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1.
Background
Inflammatory myofibroblastic tumors of the trachea are rare childhood quasi-neoplastic lesions.Case characteristics
7-year-old boy with recurrent episodes of cough, breathing difficulty and wheeze, initially treated as asthma.Intervention
CT chest and flexible bronchoscopy revealed a mass lesion of the trachea, which was excised by diode laser through the ventilating bronchoscope. Histopathology confirmed it as the inflammatory myofibroblastic tumor.Message
Use of laser ensured complete endotracheal excision of the tumor.2.
Selva Kumar Chinnakkannan Meenu Singh Rashmi Ranjan Das Joseph L. Mathew Akshay Kumar Saxena 《Indian pediatrics》2017,54(1):21-24
Objective
To study the point prevalence of allergic rhinitis and sinusitis in childhood asthma and to examine the relationship among them.Methods
In 250 children (age <13 y) with mild-to-moderte asthma, allergic rhinitis was diagnosed by clinical plus nasal eosinophilia criteria, and sinusitis was diagnosed clinically plus confirmation by computerized tomography scan.Results
The point prevalence of allergic rhinitis was 13.6%, and of sinusitis was 2%. On multivariate analysis, allergic rhinitis, sinusitis, and family history were significantly associated with asthma severity.Conclusions
Allergic rhinitis is common in childhood asthama, but sinusitis is rare.3.
Abstract
Umbilical venous lines are sometimes complicated with pleural and or pericardial effusion, often due to line migration.Case Characteristics
Bilateral chylous pleural effusion without pericardial effusion in a 28 weeks, extremely low birth infant who was on total parenteral nutrition.Observations/Investigations
Investigations including chest x ray and 2D echocardiogram showed bilateral chylous pleural effusions but appropriate tip position of the umbilical venous line.Outcome
Removal of the umbilical venous line and cessation of total parenteral nutrition resulted in complete resolution of the pleural effusion.Message
In any newborn with central venous catheter in situ, acute deteriorations specially, those related to pleural and pericardial effusions should alert the clinicians to remove the catheter and should not be misguided by apparently appearing normal correct catheter position by x-ray or 2D echocardiogram.4.
Jayasree Chandramati Abdul Majeed Ashwin Prabhu Sasidharan Ponthenkandath 《Indian pediatrics》2018,55(10):905-906
Background
Intractable obstructive apneas requiring multiple intubations are rare in newborns.Case characteristics
We report a pair of twins born at 29 weeks gestation who had severe obstructive apneas due to Paradoxical Vocal Cord Motion (PVCM).Outcome
The symptoms resolved promptly with ipratropium nebulization. Follow-up at 12 months of age revealed normal development.Message
PVCM should be considered in the differential diagnosis of intractable obstructive apneas in very low birth weight preterm infants.5.
Siva Prasad Vyasam Thangaraj Abiramalatha Nalapalu Srinivasan Hema Niranjan Thomas 《Indian pediatrics》2018,55(2):163-164
Background
Cytomegalovirus (CMV) enterocolitis is rare in term neonates.Case characteristics
A term newborn with persistent pneumonia from birth developed enterocolitis on day 18 of life.Outcome
Polymerase chain reaction (PCR) for CMV DNA was positive in urine sample. Antiviral therapy for six weeks resulted in successful treatment without any stricture formation.Message
CMV enterocolitis should be considered as a differential diagnosis in atypical cases of necrotizing enterocolitis in neonates.6.
Background
Synovial arteriovenous malformation is rare.Case characteristics
We present three children with recurrent monoarthritis secondary to synovial arteriovenous malformation.Outcome
Two children underwent excision of arteriovenous malformation. Another child had diffuse arteriovenous malformation, which was inoperable.Message
Synovial arteriovenous malformations should be considered in the differential diagnosis of monoarthritis, especially of the knee.7.
Background
The clinical management of intravenous immunoglobulin-resistant Kawasaki disease shock syndrome (KDSS) is obscure.Case characteristics
Three children presented with intravenous immunoglobulin-resistant KDSS complicated with myocarditis.Outcome
All cases were successfully managed with steroid pulse therapy.Message
Steroid pulse therapy is effective in immunoglobulin-resistant KDSS.8.
Background
Brucella has been known to cause pyrexia of unknown origin.Case Characteristics
9-year-old boy with fever and abdominal pain; multiple abscesses within the liver on ultrasonography.Observations
IgM Antibodies against Brucella were raised in his serum sample, and Brucella serum agglutination test was positive. Immunological work-up suggested selective IgA deficiency. Reduction in size following treatment with trimethoprim-sulphamethoxazole, amikacin and doxycycline.Message
Brucellosis should be considered as an etiology of liver abscess in patients not responding to conventional antibiotics.9.
Sankalp Dudeja Pooja Sikka Kajal Jain Vanita Suri Praveen Kumar 《Indian pediatrics》2018,55(9):761-764
Objective
To improve the rates of first hour initiation of breastfeeding in neonates born through cesarean section from 0 to 80% over 3 months through a quality improvement (QI) process.Design
Quality improvement study.Setting
Labor Room-Operation Theatre of a tertiary care hospital.Participants
Stable newborns ≥35 weeks of gestation born by cesarean section under spinal anesthesia.Procedure
A team of nurses, pediatricians, obstetricians and anesthetists analyzed possible reasons for delayed initiation of breastfeeding by Process flow mapping and Fish bone analysis. Various change ideas were tested through sequential Plan-Do- Study-Act (PDSA) cycles.Outcome measure
Proportion of eligible babies breast fed within 1 hour of delivery.Results
The rate of first-hour initiation of breastfeeding increased from 0% to 93% over the study period. The result was sustained even after the last PDSA cycle, without any additional resources.Conclusions
A QI approach was able to accomplish sustained improvement in first-hour breastfeeding rates in cesarean deliveries.10.
Background
Glycogen storage disease type VI (GSD-VI) presents with failure to thrive and also fibrosis in some cases, without cirrhosis.Case characteristics
2½-year-old girl presented with short stature, transaminase elevation and significant fibrosis, suggesting GSD-III.Observation
A pathogenic mutation in PYGL gene suggested GSD-VI.Message
GSD-VI should be a differential diagnosis whenever GSD-III is suspected.11.
Background
Urinoma is an encapsulated collection of extravasated urine, secondary to trauma or obstructive uropathy. Spontaneous bilateral urinoma is rare.Case characteristics
7-year-old boy with cyanotic heart disease and fever of unknown origin.Obeservation
The ultrasound abdomen and CT abdomen revealed bilateral spontaneous urinoma which was aspirated and was found to be infected. Following intravenous atibiotics the child became afebrile, with subsequent renal scans showing no recurrence.Message
Hypoxia and consequent polycythemia may be responsible for perinephric leaks leading to Non-traumatic spontaneous urinoma.12.
Objective
To develop nomogram of Transcutaneous Bilirubin among healthy term and late-preterm neonates during first 96 hours of age.Design
Longitudinal observational study.Setting
Neonatal unit of a tertiary care Hospital of Central Gujarat, India.Participants
1075 healthy term and late preterm neonates (≥35weeks).Intervention
Six-hourly transcutaneous bilirubin was obtained from birth to 96 hour of life using Drager JM 103 Transcutaneous Bilirubinometer.Main outcome measures
Nomogram of Transcutaneous Bilirubin with percentile values was obtained, rate of rise of bilirubin was calculated and predictive ability of normative data was analyzed for subsequent need of phototherapy.Results
The age-specific percentile curves and nomogram were developed from the transcutaneous bilirubin readings of 1,010 neonates. Rate of rise in first 12 hour was 0.2 mg/dL and was 0.17 mg/dL in 12 to 24 hour of life which decreased on second day of life. Neonates who required phototherapy had consistently higher readings of transcutaneous bilirubin and also higher rate of rise in first 48 hrs.Conclusion
Neonates whose transcutaneous bilirubin is above the 50th percentile should be monitored for the development of significant hyperbilirubinemia.13.
Parijat Chandra Devesh Kumawat Ruchir Tewari Rakesh Reddy Panyala S. S. Sreeshankar 《Indian pediatrics》2018,55(9):776-779
Objective
To decrease the waiting time for preterm babies visiting the Retinopathy of prematurity clinic in a tertiary eye hospital.Design
Interventional study.Setting
Tertiary eye care hospital.Patients
All preterm babies reporting for screening and follow up at Retinopathy of prematurity clinic.Intervention/Procedure
A quality improvement team comprising of a faculty (team leader), two senior residents, two junior residents, one nursing officer, and a registration staff was constituted. Fish bone analysis was done to understand various reasons for the high waiting time for preterm babies. Baseline data was collected followed by multiple Plan-Do-Study-Act (PDSA) cycles.Main outcome measures
Average waiting-time, maximum waiting-time, and last baby entry-time were measured.Results
The median average waiting-time, maximum waiting-time and last baby entry-time at baseline were 90.5 min (range 74.1 to 118.8 min), 177.5 min (range 160 to 190 min) and 111 min (90 to 118 min), respectively. At the end of 3rd PDSA cycle, these reduced to 77.6 min (range 55.2 to 94.3 min), 122 min (range 110 to 135 min), and 60 min (range 45 to 80 min), respectively and were sustained; the decrease from baseline being 14.3%, 31.2%, and 46%, respectively.Conclusion
The time spent in the waiting area at the Retinopathy of Prematurity clinic was significantly reduced by simple changes in the process flow.14.
Background
Neonatal respiratory distress due to coexisting subglosso-palatal membrane and tongue dermoid has not been reported yet.Case characteristics
A newborn with respiratory distress having a membrane in the oral cavity. Excision of membrane revealed a tongue mass with cleft palate, obstructing the nasopharynx completely. Elective ventilation was followed by excision of mass.Outcome
The child was cured with uneventful course at follow-up of six months.Message
Co-existing congenital anomalies causing airway obstruction may be missed in presence of subglosso-palatal membrane.15.
Nevitha Athikari Manamal Tanu Singhal Abhaya Kumar Darshana Sanghvi Jayanti Mani 《Indian pediatrics》2018,55(11):993-994
Background
Neuroschistosomiasis is an uncommonly reported disease.Case characteristics
An adolescent Indian boy residing in Kenya presented with headache, visual symptoms and seizures, with MRI showing space-occupying lesions in the occipital lobe and cerebellum.Observation
Brain biopsy was diagnostic of neuro-schistosomiasis; complete recovery was seen with praziquantel and corticosteroid therapy.Message
This case highlights the importance of considering epidemiology in differential diagnosis and establishing definitive diagnosis even if it is by invasive methods.16.
Vasanthan Tanigasalam B. Vishnu Bhat Sharmila Manivannan Malathi Munisamy Swapnil Parchand 《Indian pediatrics》2018,55(7):601-602
Background
Schimmelpenning syndrome is a multisystem disorder.Case characteristics
A term female neonate with sebaceous nevi of the face had choroid osteoma of the right eye.Observation
At one month of age, the infant was observed to have choroidal neovascularization that was successfully treated with laser photocoagulation and anti-VEGF.Message
Choroid osteoma and neovascularization are rare associations of Schimmelpenning syndrome, and should be screened for and managed early.17.
Background
Immunodeficient children are more prone for invasive cryptococcal infections.Case characteristics
A 2-year-old boy with disseminated cryptococcosis was evaluated for underlying immunodeficiency without success.Intervention/outcome
Child was managed successfully.Message
Immunocompetent children with disseminated cryptococcosis can present diagnostic or therapeutic challenge in resource-limited settings.18.
Sandeep Narayan Lal Jaspreet Kaur Pooja Anthwal Kanika Goyal Pinky Bahl Jacob M. Puliyel 《Indian pediatrics》2018,55(1):27-30
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.19.
Dilip Bharodiya Tanu Singhal G. S. Kasodariya P. S. Banerjee Rajat Garg 《Indian pediatrics》2018,55(1):69-70
Background
Human trypansomiasis due to infection by animal trypanosomes is rarely reported from India.Case characteristics
We describe clinical presentation of a 2-month-old boy from a rat infested house in rural Gujarat who was diagnosed to be havinginfection with the rodent parasite Trypanosoma lewisi.Observation
The fever and parasitemia resolved on treatment with liposomal amphotericin B, Ceftriaxone and Amikacin, and there was no recurrence of parasitemia over a 2 month follow-up.Message
The case highlights the need for increased awareness and heightened surveillance for this rare zoonotic infection.20.
Kln Rao Prema Menon R Samujh Jk Mahajan M Bawa Ma Malik Br Mittal 《Indian pediatrics》2018,55(12):1046-1049