Dysmorphism in non-syndromic autism: <Emphasis Type="Italic">A cross-sectional study</Emphasis>

Objectives

To determine the effect of association of dysembryogenesis (manifested by presence of dysmorphic markers) on the developmental profile of autistic children.

Methods

26 autistic children were classified into complex autism (if they had specific dysmorphic markers) or essential autism (in the absence of dysmorphic markers) using the Miles Autism Dysmorphology Measure (ADM). The developmental abilities (Griffith’s Mental Development Scales) and the clinical severity (Childhood Autism Rating Scale) of both groups were compared. The prevalence of dysmorphic markers was also determined in 140 non-autistic controls.

Results

Children with complex autism had poorer development (General Quotient 29.4 vs 34.0, P=0.06) and earlier onset of autistic symptoms (18 vs 24 mo, P=0.05). Dysmorphic markers were significantly more in autistic children compared to normal children (27% vs 10%, P=0.002).

Conclusions

Dysembryogenesis may contribute to the clinical heterogeneity of autistic children.

     

CDC Kerala 13: Antenatal,Natal and Postnatal Factors Among Children (2–6 y) with Autism – A Case Control Study

Objectives

To compare antenatal, natal and postnatal factors among children between 2–6 y of age with autism and a control group of normal children.

Methods

One hundred and forty three confirmed cases of 2–6 y-old children with autism, attending autism clinic of Child Development Centre, who had a CARS score of ≥?30 were included in the study. Two hundred normal children in the same age group were recruited from the well-baby/immunization clinic of SAT Hospital, Thiruvananthapuram. Data was collected using a structured pre-piloted questionnaire consisting of 21 antenatal, 8 natal and 6 postnatal risk factors.

Results

The multivariate analysis on antenatal, natal and postnatal possible risk factors for autism showed statistically significant high odds ratios for (i) excess fetal movement (OR?=?11.44; 95 % CI: 2.85 – 45.98); (ii) maternal respiratory infection/asthma (OR?=?6.11; 95 % CI: 1.56–24.02; (iii) maternal vaginal infection (OR?=?5.20; 95 % CI: 1.72 – 15.73); (iv) maternal hypothyroidism (OR?=?4.25; 95 % CI: 1.38–13.07) and (v) family history of neuro-developmental disorders (OR?=?2.90; 95 % CI: 1.72 – 4.88).

Conclusions

This case control study involving 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children has shown that excess fetal movement, maternal respiratory infection/asthma, maternal vaginal infection, maternal hypothyroidism and family history of neuro-developmental disorders are possible risk factors for autism.

     

CDC Kerala 9: Effectiveness of Low Intensity Home Based Early Intervention for Autism Spectrum Disorder in India

Objective

To validate effectiveness of low intensity, home based early intervention (EI) models in autism for countries with low disability resources.

Methods

Fifty-two toddlers and young children were assessed before and after intervention with Childhood Autism Rating Scale, Vineland Social Maturity Scale, and Receptive-Expressive Emergent Language Scale. Developmental and speech therapists helped mothers assemble low-cost training kits based on the developmental age of the child, gave initial training in the basic behavioral technique to address the three autism symptom clusters at home. Follow-up support was given either on a weekly, fortnightly or monthly basis. Most of the children were also placed in play-schools. Data was analyzed using appropriate bivariate and multivariate techniques.

Results

There was statistical and clinical amelioration in the severity of autism, with acquisition of social skills and language skills (all P?=?0.001) after intervention in children with mild to severe autism. Gender showed a trend in becoming a significant predictor for intervention response.

Conclusions

Low-intensity, home-based EI can be effectively used in situations where there is paucity of disability resources in countries like India, especially in primary-care and community settings.

     

Effect of gluten free diet on gastrointestinal and behavioral indices for children with autism spectrum disorders: a randomized clinical trial

Background

Genetic and environmental factors are both responsible for the etiology of autism spectrum disorders (ASD). Although epidemiological studies have been conducted to clarify the association between restriction diets and ASD, the conclusion remains unclear. This study was undertaken to investigate the effect of gluten free diet (GFD) on gastrointestinal symptoms and behavioral indices in children with ASD.

Methods

In this randomized clinical trial, 80 children diagnosed with ASD by the Autism Diagnostic Interview-Revised (ADI-R) were assigned into GFD (n=40) and regular diet (RD) (n=40) groups for 6 weeks. At the beginning and end of the intervention, the ROME Ш questionnaire for evaluating gastrointestinal symptoms and Gilliam Autism Rating Scale 2 questionnaire (GARS-2) for assessing psychometric properties were completed.

Results

Of the 80 children, 53.9% had gastrointestinal abnormalities. In the GFD group, the prevalence of gastrointestinal symptoms decreased significantly (P<0.05) after intake of GFD (40.57% vs. 17.10%) but increased insignificantly in the RD group (42.45% vs. 44.05%). GFD intervention resulted in a significant decrease in behavioral disorders (80.03±14.07 vs. 75.82±15.37, P<0.05) but an insignificant increase in the RD group (79.92±15.49 vs. 80.92±16.24).

Conclusion

This study suggested that GFD may be effective in controlling gastrointestinal symptoms and ASD behaviors.

     

CDC Kerala 8: Effectiveness of a Clinic Based,Low Intensity,Early Intervention for Children with Autism Spectrum Disorder in India: A Naturalistic Observational Study

Objective

To document the effectiveness of low intensity, clinic based intervention models for Autism Spectrum Disorders (ASD) in countries with low disability resources.

Methods

Thirty-nine participants with a mean (SD) of 36.03(11.15) mo were assessed before and after intervention with Childhood Autism rating scale (CARS), and at baseline with the Denver Developmental Screening Test for quantifying the effectiveness of the clinic-based intervention in ameliorating autism symptoms and studying the effect of developmental disability respectively. Developmental therapists in the clinic gave low-intensity group intervention for 45–60 min to the child through mother and encouraged to continue the training, for 3–4 h, at home to address the specific goals in the three ASD symptom clusters. Most of the children were also placed in play-schools. Follow-up support was given either on a weekly, fortnightly or monthly basis. Data was analyzed using appropriate bivariate and multivariate techniques.

Results

There was amelioration in the severity of autism after intervention, which was statistically and clinically significant. Intervention was useful to help children with mild to severe autism.

Conclusions

Low-intensity, clinic-based intervention can be effectively used in situation where there is paucity of disability resources.

     

ADD-H-Comprehensive Teacher’s Rating Scale (ACTeRS): A Measure for Attention Deficit Hyperactivity Disorder Among Children with Intellectual Disability in India

Objective

There is no validated measure for assessing Attention Deficit Hyperactivity Disorder (ADHD) in India, and therefore, the authors validated the ADD-H Comprehensive Teacher’s Rating Scale (ACTeRS).

Methods

Teachers/parents/clinicians of 110 children with ADHD completed the ACTeRS. The diagnosis of ADHD was confirmed by an independent multi-disciplinary team using ICD-10 diagnosis for diagnostic accuracy and criterion validity. The convergent and divergent validity were assessed by another rater. The data was analyzed for diagnostic accuracy, reliability and validity appropriately.

Results

An ACTeRS score of ≥61 [Sensitivity (Sn) =85.51 %; Specificity (Sp)?=?90.24 %; Area under the curve (AUC)?=?0.94] is appropriate for the diagnosis of ADHD. The test-re-test reliability [Intra-class correlation coefficient (ICC)?=?0.87], internal consistency (Cronbach’s α?=?0.80; range of 0.89–0.93), section-total correlation, face and content validity for the ACTeRS were good. Convergent validity of attention deficit, hyperactivity and oppositional subscales of ACTeRS with the corresponding subscales of Swanson, Nolan & Pelham Rating Scale—Revised (SNAP-IV) was moderate (r?=?0.60, P?=?0.005; r?=?0.49, P?=?0.02; r?=?0.58, P?=?0.008 respectively), and negative correlation with the Childhood Autism Rating Scale (r?=??0.36; P =0.1) for divergent validity was found. The criterion validity analysis showed a high concordance rate of 82.52 % between ACTeRS and International Classification of Diseases, Edition10 (ICD-10) diagnosis of ADHD. A 4-factor structure was replicated.

Conclusions

The ACTeRS has adequate psychometric properties for use in the Indian population for identifying ADHD.

     

Simultaneous two-site blood culture for diagnosis of neonatal sepsis

Objective

To evaluate efficacy of two blood cultures taken simultaneously from two different sites as compared to standard practice of single blood culture in diagnosis of neonatal sepsis.

Study Design

Prospective cohort study.

Setting

A tertiary-care center at a public hospital.

Participants

475 neonates admitted to intensive care unit with suspected sepsis, from August 2014-July 2015.

Intervention

Two blood cultures drawn from two different peripheral veins in patients with suspected neonatal sepsis.

Main outcome measures

Increase in culture-positivity rate with use of two blood cultures.

Results

475 babies with suspected sepsis were enrolled. 185 patients had only first culture positive (38.9%). When we added second culture positivity, yield increased to 221 (46.5%). Adding on second culture increased the culture yield by 36 (7.6%; 95% CI 2.41 to 12.79; P=0.018). The most common organisms isolated were E. coli, S. aureus and Candida spp. Major morbidities and mortality were more common in blood culture positive patients Contamination was ruled out in 25 babies who grew Coagulase negative Staphylococcus (CONS) (n=10) and Candida spp. (n=15) in either of the two cultures.

Conclusion

Two blood cultures taken simultaneously from two different sites improve rate of pathogen detection as compared to routine practice of single blood culture.

     

Serum proteomic profiling for autism using magnetic bead-assisted matrix-assisted laser desorption ionization time-of-flight mass spectrometry: a pilot study

Background

The pathogenesis of autism spectrum disorders remains elusive and currently there are no diagnostic or predictive biomarkers in autism available. Proteomic profiling has been used in a wide range of neurodevelopmental disorder studies, which could produce deeper perceptions of the molecular bases behind certain disease and potentially becomes useful in discovering biomarkers in autism spectrum disorders.

Methods

Serum samples were collected from autistic children about 3 years old in age (n = 32) and healthy controls (n = 20) in similar age and gender. The samples were identified specific proteins that are differentially expressed by magnetic bead-based pre-fractionation and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-ToF-MS).

Results

Eight protein peaks were significantly different in autistic children from the healthy controls (P < 0.0001). The two peaks with the most significant differences were 6428 and 7758 Da in size.

Conclusion

According to differences in serum protein profiles between the autistic children and healthy controls, this study identified a set of differentially expressed proteins those are significant for further evaluation and might function as biomarkers in autism.

     

Impact of simulation-based training on perceived provider confidence in acute multidisciplinary pediatric trauma resuscitation

Purpose

Simulation-based training has the potential to improve team-based care. We hypothesized that implementation of an in situ multidisciplinary simulation-based training program would improve provider confidence in team-based management of severely injured pediatric trauma patients.

Methods

An in situ multidisciplinary pediatric trauma simulation-based training program with structured debriefing was implemented at a free-standing children’s hospital. Trauma providers were anonymously surveyed 1 month before (pre-), 1 month after (post-), and 2 years after implementation.

Results

Survey response rate was 49% (n?=?93/190) pre-simulation, 22% (n?=?42/190) post-simulation, and 79% (n?=?150/190) at 2-year follow-up. These providers reported more anxiety (p?=?0.01) and less confidence (p?=?0.02) 1-month post-simulation. At 2-year follow-up, trained providers reported less anxiety (p?=?0.02) and greater confidence (p?=?0.01), compared to untrained providers.

Conclusions

Implementation of an in situ multidisciplinary pediatric trauma simulation-based training program may initially lead to increased anxiety, but long-term exposure may lead to greater confidence.

Level of evidence

II, Prospective cohort.

     

Double dose <Emphasis Type="Italic">versus</Emphasis> standard dose hepatitis B vaccine in HIV-infected children: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To compare the efficacy of double dose (20 μg) with standard dose (10 μg) of hepatitis B vaccine in HIV-infected children.

Methods

Unvaccinated HIV-infected children were randomized to receive 3 doses of double dose (N=27) or standard dose (N=28) of recombinant Hepatitis B vaccine. Anti-HBs antibody titres were measured 3 mo after the last dose. An antibody titre ≥10 mIU/mL 12 weaks after the third dose was considered as serporotection.

Result

Seroprotection was achieved by 17 (60.7%) children in standard dose group against 20 (74%) in the double dose group [RR (95%CI) 0.8 (0.17-1.7); P=0.29]. CD4 count < 500 cells/mm3 was significantly associated with lower rates of seroprotection.

Conclusion

Double dose of hepatitis B vaccine does not seem to provide any advantage when compared to standard dose in HIV-infected children.

     

Development of a Prognostic Prediction Model to Determine Severe Dengue in Children

Objective

To develop a prognostic prediction model using the seven warning signs highlighted by WHO revised Dengue fever classification 2009 to determine severe dengue in children.

Methods

In this prospective analytical study conducted in a tertiary care centre, consecutive sampling of all children aged 1mo to 12y admitted with serologically confirmed Dengue was done from May 2015 through August 2016. After excluding 27 patients with co-infections and co-morbidities, 359 patients were followed up daily to assess clinical and laboratory progression till discharge/ death. Independent predictors were abdominal pain or tenderness, persistent vomiting, lethargy, mucosal bleed, clinical fluid accumulation, hepatomegaly >2 cm and rising hematocrit concurrent with platelet count <100?×?10⁹/L. Outcome measure was severe dengue defined as per WHO guidelines 2009.

Results

Among 359 children, 93 progressed to severe dengue. In univariate analysis, significant predictors were clinical fluid accumulation (OR 4.773, p?=?0.000, 95%CI 2.511–9.075), persistent vomiting (OR 1.944, p?=?0.010, 95%CI 1.170–3.225), mucosal bleed (OR 2.045, p?=?0.019, 95%CI 1.127–3.711) and hematocrit ≥0.40 concurrent with platelet count <100?×?10⁹/L (OR 2.985, p?=?0.000, 95%CI 1.783–4.997). The final multivariable model included clinical fluid accumulation (aOR 3.717, p?=?0.000, 95%CI 1.901–7.269), hematocrit ≥0.40 concurrent with platelet count <100?×?10⁹/L (aOR 2.252, p?=?0.004, 95%CI 1.302–3.894) and persistent vomiting (p?=?0.056) as predictors of severe dengue.

Conclusions

Among seven WHO warning signs, predictors of severe dengue as suggested by the present multivariable prediction model include clinical fluid accumulation, persistent vomiting and hematocrit ≥0.40 concurrent with platelet count <100?×?10⁹/L.

     

Nasal Continuous Positive Airway Pressure in Bronchiolitis: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objective

To evaluate the efficacy of nasal continuous positive airway pressure (nCPAP) in decreasing respiratory distress in bronchiolitis.

Design

Randomized controlled trial.

Setting

Tertiary-care hospital in New Delhi, India.

Participants

72 infants (age < 1y) hospitalized with a clinical diagnosis of bronchiolitis were randomized to receive standard care, or nCPAP in addition to standard care, in the first hour after admission. 23 parents refused to give consent for participation. 2 infants did not tolerate nCPAP.

Intervention

The outcome was assessed after 60 minutes. If nCPAP was not tolerated or the distress increased, the infant was switched to standard care. Analysis was done on intention-to-treat basis.

Main outcome measures

Change in respiratory rate, Silverman-Anderson score and a Modified Pediatric Society of New Zealand Severity Score.

Results

14 out of 32 in nCPAP group and 5 out of 35 in standard care group had change in respiratory rate ≥10 (P=0.008). The mean (SD) change in respiratory rate[8.0 (5.8) vs 5.1 (4.0), P=0.02] in Silverman-Anderson score [0.78 (0.87) vs 0.39 (0.73), P=0.029] and in Modified Pediatric Society of New Zealand Severity Score [2.5 (3.01) vs. 1.08 (1.3), P=0.012] were significantly different in the nCPAP and standard care groups, respectively.

Conclusion

nCPAP helped reduce respiratory distress significantly compared to standard care.

     

CDC Kerala 11: Diagnosis of Autism Among Children Between 2 and 6 y - Comparison of CARS against DSM-IV-TR

Objectives

To compare diagnosis of childhood autism using CARS cut off scores of ≥30 and the new Indian cut off scores of ≥33 against the gold standard DSM-IV-TR criteria available during the study period 2009–10.

Methods

The study was conducted at the autism clinic of Child Development centre (CDC), Kerala. Two hundred consecutive children between 2 and 6 y with symptoms suggestive of autism were administered both CARS by a trained developmental therapist and DSM-IV-TR by a developmental pediatrician on the same day, both blind to the test results of each other. Diagnosis of autism using CARS cut off scores 30 and above, as suggested in original tool administration manual and 33 and above, as suggested for diagnostic use in Indian population was compared with DSM-IV-TR diagnosis. Data was analyzed using SPSS (version 19.0) software.

Results

Against DSM-IV-TR diagnosis as gold standard, the new CARS cut off scores ≥33 had a higher Specificity (74.3 %), Positive predictive value (PPV) (81.9 %), Positive likelihood ratio (LR) (2.66) and Negative LR (0.43), but had a lower Sensitivity (68.3 %), Negative predictive value (NPV) (57.9 %) and accuracy (70.5 %), as compared to the cut off scores of ≥30.

Conclusions

The CARS prevalence of autism for cut off points ≥30 and ≥33 was 71.5 and 52.5 % respectively against 63 % prevalence by DSM-IV-TR.

     

Probiotics for promoting feed tolerance in very low birth weight neonates — <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To measure the efficacy of a probiotic formulation on time to reach full enteral feeds in VLBW (very low birth weight) newborns.

Design

Blinded randomized control trial.

Setting

A tertiary care neonatal intensive care unit (NICU) in Southern India between August 2012 to November 2013.

Participants

104 newborns with a birth weight of 750–1499 g on enteral feeds.

Intervention

Probiotic group (n=52) received a multicomponent probiotic formulation of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium longum and Saccharomyces boulardii once a day at a dose of 1.25×10⁹ CFU from the time of initiation of enteral feeds till discharge and the control group (n=52) received only breast milk.

Outcome measure

Time to reach full enteral feeds (150 mL/kg/day).

Results

The mean (SD) time to reach full enteral feeding was 11.2 (8.3) days in probiotic vs. 12.7 (8.9) in no probiotic group; (P=0.4), and was not significantly different between the two study groups. There was a trend towards lower necrotizing enterocolitis in the probiotic group (4% vs. 12%).

Conclusion

Probiotic supplementation does not seem to result in significant improvement of feed tolerance in VLBW newborns.

     

Vitamin D Deficiency in Ambulant Children on Carbamazepine or Sodium Valproate Monotherapy

Objective

To assess the effect of monotherapy with Carbamazepine (CBZ) and Sodium valproate (VPA) on serum 25-OH vitamin D levels in children with epilepsy compared to controls.

Design

Cross-sectional study.

Setting

Outpatient department of a tertiary-care Pediatric Neurology centre, and a nearby day-care centre and school.

Study period

June 2012 to May 2013

Participants

Children with epilepsy aged 2 to 13 years on monotherapy with CBZ (n=28) or VPA (n=28) for at least 6 months; 109 age-matched controls from a nearby day-care centre and school.

Results

The median (IQR) values of 25 (OH) vitamin D was 18.0 ng/mL (13.7-27.3), 21.35 ng/mL (16.4 -25.2) and 30.5 ng/mL (19.1-43.7) in CBZ, VPA and control group, respectively (P=0.008). 60.7% of patients in CBZ group and 35.7 % in VPA group had low 25 (OH) D levels (<20 ng/mL) compared to 27.8% in controls (P=0.001).The serum alkaline phosphatase level was higher in children on carbamazepine therapy (P=0.001) than controls.

Conclusion

This study identifies significant risk of vitamin D deficiency in ambulant children with epilepsy on monotherapy with CBZ or VPA.

     

Carbapenem-resistant <Emphasis Type="Italic">Enterobacteriaceae</Emphasis> in pediatric bloodstream infections in rural Southern India

Objective

To measure the frequency of antimicrobial resistance in pediatric blood culture isolates of Escherichia coli and Klebsiella spp. with focus on carbapenem resistance.

Methods

Over a period of three years, pediatric blood culture isolates were tested for antimicrobial susceptibility, including molecular investigations for carbapenem resistance.

Results

Amikacin, carbapenems, colistin and tigecycline had an antimicrobial efficacy of >70% (n=140). 7 of the 15 randomly selected isolates were positive for carbapenemase gene; among them, five were New Delhi Metallo β-lactamase (NDM).

Conclusion

There was a high prevalence of Klebsiella spp. in pediatric bacteremia and dissemination of NDMmediated carbapenem resistance in pediatric wards.

     

Family-centered care to complement care of sick newborns: <Emphasis Type="Italic">A randomized controlled trial</Emphasis>

Objective

To assess the impact of family-centered care in delivery of care to sick newborns, on nosocomial infection rate.

Design

Randomized controlled trial

Setting

Tertiary referral nursery (October 2010 to March 2012).

Participants

295 neonates randomized at the time of hospitalization in neonatal intensive care unit.

Intervention

Parent-attendant of intervention group were trained using an indigenously developed and pretested, culturally sensitive, simple audio-video tool that covered domains of personal hygiene, hand washing, danger signs recognition and feeding of sick neonate. Control group received routine care by nurses and doctors.

Outcome measure

Primary: culture positive nosocomial infection rate. Secondary: culture negative nosocomial infection rate, duration of hospitalization, mortality and breastfeeding rate.

Results

Two-thirds of family caregivers were fathers/ mothers and about 20% were grandparents. About 60% of family care givers were either illiterate (25%) or primary/middle pass (34%). Incidence of nosocomial episodes of sepsis was not different between groups (incidence rate difference 0.74, 95 % CI -4.21, 5.6, P = 0.76). Pre-discharge exclusive breastfeeding rates were significantly higher in intervention group [80.4% vs 66.7% (P=0.007)].

Conclusions

There was no significant difference in nosocomial infection rate between the two groups. Translating and adapting principles of family-centered care was feasible, and improved the pre-discharge exclusive breastfeeding rates.

     

Pain Control Interventions in Preterm Neonates: <Emphasis Type="Italic">A Randomized Controlled Trial</Emphasis>

Objectives

To compare individual efficacy and additive effects of pain control interventions in preterm neonates.

Design

Randomized controlled trial

Setting

Level-3 University affiliated neonatal intensive care unit.

Participants

200 neonates (26-36 wk gestational age) requiring heel-prick for bedside glucose assessment. Exclusion criteria were neurologic impairment and critical illness precluding study interventions.

Intervention

Neonates were randomly assigned to Kangaroo mother care with Music therapy, Music therapy, Kangaroo Mother care or Control (no additional intervention) groups. All groups received expressed breast milk with cup and spoon as a baseline pain control intervention.

Main outcome measure

Assessment of pain using Premature Infant Pain Profile (PIPP) score on recorded videos.

Results

The mean (SD) birth weight and gestational age of the neonates was 1.9 (0.3) kg and 34 (2.3) wk, respectively. Analysis of variance showed significant difference in total PIPP score across groups (P<0.001). Post-hoc comparisons using Sheffe’s test revealed that the mean (SD) total PIPP score was significantly lower in Kangaroo mother care group [7.7 (3.9) vs. 11.5 (3.4), 95% CI(–5.9, –1.7), P<0.001] as well as Kangaroo mother care with Music therapy group [8.5 (3.2) vs. 11.5 (3.4), 95%CI (–5.1, –0.9), P=0.001] as compared to Control group. PIPP score was not significantly different between Control group and Music therapy group.

Conclusions

Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-prick as compared to expressed breast milk alone. Kangaroo mother care with expressed breast milk should be the first choice as a method for pain control in preterm neonates.

     

The fetal lung-to-liver signal intensity ratio on magnetic resonance imaging as a predictor of outcomes from isolated congenital diaphragmatic hernia

Purpose

We investigated the developmental changes in the unaffected contralateral lungs of patients with isolated left-sided congenital diaphragmatic hernia (CDH) using signal intensity ratios on prenatal magnetic resonance imaging (MRI) and determined whether these changes correlated with clinical outcomes.

Methods

We performed 47 fetal MRI screens on 30 patients with isolated left-sided CDH. A cohort of 88 fetuses was selected as the control. We calculated the lung-to-liver signal intensity ratio (LLSIR) using region of interest analysis and compared LLSIR between the groups and between those in the CDH group with good and poor prognoses.

Results

In the control group, LLSIR increased as pregnancy progressed [regression line?=?2.232?+?0.135?×?(GW—23), r?=?0.669]. In the CDH group, especially in the poor prognosis group, LLSIR did not significantly increase as pregnancy progressed [regression line for good prognosis?=?1.827?+?0.092?×?(gestational week—23), r?=?0.733; regression line for poor prognosis?=?1.731?+?0.025?×?(gestational week—23), r?=?0.634].

Conclusion

Fetal LLSIR on T2-weighted MRI is an accurate marker of fetal lung maturity that correlates with postnatal survival and can potentially be used as a prognostic parameter in CDH management.

     

CDC Kerala 12: Socio-demographic Factors Among Children (2–6 y) with Autism – A Case Control Study

Objectives

To compare the socio-demographic factors among children between 2 and 6 y of age with autism and a control group of normal children.

Methods

One hundred forty three confirmed cases of 2–6 y-old children with autism, attending autism clinic of Child Development Centre, who had a CARS score of more than 30 were included in the study. Two hundred normal children in the same age group were recruited from the well-baby/immunization clinic of SAT Hospital, Thiruvananthapuram. Data was collected using a structured pre-piloted questionnaire consisting of 11 socio-demographic possible risk factors.

Results

The multivariate analysis on socio-demographic characteristics as possible risk factors for autism has shown that (i) upper and upper middle socioeconomic status (OR: 7.13; CI: 3.26–15.57) and (ii) male gender (OR: 3.95; CI: 2.22–7.04) were significant risk factors for autism, whereas place of residence, rural (OR: 0.41; CI: 0.24–0.68) is a protective factor.

Conclusions

This case control study involving 143 children between 2 and 6 y with autism as per CARS criteria and a control group of 200 normal children has shown that upper and upper middle socioeconomic status and (ii) male gender are significant risk factors for autism, whereas place of residence, rule is a protective factor.