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.     

Relationship of Exclusive Breast Feeding for 6 mo to Linear Growth up to 18 mo of Age

Objective

To assess if linear growth in infant is optimal, with exclusive breast feeding for 6 mo as advised by the WHO.

Methods

This prospective follow up study included 71 full term babies of middle socio economic group healthy mothers. The mothers were instructed to breast feed the babies who were followed up to 18 mo of age for assessment of linear growth. The study was conducted in Metro General Hospital, Noida, U.P. Fifty six babies weighed ≥2.5 kg, and 15 babies weighed <2.5 kg at birth. The main outcome measure was linear growth in exclusively breast fed infants.

Results

At 18 mo, infants ≥2.5 kg on exclusive breast feeding for <6 mo and receiving semisolids early gained more length by 3.4 cm than those receiving breast feeding for ≥6 mo, and infant <2.5 kg gained more weight by 1.2 kg.

Conclusion

For infants ≥2.5 kg of middle socioeconomic group, exclusive breast feed for 6 mo seems sufficient for optimal growth as compared to standard and reference growth data.     

Using Multitouch Collaboration Technology to Enhance Social Interaction of Children with High-Functioning Autism

Aims. Children with high-functioning Autism Spectrum Disorder (HFASD) have major difficulties in social communication skills, which may impact their performance and participation in everyday life. The goal of this study was to examine whether the StoryTable, an intervention paradigm based on a collaborative narrative, multitouch tabletop interface, enhanced social interaction for children with HFASD, and to determine whether the acquired abilities were transferred to behaviors during other tasks. Methods. Fourteen boys with HFASD, aged 7–12 years, participated in a 3-week, 11-session intervention. Social interactions during two nonintervention tasks were videotaped at three points in time, one prior to the intervention (pre), a second immediately following the intervention (post) and a third three weeks after the intervention (follow-up). The video-recorded files were coded using the Friendship Observation Scale to ascertain the frequencies of positive and negative social interactions and collaborative play. Differences in these behaviors were tested for significance using nonparametric statistical tests. Results. There were significantly higher rates of positive social interactions and collaborative play, and lower rates of negative social interactions following the intervention suggesting generalization of the social skills learned during the intervention. Improvement was maintained when tested three weeks later. Conclusion. These findings provide support for the use of collaborative technology-based interventions within educational settings to enhance social interaction of children with HFASD.     

CDC Kerala 2: Developmental Intervention Package for Babies &lt;1,800 g – Outcome at 6 mo Using DASII

Objectives

To describe the experience of using developmental intervention package among low birth weight babies less than 1,800 g and developmental outcome at the end of 6 mo monthly intervention.

Methods

Babies below 1,800 g, discharged from neonatal intensive care unit (NICU) of Sree Avittom Thirunal (SAT) hospital, over the last 3 y, were followed at Child Development Centre (CDC) Kerala and offered monthly evaluation by different tools and developmental intervention using a package by trained developmental therapists and mothers were encouraged to continue the same at home. At the end of 6 mo the developmental outcome was assessed using Developmental Assessment Scale for Indian Infants (DASII).

Results

Out of a total of 821 babies enrolled for early stimulation program, 740 babies successfully completed 6 mo follow up and stimulation program. Comparing the outcome at 4 and 6 mo, both grading for head holding and gross motor part of DDST showed a statistically significant reduction in abnormal findings. At 6 mo assessment on DASII, motor DQ abnormalities were a high 80 % for 600–900 g, as against 17.1 % abnormalities for 1,500–1,800 g birth weight group.

Conclusions

The results of this intensive early stimulation program for babies below 1,800 g have shown the importance of monthly early intervention using a mother oriented systematic developmental stimulation package.

     

Shared Decision-Making with Parents of Acutely Ill Children: A Narrative Review

Background

Shared decision-making (SDM) has mostly been used with adults and parents in the primary care setting, and there is limited knowledge on the use of SDM with parents of acutely ill children. The objective of this study was to review the literature on SDM with parents in the management of acutely ill children.

Is Waiting for Rehabilitation Services Associated with Changes in Function and Quality of Life in Children with Physical Disabilities?

Objectives. To determine whether longer waiting times for rehabilitation were associated with deterioration in child functional status and/or quality of life. Methods. Parents of 124 children (mean age 45 months) with physical disabilities (e.g., cerebral palsy, global developmental delay, spina bifida) who were referred to pediatric rehabilitation centers were interviewed every three months, from referral until admission into the rehabilitation program. Information from parental interviews included socio-demographics, parental empowerment (Family Empowerment Scale), function (WeeFIM: Functional Independence Measure for Children), and quality of life (PedsQL). Data on date of referral, age, gender, and diagnosis were obtained from hospital databases. Results. Half of the sample waited more than 9.1 months (95% confidence interval: 6.5–16.1) for admission to a public rehabilitation program. A total of 42% paid for some private services while waiting. Over the waiting period, there was statistically significant improvement in WeeFIM cognition and total scores but not in mobility scores. PedsQL psychosocial summary score declined over the waiting period (p < .05). Conclusion. Longer wait times for rehabilitation were associated with declining psychosocial quality of life. Reducing waiting times for rehabilitation services may allow rehabilitation specialists to address psychosocial problems for these children.     

Association of <Emphasis Type="Italic">IL-10</Emphasis> Gene Polymorphism (−819C &gt; T, −592C &gt; A and −1082G &gt; A) with Preterm Birth

Objective

To analyze the association of IL-10 gene and its polymorphisms with preterm birth (PTB).

Methods

Five hundred and fifty nine women with term birth and 559 with preterm birth were recruited from Lucknow, India. Genetic association analysis was conducted between cases and controls. Subjects recruited as cases were women (aged between 18–40 y) with singleton delivery before 37 wk of gestation and controls were with delivery after or on 37 wk. The genotyping was performed for rs1800871, rs1800872 and rs1800896 for assessing the allelic distribution, haplotypic association and linkage disequilibrium analysis. IL-10mRNA levels were evaluated by real time quantitative polymerase chain reaction (PCR) method.

Results

The risk of PTB was found significant in women carrying IL-10 (?1082) GA genotype [OR=1.72(1.7–2.5), p=0.006]. The haplotypic analysis of studied polymorphisms for rs1800871, rs1800872 and rs1800896 depicted the association of ATA (p=0.02) and ATC (p=0.01) haplotypes with PTB. The IL-10 mRNA levels were significantly lower in cases (p=0.05).

Conclusions

IL-10 marks a protective impact in the inflammatory pathway of PTB.

     

ALL-BFM 95 Treatment in Turkish Children with Acute Lymphoblastic Leukemia—Experience of a Single Center

Little is known about the likelihood of curing children with high-dose chemotherapy regimens for treatment of childhood acute lymphoblastic leukemia (ALL) in Turkey. The authors here report their 13 years’ experience with original ALL-BFM (Berlin-Franfurt-Münster) 95 protocol in a cohort of 140 Turkish children with ALL. Complete remission rate was 97.7% with a relapse rate of 12.9% and death rate 17.9% during a median follow-up of 69 months. The event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) in these patients at 12 years were 75.0%, 87.1%, and 80.6%, respectively. These results show that ALL-BFM 95 protocol is equally applicable in the experienced centers, even in developing countries without substantial treatment-related toxicity. High rate of infection deaths are to be reduced with correct policies.     

Severe combined immunodeficiency caused by a splicing abnormality of the <Emphasis Type="Italic"> CD3δ </Emphasis>gene

CD3 deficiency is a recently identified rare form of severe combined immunodeficiency. We analysed the CD3 gene in a Japanese family with severe combined immunodeficiency. The patients lacked T-cells with normal numbers of B-cells and natural killer cells in peripheral blood. We found a novel homozygous mutation in the splicing acceptor site of intron 2 (IVS2–2AG) in these patients. Analysis of patients mononuclear cells revealed the CD3 splicing abnormality. Chest X-ray films and computed tomography revealed small sized thymuses in these patients. Conclusion:The CD3 gene should be analysed in patients with severe combined immunodeficiency lacking T-cells with normal B- and natural killer cells irrespective of the thymus size.     

<Emphasis Type=Italic>PTPN11</Emphasis> Gene Mutation and Severe Neonatal Hypertrophic Cardiomyopathy: What Is the Link?

Noonan syndrome (NS) is an autosomal dominant disorder characterized by multiple dysmorphic features and a broad spectrum of congenital heart defects. Specific mutations of the PTPN11 gene are associated with 50% of the NS cases and 90% of the multiple lentigines/LEOPARD syndrome (ML/LS) cases. These two allelic conditions have several overlapping clinical features. This study describes the association between the Gln510Glu mutation of the PTPN11 gene and lethal progressive hypertrophic cardiomyopathy (HCM) in a newborn with the NS phenotype. The findings confirm the intriguing relationship between site-specific mutations of the PTPN11 gene and rapidly progressive HCM.     

A Localized Case–Control Study of Extra-Gastric Manifestations of <Emphasis Type="Italic">Helicobacter pylori</Emphasis> Infection in Children

Objective  

To study extra- gastric manifestations of H. pylori infection among children in Egypt.     

Evaluation of Health Related Quality of Life in 6–18 Years Old Patients with Acute Leukemia during Chemotherapy

Objective  

To evaluate the quality of life (QOL) of Iranian children with acute leukemia during chemotherapy.     

Selective deficiency of naïve CD4<Superscript>+</Superscript> T-lymphocytes in a child with congenital lymphoedema

We describe the first known case of congenital lymphoedema associated with selective deficit of naïve CD4⁺ T-lymphocytes. A high proportion of naïve CD4⁺ T-lymphocytes was found in the ascitic fluid, supporting the hypothesis of extra-vascular sequestration of these cells into lymphoedematous tissue.Abbreviation ICL idiopathic CD4⁺ lymphocytopenia     

Gene Polymorphisms of TNF-α<Superscript>−308</Superscript>, IL-10<Superscript>−1082</Superscript>, IL-6<Superscript>−174</Superscript>, and IL-1Ra<Superscript>VNTR</Superscript> Related to Susceptibility and Severity of Rheumatic Heart Disease

Rheumatic heart disease (RHD) is an inflammatory disease of the heart tissues caused by interactive immune, genetic, and environmental factors. The objective of this study is to test for the association of polymorphisms related to cytokine genes with susceptibility and severity of RHD among affected children from the Nile Delta region of Egypt. The study included 50 children with chronic RHD (29 males and 21 females), with a mean age of 12.2 years, in addition to 98 healthy unrelated controls. Cases were further classified on the basis of echocardiographic findings into those with only mitral valve disease (MVD) or multivalvular lesions (MVLs) and also as mild, moderate, or severe valve lesions. For all cases and controls, DNA was extracted and amplified using polymerase chain reaction with sequence-specific primers for detection of single nucleotide polymorphisms (SNPs) in the promoter regions of cytokine genes tumor necrosis factor (TNF)-alpha(-308 )G/A, interleukin (IL)-10(-1082 )G/A, and IL-6(-174 )G/C as well as a variable number of tandem repeats (VNTRs) in intron 2 of the IL-1Ra gene. All cases showed a significantly higher frequency of homozygous genotypes of TNF-alpha(-308 )A/A [odds ratio (OR) = 5.7, p < 0.001], IL-10(-1082) A/A (OR = 3.1, p < 0.05), IL-10(-1082) G/G (OR = 5.2, p < 0.05), and IL-1Ra A1/A1 (OR = 2.2, p < 0.05). Cases with MVD showed higher frequencies of genotypes TNF-alpha(-308 )A/A, G/G; IL-10(-1082) G/G; and IL-1Ra(VNTR) A1/A1 (p < 0.05). Cases with MVL showed a significantly higher frequency of homozygous A/A genotype of both TNF-alpha(-308 )(OR = 10.6, p < 0.05) and IL-10(-1082) (OR = 5.2, p < 0.05). The same was observed for cases with severe valve lesions. On the other hand, all studied groups showed significantly lower frequency of heterozygous genotypes of TNF-alpha(-308 )G/A, IL-10(-1082) G/A, and IL-1Ra(VNTR) A1/A2. No significant difference was found regarding the frequency of IL-6(-174 )G/C polymorphisms in total cases or subgroups compared to controls (p > 0.05). Predisposition to RHD is influenced by genetic factors including cytokine gene polymorphisms, with possible susceptibility to severe disease with multivalvular affection among cases with composite polymorphism (TNF-alpha(-308 )A/A and IL-10(-1082) A/A) and (TNF-alpha(-308 )A/A and IL-10(-1082) G/G).     

4-6 year-Old Children’s Experience of Subjective Well-Being and Social Relations in ECEC Institutions

There is a need for research about children’s perspectives on their everyday lives in Early Childhood Education and Care (ECEC) institutions, using methods that involves the children themselves and takes their voices seriously. This study aims at exploring what promotes and constrains children’s wellbeing in light of their social relations to other children and staff in ECEC institutions. Research on children’s own perspectives about their well-being has mainly been conducted among children older than those of preschool age, and therefore this study aimed at highlighting the voices of 4–6-year-old children regarding how they experience their lives in ECEC institutions. Quantitative data was collected through conversations with 171 Norwegian 4–6-year-old children based on an electronic questionnaire. The results indicate that relations, both with other children and with the practitioners, are important for children’s well-being - particularly, liking the other children and experiencing that the children are kind to each other in the ECEC.     

Measuring the Prevalence of Children at Risk Using <Emphasis Type=Italic>Parents’ Evaluation of Developmental Status</Emphasis> in a Telephone Survey

This study determined the reliability and feasibility of adding a validated parent-report screening tool to a public health telephone survey to estimate the prevalence of children at risk for developmental problems. Adults with children (0 to 6 years) in three public health regions in Ontario, Canada, were surveyed by telephone using the Parents’ Evaluation of Developmental Status (PEDS) tool; a 10-item screening measure that involves eliciting, categorizing and weighing parents’ concerns about their children. In Phase 1, responses to the PEDS were taped and reviewed by an expert in the PEDS and child development. Lay telephone interviewers’ and the expert’s PEDS scores were compared. In Phase 2, participants were mailed the PEDS for written completion; written scores were compared to telephone interview scores. Reliability was assessed by agreement and Kappa statistics. In Phase 1, overall agreement was 0.83, with weighted kappas = 0.74–0.78, indicating good-to-excellent agreement between scores generated from trained lay interviewers and those from the expert. In Phase 2, overall agreement was 0.69, with weighted kappas = 0.59–0.62, representing fair-to-good agreement between telephone and written modes of administration. Telephone administration of PEDS tended to identify lower risk levels than written administration. The average time spent collecting information over the telephone was less than two minutes. The PEDS can feasibly and reliably be added to a telephone-based health surveillance system to assess the prevalence of children at risk for developmental problems. Training requirements for lay interviewers were acceptable and they were able to code developmental information with a high degree of reliability.     

Distribution of brain infarction in children with tuberculous meningitis and correlation with outcome score at 6 months

Background Prognostic indicators for tuberculous meningitis (TBM) offer realistic expectations for parents of affected children. Infarctions affecting the basal ganglia are associated with a poor outcome. Objective To correlate the distribution of infarction in children with TBM on CT with an outcome score (OS). Materials and methods CT brain scans in children with TBM were retrospectively reviewed and the distribution of infarctions recorded. The degree of correlation with OS at 6 months was determined. Results There was a statistically significant association between all sites of infarction (P = 0.0001–0.001), other than hemispheric (P = 0.35), and outcome score. There was also a statistically significant association between all types of infarction (P = 0.0001–0.02), other than hemispheric (P = 0.05), and overall poor outcome. The odds ratio for poor outcome with bilateral basal ganglia and internal capsule infarction was 12. The odds ratio for poor outcome with ‘any infarction’ was 4.91 (CI 2.24–10.74), with ‘bilateral infarctions’ 8.50 (CI 2.49–28.59), with basal ganglia infarction 5.73 (CI 2.60–12.64), and for hemispheric infarction 2.30 (CI 1.00–5.28). Conclusion Infarction is associated with a poor outcome unless purely hemispheric. MRI diffusion-weighted imaging was not part of this study, but is likely to play a central role in detecting infarctions not demonstrated by CT.