rhonchi with equal bilateral air entry. There was hepatomegaly with span of
10cm,soft,non tender with rounded margins. On CNS examination she ws Drowsy, altered with
GCS score of 10/15, with no sign of meningeal irritation andfocal neurological deficits. So
diagnosis of broncho pneumonia with septicemia with meningitis was considered. Child
deteriorated over a period of 4 days, GCS worsened with elevated serum ammonia and dropped
liver enzymes with shrinking liver requiring ventilatory support and child finally succumbed.
CXR was suggestive of bronchopneumonia .Fundus was WNL. ABG suggestive of metabolic
acidosis and ESR was 82mm/hr. PS for MP : -ve . PT was 24 sec for a control of 12sec. IgM
Lepto and Dengue as well as IgM for HAV & HBsAg were negative. Serum Ammonia was
elevated (102mg/dl) . Liver biopsy after death showed microvesicular steatosis with fatty liver
change. So based on clinical presentation and lab parameter diagnosis of REYE’S SYNDROME
was considered.
GE/17(P) SPECTRUM OF CHRONIC LIVER DISEASES IN CHILDREN
Bhaskar shenoy, Siva Prasad P G V
Department of paediatrics, Manipal Hospital, Bangalore, Karnataka
bshenoy@gmail.com; drpgvsiva@yahoo.co.in
Background: Chronic liver disease encompasses a wide spectrum of disorders, including
infectious, metabolic, genetic, drug induced, idiopathic, structural and autoimmune diseases.
Objectives: To evaluate the clinical spectrum of chronic liver diseases in Tertiary level referral
hospitalized children. Methodology: A prospective analysis of all patients with a diagnosis of
chronic liver disease over a period of 2 years. Results: During the 2 years study period, 1.1% (65
out of 5544) children with chronic liver diseases were included. The etiological spectrum includes
biliary Atresia (32%), neonatal hepatitis (20%), Glycogen storage disorders (16%), cirrhosis with
portal hypertension (7%), chronic hepatitis (6%), autoimmune hepatitis (3.1%), Wilson's disease
(3.1%), criggler-najjar syndrome (3.1%), allagille’s syndrome and undifferentiated embryonal
sarcoma of liver (1.6%) and undiagnosed chronic liver disease (1.6%). Cirrhosis was documented
in 7.6% and chronic hepatitis in 6.1% of cases with chronic liver disease. The Mortality rate in
this study is 10%. Conclusions: In this study, biliary Atresia and neonatal hepatitis constituted
more than 50% of cases. Undifferentiated embryonal sarcoma of liver was noticed in the present
study apart from allagille’s syndrome, neonatal haemochromatosis and criggler-najjar syndrome.
No cases of hepatoma, hepatoblastoma and hepatocellular carcinoma were seen. The undiagnosed
chronic liver disorders constituted very less (1.6%) percentage of cases when compared to other
studies. Availability of liver transplantation has improved the outcome and survival in certain
chronic liver diseases.
GE/18(P) APLASIA CUTIS CONGENITA- A RARE CASE REPORT
M. Kumar, T. Nagarajan, R. A. Sankar Subramanian, S. Rajasekaran, P. Amudha Rajeswari,
S.Sambath, E.Sivakumar
Institute of Child Health,Madurai Medical College, Madurai, Tamilnadu.
drkumaresic@yahoo.co.in
Introduction: Aplasia cutis congenita is a rare congenital dermatological disorder in newborn
children. In India 69 cases has been reported so for. Case Report: An alive first order Female child
born to a nonconsanguinous parents by labour naturalis .Antenatal USG at 2 nd month showed
Twin gestation and she had an h/o spontaneous abortion at 4 th month(expelled out a thin
macerated baby)-Fetus papyraceous. Followup USG at 7 th month showed an alive single intra
uterine fetus. On examination the baby’s cry and activity is good ,weighed 2.9 Kg ,Head
circumference 35cm, vitals stable. Had a bilaterally symmetrical skin defect over the body. All the
systems are unremarkable.
X-ray skull, USG abdomen, NSG are normal. Clinically the child
was diagnosed as a cas of APLASIA CUTIS CONGENITA. As per Frieden’s classification this
case was fit into Group 5 Discussion: Aplasia cutis congenita is a heterogenous group of disorder
charecterised by the absence of a portion of skin in a localized or widespread area at birth.It is
most often a benign isolated defect, but it can be associated with other physical anomalies or
malformations include limb defect, epidermal and organoid nevi, epidermolysis bullosa and fetus
papyraceous. Spontaneous healing is the rule over a period of weeks to months with hypertrophic
or atrophic path of alopecia.
GE/19(P) CYCLIC VOMITING SYNDROME (CVS): A CASE REPORT
Jadab Kumar Jana, Atanu Roy, Nabendu Chaudhuri
H/O- Nabakumar Adhikary, Tikorhat More, Lakudi, Burdwan -713102
jadabjana@gmail.com
Introduction: CVS is a chronic functional disorder of unknown etiology affecting children with
preponderance of female sex. The exact pathophysiology not known but several studies support
altered autonomic function in CVS. This syndrome is characterized by recurrent, discrete,
stereotypical episodes of rapid-fire vomiting between varying periods of completely normal health
and has four phases - Symptom-free interval phase, Prodrome phase, Vomiting phase, Recovery
phase. Characteristics of vomiting are –children of 2 -7 years mostly affected, four or more
episode per hour, average 12 episodes per year and each episode lasting 2-3 days. Infection,
emotional stress and anxiety are triggering factors. It is hard to diagnosis, because no tests can
establish a diagnosis of CVS. Treatment of CVS: during attack – intravenous fluid and
ondansetron, and cyproheptadine and amitriptyline for prevention. Case report: A 7 years old
female child was brought to pediatrics OPD with history of recurrent bouts of vomiting every 1- 2
months since 1 and 10 months of her age. Each episode was characterized by 5-6 emesis per hour,
lasting for 2-3 days and the child became pale and drowsy following vomiting. Between two
episodes she dealt normal life. No triggering factors identified. No history of either CVS or
migraine in her family member. There was history of admission to PHC/ BPHC level for 20 times
during attacks and received symptomatic treatment each time. Parents with their child were
attending clinic more than150 times for finding out the problem. The child was healthy and grown
with peer groups. All investigations, done to rule out possible causes of cyclic vomiting, did not
give any positive finding. Based on detailed clinical history and negative investigation finding,
diagnosis of CVS was made and the child was put on amitriptyline. No history of attack during
last 3 months was reported. Now the child is on follow up. Conclusion: It is challenging for
physician, because he/she takes time to identify a pattern or cycle to the vomiting that nearly
pathognomonic of CVS. It also causes great anxiety to parents for delay diagnosis and financial
burden over them without getting positive investigation reports.
GENE/01(O) CAUDAL REGRESSION SYNDROME: A CASE SERIES
Ashwin Borade, Ashwin S. Prabhu, Sajitha Nair, Mohan K. Abraham
Department of Pediatrics, Amrita Institute of Medical Sciences, Elamakkara (P.O), Kochi, Kerala682026
ashwinborade@yahoo.com, sajithas@aims.amrita.edu
Introduction: Caudal regression syndrome (CRS) is a rare congenital anomaly resulting from an
insult to the structures of the caudal eminence of the developing fetus and occurs in approximately
1 of 25,000 live births. It may be associated with anomalies of other structures derived from the
caudal eminence: the hindgut and the urogenital system. Aims and Objective: A case series of
CRS is presented here to highlight the importance of early diagnosis and evaluation of associated
anomalies so that early multi disciplinary intervention can be initiated. Subjects and methods: The
medical records of 5 children admitted to the pediatric and pediatric surgical wards of Amrita
Institute of Medical Sciences over a period of 3 years from January 2006 to April 2009 with a
diagnosis of CRS were reviewed. All children were evaluated for the presence of associated renal,
genitourinary and intestinal anomalies by ultrasound abdomen with assessment of post void
residual urine, renal function tests, urine culture, micturating cysto-urethrogram (MCU),
intravenous pyelography (IVP) dimercaptosuccinic acid renal scintigraphy (DMSA) and barium
enema. Results: None of the patient with CRS had motor or sensory deficits at presentation. Four
patients had associated anorectal malformation, which was operated in the neonatal period
elsewhere. One child had skeletal deformities in the form of bilateral CTEV and another child had
congenital cyanotic cardiac disease. MR imaging was the modality used for diagnosis of CRS in
all patients. At initial presentation to our hospital, 4 patients had UTI, 2 had grade V
Vesicoureteral reflux on MCU, 3 had multiple renal scars on DMSA scan and 1 patient had
deranged renal function and hypertension. Inn 3 patient urodynamic study was performed to
identify the risk factors to the kidney. All of them had evidence of neuropathic bladder.
Conclusion: A through evaluation of all suspected cases of CRS is require to avoid morbidity due
to associated anomalies.
GENE/02(P)
CHOLESTATIC
JAUNDICE
WITH
CHONDROECTODERMAL
DYSPLASIA (ELLIS-VAN CREVELD SYNDROME): A CASE REPORT
RK Singh
Military Hospital, Ahmednagar (MAH), Pin-414002
address-rrarri@yahoo.co.in
Ellis–van Creveld syndrome is a rare autosomal recessive syndrome characterized by skeletal
anomalies and congenital cardiac defects. Authors are reporting a case of this syndrome, a four
month old female infant presenting with yellow discoloration of eyes. She was found to have
cholestatic jaundice. Her liver biopsy demonstrated portal tracts expanded by fibrosis, ductular
proliferation and evidence of bile stasis.
GENE/03(P) LANE HEMILTON SYNDROME-A CASE REPORT
Pradeep Debata, A Dhama, D.K Taneja, J.N.Mohapatra.
Deptt. of Pediatrics,VMMC & Safdarjung Hospital, New Delhi.
pkdebata66@yahoo.co.in
Idiopathic pulmonary haemosiderosis (IPH) is a rare disease characterized by triad of alveolar
hemorrhage, hemoptysis and iron deficiency anemia. The prevalence of IPH alone is estimated at
0.24 to 1.23 per million in selected populations. Association of pulmonary haemosiderosis with
celiac disease, known as Lane Hamilton Syndrome is even rarer. An 11- year old male presented
to our pediatric emergency unit for cough, blood in sputum and tachypnea. He had history of loose
stools, pain abdomen and progressive weight loss for 1 year. He had repeated bouts of hemoptysis
with tachypnea for last 5 months requiring hospitalization and packed red cell transfusion thrice.
Examination revealed marked pallor, tachypnea, and tachycardia with bilateral coarse crepitations
predominantly in the basal areas of the chest. There were hypochromic, microcytic anemia, normal
coagulation profile and mildly deranged LFT. Sputum for Acid Fast Bacilli, Mantoux test and
contact survey were negative. X-ray showed opacities in the lower zones. HRCT scan of the
thorax showed multiple diffuse scattered areas of alveolar consolidation. Bronchoalveolar lavage
(BAL) analysis revealed macrophages and lymphocytes in the hemorrhagic background. Pearl’s
stain for haemosiderin laden macrophages was positive. Pulmonary function test revealed
restrictive airway disease. IgA-anti tissue transglutaminase serology was positive. In the duodenal
biopsy was suggestive of celiac disease. Secondary causes of Haemosiderosis were excluded with
relevant investigation.A final diagnosis of Lane Hamilton Syndrome was made. Patient was
started on gluten-free diet. His symptoms improved and was asymptomatic in the follow-up at 6
months of discharge from hospital. Though Coeliac disease is yet to be established as a cause of
Pulmonary Haemosiderosis but their association gives a good prognosis.
GENE/04(P) HOLT ORAM SYNDROME : A CASE REPORT.
Nishant, R Prasad, N P Gupta.
Department of Pediatrics, Darbhanga Medical College, Laheriasarai.
drnishant_dmch@sify.com
We report a 1 month old male,3rd child, FTND, presented with complaints of lower respiratory
tract infection with limb malformations. Birth history was normal and there was no such family
history. On examination, the baby was normal for age, obvious limb abnormalities included
bilateral absence of thumb and phocomelia. Features of LRTI were present and on auscultation
systolic murmur(grade 3)was audible at pulmonary area and possible diastolic murmur at left
lower sternal border. X-ray revealed limb abnormalities that included bilateral absence of radii and
first carpal bone. Lower limb was normal.CBC showed normal platelet count and Hb%. Echo
revealed secundum type ASD. Discussion- Holt Oram Syndrome also called heart-hand syndrome,
is an autosomal dominant inherited disorder characterized by abnormalities of the upper limbs and
heart. It occurs due to mutation in the transcription factor TBX5, which is important in the
development of both the heart and upper limbs. Upper limb abnormalities are always present.
Abnormalities may be unilateral or bilateral and asymmetric ; and may involve radial, carpal or
thenar bone. UL deformity include unequal arm lengths, abnormal forearm pronation and
supination,triphalangeal or absent thumb,abnormal opposition of thumb and phocomelia. Around
75% have some cardiac abnormality in the form of ASD (usually secundum variety),VSD, Cardiac
conduction defects such as progressive A-V block and atrial fibrillation. D/D- TAR
Syndrome,Fanconi anemia. Absent Radius, Carpal Bone With Absent Thumb
GENE/05(P) PENTALOGY OF CANTRELL-A RARE CASE REOPORT
K. S. Nandini, T. M. Ananda Kesavan, K. K. Purushothaman
Govt. Medical College Thrissur, Kerala-680596
dranandiap@gmail.com
Introduction: Pentalogy of Cantrell is a rare sporadic abnormality. Less than 50 cases have been
reported in literatures. First described by Cantrell et al in 1958. Case Report: This is the case
report of an unmarried primi ,who had some ayurvedic medication in 2nd month to abort the baby
, but failed and continued pregnancy. No antenatal checkups were done in the first two trimesters.
In third trimester when she consulted a doctor an antenatal USG was done. It showed ectopia
cardia .she had uneventful antenatal period. Delivered by forceps delivery .On examination heart
was outside the body along vertical defect over the chest .There was defect in pericardium,
sternumand diaphragm. Part of liver is also outside the body. Umbilical cord was inserted more
proximally(fig 1).The baby survived only for 6 hrs. In view of these findings the diagnosis of
pentalogy of Cantrell was made. Discussion: The components of pentalogy are: i) Supraumbilical
anterior abdominal wall defect. ii) defect of the lower sternum, iii) deficiency of the anterior
diaphragm, iv) defect of diaphragmatic pericardium, v) various intracardiac defects. Ventromedial
folding of the mesoderm layers give rise to thoracic and abdominal walls, sternum, septum
transversum of the diaphragm, pericardium and epimyocardium. The defect is believed to result
from defective lateral mesoderm folds around 28-32 days of menstrual age. The causes postulated
are: i) Vascular dysplasias resulting in vascular steal phenomenon, ii) Mechanical teratogenesis by
amnion
rupture.
Associated systemic congenital anomalies reported in literature are: i) CVS - intracardiac defects
especially ASD, VSD, PDA, Aortic stenosis, double outlet right ventricle, hypoplastic pulmonary
trunk and total anomalous pulmonary venous drainage, ii) CNS - Encephalocele, syringomyelia,
exencephaly, spina bifida, hydrocephalus, iii) GIT - Omphalocoele, imperforate anus, anterior
diaphragmatic hernia, iv) GUT - Horse-shoe kidneys, cystic changes in both kidneys, v) Skeletal
system - deformed anterior rib cage, kypho-scoliotic spine, spina bifida, vi) Single umbilical artery
and polyhydramnios. The prognosis depends on the severity of the anomalies. Most of the cases
detected prenatally have a fatal outcome. For the severe forms, the prognosis is very poor, since
the reduction of heart in the chest causes kinking of great vessels. We are publishing this case
because of its rarity.In our case the outcome was bad,the baby died Fig 1: Newborn with defect in
the sternum and ectopic heart. Cephalic insertion of umbilical cord also seen
GENE/06(O) CLINICAL PROFILE OF LYSOSOMAL STORAGE DISEASES IN A
TERTIARY HEALTH CARE CENTRE
Simi G, Sankar V H, Lalitha Kailas
Department of Pediatrics, SAT Hospital, Government Medical College, Thiruvananthapuram
drsimig@gmail.com
Lysosomal storage disorders represent a group of genetically distinct, biochemically related
inherited disorders which though individually rare collectively form a significant number of cases
in a tertiary health care center. Aims and objectives: To study the prevalence of lysosomal storage
disorders in our community by studying all suspected cases attending Pediatrics OP and Genetics
clinic , Government Medical College hospital over a period of 2 years To study the clinical profile
of these patients Materials and methods: All patients with lysosomal storage disorders , both
confirmed and those with high clinical probability attending OP and Genetics clinic over 2 year
period from June 2007 to May 2009 were included in the study. Data was collected with the help
of a performa with direct interview and case records Relevant photographs and investigation
reports were collected Results: Total no of cases
20 GM1 Gangliosidosis - 3 GM2
Gangliosidosis - 2Hurler syndrome - 3 Hunter - 2 Gaucher – 3 Pompe – 2 *Morquio - 2 *San
Fillipio - 3 All enzyme proven except * which was clinical diagnosis Common presentations
include development delay, regression, hepatosplenomegaly , skeletal changes , coarse facies
seizures etc +/- positive family history. Clinical phenotype of each group was analysed.
Conclusions: Analysis showed that a significant number of lysosomal storage disorders are being
diagnosed in our hospital . the clinical profile show similarities in clinical presentations which can
be used to clinically diagnose these conditions. Early confirmation of diagnosis can help us offer
treatment options when available , genetic counseling for the family , explain prognosis, screen
family members and predict recurrence rates.
GENE/07(O) THE RIDDLE OF LIDDLE
Jainy N. J, Rajiv Sinha, Indrayani Salphale , Indira Agarwal
Department of Child Health (Unit II), Paediatric Nephrology, Christian Medical College Vellore
child2@cmcvellore.ac.in; indiraagarwal@cmcvellore.ac.in
Introduction: Hypo-reninaemia is rather uncommon in paediatric hypertension. Although rare this
form of hypertension is important, as it not only identifies the possibility of a more specific
treatment but also helps us in understanding renal physiology. We report a case from a tertiary
care centre in south India who had this unusual presentation. Case: A one yr old boy presented
with polyuria, polydipsia and recurrent fever. His investigations showed hypokalemia and
hypochloremia, with normal serum sodium. Urine biochemistry showed hypercalciuria but urinary
chloride, sodium or potassium was not elevated. Blood pressure during this admission was often
difficult to measure because of his irritability but on follow up it was noted to be persistently
elevated. In addition his plasma rennin and aldosterone was reported to be suppressed. He was
readmitted for further evaluation wherein hypertension was reconfirmed. Repeat serum
aldosterone and plasma renin were again low and 24 hr urinary steroids were normal. Detailed
history revealed that his father was on antihypertensive medications since 30 yr of age. In view of
hypokalemia, metabolic alkalosis, early onset familial hypertension and low plasma rennin and
aldosterone along with normal urinary steroid he was diagnosed as Liddle’s syndrome. He is
currently well managed on triamterene and salt restriction. Conclusion: Liddle’s syndrome is a
rare form of autosomal dominant early onset monogenic hypertension. It is caused by mutations
in the epithelial sodium channel (ENaC). A search was done for common mutation (SCNN1B;
SCNN1G ), which was negative. The absence of detailed genetic study among Indian population
means that a negative result does not rule out the diagnosis. The case underlies the importance of
keeping the possibility of monogenic hypertension in one’s differential diagnosis of paediatric
hypertension. Detailed genetic studies are needed to define the mutation pattern in Indian
population of Liddle’s syndrome.
GENE/08(P) CASE REPORT: MENKES KINKY HAIR DISEASE
A. K Dutta, Kaustav Nayek, T.N Ghosh, Nilanjan Ghosh
Burdwan Medical College, Burdwan, West Bengal
niltughosh@gmail.com
Introduction: Menkes disease is an X-linked lethal multi system disorder caused by disturbances
of copper distribution in different tissues due to mutation of p ATPase7 gene. The estimated
prevalence of the disease is 1 in 100000 to 1 in 250000 . The affected individual suffers from
malfunction of copper containing enzymes resulting in multi systemic disturbances. Nervous
system problems include gross mental retardation, convulsions, cortical atrophy, asymptomatic
subdural effusion, gross trunkal hypotonia and progressive neurological deterioration, Vascular
problems with weak collagen tissues causes easy break ability, connective tissue abnormality
gives rise to characteristics steel, fuzzy, wooly, sparse hair with easy pluckability Case Report: An
eight month old male infant with protein energy malnutrition was admitted in the hospital with the
history of repeated attacks of convulsion since four months of age. He was also suffering from
frequent attacks of cough and cold since 6 months of age which was marked prior to admission.
The infant had fair complexion, sparse fuzzy wooly hair with marked trunkal hypotonia. He had
also mental retardation. Serum copper and ceruloplasmin levels were low, MRI showed prominent
extraaxial spaces with gliosis, MR angiography revealed tortuosity of cerebral vessels.
Microscopic examination of hair revealed pili torti. The patient was diagnosed as Menkes disease
and treated symptomatically. For lack of facilities we were not able to do genetic study.
GENE/09(P) CRIGLER NAJJAR SYNDROME (TYPE 1) – CASE REPORT
Karuna Thapar, Shashikiran Singh, Ira Dhawan, Rachna Kapoor
Department of Pediatrics, Government Medical College, Amritsar
kthapar2000@yahoo.com
Introduction: Crigler Najjar Syndrome is characterized by non-hemolytic un-conjugated
hyperbilirubinemia due to congenital deficiency of glucoronyl transferase. Type 1 defect is
characterized by onset of jaundice at birth, marked severity of jaundice which may lead to
kernicterus and lack of response to phenobarbitone. Type II is a mild variant with onset of
jaundice between birth & 10 years with amelioration of jaundice following phenobarbitone
therapy. Type I is inherited autosomal recessive while Type II is autosomal dominant. Case
Report: A two & half months old male child 1st in birth order full term normal vaginal delivery,
cried immediately at birth was brought with yellowish discoloration of body since birth, seizures
for 1 month and fever for 2 days. On examination child weighed 3.6 kg with normal body
proportions and head circumference. Child was deeply jaundiced, and had signs of kernicterus.
Rest of the systemic examination was normal. On investigations hemogram was normal;
septicemia profile negative, direct coomb’s test was negative. Thyroid function tests were normal,
serum calcium 10.28 mg %, (I- 5.10 mg %), Cultures were Sterile, G6PD was negative, Blood
sugar 69 mg %. Liver function tests were normal, No ABO-Rh incompatibility, Total Serum
Bilirubin was 27.6 mg % with 1.99 mg % (Direct). All causes of neonatal jaundice and indirect
hyperbilirubinemia were ruled out. Child was managed with phototherapy & oral phenobarbitone.
Since the child did not respond to conservative management, the case was labeled as Crigler
Najjar Syndrome Type 1. Consent was not given for Genetic study by parents.
GENE/10(P) MALIGNANT INFANTILE OSTEOPETROSIS - RECURRENT FEBRILE
EPISODES IN A YOUNG INFANT
Dhivyalakshmi J, Premila Paul
Dept. of Pediatrics, Safdarjung Hospital, New Delhi
dhivya8@yahoo.co.in
32 day old male child presented with high grade fever, respiratory distress for 10 days. Child was
born to P2L1 mother with h/o previous still birth out of non-consanguineous marriage. He had h/o
progressive pallor and abdominal distension and recurrent fever since day 3 of life. The child had
severe pallor, RR was 70/min with chest indrawing, Head circumference was 39 cms, anterior
fontanelle was 6.5X6.5 cms, frontal bossing, prominent costochondral beading and firm
hepatosplenomegaly each measuring 7 cms below costal margin. Investigations: Hb– 8.6 gms%,
TLC– 20,400/cu.mm, DLC– P19L71M7E3, Plt– 68,000/cu.mm, PCV– 28.4%, P/S- anisocytosis,
polychromic RBCs, NRBCs– 75/100 WBCs, few myelocytes and promyelocytes and
thrombocytopenia.
Retic
count3%.
Blood
C/S–
no
growth.
S.calcium/phosphorus/alk.phosphatase – 9.4mg% / 4.4mg% /200 IU. Skeletal survey lead to the
diagnosis which showed generalized increased bone density especially at base of skull and
vertebra(rugger jersy spine), bone in bone appearance in femur suggestive of osteopetrosis. Bone
marrow aspiration showed osteoclastic giant cells, dyserythropoiesis and mild myeloid
maturational arrest. Autosomal Recessive Osteopetrosis (Osteopetrosis congenita,
infantile/malignant osteopetrosis) is a rare disorder seen 1:200000 population. Recurrent infections
are due to reduced superoxide production in leukocytes. Onset within 3 months of life and visual
and hearing impairement have poor prognosis. Treatment of choice is bone marrow
transplantation. Calcitriol, interferon-γ, corticosteroids are also considered for treatment. This is
the youngest child diagnosed as per literature in India. Osteopetrosis should be considered in a
febrile infant with cytopenias and hepatosplenomegaly to avoid wrong diagnosis and timely
management. The diagnostic test, skeletal radiography is simple and readily available.
GENE/11(P) GALACTOSEMIA- A CASE REPORT
S. Aneja , Richa Arora
Kalawati Saran Children Hospital, New Delhi
richa80arora@yahoo.com
Galactosemia is an inborn error of carbohydrate metabolism which results from recessive
inheritance of an enzymatic defect in metabolism of galactose. Diagnosis in the early neonatal
period can prevent long term morbidity.We hereby present a typical case of galactosemia timely
diagnosed and appropriately managed. 3 day old child presented to the emergency with neonatal
seizures. Baby was first in birth order, born out of a non consanguineous marriage. At the time of
admission the child was lethargic, hemodynamically stable however had no frank seizures. Blood
sugar was 48mg%. Initial sepsis screen was sent, baby started on antibiotics in view of suspected
sepsis with meningitis. Baby was started on glucose infusion. As soon as the infusion was stopped
lethargy occurred and blood sugars dropped. Urine reducing sugar was positive with no
glycosuria. Serum sample for GALT assay was sent, simultaneously introducing galactose free
diet. Baby showed a dramatic improvement in symptomatology being active and feeding well.
GALT assay revealed low transferase activity. Baby was subsequently discharged on galactose
free diet and counseling of parents. On continued 3 month follow up child is doing well, gaining
weight and achieving milestones. Repeat urine reducing sugar is now negative.
GENE/12(P) A FAMILY OF X LINKED RECESSIVE HYPOHIDROTIC ECTODERMAL
DYSPLASIA WITH PARTIAL EXPRESSION IN CARRIER FEMALES
Kumar G.M, Savitha M.R, Chinna P
Department of Pediatrics, Mysore Medical College and research institute, Mysore, Karnataka
drsavithamr@yahoo.com
Introduction: Ectodermal dysplasias are heterogenous group of disorders primarily involving skin,
hair, nails, eccrine glands and teeth. There are about 150 different types. Clinically they are
divided into hidrotic and anhidrotic forms. The most common is X linked recessive hypohidrotic
ectodermal dysplasia Case report: Male baby was received to our NICU for low birth weight. On
examination baby was small for gestational age with sparse thin hypopigmented scalp hair,
paucity of eyelashes, eyebrows, loose skin folds under the eyes, everted lips, and pale wrinkled
skin. Similar features were found in other sibling and maternal uncle, 2 and 8 years old
respectively and also they had other features like hypohidrosis, heat intolerance, square face,
flattened nasal bridge, hypoplastic nipples and absent dentition in the sibling, only first molars
erupted in the uncle. Palms, soles, nails were normal. Retrospectively when mother and grand
mother were examined, they had thick everted lips, conical shaped teeth. In view of these findings
diagnosis of X linked recessive hypohidrotic ectodermal dysplasia was made. Pedigree chart is
depicted below Discussion: Since our patients had abnormality in hair, teeth and sweat gland
function it fits into 1-2-4 subgroup. Mother and grandmother probably being carriers had some
features. This is due to lyonization and somatic mosaicism for the abnormal X chromosome. We
conclude that with early diagnosis and appropriate symptomatic management of hyperthermia,
infantile deaths can be prevented. Also, diagnosing female carriers with subtle clinical features
helps us to a certain extent for genetic counselling for future pregnancies.
GENE/13(P) CARDIO FACIAL SYNDROME WITH UNUSUAL ASSOCIATION OF
ANOTIA AND FACIAL PALSY
M.K.Behera, T.K.Motta, S. Natu, Paresh Soni, A. Naik , S. Panday, U. Keskar , Maya Patil , Arti
Nale ,Mahesh Gosavi, Sarika Shinde
Department of Pediatrics, SKN Medical College & Hospital, Pune - 411042
manaskumarbehera@yahoo.co.in
Cardio facial syndrome is a known clinical entity with asymmetric crying facies associated with
cardiac defects giving a clue to clinicians for congenital heart disease Cardio facial Syndrome
with anotia and facial paralysis is an unusual finding very rarely reported. A case report .A seven
months female baby was admitted to our hospital history of fever , breathing difficulties She was
born of a non consanguineous marriage and there was no history of taking any teratogenic drug or
any infection during antenatal period. Her weight, length, head circumference, developmental
milestones were within normal limit ..She had anotia (Rt ), rudimentary ear Lt side with lower
motor neuron type facial paralysis on Rt side. Asymmetric crying faceies was noted with right lip
being pulled down while crying Cardiovascular system examination revealed ventricular septal
defects .No other external malformations detected USG examination of abdomen & kidney , CT
Scan brain revealed no abnormality .Karyotyping was not done as her parents were unable to
effort . There was no signs of cardiac failure . She was treated with antibiotics and other
symptomatic therapy for pneumonia with improvement Cardio facial syndrome may be associated
with skeletal , genitourinary ,gastrointestinal tract , cleft lip and palate and nervous system and
respiratory tract anomalies . Anotia and facial paralysis are rarel associated and one case had been
reported Anotia , facial paralysis and congenital heart disease has been reported with teratogenic
drugs like retinoic acid and thalidomide and sometimes with deletion of 22q11.Though cardiac
abnormality are rare with anotia and facial paralysis but one should look for ventricular septal
defects and pulmonary stenosis .
GENE/14(P) GOLDENHAR SYNDROME: UNUSUAL ASSOCIATION WITH ATRIAL
SEPTAL DEFECT: A CASE REPORT
Meetu Rawat Gupta, Arti Maria
Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi.
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Goldenhar syndrome, typically constituted by oculo-auriculo-vertebral dysplasia
with hemifacial microsomia is a rare(incidence 1:3500-1:5600) congenital anomaly involving the
first and second branchial arches. Although association with congenital heart diseases like VSD,
PDA, TOF and COA have been reported, association with Atrial septal defect(ASD) is
uncommon. We report a case of Goldenhar syndrome in a newborn with ASD. Case Report: A
preterm 34 weeks(1.58kg) AGA, product of non-consanguineous marriage, born to a primigravida
mother, was brought at first day of life with complaint of facial deformities. On examination, there
were bilateral malformed pinnae, a sinus over right nasolabial fold, high arched palate with
midline cleft of soft palate and coloboma of the right upper eyelid. Cardiovascular examination
revealed ejection systolic murmur at left 2nd and3rd intercostal spaces. There was no cyanosis,
normal peripheral pulses and 4 limb blood pressures. Rest of systemic examination was
unremarkable. Echocardiography done revealed a small ASD. Investigations done to rule out other
congenital malformations namely chest and spine X-rays, cranial and abdominal ultrasound were
all normal. Eye padding was done with strict maintenance of hygiene. BERA done at follow up
was normal. Baby remained hemodynamically stable and neurodevelopmentally normal and is on
regular follow up with periodic assessment and echocardiography, awaiting cosmetic
reconstruction for auricular deformity. Conclusion: These clinical features are consistent with
diagnosis of Goldenhar syndrome. However cardiac malformations are occasional and prognosis
depends on type of cardiac defects. ASD is uncommonally reported in literature, prompting us to
report this case.
GENE/15(P) HARLEQUIN ICHTHYOSIS – A CASE REPORT
Amarendra N Prasad
Pediatrician, Military Hospital, Namkum, Ranchi – 834010.
dranprasad@gmail.com
Introduction:- Harlequin Ichthyosis is a rare genetic skin disorder that involves excessive skin
growth. It is most severe form of congenital ichthyosis, characterized by a thickening of the
keratin layer in fetal human skin. The skin contains massive, diamond-shaped scales. Case
Report:- A 34-36 week preterm female baby was born with characteristic appearance that
immediately prompted a diagnosis of harlequin ichthyosis. The skin of the baby was split into
plaques of rigid fixed skin, seperated by deep red fissures (Fig 1). Her facial features were
obliterated by thickened skin, undeveloped nose and pinna, severe ectropion and eclabium.
Fingers and toes were hypoplastic and held in flexed contractures like ‘mittens’. Movements were
restricted and sucking was ineffectual. Discussion:- The underlying genetic abnormality has been
identified as a mutation in the lipid-transporter gene ABCA12 on chromosome 2. Incidence is 1 in
1 million births, and more than 100 cases have been reported so far. Survival rate is 50 %, and
death is usually due to dehydration (hypernatremic), sepsis or respiratory failure. Clinical features
include severe cranial and facial deformities. The ears and nose may be very poorly developed or
absent entirely. The eyelids are severely everted (ectropion), which leaves the eyes and the area
around them very susceptible to trauma. The lips are pulled by the dry skin and fixed into a wide
grimace (eclabium). Arms, feet, and fingers are almost always deformed in such a way that they
cannot bend properly, and may be hypoplastic. The dilemma of providing intensive nursing care to
these patients while accepting the outcome of severe life-long ichthyosis poses a difficult situation
to both caretakers and families.
GENE/16(P) CASE REPORT: CINCA SYNDROME
Payal R. Shah, Neeta R. Sutay, Manish K Arya, Mangesh Jadhav, Amol Bhajankar.
Dept. of Pediatrics , Grant Medical College and Sir J.J.Hospital, Mumbai-8.
manjioo7@yahoo.co.in
Introduction: Chronic infantile neurological cutaneous articular(CINCA) syndrome is a rare
congenital inflammatory disorder characterised by a generalised urticarial like skin rash, a severe
joint involvement with arthritis and central nervous system symptoms such as chronic aseptic
meningitis, cerebral atrophy, papilledema and sensorineural hearing loss. Case Report: Two and
half year old girl was presented with fever on and off and generalised maculopapular rash since 3
weeks of life. Child birth history was normal. Later on after few weeks patient developed
swelling and tenderness of joints of arms and legs which progressively resulted in deforming
arthropathy. For above complaints patient was labelled as a case of juvenile rheumatoid arthritis.
She was treated with antibiotics and antiinflammatory drugs with a poor response and was
referred to our hospital. On examination child was irritable, pale, wasted and stunted with
deforming arthropathy involving bilateral wrist, elbow, hip, knee and ankle. In the ward child
developed recurrent transient generalised urtticarial rash. On fundus examination child was having
bilateral uveitis and blurring of optic disc margin. So we did CSF which was suggestive of chronic
meningitis with lymphocyte predominance with few eosinophils. CBC showed anaemia,
polymorphonuclear leukocytosis, thrombocytosis with elevated ESR. ANA and RF factor was
negative. Radiographs showed severe inflammation of metaphysis and epiphysis with thinning of
cortex and generalised osteopenia. Patient was started on methotrexate, low dose oral steroid and
naproxen with symptomatic improvement. So based on above clinical feature and investigation a
diagnosis of CINCA syndrome was considered and sample was sent for CIAS1 gene study.
GENE/17(P) PFEIFFER’S SYNDROME: DYSMORPHISM A CLUE TO DIAGNOSIS
Manish K Arya, Payal Shah, A.D. Rathod.
Dept. of Paediatrics, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 8
manjioo7@yahoo.co.in
Introduction: An acrocephalosyndactyly syndrome characterized by craniosynostosis, mild
syndactyly of the hands and feet, and dysmorphic features. Case Report: We report a 4day old
male child admitted in view dysmorphic features. It was a FTND, 3.2kg .. Child had
craniosynostosis,clover leaf shaped skull, with prominent eyes, with low set ears with atretic
external auditory canals, natal teeth, high arched palate, hypoplastic maxilla, with broad
hypoplastic thumbs. X-ray skull s/o synostosis of saggital as well as coronal sutures, with central
retinal vein occlusion of both eyes.X- ray elbow s/o humero radial synostosis. MRI- microcephaly,
brachycephaly with non communicating hydrocephalus with infarcts of R parietal & temporal
lobes. Clinical features were s/o Pfeiffer syndrome. Discussion: PFEIFFER’S SYNDROME: An
acrocephalosyndactyly syndrome characterized by craniosynostosis, mild syndactyly of the hands
and feet, and dysmorphic features. Autosomal dominant/ de novo mutations. Chromosome 8p11.2p12. gene – fibroblast growth factor receptor – 1gene. There is abnormal osseous development
leading to irregular bridging between the early islands of mesenchymal blastema that eventually
forms bone particularly in the cranium and distal extremeties . Major diagnostic criteria is based
on clinical features. Treatment is craniotomy for hydrocephalus, corrective surgeries for facial
deformities, genetic counseling with chances of 50% affection if one parent is affected.
GENE/18(P) WAARDENBURG SYNDROME : A CLINICAL PROFILE
Payal Shah, Manish K Arya, N.R.Sutay
Dept. of Paediatrics, Grant Medical College And Sir J.J. Group of Hospitals, Mumbai 8.
manjioo7@yahoo.co.in
Introduction: Waardenburg syndrome (WS) is named after the Dutch ophthalmologist who, first
described a patient with hearing loss, dystopia canthorum (ie, lateral displacement of the inner
canthi of the eyes), and retinal pigmentary differences. Case Report: 1 month old male baby,Ist
BOB,BONCM admitted with complaints off progressive enlargement of head size since birth. He
was also complaining off lethargy and decreased feeding since 4-5 days. He had history of
operation on day2 of life for lump in the back. His birth and family history were normal. On
examination child was euthermic with HR-140/min and RR-30/min,irregular. AF was 3x3 cm,
bulging with sutural separation and prominent Scalp veins. Child is having white forelock,
Heterochromia iridium, Dystopia canthorum and Broad nasal root. He also had hypopigmented
patches on right forearm. On CNS examination child was lethargic with weak cry. There were
No cranial nerve deficits and no sunsetting sign. There was hypertonia and brisk reflexes in both
upper limbs. Sensations in lower limbs were diminished. Poor Moro’s was weak and there was
scar of MMC repair on back. Rest systemic examination was normal. So diagnosis of
Waardenburg syndrome Type 1 with hydrocephalus with operated meningomyelocoele was
considered. Discussion: it occurs due to failure of proper melanocyte differentiation. Mutations in
the PAX3 gene located on chromosome band 2q35 resulting in mutations in the microphthalmiaassociated transcription factor (MITF) gene.
GENE/19(P) APERT SYNDROME – A TYPE OF ACROCEPHALOSYNDACTYLY - A
CASE REPORT.
Nalinikanta Panigrahy,Abanikant Sahu,A Sailaja, M Suresh babu, P Sudarasini.
Department of pediatrics, ASRAM Medical College, eluru, AP.
nalini199@gmail.com
Introduction: Apert syndrome is an autosomal dominant inherited disease characterized by
craniosynostosis, exorbitism, midfacial hypoplasia and symmetric syndactyly of hands and feet
with an incidence of 1 in 65,000 live births. Case Report: A 8 year old boy presented with history
of excessive sweating and Exaggerated when managed with POP cast for a recent left femur’s
fracture. On examination calvaria was lengthened vertically and shortened anterior-posteriorly
(Turribrachicephaly), short wide nose, bilateral proptosis with exorbitism and corneal ulceration.
There was symmetric syndactyly of all fingers and toes giving appearance of a “mitten hand” and
“sock foot”. Mental subnormality, delayed milestones and speech impairment was also present. A
provisional diagnosis of Apert Syndrome was done and Radiological investigations were done.
Skull radiographs revealed fused coronal sutures,turribrachycephaly skull contour, increased
convolutional
markings
suggestive
of
increased
intracranial
pressure
and
hypertelorism.Conclusion: Early multispeciality approach for surgical intervention is imperative to
prevent progressive synostoses.
GENE/20(P) GOLDENHAHAR SYNDROME WITH PETERS ANOMALY – A RARE
ASSOCIATION
Nalinikanta Panigrahy,B Yamuna,Abanikant Sahu,P Sudarsini.
Department of pediatrics, ASRAM Medical College,eluru,AP.
nalini199@gmail.com
Goldenhare syndrome, also known as oculoauriculovertebral (OAV) syndrome and first – second
brachial arch syndrome is a malformation complex. The average incidence is 1:5600 in live born
infants. Abnormal embryonic vascular supply ,disrupted mesodermal migration and
maldevelopment of neural crest cells forming cephalic mesenchyma (neurocristopathy) are
proposed theories of this malformation. Peters anomaly, characterized by a focal defect in the
posterior cornea, desments membrane and endothelium is also believed to be a neurocristopathy
resulting from abnormal migration of neural crest cells. Although origin of both of these is same,
to our knowledge only 1 case reported from India till date. Case report: - A term male newly borne
baby delivered by spontaneous vaginal delivery to a primigravidae 24 yrs mother who married to a
2nd degree relative. Clinical examination revealed dysplastic small ears, auricular tags, bilateral
peters anomaly in eyes (corneal opacities), non midline cleft upper lip, cleft palate, and bilateral
undescended testes. Chest x-ray revealed dextrocardia and 11 pairs of ribs but without any
vertebral anomaly. Abdominal USG, cranial USG and 2D echo revealed dextrocardia without any
evident congenital anomaly. TORCH test was negative, TSH was 56 miu/L and chromosomal
study was normal. With all above features infant was diagnosed to be a case of Goldenhar
Syndrome with Peters anomaly and further surgical management planned and oral thyroxin
started. Conclusion: - Goldenhar Syndrome with Peters anomaly may reflect a common origin.
Identification of this syndrome may help us better understanding of basic pathogenesis, disease
spectrum, management plan and further genetic counseling of family.
GENE/21(P) EXCESSIVE MONGOLIAN SPOTS IN MUCOPOLYSACCHARIDOSES
Nalinikanta Panigrahy, A Vasundhara, A Sailaja, J Muraliswar Rao, P Sudarsini
Department of pediatrics and Radio diagnosis, ASRAM Medical College, Eluru, AP.
nalini199@gmail.com
Introduction: Mongolian blue spots are commonly seen in up to 90% of Asian babies. Although
typical and limited Mongolian spots are begin skin markings at birth, which fade and disappear as
child grows but extensive and unusual Mongolian spots deserve special attention. Hurler
syndrome is a mucopolysaccharidoses, which is inherited. Lysosomal storage diseases usually not
associated with specific cutaneous findings. We describe two infants with extensive Mongolian
spots in association hurler syndrome, one of which was associated with lissencephaly. Case – 1 A
male child born to non-consanguineous marriage was examined at the age of 11 months for
delayed developmental milestones who didn’t attain neck control, sitting or standing at present. He
exhibited coarse facies, large tongue with noisy breathing, short neck, corneal clouding,
hepatosplenomegaly and wide spread Mongolian spots extending over the back and upper and
lower extremities. Semi quantitative screening test was done in urine for mucopolysachoridoses
was positive, later enzyme assay conformed the definite diagnosis of hurler syndrome. Skeletal
survey was compatible with mucopolysacchoridoses. There was gross psychomotor retardation
with normal EEG study and evidence of lissencephaly in CT scan of brain. This case was
diagnosed as a case of hurler syndrome with lissencephaly. Case – 2 A 3-½ years old male child
product of consanguineous marriage admitted to our hospital with severe respiratory distress with
clinical and radiological feature of pneumonia. The child had repeated history of LRTI and global
developmental delay since infancy. Examination revealed short stature, microcephaly, course
facies with depressed nasal bridge, corneal haziness, large tongue, widely spaced teeth,
protuberant abdomen with hepatosplenomegaly, umbilical hernia, B/L surgical scars on inguinal
region. He has extensive Mongolian spots all over trunk, skeletal survey revealed thickened
calvarium , beaking of vertebrae, spade like ribs and bullet shaped metacarpals .Echocardiography
revealed cardiomyopathy and mitral valve insufficiency. This episode of streptococcus pneumonia
responded to a 7 days course of injection Ceftriaxone. Child had normal neuroimaging features but
with gross psychomotor retardation (child was not able to sit, walk, picking objects, and had
delayed speech.) Enzyme assay revealed complete deficiency of alpha –L iduronase in leucocytes.
In view of clinical picture skeletal survey and enzyme analysis, the child was diagnosed to have
Hurler syndrome. Conclusion: As classically, the neonatal period in patients with HS is uneventful
and infant may appear normal. Neurological regression and other organ dysfunctions typically
may occur after 1 to 2 years of age. Findings of these excessive and abnormal Mongolian spots in
newborns period may aid in early detection and early management (Bone marrow and Enzyme
replacement) of this storage disease.
GENE/22(P) A STUDY OF KARYOTYPE IN CLINICALLY SUSPECTED CASES OF
ANEUPLOIDY
Kotyal B Mahendrappa, Geethanjali,H T, Shamasunder
No 93 fourth main 10th Cross, Vidyaranyapuram, Mysore - 570008
–kotyalmahendrappa@yahoo.co.in
Introduction: The present study describes the cytogenetic findings ina population suspected of
having chromosomal anomalies. A precise cytogenetic diagnosis in suspected cases of aneuploidy
helps in the prognosis,management & genetic counseling of the affected patients & their families.
Aims & Objectives-1)To identify the numerical chromosomal abnormalites by studying the
karyotype of clinically suspected cases of aneuploidy so that diagnosis can be made. 2)To describe
the different types of chromosomal abnormalites,sex ratio & parental age distribution & other
disorders associated with chromosomal abnormality.3)To provide genetic counseling to the
individuals or their parents so that they can make their own informed decisions. Materials &
Methods- 50 cases were randomly selected among the refered cases to jss hospital on the basis of
simple random sampling technique .karyotyping was done using haparinised blood sample from
each child selected .a minimum of 30 metaphases are scored in each case &100metaphases are
scored in mosaicsm. the statiststcalmethods used are frequencies/descriptive statiststics,
contigency coeficient test &
chi-square test Results: cytogenetic studies were done in 50 cases.
41 out of 50 (82%)cases were shown to have chromosomal abnormalites. 40 cases (80%)were
down syndrome &1case (2%) was of turners syndrome. in our study the prevalence of down
syndrome in the older maternal age of >30 years at conception [55%] was more when compared
to maternal age at conception <30 years[45%] Conclusion: the present study, though includes a
small number of referred cases,clearly demonstrates the importance of cytogenetic evaluation in
patients who are clinically suspected with a chromosomal abnormalities. this study was a sincere
attempt made to help the clinicians in detecting,diagnosing and managing the patients affected
with aneuploidy.
GENE/23(P) SCOT DEFICIENCY: A CASE REPORT
Atul Kulkarni, Sunil Vaidya, Sandesh Padwal
Ashwini Sahakari Rugnalaya, Solapur, Maharashtra
dratulkulkarni@rediffmail.com drsvaidya@gmail.com drsandeshpadwal@gmail.com
An 8 months female BONCM admitted with chief compliant of fever, Vomiting, difficulty in
breathing since 2 day, drowsiness since morning. Family and antenatal, natal postnatal history
normal. Developmental history normal. Baby unconscious, PR=134/min, RR=40/min. Gasping
respiration so emergency intubation done dehydration present, Peripheral pulse feeble.
Hepatomegaly 4cm soft, spleen just palpable, unconscious, reflex absent, b/l pupil NSRTL
Investigation : ABG: PH 6.73, PCO2= 15.2, PO2= 209,HCO3 (act)= 2,HCO3 (std)= 4.1,O2 sat
98,Na= 143,K =5.3,Cl= 106, Tc =31900/cumm ,Hb = 9.3 gm%,plt=5,08,000/cumm,Hct
=28.6%,Urea =79 mg/dl,Sr. Creat.= 1.1mg/dl,SGPT= 12 mg/dl, BSL = 152mg/dl,Urine sugar
=Nil,Urine ketone=4+ Day 2nd investigation ABG =Ph 6.99, Pco2 =28, Po2=132, HCO3(act)=
6.7, HCO3 (std)=8.4, BE = -24.6, O2 sat 97.8%,Urine sugar=nil, Urine ketones=4+,BSL=104%
Continuous correction of acidosis is going on. Blood culture=no growth.
Sr.ammonia=474umol/L(9-30.0). Sr.lactate=7.9mMol/L(.2-2.1) bsl 68 mg/dl . Diagnosis: Inborn
error of metabolism.: Succinyl-Co A: 3-Keto Acid co A transferase (SCOT) deficiency
nTRETMENT: Management of acute episode with Continuous correction of acidosis is going on.
And Started on inj. Carnitor , Tb biotin , on multivitamin, Feeding without protein , On subsequent
day Pt consciousness improved, patient exuberated and general condition improved. Discussion:
Succinyl-Co A: 3-Keto Acid co A transferase (SCOT) deficiency is a mitrochondrial matrix
enzyme responible for the formation of acetyl Co A by transefer of a Co A moiety from SuccinylCo A to acetoacetate . This step is the rate-limiting step in the utilization of ketone bodies. Extra
hepatic tissue needs SCOT to use ketone bodies as an alternative energy source to glucose. Hence
a complete deficiency in SCOT means that extrahepatic tissues cannot use the ketone bodies
produced by the liver at all. SCOT deficiency characterized by intermittent ketoacidotic events
with however no symptoms between episodes. SCOT deficiency patients develop ketosis or
ketoacidosis easily in ketogenic situation such as fasting febrile illness, and other stresses.neonatal
onset common, higheven in postprandial times. Permanent ketosis is a pathognomonic feature of
SCOT deficiency if present but the absence of permanent ketosis does not rule out SCOT
deficiency. Human SCOT is expressed in extrahepatic tissues and abundant in the heart and
kidney. An enzyme assay is essential for the diagnosis of SCOT deficiency.. Fibroblasts peripheral
lymphocytes and EB-transformed lymphobsts are used in enzymatic diagnosis. SCOT deficiency
is an autosomal recessive disorder.prenatal diagnosis by cultured aminocytes has measureable
SCOT activity.
GENE/24(O) ORGANIC ACIDURIAS- ANALYSIS OF SPECTRUM OF DISORDERS
AND THEIR MANAGEMENT.
Radha Rama Devi, Alpa Dherai, Manju, Lokesh Lingappa
Department of Paediatric Neurology, Rainbow Children’s Hospital and Perinatal Centre,
Hyderabad
siriloki@gmail.com
Objective: To assess occurrence of Organic acidurias (OA) in neonatal encephalopathy,
hypoglycaemic, seizures with severe acidosis, unexplained developmental delay, acute metabolic
crises & epilepsy in infants and Children.Methods: Urinary OA profiles of 250 patients referred
to tertiary care paediatric centre during period of Jan 2008 – June 2009 were studied using Gas
Chromotography Mass Spectroscopy (GC/MS) and Tandem Mass spectrometry. Results: OA
disorders were detected in 28 patients; age day 3 to 4 years. Branched chain OAsMethyl Malonic
academia (n = 3) in patients 7 months to 4 yrs . One developed severe spastic diplegia following
acute encephalopathy. Propionic acidemia (n=2) in a sick neonate and 2 yr 6 month old boy
during Metabolic crises. MSUD noted in 3 neonates with severe encephalopathy, metabolic
acidosis and ketosis leading to death in two. Glutaric Aciduria 1 (GA1) was most prevalent
disorder in our study (n =5). One child diagnosed by newborn screening (NBS) and is on special
diet, supplements; normal outcome at 16 months . The remaining 4 suffered severe neurological
disability due to late diagnosis (1 to 4 year). Other defects like Isovaleric academia, 2 oxoadipic
aciduria, HMG CoA lyase, 3 methyl glutaconic aciduria, Glutaric aciduria 2, Succinic
Semialdhyde dehydrogenase deficiency etc were diagnosed . Respiratory chain disorders and
lactic acidosis in 10 children while Fatty acid oxidation defects were noted in three. ConclusionStudy provides the information on range of Organic acidurias existing in community and need to
diagnose them early to improve outcome and provide genetic counselling.
GENE/25(P) EPIDERMOLYSIS BULLOSA SIMPLEX-A CASE REPORT
Reetesh Dwivedi, Sanjay Kr. Singh, Niranjan Kr. Singh
FF-2, Fifth Floor, Doctor’s Residence, Era’s Lucknow Medical College& Hospital, Sarfarajganj,
Hardoi Road, Lucknow -226003
reeteshdwivedi@yahoo.com
Introduction: Epidermolysis bullosa (EB) is a group of heritable mechanobullous disorders
characterized by fragility of the skin within the cutaneous basement membrane zone (BMZ). Here
we report a newborn with Epidermolysis bullosa simplex. Case Report: A 3 days old neonate born
of second degree consanguinous marriage was admitted with complaints of blisters and
denudation of skin of both knees, shin, feet, dorsal aspects of forearm, hand, elbow and back since
birth. Examination revealed presence of blisters and peeling off of skin over knees, leg, feet, hand,
elbows and back. Eyes and internal mucous membrane were normal. There was no H/o lethargy,
refusal to feed in the baby and sepsis screen was negative. A possibility of EB was considered and
skin biopsy was done which revealed intraepidermal blistering suggestive of EBS-Koebner type.
Discussion: Epidermolysis bullosa is a general term for heterogenous group of congenital
hereditary blistering disorder and is categorized under three major headings as- Epidermolysis
bullosa simplex (EBS), Junctional Epidermolysis bullosa (JEB) & Dystrophic Epidermolysis
bullosa (DEB). EBS is inherited as autosomal dominant (AD) with variable expressivity whereas
JEB as autosomal recessive (AR). DEB can be inherited as AD or AR . Incidence of EB is
approximately 10-30 cases per million. EBS-Koebner is characterized by presence of blisters at
birth or during neonatal period and commonly involve hands, feet, elbow, knees, legs and scalp.
Intraoral lesions are minimal, nails rarely become dystrophic & usually regrow when
shed.Dentition is normal. Secondary infection is the primary concern. Propensity of blisters
decreases with age and long-term prognosis is good. Bullae heal with minimal or no scar or milia
formation. A through history and physical examination followed by skin biopsy leads to diagnosis
of this condition. Electron microscopy is the gold standard for determining the level at which
blistering occurs whereas immuofluorescent microscopy can provide additional information on the
level of blistering and underlying molecular defects. The defect in all types of EBS is in central
alpha-helical coil of keratin5 or 14, which makes up intermediate filaments of the basal
keratinocytes. Current therapy includes avoidance of trauma, heat along with management of skin
infections and deformities. Application of skin equivalent as Apligraft helps in wound healing.
Isotretinoin is currently under investigation for patient with EB. Protein therapy and gene therapy
are the newer modalities.
GENE/26(P) PERIODIC PARALYSIS – 2 CASE REPORTS
Karuna Thapar, Shashikiran Singh, Ira Dhawan
Assos.Professor, Govt. medical college, Amritsar
kthapar2000@yahoo.com
Introduction: Periodic paralysis is a group of rare genetic dieases that lead to weakness or
paralysis (rarely death) from common triggers such as cold, heat, high carbohydrate meals, not
eating, stress or excitement and physical activity of any kind. The underlying mechanism of these
diseases are malfunctions in the ion channels in skeletal muscle cell membranes that allows
electrically charged ions to leak in or out of the muscle cell, causing the cell to depolarize and
become unable to move (a channelopathy). Here we report 2 cases.One with hypokalemia and
other with normokalemia 1st case: A 12 years old male child was brought with complaints of
sudden fall while playing followed by inability to move both lower limbs for 7 to 8 hrs. No H/O
fever, vomiting, headache, I/M injections,seizures,alteration of sensorium. H/O similar complaints
1 year back followed by spontaneous recovery O/E General condition was stable, nystagmus on rt
lateral gaze was present, child was ataxic,CNS-Higher functions were normal,no cranial nerve
palsy,sensory system-Loss of touch,pain till both thighs,loss of joint position sense in both lower
limbs,power 0 in both lower limbs,DTRs knee present bilaterally,ankles not elicitable,plantars
normal.on investigations S.Na 132 meq/l,S.k 3.1 meq/l,S.Calcium 11.2 mg% during the
attack.ECG-Normal,MRI(Brain)-Normal,.Child was given I/V potassium chloride after which the
child regained power within 4 hrs and later on follow up was absolutely fine.Diagnosis of periodic
paralysis was made. 2nd case: 4yrs old male child was brought by caretakers of nariniketan with
inability to stand for 3-4 hrs .H/O similar complaints in past.O/E General condition was
stable,vitals were normal,On CNS examination higher functions were normal,there was no cranial
nerve palsy,Tone was decreased in both lower limbs,Power was Grade II in both lower
limbs,DTRs were absent in both lower limbs,Plantars were normal.On investigations-Hemogram
was normal,S.Na 141.3 meq/l,S.K 4.1 meq/l,S.Calcium 8.9 mg%MRI Brain was normal,ECGNormal,Genetic analysis was normal.Child was managed conservatively and he recovered in 5
hrs.This case was also diagnosed as periodic paralysis. Discussion: Periodic paralysis is an
autosomal dominant myopathy leading to a spectrum of familial phenotypes.Specific diseases
include;Hypokalemic periodic paralysis-where potassium leaks into muscle cells from blood
stream, Hyperkalemic periodic paralysis-where potassium leaks out of the cells into the blood
stream, Paramytonia congenita-primary symptom is musle contracture which develops during
exercise or activity.This form often accompanies hyperkalemic periodic paralysis or may present
alone.
GENE/27(P) A CASE OF PYKNODYSOSTOSIS
V.K.Vijaya Mohan, Nandini Kuppusamy, R.A.Sankarasubramanian, P.Amutha Rajeswari
Institute of Child Health & Research Centre, Madurai Medical College, Madurai.
vijaypaeds_08@yahoo.com
Introduction: A case of Pyknodystosis is presented for its rarity.Case Report: 1 Year old female
child admitted with fever, cough, cold for one week duration. History of breathlesness +Previous
admission @ 8 months of age for bronchopneumonia and got treated. 1st male child died at 5
months of age due to LRI. Normal developmental milestones .O/E child short statured, pallor+,
dyspneic, microcephaly +, AF wide open, PF open,exophthalmos.wt-5 kg ,ht -57 cm,, HC -38 cm,
US/LS -1.8 :1, RS- ICR, SCR +, B/L creps +, P/A liver 3 cm firm, spleen 2 cm firm. No murmur.
Tone normal.
Investigations revealed hypochromic microcytic anaemia.
X-ray chest
bronchopneumonia. X-ray upper limp hyper dense bone, absent carpal bones. Thyroid profile –N,
opthal opinion – pseudoproptosis. Discussion: Pyknodysostosis has an autosomal recessive
inheritance .consanguinity in 30 %.gene location ch 1q21. General features include short stature,
fronto parietal bossing, AF & sutures remain open till adulthood, wormian bones, hypoplastic
paranasal sinuses, beaked nose, relative proptosis, obtuse mandible angle, crowded & deformed
deciduous teeth. Complications include fractures, dentalabscess, osteomyelitis of jaw. They have
normal life expectancy. Haematopoiesis is not affected. There is no definitive treatment.
GENE/28(P) PENTOLOGY OF CANTRELL – A RARE CASE REPORT
M. Jhancy, P. Bindu, Vikram Kumar
Department of Pediatrics, R.M.C, Kakinada
jhansimalay@yahoo.com
A male baby born to 22 yr old primi, at term by normal vaginal delivery at kakinada, admitted to
nicu on day one with pulsating supraumblical defect & lower sternal defect covered by skin.
Mother had regular antenatal check ups No consanguinity Antenatal ultrasound was not done
Newborn was diagnosed as having ectopia cardis with possibility of Pentology of Cantrell Expired
next day before surgical intervention ECTOPIA CARDIS Discussion:The Pentalogy of Cantrell is
an extremely rare congenital anomaly. The complexity of this syndrome is usually incompatible
with life The exact incidence not found in the literature Incidence 1:100000 births, with a male
preponderance (M : F = 2 : 1.2) Cantrell, Haller, and Ravitch, in 1958, were the first to describe
this syndrome1 Characterised by a Midline supraumbilical abdominal wall defect, Defect of the
lower sternum, Deficiency of the anterior diaphragm, A defect in the diaphragmatic pericardium,
Congenital intracardiac defects Displacement or eventration of the heart through the
abdominothoracic wall defect is called ectopia cordis. It presents as Cervical Thoracic
Thoracoabdominal Abdominal types2 The entire group of anomalies closely related in
embryologic development, arising as the result of defective formation and differentiation of the
ventral mesoderm at about 14-18 days of embryonic life3 Classified into Class 1: Exact diagnosis,
with the five defects Class 2: Probable diagnosis, with four defects Class 3: Incomplete diagnosis,
with combination in the defects (always accompanied by sternal defects). Treatment: Immediate
surgical repair (except for the intracardiac abnormalities) Prognosis in cases of ectopia cordis is
worse Thoracoabdominal ectopia - slightly better prognosis
GENE/29(P) BARDET BIEDL SYNDROME- A CASE REPORT
Iragouda Patil, Ushakiran C B, B Krishnamurthy
Dept of Pediatrics, MMC & RI, Mysore, Karnataka
ukboregowda@yahoo.co.in
A 7 year old female child presented with c/o excessive weight gain over last 4 years and dimness
of vision at night. The child was born as a term LGA baby to non consanguineous parents and had
delayed social and lanuage development with poor scholastic performance. On examination
weight and BMI >95th centile,truncal obesity,short stubby fingers with polydactyly,syndactyly of
toes,eyes-nystagmus and atypical retinitis pigmentosa. Lipid profile was impaired.other clinical
features and natural history discussed in brief.
GD/01(P) SEXUAL MATURITY: AGE OF ATTAINMENT OF VARIOUS STAGES
Ritu Gupta, Ravinder K. Gupta
Department of Physiology, Govt. Medical College, Jammu (J&K) 180001
riturgjammu@indiatimes
Objective: - To assess the growth and sexual development of schoolchildren in the age group of 818 years. Design: - Cross sectional clinical evaluation.Material and methods: -About 500 children
(280 boys and 220 girls) from local school were examined after written consent. Students with
systemic illness were excluded from the study. Anthropometry measurements were taken and
body mass index (BMI) was calculated .Evaluation of sexual maturity rate according to Tanner
staging was done. In girls, age of menarche was noted. Results: - In boys, different stages of pubic
hair, penis and testicular development occurred simultaneously. Mean age of boys in SMR stage 1,
2, 3 and 4 were 11. 33, 13 .71, 14.76, 15.30 years respectively. The mean age of girls in SMR
breast stages 1, 2, 3, and 4 were 11.66, 12.70, 13.80, and 14.70 years respectively. Stages of pubic
hair development follow closely at 11.30, 12.90, 14.25, and 14.80 respectively. The menarche
occurred between stages 2 and 3 at 13.10 years. Peak weight and height velocity was seen in girls
between stages 1and 2 .The mean weight and height gain was 9.6 Kg and 15 cm respectively. In
boys, peak weight and height velocity occurred between stages 2 and 3 and mean weight and
height were 8.15 Kg and 9.2 cm respectively. The body mass increases between stages 1 and 2 in
both sexes when they enter puberty. Conclusions: - Onset of puberty in girls and boys was 12.60
years and 13.50 years respectively. The girls reach SMR stage 4 by 14.60 years while boys reach
stage 4 by 15. 40 years. Menarche occurred at13.10 years between SMR stages 2 and 3.
Adolescent growth spurt was seen between stages 1and 2 in girls and between stages 2and 3 in
boys.
GD/02(P) AUDIT OF ADHD DIAGNOSIS AND MANAGEMENT AT WYCOMBE
HOSPITAL
Kamal Sawhney
kksawhney@hotmail.com
Introduction: Recently NICE has published new guidelines for management of ADHD in
UK.This included reviewing diagnostic criteria,drug treatment and other management strategies
for children with ADHD. Aims And Objectives: To ensure children with diagnosis of ADHD are
receiving, Comrehensive assessment. Appropriate drug treatment. Behavioural management.
Material And Method: Data was collected from medical records of 157 children attending the
ADHD clinic at Wycombe General Hospital.The data was analysed by the clinical Audit and
Effectiveness Department. Results: Results were analysed for referral pathways,referral and
diagnostic process,treatment strategies,comorbidities and there management and behavioural
management strategies.Conclusion: Drug treatment was appropriately started by qualified health
professiona. Nice guidelines were followed in majority of cases.
GD/03(P) EFFECT OF OBESITY ON BEHAVIOUR OF PLASMA INTERLEUKIN-6
LEVELS ON PERFORMING GRADED EXERCISE: IMPLICATIONS ON PEDIATRIC
POPULATION.
Ambarish Vijayaraghava, Rashmi. S Murthy, Chandrashekara. S, Vasanthakumar. K. C
Departments of Physiology, M. S. Ramaiah Medical College and Teaching Hospitals, Bangalore
ambarishv@rediffmail.com
Introduction: Childhood obesity is a major problem facing parents and medical fraternity alike.
Interleukin-6 is a pro-inflammatory cytokine. Its levels in plasma increase in various inflammatory
disorders and in individuals predisposed to inflammatory disorders and also with physical stresses.
Obesity is a predisposing factor for various diseases associated with inflammatory conditions.
Objective: To observe the changes in plasma IL-6 levels in obese and non-obese individuals with
graded physical activity. Methods: 8 healthy, age matched, obese (5 males and 3 females) and 8
non-obese healthy volunteers (5 males and 3 females) in age group of 18 to 30 years performed
one bout each of moderate exercise and strenuous exercise. Blood samples were collected: (1)
before one bout of moderate exercise (baseline), (2) after one bout of moderate exercise, (3) after
one bout of strenuous exercise. Plasma IL-6 levels were estimated using the Sandwich Elisa
Technique.
Results: Plasma IL-6 levels in pg/ml
Baseline
Moderate Exercise
Strenuous Exercise
Non-Obese (n=8)
57.5
97
77
Obese (n=8)
86
147
115
Conclusions: Obese individuals have greater levels of IL-6 in their plasma even at resting state.
The levels of IL-6 have a tendency to shoot up more in the obese compared to the non obese with
a single bout of exercise.The IL-6 levels did not approach the baseline value in the obese
individuals as much as it did in the non-obese, indicating that obesity may prevent from gaining
the full benefits of the same kind of exercise done in one obese.
GD/04(P) ASSESSMENT OF MEAN AGE OF ONSET OF PUBERTY OF AFFLUENT
UDAIPUR BOYS FROM 8 TO 18 YEARS OF AGE
Devendra Sareen, Javed Ahmed, Dharam Singh, Jitendra Jain, Umang Upadhyay, Mahesh
Upadhyay
27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Summary: Sexual maturation assessment is easiest and reliable beside measurement of
development age, which is more relevant and practical than chronological age in adolescent study.
The present study was carried out on affluent class children from various English medium schools
of Udaipur city. This was a cross sectional study comprising of approximately 900 boys age
between 8 to 18 years of age. Children were thoroughly examined for presence of any systemic
disorders or major surgery which can affect their growth and were excluded. Age and date of birth
was asked to children and reconfirmed from school record. The assessment of puberty was done
by SMR grading taking into consideration the pubic hair, size of the penis and testes. The
testicular volume was estimated by Prader Orchidometer. All the observations were recorded in
printed performa and data analysis was done. We observed that mean age of onset of G2 was
11.97 years and puberty ranged from 8.84 to 15.09 years. Mean age of G3,G4,G5 was 13.15,
14.78 and 15.80 years. These were comparable with national and international standards. Udaipur
Children achieved G5 stage around a year earlier than national average. Mean age of onset of PH2
stage was 11.99 years with SD of 1.41 years (range of 8.5 years to 15.5 years). Mean age of onset
of PH3, PH4 and PH5 was 13.7, 14.9, 16.3 years. Udaipur children reached adult PH5 stage ½ to
1½ years later when compared with international standard. Thus, these children showed difference
in maturation of genital and pubic hair development. Efforts have been made in this pioneering
study to establish the pubertal norms for boys in Udaipur. These standards would hopefully
provide baseline for understanding the pubertal trends in community.
GD/05(P) MEASUREMENT OF TESTICULAR VOLUME TO ASSESS PUBERTAL
DEVELOPMENT IN SCHOOL BOYS OF UDAIPUR
Devendra Sareen, Javed Ahmed, Dharam Singh, Umang Upadhyay, Jitendra Jain, Mahesh
Upadhyay
27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Summary: Testicular enlargement is first physical manifestation of puberty in boys. The present
study was done to measure the testicular volume in school boys to assess pubertal development in
them. For this 900 boys between 8 to 18 years of age were selected. These boys were affluent class
children from various English medium schools of Udaipur city. Children were thoroughly
examined for presence of any systemic disorders or major surgery affecting their growth and were
excluded. Age and date of birth of each child was asked and confirmed from available school
records. A detailed assessment of the weight and height of each child was done. Testicular volume
was estimated in this study by comparison with ellipsoid of known volume (Prader Orchidometer)
that was equal to or just smaller than the testis. Both the testis were compared and larger testes
measurement was taken. The SMR grading was done in each child. All the observations were
compiled and data analysis was done. We observed that mean testicular volume at G2 stage was
5.6 ml. Mean testicular volume in G3, G4, G5 was 11.5, 18.50 and 25 ml. respectively. Testicular
volume of 4ml was attained at mean age of 11.97 years with SD of 1.3 year. The mean age of
attainment of 3 ml of testicular volume was 9.4 years, 12 ml at 12.9 years. Adult testicular volume
of 15 ml was reached on an average at 13.9 years but testis continue to grow and 25 ml of volume
attained at a mean age of 15.9 years. Thus, testicular volume measurement by orchidometer (e.g.
Praderk) is easy and reliable and accurate method to assess puberty in community. Testicular
volume determination adds more objectivity to SMR detection and helps to differentiate G2 from
G1 stage, which is otherwise clinically quite difficult at times.
GD/06(P) STUDY OF OBESITY IN THE TRIBAL ADOLESCENT GIRLS OF UDAIPUR
Nitin Goyal, Srishti Sareen, B. Bhandari
C/o Dr. Srishti Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Summary: Childhood obesity is one of the prevailing nutritional problem in the developed and
developing countries affecting the children in the community. Its effective prevention and
treatment has a major impact on the prevalence of adulthood obesity and its various complications.
The present study had been undertaken to assess the prevalence of the obesity in the tribal
adolescent girls of Udaipur. This cross sectional study was conducted on 500 adolescent girls
between 12 to 18 years of age who were studying in Mahila Mandal Sr. Secondary School,
Udaipur. All the girls belonged to Hindi medium. After obtaining a detailed history regarding diet,
body mass index (BMI) of each girl was calculated by formula BMI = weight (kgs.)/height (m 2).
BMI was analysed at 50th, 85th & 95th percentile. Girls with BMI more than 95th percentile were
labeled as obese. Prevalence of obesity was assessed by both CDC and Indian standards.
Prevalence of obesity was 2.2 percent with CDC standards and 2.4 percent with Indian standards.
The peak of obesity was observed at around 15 years of age among both CDC and Indian
standards. Non-vegetarian girls were more obese than their vegetarian counterparts. Hence,
adolescent girls should be encouraged to play outdoor games regularly in the evening and they
should avoid eating junk foods to avoid developing obesity in them.
GD/07(O) TO EVALUATE THE CONSEQUENCES OF MATERNAL ANAEMIA ON
FETAL GROWTH PARAMETERS
Sumit Mehndiratta, Saroj Kar, Kamla Sharma
B 246, Yojna Vihar, Delhi- 110092
drsmehndiratta@rediffmail.com; drsmehndiratta@gmail.com
Introduction: Maternal nutrition, infections, drug and toxin exposure in antenatal period play a
crucial role in fetal growth. Maternal anemia is one of major preventable cause of unfavorable
pregnancy outcome. NFHS-3 estimates around 57.9% pregnant women in India to be anemic.
Aims and Objectives: To determine relationship between maternal Hb with on various
anthropometric indices of fetus Material and Methods: Study period 12 months. 219 Pregnant
women who delivered at term were recruited during 1st stage of labor. Mothers with pregnancy
complications and with chronic medical or surgical illness were excluded. The neonates with birth
complications and gross congenital anomalies were excluded.187 term neonates were included in
final analysis. Maternal Hb was analyzed. The mothers were divided into four groups according to
Hb concentration into normal and mild, moderate and severely anemic. Neonatal anthropometric
indices were recorded as per standard protocols. Statistical analysis:SPSS version 11. Results: The
mean birth weight of babies born to anemic mothers was significantly reduced as compared to non
anemic mothers. The mean anthropometric indices –crown heel length, crown rump length, head
circumference, chest circumference and mid arm circumference showed and increasing trend
along with the increasing Hb concentration. Statistically significant differences in the mean
indices were found in between the severely anemic and moderately anemic groups when compared
to non-anemic group. It was also found that the maternal Hb has strongest positive relation with
the birth weight of the newborn followed by crown heel length and head circumference.
GD/08(O) OBSERVATIONAL STUDY: CLINICAL OUTCOME IN 531 CHILDREN
WEIGHING MORE THAN NORMAL.
Priti Phatale, Hemant Phatale
Samrat Endocrine Institute of Diabetes, Obesity & Thyroid, 60 New Rokadiya Hanuman colony,
Near Cosmos Bank, Aurangabad. MS.
pritiphatale@yahoo.co.in
Material & Methods: - 531 children between 2-18 years weighing more than normal referred to
Samrat Endocrine Institute were studied. Weight (Electronic Weighing Scale) & Height
(Stediometer) were measured. BMI & BMI centile were calculated. As per CDC data was
categorized into overweight & obese groups. In all children Fasting Insulin, FBG,HOMA IR, TSH
& Lipid profile were studied. Results :- Female preponderance over male (F-53.9 % Vs M-46.1
%). Children ≥ 10yrs are more than < 10yrs (64.2 % Vs 35.8%). Obese children are double than
overweight ( 67.4 % Vs 32.6%) Hypertension is found more in obese group than overweight ( 27.2
Vs 13.9 %). IFG found equally in both overweight & obese group ( 6.7% Vs 5.4 % ) DM type 2
observed in one obese boy & one obese girl. Chronic anovulatory cycles observed more in obese
than overweight girls.(26.3 % Vs 15.3 %). Early puberty equally in both obese & overweight girls.
( 4.9 % Vs 4.8 % ) Regular follow-up was in 167out of 531 children who responded well to diet
exercise & medication. Significant weight reduction observed in both obese & overweight
children. ( 54.3 % Vs 50.9 % ) 17 overweight & 11 obese children achieved normal weight
centile. Significant weight reduction achieved in both groups with good height spurt & pubertal
progression. Conclusion: 1. Co-morbidities seen in both obese & overweight children.
2. Regular follow up & family motivation are keys to success.
GD/09(P) GROWTH PATTERN IN THALASSEMIC CHILDREN
A. P. Dubey
Department of Pediatrics, Maulana Azad Medical College & Associated Lok Nayak Hospital,
New Delhi.
apdubey52@rediffmail.com
Objective: To study the growth pattern and pubertal development in multitransfused thalassemic
children. Design: Descriptive prospective study Methods and Materials:53 patients 5 to 18 years
of age with multitransfused thalassemia were evaluated every 3 months over a period of 9 months
and their anthropometric data (weight, height etc.) were recorded. Hemoglobin estimation, serum
ferritin, and liver function tests and bone age estimation were done in all patients and GH
provocative tests, Thyroid function tests & serum LH/FSH/Estradiol/Testosterone estimation were
done wherever specifically indicated. The data collected was compared with both Indian and
NCHS standards. Results:60%(32/53) patients were found to be short statured (below the 3rd
centile),the proportion increasing progressively with increase in age. A proportionate reduction in
weight compared to height was seen. Proportionate body growth was seen in 79% (42/53) patients.
The height age and bone age corresponded to the chronological age in patients up to 12-13 years
of age, after that marked difference in chronological age, bone age and height age was seen.
Height velocity was also lesser in shorter patients (42 ± 18mm/year) .The age at starting chelation,
mid parental height and HCV infection were seen to be significant factors in determining stature.
Growth hormone provocative tests that were done in 14 patients(all less than 3rd centile) showed a
GH peak of <10 ng/ml in 9 patients. Delayed puberty was seen in most cases.Conclusion: Thus it
can be concluded that the multitransfused thalassemic patients show growth retardation and
pubertal delay with multiple contributory factors.
GD/10(P) GROWTH PATTERN IN BRONCHIAL ASTHMA - PERSISTENT TYPE
K.K. Locham, Manpreet Sodhi, Harshvardhan Gupta
Department of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala-147001
kklocham@hotmail.com
Bronchial asthma is a leading cause of chronic illness in childhood. Growth is retarded in these
children either due to disease or due to preventive corticosteroid therapy. Aims & Objective: To
assess the growth pattern in Bronchial asthma-Persistent Type. Material & Methods: 6 Children
with bronchial asthma with mild persistent variety were the subjects of the study. None of the
child was on preventive corticosteroid therapy. Age, sex, residential background, past and family
history, weight, height and upper to lower segment ratio were recorded on a predesigned
proforma. Clinical examination and radiological findings were also recorded. Serum IgE was
assessed in every case. Results: 3 children were infants. 2 were the age group of 1-3 yrs and 1 was
in the age group of 3-6 years. 3 each had rural and urban residential background. History of
recurrent attacks was present in 4 cases. Family history was positive for allergy in 2 cases. Only 2
children had malnutrition grade I. All 6 had normal height and normal upper to lower segment
ratio. Features of hyperinflation in the form of obliteration of liver dullness and obliteration of
cardiac dullness was observed in 3 & 2 cases respectively. Chest expansion was decreased in only
2 children. Radiologically features of hyperinflation were seen in 5 cases. Only 2 cases had areas
of radio opacities. 3 children had elevated serum IgE levels. Conclusion: Growth was not affected
in bronchial asthma of mild persistent type.
GD/11(O) NOSE TRAGUS XIPHISTRENAL LENGTH [NTXL] AS AN ALTERNATIVE
METHOD FOR MEASUREMENT OF BIRTH WEIGHT
Kunal Mukherjee, S.S. Beriha, N. Mohanty
Department of Pediatrics SCB Medical College, Cuttack
dr.kuns@rediffmail.com
Introduction: The birth weight is a vital parameter which throws light into the past events as well
as future development of a newborn. India has 74%rural population of which 85% of the
deliveries occur at home mostly by traditional birth attendants, the birth weight is often either not
recorded or falsely stated due to various reasons, so it is important to formulate a method which
will be cheap, easy to carry out and can predict the birth weight with acceptable accuracy. The
current study is an exercise to find an easy method with reference to Nose-Tragus- Xiphisternum
length (NTXL) at birth Aims & Objectives: To ascertain birth weight and different anthropometric
parameters at birth and to find out if any relation exist between NTXL and birth weight. Materials
& Methods: Study Design: Randomized cross-sectional Period:
Feb2009-June2009
Place:
Department of Pediatrics, SCB MCH , Cuttack.300 live born, singleton healthy babies
weighing>1.5 Kg without congenital anomalies were included. The gestational age was calculated
both by the New Ballard Scoring System and from the 1st day of last menstrual period, weight was
recorded by electronic balance, crown-rump length and crown-heel length were measured by
infantometer, head circumference, chest circumference, mid-arm circumference, maximum thigh
circumference and Nose-Tragus-Xiphisternum length were measured by non stretchable
measuring tape. Standard statistical methods were used to calculate statistical constants. Results:
Coefficients of correlation of birth weight with different parameters are –Crown-heel length –
0.898, Head circumference – 0.899, Chest circumference – 0.897 Crown-rump length – 0.853,
Mid-arm circumference – 0.833, Maximum thigh circumference – 0.947Nose-TragusXiphisternum-length – 0.959 and all are statistically significant at p <0.001. The 99% confidence
limits for NTXL of different birth weights were < 1.5 Kg15.42 ± 0.1182, 1.5 – 2 Kg16.59 ±
0.1096, 2 – 2.499 Kg
17.62 ± 0.1302 and 2.5 – 2.999 Kg18.82 ± 0.1306 Conclusion:
The suggestive effective working cut-off for different weight groups rounded off are as follows:
16 cm – 1.5 Kg, 17 cm – 2 Kg, 18 cm – 2.5 Kg and 19 cm – 3 Kg. These may be used to assess the
weight of a newborn when birth weight was not taken and not available in the community. The
above procedure is based on easily available, easy to carry, simple to perform an act which can be
tried to measure the birth weight in remote areas by even minimally trained persons.
GD/12(O) DISTRIBUTION OF SEXUAL MATURITY RATING IN RELATION WITH
AGE OF MENARCHE IN GIRLS OF DEHRADUN
Meetu Rawat Gupta, Rakesh Mamgain
Department of Pediatrics, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Dehradun
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Menarche is an important event in sexual maturity of girls. It usually occurs at 4 th
stage of Breast development stage(BDS) and Pubic hair stage(PHS). The present study was
conducted to study the stages of puberty in relation to age of menarche. Objective: To study
correlation of stages of sexual maturity with age of menarche in girls of Dehradun. Materials and
Methods: A cross-sectional study was conducted in 990 middle and high school girls of Dehradun.
Age of menarche and sexual maturity rating was recorded in a predesigned proforma. Results: 628
out of 990 girls had attained menarche, with mean age at menarche(MAM) 12.40±1.10 years.
Menarche was attained in 100%(81) girls at PHS5, 99.2%(355) at PHS4, 42.9%(188) at PHS3 and
4.5%(4) at PHS2. None of the girls had attained menarche at PHS1. MAM of girls with PHS5 and
PHS4 was 12.59±0.56 and 12.55±0.55 years respectively which was more than MAM of girls with
PHS3 and PHS2(12.28±0.56 and 10.1±0.27 respectively). Similar observations were seen with
BDS, with menarche attained in 100% at BDS5(45) and BDS4(206) while 82.46%(362) at BDS3
and 5.98%(15) at BDS2. None of the girls had attained menarche at BDS1. MAM of girls with
BDS5, BDS4 and BDS3 was 12.52±1.14, 12.61±0.54 and 12.41±0.54 years respectively which
was more than MAM of girls with BDS2(11.43±1.17) years. Conclusions: Age of menarche
correlates with sexual maturity in girls of Dehradun. The lower mean age of menarche in girls
with BDS2 and PHS2 and 3, is an indicator of an ongoing secular trend of fall in the age of
menarche.
GD/13(P) PREVALENCE OF OBESITY AND OVERWEIGHT IN CHILDREN AND
ADOLESCENTS OF KDAV SCHOOL AT JAMNAGAR AS A PART OF CASHE
PROJECT STUDY
Udayan Patel
DAOH & FWC, Reliance, Jamnagar
udayan.patel@ril.com
Aims &Objective: A CASHe (Change Agents for Safety Health and Environment) Project Study
to know the prevalence of childhood obesity in KDAV (Kokila Ben Dhirubhai Ambani
Vidhyamandir) school at Reliance greens, RIL, Jamnagar, and to measure the response of various
interventions taken to reduce obesity. Introduction: Child obesity is already recognized as a public
health problem world wide. Obesity is generally defined as abnormal or excessive accumulation of
fat in adipose tissue to the extent that health may be impaired. It is characterized by a weight well
above the mean for their height & age and Body Mass index well above the normal. The
prevalence of childhood obesity is rising worldwide and is associated with many risk factors for
later Heart disease, Hypertension, Cancer and other chronic diseases. Obese children are also
recognized to have risk of hyperlipidemia, hyper-insulinemia and early atherosclerosis in later life.
However children in the pre- adolescent age group of 8-10 years are increasingly facing these
problems but prevention of obesity must start in childhood. Methodology: A CASHe team was
made which comprises of Pricipal, Doctor, Sports teacher & Coordinator. Few meetings were
conducted at KDAV School and complete plan was discussed. Base line survey in KDAV School
was done in the month of June 2007. Weight of the student was taken with calibrated electronic
weighing machine (to the nearest of 100 gm) & Height was obtained with an anthropometric rod.
We used the WHO recommended definition. The age-sex specific body mass index (BMI= wt/ht2 )
reference to define obesity (BMI equal to or more than 95 th percentile) and overweight (BMI
equal to or more than 85th percentile and less than 95th percentile). We used CDC (Centre for
Disease Control and prevention 2000) growth chart from US to determine obesity and overweight.
After the baseline survey on 1304 students 142 overweight and 28 obese students were found. Few
meetings were conducted at KDAV School and complete plan was discussed. To start with speech
on Hazards of Childhood obesity, Nutrition and Balanced Diet was delivered by our CMO &
Doctors on various days in the school assembly which was the main awareness drive among
students. Interventions: Various interventions started which includes continuous awareness about
Diet and physical activity in school assembly, Lecture organized at KDAV School by Senior
Nutritional consultant, on Childhood obesity, Balanced diet & Nutrition, Individual personal
counseling by Pediatrician and Nutritional consultant of obese student & their parents. Regular
monitoring of food by class teacher, sports teacher and principal to avoid junk food in their lunch.
Session on Adolescent education was organized at KDAV school, Senior Pediatrician from
Jamnagar has given lecture on life skills, growth & Development and Nutrition, Drawing
competition was organized on the topic Effects of fast food and Soft drinks on human health in
the school premises. Results: After six months of intensive interventions, Follow -up was done in
Feb. 2008 and August 2008 which shows percentage reduction in overweight and obese students.
Details of the results will be discussed in the conference.
HO/01(P) MEGALOBLASTIC ANEMIA:CLINICO – HEMATOLOGICAL PROFILE IN
50 CHILDREN
Ravinder K Gupta, Sunil Dutt Sharma, Ritu Gupta
Associate Professor , Department of Pediatrics, Acharya Shri Chander College of Medical
Sciences (ASCOMS) , Sidhra, Jammu.
drrk_gupta2000@yahoo.com
Objective: To study the varying clinico – hematological manifestations in 50 children and to find
out relative prevalence of cobalamin and folate deficiency in children with megaloblastic anemia.
Design:
Prospective study.
Setting:
Pediatric Clinic Subjects and methods -Fifty
children (6 months – 16 years) diagnosed as Megaloblastic anemia (Hemoglobin less than 10 g/dl,
and MCV more than 90 fl ) over a period of 3 year ( May 2006 to April 2009) were prospectively
studied. All anemic children with or without bleeding manifestations had their peripheral blood
smear examined. Complete hemogram including platelet count and mean corpuscular volume (
MCV) were carried out in each child using Coulter counter. All the cases with macrocytic blood
picture were subjected to bone marrow examination to confirm the diagnosis of megaloblastic
anemia. Serum B12 and folic acid could be estimated by radioimmunoassay in 29 children. The
diagnosis of megaloblastic anemia was established on the basis of macrocytic PBF and
megaloblastic bone marrow. Biochemically pure vitamin B12 deficiency and folic acid deficiency
were diagnosed when serum levels were below 80 pg/ml and 3ng/ml, respectively .Iron studies
were done as an additional investigation for further ruling out concomitant iron deficiency .
Relevant investigations were also done in case of various associated infections. Results - The
children were in the age group of 12 months to 16 years with male predominance (male: female
ratio being – 1.3:1). All the children belonged to peri-urban areas. About 23 children had normal
nutritional status while 7, 6 and 4children belonged to grade II, III and IV respectively as per IAP
classification. The presenting features were pallor(100%),fever (52%),cough/coryza(38%),
diahhrea(20%), bleeding manifestations (12%),tremors (6%), lethargy(6%) etc. All the children
had pallor on examination. Hepatomegaly (up to 4cm) and splenomegaly were seen in 38% and
10% respectively. Other signs included pedal edema(24%),icterus(14%), petechiae (10%),
hyperpigmentation (10%), etc.There were no neurological deficits in any of the studied children.
All the children had anemia with hemoglobin levels of 4.5- 9.7 gram/dl. About 46% children had
severe anemia (Hb<7gm/dl). Leucopenia (WBC count <4000/mm3) was seen in 14% cases while
platelet count less than 1 lac/mm3 was detected in 30% cases. Peripheral smear showed
predominantly macrocytes, macro-ovalocytes and pear shaped poikilocytes. Hypersegmentation of
large sized neutophils was seen in almost all cases.In all cases, bone marrow was hypercellular
with erythroid hyperplasia showing megaloblastic maturation and reversal of M: E ratio. The
characteristic finding was nuclear-cytoplasmic dissociation . Values of serum B12 and folic acid
were available in 29 cases. B12 levels were low in 9 cases (<80 pg/ ml), dual deficiency of B12
and folic acid in 12 cases and 1 case had pure folate deficiency (<3 ng/ml). Seven children had
normal B12 and folate levels.Liver function tests of seven icteric children revealed normal levels
of transaminases (SGOT and SGPT).The serum bilirubin levels ranged from 1.6 mg/dl to 3.4
mg/dl with predominance of indirect component thus suggesting mild hemolysis.The children
were put on oral folic acid (5 mg/day) or/and intramuscular vitamin B12 (100 μg/day) for 4 weeks.
Initially vitamin B12 was given daily for a week followed by alternate day administration and then
twice a week injection. Proper dietary advice was given in all cases. Three patients, who were
severely anemic also, received blood transfusions. Antibiotics were administered in infective
cases. Follow-up of patients showed improvement in all cases except one. This child who
succumbed was severely malnourished with signs of multiple vitamin deficiency and
bronchopneumonia. It is concluded that any malnourished and anemic child presenting with
bleeding manifestations, a strong suspicion of megaloblastic anemia should be entertained.
Anemia is not the only problem in these children, as is evident from the finding of neutropenia and
thrombocytopenia . Also cobalamin deficiency appears to be emerging as a significant contributor
to nutritional megaloblastic anemia.
HO/02(P) CLINICAL PROFILE OF AUTO IMMUNE HAEMOLYTIC ANAEMIA IN
CHILDREN
Jyoti Ranjan Champatiray, N. Mohanty
S.C.B. Medical College, Cuttack, Orissa
jrchampatiray@yahoo.co.in
Aim :- To Study clinical profile, laboratory parameters, and treatment outcome of AIHA in
children. Materials Method :- This is a prospective study involving all patients of AIHA below 14
yrs diagnosed during May 2006-09 (n=3). Age, Sex, clinical presentations of all cases were
studied. In all these cases CBC, PSC, Recticount, G-6-PD Activity, LFT, RFT, ANA, Sepsis
screening, DCT was done. No of BT before diagnosis was documented. Average time for
diagnosis and no of BT after treatment was also documented. The patients were put on follow up
every 4wks. The dose and duration of therapy was recorded. RESULT :- Total 8 cases reported.
The age range was 5-13 yrs. All patient had pallor as presenting complaint followed by
Splenomegaly, Hepatomegaly, Fever, Jaundice, Haemoglobinuria , Lymphadenopathy. Average
Blood transfusion given before diagnosis was 4. Average time duration to diagnosis was 4 days.
Average 1-2 transfusion was needed after treatment with steroid. Out of 8 cases, 5 had Primary
AIHA and 3 had secondary AIHA. The secondary causes were SLE, Lymphoma and TB . Oral
Prednisolone Produce remission in all cases. 3 cases had relapse after initial response. All three
responded to a second course of steroid, but one case Subsequently diagnosed as Lymphoma.2 out
of 5 Primary cases needed steroid in a tapering dose for 16-24 wks. 3 Patients responded to a short
course of 3 - 4 wks of steroid with no relapse till yet. Patient who was on steroid for 16-24 wks
had cushingoid facies, truncal obesity and striae which subsided after stoppage of drug.
Conclusion :- AIHA is an uncommon cause of haemolytic anaemia in children. Lymphoma, SLE,
TB are common secondary causes of AIHA. Frequent Blood transfusion without expected rise of
Hb and difficulty in grouping due to lysis are early clues to the diagnosis, prompt treatment, and
need of lesser BT. Steroid though cause remission may need a long term therapy (16 wks) to abate
relapses.
HO/03(P) CASE REPORT: TRANSFUSION ASSOCIATED GVHD IN A CASE OF
SEVERE COMBINED IMMUNE
Kaustav Nayek, T.N Ghosh, Nilanjan Ghosh
Burdwan Medical College, Burdwan, West Bengal
niltughosh@gmail.com
Introduction: SCID represents a rare group of congenital, sometimes fatal disorders with an
incidence of approximately 1:30,000 to 1, 00,000 live births. Sometimes erythromatous rash with
devastating features develop in SCID patients who have been transfused non irradiated blood or
blood components accidentally before the diagnosis of SCID have been made. High fever usually
manifests 8-10 days after the transfusion, followed by appearance of a central maculopapular rash
which eventually extends to the extremities. In severe cases the rash may progress to generalized
erythroderma and desquamation. Additional clinical findings may include anorexia, nausea,
vomiting and watery diarrhea with or without elevated liver enzymes and hyper bilirubinaemia.
Case report:
A six month old male baby was referred to Burdwan Medical College from a sub
divisional hospital with high fever and bronchopneumonia who had developed erythroderma
following blood transfusion. His two elder siblings died at 4 months of age following fever.
Examination revealed the baby had no tonsil, absent BCG scar mark and no lymph nodes.
Investigations showed he had no thymus. Keeping in mind the history, clinical findings and
investigations a primary immunodeficiency was suspected. His lymphocyte subsets and serum
immunoglobulins were estimated. They were suggestive of T-B-NK+ Severe Combined Immune
Deficiency associated with TA GVD. The patient was treated with IV amoxicillin/clavulanic acid
and Trimethoprim sulphamethoxazole , Inj. Hydrocortisone and Cyclosporin. Unfortunately his
condition detoriated rapidly. He went into intractable shock and eventually died on 5th day of
admission
HO/04(P) TWO CASES OF CELIAC DISEASE PRESENTING AS REFRACTORY IRON
DEFICIENCY ANEMIA
Kirandeep Sodhi , B M John, S S Dalal , Y K Kiran, K S Multani , Rahul Sinha,Chandrashekhar
Command Hospital (Airforce) Bangalore
kiransodhi_63@rediffmail.com
Two children aged nine yrs and three years respectively presented to the Pediatric OPD over a
period of one and a half years with complaints of easy fatigability and tiredness. On examination
both the children were found to be anemic with a hemoglobin of 8 and 6 gms respectively.There
was no significant lymphadenopathy , hepatosplenomaegaly , sternal tenderness etc .There was no
evidence of any blood loss , chronic diarrhea etc There was no history of parental consanguinity
.Further investigations revealed a microcytic hypochromic type of anemia . The iron studies
suggested an iron deficiency anemia with markedly low serum iron , increased TIBC , and low
ferritin. Hemoglobin electrophoresis was normal . The patients were dewormed and started on oral
iron therapy at therapeutic doses . There was no reticulostosis observed following start of
treatment. Despite one month of regular iron therapy in the therapeutic doses there was no
change in the hemoglobin levels prompting us to search for causes of refractory iron deficiency
anemia . Anti TTG antibodies were asked for which showed very high levels (>in both the
patients. A diagnosis of celiac disease was made and the patients were started on gluten free diet.
Both patients showed dramatic improvement and hemoglobin levels done after a month of gluten
free diet showed improvement and were completely normal after three months of gluten removal
from the diet.
These two cases highlight the fact that celiac disease may be present in the
absence of gastrointestinal symptoms as both our patients never had any symptoms related to the
gastrointestinal tract. Nutritional iron defeiciency anemia is a common condition in childhood and
responds well to iron therapy. Our cases highlight the importance of keeping a high index of
suspicion of celiac disease in refractory IDA even in the absence of gastrointestinal symptoms.
HO/05(P) BLEEDING DISORDERS IN CHILDREN: DIAGNOSIS, SEVERITY AND
OUTCOME.
T Seth, Sanjeev Verma, Nitin Gupta, R Kapoor, Pravas Misra, R Saxena
Department of Hematology AIIMS, New Delhi
tuliseth@yahoo.com
Introduction: Inherited bleeding disorders may manifest anytime in childhood, sometimes with
catastrophic results. Correct diagnosis is required for management, family counseling and future
care. Objectives: To review the cases of inherited bleeding disorders presenting at a large referral
hospital, to study the presenting features, risk for serious hemorrhage and sequelae. Methods:
Chart review of children diagnosed with bleeding problems who presented to the Hematology
outpatient department performed for the period August 2004-August 2009. Historical facts on
presenting symptoms, severity of bleed, age of onset, family history, diagnosis and disability were
noted, descriptive statistics performed using SPSS. Results: A total of 395 cases were identifiedHemophilia A- 201, Hemophilia B- 62, von Willebrand disease-58 and isolated platelet function
defect- 23, Glanzman’s- 13, other rare factor deficiencies- 38. Patients with early onset and
positive family history were more likely to have a severe congenital bleeding disorder (p<0.001),
mean age of onset for patients with a family history was earlier than for those without (p<0.01).
Patients on primary prophylaxis versus on demand factor replacement therapy, had no life
threatening bleeds; but difference in deformity and disability in our study did not reach statistical
significance. Conclusion: Families with a positive history of bleeding disorders are more likely to
be aware of symptoms and present to the hospital early. Early institution of factor replacement
support can prevent disability, however as the diagnosis is often delayed, late institution of support
may be inadequate to prevent deformities and permanent disability in these children.
HO/06(P) ACUTE ITP PRESENTING WITH INTRACRANIAL BLEED
Richa Arora, M.S.Prasad, Sushant Bhanja
VMMC and Safdarjung Hospital, New Delhi
richa80arora@yahoo.com
ITP (idiopathic thrombocytopenic purpura) is a well known clinical entity usually presents with
petechiae, epistaxis, haematuria, gastrointestinal bleeding. Intracranial hemorrhage in ITP is rare
(1%), especially at presentation and is a potentially fatal complication. We present a case of 10 yr
old boy who was a diagnostic dilemma. He presented with acute history of fever, headache and
neck stiffness for 2 days. Keeping in mind the short history, meningitis was considered. After the
fundus examination lumbar puncture was done which was hemorrhagic, however cell counts were
normal. There was no improvement in headache. Blood counts revealed Hb 9gm%, TLC
10,000/mm3, Platelet count 25,000/mm3. Non contrast CT revealed intraparenchymal bleed and
bleed in right basal ganglion. With CSF report being normal and patient having thrombocytopenia
with intracranial bleed platelet rich plasma was transfused. Bone marrow examination revealed
giant megakaryocytes. Dengue serology was negative. There was no previous history of similar
complaints. We started the child on intravenous methylprednisolone. Platelet count improved and
patient improved symptomatically. Platelet count increased to 1lac. Child was discharged, is in
close follow up.
HO/07(P) IMPROVING SURVIVAL RATES OF ACUTE LYMPHOBLASTIC
LEUKEMIA IN CHILDREN- A SINGLE CENTRE EXPERIENCE
SirishaRani Siddaiahgari, Bindu Madhavi Parachuri, Ramana Dandamudi
Department of Paediatric Haematology Oncology, Rainbow Children’s Hospital and Perinatal
centre, Hyderabad
lokisiri@googlemail.com
Aim: To analyze the clinical characteristics, complications and outcome in acute lymphoblastic
leukemia (ALL) treated with MRC (Medical Research Council UK) 2000 protocol. MethodRetrospective Setting- Tertiary Children’s hospital Study period- 2000 June to 2006 July Study
population- 71 newly diagnosed children with ALL Exclusion criteria: Infant ALL, relapsed ALL
Results: Girls were 29(40%)and boys were 32(60%) in number. Most of them(85%) were in
standard risk age group(13mths-9years),rest >10years of age. WBC count was <50,000 in
54(76%) cases, 17(24%) had high count. Immunophenotyping was done in 19 children, 16 were
Pre B ALL, 3 T cell ALL. Three out of 41 cases had unfavourable cytogenetics. After initial
induction 69/71 entered remission. Induction delay noted in 16 cases with infection/mucoisitis.
The incidence of febrile neutropenia in Induction, consolidation and reinduction was in the range
of 35-44% with an induction mortality of 1.4%. Six relapsed during or off treatment; 3 were bone
marrow relapse, 1 testicular relapse, 1 CNS relapse and 1 had combined bone marrow and CNS
relapse. Four relapsed kids died and two are in remission after treatment with Berlin-FrankfurtMunich(BFM) relapsed protocol. Mortality rate was 11.26% (8 / 71); 4 after relapse. Kids who
relapsed or died had either high count, unfavourable cytogenetics or T cell disease. Overall
survival rate was 88.74% with follow up of 3month to 6years off treatment. Discussion –This
study reveals children treated with MRC 2000 protocol in India with scrupulous supportive care in
comprehensive paediatric care setup give results at par with international outcomes.
HO/08(P) OBSERVATIONAL STUDY OF FEBRILE NEUTROPENIC EPISODES IN
PEDIATRIC ONCOLOGY PATIENTS AT A TERTIARY CARE HOSPITAL.
Bothra M, Seth R, Kapil A, Dwivedi SN, Bhatnagar S, Das RR, Sami A
Department of Pediatrics, Microbiology and Biostatistics, All India Institute of Medical Sciences;
New Delhi
meenakshibothra@gmail.com
Introduction: Febrile neutropenia in children with cancer is considered to be a medical emergency
requiring prompt empirical treatment. Aims & Objectives: To ascertain the prevalence of
bacteremia, and to identify the current spectrum of common organisms infecting these children
and their sensitivity pattern. Materials & Methods: This is an ongoing observational, descriptive
study in which 54 febrile neutropenic episodes, which satisfied the inclusion and exclusion
criteria, have been enrolled. Details obtained from the history, clinical examination and results of
laboratory investigations including blood culture were recorded in a predesigned proforma and
analysed. Results: Fifty four febrile neutropenic episodes in 36 children were studied. Blood
culture was positive in 19% of the episodes. In 9 of the episodes, bacteria could be demonstrated
in blood and in urine in 2 of the episodes. Fungal infection could be established in 2 episodes in
blood and urine each. The commonest bacteria isolated were: Staphylococcus aureus (MSSA)
followed by ESBL + E. coli. Candida was the most common fungus isolated. All the isolated E.
coli strains were sensitive to Carbapenems and resistant to Ceftazidime. MSSA isolated was
sensitive to the commonly used antibiotics in most cases except in one episode, in which it was
resistant to Piperacillin + Tazobactam. Conclusion: This study helps in identifying the currently
prevailing organisms infecting febrile neutropenic children and their changing antibiotic
sensitivity pattern and thus helps in choosing the best empiric therapy for them.
HO/09(P) SENSITIVITY OF RED CELL DISTRIBUTION WIDTH IN DIAGNOSING
VARIOUS GRADES OF IRON DEFICIENCY ANEMIA IN CHILDREN
Farhan-ul-haque, Alladi Venkatesh, Mohammed Ismail
Princess Durru Shehavar children’s and general hospital, Hyderabad
drfarhanulhaque@yahoo.com
Introduction: Iron deficiency anemia (IDA) is one of the leading causes of mortality and morbidity
world wide. Milder grades of IDA can be missed by routine hematological conditions. Hence the
present study was undertaken to study the sensitivity of Red cell distribution width (RDW) in
diagnosing IDA. Aims and Objectives: To study the sensitivity of RDW in diagnosing various
grades of IDA and compare it with other hematological parameters Materials and Methods: 100
children in the age group of 6 months to 12 years with clinical suspicion of IDA and fulfilling
WHO hemoglobin threshold for diagnosis of anemia were included for the study. After a detailed
history, routine hematological investigations were done in all cases. Iron profile was done in all
cases for confirmation of iron status. RDW was done in all cases. Results: 80% of cases were from
urban area and majority (84%) were from lower socioeconomic class. Mean RDW was 18%,
16.4% and 15.38% in mild, moderate and severe anemia respectively. The sensitivity of RDW
across all grades of anemia was 100%. However even though sensitivity of mean corpuscular
volume(MCV) and peripheral smear was 100% in severe grades of anemia, the sensitivity of MCV
was 92.3% and 94.11% in moderate and mild degrees of anemia. The sensitivity of peripheral
smear was 44.87% in moderate and 5.88% in mild degrees of IDA Conclusions: RDW is 100%
sensitive across all grades of severity of anemia. Overall RDW was found to be more sensitive
than MCV and peripheral smear
HO/10(P) THE CHANGING SPECTRUM OF PEDIATRIC HEMOGLOBINOPATHIES:
DATA FROM A LARGE NORTH INDIAN TERTIARY CARE HOSPITAL.
T Seth, B Dhingra, Sanjeev Sharma, N. Rathod, S Rathi, M Mahapatra, HP Pati
Dept of Hematology AIIMS, New Delhi
tuliseth@yahoo.com
Introduction Hemoglobinopathies can present in the pediatric age group with varied and serious
manifestations. Due to migration and marriage the classic distribution of hemoglobinopathies in
India are changing and pediatricians need to be aware of the significance and clinical presentation
of the spectrum of disorders. Objectives To study the pattern epidemiological pattern of
hemoglobinopathies and compare this to prior Indian published data. Methods All pediatric
patients presenting to hematology department and who had a hemoglobinopathy suspected were
evaluated in the period of July 2004-August 2009, reports of all HPLC were reviewed for
clinically significant abnormal, variant hemoglobins and compound heterozygous conditions.
After consent, clinical data was recorded as well as region of origin. Descriptive analysis
performed using SPSS. Results Of the total 706 children analysed for possible
hemoglobinopathies, 574 were confirmed cases. The compound heterozygous states e.g. sickle
beta thalassemia, Hb E- beta thalassemia, are increasing in frequency (19.5%), to that reported in
earlier studies. Certain disorders which were considered rare- like sickle cell disease, HbE disease
and others were found to comprise 14.2%. High carrier status (thalassemia trait 33.1%) and
frequency of beta thalassemia syndromes –major and intermedia (33.3%) still exists. Conclusions
Pediatricians need to be aware of fallacies and overlapping hemoglobins which may make
diagnosis difficult, they also need to be aware of the diagnosis and management of these
compound states.
HO/11(P) HYPERCALCEMIA - AN ATYPICAL PRESENTATION
Subandhu Gupta, Meetu Rawat Gupta, Anita Sikand Bakshi
Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi.
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Humoral hypercalcemia of malignancy(HHM) is a paraneoplastic disorder affecting
children less frequently than adults. We present a case of Medulloblastoma with refractory
hypercalcemia treated by Pamidronate. Case Report: A 7 year old boy presented with history of
trivial fall, followed by projectile vomiting and urinary retention. Examination showed an anemic
and irritable child with truncal ataxia. Bilateral Fundii showed mild papilledema. Investigations
done revealed Hb 6.2gm/dl, total leucocytes 22000/mm3, Platelets 1.38lacs/mm3. Serum Urea,
Creatinine and electrolytes were normal. CSF showed atypical cells. MRI Brain and lumbosacral
spine showed a fourth ventricular tumor with a hypodense mass in the lumbrosacral canal for
which he underwent a suboccipital craniectomy and excision of the tumor. Histology confirmed
the diagnosis of Medulloblastoma. Post-operatively he developed severe low backache, which did
not respond to analgesic therapy. On re-evaluation, S.calcium was found to be 17.1mg/dl with a
Serum Alkaline Phosphatase 271U/L, serum LDH 1710IU/L and S.phosphorus 5.4mg/dl. Urinary
spot Calcium was 32.9mg/dl and Parathharmone(PTH) level 3.46. Radiography revealed a coarse
trabecular pattern with lytic lesions in the vertebrae, pelvis and proximal femur. Bone-marrow
biopsy showed extensive metastases .He was started on Calcitonin to which the calcium levels
responded transiently but again increased to 22.7mg/dl. Thereafter he was started on Pamidronate
for refractory hypercalcemia which led to a sustained reduction in the calcium levels .He was
discharged on 3 weekly Pamidronate with a guarded prognosis. Conclusion: The hypercalcemia
assosciated with malignancy(HHM) is rapid and severe. Pamidronate therapy seems to be safe in
the short-term and effective in helping control hypercalcemia.
HO/12(O) EVENTFULL SICKLE CELL CRISES
N. L. Phuljhele, N.C.Pradhan, S.Panigrahi
Pt.J.N.M.Medical College ,Raipur, Chhattisgarh
dr.nirmal.pradhan@gmail.com
Introduction: Prevalence of sickle cell disease is around 15% in Chhattisgarh. A prospective study
on sickle cell disease was done in medical College Raipur.(C.G). Aims and Objectives:Find out
incidence of various crisis and causes of morbidity mortality Correlation of HbF level with sickle
cell crisis and mortality Precipitating factors in crisis Therapeutic response in sickle cell crisis
Material And Methods: Admitted patients between Sept. 2007 to Aug.2009 in age group 6month 14 years. Sickle cell was confirmed by Hb electrophoresis and all homozygous patients were
further evaluated by HPLC for HbF level. According to HbF level patients were divided into five
groups,gp-1 (<5%), gp-2(6-10%),gp-3(11-15%),gp-4(16-20%) and gp-5 (>20%.). Results: Total
of 536 SCD, admission from 196 patients in this period .Out of 196, 136- HbSS, 50-HbAS and
10-Combined Hemoglobinopathies .The most common causes of admissions were for VOC.
Among 386 (72%)cases of VOC,230(42.9%) had joint and limb pain,127(23.5%) had abdominal
crises, 16(2.9%)–hand foot syndrome,8(1.4%)-CNS crisis and 7(1.3%)-acute chest syndrome.
Sequestration crisis-58(10.7%), hemolytic crisis-41(7.6%) and aplastic crisis-4(0.7%).Painful
crisis and acute chest syndrome have significant female predominance. Pallor was present in all
patients and 87% had splenomegaly. The most common precipitating factors were URI-56%,
fever-48%, gastroenteritis-8%, pneumonia-6%. In treatment of painful crises 6.9% responded to
oral fluid and NSAIDS,74%-I.V.fluid and NSAIDS ,18% l.V fluids, NSAIDS and codeine and
1.1%-I.V.fluid,NSAIDS and oral morphine. I/V morphine not required in any case.27% of painful
crisis patients required blood transfusion as their Hb level <5gm/dl. According to HbF level there
were no patients in group1, 6 patients –group2, 34 patents – group3, 48 patients-group4 and
48pateint-group5. Lower incidence of painfull crisis, ACS and CNS crisis occur with increasing
HbF level. HbF level > 20% has significantly lower incidence as compared to previous group.
There were 6 deaths in this period , 4 from CNS crisis, 1 from septicemia –ACS ,1 from
sequestration crisis. All death except one from sequestration crisis had HbF level <20%.Our study
similar to Kuwait study (Najwa Ali et.al)where there is benign type of SCD and is different from
Sudan study(Bayoumi et.al) with severe disease. This can be explained by difference in mean
HbF level. Conclusion-: VOC is commonest cause of hospitalization. HbF >20% had significant
lower incidence of painfull crisis,ACS and CNS crisis.Early diagnosis & intervention required to
reduce factor and complication of SCD.
HO/13(P) STUDY OF IRON STATUS IN SICKLE CELL DISEASE AND TRAIT IN 115YRS CHILDREN.
S.Phuljhele, N.L.Phuljhele, Goverdhan Singh Thakur. Shashikapoor, Arun
A-59 Parshuram Nagar, Behind Mining Office, Telibandha Ring Road, Raipur 492001
dr_sharja@yahoo.co.in; drkumararun_1982@yahoo.com
Setting – a 700 bedded teaching hospital. Introduction - Sickle cell anemia is inherited hemolytic
anemia characterized by the presence of sickle cells, intravascular hemolysis and shortened red
blood cell life span. Present study is an effort to assess iron status in homozygous sickle cell
disease and sickle cell trait to know iron excess or deficiency. Aims and objectives- Assessment
of the iron deficiency anemia in sickle cell anemia in relation to blood transfusion in patients came
in pediatric OPD and ward. Material and methods- Case control study carried out in Pt
J.N.M.Medical College raipur (CG) during period from September 2004 to September 2005.
Inclusion criteria - Study population included children of age 1-15yrs of SS phenotype and AS in
and around Raipur city. Exclusion criteria- Cases with other known causes of anemia. Serum iron
of all patients was estimated with the help of semi auto analyzer. Serum ferritin was estimated by
ferritin quantitative EIA test by ELISA reader. Statistical analysis done using student T test.
Results – 12 non transfused patients of SS pattern had mean serum iron 81.78+/-41.18ug/dl,16 non
transfusedAS patients had mean serum iron57+/-33.64ug/dl while 23 patients of hypertransfused
group (>5 BT) had mean serum iron 110+/-28.33ug/dl and 3 AS hypertransfused group had mean
serum iron 70.66+/- 57.39ug.dl. Serum ferritin mean was 245.37+/-377.77 in 12 non transfused SS
patients, in hypertransfused group it was 836.07+/-413.00ng/dl. In AS cases serum ferritin mean
was 185.15+/-36.67ng/dl in 16 non transfused and in hypertransfused group it was 413+/-406.05
ng/dl. The results were found statistically significant with p value <0.01. Conclusion- Blood
transfusion appears to have significant effect on serum iron level, and serum ferritin levels. Sickle
cell anemia patients in area of study have adequate levels of iron and ferritin in their serum as
compared to AS patients and controls because of higher transfusion rate in SS category.
HO/14(P) BURDEN OF ANEMIA IN HOSPITALIZED CHILDREN OF LUCKNOW
Shitanshu Shrivastava, K.L.Srivastava, Rinku Gupta
Assistant Professor Pediatrics, ELMC Lucknow.
dr_shitanshu@yahoo.co.in
Introduction: - Anemia (hemoglobin level < 11 g/dL) remains one of the most intractable public
health problems in malaria-endemic countries of India It affects more than half of children, and
has serious consequence. Objectives:-1. To find prevalence of anemia in hospitalized children
aged 1-5yrs.2.To assess association of anemia with common diseases 3.To find association of
severity of anemia with Pvivax malaria. Design: A hospital based prospective study Methods:1011 children aged 1 - 5 yrs admitted in our hospital from 1/6/08 to 31/06/09were included in the
study. They were investigated for Hob , GBP , hematocrit , thick and thin blood smear for
malarial parasite ,stool examination and relevant investigations for the various diseases.
Results:- 78% children were found to be anemic(value<.005) , out of which 22% had mild
anemia, 46% had moderate anemia(odds ratio - 0.04) and 10% had severe anemia .Out of patients
with anemia PEM was associated in 73% cases (value<.005).pneumonia in 12% ,diarrhea in in
10%,heart failure in 8%,malaria in 10%, worm infestation in 4% and other infections in 2%. Out
of children with severe anemia 3 % had P falciparum positive and 6 % had parasite Pvivax
positive (value<.001) Conclusion:-Anemia is a co morbid condition in hospitalized children which
needs an integrated approach.PEM is strongly associated with anemia and Pvivax malaria is
associated with severe anemia.
HO/15(P) V617F JAK2 THROMBOCYTOSIS- A DIAGNOSTIC DILEMMA
Surekha Joshi, Charusheela Warke, Ravindra Gadade, Sushma Save, Gayatri Bramhe, Gaurav
Laddha.
Government Quarters, Building-1, Flat No. 25, Haji Ali, Mahalaxmi, Mumbai 400034
drsurekhajoshi@rediffmail.com; nairpediatric@hotmail.com
Introduction: Thrombocytosis in childhood is commonly seen as a reactive or secondary
phenomenona. In contrast primary or essential thromboctyosis (ET) which is a true
myeloproliferative disorder ( MPD), is extremely rare in children with an incidence of 1 per
million children. Here we report a this rare case of ET. Case summary: 2 yrs 6months old boy, was
admitted with fever, anasarca, distension of abdomen for 8 days with right knee joint pain and
difficulty in walking since 5 days. Examination revealed pallor, mild periorbital puffiness & pedal
oedema, minimal desquamation of palms and soles, with mild right knee joint swelling. Systemic
examination revealed a firm liver (8cm) and spleen (1cm). On admission, the x ray chest, blood &
urine culture were negative. The initial CBC documented Hb-8.2gm/dl, WBC-24x109/l & Platelet
count-321x109/l with an ESR of 28mm/hr. Patient was symptomatically treated for fever &
bilateral knee joints effusion. Further investigations to rule out a multisystem disorder with fever
were negative Subsequently in 3-4 days he became afebrile and knee joint effusion disappeared.
However, it was noticed that over the next four weeks the WBC gradually showed a decreasing
trend (from 11.4 x109/l to 4.2 x109/l), platelet count increased from 3.2 L to 6.6 L to 9.7L and ESR
transiently increased to 134 mm/hr. The patient was started on aspirin with a suspicion of
Kawasaki’s disease, in view of thrombocytosis, minimal desquamation of palms/ soles, and raised
ESR. At this time the repeat PS was suggestive of a hemolymphoid malignancy and bone marrow
examination revealed megakaryocytes without any evidence of idiopathic myelofibrosis (IMF) or
myleodysplasia (MDS). PS persisted to showed a thrombocytosis (10 lacs) with clumping of
platelets. The impression now was, myeloproliferative disorder (ET) to rule out reactivation
thrombocytosis (RT). The test for Philadelphia chromosome, to rule out CML, was negative. The
test for V617F JAK2 mutation was sent and this came positive thereby confirming our diagnosis
of a myeloproliferative disorder with essential thrombocytosis. During the course of stay in the
hospital patient developed transient intussusception which resolved spontaneously and aspirin
induced hepatitis which resolved after cessation of drug. Patient was discharged when he became
asymptomatic. At discharge his platelet count had reduced to 4.2 L and has been called on follow
up for repeat CBC, for monitoring of thrombohemorrhagic complications of ET and evolution to
IMF, MDS or AML. Discussion: Essential Thrombocytosis (ET) in childhood is extremely rare.
Secondary or reactive thrombocytosis(RT) is more common in all age groups and is a benign
phenomenon due to infections, iron deficiency and hemolytic anemias, connective tissue
diseases.ET can be of two types familial,(V617F JAK2 mutations negative), and sporadic type
(with likelihood V617F JAK2 mutation positive). This mutation is helpful in distinguishing
reactive and essential thrombocytosis. In children the MPD’s carrying positive V617F JAK2
mutation are, polycythemia vera(PV) 74 - 97%, essential thrombocytosis (ET) 33 - 57%,
idiopathic myelofibrosis(IMF) 35 - 50%, myelodysplastic syndrome(MDS).Our patient fulfilled
the revised proposal for PVSG criteria of 2005 for ET. We conclude that the V617F JAK2
mutation test and bone marrow findings are important markers in diagnostic dilemma scenarios for
essential thrombocytosis.
HO/16(O) ARSENIC TRIOXIDE (ATO) AS PRIMARY THERAPY IN ACUTE
PROMYELOCYTIC LEUKEMIA
Das RR, Mehta P, Seth R, Velpandian T, Gupta R, S Garima , Sami A, Khandelwal D, Thavaraj V
Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi
dr_rashmipgi@yahoo.com
Introduction: Acute promyelocytic leukemia (APL), is characterized by chromosomal
translocation t(15;17) and presence of PML-RARα fusion transcript. Treatment options for
pediatric APL includes conventional chemotherapy, chemotherapy and ATRA (ATRA +
anthracycline and/or cytosine arabinoside) or arsenic trioxide (ATO). Role of ATO is well
established in relapsed/refractory cases of APL. Objective: To study the role of ATO as primary
treatment modality in children with APL. Patients and Methods: From October 2005 to September
2009, data on APL patients treated primarily with ATO was analysed. The relevant details were
entered in a predesigned proforma. PML-RARα fusion gene was diagnosed by PCR/FISH preinduction as well as during follow-up. Results: Total of 12 patients (8 male, 4 female) were
diagnosed as APL during this period. Eight patients had received ATO as first line therapy.
Average age of presentation was 6.5 years (range, 2.5 to 10 years). The median WBC count was
2900 (range, 1700 to 142,000). Four patients achieved complete remission (CR) for a response
rate of 50% (PCR –ve for the PML-RARα fusion gene). Major complication was APL syndrome
(5 patients) and others were QTc prolongation, psychosis, and reversible transamnitis. One patient
died during induction (? APL syndrome ? febrile neutropenia), 3 relapsed (2 achieved remission
with ATRA and chemotherapy. The third relapsed patient died from an intracranial bleed before
reinduction could be started). The median follow-up duration is 26 months. Conclusion: ATO
seems to be a useful alternative for initial therapy for APL with comparable efficacy and safety
profile.
HO/17(P) ΔΒ THALASSAEMIA TRAIT: A CASE REPORT
Sunil Vaidya, Sandesh Padwal, Deepa Patil
Ashwini Sahakari Rugnalaya, Solapur, Maharashtra
drsvaidya@gmail.com drsandeshpadwal@gmail.com drdeepapatil@gmail.com
A 13yrs male born of 2nd degree consanguious marriage C/o Fever, Pain abdomen -15days No
history of previous blood transfusion,no history of jaundice, P/H- adviced blood transfuion 2yrs
back On Examination:Hemolytic facies Pallor ++No Icterus, lymphadenopathy Structural
abnormalities.Spleen 9cm,firm, Liver 3cm. Investigations- WBC -7500/cmm Hb – 6.4gm% Plt
ct – 1.96 lakh/cmm MCV – 71.2 fL MCH – 21.2 pg MCHC – 29.8g/dl RDW – 23.6 Peripheral
smear –hypochromic microcytosis, anisocytosis +, Target cells ++ Malaria antigen test
P.Falciparum + P. Vivax + Osmotic Fragility Test – Normal Reticulocytes -3.5% Fetal
Hemoglobin (By Alkali denaturation) 35% HbA 0.30% USG – Gross Splenomegaly.Mild
hepatomegaly Hb electrophoresis HbF 99.7% HbA2 -0.0 Diagnosis: δβ Thalassaemia trait To
confirm the
diagnosis Electrophoresis of mother’s and father’s blood was done. Hb
electrophoresis Father: HbF 8.0% ,HbA 89.2%, HbA2 2.8.Hb electrophoresis Mother: HbF 7%
,HbA 90.4%,HbA2 2.60% Discussion: DELTA BETA THALASSAEMIA complete absence of
both β and δ chain synthesis. The homozygous form – presents like β thalassaemia intermediate
and nearly 100% HbF in red cells. The heterozygous form – closely resembles thalassaemia minor
and HbF elevation 5_20%. Difference HbA2 levels are reduced or normal.+ Non Transfusion
depandent Thalassaemia Hb maintained at 7 – 7.5gm/dl 11% present present within 1st yr of
life,30% 2nd yr of life,59% later in life. Growth and Development remains normal.spleen is
palpable from beginning in majority and its size increases with time. Electrophoretic Phenotypes
Difference Between δβ trait and HPFH : Accurately differentiated by globin chain synthesis
analysis showing an α/ non α globin chain imbalance,which is more in δβ thalassaemia then in
HPFH. Identification of the molecular defect by globin gene defect by globin gene DNA analysis
confirms the diagnosis. The purpose of presenting this case is, although at outlook it looks like
index of suspicion. Treatment: 1)Transfusion therapy depends on; Haemoglobin levels,Respect
with growth and development,Size of spleen,And special circumstances like Infection
Hypersplenism,Periods of rapid growth,Pregnancies,Development of cardiac disease 2) Indication
of splenectomy : Hyperrsplenism,Transfusion Requirement 200-250ml/kg in one year.
HO/18(P) CYTOGENETIC ANALYSIS OF
PEDIATRIC ACUTE LEUKEMIA –
RETROSPECTIVE STUDY
Mishal Vikrant, SirishaRani Siddaiahgari, Ramana Dandamudi
Department of Paediatric Hematology Oncology, Rainbow Children Hospital and Perinatal
Centre, Hyderabad
lokisiri@googlemail.com
Aim: To evaluate cytogenetics characteristics in Children with Acute Leukemia Study Population:
Children aged 1-18 years with Acute leukemia-Acute Lymphoblastic Leukemia(ALL) and Acute
Myeloid Leukemia(AML) Methods- Retrospective series Study period: January 2000 to January
2008 Results-Cytogenetic characteristics of 128 children diagnosed with acute Leukemia were
analyzed. ALL was diagnosed in 108(84.35%) children and AML in 20(15.6%) children. In
ALL group boys were 65% and girls 35%. Fourteen boys and six girls had AML. Cytogenetic
data was available in 51; 47 were ALL and 4 were AML. Normal karyotype was noted in 38 cases
of ALL; hyperdiploidy in 5 cases of ALL, one each had trisomy 11 , Hypodiploidy and one was
TEL/AML positive by FISH. Translocation of 7,12 chromosomes noted in one child . In children
with AML 3/4 were Acute Promyelocytic Leukemia (APML) and all were positive for t (15;17)
translocation; all were female children in an age group 4 to 11 years. Two year old girl child with
AML –M4 was positive for Philadelphia: t (9; 22). In most of the above cases conventional
cytogenetic analysis was not conclusive. Discussion-Techniques like FISH and Real Time PCR
along with conventional cytogenetics are required for prognostication and risk adopted therapy.
HO/19(P) RITUXIMAB – AN EMERGING THERAPY FOR REFRACTORY
HEMOLYTIC UREMIC SYNDROME
Kanav Anand, Kandasamy Sasidaran, Niveditha Kamath, Arpana Iyengar, Anil Vasudevan,
Kishore D Phadke
Children’s Kidney Care Centre, Pediatric Nephrology Division, Dept of Pediatrics, St.John’s
Medical College, Bangalore, Karnataka
dr_kanav_anand@yahoo.co.uk
Rituximab-an anti CD20 monoclonal antibody, initially introduced for the treatment of non
hodgkin’s lymphoma, is off late being used for a number of off-label uses, one of them being
hemolytic uremic syndrome. Till date there are only 3 case reports of use of rituximab in
hemolytic uremic syndrome world wide, of which only 1 has been reported in a child. We report a
11 year old with refractory atypical (D-) hemolytic uremic syndrome having a stormy clinical
course where the use of rituximab led to a dramatic improvement in the activity of the disease.
Inspite of 4 weeks of plasma therapy (plasmapheresis and plasma infusion) the child continued to
be symptomatic and had persistent thrombocytopenia with features of hemolysis. Use of 2 doses
of rituximab, 2 weeks apart with each dose being 375 mg/m2, led to a good peripheral B cell
depletion as evident by the CD19 count. This resulted in an improvement in the clinical condition
and hematological parameters, although she progressed to end stage renal disease which is a
known sequelae of the disease. No major side effects were noted and the child is presently
asymptomatic on CAPD during her 4 months follow up period. Rituximab therapy seems to be on
the horizon for treating hemolytic uremic syndrome refractory to the standard therapy.
HO/20(O) TREATMENT OF PEDIATRIC ACUTE MYELOID LEUKEMIA:
EXPERIENCE OF A TERTIARY CARE HEMATOLOGY CENTRE.
Gupta N, Dhingra B, Kapoor R, Rathi S, Seth T, Mishra P, Mahapatra M
Department of Hematology, All India Institute of Medical Sciences, New Delhi-110029.
docnitingupta@gmail.com
Introduction: Intensive therapy and supportive care has improved outcome in pediatirc acute
myeloid leukemia with 50- 60% of patients can experience long term survival. We report our
experience of treating pediatric acute myeloid leukemia using 3+7 induction and high dose
cytarabine consolidation. Objective: Acute myeloid leukemias requires aggressive chemotherapy
and good supportive care, retrospective analysis of pediatric patients with acute myeloid leukemia.
Methods: Retrospective review from Sept 2006 to Aug 2009, thirty three patients, mean age
12.4yrs (range 1-18 yrs); male to female ratio 2:1. All were treated with 3+7 induction, and three
cycles of high dose cytarabine (HiDac) (3gm/m2/ivi/over 3 hrs/q 12h on day 1, 3 & 5) for
consolidation. Clinical and laboratory data was compiled. Results: Out of the thirty three patients,
twenty six (78.8%) achieved remission after one 3+7 induction while seven required second
induction. Once in remission, three cycles of high dose cytarabine was given as consolidation.
Out of thirty two evaluable patients in remission, one did not turn up for consolidation, three had
early relapse before completing consolidation, one died during consolidation due to neutropenia.
Out of twenty seven patients who completed consolidation two patients lost to follow up, ten
relapsed with mean remission duration of 4.6 months (range 1-11 months) while 15(46.8%) are
still in remission (median follow up 8 months (1-42months). Cytogenetic data for 21 patients
(normal- 14, t(8;21)-5, complex/poor -2 patients). Cytogenetic risk group analysis- 6 of 14
patients with normal cytogenetics (i.e. intermediate risk group), single patient of complex
cytogenetics and 1 of 5 patients of good risk cytogenetic group t(8;21) relapsed while one patient
t(8;21) was lost to follow up. Conclusion: Present study includes only a small number of patients
with short duration of follow up, suggests that 3+7 induction followed by high dose cytarabine
consolidation has low treatment related toxicity, however relapse free survival is inferior to more
intensive regimens. We plan to intensify our standard regimen as treatment related mortality has
been minimized by better supportive care.
HO/21(O)
THE
EXPERIENCE
OF
HEMATOPOIETIC
STEM
CELL
TRANSPLANTATION FROM AN EMERGING CENTRE IN NORTH INDIA
Manas Kalra, Satya Prakash Yadav, Veronique Dinand, Nirbhay Parashar, Sangeeta Kohli,
Dharma R Choudhary, Shyam Aggarwal, Anupam Sachdeva
Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Sir Ganga Ram Hospital,
New Delhi,
manaskalra_27@yahoo.co.in
Introduction: We are describing our experience of HSCT programme at Sir Ganga Ram Hospital,
a tertiary hospital in North India, over a period of 3 years. Patients and methods: A retrospective
study of all patients who underwent HSCT over a period of 3 years, from January 2006 to August
2009 was done and follow-up data was analyzed. Results: Thirty-nine transplants (16 allogenic
and 23 autologous) were done in 34 patients (26 males, 8 females) of which children comprised of
41.2%. The median age was 34 years (11 months-68 years). The indications for 16 allogenic
transplants were thalassemia major-6, AML-6, severe aplastic anemia-3 and high-risk ALL-1.
Donors were HLA-matched sibling in 13 cases, HLA-matched relative in 1 and unrelated
umbilical cord blood in 2. The source of HSCT was peripheral blood in 8 patients, bone marrow in
6 and umbilical cord blood in 2. Fourteen underwent myeloablative transplants and two were
given reduced intensity conditioning. Three Donor Lymphocyte infusions were given to two
patients. Seven patients (44.8%) are alive and disease free at a median follow-up of 453 days (65591 days). Thirteen showed neutrophil engraftment at a median duration of 14 days (range 11 to
44). Acute GVHD was seen in 6 patients, grade I-II was seen in 5 patients, which responded to
steroids. Steroid-refractory grade IV GVHD was seen in one child; it did not respond to
mycophenolate and infliximab. Massive bleeding (gastro-intestinal-2 and pulmonary-1) occurred
in three children. Three patients developed sinusoidal obstruction syndrome. All were given
Defibrotide and two responded. A total of 7 allogenic HSCT recipients have died, out of which 2
AML patients died of relapse at 56 and 90 days post-transplant. Two thalassemic children rejected
graft but are alive and transfusion dependent. The main indications for 19 autologous HSCT were
multiple myeloma-9, Non-Hodgkin’s lymphoma-4, metastatic neuroblastoma-2, relapsed
Hodgkin’s lymphoma-1, relapsed rhabdomyosarcoma-1, relapsed primitive neuroectodermal
tumor (PNET) of the kidney-1 and rejection post cord blood transplant in thalassemia-1. The
source of HSCT was peripheral blood in 16 patients and bone marrow in 3. Ten patients (55.6%)
are alive and disease-free at a median follow up of 114 days (range 21 - 617 days). Seventeen
patients engrafted neutrophils at a median duration of 12 days (range 9 to 30). At a median follow
up of 200 days (range 21 to 1200 days), the estimated overall survival and event free survival for
all the transplant population are 67.3% ± 8.6% and 63.5± 8.9% respectively. Overall transplant
related mortality is 23.5%, with a decrease from 28.6% to 22.2% after a dedicated HSCT unit with
HEPA filtered rooms became functional by mid 2007. Conclusion: With our encouraging results
we can conclude that it is possible to setup a HSCT unit in developing world and results get better
with each passing year.
HO/22(P) PEDIATRIC HODGKIN’S LYMPHOMA PRESENTING WITH PULMONARY
NODULES AND LEUKEMOID REACTION
Manas Kalra, Veronique Dinand, Anupam Sachdeva, Sunil Bhat, Tarun Piplani, Satya Prakash
Yadav
Pediatric Hematology Oncology & BMT Unit, Department of Pediatrics, Sir Ganga Ram Hospital,
Delhi
manaskalra_27@yahoo.co.in
Introduction: Persistent neutrophilic leukocytosis above 50x109/L in the absence of leukemia,
known as leukemoid reaction (LR), has only been reported in one adult case of Hodgkin’s
Lymphoma (HL). Here we report the first case of pediatric HL presenting with both diffuse
nodular pulmonary involvement and LR. Case Report: An 8-year-old female presented with fever
and severe pain in the hipbones and legs for 2½ months. She was started on antitubercular therapy
in a peripheral hospital in view of miliary mottling in the chest X Ray and a history of weight loss
and was referred to our centre in view of poor response to treatment. On examination she had
cervical lymphadenopathy and a mild splenomegaly. Investigations revealed a leukemoid reaction
(52.2x109/L) with neutrophilia (90%) and bilateral diffuse nodular opacities on chest X-ray.
Supraclavicular lymph node biopsy was diagnostic of HL, mixed cellularity. She was started on
chemotherapy and had a dramatic response to therapy.Both pulmonary nodules and leukemoid
reaction are rarely seen in lymphoma. Both being present in the same patient of Hodgkin’s
lymphoma has not been reported. Non-response to anti-tubercular therapy can be an indicator for
presence of Hodgkin’s Lymphoma. We also hypothesize that pulmonary nodules and leukemoid
reaction may be linked to high levels of cytokines like G-CSF released by the tumor cells, which
may explain the severe bony pains in the absence of any bone or the bone marrow involvement in
this case. Conclusion: Thus miliary mottling of lung can be a diagnostic dilemma in children,
especially when there is no supportive evidence of TB. A pulmonary lymphomatous infiltration
should always be ruled out in such cases. Neutrophilic leukemoid reaction with body aches can be
a rare clinical feature of HL, making the presentation of this child unique and unconventional.
HO/23(P) POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME (PRES) IN A
PATIENT WITH HIGH RISK NEUROBLASTOMA POST AUTOLOGOUS BONE
MARROW TRANSPLANT (BMT)
Manas Kalra, Satya Prakash Yadav, R.K. Sabharwal, Nita Radhakrishnan, Gaurav Kharya,
Anupam Sachdeva
Sir Ganga Ram Hospital, Pediatric Hematology Oncology Unit, Delhi
manaskalra_27@yahoo.co.in
Purpose: PRES is an increasingly recognized neurologic disorder with characteristic imaging
findings, associated with a multitude of diverse clinical entities like acute glomerulonephritis,
eclampsia, SLE, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, toxicity
from cyclosporine, tacrolimus, and cisplatin. Most cases manifest with acute hypertension and
seizures. PRES has rarely been reported in pediatric patients undergoing BMT. Method: A 4-yearold boy was diagnosed as High risk Neuroblastoma (N myc amplification positive) of right
adrenal gland with hepatic extension. After 4 months of chemotherapy he underwent right
adrenalectomy with right hepatectomy for local control. He was given further chemotherapy
followed by autologous BMT with Carboplatin, etoposide and Melphalan. From day þ8 he
developed fever with blood in stools. He was thrombocytopenic and needed regular platelet
transfusion. On Day +10 he developed a brief seizure, which was controlled with Lorazepam. He
was markedly irritable and had a complete bilateral loss of vision. His BP was above 95th centile
for his age and height for 2 days prior to this episode and was on sublingual Nifedepine on as per
need basis leading to a fluctuation in the BP readings. His electrolytes were within normal limits.
Results: MRI done to rule out an intracranial bleed, showed symmetrical abnormal areas of
increased signal in the cortex and sub cortical white mater of both the occipital and parietal lobes.
These findings were suggestive of PRES. He was managed with antihypertensives and
Leveteracetam. There was a complete reversal of visual defect within 5 days. He engrafted
neutrophils on day þ29 and platelets on day þ42. He is now 3 months post transplant and is doing
well. Conclusion: It is important to consider PRES as differential for a child having neurological
abnormalities post-BMT that often are considered to be due to CNS infections or bleeding
episode.
ID/01(O) TREATMENT OUTCOME OF TUBERCULOUS LYMPHADENITIS IN
CHILDREN USING DOTS STRATEGY
Sangeeta Sharma
sangeetasharma2000@gmail.com
Introduction: With the resurgence of tuberculosis, although pulmonary TB (PTB) contributes to
majority of cases, extra pulmonary TB (EPTB) is becoming more common. Children experience a
high TB related morbidity and mortality with management of TB being challenging. Aims &
Objective: To study treatment outcome of DOTS strategy. Material & Methods: Retrospective
analysis of 669 children of lymphnode tuberculosis over 9 years Results: Mean age was 9.8 years
with more girls (61.3%) than boys (38.7%){12=0.01P= 0.911 (NS)}. Most of the patients were in
the age group of 11-14 years (48.1% ) followed by 6-10 years(34.5%) and 0-5 years(17.4%)
respectively. Cervical tuberculous lymphadenitis TB (88.2%) was the commonest form for all
ages followed by axillary lymphadenitis in 3.3%. TB of other sites was seen in only 57 (8.5%)
cases. Out of total 622 (92.9%) cases of lymphnode TB where fine needle aspiration and/ or
excisional biopsy was done, it was positive (84.2%) and negative (15.6%) respectively for AFB/
cytology, while it could not be done in 47 patients. Category I, II and III was started on 15.4%,
7.5% and 77.1% patients respectively. Overall, treatment completion rate was 94.9% and the
default rate was 2.2% with a failure rate of 2.5%. Death rate was 0.3% with one being each in
category I (P=0, significant) and Category II (P=0.098, significant), Category I showed better
treatment completion (90.3%) as compared to category II (88%) (P = 0, significant) Conclusion:
The study confirms the efficacy of DOTS strategy for pediatric TB lymphadenitis
ID/02(P) APPLICABILITY OF ROCHESTER CRITERIA IN IDENTIFICATION OF
FEBRILE INFANTS <8WKS OF AGE UNLIKELY TO HAVE SERIOUS BACTERIAL
INFECTION
Lalit Chauhan, Narendra P Chhangani, Pramod Sharma, Priyanshu Mathur
Department of Pediatric Medicine, Umaid Hospital, Dr S.N Medical College, Jodhpur.
drpramodsh@hotmail.com
Introduction: Rochester criteria were developed for global assessment of a febrile baby to assess
their degree of illness and ability to predict serious illnesses. Their medical history , physical
examination ,and lab evaluation were considered when making management decisions. Only a
minority of febrile neonates would have serious bacterial infections. Therefore routine
hospitalizations and antibiotic use are not always necessary for febrile infants. Aims and
Objectives :To study the clinical profile of serious bacterial infections in infants. To study the
application of Rochester criteria in identification of infants < 8wks unlikely to have serious
bacterial infection although hospitalized for suspected sepsis. Material and Methods: All the
enrolled infants were categorized under low risk and high risk. Patients who met the Rochester
criteria were considered to have low risk for serious bacterial infection .All other children were
assumed to have high risk for serious bacterial infection .All febrile infants <8wks categorized
under low risk and high risk were subjected to clinical examination, lab evaluation for sepsis
including blood test, blood culture and urine examination and urine culture and other required
investigations to prove the serious bacterial infection. Results: Negative predictive value of babies
in low risk group by Rochester criteria for having serious bacterial infection was 59% (95%
confidence interval 38 %-80%).This suggests that in 60% of febrile infants<8wks the treating
physician can avoid them from being hospitalized and these infants can safely be offered
domiciliary care. Conclusion: This study concluded that Rochester criteria are not only useful in
identification of febrile infants not having serious bacterial infections , but also helped pick up
high risk infants having serious bacterial infections in this age group.
ID/03(O) A COMPARATIVE STUDY OF RATIO OF CEREBROSPINAL FLUID AND
SERUM ADENOSINE DEAMINASE AND GLUCOSE LEVELS IN CHILDREN WITH
CEREBRAL MALARIA AND PRESUMED VIRAL ENCEPHALITIS.
Mukesh Gupta, Vikramjeet Singh, Rakesh Jora, Pramod Sharma
Department of Pediatric Medicine, Umaid Hospital Dr S.N. Medical College, Jodhpur.
drpramodsh@hotmail.com
Introduction : The CSF and serum ADA level estimation offers a new modality for differential
diagnosis of various CNS infections.ADA estimation is simple , less time consuming, cost
effective and reproducible .ADA is a marker of cellular immunity and its activity is found to be
elevated in those diseases in which there is cell mediated immune response like cerebral malaria
and viral encephalitis. Aims and Objectives: To study the ratio of CSF ADA to serum ADA as a
discriminator of cerebral malaria from presumed viral encephalitis. To find out CSF and serum
glucose ratio as a differentiating factor between cerebral malaria and presumed viral encephalitis.
Material and Methods : A total of 80 patients with history of fever, convulsions and altered
sensorium were enrolled in the study . After detailed history and complete physical and systemic
examination they were investigated and who fulfilled the inclusion criteria were included in the
study. Results :Patients with cerebral malaria had higher mean value of CSF ADA and serum
ADA than viral encephalitis but mean ratio of CSF/serum ADA in cerebral malaria was less than
viral encephalitis .In all three groups CSF/serum glucose ratio between 0.5 -0.7, the values being
67.8%,76% and 74.1% in cerebral malaria, encephalitis and febrile convulsions. CONCLUSION:
Serum ADA has emerged out as a good discriminator between cerebral malaria and viral
encephalitis with a sensitivity of 92.9% and specificity of 80.8
ID/04(P) A STUDY OF CLINICO-MICROBIOLOGICAL PROFILE AND UTILITY OF
BACTEC IN CASES OF PYOGENIC MENINGITIS IN CHILDREN
Mahendra Meena, BD Gupta, Anurag Singh, Manish Parakh, Dhananjay Singh
Department of Paediatric Medicine, Umaid Hospital, Dr S.N Medical College, Jodhpur.
drpramodsh@hotmail.com
Introduction: Pyogenic meningitis is a very serious and common disease with grave consequences
and associated morbidity. Beside, standard antibiotic regimens are not usually effective in its
management. Aims and Objectives: To study the epidemiological profile, clinical features, and
various complications seen in cases of pyogenic meningitis of children in western Rajasthan. To
determine the etiological agents by BacT /ALERT system including their antibiotic sensitivity
patterns and to suggest newer management strategies and regimens for these patients. Material and
Methods: A total of 58 cases with proved pyogenic meningitis were included in our study. Routine
blood counts and detailed C.S.F. examination of all patients were performed at the time of
admission and repeat C.S.F. examination was done after 48 hrs to see the response of
antimicrobial therapy. If the CSF was not normal after 2 days another lumbar puncture was done
after 7 days to evaluate the response until a normal CSF was obtained. Results: In untreated
patients culture positivity is seen in 81.48% cases and overall organisms could be identified in
72.09% cases. Staphylococcus aureus was the commonest organism recovered in 19.94% followed
by Klebsiella in 11.64% and streptococcus in 11.62% patients. Combinations of vancomycin,
amikacin and piperacillin tazobactum in the age group < 2 months and vancomycin,
chloramphenicol and piperacillin tazobactum in age group > 2 months were the drug of choice
according to sensitivity pattern. Complications seen in our study group was shock in 13.9% cases,
hydrocephalus in 9.3% and raised ICT in 6.97% patients. Staphylococcus aureus was sensitive to
teicoplanin and linezolid in all cases. Bact/Alert culture system was useful and more productive
than conventional culture methodology in identifying the offending organisms. Conclusion:
Pyogenic meningitis is a significant cause of morbidity and mortality and antibiotic regimen must
be tailored to the culture and sensitivity pattern
ID/05(P) A CLINICO-MICROBIOLOGICAL STUDY OF PYOGENIC MENINGITIS IN
CHILDREN
Mahendra Meena, BD Gupta, Anurag Singh, Manish Parakh, Dhananjay Singh
Department of Paediatric Medicine, Umaid Hospital, Dr S.N Medical College, Jodhpur.
drpramodsh@hotmail.com
43 patients of pyogenic meningitis were studied. Neonatal cases were seen in 37.2% of cases.
37.2% of our patients were partially treated. Fever, convulsions, refusal to feed and vomiting were
the most common symptoms. In untreated patients culture sensitivity is seen in 81.48% cases and
overall organisms could be identified in 72.09% cases. Staphylococcus aureus was the commonest
organism recovered in 19.94% followed by klebsiella in 11.64% and streptococcus in 11.62%
patients. Combinations of vancomycin, amikacin and piperacillin tazobactum in the age group < 2
months and vancomycin, chloramphenicol and piperacillin tazobactum in age group > 2 months,
were the drug of choice according to sensitivity pattern. Complications seen in our study group
was shock in 13.9% cases, hydrocephalus in 9.3% and raised ICT in 6.97% patients.
Staphylococcus aureus was sensitive to teicoplanin and linezolid in all cases. Bact/Alert culture
system was used to identify the offending organisms. Pyogenic meningitis is a significant cause of
morbidity and mortality and antibiotic regimen must be tailored to the culture and sensitivity
pattern
ID/06(P) POST KALA AZAR DERMAL LEISMANIASIS: A CASE REPORT
Sumit Mehndiratta, Amita Tyagi, Veena Devgan
B 246 Yojna Vihar, Delhi- 110092
drsmehndiratta@rediffmail.com; drsmehndiratta@gmail.com
Visceral leishmaniasis (VL) is major health problem in India. Post kala-azar dermal leishmaniasis
(PKDL) is a well recognized dermal complication, caused as a sequel to visceral leishmaniasis
(VL). In India it develops in around 5 -15% cases of treated VL with a lag period ranging from
few months to several years. The cases may be self resoving in some instances but establishing the
diagnosis as well as treatment is challenging in some cases. The conventional treatment is with
antimony compound –sodium stibogluconate. Here we present a case report of 12 year male child
who developed adverse reactions to the therapy and was subsequently treated with ketoconazole.
The patient responded dramatically. A brief review of literature with new insights into
immunopathological mechanisms of PKDL and alternative treatment options has been presented.
ID/07(P) A COMPARATIVE CLINICAL STUDY OF EFFICACY OF MICRO IMMUNO
ASSAY WITH WIDAL TEST.
Madhu G. N., Srinivasa.S, Ravikumar
Assistant Professor Of Pediatrics, Kempegowda Institute Of Medical Sciences(Kims), K.R.Road,
V.V.Puram, Bangalore-560004
drgnmadhu@gmail.com
Introduction: Enteric fever or typhoid fever is a severe systemic disease that is found mainly in
developing countries, but it is encountered world wide because of international travel. Typhoid
fever is a disease unique to man. The diagnosis of typhoid fever in young children is also a
dilemma because of its manifestations and typical presentation may not be seen in all the cases.
Isolation of salmonella typhi organisms either by blood culture or cultures of bone marrow, stool,
and urine or bile juice is considered as gold standard. Due to parent’s urgency and enthusiastic
doctors, children receive antibiotics prior to diagnosis which makes the isolation of the Salmonella
typhi organisms difficult. Antibodies to Salmonella typhi antigen are developed in human body,
which can be detected as a diagnostic test for the enteric fever. Objectives: To compare the
efficacy of micro-immuno assay with Widal test. Methodology: Inclusion Criteria: Clinically
suspected cases of enteric fever up to the age of 15 years. Exclusion Criteria:1. Patients with
enteric fever above the age of 15 years.2. Patients who have other associated conditions.3. Patients
who have Para typhoid fever. On admission, these subjects were enrolled in to the study. Clinical
examination was done. A detailed questionnaire was recorded as per the proforma. These subjects
were investigated for Hb, TC, DC, ESR, Blood culture, WIDAL test, microimmuno assay- IgM
detection, stool routine, urine routine. Blood samples were drawn under aseptic precautions and
subjected for blood counts and cultures in children who were admitted with fever. Antibiotics
were started after drawing samples for investigations. Results: A Prospective-comparative clinical
study consisting of 40 enteric fever children was undertaken to evaluate the efficacy of: WIDAL
and Immuno Assay (dot-enzyme immunosorbant assay) COMPARISION OF MICRO
IMMUNOASSAY (Dot Enzyme Immunosorbent Assay) And Widal: In the present study 37 cases
out of 40 (92%) were positive for micro immunoassay (dot enzyme immunosorbent assay) by
Enterocheck-WB kit, 32 cases (80%) were positive for Widal and 6 cases (15%) were culture
positive. Conclusions: In the present study 92%were positive for micro immunoassay (dot-enzyme
immunosorbent assay) by Enterocheck-WB kit, 80% were positive for Widal and only 15% were
culture positive. _ Immuno assay positive but Widal negative cases were 20% whereas widal
positive and immunoassay negative cases were only 7.5%. The positive predictivity of microimmunoassay in diagnosing enteric fever is better than Widal both in first and second week of
illness. It is concluded from the present study that the micro-immunoassay (by
ENTEROCHECKWB) is better than Widal test in the diagnosis of enteric fever in children.
Micro-immunoassay done in the study was rapid in diagnosing the case, comparatively
economical and can be done on out-patient basis with small quantity of serum or whole blood
(5µl). Summary: The positive predictivity of micro-immunoassay in diagnosing enteric fever is
better than Widal both in first and second week of illness. It is concluded from the present study
that the micro-immunoassay (by ENTEROCHECKWB) is better than Widal test in the diagnosis
of enteric fever in children Micro-immunoassay done in the study was rapid in diagnosing the
case, comparatively economical and can be done on outpatient basis with small quantity of serum
or whole blood (5µl).
ID/08(P) ACUTE VIRAL HEPATITIS IN TERTIARY CARE CENTRE LIKE
PEDIATRICS DEPT OF SCB MCH & SVPPGIP, AETIOLOGY, CLINICAL PROFILE&
OUTCOME.
Bipsa Singh, Leena Das
Senior Resident, Pediatrics Dept. Scb Mch, Cuttack
bipsasingh@gmail.com
Introduction- Acute viral hepatitis is a common medical problem in developing country affecting
liver predominantly. Objectives- aetiology, clinicalprofile& outcome of ACUTE VIRAL
HEPATITIS in children. Material & method-67 children with jaundice were selected from
pediatrics dept of SCB MCH & SVPPGIP, Cuttack from (sept-2006 to aug-2009) in indoors. The
cases were diagnosed on the basis meticulous clinical history & examination relevant routine as
well as specialized liver function test& test for viral marker in all selected cases. The exclusion
criterias were family history of liver diseases, malarial hepatitis, and history of drug hepatitis /
hepatitis due to toxins, hemolytic anaemia, leptopira cases, obstructive jaundice, neonatal
jaundice (viral marker nagetive, physiologycal jaundice. Results–most common age group of
presentation was between 5-10 yrs .most of the children in the study were male (61%) & the
female constituted only 38%. Male to female ratio is 1.6-1.most common clinical symptom was
jaundice (100%). The common symptoms were anorexia (97%), nausea & vomiting 96%, myelgia
91%, fever 91% abdominal pain 80%, altered sensorium 22%, GI bleeding 11%. Most common
clinical signs were icterus 100%, hepatomegally 98%, splenomegally 51%, fever 16%, ascitis
19%, encephalopathy 22%.All investigations like LFT, CBC, PT, liver viral markers, USG of
abdomen were done. The highest value bilirubin total & direct seen in the series were 44.6%,
13.6% in the same patient. The highest SGPT was 9350 IU/L. PT was prolonged 26.8% cases.
viral markers anti HAV titre was positive in 48 (71%)cases,HBs antigen was +ve in 8 (11%)
cases anti HCV titre +ve in one thalassemia child h/o many blood transfusions,10 cases were all
viral markers –ve. Outcome-of all hepatitis A cases 42 recovered completely, 6cases developed
fulminant hepatic failure (FHF) of which 1 died& 5 recovered. Of all hepatitis B cases 3
completely recovered, 2developed FHF, 1died& 4 developed chronic hepatitis. The 1 hepatitis C
case progressed to chronic hepatitis, IN 10 cases viral markers negative. Conclusion-There is a
need of hepatitis A vaccination to young children which will reduce the risk of infection in
adolescents &adults through a herd immunity effect. Hepatitis B can be prevented by universal
immunization. Hepatitis C can be prevented by proper screening of blood & blood product in
blood bank before transfusion.
ID/09(P) TO COMPARE THE THERAPEUTIC EFFICACY OF CONVENTIONAL
DAILY ANTI TUBERCULAR THERAPY WITH FULLY INTERMITTENT THERAPY
FOR TREATMENT OF NEUROTUBERCULOSIS IN CHILDREN
Tolani A; Mishra PC; Singh DK; Rai R.
Deptt. Of Pediatrics, S.N. Children Hospital, MLN Medical College, Allahabad.
tolani_tolani@yahoo.co.in
Introduction: Discrepancies in national (IAP, RNTCP) and international (WHO, CDC, British
Infection Society) recommendations for treatment schedules of neurotuberculosis extend among
most of the countries. Due to these conflicting regimes among various organizations, present study
was planned. Objective: To compare the therapeutic efficacy of Conventional Daily Anti
Tubercular therapy with Fully Intermittent therapy for treatment of Neurotuberculosis in Children.
Material and method: The present study is a prospective study undertaken in children aged
between 6 month and 15 years admitted to our hospital. The study was conducted over a period of
13 months from July 2008 to August 2009.The diagnosis of TBM was based on the clinical case
definition devised by AIIMS. Sixty eight patients met the inclusion criteria and they were given
one of two ATT Regimes according to a simple randomization table. After 6 months of complete
course, survived patients were classified into one of the four outcomes based on the clinical
features (TRC Chennai). The present study is based on 64 patients. Group I: Patients receiving
Regime I (RNTCP Category I).Group II: Patients receiving Regime II daily therapy standard dose
of antituberculous therapy (ATT) as recommended by the Indian Academy of Pediatrics. Results:
Out of 32 cases in group I, 7(21.9%) made Complete Recovery, 3(9.4%) went in Mild sequelae,
7(21.9%) had Moderate, 5(15.6%) were in Severe sequelae and death occurred in 10(31.2%). Out
of 32 cases in group II, 5(15.6%) made Complete Recovery, 8(25%) went in Mild sequelae,
2(6.2%) had Moderate, 7(21.9%) in Severe sequelae and death in 10(31.2%). However the
difference between two groups was statistically insignificant Chi square =0.25, df=1, p>0.05.Both
the Regime I and Regime II are equally efficacious in treatment of Neurotuberculosis. DOTS
regime is as effective as Daily regime. Conclusion: The present study documents that presence of
younger age (less than 5 years), severe malnutrition, low GCS score, hydrocephalus, and stage of
disease at presentation were found to affect adversely the prognosis in children with
neurotuberculosis. But there was no significant difference in outcome on the basis of two regimens
used in the study. Additional prospective studies employing multivariate analysis are required to
determine the generalization of our findings.
ID/10(P) PROFILE OF DENGUE FEVER IN CHILDREN
Abhishek B. Patil, L. H. Bidari, M. M. Karva, Nitin Tikare, S.S. Vaidya
Dr. Bidari’s Ashwini Hospital, Ashwini Institute of Child Health & Research Centre, BLDE Road,
Bijapur – 586 103.
ashwinihospital@rediffmail.com
Introduction: The number of dengue fever (DF)/dengue hemorrhagic fever (DHF) cases reported
in India has risen in recent years. The identification of Dengue cases is by distinct clinical features
but they can present with varied manifestations. The present study was undertaken to evaluate the
profile of serologically confirmed dengue cases admitted at Ashwini Hospital Bijapur. Aims and
Objectives: To study the profile of Dengue Fever in children. Materials and Methods: Children
admitted with serologically confirmed dengue fever (DF)/ dengue hemorrhagic fever (DHF) from
March 2007 to February 2009 were studied prospectively with respect to Clinical features,
Haematological parameters, Liver enzymes, and Abdominal Ultrasonography. Dengue IgM was
done by Mac ELISA technique at National Institute of Virology, ICMR, Field station, Bangalore.
Results: Out of 120 cases [males (56%) and females (44%)] of Dengue fever, 51 were DF, 45
were DHF and 24 were DSS. Maximum number of dengue cases were seen between age group of
0- 3 years (49.17%). Maximum number of cases (50.83 %) were seen during Rainy (June –
September) season. Common symptoms were fever (100%), vomiting (62.5%) and bleeding
manifestations (56.66%). The commonest hemorrhagic manifestation was hematemesis (23.33%).
Common observed signs were hepatomegaly (96.67%), flushing of palms and soles (63.33%) and
ascites (40%). Low platelet counts and elevated ALT>50IU/L were common laboratory findings.
Most common ultrasonography finding observed were hepatomegaly (92.5%), gall bladder wall
edema (64.17%) and ascites (53.33%). Crystalloids were used in all patients while colloids were
required only in 7(29.17%) of dengue shock syndrome. Whole blood was required in 2 (4.44%)
cases of dengue hemorrhagic fever and 3 (12.5%) cases of dengue shock syndrome. Platelet rich
plasma was required in 2 (4.44%) cases of dengue hemorrhagic fever and 5(20.83%) cases of
dengue shock syndrome. Encephalitis was present in 14 children, myocarditis and pulmonary
edema was present in one child each both of whom expired.Deaths occurred in only 2 (1.67%)
cases. Conclusion: The incidence of dengue infection was more at younger age and in infancy.
Dengue is usually a nonspecific febrile illness that resolves with supportive therapy but the
clinical spectrum ranges from asymptomatic infection through severe hemorrhage and sudden fatal
shock. The management is essentially supportive and symptomatic. Use of blood and/or blood
products should be limited to some cases of disseminated intravascular coagulation causing
massive bleeding.
ID/11(O) EVALUATION OF RAPID DIAGNOSTIC TEST(OptiMAL) AND
QUANTITATIVE BUFFY COAT ASSAY FOR DIAGNOSING MALARIA IN CHILDREN
Laxmi Hadalgi, L.H.Bidari, Nitin Tikare, Vaidya, Karwa.
Dr. Bidari’s Ashwini Hospital, Ashwini Institute of Child Health and Research Centre, BLDEA
Road, Bijapur – 586 103, Karnataka.
dr.laxmihadalgi@gmail.com
Introduction: Although Microscopy is gold standard for diagnosis of malaria, has low efficacy,
hence rapid diagnostic tests(OptiMAL) and Quantitative Buffy coat assays are required for early
and specific detection and prompt treatment. Aims and Objectives: 1.
Evaluation of Rapid
Diagnostic Test(OptiMAL).2.
Evaluation of Quantitative Buffy Coat(QBC) test. Material And
Methods: This study was done in Dr. Bidari’s Ashwini Hospital, Bijapur. 50 children, in age group
6months-14years, clinically suspected of malaria were subjected to Peripheral smear, QBC and
OptiMAL tests. OptiMAL test : Plasmodium lactate dehydrogenase immunochromatographic
assay done using commercial kit Diamed OptiMAL-IT. QBC test done under fluorescent
microscope. Sensitivity, specificity, positive and negative predictive values, positive and negative
likelihood ratios were calculated. Results: Of 50 cases, 42 were confirmed positive for malaria by
peripheral smear. Of the 42 smear positives, 22(52.38%) comprised Pl.falciparum, 17(40.47%)
were Pl.vivax and 3(7.14%) had mixed infection. QBC test showed 39(78.00%) samples as
positive and 3(6.00%) as negative. The OptiMAL test showed 41(82.00%) samples as positive and
1(2.00%) as negative. By QBC method, 21(53.85%) were Pl.falciparum, 15(38.46%) were
Pl.vivax and 3(7.69%) were mixed infection. Sensitivity,specificity, positive and negative
predictive values were 96%, 88%, 88.89% and 95.65%, respectively, for Pl.falciparum and 90%,
96.67%, 94.74% and 93.55%, respectively, for Pl.vivax, compared to peripheral smear. Positive
likelihood ratio was 8 and 30, and negative likelihood ratio was 0 and 0.10 for Pl.falciparum and
Pl.vivax respectively. By OptiMAL test, 22(53.66%) were Pl.falciparum, 16(39.02%) were
Pl.vivax and 3(7.32%) were mixed infections. Sensitivity, specificity, positive and negative
predictive values were 100%, 96%, 96.15% and 100%, respectively, for Pl.falciparum and 95%,
100%, 100% and 96.77%, respectively for Pl.vivax, compared to peripheral smear. Positive
likelihood ratio was 25 and 95 and negative likelihood ratio was 0 and 0.05 for Pl.falciparum and
Pl.vivax respectively. Conclusions:1. OptiMAL is ideal diagnostic test.2. QBC test is cost
effective and less specific for species identification.
ID/12(P) PULMONARY TUBERCULOSIS MASKED BY TOXIC SHOCK SYNDROME
Usha Singh
ushasingh52@gmail.com
A one and a half year old girl child, a known case of Werdnig-Hoffman Syndrome, was admitted
with suspected septicemia and collapse consolidation of left lung. She was diagnosed as Toxic
Shock Syndrome, and treated with appropriate antibiotics for 3 weeks. Her general condition
improved, but the lung findings remained unchanged. On bronchoscpy, there was no airway
obstruction, but the broncho alveolar lavage smear was positive for AFB. She is now on DOTS
category I and is showing steady improvement.
ID/13(P) CONGENITAL TUBERCULOSIS PRESENTING AS FACIAL PALSY
Karuna Thapar, Ira Dhawan, Shashikiran Singh, Rachna Kapoor
Department of Pediatrics, Government Medical College, Amritsar
kthapar2000@yahoo.com
Introduction: Congenital facial paralysis can be associated with traumatic or developmental
causes. The traumatic causes are related primarily to difficult labor. Intrauterine trauma can occur
from pressure on the infant’s face by the sacral prominence during the birthing process.
Supranuclear palsy has been shown to be associated with intracranial hemorrhage during the
perinatal period. The causes of developmental facial nerve paralysis are numerous and include
mononeural agenesis, congenital paralysis, and congenital unilateral lower lip paralysis. Here we
report a case which presented as facial palsy because of tuberculosis. Case Summary: A 2 ½
months old male child 4th in birth order full term normal vaginal delivery conducted at home.
Mother had bad obstetric history (miscarriage & intrauterine death). Perinatal history was
uneventful. Baby was brought with cough, respiratory distress and deviation of mouth for 2
months and fever for 2-3 days. Cough was spasmodic and more at night. Fever was mild grade
with no diurnal variation. Child was bottle fed since birth with diluted cow’s milk. Mother was
diagnosed as a case of tuberculosis 5 years back and was on irregular treatment since then. On
examination - General condition was sick, child had severe respiratory distress, pallor was present,
heart rate - 172/min, respiratory rate -82/min, temperature - 101°F, Child weighed 3.85 kg, Head
circumference was 35 cm, length was 53 cm. CNS examination revealed right sided facial palsy.
Rest of the systemic examination was normal. On investigations - Hemogram and renal function
tests were normal, Serum calcium was 8.3 gm%, RBS -158 mg%, HIV- non reactive, Mantoux
was negative; Gastric lavage was positive for AFB. Chest X-ray revealed bilateral infiltrates. CSF
examination was normal, MRI brain showed borderline ventriculomegaly. Child was put on broad
spectrum antibiotics initially but there was no response. Seeing the report of gastric lavage, child
was put on Antitubercular treatment. Child improved remarkably within a fortnight and facial
palsy also improved gradually. Retrospective diagnosis of Congenital Tuberculosis with facial
palsy was made.
ID/14(P) IMPORTANCE OF CONTACT IN THE DIAGNOSIS OF TUBERCULOSIS - A
CASE REPORT
Karuna Thapar, Shashikiran Singh, Renu Gupta, Rachna Kapoor
Department of Pediatrics, Government Medical College, Amritsar
kthapar2000@yahoo.com
Introduction: Diagnosis of tuberculosis in children is to be based on a combination of clinical
presentation, sputum examination; Chest x-ray, Mantoux test and history of contact. Fever and
cough for more than 3 weeks denote need for evaluation for diagnosis of active tuberculosis.
Recent onset of fever and cough is the most common presentation. Contact is defined as any child
who lives in a household with an adult taking anti-TB therapy or has taken such a therapy in the
past 2 years. The present case highlights the importance of contact in the diagnosis of tuberculosis.
Case: 6 months old male was brought with complaints of fever and cough for 1 month. Fever was
mild grade documented 99 & 100°F, being more at night. Cough was dry, non-spasmodic, more at
night and had no relation to feeds. Child was 1st in birth order born by full term normal vaginal
delivery with uneventful perinatal events. He was exclusively breast fed since birth and
complimentary feeds were not yet started. His grandfather was diagnosed to have pulmonary
tuberculosis (sputum positive) 2 months back and was started on ATT. On examination - Child
was active and alert weighing 7.85 kg, Head circumference was 42 cm, and Length was 62 cm.
Systemic examination was normal. On investigations - Hemogram was normal, ESR – 60 mm
during 1st hour, Chest X-ray was normal; Mantoux was 12 mm. Gastric Lavage was negative for
AFB. Keeping in view the history of contact and positive Mantoux, baby was started on ATT and
he became asymptomatic within 15 days. He gained weight, cough disappeared and became
afebrile. Tracing of history of contact is extremely important in diagnosis of pediatric tuberculosis.
ID/15(P) TUBERCULOSIS PRESENTING AS MIDDLE LOBE SYNDROME AND
TUBERCULAR MENINGITIS
Karuna Thapar, Shashikiran Singh, Ira Dhawan, Rachna Kapoor
Department of Pediatrics, Government Medical College, Amritsar
kthapar2000@yahoo.com
Introduction: Middle lobe syndrome (MLS) is an uncommon lung disorder involving the right
middle lobe and/or lingula and is characterized by a spectrum of clinical and pathological lesions.
It occurs in all age groups and tuberculosis as an etiological factor accounts for only 9% of all
reported cases. Here we report this case due to its rarity. Case Summary: A six months old male
child was admitted with vomiting, respiratory distress, recurrent focal seizures for past 20 days.
Vomiting was non projectile, non bilious, 2-3 episodes per day. Associated history of recurrent
focal seizures left sided, tonic-clonic, each episode lasting 2-3 minutes was present. No history of
fever was present. Child was 3rd in birth order born by full term normal vaginal delivery at home.
Baby was breastfed with occasional top feeding with diluted cow’s milk. On examination - general
condition was sick, pallor was present, pupils were bilaterally equal and reacting to light. Vitals
were within normal limits. Child weighed 5.6 kg; head circumference was 40 cm. Central nervous
system examination revealed increased tone in right sided limbs with brisk deep tendon reflexes.
Abdomen was soft, liver was palpable 4 cms below right costal margin, and spleen was 1 cm
below left costal margin. Chest examination revealed crepts on right side, cardiovascular
examination was normal. On investigations - Hemogram was normal, Erythrocyte sedimentation
rate was 80 mm during 1st hour, Gastric lavage was positive for AFB, Chest X-ray showed right
middle lobe consolidation. CSF examination revealed proteins – 465 mg%, positive globulin,
sugar - 24 mg%, total cells 335/cumm with lymphocytic predominance. MRI Brain showed non
hemorrhagic infarcts in left ganglionic, thalamic, temporo-parietal and left cerebral infarct with
associated moderate supratentorial ventriculomegaly. Diagnosis of disseminated tuberculosis was
made. Baby was put on Antitubercular therapy (ATT). In spite of ATT, vomiting was intractable.
Chest X-ray was repeated after 15 days, 30 days and 1 month. Middle lobe consolidation remained
the same. Child started gaining weight, neurological improvement was remarkable. Vomiting
improved after 2 months but consolidation remained the same. Cough was occasional.
Considering the radiological picture, non-resolving pneumonia, vomiting and cough, diagnosis of
Middle Lobe Syndrome was made.
ID/16(O) IS PROCALCITONIN A RELIABLE STAND ALONE MARKER OF
BACTERIAL INFECTION IN CHILDREN WITH FEBRILE NEUTROPENIA?
Shanthi Kothapalli, JP Muliyil, Valsan Verghese, Leni G Mathew
C/o Dr. Leni G Mathew, Pediatric Hem/Onc, Dept. of Child Health, CMC, Vellore 632004
lenigm@yahoo.com
Introduction: Infection is a major cause of morbidity in children undergoing cancer chemotherapy.
With blood cultures being positive only in about 40% of cases, clinicians have been searching for
a reliable marker of bacterial infection which will help in choosing the appropriate treatment.
Several markers such as ESR, CRP, procalcitonin (PCT), IL-6, IL-8, sIL-2R and sTNFR-II have
shown variable efficacy. Among these procalcitonin has been found to be more sensitive and cost
effective. We undertook this study to evaluate the efficacy of procalcitonin as a diagnostic marker
of infection in children with febrile neutropenia (FN) in our department. Objectives: To assess
predictive value of PCT in diagnosis of bacterial infection in children with febrile neutropenia.
Compare efficacy of PCT with CRP in early diagnosis of sepsis in this group. Methods: 87 FN
episodes in 63 children were prospectively included, from Jan to Nov 07, for this study. Blood
culture, CRP and PCT were done. For the purpose of analysis, children were divided into those
with (17) or without bacteremia (70) and those with (33) or without (54) an obvious focus of
infection. Results: 11/17 children with bacteremia had PCT >1.0 ng/ml compared to 24/70
(p=0.02) in the non-bacteremic group. PCT of 0.5ng/ml or 1.5ng/ml did not show any significant
difference between the two groups. Number of children with CRP >10 mg/ lit and > 40mg/ lit
were not significantly different between those with or without bacteremia. The mean PCT and
CRP values are not significantly different between the bacteremic (PCT 3.75, CRP 114.36) and
non bacteremic group (PCT 4.95, CRP 83.2). Though, a significantly higher number of children
with bacteremia had PCT more than 1 ng/ml, the sensitivity (64.7%), specificity (65.2%), PPV
(31.4%), NPV (88.2%) and LR (1.85) were too low for it to be used as a diagnostic tool. When
children were divided into those with or without clinical or bacterial evidence of infection, 18/33
had PCT>1ng/ml compared to 17/54 (p=0.03). CRP values at 10 and 40mg/L did not show any
difference between the two groups. Sensitivity, specificity, PPV, NPV and LR were too low in this
group also. The mean PCT (5.33 vs 4.33) and CRP (105.9 vs 78.74) were higher in the first group,
but the difference was not significant. Conclusion: Though most of the studies showed that
procalcitonin is a diagnostic marker of bacterial infection in children with febrile Neutropenia, our
study showed that sensitivity, specificity, positive predictive value, negative predictive value and
likelihood ratio were not high enough to recommend it as stand alone diagnostic marker.
ID/17(O) INCIDENCE AND SPECTRUM OF PRESENTATION OF MYCOPLASMA
INFECTION IN CHILDREN WITH ACUTE RESPIRATORY INFECTION
D. Sarma, A. Lodha, P. Darshini, M. Bhaktiari
Dept of Pediatrics GNRC Hospital Guwahati, Assam,
devajitsharma@gmail.com
Objective: We aimed to investigate incidence of respiratory infections caused by M. pneumoniae,
in relation to age, clinical findings, and seasonal variation and to determine relationship between
clinical findings and laboratory results. Methods: Children presented in Out patient or Emergency
department, ranging 2-15 years with symptoms of respiratory tract infections between April 2006
and March 2007, were enrolled in the study. Particle agglutination test was done for detection of
Anti Mycoplasma pneumoniae antibodies. Cut of level was taken as antibody more than 1: 80.
Results: Out of 540 children studied, incidence of Mycoplasma infection was 33.14% (32.29% in
boys and 34.12% in girls). Mean age was 8.2 +/-2.2, more frequent in age group from 5-15 years
than 2-5 years. Most common mode of presentation was fever 76.53%, cough 89.94% and wheeze
25.69%. Incidence of Mycoplasma positive titer in child who had wheeze was 29.11%.Incidence
was more common from September- to December. Frequency in children who had upper
respiratory tract infection (URI) was 36.17% and 22.22% in children who had lower respiratory
tract infection (LRTI).Incidence rate in children who had recurrent respiratory tract infection was
35.48%.Two children who had presented with URI symptom also developed immune hemolytic
anemia and 6 children had erythematous macular and morbiliform rash. There was no relation
with white cell count or C reactive protein with mycoplasma infection Conclusions: Mycoplasma
pneumoniae was a common pathogen in respiratory infections in children and adolosence.
Incidence in more common in URI than LRTI. There was no relation with white cell count or C
reactive protein with mycoplasma infection.
ID/18(P) DENGUE INFECTION PRESENTING AS AN ACUTE LIFE THREATENING
EVENT IN A 3 MO OLD INFANT
Kawaljit Singh Multani, Kirandeep Sodhi , Bm John, SS Dalal
Command Hospital (Airforce) Bangalore
kawaljit000@gmail.com
Dengue viral infections are one of the most important mosquito borne diseases in the world. They
may be asymptomatic or may give rise to undifferentiated fever, dengue fever, dengue
haemorrhagic fever (DHF), or dengue shock syndrome. Annually, 100 million cases of dengue
fever and half a million cases of DHF occur worldwide. Ninety percent of DHF subjects are
children less than 15 years of age. At present, dengue is endemic in 112 countries in the world. No
vaccine is available for preventing this disease. Early recognition and prompt initiation of
appropriate treatment are vital if disease related morbidity and mortality are to be limited.Dengue
in infancy constitutes approx.20% of total dengue virus infections. In developing countries,
strengthening of dengue management capabilities at hospitals can prevent dengue-related deaths in
infants
Dengue infection in young infants presenting as a life threatening event is a rare
presentation. 03 mo old female infant presented with h/o fever - 4 days and breathing difficulty
and poor feeding - 1 day. On examination, infant was found to be apneic and required resuscitation
with bag and mask ventilation, to which the infant responded and was later kept on oxygen, iv
fluids, antibiotics. Investigations done at this point revealed leukopenia, thrombocytopenia on
peripheral smear, ICT was negative. Infant was monitored for recurrence of symptoms of
respiratory distress. During hospital stay, infant developed facial puffiness along with abdominal
distension and evaluation revealed ascites, pleural effusion, hepatosplenomegaly. Investagations
done at this stage revealed thrombocytopenia, raised AST/ALT (AST>ALT) and positive serology
for Dengue. Infant was monitored for any evidence of hemorrhgic manifestations, any features of
capillary leak syndrome and kept under conservative management.Infant had a gradual recovery
over a period of five days and was discharged after one week. The dengue hemorrhagic fever
(DHF) is an important cause of emerging disease pandemics, causing significant mortality and
clinicians should be alert to dengue fever/dengue hemorrhagic fever in infants presenting with
acute febrile illness.
ID/19(O) PATTERN OF DRUG RESISTANCE IN TYPHOID AND PARATYPHOID
FEVER
Handrashekar , Kirandeep Sodhi, S S Dalal, B M John, Kamal Kiran, K S Multani
Command Hospital (Airforce) Bangalore
kawaljit000@gmail.com
Background: Drug resistance and changing clinical pattern in enteric fever is a cause of concern in
Indian scenario as Enteric fever is a serious public health concern. Objective:This study was
carried out with an objective to assess the varied clinical manifestations in the pediatric age group
and the culture and sensitivity pattern of S typhi and S paratyphi in Bangalore Methods: 58 cases
managed in our hospital in Bangalore over last 18 months who showed positive blood cultures
were included in the study and analyzed retrospectively.The presentation details, investigations
esp widal titres and drug sensitivity pattern were recorded. Of 58 children diagnosed as enteric
fever on the basis of blood cultures, 48(82.4%) were contributed by Salmonella typhi and 10
(17.6%) were contributed by Salmonella paratyphi A. In paratyphoid fever cases, 100% were
sensitive to Chloramphenicaol, 100% were resistant to nalidixic acid,16.7% to co-trimoxazole
and ampicillin. In typhoid fever cases, 20% sensitive to nalidixic acid, 94.6 % were sensitive to
chloramphenicol, 86% to amoxicillin and 86.6 were sensitive to injectable cephalosporins.
Sensitivity to Cefixime (oral cephalosporin) was seen only in 71.4% cases. We observed that
multidrug resistant strains were seen in 5.4% of the culture positive cases. There is re-emergence
of strains fully susceptible to first line antibiotics choramphenicol and cotrimoxazole except
nalidixic acid for which 80% resistance was seen (Nalidixic acid being a surrogate maker of
quinolone sensitivity). Conclusions: In view of the emergence of drug resistance to quinolones
their indiscriminate use to be avoided. An adequate trial of first line antibiotics like oral cotrimoxazole ,amoxicillin or chloramphenicol can be tried before we start injectable antibiotics.
ID/20(P) EARLY PREDICTORS FOR THE DIAGNOSIS OF DENGUE FEVER IN
CHILDREN
Anu Gangadharan, Lalitha Kailas, Devakumar.
Dept. of Pediatrics, Meical College Thrissur
anu_gangadharan@yahoo.com
Background: Dengue viral serology may be negative initially. Hence, clinical diagnosis is crucial.
Studies to predict dengue in children are few. Aim: To identify clinical and lab parameters for
early diagnosis of dengue in children. Materials and methods: A prospective study was conducted
in a tertiary teaching institution over a period of one year, Including children below 12 yrs(
excluding neonates) with fever >38 . Predisposing immunosuppression and other infectious
process were excluded. IgM seropositivity 5 days after the onset of fever was taken as the
standard for diagnosis of dengue . Results: 171 patients studied , 84 were IgM positive , rest were
classified as other febrile illness (OFI). Average age of the dengue fever was 86.29 months and
91.94 in OFI.Average duration of fever in dengue fever was 2.7 days OFI was 2.61.Clinical
features like headache arthralgia, myalgia, pharyngeal congestion, conjunctival injection,rash,
facial erythema, abdominal pain , absence of rhinorrhoea and Lab parameters hemoglobin,
leucocyte and platelet count, hematocrit, total protein and albumin, liver enzymes, PT and APTT
were compared. Statistical analysis was done using SPSS software.
Conjunctival
congestion,myalgia ,pharyngeal injection headache were found to be statistically significant in
DF. Mean value of SGPT in dengue fever and OFI were 73.2 and 48.29 respectively showed
statistical significance (p0.004). Subgroup analysis was done based on the duration of fever, Rise
in SGPT on day 3 and pronounced leucopenia on day 5 could be predictive of dengue fever
Conclusion- combination of clinical and laboratory findings will help to diagnose dengue.
ID/21(P) NEONATAL CHIKUNGUNYA – A CASE REPORT.
Rashmi S. Murthy, Ambarish V, Pavan Kumar, Tamil Selvan
Cosmo multi speciality hospital, Kalidasa circle, Srinagar, Bangalore
rashmi153@gmail.com
Neonatal Chikungunya rarely comes to notice in India. A primigravida mother presented at 35
weeks of gestation with history of fever and joint pains since one day and pre-term premature
rupture of membranes for 3 hours. A live male baby was delivered by LSCS, cried immediately
after birth, and had a birth weight of 2.56kgs. At 6 hours after birth, the baby was lethargic with
poor suck, had a shrill cry, bilateral pedal edema and sclerema. Investigations revealed a negative
sepsis screen and negative blood culture, lumbar puncture done was normal. The child developed
features of septic shock on day 4 and thrombocytopenia on day 5. Generalized hyperpigmentation
was noticed on day 7. A diagnosis of viral sepsis was suspected and viral serology done at
National Institute of Virology revealed IgM positive for Chikungunya, Dengue IgM and IgG were
negative (mother was positive for dengue IgG). The child was treated with inotropes for shock,
antibiotics for secondary bacterial infection, platelet and immunoglobulin transfusion, and packed
cell transfusion-Hb on day 14 was 11.7 due to purpura and ecchymosis. The child gradually
improved with the above measures and took breast feeds well from day 10. The child was given
antibiotics for 14 days and was stable at discharge.
ID/22(O) PREVENTION OF PARENT -TO-CHILD TRANSMISSION
OUTCOME OF HIV EXPOSED INFANTS
Rakesh Gupta, R Praveen, Archana Gupta, V Venkateshwar, Madhuri Kanitkar
Department of Pediatrics AFMC Pune 411040
rgupta.peds@gmail.com
(PPTCT):
Worldwide, parent-to-child transmission (PCT) of human immunodeficiency virus type 1 (HIV)
represents the most common means by which children acquire HIV infection. Without
intervention, the risk of transmission from an infected mother to her child ranges from 25% to
45%. Efficacious and effective interventions can prevent
in- utero and intrapartum
transmission of HIV infection by less than 2%. This study was conducted to find out the parent-tochild transmission at tertiary care hospital in Maharashatra. PATIENTS AND METHODS: All
HIV exposed infants (babies born to HIV positive mothers) were followed up from pregnancy of
mother through delivery and after birth between January 2008 – August 2009. All the babies were
given syp Nevirapine @ 2mg/kg/single dose and syp Zidovudine @ 8 mg/kg/d in 2 div doses till 6
weeks. All babies were on formula feeds and DNA PCR was done at 6 weeks and 6 months for
confirming the diagnosis of HIV. All babies were started on co-trimoxazole prophylaxis from 4
weeks onwards and closely monitored for any infection. RESULTS: A total of 22 babies were
studied. Of these 22 babies, 12 (55%) babies were delivered by normal delivery, while 10 (45%)
by cesarean section, with M: F ratio of 1.4:1. Four couples were discordant. 18 mothers (82%)
received antiretroviral therapy. Reasons for not taking ART in 3 mothers were ignorance,
inaccessibility to PMTCT centres and fear of stigmatization. 14 infants were declared HIV
negative after 2 DNA PCR at 6 months. 4 infants are yet to be tested as they are below 6 months
and in 3 infants, HIV status could not be tested as they did not turn up for testing. In one infant 1 st
DNA PCR was positive at 4 weeks, second was negative and 3rd DNA PCR was positive at repeat
testing at 6 months, hence started on triple drug HAART. On follow up at this center at 2 years of
age, child was found to be negative on DNA PCR and ELISA. The reason for her negative status
could not be explained. CONCLUSION: In our experience, with administration of ART to mother
and infant, use of breast milk substitutes and close follow up, the incidence of MTCT can be
reduced to negligible rates.
ID/23(P) NEUROLOGICAL MANIFESTATIONS OF CHILDREN WITH DENGUE
ILLNESS
Saista farooqui, Lokesh Lingappa, Dinesh Chirla
Rainbow Children Hospital, Hyderebad
sfvision2006@yahoo.com; siriloki@gmail.com
Aim: To study spectrum of neurological manifestations of dengue illness in children and correlate
with investigation modalities, clinical outcomes. Methods: Out of the 402 children admitted with
serology proven Dengue to our centre over a period of one year, 57 had neurological
manifestations who were studied for the spectrum of presentation; the correlation of clinical,
haematological, biochemical, CSF and neuroimaging parameters with outcomes were evaluated.
Results: Neurological manifestations were seen in 14.17 % patients with Dengue infection. 61.4%
of children were aged less than 5 years. M: F ratio was 1.28: 1. Encephalopathy was seen in 59.64
% of patients, seizures in 68 %. Focal neurological deficit in one child. Patients with
encephalopathy were mainly in Grade III. Mean GCS scores were identical regardless grade of
dengue the patient belonged to. Cerebral edema was demonstrable in 43.85 % of our patients. CSF
showed elevated protein level in 82.45 % patients & lymphocytic pleocytosis was seen in only 3.5
%. Overall fatality rate was 7.01 %. All patients in fatal group had thrombocytopenia & bleeding.
None of the children had persistent residual neurological sequelae. Conclusions: There is a
crowding of neurological manifestations in the age group of 5 years. Coma and hypotension were
statistically significant factors affecting outcome. Hemorrhagic complications and circulatory
collapse are determinant factors in the prognosis. Children with encephalopathy and seizures
rather than either of symptoms alone had higher risk of death especially those with grade III
dengue fever.
ID/24(P) A CASE OF HEMORRHAGIC MEASLES- RARE PHENOMENON
Sushant Bhanja, Richa Arora, M.S. Prasad
VMMC and Safdarjung Hospital, New Delhi
richa80arora@yahoo.com
Hemorrhagic measles is a very rare phenomenon. It is occasionally seen during widespread
epidemics of measles. Hemorrhages occur in skin and mucous membranes along with high fever,
profound toxemia, sometimes cyanosis. It is accompanied with encephalitis and pneumonia –
leading causes of mortality in measles. We report a case of 9 month old child of hemorrhagic
measles with favorable outcome. Child presented with fever, cough, conjunctivitis and
hemorrhagic rash all over the body. He had severe toxemia and developed multiple complications
including severe pneumonia, gastroenteritis, mouth ulcers and drowsiness. On investigation Hb 10
gm%, TlC 4800/mm3, Platelet count 1.3 lac. Blood culture was sterile and CSF examination
normal. IgM ELISA for measles was positive. Child was managed medically. Child improved
over the next 10 days. . Thus high index of suspicion is needed to identify such cases. Timely
immunization is also needed.
ID/25(P) MANIFESTATIONS AND OUTCOME OF SEVERE FALCIPARUM MALARIA
IN CHILDREN IN KOLAR
Harish G. Naidu
drharish.g@gmail.com
Background: Severe malaria results from infection with plasmodium falciparum.The pattern and
mortality reported vary in different geographical regions depending upon parasitic factor,
epidemiological factors and host defence factors. Objective: To study the clinical manifestations and
outcome of severe falciparum malaria in children in Kolar. Material And Methods: Children aged 6
months-18 years who fulfilled the WHO definition of severe falciparum Malaria were taken up
for study. Children with pre-existing chronic systemic diseases, Neuroinfections, Known cases of
seizure disorders and febrile convulsions were excluded from the study. Diagnosis of malaria was
confirmed by peripheral smear or Optimal test. Cases were observed with reference to the
presentation, complications and outcome. Observation and Results: 46 children were taken up for
study. 34 children (73%) were above 5 years. Majority of cases occurred from may to November.
Fever was present all 46 cases. Most common complication noted were severe anemia (48%),
prostration (33%), convulsion (26%), respiratory distress (21%) and impaired conciousness (15%).
Splenomegaly was noted in 63% of cases and hepatomegaly in 58% of cases. Conclusion: The WHO
definition for severe falciparum Malaria helps in identification of high risk cases. Severe anemia,
prostration, convulsions and respiratory distress were the commonest manifestations of
severe malaria.Fever, anemia and splenomegaly still are significant as a clinical triad in
diagnosis of malaria. Both Quinine and Artemesinin derivaties are effective in treating severe
Malaria.
ID/26(P) DOES ANTIRETROVIRAL THERAPY IMPROVE NUTRITIONAL STATUS IN
CHILDREN WITH HIV?
Col Rakesh Gupta, Maj S Badal, Archana Gupta, Col Madhuri KanitKar
Department of Pediatrics, AFMC, Pune
rgupta.peds@gmail.com
With the introduction of highly active anti retroviral therapy (HAART), HIV infection which used
to be considered a fatal disease has been transformed into that of a chronic disease model. Efforts
are shifting from caring for children with advanced immunosuppression and severe opportunistic
infections to early HAART. This prospective study was conducted at a tertiary care hospital to
study the nutritional status in children with HIV. PATIENTS AND METHODS: All the children
detected to be HIV positive and attending this tertiary care hospital since Jan 2007 were included
in to the study population. Children with less than 1 year follow up or starting ART or children
had severe opportunistic infection in last l year were excluded. All the patients were closely
followed up for the progress of the disease and growth parameters were recorded. Weight gain
with change in the IAP PEM grade was taken as improvement in the nutritional status. Nutritional
status in children on ART (grp A) was compared with seopositive children not on ART (grp B).
CD4+ count was done every 6 monthly and HAART was started as and when indicated. Results
were analysed statistically. RESULTS: Of the total 114 children on follow up, 83 fulfilled the
criteria and included for the study. Maximum children were between age group of 5-10 years 40
(48%) with predominantly females. Female to male ratio was 1.2:1. Forty five (54%) children
were on ART (grp A) and 38 (46%) not on ART (grp B). Thirty nine children (87%) in ART
group showed weight gain, while only 17 (44%) children in non ART group. The improvement in
the nutritional status of children on ART was statistically significant (p value < 0.05).
CONCLUSION: In our study the weight gain was statistically significant in children on ART as
compared to children not on ART. This improved nutritional status is solely because of the ART
leading to the decreased viral load and improving the physiological status of the body or absence
of opportunistic infections or any other factor, needs further evaluation. Also we need to give
more emphasis on the weight/ growth criteria for starting ART, need further evaluation.
Weight gain
On ART
Not on ART
Total (n=83)
A
B
Weight gain +
No weight gain
( 45)
39
6
45
( 38)
17
21
38
56
27
83
ID/27(P) CLINICAL PROFILE, DIAGNOSIS AND OUTCOME OF PNEMOCOCCAL
MENINGITIS IN PEDIATRIC AGE GROUP: A HOSPITAL BASED STUDY
Das P, Kataruka M, Majhi K N, Mohanty N
Department of pediatrics, SCB Medical College & Hospital, Cuttack
mkworld80@gmail.com; doc_palash1984@yahoo.com
Aims &Objective: To analyze the epidemiological distribution, clinical profile and outcome of
pneumococcal meningitis. Material & Method: Children from birth to 14 yrs of age showing
classical features of meningitis were analyzed and children positive for pneumococcus either by
blood/ CSF culture or latex agglutination test were included in the study. Results: Out of 120 cases
of pyogenic meningitis studied, Pneumococcal meningitis was the second most common among
causes (45%), H Influenzae being the first (49%). Age distribution of cases were 42.4%, 39.3%,
18.3% in 1 month to 1 yr, 1yr-5yr, 5yr-14yrs respectively with no case in neonatal period. Poor
socio economic status (41.8%), malnutrition (20.9%), sickle cell disease (3.4%), nephrotic
syndrome (2.3%) are the major association found. 39% showed sequele, and death occurred in
28%. Latex agglutination test has highest etiological detection rate (90.9%), followed by CSF
culture (36.3%) and blood culture (15%). Conclusion: Pneumococcal meningitis is one of the
leading cause of morbidity in pediatric patients, which can be prevented by early diagnosis by
proper CSF examination & prompt treatment.LAT, though costlier, is an easy and quick test with
high predictive value, which can be used in peripheral set up.
ID/28(P) A CASE OF RABIES ENCEPHALITIS PRESENTING AS ACUTE FLACCID
PARALYSIS
Pushpalatha.K, Premalatha.R, G.B. Belavadi,
No 147/1, Mahadeshwara Building, Chamarajpett 5th Main Road, Bangalore-560018
drpushpakrishnappa@gmail.com
A 5 year old child presenting with dog bite 20 days back and later taking 4 doses of anti rabies
vaccine and presenting like acute flaccid paralysis and bulbar palsy later diagnosed by rapid
fluorescence focal inhibition test and brain biopsy proving rabies encephalitis. Case summary: 5
year old female child 2nd child of non consanguineous marriage born at term with uneventful
antenatal, birth neonatal history appropriate diet history belonging to a low socio economic strata
presented in emergency room with history of dog bite 20 days which was a class 3 bite on the left
lower limb and child subsequently had received 4 doses of anti rabies vaccine apparently
asymptomatic for the 10 days presented with progressive ,symmetric ascending weakness of the
lower limbs, complete progression of weakness in next 48 hours with no history of convulsion
child later developed bulbar palsy and respiratory failure. child was considered to have acute
flaccid paralysis encephalitis but the cause being either rabies or post vaccinial encephalopathy or
even post antirabies vaccine Gullian Barre syndrome. Neuroimaging was normal, CSF
biochemistry was normal but CSF for antirbaies antibodies by rapid fluorescence focus inhibition
test showed 1: 250 titers of antibodies suggesting rabies encephalitis rather than post vaccinial
encephalitis As the child could not be salvaged a post mortem brain biopsy revealed negri bodies
by immunoflouresect technique ( Sellers technique).
ID/29(P) STUDY OF CLINICAL AND LABORATORY FEATURES OF VARIOUS TYPES
OF TUBERCULOSIS IN CHILDREN
Nikhil Patankar, Ira Shah, Sujeet Chilkar
140/ 4153, Kannamwar Nagar -2, Vikhroli (East), Mumbai – 400083.
nikhilspatankar@gmail.com
Aim: To study clinical and laboratory features of different types of tuberculosis (TB) in children.
Material and Methods: 135 children with TB were evaluated on the basis of clinical symptoms,
physical examination, laboratory investigations and factors associated with various forms of
tuberculosis were analysed. Results: Mean age was 5.2±3.4yrs, with most children being in the 1-5
years (48.15%) age group. M: F was 1.9:1. Common features were fever (82.9%) with mean
duration of 36.8 ± 44.8 days, cough (46.7%) with mean duration of 41.6 ± 66.6 days, raised ESR
(75.79%) and anemia (36.44%). Pulmonary TB was seen in 48 (35.5%) followed by Neuro TB in
20 (14.8%), TB serositis in 16 (11.8%), Abdominal TB in 12 (8.8%), TB lymphadenopathy and
Latent TB in 11 (8.1%) each, Musculoskeletal TB in 8 (5.9%), Disseminated TB in 6 (4.4%)
patients, atypical mycobacterial TB, BCG adenitis, and Miliary TB in 1 (0.7%) patient each.
Predominant features were fever in TB lymphadenopathy, pulmonary TB and Neuro TB (P=
0.003), loss of appetite in disseminated TB (P=0.019), raised ESR in TB lymphadenopathy, Neuro
TB and musculoskeletal TB (P= 0.019), positive Mantoux test in abdominal TB and latent TB (P=
0.018).Conclusion: Clinical and laboratory features vary with the type of TB.
ID/30(P) UNUSAL MANIFESTATION OF T.B. IN CHILDREN - SCROFULODERMA
Preeti C Waghmare
Resident , Dept of Pediatrics , JNMC , Sawangi (M) , Wardha
dr_saksham@yahoo.co.in
Introduction: Tuberculosis has been described by different names and appears to be a disease as
old as human history. T.B. can affect any organ of body . In children it has unusal
manifestation like involvement of eyes , conjunctiva, esophagial T.B. , T.B. ottitis media and
cutaneous T.B. This case we came across was one of the unusal manifestations. Case Report:
3 YR old male presented with c/o ulcers over the neck , axilla and inguinal region (both
sides) since 4 years. H/o recurrent crusting followed by discharging sinuses present. H/O failure
to thrive present. h/o kochs contact present. O/E - vitals stable, Pallor - present
Lymphadenopathy present Ulcerated lessions 4x3 cm 2 to 3 in no. in neck , In both axilla 3x2
cm, in inguinal region 2x2 cm. lymph nodes were palpable and matted . Ulcers had
discharging sinuses with undermined edges, were dusky red few had crusting . abdomen
liver palpable. Investigations HB - 8.2 gm/dl ESR - 1OO/HR Sputum for AFB NEGATIVE ELISA for HIV 1 & 2 - NEGATIVE FNAC
LEFT AXILLARY LYMPH
NODES- smears shows caseous necrosis, Scanty small groups of epithelloid cells, sparse
lymphocytes, cell debries & Polymorphs. Present cytomorphology suggestive of caseating
tubercular Lymphadenitis. Diagnosis : skin t.b.- scrofuloderma. Pt was started on AKT
(HRZE)3+4(HR)3 . Pt. responded well to treatment, within 15 days lessions started to
subside and with completion of intensive phase lessions had healed.
ID/31(P) PREVALENCE OF MENINGITIS IN INFANTS AGED 6-18 MONTHS
PRESENTING WITH FIRST EPISODE OF FEBRILE SEIZURES
Gupta S, Batra P, Gomber Sunil
Department of Pediatrics, University College of Medical Sciences and Guru Teg Bahadur
Hospital, Dilshad Garden, Delhi.
drprernabatra@yahoo.com
Objectives: 1. To find the prevalence of bacterial meningitis in infants aged 6-18 months
presenting with first febrile seizure 2. To assess which clinical signs are strong indicators of
bacterial meningitis in these infants Background : 2-5% of children experience one or more
episodes of febrile seizure by 5 years of age. Most febrile seizures are triggered by fevers from
viral upper respiratory infections, ear infections, or roseola . American Academy of Pediatrics
guidelines for management of infants with febrile seizure consider lumbar puncture as a part of
routine diagnostic test for febrile seizure even though the prevalence of meningitis as depicted in
recent studies has been found to be very low. The recommendations made by AAP were
conceived in a different epidemiological era of disease pathology, with data not representative of
current prevalence. In this study we tried to find the prevalence of meningitis in infants presenting
with simple febrile seizures and try to assess whether lumbar puncture is warranted as a routine
diagnostic test. This would help in assessing whether AAP guidelines need a revision. Methods:
We assembled a retrospective continuous clinical data of infants aged 6-18 months with first
episode of febrile seizures diagnosed as per AAP guidelines. These patients were admitted to
Paediatric casualty or Pediatrics wards of Guru Teg Bahadur Hospital, Delhi from January 2003 to
December 2008. Infants who had known seizure disorder, underlying chronic neurological
condition, metabolic abnormalities or whose medical records were not available were excluded
from study. Results: Four hundred and ninety seven cases were studied during the study period.
Lumbar puncture was performed in 199(40.04%) patients after obtaining due consent from the
guardians. Rest 298 out of 497 (59.9%) were observed for a duration of 24 hours and were
discharged without any complication. Out of the patients in whom lumbar puncture was
performed, 116 (57.7%) had simple febrile seizures and 83(41.7%) had complex. Prevalence of
meningitis was 5/199 (2.5%) amongst those who underwent lumbar puncture ,out of which 1 was
between the age group of 6-12months and 4 were between 12-18months. 1/116 (0.86%) of simple
febrile seizures and 4/83 (4.81%) of complex febrile seizures had meningitis. Duration of seizures
more than 30minutes and presence of post ictal drowsiness could predict meningitis in statistically
significant way. Cold, cough, vomiting, ear discharge and rashes were the common accompanying
symptoms in these patients. Conclusion: Prevalence of meningitis in first febrile seizure was 2.5%,
out of which meningitis was only seen in 0.86% of simple febrile seizures. Thus, the
recommendations of AAP to perform LP in all cases of first simple febrile seizures need
reconsideration. Certain clinical markers like duration of seizures and post ictal drowsiness may be
used as a guide to determine which patients need CSF examination.
ID/32(P) PREVALENCE OF HIV IN CHILDREN
Prabhat Shobha, Rachna Saxena
Department of Paediatrics, Govt. Medical College & Hospital, Patiala, Punjab
sats_dol@rediffmail.com
Introduction: There is a greater need of reports describing clinical manifestations and disease
progression in HIV infected children in our country. The rate of infection is increasing, primarily
through perinatal transmission. Use of blood products for genuine indications can restrict
transfusion acquired HIV infection. Aims and Objectives: To know the prevalence of HIV
infection among the high risk children. Early diagnosis of HIV infection among children based on
clinical suspicion. Early institution of anti-retroviral therapy in children tested HIV positive and
HIV prophylaxis in babies of seropositive mothers. Material and Methods: Hospital based study
was carried out among 120 children between the age group of 0-18 years. Children were screened
by serological tests for anti HIV antibodies and PCR test was done in the newborns of seropositive
mothers. The tests were performed on high risk children i.e. Children born to seropositive mothers
Children with clinical suspicion Multi transfused children. Results: Out of 120 children 14 were
seropositive and 02 were tested positive by PCR test with overall seroprevalence of 13.3%.
Thirteen children were perinataly infected and 03 were infected through blood transfusion.
Clinical features at presentation include anaemia (87.5%), protein energy malnutrition (62.5%),
lymphadneopathy (56.2%) and tuberculosis (50%). Conclusion: A high index of clinical suspicion
is needed for the diagnosis of HIV infection. Antenatal screening of HIV infection is must for
every pregnant woman so that antiretroviral therapy could be started to them to prevent mother to
child transmission. Strict screening of blood donors is mandatory.
ID/33(P) INCIDENTALLY DETECTED MASSIVE HYPEREOSINOPHILIA IN AN
ASYMPTOMATIC CHILD: A CASE REPORT
Harmeet Singh Arora, DS Chhajta, A Arora
Dept of Pediatrics, Military Hospital, Roorkee, Uttarakhand – 247667
vicky_arora18@rediffmail.com
Introduction : Hypereosinophilia is a fairly common presentation esp in endemic areas in a
symptomatic patient, and is caused by a variety of etiologies including non clonal (reactive) causes
e.g. infections, asthma, allergies and drugs, and clonal causes e.g. acute eosinophilic leukemia,
AML, CML, Myelodysplastic syndromes and essential thrombocythemia. Tropical pulmonary
eosinophilia (commoner) and Hypereosinophilic syndrome (rare) are a distinct entitities with
characteristic diagnostic criterias. Case Report: A 6 years school going girl, first product of non
consanguineous marriage presented to the OPD with mild upper respiratory tract infection. She
was a resident of eastern UP, but didn’t visit her native place since last three years. There was no
significant past history, and she was not a known asthmatic. On examination, an alert febrile child
with 4 to 5 small, discrete and non tender anterior cervical lymphnodes and similar but larger
bilateral axillary lymph nodes palpable. Mild hepatosplenomegaly was present, chest was
clinically clear and throat was congested. Rest of the examination was unremarkable.
Investigation: Hb – 11.4 gm/dl, TLC – 97000/cumm (1.08 lac / cumm on repeat testing), DLCE91P04L04M02, Platelet count – 1.2 lac/cumm; PBS – Marked eosinophilic leucocytosis and no
blasts/ abnormal cells, and negative for microfilariae; Chest radiograph – Diffuse bilateral milliary
shadows; USS abdomen –Mild hepatosplenomegaly. Empirical standard course of
Diethylcarbamazine was started. Further evaluation – Bone marrow examination – Marked
eosinophilic infiltration; Axillary lymph node biopsy & Histopathological examination –Intense
eosinophilic infiltration ; CECT thorax –Diffuse bilateral milliary shadows; Cardiac evaluation –
NAD; Serological tests for microfilariae – Negative. Serum IgE levels couldnot be done;
Molecular study for FIP1L1-PDGFRA1 gene for constitutively activated tyrosine kinase fusion
protein mutation was negative. Managed with extended course of DEC with complete clinical,
laboratory and radiological response in about 5 weeks. Presently, TLC – 11,000/cumm, DLC –
P48L43E05M04; Chest radiograph – complete clearing. Discussion : Hypereosinophilia is
common entity esp in few parts of the country, and is usually due to Tropical pulmonary
eosinophilia, which responds to a course of DEC, thus preventing progressive pulmonary disease.
However, a detailed evaluation may at times be warranted, esp in cases of asymptomatic massive
hypeeosinophilia in non endemic areas, to rule out other sinister diagnoses including
hematological malignancies, Hodgkin’s and non Hodgkin’s lymphomas and Hypereosinophilic
syndrome. Our case had no symptoms attributable to hypereosinophilia and was incidentally
detected for a unrelated mild illness, and required extended course of DEC for adequate response.
ID/34(P) UNCOMMON PRESENTATION OF STERNAL TUBERCULOSIS
Manish Narang, Archana Dwivedi, Gopesh Mehrotra
Department of Pediatrics, University College of Medical Sciences, Delhi
manish_2710@yahoo.com; nidhi_mamc2001@yahoo.co.in
Primary tubercular osteomyelitis of sternum presenting as an acute swelling over chest is an
extremely rare presentation in pediatric population. We herein report such a case which was
diagnosed by CT scan showing lytic lesion and aspiration revealed positive culture for
Mycobacterium tuberculosis. Child improved with antitubercular treatment.
ID/35(P) CLINICAL PROFILE OF CHILDREN WITH STAPHYLOCOCCUS AUREUS
SEPSIS IN A REFERRAL HOSPITAL.
Mangla Sood, Ashwani Sood, Seema Sharma
Pratasha, North Oak Area, Sanjauli, Shimla-171006
nishoosood@yahoo.com
Aims: Staphylococcus aureus is an important pathogen causing clinical disease in children ranging
from non-invasive skin infections to severe, life-threatening sepsis. This study review all
children<16years of age with Staphylococcus aureus sepsis (SAS) admitted to paediatric ward of
IGMC, Shimla in last 5 years (April 2004 to March 2009) with their clinical presentation and
outcome. ethods: Retrospective and prospective case study. Results: Out of total 21,600
admissions 4,464 were culture positive. 134 patients (0.6% of total admissions) were identified
with SAS. 116 were community acquired out of which 5 (3.7%) were Methicillin resistant
Staphylococcal aureus (MRSA).18 were hospital acquired SAS, out of which 12(8.9%) were
MRSA. Predisposing conditions were pustules (36%), blunt trauma (12%) and injections (5%).
Fever (98%) and respiratory distress (71%) were commonest presentation followed by skin
abscess and restriction of limb mobility (12% each). Disease spectrum included multifocal disease
(67%), pleuro-pulmonary disease (44%), skin and soft tissue infections (28%) and osteo-articular
disease (20%). Clustering was seen during hot and humid months. An aggressive search for foci
and surgical drainage of infective foci was required in 50% of children. The median length of stay
in hospital was 15 (mean 21, SD 22.7, range 2–149) days. Mortality due to SAS was 15.6%
compared with the overall mortality for hospital admissions of 3.7%. Morbidity was present in10
(5.9%) children after discharge. Conclusions: SAS is largely community acquired, affects healthy
children, is multifocal, and has high morbidity and mortality. Management should include
thorough clinical evaluation, appropriate and frequent imaging studies to look for dissemination
and to drain and debride foci.
ID/36(P) STUDY OF EFFECT OF ANTIRETROVIRAL THERAPY ON GROWTH IN
HIV INFECTED CHILDREN
T. Pratima, A. Tilak Chandrapal, K. Devaraj, Aedula Srisaila Datta
Department of Paediatrics, Institute of Child Health-Niloufer Hospital, Hyderabad
kn_eshwari@yahoo.com
Aim: To evaluate the efficacy nevirapine based ART on growth parameters in confirmed HIV-I
children. Study Design : A prospective open uncontrolled longitudinal study was conducted
during Jan 2007 to Mar 2008, on 47 children aged between 18 months to 12 years selected from
orphan care centres for HIV children in and around Hyderabad and followed for a period of 48
weeks after initiation of ART. Anthropometric parameters namely, weight, height, mid arm
circumference, head circumference, body mass index, nutritional assessment and CD4+T cell
count are main parameters taken into consideration. Result : On a study conducted on 47 HIV
positive patients in 220 visits, 7 children were diagnosed to have pulmonary tuberculosis and were
taken off from the study according to National Guidelines. The significant change noticed on
initiation of ART was an increase in Wt. By 3.36 kgs, Ht. by 1.4 cms, BMI by 1.87, CD4+T count
by 300.78, intake of Calories by 270.37 kcal. and proteins by 5.08 gm on an average. It is
extremely significant as p<0.001. Conclusion : Administration of nevirapine based ART as fixed
dose combination[FDC] is feasible in resource limited settings and was found to atleast ameliorate
the acute wasting found in severe stages of HIV associated disease. There is improvement in
growth parameters, significant change in the clinical staging of infected children, prevents
immunological deterioration, except for change in height velocity as longer time period is required
to observe significant change in height when on ART. ART’s effect on BMI is complex while it
has got no significant effect in those with mild to moderate disease, it significantly changes
MEAN BMI and BMI Z scores in severely infected children.
ID/37(P) SYSTEMIC FUNGAL INFECTION
Atul Kulkarni, Sunil Vaidya, Vijay Patil, Sharanakumar Angadi
dratulkulkarni@rediffmail.com; drsvaidya@gmail.com; drvijaypatil@gmail.com;
drsharanaangadi@gmail.com
A 12 days old male baby present with Complaints of Fever Refuse to feed ,Excessive cry since 5
days Baby delivery at home but did not cry immediately after birth,so was admitted in the hospital
for treatment 14 yrs of marriage, all previous child (6 female babies) are normal On examination
:Baby conscious, Irritable, Dusky colour, febrile temp of 102 degree F, PR-146/min ,RR66/min,CRT< 2 sec,Peripheral pulse:feeble,Sclerema on thighs,
Murmur: systolic on 2nd
intercostal space,RS: tachypnea present,Intercoastal with suprasternal retraction present ,Vesicular
breath sounds ,Spasm present both side , ,Liver firm ,non-tender and 2cm palpable, Spleen not
palpable,Lump in abdomen palpable in left hypochondriac region, Investigation :TC: 8300/cumm,
Hb: 10.9gm/dl,Plt: 18000/cumm, CRP: POSITIVE, USG(abd):.Marginally bulky lt. kidney. ,Mild
hepatomegaly.Mild ascites., Blood urea 36mg%, serum creatinine-0.5mg%.
Urine(r),
normal.HIV, HBs Ag: negative blood culture-sterile CT scan(abd)Bulky poorly functioning lt.
Kidney with a nonenhancing hypodense subscapular lesion compressing the minimal residual
tissue
centrally
with
aenlargad
rt.retrocrural
lymphnode,possibility
of
nephroblastomatosis/lymphoma is more likely than the multicystic dysplastic kidney.
Trentment:initially with inj. Antibiotics. As pt had long stay in hospital but not responding to
above treatment, we additional add inj antifungal. After general condition has improved ,L. side
nephrectomy done. HPR(left nephrectomy) Acute on chronic pyelonephritis with hemorrhagic
necrosis with fungalhyphae resembling mucor species with foreign body giant cell
reaction.Discussion: Disseminated candidiasis presents like bacterial sepsis and can involve
multiple organs such as the kidneys, brain, eye, liver, spleen, bone, joints, meninges and heart.
Confirming the diagnosis by laboratory tests is difficult and a high index of suspicion is required.
Most neonatal fungal infections are due to Candida species, particularly Candida albicans .
Candida parapsilosis and Candida tropicalis ,End organ damage is more common and severe in
systemic fungal infections and can involve the kidneys, brain, lungs, eyes, liver spleen, bones and
joints.The renal manifestations can be in the form of acute renal failure, hypertension or flank
masses.Amphotericin B continues to be the mainstay of therapy for systemic fungal infections Its
efficacy in treating CNS infections is greatly enhanced by concurrent administration of 5Flurocytosine.Its use is limited by the risks of nephrotoxicity and hepatotoxicity. There is a serious
search for the use of alternative drugs that can give equal or superior efficacy in treating fungal
infections with lesser side effects than conventional amphotericin B.Systemic fungal infection is
an iatrogenic disease of modern neonatal intensive care that deserves urgent attention for its
prevention as well as effective treatment in order to minimize neonatal morbidity and mortality.
ID/38(P) EFFECT OF HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) ON
CLINICAL, IMMUNOLOGICAL AND ANTHROPOMETRIC PARAMETERS IN
CHILDREN WITH HIV INFECTION.
Romit Saxena , A.P.Dubey , P.Bhalla , T. Singh.
Departments of Pediatrics, Microbiology and Pathology, Maulana Azad medical College, New
Delhi 110002.
drromit@gmail.comCategory
Aims and objectives: To study the effect of highly active antiretroviral therapy (HAART)on
clinical, anthropometric and immunological parameters in HIV infected ART naïve children
Design: Prospective Cohort study Study Population: Children less than 12 years of age who
qualified for HAART as per the NACO guidelines between September 2007- September
2008,were enrolled at ART clinic, LNJP and started on HAART. They were followed up for next
6 months. Materials and Methods:. Patients were followed on a monthly basis and their height and
weight recorded at every visit. Absolute CD4 counts, CD4% and Absolute lymphocyte counts
were measured on a three monthly basis. A record of their clinical improvement was made and
clinical staging done sequentially at every visit. Corresponding weight for age(WFA), height for
age(HFA), weight for height(WFH),body mass index (BMI) and body surface area were obtained
and their z scores calculated .The trend was analyzed over the period of next 6 month after ART
initiation. Results:26 patients (80.03±40.96 months)were enrolled, predominantly in WHO stages
3and 4(60.27%) At presentation, 54% of the patients were severely immunosuppressed .The mean
anthropometric parameters at baseline were WFA z score -3.159;HFA z score -3.418, WFH zscore -1.91 and BMI 14.2. Initiation of therapy was associated with statistically significant
increase in the anthropometric parameters to WFA z score-2.26 , HFA z score-2.59, WFH z score0.075 and BMI 16.19.By end of 6 months of follow up 50% of patients were not significantly
immuno- suppressed ,whilst three fourth of the patients were clinically asymptomatic. Conclusion:
A statistically significant increase in anthropometric and immunological parameters was observed
after ART initiation. There was significant clinical improvement observed in most patients at end
of 6 months of follow up.
ID/39(O) PROFILE OF PRIMARY IMMUNODEFICIENCIES IN A TERTIARY CARE
CHILDREN’S HOSPITAL
Vasuki Balasubramaniam, Lakshmi Muthukrishnan, Lalitha Janakiraman
Kanchi Kamakoti Childs Trust Hospital, Chennai.
vasu_b23@yahoo.co.in
Objective: To report various primary immunodeficiencies diagnosed in children at a tertiary care
hospital, at Chennai. Methods: Case records of hospitalized children, diagnosed to have primary
immunodeficiency disorder from Jan 2005 to April 2009 were evaluated. Results: Thirty children
(M:F = 4:1) with mean age of 2.7 yr (3 mo – 9 yr) were diagnosed to have primary
immunodeficiencies. 13 children had common variable immunodeficiency, 1 had hyper IgM
syndrome, 8 had severe combined immunodeficiency, 2 had combined immunodeficiency, 2 had
hyper IgE syndrome and 2 had Ataxia Telangiectasia. 1 child had hypereosinophilic syndrome. 1
child had leucocyte adhesion defect. Common mode of presentation were recurrent / persistent
pneumonia in 19, recurrent diarrhea and Failure to thrive in 12, recurrent Otitis media in 6, skin
infections in 5, pyogenic meningitis in 3, extensive fungal infection in 3, disseminated
tuberculosis in 2 and atopic dermatitis in 1 child. Family history of sibling deaths were elicited in
4 families. Infectious agents were isolated in 19 cases.Psuedomonas aeruginosa and ESBL Ecoli
were isolated in 5 each. Pneumocystis carinii was identified in broncho alveolar lavage fluid in
3.Other organisms isolated were MRSA, Enterobacter, Proteus, Aspergillus and Streptococcus in
1 child each. Conclusion: From the retrospective analysis of case records of 30 children with
primary immunodeficiency, there is a need for high index of suspicion for diagnosis of the same in
India. Though the exact prevalence is not known there is a need for more studies to document the
magnitude of problem in these cases.
ID/40(P) MULTIPLE AMOEBIC ABSCESSES WITH ERYTHEMA NODOSUM- A RARE
CASE
Gayathri.S. Sathyajith Nair, Sajitha Nair, Rajam L
Assistant Professor, Department, Pediatrics, Amrita Institute of Medical Sciences, Kochi, Kerala
sathyajithnair@aims.amrita.edu
Introduction: Extraintestinal amoebiasis occurring in <1% of Entameoba infections manifests
most commonly as hepatic abscess (solitary/multiple).This report describes a child with multiple
hepatic, splenic and renal abscesses due to amoebiasis mimicking pyogenic abscess. Case: A 6
year old girl was brought with history of intermittent, high grade fever for 2 months with right
sided abdominal pain and multiple raised, purplish painful lesions over both lower limbs present
since 1 week. Examination revealed pallor with hepatosplenomegaly and erythema nodosum like
lesions.There were no bleeds.There was no gastrointestinal symptoms. Investigations showed
severe anaemia ,neutrophilic leukocytosis and thrombocytosis. CRP was 200mg%.Blood culture
was sterile. Ultrasound abdomen showed multiple hypoechoiec lesions in the liver,spleen and both
kidneys.Due to possibility of pyogenic abscesses she was started on broad spectrum antibiotics.
Due to the subacute history and poor response to multiple courses of antibiotics given outside an
aspirate of the liver abscess was done. Cytology showed pear shaped organisms with ingested
RBC which was highly suggestive of Entamoeba. Within 72 hours of starting Metronidazole, she
became afebrile. A 2 week course of Metronidazole followed by luminal amoebicide was given.
Hepatosplenomegaly regressed with decrease in the size of the lesions sonographically. Stool
examination showed no cysts/trophozoites. Amoebiasis serology done by ELISA was negative.
Child was well on one month follow up. Conclusion: Though multiple hepatic amoebic abscesses
are common, splenic and renal abscesses are very rare in invasive amoebiasis. Erythema nodosum,
a very rare manifestation in invasive amoebiasis was another peculiarity of this case.
ID/41(P) PROFILE OF PEDIATRIC LIVER ABSCESS FROM A TERTIARY CARE
CENTRE
Meetu Rawat Gupta, Vijay Kumar Gupta
Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi.
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Pediatric liver abscess(PLA) is frequently encountered health problem. However
disease burden remains unclear because of paucity of population-based studies. Objective: To
study incidence and clinical profile of PLA in children from a tertiary care centre. Materials and
Methods: We retrospectively studied profile of 357 cases of PLA hospitalized between 20002008.Results: Of 69987 admissions, 357 cases of PLA were diagnosed(incidence 51 per 10,000)
with mean age 8.41 years and M: F ratio of 1.68:1. Predominant symptoms were prolonged
fever(67.8%) and abdominal pain(44.3%). USG findings showed solitary abscess in81.47% and
multiple abscesses in18.5%, with involvement in 82.82%of right, 9.69%of left and 7.49%of b/l
lobe. USG guided aspirations done in 193(45.37%) while surgical drainage done in 14(3.92%),
rest 150 were conservatively managed. Of 221 abscesses aspirated, 54(24.43%)pyogenic and
22(9.95%)amebic abscesses were confirmed by pus culture and amebic serology. Staphylococcus
aureus(29.6%) was most common followed by E. coli(25.9%), Salmonella typhi(18.5%),
Enterobacter(14.8%), Streptococcus(5.6%) and CONS(5.6%). Appropriate antibiotics(as per
bacterial sensitivity where available) were given.. 4 resistant cases responded to Antitubercular
treatment(ATT), of which 3 were Tb-PCR positive while one despite negative koch’s workup, was
under strong clinical suspicion. Decreased abscess size, after 4-6 weeks of treatment was seen in
318(89.1%). Complications seen were pleural effusion in 11 and rupture into abdominal cavity in
2 cases. 26 cases did not complete treatment and 6 died. Conclusion: This study highlights
significant incidence of PLA in our population. Good antibiotic coverage and percutaneous
drainage are sufficient in most cases. ATT should be considered in non responders with Tb-PCR
as diagnostic aid.
ID/42(P) WANING OF VACCINE INDUCED IMMUNITY TO HEPATITIS B WITH
TIME IN INDIAN CHILDREN
Subandhu Gupta, Meetu Rawat Gupta, Raman Sardana, Anupam Sibal
Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: There is evidence that there is significant loss of vaccine-induced immunity to
Hepatitis B with time. However sporadic reports suggest vaccine-induced immunity upto 15 years.
There is very limited data from our population regarding this context. Objective: To assess and
compare anti-HBs titres in previously immunized children vaccinated at different time periods.
Material and Methods: This was a prospective study conducted over one year period, designed to
evaluate antibody titres to Hepatitis B in previously immunized children Children aged 6 months
to 18 years with documented evidence of Hepatitis B immunization were enrolled. Group I
comprised of children vaccinated within the last 5 years. Group II included children who were
vaccinated within last 10 years but beyond 5 years. Group III comprised of children who were
vaccinated beyond 10 years when contacted. Anti-HBs titres were assessed using ELISA.
Observations: Group I comprised of 410 children, Group II comprised of 145 children and Group
III comprised of 83 children. Of these 83.41%(342) of Group I, 81.38%(118) of Group II and
57.83%(48) had antibody titer ≥ 10mIU/ml of Anti-HBsAg while the rest had either insignificant
titres or anti-HBsAg antibody < 10mIU/ml, indicating weaning Antibody titres with time. The
proportion of seroprotection was found to be statistically significant in relation to duration from
last vaccination received(p < 0.05). Conclusion: This study supports the view that there is
significant loss of immunity with passage of time. Whether this loss of seroprotection increases
the susceptibility to Hepatitis B infection in these children needs further investigation.
ID/43(P) EFFECT OF AGE AND GENDER ON VACCINE INDUCED IMMUNITY TO
HEPATITIS B IN CHILDREN
Subandhu Gupta, Meetu Rawat Gupta, Amita Mahajan, R. N. Srivastava
Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Universal Hepatitis B(HB) immunization has significantly mitigated Hepatitis B
burden in children of all ages. Neonates as well as adolescents have high risk of exposure(as latter
become sexually active). There is paucity of literature on whether any age group or gender has
effect on vaccine-induced immunity. Objective: To assess and compare anti-HBs titres in
previously immunized children of different age groups and gender. Material and Methods: In this
prospective study conducted over one year to evaluate antibody titres to HB in previously
immunized children, children aged 6 months to 18 years with documented evidence of HB
immunization were enrolled. Those with unknown or incomplete vaccination status and
past/present HB infection were excluded. Children of different age groups and gender were
compared with respect to seroprotection rate as ascertained by anti-HBs titres. Children with AntiHBs titres ≥10mIU/ml were accepted as seroprotected. Observations: Of 638 children, 435 were
males and 203 females(M:F 2.15:1). Seroprotection rate was more in girls(81.77%) than
boys(78.62%) although with no statistically significant difference in seroprotection level. In girls
>108 months of age, seroprotection rate was significantly lower than girls <108 months of
age(p=0.019). However no such difference was seen amongst boys. Conclusions: This study
confirms that gender does not influence seroprotection rate of HB vaccine and age is also not an
independent factor affecting Anti-HBs titres in boys. Statistically significant difference seen
between seroprotection rate amongst girls <9 years and >9 years of age warrants investigation of
possible endocrinal and other biochemical factors affecting vaccine induced immunity at onset of
puberty in girls.
ID/44(P) COMPARISON BETWEEN VACCINE INDUCED IMMUNITY TO HEPATITIS
B IN CHILDREN IMMUNIZED WITH TWO DIFFERENT VACCINATION
SCHEDULES
Subandhu Gupta, Meetu Rawat Gupta, Raman Sardana, R. N. Srivastava
Department of Pediatrics, Indraprastha Apollo Hospital, New Delhi
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: According to W.H.O recommendations, three doses of Hepatitis B vaccine are
considered safe and immunogenic if given under optimal conditions. A variety of schedules can be
used for Hepatitis B immunization in national programmes, depending on the local
epidemiological situation. IAP recommends dosing schedule of 0, 1 and 6 months while Delhi
Government Health services advocates 0, 1 and 2 months schedule. Objective: To compare the
efficacy of the two different vaccination schedules in previously immunized children. Material and
Methods: In this prospective study conducted over one year, children aged 6 months to 18 years
with documented evidence of Hepatitis B immunization were enrolled. Group I comprised of
children vaccinated according to vaccination schedule of 0, 1 and 6 months. Group II included
children who were vaccinated with at least 3 doses at 0, 1 and 2 months. Anti-HBs titres were
assessed using ELISA. Observations: Group I comprised of 419 and Group II comprised of 219
children. In Group I, 329(78.52 %) children had anti HBs-titres ≥10 mIU/ml. In Group II,
179(81.73%) children showed anti HBs-titres ≥10 mIU/ml with no statistically significant
difference between seroprotection induced by the two vaccination schedules.Conclusion: Both the
vaccination schedules were found equally efficacious in providing seroprotection against Hepatitis
B. Hence either schedule can be added to existing national immunization programmes without
requiring additional visits for immunization.
ID/45(P) TOXIC SHOCK SYNDROME DURING MEASLES VACCINATION
L. S. Deshmukh, A. M. Lingayat, Nilesh V. Darvhekar
Dept of Pediatrics, GMCH Aurangabad
i4vega@yahoo.com
Aims and Objectives: To study the cases of Toxic shock syndrome during measles vaccination in
children. Materials and Methods: 35 children were vaccinated. 10 children between age of 9 mo
and 1 year; 6 males and 4 females developed symptoms after 6-8 hours of vaccination. Out of 10
children admitted, 5 had severe illness, with fever, hypotension, tachycardia, tachypnoea, delayed
CRT, vomiting, loose motions and signs of dehydration. Other 5 patients had mild illness with
fever, vomiting and loose motions. Patients were clinically suspected as suffering from toxic
shock syndrome and investigated for CBC, PS, Stool examination, Blood culture, LFT, KFT,
ABG, Serum electrolytes, and ECG. Patients were treated with IV fluids, antibiotics (cloxacillin,
cefoperazone-sulbactum, and clindamycin), inotropic support and symptomatic management.
Results: Out of 10, 4 patients died within 24 hours. They were resuscitated and ventilated but
ultimately succumbed. Remaining 6 patients were meticulously monitored, treated and survived.
All of these 6 were discharged successfully after 15 days. Conclusion: Toxic shock syndrome due
to Staphylococcus species is a rare but potential lethal complication of measles vaccination. It can
be certainly prevented by safe vaccination practices.
ID/46(P) HYPEREOSINOPHILIA- A CASE REPORT
S.M.Joshi, S.Save, G.S.Brahme, C.Warke, R.Gadade
Dept. of Pediatrics, TNMC & BYL Nair Hospital, Mumbai
nairpediatric@hotmail.com
Introduction:-Hypereosiniphilia represents a heterogenous group of leukoproliferative disorders
with multiorgan dysfunction (cardiac, pulmonary & CNS) & characterized by eosinophil count
exceeding 1500cells/mm3 & persisting for 6 months.Case Report:-A 7year old male child was
transferred for HRCT Thorax with h/o fever,cough & pain in lower limbs for 2wks & had a
transient illness with anemia, anasarca & oliguria earlier. On admission, patient was
undernourished, vital parameters were normal with just palpable spleen. Course In Ward:Investigations revealed Hb-9.6gm%, TC-24,400(with E-89%), Platelet count-1,20,000, ESR
44mm/hr& MT -ve. Absolute Eosinophil count(AEC) was 21,400. In view of bilateral nodular
shadows on chest X-ray, fibrosis & traction bronchiectasis in the left upper lobe on HRCT Thorax
&
high
AEC
the
following
possibilities were
considered-a)IDIOPATHIC
HYPEREOSINOPHILIC SYNDROME (IHS) b) EOSINOPHILIC LEUKEMIA &
c)KOCH’S(eosinophilia of infective etiology) Bone marrow examination showed predominance
of eosinophilic precursors with blasts < 2% & Fusion gene analysis(F1P1L1-PDGFRά) was
normal. Other causes of eosinophilia were ruled out. Patient was treated with Albendazole,
Hetrazan ,Prednisolone & after 2 months, was given Hydroxyurea in view of high AEC (2880).
Recent hemogram has shown AEC as 2000 while on hydroxyurea. At the end of 12wks patient
was advised AKT in view of MT +ve (15mm), high ESR(110mm/hr) & failure to weight gain.
DISCUSSION:- Diagnosis of HES is advocated ,based on the criteria evolved by Chusid et al in
1975 & are:-a)AEC >1500/mm3 for >6 months b)No identifiable etiology c)Signs & symptoms of
organ involvement. HES is associated with high mortality /morbidity due to pulmonary infiltrates
,fibrosis, endomyocardial fibrosis & encephalopathy . The IHES may rarely evolve into chronic
eosinophilic leukemia..Symptomatic patients are advised prednisolone as initial therapy
&chemotherapeutic agents for nonresponders, Hydroxyurea being the preferred drug. Second line
drugs like Imatinib & Interferon-α are warranted for our patient at this stage. Aggressive medical
& surgical therapy (thrombectomy,endocardial resection & valve replacement) is mandatory in
this disorder in view of high mortality.
ID/47(P) A STUDY OF THE PROFILE OF CHIKUNGUNYA INFECTION IN CHILDREN
IN A TERTIARY CARE HOSPITAL
Bharath.Kumar Reddy.K.R., Prahalad Kumar A, Basavaraja G.V.,.Govindaraj.M.
Indira Gandhi Institute of Child Health (IGICH), Bangalore
bharathreddykr@yahoo.co.in
Introduction: Chikungunya fever is caused by Chikungunya virus (CHIK) and spread by Aedes
aegypti and Aedes albopictus. The median incubation period is 2 to 4 days. Vertical transmission
of disease from mother to child has also been documented. Clinical manifestations are very
variable, from asymptomatic illness to severe debilitating disease. Children are among the group at
maximum risk for severe manifestations of the disease and some clinical features in this group are
distinct from those seen in adults. Hence studies on the clinical profile of the infection in children
and supportive laboratory evidence to the same is required. Aims and Objectives: To study the
clinical profile of chikungunya infection in the pediatric age group.To study with diagnostic
evaluation the presentations of chikungunya infection. To study the outcome of chikungunya
infection in children Materials and Methods: Ninety eight children between the age group of 24
days to 18 years presenting with features of chikungunya fulfilling WHO criteria, admitted to
Indira Gandhi Institute of Child Health from June 2008 to August 2009 (15 months) formed the
study group. After obtaining complete history and thorough clinical examination, these children
were further evaluated and haematological features and other laboratory diagnostic modalities of
chikungunya were noted in each subject. For the confirmation of the diagnosis, the serum samples
of all the study subjects were sent for Chikungunya IgM serology to National Institute of Virology
(NIV). Those children who were negative for Chikungunya IgM were excluded from the study.
The children with Chikungunya were effectively managed as per the standard protocols in the
PICU Statistical methods included the Chi square and Fisher test to find the significance of an
elevated PCV and a decreased platelet count. The logistic regression has been carried out to find
the effect of various factors on the haematological parameters and clinical features. Repeated
measures ANOVA have been used to find the significance of change during the study period for
Haemoglobin and PCV. Statistical software namely SPSS 10.0 and Systat 8.0 were used for the
analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc.
Results: Age : The mean age of subjects was 8.4 years with the youngest being 24 days and oldest
being 17 years of age. Maximum number of cases were seen in the age group of > 10 years
Gender: 69.8 % were found to be male with 30.2% female (M:F = 2.5:1) Fever: Average days of
fever prior to admission : 7.1 days, with 45.3 % presenting with < 5 days of fever Typical clinical
features 24.5% presented with myalgia, with significance more in the older age group > 10 years
13.2 % presented with arthralgia with a significant number in the > 10 years age group. Only 1.9%
presented with petechiae A significant 56.7 % presented with shock on the first day of admission.
Other clinical manifestations in chikungunya
CLINICAL FEATURE
NUMBER
PERCENTAGE
PAIN ABDOMEN
18
34
BLEEDING
6
11.3
MACULO PAPULAR RASH
23
43.4
SPLENOMEGALY
19
35.8
HEPATOMEGALY
34
64.2
LYMPHADENOPATHY
18
34
COUGH
6
11.3
PHARYNGEAL CONGESTION
6
11.3
VOMITING
30
56.6
DIARRHOEA
3
5.7
HEADACHE
13
24.5
Haematological/laboratory parameters More than 54.9% presented with a normal Haemoglobin
A majority (35.8%) patients had a platelet count of >1,50,000 on day 1 of admission, with 15.3%
having a platelet count < 50,000 PCV was found to be on the lower side of normal ranging from
25-35 The leucocyte counts were in the range of 4000-8000 with a differential predominance of
polymorphs A significant number of patients (50 %) were found to have a prolonged aPTT, found
more in patients who presented with shock, petechiae and bleeding manifestations. Hyponatremia
was found in 60% patients, with normal potassium levels Liver enzymes (SGOT/SGPT) were
found to be on the higher range (160-300), in 30-46.2% of patients Conclusion: Chikungunya is an
important preventable mosquito borne disease. Early recognition and effective management of
chikungunya will prevent significant mortality and morbidity. Hence knowledge and research into
the various presentations of chikungunya fever in the pediatric age group is required for all
treating physicians
ID/48(P) MALARIAL HEPATITIS DUE TO P.VIVAX
Samarendra Mahapatro, S.S .Kar, R.Tripathy
Dept of Pediatrics, Hi-Tech Medical College, Bhubaneswar, Orissa
samarendramahapatro@yahoo.com
Malaria parasite particularly P.Falciparum usually causes multiorgan involvements. It involves
CNS, Hepatic, Hematological, GI, Respiratory, Renal systems.Multiorgan involvements with
P.Vivax is unusual. But we have reported nine cases of unusual presentation of P.Vivax (from Jan2009 to Aug 2009) in the age group of 2 -9 years. All the children presented to us with fever and
yellow coloration of urine and conjunctiva .All the cases were diagnosed as Infective Hepatitis
elsewhere before referral to our hospital. On examination we have found icterus and
hepatosplenomegally.Routine hematological investigations (Hb, DC, and TLC) were normal.
Liver function tests were abnormal. P.Vivax was positive in either ICT test or in the blood smear
slide or in both tests. None of the case was having P.Falciparum positive. Viral markers for viral
hepatitis were negative. USG of Abd was done in all the cases to rule out any surgical cause of
jaundice. Also we have done relevant investigations to rule out any hemolytic anemia. We have
managed the children with Antimalarial (IV Quinine) and symptomatically we had managed the
jaundice. Recovery was uneventful in all the children and radical cure was also given. ConclusionWe should think about P.Vivax, while evaluating a case of fever with icterus.We should not
assume all the cases of fever with icterus are viral hepatitis.
ID/49(P) CLINICAL PROFILE OF H1N1 PATIENTS
N. Ravikumar, SV.Prasad, Subhakar
Asst. Prof AP Chest Hospital Osmania Medical College, Hyderabad
ravik1961@yahoo.com
Objective of study: To study clinical profile of patients with signs and symptoms suggestive of
Swine Flu to compare clinical profile of HiNi positive with negative. Methods: Patients with signs
and symptoms of Swine flu were included. Throat and nasal swabs were sent to NICD Delhi and
IPM Hyderabad for analysis [RtPCR]. Statistics Frequencies and percentages calculated for
clinical features. Cases and controls compared for categorical variables by chi-square and
continuous variables by student t tests Results:72 patients were referred to hospital with
symptoms. 2 were infants. 2 to 5, 6 to 12 and greater than 12 years of age were 27 (38%),
26(37%), 16(22%) respectively. 62 were from Hyderabad. Others outside. In 68% [49] there was
travel history outside Hyderabad. 41(56%) travelled abroad. 3 travelled to Pune, 1 each to Shridi
Mumbai Cochin. Contact with swine flu patients was present 48 (67%). Rhinorrhea, cough and
respiratory distress was seen in39(54%), 46(64%), 5(7%) respectively. Sore throat in 16
patients(21%). 66 were cured. 6 left against advice.H1N1 was positive in 28 (39%).Clinical
feature significantly higher in patients with swine flu were history of contact (13/28 vs 10/43, p
value 0.04), cough (24/28 vs 21/43, p value 0.005) and sore throat (13/28 vs. 1/43, p value
<0.0001) Conclusion:History of contact, Cough, rhinorrhea and sore throat are the clinical
symptoms suggestive of H1N1 in children suspected with swine flu.
ID/50(P) LARYNGEAL DIPTHERIA : STILL A LIFE THREATENING ILLNESS
Payal Shah, Manish K. Arya, Neeta R. Sutay, Kanchan
Dept. of Paediatrics, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai 8
manjioo7@yahoo.co.in
Introduction: Acute toxic infection caused by Corynebacterium resulting in pseudomembrane
formation and
paralysis of palate &
hypopharynx
as local effect and
thrombocytopenia,ATN,Cardiomyopathy and demyelination of nerves as systemic effect of toxin.
Case History: 3 year old boy admitted with complaints of fever and cough since 3 days and
swelling in neck & ↑ in respiratory activity since yesterday night noticed by father. Fever was
high grade and cough was dry in nature. Swelling in neck noticed by his parents,sudden in onset
and was gradually progressive. Patient had increase in respiratory activity,since yesterday night
and was progressive till morning. He had no history of foreign body inhalation. Birth history was
normal and child had only received pulse polio immunization. On examination child was sick
looking, febrile (38⁰C) with pulse rat of 144/min,regular and RR of 76/ min with subcostal and
intercostal and suprasternal retraction present. SPO ₂ was 87% off O ₂ and 98% on O ₂
5lit/min by mask. Child had bilateral enlarged tonsils,completely obstructing the airway,with grey
white membrane over it. He also had bilateral cervical lymphadenopathy giving Bull neck
appearance. We did throat swab culture which was suggestive of corynebacterium diptheriae. In
view of deteriorating cardiorespiratory status tracheostomy was done and child was ventilated.
Child was also treated with antibiotic and antitoxin alongwith supportive care. After 2 days child
succumbed to pulmonary haemorrhage.
ID/51(P) EXTRANEURAL CYSTICERCOSIS –PRESENTING AS A CERVICAL NECK
MASS
Nalinikanta Panigrahy, A sailaja, A surekha,J venkateswarulu,M RamaLakshmi, M Anil Mohan
Department Of Pediatrics And Pathology,ASRAM Medical College,Eluru, AP.
nalini199@gmail.com
Introduction; Cysticercosis is a systemic illness caused by larval form of pork tape worm.
Although Neurocysticercosis with involvement of CNS is the commonest manifestation, but
encystment of larvae can occurs in almost any tissue. Here we report this case of extra neural
cysticercosis which presented as a painless cervical neck resembling lymph nodes in neck hence
posing a diagnostic dilemma. CASE REPORT:A 8 years old female child presented with painless
,progressive multiple swellings over left cervical region since last 5 months. There was no history
of fever, any stigmata of tuberculosis and skin above the swelling was healthy, nontender.and
mass was subcutaneous and non matted. No contact with TB was traced, BCG scar was found, no
lymphadenopathy or organomegaly was present. Investigations revealed normal haemogram, non
reactive mountex test, normal chest X-ray. USG of neck detected multiple well circumscribed
hypoechoeic lesions.FNAC of swelling shows cysticercosis with chronic inflammatory cells.
Serum ELISA for cysticercosis was POSITIVE, There was no evidence of any other organ or
tissue involvement by cysticercosis.Patient was treated with 4 weeks Albendazole resulting into
complete resolution of swelling.Conclusion: Cysticercosis should be always kept in mind as a
differential diagnosis of any subcutaneous or intramuscular swellings, specially in endemic areas.
The diagnostic dilemma can be solved by imaging and either FNAC or biopsy.
ID/52(P) PLASMODIUM VIVAX ASSOCIATED WITH SEVERE MALARIA IN
CHILDREN –A CALL TO POLICY MAKERS
Nalinikanta Panigrahy, Radha Tripathy
Department of pediatrics ASRAM medical College, ELURU.
nalini199@gmail.com
Introduction: - Severe Malaria is classically associated with Plasmodium falciparum infection.
Little information is available on the contribution of P.Vivax to Severe disease. A Literature
Review showed since 1920 till date around 60-70 cases of severe Vivax Malaria reported, out of
which only less than 20 cases were children. We report here unique, clinical profile of
plasmodium vivax severe Malaria. Method : - This was a prospective observational study
conducted in MKCG Medical College, Berhampur, Orissa from Jan,2005 to December ,2006. All
the cases with WHO severe Malaria criteria included in this study, but here we also included
species other than P.Falciparum. All of the patients evaluated with Peripheral Blood Film (PBF)
examination and ICT test for Malaria included in this study. Out of 339 severe Malaria
manifestations 289 cases had plasmodium falciparum infection, Pf and Pv mixed infection
identified in 45 cases and only 14 cases had evidence of plasmodium Vivax malaria monoinfection
diagnosed by both PBF and ICT Rapid diagnostic test. These 14 cases of severe Vivax Malaria
cases studied in detail. Results: - After Blood smear examination and Immuno chromatographic
(ICT) test only 14 cases of severe Vivax Malaria cases were studied. Out of 14 patients, 9 male : 5
female with Mean age 6.34 years and 8 patients were below 5 years . Mean Hb of patients was
8.06 +/- 2.1 with severe anemia (< 5 gm/dl) in five patients (35%). The complications observed
were as follows Coma 5/14 (35%), Convulsions with or without altered sensorium 5/14 (35%)
Prostration with transient Altered sensorium in 2 Patients, respiratory distress in 2 patients with
evidence of pulmonary edema in one patient and ARF observed in 5 (35%). Bilateral pedal edema
with normal Hb, LFTs, RFTs and Cardiac status observed in 2 patients which resolved during
therapy. Other complications observed were thrombocytopenia in 2 patients,pancytopenia in
one,and pretreatment hypoglycemia in one patient. All patients were managed with standard WHO
protocol, (IV Quinine +/- supportive measures). Average hospital stays of patients were 90 hours
with one patient died out of 14 (7%) severe Vivax Malaria cases with multi organ failure.
Conclusion: - Plasmodium Vivax not so benign and can present as severe malaria. Hence it
requires attention of both care givers and policy makers to understand the load to community and
for its eradication.
ID/53(P) PREVALENCE AND PATTERN OF ANTIMICROBIAL SUSCEPTIBILITY OF
CLINICAL ISOLATES FORM THE TERTIARY CARE PEDIATRIC HOSPITAL.
Malviya M, Kanchan C, Neelima K, VSV Prasad, PV Gopalkrishna, Syed SR
Lotus Children Hospital, Hyderabad
manojmalviya07@gmail.com
Background: Infectious diseases are the major cause of morbidity and mortality among pediatric
patients in the developing world. Aims: To evaluate the microbiologic spectrum and susceptibility
pattern of clinical isolates from the tertiary care pediatric hospital. Methods: Retrospective review
of the microbiologic surveillance and AS data of all clinical isolates from Nov 2006 to June 2009.
AS of isolates was done by MIC-Broth dilution method according to Clinical and Laboratory
Standard Institute (CLSI) 2007. Results: 454 clinical isolates were analyzed. The frequencies of
Gram-positive (GP) and Gram-negative(GN) bacteria were 31%, and 68.9% respectively. CONS
was the most common isolate among the GP while E.coli, Burkholderia cepacia and klebsiella
were the leading 3 GN isolates. Staphylococcus aureus was susceptible to vancomycin (100%) and
oxacillin (57%). Susceptibility pattern (in percentage) in blood to E.Coli against ampicillin,
gentamycin, cefotaxime, amikacin, and mero/imipenem was 9.7, 19.6, 20, 67.7, and 100.0
respectively while for Klebsiella 0, 15, 3.9, 45.5, and 100.0 susceptibility was observed. Three
isolate of E.coli sensitive ampicillin were isolated in 2009. Burkholderia cepacia was susceptible
to co-trimoxazole (98.7%) followed by meropenem (88.2%) and ceftazidime (88.6%). The most
active antibiotics against Enterobacter cloacae were mero/imipenem (83%), amikacin (45.5%) and
cipro/levofloxacilline (32%) Susceptible to colistin (100%) and meropenem (22.2%) were
observed for Acinetobacter. Conclusions: Most gram negative isolates are susceptible to
carbamepen antibiotic except acinetobacter. There is some indication of the reemergence of
susceptibility of gram negative isolate like E.coli to basic antibiotic like ampicillin. The changing
pattern of antibiotic susceptibility observed in this study warrants the need of continuous
surveillance to guide the antibiotic therapy.
ID/54(P) CONGENITAL TUBERCULOSIS: A CASE REPORT
Sunil Vaidya, Atul Kulkarni, Sandesh Padwal
Ashwini Sahakari Rugnalaya, Solapur, Maharashtra
drsvaidya@gmail.com, dratulkulkarni@rediffmail.com, drsandeshpadwal@gmail.com
A 20 days male child presented with , Fever, Refusal to feed, Breathlessness since 8-10 days.
Antenatal history normal. Full term normal vaginal delivery at hospital. Birth weight 3.5 kg.
Mother had 10 yrs of marriage, and first three babies normal. 4th died at 3 months of age. 6th
pregnancy: FTND of male , died at 10 days of age with c/o fever.7th pregnancy:MTP done. baby
was conscious, Irritable, Dusky colour Febrile temp of 101degree f, PR-140/min, RR-66/min.
CRT< 2 sec baby had tachypnea, Intercostals & suprasternal retraction. Vesicular breath sounds,
Liver palpable 6 cm firm, non-tender, Spleen palpable 6 cm soft, Baby had intermittent spikes of
fever. On investigation: On admission: TC: 28,900/cumm, Hb: 13.5gm/dl, Plt:
4,33,000/cumm,,CRP:POSITIVE>15MG\DL, Chest xray: a round opacity in lower lobe of right
lung –round pneumonia/L PERIHILAR HAZZINESS Blood culture: sterile, HIV, HBs Ag:
negative. HSV IgM 1.3POSITIVE. PLAIN CT SCAN: Both lung field have nodular After
treating for 7 days on chest x ray: shows bilateral round pneumonia.CSF 460 cell lymphocyte
predominance. Gastric lavage for AFB staining showed acid-fast bacilli. AFB culture positive
(Bactialert) FOR Myco. Tuberculosis. Endometrial Biopsy of mother shows caseating granuloma
with chest x ray normal on respiratory symptoms. Treatment: NICU care, Antibiotics, antifungal,
Antitubercular drugs started.
Diagnosis: CONGENITAL TUBERCULOSIS Disscusion:
Congenital tuberculosis is rare, 300 cases have been reported till now. Tuberculous endometritis
can still give birth to babies with tubercular infection. Skin testing is not extremely sensitive but
should be performed; biopsy of the liver, lymph nodes, lung, or pleura may be needed to confirm
diagnosis. Infants may acquire tuberculosis (TB) by transplacental spread through the umbilical
vein to the fetal liver, by aspiration or ingestion of infected amniotic fluid, or via airborne
inoculation. This case illustrates the importance of having a high index of suspicion.
ID/55(P) DISSEMINATED DEMATECIOUS FUNGAL INFECTION WITH BRAIN
INVOLVEMENT- HOW LONG TO TREAT?
Faisal Nahdi, Ramesh Kancharla, Ranghanathan Iyer, Arunaloke Chakrabarthi, Lokesh Lingappa
Department of Paediatric Gastroenterology and Paediatric Neurology- Rainbow Children’s
Hospital and Perinatal Centre, Hyderabad
siriloki@gmail.com
Aim- Report a immunocompetent child with disseminated Dematecious fungal infection with
brain abscess Case Report- Eleven year old boy with normal growth and development presented
with pain abdomen, Jaundice, CT abdomen -large infiltrating mass lesion in liver involving
segment II ,III and IV invading hila. On diagnostic liver biopsy- infiltration of blood vessels by
fungal elements with prominent fibrosis around the granuloma; ?aspergillosis. Immune Profile
demonstrated elevated IGE and IgG; retroviral serology along with CD 3, 4, 8 counts were
normal. Two weeks later presented with generalized convulsion; MRI brain-irregular thick
walled ring lesion in right parietal region with perilesional edema-?tubercular abscess. Repeat
liver biopsy demonstrated necrotising granulomatous inflammation-demataecious fungus. Started
on I.V. Voriconazole and i.v Ambisome(3Weeks). Repeat MRI brain no change. Partial surgical
resection of brain abscess done. Completed total maximum cumulative dose of IV Ambisome;
changed over to oral Voriconazole and Itraconazole. Five months from inital presentation
presented with upper airway obstruction; CT PNS demonstrating mucosal thickening left
ethmoidal, maxillary sinuses; hypodense areas nose and nasopharynx. Septoplasty and
adenoidectomy done; biopsy revealed demataecious fungi. Again recieved IV antifungals- 4
weeks, later continued oral therapy. Whole body PET scan –demonstrated lesions in all three
areas. Diagnosis confirmed as Wangiella Dermatiditis. Currently has completed one year and
four months of therapy, no new lesions detected; existing lesions are of same size in last six month
Discussion- Wangiella Dermatiditis infection needs combined surgical and medical management
with antifungals continued for long period. Overall outcome is poor.
ID/56(P) KNOWLEDGE, ATTITUDE ANDPRACTICES REGARDING NOVEL H1N1
(SWINE) FLU AMONG PEDIATRICIANS OF CHANDIGARH CITY- A
QUESTIONNAIRE BASED SURVEY.
Vidushi Mahajan, ShivSajan Saini
Department of Pediatrics, Government Medical College, Chandigarh
vidushimahajan2003@yahoo.co.in
Aim: The age group of 10-18 years old is most predisposed to get Novel H1N1 S-OIV (swine) flu,
which comes under the purview of pediatricians. The aim of the study was to gain an insight into
the knowledge, attitude and practices regarding swine flu among pediatricians of Chandigarh city.
Methods: A cross-sectional descriptive study was conducted on pediatricians of Chandigarh city
over a period of 2 weeks (17th August-5th September 2009). This sample size was calculated
assuming an average 50% prevalence of good knowledge with confidence interval of 20%.
Knowledge, attitudes and practices related to swine flu were assessed using a structured
questionnaire. The questionnaire consisted of 18 items (14 MCQ and 4 open-ended questions).
Knowledge, attitudes of pediatricians towards H1N1 pandemic and management practices was
assessed by 10, 4 and 4 multiple-choice questions, respectively. Results: A total of 134
pediatricians were contacted and 94 responded (70% response rate). . Ninety percent (85) were
familiar with clinical symptoms and 70% (66) with incubation period. Use of both Oseltamivir and
Zanamivir was known to 33%, while 63% (59) knew of only Oseltamivir. Eighteen percent (17)
believed that breastfeeding had to be stopped for mothers receiving anti-flu drugs. The possibility,
that reinfection with S-OIV after successful therapy remains, was known to 43% (40).
Handwashing 27.7% (26) and special masks (65%) were regarded as best methods of prevention.
Most pediatricians (94%) agreed that more effort to spread awareness regarding this pandemic
should be undertaken. Conclusion: There is a mixed response in the preparedness of pediatricians
towards Novel H1N1 flu. As felt by most pediatricians, more effort to spread awareness regarding
this pandemic should be undertaken.
ID/57(P) ISOLATED CHRONIC GRANULOMATOUS HEPATITIS IN HIV POSITIVE
CHILD
Iragouda Patil ,Ushakiran C B , B Krishnamurthy
Dept of Pediatrics, MMC & RI, Mysore, Karnataka
ukboregowda@yahoo.co.in
A 10 year old female child presented with h/o abdominal distension and loss of weight over last 2
months and no h/o contact with TB. On examination –W,H and HC <3rd centile.no jaundice. Per
abdomen liver enlarged 8 cm below right costal margin,hard in consistency,smooth surface ,sharp
border and non tender.mild splenomegaly.fundus/slit lamp exam –Normal.LFT-normal.HBsAg
negative .Mantoux negative.serum AFP normal.ESR_116 mm at 1st hour. U/S abdomenhepatomegaly with no focal pathology. Liver biopsy-macrovesicular steatosis with granulomatous
Hepatitis. Brief aetiopathogenesis,clinical course and management will be presented.
ID/58(P) CLINICAL CHARACTERISTICS AND OUTCOMES OF PEDIATRIC H1N1
CASES PRESENTING TO A TERTIARY CARE HOSPITAL IN NORTH INDIA.
Rashmi Ranjan Das, Abdus Sami, R Seth, S K Kabra
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
dr_rashmipgi@yahoo.com
Introduction: The 2009 flu pandemic is a global outbreak of a new strain of an influenza A virus
subtype H1N1, first identified in April 2009, and commonly called swine flu. Aims and
Objectives: To study the clinical characteristics and outcomes of pediatric H1N1 cases presenting
to a tertiary care hospital in North India. Materials and Methods: We reviewed the case history of
20 children positive for H1N1 influenza by RT-PCR who presented to the outpatient or emergency
department. Results: The median age of presentation was 11 years (range, 3 to 16 years); 13 of 22
were male. Contact history was positive only in 8 cases. Median duration of symptom was 2 days
(range, 1 to 3 days). High grade fever was the most common symptom followed by cough and
rhinorrhea. Other symptoms included sore throat, vomiting, headache. Asthma was the pre morbid
condition in 6 cases. Nine patients required hospitalization while 13 were treated at home. Mean
length of hospital stay was 48 h, irrespective of underlying disease and mean duration of recovery
was 3 days. Indication for hospitalization was poor oral acceptance or vomiting (in 7), and
giddiness or hypotension in one patient each.. Oseltamivir was given to 19 patients and 3 patient
recovered without treatment. Conclusion: The incidence of H1N1 influenza in children is rising.
Clinical features are mild in majority and are non specific. Clinicians should consider H1N1
influenza in the differential diagnosis of children with who present acutely to health services with
flu like symptoms.
ID/59(P) DETECTION OF C-REACTIVE PROTEIN IN CSF FOR RAPID DIAGNOSIS
AND DIFFERENTIATION OF PYOGENIC MENINGITIS FROM OTHER INFECTIONS
OF CNS.
Srinivas. H. A
drsrinivasleo@gmail.com
Introduction: Pyogenic meningitis is a potentially serious infection, common in infants and older
children which requires rapid and correct diagnosis to select appropriate therapy. Aims and
Objective: Detection of C-reactive protein in CSF for rapid diagnosis and differentiation of
pyogenic meningitis from other infections of CNS. Material and Methods: The present study was
conducted in the R.L JALAPPA HOSPITAL, attached to Sri Devaraj urs Medical College, Kolar.
It is a prospective study of cases comprising of suspected CNS infections in children. C-reactive
protein titre in CSF were detected using semiquantitative latex agglutination method. The patients
who satisfied the inclusion and exclusion criteria were included in this study. Results: Of total
120 cases studied, 40 cases were pyogenic meningitis (33.33%), 12 cases were tuberculous
meningitis (10%), 45 cases were viral encephalitis (37.5%), and 23 with no meningitis
(19.16%)(no CNS infection). CSF CRP done was positive in all 40 cases, with 100% sensitivity,
and positive predictive values. A positive CSF CRP is considered pyogenic meningitis and treated
unless otherwise proved. Conclusion: Detection of C-reactive protein in CSF and Serum provides
a new dimension to specific diagnosis of pyogenic meningitis and differentiation from other CNS
infections. It is a sensitive, reliable, early diagnostic test for timely therapeutic intervention. From
this study it is concluded that a positive CSF CRP detected by latex agglutination method may be
considered to have pyogenic meningitis and treated until proved otherwise.
ID/60 (P) IDSTUDY OF HEPATITIS-A ANTIBODY SEROPREVALENCE IN CHILDREN
IN A THIRD TIER CITY AND THE NEED FOR VACCINATION
Naren S, Patil S V, Akki A S, Rath C P
Department of pediatrics, BLDEA’s Shri B M Patil Medical College, Bijapur
Objective: This study was designed to evaluate the current seroprevalence of antibodies against
hepatitis A virus in different age groups of children from Bijapur attending our hospital and
children from urban and rural/slum schools and to compare seroprevalence of anti HAV between
different socioeconomic class, age groups, sex, type of water supply, sewage and refuse disposal,
type of toilet and hand washing habits. Methods: A total of 142 children, between the age group 6
months to 5 years attending our hospital and children between age group 5 years to 15 years from
a urban and rural/slum school were included in the study. Detailed data including general
information, age, sex, education level, socioeconomic characteristics that included no. of siblings,
type of residence, source of water supply, personal hygiene and sewage treatment disposal were
taken in to consideration Qualitative analysis of serum IgG antibody against HAV was done using
commercially available ELISA kit. Conclusion: Hepatitis A seroprevalence observed in our study
suggests Bijapur can not be classified as high endemicity as other parts of India. These findings
support the implementation of mass vaccination against hepatitis A.
IC/01(P) HYPOCALCEMIA AS CAUSE OF REPEATED EXTUBATION FAILURE IN
POSTOPERATIVE CARDIAC PATIENT
Prashant Patil, Raghunath C.N., Rajesh Hegde
3rd floor PITU, Narayana Hrudhayalaya, Banglore-560099
drprashant1981@gmail.com
Repeated extubation failure increases morbidity and mortality in intensive care unit. Electrolyte
abnormality leading to extubation failure is rare cause of reintubation. We hereby report a case of
repeated extubation failure with hypocalcemia as precipitating factor. A 9month old male child
born of 3º consangiounous marriage presented with respiratory distress. Patient had no past history
of any convulsion or developemental delay. X ray showed absent thymic shadow with
cardiomegaly. ECHO showed type 1B interrupted aortic arch with severe PAH. Patient was
operated with repair of interrupted aortic arch with CPB time of 110 minutes. Patient was shifted
to PITU with moderate inotropic support. Patient was sedated and paralysed for 24hrs in view of
severe PAH. Patient was hemodynamically stable, neurologically alert. Arterial blood gases were
within normal limits. X ray showed no radiological abnormality. Postoperative ECHO showed
good repair with good repair. After successful CPAP trial, patient was extubated. In view of
dasaturation with respiratory distress after extubation, he had to be reintubated. Post reintubation
Xray, ECHO showed no significant abnormality. Serum ionic calcium was 0.788 mmol/l. Patient
was started on oral calcium supplement. Three repeat extubation trials failed. Bronchoscopy
showed no upper airway abnormality. Retrospective analysis showed serum ionic calcium to be
low ( 0.79, 087, 0.89mEq/l) at time of extubation. Patient was started on intravenous calcium.
After normalization of ionic calcium, patient was extubated successfully. Patient had parathyroid
hormone deficiency which was treated with calcium carbonate(500mg/kg). Patient had normal
calcium, after which patient was discharged.
IC/02(P) RISKS FACTORS ASSOCIATED WITH EARLY EXTUBATION FAILURE IN
POSTOPERATIVE PEDIATRIC CARDIAC PATIENTS AND THEIR IMMEDIATE
OUTCOME
Prashant Patil, Raghunath C.N., Amit Kumar
3rd floor PITU, Narayana Hrudhayalaya, Bangalore-560099
drprashant1981@gmail.com
Objective: To determine risk factors associated with early extubation failure in pediatric
postoperative cardiac patients and assess immediate outcome.Material And Methods: This is three
month prospective, observational study conducted in a tertiary care pediatric cardiac intensive care
unit. We observed 680 consecutive post operative patients over period of three months. Out of
which, 38 patients had extubation failure in 48 hours. Preoperative and postoperative data were
analyzed and outcome was assessed in terms of days of post extubation ventilation, PICU stay and
mortality. All values are in median and ranges unless otherwise stated. Chi square test was used
for categorical data.Results: The median age of study group was 10.5 months (10 days-5years)
with average weight was 6.8kg (2.5kg- 24kg). Intracardiac repair followed by arterial switch
operation were most commonly associated with reintubation. The average CPB time required for
surgery was 103+/-23.2 minutes. The mean duration of ventilation prior to extubation was 60+/14.48hrs with 46.68% patients requiring prolonged ventilation (>72hrs). 72% patients had wet
lung fields prior to extubation with 10.7% having consolidation and 15.72% had diaphragm palsy
with 3 requiring diaphragm placation. 4 out of 22 paralyzed patients required reversal prior to
extubation. 27 patients were on fentanyl infusion with average duration of 44.23hrs (17hrs118hrs). Six patients (15.7%) had neurological abnormality. The average inotrpic score was
13.22+/-7.2 (5-36). The most common indications for reintubation was respiratory distress, cardiac
arrest, PAH crisis and diaphragm palsy. The average duration of ventilation after reintubation was
8+/-2.2days. The study group has prolonged PITU stay in study as compared to control group. (P
value -0.032). The mortality among study group was 18.82% compared to average mortality of 3.2
%.( p -0.02) Conclusion: The factor associated extubation failure are age group<2 years, weight<
10kgs, prolonged CPBtime and prolonged ventilation prior to extubation. The extubation failure is
associated with increased morbidity and mortality.
IC/03(P) FACTORS AFFECTING THE OUTCOME OF SCORPION STING
ENVENOMATION IN CHILDREN AT A TERTIARY CARE CENTRE
Rajniti Prasad, Om Prakash Mishra, Nisha Pandey, T.B. Singh
Department of pediatrics & Biostatistics, Institute of Medical Sciences, Banaras Hindu University,
Varanasi-221005
rajnitip@gmail.com
Objective: The objective of this study was to identify and correlate various factors affecting the
outcome of children with scorpion sting. We hypothesized that delay in transport to hospital, prior
steroid treatment and associated systemic manifestations may be contributing factors in mortality
of these children. Methods: This was a prospective study carried out in a tertiary care hospital. The
study included 90 children admitted with history of scorpion sting aged 1 to 16 years during the
period of January 2004 to December 08. Based on local or systemic involvement, grading of
severity was done and further management protocol was followed depending on grading of
severity as per hospital guidelines. All cases coming with sting were given a dose of Prazosin (30
g / Kg /dose) and were observed. Those with signs of envenomation received Prazosin at a dose
of 30 g / Kg /dose every 6 hourly till recovery(maximum 72 hours). Patients with acute
pulmonary edema (APE) were treated with dobutamine and sodium nitroprusside drip. All cases
were monitored in intensive care unit. Result: The mean value of blood pressure, Glasgow coma
scale (GCS), hemoglobin level, total leukocyte count, sodium and potassium among survivors and
non-survivors was insignificant. Mortality was high in children, who received steroid and
antihistaminics outside and presented after 6 hours of bite. Patients, who had low pH, tachpnea,
myocarditis, APE and encephalopathy had significantly higher mortality ( p <0.05). Conclusion:
Patients presenting after 6 hours of sting with acidosis, tachypnea, myocarditis, APE,
encephalopathy are major contributing factors in scorpion sting.. Prazosin is recommended as
antidote for scorpion sting.
IC/04(P) MILK IN THE VEIN.
Mary Megha, Prameela Joji, Jayaram Das
Department of Pediatrics, Kerala Institute of Medical Sciences, Trivandrum
drmegham@gmail.com
Previously normal one year old boy, presented with recent onset breathlessness of 2 weeks. At
admission, had severe respiratory distress; not maintaining saturation with high flow oxygen; mild
pallor, facial puffiness, bounding pulses. Auscultation revealed bilateral crackles, S3 gallop.
Abdomen was distended with soft hepatomegaly of 3 cm. Child was electively ventilated for
impending respiratory failure. Provisional diagnosis was bronchopneumonia with septic shock;
suspect congenital heart disease with CCF. On blood sampling, serum was found to be milky; so
also the urine. Initial investigations revealed severe metabolic acidosis: ( P H- 6.95, HCO3- 2.1)
with grossly deranged renal parameters and lipid levels.( BUN- 97, Creat- 9.9, Triacylglycerol3620, cholesterol- 438). Acidosis persisted despite volume replacement and soda- bicarbonate
correction. ; ( PH- 7.04, HCO3-3.8). Peritoneal dialysis was initiated. Lipoprotein electrophoresis
showed increased chylomicrons, and pre- beta bands, reduced alpha bands, and normal beta bands
suggestive of hyperlipoproteinemia. USG abdomen showed multiple cysts in the kidneys.
Acidosis improved after 48 hours of dialysis.(PH-7.296, HCO3- 16). Lipemia of serum also
improved. MRI abdomen confirmed the diagnosis of ARPKD. Child was weaned off ventilator but
required CAPD. ARPKD with an incidence of 1 in 20000 can cause wide variability in degree of
renal dysfunction , with varying manifestations.. Our child was asymptomatic till one year of age
and the delay in detection had resulted in a catastrophic presentation with hyperlipidemia and lifethreatening acidosis requiring ventilation and CAPD. Hyperlipidemia associated with ARPKD is
a rare feature; which also our child had manifested.
IC/05(O) INCIDENCE AND OUTCOME OF VENTILATOR ASSOCIATED
PNEUMONIA (VAP) IN A TERTIARY CARE CENTER.
Vedavathy S, Sangamesh, Sanjeeva G N, Nalini janakiram, basavaraj G V, Govindaraj M.
Shivananda
Department: Pediatric Intensive Care Unit: Indira Gandhi Institute of Child Health, Tertiary care
centre: Bangalore.
vedadoc4u@yahoo.com
Objectives: To study the incidence and outcome of VAP Methods: Prospective study of 150
children mechanically ventilated for more than 48 hours in PICU between January 2007 to
December 2007.History, Examination and relevant investigations done. SPSS soft ware and t test
are used for statistical analysis. Results: M: F= 58.7:41.3, most common age group is 5-10 years
(35.3%). The incidence of VAP is 22.66% Early onset VAP(41.17%) and late onset
VAP(58.83%). Repeated intubations(p<0.001), central venous line insertions(p<0.001),
tracheostomy(p=0.049) and prolonged duration of mechanical ventilation(p<0.001) were found to
be the significant risk factors. There was a significant prolongation of duration of
ventilation(p<0.001), PICU stay(p=0.002), and hospital stay(p=0.003) in VAP cases. Summary
and Conclusion. Most common age group 5-10years and 58.7% are boys. Incidence of VAP is
22.66% Prolonged ventilation and repeated intubations are the major risk factors. Central venous
lines and tracheostomy are the added risk factors for VAP VAP cases had significant prolonged
duration of MV, PICU and hospital stay, Judicious use of ventilator support and early weaning
will reduce the incidence of VAP
IC/06(P) RISK FACTORS AND ETIOLOGICAL ORGANISMS IN VENTILATOR
ASSOCIATED PNEUMONIA (VAP)
Vedavathy S, Sangamesh, Sanjeeva G N, Govindaraj M. Shivananda
Department: Pediatric Intensive Care Unit: Indira Gandhi Institute of Child Health, Tertiary care
centre: Bangalore.
vedadoc4u@yahoo.com
Objectives: To study the risk factors and the pathogenic bacteria causing VAP Methods:
Prospective study of 75 children mechanically ventilated for more than 48 hours in PICU between
January 2007 to December 2007.History, Examination and relevant investigations done. SPSS soft
ware and t test are used for statistical analysis. Results: M: F= 58.7:41.3, most common age group
is 5-10 years (35.3%). Early onset VAP(41.17%) and late onset VAP(58.83%). Repeated
intubations(p<0.001), central venous line insertions(p<0.001), tracheostomy(p=0.049) and
prolonged duration of mechanical ventilation were found to be the significant risk factors. Among
the bacteria isolated, Klebsiella(40%), Pseudomonas (30%) and Acinetobacter (15%),
Polymicrobial infection in 3 cases of VAP. Majority of Pseudomonas(5) Klebsiella(6) and
Acinetobacter (3) were from late onset VAP. Summary and Conclusion. Most common age group
5-10years and 58.7% are boys. Prolonged ventilation and repeated intubations are the major risk
factors. Central venous lines and tracheostomy are the added risk factors for VAP Gram negative
organisms are the most common organisms causing VAP. Judicious use of ventilator support and
early weaning will reduce the incidence of VAP
IC/07(O) CLINICAL STUDY OF SHOCK IN CHILDREN WITH SPECIAL REFERENCE
TO PROGNOSTIC DETERMINANTS.
Lingaraja Gowda C Patil.
Post graduate, Indira Gandhi Institute of Child Health, Bangalore-29.
doclcp81@rediffmail.com
Objective: 1. To find out the occurrence of shock states in pediatric age group. 2. To categorise the
shock states in children based on etiology. 3. To find out the association of various clinical &
laboratory parameters of shock with outcome. 4. To identify independent risk factors for the
mortality in shock states. Method: A prospective study of shock in children. Setting: PICU of
IGICH, Bangalore. Participants: Children between >1month to 16 years. Results: Total 100 cases
of shock are identified of 784 PICU admissions, which accounts for 12.7% of admissions. Most
common age group was between >1month-5years. Male children are more common than female
children. Most common etiology was septic shock (48%). Highest mortality was observed in
septic shock & least in hypovolemic shock. Among the clinical parameters persistent tachycardia,
low BP, prolonged CRT, low GCS & low urine output was associated with increased mortality.
Among laboratory parameters thrombocytopenia, high creatinine levels, low pao2 and high pco2
was associated with increased mortality. Conclusion: Most common age group being 1month to 5
years. Septic shock has high incidence with high mortality. Hypovolemic shock has better
outcome.
IC/08(O) NOSOCOMIAL INFECTION IN NICU
Uma Raju, Ajoy Garg, Monisha Biswas
Department of Pediatrics, Command Hospital, Pune
rakhee.garg@yahoo.com
Introduction: Nosocomial infections are an important causes of morbidity, mortality and
prolonged hospital stay in neonatal intensive care units. Hence they are a matter of major concern
in NICUs world over being an essentially preventable condition. Aims and objectives: To study
the incidence rate, organism and antibiotic resistant pattern of nosocomial infections in an tertiary
care service hospital. Methods: A retrospective cohort study was carried out in which 265
neonates who remained at least 24 hours in the NICU from Jan 2008 to Dec 2008 were enrolled in
the studyc .Neonates with NIs were identified. incidence ,organism sensitive pattern and the
presence of risk factors was studied. Results: Incidence of nosocomial infection was 14%. 23%
were culture positive. In order of frequency, the sites of infection were primary bloodstream
infection (50%), pneumonia (17%), other LRI (13%), UTI 10%, skin site infection 4%. The risk
factors associated with Nis were low birth weight, low gestational age, mechanical ventilation,
total parenteral nutrition, umbilical catheterisation, use of antibiotics, long lines, PROM and
intubation . In order of frequency organisms grown were Stap aureus (53.8), acinobacter (30.8%),
E.coli (7.6%)and Klebsiela(7.6%). Antibiotic sensitivity pattern revealed that 70% were MRSA,
75% impepenem sensitive Acinobacter , 25% impepenem resistant acinobacter, E. Coli and
klebsila sensitive to piperacillin, meropenem, netilimycin. Commonest source of infection was air
borne . 16% of the baby with sepsis died. Death was more common in premature baby
Conclusion: Nosocomial infection is single important cause of morbidity and mortality in NICU.
In our centre staph aureus and acinebacter were the common pathogen causing nosocomial
infections with death occuring in 16% of our babies.
IC/09(O) CENTRAL VENOUS CATHETERS IN CHILDREN
Farhan Shaikh, Dinesh Chirla, Preetham, Satish, Nitasha,.Anant Sagar
Pediatric Critical Care, Rainbow Children's Hospital, Hyderabad.
drfarhan@rediffmail.com
Introduction: Central Venous Catheters (CVC) have become indispensable in intensive care units.
Different access sites are used for the cannulation with their advantages and complications. Aim:
To determine the frequency of application, indications and complications of CVC in our Pediatric
Intensive Care Unit (PICU). Materials & Methods: Prospective study done from July 2008 to Jun
2009 in a level III PICU. All the children who required central access were enrolled in the study.
The data on indications for placement, number and site of CVC inserted, number of days and
complications were evaluated. Statistical analysis was done by Wilcoxon-Mann-Whitney test.
Results: During the study period 1417 patients were admitted to our PICU and 204 were
ventilated. Total of 101 CVCs were inserted in 92 patients (59 femoral, 28 internal jugular(IJ), 9
subclavian (SC), 5 PICC lines). 9 patients had two CVCs inserted. The average days of catheter
use was 4.43 days (range 1 -14 days). Commonest indication was for resuscitation of shock and/or
to administer inotropes (n=96). CVP measurement was done through 46 lines. 16 CVCs were
placed on left side. The complication of left sided lines were similar to those on Right side
(p=0.36). 42 CVCs had 3 lumens, 37 had 2 lumens and 22 had single lumen. Complication rate of
all the three types of lumens were similar (p=0.4). 74% lines placements (n=68) took less than 2
attempts, 20% (n=19) 3-5 attempts, 4.3% (n=4) multiple attempts one was placed
surgically.15.84% of the lines (n=16) had complications (11 line related infection, 1
thrombophlebitis, 2 leaks , 1 femoral vein thrombosis and 1 pneumothorax. All sites of insertions
had similar complication rates(p=0.37) Apart from this 6 Hemodialysis catheters were placed.
Conclusions: CVCs are essential in management of sick children. Commonest indication is shock
and inotrope administration. There is no difference in complication rates amongst various types
and sites of CVCs.
IC/10(P) PERSEVERENCE AND OPTIMISM SUCCEEDS GUILLAIN BARRE
SYNDROME ON PROLONGED VENTILATORY SUPPORT
V.Sankar, M.Balasubramanian, M. Srajarajeswaran, G.Mathevan, R.A.Sankara Subramanian,
P.Amutha Rajeswari
Institute Of Child Health & Research Centre, Madurai Medical College, Madurai.
sank.stan@gmail.com
Introduction: Prolonged ventilatory support and good nursing care can save GUILLAIN BARRE
SYNDROME (GBS) patients even without immunoglobulins. Case Report: 8years old
Master.Sadeesh admitted with complaints of progressive ascending paralysis weakness of all four
limbs. History of previous respiratory infection 10 days back and No history of fever. On
Examination: • alert,Afebrile • RR 32/mt,Temp N,BP 120/70 mmHg,SPO2 98%. CNS
Examination:• Conscious •Oriented •No cranial nerve palsy
Motor system:
L
R
Bulk
Tone
Power
N
N
↓
↓
UL
1/5
1/5
LL
1/5
1/5
Neck Muscle Weakness (+)
DTR
Absent
Absent
Plantar
Absent
Absent
Investigations: HB10mg% Electrolytes Na 136 m.eq / l ,K 4.9 m.eq / l HCO3 18 m.eq / l
Creatine kinase 84 U/L Treated with •Supportive measures •IV Antibiotics •Inj. Methyl
prednisolone 500mg IV x 3 days •Ventilator support for 46 days. Course: patient developed
respiratory paralysis within 12 hrs.,immediately ventilated and maintained without any signs of
improvement.Still we continued ventilatory support for 46 days .Slowly Patient recovered with
out any residual sequelae and still on follow up.
NEO/01(P) A STUDY OF RISK FACTORS FOR LBW, VLBW & ELBW BABIES
IN WESTERN RAJASTHAN
Jora R., Gupta M, Chuhan H.,
Department of Pediatrics, RIMCH, Umaid Hopital, Dr. S.N. Medical College, Jodhpur
jorarakesh@rediffmail.com
Background - To find out the incidence of L.B.W. babies and assess the various risk factors
responsible or contributing the production of LBW ,VLBW , ELBW babies. Setting: Tertiary care
neonatal unit in western Rajasthan. Methods- The sample was selected from 8266 consecutive live
born babies delivered in the hospital from 1st April 2005 to 31st October 2005. All babies who
were 2500 gms. or below at birth were included in the study. All parameters of baby weighing
2500 gms. or below and a detailed maternal history, complications of pregnancy, anthropometry
of new born and gestational age of newborn (assessed by modified perkin’s criterion) were noted
in predesigned proforma. Results:- The incidence of LBW, VLBW and ELBW babies was
30.725%, 2.72% and 0.89% respectively. Maximum number of mothers who delivers
LBW babies belongs to the age group of 20 -35 years (87.07%). When we
compared maternal age with birth weight pattern of th ese babies we found that in
LBW group maximum number of babies was delivered by mother aged 20 -35
years (88.3%), whereas in VLBW group maximum number of babies were again
delivered by mother aged 20 -35 years (74.8%). In ELBW group maximum number
of babies was delivered in age group 20 -35 years (59.5%). When we compared parity
with birth weight 2nd and 3rd parity had better birth weight in LBW group(37.4%), as compared to
primipara (32.2%) and grand multipara (30.5%). Mothers with PIH had delivered the maximum
numbers of LBW babies. Conclusion:- Study has shown that there in increased risk of LBW
babies in teenage pregnancy and maternal age more than 30 year, primipara and grand multipara
and mother with anemia, APH, PIH and Chronic UTI.
NEO/02(P) INFLUENCE OF GROWTH ON GLYCEMIC STATUS AND INSULIN
RESISTANCE AT NINE MONTHS OF AGE IN LBW AND VLBW BABIES
Jora R., Gupta M, Gupta P.,
Department of Pediatrics, RIMCH, Umaid Hopital, Dr. S.N. Medical College,
Jodhpur
jorarakesh@rediffmail.com
Background-: To evaluate the influence of growth on Glycemic status and insulin resistance up to
9 months of age in LBW & VLBW babies. We compared these parameters with normal birth
weight babies and these babies served as controls. Methods-: 100 successive low birth weight,
(birth weight between 1000-2499 gms) were successively enrolled in the study and 50 neonates
with birth weight >2.5 kg included as controls. Of the150 enrolled babies only 101 babies could be
followed till 9 months of age (in NBW group-36, in LBW group -35, in VLBW group-30 were
followed up to nine months of age) . At the time of enrolment anthropometry and routine blood
investigation and fasting blood sugar level of neonates (after 2-4 hours fasting) was performed.
After discharge, enrolled babies were followed every 3 monthly (+10 days) up to 9 months of age
on each follow up anthropometry assessment and fasting blood sugar of neonates (after 2-4 hours
fasting) was done. At the age of 9 months venous blood was taken for serum insulin levels (after
2-4 hours fasting). Statistical analyses were performed using t-test. Results-: Mean plasma
Glucose and pondral index were at enrolment in NBW babies was higher than LBW and VLBW
babies and mean P.Glucose levels at 9 month was higher in VLBW followed by LBW than in
NBW (P value<0.01). Maximum S. Insulin level at 9 month found in VLBW babies followed by
followed by LBW and NBW but statistically significant in LBW and VLBW in comparison to
NBW. Maximum IRI at 9 month occurred in VLBW babies followed by LBW and NBW. When
we compared weight gain at 9 month of age in three group these had been maximum weight gain
in VLBW babies followed by LBW &NBW. Conclusion-:. Low birth weight is an independent
risk factor for insulin resistance and this can lead to deleterious effect in their later life in the form
of development of diabetes, hypertension, coronary heart disease.
NEO/03(P) A CASE OF TRIPLET WITH ‘SUPER-TWINS’
Lt Col A. N. Prasad
Cl Spl (Pediatrics), Hospital Namkum, RANCHI – 834010
dranprasad@gmail.com
There has been a remarkable rise in the number of triplet births over the past two decades. Yet,
babies born in triplet arrive smaller and earlier than single births and are at greater risk of infant
death and lifelong health problems. Infant mortality rates are 12 times higher for these births than
for single births. The average birth weight of a triplet newborn is only half that of a single birth
and the period of gestation is, on average, 7 weeks shorter. Triplets are not complications of
pregnancy, but any pregnancy that involves triplets is considered complicated. Triplets have
unique conception, gestation and birth processes; impact on the family system; developmental
environments; and individuation processes. Therefore, in order to ensure their optimal
development, the triplets and their families need access to health care, social services and
education which respect and address their differences from single born children. Here we report a
case of triplet babies born vaginally, and nursed successfully, with favorable outcome.
NEO/04(P) MATERNAL ANTENATAL PROFILE AND IMMEDIATE NEONATAL
OUTCOME IN VERY LOW BIRTH WEIGHT BABIES
Vinayak Patki, Shabana Shaikh, Swati Chougule, Vaibhavi Ghate
Dept. of Pediatrics, Wanless Hospital, Miraj – 416410
vkp31073@rediffmail.com
Objective: To find out maternal risk factors associated with VLBW babies and study their
association with morbidity and mortality of VLBW babies. Method: The study was a prospective
cross-sectional analysis. One hundred & ten inborn VLBW babies admitted in NICU, Wanless
Hospital, Miraj were studied during the period of one year. All the babies were studied from the
day of admission or birth and followed up till discharge or death. Mothers of these babies were
studied to find out risk factors. Morbidity and mortality were compared according to birth weight
and gestational age of baby. Only those causes of morbidity where statistical significance with
relation to such maternal antenatal factors could be drawn, were studied by using Chi-square test.
Results: Majority (71.82 %) mothers of VLBW babies had adverse risk factors. Anemia, PROM
>=12 hrs and PIH were the commonest adverse maternal factors. Majority (75.45%) VLBW
babies developed one or other kinds of morbidity .The common morbidites were neonatal sepsis
(30%), RDS (19.09%) and NNH (18.18%). The mortality in VLBW babies was only 21.81 %.
RDS (50%) was the commonest cause of death in VLBW, followed by sepsis (16.6%).The
mortality was highest in babies weighing less than750 gram and less than 28 weeks of gestation.
Both morbidity and mortality decreased significantly in babies with higher birth weight.APH,
multiple pregnancy and LSCS had statistically significant association (p<0.001) with RDS
.Presence of PROM >=12 hrs and maternal fever had increased the risk of neonatal sepsis.
Presence of PIH, abnormal presentation, multiple pregnancies and meconium staining of liquor
were significantly associated with asphyxia. Conclusion: The identification of adverse maternal
factors and its appropriate management can lead to better outcome of the VLBW baby.
NEO/05(P) EFFECT OF OILMASSAGE IN PRETERM BABIES WITH RESPECT TO
WEIGHT GAIN
R.H. Gobbur
Professor of Pediatrics, Shri .B. M. Patil Medical College, Bijapur-586103.
rhgobbur@gmail.com
Objective: To study the role of oil massage in preterm babies (gestational age <36 weeks& wt.
<2000gm). In improving weight gain. Design; Case- control study. Subjects; 30 preterm babies
<36weeks gestation,<2000gram weight.& 15 matched control preterm babies. All cases&
controls were stable and on exclusive breast milk .Directly breast fed or expressed breast milk fed
with spoon or through NGT. Method; a trained nursing staff Applied 5 ml of coconut oil over all
available surfaces of the preterm Babies, from Day 5 To Day 10th, 4 times daily .Detailed feeding
& weight charts were recorded .There were no side effects like rashes in any baby, unlike in other
studies Statistics; Un Paired” t “test was applied to the weight gain before& after oil application,
to the cases and controls.Results: Weight gain in oil massaged preterm babies were,(wt. Gain in
Gm/Kg/day.) And total weight gain was 45, 40.3, 57.14, 48.3Gm in cases V/S 25, 20, 11.4,20 Gm
in the control babies. Conclusion: Coconut oil application is effective, in causing rapid weight
gain in premature babies
NEO/06(P) CONGENITAL GIANT MELANOCYTIC NEVUS IN A NEONATE: A CASE
REPORT WITH REVIEW OF LITERATURE AND NEW THERAPEUTIC OPTIONS
Sumit Mehndiratta, Ruchika Mehndiratta
B 246, Yojna Vihar, Delhi- 110092
drsmehndiratta@rediffmail.com;drsmehndiratta@gmail.com; drruchika2006@gmail.com
A new born male child was delivered vaginally, product of nonconsanguinous marriage to a
second gravida mother with an uneventful antenatal period. The child, was found to have darkbrown to blackish pigmented patch approximately 10cms × 10cms on left leg extending from
below the knee to about 2.5cm beyond the ankle ; a giant melanocytic naevus. There were no
associated anomalies at birth. Congenital melanocytic nevi are not uncommon, but their giant
forms are rare. A brief discussion of the clinical problems associated and the treatment options
have been presented. They form a frequent cause of cosmetic concern because of their size and
appearance. They also pose a serious health risk because of their malignant potential. There are
sections of society which still consider it to be ill omen and are ignorant about the future
implications of giant naevi. While surgery remains the mainstay of treatment, newer options in the
form of Laser therapy and artificial skin substitutes have also been found to be useful. These may
eventually make this disfiguring and potentially malignant condition more manageable in the
future. Parental counseling plays an important role.
NEO/07(P) TRADITIONAL NEWBORN CARE AMONG GRADUATE MOTHERS IN
JAMMU
Ritu Gupta, Ravinder K Gupta
Child Care Centre, Nai Basti, Jammu Cantt. Jammu, (J&K) 180003
riturgjammu@indiatimes.com
Objectives :- To observe various traditional newborn care practices among graduate mothers of
Jammu.Design : - Prospective Study Settings :- Pediatric Clinic Subjects and Methods: - Five
hundred grauate mothers and family members accompanying the newborns living in peri-urban
parts of Jammu coming for routine checkup constituted the study group. The study was carried out
during the period from March 2008 to February 2009. The attendants were interviewed with a
preset questionnaire which included type and place of delivery, sex of baby, educational status,
birth order, type of ingredient applied to umbilical stump, feeding pattern and various traditional
practices being practiced . Results: Majority of deliveries (64%) had been conducted at
government institutions by qualified doctors. Rest 35% deliveries had been conducted at private
nursing homes, while 1% deliveries had taken place at home by trained staff nurses.The mode of
deliveries were per vaginal (67%), LSCS (29%) and after forceps application (4%). There was
definite male predominance (M: F—1.5:1). About 57% mothers were graduate while 43% mothers
were postgraduate. About 67 % babies belonged to joint family. Fifty eight percent fathers were
employed in different type of services while 42% were shopkeepers /self-employed. Hot Oil, ghee,
“Jeful”, turmeric, etc was the ingredients applied on umbilical stump in 31.5% babies. Delayed
initiation of breastfeeding was noticed in 67% babies. About 43.5% mothers discarded the
colostrum thinking that not good for the baby. Prelacteal feeds in form of honey, rose water,
glucose, water, onion juice, cow’s urine etc were given to about 96% babies. About 13.5 %
babies were not given proper clothing and these babies were covered by either towels or
unstitched clothes till the fixed period. Surma/ kajal were applied in the eyes in 56% babies. Also
almost every mother did apply “Kala Tikka” behind the ear or on forehead .Amulet (sacred thread)
was tied on arms/legs in 23% babies. Knife, iron rod, key, match stick were the items carried by
the attendants of baby in 57% cases while taking the baby outside or were kept under the pillows.
Pacifiers were used by about 23.5% mothers. Hot oil was instilled in the ears of the babies (in case
of excessive crying) by about 11% mothers/attendants. Boiled water containing cardamom,
ajwain, jeera etc was given to the babies by about 22% mothers. Janam ghutti still remains the
choice of antispasmodic /carminative ingredient by about 78% mothers. Conclusion: - Despite the
education status of mother false beliefs and harmful social customs in neonatal care are still
rampant. The cultural practices are passed on from one generation to another. The blind faith in
the traditional health practices of doubtful utility may lead to non acceptance of modern system of
medicine. Proper information, education and counseling especially during antenatal period shall
definitely prevent neonatal morbidity. Health education through media (electronic and print ) can
definitely be helpful in curbing these futile traditional health care practices.
NEO/08(P) ACUTE RENAL FAILURE IN CRITICALLY ILL ADMITTED NEONATES
BD Gupta, Kamal Moondra, PramodSharma, Mona Sood, Manish Parakh
Department of Pediatrics, Umaid Hospital, Dr SN Medical College Jodhpur
drpramodsh@hotmail.com
Introduction -Acute renal failure is a significant cause of morbidity and mortality in Neonatal
ICU’S.The renal failure may be non -oliguric and these babies may thus be missed if not looked
for with routine screening.METHODOLOGY -229critically sick neonates were screened for renal
function.In those babies with detection of renal failure standardised protocolised management
regimen was offered and renal functions were monitored by sequential estimation and other
parameters like serum electrolytes, urinary electrolytes, renal failure index and FENA were
estimated. RESULTS: 61 neonates had acute renal failure with an incidence of 21.6%. Incidence
of ARF was high in outborn babies compared to the intramural babies (35.5%Vs 19.5%).Incidence
in term babies was higher compared to pre term values(30.1Vs8.3% p<0.01)59%of the study
group had prerenal failure(GroupA) while 41%had intrinsic renal failure(GroupB)with
FENavalues being1.62+0.73 and 12.22+9.29respectively.Mean serum creatinine on day1 was
1.77+0.66mg/dl in GroupA and 1.24+0.56mg/dl on day3 .Levels in GroupB were 5.15+3.09mg/dl
and 3.09+2.29mg/dl respectively.BUN/S creatinine in Group A was 29.37+15.80and it was
21.17+14.72 in Group B.Renal failure index was 2.28+0.90in Group A and 18.27+14.32 in
GroupB Neonatal sepsis, severe birth asphyxia and meconium aspiration syndrome were the main
causes of ARF in 52.5% ,29.5% and 9.8% cases respectively. 90.2%of our study group were non
oliguric renal failure. Mortality was higher in study group (3.1%) as compared to sick neonates
with normal renal function. Conclusion: Cases with oliguric and hyperkalemia carried a poor
prognosis. Associated renal failure significantly increases the mortality. Acute renal failure is a
significant cause of co morbity in critically ill neonates.
NEO/09(P) RETROPHARAYNGEAL ABCESS IN THE NEONATE – A RARE CASE
REPORT
Jagjit Singh, Geeta Gathwala
Flat
No.15,
Couple
Hostel, Medical
Campus
Pgims
Rohtak
124001
dr_jagjitdalal@yahoo.com
Retropharyngeal abcess occur very rarely in the neonate,we report one such case. The index case
presented with fever, cervical lymphadenitis and acute onset severe respiratory distress due to
airway obstruction. CT Head and neck revealed retropharyngeal abcess extending from base of
skull to mediastinum. Case was managed with antibiotics alone. The aim of this case report is to
bring to attention this rare cause airway obstruction wherein early recognition and timely
intervention can be life saving. Details of poster will be presented in conference
NEO/10(P) PROTEIN C DEFICIENCY IN A
NEONATE WITH PURPURA
FULMINANS
Sreeja Kothapally, J.Harish, G. N. Madhu, R. Nisarga
# 414,Ladies Hostel, KIMS, Banashankari 2nd Stage, Near BDA Complex, Bangalore-70
drsreeja09@gmail.com
Introduction: Neonatal purpura fulminans is a very rare disorder characterized by intravascular
thrombosis and hemorrhagic infarction of the skin which is rapidly progressive accompanied by
disseminated intravascular coagulation. Its associated with deficiency of natural anticoagulants
protein C, Protein S, Antithrombin III. Protein C (PC) is a vitamin K-dependent serine protease
anticoagulant which degrades activated factors V and VIII in plasma. Homozygosity or compound
heterozygosity for PC mutations are very rare, found in only 1 in 2,50,000 newborns. The
complete lack of plasma PC activity in these patients results in neonatal purpura fulminans
presents with sudden onset of widespread purpuric lesions progressing to gangrenous necrosis,
disseminated intravascular coagulation (DIC) and shock. We report a case of 2day old neonate
who developed purpura fulminans diagnosed to have Protein C deficiency. Case Report: After an
uneventful pregnancy, A term, 2.6 kg male baby born by normal vaginal delivery to a II degree
consanguineously married couple was referred to our NICU on day 2 of life with two ecchymotic
lesions over the flexor surfaces of the thighs extending to the buttocks on both the sides. No
apparent congenital malformations noted. Mother had an abortion before the present one for
cardiovascular anomalies on ultrasound scan. Family history for thromboembolic events were
negative. Baby looked ill but not distressed or febrile and was sucking well at breast. Systemic
examination did not reveal any abnormality with peripheral pulses well felt. On day 3 of life,
lesions progressed to involve the lower quadrant of abdomen and remained static since then for the
next 3 days. The lesions vesiculated at places forming hemorrhagic bullae with subsequent
necrosis and black eschar formation. The margins of the lesions were erythematous and indurated.
No other bleeding manifestations. A complete blood count revealed moderate thrombocytopenia
(69000 cells/cmm) and a normal total count with normal values for hematocrit, PT and PTT. The
patient received fresh frozen plasma and platelet transfusions and was started on a course of
piperacillin-tazobactam and netilmycin. Inj Vit.k was given on admission. Daily cleaning and
open dressing was done with antibiotic ointment. On day 6 of life, purpuric lesions spread to
involve dorsum of the forearm and hand. Absence of signs of sepsis with rapidly progressive
purpura with septic workup being negative, a diagnosis of coagulopathy was suspected and protein
C levels only were done from hospital fund in view of financial constraints. The patients protein C
level was 10% (reference range 70-90%). With the falling hematocrit and not coagulable PT,PTT
inspite of repeated plasma transfusions on day 7 of life, prognosis explained. Parents took the baby
against advise and kept follow up on phone. Baby died on 9th day after birth. Extensive purpura
over the groin progressing to the trunk with hemorrhagic bullae and necrosis. purpura extending to
the loin. Discussion:The homozygous or compound heterozygous deficiency of protein C
deficiency is rare and severe condition which usually leads to neonatal purpura fulminans, while
heterozygous deficiency predisposes to venous thrombosis in adulthood. Homozygous protein C
deficiency is a potentially lethal disorder presenting in the neonatal period and can lead to
ophthalmologic complications. Purpura fulminans presents as widely distributed areas of
progressive skin necrosis and microvascular thrombosis over the body. This study reports a case
of severe protein C deficiency with neonatal purpura fulminans. The thrombophilia study
indicated the patient was most likely omozygous for protein C deficieny. Diagnosing homozygote
infants with protein C deficiency depends upon the appropriate clinical picture, a protein C level
that is essentially unmeasurable and confirmation of heterozygote state in the parents. The level of
protein C in this patient was 10% but this was measured on day 6 of life when the patient was
already on FFP and platelet transfusions. The international committee on thrombosis and
haemostasis published recommendations for initial and long term treatment of patients with severe
protein C deficiency. The standard initial treatment is FFP in a dose of 20 ml/kg every 12h until
clinical symptoms disappear. Purified protein C has now become available and it is the treatment
of choice in patients with severe deficiency. The most widely used long term treatment is oral
anticoagulation (warfarin) to maintain an INR range between 2.5 and 4.4. Other options such as
low molecular weight heparin and protein C Concentrate administration have been tried with
excellent results. Finally, genetic analysis is essential in the risk assessment for affected couples
planning to conceive and for prenatal testing of the fetus during a subsequent pregnancy.
NEO/11(P) NEONATE WITH RITODRINE INDUCED HYPOGLYCEMIA
Lt Col Karthik Ram Mohan, Col Shashi Bhushan
Maj Sawant MB, Radiologist, MH Allahabad
drkram@rediffmail.com; rnr4u@rediffmail.com
Male neonate was delivered at 33wk 6day gestation by emergency LSCS to a 27 yr G 2P1L1 lady
who had been given Intravenous Ritodrine in an attempt to delay delivery. Ritodrine was stopped
as she developed tachycardia. Baby had moderate cry at birth with APGAR score 6 at 1 min and 7
at 5 min. However, from birth, baby was hypotonic and lethargic though his vitals were stable.
Birth Wt 2.19 kg, AGA 34 Wks, AFD. Blood sugar by dextrostix at around 20 min age was 24
mg/dl. Baby was given a dextrose bolus followed by a dextrose infusion. With this, blood sugar
normalized and there was significant improvement in activity & cry but hypotonia persisted.
Maternal blood sugar WNL. Baby’s septic screen was negative, Blood culture showed no growth,
Electrolytes WNL. Activity normalised on D3 of life. Baby also had Feed intolerance was able to
tolerate feed only from D4 of life. At discharge, baby was active, feeding well and clinically
WNL. Follow-up showed no residual neurological defect and USG Brain was normal. Ritodrine, a
Beta adrenergic agonist used as a tocolytic crosses the placenta and neonatal hypoglycemia and
has been reported following maternal intravenous Ritodrine administration. Fortunately, follow-up
studies have revealed no long-term ill effects or significant problems in child development. To
conclude, babies born to mothers given Ritodrine must be closely monitored for possibility of
hypoglycemia. Hypotonia and Feed intolerance could be possible associations.
NEO/12(P) CORD BLOOD GLUOCOSE LEVELS IN LBW NEW BORNS
Devendra Sareen, Prakash Kumar, Asha Mathur, Dharam Singh, Mahesh Upadhyay, Nitin Goyal,
Jitendra Jain, Umang Upadhyay
C/o: Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, UDAIPUR-313 001
drsareen@yahoo.com
Low birth weight new born contribute a major part of all live births in our country. They are prone
to various complications. Hypoglycemia is one of them. This study was planned with the aim of
finding the cord blood glucose levels in low birth weight new born. One hundred full term
normally delivered new born were studied. The cases were divided into two groups of 25 each.
Group I comprised of low birth weight new born weighing between 1.5-2.0 kg. and gr. II had low
birth weight new born weighing between 2.0-2.5 kg. respectively. 50 full term new born weighing
more than 2.5 kg. served as control cases. It revealed that mean cord blood glucose in gr. I (LBW
new born weighing between 1.5-2.0 kg.) was 47.91 mg/%, in gr.II (LBW new born weighing
between 2.0-2.5 kg.) was 56.55 mg/%, and in control group (new born weighing more than 2.5
kg.) was 73.04 mg/%. So the cord blood glucose was significantly low in gr. I and gr. II. Hence,
the new born weighing below 2.5 kg. are at risk to develop hypoglycemia specially when their
birth weight is below 2.0 kg. So cord blood glucose must be estimated in these LBW new born
who are 'at risk' to develop hypoglycemia and early feeding must be started in these new born to
avoid hypoglycemia.
NEO/13(P) ASYMPTOMATIC BACTERIURIA IN NEONATES
S K Jatana, V Negi, S Das
HOD & Consultant Pediatrics, Command Hospital (WC) Chandimandir, Panchkula 134107
suniljatana@hotmail.com
Introduction: Urinary tract is very often the site of bacterial localization and the symptomatology
is variable. If Urinary Tract Infection is not detected early, it may lead to parenchymatous renal
damage. More often neonates are asymptomatic and the infection remains undetected. Incidence of
asymptomatic bacteriuria in neonates reported in literature varies between 1-3%. A positive
approach to diagnosis of UTI is necessary to prevent the above mentioned complications. Aims &
Objectives: A study was undertaken to estimate the incidence of asymptomatic bacteriuria in
neonates. Material & Methods: Two hundred term normal neonates without any minor / major
perinatal complication formed the study group. Urine samples were collected from these neonates
by suprapubic aspiration. The urine samples were sent for routine, microscopic examination and
culture. > 5 WBC/HPF were considered significant. Any number of bacterial growth was
considered significant. In case of positive cultures additional investigations were done including
Blood urea, Serum creatinine, Ultrasonography & IVU if indicated. Results: There were 96 males
and 104 females in the study. 5 urine samples (2.5%) showed bacterial growth and also had > 5
WBC/HPF. The organism isolated in all 5 bacterial growth was E. Coli. Out of these 5 positive
cultures 03 were from male (3%) and 02 (1.9%) from female neonates which was statistically
significant. One neonate with positive cultures revealed bilateral hydronephrosis. Investigations in
all other neonates with positive cultures were normal. Conclusion: incidence of asymptomatic
bacteriuria in neonates is not very low to be ignored. It was found to be 2.5% with a slight male
preponderance. One male neonate had bilateral hydronephrosis on further investigations.
NEO/14(P) A STUDY OF NEONATAL THROMBOCYTOPENIA
K.M. Mehariya,Chirag D. Shah, Nilesh Panchal, Amitabh
B.J. Medical College, Civil Hospital, Ahmedabad
dramit_amy@yahoo.co.in
Introduction-:Neonatal Thrombocytopenia Is Defined As Platelet Count <1.5lalhs/Cmm.Occurs In
22-35% Of All Babies Admitted To Nicu.Occurs In Upto 50% Of Babies Requiring Intensive
Resuscitation.20% Of Episode Is Severe(Platelet Cont <50,000).Commonest Hematological
Abnormality In Newborn. Aims And Objective: To Study Etiology And Severity Of
Thrombocytopenia In Newborns, To Study Various C/F, Common Comorbid Condition Leading
To Thrombocytopenia And The Outcome. Materials And Methods: Retrospective Study Of 150
Neonates From Aug 2006 To Sept 2008 At B.J.M.C Ahmedabad, Guj. Neonates Showing
Bleeding And Having Platelet Count < 1.5 Lakhs Were Selected. Initial Platelet Count Done On
1st Manifestation Of Bleeding.After Any Therapeutic Intervention ,Count Repeated After 12 Hrs.
Treatment Given As Per Nicu Protocols. Sample Collected By Venipuncture In Edta Bulb.Count
Done By Autoanalyser,Confirmed On Ps. Observation: Severe Thrombocytopenia Present In 54%
And Moderate(50000-1.5 Lakhs), In 16% .61.33% Were Preterm. 38% Iugr. 47% Presented
Early(<72 Hrs) ,52% Presented Late(>72 Hrs).82% Were Lbw.68% Had Septicemia ,28% Had
Birth Asphyxia,19 % Had Mas,18% Had Dic,9% Had Nec.53% Of Eos And 51 % Of Los
Developed Severe Thrombocytopenia. Upper Gi Bleed Was Most Common,Followed By
Petechiae/Ecchymosis.81 % Were Given Platelet Conc. Mortality Was 29 % With Severe
Thrombocytopenia And 24% With Moderate Thrombocytopenia . Conclusion-Significant
Association Between Onset Of Thrombocytopenia And Maturity.Sepsis,Prematurity.Iugr,Birth
Asphyxia Common Associated Morbidities. Life Threatening Blleds Common With Severe
Throbocytopenia. No Difference Found Among Both Sexes. Factors Leading To Birth Asphyxia
And Sepsis Directly Influence Platelet Count. Significant Association Between Onset Of Sepsis
With Onset Of Thrombocytopenia.
NEO/15(P) MOLAR TOOTH SIGN IN A NEONATE
Pooja Dewan, Sidharth Kumar Sethi, MMA Faridi, Sumer Kumar Sethi
Department of Pediatrics, University College of Medical Sciences, Delhi, & Department of
Radiology, VIMHANS, Delhi
poojadewan@hotmail.com
Joubert syndrome is a rare autosomal recessive congenital malformation of the brainstem and
cerebellar vermis. A term neonate presented with hypotonia, abnormal respiratory pattern
(tachypnea interspersed with apneic episodes), and seizures in the first week of life. Magnetic
resonance imaging of the brain revealed corpus callosum dysgenesis, aplastic cerebellar vermis,
and Dandy Walker malformation. Superior cerebellar peduncles were thickened, straight and
elongated giving the brainstem an appearance of ‘molar tooth’. A diagnosis of Joubert syndrome
was made based upon the characteristic clinical features (hypotonia, periodic hyperapnea, ataxia,
coarse facies, nystagmus, psychomotor delay) and the typical radiographic signs (molar tooth sign
and bat wing sign) seen on neuroimaging.
NEO/16(P) SERUM LEVELS OF CALCIUM, MAGNESIUM AND TRACE ELEMENTS
AS PREDICTORS OF SEVERITY AND OUTCOME IN HYPOXIC ISCHEMIC
ENCEPHALOPATHY.
MP Nagapoonam, RS Sethi, SP Singh
Department of Pediatrics, M.L.B Medical College, Jhansi, U.P
drpoonam.27@gmail.com
Introduction: Hypoxic ischemic encephalopathy (HIE) is one of the leading causes of neonatal
mortality and disabling neurological sequelae. Although free radical injury and other possible
mechanisms of injury have been previously elucidated, the status of serum levels of calcium,
magnesium and trace elements has not been extensively studied in neonates with HIE. ObjectiveTo assess the calcium, magnesium, iron, copper and zinc levels in the serum of neonates with HIE
and their possible role in predicting its severity and outcome. Subjects and Methods: 34 term
neonates with HIE and 22 matched controls comprised the sample of this prospective case
controlled study. Serum calcium, magnesium and trace elements (copper, zinc, iron) were
determined by colorimetric method using auto analyzer. Data were analyzed by statistical software
SPSS 15. Results: The levels of serum calcium were significantly decreased and the levels of
serum iron were significantly increased in neonates with HIE. Serum copper levels were
significantly elevated in HIE stage III cases only. No difference was observed in serum
magnesium and zinc levels. Serum calcium levels showed progressive decrease and serum iron
levels showed progressive increase with increasing severity of HIE. Lower serum calcium levels
and higher iron and copper levels were also associated with poor outcome. Conclusion: Serum
calcium, iron and copper levels could be potential markers for predicting the severity of HIE and
its outcome. Further studies should be carried out to strengthen this association, which could pave
the way for early interventional strategies to improve the outcome in neonates with HIE.
NEO/17(O) ROLE OF ORAL GLUCOSE, SUCROSE, PACIFIER IN RELIEF OF PAIN
IN NEWBORN INFANTS AFTER VENIPUNCTURE.
Sumana Kundagrami, J. N. Behera, S. Hazra, Anil Mohanty
Department of Pediatrics, SCB Medical College & Hospital, Cuttack.
sumana_kundagrami@yahoo.com
Introduction - Newborns sense pain as much as we do.So during any painful procedure they
should be provided analgesia which is simple, safe and effective. Aims & Objectives - This
prospective randomised study is to assess neonatal pain by health care professionals and effects of
oral glucose, sucrose, pacifier to prevent and treat pain associated with routine minor
painful procedures (venipuncture). Materials & Methods - Term newborns aged at least 24
hours were subjected to venipuncture as part of routine medical care for screening of neonatal
sepsis, hypothyroidism, jaundice. These babies were not given feeding for previous 30 minutes of
procedure. Newborns with neurological disorders (HIE) were excluded. Pain assessment was done
by NIPS scale. Cases were divided into 5 groups, consisting of Group I - given 2 ml of
30% glucose, Group II - 2 ml 30% sucrose , Group III - allowed to suck pacifier, Group IV - 2 ml
30% glucose followed by pacifier and Group V - given placebo ( 2 ml sterile water).
Randomisation was done in advance by an assistant not involved in this study. Data were analysed
with SPSS software statistics. Median scores ( after converting them to ranks ) of all groups were
compared with the non parametric Mann - Whitney U test. Results - There were 31 cases taken in
each group with mean birth weight from 2414 2495 gm and the age group was between 2 to 5 days
of life. Male : Female ratio was 1.3:1. The median scores of groups I to V were 3,3,2,1.5 & 6
respectively. The mean ranks of groups I to V were 88.35, 74.52, 54.85, 34.85 & 137.42
respectively with p value < 0.001. The mean ranks of Group I to V , IV to V, III to V, II to V, I to
V, IV to III & IV to II when compared also showed p value < 0.001. 30 % glucose was found to be
more analgesic than 30% sucrose .Combined 30% glucose and pacifier had even better analgesic
effect than pacifier alone or 30% glucose or 30% sucrose orally. Conclusion - The analgesic effect
of glucose, sucrose solutions and pacifiers on newborn infants can be clearly detected by a
behavioural pain rating scale. Sweet solutions and pacifiers constitute simple and safe
interventions that can be used to provide analgesia in newborns during minor painful procedures
like venipuncture.
NEO/18(P) CLINICAL AND DIAGNOSTIC PROFILE OF NEONATES WITH SEPSIS
Ajay K. Tiwari, Madhuri Garg
B-1/461, Janak Puri, New Delhi-110058
ajaytiwari06@yahoo.com
Introduction: Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection
and accompanied by bacteremia in the first month of life which results in 30-50% neonatal deaths
in developing countries. Aims & Objectives: To study the clinical and diagnostic profile of
neonates with sepsis and To study the pattern of microorganisms in cultures of proven cases.
Material and Methods: 100 babies under the age of 28 days- preterm or full term who were
clinically suspected to have septicemia. Clinical suspicion was made on the basis of maternal risk
factors like leaking per vaginum >24 hours, premature rupture of membranes, maternal fever or
features in the babies like abnormal cry, refusal to feed, lethargy, jaundice, fever, convulsions,
diarrhea, hypothermia, abdominal distension, vomiting, bleeding tendencies, cyanosis etc..
Following tests were done-Blood culture, Total leukocyte count, Differential leukocyte count,
absolute neutrophil count along with peripheral smear-toxic granules & band cells, micro-ESR, C–
Reactive protein, x-ray chest etc. Results: There were 30 cases of proven sepsis and 70 cases of
suspected sepsis. The most common bacterial pathogen was Coagulase-negative Staphylococcus
(26%) followed by Staph.sp (13%), E.Coli (10%), Enterococcus (6%), Klebsiella (6%) and
Streptococci (6%). The incidence of Candida infection was also quite high being 30% This finding
suggests that there was high prevalence of nosocomial infection by CONS and Candida sp.
especially in high-risk neonates with prolonged antibiotic therapy and prolonged NICU stay
(more than 2 weeks). The mortality in the proven sepsis group was 30%. CRP with combination of
other tests has higher sensitivity. Conclusions: Since Candida and CONS are the most common
organisms detected, especially in the LBW babies, special care and important preventive measures
regarding their antibiotic therapy and prolonged stay need to be taken in the nurseries. From time
to time similar studies will be required to observe the changing profile in bacterial profile and to
choose antibiotics accordingly, so that neonatal mortality due to infection can be significantly
decreased worldwide.
NEO/19(P) STUDY OF FEEDING PRACTICES
HOSPITALIZED NEWBORN
Agarwal Vishnu, Gupta R.K.
J –II/4, New Naya Sikha Apartment, Gandhi Nagar, Jaipur
vishnu.agarawal@yahoo.in
IN
HOME
DELIVERED
Institution: Department of Paediatrics, Umaid Hospital for Women and Children, Dr. SN Medical
College, Jodhpur. Introduction: India is a vast country where 25 million babies are born every
year, accounting for about 50 births every minute. Each year, about 5 million newborns die in the
world before they are 4 weeks old and half of them die in their first 24 hours. 98% of these deaths
occur in the developing countries. Of these, one million deaths are contributed by India, where 7080% of all the deliveries still occur at home and conducted by untrained personnel. Amazingly,
three neonates die every minute in India. The overall Neonatal mortality rate (NMR) per 1000 live
births for the whole country is about 37 (with approximately 41 for rural areas and 23 for urban
areas), is exceedingly high when compared with that of UK and USA (3 & 4 respectively).
Objectives: To study feeding practices in home delivered hospitalized newborn. Material and
Methods : Total 300 home delivered hospitalized newborn (100 each from urban, urban slums and
rural areas of western Rajasthan) admitted in Umaid Hospital, Department of Paediatrics,
Dr. S.N. Medical College, Jodhpur were studied. Preformed questionnaire was prepared and filled
by interviewing attendants (preferably mother / grand mother). The data was analysed statistically.
Observations : 97.65% of newborn were of less than 7 days. Male : female ratio was 3.76:1.
40.66% of these were LBW and 16.00% were preterm. Only 44.33% newborn were given
colostrum while 79.33% newborn were given various prelacteal feed like jaggary, honey, ghee &
ghutti. To our surprise, only in 6.40% newborn breast feeding was given within 1 hour. In 36.00%
newborn top milk was given in neonatal period. Conclusion: There is an urgent need to improve
immediate neonatal feeding practices in rural and urban areas by involving T.B.A., Dais, ANM
and other health workers as well as adding infant feeding and newborn care as a topic in secondary
school curriculum.
NEO/20(P) OUTCOME OF VLBW BABIES – PAST AND PRESENT SCENARIO IN AN
INDUSTRIAL HOSPITAL
S.Nath , K.G.Sharma , R.Pancholi, Saifullah KM
57 Riverview Enclave, Telco Colony, Jamshedpur-831004
smritin@tatamotors.com
Introduction- Very low birth weight babies(VLBW) form high risk group and are more vulnerable
to death during neonatal period .Due to advancement in neonatal intensive care, survival rate of
VLBW has increased. Aim and objectives-To evaluate the outcome of VLBW babies in level II
NICU and to compare with study done 10yr back in conventional NICU in same hospital. Material
and method- Design- Prospective observational study Setting- Accredited level II NICU Tata
Motors Hospital Study Period-April 08-March 09 study group- Newborns weighing <
1500gm(inborn cases only). New therapeutic interventions used in present level II accredated
NICU 1. Surfactant therapy 2.CPAP 3.Mechanical ventilation Result- Present study- Gr.I
Previous study (Jan 1997-Dec.97)- Gr. II Incidence of LBW is 22.7% (total no.229) out of which
4.4% (total no.45) is VLBW whereas in gr. II 24.6%( total no. 258) and 1.2% (total no.28)
respectively Received antenatal care in gr. I -66.6% & in gr II 21.4% , survival rate in grI is 91%
(only 4 cases died) as compared to 71%( 8 cases died) in gr.II. In gr I, 26.6% of cases were
given surfactant and CPAP was used in 88.8% , mechanical ventilation in 37.6% .Mortality from
RDS was nil in gr.I as compared to 25% in gr. II. Mortality from Birth asphyxia in gr I was
75%( in gpII 62.5%) and 25% from sepsis in gr I & in gr.II 12.5% cases Conclusion- Present
study showed improved morbidity & survival of VLBW babies.Therefore we conclude that role
of new theraputic intervention is important for outcome of VLBW babies .
NEO/21(P) EVALUATION OF MIDARM CIRCUMFERENCE IN NEWBORN – AN
INDICATOR OF LBW BABIES
S. Nath, Vivek Kumar, R.Pancholi, Saifullah KM , P.Sinha
57 Riverview Enclave, Telco Colony, Jamshedpur-831004
smritin@tatamotors.com
Introduction- Midarm circumference (MAC) , an important parameter for identifying malnutrition
& mortality risk is widely used in children aged 1-5 years. Only few studies have shown a
significant association between MAC<9cm and Birth wt.< 2.5kg . As there is a paucity of
evidence from large multicentric studies, this method of predicting LBW by peripheral health care
personnel has not been adopted routinely. Since it is a very simple, cost effective method & can be
easily applied by minimally trained persons in developing countries like India, we conducted this
study with following aims and objectives Aim & Objective: To know the co-relation between
MAC and LBW and to determine sensitivity & specificity of MAC as an indicator of LBW.
Material &Method- Design- Prospective observational ongoing study Setting-NICU& Postnatal
ward, Tata Motors Hospital Study Period-August- September 2009 Study gr.-Babies born to
healthy mothers Exclusion criteria – Multiple pregnancy, PIH, diabetic mother, , reno-vascular,
cardiac dis in mother, congenital anomaly of newborn Method-MAC was measured by fiberglass
non-stretchable measuring tape width 1cm, subdivision 0.1cm within first 48hrs of life. A total of
three consecutive measurement were taken for each newborn by same observer & the mean value
was considered for analysis. (rounded to nearest 0.1 cm ). All baby weighed within first hour of
life & were evaluated in term of WHO definition of LBW. Stastical Method Statistical ToolSPSS-10 Method used- SD, Correlation(Pearson),Specificity& sensitivity Result- total 100 cases
were studied. Range of wt. 1.17kg to 3.39kg( Mean 2.45 kg & SD 0.55) Range of MAC 6 cm.to
11.6 cm ( Mean 9.01 cm, SD 1.32). Pearson Corelation coefficient 0.925. high level of correlation
(+) between the two variables (birth weight & MAC) found . Specificity & sensitivity of MAC
0.86 if value 9 is taken as standard value. Conclusion- MAC can be used as a simple tool for
screening of newborn who need special care & hospitalization..It can be used at home &
periphery where weighing scale is not available
NEO/22(P) NEONATAL SHOCK AND RECURRENT SEIZURES IN A CASE OF BIRTH
ASPHYXIA – RARE PRESENTATION OF ADRENAL HEMORRHAGE
Dhivyalakshmi J, Premila Paul, Madhu Garg
Dept. of Pediatrics, Safdarjung Hospital, New Delhi
dhivya8@yahoo.co.in
20 hours old female child with h/o birth asphyxia born out of non-consanguineous marriage to a
primigravida mother at term gestation presented with two episodes of multifocal seizures. B.wt –
2.8kg. No significant antenatal history. Child was lethargic, hypertonic, with poor neonatal
reflexes. She had no congenital malformations and was normoglycemic and normocalcemic.
Seizures required anticonvulsants (phenobarbitone and phenytoin). At 36 hrs of life, child was
pale, icteric with cold peripheries and prolonged CRT, feeble pulses and had multifocal seizures.
Child was managed for shock as per standard protocol but became dopamine dependent.
Investigation showed no evidence of sepsis, RBS– 40mg%, S.Na+ - 129 mEq/L, S.K+ - 5.7 mEq/L.
USG skull revealed cystic leukomalacia, no Intra cranial bleed. Possibility of adrenal hemorrhage
was considered. USG abdomen showed right adrenal hemorrhage measuring 2.8X3 cms. Serum
Cortisol – 18.2ng/ml (range: 60 – 230). Child was given hydrocortisone 100mg/m2/day,
fludrocortisone 100mg/day and hypertonic saline 11ml/day. Seizures and shock were controlled.
Gradually hydrocortisone dose was reduced and child was discharged on oral hydrocortisone
10mg/m2/day, fludrocortisone 100mg/day and hypertonic saline 4ml/kg/day after 2 weeks of
admission. Presently, Child is stable and on regular follow up, serum electrolytes after 2 weeks of
discharge was normal. Incidence of adrenal hemorrhage is 3% by USG screening. 90% are
unilateral, 75% of which occurs on the right adrenal. Unilateral Adrenal hemorrhage is more
common and is usually asymptomatic. Massive and bilateral hemorrhages are rare. Adrenal
hemorrhage presenting as adrenal insufficiency is a potential but very rare presentation which has
to be considered in asphyxiated neonates with shock.
NEO/23(P) NEONATAL OUTCOME OF INFANTS BORN TO DIABETIC MOTHERS
IN A TERTIARY CARE IN INDIA
Annie Jyothirmayi, Manish Kumar, Sridhar Santhanam, Anil Kuruvilla, Atanu Kumar Jana,
Niranjan Thomas
Department of Neonatology, Christian Medical College, Vellore 632 004
neonat@cmcvellore.ac.in
Introduction: Diabetes complicating pregnancy is associated with increased perinatal mortality
and morbidity. There is a paucity of recent data on neonatal outcome of such pregnancies and
literature that is available is from an era when oral hypoglycemic agents (OHA) were not used.
Aim & Objectives: To study the neonatal outcome of infants born to diabetic mothers and
compare the complications between those treated with insulin or OHA. Methodology: This
prospective cohort included babies born to diabetic mothers between November 2008 and August
2009. Maternal details were obtained and physical examination was performed on the neonate.
Hourly feeds were started soon after birth and blood sugars checked at 1, 3 and 5 hours of life. The
hematocrit and calcium levels were measured. Analysis was done using SPSS software. Results:
Of the 186 diabetic mothers, 8 had pre-gestational diabetes and 178 had gestational diabetes.
Insulin was used in 82 (44.1%) while 104 (55.9%) were treated with OHA. Fifteen percent of the
babies were born preterm. Sixty three (33.9%) were large for gestational age while 9 (4.8%) were
small for gestational age. Hypoglycemia was seen in only 16 (8.6%) babies and persisted beyond
the first 5 hours in 2 (1.1%). There was no difference in hypoglycemia between infants of mothers
on insulin or OHA (7 vs. 6, p=0.5). Four (2%) babies had polycythaemia while no one developed
hypocalcaemia. Conclusions: There are an increasing number of diabetic mothers being treated
with OHAs. The neonatal complications seen in this study are much lower than reported in
literature, probably reflecting better perinatal care. There was no difference in neonatal outcome
between infants born to mothers treated with insulin or OHAs.
NEO/24(P) ROLE OF INVESTIGATIONS IN OLIGOHYDRAMNIOS HOW MANY
REVEAL ABNORMALITIES?
K.K . Locham, Manpreet Sodhi, Gargi Goyal
Department of Pediatrics, Government Medical College/Rajindra Hospital Patiala-147001
kklocham@hotmail.com
Oligohydramnios is known to be associated with renal malformations, limb deformities and
hypoplastic lungs. Aims & objectives: To evaluate the role of investigating the new borns in
oligohydramnios. Material & methods: The study included 12 inborn new borns delivered to
mothers with oligohydramnios. Sex, gestation, weight, antenatal risk factors & Apgar score at one
minute were recorded on a predesigned proforma. Babies were evaluated for craniofacial and limb
deformities. USG for kidney and urinary bladder was done and blood urea was assessed in every
case. Results: There were 11 term babies and 1 preterm baby. Antenatally, one case each had
pregnancy induced hypertension (PIH), fetal hydronephrosis B/L and genital warts. 8 babies were
AGA and 4 were SGA. Birth asphyxia (mild) was present in only one case. Blood urea was
evaluated in all cases in whom 11 cases had normal level. USG for kidney and Urinary Bladder
was normal in 8 cases in whom it could be evaluated. The baby with antenatal hydronephrosis B/L
also had normal study after birth. None of the baby had either craniofacial abnormalities or limb
deformity. Majority of babies (10) had passed urine by 36 hours of life. Conclusion: 8% babies
had deranged blood urea hence there is a need to investigate.
NEO/25(P) GLOMERULAR FILTRATION RATE IN PERINATAL ASPHYXIA
K.K. Locham, Jaswir Singh, Maninder Kaur, Manpreet Sodhi, Parminder Singh, Deepak Sharma
Department of Pediatrics & Biochemistry, Govt. Medical College/Rajindra Hospital, Patiala –
147001
kklocham@hotmail.com
Aims & Objectives: To evaluate the glomerular filteration rate (GFR) in perinatal asphyxia
Material & Methods: 100 AGA newborns with perinatal asphyxia were included in the study
group and 50 normal newborn babies were taken as control. Serum creatinine in the cord blood
was estimated by manual method of Brod & Sirota. GFR was calculated & expressed in
ml/min/1.73m2 by Schwartz formula. The data so obtained was analyzed statistically. Results:
Mean GFR in perinatal asphyxia & control group was 18.55+5.3 and 18.914+5.94 respectively
(p>0.05). Mean GFR in perinatal asphyxia group at different periods of gestation from 28wk to
42wks was 12.21, 9.71+0.452, 11.27, 11.4, 12.71+1.055, 15.203+2.23, 14.379+2.98, 14.22+1.56,
15.63+1.96, 21.83+3.01, 23.95+3.315, 24.05+5.25, 24.23+3.96, 20.25, 24.318+3.4 respectively.
The difference in mean GFR at different periods of gestation between perinatal asphyxia and
control group was not significant. The difference in mean GFR between birth asphyxia alone and
control group was not statistically significant. Mean GFR in mild, moderate & severe birth
asphyxia was 19.37+6.149, 18.326+5.121 & 16.63+4.57 respectively. Statistically, the difference
in mean GFR between different grades of asphyxia & control groups was not significant.
Similarly, statistical difference in mean GFR among different grades of asphyxia was not
significant. Conclusion: GFR increases with increase in gestation. However GFR is not influenced
by severity of asphyxia.
NEO/26(O) EFFECT OF ANAESTHESIA ON THE NEONATAL OUTCOME.
K.K. Locham, T.S. Punia, Manpreet Sodhi, Manu Sharma, Harshvardhan Gupta
Department of Pediatrics, Govt. Medical College/Rajindra Hospital, Patiala-147001
kklocham@hotmail.com
Aims & Objective: To evaluate neonatal outcome in mothers receiving anaesthesia during
caesarean section. Material and Method: The study group included 100 newborns, 50 delivered
under general anaesthesia and 50 delivered under spinal anaesthesia. Neither the mother nor the
baby had any co-existent illness that could have an effect on well being of the baby. 50 newborns
delivered via normal vaginal delivery were taken as controls. The neonatal outcome and the Apgar
score were recorded at 1 and 5 minutes of age. The data so obtained was analysed statistically by
using t-test. Results: The mean Apgar score in Anaesthesia and NVD group at 1 min was 8.29
0.478 & 8.28 0.454 respectively (p = 0.9024). At 5 min, the score was 9.1 0.333 & 9.1 0.303
respectively (p=1). While comparing the general & spinal anaesthesia group, mean Apgar at 1 min
was 8.22 0.465 &8.36 0.485 respectively (p = 0.1439) and at 5 min, it was 9.08 0.340 & 9.12
0.328 respectively (p=0.5508). All the results on comparison were found to be non significant.
Conclusion: There was no asphyxia following anaesthesia.
NEO/27(P) CLINICAL SPECTRUM OF NEONATES ADMITTED WITH SEPSIS IN
SERVICE REFERRAL HOSPITAL.
Ajoy Garg, Uma Raju, Monisha Biswas
Department of Pediatrics, 7Air Force Hosp, Kanpur
rakhee.garg@yahoo.com
Introduction: Sepsis is commonest admitting diagnosis of most neonatal units and is responsible
for increasing morbidity, mortality and cost of treatment.. Aims and objective: To study the
clinical spectrum of neonates admitted with sepsis in service referral hospital. Methods: A
retrospective, descriptive study . Neonate inborn/referred to NICU from Jan 2007 to Aug 2009
included. Risk factor, demographic data, incidence, mortality, culture positivity and antibiotic
sensitivity pattern were studied. Results: Neonates with sepsis were 154( 39.7 %) over 30 mos.
Male: female ratio were 1:2.2. 61 %( 94) were sepsis screen negative and 39%(60) were sepsis
screen positive. 35%(21) were LBW,10%(6) ELBW,27%(16) VLBW,31%(19) normal birth
weight. 27 %( 16) had early onset sepsis& 73% (44) late onset infection.Main risk factor was
prematurity.11.4% (44) developed nosocomial infection . 10(16%) were culture positive i.e.
proven sepsis. Pathogen grown were Stap aureus 3 (30%) Klebsiella 2(20%), , E.Coli 2(20%)
Acinobater 2 (20%), Pseudomonas 1(10%).67% MRSA 37% Vancomycin resistant
Staphylococcus , Acinobacter only sensitive to imepenem and colistin. E.Coli and Klebsiella
sensitive to ceftriazone, piperacillin ,imipenem, and pseudomonas sensitive piperacillin and
imipenam . Mortality due to sepsis was 20 %( 10) of which 05 were ELBW. NICU mortality due
to sepsis was 59%. Conclusion: Sepsis remains the important cause of mortality and morbidity in
NICU. The most significant risk factor was prematurity. MRSA was the commonest implicated
pathogen. Imipenams were the most commonly used antibiotics. Mortality due to sepsis was 20%.
NEO/28(P) INVASIVE FUNGAL INFECTION IN NEONATES – RESPONSE TO
MONOTHERAPY WITH FLUCONAZOLE
M.R. Savitha, G.M.Kumar, Bharath A.P, Iragouda. M. Patil
Department of Pediatrics, Mysore Medical College & Research Institute, Mysore
drsavithamr@yahoo.com
Introduction: Invasive fungal infection is an increasing cause of mortality and morbidity in
neonates. The diagnosis is difficult, as the organism is slow and difficult to grow. Fluconazole is
less toxic drug with good CSF penetration and has an advantage of oral formulation.Aims and
Objectives: 1.To study risk factors and clinical features of neonatal fugal sepsis 2. To study
efficacy of Fluconazole Monotherapy Methods: This 1 year retrospective study included 21
neonates with invasive fungal infection, which was defined as culture of fungus or demonstration
of fungal hyphae from sterile site like urine, CSF or blood. Results: Weight of 2/3 rd cases were
less than 1.5 kg. 12 cases (57.1%) were small for gestational age (SGA). 12 cases (57.1%) were
preterm. Mean age of diagnosis was 11.01±7.41 days. Major clinical features were lethargy,
respiratory distress, hypotension, hypoglycemia and abdominal distension in 18, 9, 9, 8 and 7
cases respectively. Hyperglycemia and thrombocytopenia were seen in 6 cases each. 10 cases had
concurrent bacterial sepsis. All 21 neonates were on higher antibiotics. Urine fungal hyphae were
positive in 18 and blood culture was positive for candida in 3 cases. All cases were started on
Fluconazole 6 mg/kg intravenously. 18 cases recovered and 3 cases died. No adverse effect was
documented. Conclusions: Fungal sepsis is to be suspected in clinically septic SGA, preterm
neonate on higher antibiotics and investigating urine for fungal hyphae is useful in them
Fluconazole monotherapy has an efficacy of 85.71% with no adverse effects documented.
NEO/29(P) TWO DIVERSE PRESENTATION OF MEGA CISTERNA MAGNA
Kumar.G.M, Savitha.M.R, Sanjay.K.M
Department Of Paediatrics, Mysore Medical College And Research Institute, Mysore, Karnataka
drsavithamr@yahoo.com
Introduction: Cisterna magna is one of the three principle openings in subarachanoid space
between arachanoid and piamater layers of meninges located between cerebellum and medulla
oblongata. It usually measures 3-10mm. If more than 10mm it is called mega cisterna magna. It is
found incidentally in less than 1% of antenatal ultrasound. They are usually asymptomatic. Here
we are reporting 2 neonates with diverse presentation. Case Report : 01 A female newborn
delivered to a nonconsanguinous couple at 32 wks presented with antenatal y detected mega
cisterna magna . Child was asymptomatic. On examination there was no facial dysmorphism,
systems were normal. Routine blood investigations were normal. CT scan head showed mega
cisterna magna measuring 11 mm. Case Report: 02 A male newborn delivered to a
nonconsanguinous couple by cesarean section presented with multifocal clonic type seizures at
4hrs of life which was resistant to common antiepileptics. Intermittent Seizures prolonged for
about 9 days and child was put on 4 antiepileptics. On examination there was macrocephaly with
no facial dysmorphism. Routine blood investigations were normal. CT scan head showed mega
cisterna magna measuring 11.4mm in posterior fossa. Before we could investigate for other causes
of resistant seizures they went against medical advice. Discussion : Megacisterna magna is usually
asymptomatic .Rarely they may present with macrocephaly, refractory seizures which may be
associated with pyridoxine dependency, cerebral malformation, chromosomal anomalies or
TORCH infection. Hence neonates with mega cisterna magna and refractory seizures should be
investigated for above said conditions.
NEO/30(P) TYPE 1 DIABETES MELLITUS IN NEONATE: A CASE REPORT
Atul Kulkarni, Sunil Vaidya, Sachin Mulay, Sharana Basavaraj Belavat
Ashwini Sahakari Rugnalaya and Research Centre, Solapur, Maharashtra.
drsvaidya@gmail.com, dratulkulkarni@rediff.com, sbelavat@gmail.com.
15 days Female P1L1A0 born of non-consanguineous marriage presented with complains of
weight loss and failure to thrive, fever, irritability and breathlessness. Baby was weighing 1.44 kgs
on admission.Baby delivered by LSCS weighing 1.75 kgs. There was no history of fever/PIH/ to
the mother. H/O Diabetes Mellitus in the family is present. O/E: Child had wt loss, tachypnea,
dehydration, acidotic breathing and was irritable. HR-160/min, RR-76/min. Investigations:
BSL(R) was 473mg/dl by lab. ABG - Metabolic Acidosis, CRP-Negative, Urine-Acetone ++++,
Sugar ++++, Insulin levels-1.5 micro IU/ml (fasting) [normal 2-25 micro IU/ml], HbA1C
(Glycoselated Hb)- 12.2%(more than 9%-poor control), C-peptide-0.16ng/ml (normal 0.97.1ng/ml), Urea-57mg/dl, Creatinine-1.3mg/dl, Electrolytes-Na-127mmol/L, K-6.8mmol/L,Ca1.7mmol/L, GAD(Glutamic Acid Decarboxylase)65-Negative, ICA(Islet Cell Antigen)512Negative, Total Cholestrol-98mg/dl, Triglycerides-207mg/dl, TORCH IgM Antibodies-Negative.
Diagnosis: Neonatal Diabetes Mellitus Type 1. Treatment: With Human Insulin, Antibiotics, IV
fluids child improved clinically, regained appetite and wt. by 500gms at discharge. Discussion:
Neonatal permanent DM is rare & incidence is 1 in 100,000 newborns. It is of two types Transient
and Permanent. Onset of Permanent DM within 6 months of age is most unusual. Occurs most
often in infants who are small for gestational at times associated with metabolic acidosis but with
minimal or no ketonuria or ketonemia. 1/3rd patients have family h/o DM. In this case as the ISA
is negative probably the disorder is genetic.
NEO/31(P) PROGNOSTIC INDICATOR OF SICK ASPHYXIATED NEONATE
ADMITTED TO INTENSIVE CARE UNIT
Pradhan DD, Meher BK, Mohanty N
ACRC, Department of Pediatrics, S.V.P. Postgraduate Institute of Pediatrics, Cuttack
bkmeher187@yahoo.co.in
Introduction: Neonatal ICU caring for outborn asphyxiated babies with hemodynamic instability is
a major cause of admission with very high rate of mortality, cost of therapy & resource allocation
in a resource limited setting. Aims & Objective: This study was done to find out major prognostic
indicators for such neonate. Materials & Method: This Prospective observational study was
conducted in NICU of ACRC, SVPPGIP, Cuttack. Out of the 416 neonate admitted to 9 bedded
NICU, 165 asphyxiated babies were analysed for demographic characteristics, grade of asphyxia ,
associated morbid condition. Primary & secondary outcome variables like, Survival or death ;
lengh of ICU stay, duration of ventilator therapy; were analysed with different indicators.
Results: Male outnumbers female ( 3.7:1). Majority admitted on day1 44.2% (n=73), rest on day2
26.1% (n=43), after day7 3.6%( n=6). HIE-II constitutes 73.9% (n=122) , HIE-III 16.9% (n=28),
& HIE-I 9.1% (n=15). Term babies were 86.1%(n=142), preterm 9.7%(n=16) & postdated 4.2%
(n=7). Normal birth weight (2.5 -3.5) were 63.6% (n=105), LBW(<2.5kg) 33.3%( n=55) &
>3.5kg only 3%( n=5). Condition associated were sepsis 21.8% (n=36) followed by MAS
15.7% (n=26). 42.4% (n=70) were admitted to ICU on the same day of hospitalization whereas
30.9% (n=51) , 10.9%(n=18), were admitted after 1day & 2day, respectively. Mean duration of
hospitalization was 5.5days (Range 1-38days). Out of the 165 babies, 45 (27.2%) were LAMA,
22(48.9%) between 2nd & 3rd day, 73.3% (n=33) were HIE-II, 17.8% (n=8) HIE-III. 41(n=91.1%)
were term , 33(73.3%) were ventilated and the mean duration was 2.87 days(Range 1-11 days).
91(55.2%) out of 165 babies were discharged from ICU, majority between day 4-7 i.e. 37.4%
(n=34), all of HIE-I , 80.5% (n=66) HIE-II & 25%(n=5) of HIE-III. Term babies had survival
of 76.2%(n=77) compared to postdated 60%(n=3) & preterm 50%(n=7). Large babies (>3.5 kg)
had poor survival (60%). c 45.45% babies (n=75) required mechanical ventilation. 33(44%) got
LAMA. 17(22.7%) were survived to ICU discharge, 52(69.3%) were HIE-II & 23 (30.7%) were
HIE-III. Mean duration of ventilation for babies who survived was 3.1days( Range 1-6days)
against 2.72days( Range 1-11 day) for those who didn’t survive. Conclusion: HIE-III , preterm &
postdated babies , babies with birthweight .3.5kg , need of ventilation & prolonged ventilation
were associated with poor outcome in asphyxiated neonate.Associated conditions like MAS ,
Sepsis don’t add significantly to mortality, however prompt recognition of asphyxia , earlier ICU
admission , & prophylactic early intubation carries a good prognosis.
NEO/32(O) CHARACTERISTICS & SURVIVAL OUTCOME OF NEONATE
RECEIVING MECHANICAL VENTILATION.
Pradhan DD, Meher BK, Mohanty N
ACRC, Department of Pediatrics, S.V.P. Postgraduate Institute of Pediatrics, Cuttack
bkmeher187@yahoo.co.in
Introduction: Mechanical ventilation is an integral part of NICU and in a high neonatal mortality
& resorce limited setting , it is important to analyse the survival outcome for prioritising need for
ventilator care . Aims & Objective: This study was carried out to find out the characteristics &
outcome of neonate receiving mechanical ventilation(MV) . Materials & Method: This Prospective
Observational Study was conducted in NICU of ACRC, SVPPGIP, Cuttack. Out of the 416
neonate admitted to 9bedded NICU during oct-2008 to july-2009 , 142 ventilated neonate were
analysed . Demographic details; ICU admission diagnosis ; modes, indication,length of MV
were anlysed. Survival or death & length of MV were taken as outcome variables and analysed
statistically. Results: Birth asphyxia was the commonest indication of MV(n=75,52.8%),followed
by
prematurity(n=35,24.6%)
,
sepsis(n=23,16.2%),
post-operaive(n=4,
2.8%),
kernicterus(n=3,2.1%) , CHD & bleeding(n=1,0.7%) . Due to several reasons 49 out of 142
babies(34.5%)
were got LAMA, out of which asphyxia was
leading cause(44%) ,
prematurity(25.7%) & sepsis( 21.7%). Mean duration of MV was 1.26days(Range 1-11 days).
SIMV was the initial mode of ventilation in the majority(n=130,91.5%) & CPAP(n=12, 8.5%).
Indication for MV was Respiratory failure(n=50,35.2%), intractable seizure(n=25,17.6%), severe
sepsis(n=23,16.2%),
apnea(n=20,14.1%),
respiratory
distress(n=15,10.6%),
Postoperative(n=4,2.8%), heart failure(n=1,0.7%) & Bleeding(n=1, 0.7%). Overall mortality in
this study group was 65.6%(n=61). Death among post-operative condition was 100%(n=4),
prematurity(n=20), sepsis 66.7%(n=12), asphyxia 59.5%(n=25). Overall RR of survival was 0.34,
higher for CHD(RR=1), jaundice(RR=1), asphyxia(RR=0.4) and lower for sepsis(RR=0.33),
preterm(RR=0.23), post-operative(RR=0). Conclusion: Respiratory failure & Intractable seizure
are the commonest indication of MV in our ICU. Asphyxiated neonate opted more for
discontinuation of therapy than septic & preterm babies. RR of survival is better for preterm &
sepsis compared to overall survival. Asphyxia had a poor survival outcome.
NEO/33(P) LIPID PROFILE AND ATHEROGENIC INDICES IN NEWBORN AND
THEIR RELATION WITH GESTATIONAL AGE.
Jain R., Tripathi V.N., Singh R.D., Pandey K.
Department of Pediatrics and Department of Obstetrics and Gynecology, G.S.V.M. Medical
College, Kanpur
drrakhi09@gmail.com
Cardiovascular disease is a common cause of death in developed countries and also is a rising
trend in developing countries. Objective: To study lipid profile and atherogenic indices in
newborns and its relation to gestational age.Materials and methods: A hospital based cross
sectional study. Umbilical venous blood was obtained from 150 neonates, divided into two groups
on the basis of gestational age and subdivided on the basis of birth weight. Lipid profile (total
cholesterol, LDL cholesterol, HDL cholesterol, VLDL cholesterol, triglycerides) and atherogenic
indices(TC/HDL, LDL/HDL, Apo B/Apo A-I) were evaluated. Student t test applied to test the
significance.Results: Total cholesterol(TC) and LDL were significantly higher in preterm low
birth weight( LBW ) newborns as compared to term LBW neonates (162.75,107.11 mg/dl v/s
132.50,75.51 mg/dl respectively ,P<0.05). VLDL and apolipoprotein B were increased highly
significantly in preterm LBW newborns than in term LBW group( P<0.001) . TC/HDL and
LDL/HDL were significantly increased in preterm LBW newborns than in term LBW
group(P<0.05) and preterm NBW babies than term NBW group(P<0.05).Apo B/Apo A-I was
highly significantly increased in preterm neonates in comparison to term group(0.71v/s
0.54,P<0.001). Gestational age was inversely correlated with TC, LDL , VLDL, apolipoprotein
B , TC/HDL, LDL/HDL and Apo B/Apo A-I.Conclusion: These findings demonstrate a trend
towards worse lipid profile in preterm low birth weight newborns . There is a need to investigate if
this atherogenic lipid profile is a marker for future cardiovascular diseases.
NEO/34(P) AN UNUSUAL CAUSE OF HEMOLYTIC DISEASE OF THE NEWBORN
Sendil kumar Desingh, Swathi Padanakatti, Nisha Reddy, Kuruvilla Thomas
Department of Neonatology/ Pediatrics, Sundaram Medical Foundation, Dr. Rangarajan Memorial
Hospital, Chennai
padankatti@gmail.com
Introduction: Rh hemolytic disease was a frequent cause of hemolytic disease of the newborn in
the past, frequently requiring exchange transfusions. Its incidence is fast declining with the
widespread use of anti D immunoglobulin. We describe here a newborn with features of hemolytic
disease who was found to have a rare minor blood group incompatibility. Case study: A 13 days
old baby, the second child of parents of a non-consanguineous marriage, was brought with
jaundice since day 3 of life. The baby was icteric and had a palpable spleen; she had no features of
sepsis. Initial investigations suggested hemolysis (low hemoglobin, elevated reticulocytes,
elevated bilirubin). The mother and baby were O positive; father was A negative. Baby’s DCT and
mother’s ICT were both strongly positive. These suggested blood group incompatibility, but ruled
out the common Rh and ABO incompatibilities. Further evaluation showed Rh phenotypes as
being: mother – CDe/CD(-)e; father – cde/cde; baby – CDe/cD(-)e. A panel study showed anti c
antibodies in the mother’s serum and baby’s RBCs. This confirmed the diagnosis of neonatal
hemolytic disease due to ‘small c’ incompatibility. Intensive phototherapy and hydration were
initially begun. When jaundice and anemia worsened, three doses of intravenous immunoglobulin
were given with which the baby improved. Conclusion: It is important to be aware of the existence
and severity of minor blood group incompatibilities. IVIg has been shown to be useful in Rh
hemolytic disease. It is postulated to competitively inhibit the Fc receptor sites of the
reticuloendothelial cells. We used IVIg in ‘small c’ incompatibility successfully, assuming a
similar mode of action.
NEO/35(P) DEALING WITH PREMATURITY IN A COMMUNITY HOSPITAL IN
URBAN CHENNAI
Swathi Padankatti, S Uthayageetha, K Malleswari, Sendilkumar Desingh, Kuruvilla Thomas
Department of Neonatology/ Pediatrics, Sundaram Medical Foundation, Dr. Rangarajan Memorial
Hospital, Chennai
padankatti@gmail.com
Introduction: Prematurity significantly increases neonatal morbidity and mortality. 11-14% of
babies are born preterm in India. Survival and quality of life in preterm neonates have improved
considerably with better antenatal and NICU care. Ours is a small NICU of a community hospital,
practising rational and evidence based medicine. Aims and Objectives: To study 1) incidence of
prematurity in a community hospital 2) preterm admissions and associated morbidity and
mortality in the NICU, over a three year period. Materials and Methods: This was a retrospective
study. Hospital records from the labour room, level II nursery and NICU were studied during the
period January 2006 to December 2008. Prematurity was defined as less than 37 completed weeks
of gestation. Simple percentages were computed. Results: Of a total of 4808 deliveries during the
study period, 222 were premature deliveries. The major risk factor for prematurity was PIH. 42%
of preterm neonates required Level II care and 27% required NICU care. Eighty eight preterms
were admitted to NICU during this period, comprising 31.8% of NICU admissions. The major
complications were RDS (27%) and sepsis (17%). 12.5 % had PDA, 6.8% had IVH and 2.3% had
NEC. 28.6% required ventilation. Overall mortality was 11.7% and decreased from 13% in 2006
to 8% in 2008. IVH (25%) and sepsis (25%) were major causes of mortality. Mortality was
highest in <28 weeks gestation group (67%) and lowest in 32-36 weeks group (0%). Conclusions:
Incidence of prematurity in our hospital was 4.6%, lower than other reports from India. Overall
morbidity and mortality are low; preterm survival has improved over the past three years.
NEO/36(P) PROFILE OF CONGENITAL
A HOSPITAL BASED PROSPECTIVE STUDY
Ashwani Sood, Seema Sharma, Mangla Sood
Department
of
Pediatrics,
Indira
Gandhi
seema406@rediffmail.com
ANOMALIES
Medical
IN
College,
NEWBORNS:
Shimla
(HP)
Introduction:Congenital anomaly (CA) is any alteration present at birth of normal anatomic
structure and has cosmetic, medical or surgical significance. The worldwide incidence of CA is
estimated at 3-7% and remains an important cause of the perinatal mortality and morbidty. Aim:
To know the profile of CA in newborns and to plan immediate medical and surgical care.
Study Design: Hospital based prospective descriptive study of CA in one year. A thorough
perinatal history, 3 generations family pedigree and a meticulous examination of baby was done.
Results: Of 5221 live and still births ,born between August 2008 to July 2009, 80 had one or other
CA with incidence of 1.5%. 38% had single CA and 62% had multiple CA. The incidence was
higher in males (M: F = 1.3:1), and in neonates born to young (5%) and elderly (9%) mothers.
With increasing parity of 3 and above , frequency of CA increased (6.34%). The pattern of CA
included musculoskeletal (28.7%), CNS (21.3%), GIT (20%), syndromic(18.7%),
genitourinary(8.75%),and CVS (4%). In musculoskeletal group, telipes and in CNS,
meningomyeleceole was the commonest. CA in still born babies (5.09%) was higher compared to
live born babies (1.40%) and in babies conceived after assisted reproductive technology(4%).
Conclusion: The study shows the pattern of CA and to plan future cost effective strategies for
prevention, early diagnosis & management. Ultrasonographic evalaution should be performed at
around 18-20weeks rather than in first trimester. The incidence represent only those CA which
were visible on gross examination. The postmortem of stillborn and neonatal deaths is not a
routine feature, and therefore has not been taken into consideration.
NEO/37(P) DIAGNOSIS OF URINARY TRACT INFECTION IN NEWBORN-CAN WE
MAKE IT AT POINT OF CARE USING MULTISTIX ?
Poonam Singh, Venkatpathi Raju, Avinash Bhosale, Suresh Kumar Surapaneni
C/o. Dr. Suresh Kumar Surapaneni, Pragna Children Hospital, 6-3-347/22/B/1 Dwarakapuri
colony Near Sai Baba Temple, Punjagutta, Hyderabad
sureshkumarsurapaneni@gmail.com
Introduction: - Rapid diagnosis of UTI in newborns at point of care remains elusive. Aims and
Objectives: -To study incidence of UTI in neonates and to explore role of urinary multistix in
septic screening. Material and Methods: - A total of 146 neonates (preterm and term), admitted in
NICU, were randomly selected. Urine midstream samples were collected in sterile urine bags and
then microscopy, multistixs test and urine culture done. Routine blood septic screen done. Results:
- Out of 146 neonates screened with multistixs test . 7 were nitrites test (NT)positive .6 were
leucocyte esterase test (LET) positive, out of which 5 also had positive NT. Positive predictive
value (PPV) of NT and LET 28.5%and 33.3% respectively and PPV on combining both 40% .
Incidence of UTI in our study 1.36%. Mean duration of stay of neonates was 6+_4.7 days with
pyuria 11+_6.06days, with UTI was 9 days.The duration of stay for neonates with pyuria was
higher than those without pyuria and is significant by Mann Whitney U test. Conclusion: -High
index of suspicion is required for diagnosing UTI in newborn and multistixs are promising rapid
screening tests.
NEO/38(P) UNUSUAL CAUSE OF NEONATAL HYPOGLYCEMIA:
DEFICIENCY
Meetu Rawat Gupta, Arti Maria
Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi.
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
MCAD
Introduction: Neonatal hypoglycemia, frequently encountered, is often attributed to sepsis, shock,
asphyxia etc. rather than inborn errors of metabolism(IEM). Medium-chain-Acyl-Codehydrogenase deficiency(MCADD) in neonates is rare(incidence1:9000). We report this case to
emphasize the need of timely diagnosis. Case Report: A 20 day female, term AGA, born to
G4P2A1 mother, with uneventful antenatal or perinatal period, presented with multifocal seizures,
poor feeding and lethargy. Obstetric history revealed 1 abortion and 2 early neonatal deaths(cause
unknown). On examination, she was hemodynamically stable with normal facies, no
organomegaly, cataract or abnormal body odour. Sepsis screen was negative(normal leucocyte
count, platelets, CSF analysis, negative CRP, sterile blood culture) with normal biochemical
profile except low blood sugar(20mg/dl) for which IV Dextrose bolus of 0.2mg/Kg was given
followed by gradually increasing infusion rate(GIR) upto 6mg/Kg/min. Enteral feeds were started
and gradually built up while tapering GIR on which baby developed recurrent hypoglycemia. On
strong clinical suspicion of IEM, investigations done showed negative urine for reducing
substance and ketones, normal ABG, serum Ammonia and lactate. VDRL, TORCH profile and
Thyroid function test were also normal. Tandem Mass Spectrometry sent confirmed MCADD.
The baby was managed on hourly feeds on which the baby remained euglycemic and seizure free
at discharge. At 3-months follow-up, she showed adequate weight gain, normal neurodevelopment
and head growth. Conclusion: In MCADD, severity of hypoketotic-hypoglycemic episodes
increases with time and may result in residual neurological damage or fatal outcome. Thus a high
index of clinical suspicion, early diagnosis and therapeutic intervention is warranted in neonatal
hypoglycemia.
NEO/39(O) GENERALIZED ARTERIAL CALCIFICATION OF INFANCY (GACI):
PRESENTING AS REFRACTORY HYPERTENSION AND HYPERCALCEMIA IN THE
NEONATAL PERIOD.
Neelima K, Kanchan C, V.S. V Prasad, Malviya M
Lotus Children Hospital, Hyderabad
manojmalviya07@gmail.com
Background: GACI is an uncommon, but lethal condition associated with diffuse calcification of
the arterial system. In the cases described in the literature, most were diagnosed at autopsy and
very few survival have been reported beyond one year of age (1). ENPP1 gene of maternal or
paternal chromosome origin has been reported as a cause of GACI. To our knowledge, this is the
first case report of GACI from India. Case History: A 24 hour old, infant born at 36 weeks of
gestation by LSCS presented with respiratory distress since birth. Mother had a polyhydramnios
and fetal scan showed pericardial effusion. On examination, she had tachycardia, tachypnea, non
palpable peripheral pulsations and severe refractory hypertension. Serial Echocardiogram showed
progressive biventricular dysfunctions. She was managed with anticardiac failure measures,
inotropes and antihypertensive therapy. Her investigations revealed: diffuse rim of calcification of
entire aorta and its branches in chest and abdomen on CT and Ultrasound scan, elevated CRP, and
hypercalemia. In view of antenatal pericardial effusion, diffuse calcification of the arterial system,
and refractory hypertension, a diagnosis of GACI was made. She was commenced on calcium
chelation therapy with IV Palmidronate (0.1mg/kg) dose used successfully by others (1). She
improved and was discharged after 4 weeks with maintenance dose of oral risedronate sodium.
She was readmitted with refractory cardiac failure at three months of age and died. Repeat
imaging showed increased calcification of major vessels with involvement of coronaries. We
speculate that the dose of chelation therapy was suboptimum or diseases progression was very
rapid because of some new mutation. Conclusions: GACI can present as refractory hypertension
and hypercalcemia in newborn period. Imaging study is useful in confirming the diagnosis. More
research is needed to quantify the extent of calcification and optimum dose required for chelatio
NEO/40(O) BREAST CRAWL – CAN SAVE 2.5LAC BABY/YEAR.
N.L. Phuljhele, Minakshi Jha
Department of Pediatrics and Neonatology and Obstetrics and Gynecology Department, Pt .J.N.M
Medical College. Raipur
arunworlds1234@yahoo.com
Introduction: Breast crawl decreases neonatal mortality by establishing breast feeding within one
hour. Initiation of breast feeding in early hour every minute after birth is crucial.” every newborn
when placed on mothers abdomen soon after the birth,has the ability to find her mother’s breast all
on her own and to decide when to take first breast feed .This is called breast crawl. Design ;
Prospective cohort observational study . Methodology ; Cases and controles were selected from
the full term newborn babies delivered vaginally and were paired to match the two group of
infants for temperature,sugar and weight gain. Inclusion criterion -100 babies of GA >36wk with
APGAR >6 and wt > 1800gm. Exclusion criterion - Those babies born of out born and inborn
LSCS,APGAR<6 and babies with congenital malformation Breast crawl was initiated as per the
protocols. Odds ratio & Log Odds ratio with Chi Square test of significance were used for
statistical analysis of data. Result ; Primary results ;- Out of 100 full term babies 78 baby able to
successfully crawl within 45 min. Secondary results ;- out of 78 breast crawl baby,97.4% babies
able to maintain temp,100% babies able to maintain blood sugar,89% babies had decreasing
crying episode,90% babies had decreased sickness episode and do not require admission in
nursery.96% baby good weight gain in follow up. Conclusion ; Breast crawl in our set up is 78%
successful. Breast crawl has very beneficial effect on health of neonate by preventing
hypoglycemia, hypothermia and decreased crying episode.
NEO/41(P) PREVALENCE OF GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD)
DEFICIENCY IN NEONATAL HYPERBILIRUBINEMIA AND TO COMPARE THE
COURSE OF JAUNDICE IN G6PD-DEFICIENT AND NORMAL PATIENTS.
Reeta Bora, Pankaj P Panyang
pankajpanyang@gmail.com
Introduction : Glucose-6-phosphate dehydrogenase(G6PD) is an enzyme in the first step of the
hexose-monophosphate shunt required for the generation of NADPH. Red blood cells of neonates
with deficient G-6-PD are potentially susceptible to severe haemolysis and may result in
hemolytic jaundice.It is important also to diagnose this condition in early infancy in areas where
malaria is endemic,as this state may lead to haemolysis with administration of antimalarials. Aims
and Objectives : (1) To investigate the prevalence of Glucose-6-phosphate dehydrogenase (G6PD)
deficiency in neonatal hyperbilirubinemia and (2) to compare the course of neonatal jaundice in
G6PD-deficient and normal patients. Materials and Methods: All babies admitted in the NICU of
Assam Medical College and Hospital, Dibrugarh ,Assam with NNJ and in whom all
investigations were done were included in the study. Study period was from Nov 2007 and Dec
2008. Results: A total of 213 jaundiced neonates were included out of which 28 (13%) were G-6PD deficient. Males comprised of 85% (24) among the G-6-PD deficient babies. G-6-PD deficient
babies required a longer duration of phototherapy (94.6 Hrs) as compared to G6PD normal babies
(63.9 Hrs) and also a higher maximum average TSB level (20.2 mg/dl) as compared to G6PD
normal babies (16.7 mg/dl). The number of babies requiring double volume exchange transfusion
(DVET) in G-6-PD deficient babies was higher (32%) as compared to (14%) normal G-6-PD
babies. Conclusion: Low G-6-PD activity is a common cause of neonatal jaundice in this area. It is
more common in males. Babies with NNJ and G6PD deficiency needed phototherapy for longer
duration and also need for DVET was higher amongst them.High incidence of G6PD in jaundiced
newborn babies is important to be noted as thi area is a malaria endemic area and many babies
might need antimalarial in their future life.
NEO/42(P) DETERMINANTS
OF RETINOPATHY OF PREMATURITY – A
HOSPITAL BASED OBSERVATIONAL STUDY
Pandita Neerul, Gupta Ashok K, Sharma Ashok K, Gupta Surbhi
C/o. Dr. Ashok Gupta, 50 B/D Gandhi Nagar Jammu, J&K- 180004
doc_ashokg@yahoo.com
Advances in neonatology and improvements in quality of care have resulted in increasing number
of premature and extremely low birth weight infants surviving the neonatal period leading to an
increase in the population at risk for developing retinopathy of prematurity (ROP). Due to
advances made in the neonatal care at our centre , where 50 to 60 high risk deliveries are
conducted of which 1/3 are preterms / LBW babies and also all preterm/ LBW &high risk babies
delivered outside are admitted, there may be increasing number of preterm / LBW babies who are
at risk of developing ROP.This study was designed to evaluate incidence as well as various risk
factors associated with ROP in our population and in future planning of their treatment, on 200
preterm / LBW newborns admitted in NICU in PG Dept. of Paediatrics, GMC, SMGS Hospital,
JAMMU over a period of 1 year. All were subjected to indirect binocular ophthalmological
examination performed by same ophthalmologist between 4-6 weeks of age postnatally , with no
prior knowledge of the patient’s medical history. Repeat evaluation once every 2 weeks was done,
till discharge, if first examination was normal.. 25 (12.5%) developed ROP. 23 ( 92% ) were in
stage 1 and 3 (8% ) in stage 2 of ROP. All had completed temporal vascularizatiopn on repeat
follow-up examination done after 1 week. The incidence ( 12.5 % ) and severity of ROP in
present study was less as compared to other studies, possibly due to better neonatal care services
in our institution and non-availability of ventilatory support, and hence, not many of extremely
LBW/ premature babies survive TILL 4 TO 6 WEEKS OF POSTNATAL AGE, WHEN FIRST
EXAMINATION for ROP is to be done. Evaluation for ROP is mandatory for timely treatment
in babies who have progressed to threshold stage disease so as to prevent long term morbidty of
ROP which ranges from mild myopia to blindness.
NEO/43(P) NON-INVASIVE VENTILATION (BUBBLE CPAP) AS PRIMARY
VENTILATOR SUPPORT FOR NEONATES WITH ACUTE RESPIRATORY FAILURE
(ARF): A STUDY ON THE EFFECT ON MORTALITY AND MORBIDITY.
Neelima K, Kanchan C, V.S. V Prasad, PV Gopalkrishna, Malviya M
Lotus Children Hospital, Hyderabad
manojmalviya07@gmail.com
Background: Both conventional ventilation (CMV) and CPAP are frequently used as the primary
modality for infant presenting with ARF, however, evidence regarding the “best” primary
ventilatory modality is still lacking. Aims: To report our experience of nasal CPAP as primary
ventilator support strategy in neonates admitted for ARF. Design: Retrospective comparative audit
over a period of 2 years Methods: All the neonates admitted to NICU requiring respiratory
support, in the form of CPAP and/ or CMV, were included in the study. Two cohort chosen for
comparison were The CMV era (January- December 2007): CMV as the primary modality The
CPAP era (January-December 2008): CPAP as the primary modality with standardized ventilator
regimen Results: The numbers of neonates requiring respiratory support (CMV and/or CPAP)
were almost similar (CMV era: 77/308, (25%), CPAP era: 94/372, (25.2%). No statistically
significant differences were found in the baseline characteristics. The CPAP era was associated
with decreased in incidence of total number days of hospital stay (23.5 vs 15.4, p= 0.001), days on
mechanical ventilations (8.3 Vs 5.9; p= 0.001), ROP (14.2 Vs 2.1; p= 0.01), sepsis (16.8% Vs
9.4%; p = .04), and NEC (9%, Vs 0% p= 0.01) but was associated with increased in incidence of
pneumothorax (1.2 Vs 9.5 p=0.05). There was no difference in mortality and total number of
respiratory support days between the groups. Conclusions: A standardized ventilator regimen with
bubble CPAP can be safely use as a primary ventilator support for neonate with ARF and is
associated with decreased hospital stay, sepsis, NEC and ROP.
NEO/44(O) PREDICTION OF SIGNIFICANT HYPERBILIRUBINEMIA IN HEALTHY
TERM NEWBORNS USING CORD BILIRUBIN
Niraj K Sinha, Nikhil,Venkatpathi Raju, Ramamohana Rao, C Suresh Kumar , Suresh Kumar
Surapaneni
Pragna Childrens Hospital, 6-3-347/22/B/1 Dwarakapuri Colony Near Sai Baba Temple,
Punjagutta, Hyderabad
sureshkumarsurapaneni@gmail.com
Aims and Objectives: To determine the predictive value of cord bilirubin in term newborn babies
at risk of developing significant hyperbilirubinemia (TSB >15 mg/dl on Day 5 of life) Material
and Methods: Prospective hospital based follow-up study of term 200 neonates. Cord blood
bilirubin was collected .All babies were followed on day 5 for the evidence of neonatal jaundice .
Results: The incidence of significant jaundice was 23 %. Mean cord bilirubin levels in jaundiced
babies were 2.63 +/- 0.375 mg/dl and in non jaundiced 1.48 +/- 0.357 mg/dl.
CUT-OFF
SENSI - SPECI - PPV
NPV
FALSE
FALSE
VALUE
TIVITY FICITY
NEGATIVE POSITIVE
RATE
RATE
2.05 mg/dl 95.7 %
96.1 %
91.6 %
98.6 %
4.3 %
3.8 %
2.15 mg/dl 95.7 %
97.4 %
91.3 %
95.7 %
4.5 %
2.6 %
2.25 mg/dl 95.7 %
98.7 %
96.0 %
99.0 %
4.5 %
1.3 %
2.35 mg/dl 82.6 %
98.7 %
95.0 %
95.0 %
17.4 %
1.3 %
cut-off value of 2.25mg/dl has better predictive value compared to cut-off value of 2.05 and 2.35
mg/dl. Area under the curve is 0.974 with P value < 0.001 Conclusion: There was an excellent
correlation between cord bilirubin and Day 5 TSB [r = 0.889]
NEO/45(P) COMPARISON OF PAIN BEHAVIOR IN TERM, PRETERM AND SFD
INFANT’S IN TERTIARY CARE NICU
Prashanth Avadh, Venkatpathi Raju, Ramamohana rao,Parag dahake , Suresh Kumar Surapaneni
Pragna Childrens Hospital, 6-3-347/22/B/1 Dwarakapuri Colony Near Sai Baba Temple,
Punjagutta, Hyderabad
sureshkumarsurapaneni@gmail.com
Aims and Objectives: To compare pain behavior in term, preterm and SFD infants using NIPS
(neonatal infants pain scale) Material and Methods: 100 new born infants were assessed for
neonatal infant pain scale after heel lance procedure in NICU . The NIPS score were measured by
two people. Video clips were made. NIPS consists of six components. Facial expression (0-1), cry
(0-2), breathing pattern (0-1), arm movement (0-1), leg movement (0-1), state of arousal (0-1).
Total NIPS score range from 0-7. NIPS score more than 3 indicates pain. More score means baby
showed more response to pain Results: NIPS score is useful in pain expression in all term, preterm
and SFD babies. Term babies show more pain expression as compared to preterm babies. Term
SFD and Term AFD shows nearly similar pain expression. Preterm SFD and preterm AFD express
nearly similar pain by NIPS score Term AFD express more pain as compared to preterm AFD.
Term SFD express more pain as compared to preterm SFD. AFD (Term and preterm) express
more pain as compared to SFD (Term and preterm) babies. Conclusion: NIPS can be used for pain
assessment in term, preterm and IUGR babies.
NEO/46(P) NEONATE PRESENTING WITH SVT AS ACUTE LIFE THREATENING
EVENT
Kamal Kiran, Bm John, Kirandeep Sodhi, Rahul Sinha
Command Hospital (Airforce), Bangalore
drykk4u@hotmail.com
Neonatal Supra Ventricular Tachycardia is a rare event. 02 day old neonate presented with sudden
onset irritability, breathlessness and feeding difficulty on day 02 of life. On evaluation, neonate
was found to be irritable and HR 240/min, RR 74/min with S/C and I/C retractions, MAP
40mmHg, SPO2 90%, and poor peripheral pulses. Investigations done at this point revealed
Narrow complex tachycardia with HR 240/min, Inj Adenosine was administered which reverted
the rhythm to sinus rhythm for 20 seconds but immediately reverted back to SVT rhythm, Cardio
version did not revert rhythm successfully. IV Metoprolol was administered followed by bolus
dose of Diltiazem, which reverted SVT to sinus rhythm successfully. Neonate was subsequently
placed on oral beta blockers, as maintenance therapy there was no recurrence of SVT y. Neonate
was discharged on day six of life for subsequent EP study.
NEO/47(P) THE VALUE OF FIRST DAY BILIRUBIN MEASUREMENT IN
PREDICTING DEVELOPMENT OF SIGNIFICANT HYPERBILIRUBINEMIA IN
HEALTHY NEAR TERM NEW BORN.
P.Dowerah, Monalisa Borkotoki, Praveen PGT
pjf_62@yahoo.co.in
Introduction: Neonatal hyperbilirubinemia is one of the commonest new born problem in most of
the neonatal units.infants discharged within 48hrs of birth have a chance of developing
hyperbilirubinemia and complications later on.various studies have shown the value of cord
bilirubin in predicting subsequent hyperbilirubinemia. Aims and objectives: To evaluate predictive
value of total serum bilirubin level at 24+/-6hr postnatal age for identifying term and nearterm
infants at low risk for subsequent hyperbilirubinemia. Materials And Method: The study was
conducted in the neonatal care unit of dept of pediatrics, assam medical college and hospital.for a
period of one year. Serum bilirubin estimation was performed at 24+/-6hr after birth,average of
two readings was taken.bilirubin estimation was done spectrophotometrically using twin beam
method(540-465 nm wavelengh) . Rh incompatibility and significant illness requiring nicu
admission were excluded.it was a single observer prospective study.the sample size was taken to
be 150 as per 4pq/l2 assuming the prevalance of hyperbilirubinemia to be 5-10% in infants with
tsb=6mg/dl at 24+/-6hrs. Results: In our study the bilirubin level of 6mg/dl on first day had the
highest sensitivity(93.33%) and this critical bilirubin level had a very high (98.92%) negative
predictive value and fairly low (26.41%) positive predictive value. According to our findings .a
critical cut off level of 6mg/dl in the first 24 hrs of life predicted 93.3% of new borns who
developed jaundice subsequently. Conclusion: from this study it was observed that tsb level
<6mg/dl AT 24+/-6hrs of life can predict the absence of subsequent hyperbilirubinemia with high
probability ,sensitivity,specificity,positive predictive value,negative predictive value.infants at low
risk can be discharged early.
NEO/48(O) A STUDY OF CORRELATION OF FOOT LENGTH AND GESTATIONAL
MATURITY IN NEONATES.
Deepa S, Vijaykumar B, Krishnamurthy B
Room no.19, MMC PG Ladies Hostel, Opp. NBC, Vinobha Road, Mysore-570005.
deepasri5@yahoo.co.in
Introduction:Since decades attempts have been made to find an alternative measurement for
gestational age and birth weight estimation of the new borns.Foot length has been studied by
various authors as proxy measurement which can be measured easily in sick and preterm
newborns. Objective:This study was done to find correlation of foot length with gestational age
and other anthropometric measurements(birth weight,head circumference and crown heel length).
Methodology: Study sample of 800 newborns were selected by simple random sampling technique
born at Cheluvamba Hospital attached to Mysore Medical College and Research Institute, Mysore
from December 2007 to November 2008.Babies with limb deformities were excluded from the
study group.Gestational age was assessed by New Ballard score and babies were grouped into
term,preterm and postterm.These 3 groups were categorized in to appropriate for gestational
age(AGA),small for gestational age(SGA) and large for gestational age(LGA) using Lubchenco
intrauterine growth curve.Correlation of foot length with gestational age and other anthropometric
parameters in these groups were statistically analyzed by correlation and regression analysis.
Results:In the study male newborns were 53% and female 47%.In the study group 203 babies
(25.4%) were low birth weight babies,520 newborns (65%) had birth weight in the range of 2.53.5 kg. 77 newborns (9.6%) had birth weight > 3.5 kg.Of the 800 newborns preterms were 124
(15.5%), terms were 604 (75.5%) and post-term 72 (9%). The mean foot length was 7.4235 cm
with a range of 4.5-8.8 cms. Foot length correlated significantly (p < 0.05) with gestational age,
birth weight, head circumfernece and crown heel length in preterm SGA, preterm AGA,term SGA
and term AGA groups.The correlation coefficient of foot length with gestational age was
maximum in preterm AGA and preterm SGA groups(r>0.8) followed by term SGA(r=0.48) and
term AGA(r=0.44).Other groups had no correlation between foot length and gestational age.
Postterm AGA and postterm SGA groups had correlation between foot length and birth weight.
Conclusion:Foot length is a simple and reliable anthropometric measurement to assess gestational
age and birth weight in preterm and term neonates especially who are sick.Foot length can be
reliably measured by peripheral heath care workers and could be used effectively for identifying
and refering high risk newborns.
NEO/49(P) CORRELATION OF APGAR SCORE WITH UMBILICAL ARTERIAL
BLOOD ACID BASE STUDIES IN NEONATES
VN Tripathi, Gaurav Agarwal, Pawan Rawal
From Department of Pediatrics, GSVM Medical College, Kanpur, UP
gauravag79@gmail.com
Introduction Apgar score (AS) has been used as a measure of asphyxia at birth, since its
introduction. A low AS is understood to indicate asphyxia however, this score is unsatisfactory for
predicting the neurological outcome although to more objectively define immediate newborn
condition, use of umbilical arterial acid base studies has been suggested yet due to its limited use
no consensus for a significant metabolic acidosis has been defined. Objective To study the
correlation of AS at 1 and 5 minutes with Umbilical arterial blood gas analysis in neonates.
Material and Methods In this case control study, 100 newborns delivered at UISE hospital, GSVM
Medical College Kanpur were divided into 3 groups on the basis of AS at 1 and 5 minutes.25
babies of group I with AS <7 at 1 and >7 at 5 minutes and 25 babies of group II with AS < 7 at
both 1 and 5 minutes were compared with 50 babies with AS > 7 at both 1 and 5 minutes.
Umbilical blood samples were taken and subjected to blood gas analyzer. Mean and Standard
deviations were calculated for all blood gas parameters in each of the three groups and statistical
calculations were carried out. Results It was observed that AS is a poor means for diagnosing
asphyxia. The cut off points for labeling a case of asphyxia were pH<7.15, pO2<15 mm Hg,
pCO2> 55 mm Hg and Base deficit >10 meq/lit. Out of all the parameters pH was most specific
(88%) and correlated best with AS although pCO2 was more sensitive (47.91%) than pH (36%)
but its specificity (74%) was less.Conclusions Umbilical blood gas analysis should be done
routinely to find out the cause of morbidity in clinically depressed newborns showing no
biochemical asphyxia Also it is clear that out of all the parameters only pH is the most specific
and best correlated with clinical status of baby.
NEO/50(O) CASE REPORT OF PERMANENT NEONATAL DIABETES MELLITUS
WELL CONTROLLED ON ORAL SULFONYLUREAS
Rajesh Joshi, Ankur Phatarpekar
B.J. Wadia Hospital for Children, Mumbai.
drankurmd@gmail.com
Introduction: First case reported of Permanent Neonatal Diabetes Mellitus who was shifted from
insulin to oral glibenclamide in India. Report: 1month 6 days old male child presented with
complaints of fever, polyuria , breathlessness & decreased feeding since 2 – 3 days.on
examination pt was febrile – 102 F wit acidotic breathing, signs of dehydration were present and
systemic examination was normal. Pt had RBS-600mg% , blood gas showed acidosis Urine R/MKetones 2+, Sugars 3+.So the patient was found to be in Diabetic Ketoacidosis.
Patient was
given DKA management. Later on was shifted to s.c. insulin 1 U/kg/d which was gradually
increased to 1.5U/kg/d as per the blood sugar control. Patient was diagnosed to have permanent
neonatal diabetes mellitus (PNDM). Patients blood was sent for genetic molecular analysis which
showed a mutation L233F in KCNJ11 gene which encodes the Kir6.2 subunit of K ATP channel.
Mother was found to be mosaic for the same mutation.
The patient was started on oral
Glibenclamide 0.1 mg/kg/day & increased to 0.4mg/kg/day and insulin was totally stopped.
Patient is in regular follow-up and maintaining his blood sugars with better glycemic control than
on insulin. Discussion: The KATP channel is a 4:4 complex of Kir6.2 and sulfonylurea receptor
(SUR) subunits which is present on many cells including the β cells in pancreas. Mutations in k
channel leads to diabetes mellitus, low birth weight, epilepsy, developmental delay& dysmorphic
feature.KATP channels that are insensitive to ATP as a consequence of Kir6.2 mutations can still
be closed by sulfonylureas that bind to the SUR subunit and close the channel directly.
Conclusion: Our patient was found to have a mutation in Kir6.2 subunit of the K ATP channel and
was successfully shifted from s.c. insulin to oral glibenclamide with better glycemic control. This
is the 1 st case reported from India of a neonatal diabetic completely being treated on
sulfonylureas.
NEO/51(P) INCIDENCE OF EARLY ONSET SEPSIS IN TERM NEWBORN INFANTS
AT RISK
Arul Premanand LB, Jana AK, Kuruvilla KA
Dept of Child Health, Christian Medical College, Vellore
anilkdj@hotmail.com
The management of asymptomatic term neonates born to mothers with risk factors for early onset
sepsis is ill-defined. Aim: To estimate the incidence of early onset sepsis in term infants born to
mothers with risk factors and to determine the bacteriological spectrum of infection. Materials &
Methods: A hospital based study done from 2006 - 2007. Data regarding antenatal and perinatal
events was collected, investigations including WBC count and blood culture were done within 1
hour of birth and infants administered intravenous crystalline penicillin and gentamicin. Infants
were monitored closely for features of sepsis. For asymptomatic blood culture negative infants,
antibiotics were given for 72 hours. The duration and choice of antibiotic therapy in infants who
remained symptomatic or had a positive blood culture was determined by clinical course and
laboratory results. Results: 7032 term babies were born in the study period of whom 578 (8.2%)
were at risk of sepsis. 55 babies (9.52%) were symptomatic; respiratory distress was the most
common symptom. Nine (1.56%) babies had a significant growth in blood culture; Group B
Streptococcus was the most common organism. 95.5% of babies were given antibiotics for 3 days.
Among mothers who received intrapartum antibiotics, 12 (7%) babies developed symptoms. One
baby died, who was among the symptomatic babies. Conclusion: The incidence of early onset
sepsis in term babies born to mothers with one or more risk factors is low. Prolonged duration of
antibiotics and hospital stay was not required for most babies.
NEP/01(P) ANTENATAL DIAGNOSIS OF BILATERAL MULTICYSTIC DYSPLASTIC
KIDNEY
Ashwin Borade, Ashwin S.Prabhu, Geeta S. Prabhu , Sasanga R. Prabhu
C/O Dr. Geeta S. Prabhu, Department of Obstetrics & Gynecology ,“Sangeeth” Nursing Home
,South Cherlai, Kochi - 682002.
ashwinborade@yahoo.com
Multicystic dysplastic kidney disease (MCDKD) is the most common cause of neonatal renal mass
and either the most or second most common neonatal abdominal mass. The incidence of MCDKD
is about 1 in 5,000-10,000 births. With use of high resolution Ultrasonography (USG) ,the
diagnosis of renal anomalies can be made as early as second trimester . We report a second
gravida who presented at 24 weeks with severe oligohydrominos who on ultrasonographic
evaluation showed fetus with feature of MCDKD. Case Report;- A 26-year-old a unbooked
patient second gravida who had noticed to have severe oligohydrominos at 24 weeks of gestation
was referred for further evaluation. There was no significant maternal or family history including
any renal disorder. In view of severe oligohydrominos, she was evaluated .The fetal scan showed
bilateral, symmetrically enlarged, echogenic kidneys filling the fetal abdomen. Both kidneys
showed multiple cysts of varying sizes. The urinary bladder was not visible. Liquor was markedly
reduced. There was no lung abnormality and growth retardation. There were no other anomalies
noted. A diagnosis of bilateral multicystic dysplastic kidneys was made. The family members and
patient were counseled regarding the poor prognosis and outcome .The patient went into
premature contractions and delivered vaginally at 25 weeks. The delivery was difficult due to the
large size of the fetal kidneys. The fetus showed features of Potter's facies. Child survived only for
few minutes. In view of poor prognosis and unwillingness of parents further evaluation was not
done. Fetal autopsy was not done for same. Conclusion :MCDKD is a congenital dysplasia of the
kidney characterized by large nonhomogeneous dilations of the collecting tubules. It may occur
unilaterally or bilaterally. Early diagnosis can be followed by medical termination of the
pregnancy. Regular antenatal sonography is the key imaging modality in present era. We
highlight this case for its rarity and also suggest attention should be given for early
ultrasonographic diagnosis of this anomaly.
NEP/02(O) BEHAVIOURAL ABNORMALITIES IN CHILDREN WITH NEPHROTIC
SYNDROME
O.P Mishra, Biswanath Basu ,S. K Upadhyay, Rajniti Prasad, Franz Schaefer
Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi221005
opmpedia@yahoo.co.uk.
Objectives: Glucocorticoid therapy in children with nephrotic syndrome can lead to many adverse
effects including behavioural problems.The present study was undertaken to assess the changes in
individual behavior among different sub-groups of patients with idiopathic nephrotic syndrome
and also to find out relationship, if any, between different behavioural problems with cumulative
dose of steroid therapy. Patients and Methods: Prospective hospital based study. We assessed
behavioural patterns in 131 children and adolescents with steroid responsive idiopathic nephrotic
syndrome (INS) aged 1.5 to 15 years. Fifty healthy children matched for age and gender served as
controls. Interventions: The Achenbach Child Behaviour Checklist was used to assess individual
behavioural dimensions. Patients were sub-grouped according to age (1.5-5 and 6-15 years) and
disease status (first attack before and after 12-week prednisolone treatment, infrequent relapsers,
frequent relapsers/steroid dependent). Results: All groups had significantly elevated mean
behavioural abnormality scores for all dimensions assessed in both the age groups, except rule
breaking behaviour . Besides sleep problems, frequently relapsing/steroid-dependent patients
exhibited maximum scores in comparison to first attack and infrequent relapsers in 1.5 to 5 year
age group. Total and individual behavioural scores showed close associations with cumulative
prednisolone dose in both age groups. Conclusions: It is clearly evident that patients of nephrotic
syndrome should be given due consideration in clinical practice for the development behavioural
abnormalities after steroid therapy.
NEP/03(P) THE CLINICAL PROFILE OF CHILDREN WITH CHRONIC RENAL
FAILURE AT FIRST PRESENTATION TO A TERTIARY HEALTH CARE CENTER
David Suvarna Raju Parimi, Indira Agarwal, Peter Prashanth.
Department of Child Health And Pediatric Nephrology, Christian Medical College, Vellore - 632
004
child2@cmcvellore.ac.in; indiraagarwal@cmcvellore.ac.in
Aims and Objectives: To study the clinical profile of children with Chronic Renal Failure (CRF) at
first presentation, assess disease burden and rate of progression. Design and Setting: Descriptive
study. Paediatric Nephrology outpatient clinic at Christian Medical College, Vellore (from 2002 to
2007) Methodology: Medical Records of children were analyzed. Clinical profile, examination
findings and biochemical parameters were noted. Growth profile and the rate of progression of
renal disease were evaluated. Data was statistically analyzed using SPSS package 16.0 Version.
Results: 158 children with newly diagnosed CRF were analyzed. Male: Female 3: 1. 60.8% had
tubulo- interstitial disease; 39.2% had glomerular disease. 42.4% were aged between 5 - 12 years.
Mean GFR was 27.47 mL/min/1.73m2. 39.87% and 27.84% had CKD stage 4 and 5
respectively.52.5% weighed below 3rd centile,52.5% had stunted growth.75.9% belonged to low
income group (<Rs 3000).The commonest etiologies were urological (47.46%) chronic
glomerulonephritis (12.02%) hereditary(1.9%)congenital (8.86%) and idiopathic (24%). 41%
were advised dialysis and 1.9% transplantation. 48.7% children dropped out, 94.8% stating
financial reasons. 43% continued conservative treatment, 6.3% had dialysis, 1.9% underwent
Transplant. A change in GFR of
2.95 ml/min/per year in the first two years and 2.65
ml/min/1.73m2 per year in the next 2 years was noted. At the end of 5 years, 54.5% (6/11) were in
stage 4 and 45.5 % (5/11) were in stage 5 (p- 0.003). Conclusion: Early recognition and screening
for renal disease is required. Outcome will remain poor unless social service organizations take up
their cause.
NEP/04(O) TO EVALUATE EFFICACY AND SIDE EFFECTS OF VINCRISTINE IN
CHILDREN WITH STEOID DEPENDENT NEPHROTIC SYNDOME.
Vijay K. Gavade, Vishnuvardhan Rao, Mehul A. Shah
Rainbow Children’s Hospital, Hyderabad.
vijaygavade@gmail.com
Introduction :Approximately 70% of children with nephrotic syndrome are known to have
relapses. There are limited drugs available to treat children with frequently relapsing or steroid
dependant nephrotic syndrome. Some of these drugs (MMF and CNI) are expensive and carry
significant side-effects. There are very few international and no Indian studies published to
evaluate efficacy and side effects of Vincristine in nephrotic syndrome. We performed a
prospective study to determine the role of Vincristine in steroid dependent nephrotic syndrome.
Aim: To evaluate efficacy and side-effects of Vincristine in children with steroid dependant
nephrotic syndrome. Objectives: To study the change, if any, in the frequency of relapses rate
following Vincristine therapy To study the effect of underlying renal histopathology on the
response to treatment with Vincristine To study side effects of Vincristine in the present study
group. Materials & Methods : Children between 9 months and 18 years with frequently relapsing /
steroid dependant Nephrotic syndrome, who have previously, being treated with
Cyclophosphamide, Levamisole or other immunosuppressive drugs were included. After inducing
remission with the corticosteroids, children will be administered Vincristine at 1mg/m2/dose I.V
once a week for 4 weeks followed by 1.5 mg/m2/dose I.V once a month for 4 months. Steroids
therapy will be tapered slowly. Patients will be monitored for proteinuria, blood pressure, growth
and side effects of Vincristine (abdominal pain, constipation, weakness). Children will be
followed up for atleast 1 year after Vincristine therapy. Type of Study: Prospective study.
Stastical Analysis: STATA 8 software using Wilcoxan Matched-paired single rank test to
compare relapse rate between previncristine and post Vincristine. Results: 1) 11 of 20 (55%)
children had decrease in the frequency of relapses in the 1 year post VCR therapy (p value =
0.025). 7 of these 11 (35% of the total) had no relapses in the first year of follow-up. 2) Children
with IgM Nephropathy were non-responders (100%) and its usefulness in minimal change disease
is 50%. 3) The safety profile - 7 children had minor side-effects that were treated with
symptomatic treatment and in none of these patients, VCR therapy had to be discontinued or
modified. Conclusion: We observed that Vincristine therapy is useful in some children with
steroid dependant nephrotic syndrome, especially those with minimal change disease on renal
biopsy and it was well tolerated with few side-effects. The ease of administration, low cost, and
effectiveness in selected children does indicate its role in children with SDNS. Few of the
limitations of the present study are the small number of subjects and lack of a control group.
NEP/05(P) A COMPARATIVE STUDY OF LIPID PROFILE IN FIRST ATTACK VS
RELAPSE CASES OF IDIOPATHIC NEPHROTIC SYNDROME IN CHILDREN
Das S.K. , Pradhan S.K. , Jena P. , Satpathy S.K. , Mohanty N
Sardar Vallavbhai Patel Post Graduate Institute of Pediatrics & S.C.B Medical College , Cuttack 753002, Orissa
swayam.dr007@gmail.com
Introduction: Nephrotic dyslipoprotenemia usually revert to normal with remission but
hyperlipidemia is a well known risk factor of atherosclerosis and glomerular injury in children .
There are few studies comparing the spectrum of dyslipidemia in initial attack and subsequent
relapses of nephrotic syndrome. Aims and Objectives: To compare the lipid profile in first attack
and relapse cases of Idiopathic Nephrotic Syndrome in Children. Study Design and Methodology
The prospective study was conducted between May 06 to Nov 06 at S.V.P.P.G.I. and S.C.B.
Medical College , Cuttack.. Total of 55 cases of aged 1 to 14 years, ( n = 30) were included in
first attack and ( n = 25) were in the relapse group. The demographic data , lipid profile ,
magnitude of hyperlipidemia and serum albumin were included in the study. Results: The total
serum cholesterol level ( 470 ± 116) mg/dl was higher in relapse as compared to first attack with
higher Serum TG ( 305 ± 115) mg/dl LDL (354± 126) mg/dl , VLDL ( 59 ± 24)mg/dl . However
serum HDL ( 41 ± 8) was found to be lower in relapse as compared to first attack. The serum
albumin level ( < 2.5 gm/dl) was low in all cases but in 12 % cases ( n = 4) of relapse group was
very low ( < 1 gm/dl) Conclusion: This establishes a higher serum cholesterol, TG, LDL, VLDL
and marginally lower HDL level in relapse group as compared to first attack which may be
explained by lower serum albumin level in causing higher lipid profile. This emphasis the need of
close monitoring of lipid profile and in all further episode of relapse group for dietary
modification and early intervention .
NEP/06(P) EARLY PREDICTION OF STEROID RESPONSIVENESS IN NEPHROTIC
SYNDROME BY SERIAL MEASUREMENT OF URINARY PROTEIN-CREATININE
RATIO
Pradhan Janaki Ballav, Jena Pradeep, Mohanty Niranjan,
Dept of Pediatrics, SVPPGIP & SCB Medical College, Cuttack
pradhan.janakiballav@gmail.com
Introduction: Nephrotic syndrome, a benign & chronic form of renal disease, results long hospital
stay & increased expenditure to family & society. If treated properly, mostly remits or relapses
with lesser complications. Aims & Objectives: The study of serial decline of urinary protein to
urinary creatinine ratio for prediction of early responsiveness
to steroid therapy in nephrotic
syndrome well before the urine actually becomes protein free. Materials & Methods:
Retrospective cross-sectional study of 60 nephrotic syndrome indoor patients of pediatric age
group. Urinary protein, urinary creatinine, qualitative urinary protein measurement by heat test &
sulfosalicylic acid test after starting of steroid up to 10th day & weekly thereafter till urine was
protein-free for 3 consecutive days. Results: Out of 30 cases studied; the result shows that earlier
the steroid treatment, earlier the remission. Analysing the trend from qualitative proteinuria, out of
30 patients, 23(76%) responded by 3rd day. 25(83.33%) by 5th day, 28(93.3%) by 7th day &
30(100%) by 10th day. But in comparison the steroid responsiveness as measured by quantitative
method (UProtein/UCr), clinical significance of additional 3.3% patient can be picked up by 3rd day,
13.3% by 5th day and 6.7% by 7th day. Conclusion: Serial measurement of UProtein/UCr shows an
additional & early marker for steroid responsiveness. By serial measurement of UProtein/UCr, the
total remissions occur in 7th day as compared to qualitative protein measurement which occurs in
approx. 10th day.
NEP/07(P) A STUDY OF RENAL DISEASES IN CHILDREN-EXPERIENCE IN
JHARKHAND.
Anil Kumar Chaudhary
Professor, Dept of Pediatrics, RIMS, Ranchi
dr_akchaudhary@rediffmail.com
Introduction: Renal diseases are important cause of morbidity and mortality in children. If
diagnosed early most of these conditions have a favorable outcome. Aims & Objectives:The
present study was done to know the various types of renal diseases present in the state of
Jharkhand and their age & sex distribution and other demographic pattern. Material &
Methods:The study was carried out in the Department of Pediatrics, RIMS, Ranchi from January
2006 to December 2006.The number of cases studied was 131 on the basis of various
presentations of renal diseases, confirmed by laboratory tests. This was hospital-based study on
admitted cases. Result: Total number of admission in the department of Pediatrics was 2834, out
of these 131(4.62%) cases were diagnosed as having different renal diseases. Out of 131 cases
96(73.2%) cases were of Nephrotic syndrome, 20(15.2%) cases were of acute glomerulonephritis,
8(6.1%) cases of UTI were diagnosed. The ARF and CRF were 5(3.8%) & 2(1.52%) respectively.
The age distributions in nephrotic syndrome cases were 51(53%) between the ages of 5-8 years,
next between 1-4 years of agei.e.29cases (30%). The sex distribution of nephrotic syndrome was
1.4:1(male-56 & female-40). The 11 cases out of 20 cases of AGN were female (M: F=0.81:1).
Out of 20 cases of AGN 10 were below the age of 8 years. In UTI out of 8 cases 2 were female
(M: F=3:1) and 5 cases out of 8 UTI cases were below the age of 8 years. The 2 cases of ARF
were due to malaria and 1 each due to glomerulonephritis & HSP. Out of 131 cases 4 died during
hospital stay, 1 due to malaria leading to ARF, 2 due to AGN & 1 due to nephrotic syndrome.The
81(84.38%) cases were responsive to steroid and 58 cases (60.41%) recorded as first episode of
nephrotic syndrome.E.coli was most common organism found in UTI (62.5%), followed by
Klebsiella (25%). Conclusions:The incidence of nephrotic syndrome in our study was found to be
33.87 per 1000 hospitalized children and it accounted for 73.2% cases of renal diseases. In Indian
subcontinent the incidence is estimated to be 90-100 per million populations. AGN is less than 5%
as per various studies and in our study only 0.71% found. The incidence of renal failure is 2-5 per
million populations of children and it was 2.47 per 1000 children in our study.Above findings
suggests poor medical awareness among patient,parents & physician about kidney
diseases.Doctors working in periphery may not be aware of this high incidence of renal diseases in
Jharkhand.Further studies which include large sample and broad base are required to know the
exact incidence of these diseases in general pediatric population.
NEP/08(O) LIPID PROFILE IN CHILDHOOD NEPHROTIC SYNDROME: IMPACT OF
TREATMENT OF NEPHROTIC SYNDROME AT THREE MONTHS OF FOLLOW UP.
Prasanth K.S , Susan Uthup , Geetha. S , Lalitha Kailas
Dept. of Paediatrics, SAT Hospital, Govt. Medical College, Thiruvananthapuram.
drprasanthks01@gmail.com
We have studied the lipid profile in Childhood Nephrotic Syndrome (NS) and observed
persistence of dyslipidemia at 3 months of follow up in Steroid Resistant, Dependent and Frequent
Relapsing Nephrotic Syndrome. Longer follow up in dependent & frequent relapsers is required to
assess the need of lipid lowering therapy as in resistant NS. Objectives: To identify the pattern of
lipid profile in childhood nephrotic syndrome ( first episode or relapse) and follow up the pattern
after three months of starting treatment; and to compare the effects of treatment of nephrotic
syndrome on lipid profile in steroid sensitive, frequent relapsing, steroid dependent and steroid
resistant nephrotic syndrome at 3 months after recruiting into the study. Settings: Tertiary care
teaching hospital. Design: Prospective Hospital based Cohort Study. Methods: Children with
idiopathic nephrotic syndrome during relapse were categorized into 4 groups: infrequent relapsing
nephrotic syndrome (IRNS), frequent relapsing nephrotic syndrome (FRNS ) ; steroid dependent
nephrotic syndrome (SDNS ) and steroid resistant nephrotic syndrome (SRNS ).The fasting
venous blood samples were analyzed for the total cholesterol , triglycerides , high density
lipoprotein – cholesterol , low density lipoprotein – cholesterol and very low density lipoprotein
– cholesterol at entry point and after three months of starting steroids. Data was analyzed using
ANOVA and paired t test for significance. Results: Statistically significant (P < 0.05) drop in
lipid profile on follow up was noted in all categories of children with nephrotic syndrome other
than SRNS. Abnormal lipid profile (> 95th centile of normative data with which comparison was
made) was persisting in SRNS as well as in FRNS and SDNS on follow up at 3 months.
Conclusion: In FRNS and SDNS, extended follow up is needed to ascertain the persistence of
hyperlipidemia associated with multiple relapses and the need for lipid lowering therapy as
recommended for SRNS.
NEP/09(P) CLINICOETIOLOGICAL STUDY OF ENURESIS IN CHILDREN
Neelam Bansal, V. N. Tripathi, Rupa D Singh
Department of Pediatrics, G.S.V.M. Medical College, Kanpur
drneelambansal@gmail.com
Objective :
To evaluate the risk factors associated with primary and secondary enuresis.
Material and Methods : A hospital based cross sectional study conducted in Govt. hospital of
Kanpur, in 9400 children between 5-18 years of age attended OPD during the study period, March'
08-June'09. 320 of these were cases of nocturnal enuresis. A detailed history inclusive of age, sex,
type of enuresis, family size and similar affection, birth order, socioeconomic status, sleep pattern,
behavioral and psychological background, bowel and bladder habits and history of secondary
enuresis was taken. All underwent physical examination, urine analysis and culture and special
investigations were done as per required. Result : Incidence was found to be 3.4%. Mean age in
male was 9.96+2.61 and female 9.25+2.50. Male : Female - 1.75:1, maximum between 7-9 years
of age. 86.25% children had severe enuresis (>3 times/weak). Large family size, low SES,
subsequent birth order, deep sleep and genetic predisposition were significantly associated, both
with primary and secondary enuresis (P<.001), while constipation and diurnal voiding daytime
symtoms (DVDs) were significantly only with primary and urinary tract infection with secondary
enuresis. Behavioral and psychological factors did not have significant association. Conclusion :
Due to large family size, low SES and high birth order, parents do not pay sufficient attention to
their children. A positive family history show a very causal attitude of parents towards enuresis, in
hope of spontaneous resolution and become concerned only when severity of enuresis and DVDs
does not resolve despite increase in age.
NEP/10(O) EFFECT OF IMIPRAMINE, OXYBUTININ AND DESMOPRESSIN IN
CHILDREN WITH PRIMARY NOCTURNAL ENURESIS
Sanjiv Nanda, Anubha
PGIMS, Rohtak
smitimom@gmail.com
Introduction: Nocturnal enuresis is a widespread and potentially disabling disorder for children.
Aims & Objectives: To compare the efficacy of Imipramine, Oxybutinin and Desmopressin in the
treatment of primary nocturnal enuresis. Material & methods: Ninety children of either sex in the
age group of above 5years to 14 years, presenting with primary nocturnal enuresis, were randomly
divided into 3 age and sex matched groups to receive Imipramine (Group I), Oxybutinin (Group
II) and Desmopressin (Group III). Number of wet nights after drug therapy, after follow up period,
occurrence of side effects and degree of compliance was noted. The results were statistically
compared using student t- test (paired and unpaired) and analyzed. Results: Mean number of wet
nights/ month after drug administration period in were 1.771.22 (mean reduction 22.634.61),
1.81.06 (mean reduction 22.226.35) and 1.11.21 (mean reduction 23.04.59) in Gp I, II and III
respectively. The mean change in number of wet nights per month during the follow up period was
from 1.77±1.22 to 3.8±1.71 nights per month in group I, from 1.8±1.06 to 2.67±1.67 nights per
month in group II and from 1.1±1.21 to 2.2±1.9 nights per month in group III. After the drug
treatment period the mean number of dry nights was 26.231.22 nights/ month, 26.21.06 nights/
month and 26.911.2 nights/month in group I, II and III respectively. Responders at end of drug
administration period were 43.3% (Group I), 30% (Group II), and 70% (Group III). Incidence of
relapse was 76.9%, 33.3% and 33.3% in I, II and III respectively. Conclusions: All the three drugs
cause significant reduction in wet nights. However Desmopressin had the highest response rate
and the lowest relapse rate. Imipramine had a better response rate than Oxybutinin but it also had
the highest relapse rate among the three drugs. The side effects were minimal and the compliance
was very good in all the groups.
NEP/11(P) URINARY TRACT INFECTION AND UNDERLYING URINARY TRACT
ABNORMALITIES IN CHILDREN
Dey P.K., Singh R.P., Tripathi V.N. , Arya A.K. ,Mangal Y. D., Upadhaya G.C.
Department of Pediatrics, L.L.R and Associated Hospital,G.S.V.M.Medical College.Kanpur
drpranabdey@gmail.com
Introduction: Urinary Tract Infections (UTI) may be a variety of presentation of underlying
urinary tract abnormalities including vesicoureteric reflux (VUR), urolithiasis, and obstructive
uropathy. The long-term complications of UTI with these conditions are recurrent UTI , renal
scarring, hypertension, and chronic renal failure. Objective: To study the prevalence of the
underlying abnormalities of the urinary tract in children with urinary tract infection (UTI).
Materials and Methods: Hospital based prospective study on 180 patients ( 6 months to 10 years)
with symptomatic UTI diagnosed by positive urine culture (colony count>105 CFU/ml) over a
period of 1 and1/2 years. Patients with incomplete investigations were excluded from the study.
102 patients (62girls and40 boys) were included in this study. Antibiotcs are given according to
the sensitivity pattern. Renal ultrasonogram and MCU were obtained for all patients with
symptomatic UTI except for first episode of cystitis in girls over 5 years of age with normal renal
ultrasonogram.Results: Out of 102 patients 62 (60.78%) girls and 42 (39.21%) boys, most of the
patients (62.73%) within 6 months-5 years old.The
commonest
presentation fever
(84.3%),increased frequency of urine (38.4%).The
commonest organism was E.Coli
(81.7%).VUR was found in 31(30.3%),18 girls,13 boys.Other urinary tract abnormalities were
urolithiasis in 8 (7.8%) patients ,Ureteropelvic junction obstruction in 4,Ureterocele in1
girl,Ureteric duplex in1 boy,Posterior urethral valve in1boy respectively.Conclusions : 30% of
patients had VUR and 14.7% had other abnormalities in urinary tract. These support the idea that
nearly all the symptomatic UTI patients need a appropriate complete imazing work up.
NEP/12(P) ROLE OF LOW DOSE STEROIDS IN STEROID DEPENDENT &
FREQUENTLY RELAPSING - NEPHROTIC SYNDROME
B. Sarath Balaji, M. Kulandaivel, Chitra Ayyappan, P.Amutha Rajeswari
Institute of Child Health & Research Centre, Govt. Rajaji Hospital, Madurai.
aapabirami@yahoo.co.in
Aim: To establish the Role of Low Dose Steroids in Steroid Dependent & Frequently Relapsing Nephrotic Syndrome and follow up for new relapses and steroid side effects. Definition: Frequent
Relapser: Two or more episodes in 6 months or Four or more episodes in 12 months Steroid
Dependent Nephrotic Syndrome:Tow consecutive relapses during alternate day steroids or within
14 days of stopping steroids Study Design: Prospective Interventional Study. Study Period: July
2008 to September 2009 Materials and Methods: All frequently relapsing and steroid dependent
children (28boys & 6girls) of Nephrotic Syndrome registered in our Nephrology O.P. were started
on Oral Prednisolone at a dose of 1.5mg/kg every alternate days tapered at the rate of
0.25mg/kg/month till the dose of 0.5mg/kg every alternate day which was maintained for 9-18
months. During this period, children were observed for relapses steroidal side effects and
monitoring of monthly Blood pressure, monthly blood glucose and monthly weight.
Ophthalmologic examination for posterior sub capsuler cataract were done before and at the end of
study period. Height was estimated before and at the end of study period. Results: Among the
study group 26 children (23boys & 3girls) (76.47%) did not develop any relapse and 8 children
(6boys & 2girls) (23.53%) developed one relapse during the study period. 2 children who relapsed
had posterior sub capsuler cataract (vision not affected) and 2 children developed hypertension.
Children with the above steroidal side effect are now on cyclophosphamide therapy. Conclusion:
76.47% frequent relapsers and steroid dependent subjects who were on low dose (tapering)
steroids did not develop any relapse or side effects of steroids during the followup period.
NEP/13(P) NEPHROTIC SYNDROME WITH BARTTER SYNDROME-A RARE
COEXISTENCE IN CHILDREN
Hema Mittal, Anju Aggarwal, Sanjib Kr Debnath, Veena Batra, Prerna Batra
Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur
Hospital, Delhi,
hema_g10@hotmail.com
Introduction Simultaneous presence of Nephrotic Syndrome( NS) and Bartter Syndrome(BS) is
rare. We report two boys diagnosed of NS who presented with features consistent with
BS(presence of hypokalemic metabolic alkalosis, normotension, excessive urinary chloride and
calcium loss) Case I: A 6.5 years boy diagnosed of NS 4 years back presented with loose motions,
vomiting and neck flop. On examination child weighed 15 kg, length 106 cm, BP-100/74 mm Hg,
mild dehydration and neck flop. Systemic examination was normal. Investigations revealed
persistent hypokalemia (0.8- 3.5mg/dl), metabolic alkalosis (pH 7.6, Co2 24.4, Hco3 31.5, BE 2.9).
24 hours urinary loss of chloride was calcium was high (142meq/L,121mg respectively).
Ultrasound abdomen showed normal kidneys and adrenals. Renal biopsy concluded minimal
change disease; but focal and segmental sclerosis could not be ruled out. Ibuprofen administration
normalized serum potassium. Recurrence of hypokalemic alkalosis and increased renin level (7.75
ng/ml/hr) after 48 hours of stopping ibuprofen further supported the diagnosis of BS. Case II A 8
year old boy with NS since 2 years presented with loose motions, pain abdomen, increased water
intake and urinary output. On examination child weighed 14 Kg, length 120 cm, BP-100/74,
severe dehydration, generalized wasting, and mild pallor. Systemic examination was normal.
Investigations revealed hypokalemia (2.2meql/L), metabolic alkalosis (pH 7.6, CO2 33.4, HCO3
32.3, BE 13.4) and high 24 hours urinary loss of chloride (46mmol/L) and calcium (54mg).
Ultrasound abdomen showed normal kidneys and adrenals. Renal biopsy revealed increase in
mesangial matrix and normal juxtaglomerular apparatus. Potassium levels normalized after
ibuprofen treatment and recurred after stopping ibuprofen. On follow there is improved growth
and normal potassium levels Conclusion: This case highlights rare coexistence of two syndromes
and calls for further investigations for the possible genetic relationship between them.
NEP/14(P) TO COMPARES THE EFFICACY OF 5% AND 20% ALBUMIN IN
TREATING ANASARCA IN CHILDREN WITH NEPHROTIC SYNDROME.
Ajoy Garg, Madhuri Kanitkar, Uma Raju,
Department of Pediatrics, Command Hospital, Pune
rakhee.garg@yahoo.com
Introduction: Nephrotic syndrome is a state of intravascular volume depletion; use of albumin
along with diuretic prevents hypovolemia and helps to manage refractory edema. Aim and
objective: To compares the efficacy of 5% and 20% albumin in treating edema in children with
nephrotic syndrome Material and method: Randomized cross-over study comparing efficacy of
two different concentration of human albumin. Conducted from July 2006 to July 2008. Children
with Nephrotic Syndrome presenting with anasarca were included. Baseline urine output and wt
recorded .After random allocation; patients were given 5% or 20% albumin @ 1gm/kg over 4 hrs
and Frusemide @ 2mg/kg bolus given midway. Urine output and weight recorded. Washout
period of 24 hrs was allowed. Baseline weight, , and urine output recorded over 24 hrs before
infusion of other form of albumin i.e. 5% or 20% Frusemide was given at midway @ 2mg/kg.
Weight and urine output recorded. Data was analyzed by using paired T test Result: Clinical
profile of 24 children (Male: Female ratio 3:1) with anasarca were studied. They were aged
between 15months to144 months. There is significant increase in urine output and reduction in
weight when albumin is used along with frusemide. There was no significant difference between
the infusion of 20% or 5% albumin in reducing weight and increasing urine output. There was
statistically significant weight reduction with sequential use of Albumin i.e. use of 5% albumin 1st
followed by 20% albumin and vice versa. Conclusion: Albumin along with furesimide has role in
treating anasarca and sequential use of 5 and 20% is more effective.
NEU/01(P) SPECTRUM OF PRESENTATION OF NEUROCYSTICERCOSIS IN
CHILDREN
Ravinder K. Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences (ASCOMS) Sidhra,
Jammu.
drrk_gupta2000@yahoo.com
Objective:To study the diverse initial presentation of neurocysticercosis and its correlation with
the radiological finding
in children. Setting: Outdoor and Indoor wing of Department of
Pediatrics ASCOMS Hospital. Design:Prospective Study Subjects and Methods: A prospective
study consisting of fifty children from outdoor and indoor wing of Department of Pediatrics,
Acharya Shri Chander College of Medical Sciences (ASCOMS), Sidhra confirmed to have
neurocysticercosis (NCC) was conducted. All of them were treated. The initial presentation of
these children and the correlation with the radiological location in form of CT scan and MRI Brain
were analyzed. Relevant investigations were performed to exclude other causes. Each child was
given anticonvulsants, albendazole for 4 weeks and short term steroids. These children were
followed after 6 months and were asked to have neuroimaging repeated. Results: There was a
definite male dominance (M:F = 1.5 :1). Majority of the children (64%) were between the age
group of 3-9 years. Initial presentation were simple partial seizures (54%) with [motor (20),
sensory (2) symptoms and secondary generalization (5)]. Other types of seizures included complex
partial seizures (22%) and generalized tonic clonic seizures (28%). Headache (4%) and visual
complaints (2%) were other presenting features. Right parietal (30%), left parietal (24%), right
parieto-ocipatal (18%), left temporal (14%) and multiple lesions (14%) were the radiological
evidence (CT scan and MRI Brain). Repeat neuro imaging done after 6 months showed complete
resolution of the lesions in (76%) cases, regression of lesions (16%) and calcification (8%). There
was no recurrence of seizures. Conclusion: Neurocysticercosis has varied presentation. Besides
partial seizures, generalized tonic clonic seizures can also be the initial presentation. Parietal
lesions are the commonest neuro imaging finding. Albendazole therapy can lead to complete
resolution. Neurocysticercosis has a better prognosis.
NEU/02(P) APLASIA CUTIS CONGENITA WITH ACALVARIA
Prashant Patil, Rekha S., Ashok Rathod
Room no. 426, 300 Resident Doctor Quarters, Grant Medical College & Sir J.J. Group of
Hospitals, Mumbai-400008
drprashant1981@gmail.com
APLASIA CUTIS CONGENITA is a rare condition characterized by the total congenital absence
of all skin layers, most commonly on the scalp , rarely affecting deep tissues such as the skull
bone and dura. Mortality is related to the depth and size of the lesion. The treatment remains
controversial both surgical and conservative managements are described. We present a case of
complete aplasia cutis with absent parietal bone which was managed conservatively with normal
developemental milestones. A 14day old male weighing 2.5 kg born to primigravida by
nonconsanginous union was referred to us for large scalp and skull defect. No antenatal ultrasound
were done. There was no history of any antenatal maternal illness or any medication taken. On
examination, patient had large full thickness scalp defect measuring 1812cms on vertex and
lateral side, thereby exposing the dura. The edges of defect showed early granulation tissue. There
was encephalocele in frontal area measuring about 1.21.5cms with herniation of pia arachnoid
through a wall defect. without CSF leakage.The rest of systemic examination was normal.
Neuroimaging ( CT scan, MRI) revealed absent parietal bone with normal intracranial content.
Patient was managed conservatively with saline dressings twice daily and bacitracin ointment to
prevent infection. Patient was discharged after 2 months with counseling. On regular follow up,
Patient had normal developmental milestones with reduction in size of lesion. At age of 10
months, patient had meningitis. Despite antibiotic and rotational flap surgery, patient succumbed
to infection.
NEU/03(P) SCHIZENCEPHALY: A CASE REPORT.
Nishant, N P Gupta, R Prasad.
Department of Pediatrics, Darbhanga Medical College, Laheriasarai.
drnishant_dmch@sify.com
Five years old, male, presented with recurrent seizure and gradual decline of intellectual function
since one year. Seizure was of generalized tonic clonic type and persisted for approx.10 min.and
response to antiepileptic drug was poor. The child also had weakness on left side of the body.
Weakness was more pronounced on left lower limb. Birth History was normal. There was no
family history. On examination, patient was thin built with failure to thrive and having
microcephaly. Child was conscious with stable vitals. Features of UMN lesion were present. CBC
and CXR were normal.CSF examination was normal. Eye examination was normal. CT Scan
showed well defined extraaxial cystic right parietal area (showing CSF density 9 HU)
communicating with the body of right lateral ventricle confirming OPEN LIP
SCHIZENCEPHALY. MRI showed that the cleft is lined by gray matter. DiscussionSchizencephaly is an uncommon disorder of neuronal migration characterized by a CSF–filled
cleft, which is lined by gray matter. Patients may present with intractable seizures, microcephaly,
mental retardation, hemiparesis or quadriparesis and hypotonia.The cleft may extends across the
entire cerebral hemisphere and may be unilateral or bilateral and may be closed (fused lips), as in
schizencephaly type I, or separated (open lips), as in schizencephaly type II. Schizencephaly type
II occurs more commonly than type I and has poor prognosis. Open Lip Right Schizencephaly
NEU/04(P) CLINICAL PROFILE OF MENTALLY HANDICAPPED CHILDREN OF
PRAYAS SANSTHAN
Nitin Goyal, Abhishek Ojha, Devendra Sareen
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
Mentally handicapped children form the most vulnerable group of our community. The present
study had been planned to find the clinical profile of these mentally handicapped children. For this
study 75 children of Prayas Sansthan were thoroughly evaluated. After obtaining a detailed
history, a thorough physical examination of each child was done with special emphasis upon the
neurological assessment. All the observations were recorded in the performa and subsequently
data analysis was done. We observed that among 75 children studied, males predominated over
females in a ratio of 3:1. Mental retardation was observed in all the children studied. The
commonest handicap was cerebral palsy seen in 28.6% children. Further spastic quadriparetic CP
was commonest (20.8%), followed by choreo athetoid (2.6%), mixed CP (2.6%), Atonic diplegia
(1.3%) and hemiparetic CP (1.3%). Next to CP was autism (10.4%) and Down syndrome (9.1%).
Frank convulsions were observed in (14.3%) children. As regards mental retardation profound MR
was seen in 7.8% children, severe MR in 18.2%, moderate MR in 57.2% children and mild MR
was seen in 14.3% children only. Delayed speech was encountered in 16.9% cases while defective
hearing was observed in 14.3 of them. Multiple disabilities were observed in 18.2% of these
children. Hence, we must subject these mentally handicapped children for their neurological
assessment, so that early intervention can be done wherever indicated.
NEU/05(P) REPORT OF TWO CASES OF FULMINANT CEREBELLITIS- A
POTENTIALLY FATAL CONDITION
Pawan K. Darak, Mahesh Kamate, Vivek Chetal, Virupaxi Hattiholi
Resident, Dept. of Pediatrics, KLE University’s J N Medical College, Belgaum,
drmaheshkamate@gmail.com
Acute cerebellitis is a condition that is frequent in childhood and may result from viral or
autoimmune etiologies. This disease has been reported to have a variable course and is usually
benign. Acute cerebellitis with cerebellar swelling, hydrocephalus and brainstem compression,
when it is known as fulminant cerebellitis, is an exceptional but life-threatening condition.
Suspicion of this entity leading to quick diagnosis and a timely intervention in the form of
institution of high dose steroids, ventilation and surgical decompression will help in saving these
patients. We present two cases of fulminant cerebellitis with varying severity where in one could
be salvaged by early diagnosis and adequate management and death resulted in one case due to
brainstem involvement. Case-I was a 9-year-old boy who was referred to the PICU with
complaints of severe occipital headache, vomiting and worsening gait. Neurological examination
revealed a conscious boy with bilateral lateral rectus palsy, brisk reflexes and truncal ataxia. Over
a period of next 24 hours, the child’s sensorium deteriorated and he lapsed into coma. Magnetic
resonance imaging (MRI) demonstrated hydrocephalus with signal changes in the cerebellum and
brainstem compression. Child was subjected to external ventricular drainage and ventilated. Highdose methylprednisolone was initiated but the child continued to worsen and died within 24 hours.
Case II was a ten year old girl who presented in a similar manner but responded to our treatment
and recovered within one week. MRI revealed cerebellitis with brainstem compression and CSF
was normal in this case. The etiologies, clinical course and therapeutic interventions of this
potentially life-threatening condition are briefly reviewed.
NEU/06(P) TUBEROUS SCLEROSIS (A CASE REPORT)
Karuna Thapar, Renu Gupta, Ira Dhawan
renu.gupta31@gmail.com
Introduction: Tuberous Sclerosis as tuberous Sclerosis complex is a rare, multi system genetic
disease that causes benign tumor to grow in brain and other vital organs such as kidneys, heart,
eyes, lungs and skin. A combination of symptoms may include seizures, developmental delay,
behaviour problems skin abnormalities, lung and kidney disease. Case report:A 4 years female
child came with complaints of cough, headache, single episode of vomiting and focal seizure. Past
history of recurrent seizures since age of 10 months. Perinatal history was insignificant. O/E G.C
was fair ,vitals were within normal limits .Anthro poemetry Ht = 100 , Wt = 12 , HC = 47
cm(microcephaly) , Systemic examination revealed- alopecia,forehead plaque,angiofibroma over
face. Post ictal neurological examination and rest of systemic examination was normal,On
investigation-routine investigations were witin normal limits Echo-cardiography & USG
Abdomen were normal,Fundus was normal,EEG was abnormal, MRI brain revealed cortical and
subcortical white matter lesions with subependymal nodules consistent with those of tuberous
Sclerosis. On basis of diagnostic criteria – facial Angiofibroma cortical tuber in brain and
subependymal nodules diagnosis of tuberous sclerosis was made.child was put on antiepileptic
treatment,seizures were controlled.The case is being reported for its rarity
NEU/07(P) BENIGN CONGENITAL HYPOTONIA
Karuna Thapar, Ira Dhawan, Renu Gupta, Shashikiran Singh
renu.gupta31@gmail.com
The term benign congenital hypotonia is still used to describe children with mild hypotonia who
appear to have a favourable outcome and in whom no other diagnosis at this stage can be made.
True incidence of benign congenital hypotonia is not known but is less than first thought as many
have now received other diagnosis.There is a familial tendency with approximately 30% of
affected children having same family tendency. Boys and girls are equally affected. Case Report :
7 days old female child came in pediatric unit with chief complaints of lethargy since birth,
decreased movements of limbs since birth.Antenatal history was uneventful.History of breech
presentation with prolonged labour was present and trial labour by dai at home was given, which
landed to LSCS at hospital. Baby cried immediately after birth. On Examination – G.C fair, vitals
were within normal limits but generlised hypotonia present. Lower limbs were more hypotonic
than upper limbs. Neonatal reflexes were sluggish except sucking and rooting. Anthropometry
was within normal limits.Deep tendon reflexes were present.Superficial reflexes were present
with planter dorsiflexed. Rest of systemic examination was in normal limits On investigations
CPK levels,electrolytes,EMG and motor nerve coduction were normal .All causes of neonatal
hypoplasia were ruled out and child progressed over 12 days of life child started active movements
and was discharged. This case is reported for its rarity&knowledge of pediaticians
NEU/08(P) LATE INFANTILE FORM OF METACHROMATIC LEUKODYSTROPHY –
A CLINICO-RADIOLOGICAL CORRELATION
Dhivyalakshmi J, Premila Paul
Dept. of Pediatrics, Safdarjung Hospital, New Delhi
dhivya8@yahoo.co.in
Four year old male child born out of non- consanguineous marriage came with history of
progressive loss of milestones starting from lower limbs gradually involving trunk and upper
limbs and inability to speak over a period of 1 ½ years. There was H/O altered sensorium with
generalized hypertonia and coarse tremors of hands. H/O similar illness in the elder sister who
died at 4 yrs of age. No other significant history. He had Rt. eye primary optic atrophy and Lt. eye
optic disc coloboma but preserved pupillary responses, spasticity, coarse tremors of hands and
absent DTR’s with B/L upgoing plantar response. He had cortical thumb and head circumference
was 50cms. There were no neurocutaneous markers. Possibility of metachromatic leukodystrophy
was considered. MRI brain showed diffuse periventricular and deep white matter hyperintensities
suggestive of demyelination with linear striations(tigroid/leopard skin appearance) with relative
sparing of subcortical U-fibers,cerebral and cerebellar atrophy and corpus callosum
hyperintensities. Features were suggestive of metachromatic leucodystrophy and pelizaeus
Merzbacker disease. VER showed extinguished responses in both eyes. BERA showed poor wave
forms suggestive of poor hearing. Metachromatic leukodystrophy was confirmed by Arylsulfatase
A enzyme assay which was less than detectable levels (normal – 25 to 80 nmol/hr/mg). Nerve
conduction studies revealed sensory motor neuropathy (axonal and demylinating). Metachromatic
leukodystrophy is an autosomal recessive disorder (Chromosome 22q13.31 qter) caused by
deficiency of the lyzosomal enzyme (arylsulfatase A) or its activator protein. No racial or sex
predilection. Late infantile form is the most common presentation. Presently, there is no effective
treatment for the late infantile form.
NEU/09(P) FOLLOW UP OUTCOME OF NON TRAUMATIC COMA IN CHILDREN - A
PROSPECTIVE STUDY
Bindu Madhavi Parchuri, Dinesh Chirla, Farhan Shaikh, Ramesh Kancharla, Preetham Kumar,
Lokesh Lingappa
Department of Paediatric Intensive Care, Rainbow Children’s Hospital Group, Hyderabad.
drbindu@gmail.com
Objectives: To study the clinical profile, immediate and follow up outcome of children with non
traumatic coma. To determine the clinical signs predictive of outcome. Study period- 2007 June to
2008 June Subjects- Children with non traumatic coma GCS </=12; 2mo to 18 years Exclusion
Criteria- Trauma and burns with coma Prospective observational study Methodology: Etiology of
the coma was determined on the basis of history, examination and relevant laboratory
investigations. Immediate and follow up outcome were assessed with Glasgow outcome scales.
Chi-square test and logistic regression analysis were done to determine predictors of outcome.
Results: Etiology of coma in 46.15% children was CNS infection making it the most common
cause of non-traumatic coma. (Viral encephalitis- 32.7%, bacterial meningitis- 9.61%, tubercular
meningitis-3.8%); other causes were toxic-metabolic conditions (23%), status epilepticus (15.4%),
intracranial bleed (4%).Out of 88% children survived, 54% had good recovery, 15.4% had
moderate disability, 11% had severe disability and 8% in persistent vegetative state. Survival was
better in patients with CNS infection (95%) when compared to status epilepticus (75%) and the
disability was more with the toxic and metabolic causes. Survival was better with increasing GCS.
On follow up, 84% were in good recovery, 9% were with moderate disability, 4.6% in severe
disability and 2.3% in vegetative state. One child with 2-hydroxyglutaric aciduria died one week
after discharge. Conclusion: Higher GCS and infectious causes of non traumatic coma had better
immediate and follow up outcome. Ventilation in itself was not a poor prognostic indicator.
NEU/10(O) CLINICAL, NEUROIMAGING, AND LABORATORY PROFILE OF
CHILDREN WITH ACUTE DISSEMINATED ENCEPHALOMYELITIS.
Gurdeep S Dhooria, Harmesh S Bains, Deepak Bhat, Shalini Sikka
Dayanand Medical College & Hospital, Ludhiana, Punjab
gurdeep2005_123@sify.com
Type: A retrospective hospital based study Objective: To study the clinical, neuroimaging, and
laboratory profile of children with acute disseminated encephalomyelitis (ADEM). Methods:
Eleven children admitted in Pediatric Department of Dayanand Medical College and Hospital,
Ludhiana over a 4 year period, consistent with diagnosis of ADEM on clinical and investigative
grounds were included in the study. Results: Six cases (54%) cases were between age group of 611yrs. Patients presented most often with fever (82%), headache (64%), altered sensorium (64%),
vomiting (36%), and seizures (36%). Neurological signs commonly seen were hyperreflexia
(64%), cranial nerve palsy (45%), hypertonia and gait disturbance (36%) each. Respiratory failure
was present in 2 patients (18%). Optic neuritis was seen in one patient. Spinal fluid abnormalities
occurred in 55% cases. Brain magnetic resonance imaging identified lesions in the cerebral cortex
in 44%, subcortical white matter in 45%, periventricular white matter in 36%, brainstem in 18%
of patients and deep gray matter in 10%. Ten patients (91%) were treated with corticosteroids.
Majority of patients survived. One patent died of severe sepsis and shock with pneumonia and
respiratory failure. Six patients (54%) had neurologic sequelae at the time of discharge.
Conclusions: Magnetic resonance imaging was the imaging of choice for establishing the
diagnosis. Prognosis for survival and outcome was good in majority of the patients. Recurrent
episodes of ADEM must be differentiated from multiple sclerosis.
NEU/11(P) MICROCEPHALY IN OUR SET UP: AN EVALUATION
K.K. Locham, Manpreet Sodhi, Neha Sharma
Department of Pediatrics, Government Medical College/Rajindra Hospital, Patiala - 147001
kklocham@hotmail.com
Microcephaly has got varied causes. Evaluating its cause is an uphill task. Aims & Objectives: To
know the cause of microcephaly in our set up. Material & Methods: 16 indoor children were the
subjects of the study. Microcephaly was diagnosed when head circumference of child was less
than 3rd percentile of NCHS standard. Age, sex, grade of malnutrition, etiological factors and
associated malformations were recorded on a pre-designed proforma. CT scan was done
depending upon the affordability. Results: Majority (9) of cases were infants of whom 7 were
male. 5 children were in age group of 1-3 years & out of whom 4 were female. 2 children were in
3-6 years age group. Malnutrition was observed in 14 cases. 4 had acute & 10 had chronic
malnutrition. Maximum (7) cases were of grade III followed by 4 of grade II & 2 grade IV
malnutrition. One case was of grade I malnutrition. Microcephaly was associated with
malnutrition alone in 14 cases, with cerebral palsy in 2 cases, post meningitic sequelae in 1 case &
suspected intrauterine infection in 2 cases. 3 cases had down syndrome. One child with Down
syndrome also had malnutrition. It was idiopathic in 2 cases. CT Scan could be done in 6 cases. It
was normal in 4 & 2 cases had infarction as a sequelae of hypoxic ischemic encephalopathy.
Conclusion: In majority of cases, cause was malnutrition.
NEU/12(O) CLINICAL PROFILE & OUTCOME OF GBS IN A TERTIARY CARE
HOSPITAL
Abhishek, Leena Das, S.S.Beriha, Niranjan Mohanty
Department of Pediatrics, SCB medical College, Cuttack
a_singh2711@yahoo.co.in
Objective- To see the clinical profile, progression, complication & the outcome of GBS DesignLongitudinal prospective study for 2 years Subjects & Method- 32 cases of GBS admitted to
Pediatrics dept of SVPPGIP, Cuttack were taken from September 2007 to August 2009 .
Diagnosis was made basing on clinical criteria and CSF study. Results-24(75%) cases were male
& 8(25%) were female.5(15.6%)cases were <3year of age, 10(31.25%) were between 3-5yr,
11(34.37%) were between 6-10yr, 6(18.75%) were >10yrs. All cases had lower limb weekness at
presentation. 21(65.62%) cases progressed to involve upper limb, out of this 18 cases (85.7%)
got involved in the 1st day itself. Respiratory muscle involvement was in 13 cases (40.62%). From
the onset of weekness respiratory muscles got involved on 1st day in 8 (61.5%), on 2nd day in 3
(23%), on 3rd day in 2(15.38%) cases. Cranial nerves were involved in 8 cases(25%).
Hypertension was found in 7 cases.(21.87%). None had sensory involvement .Raised ICT was
seen in 4 cases (12.5%), 16 cases (50%) were admitted to ICU. 8 (25%) required ventilator but
only 6 accepted. Duration of patients on ventilators was 2-3 week in 1 case (16.66%) ,3-4 week in
4(66.66%) & >4week in 1case(16.66%). Duration of ICU stay was <1week in 9(56.25%)cases &
>3 weeks in 3 (18.75%) cases. 3 patients(9.37%) died in hospital while 5(15.62%) Left Against
Medical Advice Conclusion- GBS is predominant in males. Age group of presentation is 3-10
years. Presentation is usually ascending type. Upper limb if involved do so within 1 day of onset
of lower limb weekness. Respiratory mucle involvement is usually within 3 days of onset of
weakness. Hypertension is seen in significant proportion. Sensory involvement is very uncommon.
Majority require ICU care. Those with repiratory failure require ventillatory support for 3-4
weeks. Fatality is quite high as compared to international standards.
NEU/13(P) MEGA CISTERNA MAGNA – A BENIGN DEVELOPMENTAL VARIANT
MASQUERADING AS SPACE OCCUPYING LESION– A CASE REPORT
Harmeet Singh Arora, DS Chhajta.
Dept of Pediatrics, Military Hospital, Roorkee, Uttarakhand – 247667
vicky_arora18@rediffmail.com
Introduction : Mega cisterna magna is a rare, usually benign congenital developmental intracranial
malformation, and is a component of spectrum of Dandy walker malformation complex, with
normal vermis and cerebellar hemispheres. It is a rare cause of midline, extra-axial, posterior fossa
cyst. It may present as a massive, horrifying intracranial mass, masquerading as brain tumour.
Case report : Eleven years preadolescent boy , first product of non consanguineous marriage,
presented to us for the first time with his history of five episodes of partial complex rt sided
seizures since eight years of age. He was a developmentally normal child. Seizures were well
controlled on single anti seizure drug, with recurrence of seizures few days back while on tapering
doses of AED. EEG done at onset revealed abnormal record on left side with no secondary
generalization. On clinical evaluation – Unremarkable general and systemic examination, with no
signs of raised intracranial pressure and of cerebellar dysfunction. Ophthalmological and ENT
examination was normal. Further evaluation – CT scan head – Non enhancing hypodense large
cystic mass in posterior fossa. MRI brain- Massive cystic mass in posterior fossa communicating
with a normal fourth ventricle and subarachnoid space, with no associated malformations or
features of raised intracranial pressure, with normal myelination and normal ventricles. The
diagnosis of Mega cisterna magna was entertained, with no active intervention. Presently, child is
on regular follow up, and is asymptomatic and seizure free. Parents suitably explained about the
benign nature of the lesion. Discussion: Mega cisterna magna is an invariably benign
developmental intracranial anomaly and requires no active intervention, but warrants good
parental counseling and reassurance. However, occasionally it may be associated with infection
(esp CMV), inflammation, infarction, chromosomal anomaly (trisomy 18) and rarely mass effect,
warranting differentiation from other sinister space occupying lesions.
NEU/14(P) RECCURENT ENCEPHALOPATHY DUE TO EPISODIC ATAXIA TYPE 2
G. Sathyajith Nair, Ashwin Borade, L.Rajam
Department, Pediatrics, Amrita Institute of Medical Sciences, Kochi, Kerala
sathyajithnair@aims.amrita.edu
Introduction: Episodic ataxias are rare neurological conditions characterized by spells of
incoordination and imbalance, often with associated progressive ataxia. The genes lesioned in
episodic ataxia of early onset include neuronal voltage-gated potassium and calcium channels,
which are widely distributed in the nervous system but are particularly abundant in the cerebellum.
At least six episodic ataxia (EA) syndromes have been described, but only EA1 and EA2 have
been documented in multiple families. Case: We report a 7 year old boy born from a nonconsanguineous marriage presented to us with a 3 year history of repeated episodes of
encephalopathy, seizures, truncal ataxia and nystagmus. In view of the prominent ataxia during the
onset of the encephalopathy and for a prolonged duration afterwards a possibility of episodic
ataxia was considered. He was started on Acetazolamide. To this intervention, he responded
remarkably. Conclusions: There are very scanty case reports that have been published and that too
in predominantly in adult cases. We present this case to bring about an awareness in all clinicians,
that in cases of recurrent encephalopathy where the etiology is not ascertained and ataxia is a
prominent manifestation, episodic ataxia as a clinical entity should be thought of.
NEU/15(O) DRASTIC PRESENTATION OF A COLLOID CYST
Anu Gangadharan, Anandakesavan,K G Sujatha
anu_gangadharan@yahoo.com
Colloid cyst has often been recognized as an incidental finding since use of neuroimaging
However, rarely is it recognized post mortem. We present a unique case where choroid cyst
manifests for the first and the last time in a well grown 11 yr old. 11 yr old well grown boy with
sudden onset altered sensorium, headache and vomiting of 2 days duration . No history of fever
/significant past illness. On admission GCS scale of E0M2V0---he was unresponsive to painful
stimuli, had occasional decerebrate posturing. Pupils were anisocoric,left was dialated. He had a
heart rate of 62 per minute and a BP of 130/90. Fundus showed features of papilledema in both
eyes. The reflexes were elicitable bilaterally normally and the plantar was bilateral extensor. Other
systems within normal limits. Considering the diagnosis of ICSOL Emergency CT scan showed
features of cerebral edema with dilated lateral and 3rd ventricle. However the 4th ventricle was
normal in size. The MRI for clear delineation of structures. However the child succumbed to death
during the MRI within 8 hrs of admission to the hospital. The MRI showed a colloid cyst which
was protruding into the 3rd ventricle and causing features of raised intra cerebral pressure
NEU/16(P) PREVELANCE OF ANTIPHOSPHOLIPID ANTIBODIES IN CHILDREN
WITH EPILEPSY
Archana Iyengar, S Narasimha Rao
Dept of Paediatrics, Niloufer Hospital, Osmania Medical College, Hyderabad.
drarchanaravikiran@gmail.com
Introduction: In addition to the known classic risk factors for epilepsy, many clinical studies have
suggested aberrations of the immunological systems like deficiency of IgA, imbalance of ther
immunoglobulin subclasses and presence of various autoantibodies as an associated factor. Aim:
To study the incidence of antiphospholipid antibodies in children with idiopathic/cryptogenic
epilepsy. Material and Methods: After taking ethics committee approval twenty eight children
with epilepsy aged less than 16 years were enrolled in the prospective study.Children with birth
asphyxia, neonatal seizures, seizures due to fever/ meningoencephalitis/ metabolic abnormality/
trauma/ connective tissue disease and those with conditions associated with transient rise in aPL
antibody titres were excluded from the study. After taking informed consent from parents the
chldren were evaluated for the presence of aPL antibodies, any abnormal finding in EEG or in
neuroimaging. Pearsons Chi Square test was used for statistical analysis, a p-value was considered
as significant. Results: There was no statistically sigificant association was found between
demographic distribution, developmental history, duration or onset of epilepsy and presence of
aPL antibodies.In 6 children who had abnormal neuroimaging 5 were positive for aPL antibodies
which was statistically significant. Seven children of the seventeen children with GTCS and one
child of the four children with atonic seizures weree positive for aPL antibodies whereas all the
four children in complex partial seizures group were positive for aPL antibodies.There was no
statistically significant association between abnormal EEG finding and presence of aPL
antibodies Conclusion: High prevalence of aPL antibodies in children with epilepsy indicate high
probability of associated immunological dysfunction.Children with complex partial epilepsy,
abnormal neuroimaging findings and long duration epilepsy were found to be frequently
associated with aPL antibodies.
NEU/17(P) CEREBRAL PALSY: PROFILE AND ROLE OF NEUROIMAGING.
Anju Aggarwal, Sanjib K. Debnath, Hema Mittal, Deepak Patel.
Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur
Hospital, New Delhi.
aanju67@gmail.com
Introduction- Early diagnosis and search for underlying etiology of cerebral palsy( CP) is desired
for initiating measures to decrease its burden. Objectives -To study the profile of children with CP
and role of neuroimaging in finding the underlying etiology. Methods: Profile of 200 children(
1month – 12 years) attending Neurodevelopmental Clinic over a period of two years, diagnosed
as CP was analyzed. Detailed history and clinical findings were recorded. Neuroimaging findings
were classified according to standard format. Results- Of the 320 children screened 200 were
diagnosed as CP. There were 161(80.5%) males,177(85.5%) delivered vaginaly, 166(77.8%) at
term gestation. History of birth asphyxia was present in 85(41.1%). There were 155(77.5%)
quadriplegic CP, hemiplegic 23(11.5%), diplegic21(10.5%). Spastic CP was present in
198(94.5%). Microcephaly was present in 121(60.5%),epilepsy in 42% ,visual abnormality in
74(37%) and hearing abnormality in 40(20%). Neuroimaging(MRI/ CT) was done in 98(49%)
cases of which 94(95.91%) were abnormal. Neuroimaging features of hypoxemic ishaemic
eccephalopathy(HIE) as periventricular leukomalacia, encephalomalacia, peritrigonal gliosis were
present in 46(48.93%) , atrophy/gliosis/infract in 16(17.02%), hydrocephalus and basal ganglia
involvement 9(9.57%) each, cerebral malformation 7(7.44%). Type of abnormality did not relate
to birth asphyxia, sex , epilepsy, gestation, type of CP, microcephaly( P>0.05). Of the cases with
neuroimaging finding of HIE (n=46) 22(47.9%) had history of birth asphyxia. Not all cases birth
asphyxia had findings of HIE. HIE findings were present in 51.1% of spastic CP . No cases of
hypotonic, dystonic or mixed CP had finding of HIE. Conclusion- Birth asphyxia is a common
cause of cerebral palsy. Neuroimaging helps in identification of underlying etiology and helps in
better patient management.
NEU/18(P) CNS NEOPLASM: A MISSED DIAGNOSIS
Tushar Godbole, Anju Aggarwal, Hema Mittal.
Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur
Hospital, Delhi
aanju67@gmail.com
Introduction: Tuberculoma is a common intra-cranial space occupying lesion in India . Rarely
neoplasms may mimic tuberculoma. Case Report: A 10 year old boy presented with fever and two
episodes of generalised seizures. The child was developmentally normal. Clinical examination did
not reveal any neurological deficit. Seizures responded to loading dose of valprote. Chest X ray
was normal. Mantoux test was positive. MRI brain revealed diffuse gyral swelling with signal
alteration in the left temporal lobe.There was a rounded lesion of 22x19 mm with central hyperintensity and hypo-intense rim on T2W images. A possibility of infective aetiology was kept.
Child was prescribed antitubercular therapy with steroids. After 3 months child presented with
headache,vomiting and another episode of seizure. On examination there was incipient
papilloedema and signs of raised intracranial tension without neurological deficit. A CT brain
performed was suggestive of a heterogeneously attenuating enhancing mass lesion in left parietotemporal area of size 50x35 mm with peri-lesional white matter edema. There was a midline shift,
without any evidence of hydrocephalus. MR spectroscopy revealed a well resolved lipid lactate
peak, with reduced/ void NAA at 2ppm, stable CR at 3ppm, increased/ CR at 3.2 ppm, suggesting
a possibility of low grade glioma. Child was operated and biopsy revealed a high grade glioma.
Child improved on standard management with radiotherapy. Conclusion: Mass lesions on
neuroimaging may be diagnosed as tuberculoma due high prevalence of tuberculosis. We suggest
that these lesions should undergo MR spectroscopic examination for early and appropriate
management.
NEU/19(P) DYSFERLINOPATHY IN TWO YOUNG INDIAN
CHILDREN
Sheffali Gulati, Suvasini Sharma, M C Sharma, Pankaj Pathak
Associate Professor, Division of Child Neurology, Department of Pediatrics, All India Institute of
Medical Sciences, New Delhi-110029
sheffaligulati@gmail.com
Dysferlinopathy, a rare muscular dystrophy in children, is characterized by proximal muscle
weakness, predominantly pelvic girdle; slow progression, calf hypertrophy, normal intelligence
and highly elevated CPK levels. We describe an unusually early presentation of Dysferlinopathy
in 2 young boys. Case 1: A 7-year old boy with increased falls while walking and enlargement of
calf muscles noted since 3 years of age. He had no difficulty in climbing up stairs, or getting up
from the floor. There was no history of weakness in shoulder, arm, face or neck muscles.
Examination revealed bilateral calf hypertrophy, normal tone and mild weakness (4/5) in hip
extensors bilaterally. Gower’s sign was absent. The CPK was 7346 IU/L. The DMD gene deletion
was negative. Muscle biopsy revealed normal fascicular architecture, mild variation in fiber size,
some groups of regenerating fibers, and adipose infiltration in the perimysium.
Immunohistochemistry for alpha, beta, gamma, and delta sarcoglycans, as well as for dys 1,2,3
showed normal reactivity, but reaction for dysferlin was negative, establishing the diagnosis of
dysferlinopathy. Case 2: A 6 year old boy presented with falls while running and difficulty in
climbing stairs. Examination revealed bilateral calf hypertrophy and weakness of hip extensors
and abductors. The CPK was 6670 IU/L. Muscle biopsy showed muscular dystrophy.
Immunohistochemistry for alpha, beta, gamma, and delta sarcoglycans, as well as for dys 1,2,3
showed normal reactivity, but reaction for dysferlin was negative. Immunoblot revealed absent
dysferlin with preserved calpain. Conclusion: Two young boys with dysferlinopathy are described.
Diagnosis requires immunohistochemistry and immunoblot.
NEU/20(P) COMPLETE CLINICO-ELECTRICAL RESPONSE TO KETOGENIC DIET
ALONE IN WEST SYNDROME
Sheffali Gulati, K.N.Vykunta Raju, Suvasini Sharma
Associate Professor, Division of Child Neurology, Department of Pediatrics, All India Institute of
Medical Sciences, New Delhi-110029
sheffaligulati@gmail.com
We report two children with west syndrome who responded to ketogenic diet (KD) after failure of
multiple antiepileptic drugs (AED). Case one -21 months old boy, cryptogenic west syndrome,
with infantile spasms since 6 months of age. EEG revealed hypsarrthmia. No improvement with
inj ACTH, vigabatrin, valproate, topiramate, clobazam, nitrazepam, vitamin B6, eptoin. He was
started on Ketogenic diet (KD), with 4:1 ratio (fat:carbohydrates+proteins) on non fasting
regimen. There were no reported complications. His spasms completely stopped on fifth day. At 6
months, his EEG was normal and all AED were tapered. His repeat EEG at 9 was also normal. At
18 months he was seizure free with KD alone. Case two-12 months old boy, Symptomatic west
syndrome secondary to perinatal hypoxic ischemic encephalopathy had infantile spasms from 4
months of age. He failed injection ACTH, valproate, clonazepam, vigabatrin. EEG revealed
hypsarrthmia. He was started on KD with 2.5:1 ratio with non fasting protocol. No complications
were reported. His spasms completely subsided on day 7 of diet. At 6 months after KD initiation,
EEG was normal. All AEDs were tapered and stopped. There was no recurrence clinical and
electrically at 1 yr after initiation of KD. In Conclusion, KD alone may be effective without other
AED in west syndrome refractory to multiple antiepileptic drugs.
NEU/21(O) ETIOLOGICAL ASPECTS OF WEST SYNDROME
Sheffali Gulati, Gurpreet Kochar, Suvasini Sharma, Naveen Sankhyan
Associate Professor, Division of Child Neurology, Department of Pediatrics, All India Institute of
Medical Sciences, New Delhi-110029
sheffaligulati@gmail.com
Introduction: West Syndrome, an infantile epileptic encephalopathy, consists of clusters of
spasms, an EEG pattern called hypsarrhythmia and psychomotor retardation in most patients. It is
associated with many underlying conditions and described as idiopathic, cryptogenic, and
symptomatic. Objective: To determine the aetiological diagnosis in patients with West Syndrome
Method: In this retrospective study, 66 patients were evaluated. All patients fulfilling the
diagnostic criteria for West Syndrome were investigated clinically, electroencephalography,
neuroimaging and metabolic evaluation wherever indicated. Results: Out of 66 patients, 52 (78%)
were boys. Mean age at onset of spasms was 6.3 (+/- 4.8) months and mean age at presentation
was 18.4 (+/- 11.4) months. Two patients (3%) had normal development prior to onset of spasms
and no underlying cause was identified, forming the idiopathic group. Fourteen patients (21%)
with neurological impairment of unknown aetiology formed the cryptogenic group. The greatest
number of patients (50 ; 75%) formed the symptomatic group, in which developmental delay
preceded the onset of spasms and etiology was established. Out of symptomatic group, birth
asphyxia followed by hypoxic ischemic encephalopathy was the most common etiology seen in 36
(54%) cases. Other etiological factors were neonatal sepsis with or without meningitis in 17
(25%), hypoglycaemia in 5 (7.5%), cortical malformations in 4 (6%), tuberous sclerosis in 2 (3%)
patients, intra-uterine infections and perinatal stroke in 1 (1.5%) patient each. Conclusion: The
results indicate that birth asphyxia was the largest contributor to West syndrome with possibility
of primary prevention with good quality perinatal care.
NEU/22(P) CALPAINOPATHY: FOUR CASES IN TWO FAMILIES
Sheffali Gulati, Suvasini Sharma, Anita Choudhary, Naveen Sankhyan, M C Sharma, Pankaj
Pathak, Atin Kumar
Associate Professor, Division of Child Neurology, Department of Pediatrics, All India Institute of
Medical Sciences, New Delhi-110029
sheffaligulati@gmail.com
Calpainopathy is a rare autosomal recessive limb girdle muscular dystrophy. No cases have been
reported in literature from India to date. We report 4 cases from our centre. Case 1: A 12 year old
girl was brought with complaints of progressive difficulty in climbing stairs and lifting heavy
objects, which had been noticed for the past 18 months. There was no history of pain, muscle
cramps, facial weakness or squint. Examination revealed a thin built girl, with atrophied arms and
legs. There was prominent scapular winging, and lax abdominal wall. Power was 3/5 at all
proximal joints. Case 2- 4 : A ten year old boy presented with complaints of progressive difficulty
in climbing stairs and getting up from floor starting at 5 year of age and toe walking since 7 year
of age. There was no evidence of facial muscle weakness, respiratory muscle involvement, or
muscle hypertrophy. His two male sibs ( aged 30 yr and 8 yr) were similarly affected. The elder
brother had lost ambulation at 25 years of age. On examination, they had winging of scapulae
andtendoachilis contractures. Results: The CPK was 471 IU/L (case 1), 519 IU/L (case 2), 240
IU/L(case 3). Muscle biopsy revealed features of muscular dystrophy. Immunostain for dystrophin
1,2 and 3, sarcoglycan (alpha, beta, gama, delta) and dysferlin showed normal membrane
positivity. Immunoblot revealed absent calpain. Muscle MRI (lower limb) done in case 1 and 2
showed atrophy of muscles in posterior compartment of thigh.
NEU/23(P) USE OF SALINE INJECTION AND SUGGESTION FOR INDUCING
PSYCHOGENIC SEIZURES
Rekha Mittal
Base Hospital Delhi Cantt – 110010
drrekhamittal@rediffmail.com
(a)Introduction : Psychogenic seizures often have to be diagnosed based on the history alone.
Sometimes the history is so characteristic of a seizure that it may be impossible to distinguish
between a real seizure and a psychogenic one, based on history alone. In such cases it helps if one
is able to observe an event, and suggestion that to the child that he /she is going to have a seizure
with a saline injection can often precipitate an event in child. (b) Aims & Objectives : To study the
usefulness of suggestion followed by saline ingection to induce psychogenic seizures for
observation (c) Material & Methods : 13 cases of suspected psychogenic seizures were told that
they would be given an injection that would precipitate a seizure. A saline injection was then
administered and the child observed. (d) Results Out of 13 ( 8 males and 5 females) children , all
of whom were on anticonvulsants, 10 had an event following saline injection, that was diagnosed
to be a non epileptic event, enabling correct diagnosis and withdrawal of anticonvulsant drugs. (e)
Conclusions. Suggestion followed by saline injection is a good method to induce psychogenic
seizures for observation of the event.
NEU/24(P) STARTLE EPILEPSY PRESENTING AS DROP ATTACKS: A CASE
REPORT
Payal Shah, Neeta R. Sutay, Mangesh Jadhav
Dept. Of Paediatrics, Grant Medical College And Sir J.J. Hospital, Mumbai 8
manjioo7@yahoo.co.in
Introduction: Startle epilepsy is characterized by seizures induced by sudden and unexpected
stimuli, usually a sudden sound. Most patients with startle epilepsy are sensitive to only one
sensory modality, but the unexpected nature of the stimulus rather than the sensory modality is the
distinguishing feature. Case report: A 4.5 year old boy presented with complaints off dropping of
head over his shoulder precipitated by auditory stimuli such as sudden loud noises since 1.5 years
noticed by parents. The attack usually lasted for 10 to 20 seconds, and there was no aura, nor was
there a postictal phase. Patient birth history and developemental history were normal. Neurological
examination revealed no abnormality. Patient does not have similar attack in response to other
sensory modality. So a case of startle epilepsy was considered and patient was investigated.
Computed tomography (CT) scanning report was normal. MRI brain did not show any
abnormality. Interictal electroencephalography (EEG) showed diffuse slowing and asymmetry of
background activities with lower amplitude over the right centro-parieto-temporal region. The ictal
EEG showed a paroxysmal bilaterally synchronized high amplitude single spike followed by a few
slow waves lasting about one second over the bilateral centro-parieto-temporal regions. The
seizure resisted anticonvulsant therapy and no significant responses were observed despite the use
of combined therapy with valproic acid, phenytoin, primidone and clonazepam. Prognosis: These
patients, with intractable epilepsy, have significantly increased mortality compared to the general
population. Surgery has been reported to control startle epilepsy associated with infantile
hemiplegia.
NEU/25(P) STAPHYLOCOCCAL SCALDED SKIN SYNDROME
Payal Shah, Manish K Arya, A.D. Rathod
Dept. of Paediatrics, Grant Medical College & Sir J.J. Group of Hospitals, Mumbai 8
manjioo7@yahoo.co.in
Introduction : Staphylococcal Scalded Skin Syndrome is generalized exanthematous disorder with
cutaneous tenderness,widespread blistering & superficial desquamation. Case report: 8 months
male child, 2nd BOB,BONCM admitted with C/O Fever , multiple bullous lesions, Generalized
redness & swelling all over the body and Increase respiratory activity. These symptoms were
developed and progressed over a period of 4 days. On examination child was Febrile, tachycardic
with poor peripheral pulsation and tachypnic with subcostal and intercostal retractions. Child was
hypotensive with blood pressure of 80/50 mmHg. He is having generalized erythematous rash,
oedema and vesiculo-bullous lesions over flexor aspect of forearm & wrist as well as lateral &
plantar aspect of foot,submental region. Oral mucosa was not involved. There was no abnormality
found on systemic examination apart from hypotensive shock. CBC was suggestive of
polymorphonuclear leukocytosis. RFT showed prerenal azotemia with BUN 70 and S.Creatinine
0.9. S. electrolyte and LFT were normal. Blood culture showed no growth. SKIN BIOPSY was
showing intraepidermal bulla with acantholytic cells in subepithelial tissue suggestive of
Staphylococcal Scalded Skin Syndrome. Patient was resuscitated with fluid for hypotensive shock.
He was treated with intravenous antibiotics such as Vancomycin & Amikacin alongwith
supportive skin care in the form of application of vaseline after shedding epidermis and cradle
cover. Child responded to treatment and his skin lesion desquamated and healed without scarring.
Staphylococcal Scalded Skin Syndrome was caused by Epidermolytic toxins A & B by phage 2
staph aureus type 55, 71 ,1 & 3.
NEU/26(P) ACUTE DISSEMINATED ENCEPHALOMYELITIS: HYPER ACUTE
PRESENTATION
Payal Shah, A.D. Rathod, Manish K Arya
Dept. of Paediatrics, Grant Medical College And Sir J.J. Group of Hospitals, Mumbai 8.
manjioo7@yahoo.co.in
9 years old boy, BONCM, brought with fever and vomiting since 9 days. Patient developed
weakness of both lower limbs, pain in the back and urinary retention since 5 days. On day 2 of
admission he developed one episode of Right sided focal convulsions lasting for about 5 minutes
followed by post ictal drowsiness for about 15 minutes. He did not have any significant birth and
family history. On examination child was conscious with stable vitals. On CNS examination
Higher functions was normal with no cranial nerve deficit and no signs of meningeal irritation
were present. There was hypotonia in both lower limbs with power of 1/5 with tone and power of
upper limbs being normal. DTR of lower limbs were exagarated with bilateral extensor plantars.
There was paresthesia at T 2 – T 3 LEVEL. Haemogram and x-ray chest and spine were normal.
MRI spine showed diffuse swelling and signal intensity changes in the cervical and dorsal
portions of the spinal cord extending in to the lower brainstem with patchy intense enhancement
on post contrast study s/o acute myelitis or acute demyelination. In the ward after episode of
convulsion patient developed sign of meningeal irritation and papilloedema. CSF was s/o
meningitis. MRI brain showed Illdefined altered signal intensity areas noted in bilateral high
parietal regions, right occipital region, medulla oblongata and upper cervical cord S/o Acute
Encephalomyelitis. So diagnosis of Acute disseminated encephalomyelitis (ADEM) was
considered. Patient was started on high dose methyl prednisolone and responded gradually.
NEU/27(P) INIENCEPHALY: AN UNCOMMON NEURAL TUBE DEFECT
Nalinikanta Panigrahy,D satish,P lakshmikanth,P sudarsini
Department of pediatrics,ASRAM Medical College,Eluru, AP
nalini199@gmail.com
Introduction: - Iniencephaly is a rare and usually lethal neural tube defect, the name derived from
an abnormality of the neck (inien) and brain (cephaly) characterized by occipital bone
abnormality, rachischisis of varying degree, and fixed, extreme retroflexion of head. Incidence of
iniencephaly has been reported to be 1 in 60,000 deliveries with 90% cases occur in female babies
Case report: - A 27 year old primigravida delivered a full term female infant by cesarean section at
37 weeks of gestation. The pregnancy was complicated by polyhydramnios and reduced fetal
movement and foot and cord presentation at birth. The birth weight was 2300 Grams, with head
circumference 36 cm and a length of 42 cm. The head was large tilted upward and neck was
extremely short. The occipital scalp was fused with back and had a ruptured occipital
encephalocele and the chin was not separated from chest. There was peeling of skin all over body
and hydrops fetalis like edema of whole body with oozing of water from peeled skin areas. The
baby born with no spontaneous respiration and HR=40/minute, no aggressive resuscitation was
initiated and the baby died 20 min later. Cord blood CBC was normal, TORCH screen was
negative and Karyotyping was normal. A total body radiograph was obtained but the parents
denied postmortem. X ray showed fused short cervical spine and underdevelopment of thoracic
vertebrae. Prenatal diagnosis can be made by ultrasonography and deformed fetal body may
endanger the mother’s life during labour, caesarian delivery may be considered in required cases.
NEU/28(O) CLINIC-ETIOLOGICAL AND NEURODEVELOPMENTAL ASSESSMENTS
OF CEREBRAL PALSY PATIENTS ATTENDING TO A TERTIARY CARE TEACHING
HOSPITAL.
Nalinikanta Panigrahy, A Sailaja, D Satish,G Sampoorna, Suresh kumar panda, P Sudarsini
Department of Pediatrics, ASRAM Medical College, Eluru, AP.
nalini199@gmail.com
Objective : To study the possible etiological factor , modes of clinical presentation and neuro
developmental profile of children with cerebral palsy Design : prospective observational study
from January 2007 to july 2009. Materials and Methods : 150 consecutive children with cerebral
palsy between 3 months to 15 yrs of age who were attending Department of Paediatrics ASRAM
MEDICAL COLLEGE , ELURU were evaluated ..detailed history and physical , neurological
examination and developmental assessment(DENVER,DASII,VINELAND) were carried out
.They were investigated with CT/MRI ,EEG, Fundoscopy when ever required .Of 150 children
(103males , 47 females ) included in study 11% were preterm ,Spastic type of cerebral palsy was
commonest (81%) among spastic cerebral palsy , spastic quadriplegia (72%) was followed by
spastic diplegia (25%). Birth asphyxia was observed in 23% cases and TORCH infection was
identified in three cases . Delayed motor milestones (57%) and convulsions (31%) were the
common mode of clinical presentation followed by speech impairment. Other associated defects
microcephaly was present in 36% of cases while auditory and visual defects in 12% and 15% of
patients respectively . Mental retardation was present in 45% of cases, out of which only 19% pt
had severe MR. In 52 patients we could do neuroimaging,6 patients showed hydrocephalus, 3
patients showed porencephaly, 5 patient had chronic infarction ,two diagnosed as case of dyke
Davidoff masson syndrome ,rest patients had cortical atrophy. On developmental assessement,
according to GMFCS classification 22.5% had gross motor delay and 30% had motor functional
skills that allowed for ambulation. Social age was delayed in 58% patients.Physical growth
delayed in 76% cases ,mean DQ was 42% in estimated patients. Conclusion :The incidence of
cerebral palsy is significant In pediatric population in this locality of Andhra Pradesh.Associated
problems of epilepsy , learning disabilities were also observed . Therefore ,their is urgent need for
early identification , proper assessment , judicial management of their associate complications and
vocational rehabilitation as many patients identified early and were in ambulatotory stage.
NEU/29(O) NEUROCYSTICERCOSIS – REVIEW OF 92 CONSECUTIVE PATIENTS IN
A TERTIARY CARE CENTRE OF ANDHRA PRADESH.
NalinikantaPanigrahy, A Sailaja,AbanikantSahuG SidharthKiran, K Umamaheswwar Rao
Department of pediatrics, ASRAM Medical college, Eluru, AP
nalini199@gmail.com
Background: Neurocysticercosis (NCC) is the commonest parasitic infestation of CNS world wide.
From our previous reporting of hospital based pediatric afebrile seizure (58%) and other studies from
west Godavari district of Andhra Pradesh it is evident that NCC is the commonest cause of afebrile
seizure in children in this locality. The clinical and radiological features of consecutive 92 patients with
NCC were studied and discussed. Setting: The subjects of this study were 92 consecutive children up to
14 years of age who were diagnosed as NCC in the department of pediatrics, ASRAM medical college,
eluru, Andhra Pradesh from July 2007 to July 2009 .Cases were prospectively followed up clinically
and with repeated Neuroimaging after proper management with AEDs and Short course of
Albendazole(8 days) and data collected in this prospective observational study and were analyzed
Results: There were 54 boys and 38 girls with age range 2 years to 14 years with average age of 9.9
years. Seizures were present in 95.6 %( 88/92) cases, 76 %( 88/92) had focal seizure and 6 patients had
status epilepticus. Features of raised ICT were seen in 25% patients, 2 cases with encephalopathy,
persistent focal deficits observed in 4 patients. Single lesions were seen in 86% cases (78/92), with ring
lesion in 70 patients (76%), disc lesions in 9 patients, perilesional edema in 55 patients (60%) and
calcification in 37 patients (40%). On follow up only 3 patients required 2 AEDs for recurrent seizure.
CT scan follow up for all single lesions showed complete resolution of lesions by 2-3 months in 74%
(58/78) cases and by 6-9 months of treatment in another 12 patients. Conclusion: Majority patients,
irrespective of types of AED showed good seizure control and resolution of lesions after short course of
Albendazole.
NEU/30(P) COMPARATIVE STUDY OF INTRAMUSCULAR & INTRAVENOUS
MIDAZOLAM IN ACUTE SEIZURE
S.Nath, K.G. Sharma, R. Pancholi
Department of Pediatrics, Tata Motors Hospital, Jamshedpur, Jharkhand
smritin@tatamotors.com
Introduction: Seizures are a common neurologic problem in pediatric age group. Prompt &
appropriate intervention is required in acute seizure to terminate the attack. Midazolam is used as
first line of treatment in many centres. It can be administered by intravenous, intramuscular,
intranasal, oral or rectal routes. Few studies are available about its use in acute seizure in children.
Aim & Objective:. To evaluate the efficacy & compare to of intramuscular and intravenous
midazolam in the management of acute seizure. Material & Methods:Design—Randomized
controlled trial analytical study Study period- August 2007-August 2009 Study populationChildren with acute convulsion within age of 1 month to 14 yrs . Exculsion criteria-1. Refuse to
participate in study 2. Convulsion continued for more than 30 minutes Randomization- By
sequence generation by computer data sheet in block of six. Blinding- not done Intervention – IM
injection of midazolam in a dose of 0.15 mg/ kg or Iv same dose Measurement by stop watch was
taken to observe duration of convulsion from administration of drug in two different route to
cessation ofconvulsion. Result: Total No. ofcases was 100. In our study 42% were in age gr. Of 514 yrs. 6o% cases were male. Pyogenic meningitis was leading cause of seizure (20%) in all age
gr. Total cases were divided into two Groups Gr.I- 25 cases ( Received IM midazolam) Gr II- 75
cases ( Received IV midazolam) Mean time taken for initial control of acute seizure in Gr.I is
240+/- 128.88 secs and in GrII 180.52+/-105.96( Pvalue <0.05 ) Conclusion: Our study shows
time taken for control of initial acute seizureby intravenous midazolam is less in comparison to
intramuscular midazolam which is statistically significant.
NEU/31(P) A RARE CASE OF DANDY WALKER MALFORMATION ASSOCIATED
WITH AGENESIS OF CEREBELLAR VERMIS
Kotyal B Mahendrappa, Anilkumar
No 93 fourth main 10th Cross, Vidyaranyapuram, Mysore - 570008
–kotyalmahendrappa@yahoo.co.in
Dandy walker malformation (DWM) consists of a cystic expansion of the fourth ventricle in the
posterior fossa & midline cerebellar hypoplasia, which results from a developmental failure of the
fourth entricle during embryogenesis. DWM was first described in 1914 by w . dandy & k
blackfen. Later in 1954 C BENDA desgnated the term DWM . DWM is a rare disease listed by
the office of the rare disease(ORD) of the NIH(national institute of health). We are presenting
this case because of its rarity & the associated anomaly agenesis of cerebellar vermis Case
Report: A one and a half year old boy born to second degree consanguinously married parents
was brought with progressive increase in the size of the head since last 6 months . Child has delay
in motor development.There was no history of any acute CNS insult in the antenatal natel &
postnatel period. On examination he has hydrocephalus with a large head with prominent occiput
(occipetal bossing) ,has HC of 52 cm,wide open AF & prominent veins over the scalp. He has
mild truncal ataxia ,fundus was normal. CT HEAD showed bilateral hypoplastic cerebellar
hemispheres with large cisterna magna the cerebellar vermis is absent. the fourth ventricle
communicating with cistern magna. Lateral & third ventricle are grossly dilated with thinnedout
cerebral parenchyma sulci & sylvian fissures are obiterated. other hematological & biochemical
investigations were with in normal limit.Child was treated with v p shu nt using chebras v p
shunt. child showed some improvement in the motor function after the surgery Child of dandy
walker malformation with occipetal bossing and holding his mother to compensate truncal ataxia
NEU/32(P) CERVICO-MEDULLARY JUNCTION ANOMALY : PATIENT PRESENTING
WITH QUADRUPARESIS
B. J. Parmar, Charul Purani, Shreyans Gupta
B.J. Medical College, Civil Hospital, Ahmedabad
shreyans200@yahoo.com
Introduction : Cervico-medullary junction anomaly in the form of hypoplastic dens causing
quadruparesis is a common event in lower breed of animals and very less common in humans
unless traumatized. Case Report : A 4 year old girl presented with quadruparesis with inability to
move any part below neck since 2 days. There was no history of trauma or any congenital defect
or fever or no other systemic symptoms. Patient was immunized for age. Patient was totally
asymptomatic before 2 days. Fundus was done with X-ray Cervical spine, both being normal. CSF
report normal. EMG-NCV done for quadruparesis suggested upper motor neuron type of lesion
but on examination patient had hypotonia with power 0/5 in all four limbs. An urgent MRI
Brain+cervical spine done which was suggestive of cranio-vertebral anomaly with hypoplastic
dens that was compressing posteriorly on cervico-medullary junction causing ischemia. Patient
was sent to neurosurgeon who got the atlanto-axial subluxation in one of their cervical spine xrays and thus operated the patient with wiring and fixation of the atlas. Patient gradually improved
with physiotherapy and antibiotics. In follow-up after 3 months patient had improved clinically
with power 5/5 in all four limbs and no inability of movement from below neck.
NEU/33(P) ROLANDIC EPILEPSY WITH POTT’S PUFFY TUMOUR: A RARE
PRESENTATION
B. J. Parmar, Charul Purani, Shreyans Gupta
B.J. Medical College, Civil Hospital, Ahmedabad
shreyans200@yahoo.com
Introduction: Rolandic epilepsy is a partial epilepsy of late childhood with centerotemporal spikes
in EEG. Pott’s Puffy Tumour is a rare serious complication of frontal sinusitis with osteomyelitis
of frontal bone, subdural abscess with empyema associated with focal meningitis or cerebritis.
This case presented is a rare presentation of association of Pott’s Puffy Tumour with Rolandic
Epilepsy. Case Report : An 11 year-old boy presented with first episode of left sided partial tonicclonic convulsion with secondary generalization, with swelling over left eye and forehead, the
convulsion immediately being subsided on Injectable Diazepam. Patient had history of fever and
headache since 5 days. After stabilization, patient’s EEG done was suggestive of right sided
temporal spikes with CSF having TC-32 cells(all polymorphs), protein-152, sugar-28. The
swelling over forehead was doughy, pitting and tender with left eye having periorbital cellulitis (as
per ophthalmologic opinion). MRI Brain done was suggestive of Left sided pansinusitis with left
pre-septal orbital cellulitis with right frontotemporoparietal meningitis and subdural empyema
with changes of frontal osteomyelitis. Patient had been treated with 21- day injectable antibiotics ,
single anticonvulsant, with Functional Endoscopic Sinus Surgery with Trephinisation of sinuses
being done by ENT deptt . Patient was discharged with decreased forehead and periorbital
swelling with no convulsion. He was discharged with more 3-week oral antibiotics and anticonvulsant at home. Follow-up advised.
NEU/34(O) REFTRACTORY EPILESPY IN CHILDREN FROM 6 MONTHS TO 18
YEARS OF AGE IN KANPUR
T. Mohammad, Singh R .P, Tripathi V.N., Kumar N., Rao Y.K., Varma P.
Deptt. of Pediatrics, R No. 107, PG Boys Hostel, GSVM Medical College, Kanpur- 208002
princeofsandila@gmail.com
Introduction: Reftractory epilepsy comprises 15-35% patient of seizure disorders. since there is
paucity of data on refractory epilepsy/seizure in children there was need to study this disorder so
this study had been design. Aims and Objective: To find out etiology of refractory epilepsy in
children from 6 months to18 years of age. Study Design :cross sectional study Setting : Hospital
based Material and Methods: This study was conducted in epilepsy clinic, Department of
pediatrics, and neurology unit of KPS Institute of Medicine GSVM Medical College, Kanpur.
Result: A total of 100 patient were selected in which 42 were female and 58 were male. 40% had
seizure onset before 3 yrs of age and below 10 years of age the onset of seizure was 89%. 49% had
generalized tonic clonic type seizure, 40% had partial seizure and rest had mixed type. EEG was
done in all patient and was abnormal in 82% of cases. Cause was found in 49 patients in which
approx. 63% had cerebral infection 31% had perinatal asphyxia and 6% had cerebral vascular
disorder. Conclusion : Cerebral infection was the main cause of refractory epilepsy.
NEU/35(O) OUTCOME OF SELECTIVE MOTOR FASCICULOTOMY IN UPPER LIMB
SPASTICITY AND DYSTONIA IN NON PROGRESSIVE NEUROLOGICAL
DISORDERS
A.K. Purohit, Aneel Kumar P., Suchanda Bhattacharjee
Dept. of Neurosurgery, NIMS, Hyderabad
akpcpcp@gmail.com
Objectives: To assess the outcome of selective motor fasciculotomy (SMF) in relieving upper limb
spasticity and thereby improving motor function in patients with nonprogressive neurological
disease like cerebral palsy. Methods and Results: Twenty two patients (12F:10M) with age
ranging from 5 to 22 (mean – 11.7) years with upper-limb resistant spasticity due to cerebral palsy
were assessed using Modified Ashworth Scale, Wee FIM Scale and functional evaluation. Fortythree selective motor fasciculotomy procedures were performed on the musculocutaneous nerve
for spastic elbow flexors (n =14), the median nerve for spastic wrist flexors and pronators (n=28),
and the ulnar nerve for ulnar deviation and spastic wrist flexion (n=1). Results of follow up of 18
patients showed significant reduction of spasticity as assessed by Modified Ashworth Score in all
groups of muscles though the response in different groups varied. Improvement was also noted in
the functional assessment and in performance of daily activities. There were no complications of
this procedure and recurrence of spasticity in 9 (3-14) months follow-up period. Conclusions:
Selective motor fasciculotomy significantly helps in relief of spasticity and improvement of
function in patients having harmful spasticity of the upper limb due to cerebral palsy that has been
refractory to non ablative therapies. The procedure is cost effective and is associated with no
complication rate and recurrence.
NUT/01(O) NUTRITIONAL ASSESMENT OF UNDER FIVE CHILDREN OF MIGRANT
LABOUR POPULATION
Ravinder K. Gupta
Department of Pediatrics, Acharya Shri Chander College of Medical Sciences (ASCOMS), Sidhra,
Jammu. 180017 (J&K)
drrk_gupta2000@yahoo.com
Objective :- To assess the the nutritional status of underfive children of migrant labour
population.Design :- Prospective study Settings :- Pediatric clinic Subjects and methods:- Two
hundred consecutive under five children with their respective mothers belonging migrant labor
population from Ganjam district of Orissa living in slum communities of Jammu were enrolled
for the study. The data for the present study was collected using a pretested semi-structured
questionnaire. The mothers were interviewed to collect the required information. Data on age, sex,
per capita income and occupational status of the parents was collected. Nutritional status of child
was assessed with the help of anthropometric measurements and nutrient intake. Nutritional status
of children registered for the study was assessed by utilizing weight for age criteria. The NCHS
standards for weight for age were utilized for classification of children in various grades of
nutritional status. Classification recommended by Indian Academy of Pediatrics (IAP) was
utilized to classify children in various nutritional categories Results :- A total of 200 consecutive
under five children and their mothers from two urban slum communities constituted the study
population. It was observed that 58% children were males. Majority of indexed children were 2nd
or 3rd born. There were 35% infants while rest belonged to 1-5 year group. Forty per cent of the
children belonged to the families with per capita monthly income less than Rs. 2000. Only 27%
belonged to the families with per capita income between Rs.2000- 3000. Fifty seven per cent
mothers of the indexed children were housewives. It was found that 20, 17, 13 and 6% children
were in Grades I, II, III and IV category of malnutrition, respectively. Forty four per cent of the
children were in normal nutritional grade . The mean weight of the mothers of indexed children
was 50.8 ± 6.3 kg and the mean height was 152.2 ± 6.3 cm. Exclusive breastfeeding was a rarity.
However, 43 % were breastfed while rest were not at all given breastfeeds. Weaning was not
started in 13 % children, while 44% were weaned just before 1st birthday. It was observed that 164
(82.0%) children received top milk. Amongst those receiving top milk, about 68% children started
receiving it when they were less than 6 months of age. Twenty per cent children started receiving
top milk when they were 9-11 months of age. Results revealed that 176 (86.0%) children received
diluted top milk. Out of these, 65 (32.5%) children received top milk diluted with water in the
ratio of 1:1 followed by 2:1 by 27 (13.5%) and 4:1 by 22 (11%) subjects.It was observed that only
43 % children were consuming semi-solids at 7 to 8 months of age. Moderate anemia (7-10g%)
was encountered in 64% children. Vitamin D deficiency features were present in 53% children,
while vitamin A deficiency features were seen in 27% children. Dental caries was observed in
26% children ,while Vitamin B complex deficiency features in form of glossitis, angular
cheilosis, stomatitis etc. were seen in 19% children. Hepatomegaly was seen in 16% while
splenomegaly was seen in 8% cases. Skin changes were seen in 6% cases. Conclusions :- The
study revealed that about 19% of children of migrant labor population belong to III – IV grade
malnutrition which is quiet significant. The possible etiological factors found for causation of
PEM among these children were essentially non feeding of colostrum, lack of exclusive
breastfeeding, late introduction of semisolid and solid foods, ignorance regarding feeding ,
dilution of top milk and faulty feeding practices. Health education should be imparted to mothers
to improve quality of food provided to these children with addition of high quality proteins and
stress to be given to encourage home available food items to improve the nutritional status of their
children.
NUT/02(O) A STUDY OF SERUM ELECTROLYTES IN CHILDREN OF SEVERE
MALNUTRITION IN WESTERN RAJASTHAN
Dabi DR, Jora R, Verma S, Sharma P, Gautam
Department of Pediatrics, RIMCH, Umaid Hospital, Dr. S.N. Medical College, Jodhpur
jorarakesh@rediffmail.com
Objectives-: To study the changes in serum electrolytes (K, Na, Mg, Ca ) in severe PEM cases at
our centre which caters the whole of Western Rajasthan. Methods-:Children with severe PEM
(grade III & IV ) from 6 months to 5 years of age were included in the study and healthy children
of same age and sex were taken as controls. Children with diarrhea, liver or kidney disease at the
time of study were excluded. Serum Sodium, Potassium, Calcium, Magnesium, total protein,
albumin & globulin of both cases as well as of controls were estimated. Results-:Prevalence of
severe PEM cases from 6 months to 5 years of age was 4.74%. Maximum number of cases (51%)
belonged to 1-2 years followed by 24% from 2-3 years age group. 59% cases were of PEM grade
3 while 41% of PEM grade 4. 70% cases were of marasmus while 30% of marasmic kwashiorkor.
Mean serum Magnesium, Potassium, Calcium and Sodium levels in PEM grade III, IV and in total
PEM cases were lower than controls and their difference with controls were highly significant
(p<0.001). Similarly difference in serum Magnesium, Potassium, Calcium and Sodium levels
between marasmus vs control and marasmic kwashiorkor vs control were highly significant
(p<0.001). Conclusions-: Infants and children with severe PEM prone to have wide variety of
metabolic disturbances, mainly of serum electrolytes (Mg, K, Ca, & Na) which should be
corrected immediately.
NUT/03(O) AN INTERVENTIONAL STUDY TO SEE THE IMPACT OF COUNSELLING
ON EXCLUSIVE BREAST FEEDING PRACTICES.
Parveen Mittal, Paramjeet Kaur, Naresh Kundra
House No. 37, Khalsa College Colony,Near Saket Hospital, Patiala
doc_parveen@yahoo.co.in
Introduction: Poor infant feeding practices and their consequences are one of the world’s major
problems. All infants upto the age of 6 months should receive ‘exclusive breast feeding’ but many
infants are deprived of this nector provided by ‘nature’. This indicate that there is some area which
needs to be explored and mothers do need help in the form of proper ‘counselling’ to achieve
‘exclusive breast feeding’. Present study was planned to see the impact of ‘counselling’ on breast
feeding ‘practices’. Aims And Objectives:To study the effect of counselling on initiation of breast
feeding and to study the impact of counselling on rate of exclusive breast feeding. Material And
Methods:
Current studies was done in Tripuri area which is under an Urban MCH Centre
attached to Government Medical College, Patiala. House to House survey was done and two
groups of pregnant woman were made, each group consists of 100 pregnant woman. One group
was kept as intervention group in which counselling was done and second group was registered as
control in which no counselling was done. The first visit to intervention group was made during
the last trimester and emphasis was made on early and successful initiation of ‘breast
feeding’.Second visit was made within three days after delivery. During this visit the data was
collected about the time of starting of breast feeding after child birth and whether the prelactal
feeds were given or not. The mothers were also counselled about any problem in mother or baby
regarding breast feeding. They were also told about the benefits of exclusive breast feeding.
Further visits were made at the completion of three and six months and data was collected to know
the rate of exclusive breast feeding. Control group was visited twice at three and six months after
child birth and relevant data was collected. Data collected was statistically analysed.
Observations:In the study group, 58% of mothers started breast feeding within first hour of child
birth, while in control group, only 7% of mothers started breast feeding within first hour of child
birth. The difference was statistically highly significant (p<0.05). Further in study group 100% of
mothers started breast feeding within the 1st 12 hours whereas in control group only 65% mothers
started breast feeding during 1st 12 hours and out of remaining 35%, 10% started between 13-24
hours while 25% started breast feeding after 24 hours.
Regarding effect of counselling on
prelactal feeds in study group the prelactal feeds are given only in 14% of cases. While in control
group it is found to be 73% of cases and the difference was statistically highly significant
(p<0.05). Exclusive breast feeding at 3 months of age was seen in 65% of mothers who were
counselled regarding benefits of breast feeding while it was only in 25% of mothers who were not
counselled, again the difference was highly significant. Mothers who continued exclusive breast
feeding upto 6 months of age in study group were 42% while in control group only 11% mothers
continued breast feeding upto 6 months of age, the difference being highly significant
(p<0.05).Conclusion: Counselling can definitely increase the rate of exclusive breast feeding upto
6 months of age. Counselling also helps in easily initiation of breast feeding and eradicating the
bad practices in breast feeding like giving the pre lactal feeds.
NUT/04(P) WHOLE BLOOD ASCORBATE LEVELS IN MALNOURISHED CHILDREN
Devendra Sareen, S.R. Giri, Dharam Singh, Jitendra Jain, Umang Upadhyay, Mahesh Upadhyay
C/o: Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, UDAIPUR-313 001
drsareen@yahoo.com
Malnutrition plays a vital role in morbidity and mortality of Pediatric population. Relation
between malnutrition and vitamin C has been recognized since long. The present study had been
undertaken to determine vit. C levels in different grades of malnutrition in children. For this study
100 children suffering from different grades of malnutrition were selected and 25 age matched
healthy children served as control. After a thorough history and physical examination, each child
was subjected to whole blood ascorbate levels by calorimetric "2,4-di-nitro phenyl hydrazine"
method. All observations were recorded and data analysis was done. We observed that whole
blood ascorbate levels were significantly low in malnourished children (0.51±0.09 mg/%) as
compared to age matched healthy control (0.77±0.07mg/%). As the severity of malnutrition
increased, the ascorbate levels decreased significantly. In PEM grade I levels were
(0.54±0.09mg/%), in PEM gr. II (0.46±0.12mg/%) and PEM gr. III (0.42±0.08mg/%) and PEM
gr. IV (0.39±0.08 mg/%) in comparison to healthy controls (0.77±0.007 mg/%). Hence, the
supplementation of vit. C to the children who are suffering from severe grades of malnutrition is
justified, as this will increase their resistance to fight against various infections.
NUT/05(P) NUTRITIONAL DEFICIENCY IN MENTALLY HANDICAPPED CHILDREN
OF UDAIPUR - AN ANALYSIS
Abhishek Ojha, Srishti Sareen, Dharam Singh, Jitendra Jain
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
Mentally handicapped children are a challenge to our country. They are vulnerable to various
nutritional deficiencies. The present study had been undertaken to detect various nutritional
deficiencies in these children. 75 mentally handicapped children (between age group 5-18 yrs.) of
Prayas Sansthan (an institute for mentally handicapped children) were evaluated in detailed for
nutritional deficiency. After taking a detailed dietary history a thorough physical examination was
done. Observations were recorded in printed protocol and data analysis was done. It revealed that
66.6% children had wasting and 18.7% had stunting. Vit. A deficiency was observed in 23.4%
children (x1A -13.2%, x1B -8.9% and x2 -1.3%). Only 2.6% children revealed Vit. D deficiency
and scurvy (1.3%). Angular stomatitis (19.5%) and cheilosis (9.1%) were predominant Vit. B
complex deficiencies. Anemia was observed 49.4% children. Commonest anemia being iron
deficiency (44.2%), folic acid deficiency (7.8%), dimorphic variety (6.5%), Vit. B 12 deficiency
(2.6%) and hemolytic anemia (1.3%). Dental caries was observed in 48.1% children and 6.5% of
these children revealed clinical evidences of zinc deficiency. We must supplement nutritive food
to this vulnerable group of community, so that these children can over come the deficiency of
nutrients and remain healthy.
NUT/06(P) RADIOLOGICAL & BIOCHEMICAL PROFILE IN CLINICALLY
DIAGNOSED RICKETS
K.K. Locham, Manpreet Sodhi, Deepak Sharma
Department of Pediatrics, Govt. Medical College/ Rajindra Hospital, Patiala – 147001
kklocham@hotmail.com
Aims & Objectives: To study radiological & biochemical profile in Rickets diagnosed clinically
Material & methods: 27 indoor children with clinically diagnosed rickets were the subject of
study. Age, sex, residential background, chief complaints, developmental status, weight,
length/height were recorded on a proforma. Serum Calcium, Phosphorus & Alkaline phosphatase
were estimated. X-ray wrist/knee joint was done in all cases. Results: The study group had 15
infants (<1 yr) and 12 children (11 between 1-3 yr age & 1 child between 3-6 yr age group). 17
children (62.9%) were from rural background. The chief complaints were fever (66.6%), vomiting
(59%), diarrhoea (44.4%), cough (37%), respiratory distress (22.2%) and seizure & pallor (18.5%
each). Constipation was main complaint in 7.4%. No child presented with bony deformities. 15
children (55.5%) had malnutrition. Maximum (93.3%) cases had malnutrition grade Ī. In 48%
children, height was >95% of median for age. 18.5% had delayed motor development. Majority
(85%) had frontal & parietal bossing, 48% had prominent costo-chondral junctions. Wrist
widening was present in 63% of cases. Radiological evidence of rickets was seen in 22% cases.
Serum Phosphorus was decreased in 81.5% & Alkaline phosphatase was elevated in 66.6%.
Serum Calcium was normal in all the cases. Conclusion: Radiological evidence of rickets was
observed in 22% cases only while serum phosphorus & alkaline phosphatase were altered in the
majority.
NUT/07(P) NUTRITION STANDARDS OF 1070 ANGANWADI PRESCHOOL
CHILDREN- ARE WE ACHIEVING THE TARGETS???
Nithin Kondapuram, M.R.Savitha, Rohini. K.Patil
Department of Pediatrics, Mysore Medical College & Research Institute, Mysore
drsavithamr@yahoo.com
Introduction: The incidence of undernourishment in India as per NFHS 3 is 40%. Integrated Child
Developmental Scheme programme(ICDS) has a strong nutrition component. Aims and
Objectives: To assess the nutritional status of the preschool children attending Anganwadi,
separately for both sexes To compare the ICDS growth chart with IAP ( Indian academy of
Pediatrics) growth chart in assessing the underweight in preschool children Materials and
Methods: The nutritional status of 1070 children attending the anganwadi centers in the Mysore
city were assessed for daily caloric intake by 24 hours dietary recall and detailed anthropometry,
and clinical examination was done. Results: Of the 1070 children examined, 577(53.9%) were
boys and 493(46.1%) girls. Only 4.5% of the children had normal caloric intake.99.2% of girls
and 92.4% of boys were calorie deprived. Also 90.3% of boys and 92.3% of girls were
underweight and 84.4% of boys and 85.5% of girls were stunted according to IAP growth chart
while only 49.2% of boys and 60.2% of girls were underweight according to ICDS chart. Overall
57.2% were anemic and 65.7% of girls, 49.7% of boys were pale. Conclusions: Calorie deficiency
among children attending the anganwadies in the Mysore city is very high. There is a high
prevalence of both chronic and acute malnutrition and anemia. ICDS charts grossly under
diagnosed children with low weight. There was a severe gender difference with girls lagging
behind the boys in all the fields. There is a need to change the ICDS chart incorporating IAP
recommendation.
NUT/08(P) NUTRITIONAL STATUS OF CHILDREN IN AN ORPHANAGE
Abhishek, Phalguni Padhi
Dept of Pediatrics S.C.B. Medical College, Cuttack
a_singh2711@yahoo.co.in
Objective- to find out prevalence of PEM, deficiency states & some associated factors among
children of 1-14 years from an orphanage of Cuttack. Design- cross sectional study Methodology64 children of a single orphanage from Cuttack were randomly selected. Infants were excluded
due to shorter stay at orphanage. As the center was a female based orphanage most of the subjects
were female. Various anthropometric data were recorded. Aggarwal growth charts & age
independent indices were used to classify malnutrition. Hemoglobin was estimated by colorimetric
method using Sahli’s hemoglobinometer. WHO criteria was used to define anemia. Head to toe
examination was done to find out signs suggestive of various vitamin & mineral deficiencies. Each
child & his/her worker was thoroughly interviewed regarding diet & sanitation. Personal records
were checked to confirm age of the child. Results- As per IAP classification 6(9.3%) children
were in grade 1, 6(9.3%) in grade 2 & 2(3.1%) in grade 3 PEM category. Of these undernourished,
71.5% were under 5 years of age. Using Kanawati Index 14(21.8%) were from mild malnutrition
category, of these 85.8% were from under5 age group. 52(81.2%) were found to be anemic.
18(28%) showed Vitamin A deficiency. The 7day menu contained variety of foods from various
food groups to provide sufficient nutrients. Menu was strongly adhered to. Calculation of nutrient
content of food was not possible as apart from milk children were allowed to eat as much or as
little as they want. All washed their hands with soap & water after defecation. Only 24(37.5%)
washed their hands before each meal & only 10(15.6%) used soap as well. 30(78.9%) of more
than 5 year age knew the importance of hand washing. All bathed & had their clothes washed
every day. Conclusion-Weight of most of the children is satisfactory. Those underweight are
mainly under 5 years age, probably related to duration of stay at orphanage. Large numbers of
children are anemic & significant numbers have Vitamin A deficiency. Education of workers &
children of orphanage are required regarding importance of fruits & vegetables in diet .Children
need to be encouraged regarding various hygienic practices. Iron & vitamin A prophylaxis
programme in all orphanages are need of the hour. All children were given iron formulation as per
weight, all under 5 year children were given oral Vitamin A preparation as per age, those with
signs of deficiency were prescribed 3 doses as per schedule.
NUT/09(P) STUDY OF SERUM MAGNESIUM LEVEL IN CHILDREN WITH PROTEIN
ENERGY MALNUTRITION
N. L Phuljhele, Arun kumar.
A-59 Parshuram Nagar, Behind Mining Office, Telibandha Ring Road, Raipur 492001
drkumararun_1982@yahoo.com
Setting – a 700 bedded teaching hospital. Introduction - Magnesium is the second most common
intracellular cation in the body and plays an essential role in numerous cellular reactions. It is
involved in many enzymatic steps including the synthesis of fatty acids and proteins, the
glycolytic pathway, and the formation of cyclic adenosine monophosphate (cAMP). Magnesium
depletion in malnourished children may remain asymptomatic or may produce symptoms such as
tremors, athetoid movements, seizures, and psychomotor changes. Aims and objectives- To asses
the level of serum magnesium in children with protein energy malnutrition in patients attending
pediatric OPD and ward. Material and methods- Case control study carried out in pediatric
department, Pt J.N.M.Medical College. Raipur (CG) during period from August 2008 to August
2009. Inclusion criteria - Study population included children of age 1-5yrs with various grades of
malnutrition. Exclusion criteria- Children with infections of the liver, kidney, or other systemic
disorders were excluded from the study. healthy children were selected as controls (weight for age
>80 per cent of the expected). The nutritional status of the children was assessed in relation to
weight for age and height for age using the Indian Academy of Pediatrics and Waterlow
classifications, respectively. Weight was recorded to the nearest 50 g and stature to the nearest 0.1
cm. NCHS reference data were used for the purposes of comparison. Venous blood was collected.
Serum was stored at —20°C until analysis. Magnesium was measured by atomic absorption
spectrophotometry. The data were analysed using Student's r-test and correlation coefficient.
Observation –Mean serum magnesium level is studied in 200 children with various grades of
malnutrition . Mean values of magnesium were 2.2+/-0.18mg/dl in 65 cases of grade I, 1.65+/0.10mg/dl in 70 cases of grade II , 1.45+/-0.20mg/dl in 35 cases of grade III and 1.15 +/0.28mg/dl in 30 cases of grade IV malnutrition in comparison to 50 controls with mean value of
2.5+/-0.15mg/dl. Discussion & Conclusion- The results of this study indicated that serum
magnesium levels were significantly low in children with moderate and severe malnutrition.
Hence magnesium supplementation is required in protein energy malnutrition in population of
Chhattisgarh .
NUT/10(O) CLINICAL SPECTRUM AND VARIOUS PREDISPOSING FACTORS IN
CHILDHOOD OBESITY
BN Behra, BR Thapa, Ravi Angara, Kartar Singh.
Pediatric Gastroenterology, Hepatology and Nutrition, PGIMER, Chandigarh.
drraviangara@yahoo.co.in
Background: Obesity is pandemic. The prevalence of obesity is related to changing eating habits,
reduced physical activity and increased sedentary habits. Objective: To determine the various risk
factors for childhood obesity in obese children(2-15 years) with reference to their dietary pattern,
physical activity and BMI and to observe the clinical difference between obese and control groups.
Subjects and Methods: 64 obese and 40 healthy children, were enrolled and demographic details,
anthropometry, general physical examination were noted. Blood sugar, hemogram, LFT, USG,
lipid profile, thyroid profile were done. Dietary assessment, physical activity, time spent on TV,
computer were assessed. Result: Obesity was more among urban nuclear families. The mean
calorie (2772.6±345.2) kcal/day, protein (70.45±9.9) g/day and fat (94.14±14.9) g/day intake was
higher among obese children compared to control. Mean calorie, protein, and fat consumption
showed direct correlation with BMI. However, an inverse correlation was found between BMI
with calorie intake per kg body weight, cholesterol, triglycerides, LDL, and HDL. 92% of obese
children spent less than one hour per day on outdoor activities, more than 45% spent time 2 hours
or more on sedentary activities. Obese children were also consuming more cold drinks and snacks
significantly higher amounts than control groups. Conclusion: Childhood is associated with high
calorie and low protein intake. Physical activity was grossly inadequate among 92% of obese
children. However, excess sedentary habits remained the most important determinant of childhood
obesity.
NUT/11(P) A STUDY ON OUTCOMES OF SEVERE GRADES OF PROTEIN ENERGY
MALNUTRITION
Bharat Parmar, Charul Purani, Shreyans Gupta
B.J. Medical College, Civil Hospital, Ahmedabad
shreyans200@yahoo.com
Introduction- PEM is a class of conditions resulting from varying degrees of protein lack and
calorie inadequacy. Aims and Objectives- To Study the incidence of PEM in hospitalized patients.
To study the outcome of severe grades of PEM. To study various complications of PEM. Materials
& methods: A prospective study from 1/12/08 to 31/8/09 in Department of Pediatrics, B. J.
Medical College, Ahmedabad, covering 1100 PEM patients in total. Selection criteria: All indoor
clinically diagnosed PEM patients with age <5 yrs. Observation- PEM patients still occupy
11.92% of total pediatric patients (1100 of total 9225 indoored patients) in our hospital. 28.93%
(315 of total 1100) of total PEM patients belong to grade III and IV, i.e., severe malnutrition.
13.65% (43 of 315) of all severely malnourished, i.e., 3.91% (43 of 1100) of total PEM patients
are expired of its complications like hypoglycemia, hypothermia, dyselectrolytemia, infection,
decreased immunological status and others. Conclusion- Mortality in grade III and IV malnutrition
is very high as compared to grade I and II. Morbidity associated with grade III and IV is still
significantly high despite of various national programmes running to put a control over it. PEM
remains the most concerned factor to prevent Under-5 mortality rate to be high.
RESP/01(P) ASSESSMENT OF LUNG FUNCTION (SPIROMETRY) IN
ASTHMATIC CHILDREN WITH RECURRENT URI
Ashu Rastogi, Kamna S Nigam,
Asst. Proff., Deptt. Of Pediatrics, SRMS Institute of medical sciences, Bareilly (U.P)
drpaed@rediffmail.com
NON-
Introduction: Cough and upper respiratory tract infection is the most common manifestation in the
children prone for hyper reactive airway. If these symptoms are left without treatment it may alter
the lung function. Aims and Objectives: This study has been undertaken to assess the lung
function of non asthmatic children with recurrent URIs and identify children with altered lung
functions at the earliest to prevent further damage. Study Design: Matched Case Control Study.
Material and Methods: 233 symptomatic non- asthmatic school children of 8-18 yrs were selected
through preformed questionnaire. 128 closely matched children were taken as control. These
children were subjected to spirometry for assessment of lung function which was done with
Portable Turbine Spirometer (Spirodec). Various parameters of lung function indices like PEFR,
MMEFR, FVC, and FEV1 were assessed. Results: Statistically significant changes (p<0.0001) in
lung function were observed in cases as compared to controls. Amongst the cases, 88% of children
had changes in PEFR. PEF25-75 (MMEFR) was detected to be abnormal in 67.6%, FEV1 in 55.8%,
FVC in 50.6% and FEV1/FVC in 12.8% of cases respectively. PEFR is observed to be most
sensitive to detect alteration in lung function in our study. Episodes of frequent cough and cold > 3
episode (81.5%) is most common complaints followed by breathlessness on exertion (81%),
allergic rhinitis (62.2%), symptoms on emotional upset (60.5%), and night time cough (45.9%).
Family history in study group revealed that history of respiratory problems was present in 27 % of
the cases while only 3% family members of controls had such history. Conclusion: Lung functions
are altered in children with recurrent URI. Episodes of frequent cough and cold are the most
common symptoms. Of the lung functions, PEFR is most frequently altered but was nonspecific.
FEF25-75 is the most sensitive & specific lung function. These children with altered lung function
should be monitored closely and if required be given preventer group of drugs to protect the health
damage and the adverse effect on growth.
RESP/02(O) PARENTAL KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING
CHILDHOOD BRONCHIAL ASTHMA
Ravinder K Gupta, Ritu Gupta
136 Nai Basti, Jammu Cantt. Jammu - 180003
drrk_gupta2000@yahoo.com
Objectives: To assess the parental knowledge, attitude and the practices employed regarding
childhood bronchial asthma. Materials and methods: Parents of 200 patients who fulfilled the
clinical diagnosis of childhood asthma and coming for consultation were considered for the study.
The period of the study was almost a year i.e from June 2008 to May 2008.The parents were
interviewed as per the pre -structured questionnaire which included socio-economic status, sex,
age and religion. This also included the knowledge of natural history, etiology and the treatment
modalities. Results: Among 200 patients about 128 children belonged to urban areas. The male
female ratio being 1.5:1. Among the religion wise the distribution was Hindus, Muslims and Sikhs
was 61 %, 24 % and 15% respectively. The age of patients ranged from 2-16 years. The duration
of illness ranged from 1-7 years. About 32% considered it to a hereditary, and 26% thought it as
contagious. Chief sources of asthma related knowledge were doctors (35%), friends /relatives
(20%), magazines / newspapers (18%) and electronic media (12%). About 15% had no knowledge
at all. About 34% parents considered it as a stigma. About 23% parents were hesitant in leveling
their child‘s diagnosis as asthma. The knowledge of precipitating agents causing bronchial asthma
was known to about 37% parents. Exposure to cold, foods (rice, curd, banana, grapes, cold drinks
etc) pets, insects, perfumes, dust, smoke, stress and exercise were the common precipitating
factors. The knowledge of timely treatment that will help to control acute exacerbations of asthma
and prevent its complications was known to about 43% parents. Only 21% parents have positive
attitude towards inhaled rescue medications and believed it as best treatment modality. About 47
% considered it as stigma. Rest 38% did not have positive attitude towards continued prophylactic
medication in spite of having the knowledge regarding this. Environmental control measures for
allergen avoidance were being practiced by about 56% parents. There was no delay in treatment
seeking. About 55% within 6 hours, 36% within 24hours and rest within 36 hours consulted the
doctor. About 35% parents had consulted other system of medicine (homeopathy, ayurveda,
naturopathy etc). Conclusions: There is poor knowledge, positive attitude and correct practices
regarding various aspects of childhood bronchial asthma. Motivation for prophylactic inhaled
medication is necessary. There is need to educate parents regarding the precipitating factors
causing bronchial asthma and judicious use inhaled medications.
RESP/03(P) BRONCHIOLITIS AND RISK OF SUBSEQUENT WHEEZING
Kalyani Pillai, V. K. Parvathy, Ramaraj, Sunil Menon
Santhwanam, Mallika Gardens, Chittilapilly P O, Thrissur, Kerala 680551
pillaiskpillai@dataone.in
Summary & Introduction: RESPIRATORY SYNCYTIAL VIRUS (RSV) bronchiolitis in children
is strongly associated with subsequent wheezing and asthma. This strong association has been
suggested by numerous studies of infants and young children who were hospitalized with RSV
bronchiolitis and who were followed years later. Studies addressing the potential effect of severity
of RSV bronchiolitis on the subsequent development of wheezing and asthma are lacking. The
effect of disease severity on subsequent wheezing was evaluated in this study in patients
diagnosed with bronchiolitis in a large general pediatric practice. Hospitalization was used as the
measure of disease severity. Recurrent wheezing within first year of first episode was used as the
outcome. We hypothesized that hospitalized patients have higher risk of recurrent wheezing
compared to nonhospitalized patients. Aims & Objectives: The objective was to determine the
effect of requirement of hospitalization as a measure of disease severity of bronchiolitis on
subsequent wheezing. Material & Methods Records were reviewed of all patients younger than 2
years of age with first episode of wheezing presenting to pediatric out patient clinics between
June 2007 and June 2008 who are now at least 1 year older. Multivariable logistic regression was
performed to identify variables that were related to the odds of having recurrent wheezing
including age, gender, history of smoke exposure, family history of asthma/allergic rhinitis and
hospitalization. One hundred fifty-five patients were included. Results: Multivariate analysis
identified hospitalization, and male gender as independent significant determinants of recurrent
wheezing. Twenty-three of the 41 hospitalized patients had recurrent wheezing compared to 52 of
114 of the nonhospitalized patients (p < 0.037). Fifty-two out of 90 males had recurrent wheezing
compared to 23 of 65 females (p < 0.01). Conclusions: Recurrent wheezing within 1 year of first
episode of bronchiolitis was higher in patients with illness severe enough to be hospitalized. This
supports the notion that bronchiolitis is a heterogeneous airway disease and the severity plays an
important role in recurrent wheezing.
RESP/04(P) ASSESSMENT OF CLINICAL & LABORATORY INDICATORS AS
PREDICTORS OF CHLAMYDIA TRACHOMATIS INFECTION IN INFANTS OF UPTO
SIX MONTHS OF AGE WITH LOWER RESPIRATORY TRACT INFECTION IN
BUNDELKHAND REGION.
Mishra Kamal N., Kaushik A. , Bharadwaj P., Anuradha , Srivastava K.L.
538 K /280, Triveni Nagar - 2, Sitapur road, Lucknow -226020
drkamalmishra@gmail.com
Introduction: Etiology of pneumonia in early infancy is not well described in developing
countries, although a number of investigations have focused on later infancy and preschool years.
This study addresses this issue, while focusing on the infants under 6 months of age showing
significant association of seropositivity of Chlamydia trachomatis with duration of cough and
absolute eosinophil count. Aim & Objectives: To assess clinical & laboratory indicators as
predictors of Chlamydia etiology. Material & Method: A Hospital-based study, where 50 infants
upto six months of age were assessed clinically & underwent laboratory investigations using
hemogram, Chest X Ray and IgM ELISA. Results: Out of 50 infants, 12 (24%) were tested
positive and 38 (76%) were found to be negative for C. trachomatis infection. In 50% infants
positive for C. trachomatis, duration of cough was prolonged for more than two weeks and
association of duration of cough with
C. trachomatis positivity was found to be statistically
significant . Around 58% of infants positive for C. trachomatis were afebrile. Association of
eosinophilia (i.e. absolute eosinophil count more than 300 per cu mm) with positivity of C.
trachomatis was found to be statistically significant. 83.3% of infants positive for C. trachomatis
had eosinophilia. Conclusions: Amongst the various clinical & laboratory parameters studied,
significant association with disease etiology was seen with prolonged and distressing cough &
increased absolute eosinophil count in blood.
RESP/05(O) TO STUDY THE EFFECT OF PROLONGED USE OF INHALED
CORTICOSTEROIDS ON CARBOHYDRATE METABOLISM IN CHILDREN HAVING
PERSISTENT BRONCHIAL ASTHMA
Parveen Mittal, Sonia Saroa
House No. 37, Khalsa College Colony,Near Saket Hospital,Patiala
doc_parveen@yahoo.co.in
Introduction: Steroid hormones have multiple effects on body metabolism especially carbohydrate
metabolism. Although inhaled steroids have a better safety profile than oral steroids still there is
always a concern about the effect of long term use of inhaled steroids. In cases of persistant
bronchial asthma, inhaled steroids for a prolonged time form the mainstay of therapy. So, present
study was designed to measure the levels of glycosylated haemoglobin (HbAIc) in children having
asthma on long term inhaled steroids as HbAIc provides an indication of average blood glucose
concentration during the preceding 8-12 weeks. Aims And Objectives:To study the levels of
HbAIc in children having mild to moderate persistant bronchial asthma using long term inhaled
steroids. Material And Method:32 children from 5 years to 12 years of age having mild to
moderate persistent bronchial asthma were enrolled for the study group. Children included were
using inhaled steroids for at least previous 6 months and the dose of inhaled steroids was either
Budesonide 200g to 400g BD or Fluticasone propionate 125-250g BD. Children having
diabetes mellitus, cardiac or pulmonary disease, on oral steroids or with history of acute
exacerbation in recent past were excluded from the study. 18 children (Age and sex matched)
having mild to moderate persistent brochial asthma but not on inhaled steroids were taken as
control. HbAIc levels were measured in botht he groups and the results were statistically analysed.
Results:The mean HbAIc level in the study group was 5.91±0.61% while in the control group the
mean HbAIc level was 5.47±0.24%. The difference between the two groups was statistically
significant (p<0.05), however, the mean HbAIc level in both the groups were within normal limits
(5-8%).Out of 32 children in the study group, 21 were using Budesonide, and 11 children were
using Fluticasone propionate. HbAIc levels were also compared in children using Budesonide and
children using Fluticasone propionate.The mean HbAIc levels in children taking Budesonide was
5.80±0.59% while in children taking Fluticasone mean HbAIc level was 6.1±0.66%.There was no
statistically significant difference between the two groups (P>0.05). Mean blood glucose level was
also calculated from the HbAIc level by using the formula HbAIc x 35.6 – 77.3 =mg%. According
to this formula, approximate, mean blood glucose level was 133mg% in study group while it was
117mg% in control group, both the values remain within the normal limits. Conclusion: Although
levels of HbAIc are slightly higher in children using long term inhaled steroids but the values were
well within the normal limits indicating that prolonged use of inhaled steroids have no adverse
effect on long term glycemic control in children with persistent bronchial asthma.
RESP/06(P) TO COMPARE THE EFFICACY OF NEBULISED BUDESONIDE WITH
ORAL STEROIDS IN ACUTE BRONCHIAL ASTHMA EXCERBATION
Parveen Mittal, Gaurav Sethi, Sonia Saroa
House No. 37, Khalsa College Colony, Near Saket Hospital, Patiala
doc_parveen@yahoo.co.in
Introduction: “Bronchial asthma is an inflammatory disease rather than mainly a bronchospastic
disease” is the rational for using potent anti-inflammatory agents in the treatment of bronchial
asthma. Systemic corticosteroids, either oral or intravenous are the most commonly used anti
inflammatory agents during an acute exacerbation of bronchial asthma. As children suffer from
frequent exacerbation of bronchial asthma repeated courses of systemic steroids may results in
systemic side effects. Inhaled steroids have fewer systemic side effects than systemic steroids, and
are the mainstay of treatment for chronic bronchial asthma but there is a concern that
corticosteroids administered by aerosol may not provide the same rapid and effective therapy as
oral corticosteroids when used for rescue therapy in acute exacerbation of bronchial asthma. So
the present study was planned to compare the efficacy of inhaled budesonide by nebuliser versus
oral steroids in children with acute bronchial asthma in age group of 5-10 years. Aims And
Objectives:To compare the efficacy of nebulised budesonide versus oral steroids in acute asthma
exacerbation by accessing the clinical criteria as well as by measuring the peak expiratory flow
rate (PEFR).Material And Methods:80 children in the age group of 5-12 years with acute
exacerbation of asthma were taken for study and were randomly allotted 2 treatment groups.
Group A (Nebulised Budesonide group) received oral placebo and single dose of nebulised
budesonide (800g) with a nebuliser and oxygen flow of 6-7 ltr/min. Group B (oral Prednisolone
group) received oral Prednisolone (2mg/kg) single dose (maximum of 60mg) and nebulised place
(normal saline). Children having severe asthma not responding to treatment or requiring
ventilatory support, having chronic lung disease or heart disease, who were not able to undergo
PEFR reliably or with first attack of wheezing were excluded from the study. Both the groups
received nebulised salbutamol within 20 mins before the experimental track, immediately after the
therapy and 20 mins after the therapy. Clinical assessment and PEFR was also done before test
therapy and at 1½ hour, 3 hr, 4½ and 6 hr after the test dose. For clnical assessment, a clnical
respiratory distress assessment score (RDAS) and asthma score (pediatrics) were used, while for
PEFR, 3 readings were taken and best of them was recorded. Data collected was analysed
statistically.Results:Before the start of test therapy, mean respiratory distress assessment score
(RDAS) was 7.62 ± 2.44 in group A (nebulised budesonide group), while it was 7.62 ± 2.61 in
group B (oral prednisolone group), thus there was no significant difference in RDAS in two
groups (P=1). After test therapy, the mean RDAS at 1½ hr, 3 hr, 4½ hr and 6 hr in group A was
5.97 ± 2.12, 4.83 ± 1.96, 3.6 ± 1.93 and 2.48 ± 1.67 respectively while in groupB, the
corresponding mean RDAS was 6.17 ± 2.48, 5.15 ± 2.11, 4.25 ± 1.9 and 3.45 ± 2.17 respectively.
Thus improvement in RDAS was more in nebulised budesonide group as compared to oral
prednisolone group. But difference was statistically significant (P<0.05) only after 6 hours of
treatment.Mean asthma score in group A and group B before starting test therapy was 8.12 ± 1.79
and 8.12 ± 1.83 respectively. The difference between the two groups was not significant (p=1).
After starting test therapy, the mean asthma score in group A after 1½ hr, 3 hr, 4½ hr and 6 hr was
6.92 ± 1.85, 5.65 ± 2.18, 4.53 ± 2.39 and 2.55 ± 1.88 respectively. While in group B, mean asthma
score was 7.38 ± 1.93 and 6.6 ± 2.04 at 1½ hr and 3 hr after test therapy, while it was 5.45 ± 2.1
and 3.67 ± 1.75 at 4½ hr and 6 hr after test therapy. Thus the improvement in mean asthma score
is more in group A (nebulised budesonide group) as compared to group B (oral prednisolone
group). The difference between the two groups was statistically significant at 3 hr (p=0.04), while
it was highly significant at 6 hr after start of therapy (p=0.06). Mean PEFR was 142 ± 47.9 and
134.5 ± 55 in group A and B respectively before starting the test therapy showing no significant
difference in two groups (p=0.52). 1½ hr after test dose, mean PEFR improved in both the groups,
being 149.5 ± 50.9 in group A and 140 ± 56.5 in group B, but the difference between 2 groups was
again not significant (p=0.43). Similarly mean PEFR showed improvement at 3 hr, 4½ hr and 6 hr
after test therapy. The values being 156.5 ± 52.4, 160.5 ±53.3 and 167.75 ± 57.4 in group A and
142.75 ± 57, 148.2 ± 57.9 and 152.25 ± 58.2 in group B respectively. The difference between the
two groups was not statistically significant. Conclusion: In acute exacerbation of asthma, clinical
improvement is better with neublised budesonide as compared to oral steroids and repeated
courses of oral corticosteroids have more side effects than nebulised corticosteroids. So nebulised
budesonide may be used in acute exacerbation of asthma in place of oral steroids.
RESP/07(O) PARAPNEUMONIC EFFUSIONS IN CHILDREN
Dreshwarachary Chary
dreshwarachary@yahoo.com
Indroduction: Parapneumonic effusions occur as a complication of underlying bacterial
pneumonia. Three types of effusions are recognized.1. Uncomplicated parapneumonic effusion
(simple).2. Complicated parapneumonic effusion.3. Parapneumonic effusion with pus (empyema).
Aims and Objectives: This study analyzed the clinical features, investigations, bacterial aetiology
and management of 118 patients who were admitted with diagnosis of pneumonia, Parapneumonic
effusions (simple) and parapneumonic effusion with pus at M.G. M Hospital, Warangal., A.P
during the period of Feb 2004 - Nov 2007. Materials and Methods: The diagnosis of pneumonias,
parapneumonic effusions (simple), parapneumonic effusion with pus (empyema) were made by xray of chest, ultra sonogram of chest, C.T scan of chest and specific characteristics of pleural fluid.
The treatment of parapneumonic effusions with pus (empyema) was based on the results of
diagnostic thoracentesis. Results: During this study pe
(55.93%) were admitted
with signs and symptoms of pneumonia (male - 36 (54.54%), female - 30 (45.46%)
(5.09%) were admitted with simple parapneumonic effusion (male - 2 (33.33%), female - 4
(66.67%)
(38.99%) were admitted with parapneumonic effusions with pus
(empyema) (male - 22 (47.83%), female - 24 (52.17%)).Pleural fluid samples were obtained by
thoracentesis in 52 patients (6 patients with simple parapneumonic effusions & 46 patients with
parapneumonic effusions with pus). In 46 patients suffering with PPE with pus, the pleural fluid
was exudative in type (proteins > 2.5Gms-3.5gms). In 6 patients suffering with simple PPF the
pleural fluid was serous in nature and proteins were < 2.5GMS.Pleural fluid cultures were
negative for organisms in 43 patients, but pseudomonas grown in one patient and E.Coli grown in
one patient. · No complications were observed during thoracostomy tube drainage in 39 patients. ·
Pyopneumothorax was observed as a complication in 7 patients. · Pneumotocele and lung abscess
was seen in one patient. · Seizures were observed in one patient and meningitis was ruled out. ·
Duration of hospital stay was observed from 15 days to 43 days. Patients who suffered with
pyopneumothorax as a complication were hospitalized for more than 18-43 days. Patients with
simple PPE were hospitalized for only 7days. Prolonged hospital stay of PPE with pus (empyema)
was due to delayed admission and diagnosis and non availability of urokinase and VATS
procedure in our hospital. Conclusion: Parapneumonic effusoins in children occur as a
complication of underlying bacterial pneumonias. Comparative studies show that early diagnosis,
prompt treatment with suitable antibiotics, thoracentesis, tube thoracostomy, intra pleural
fibrinolytics such as urokinase, VATS procedure shorten the duration of hospital stay as short as
7.4 - 9.5 days and complications.
RESP/08(P) COMPARATIVE STUDY OF NEBULIZED SALBUTAMOL VERSUS
ADRENALINE IN WHEEZE ASSOCIATED RESPIROTORY TRACT INFECTION IN
INFANT
Nagendra Prasad Gupta, Ajit Prakash, Rameshwar Prasad
mr.ajitprakash@rediffmail.com
Introduction- Wheezing associated with respiratory tract infection (WRTI) is an extremely
common problem in children less than 2 years of age1 Acute viral Bronchiolitis, Wheezy
bronchitis, infantile Asthma and wheeze associated respiratory tract infection are common
diagnosis in such infants2-4. Aims & Objective :-To assess the efficacy of bronchodilators in
wheeze associated respiratory tract infection and to compare the efficacy of nebulized Adrenaline
with nebulized salbutamol for the treatment of the above condition. Design & Setting :- Hospital
based prospective study was conducted in the Department of Pediatrics, Darbhanga Medical
College & Hospital Laheriasarai(Bihar) . Methods & Materials :- The present study was conducted
on 120 children between 2-24 months of age with clinical diagnosis of bronchiolitis5 All children
were divided into two groups. 60 Children in Adrenaline group and 60 children in Salbutamol
group. Children received 3 doses at 20 minute intervals of either adrenaline (.01ml/kg of 1:10000
solution diluted in Normal saline to make a total volume of 3ml) or Salbutamol (0.15mg/kg
diluted in normal saline to make a total volume of 3ml) via nebulizer with oxygen. Changes in
heart rate, respiratory rate, RDAI score2, clinical score (Yale observation scale)6 and the side
effects were studied. Results :-After three doses of nebulization, both the adrenaline and
salbutamol group showed significant improvement in mean respiratory rate, RDAI score and
clinical score. However, these changes were significantly more marked in the adrenaline group as
compared to salbutamol group for all parameters7-8. Both adrenaline and salbutamol showed
significant increase in heart rate, more so in the case of adrenaline. No other side effects were
observed9-10. Conclusion :- A significant improvement in combined clinical scores were
observed in both adrenaline & salbutamol group, with more(significant) so in case of adrenaline in
the management of wheeze associated respiratory tract infection.
RESP/09(P) STUDY AND ANALYSIS OF PREVENTABLE FACTORS ASSOCIATED
WITH CHILDHOOD BRONCHIAL ASTHMA.
Nishant, N P Gupta, R Prasad.
Department of Pediatrics, Darbhanga Medical College, Laheriasarai.
drnishant_dmch@sify.com
Introduction-Asthma is a chronic inflammatory disease of airways that is characterized by
increased responsiveness of the tracheobronchial tree to a multiplicity of stimuli. There is no
permanent cure of asthma; hence prevention plays a pivotal role in reducing its morbidity and
mortality. Aim-To study and analyze the role of various preventable factors and measures that can
reduce morbidity and mortality from childhood asthma. Design and Settings-Hospital based
retrospective study conducted in the department of pediatrics, Darbhanga Medical College and
Hospital, Laheriasarai, Bihar. Material & Methods-The present study was conducted on 130
children, suffering from asthma, between 5-15 years of age. All the previously diagnosed
asthmatics were taken and analyzed using these ‘preventable factors’. Result-Among 130 cases of
bronchial asthma, various ‘preventable factors’ were in the following order-1)Failure to use
asthma crisis management plan(81.5%,106 children);2)No control of environmental
triggers(78.4%,102 children); 3) Poor compliance with preventive treatment(44.6%,58
children).;4) Low level of asthma knowledge(36.9%,48 children); 5)Inappropriate preventive
treatment(34.6%,45 children);6) Not using steroids before the current admission,inspite of an
attack lasting more than 24 hours(26.9%,35 children); 7)Not visiting a pediatrician regularly in
children with persistent asthma(23.8%,31children); 8)Delay of >12 hours in starting β2 agonist at
home after the onset of asthma symptoms (17.6%,23 children);9)A delay of >24 hours in seeking
medical care after starting β2 agonist at home, despite their non-response(10%,13 children);and
10)Not controlling co-morbid conditions that can worsen asthma i.e.GER, rhinitis,
sinusitis(6.1%,8 children).From the ten possible ‘preventable factors’,98% of the children
previously diagnosed with asthma had at least one preventable factor and 59% had three or more.
Conclusion-Good compliance with preventive treatment with good knowledge of asthma,
regularly visiting pediatrician for persistent asthma, early start of treatment at home, good control
of environmental triggers and co-morbid conditions, seeking early medial care and use of asthma
crisis management plan in case of acute exacerbations can reduce morbidity and mortality from
asthma upto significant level.
RESP/10(P) HOW MUCH AWARE ARE OUR HEALTH PERSONNEL REGARDING
DIAGNOSIS OF SEVERE PNEUMONIA IN CHILDREN
Devendra Sareen, Anand Jain, Dharam Singh, Jitendra Jain, Mahesh Upadhyay, Umang Upadhyay
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
Pneumonia in children is still a major cause of high morbidity and mortality under 5 years of age.
WHO has launched a control program for ARI in children with particular emphasis upon diagnosis
and management of severe pneumonia in children below 5 years. The present study was aimed to
assess the awareness of health personnel regarding diagnosis of severe pneumonia in children. For
this study, 200 health personnel were selected out of which 100 (50%) were trained and 50% were
untrained for ARI program. After completely filling the performa data analysis was done. We
observed that regarding chest indrawing in trained group 44% were correct, 22% were partially
correct and 34% were incorrect. While in untrained group only 15% were correct 17% were
partially correct and 68% were incorrect. Regarding method of counting respiratory rate in trained
group 58% were correct, 33% partially correct and 9% were incorrect. In untrained group the
corresponding figures being 16%, 36% and 48% respectively. Regarding knowledge about signs
and symptoms of severe pneumonia in the trained group 29% were correct, 14% partially correct
and 31% incorrect. In untrained group these figures were 6%, 37% and 57% respectively.
Knowledge regarding diagnosis of pneumonia in the trained group 15% were correct, 75%
partially correct and 13% were incorrect. In untrained group only 5% were correct 57% partially
correct and 38% were incorrect. Hence, the untrained workers must be trained by attending ARI
training programs organised for them from time to time, so that they are able to diagnose life
threatening illnesses in children like pneumonia so that mortality because of this dreadful
condition can be brought down.
RESP/11(P) HOME MANAGEMENT OF ACUTE RESPIRATORY INFECTIONS IN
CHILDREN- PRACTICES OF HEALTH WORKERS
Devendra Sareen, Anand Jain, Dharam Singh, Mahesh Upadhyay, Jitendra Jain, Umang Upadhyay
Deptt. of Pediatrics, R.N.T. Medical College, Udaipur
drsareen@yahoo.com
In our country acute respiratory infections are one of the important cause of morbidity and
mortality in young children. The present study was aimed for assessment of practices of health
workers regarding home management of ARI in children. The survey tool included a detailed
questionnaire covering all aspects of home management of ARI. This study was conducted in rural
and urban areas of Udaipur district and 200 health workers participated in the present study. After
detailed assessment of the questionnaire, data analysis was done. We observed that regarding
home care management 55% workers advised keeping child warm 70% advised giving home
made fluids and 25% advised continuing breast feeding. About follow up advice only 55% had
adequate knowledge and 45% had in adequate knowledge. For drugs and doses of antibiotics 91%
had correct knowledge about drug and only 8% had correct knowledge about their doses.
Regarding drugs used for fever 90% had correct knowledge about drug and 49% had correct
knowledge of its doses. For prevention of ARI 50% advised avoiding exposure to cold and breast
feeding, immunization and good nutrition was advised by 15%, 10% and 2% respectively. Hence,
we advocate time to time organization of intensive training programs directed towards
improvement in knowledge of health workers regarding ARI in children so that they can impart
their knowledge to the parents of this vulnerable age group and help us to bring down morbidity
and mortality in children because of ARI in the community.
RESP/12(P) NON- RESOLVING PNEUMONIA IN A 5 MONTH OLD CHILD– RARE
PRESENTATION OF ENDOBRONCHIAL TUBERCULOSIS
Dhivyalakshmi J, Premila Paul, K. C. Aggarwal
Dept. of Pediatrics, Safdarjung Hospital, New Delhi
dhivya8@yahoo.co.in
5 month old child born to P2L2 mother out of non-consanguineous marriage presented with fever,
cough for 5 days and rapid and difficult breathing for 2 days. Child was exclusively breast fed and
immunized till date. Child had pallor and grade III malnutrition(IAP). Child had obvious distress
with RR-70/min, bilateral crepitation and wheeze with bronchovesicular breath sounds in left
upperlobe area and mild hepatosplenomegaly. Rest of systemic examination - normal limits.
Investigations revealed no evidence of sepsis. CXR showed inhomogenous opacity over left upper
zone. Child’s condition didn’t improve with 10 days of antibiotics(first and second line). Repeat
CXR showed extension of consolidated area. Diagnosis was revised to rule out congenital
anomalies of lung, Tuberculosis and Immunodeficiency syndromes. MTx, G.A for AFB- negative.
CXR of mother showed middle lobe consolidation. HIV serology of mother was non-reactive.
Immunoglobulin profile was normal. CT chest showed necrotizing mediastinal adenopathy,
consolidation with air and fluid bronchograms in left upper lobe and acinar opacities in right upper
and middle lobe suggestive of tuberculosis. Bronchoscopy revealed mucosal unhealthy
granulomas and external compression of left main bronchus and upper lobe. BAL for AFB was
positive. Child was started with cat-I ATT and steroids. Thus, the diagnosis of endobronchial
tuberculosis(EBTB) with progressive pulmonary TB(PTB) was established.EBTB is a highly
infectious disease and occurs in 30-60% of children with PTB1. Complications like bronchial
scarring and stenosis occurs with delay in diagnosis and treatment as systemic steroids are
required for treatment. CT scan and bronchoscopy are the diagnostic modalities of choice.
Prognosis is excellent with timely treatment.
RESP/13(P) A STUDY OF BRONCHIAL ASTHMA IN CHILDREN
Neelam Raval, Rashmi Thanvi, Ajay Kumar, Amitabh, Mitesh Raj
B.J. Medical College,Civil Hospital,Ahmedabad
dramit_amy@yahoo.co.in
Introduction- Asthma is a chronic inflammatory disorder of the airways. Aims and objective- To
Study the various clinical manifestations and aggravating factors of asthma. To study the effect of
inhaled bronchodilators in acute attack.To study the effect of various preventive drug regimens.
Materials & methods: A prospective study from 1/8/07 to 31/7/09 in department of pediatrics.B.J.
medical collage, Ahmedabad.Selection criteria:All patients with >3 attacks of acute wheezy
bronchitis or WALRTI, Frequent episodes of wheezing ,Activity induced cough,Cough
particularly at night Observation- M:F::2.3:1,52% of the patients between 1-6 years of age, 45.6%
between 7-12 years of age & 2.1% were <1 year of age.Breathlessness present in 100% of
patients,cough in 84.2% ,fever in 35% , and wheezing in 97.8% of patients. Nocturnal cough in
26.4% of patients. 80% patients were mild intermittent category,19.3% mild persistent , 0.7%
moderate persistent category. Seasonal variation,URTI, Exposure to smoke and house dust, food
and physical activity were aggravating factor. 76.4% of the patients had night time exacerbations.
AEC was >400 in 34.3% .Oral steroid used in 36.4%,Intravenous steroids in 17.8%,Subcutaneous
terbutaline in 15.7% patients. Aminophyline iv infusion in 7.1% of patients,Mgso4 infusion in
1.4% of patients. 96.7% response to Preventive inhaled steroid.Conclusion-The prevalence of
bronchial asthma is 5.4% among the acute wheezy bronchitis & WALRTI, maximum number of
patients in 1-6 years of age.Increased awareness,availability of better drugs has made the
management easier
RESP/14(P) HYDATID CYST OF LUNG;RARE CAUSE OF MASSIVE HEMOPTYSIS
Richa Arora, Bhanu Bhakhri, Premila Paul, Lavanya, Shushant
VMMC and Safdarjung Hospital, New `Delhi
richa80arora@yahoo.com
Echinococcosis is an important zoonotic disease with reported annual incidence as high as 13-27
cases per 1,00,000 population in certain countries of central Asia. We describe a patient with
hydatid cyst of lung with unusual presentation and findings. A ten-year-old girl, resident of Bihar
with farming background, had history of cough, fever, weight loss and episodes of hemoptysis for
past 2 years. She presented in emergency after a bout of massive hemoptysis. There was no
history of chest trauma, foreign body inhalation or contact with a case of tuberculosis however
there was a history of exposure to pet dog and cattle. She had received antitubercular treatment for
nine months with no improvement. Bronchial breathing and coarse crepts were present in the right
infrascapular area.Investigations revealed hemoglobin 3.0 g/dl, platelets 2.3 lacs/cmm and total
leucocyte 9300 cells/cmm. A 4 cm × 4 cm circular lesion with air fluid level inside was present in
right lower lung field on X-ray chest. CECT scan of thorax revealed a cystic lesion 4 cm in
diameter in upper lobe of the right lung and multiple lesions neighboring the former, some were
cystic and the others solid suggestive of hydatid cyst. Similar lesions were present in the lower
lobe of the right lung. ELISA for echinococcus was positive. Patient showed improvement with 4
weeks of albendazole therapy. Follow up chest x- ray after 4 weeks also showed improvement.
Hydatid disease of lung can present as massive hemoptysis. Although it is one of the less
common causes of massive hemoptysis, hydatid disease of the lung requires greater attention in
countries like India in which hydatid cyst disease is common and should be kept as a differential
diagnosis of tuberculosis.
RESP/15(O) A STUDY OF ASSOCIATION OF SERUM IGE LEVELS AND
EOSINOPHILIA WITH SEVERITY OF ASTHMA
Col Rakesh Gupta, Ankit Shah, Col M N Mishra, Col Madhuri KanitKar
Department of Pediatrics, AFMC, Pune
rgupta.peds@gmail.com
Asthma is a chronic respiratory condition in childhood and its prevalence is increasing especially
in urban areas. As per some studies, raised serum IgE levels and eosinophilia indicate prediction
of severity of childhood asthma. This study was conducted at tertiary care hospital in
Maharashatra to determine the association of serum IgE levels and eosinophilia with severity of
asthma. Patients And Methods: All the children below 12 years of the age diagnosed as Bronchial
Asthma and attending this tertiary care hospital since Jan 2007 were included in to the study
population. Children with acute respiratory infection, chronic obstructive and suppurative lung
disease and those with thoracic skeletal abnormalities were excluded. The diagnosis and severity
of Asthma was assessed on the history, clinical evaluation and spirometry if feasible based on
Global initiatives for Asthma (GINA) guidelines 2007. Eosinophil count was done in all cases.
Serum IgE levels were done in a sub group of 51 patients which included all grades of severity.
Statistical comparison of levels of IgE and eosinophilia between different groups of severity was
done. Results: A total 198 children diagnosed as bronchial asthma were evaluated for the study.
One third of children 72 (36%) were between 4-8 years of age, majority were male with M : F
ratio of 1.9:1. Age of onset in majority of children was below 2 years in 137 (69%) children,
family history was present in 84 (42%) cases and history of atopy in 20% children. The severity of
Asthma was assessed as mild intermittent in 34 (17%), mild persistent in 109 (55%), moderate
persistent in 48 (24%) and severe persistent Asthma in 7(4%) cases. Raised serum IgE level and
eosinophilia were commonly seen in moderate and severe persistent asthma as depicted in table
1&2, however the association between the two and severity of asthma was not statistically
significant. CONCLUSION: In our study, bronchial asthma was commonly seen in the school age,
with onset below 2 years age. Most cases were of mild persistent asthma. High serum IgE levels
and eosinophilia were commonly observed, but there was no significant association with severity
of asthma. Table-1 showing the association between the serum IgE levels and severity of Asthma
IgE level < IgE level > 200
Asthma grading
Total
200 IU/ml
IU/ml or Max
Mild Intermittent
4
4
8
Mild Persistent
5
22
27
Moderate Persistent
2
8
10
Severe persistent
3
3
6
14
37
51
Table-2 showing the association between Eosinophilia and severity of Asthma
Asthma grading
AEC <500/cu AEC > 500/cu Total
mm
mm
Mild intermittent 21
13
34
Mild persistent
68
Mod persistent
23
Severe persistent 3
115
41
25
4
83
109
48
7
198
RESP/16(O) CLINICAL- RADIOLOGICAL CORRELATION OF RESPIRATORY
TRACT INFECTION IN CHILDREN (1-5 YEAR AGE)
Prakash. R,
Room no. 88, Hostel no.1, NSCB MCH, Jabalpur.
drprakashr@gmail.com
Introductions- Respiratory tract infection constitute the most important cause of morbidity &
mortality in under 5 years age group Aims and objectives- 1. To localize the lesion, according to
clinical presentation and correlate it with its chest roentgenogram. 2. To evaluate how well are
individual clinical findings correlated with the chest roentgenogram. Materials & Methods- A
prospective hospital based study conducted with 60 children (1-5years) attending OPD or who
were admitted in pediatric ward of our hospital, with complaints suggestive of respiratory tract
infection. Study was conducted with precoded proforma with 2 parts; 1. clinical details of patients
, 2. Detailed interpretation of chest x-ray by a radiologist. Results: in this study, highly significant
clinico-radiological correlation was found in cases of consolidation, collapse and cardiac disease,
and significant correlation was found in LRTI and pleural effusion. The most sensitive clinical
finding correlating with the radiological diagnosis was adventitious sound, least sensitive being
percussion. The most specific finding was decreased breath sound, which was also with high
sensitivity and diagnostic accuracy. Conclusion: complete and repeated clinical examination is the
single best, cost-effective diagnostic tool for the initial management of childhood respiratory tract
infection.
RESP/17(P) UNUSUAL CAUSE OF CYANOSIS IN A CHILD
N. Chitra, I. B. Vijayalakshmi
Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru,
Karnataka
dr_chitra@yahoo.com, chitradr@gmail.com
Cyanotic child is a distressing medical presentation with diverse and heterogeneous causes.
Cardiac, pulmonary etiologies are most common and hematologic, toxic, metabolic causes occur
less commonly. We present a child with an unusual cause of persistent cyanosis. Case Report: 21
months old male child, referred for cyanosis observed by a doctor one month back. History of
recurrent respiratory tract infections present. Admitted for 15 days, at birth, for chest retractions
and right upper lobe pneumonia. On examination had central cyanosis, grade I clubbing with SaO 2
of 60% . Heart rate, blood pressure was normal. CVS – normal heart sounds, SSM in PA, soft
continuous murmur in right infraclavicular area. Other systems were normal. Chest Xray showed
non homogenous opacity in right upper zone. Echocardiogram showed small ostium secundum
ASD left to right shunt, normal PA pressure. Contrast Echocardiogram showed delayed positive
contrast. PA angiographic study showed plexiform mass of dilated vascular channels with three
feeders in the right upper pulmonary lobe. Two feeders were occluded with Cooks emobolization
coil and one large feeder with vascular plug. There was immediate increase in SaO 2 to 88%. After
6 months follow up he is asymptomatic. Conclusion: Pulmonary arteriovenous fistula is a rare
vascular abnormality in children not easily diagnosed routinely. Persistent cyanosis, even in an
otherwise well child, should be investigated and pulmonary arteriovenous fistula suspected when
the workup indicates the presence of a noncardiac right to left shunt. Early diagnosis and treatment
is important to avoid complications.
RESP/18(P) ENVIRONMENTAL RISK FACTORS IN RELATION TO CHILDHOOD
ASTHMA IN RURAL AREA
Ashwani Sood , Seema Sharma, Mangla Sood
Department of Pediatrics, Indira Gandhi Medical College & Hospital, Shimla
seema406@rediffmail.com
Introduction: Asthma is a common chronic disorder with increasing prevalence both in children
and adults. WHO estimates that annually 15 million disability-adjusted life-years are lost and
250,000 asthma deaths are reported worldwide. Approximately 500,000 annual hospitalizations
(34.6% in individuals aged 18 y or younger) are due to asthma. Objective: To study the
relationship between environmental factors and childhood asthma in a rural area. Methods:
A hospital based descriptive co-relational study was carried out in Punjab, over a period of one
year in children (6-15yrs) having asthma. Results: In 200 children studied (boys 64% and 36%
girls), asthma attacks were increased during particular season (86%), after exert ional work (70%)
and along with ARI (72%). The risk of asthma was more in children where smoke producing fuel
was used (70%), presence of insects/pets/domestic animals (70%) and moisture, mold (42%) in the
home, born prematurely/LBW (56%), with family history of atopy (44%), one smoker in family
(38%), and who belonged to poor socio-economic status(44%).Breast feeding was protective in
reducing the incidence by(62%). No relationship was found with consumption of junk food and
emotional
factors.
Conclusion: This study shows that asthma is an important public health issue in rural communities
as well as in urban areas. Breast feeding, use of LPG for cooking, early treatment of ARI reduces
incidence of asthma attacks. Further study of indoor and outdoor risk factors which trigger attacks
of asthma and study of means to reduce or delay the development of asthma in susceptible
individuals in this population is suggested.
RESP/19(P) CLINICAL STUDY OF EMPYEMA THORACIS IN CHILDREN
M.K. Behera, T.K. Motta, S. Natu, Paresh Soni, A. Naik, S.Panday, U. Keskar, Maya Patil, Arti
Nale, Mahesh Gosavi, Sarika Shinde
Department of Pediatrics, SKN Medical College & Hospital, Pune - 411042
manaskumarbehera@yahoo.co.in
Introduction: Empyema thoracic is a common condition in children and causes significant
mortality and morbidity and pose a therapeutic challenge to clinicians. Aim and Objective: A
study was undertaken to analyze the demography of empyema cases and to evaluate the efficacy
of management like chest tube drainage , antibiotic, and VAT surgery and compare the outcome.
Material & Method: A cross Sectional retrospective study of empyema cases admitted to SKN
Medical College Pune wef. March 2007 to Aug 2009 was carried out. Neonates and other
secondary cases of empyema were excluded from the study. Routine investigations , X-Ray, USG,
pleural Fluid analysis, C.T. & MRI scan of chest were done. Cases are managed with IV fluid
antibiotics, ,blood transfusion ICD and VAT surgery where required. Result:Twenty one cases
of Empyema were recorded out of total paediatric admission of 8036 cases ( 0.26%) where as
pneumonia & LRTI cases constitute 896 (11.15 %) of total admission. Cases ranges from 10
months to 10 yrs with mean age of 36 months maximum cases – 16 (76.2%) were less than 5 yrs
, Male & Female ratio 13 :8 ,Majority of cases 18 (85.7 %) were weighing below 3 rd percintile
of expected norms. Common presentation were Cough (100 %), persist ant fever (90.5 %),
dyspnoea (85.7 %) chest pain (24 % ) . Majority of cases received antibiotics before admission to
this hospital. Blood & pleural fluid culture isolate only in 5 (24 %) and comment organism was
staphylococcus. Rt sided empyema detected in 11 (52.7 %) , Left side 8 (38 %) and both side 2
(9.52 % ) . All were anaemic and in 9 (42.3 %) Hb % were below 7 gm %. Three (14.3 %) cases
managed with antibiotics alone, CTD - 6 (28.6 % ) .VATS – 12 ( 57.1 % ). Average duration of
hospital stay 16.42 days ,cases without tube 9 days with CTD – 16 days and VATS.19.75 days
.Average duration of ICD in CTD alone was 9.5 days and in VAT .Surgery 8.5 days. All cases
recovered and non death reposted and of thickened pleura were detected in majority of cases.
Conclusion: Empyema always pose therapeutic challenge but if diagnosed early and treated
appropriately is always rewarding . VAT surgery is safe & beneficial.
RESP/20(P) CLINICAL EFFICACY OF SUBLINGUAL IMMUNOTHERAPY IN
NASOBRONCHIAL ALLERGY
K. Nagaraju
Senior Consultant in Pediatric allergy, V. N Allergy and Asthma research centre ,No.1,
Kattabomman street, Tambaram West, Chennai
majorknr@yahoo.co.in
Aim : To evaluate the efficacy of sublingual immunotherapy (SLIT) in children with allergic
rhinitis and asthma Materials and methods : Prospective study done in VN Allergy & Asthma
Research Centre, Chennai during period January 2007 to December 2009 Results : During this
period, 154 children were enrolled in the study of which 50 children had allergic rhinitis, 20
children had asthma and 84 children had features of both allergic rhinitis and asthma(diagnosed as
per ARA and GINA guidelines) . Their age ranged from 2-18 years. Of the 154 children, 86 were
boys and 68 were girls and the male : female ratio was 1:2:1. Children with moderate persistent
rhinitis not responding to corticosteroids and antihistaminics, children with mild & moderate
persistent asthma were included.Prior to administration of SLIT, complete history, thorough
physical examination and baseline investigations (complete blood counts, CRP, ESR, serum IgE,
ASO titres, allergic skin testing, and nasal smear for eosinophils , spirometry (> 8 years) were
performed. Sublingual immunotherapy was administrated in increasing concentrations. First dose
administered under supervision and than administered once daily for 3 months followed by
biweekly for one year and then once weekly for 2 years. The children were followed up for
clinical improvement in symptoms. Following SLIT, 60% stopped inhaled corticosteroids and
antihistamines by 6 months, 80% by one year and 90% by 2 years. Conclusion: SLIT improved
the nasobronchial allergy in majority (90%) of our children with tolerable side effects.
Compliance is good and reduces usage of medications. A few side effects of SLIT was observed in
out series. 4 children had buccal itching, mouth ulcer in 3. diarrhoea and vomiting in 2 each.
RESP/21(P) CASE REPORT-UNUSAL CAUSE OF REPEATED
BRONCHUS OBSTRUCTION DUE TO PEN CAP
Payal Shah, Manish Arya, A.D.Rathod, Ganesh Jevlikar
Dept. of Paediatrics, Grant Medical College & Sir J J Hospital, Mumbai 8.
manjioo7@yahoo.co.in
PNEUMONIA-
Nine years old male child presented with complaints of recurrent cough, breathlessness, loss of
appetite over 2 years. empirically was started on antikochs treatement for 6 months . Within a
period of 2 years patient was admitted for four times for the chest complaints. On examination
patient had decreased air entry with decreased vocal resonance with fine crepts. Skiagram of chest
was suggestive of consolidation and collapse of left upper lobe . CT Thorax showed narrowing
of left main bronchus lumen by nodular lesion in anterior wall with air trapping in left lung with
left hilar adenopathy. Bronchoscopy showed blue ring like structure in left main bronchus which
turned out to be cap of pen. After few days of bronchoscopy there was significant increase in
chest expansion on left side. Follow up skiagram of chest showed improvement. On follow up
patient cough was subsided and was symptomaticaly better. Discussion:Airway Foreign Body are
of 3 types: Laryngeal, Tracheal and Bronchial. Bronchial FB may cause immediate cough dyspnea
and wheezing, unilateral decreased breath sounds or may lead to lodged FB leading to recurrent
episodes of high fever, cough, breathlessness on exertion responding partially to antibiotics
RESP/22(P) CONGENITAL LOBAR EMPHYSEMA (CLE): A CASE REPORT.
Asok Kumar Datta, Shyamali Mandal, Jadab Kumar Jana
C/o. Dr. Jadab Kumar Jana, H/O- Nabakumar Adhikary, Tikorhat More, Lakudi, Burdwan 713102
jadabjana@gmail.com
Objective: To create awareness about the management of asymptomatic / mild symptomatic CLE
by conservative approach. Introduction: CLE is an uncommon but potentially life threatening rare
malformation of lung development due to partial obstruction of bronchus. Patients often present
within the first 6 months of life with recurrent respiratory distress. It is caused by hyper inflation
of the lung lobe with compression of the normal lung parenchyma and contra lateral displacement
of the mediastinum. Chest X-ray and CT scan of thorax are diagnostic. Because of increased use
of imaging, this lesion is frequently found in asymptomatic and mildly symptomatic children,
prompting us to adopt a more conservative approach to these children instead of traditional
surgical approach. Case report: A 22 days old male neonate presented with respiratory distress.
The baby was delivered normally and natal and early neonatal period was normal. On examination
the baby was found in mild respiratory difficulty, respiratory and heart was 80 and 130 per minute
respectively, weight 3.0 kg, length 55 cm and head circumference 35 cm. There was no cyanosis,
jaundice or any signs of heart failure. Examination of respiratory system revealed less movement
of left upper chest, trachea was shifted to the right, vocal resonance was decreased in left side and
on auscultation diminished breath sound was found on left side. Other systems appeared normal.
Chest X-ray and CT thorax showed marked over distension of the left upper lobe with mediastinal
shift to the right and collapse of the ipsilateral remaining lung field. Discussion: All the features
suggestive of the CLE were present in this case. As there is no contentious opinion, controversy
exists regarding surgical and conservative management of this malformation. In our case
conservative management was given and we are following up the baby. After two month follow
up, he is normal and growing up with peer group. Conclusion: The early diagnosis of this case and
the importance of conservative management rather than advocations of surgery in all CLE cases
are noteworthy. The importance of follow up is stressed.
RHE/01(O) PROFILE OF CHILDHOOD LUPUS FROM KOLKATA.
Ganguli Suhas, Mondal Rakesh, Nandi Madhumita, Ghosh JB.
Pediatric Rheumatology Clinic, Department of Pediatrics, IPGMER & SSKM Hospital, Kolkata.
madhumitabanik@rediffmail.com
a)Introduction: Systemic lupus erythematosus(SLE) is a multi-system autoimmune disorder.
Major organ abnormalities are nephritis, hematological abnormalities including anemia and
thrombocytopenia and CNS lupus. Arthritis and skin involvement are seen as minor organ
involvement. b) Aims and Objectives: To analyze the childhood SLE database from Kolkata.
c) Methodology: We prospectively followed up all 42 patients of SLE who were diagnosed over a
period of 5 years in our pediatric rheumatology clinic. The resultant database was analyzed using
standard
statistical
methods.
d) Result and Analysis: 3.9%(42) of all rheumatology cases in our clinic over last five years
(n=1063) was suffering from SLE.The numbers of children in 5-8 years and 8-12 years age groups
were 12 and 26 respectively. The overall female (n=33) to male (n=9) ratio in our study is 3.6:1.
About 52 % (n=22) had clinically apparent nephritis, 54 % patients (n=23) had hematological
dysfunctions which included anemia (n=16), thrombocytopenia (n=10) and pancytopenia (n=4)
and central nervous system and Neuropsychiatric SLE was found in 26 % cases (n=11). Among
the minor organs, joints outnumbered (n=30) others strikingly with a proportion of 71 % of all
patients followed by skin involvement in 54 % (n=23) cases. Fever was one of the most common
presenting features (n=30). Lymphadenopathy and hepatosplenomegaly were found in 7 % (n=3)
and 35 % (n=15) cases respectively. Among the rare manifestations were panniculitis (n=1),
digital gangrene (n=1), autoimmune hemolytic anemia (n=1) and autoimmune hepatitis (n=2).
Only 4 % patients (n=2) tested negative for ANA. Among the typical features of ANA negative
disease only nephritis was found in these patients. Anti dsDNA was positive in 50 % cases (n=21).
Anti Ro and anti La antibodies were positive in two cases of neonatal lupus.
e) Conclusion: Our study delineates the differences of childhood lupus from contemporary
observations.
RHE/02(P) BILATERAL OPTIC NEURITIS IN PEDIATRIC SYSTEMIC LUPUS
ERYTHEMATOSUS ASSOCIATED WITH ANTIPHOSPHOLIPID ANTIBODIES
Soumya Patra, Sriram Krishnamurthy, Nilay Nirupam, Anju Seth, Sarita Beri, Satinder Aneja
C/o Dr Sriram Krishnamurthy, Assistant Professor, Department of Pediatrics, Lady Hardinge
Medical College, New Delhi-110001.
drsriramk@yahoo.com.
Systemic lupus erythematosus can be associated with a wide spectrum of neurological and
ophthalmological manifestations, with optic neuritis being a rare but potentially devastating
complication. Bilateral optic neuritis is extremely uncommon in pediatric systemic lupus
erythematosus and sporadic cases are reported in the literature. We describe an 11 -year -old girl
who presented with fever and progressively increasing pallor for 4 months, and headache for 7
days. Examination showed severe anemia and hepatosplenomegaly. Soon after admission, she
started developing rapid deterioration of vision, worsening to no perception of light with afferent
pupillary defect. Fundoscopy showed optic neuritis. Investigations revealed autoimmune
hemolytic anemia and thrombocytopenia. Double stranded DNA (dsDNA) was positive,
confirming a diagnosis of systemic lupus erythematosus. Antiphospholipid antibodies were also
positive. Magnetic Resonance Angiography showed multiple thrombi in the cerebral venous
sinuses, for which anticoagulant therapy was initiated. Urinalysis was normal. She was managed
with intravenous methylprednisolone, cyclophosphamide and oral prednisolone. She is presently
under follow-up and symptomatically better, although visual sequelae are persisting.
RHE/03(O) EVALUATION OF THE EFFECTS OF CHEMOTHERAPEUTIC AGENTS
ON THE SEXUAL MATURITY, GROWTH AND RENAL OUTCOME OF CHILDREN
WITH LUPUS NEPHRITIS
Sophy Korula, Indira Agarwal, Anna Simon
Department of Child Health, Christian Medical College, Vellore
child2@cmcvellore.ac.in; indiraagarwal@cmcvellore.ac.in
Aim: To determine the risk of gonadal toxicity and growth retardation in children treated for
Lupus nephritis and their renal outcome. Design and Setting: Concurrent cohort study in the Child
Health Department, Christian Medical College and Hospital, Vellore. Methodology: Children with
SLE nephritis class III / IV were started on either Cyclophosphamide or Mycophenolate based on
their affordability. Patients were assessed after a minimum of 6 months of therapy for gonadal
toxicity, growth velocity and renal status. Results: 20 children with SLE Class III / IV nephritis on
Cyclophosphamide / Mycophenolate formed the study group. 12 received Cyclophosphamide and
8 Mycophenolate. All received.hydroxychloquine and steroids. F: M ratio was 18:2. Mean age was
14.4 years. Mean duration of therapy was 29.8 months. Average pulses of Cyclophosphamide
were 11.8. 2/12 in Cyclophosphamide group and 1/8 in the Mycophenolate group had sustained
amenorrhea (p = 0.99). All 3 had normal hormonal study and ultrasound and hence did not qualify
to have gonadal toxicity. 9/20 (45%) had growth delay but difference between the two groups (5 in
cyclophosphamide and 4 in Mycophenolate group) was not statistically significant. (p = 0.99). All
had normal renal function except 1 in the Mycophenolate group (e GFR of 55 ml/min/1.73m2).
Conclusions: Gonadal toxicity was not a major problem amongst children on treatment for SLE.
The rate of sustained amenorrhea is similar to data available for premature ovarian failure
described in those <20 years of age. Growth delay was a cause for concern. Renal outcome
remained good.
RHE/04(O) PROFILE OF ENTHESITIS RELATED ARTHRITIS IN A TERTIARY CARE
CENTRE
Meetu Rawat Gupta, Tribhuvan Pal Yadav
Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi.
meetur2007@yahoo.com; meetur2007@yahoo.com; subg2002@yahoo.com
Introduction: Enthesitis related arthritis(ERA) is defined by presence of arthritis/ enthesitis and
any two of (1)Sacroiliac joint(SIJ) tenderness (2)HLA-B 27 positivity (3)Family h/o HLA-B27
associated diseases (4)Anterior uveitis (5)Onset of arthritis in boy >8 years of age. Objective: To
study profile of ERA in children visiting Pediatric Rheumatology clinic in a tertiary care center.
Materials and Methods: Data was collected from 2001 to 2009. Results: 19 boys were diagnosed
as cases of ERA. Age of onset was 8-16 years, mean 12.03(±2.64) years. Clinical presentation was
arthritis(28.57%), limping(57.14%) and morning stiffness(33.33%). Gap between disease onset
and presentation was 1-72 months(19.47±20.14). Peripheral joint involvement at 6 months of
onset was seen in 84.2%, with knee(57.9%), ankle(36.8%), wrist(21.1%) and elbow(15.8%). Axial
joint involvement of only hip seen(21.1%). Sacroilitis was clinically suspected in 52.6%, with SIJ
tenderness(70%) and pelvic compression test(50%). Follow up showed peripheral joint
involvement(84.2%), mostly knee(73.7%), ankle(63.2%), elbow(36.8%), MCP,PIP&DIP(36.8%),
midtarsal(31.6%), wrist(26.3%) and axial involvement(57.9%), involving hip(52.6%),
spine(21.1%), shoulder(15.8%) and SIJ(15.8%). Enthesitis was present in89.5%
tendoachilles(47.4%) and suprapatellar(26.3%). Family h/o chronic backache was present
in42.86%. Schober’s test was positive in6(31.6%). ANA&. RF done in16 cases was negative.
HLA-B27 could be done in14 and was positive in10(73.33%). Although sacroilitis was clinically
suspected in52.6% cases, but confirmed radiologically in3(30%). Treatment given was
Naproxen(100%), Methotrexate(36.8%), Sulphasalazine(47.4%) and Prednisolone(15.8%).
Follow-up data of 13 patients showed complete remission in30.8%, partial remission in53.8% and
no response in15.4% cases. Conclusion: A high clinical suspicion of ERA should be kept in
mind while dealing with a boy with arthritis, enthesitis with/without axial joint involvement.
RHE/05(O) CASE REPORT: TWO CHILDREN WITH TAKAYASU’S ARTERITIS WITH
ACTIVE TUBERCULOSIS – IS IT UNDERDIAGNOSED?
Bharath Kumar Reddy K.R., Alka Rani.T.Patil, Govindaraj.M
Indira Gandhi Institute of Child Health, Bangalore
bharathreddykr@yahoo.co.in
Introduction: Takayasu's arteritis (TA) is one of the commonest acquired disorders of the aorta and
its branches. Its etiology and pathogenesis remains a subject of speculation and is now of a
worldwide distribution. The clinical features of TA are varying especially with significant
differences with that in the adult and pediatric age group. Hence, this case report aims at throwing
light on this disease, aiding early diagnosis and recognition by practicing physicians. Case Report:
This case report includes details of two children who were admitted in Indira Gandhi Institute of
Child Health. One child was being evaluated for uncontrolled hypertension for nearly 2 years and
the other child presented to us with Hypertensive encephalopathy referred from NIMHANS. Bruit
was noted in both the patients along with high uncontrolled blood pressures for which
ultrasonography was done. The 12 year old male child showed a small right sided kidney with a
normal left sided kidney. He was further subjected to angiography which showed a suprarenal,
renal and infrarenal involvement of the aorta. Multiple mid thoracic occlusions noted with right
renal artery completely occluded. Superior mesenteric artery was also found to be involved. The
other child showed an involvement of predominantly suprarenal aorta. Ishikawa's criteria were
used to establish the diagnosis of TA while NIH criteria were followed for ascertaining disease
activity. Aortic involvement was classified on the basis of Lupi - Herrera's modified classification.
Both patients had active abdominal tuberculosis with Mantoux positivity, for which they were
being treated. Anti-streptolysin O (ASO) and anti-nuclear antibody (ANA) titres were negative
each with no clinical features of rheumatic or autoimmune disease. Anti-hypertensive drugs were
started in both children who presented with hypertension. Both of them required just 1 anti
hypertensive initially. However, at least 3 anti-hypertensive agents were later needed for
controlling the blood pressure. Successful aortoplasty was done in one child and planned for the
other. Both the children were started off on Prednisolone and Cyclophosphamide and being
managed with anti hypertensives and anti tubercular treatment. Conclusion:TA is the commonest
cause of Renovascular hypertension in Asians and Africans. Several differences have been
observed between paediatric TA and adult disease. An increased frequency of constitutional
symptoms noted in children could account for delayed diagnosis. Its association with tuberculosis
(which is very common in India) needs more study. Indians, as demonstrated in some studies have
a predominant involvement of thoracic and abdominal aorta. Irrespective of the surgical procedure
undertaken, the outcome appears to be favorable when the disease is quiescent or diagnosed
earlier. Hence a high degree of suspicion is required during an evaluation for hypertension.
Thorough knowledge and methodology to aid diagnosis would help in hitting at the diagnosis
faster among treating physicians.
RHE/06(P) CASE SERIES: THE VARIED CLINICAL PRESENTATIONS OF LUPUS
NEPHRITIS IN CHILDREN
Bharath Kumar Reddy K.R., Alka Rani.T.Patil, Govindaraj.M
Indira Gandhi Institute of Child Health, Bangalore
bharathreddykr@yahoo.co.in
Introduction: Renal manifestations are present in nearly two thirds of children with Systemic
Lupus Erythematosis (SLE). Children with SLE may present with a combination of symptomatic
hypertension, nephrotic syndrome, or gross haematuria. A wide range of extra renal manifestations
may predominate in some children. Often, the choice of therapy is influenced by potential renal or
extra renal complications of the regimens, and hence the physician caring for children with SLE
must have a clear understanding of both the renal and extra renal presentations of SLE and their
care. Case Series: This case series elaborates on 6 children of SLE presenting to Indira Gandhi
Institute of Child Health between April 09 to September 09. All the six cases were found to be
females. A relatively early age of onset was noted with the youngest being 2.5 years of age. The
predominant presentation being nephrotic syndrome in most children.One child presented with
nephritis and another child presented with seizures and was thereafter diagnosed as SLE with CNS
manifestation which by itself is a rare presentation. Another child who was found to be negative
for ANA and dsDNA with a normal C3 at presentation, however, showed Lupus nephritis class IV
changes, in spite of fulfilling only 3 out of 11 criteria. One of our children developed an active
vasculitis, presenting with skin rash and succumbed with ARDS as a complication of SLE. ACR
(American College of Rheumatology) criteria were used to establish the diagnosis SLE, with renal
biopsy of 4 out of 6 children graded by the Revised WHO classification of Lupus Nephritis, and
further given a score of the Activity Index (AI) and Chronicity Index (CI) noted
histopathologically. All children were treated with Pulse Methyl Prednisolone therapy and
Cyclophosphamide (except one child who is maintained on oral prednisolone), the response of
which is currently being studied Conclusion: SLE is appearing to be a relatively common form of
vasculitis in children, unlike previous reports. Extra renal manifestations and atypical
presentations of SLE are coming to the fore. By adequate knowledge of the disease among treating
physicians, it is possible to identify SLE at a relatively earlier age group, thus improving prognosis
with early treatment modalities. Atypical and unusual presentations of the disease must be kept in
mind.
RHE/07(P) GENERALIZED MORPHEA: A CASE REPORT
Payal Shah, N.R. Sutay, Manish K. Arya, Mangesh Jadhav
Dept. Of Paediatrics, Grant Medical College & Sir J.J. Group Of Hospitals, Mumbai 8.
manjioo7@yahoo.co.in
Introduction : Generalized morphea is a subtype of localized scleroderma, which lacks systemic
manifestations and displays widespread, multiple, well-circumscribed, indurated plaques. Case
report: 5 year old boy presented with history of change in colour and texture of skin of trunk and
extremities and limitation of movement of right ankle joint since 2 years. Initially patient had
discrete area of erythema and progressed steadily with induration of the plaques and affection of
other body areas. The surface became smooth and shiny. Patient also complained about restriction
of ankle joint since 6 months. He did not have any systemic complaints and similar family
history. Physical examination revealed multiple, hyper-, hypopigmented and ivory-colored
indurated plaques with atrophic, shiny surface on the upper and lower extremities, trunk, and
buttocks. Some of them were surrounded by violaceous border. The complete blood count with
differential, liver function tests and urinalysis were normal. Antinuclear antibodies, anti-Scl-70
antibodies, and were negative. X-ray lungs were normal. The skin biopsy showed an epidermal
atrophy, a sparse superficial and predominantly deep dermal and subcutaneous perivascular
infiltrate of lymphocytes and plasma cells, and the collagen bundles appeared thickened and
closely packed with paucity of adnexal structures suggestive of morphea. Patient was started on
high-potency topical glucocorticoids along with Systemic glucocorticoids. He was also given
weekly dose of Methotrexate with partial improvement. So our case report shows the typical
clinical and histology features of one of the rarest subtypes of localized scleroderma - generalized
morphea.
RHE/08(P) INCOMPLETE KAWASAKI DISEASE A CHALLENGE FOR TIMELY
DIAGNOSIS
Arathi Srinivasan, Janani Sankar
Kanchi Kamakoti Childs Trust Hospital, 12A, Nageswara Road,Nungambakkam, Chennai 600034.
jananis_2000@yahoo.com
Kawasaki disease is an acute self limited vasculitis first described by Tomisaku Kawasaki. This
entity is diagnosed as per the criteria proposed by the American Heart Association. 1 Recognition
of a child with the constellation of classical signs is not difficult, but more and more children are
being recognised who do not fulfil the criteria. Such patients are under diagnosed and their timely
diagnosis is a challenge. Recently, an algorithm is proposed to evaluate such incomplete cases.2
Here we report 2 infants with incomplete presentation mimicking acute infections. Case Reports
Two infants,a 11 months old male infant and a 5 months old female infant presented with high
grade fever of 4 -5 days duration with no localising symptoms.Both had high total counts,high
ESR and CRP and platelet count in the high normal range.In view of the young age both were
treated as occult bacterial infection pending cultures.Both of them continued to have high grade
fever spikes with irritability as the predominant associated symptom.CXR,USG abdomen and CSF
analysis also remained normal with sterile cultures.Repeat CBC revealed further increase in total
count,very high platelet count and rising ESR.In view of this incomplete Kawasaki disease was
suspected and Echo was done which revealed coronary ectasis in both infants.They improved with
high dose IVIG. So though Kawasaki disease is commonly confused for infections, in our scenario
of a developing country, where infections are more common, the index of suspicion still remains
low. It is not uncommon for a paediatrician in a developing country to see such cases routinely.
Many children get treated for occult bacterial infections as a cause of pyrexia of unknown origin,
probably this delays the suspicion with the loss of a valuable time. The two infants presented here
may just represent the tip of an iceberg, with the large portion of unrecognised and untreated cases
being submerged. The onus is on the treating clinician to recognise the disease in the acute phase
itself even with incomplete presentation so as to reduce the disease burden later in life.
STA/02 HOW GOOD IS THE NEW ORAL IRON CHELATOR; DEFERASIROX IN
INDIAN CHILDREN WITH BETA THALASSEMIA MAJOR?
Yogesh Shewale, Rashmi Shad Vinay
G2, New Doctors Quarters, School Building, Choithram Hospital Campus, Manik Bagh Road,
Indore
Email: drrashmishad@yahoo.com
Objective: To evaluate efficacy and safety of oral iron chelator; deferasirox in iron overloaded
patients with Beta thalassemia major. Design: Prospective, descriptive study. Setting: Thalassemia
Day Care Centre. Subjects: 47 children more than 2 years with beta thalassemia major taking
deferasirox between August-2008 and September-2009.Method: Children receiving deferasirox at
different doses were followed for one year. Outcome measures: Changes in serum ferritin, SGPT,
creatinine from individual baseline at different dosage groups, various adverse effects and reasons
of poor compliance. Results: After nine months follow up, children who received deferasirox in
dose 20-25.9mg/kg/day showed mean 62.18% increase in serum ferritin from baseline. Children
who received dose 26-30.9 mg/kg/day showed mean 52.99 % increase and children who received
31-35mg/kg/day showed mean 12.31% increase in serum ferritin from baseline. Children showing
consistent decrease in serum ferritin received higher doses of deferasirox (mean 28.7mg/kg/day).
Dose more than 30 mg/kg/day showed transient rise in serum creatinine. Increase in serum SGPT
was reversible. Most common adverse effect noted was abdominal pain followed by nausea and
rash. No one required interruption of therapy due to rise in serum SGPT, creatinine or adverse
effects. Common causes of poor compliance as observed in 10(21%) children were no response to
therapy, parenteral anxiety of rising serum ferritin values, cost of therapy and investigations.
Conclusion: Higher doses 31-35 mg/kg/day of deferasirox are required for maintaining serum
ferritin near baseline with frequent monitoring of serum creatinine.
STA/05 COMPARISON OF CEREBRAL PERFUSION PRESSURE VERSUS INTRA
CRANIAL PRESSURETARGETED THERAPY IN CHILDREN WITH ACTURE CNS
INFECTION: A RANDOMIZED CONTROLLED TRIAL
Ramesh Kumar R., Arun Bansal
Dept. of Pediatrics, PGIMER, Chandigarh
Email: krramesh_iway@yahoo.co.in
Background and rationale: Acute CNS infection is associated with high mortality and
neurodeficits despite advent of newer treatments. Appropriate measures to manage raised ICP are
expected to improve the outcome by reducing secondary brain injury. Studies comparing the
outcome in CPP versus ICP targeted therapy in acute CNS infection are lacking and majority are
primarily on traumatic brain injury. Objective: To compare the CPP versus ICP targeted therapy in
children with acute CNS infection. Method: Design: Open label randomized pilot trial between
JULY 2007 and JUNE 2009. Setting: Level III PICU of tertiary care teaching hospital.
Participants: Seventy five children, aged 1 to 12 years, consecutively admitted to PICU with acute
CNS infection and Glasgow Coma Scale (GCS) ≤ 8 were randomized to two groups.
Interventions: All patients received antipyretics, sedation and anticonvulsants and were ventilated
to maintain normoxia (PaO2 60–80 mm Hg) and normocarbia (PaCO2 30-35 mm Hg) using
uniform protocol. In ICP group (n-39), an ICP<20 mm Hg was targeted using mannitol and/or
hypertonic saline. In CPP group (n-36), a CPP>60 mm Hg was maintained with help of fluids,
vasoactive therapy and measures to reduce ICP. Intraparenchymal pressure transducer
(CODMAN®) with continuous oscillatory monitor displays of ICP were used for ICP monitoring.
Heart rate, respiratory rate, blood pressure, mean arterial blood pressure, CPP, CVP, ICP, SPO2
and ETCO2 were monitored. Outcome measures: Primary outcomes: At end of 72hours, (1)
Mortality (2) Feasibility (3) GCS improvement. Results: Patients in two groups were similar with
respect to age, GCS and severity of illness (PRISM I & III). Acute viral encephalitis 39 cases
(20vs19) and acute meningitis 36 cases (16vs20) were proven. Significant positive correlation was
present between CPP and ICP in both groups (r=0.496 vs 0.411 and p=<0.001 vs <0.001) which
was clinically demonstrated by a decrease in ICP with improvement in CPP. Negative correlation
was present between MABP and ICP in both groups (r=0.005 vs 0.163 and p=0.701 vs 0.018)
which means that autoregulation was intact. At end of 72 hours, (1) in CPP group 34(94.4)
patients and in ICP group35 (89.7%) patients survived (P=0.453) (2) targeted therapy was
achieved in 33 (91.7%) and 35(89.7%) patients in CPP and ICP group respectively (P=0.048) (3)
trend of GCS improvement was towards significant in CPP group (x2 = 0.052). At PICU
discharge, 6 patients in CPP group, 12 patients in ICP group died (P=0.153), survival was better in
acute meningitis patients (P = 0.07). Conclusion: Survival, GCS improvement and feasibility was
better in patients in the CPP group.
STA/08 RANDOMIZED TRIAL OF MAGNESIUM SULFATE INFUSION VERSUS
TERBUTALINE INFUSION IN CHILDREN WITH ACUTE SEVERE ASTHMA
Grover Sudhanshu Gian, Bansal Arun
C/o. Dr. Sunit Singhi, Proffessor and Head, Department of Pediatrics, Advanced Pediatric Centre,
PGIMER, Chandigarh
Email: sunit.singhi@gmail.com
Objective: To compare the efficacy of magnesium sulfate infusion and terbutaline infusion in the
management of acute severe asthma in children. Design: Randomized controlled trial. Subjects: 57
children between 1 to 12 years of age presenting with acute severe asthma not responding to
conventional treatment (humidified oxygen; nebulization with ashthalin, budesonide and
ipratropium bromide; and one dose of oral or intravenous steroid) were enrolled from January
2008 to May 2009. Randomization: Computer generated random number table was used to
randomize the patients to receive intravenous magnesium sulfate (n=29) or terbutaline infusion
(n=28). Intervention: Clinical Asthma Severity Score (CASS) which included respiratory rate,
oxygen saturation, retractions, wheeze and dyspnea was used to monitor patients at 1,2,4,8 and 12
hours. Results: 35 male and 22 female patients with no significant difference in demographic
variables were studied. The mean CASS at 0 hour was 10.03 in the magnesium sulfate group and
10.03 in the terbutaline group (p=0.454). In the magnesium sulfate group, 28 out of 29 patients
had treatment success(96.6%), compared with 20 out of 28 patients(71.4%) in the terbutaline
group (p=0.009). The time cycled analysis of the changes in CASS at different intervals of time
showed that changes were more significant in patients receiving magnesium sulfate (p=0.001).
The magnesium sulfate group did not have any significant side effects, while 2 patients in
terbutaline group had hypokalemia (p=0.148). Conclusion: Magnesium sulfate leads to a faster
clinical response in patients with acute severe asthma not responding to conventional treatment as
compared to terbutaline.
JF/04 INFANTILE THIAMINE DEFFICIENCY HAS VARIABLE CLINICAL
PRESENTATION AND IS OFTEN OVER LOOKED
Madap Karuna, Kondala B. Murali Krishna, Ippela Nalini Prasad
# 8-7-188 / 6 A, Behind St. Andrew’s School, Samatha Nagar, Old Bowenpally, Secunderabad –
500011
Email: karuna_pottala@yahoo.com
Objectives: To study in detail the commonly misdiagnosed cases of beriberi in terms of
epidemiological, clinical and biochemical and radiological features, response to thiamine, sequalae
and follow up, especially the prevalence of beriberi and unusual presentations like infantile
encephalitic beriberi. To highlight uniform characteristic clinical presentation to have an eye of
suspicion in diagnosing these cases and prompt treatment and its response to thiamine
supplementation, as it is life saving. Design: Prospective study of infants presenting to emergency
department of our hospital during 2003-2007. Participants: Two different groups of patients, one
included infants presenting with acute neurological manifestations suspecting encephalitic beriberi
and the other group with acute cardio respiratory symptoms with unexplained CCF among cardiac
beriberi cases. Main outcome: Prevalence of beriberi especially in exclusively breast fed infants
coming from low socio-economic background. Commonly misdiagnosed but uniform
characteristic features aid in diagnosing Infantile Thiamine Deficiency. Results: Clinical features
among the encephalitic group were seizures(55.4%), altered sensorium(63.3%), acute loss of mile
stones(86.1%), external ophthalmoplegia/ptosis(76%), nystagmus(4.8%), developmental
delay(6.6%), involuntary movements(38.5%), hypotonia(76%), respiratory difficulties(74.1%)
among them characteristic sighing and sobbing breathing(93.5%), apnoea(6.5%).Elevated serum
lactate(86.7%)and neuro imaging showed characteristic symmetric hypo-dense lesions in the basal
ganglia. Among cardiac group tachypnoea(100%), chest indrawing(100%), tachycardia(100%),
hepatomegaly(80%), cough(76.3%) and pulmonary crepitations(10.9%) elevated serum
lactate(98.2%), chest Xray suggests cardiomegaly in all infants, ECG revealed sinus tachycardia.
In both the groups, majority of the infants and the mothers had low ETKA levels Fever
precipitated this acute illness in majority of these infants. Aphonia was a common clinical feature
in many of the infants in both the cohorts. Conclusion: Thiamine deficiency in India is far from
controlled and many present with neurological and /or cardiac symptoms. Clinicians should
consider the possibility of infantile thiamine deficiency and its typical life threatening presentation
as timely thiamine therapy is life saving. Especially in exclusively breast fed infants hailing from
low socio-economic group, Infantile Encephalitic Beriberi (IEBB) is thought to be rare form of the
thiamine deficiency as it is poorly described in the literature but its characteristic clinical
presentation aids in diagnosis. Further response to thiamine itself is diagnostic of underlying
thiamine deficiency.
JF/11 EARLY DETECTION OF AUTISM-COMPARISON OF TWO SCREENING
TOOLS
Manju Geroge Elenjickal, Sobha K.
Assist. Professor in Pediatrics, Pushpagiri Medical College, Tiruvalla – 689101
Email: mysticmanju@rediffmail.com
Background: The incidence of autism, is on the rise in India. There are not many well conducted
systematic studies in this subject to identify the various risk factors based on the geographic,
cultural and genetic differences or similarities of Indian population with the rest of the world.
Objectives: To study the comparative efficacy of two screening tools for early detection of Autism
namely CHeck List for Autism in Toddlers (CHAT) and Trivandrum Autism Behavior Chart
(TABC) and to study the prevalence and various factors influencing the incidence of Autism.
Setting: Pushpagiri Institute of Medical Sciences & Research Centre, Tiruvalla, a Tertiary care
Medical College in central Kerala. Period: 6 months from September 2008 to February 2009.
Method: 400 children between 18 and 36 months attending various day care centres and
playschools around a radius of 20 km of our medical college were screened for autism using the
two tools, CHAT and TABC in a single setting after carefully taking the history and recording the
information in a proforma. The observations were evaluated and results drawn. Statistical analyses
of the results were done using kappa, chi- square, and Fisher exact tests where ever appropriate.
Results and Conclusions: 14 children were screened positive for autism by CHAT and 18 children
by TABC. Kappa analysis showed that both these tools are in good agreement (K=0.75) with each
other. No statistically significant association could be drawn between sex, birth order, area of
residence, parental age, mother’s education or gestational age. Statistically significant association
was obtained between low paternal education status (P<0.037), developmental delay like no social
smile at 2months, no talking by 12 months, no protodeclarative pointing, and no wave bye-bye
(P<0.00001) and autism.
JF/12 NON PHARMACOLOGICAL METHODS OF PAIN RELIEF IN NEONATES: IS
MOTHER’S VOICE AS EFFECTIVE?
Gaurav Monga, Amit Gupta, Sanjeev Dutta
S/o. Sh. Vijay Kumar Monga, House No. 5096, Gali Affim Wali, Postoffice Bazaar, Bathinda –
151001
Email: GAURAVMONGA_99@YAHOO.COM
A randomized controlled trial study was done to assess the pain in neonates and to compare the
effects of non pharmacological methods on pain relief after a painful stimulus in 100 stable term
neonates using NIPS scale. 10% dextrose, Expressed breast milk (EBM), Breast feeding and
mothers voice were used. At 30 seconds after the painful procedure, the pain scores were lowest in
EBM group but this effect could not be sustained at 1minute and 2 minute interval. At 1 minute
and 2 minute interval pain scores were minimum in breast feeding group followed by mother’s
voice group and 10% dextrose group. All the intervention groups had comparable duration of time
of first cry with respect to control group. Cry, as an obvious measure of pain was assessed and it
was found that all the intervention groups although had a comparable time of first cry but there
was significant reduction in total duration of cry (breast feeding followed by mother’s voice
having the best effect). Increase in heart rate seen with painful stimuli showed significant
reduction with all the non pharmacological methods having a comparable effect. Although a
significant fall in SpO2 levels was noticed after painful prick in all in intervention groups but the
effect was insignificant when compared to the control group In conclusion this study suggests that
breast feeding; mother’s voice 10% dextrose and EBM are effective non pharmacological methods
of pain relief. Mother’s voice was analyzed as a novel method has been found to be a new and an
effective method for pain relief in neonates. The effects on pain though less than that of breast
feeding, were better in comparison to 10% dextrose, EBM and control group.
JF/13 KNOWELDGE AND AWARENESS IN THE MOTHERS ABOUT BENEFITS OF
KANGAROO MOTHERCARE FOR HER BABY
M. Gopi Krishna, B. Sangeetha
Dept. of Pediatrics, Kakatiya Medical College, Warangal
Email: gopikrishna.dr@gmail.com
Introduction: Kangaroo Mother Care (KMC) is a new technique, in our country. Knowledge
regarding the procedure and benefits are not known to many mothers and their families. The
knowledge about KMC is not found in health education at school or college level. So, even most
of the educated Indian mothers do not have knowledge about it. There is an insufficient data in our
country regarding the acceptability of KMC by the mothers. Aims and Objectives: The present
study was undertaken to know the knowledge and awareness about the benefits of KMC, to their
preterm babies, among the mothers. Material and Methods: This is an observational study with a
structured questionnaire. Mothers of 46 babies are the study subjects. Relevant questions were
timed before and after 1 hour of KMC. Data was entered in the Micro soft Access Data base and
appropriate statistical test were done by using Epi Info, 3.5.1, C.D.C. U.S.A. Results: There is no
association between the educational status of mother or father with knowledge of KMC (chisquare: 13.2; p value: 0.063). 97.8% of mothers could understand what was explained to them in a
single session (p value <0.001). Additional explanation by using visual aids (photographs), did
not add to the betterment of knowledge about KMC (Z: 1.04, p value: 0.297). 90.6% of mothers’
feel that fathers can implement KMC. After 1 hr of KMC 96% of mothers developed confidence
of implementing KMC. Positive feeling like closeness to baby (93.5%), sense of goodness
(97.8%), decreases in anxiety (93.5%), stress reduction (78.3%) was observed. 73.9% of mothers
did not find any practicable problem during the procedure (Z: 4.38, p value : <0.001). In our study
significant number of mothers (39.1%), still could not feel it practicable to give feeding while on
KMC, (Z: 1.88, p value: 0.060). 52% of the mothers felt 1hr as practicable duration for KMC and
19.6% felt 2 hrs as practicable duration for KMC. Only 6.5% of mother felt 12hr as practicable
duration of KMC. All the mothers expressed their willingness to continue KMC at home.
Conclusions: Literacy is inadequate to bring knowledge about KMC in mothers. It needs specific
health education. Even illiterate mothers can understand and implement KMC with simple and
clear oral instructions. Health care workers can be a good source of this health education. 24 hrs
KMC is not practicable to most of the mothers. Positive feelings arise in mothers even with one
hour of KMC.
VBR/01 STUDY OF PROTEIN C, PROTEIN S AND ANTITHROMBIN III LEVELS AS
EARLY PREDICTORS OF DISSEMINATED INTRAVASCULAR COAGULATION IN
INFANTS WITH SEPSIS
Dhivyalakshmi J.
C/o. Mr. Arachelvan, B-23, Golf view Apaprtments, (MIG Flats), Saket, New Delhi 110017
Email: dhivya8@yahoo.co.in
OBJECTIVES: To study the changes in the levels of Protein C(PC), Protein S(PS), Antithrombin
III(AT-III) as early predictors of disseminated intravascular coagulation(DIC) in infants with
sepsis. DESIGN: Prospective cohort study. SETTING: Department of Paediatrics, Safdarjung
Hospital, Newdelhi. PATIENTS: 62 sepsis screen positive infants1 and 60 healthy controls aged 01 yr were enrolled. In view of age related differences in the PC, PS, AT-III values the age cut-off
was taken as 3 months2. We had 20 cases aged birth to 3 months of life (GROUP A) and 42 cases
aged 3 months to 1 year (GROUP B). METHODS: Sepsis was diagnosed by clinical and
laboratory findings. Prothrombin time, Platelet count, Serum Fibrinogen, FDP’s, PC, PS and ATIII were done on day 2 (sample I) and on day 7 of admission (sample II) and were analysed for
DIC. RESULTS: The Sample I levels of PC, PS and AT-III were decreased in subjects with DIC
when compared to sample II and compared to subjects without DIC(p<0.005). In sample II, PS
and AT-III didn’t show a significant change with DIC in group A. However, AT-III had a
significant change in group B(P=0.001). Only PC(p<0.05) continued to be significantly low in
both samples and in both the groups. The best predictive value for Protein C was 28% - 30 %
(sensitivity – 70% to 90%, specificity – 93.3% to 100% respectively). CONCLUSIONS: Protein C
showed consistent derangements with sepsis and DIC and could be the ideal early predictor of
DIC. Early estimation should be considered as the derangement occurs even before the clinical
manifestation of DIC.
VBR/03 COMPARISON OF ANTINOCICEPTIVE EFFECT OF DIRECT BREAST
FEEDING AND 25% DEXTROSE WITH PLACEBO DURING 1ST WHOLE CELL DPT
VACCINATION IN HEALTHY TERM INFANT: A RANDOMIZED PLACEBO
CONTROLLED TRIAL
Gaurav Goswami, Rajesh Chaudhary, Amit Upadhyay
Dept. of Pediatrics, Lala Lajpat Rai Memorial Medical College, Meerut
Email: mail2gauravpedia@gmail.com
Aims and Objective: To compare antinociceptive effect of direct breast feeding over 25% dextrose
solution and placebo as we give 1st intramuscular whole cell DPT injection to infant. Design: A
prospective, randomized, placebo controlled double blind trial. Setting of study: This study was
performed in immunization clinic of Department of Pediatrics, LLRM medical college from
Oct,08 - Sept,09 Participation: Participants were infants less than 3month of age for their 1st DPT
vaccination, allotted in three groups of 40 each through random generated numbers, sealed in
opaque envelopes with serial number on it. Intervention: One person checked the sealed envelope
and administered the vaccine to the groups, and second observer did the video recording. The third
observer, who was blinded to the intervention groups, analyzed the video recording & noted the
outcome variables. Statistical analysis – Data was analyzed using STATA 9.1 software. Analysis
of continuous data with normal distribution was analyzed by one way ANOVAs test followed
Bonferroni correction for multiple comparisons and non normally distributed data by Kruskal
Wallis test. Categorical data was analyzed by “chi-square test”. Outcome measure: The primary
outcome variable was the duration of cry after vaccination. Secondary outcome variable was
Modified Facial Coding Score and latency of onset of cry. Results: 120 babies were enrolled (40
in breast feed group, 40 in 25% dextrose fed group and 40 in distilled water fed group). Median
(interquartile range) duration of cry was significantly lower in direct breast fed 33.5 (17-54)
seconds and 25% dextrose fed babies 47.5 (31-67.5) seconds as compared to babies given distilled
water 80.5 (33.5-119.5) seconds (P < 0.001). Conclusions: Direct breastfeeding and 25% dextrose
are potent analgesic intervention in young infants during DPT vaccination in young infants less
than 3 month of age.
VBR/09 ETIOLOGY OF NUTRITIONAL RICKETS: A CASE CONTROL STUDY
Varun Aggarwal
House No. 123, Pocket E-21, Sector 3, Rohini, Delhi 110085
Email: drvarunaggarwal@gmail.com
Objective: To study the role of calcium and vitamin D deficiency in etiology of nutritional rickets
in young children. Design: Case control study. Introduction: Rickets is conventionally thought to
be due to vitamin D deficiency. Studies from some tropical countries have postulated low dietary
calcium as the cause of nutritional rickets. Both Vitamin D and dietary calcium deficiency are
highly prevalent in India. Information on their relative contribution in the etiology of rickets in
Indian children is limited. Methods: We compared 67 children with nutritional rickets with 68 age
and sex matched healthy controls. The baseline demographic (nutritional status, sun exposure (UV
score), dietary calcium and phytate intake) and biochemical data (serum calcium, inorganic
phosphate, alkaline phosphatase, 25(OH)D3 and parathyroid hormone) was compared among the
cases and controls. Results: Mean (± S.D.) intake of calcium was found to be significantly lower
in cases as compared to controls (204.71±129.04 ‘vs’ 453.27±234.1 mg/day, p<0.0001). Also,
there was significantly lower dairy calcium and higher phytates content in the diet of cases as
compared to controls. Mean serum 25(OH)D3 levels in both cases and controls was in the range of
deficiency (15.94±12.43 ng/ml and 19.9±13.4 ng/ml respectively; p=0.08). There was no
significant difference in the mean serum 25(OH)D3 levels and UV among the cases and controls.
In cases with rickets, regression analysis showed a significant correlation (r=-0.279; p=0.0278)
between dietary calcium intake and radiological score. Conclusions: Results of our study indicate
that rickets develops when low dietary calcium intake co-exists with a low or borderline vitamin D
nutrition status.
VBR/12 BIOPHYSICAL PROFILE OF BLOOD PRESSURE IN URBAN SCHOOL
CHILDREN
K. Pavan Kumar
Dept. of Pediatrics, Mahavir Hospital & Research Centre, Hyderabad 500004
Introduction: Hypertension, a Modern Epidemic, is one of the major risk factors for coronary heart
disease & stroke, which are the leading causes of morbidity and mortality across the world. It was
documented that almost 75 % of cases of Hypertension and 90 % cases of Pre- hypertension in
children and adolescents are undiagnosed - an ICEBERG Disease. The Children in the upper
percentile of Blood Pressure levels are more likely to become hypertensive in adulthood. Hence,
early recognition of Hypertension & its risk factors in children may help in preventing
cardiovascular diseases in later life. The Reference norms varies with racial, ethnical & cultural
differences across the world, hence it is essential to have a local reference data. Studies pertaining
to Blood pressure of Indian school children are very few, No Published Data in Andhra Pradesh so
far. In this context, the present study is done. Objectives: To establish the Normal Distribution
pattern of Blood Pressure in apparently healthy school children. (Age 5 – 14 years) To Study the
prevalence of Pre-hypertension & Hypertension in Urban school children To evaluate the
relationship of Blood Pressure with variables like Age, Sex, Weight, Height, Body Mass Index
(BMI), Socioeconomic status and Family history. Material and Methods: Under NICE Foundation
School Child Health Care Plan, a Cross – sectional study was conducted on 2500 children in the
age group of 5 – 14 years from 10 randomly selected schools of Hyderabad city during March
2008 - June 2009. Clinical examination was carried out between 8:00 AM to 12:00 noon after
prior explanation of procedure to the children. Blood pressure measurements were made by one
examiner as per AHA Guidelines and Definitions of Hypertension & Pre hypertension were as per
the current Fourth task force report on the Diagnosis, Evaluation, and Treatment of High Blood
Pressure in Children and Adolescents. Blood pressure was recorded three times and the mean was
taken. For children who has recorded high blood pressure, the factors like anxiety and fear were
removed and re-recorded after one hour of rest. Children suffering from acute or chronic illness
were not included. Results and Observations: The Prevalence of Hypertension among children
between 5 – 14 years was 7.2 % (6.6 % in Boys & 7.9 % in girls), with high Prevalence in 7 & 8
yr age group. The Prevalence of Pre-hypertension was 4.7 % and was found to be twice in Boys
(6.2 %) as compared to that in Girls (3 %). Multiple regression analysis showed Positive and
significant correlation of age, weight, height, BMI, Socioeconomic status & Family history with
each SBP and DBP. The mean SBP and DBP in obesity group (123.3 mm of Hg & 76 mm of Hg)
were significantly higher than Overweight ( 109.4 mm of Hg & 69.8 mm of Hg ), while
overweight was significantly higher than normal weight group (103 mm of Hg & 64.3 mm of Hg),
(P < 0.0001). There were high mean Systolic & Diastolic blood pressures in the children of High
socio – economic status (P < 0.0001). Family history of hypertension was present in 16.8 %
children with high blood pressure compared to 6 % in normotensive parents (P < 0.0001).
Conclusions: Regular Blood pressure measurement of children is mandatory for early detection of
Pre hypertension & Hypertension. High Body mass index & Positive Family history of
Hypertension forms an important indicator of childhood hypertension and appropriate therapeutic
life style changes should be initiated to prevent Hypertension & its complications.
SSM/04 GROWTH AND NUTRITIONAL STATUS AT CORRECTED TERM (39-41
WEEKS) GESTATIONAL AGE IN VERY LOW BIRTH WEIGHT INFANTS.
Ashish Jaiswal, Srinivas Murki,
Fernandez Hospital, Hyderabad -500001
Email: drashishjaiswal@gmail.com
Objectives: To evaluate the growth and nutritional status at term (39-41 weeks) corrected
gestational age in VLBW infants and to study the predictors of malnutrition. Study design:
Prospective analytical study. Settings: Tertiary care perinatal centre with level III NICU. Subjects:
All Inborn VLBW infants and discharged alive from the hospital. Data collection: Relevant
perinatal, clinical variables and anthropometry data at birth, at hospital discharge and at term
gestation. Primary outcome: Z scores of weight, occipitofrontal circumference, length and
predictors of postnatal malnutrition (z-score for weight < -2SD) at term gestation. Results: The
mean gestational age and the mean birth weight of study subjects were 31.03±2.18 weeks and
1195.28±191.25 grams respectively. 26 (58.3 %) infants had birth weight less than 1000 grams
and 65 (37.4%) infants were of gestation less than 31 weeks. The mean weight, the mean length
and mean OFC at term gestation were 2367.32±521, 43.72±3.3 and 32.65±1.6 respectively. The
mean z scores for weight, length and OFC at term gestation was −1.66±1.2, −1.98±1.3 and
−0.48±0.7 respectively. Forty three percent (n=75) infants were malnourished. Birth weight (p=
0.005), gestational age (p= 0.001), z-score at birth (p=0.001), female sex (p= 0.004), duration of
oxygen (p=0.008), duration of hospitalization (p= 0.005) and average post discharge weight gain
per day (p <0.001) predicted malnutrition. Conclusion: There is a high prevalence of postnatal
malnutrition in VLBW infants. Poor intrauterine growth, female sex, lower birth weight, lower
gestation, infant sickness and poor post-discharge weight gain contribute significantly to postnatal
malnutrition
SSM/05 COMPARATIVE ASSESSMENT OF FETAL MALNUTRITION BY
ANTHROPOMETRY AND CAN SCORE
Soundarya Mahalingam, B. S. V. Shivanagaraja, Raghuveera Kamila
304, Greenfields Apts., 6th Cross, Behind K.M.C. Hospital, Attavar, Mangalore 575001
Email: soundarya29@gmail.com
Fetal malnutrition (FM) implies soft tissue wasting at birth with significant postnatal
consequences and morbidity, and is identified by clinical assessment (CAN score) and
anthropometric indices. No previous studies have been done to study all these parameters and
evolve a screening method. Objectives: (1) To identify the incidence of FM using CAN score and
compare the nutritional assessment by anthropometry (2) To evolve a screening tool for rapid
assessment of FM. Methods: Prospective study in Government district maternity hospital. 300
term newborns were assessed by CAN score and anthropometry recorded. The newborns were
classified as per weight for gestational age and Ponderal index (PI), Body mass index (BMI) and
midarm circumference/ head circumference ratio (MAC/HC) and compared to CAN score for their
accuracy in identifying FM. Results: Incidence of FM was 24%. The newborns identified as
malnourished by PI, BMI, MAC/HC were evaluated by CAN score and a significant number of
them (31/78 in PI, 60/121 in BMI, 51/81 in MAC/HC) were found well nourished. Similarly those
recognized as normal by PI, BMI, MAC/HC were malnourished by CAN score assessment
(25/222 in PI, 11/179 in BMI, 42/219 in MAC/HC) with statistical significance (0.0001). Among
these indices, BMI had the highest sensitivity and CAN score very high specificity. 11 neonates
with normal BMI had low CAN score however 9 of them had normal PI. Conclusion: FM is best
identified by CAN score. BMI is the best screening tool for malnutrition and when coupled with
PI will identify most normally nourished newborns.
SSM/10 INTRAUTERINE GROWTH CURVE BY DIFFERENT ANTHROPOMETRIC
MEDHODS
Kunal Mukherjee
Dept. of Pediatrics, SCB Medical College, Cuttack
Introduction: Fetal Growth entails the development. and maturation of the fetus over the course of
pregnancy. Extreme variation in fetal growth is recognized as a risk factor for newborn mortality,
morbidity and developmental delay Estimation of Intra-Uterine Growth is ideally now a days
done by ultra-sonography but it is expensive and not universally affordable in INDIA.This study
has been done to find an alternate approach by using the data derived at birth of the different
anthropometric parameters at various gestational. period. The data was then plotted and respective
intra-uterine curves have been made. Aims &Objectives: To ascertain birth weight and different
anthropometric measurements in term and preterm infants To obtain intrauterine growth curves
from the data thus obtained To compare the above curve with various national and international
curves Methods and Materials: Study Design: Randomized Cross Sectional Study Period: JulyDecember 2008 Place: SCB Mch Cuttack 300 Live born singleton healthy babies >28WK without
any dysmorphism were included Exclusion: Twins ,IDM , babies born of mothers suffering from
Toxemias of pregnancy The gestational age was assessed by New Ballard Scoring System (NBSS)
and was compared with gestational age calculated from the first day of last menstrual period
(LMP). Weight taken by electronic balance within one hour of birth and recorded nearest to50
gm. Crown Heel Length and Crown Rump length were measured by Infantometer. Head
Circumference, Chest Circumference, Mid-arm Circumference, Maximum Thigh Circumference
measurement by a non-stretchable measuring tape. The Mean Standard deviations and percentiles
of different anthropometric parameters were calculated for different gestational ages and 3 rd 10th
25th 50th 75th 90th 97th percentiles for birthweight were plotted for respective gestational ages from
28-42 weeks. with help of PRICE BENZ I Results: The Intrauterine growth curve of the300
newborns in Cuttack was thus obtained .It was compared with theUsher ,Babson(western)and
Ghose ,mukherjee.etal,seth (high urban)curves. The growth of babies was comparable to western
only up to 30 wks In comparision to the Ghosh,Mukherjee charst our chart crossed it emphasizing
that the growth of Indian children has been better than before . In comparision to the usg based
growth charts our chart iscomparble with it upto 34 weeks Conclusion: In comparision to Indian
studies apart from high socioeconomic studies our chart crossed it emphasizing that the growth of
Indian children has been better than before mainly due to improved antenatal care Nutritional
supplements& also due to secular trends.However western standards are a distant goal. Ultrasound
is costly observer dependant& not readily available in every part of India Our chart can be used
with relative accuracy for plotting the intrauterine growth of Indian children
MISC/01(O) A HOSPITAL BASED STUDY OF ASSESSMENT OF MISSED
OPPORTUNITIES OF IMMUNIZATION IN CHILDREN AGED LESS THAN TWO
YEARS
Dabi DR, Yadav A, Verma S, Jora R
Department of Pediatrics, RIMCH, Umaid Hopital, Dr. S.N. Medical College, Jodhpur
jorarakesh@rediffmail.com
Objective: To find out the prevalence of missed opportunities of immunization in children and the
reasons for the same. Design: Cross sectional interview based case control descriptive study.
Setting: Tertiary level teaching hospital-- Umaid Hospital, Regional Institute of Maternal and
Child Health, Dr. S. N. Medical College, Jodhpur Method: Immunization status was assessed via
interview method using standard protocols recommended by the WHO, for a total of 600 children
aged less than two years (200 indoor and 400 outdoor patients) picked up through a table of
random numbers. The children who had missed an immunization opportunity were compared with
those who had not, for socio-demographic variables and reasons for missed opportunity were
determined. Results: 48.5% of the children were immunized up to date, 33.82% were partially
immunized not up to date and 15.17% were completely un-immunized. The status of 2.5%
children could not be assessed and were excluded from the study. 45.64% of children had missed
an opportunity for immunization. Illiteracy, higher birth order, rural residence, poor
socioeconomic status emerged as the risk factors. Physician negligence (82.39%), ignorance by
parents in 79.40% and false contraindications (mild acute illness in 21%, current antimicrobial
therapy in 8.22%, convalescent phase of illness in 7.86%, recent exposure to infectious disease in
5.24%, fever precipitating seizures in 1.12%, pre-maturity 0.74% in that order) were the main
causes. Conclusions: Immunization is an important but yet neglected part of child health visits.
Each child’s immunization status should be assessed at every health care visit to avoid missed
opportunities.
MISC/02(P) HOW RELIABLE IS OCCLUSION ALARM OF SYRINGE PUMP
INFUSING INOTROPES?
Amit Kumar, Prashant Patil, Raghunath C.N.
3rd floor PITU, Narayana Hrudhayalaya, Banglore-560099
drprashant1981@gmail.com
Introduction: Postoperative pediatric cardiac surgical patients have myocardial dysfunction for
initial 12-24 hrs. Therefore inotropic support is vital for initial smooth recovery. Syringe pump has
been designed to alarm if occlusion pressure exceeds desired limits. Objective: To evaluate the
occlusion alarm time of syringe pump at various sensitivity & flow rate. Method: Three calibrated
syringe pump (PERFUSOR COMPAQ of B.BRAUN) were used in the study. Syringe size used
was of 20ml & 50ml. To mimic the clinical setting 200cm extension tubing was attached to
syringe & to other end a three-way stopcock was attached. Syringes were filled with normal saline
& the tubings including 3-way were flushed with normal saline. The alarm time was recorded with
occluded 3-way at the rate of 1ml/hr, 2ml/hr, 5ml/hr & 10ml/hr using alarm setting of P-1, P-2 &
P-3. Results: At a low flow rate of 1 ml/hr, the time for alarm occlusion (min:sec) were 7:55:07+/51.99, 14:28:47+/-1:43:01, 34:06:64+/-5:09:18 with 50 ml syringe at P1, P2, P3 sensitivity setting
respectively and corresponding values for 20 ml syringe were 5:17:57+/-45:55, 8:33:07+/- 28:82,
10:09:59+/- 36:50. At high flow rate of 10 ml/hr, time for alarm occlusion were 50:93+/-6:67,
2:55:80+/-10:76, 3:18:75+/- 8:75 for 50 ml syringe. At 5ml/hr and 2 ml/hr flow rates, findings
were intermediate between 1 ml/hr and 10ml/hr flow rate. The occlusion alarm time for 20 ml
syringe were shorter than those for 50 ml syringe( p -0.02) . At a lower flow of 0.5 mL/hr, none of
the pumps alarmed despite 30 minutes of distal occlusion, regardless of syringe size and
sensitivity. Conclusion: Occlusion alarm of syringe pump infusing inotropes are not reliable with
high variability. To detect early occlusion , smaller syringe size, higher flow rate & higher
sensivity setting (p1) should be used for inotrope infusion.
MISC/03(P) AUTOPSY OF STILLBIRTH: HOW MUCH IT HELPS TO IDENTIFY THE
ETIOLOGY
Jadab Kumar Jana, Utpal Dan, Nabendu Chaudhuri
H/O Nabakumar Adhikary, Tikorehat More, Lkudi, Burdwan -713102
jadabjana@gmail.com
Introduction: There is no declination of stillbirth rate in last two decade and it remains almost
same. This is because of no extensive study on that part had been carried out to identify the
causative factors of stillbirth and formulate the preventive measure to reduce the same, though it
contributes major portion of perinatal mortality in our country. Aims and Objectives: The purpose
of this present study was to find out the etiology of stillbirth. Materials and Methods: This
observational study was conducted over 20 stillbirth babies delivered at Burdwan Medical College
in West Bengal. The meticulous external examination was done followed by necropsy study.
Results: Out of 20 babies, 7 babies had both external as well as internal congenital malformation.
Externally 13 babies were normal but necropsy study revealed internal congenital malformation in
three more babies. Conclusion: 1.Necropsy study help to identify spectrum of congenital
malformation in those babies who have external malformation. 2. It helps to find out congenital
malformation in apparent looks normal babies. Thus, proper evaluation of congenital
malformations that might be the causes of stillbirth can be made by necropsy study not only by
morphological examination alone.
MISC/04(P) EPIDEMIOLOGICAL STUDY OF STILLBIRTH
COMMUNITY IN WEST BENGAL
Jadab Kumar Jana, Nabendu chaudhuri
H/O Nabakumar Adhikary, Tikorehat More, Lkudi, Burdwan -713102
jadabjana@gmail.com
IN
A
RURAL
Introduction: Stillbirths contribute major portion of perinatal mortality in Bengal but adequate
attention has not been paid to decrease stillbirths. A well designed systemic study has been
conducted in the department of Gynaecology & obstetrics, Burdwan Medical College, to reduce
stillbirth rate. Aims and Objectives: To study the incidence and risk factors of stillbirth,
epidemiological factors related to stillbirth and to find out the impact of interventional programme
that has been taken to decrease the same. Materials & Methods: This study protocol was prepared
in two aspects. Thorough analysis of Bed Head Tickets and Verbal autopsy of mothers who had
stillbirth and focused group discussion amongst parents, doctors and nursing personnel were done
in retrospective phase (2004-2005). The interventional programme with application of the
knowledge obtained from retrospective study was done in the prospective phase (2006-2007).
Results: In the retrospective study, 1085 Bed Head Tickets and verbal autopsy were thoroughly
analyzed. Eight Focused group discussions were conducted four in each phase. The stillbirth rates
were 18.68 and 15.70 per 1000 births in retrospective and prospective phase respectively. The
identified risk factors were - early marriage and motherhood, failure of family planning
adaptation, poor antenatal and intrapartum care, strenuous work during antenatal period,
nutritional deprivation, poor recognition of risk factors, and fetal malformation. Conclusion: There
was definite decrease of stillbirth rate (15.96%) which indicates the effectiveness of interventional
programme and risk factors were identified more than 60% cases. This study recommends that
interventional programme conducted in present study should be followed in every tier of health
systems to decrease the stillbirth rate which ultimately decrease the perinatal mortality.
MISC/05(P) USE OF OBJECTIVE STRUCTURED CLINICAL EXAMINATION (OSCE)
FOR EVALUATING STUDENTS PERFORMANCE IN PEDIATRICS
Varsha Phadke, Sujata Kanhere, Malabika Behera
K. J. Somaiya Medical College, Mumbai.
varshadp@gmail.com
Introduction: Objective Structured Clinical Examination is a reliable and valid method of
assessment. This study was conducted to explore student’s perception of OSCE as a Pediatric
evaluation method. Aims and objectives- To evaluate students’ perception of OSCE compared to
viva and case presentation Use OSCE to identify lacunae in teaching specific clinical skills.
Materials and methods-A 10 station OSCE was administered to 22 third MBBS students in
addition to case presentation. Students and faculty were administered feedback questionnaire.
Marks obtained by students in OSCE and case presentation were compared. Group scores on
individual OSCE stations were analyzed. Results- OSCE was considered the best method to test
width of knowledge, clinical skills and application of knowledge (95%). OSCE is fair, easy to
score and reduces bias (90%). However, 9% students found it stressful. 14% disagreed that OSCE
minimizes chances of failing. Viva was rated as a better tool for testing depth of knowledge
(95%). Case presentation tests holistic approach to a patient and analytical skills (95%). It is easy
to score, less stressful, less rigid (82%). The marks obtained by students in OSCE (mean-14.45,
SD-1.49) and case presentation (mean-13.27, SD-2.18) were comparable. Group scores for
performance at 2 stations was not satisfactory (46.5 and 53) when compared with the mean group
score (63.6) indicating lacunae in teaching. Conclusions- OSCE provides a standardized way of
assessing clinical competence but it should be used in combination with case presentation. OSCE
can be used effectively to identify lacunae in teaching methods.
MISC/06(O) ANTIBIOTIC USE IN A TERTIARY CARE HOSPITAL
P. Veena, T. M. Ananda Kesavan , K. K. Purushothaman
Dept of Pediatrics, Govt. Medical College, Thrissur, Kerala-680596
dranandiap@gamil.com
Introduction: One of the most commonly used drugs in pediatrics is the antibiotics. It is strange
that it is also one of the most common misused drugs. Objectives: This study was conducted to
analyze the use of antibiotics in a tertiary care hospital. Also to see the extent of the newer
spectrum antibiotics Materials and Methods :This retrospective study was conducted in Govt.
Medical College, Thrissur during January 2008 to June 2009.All children admitted in the ward
were included in the study. Infants less than one month of age and children transferred from other
departments were not included in the study Results : Totally 2356 children were admittedduring
18mo period. Most common indication for hospital admission was respiratory diseases followed
by acute diarrheal disease, viral fever,anaemia,febrile seizure, seizure disorder, congenital heart
disease with complications. Antibiotics were used in 1167(49%) cases. Commonest antibiotic used
was ampicillin (54.2%) followed by gentamicin(GM),amoxycillin,,crystalline penicillin(CP),
cefotaxime, cloxacillin , ceftriaxone , erythromycin and cotrimoxazole .Some of the rarely used
antibiotics were vancomycin, amikacin, cephalexin, azithromycin, meropenam, cefipime,
piperacillin Multiple antibiotics were used in certain situations like HIV, bronchopneumonia with
PEM, pneumonia with CHD, ALL.40% of deaths occurred during 24 hours of admission and
majority of death were due to congenital or chronic illness. Symptoms that persisted due to the use
of antibiotics were drug fever, diarrhea, thrombophlebitis. Conclusion: Almost all infectious
diseases can be managed with the good old antibiotics like Ampicillin, GM, CP and Cloxacillin.
Antibiotic resistance is very rare in community acquired infections. It is very rare for two
antibiotics to fail (unless it is a nosocomial infection or immuno-compromised patient).
Antibiotic failure is rare , it is often the physician who fails. Good old drugs are still effective. It
is better to avoid drug combinations whenever possible. Newer antibiotics should never be the
drug of first choice. The limitations of this study is that the number is small, it is not well
supported by culture reports, and similar data from literature is not available for comparison
MISC/07(P) A DESCRIPTIVE ANALYSIS OF KNOWLEDGE OF RESUSCITATION
AMONG INTERNS
K. Shreedhara Avabratha , B.Sanjeeva Rai.
Dept of Pediatrics, Fr. Muller Medical College Mangalore, Karnataka.
shreedharkdr@gmail.com
Introduction: The ability to recognize and treat a respiratory or cardiac arrest is a basic medical
skill that all doctors are generally assumed to possess. However structured basic life support
(BLS) and advanced life support (ALS) training is lacking in the undergraduate curriculum. Aims
& Objectives: To assess the resuscitation knowledge among interns. Material and methods:
Descriptive study carried out in a medical College at Mangalore. Interns were given a
questionnaire containing 20 simple questions covering various aspects of resuscitation (BLS,
ALS-cardiac/pediatric). Those who had attended resuscitation courses were excluded. Results:
Seventy one interns were included in the study. 34 (47%) could answer 10 or more questions.
While question on foreign body removal was answered by 63(88%), only 5 (7%) knew that
brachial artery has to be palpated to check infant’s pulse. 48(67%) were aware that intraosseous
route is an alternative to peripheral IV access. While 81% and 73% aware of the recommended
number of breaths and compression rate respectively, only 47% had knowledge of the correct
ratio. There was lack of consistency and uniformity in the answers given. Conclusions: The study
demonstrates a low level of resuscitation knowledge among interns and the knowledge is
scattered. Training in life support should become a standardized and a mandatory component of all
medical school undergraduate curriculums. Same was felt by all the participants of the study also.
MISC/08(P) ACUTE TOXICITY OF GLUE SNIFFING- A RARE EXPRTIENCE
Pradeep Debata, Anuj Dhama, Puneet, D.K. Taneja
Deptt. of Pediatrics, VMMC & Safdarjung Hospital, New Delhi.
pkdebata66@yahoo.co.in
Volatile substance abuse, commonly referred to as glue sniffing, is quite prevalent. Diagnosis of
substance abuse toxicity is difficult and relies entirely on the history and the presentations. A 12
year old boy with generalized weakness, progressively increasing respiratory distress and altered
sensorium was admitted. He was working at a tyre-puncture shop being thrown out of home. He
had dry and scaly skin, poor oral hygiene with perioral dermatitis. He was in coma grade 1, had
severe respiratory distress. He was drowsy with fretful behavior, aphonia and generalized
hypotonia. In chest, bilateral wheeze and basal crackles were there. Bowel sounds were decreased.
Hemoglobin was 10.1 gm %, leucocytosis (TLC 44000/cumm) and platelet count of 39000/cumm
with normal peripheral smear. Urine RE shows RBC casts. There were Hypokalemia and
Metabolic acidosis. LFT was mildly deranged. CSF was normal. Blood, CSF and urinary cultures
had no growth. HIV ELISA was negative. Chest X-Ray showed c right lower lobe consolidation.
Renal USG shows renal parenchymal disease. CECT head and NCV were normal. He was given
supportive care. Patient improved significantly but had respiratory distress. Pulmonary function
test done at this time revealed moderate restrictive disease. HRCT chest findings were suggestive
of right lower and left anterior basal segmentconsolidation. In view of the multisystem
involvement and no etiological cause identified; patient’s history was revisited and history of glue
sniffing for 4 years which increased in last week was obtained. We reviewed the literature on
substance abuse and were amused to discover that all the symptoms and signs represented a
spectrum of toluene toxicity secondary to glue sniffing and substance abuse.
MISC/09(P) BUTTON BATTERY INGESTION: A CASE REPORT AND REVIEW
Ajay K. Tiwari, Shri Ram Agrawal
B-1/461, Janak Puri, New Delhi-110058
ajaytiwari06@yahoo.com
Introduction: Foreign body ingestion is a medical emergency in less than one percent of all
patients and it peaks between six months to three years of age. Most common sites for impaction
are cricopharyngeal area, middle one third of the esophagus, lower esophageal sphincter, pylorus
and ileocecal valve. An important and frequently seen foreign body ingestion in children is disc or
button batteries out of which mercury batteries are most dangerous because of their direct
corrosive effects and potential to cause burns. Case Report: A 2-year-old male child admitted with
history of excessive irritability, drooling of saliva, coughing and breathing difficulty after
accidentally ingesting button battery six hours earlier. On examination, child had respiratory
distress and a neck radiograph showed coin shaped shadow at cervicothoracic region. An upper
gastrointestinal endoscopy revealed button battery impacted at cricopharynx with surrounding
inflamed and ulcerated mucosa (fig-1). The battery was pushed down in mid esophagus and
removed after grasping with snare (fig-2). A repeat endoscopy of rest of esophagus, stomach and
duodenum was normal. Child continued to have respiratory distress with stridor for next five days
for which, he was kept nil orally and given intravenous fluid, antibiotics, oxygen and nebulization.
Child was discharged after nine days of hospital stay. Discussion: Although most of button
batteries reach stomach, if a button battery remains in the stomach for more than 48 hours or the
size is bigger than 2cm in diameter, endoscopic removal is recommended. A button battery
ingestion case should be managed as follows: an early x-ray for battery localization, endoscopic
removal of batteries lodged in the esophagus and also from the stomach if battery size is more than
20 mm, a close follow up of children with batteries beyond duodenum and identification of battery
composition. Since button batteries can cause serious complications after ingestion hence warning
labels with treatment instructions should be made mandatory for all electronic instruments. Parents
should dispose of the used batteries safely.
Fig-1. Button Battery Impacted At Cricopharynx
With Inflamed & Ulcerated Sorrounding Mucosa. Fig-2. Battery Pushed Down In Mid Esophagus
And Grasped With Snare.
MISC/10(P) ARE OUR CHILDREN SAFE, SCHOOL TRANSPORT, PROBLEMS ON
THE SAFETY OF SCHOOL CHILDREN,PUBLIC HEALTH CHALLANGE
Manju Lata Sharma
Survelliance Medical Officer, W.H.O., NPSP, Bikaner
drmanjulatas@yahoo.com
The transport of children to the school is the most neglected part till date, Aims and Objectives, to
study the various problems and impact in transporting the children to school. To highlight the
problems, safety measures adopted in transporting the children to school, so as to stimulate
rethinking on school transport and traffic regulations on the safety of children. Material &
Methods The study is done in 10 schools over the city. 350 school children of (3 - 15 Yrs.) School
children, parents, drivers of vehicles and school authorities were interviewed with the help of a
preset questionnaire. The questions were aimed at knowing what measures adopted in transporting
the children to school from this information. Various problems and issues were identified
Observations Various modes for transportation By private vehicles ,Auto rickshaws 50% School
Bus 25%, own vehicle 5%,Parents drop the children8%,foot10 % Chauffer driven car2%Various
reasons for different mode of transport No School vehicles, No Options, School is far , No time to
drop the child, Less school vehicles, Insufficientspace,House is not on the route own
vehicle,,Notime,near to house,Feel independent,adventurous,
Convenient, health
problem.Recurrent respiratory infectns.20%,Pain ,aches 15%Loss of appetite, tiredness
20%,Accidents 5% of children have minor to serious injuries Conclusion The study brings out
that transporting of the children to school is most neglected part at parents, school and
Government
level.
impact
on
the
health
of
children
and
safety
of
childrren.RecommendationsSchool authorities should take care of transport of children Do not
send the children in overcrowded,School transport vehicles should be checked at regular intervals
to avoid accidents
MISC/11(P)
VACCINE
RELATED
REACTOGENICITY
FOR
PRIMARY
IMMUNIZATION: A RANDOMIZED CONTROLLED TRIAL OF 23(WIDER) VS.
25(NARROWER) GAUGE NEEDLES WITH SAME LENGTHS"
Bhavneet Bharti
Asstt Professor, Advanced Pediatric Center, PGIMER , Chandigarh
bhavneetb@yahoo.com
Introduction: The local reactions and pain associated with the vaccination are widely recognized
as a source of anxiety and distress for parents and health care providers. Studies have shown that
longer length of needle is associated with reduced local reactogenicity, yet there are only few
studies comparing the gauge of needle. Aims & Objectives: To compare vaccine reactogenicity
during primary immunization in healthy infants using two different bore sizes 23 vs. 25 gauge
needles Materials & Methods: The study was planned as a Randomized Controlled Trial; 155
participants reporting to the vaccination room of Advanced Pediatrics Center for primary
immunization were assigned to two intervention groups (23 vs. 25 gauge). Parent-reported local
and systemic reactions were recorded daily for three days after the immunization as the main
outcome measures. Results: Swelling (24%) and tenderness (21%) were two most common parentreported local symptoms followed by restriction of movements (18%) and redness (10%) on day 1.
Any local reaction on day 1 was statistically similar in 25 gauge vs. 23 gauge group (RR 0.77;
95% CI: 0.32 to 1.82) (P=0.54), but fever (day 1) showed higher trend in 23 gauge needle group
(RR 2.24; 95% CI: 0.92-5.47) (P=0.07). Furthermore, on analysis of serially reported local and
systemic reactions for 3 consecutive days by generalized estimating equations, odds of redness,
swelling, tenderness, restricted movement and fever were statistically similar between two needle
groups. On the other hand, median (±SE) crying time (in seconds) was significantly prolonged in
the 25 gauge needle (39±2) as compared to 23 gauge group (30±1.3) (log rank test, P=0.001).
Conclusion: The use of same length needles with narrower (25) or wider (23) gauge did not show
significant differences in local reactogenicity during primary immunization. Fever, however, was
reduced marginally in 25 gauge group whereas crying duration was significantly shorter with 23
gauge needle. Finally, larger studies are needed to further evaluate objectively the outcome of
reactogenicity.
MISC/12(O) PEDIATRIC EMERGENCY TRANSPORT – INDIAN EXPERIENCE.
Anant Sagar, Dinesh Chirla, Farhan Shaikh, Preetham, Satish.
Rainbow Children Hospital ,Hyderabad
sagarman1979@yahoo.co.in
Introduction: Pediatric emergency transport (PET) is an established service in developed countries.
However in our country there is no established transport service. Parents bring the child in their
own vehicle or by private ambulance with paramedics. Rainbow Children’s hospital has
established PET service in Hyderabad and picks up patients from hospitals within city and
surrounding districts and state (upto 300kms). AIM- To study the profile of critically ill children
who were transported by paediatric emergency transport team from within city and surrounding
districts/state. Material and Methods: Retrospective observational study of patients transported by
PET team and admitted in our PICU during a period from may’07 to april’09. The PET team
consists of senior registrar/Intensivist, nurse and paramedic. The ambulance is fully equipped with
monitor, syringe pump, suction, oxygen and ventilators. We collected the demographic data,
indication for transport, need for ventilation, interventions required and outcome of these patients
in short and long transport. Results: Total 60 patients were transported by Rainbow PET team.
There were 37 boys (61.6%) and 23 (38.4%) girls. 65% of the children were <3 years old. Mean
Duration of PICU stay of the transported children was 5.6 days. 47 children were transported
from within city while 13 were transported from surrounding district and state. The common
indications for transport was respiratory distress +ventilatory support 36.6%(22), Shock
31.6%(19),
seizures + altered sensorium30%(18),
renal failure1.6% (1) and hepatic
encephalopathy1.6%(1). 17 (28.3%)were transported because of parental request. Total 18
(30%)of transported children required ventilation in our centre. 12 were intubated in referral
hospital and 6 after arrival in our hospital. 23(38.3%) required fluid boluses during transport and
6(10%) were started on vasoactive drugs. 28.3% required other interventions like oxygen or i.v.
antiepileptics. No major adverse events occurred during the transport. 8 children died in the
transported group (Mortality rate of 13.3%). 5 of them died in less than 24 hours and all were
from within city. 21 had GCS below 9 out of which 6 died. Mean PRISM of those who died (n=8)
was 19.25. We had 10 children brought dead to emergency room in last 1 year. We do not know
how many children who were referred and did not reach hospital and died on way. Conclusion: It
is feasible to provide pediatric emergency transport service in India. Respiratory distress/ventiltory
support being the major call for transport. PET service improves outcome of critically ill children.
MISC/13(P) CASE REPORT: RENAL HEMORRHAGE DURING HIGH – DOSE
VALPROATE MONOTHERAPY
Harmesh S. Bains, Gurdeep S. Dhooria
Department of Pediatrics, Dayanand Medical College, Ludhiana , Punjab
gurdeep2005_123@sify.com
Valproic acid is a widely used antiepileptic drug. Liver toxicity is the major side effect.
Thrombocytopenia can also occur; however, few patients require drug discontinuation. To the best
of our knowledge, Valproate induced renal hemorrhage has not been described, this is the first
case of renal hemorrhage during valproate monotherapy.
MISC/14(P) ROLE OF 1ST CARE PROVIDER FOR COMMON CHILDHOOD
ILLNESSES IN URBAN SLUMS OF MEWAR
Devendra Sareen, Nilesh Gothi, Dharam Singh, Deepak Tak, Mahesh Upadhyay, Jitendra Jain,
Umang Upadhyay
27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
The urban slums encircle the Udaipur city from periphery. These urban slums are located in that
part of the city which has poor surrounding, hence the population is more prone to develop various
illnesses. The present study had been planned to assess the role of 1st care provider for common
childhood illnesses in urban slums of Udaipur. This study was carried out in 32 urban slum
clusters of Udaipur city. Each slum was visited and families encountered with under five children
that had an illness episode in last one month were interviewed. Total 200 families were
interviewed using a pre-tested questionnaire. The observations were recorded in a printed protocol
and data analysis was done. We observed that the 1st care provider were RMP (22%), Bengali
Doctor (16%), Private Doctor (14.5%), paramedical staff (13%), Dispensary (12.5%), Ayurvedic
Doctor (11%), Homeopathic Doctor (7.5%) and Medical College (3.5%). Families preferred
private providers as 1st provider because of easy accessibility (33%) and low cost of treatment
(31%), Private providers (quack) were consulted when danger signs were not present (49.5%),
while trained physician were consulted only in presence of danger signs (65%). Low income
group preferred consulting quacks (68.2%) while trained physicians were consulted by high
income group (63.4%) only. Under privileged caste (81.3%), poor maternal education (62.8%) and
consultation for female child (61%) were the major factors for choosing quacks as the 1st provider
while privileged caste (39.8%), higher maternal education (39%) and consultation for male child
(32%) were the major factors for the selecting trained physician as the 1st provider. Hence, we
must educate the urban slum families for consultation with the trained medical staff at the earliest
before development of danger signs in children. The referral services should be made prompt so
that the under five children of the slum areas get the required medical facilities at the earliest.
MISC/15(P) AWARENESS REGARDING PERSONAL HYGIENE IN MENTALLY
HANDICAPPED CHILDREN OF MEWAR
Nitin Goyal, Abhishek Ojha, Devendra Sareen
C/o. Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Mentally handicapped children are mores prone for various childhood diseases. The role of
personal hygiene is vital for them. The present study had been planned to assess the awareness of
mentally handicapped children of Prayas Sansthan of Udaipur. For this study 75 children of the
institute between 6-18 yrs. of age were selected and they were interviewed regarding their
knowledge and attitude about personal hygiene. After gaining the confidence of the children, with
the help of teachers of the school, these children were interviewed and we filled up the pre-tested
performa. The data analysis was done. We observed that 83.8% of children were aware about
brushing the teeth, but correct method of brushing was known to only 15.6% of them. Only 46.8%
were aware regarding proper nail cutting and hygiene. Regarding proper care of hair only 48.1%
were well aware. As regards, proper hand washing 48.1% were correct, 27.3% were partially
correct and 24.6% had no concept of proper hand washing. Daily bathing was observed in 81.9%
of children. Female children were more aware (62%) about personal hygiene in comparison to
male ones (38%). Older children between age group of 12-18 yrs. had better concept of personal
hygiene (64%) in comparison to young children between 6-12 yrs. (36%). Hence, we must impart
knowledge of personal hygiene to this most vulnerable group of society so that their awareness
regarding personal hygiene reaches at optimum level so as to protect them from various child hood
illnesses.
MISC/16(P) ANALYSIS OF EXTRA CURRICULAR ACTIVITIES OF CHILDREN OF
CHILD LABOUR SCHOOLS OF UDAIPUR DISTRICT
Abhishek Ojha, Srishti Sareen, Dharam Singh
C/o. Dr. Devendra Sareen, 27-F, New Fatehpura, Near Sukhadia Circle, Udaipur-313 001
drsareen@yahoo.com
Child labour schools are the center of all round development of child labourers studying in it. This
study had been planned to analysis the extra curricular activities of child labour schools in and
around Udaipur. For this study 400 children studying in different child labour schools located in
cohorts of Udaipur were selected. They were taken into confidence and were interviewed
regarding their interest in various extra curricular activities regarding dance, music, craft etc. All
data were recorded in printed protocol and data analysis was done. It revealed that most of the
children were interested in singing (56%), music (47.5%), dance (43.75%), craft (42.25%),
drawing (39.5%), mono-acting (32%), story writing (26.2%) and debate (20.5%). The interest of
the male children was more in dance (69%) and singing (64.5%). Their inclination was more for
the western music (62%) in comparison to traditional Indian music (38%). The female children
were more inclined towards craft (78%) and traditional Indian culture (72.25%). Younger children
were more interest in music (67.5%) than older children (32.5%). We must sort out the interest of
the child and try to develop him or her in that field. Further they should be motivated for mores
fruitful activities like craft and drawing, so that when they attain adulthood they can be directed
towards their field of interest which would ultimately help them to build up their future career.
MISC/17(P)
LIFE
THREATENING
REBOUND
METHEMOGLOBINEMIA
FOLLOWING PAINT INGESTION
Nidhi, Manish Narang, Archana Dwivedi, JP Kapoor
Department of Pediatrics, University College of Medical Sciences, Delhi.
manish_2710@yahoo.com; nidhi_mamc2001@yahoo.co.in
A 4-year-girl presented with cyanosis and altered sensorium after ingestion of paint. She was
diagnosed as a case of methemoglobinemia and treated appropriately with methylene blue. She
responded to treatment but again deteriorated the next day for which a repeat dose of methylene
blue was needed. One should be aware about rebound methemoglobinemia and the need for
further monitoring and treatment.
MISC/18(P) AMMONIUM DICHROMATE INGESTION- A RARE PRESENTATION OF
POISONING IN CHILDREN
Sunil Menon, Bijesh, Kalyani Pillai, Ramaraj, V.K.Parvathy.
Assistant Prof. of Paediatrics,Amala Medical College,Amala Nagar,Thrissur-680555
sunilsree99@yahoo.co.in
Ammonium dichromate crystals are odorless ,attractive , orange – red, fatal if ingested. Reported
poisoning are rare in Kerala. Dichromates (sodium,potassium, and ammonium) are important
hexavalent chromium compounds . Dichomates are used in printing,dyeing,plastics and rayon
manufacturing. Primary routes of entry : skin,eye contact,ingestion,inhalation.Target organs ;
eyes,skin,respiratory
system,kidneys,liver.
Ingestion
can
cause
vertigo,abdominal
pain,vomiting,convulsions,severe
coagulapathy,intravascular
haemolysis,
hepatorenal
failure.Chronic inhalation of chromate dust causes conjunctivitis,lacrimation, nasal septum
ulceration, respiratory cancer. Treatment of acute poisoning : BAL and large doses of ascorbic
acid(IV).Stomach wash with a solution of ascorbic acid. Large quantities of water.(If available,
several glasses of milk) may be given. There are reports of favourable results with Nacetylcysteine. Case: We present Nasam 2 year old child with ammonium dichromate ingestion,
who was given these crystals by his brother .Father worked from home for printing letters on bags
and purses for banks and shops. The child presented with vomiting, abdominal pain and copious
mucoid secretions from rectum with weak rapid pulse,shallow respiration,clammy skin,
seizures,severe coagulopathy.hepatorenal failure. Child expired after 36 hours. Autopsy revealed
gastrointestinal mucosal bleed and intestinal wall oedema. Conclusion: This is a rare poisoning in
children Timely detection and availability of drugs like BAL, (IV) ascorbic acid can be lifesaving.
MISC/19(P) STUDY OF EFFECTS OF INADVERTENT ADMINISTRATION OF
ALBENDAZOLE IN CHILDREN LESS THAN 1 YEAR OF AGE
L. S. Deshmukh, A. M. Lingayat, A. P. Kirtane
Department of Pediatrics, GMCH Aurangabad
i4vega@yahoo.com
Aims and Objectives: To study the effects of inadvertent administration of albendazole in children
less than 1 year of age. Materials and Methods: 7 Children age less than one year inadvertently
administered with albendazole in December 2008, under national programme. All 7 children were
given syrup. Albendazole 200 mg (single dose). The age group was ranging from 6 mo to 11 mo.
There were 4 males and 3 females. 2 of them were also administered Hepatitis B vaccine. Out of 7
patients, 4 were asymptomatic and 3 patients had fever; 3 with loose motions; out of these 2 had
vomiting. All these patients were suspected of to be suffering from albendazole toxicity. All of
them were investigated for CBC, LFT, KFT, stool examination. These patients were treated with
IV Fluids, ORS, antipyretics, prebiotic supplementation and zinc. Results: Asymptomatic patients
were observed for 24 hours and then discharged. All symptomatic patients recovered fully in 48
hours and were discharged. Conclusion: Albendazole seems to be unsafe less than 1 year of age
and due precaution should be taken during its administration.
MISC/20(P) A NOVEL APPROACH TO MANAGE ELECTRIC BURN INJURIES OF
BACK IN CHILDREN
Anant Sagar, Dinesh Chirla, Farhan Shaikh, Preetham, Satish.
Rainbow Children Hospital ,Hyderabad
sagarman1979@yahoo.co.in
Aim: to manage electric burn injuries anywhere in the body is a daunting task Case history: A
7year male child who met with high voltage electric burns with an electric transformer, presented
to us with an entry wound around right shoulder and exit wound in left foot. Entry wound was
extensively deep, almost till scapula with extensive charring of surrounding tissue. Exit wound in
left foot was involving the skin of sole with full thickness involvement and gangrenous second,
third and fourth toe. He had flash burns involving the entire face and parts of neck region too. The
burn injury extended to both ears including post aural region on the right side. Back was involved
completely with second degree full thickness burn with right shoulder wound involvement being
deep upto bone. There was circumferential involvement of right arm with deep burns on the
posterior aspect and some areas extending to forearm also. He was brought to us within one hour
of sustained burn injury. He was started on empirical broad spectrum antibiotic and fluid
management done based on parkland formula. Urine was alkalinized and target urine output of
1.5ml/kg/hour was maintained during the initial course of the treatment. On second day to prevent
excessive rhabdomyolysis, debridement of wound was done as there was myonecrosis of the
wound involving right scapular region (there was rising urea, creatinine and CPK on second day).
To augment the improvement in wound bed of shoulder/left arm, Vacuum assisted drainage
(negative pressure therapy) was applied. There was improvement in granulation seen within
48hours of negative pressure therapy. Collagen dressing was done over rest of the back area with
second degree burn. Minimal slough was removed/excised bedside, and negative pressure therapy
continued for another 48 hours. (140 to 160mm of water). Patient was posted for skin grafting
after he was haemodynamically stable and wound showed good granulation tissue (96 hrs post
debridement). Skin graft taken from right thigh and leg. While grafting the wounds on right
scapular region were the bone was exposed, adjacent muscle was mobilized to cover the exposed
bone. Graft uptake was 100%. As almost ¾ th of the back was covered with burn wounds, with
complete face involvement, a sponge frame was prepared. This allowed the patient to lie in his
back, thus the patient compliance and nursing became very easy and comfortable. Negative
pressure therapy was continued over the graft also. Post operative negative pressure was continued
for another 4 days. This helped in preventing graft movement and maceration. During the course
of treatment he was afebrile with no evidence of infection of wound or graft side. DiscussionVacuum assisted wound closure (VAC) is a closed system, which applies negative pressure to the
wound tissues. Studies have shown beneficial effects on wound blood flow and proliferation of
healing granulation tissue. Theoretically, the method acts by removal of excess tissue fluid from
the extravascular space, which lowers capillary after-load and thereby promotes the
microcirculation during the early stages of inflammation. Additionally, the mechanical effect of
the vacuum on the tissue at the wound surface appears to have an "Ilizarovian" effect resulting in
an exuberant proliferation of healing granulation tissue. The preferential indications for Vacuum
Assisted Closure include pressure sores, leg ulcer, wounds with skin defects, burns, complications
of surgical wounds and delayed healing.The case was interesting, because the child had extensive
burn area, which involved back and circumferential chest area with facial involvement, hence it
was difficult to manage the child in any of the position. This sponge frame prepared allowed us to
lie the child on the back with out movement of graft and preventing maceration. As already
discussed the compliance of the child also increased. Child also had axillary involvement with the
burn, and the sponge frame allowed us to keep the arm abducted. Negative pressure therapy done
in the electrical wound burn is also unique, and the result we saw was very encouraging.
MISC/21(P) BEWARE, TELEVISION CAN KILL YOUR CHILD
Kanchan C, V.S. V Prasad, Malviya M, P.V. Gopalkrishna, Dayal A
Lotus Children Hospital, Hyderabad
drkanchanc@yahoo.co.in
Objectives: To report the rising number of severe head injuries associated with falling television
sets kept on trolley, over the children. Study design: Retrospective case series form June 2008 to
June 2009 Setting: Tertiary care center in Hyderabad. Study population: All children with history
of television set falling directly leading to head injury were included: Results: 9 children of
median age 24 months (range 18-36 months) were reported with head injury secondary to falling
television set. Out of 44.4% (4/9) who required mechanical ventilation 33% (3/9) died who had
basal skull fracture within 24 hours of admission. All remaining six had different grades of skull
fractures and brain parenchyma injuries. On historical review with all the nine families; all nine
children were playing around television trolley. Conclusion: From our series, falling television
sets is associate with severe form of head injury including death and seen mostly in children less
than 3 years of age. Prevention focused on improved public and medical fraternity awareness of
this danger, and modified design of the standard support structures can decrease the number of
injuries, which will benefit children overall.
MISC/22(P) COSTING OF SEVERE PNEUMONIA IN HOSPITALIZED INFANTS AND
CHILDREN AGED 2-36 MONTHS, AT A SECONDARY AND TERTIARY LEVEL
HOSPITAL OF A NOT-FOR-PROFIT ORGANIZATION
Hanehøj M, Madsen H, Das AR, Puliyel M, Rose W, Moses PD., Konradsen F, John KR, Bose A
Dept of Community Health, Christian Medical College, Vellore-632002.
abose@cmcvellore.ac.in
Objectives: To determine health care provider cost and household cost of the treatment of severe
pneumonia in infants and young children admitted to secondary and tertiary level health care
facilities. Methods: The study was done in a private, not-for-profit medical College hospital, in
Vellore, India, in mid-2008. Children between the age of 2-36 months admitted with severe
pneumonia with no underlying chronic disease were included in the study. The relatives were
interviewed daily on matters relating to patients view point of the costs. These were direct medical
costs, direct non-medical costs which included the cost of travel, accommodation and special
food during the period of illness and indirect costs of productivity loss for family members.
Patient specific resource consumption and related charges were recorded from charts, nursing
records, pharmacy lists and hospital bills, and the providers view point of the costs was estimated.
Unit cost estimates for bed days, treatment and investigation inputs were calculated. Results:
Total cost to health care provider for one episode of hospitalized childhood pneumonia treated at
secondary level was USD 83.89 (INR 3524) and USD 146.59 (INR 6158) at tertiary. Mean
household expenditure on secondary level was USD 41.35 (INR 1737) and at tertiary level was
USD 134.62 (INR 5655), the largest single expense being medicines in the former and the
hospitalization in the latter. (one USD=INR 42.1 at time of study). The unit cost estimates that
were produced can be used for calculation of the cost of treatment of pneumonia in individual
organizations, based on rates. An interesting but valid point found is the debt trap that health care
causes, in lower socio-economic strata. Conclusions: The considerable cost difference that exists
between secondary and tertiary level treatment argues for admission at lowest appropriate
treatment level, in order to lower costs for patients and providers.
MISC/23(P) DIFFERENT POLLUTION ZONES AND SEVERITY OF BRONCHIAL
ASTHMA IN KANPUR (U.P.) INDIA
Senthil Kumar S.P., Tripathi V.N., Rao Y.K., Arya A.K.
Department of Pediatrics, GSVM Medical College, Kanpur
drsenthilsp@yahoo.in
Objectives: The aim of this study was to show the relation between exposure to different air
pollution zones (Classified based on suspended particulate Matter concentration in air) and to
asthma severity. Method: The study was hospital based cross-sectional study. It was conducted at
Pediatric outpatient clinic, L.L.R. Hospital, Kanpur, during the period of Jan. 08 – June, 09. It
included 50 children with moderate persistent asthma ( according to GINA guidelines 2007
classification) with age range of 5- 18 yrs and were divided into two groups. Group I included
25 moderate persistent asthmatics exposed to air pollution due to smoke and dust with suspended
particulate matter ( SPM) concentration of > 350 µg/m3 and group II included 25 moderate
persistent asthmatics exposed to air pollution due to smoke and dust with suspended particulate
matter ( SPM) concentration of < 350 µg/m3. All patients were assessed clinically and by
spirometric examination. Results: Comparing both groups I,II as regards their spirometric results;
group II had higher values in all parameters ( FVC, FEV1,PEF and FEF 25 – 75) with p values
<0.05, <0.01, <0.05, <0.05 respectively and this proves that, children exposed to air pollution due
to dust and smoke with SPM levels <350µg/m3 had better spirometric values when compared to
children exposed to air pollution due to dust and smoke with SPM levels > 350 µg/m 3 of the same
class of asthma severity (moderate persistent asthma). Conclusion : In the light of evidences found
we conclude that in Kanpur city asthma severity increases with increase in SPM concentration in
air.
MISC/24(P) ACCIDENTAL SWALLOWING OF SMALL BATTERIES IN CHILDREN
Samarendra Mahapatro, S.S .Kar, R.Tripathy
Dept of Pediatrics, Hi-Tech Medical College, Bhubaneswar, Orissa
samarendramahapatro@yahoo.com
Accidental swallowing of foreign bodies is a common problem in small children. Small children
accidentally swallow a lot of things like coins, buttoms, small metallic objects. This is a common
problem and the anxious parents bring the child to the Emergency Depts. We have reported eight
cases(From Jan 2009 to Aug 2009) of accidental swallowing of small batteries (used in watch
,calculator, toy etc).All the parents had given a history of accidental swallowing of these small
batteries while the child was playing with the Toys. Children usually dismantle the toys while
playing. All the children belong to 1-4 years age group. None of the children have any symptoms
luckly.All the children had passed the battery in the stool with in 48hours of swallowing the
battery. Conclusion-Parents should be careful while selecting toys for their children. Usually they
dismantle the toys and manipulate the parts of the toys and accidentally swallow the parts of the
toys. Particularly the electronic toys operated by small battery are dangerous. If accidentally small
battery is ingested, it may cause Intestinal obstruction. It may cause perforation of GI tract (due to
chemicals and leakage from the battery).
MISC/25(P) A RARE CASE REPORT OF ACQUIRED VESTIBULAR ANUS
Bikas Bihari Tripathy, Samarendra Mahapatro, Rajib Roy, Rasmi Patnaiak, S.S .Kar, R. Tripathy
Dept of Pediatrics and Pediatric surgery, Hi-Tech Medical College, Bhubaneswar, Orissa
samarendramahapatro@yahoo.com
A 5 years female child was admitted to our hospital with complaints of passing stool and urine
from a common perineal opening following a bamboo-stick injury to her perineum 6 months back
while playing. She was also having intermittent painless bleeding (fresh blood) during defecation
during this period. On examination it was diagnosed as a case of acquired vestibular anus due to a
perineal tear of posterior vaginal wall, perineal body & anterior rectal wall. On Endoscopy a high
rectal polyp on anterior rectal wall was detected .Polypectomy & surgical repair of vagina,
perineum and rectum was done .The patient was doing well on follow-up. The child got injury
while playing with a sharp object; which should be avoided to prevent such type of accidents.
MISC/26(P) CONGENITAL GENU RECURVATUM
Payal Shah, Manish Arya, Yogeeswari, Bela Verma
Dept. of Paediatrics, Grant Medical College and Sir J.J. Group Of Hospitals, Mumbai 8
manjioo7@yahoo.co.in
Introduction: Congenital back knee deformities characterized by isolated hyperextension of the
knee or anterior subluxation of tibia or anterior dislocation of tibia. Case history: 5Days old
female child born to a registered & immunized mother, 23 yr old primigravida by spontaneous,
vertex, vaginal delivery. There was no significant antenatal risk factors. It was nearterm delivery
with birth weight of 2.1 kg. There was no significant perinatal events. Baby was euthermic with
stable vitals. On examination baby had hyper extension of the left knee with resistance to
flexion. There was no evidence of any dislocation of the knee joint and hip joints as evidenced by
barlow’s test. Apparent limb length discrepency was noted with CTEV of the left foot present.
Recurvatum angle was 60 degree. No other evidence of obvious external congenital anomalies
and meningomyelocele. No evidence of skin laxity or loose skin folds were noted. Systemic
examination was normal. X – rays of both lower limbs showed no evidence of fracture or
dislocation normal joint space and mild acetabular dysplasia suggestive of genu recurvatum.
Child was treated with Splinting and plaster cast application in extreme flexion. Discussion : it
occurs due to hypoplastic cruciates causing lateral displacement of patella resulting in
fibrosis,spasticity of quadriceps muscle. Intra uterine factors like oligohydramnios,
malpositioning, increased mechanical pressure, increased hydraulic pressure play a major role in
pathogenesis in genu recurvatum.
MISC/27(P) SRINOMELIA (MERMAID BABY) –A RARE ANOMALY
Nalinikanta Panigrahy,Ch Suman,P nagasree and P Sudarsini
Department of pediatrics, ASRAM Medical College,Eluru, AP.
nalini199@gmail.com
Introduction: Sirinomelia (mermaid baby) is a rare congenital anomaly characterized by fused or
single lower limb and several visceral anomalies with incidence of 1.5-4.2 per 100.000 births.
Vascular steal phenomenon, post axial mesodermal defect or teratogenic defects have been
implied in the pathogenesis with absence of chromosomal abnormalities and familial inheritance
has been noted in almost all cases .Due to its close resemblance to the mermaid of Greek and
Roman mythology, sirinomelia has fascinated scientist for centuries. CASE REPORT: A term
infant of 1980 grams, small for gestational age, deformed, and of undetermined sex was born by
spontaneous vaginal delivery to a 28 years, primigravida, diabetic mother with consanguineous
marriage .Antenataly she was diagnosed to have oligohydramnious and for last 2 weeks noticed to
have a markedly reduced uterine size .Last 6 hours there was fetal heart rate irregularities and
infant born as still born. On examination the skull was a mass of floating bones, there was no
external genitalia or anal opening and had a single umbilical artery. There was a single fused
lower limb with absent of leg and foot. Necrogram revealed hypo plastic sacrum, deformed pelvic
bones, a single femur and rudimentary leg bones. Postmortem was refused by parents.
CONCLUSIONS: As sirinomelia is a lethal condition and can be diagnosed as early as 20 weeks
of pregnancy, an early antenatal diagnosis in cases of oligohydramnious and IUGR, will allow
prenatal counseling for possible pregnancy termination
MISC/28(P) STUDY ON VARIOUS MODES OF POISONING IN CHILDREN
Sumantra Raut, Manik Kataruka, Niranjan Mohanty
Dept. of Pediatrics, SCB Medical College
drsuman.raut@gmail.com
Aims and Objective: To analyze the pattern of various groups and modes of poisoning in
hospitalised children (1-18 years of age) and to assess the changing trends due to poisoning over
the years by comparing it with previous studies. Material and Methods: Children 1-18 years
admitted in SCBMC, department of pediatrics from February to August 2009 with poisoning
(accidental, suicidal and homicidal modes)were studied. Food poisoning and idiosyncratic
reactions to drugs are excluded. Results: Out of146 children admitted, most are due to nonmedicaments 70(47.96%)followed by bites and stings 64(43.8%).Among 82 oral poisonings most
are hydrocarbons 32(39%)followed by pesticides 26(31.7%).Out of all cases 38(46.34%)were >7
years, about 50%(41 cases)were <5 years. Overall male: female=2.57:1.Out of 22 oral poisonings,
53(64.63%) are from rural area. Out of total 64 bites and stings, 57(89.06%) are from rural area.
Out of all 82 oral poisonings 47(57.32%) are accidental and 35(42.68%) are suicidal cases. The
trends are varying over the years for different groups of poisoning. Conclusion: The pattern of
poisoning is changing from time to time. Suicidal poisoning is rising due to various socio-cultural
and environmental factors which needs attention. Care should be taken in rural areas to keep
poisonous substances away from reach of children to prevent accidental poisoning and proper
psychological counselling to avoid suicidal poisoning in older children.
MISC/29(P) COMPARISON OF THE EFFECT OF STRUCTURED MATERNAL
BREASTFEEDING EDUCATION BY DOCTORS VS GRANDMOTHERS ON
KNOWLEDGE OF MOTHERS.
Nivedita Seehra, Bhavana Lakhkar
Resident, Paediatrics, AVBRH, Sawangi (Meghe), Wardha
drniveditaseehra@gmail.com
Introduction: Breast Feeding Has Been Proved To Be The Best Feeding. It is the birthright of the
child to get breast milk. Unfortunately a large number of babies do not get breast milk just because
mothers did not have knowledge. It is a huge task to impart this important knowledge to a large
number of mothers. This study is being done to see whether grandmothers can be utilized to
impart knowledge to mothers. Objectives:- Primary To compare the efficiency of education
imparted by grandmother as compared to doctor. Secondary – To educate the mothers about
different aspects of breastfeeding using a module. Methodology:Educators :- a) Doctors b)
Grandmothers (trained by doctors) Subject :- Mothers attending antenatal clinic in Obstetrics &
Gynaecology department in AVBRH. Two groups of antenatal mothers will be formed – one
group will be educated by doctors using pre-planned structured teaching module while the second
group will be educated by trained grandmothers. A questionnaire based on breastfeeding module
was prepared to assess the knowledge of mothers and grandmothers. Mothers and grandmothers
will solve the questionnaire before and after the breastfeeding education session. Comparison will
be done on the basis of solved questionnaire. Results – In the group trained by doctors 36%
mothers scored 100% marks, 20% mothers scored 93%marks, 20% mothers scored 86% marks
12% mothers scored 80% marks and 12% mothers scored 73% marks while in the group trained
by grandmothers 28% mothers scored 100% marks, 24% mothers scored 93%marks, 20% mothers
scored 86% marks 20% mothers scored 80% marks and 08% mothers scored 73% marks.
Conclusion – May be grandmothers are equal to the doctors as far as the maternal education is
concerned.
MISC/30(P) NASAL MIDAZOLAM FOR SEDATION IN CHILDREN FOR VARIOUS
PROCEDURES
Poonam Chullar, Col A Saxena, Col Rekha Mittal
Base Hospital , Delhi Cantt – 110010
drrekhamittal@rediffmail.com
(a)Introduction: Children often require sedation for various procedures to be carried out because
they are apprehensive and may not permit proper conduct of the procedure. Many drugs are used
sometimes in combination, and an anesthesiologist may be required. However for simple
procedures this produces a strain on hospital resources. Midazolam is a drug which can be
administered easily nasally and is being tried as a sedative for some procedures like dental
extraction and minor surgeries. (b) Aims & Objectives: The study was a preliminary study carried
out to evaluate the efficacy of midazolam in various procedures in children. (c) Material &
Methods (including statistical methods where relevant) Midazolam was administered nasally to 10
children in age group requiring painless , painful and anxiety inducing procedures in a dose of 0.2
- 0.6 mg/kg. Vital parameters were recorded before and during the procedure. Success of sedation
was defined as successful conduct of the procedure. Children with hepatic, renal or hemodynamic
compromise were excluded from the study. (d) Results: Out of 10 children, 8 children were
successfully sedated. Vital parameters were stable throughout in all the children. No side effects
were no noted. Children more than 3 years had no memory of the procedure. (e) Conclusions:
Nasal Midazolam may be an effective and safe sedative in various OPD and indoor procedures,
especially if IV access is not available. Further studies are required to confirm the efficacy of this
drug for sedation by the nasal route.
MISC/31(P) CLINICAL AND ETIOLOGICAL PROFILE OF HYPOCALCEMIA IN
CHILDREN PRESENTING IN OUTPATIENT PEDIATRIC SERVICES.
Shilpa Borse
shilpaborse@yahoo.com
Aims and Objectives: To study the clinical and etiological profile of hypocalcemia in children and
correlation with biochemical parameters. Materials and methods: Records and details of children
including history,clinical features, blood investigations presenting to paediatric OPD were
retrospectively studied. Unpaired student T test was used to compare variables. Results: 29
children [17 males] were studied.Mean age of presentation was 4.4yrs (range 3 months-14 yrs). Of
these,most children were symptomatic with deformities in 62%[n=18];convulsions in 31%[n=9].
All children were born full term.Mean BMI was 15.3; 51.7%[n=17] had pallor on
presentation(M=41.3%,F=10.3%) and 85.8%[n=22]had signs of rickets. Of these patients,males
were
significantly
taller(
p=0.024)
and
heavier
29
(P=0.033) than females .Though the ionic calcium levels were lower in males(mean 0.94),serum
PTH levels(p=0.016) and alkaline phosphatase levels (p=0.005) were significantly higher in
females as compared to males.
CAUSE (PERCENTAGE)
Nutritonal vit D deficient rickets(41.3)
Renal
unknown
MALES
8
2
4
FEMALES
8
2
0
Hypomagnesemia (3.4)
2
0
osteopetrosis (6.8)
1
1
Peudohypoparathyroidism type 1B(3.4)
0
1
Conclusion: Amongst the children studied most common presentation was deformities; males had
higher weight and height SDS with no significant difference in BMI SDS. Males had significantly
lower value of ionic calcium,urine calcium/ creatinine ratio and parathyroid hormones levels,
where as females had significantly high values of alkaline phosphatase than males. Most common
cause of hypocalcemia was found to be nutritional vitamin D deficiency.
MISC/32(P) IMMEDIATE COMPLICATIONS OF PERCUTANEOUS CENTRAL
VENOUS CANNULATION IN CHILDREN
G. Dheer, G.K. Chaudhry, T. Singh
Department of Pediatric Medicine, Christian Medical College and Hospital, Ludhiana
drgdheer@gmail.com
Objective: To study the incidence of immediate complications associated with percutaneous
central venous catheterisation. Methods :Total of 103 central venous catheters (CVCs) were
inserted in 70 children over a period of 18 months, governed by a uniform protocol. Sixty three
percent catheters were inserted in neonates, 23.3% in infants, 13.6% in children between 1-12
years of age. Results: There were a total of 41 insertion related immediate complications out of
which 75.6% were in neonates. Neonatal age, Hemodynamic instability and more number of
attempts to catheterize the vein had a higher risk of insertion related problems. There was no
mortality directly as a result of the procedure. Conclusion: In our practice, it was observed that
complications were fewer with increasing familiarity with the procedure. Hence, percutaneous
central venous catheterization is a safe procedure when done in experienced hands.
MISC/33(P) RARE CASE REPORTS OF WARFARIN EMBRYOPATHY
Pravakar Mishra, Anu Thukral, Arun S, Ramesh Agarwal, Ashok K Deorari, Vinod K Paul
Division of Neonatology, Department of Pediatrics, AIIMS, New Delhi-110029.
drpmishra61@gmail.com
Warfarin embryopathy is a rare condition resulting from maternal ingestion of warfarin during
pregnancy. The axial and appendicular skeletons are primarily affected. Infants present with
hypoplastic nose , eye abnormalities, mental retardation, brachydactyly and scoliosis. In addition
to fetal warfarin syndrome (ie, CNS defects, nasal hypoplasia, skull defects, abnormal ears,
malformed eyes, microcephaly, skeletal deformities & mental retardation), these agents also
increase the risk of spontaneous abortions, stillbirths and prematurity. The effect of warfarin is
directly dependent on the time of dosage. While embryopathy results from exposure during early
pregnancy(6-9wks), CNS disorders are due to ingestion after 12 wks of pregnancy. We report 3
cases of warfarin embryopathy who were born to mothers with irregular follow up due to
constraints. They were on warfarin throughout pregnancy and a switch to heparin was made after
delivery. Case 1 Hypoplastic nasal bridge only. Case 2 Hypoplastic nasal bridge with
chondrodysplasia punctata. Case 3 Camptodactily, Severe hypoplastic nasal bone requiring BagMask Ventilation at birth, unsuitable for CPAP, needed mechanical ventilation(SIMV) due to
airway obstruction, finally requiring Fiberoptic Flexible Nasopharyngeoscopy and Tracheostomy
resulting prolonged stay in NICU. Mother had 2 spontaneous abortions and polyhydramnios.
Details of clinical and classic radiological features and difficulties in management will be
discussed in Powerpoint Presentation. Conclusion:Risks and benefits of treatment should be
discussed with each woman who plans
to become or is pregnant while taking warfarin.
MISC/34(P) A CASE OF JUVENILE XANTHOGRANULOMA
P.Viji, M.Balasubramanian, M.S.Raja Rajeswaran, G.Mathevan, R.A.Sankarasubramanian,
.P.Amutha Rajeswari
Institute Of Child Health & Research Centre, Madurai Medical College, Madurai.
sank.stan@gmail.com
Introduction: A case of Juvenile xantho granuloma is presented for its rarity and the Ocular
morbidity caused by such a benign dermatological condition. Case Report:3 months old female
baby was brought with multiple skin lesions over the face and reddish spot in the left eye for past
2 months. On examination multiple small 2 – 5 mm. yellowish orange papules were present over
the face. Left eye showed hyphaema. right eye was normal. Systemic examination was normal.
Routine blood investigation were normal. Lipid profile, CT brain were normal. Biopsy was done
from the papule over the forehead. Biopsy report showed xantho granuloma. The child was
diagnosed as a case of Juvenile xantho granuloma with hyphaema of left eye. The child was
treated with topical acetazolamide drops and topical steroids.The hyphaema cleared. Discussion:
Juvenile xantho granuloma or nevoxantho granuloma is a benign self healing disorder accounting
for about 80 – 90% of non-langerhans cell histiocytosis. It is characterized by firm, dome shaped,
yellowish pink or orange papules or nodules over the skin. They usually occur before 1 year of
age. Ocular lesions are most typical producing spontaneous hyphaema which may lead on to
secondary glaucoma, uveitis, iritis, hetero chromia iridis. Systemic involvement may occur. Histo
pathology shows dermal infiltrate of lipid laden macrophags – touton giant cells. JXG is
commonly associated with cafe-au lait macules, juvenile myelomonocytic leukema,
neurofibromatosis, urticaria pigmentosa. Skin lesions require no treatment. Early recognition of
hyphaema and treatment with topical or systemic steroids is necessary to prevent secondary
glaucoma.