Pediatric Department Research Articles

Remineralising Effects of L-arginine Fluoride Mouthwash versus Sodium Fluoride Mouthwash: A Protocol of an In-vitro Study

Introduction: Preventing dental caries and maintaining oral health are important for children’s quality of life, as they profoundly impact overall well being, self-esteem and long-term health outcomes. Despite breakthroughs in preventive dentistry, oral infections and tooth decay remain common among children, highlighting the need for novel and efficient preventive interventions. Although fluoride is a proven preventive measure against tooth decay, L-arginine, a naturally occurring amino acid, has shown promising results in enhancing remineralisation and has gained interest due to its role in maintaining oral health. The combination of L-arginine and fluoride in mouthwash may improve dental health. Need of the Study: L-arginine fluoride is utilised in oral care products such as varnishes and toothpastes; however, there are no studies examining the efficacy of L-arginine fluoride as a mouthwash. Aim: To assess the remineralising activity of L-arginine fluoride mouthwash compared to sodium fluoride mouthwash. Materials and Methods: The present in-vitro study will be conducted in the Department of Paediatric and Preventive Dentistry, Sharad Pawar Dental College, Wardha, Maharashtra, India from September 2024 to December 2025. Forty-two teeth with no white spot lesions or caries will be included, while teeth with lesions, fractures, or wear will be excluded from the study. The teeth will be randomly divided into six groups with different concentrations of L-arginine fluoride, and a control group with sodium fluoride will also be evaluated. The teeth will be assessed for Ca/P ratio using Scanning Electron Microscopy with Energy Dispersive X-ray (SEM-EDX), mineral density using micro-Computed Tomography (micro-CT), and for mineral gain and remineralisation using a specific formula. The data will be statistically analysed using Statistical Package for Social Sciences (SPSS) software version 22.0; a two-way Analysis of Variance (ANOVA) with Bonferroni post-hoc test, a one-way ANOVA with Student-Newman-Keuls (SNK) test, and Kruskal-Wallis one-way ANOVA will be used. A p-value of <0.05 will be considered statistically significant.

Study on Feeding Diversification in Infants Aged 6 to 24 Months at the Therapeutic Nutrition Unit in the Paediatric Department of the Regional Hospital Center (RHC) of Man (Côte d’Ivoire)

Introduction: Inappropriate infant feeding practices are a factor in malnutrition in western Côte d'Ivoire, which can cause several problems. In fact, in this part of the country, 26% of children under the age of 5 are undernourished, and 6% of these children are wasted. In order to assess knowledge and practices regarding infant feeding, this survey was carried out among motherchild pairs at the Regional Hospital Center (RHC) of Man. Methods: This was a descriptive survey carried out from February to March 2023 in the therapeutic nutrition unit of the paediatric department of the RHC of Man. The target population consisted of 250 mother-child pairs attending the unit. The questions mainly focused on the sociodemographic characteristics of the infants, the socio-economic characteristics of the household, supplementary feeding, and information channels related to nutrition and feeding of children aged between 6 and 24 months. Results: The age group of 12 to 18 months was the most representative (40%), with a female predominance (56%). Exclusive breastfeeding was practiced in only 42% of infants, with early introduction of water in 63.6% between 4 and 6 months. A total of 98.8% of infants were up to date with their vaccination schedules, and 36.4% received medical follow-up. Diversification began before 6 months in 62% of infants, and in the majority of cases, cereal-based porridge was introduced between 4 and 6 months. The introduction of vegetables and meat was delayed, occurring between 7 and 12 months (42.4%) and between 13 and 18 months (28%) respectively. Breastfeeding cessation occurred in 23.6% between 13 and 18 months. The most common difficulties in supplementary feeding were childhood illness (38%) and children's refusal to eat (26%). Conclusion: Inadequate practices and introduction of complementary foods were noted in the majority of cases. Hence, there is an urgent need to educate mothers on WHO recommendations regarding infant feeding diversification.

Family centered care in pediatric cardiac surgery departments: Nurses’ perceptions

Background: Family-centered care (FCC) in pediatric healthcare settings holds significant implications for hospitalized children and their family, as well as for healthcare providers, particularly nurses. This study aims to explore the perceptions of Pediatric Nurses (PN) working in Pediatric Cardiac Surgery departments regarding FCC. Materials and Methods: A cross-sectional study was conducted between November 2021 and July 2022 at two pediatric hospitals and a Cardiac Surgery Center in Athens, Greece. The Family Centered Care Questionnaire–Revised (FCCQ-R) was utilised to assess nurses' perceptions of FCC. This questionnaire consists of 45 items divided in 9 subcategories accessing the current nursing practice and the perceived necessity of FCC. Data analysis was performed using SPSS-28, with a significance level set at α=0.05. Results: 62 nurses were recruited. Most nurses were female (93.5%), with 41.9% aged between 31 and 40 years. Mean scores for the necessity scale and current scale were 25.93 (±5.26) and 17.85 (±4.25), respectively, with Cronbach's alpha coefficients of 0.942 and 0.937, respectively. Predictors of the current scale score included age group 51–60 years (β=4.62, p=0.010) and necessity scale score (β=0.26, p=0.016), whilst predictors of the necessity scale score included years of experience (β=-7.31, p<0.001) and daily scale score (β=0.35, p=0.019). Conclusions: Nurses acknowledge the importance of FCC dimensions but may encounter challenges in consistently applying them in their work. Further strategies may be required to bridge this gap and enhance the integration of FCC principles into pediatric nursing practice.

P-520. Barriers and facilitators towards HIV Pre-Exposure Prophylaxis (PrEP) prescription among healthcare providers in North Louisiana

Abstract Background The HIV/AIDS epidemic remains a major global health challenge. To end the HIV epidemic, it is crucial to ensure that everyone has fair and equal access to HIV treatment and prevention, including PrEP. Identifying and addressing barriers to PrEP prescription to ensure equitable access to prevent new infections is essential to end the HIV epidemic. Therefore, this study aims to identify incentives and barriers towards HIV PrEP prescription among healthcare providers in North Louisiana.Figure 1.How would you rate your knowledge of PrEP?The majority of participants (48%) rated their knowledge about PrEP as fair, good in 20%, and it was reported as poor in 16% of participants. Methods This is an ongoing observational cross-sectional survey study that aims to identify knowledge, attitudes, and intentions toward HIV PrEP among healthcare providers. Participants are faculty, residents, and fellows from the departments of Medicine, Pediatrics, Family Medicine and Obstetrics and Gynecology at an academic center in North Louisiana. A multi-modal recruitment strategy is being used to maximize the number of participants. We have conducted a preliminary descriptive analysis of the responses obtained from the study participants.Figure 2.Have you ever prescribed PrEP to a patient?Among healthcare providers surveyed, the majority (68%) reported that they had never prescribed PrEP to a patient. Results A total of 50 healthcare providers have taken the survey so far. Based on our initial findings, most study participants rated their knowledge of PrEP as either fair (48%) or poor (16%) (Fig.1). Concerning awareness of potential side effects, 44% reported poor knowledge. Most respondents (68%) had never prescribed PrEP (Fig.2). Barriers to PrEP prescription included: lack of PrEP provider training, lack of clinical guidelines for prescription and monitoring, challenges related to clinical and laboratory monitoring requirements, time constraints for patient education, and lack of insurance coverage (Fig.3). Facilitators to PrEP prescription included: access to resources such as PrEP prescription guidelines, implementation of Electronic Medical Records (EMR) order sets, clinical pharmacist support, and having peers who are knowledgeable and supportive of PrEP provision within their practice (Fig.4).Figure 3.Potential barriers to prescribing PrEP.Lack of provider training on PrEP was considered a very likely barrier to prescribing PrEP by 45% of respondents, while more than 50% of participants considered staffing and time constraints likely to be a barrier. Conclusion In order to make a significant contribution to HIV prevention, it is crucial to identify gaps in knowledge, attitudes, and practices among healthcare providers. This study’s ultimate goal is to improve PrEP implementation and dissemination, ultimately reducing new HIV infections among at-risk populations in Louisiana.Figure 4.Facilitators of PrEP prescription.More than 60% of participants considered that having Electronic medical records (EMR) order sets was an extremely likely facilitator, followed by clinical pharmacy support and having knowledgeable and supportive peers of PrEP use. Disclosures All Authors: No reported disclosures

P-1157. Clinical and Economic Outcome of Drugs Used in the Treatment of Pneumonia in Pediatric Population in a Tertiary Care Hospital in India-A Pharmacoeconomic Analysis

Abstract Background Antibiotic therapy expenses for treating pneumonia in hospitalized pediatric patients can substantially impact healthcare expenditures. We conducted a longitudinal study to investigate prescription appropriateness, predictors of treatment patterns, and key outcomes—readmission rates, length of hospital stay (LOS), and direct and indirect costs associated with diagnosing and treating community-acquired pneumonia in pediatric patients admitted to a tertiary care hospital in India. Methods We observed 180 children diagnosed with pneumonia and receiving antibiotic treatment upon admission to the pediatric inpatient department. We collected demographic data and prescription details, calculating direct and indirect costs. Multivariate regression analysis was employed to identify predictors of LOS and costs, while one-way ANOVA was utilized to assess cost disparities among treatment groups. Results Among all pneumonia admissions, mild-to-moderate cases accounted for 78.1% of cases; 66% (119 out of 180) of children had comorbid conditions alongside pneumonia. Beta-lactam antibiotics constituted the majority of prescriptions (54%), followed by aminoglycosides (20%) and macrolides (12%). Parenteral antibiotics were administered in 62.2% of cases, and switch therapy was performed in 45.5% (82) of cases. The median LOS was 3 days, with a cure rate of 95.5% (95% CI: 97-100%). Switch therapy was significantly associated with shorter LOS and substantially lower treatment costs. The average cost per pneumonia patient management was 14363 ± 782 INR ($172.26 ± 9). Conclusion Hospital management of pediatric pneumonia was more influenced by early discharge policies than by clinical variables. Disclosures All Authors: No reported disclosures

P-635. “Exploring Knowledge and Barriers to HPV Vaccination among Mothers of 9-14 Years Olds - a Descriptive Study in a Tertiary Care Hospital”

Abstract Background Human Papillomavirus (HPV) vaccination is pivotal in preventing cervical cancer and other HPV-related diseases. However, uptake remains suboptimal, partly due to parental knowledge gaps and barriers Association between Knowledge Level & Factors Hindering Vaccination Methods This prospective descriptive study was conducted in a tertiary care hospital in Trivandrum, Kerala. A structured preformed questionnaire was administered to total of 268 participants who were mothers of girl children aged 9-14 years attending outpatient pediatric department. The questionnaire assessed knowledge about HPV, the vaccine available for HPV, and factors influencing vaccinations. Results Among the 268 study subjects, a significant majority, comprising 91.4%, demonstrated a commendable level of understanding regarding the HPV vaccine. Various factors were identified as barriers to vaccination uptake, with safety concerns being the most prevalent, cited by 91% of respondents. Additionally, a notable percentage (36.9%) expressed uncertainty regarding potential future infertility concerns linked to the vaccine, while 67.2% cited the high costs associated with it as a deterrent. Nevertheless, an overwhelming majority (99.6%) acknowledged the indispensable role of vaccines in disease prevention. Conclusion The substantial knowledge observed within our study cohort can be credited to the state's commendable literacy rates and the concerted efforts of governmental and non-governmental entities to fortify healthcare awareness. This study provides valuable insights the gaps in knowledge and measures to augment HPV vaccination rates among adolescents. Disclosures All Authors: No reported disclosures

Comparative assessment and effectiveness of rotavirus vaccine among 2 months to 5 years old children with acute gastroenteritis including dysentery

Background: Rotavirus infection is a leading cause of severe gastroenteritis in children under five, contributing significantly to morbidity and mortality worldwide. This study aims to find out impact and effectiveness of Rotavirus vaccine (RV5) among 2 months to 5 years old children with acute gastroenteritis including Dysentery. Methods: This is a Prospective Observational study to find out impact and assessment of ROTAVIRUS VACCINE (RV5) among 2 months to 5 years old children admitted with Acute gastroenteritis including Dysentery in a hospital-based setting in Department of Paediatrics, Government medical college between October 2023 to October 2024. Vaccination information collected from Mamta card / Vaccination card. Results: In this study, we compared the severity of AGE based on dehydration among patient who received complete series of Rotavirus vaccine (RV5) and those who not taken the complete dose followed by χ²=9.84 and p value= 0.007 which is statically significant, which indicate that persons who have taken the complete set of rotavirus vaccine has significant decreases in AGE severity than those who have not taken complete dose of Rotavirus vaccine. AGE with no dehydration is observed more in those who had taken complete dose of vaccine and also AGE with severe dehydration is less in those who had taken complete dose of vaccine. Conclusions: Children who have taken all doses of rotavirus vaccine (RV5) has duration of hospital stay and duration of vomiting and duration of diarrhoea is less compared to those who have not taken complete doses of Rotavirus Vaccine.

Perfusion index monitoring and its correlation with outcome in neonates undergoing surgery

Background: The perfusion index (PI) has been found to be a reliable indicator of peripheral perfusion and can be used to monitor perfusion in neonates undergoing surgical procedures. To study correlation of perfusion index with the need for post op mechanical ventilation, ICU care and inotropic support in neonates undergoing surgery. Methods: Eighty neonates posted for surgery were enrolled after taking proper written informed consent from the parents. HR, BP and SPO2 and PI were recorded at 3 minutes interval for the first 30 minutes of surgery, followed by every 5 minutes till the end of procedure. Neonates requiring admission in the Department of Pediatrics were shifted to the Neonatal ICU or ward. Post-operative vitals were monitored initially every 30 minutes for first 24 hours followed by 2 hourly. Results: There was a statistically significant association between PI and need for post-op mechanical ventilation (MV). Duration of post-operative MV based on PI showed no significant difference. A lower PI was strongly correlated with an increased likelihood of requiring ICU-level care post-operatively, but not the duration of ICU stay. There was a potential association between PI and the requirement for inotropic support. Mortality rate was higher in patients with low PI, but not statistically significant. Conclusions: Low PI in neonates is associated with poor outcome in terms of need for ICU stay, need of postoperative mechanical ventilation and inotropic support.

Difference in weight gain among breast-fed and mix-fed infants at 6 weeks

Background: Breastfeeding practice protects children from a large number of illnesses, increases IQ and improves a strong bond between mother and infant. Body weight is an important sign of a baby’s growth and development. The relationship between breastfeeding and body weight is crucial for the wellbeing of neonates. Methods: This cross-sectional study was conducted at Department of Paediatrics, ASCOMS, Jammu for a period of 06 months. In the study 200 neonates were included and divided into two groups on the basis of self-reported feeding mode (breast-feeding and mix-feeding). History on maternal parameters and infant parameters at birth and 06 weeks were noted on a pre-designed proforma. The data was recorded in Microsoft excel sheet and was analysed by SPSS 20.0 version. Results: It has been observed in our study that none of the maternal parameters significantly differed among the two feeding modes (Breast fed and mix-fed). Out of 100 breastfed infants 45% had weight 4.0-4.2 kg, 32% had weight 4.2-4.4 kg, 14% had weight >4.4 kg and 9% had weight<4 kg. Out of mix-fed infants 48% had weight 4.0-4.2 kg, 28% had weight 4.2-4.4 kg, 10% had weight >4.4 kg and 14% had weight<4 kg. Further, the weight gained by infants at 06 weeks after birth slightly differed with breastfed infants having slightly more weight gain as compared to mix-fed infants. Conclusions: The current study found slight difference in weight gain between infants who were exclusively breastfed and those who were mix-fed at 06 weeks of life.

Evaluation of Hospital Outcomes Among Very Low Birth Weight Babies in a Community-Level Medical College Hospital

Introduction: Very low birth weight (VLBW) babies are at increased risk from a wide range of hazards resulting from immaturity of structure and functions of many organs, which may cause death or permanent damage. Objective: The objective of this study was to evaluate immediate outcomes in VLBW babies. Materials and Methods: This hospital-based prospective cohort study was conducted in the Department of Paediatrics, Kumudini Women’s Medical College and Hospital, Mirzapur, Tangail from August 2008 to July 2009. At enrollment VLBW babies (birth weight <1500 grams) were assessed for gestational age and weight. Patients were followed up daily till discharge or death. The outcome in terms of survival till discharge was recorded. Informed verbal consent from the caregiver was taken before enrolment. Results: A total of 60 VLBW neonates were enrolled in the study. Eight (13.3%) neonates had weights below 1000 grams and 52 (86.7%) had 1000-1499 grams. Five (8.3%) neonates had gestational age <28 weeks, 44 (73.3%) were 29-32 weeks, and 11(18.3%) were 33-36 weeks. Maternal age, place, and mode of delivery were significant contributory factors. In the present study, 35(59%) of VLBW babies expired; 100% of babies died below 1000 grams. Neonatal mortality showed an inverse relationship with birth weight and gestational age. Conclusion: Proper antenatal care should be encouraged throughout the country to prevent the neonatal mortality associated with VLBW infants. Management of labor is important and facilities for the management of high-risk pregnancy should be made available widely. Immediate management of newborns after birth can prevent the worst hospital outcomes in our country. The Journal of Ad-din Women's Medical College; Vol. 12 (2), July 2024; p 21-25

P-06 WHEN IS GENDER SELECTION IN CONGENITAL ADRENAL HYPERPLASIA?

Abstract Introduction Congenital adrenal hyperplasia (CAH) is one of the most common (classical type; nonclassical type) genetic diseases and is inherited in an autosomal recessive manner. This disease can lead to adrenal insufficiency, fluid-electrolyte disorder, and ambiguous genitalia as a result of axis dysfunction in cortisol biosynthesis. The optimal time for gender identity formation is between the ages of 18 and 36 months. The gender assignment of patients with CAH should be done as soon as possible before people around them know about it. Clinical Case A 23-year-old patient with known CAH due to 21-hydroxylase deficiency was referred to our clinic by a psychiatrist 1 year ago with the diagnosis of gender dysphoria. In his history, the patient was admitted first to the hospital with complaints of nausea and vomiting only one month after birth by his family. During examination at that time, BP was 70/40mmHg, and genital examination revealed ambiguous genitalia. In laboratory tests, Na:128mEq/l, K:5.1 mEq/l, DHEA-SO4: 4mcg/dl, basal cortisol: 1.18 mcg/dl and 17-OH progesterone: 6.8 ng/ml were found, and Karyotype analysis was reported as 46 XX. According to these results, the patient was diagnosed with CAH. Genetic analysis revealed CYP21A2 IVS2-13 C>G homozygous mutation. The patient who has classical type CAH was accepted as a phenotypically and genetically female child by her family and had undergone 2 correction operations since the age of 1 due to ambiguous genitalia. Between 2003 and 2013, he continued his follow-up in the pediatric endocrinology department and used Hydrocortisone + Fludrocortisone treatment in varying doses. He expressed that he did not go for regular check-ups and did not use his medications until 2018. Due to being untreated for a long time, his testosterone levels were high as male normal ranges, and his phenotype was male. The Ferriman-Gallwey score was determined as 22, and reconstruction scars and narrow vaginal opening were observed in the genital examination. In the laboratory test without any treatment were 17-OH-progesterone > 20ng/ml, basal cortisol: 7.8 mcg/dl, ACTH: 570 pg/ml, total testosterone: 524 ng/L, estradiol: 42 ng/L, DHEAS:252 mcg/dl, FSH:4.5 IU/L, LH: 0.76 IU/L, Na:136 mEq/L, K:4.3 mEq/L. The patient, who had simple virilizing CAH and gender dysphoria together, was first planned to start steroid replacement therapy in terms of CAH treatment. According to his clinical course, a decision was made to re-evaluate him in terms of identity change and testosterone replacement therapy. Conclusion The majority of CAH patients were raised as chromosomally female-identifying and living as female despite masculinized gender behaviors. Only 5.2% of these patients experienced gender dissatisfaction. Recent studies have shown that rather than intrauterine hormone exposure, regular treatment during the growth period and gender orientation during follow-up are more accurate and important regarding psychosocial satisfaction.Figure 1Possesses a masculine phenotype without using any testosterone

Investigation of vitamin D deficiency in girls with growth and development variations—a single center study

PurposeTo understand the status of vitamin D deficiency in girls with growth and developmental variations, as well as the impact of COVID−19 on their vitamin D levels, and to provide reference for the prevention and treatment of vitamin D deficiency in children.MethodsA retrospective analysis was conducted on 1,345 instances of girls with growth and developmental variations who visited our pediatric endocrinology department and completed vitamin D detection. A total of 279 girls with complete data were included in this study. Among them, 246 girls were classified into four groups based on different growth and developmental variations: early puberty group, menarche group, obesity group, short stature group, and 33 healthy girls served as the control group. Besides, the girls were divided into pre-epidemic and post-epidemic groups by the occurrence of the COVID-19 epidemic. Vitamin D were measured in all girls. The 25(OH)D <20 ng/ml was used as the standard for vitamin D deficiency.ResultsThe levels of vitamin D in the early puberty group, menarche group, obesity group, short stature group, and control group were as follows: 20.23 ± 5.90 ng/ml, 17.85 ± 5.69 ng/ml, 21.31 ± 8.99 ng/ml, 27.90 ± 12.27 ng/ml, and 29.42 ± 12.65 ng/ml, respectively. The levels of vitamin D in the early puberty group, menarche group, and obesity group were significantly lower than those in the control group (P < 0.05). The individual vitamin D deficiency rates in the aforementioned groups were 52.07%, 73.91%, 59.46%, 30.95%, and 30.30%, respectively. The vitamin D levels in the pre-epidemic and post-epidemic groups were 20.48 ± 6.22 ng/ml and 22.50 ± 9.74 ng/ml, respectively (P > 0.05).ConclusionGirls with early puberty, menarche, and obesity have a certain deficiency of vitamin D levels, and appropriate vitamin D treatment should be provided clinically. Girls with short stature and healthy girls also have certain levels of vitamin D deficiency, and awareness of prevention should be strengthened.

Effect of ligamentum teres uteri preservation in laparoscopic high hernia sac ligation in children with indirect inguinal hernia.

Routinely separating the ligamentum teres uteri (LTU) intraoperatively remains an unresolved issue for female children undergoing surgery for indirect inguinal hernia (IIH). To identify the effect of LTU preservation in laparoscopic high hernia sac ligation (LHSL) in children with IIH. The participants were 100 female children with unilateral IIH admitted from April 2022 to January 2024 to the Pediatric Surgery Department of Zhangzhou Municipal Hospital of Fujian Province. They were categorized based on LTU retention into the control group (n = 45 cases), which underwent LTU ligation intraoperatively, and the experimental group (55 cases), which had the LTU preserved intraoperatively. All children underwent LHSL. This study comparatively analyzed the operation time, hospitalization time, blood loss, postoperative recurrence rate, and complications (repeated pain in the inguinal region, foreign body sensation in the inguinal region, bloody exudation at the inguinal incision, and incision infection), which were all comparable between the two groups. The above results indicate that LTU preservation during LHSL exerts certain therapeutic benefits for children with IIH. LTU preservation does not increase hospitalization time, blood loss, postoperative recurrence rate, and complications, which is safe and feasible, compared with conventional LTU ligation. LHSL with LTU preservation should be performed if conditions permit, which is worth popularizing.

Primary adrenal insufficiency in children excluding congenital adrenal hyperplasia: insights from 33-year single-center experience in Tunisia.

Primary adrenal insufficiency (PAI) is a rare but potentially life-threatening condition. Congenital adrenal hyperplasia (CAH) is the most common cause of PAI in children. To date, numerous non-CAH causes have been identified through genetic analysis but they remain poorly characterized. We aimed to describe the clinical presentation, etiology, genetic analysis, and long-term outcome of non-CAH PAI in children. We retrospectively collected clinical and laboratory data from patients with non-CAH PAI who were followed up during a period of 33 years (1988-2020) at the pediatric department of a university hospital center in southern Tunisia. We identified 52 patients with non-CAH PAI (35 boys and 17 girls). The mean age at diagnosis was 4.8 years (0.05-18.7 years). Hyperpigmentation was the most frequent symptom at diagnosis (92.3%), followed by asthenia (84.6%), weight loss (57.7%), recurrent vomiting (53.8%), and dehydration (42.3%). The most prominent biochemical findings were hyponatremia (60.4%), hypoglycemia (35.4%), and hyperkalemia (16.6%). A total of 21patients (40.4%) presented with adrenal crisis at disease onset. The most common causes of non-CAH PAI were inherited genetic conditions and included Allgrove syndrome (n=15), X-linked adrenoleukodystrophy (n=10), autoimmune polyglandular syndrome (APS) type 2 (n=2), familial glucocorticoid deficiency type 1 (n=1), MCM4 mutation responsible for DNA repair defect (n=1), SF1 deficiency (n=1), APS type 1 (n=1), and autoimmune PAI (n=3). The cause of PAI remained unknown in 34.6% of cases. During follow-up, 24 patients (46.2%) presented with statural growth delay, and eight patients (15.4%) developed obesity. Allgrove syndrome was the most common etiology of non-CAH PAI in our study, followed by X-linked adrenoleukodystrophy. Today, advanced molecular analysis can be useful for diagnostic investigations, especially in patients with no specific diagnostic features.

The Impact of Maternal Education and Socioeconomic Status on Child Health Outcomes in Edo State, Nigeria

The understanding of child health has significantly evolved over the years. Modern perspectives recognize that a healthy childhood is shaped by a complex interplay of factors—biological, social, environmental, and psychological. The study aimed to understand the impact of maternal education and socioeconomic status on child health. The study further sought to investigate the impact of maternal attitude and health practices on child health in a Nigeria context. The study was conducted in the 21-bed sitter pediatric department of Irrua Specialist Teaching hospital, Irrua (ISTH), Edo state Nigeria. A descriptive cross-sectional study was employed from October 2023 to April 2024. A total of 60 questionnaires were distributed for collection of data. From the study, it was seen that all mothers have received various degree of literacy with majority (46.70%) of the women having gotten tertiary level of education and the least (16.70%) having primary level of education with 90% of the women displaying good knowledge. More of the women were middle income earners (60%) while just a few (20%) were high income earners. The study found a positive correlation between maternal attitudes and socio-demographic characteristics, with most women demonstrating favorable attitudes. These findings highlight the importance of maternal education and socioeconomic status in shaping child health outcomes, with potential implications for policy and intervention strategies. The relevance of this study will help all and sundry to step up in contributing their role in reducing children mortality and improve overall quality health care delivery.

A study on clinical profile and correlation between electroencephalogram and neuroimaging in unprovoked seizures in children aged between 2 months to 12 years

Background: Seizure is one of the commonest neurological illnesses in children and is also an important cause of mortality and morbidity in childhood proper diagnosis and management helps in improving the everyday life of children with seizures. The study is conducted to find the clinical profile and correlation of electroencephalogram (EEG) and neuroimaging and their correlation in the unprovoked afebrile seizures in children aged between 2 months and 12 years. Methods: This is a hospital based prospective observational study conducted for a period of 1 year and total of 63 children were included in the study with unprovoked seizures admitted in pediatric department of government Cuddalore medical college and hospital, Chidambaram. The data regarding their name, age, sex, type of seizure, past history of seizures, treatment history, developmental history, family history and EEG/neuroimaging findings are collected and recorded in a preformed proforma and analysed. Results: Among the 63 children, majority belonged to 1-5 years age group with male preponderance. About 80% of patient had generalised seizures and 20% had focal seizures. About 90% had abnormal EEG whereas 25.8% had abnormal neuroimaging. Majority of the abnormal neuroimaging is shared by focal seizures group. About 83% of children required single antiepileptic only. Conclusions: The EEG abnormality occurred equally in both generalised and focal seizures. Higher incidence of neuroimaging abnormality is seen in focal seizures. Idiopathic seizures were the most common etiology. There is a higher correlation between neuroimaging abnormality and EEG changes in focal seizures than generalised seizures. Electroencephalogram and neuroimaging are mandatory in evaluating children with unprovoked seizures.

Accumulation of severe Streptococcus pyogenes infections among children admitted to the pediatric department of a county hospital

Accumulation of severe Streptococcus pyogenes infections among children admitted to the pediatric department of a county hospital

Adherence to Perioperative Antimicrobial Prophylaxis in Children in the Settings of Neurosurgery, Otorhinolaryngology, and Orthopedics

Introduction: Data about compliance with perioperative antimicrobial prophylaxis (PAP) guidelines in the pediatric population are limited. This study aims to evaluate PAP adherence in pediatric surgical subspecialty departments. Methods: A prospective cohort study was conducted from September 2023 to October 2024 at “Aghia Sophia” Children’s Hospital, Athens, Greece. Children <16 years old undergoing surgical procedures in the neurosurgery (NS), orthopedics (OP), and otolaryngology (ORL) departments were included. Data on demographics, surgical characteristics, and PAP practices (timing, agent, duration, and redosing) were collected and compliance with the international guidelines was evaluated. Results: A total of 301 children were included, with a median age (IQR) of 7 (8) years. PAP was received by 249/301 (82.7%) children (100% in the OP and NS, and 48% in the ORL). However, indications for PAP had 50.8% of children: 102/103 (99%) in the NS, 47/98 (47.9%) in the OP, and 4/48 (8.3%) in the ORL. Most children received broad-spectrum or combination of antimicrobials and/or antibiotics for longer duration. Appropriate PAP according to the guidelines was administered in 0% children in NS, 2% in OP, and 2.1% in ORL. Multivariable analysis in the ORL regarding the use of PAP revealed that shorter procedures (≤60 min; OR: 22.9, p = 0.003) and clean wounds (OR: 33.4, p < 0.001) were significantly associated with not using PAP. Conclusions: This study highlights gaps in the PAP guideline adherence in pediatric surgical departments, and the need for educational interventions to improve compliance and reduce antimicrobial use. Based on these findings, we plan to implement an educational intervention in order to optimize PAP practices in the pediatric population.

Prevalence and Risk Factors of Developmental Delay among High-risk Preterm NICU Graduates – A Cross-Sectional Study

Objectives: Preterm and low birth weight neonates are vulnerable to developing neurodevelopmental handicaps more frequently compared to their term counterparts. Neurodevelopmental delay is multifactorial and is likely a consequence of an immature brain, perinatal risk factors, and environmental exposures. The study objective was to determine the prevalence of developmental delay in high-risk preterm infants and also to determine the risk factors for delay in development. Material and Methods: The study was an analytical cross-sectional study conducted in the Department of Pediatrics of a tertiary care medical college hospital from October 2021 to October 2022. Infants born as high-risk preterm neonates who required neonatal intensive care unit (NICU) stay in the early neonatal period were included in the study at the corrected age of 1 year after informed parental consent. Infants whose parents did not consent to the study were excluded from the study. Details of maternal, neonatal, and perinatal risk factors were noted in a pro forma. All infants included in the study were part of the follow-up program in the high risk newborn follow-up clinic and were assessed for growth and development periodically. A detailed neurological examination was done. During the follow-up of high-risk neonates, clinical assessment tools like Amiel-Tison angles were used. Details regarding the passive tone and active tone were documented in the follow-up card and reviewed. Early intervention was planned if tone abnormalities were identified. Developmental screening was done using the Trivandrum developmental screening test. Only trivandrum developmental screening test (TDSC) was used in screening, and confirmatory tests such as Bayley and developmental assessment scale for Indian infants (DASII) were not used in the study center. Although TDSC is not a confirmatory test, in a resource-limited setting, it may help to identify infants with delays in development early and refer them to a higher center. The prevalence of developmental delay was expressed in proportion with a 95% confidence interval (CI). Risk factors were determined by bivariate, followed by multivariate logistic regression analysis. P < 0.05 was considered significant. Results: The present study included infants who were high-risk preterm NICU graduates, of whom 57.2% were male. 22.7% of neonates had birth weight <1750 g. The prevalence (95% CI) of developmental delay was 18 % (12.2–27.6%). There were 18% neonates with gross motor delay, 13% with delay in fine motor development, 18% with delayed language development, and 14% with delay in social and adaptive milestones. By multivariate analysis, it was found that among the neonatal risk factors, apnea and birth weight <1.75 kg were independent risk factors for developmental delay. Conclusion: High-risk preterm NICU graduates are at risk of neurodevelopmental delay, and we observed an 18% prevalence of delay. Periodic follow-up and early intervention of babies with risk factors such as apnea and birth weight <1.75 kg is necessary.

Assessment of Nutritional Status in Children Aged 6 to 59 Months Using MUAC: An OPD-Based Study in a Tertiary Children Health Care Centre in Bangladesh

Background: Malnutrition is a major public health concern among children under five years of age in low- and middle-income countries, contributing to high morbidity and mortality. Despite progress, malnutrition remains a significant issue in Bangladesh and is influenced by socioeconomic disparities and maternal education. Mid-Upper Arm Circumference (MUAC) is a practical tool for assessing nutritional status in resource-limited settings. This study aimed to determine the nutritional status of children aged 6–59 months in the outpatient department (OPD) of a tertiary hospital in Bangladesh. Methods: A retrospective observational study was conducted at Department of Pediatrics, MR Khan Shishu Hospital & Institute of Child Health, Dhaka, from January 2010 to January 2011. Data from 200 children aged 6–59 months were analyzed. Nutritional status was classified as normal, moderate or severe based on MUAC values. Associations among demographic factors, maternal education, and malnutrition were also explored. Results: Among the 200 children, 24.5% were malnourished, including 10.5% with severe malnutrition and 14% with moderate malnutrition. Children aged 36–59 months had the highest malnutrition prevalence (29%). Females (21%) were more likely to be malnourished than males (16.5%). Maternal education strongly affected outcomes, with malnutrition being the highest among children of illiterate mothers (47.5%). Conclusion: Gender and maternal education influence the nutritional status of children in Bangladesh. For nutritional assessment, the MUAC is an effective tool that underscores the need for interventions that target these disparities.