Normative Data for IVC Diameter and its Correlation with the Somatic Parameters in Healthy Indian Children

Objective

To determine the normative data for inferior vena cava (IVC) diameter in children and its correlation with various somatic parameters like height, weight and body surface area in Indian children. Readily available baseline data of IVC diameter in normal children shall be of great help in rapid assessment of variations in sick children.

Methods

Total 475 healthy children aged one month to 12 y visiting out patient clinics (OPD’s) were enrolled in this study. Weight, height and body surface area were calculated at the time of examination. The maximum and minimum diameters of IVC were measured during the expiratory and inspiratory phase of the respiratory cycle respectively using M mode ultrasonography. Collapsibility Index was also calculated for each subject by measuring difference between the maximum (expiratory) and minimum (inspiratory) IVC diameters divided by the maximum diameter.

Results

The mean age of study subjects was 4.72 ± 3.72 y. Out of 475 subjects, 285 (60%) were boys and 190 (40%) were girls. Mean weight for age (%) of subjects was 89.18 ± 13.26%. Correlation was studied between physical parameters and IVC diameter which revealed a positive correlation of age, height and weight with both maximum and minimum IVC diameter. Regression analysis was also performed to derive the equations for maximum and minimum diameters of children from 1 y to 12 y.

Conclusions

This study provides reference values of IVC diameters for Indian children of different age groups.

     

Physical Activity Patterns Among School Children in India

Objective

To assess the prevalence of physical activity and its relation with socio-demographic variables and eating habits among school-aged children in India.

Methods

The study incorporated secondary analysis of anthropometric measurements and questionnaires on lifestyle and dietary habits of 1,680 school children aged between 3 and 11 y, obtained while carrying out the OBEY-AD project. The inventory contained questions about several variables concerning to physical activity, educational background, lifestyles and eating habits for both children and parents. Questions were organized along specific contents, which could be informative topics, picture choices and multiple answers choices.

Results

Prevalence of inactivity was 21 % and exhibited significant variations between cities. Physical activity was significantly associated to socio-economic status and consumption of fruits and vegetables. No association could be revealed with children’s BMI.

Conclusions

Health-promotion interventions aimed at improving healthy lifestyles in Indian children should focus on population strata with low socio-economic status.

     

Is My Kid Out of Size? Indian Mothers’ Desirability Bias in Evaluation of Their Children’s Weight

Objective

To quantify mothers’ social desirability bias with respect to their children’s weight in a cross-regional Indian setting.

Methods

The OBEY-AD was a cross-sectional study which has been realized in 7 Indian cities (Bengaluru, Mumbai, Chennai, Hyderabad, Kolkata, New Delhi and Surat), enroling 1,680 children aged 3–11 y of which 50 % were females. Children’s BMI scores were computed, standardized according to WHO growth charts and categorized as Normal, Overweight, Obese and Underweight. Mothers were asked to judge the weight status of their children through an iconographic test, indicating the shape, which better mirrors the size of their kids. Socio-demographic data, especially employment, income and education, was accessed by administrating a cross-sectional questionnaire to the mothers, involved for the study.

Results

Overall, 369 children resulted as obese or overweight (23.5 %). Out of them, 75 % (278) were not recognized as such by their mothers. Such figures range from up to 76 % in Chennai and Surat down to 72 % in Hyderabad, Kolkata, New Delhi and Mumbai. Overall agreement between perceived and desired weight status of children was very poor (p?<?0.001). Surprisingly, overall 10 % of overweight/obese children were considered as even too lean by their mothers.Misperception of children’s weight status seemed to be significantly related to urban differences and socio-economic status.

Conclusions

This study quantifies the extent of the so-called social desirability bias, namely mother’s unconscious attitude to adapt empirical evidence to more culturally legitimized ideal-types of what their children’s weight status is expected to be. Its association with westernized representations of leanness as evaluation criteria for beauty has important policy implications.

     

Clinical Characteristics and Follow-up of South Indian Children with Autoimmune Encephalopathy

Objective

To describe the clinical characteristics of a cohort of south Indian children with probable autoimmune encephalopathy from a tertiary care academic hospital and to compare this data with the existing literature.

Methods

Patients with encephalopathy plus one or more of neuropsychiatric symptoms, seizures, movement disorder or cognitive dysfunction were identified. Common infectious causes were excluded. Clinical characteristics, investigations, management and outcome were analyzed.

Results

Thirteen patients were included in the study; 12 were females (92.3 %) and mean age was 9.6 y. Most common presentation was behavior change (13 patients) followed by seizures (11 patients). Three patients showed lymphocytic pleocytosis in CSF and one patient had oligoclonal bands. Initial MRI was normal in all patients except in one. Most common EEG abnormality was mild background slowing. Only one child had ovarian tumor. S.NMDA receptor antibody was positive in 10 patients (83 %), and all of them received immunotherapy. Six out of 13 children were followed up for more than 1 y (mean – 21 mo). Recurrence was noted in 4 out of 6 patients (66 %). On last follow-up, good recovery was seen in 2 children (33 %), moderate disability in 3 (50 %) and severe disability in 1 (16 %).

Conclusions

The clinical characteristics and outcome of one of the largest single center cohort of Indian children with autoimmune encephalopathy is reported. Autoimmune encephalopathy should be considered as a differential diagnosis in the acute and subacute encephalopathies of childhood and treating pediatrician should be aware of this entity.

     

Long-term outcome and need of re-operation in gastro-esophageal reflux surgery in children

Background

Fundoplication is considered a mainstay in the treatment of gastro-esophageal reflux. However, the literature reports significant recurrences and limited data on long-term outcome.

Aims

To evaluate our long-term outcomes of antireflux surgery in children and to assess the results of redo surgery.

Methods

We retrospectively analyzed all patients who underwent Nissen fundoplication in 8 consecutive years. Reiterative surgery was indicated only in case of symptoms and anatomical alterations. A follow-up study was carried out to analyzed outcome and patients’ Visick score assessed parents’ perspective.

Results

Overall 162 children were included for 179 procedures in total. Median age at first intervention was 43 months. Comorbidities were 119 (73 %), particularly neurological impairments (73 %). Redo surgery is equal to 14 % (25/179). Comorbidities were risk factors to Nissen failure (p = 0.04), especially children suffering neurological impairment with seizures (p = 0.034). Follow-up datasets were obtained for 111/162 = 69 % (median time: 51 months). Parents’ perspectives were excellent or good in 85 %.

Conclusions

A significant positive impact of redo Nissen intervention on the patient’s outcome was highlighted; antireflux surgery is useful and advantageous in children and their caregivers. Children with neurological impairment affected by seizures represent significant risk factors.

     

Food Packaged with Toys: An Investigation on Potential Obesogenic Effects in Indian Children

Objective

To investigate, in a large pan Indian sample of school children, whether gadgets (toys) added to food increase food consumption, and if contemporary exposure to TV and/or advertising is a further promoting factor.

Methods

A total of 1,680 Indian children were first randomized to food exposure with or without toy and then to a five-level exposure to TV viewing and advertising according to a 2?×?5 full factorial ad libitum eating design study. The sample size was computed to detect a difference of 20 Kcal of caloric intake (assuming the same standard deviation of 20 Kcal in both groups) between “food with gadget” (Toy) and “food alone” (No Toy) groups in each level of the exposure to TV and advertising factor, given an alpha error equal to 0.05 and a power of 0.90.

Results

Mean caloric intake both in “Toy” and “No Toy” group was around 223 Kcal. When considering exposure to TV and advertising, mean values varied negligibly between 222 and 225 Kcal. According to linear models for the effect of gadget and exposure to TV and/or advertising on children’s intake, no significant adjusted associations were found, neither as main effects nor as interactions.

Conclusions

Food consumption by children is not influenced by the presence of added toys, even after adjustment for several potential confounding factors. The city where they live and age significantly influences Indian children’s caloric intake.

     

Age Specific Peak Expiratory Flow Nomogram in Children

Objective

To determine peak flow rate nomogram in children between 5 to 12 y of age in suburban population.

Methods

This was a cross-sectional study randomly done on 5000 healthy school children. Mini-Wright flow meter was used for measurement of peak expiratory flow rate (PEFR). The range of age, weight and height were defined and linear and multiple regression analysis were performed.

Results

Correlation between PEFR and height was more significant and between PEFR and weight was lower. On the basis of height, the regression equation for both sexes were drawn; Boys: PEFR = 3.29 (Height in cm) - 218.38; Girls: PEFR = 3.25 (Height in cm) - 216.49.

Conclusions

Thus, region specific nomograms for PEFR for assessing the severity and monitoring of airway obstruction in relation to age, sex, weight and height of children can be determined.

     

Polymorphism of 3′ UTR of MAMLD1 gene is also associated with increased risk of isolated hypospadias in Indian children: a preliminary report

Objective

To study MAMLD1 gene polymorphisms, serum LH and testosterone levels amongst Indian children with isolated hypospadias (IH) and controls.

Materials and methods

Screening of the MAMLD1 gene was performed by PCR sequencing method in 100 Indian children aged 0–12 years presenting with IH and 100 controls. LH and testosterone hormone levels were also assessed (categorized in four age-wise groups).

Results

IH subjects had significantly higher incidence of MAMLD1 polymorphism as compared to controls (33 vs 15 %, p = 0.01). Of various genomic variants identified in this study, the noteworthy novel ones were missense mutation P299A and single nucleotide polymorphism c.2960C>T in 3′ UTR of Exon 7. While p 299A was found to cause protein structural instability consequent to amino acid change, eighty percent subjects with c.2960C>T in 3′ UTR of Exon 7 (corresponding to newly discovered currently non-validated exon 11) were found to have lower testosterone levels when compared with their age group mean. IH showed statistically higher incidence of c.2960C>T in comparison to controls (22 vs 10 %, p value 0.046) and about 2.5-folds higher risk of this anomaly.

Conclusion

Occurrence of MAMDL1 gene polymorphisms, specially of c.2960C>T in 3′ UTR of its exon 7 is associated with a higher risk of IH in Indian children, probably by lowering androgenic levels.

     

Psychosoziale Gesundheit von Kindergartenkindern im Urteil von Eltern und Pädagogischen Fachkräften

Background

Psychosocial health is of major importance for kindergartener’s development.

Objective

The aim of the study was to examine correlations between developmental and health problems and behavioral problems. Additionally, we examined inter-rater reliability between parent’s and kindergarten teacher’s ratings on developmental and health problems. The total sample consisted of 1036 kindergarteners aged 3 to 6 years.

Materials and methods

A questionnaire was assessed by both parents and kindergarten teachers. The developmental and the health status, as well as the child’s behavior over the past four weeks, were addressed.

Results

Statistically significant correlations were found between developmental and health problems and behavioral problems. Inter-rater reliability varies by questionnaire scales.

Conclusions

Results stress the need for integration of various judgments of different information sources and plead for a multiperspective elicitation of psychosocial health in kindergarteners.

     

CDC Kerala 16: Early Detection of Developmental Delay/Disability Among Children Below 6 y — A District Model

Objective

To develop a district model for establishing early detection of childhood disability below 6 y of age and to develop appropriate referral linkages for confirmation of the diagnosis and establish home based early intervention therapy to all needy children.

Methods

Trained Accredited Social Health Activist (ASHA) workers conducted the preliminary survey for identifying developmental delay/disability among children below 6 y of age using Trivandrum Developmental Screening Chart (TDSC) (0–6 y) and a team of experts assessed the screen positives in developmental evaluation camps conducted at primary health centres (PHCs).

Results

Community survey was carried out and 1,01,438 children below 6 y of age in Thiruvananthapuram district were screened by ASHA workers and 2,477 (2.45 %) positive cases (TDSC two or more item delay) were identified and these children were called for the developmental evaluation camps conducted at 80 PHCs in the district. Among the 1,329 children who reached the evaluation camps 43.1 % were normal. 24.98 % children had speech and language delay and 22.95 % children had multiple disabilities. Developmental delay was observed among 49.89 % children and cerebral palsy in 8.43 % and intellectual disability 16.85 % were confirmed. Visual impairment in 3.31 % and neuromuscular disorders in 1.35 were found among children evaluated in the camp.

Conclusions

The results of this district wide early detection of disability survey by trained ASHA workers among children below 6 y of age showed a community prevalence of 3.08 % observed, based on two or more item delay in TDSC and among these children, 43.1 % were normal, 49.89 % had developmental delay, 24.98 % had speech and language delay and 22.95 % had multiple disabilities.

     

CDC Kerala 17: Early Detection of Developmental Delay / Disability Among Children Below 3 y in Kerala - A Cross Sectional Survey

Objective

To conduct a community survey to understand the prevalence and type of developmental delay / disability among a representative state wide community sample of children below 3 y.

Methods

A state wide community based cross sectional survey was done with the help of the Integrated Child Development Services (ICDS) network in Kerala after giving one day training program at Child Development Centre (CDC), for one randomly selected anganwadi worker in each of the panchayath/municipal ward, from all districts of Kerala, to equip them to screen all children below 3 y in their anganwadi areas, using simple community screening tools like Trivandrum Developmental Screening Chart (TDSC) 0–3 and Language Evaluation Scale Trivandrum (LEST) 0–3. Those children with one or more item delay in TDSC or LEST were called to the developmental evaluation camps held at ICDS block level and trained pediatrician/medical officer re-evaluated the children with developmental delay.

Results

A total of 32,664 children below 3 y were screened across the state and overall 2.5 % prevalence of developmental delay was observed using TDSC and 2.8 % using LEST 0–3 y and 3.4 % using TDSC and/or LEST positive. Out of the total 1,110 children clinically evaluated by a trained pediatrician, 69.3 % children had developmental delay, 14.3 % speech delay, 5.7 % global delay, 5.3 % gross motor delay and 3.6 % suspected of hearing impairment.

Conclusions

The study results showing 3.4 % prevalence of developmental delay using TDSC and/or LEST by trained anganwadi workers or ASHA workers could be replicated in other states in India, under Rashtria Bal Swasthya Kariyakram.

     

Prevalence of Vitamin B<Subscript>12</Subscript> and Folate Deficiency in School Children Residing at High Altitude Regions in India

Objective

To assess the prevalence of vitamin B₁₂ and folate deficiencies among children residing at high altitude regions of Himachal Pradesh, India.

Methods

A total of 215 school children in the age group of 6–18 y were included. Biochemical estimation of serum vitamin B₁₂ and folate levels was undertaken using chemiluminescence immunoassay method. The consumption pattern of foods high in dietary vitamin B₁₂ and folate was recorded using Food Frequency Questionnaire.

Results

The median levels (interquartile range) of serum vitamin B₁₂ and folate were 326 (259–395) pg/ml and 7.7 (6–10) ng/ml respectively. The prevalence of vitamin B₁₂ and folate deficiency amongst school age children was found as 7.4% and 1.5% respectively.

Conclusions

A low prevalence of vitamin B₁₂ and folate deficiencies was found amongst children aged 6–18 y living at high altitude regions in India. This is possibly due to high frequency of consumption of foods rich in vitamin B₁₂ and folate.

     

Clinical Features and Peripheral Blood T Lymphocyte Subsets in Hand,Foot, and Mouth Disease According to Different Pathogens

Objective

To investigate the changes in lymphocyte subsets that are caused by infection with different pathogens in children with hand, foot, and mouth disease.

Methods

T lymphocyte subsets were measured in the patients’ peripheral blood, and serum, throat swab, and fecal samples were tested for enterovirus.

Results

Fecal and throat swab samples exhibited similar positive detection rates, and were significantly more likely to be positive, compared to serum samples (P < 0.01). The EV71-positive group exhibited significantly lower CD4 + TM cell counts (QR: 1.058), compared to the CD4 + TM cell counts in the CoxA16-positive group (QR: 1.391; P < 0.05).

Conclusions

Throat swab and fecal samples exhibited significantly higher positive detection rates, compared to serum samples. In addition, EV71-infected children exhibited significantly lower CD4+ T-cell counts, compared to CoxA16-infected children, which suggests that EV71 infection may be associated with a poorer prognosis.

     

Post-resection outcomes for pediatric ovarian neoplasm: is ovarian-preserving surgery a good option?

Purpose

Pediatric surgeons often care for children with ovarian tumors. Few studies report long-term outcomes for these patients. This study characterizes intermediate-term results for patients who underwent surgical resection of ovarian neoplasms as children.

Methods

Patients who underwent surgery for ovarian neoplasms at a children’s hospital were identified. They were invited to participate in a telephone-based survey assessing post-surgical recurrence, dysmenorrhea, quality of life, and fertility.

Results

188 patients were identified; 79 met criteria. 31 patients had ovarian-sparing tumor resection; 48 had oophorectomy; five had recurrences. 56 were successfully interviewed at a median follow-up of 4.6 years. Dysmenorrhea rates of 52 and 78 % were reported (p = 0.07), respectively. Two patients suffered from infertility. Quality of life was generally reported as good.

Conclusion

Intermediate outcomes are good for patients who underwent ovarian-sparing tumor resection or oophorectomy for pediatric ovarian tumors. Additional long-term monitoring would be beneficial to better assess fertility and dysmenorrhea outcomes.

     

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.

     

Behavioral consequences of children with sleep-disordered breathing after adenotonsillectomy

Background

Adenotonsillectomy (AT) has been an effective treatment for sleep-disordered breathing (SDB) in children, and several studies described the risk of postoperative weight gain and obesity in children treated with AT. The present study aimed to evaluate behavioral improvements in children with SDB one year after adenotonsillectomy and to investigate an influence of postoperative weight gain on behaviors.

Methods

The study included 170 children aged 5–11 years who underwent adenotonsillectomy for SDB and 150 controls. Body mass index percentile was obtained for age and gender, and parental sleep-related breathing disorder (SRBD) questionnaire was used to assess the severity of SDB. Psychological assessment was performed pre- and post-adenotonsillectomy using standardized questionnaires including strength and difficulties questionnaire, children’s depression inventory and screen for child anxiety-related emotional disorder.

Results

The mean age of 170 patients was 7.7 ± 1.5 years with 73 (42.9%) girls and 97 (57.1%) boys. The mean follow-up period were 15.4 ± 2.7 months. The patients had shown significant improvements in SDB scores as well as in questionnaire-based behavioral problems after adenotonsillectomy. The odds of a child being overweight were significantly increased after adenotonsillectomy. Less improvements in hyperactivity and conduct problems were observed in the patients with older ages, higher SRBD scores, and overweight/obesity at 1-year follow-up after adenotonsillectomy.

Conclusion

These data suggest that abnormal behavioral outcomes should be evaluated postoperatively, which potentially could be reduced with the early adenotonsillectomy and adequate postoperative weight control.

     

Assessing colonic anatomy normal values based on air contrast enemas in children younger than 6 years

Background

Contrast enemas with barium or water-soluble contrast agents are sometimes performed in children with severe intractable constipation to identify anatomical abnormalities. However there are no clear definitions for normal colonic size or abnormalities such as colonic dilation or sigmoid redundancy in children.

Objective

To describe characteristics of colonic anatomy on air contrast enemas in children without constipation to provide normal values for colonic size ratios in children.

Materials and methods

We performed a retrospective chart review of children aged 0–5 years who had undergone air contrast enemas for intussusception. The primary outcome measures were the ratios of the diameters and lengths of predetermined colonic segments (lengths of rectosigmoid and descending colon; diameters of rectum, sigmoid, descending colon, transverse colon and ascending colon) in relation to the L2 vertebral body width.

Results

We included 119 children (median age 2.0 years, range 0–5 years, 68% boys). Colonic segment length ratios did not change significantly with age, although the differences for the rectosigmoid/L2 ratio were borderline significant (P?=?0.05). The ratios that involved the rectal and ascending colon diameters increased significantly with age, while diameter ratios involving the other colonic segments did not. Differences by gender and race were not significant.

Conclusion

These data can be used for reference purposes in young children undergoing contrast studies of the colon.

     

Yield of imaging performed as per Indian Society of Pediatric Nephrology guidelines in children with urinary tract infection

Objectives

To assess yield of imaging performed as per Indian Society of Pediatric Nephrology (ISPN) urinary tract infection (UTI) guideline.

Methods

Ultrasonography (USG), voiding cystourethrography (VCUG) and dimercaptosuccinic-acid (DMSA) scintigraphy were performed in 183 children (age 0–5y) with first episode (age 0–1y) of UTI or recurrent (age <5y) UTI, as per ISPN recommendations.

Results

Significant abnormalities were detected in 110 (63%), with vesicoureteric reflux (VUR) grades 3–5 in 31% and renal scars in 43%. Combined USG and DMSA had a negative predictive value of 94% for significant VUR.

Conclusion

ISPN guideline resulted in a high yield of detection of significant abnormalities.

     

Efficacy of Flippits to Reduce Pain in Children during Venipuncture – A Randomized Controlled Trial

Objectives

To investigate the efficacy of distraction by flippits/distraction cards in relieving pain associated with pediatric venipuncture process in young children.

Methods

This study was a prospective, non-blinded, randomized controlled trial. The sample consisted of 210 children aged 4 to 6 y undergoing phlebotomy in the sampling room of the Advanced Pediatric Center outpatient department and were randomly assigned to control and intervention groups. Latter were exposed to distraction using flippits/distraction cards during the procedure. Pain was assessed for both groups by using FLACC (Face Legs Activity Cry Consolability) behavior pain assessment scale. In addition, procedural pain was also assessed by Wong Bakers Faces Pain Scale (WBFPS) using children and parents’ report.

Results

Flippits (distraction cards) had a significant effect on behavioral response to pain in children during blood sampling as evidenced by lower mean pain scores in the intervention group (2.75 ± 0.97) as compared to the control group (3.24 ± 0.85) as per FLACC behavioral pain assessment scale (p < 0.001). Parents and self reported pain as per Wong Baker Faces Pain Scale was also lower in the intervention group as compared to the control group (p < 0.001). Odds of severe pain/discomfort (total pain score 7–10) were 2.5 times higher in controls as compared to the intervention group (OR 2.5; 95% CI: 1.40–4.45) (P 0.002).

Conclusions

The use of simple distraction technique using flippits can significantly relieve the pain associated with blood sampling in children.