Radiofrequency Ablation for Supraventricular Tachycardia in Children ≤15 kg Is Safe and Effective

Risks associated with radiofrequency ablation (RFA) have been reported to be increased in children ≤15 kg. We sought to compare the safety and efficacy of RFA in children <15 kg with those between 15.1 and 20 kg. Clinical, electrophysiologic, and RFA data for all patients ≤20 kg who underwent RFA for supraventricular tachycardia between January 1994 and January 2003 were reviewed. Patients were divided into those ≤15 kg (group 1, n = 25) and those between 15.1 and 20 kg (group 2, n = 44). The two groups differed significantly in age and weight by design (group 1: mean weight, 11.9 ± 3.0 kg; age, 2.8 ± 1.9 years; group 2: weight, 18.0 ± 1.5 kg; age, 5.1 ± 1.1 years). There were no significant differences in other baseline characteristics except for incidence of structural heart disease (28% group 1 vs 7% group 2, p < 0.01). No significant differences in mechanism of tachycardia, arrhythmia cycle length, number of total and brief RFA applications, total RFA time, average and maximum RFA temperatures, total procedure duration, short-term success rate (96% group 1 vs 86% group 2, p = 0.17), long-term success rate (91% group 1 vs 89% group 2, p = 0.76), or major complications (8.0% group 1 vs 2.3% group 2, p = 0.39) were found. There were no procedure-related deaths in either group. These data suggest that, in two large volume electrophysiology centers, the procedural risks and outcomes of RFA are similar between patients weighing less than 15 kg and those between 15.1 and 20 kg.     

Is Left Ventricular Noncompaction in Children Truly an Isolated Lesion?

Left ventricular noncompaction (LVNC) is a form of cardiomyopathy resulting from a disorder of endomyocardial morphogenesis. It has been associated with significant morbidity and mortality. The aim of this study was to characterize associated cardiac findings in children with LVNC and to identify risk factors associated with increased mortality. From our echocardiography database, we identified 46 patients diagnosed with LVNC between December 1999 and February 2005. The mean age at presentation was 3.6 ± 5.6 years, and the mean duration of follow-up was 1.9 ± 2.1 years. Left ventricular ejection fraction was decreased in 24 patients (52%; mean 39.5% ± 13.1%). Thirty-six patients (78%) had associated cardiac lesions, including atrial septal defect (n = 16 [35%]), ventricular septal defect (n = 17 [37%]), patent ductus arteriosus (n = 14 [30%]), and Ebstein’s anomaly (n = 5 [11%]). Electrocardiogram abnormalities were found in 80% of patients; most commonly they included left (n = 15 [43%]) and right ventricular hypertrophy (n = 19 [54%]). Documented arrhythmias included ectopic atrial rhythm (n = 2), junctional rhythm (n = 2), supraventricular tachycardia (n = 2), and ventricular tachycardia (n = 1). Overall mortality was 20%, and there was no association with ejection fraction, morphologic defect, or arrhythmia. Mean age at diagnosis in survivors (4.5 ± 6.1 years) was higher than nonsurvivors (0.4 ± 0.7 years) (p < 0.0001). LVNC is a rarely isolated form of cardiomyopathy, and it is associated with significant additional cardiac abnormalities. Although it does not have an invariably fatal course, early presentation in infancy does carry an increased risk of mortality.     

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.

     

What Matters in for the Subjective Well-Being of Children in Care?

Children’s subjective well-being (SWB) constitutes an important component in understanding their quality of life. However, little is known about children in public care regarding their perceptions and satisfaction with life. The purpose of this study is to explore differences in SWB between adolescents in residential care, kinship care and family foster care with no relatives. The study used data from care population in Catalonia (Spain) aged 12–14 years (N?=?669): 397 adolescents in residential care, 251 adolescents in kinship care and 41 adolescents in non-kinship foster care. The questionnaire of the International Survey of Children’s Well-Being (ISCWeB) was adapted for children in care. It includes a psychometric scale on SWB, the Personal Well-Being Index-School Children (PWI-SC6). Multiple regressions have been used to explore which factors are related to children’s subjective well-being according to type of placement. Findings showed that adolescents living in kinship and non-kinship foster care reported better SWB in all life domains than those in residential care. On one hand, variables as gender and age and on the other hand, the agreement with their placement, satisfaction with the school, with their relationships with friends, and with their use of time and computer, may have an influence on their SWB. These findings highlight the need to address the participation of children any decision that affects their lives, the importance of supporting the education of children in care, and the importance of having friends and of their leisure time. Results are discussed in view of the value of practice and political implications.     

Is Group-Based or Individual-Based Intervention more Effective for Quality of Life Outcomes in Children with Developmental Coordination Disorder? A Systematic Review

Aims: To examine whether group-based or individual-based treatment programs are more effective for quality of life (QOL) outcomes in children with developmental coordination disorder (DCD). Methods: A systematic search of the literature was conducted, in accordance with the PRISMA guidelines. Quality of the papers was assessed using the Modified Downs and Black Checklist. Peer-reviewed clinical experimental studies of children diagnosed with DCD with any QOL related outcome measure were included, of all years, languages, and approaches of intervention. Results: Sixteen studies were identified for inclusion, of mixed methodological qualities (predominantly low). Improvement of QOL with both group-based and individual-based interventions were shown, though large degrees of heterogeneity were observed in study designs, participants, modes of interventions, durations, and outcome measures utilized. Conclusions: The effectiveness of group-based versus individual-based interventions on QOL of children with DCD is unclear. There is a pressing need for a high quality, powered trials, utilizing the randomized control trial paradigm, comparing both intervention approaches with standardized treatment approaches and outcome measures to determine and compare the effect on QOL of children with DCD.     

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.

     

Fatty Liver Disease in Children—What Should One Do?

The world’s population is increasingly overweight and obese. According to the World Health Organization (WHO) as of 2010, 43 million children under the age of five were overweight. Once considered to be limited to developed countries, overweight and obese children are now found in low- and middle-income countries, though most commonly in urban areas. Furthermore the WHO now cites the conditions of overweight and obesity as being associated with more deaths around the globe than those associated with being underweight. With this increased prevalence of overweight and obese children has come a host of other medical problems including nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). This review will focus on NAFLD and NASH, their definitions, epidemiology, diagnosis and treatment. The authors will also discuss NAFLD in the Indian subcontinent, and the future of NAFLD and NASH.     

Efficacy of Topiramate as an Add-on Drug in Seizures in Indian Children—An Observational Study

Objective

To assess the efficacy of Topiramate as an add-on drug in the treatment of seizures in children of age group 0–12 years.

Methods

Fifty children of age 0–12 years with seizures viz. partial seizures with or without secondary generalization, myoclonic jerks, infantile spasms, generalized tonic–clonic seizures, absence or mixed seizures were chosen from the out-patient department. Topiramate was added in small doses to conventional antiepileptics, and increased till the most effective/best-tolerated dose was reached. A Seizure Improvement Scale (SIS) was used. Outcome variables included seizure type, frequency, severity, SIS based on starting dose and the dose at the end of 6th month, EEG pattern, number of concomitant drugs used and adverse effects. Data was collected in monthly follow up visits for next 6 months (0–6 month study period). Details of seizures and medication availed by the study population during the 6 month period prior to the start of study were retrieved from available case records; this was used as control (?6 to 0 month study period). Using each of the outcome variables, efficacy was ascertained by clinical and statistical comparison.

Results

Myoclonic jerks, generalized tonic clonic seizures, partial seizures with secondary generalization and complex partial seizures constituted 75% of seizures. Z-test for proportion showed significant reduction (p?p?p?75%, >50% and <50% reduction in seizure frequency, respectively at the end of 6 months. Statistically significant reduction in severity (status epilepticus) was found. An association between starting dose and position in the SIS was noted (Chi-square test); the authors recommend a starting dose of 1–2 mg/kg/day. Similarly, significant association between dose at the end of 6^th month and position in the SIS was found; the authors recommend an optimum maintenance dose of 2.5–7.5 mg/kg/day. Though not statistically significant, the percentage of subjects using one concomitant antiepileptic drug (monotherapy) increased from 23% to 34%; those using 2 and 3 drugs (polytherapy) decreased from 40% to 34% and 33% to 27%, respectively. EEG pattern reverted back to normal in eight children. Apart from minor adverse effects, none had serious systemic manifestations during the study period.

Conclusions

The authors support the efficacy and safety of Topiramate as an add-on drug in seizures in children.     

Why Aren't We Achieving High Vaccination Rates for Rotavirus Vaccine in the United States?

BackgroundRotavirus vaccine (RV) coverage levels for US infants are <80%.MethodsWe surveyed nationally representative networks of pediatricians by internet/mail from April to June, 2019. Multivariable regression assessed factors associated with difficulty administering the first RV dose (RV#1) by the maximum age.ResultsResponse rate was 68% (303/448). Ninety-nine percent of providers reported strongly recommending RV. The most common barriers to RV delivery overall (definite/somewhat of a barrier) were: parental concerns about vaccine safety overall (27%), parents wanting to defer (25%), parents not thinking RV was necessary (12%), and parent concerns about RV safety (6%). The most commonly reported reasons for nonreceipt of RV#1 by 4 to 5 months (often/always) were parental vaccine refusal (9%), hospitals not giving RV at discharge from nursery (7%), infants past the maximum age when discharged from neonatal intensive care unit/nursery (6%), and infant not seen before maximum age for well care visit (3%) or seen but no vaccine given (4%). Among respondents 4% strongly agreed and 25% somewhat agreed that they sometimes have difficulty giving RV#1 before the maximum age. Higher percentage of State Child Health Insurance Program/Medicaid-insured children in the practice and reporting that recommendations for timing of RV doses are too complicated were associated with reporting difficulty delivering the RV#1 by the maximum age.ConclusionsUS pediatricians identified multiple, actionable issues that may contribute to suboptimal RV immunization rates including lack of vaccination prior to leaving nurseries after prolonged stays, infants not being seen for well care visits by the maximum age, missed opportunities at visits and parents refusing/deferring.     

Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study

Objective

To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India.

Methods

This case-control study was conducted in a medical college hospital in children below 5 y of age. All cases of SAM (diagnosed as per WHO definition) between 6 and 59 mo of age were compared with age-matched controls with weight for height above -2SD of WHO 2006 growth standards. Data regarding socio-demographic parameters, feeding practices and immunization were compared between the groups by univariable and multivariable logistic regression models.

Results

A total of 76 cases and 115 controls were enrolled. Among the 14 factors compared, maternal illiteracy, daily family income less than Rs. 200, large family size, lack of exclusive breast feeding in first 6 mo, bottle feeding, administration of pre-lacteals, deprivation of colostrum and incomplete immunization were significant risk factors for SAM. Regarding complementary feeding, it was the consistency, rather than the age of initiation, frequency and variety which showed a significant influence on occurrence of SAM. Multivariate analysis revealed that the risk of SAM was independently associated with 6 factors, namely, illiteracy among mothers, incomplete immunization, practice of bottle feeding, consistency of complementary feeding, deprivation of colostrum and receipt of prelacteals at birth.

Conclusions

The present study identifies certain risk factors which need to be focused on during health planning and policy making related to children with SAM in India.     

Is pneumoperitoneum an absolute indication for surgery in necrotizing enterocolitis?

Background  Necrotizing enterocolitis (NEC) is the most common gastrointestinal medical/surgical emergency in neonates. Non-operative support is needed in 70% of NEC cases, and surgical intervention in the rest 30%. Historically, pneumoperitoneum has been considered as an absolute indication for laparotomy. In the present study we emphasize that pneumoperitoneum is not an absolute indication for exploratory laparotomy in NEC cases. Methods  We prospectively studied 58 patients with severe NEC having pneumoperitoneum on abdominal X-ray in the last 5 years. At the time of admission, the patients were given intravenous fluid, total parental nutrition, blood transfusion and broad spectrum antibiotics followed by abdominal tapping (paracentesis). All the patients with pneumoperitoneum were closely monitored for 48 hours if abdominal tapping was repeated. When the disease seemed to worsen clinically, radiologically and laboratorially, the patient was subjected to exploratory laparotomy. Results  Of the 58 patients, 40 were treated conservatively whereas 18 underwent surgical intervention. The overall mortality in the present study was 12.1%, including 5% of the patients managed conservatively and 27% of the patients undergoing surgery. Conclusions  Pneumoperitoneum is not an absolute indication for surgery in cases of neonatal NEC. Most of the patients can be treated conservatively.