Poor Weight Gain Research Articles

Atypical Presentation of Duodenal Atresia in a Newborn With Trisomy 21: A Simulated Case Report and Narrative Review

Duodenal atresia has a strong association with chromosomal anomalies, particularly trisomy 21. Duodenal atresia is identified prenatally in up to 60% of cases, and intestinal obstructions often present with signs, including difficulty feeding, emesis (particularly in the first 24 to 48 hours of life), abdominal distension, and inability to pass meconium in the immediate postnatal period. In this article, we present a simulated case of a neonate with trisomy 21 who presented at age 2 weeks for evaluation of poor weight gain and feeding intolerance and was diagnosed with duodenal atresia. Imaging is the mainstay of diagnosis and imaging modalities, such as abdominal radiographs or upper gastrointestinal studies, will reveal a “double bubble” sign. This sign indicates proximal dilation of the duodenum and stomach, suggesting duodenal atresia. Management often involves surgical correction to bypass the obstruction and parenteral nutrition, as enteral feeds are often introduced slowly postoperatively. Early diagnosis and a collaborative multidisciplinary approach are vital to successful treatment. [ Pediatr Ann . 2025;54(4):e139–e143.]

Obesity Prevalence in DDX3X-Related Neurodevelopmental Disorder.

The purpose of this study is to analyze the prevalence of obesity in those affected by DDX3X-related neurodevelopmental disorder (DDX3X-NDD). Initial descriptions suggested that individuals with DDX3X-NDD suffered from poor weight gain or failure to thrive in early childhood, likely in the setting of feeding difficulties and secondary to associated hypotonia. However, through a patient's parent, we came to learn that obesity was a common problem for older patients. To investigate this, we developed a survey to be distributed to caregivers of patients with DDX3X-NDD. The flyer contained a QR code to access an online and anonymous survey, with questions regarding the diagnosis of DDX3X-NDD and concerns about obesity in the affected child. Approximately 31% of the study population (n = 70) expressed concerns about obesity on the anonymous survey, and nearly half of this population found obesity to be a concern after the diagnosis of DDX3X-NDD. Common interventions that were implemented for obesity concerns included medications, visits with Endocrinology specialists, exercise regimens, and diet modifications. There is not a defined correlation between concerns for obesity and other medical diagnoses affecting this clinical symptom prevalence, since it is understood that autism can affect diet and weight. The degree of intellectual disability in those with obesity concerns and diagnoses of DDX3X-NDD was not established. Our findings suggest that while poor weight gain due to feeding difficulties in infancy is common, obesity is a common health concern for older DDX3X-NDD patients.

Music Therapy Intervention Using a Holy Quran Recitation Improves Feeding Status, Weight Gain and Length of Stay Among Preterm Infants in the Neonatal Intensive Care Unit: A Randomized Clinical Trial.

One of the most important challenges that preterm infants face is nutritional problems. Poor postnatal weight gain can lead to various complications. To determine the effects of listening to the Holy Quran on the feeding status, postnatal weight gain, and length of hospital stay of preterm infants. The current randomized clinical trial was conducted in the city of Qazvin in 2024. The samples included 80 preterm infants hospitalized in neonatal intensive care unit, who were randomly assigned to the intervention and control groups (40 in the Holy Quran recitation group and 40 in the control group). In addition to the routine care, the participants in the intervention group listened to the Holy Quran via headphones for 20minutes 3 times a day, whereas the participants in the control group did not receive any intervention. The mean days to achieve the first oral feeding (P <.001), the mean days to achieve full oral feeding (P <.001), the mean weight gain at the time of achieving the first oral feeding (P <.046), and the mean length of hospital stay (P <.001) were significantly lower in the intervention group than in the control group. In addition to standard treatments, listening to the Holy Quran, as a complementary method, can improve some parameters related to feeding and the quicker discharge of preterm infants.

Single ventricle infants: outcomes and impact of home monitoring programme enrolment.

Poor weight gain in infants with single ventricle cardiac physiology between stage 1 and stage 2 palliative surgeries is associated with worse outcomes. The growth of infants with single ventricle physiology, enrolled in home monitoring programmes in the United Kingdom, has not been widely described. To explore the growth of infants with single ventricle physiology supported by a home monitoring programme, at a tertiary centre in the South of England. A retrospective review of two cohorts, comparing weight gain amongst infants with single ventricle physiology, before and following the implementation of a home monitoring programme. Inclusion was dependent on a diagnosis compatible with single ventricle physiology during the interstage. Enrolment into a home monitoring programme (cohort 2) was associated with 55% more infants being discharged home during the interstage period (p < 0.05). Interstage mortality did not differ between cohorts. There were no differences in interstage growth velocity between cohorts (cohort 1 23.98 ± 11.7 g/day and cohort 2 23.82 ± 8.3 g/day); however, infants in cohort 2 experienced less growth deceleration early in life, and achieved catch-up growth at 12-23 months. Interstage nasogastric feeding, regardless of the cohort, was associated with worse growth outcomes. A home monitoring programme for infants with single ventricle physiology provides the opportunity for infants to be safely discharged home to their families and cared for at home during the interstage. Infants in the home monitoring programme experienced better growth, achieving weight restoration at 12-23 months.

Outcomes Associated With Remote Patient Monitoring for Poor Weight Gain.

Outcomes Associated With Remote Patient Monitoring for Poor Weight Gain.

Unusual Presentation of Classical Galactosemia: A Case Report of Iranian Experience.

Galactosemia is a rare autosomal recessive metabolic disorder with four main types, and classic galactosemia is the most prevalent. These patients have galactose-1-phosphate-uridyltransferase deficiency. We report on a case of an infant who was admitted with poor feeding, lethargy, and poor weight gain. Based on the clinical symptoms and laboratory findings, the patient was considered to have a metabolic disorder. The patient had unusual presentations such as macrocytic anemia requiring blood transfusions, repeatedly metabolic acidosis requiring bicarbonate therapy and failure to thrive in addition to neurodevelopmental delay which led the authors to different diagnoses and suspect to mitochondrial disorders. Finally, in one of the assessments before blood transfusion, a high galactose-1 phosphate was detected, and galactose-free diet was started which led to neurologic and physical of the child. The whole-exome sequencing (WES) also revealed a likely pathogenic homozygous mutation in GALT (c.794 C>G, p. Pro265Arg) confirming the diagnosis of classic galactosemia. In Iran, global neonatal metabolic screening is not done for galactosemia which results in late diagnosis of the affected patients. So, we suggest adding galactosemia to neonatal metabolic screening in Iran.

Immunological Factors and Macronutrient Content in Human Milk From Women With Subclinical Mastitis.

Subclinical mastitis is an asymptomatic inflammatory condition of the lactating mammary glands possibly associated with premature interruption of breastfeeding and poor weight gain in infants. However, data on human milk composition in mothers with subclinical mastitis are limited and inconsistent. Although human milk from donors with subclinical mastitis may be used after pasteurization if it meets the criteria, whether the composition is suitable for donor human milk remains unknown. This study assessed the human milk composition of participants with subclinical mastitis and verified the safety of donor human milk, including that from mothers with subclinical mastitis. This cross-sectional survey included 106 milk samples collected between March 2022 and January 2023. Subclinical mastitis status was assessed using the sodium-potassium ratio, which was measured using an ion-selective electrode. The concentrations of lactoferrin and secretory Immunoglobulin A were analyzed using an enzyme-linked immunosorbent assay. True protein, fat, carbohydrate, and energy levels were analyzed using a mid-infrared transmission spectroscopy. In human milk from the subclinical mastitis group, lactoferrin and true protein concentrations were significantly increased compared to those without subclinical mastitis. A positive correlation was observed between lactoferrin and secretory Immunoglobulin A levels. Increased immunological substances and protein concentrations in human milk are similar to those observed in clinical mastitis, indicating an inflammatory response in the body, even in asymptomatic individuals. Immunological substances and proteins are beneficial for preterm infants. Therefore, human milk from mothers with subclinical mastitis is suitable for use by milk banks.

Genomic and phenotypic selection indices for decreased birth weight, shortening fattening period, and regulating total weight gain in beef cattle.

This study aimed to develop genomic and phenotypic indices for beef cattle selection that afford progeny with reduced birth weight and fattening period. The indices should also allow regulating total weight gain during the fattening period and avoid marked increases of inbreeding. Whether addition of constraint on total weight gain to constraints on body weight gain at up to four specific time points during the fattening process was effective for the weight gain until the end of the fattening period was examined in two selection indices with the selection trait being a phenotypic or a genomic breeding value random regression coefficient. Both indices afforded cattle with desired weight gains at specific time points and desired total weight gains. One cycle of index-based selection made it possible to shorten the fattening period two weeks compared with that before selection while maintaining the same final fattening weight as before selection. The impact of constraining total weight gain was smallest when the number of weight gain constraints at specific time points was three or four. However, constraining total weight gain was necessary to avoid poor total weight gain when the number of weight gain constraints at specific time points was only one or two. The developed indices make it possible to regulate total weight gain during the fattening process and to achieve desired weight gains at specific time points. Importantly, the indices bring about genetic improvement without an excessive increase of inbreeding. Thus, we expect that these indices will contribute to sustainable genetic improvement in cattle while maintaining genetic diversity.

Supraglottoplasty outcomes and peri-operative care in congenital laryngomalacia.

This study aimed to identify factors predicting postoperative ICU admission, the need for orotracheal intubation (OTI), and the occurrence of supraglottic stenosis in children undergoing supraglottoplasty for laryngomalacia. A retrospective analysis was conducted on 31 children (Dear Reviewer, we would have greatly preferred to include a larger sample size. However, as you know, this type of management is rare, and we deliberately selected a 7-year period to ensure a minimum of 30 children while avoiding significant differences in management guidelines over time. Thank you for your understanding.) who underwent supraglottoplasty at Robert Debre University Hospital from February 2016 to June 2023. Patient demographics, medical history, pre- and postoperative findings, and outcomes were evaluated. Statistical analyses were performed using R software. A total of 60% of patients required ICU admission postoperatively. Factors predictive of ICU admission included a history of genetic anomalies, younger age at surgery, poor weight gain, and preoperative enteral feeding. Among those requiring OTI, significant predictors included a history of neurological disease, abnormal vocal cord mobility, and intraoperative arterial oxygen saturation dropping below 90%. Two patients developed supraglottic stenosis, with a noted correlation to surgical technique and preoperative respiratory severity. While supraglottoplasty is generally safe and effective, specific factors can predict the need for postoperative ICU care and intubation. The findings highlight the importance of thorough preoperative assessments and optimization of gastroesophageal reflux management to mitigate complications.

Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.

Kyphectomy followed by self-sliding pedicle screw and translumbosacral rod impaction and fixation: a novel growth-friendly technique in myelomeningocele patients.

Double Outlet Right Ventricle: A Rare Finding in a 15-Month-Old Female With Failure to Thrive.

Double outlet right ventricle (DORV) is a rare congenital heart defect where both the aorta and pulmonary artery originate from the right ventricle, often accompanied by additional cardiac anomalies to mitigate circulatory imbalance, though such compensations usually fail. We report a 15-month-old infant with recurrent respiratory infections and poor weight gain, referred for computed tomography angiography. Physical examination showed a small, non-syndromic infant with pallor, tachypnea, irritability, and finger clubbing. Initial imaging revealed cardiomegaly and lung infiltrates; echocardiography and computed tomography angiography confirmed additional intracardiac defects of double superior vena cavae, a hypoplastic aortic arch, hypertrophic right ventricular wall, and a patent ductus arteriosus. Corrective surgery was delayed due to respiratory complications. This case emphasizes the critical need to consider cardiac pathology in pediatric patients with recurrent respiratory symptoms, as untreated DORV can lead to high mortality.

The Prevalence of Associated Congenital Cardiac Anomalies (Shunt-Dependent Lesions) in Children with Transposition of Great Artery

Background: Transposition of the great arteries (TGA) is a rare cyanotic heart disease associated with congenital cardiac anomalies; often called shunt-dependent lesions. Transposition of the great arteries is also linked to syndromic correlates. Aim: This study was to document the prevalence of TGA and various forms of shunt-dependent lesions in children with TGA. Methods: This was a descriptive study where one thousand and five echocardiography were carried out in two health institutions over 9 years. Results: Data were analyzed with IBM statistical software version 20. The prevalence of children with TGA was 1.7%. The majority of the infants, 73.3%, had ASD as shunt-dependent lesion. All the infants, 100.0%, presented with cyanosis, breathlessness, and poor weight gain. Less than one-tenth of the infants, 6.7%, had an intact septum. The highest proportion of the infants, 80.0%, has more than one congenital cardiac anomaly (shunt-dependent lesions). Infants with TGA have lower left ventricular mass (LVM) of 119.1 ± 116.5 compared with control (18.8 ± 12.6). This was statistically significant, Mann–Whitney U test (11.024), P &lt; 0.001. The under-filled left ventricular mass was found in 73.3% of the infants. Infants with TGA co-existing with Teratology of Fallot (TOF) was (1/15) 6.7%; large Ostium secundum atrial septal defect was (OS ASD) (1/15) 6.7% and cases of ventricular septal defect (VSD) with associated ASD were (1/15) 6.7%. All infants had left aortic arch, which is a normal variant. None (0/15) had any surgical intervention as most were lost to follow-up. Conclusion: The prevalence of TGA was low in this setting. There were several shunt-dependent lesions associated with TGA. Atrial septal defect is the commonest. Poor management outcome was due to late presentation.

Optimal site for applying transcutaneous bilirubinometer as an outpatient screening tool for neonatal jaundice: a comparison between the sternum and forehead.

The gold standard for assessing neonatal jaundice (NJ) is the serum total serum bilirubin (TSB) level by the diazo method. A transcutaneous bilirubinometer (TCB) provides a convenient, noninvasive readout within minutes. The reliability of TCB as the diagnostic tool and the proper site for TCB measurement remains unsettled. This study aimed to (1) evaluate the reliability of TCB in the NJ outpatient management and (2) identify a better site to obtain TCB readings. This retrospective study examines data collected prospectively over 15 months at a level III facility. Parents were advised to bring their neonates back to our nursery if neonates were judged to be at risk for NJ or poor weight gain, and a follow-up with the primary practitioner was not available. Those who had received phototherapy or sustained forehead bruising were excluded from the analysis. Blood was collected immediately after TCB readings for TSB measurement using the di-azo method. The primary endpoint was admission for treatment according to the AAP 2004 guidelines. A mixed-effects model was used to assess the correlation of forehead TCB (TCB-f) or sternal TCB (TCB-s) with TSB by adjusting for age at measurement (hours), gestational age (GA), sex, and race. Repeated Measure Receiver Operator Characteristic (ROC) curves were constructed for TCB readings against the hospital admission, and the cutoffs for each method were selected to balance the sensitivity and specificity. There were 500 visits for 350 neonates, including 136 females, 114 white, 134 black, 71 Hispanic, and 30 Asian. The mean GA was 38.5 weeks [standard deviation (SD) = 1.6], and the mean body weight (BW) was 3,238 g (SD = 506). Forty-five (12.9%) neonates were admitted for phototherapy or blood exchange transfusion according to the TSB levels. Only 43 admitted neonates had all three measurements. Assuming TCB has the same reading as TSB, 30 out of 43 (69.8%) and 20 out of 43 (46.5%) neonates would be sent home if only TCB-f and TCB-s were used, respectively. TCBf has a trend of underestimating the necessity of hospitalization compared to TCBs (p = 0.092 by McNemar test). After adjusting for age of measurement, GA, sex, and race, both TCB-f and TCB-s readings positively correlated with TSB (p < 0.0001). Using repeated measure ROC, with hospital admission for treatment as the primary outcome, the area under the curve (AUC) for TCB-f was 0.79 (95% CI: 0.71-0.86), and AUC for TCB-s was 0.86 (95% CI: 0.81-0.92). A cutoff of 14.3 for TCB-s gave a sensitivity of 81% and a specificity of 78%. A cutoff of 12.6 for TCB-f gave a sensitivity of 80% and a specificity of 65%. TCB measurements can discriminate well in predicting admission for NJ treatment in our nursery but tend to underestimate the severity. The sternum is a better site for TCB measurements. We must point out that more than 40% of neonates who should be admitted for NJ management would be sent home if TSB were not obtained simultaneously. We recommend adjusting TCB readings according to unit-based calibration before clinical implementation.

The natural history of untreated X-linked nephrogenic diabetes insipidus with mutation in the vasopressin V2 receptor gene.

Nephrogenic diabetes insipidus (NDI) results from the kidneys' inability to concentrate urine. We describe a 6-month-old male with a history of poor weight gain who presented with an incidental finding of hypernatremia (155mEq/L) during an episode of acute gastroenteritis. The arginine vasopressin (AVP) test, along with molecular analysis revealing the M272R mutation in the AVP receptor 2 (AVPR2) gene, confirmed the diagnosis of congenital NDI. Interestingly, this mutation was also identified in the patient's maternal grandfather, who had never been diagnosed or treated for NDI despite a history of polydipsia, polyuria, and evidence of chronic kidney disease (CKD), severe bilateral hydronephrosis, hypertension, and severe bladder dysfunction. Early intervention with hydrochlorothiazide in the infant resulted in a significant reduction in urinary output and improved growth. The untreated grandfather's case highlights the potential severity of untreated NDI and the benefits of timely therapeutic intervention. This report contributes to the limited long-term data on congenital NDI, emphasizing the critical role of early detection and consistent management in preventing severe complications such as CKD, hydronephrosis, and bladder dysfunction. Regular follow-up, including renal ultrasound and monitoring of renal function, is essential for effectively managing NDI and improving patient outcomes.

Chyme reinfusion practices in the neonatal population.

Chyme reinfusion therapy (CRT) is a safe and effective method to improve nutritional outcomes and promote intestinal adaptation in patients with stomas. This practice involves refeeding the proximal stoma output, down the distal limb, and mimics a state of intestinal continuity; thereby promoting growth and adaption of the distal bowel. Despite its promise, CRT in neonates is a relatively underutilised practice and can be of significant value in neonates with congenital bowel anomalies or necrotising enterocolitis. We aimed to identify the frequency, methodology and adverse effects associated with CRT in our neonatal population. We aimed to identify the frequency, methodology and adverse events associated with CRT in our neonatal population. A ten-year retrospective cohort study was conducted using database searches at two major paediatric hospitals in New Zealand. All patients with suitable anatomy were identified, and data on CRT methodology and outcomes were recorded. Of the 49 eligible neonates, 23 (47%) underwent CRT. Indications for CRT included high stoma output, malnutrition with poor weight gain, and routine refeeding prior to stoma reversal. A nasogastric feeding tube was inserted into the distal limb and collected chyme was reinfused via manual bolus or automated syringe driver. The median (IQR) weight gain increased from 13.9 (3.50-22.89) to 24.37 (19.68-29.99) g/day during CRT (p = 0.04). 18 infections requiring medical intervention but unrelated to CRT occurred in 13 patients (56%). Amongst our cohort, there was a high rate of non-infectious events, including peri-stomal skin irritation (60%), stoma prolapse (43%) and stomal bleeding (26%). CRT is an underutilised method of improving nutrition in neonates with intestinal failure. Premature neonates requiring double enterostomy formation are at high risk of infectious and non-infectious complications, but few of these are related to CRT. Standardised protocols providing clear eligibility criteria and detailed methodology for CRT are required to promote uniform utilisation of this practice.

A low-fat amino acid diet reverses intestinal failure and shows good growth trends in five infants with diacylglycerol transferase 1 (DGAT1) deficiency: a prospective cohort study

BackgroundCongenital diarrheas and enteropathies (CODEs) caused by diacylglycerol transferase 1 (DGAT1) mutations often cause disease within 2 weeks after birth. If not treated properly, the disease can be life-threatening; therefore, early diagnosis and rational treatment strategies are essential. This study was conducted to improve the understanding of congenital diarrhea caused by DGAT1 deficiency.MethodsClinical data from five congenital diarrhea infant cases caused by DGAT1 deficiency were analyzed. Infants were prospectively provided with a nutritional intervention with a low-fat amino acid formula for special medical purposes (FSMP). Their gastrointestinal symptoms and nutritional complications before and after interventions were compared.ResultsDue to poor weight gain and gastrointestinal symptoms after birth, infants were treated by our clinical nutritionist. Genetic testing confirmed a compound heterozygous mutation in DGAT1. Neither hydrolyzed nor high-medium chain triglyceride (MCT) formula significantly alleviated diarrheal symptoms; however, a low-fat amino acid diet rapidly relieved symptoms and significantly improved nutritional status, with infants showing better tolerance to dietary fat content with age.ConclusionsInfants with DGAT1 deficiency can be diagnosed by genetic testing. A low-fat amino acid FSMP formula and diet can quickly relieve diarrhea, vomiting, and other symptoms, and also improve infant growth and development.Trial registrationEthical approval was obtained from the Medical Ethics Committee of the Children’s Hospital of Fudan University (reference code: No.(2022)405).

Multidisciplinary Surgical Care for a Cervical Esophageal Duplication Cyst.

We present a case of a three-month-old male who presented with a cervical esophageal duplication cyst requiring early surgical intervention. The patient presented with feeding difficulties, poor weight gain, and respiratory distress. Due to the position of the cervical esophageal duplication cyst and airway compression, this unique case required a multidisciplinary surgical approach involving both otolaryngology and cardiothoracic surgery.

Abstract 4141460: Exploring Novel Data-Driven Clustering Methods for Uncovering Patterns in Longitudinal Neonatal Postoperative Temperature Measurements

Introduction: Neonatal hypothermia (&lt; 36.5 o C) after CPB is considered benign despite lack of evidence on its prognostic significance. Question: Are group-based trajectory modeling (GBTM), k-means, and self-organizing map (SOM) clustering approaches clinically useful for evaluating their associations with important outcomes? Aims: Identify distinct postoperative temperature trajectories in neonates after CPB using novel machine learning (ML) clustering methods, corroborate findings, and evaluate prognostic value on outcomes. Methods: Secondary cohort analysis of prospectively collected data. Accessed data from a single pediatric referral center's CardioAccess registry consistent of postoperative neonates with congenital heart defects (CHD). 48-hourly postoperative temperature measurements were extracted from patient records. GBTM, SOM, and k-means clustering identified cluster membership and model fit was optimized for 3 clusters based on existing knowledge. The primary outcome was a complication composite of severe bleeding, illness severity, cardiac arrest, arrhythmia, delayed first successful extubation, prolonged ICU LOS, very poor weight gain, and 30-day mortality. 3 data driven techniques were compared and then associated with outcomes using adjusted multivariable binary logistic regression (LR). Results: 450 neonates ≥ 34 weeks gestation undergoing CPB between 2015 and 2019 met inclusion criteria. GBTM, SOM, and k-means clustering identified temperature group assignment for 3 clusters: 1) persistent hypothermia (n=38, 9% vs. n=49, 11% vs. n=40, 9%), 2) resolving hypothermia (n=233, 51% vs. n=227, 50% vs. n=147, 33%), and 3) normothermia (n=179, 40% vs. n=174, 39% vs. n=263, 58%). Concordance of techniques showed strong agreement between GBTM and SOM (kappa= 0.92). The kappa test comparing GBTM and k-means assignment was 0.41, indicating a weak to moderate agreement. After adjustment in the multivariable binary LR, persistently hypothermic neonates compared to normothermic neonates were associated with higher odds of the complication composite outcome in the GBTM (OR: 2.8 [1.0-7.3], p 0.041) and SOM (OR: 2.3 [1.0-5.4], p 0.045) models, but not the k-means model (OR: 1.4 [0.7-3.1], p 0.38). Conclusion: Exploring concordance between different unsupervised ML techniques, shows that neonatal temperature after CPB follows distinct postoperative trajectories, and those exhibiting a persistent hypothermia trend are at higher risk of adverse outcomes.

Esophageal achalasia presenting as recurrent pneumonia in children: A case series.

Esophageal achalasia (EA) is a rare primary esophageal motility disorder that is considered a rare etiology of dysphagia among infants and children. The proposed primary pathophysiology is related to the loss of ganglion cells in the distal esophageal sphincters, particularly in the Auerbachian muscle layer, which then leads to the dysmotility and failure of lower esophageal sphincter relaxation. Dysphagia, vomiting, poor weight gain, cough, and recurrent aspiration pneumonia are the most common presenting complaints. Herein, we report 3 cases of EA who presented with chronic cough and recurrent aspiration pneumonia. This study reviewed 3 pediatric patients with typical symptoms of EA. All the patients were admitted and referred to the pediatric pulmonology service for evaluation of recurrent pneumonia and suspected aspiration syndrome. All patients underwent a barium esophagogram as a part of the aerodigestive workup of recurrent vomiting, dysphagia, and aspiration pneumonia. Additionally, all the patients underwent workup for other associated congenital anomalies, which included echocardiography, brain magnetic resonance imaging, and an abdominal ultrasound. All patients had EA and presented with recurrent pneumonia. All patients had isolated EA, and none had any evidence of Allgrove syndrome. Pneumatic balloon dilatation was performed for all patients at the same time as the upper gastrointestinal endoscopy. Later, all the patients underwent a laparoscopic Heller myotomy and had no postoperative complications, and their symptoms resolved. EA is a rare condition in children, yet it can be a serious and life-threatening condition if left untreated. Our cases emphasize the significance of considering achalasia in children who experience esophageal dysphagia and recurrent pneumonia. Several pediatric cases have been reported in which respiratory involvement was the primary manifestation of achalasia. These cases highlight the importance of considering gastrointestinal disorders, particularly EA, in the differential diagnosis of children who experience recurrent pneumonia. Early diagnosis and treatment with laparoscopic Heller myotomy can lead to good outcomes for children with achalasia.

Molecular Detection and Isolation of Chicken Astrovirus from Commercial Chicken Flocks of Kerala, India

Reduced productivity due to enteric infections in chickens is a very common challenge in the poultry industry of India. Various studies associated Chicken astrovirus (CAstV) as a common pathogen in commercial flocks exhibiting poor weight gain, stunted growth and visceral gout. However, no published report documented the detection of the virus from Kerala so far. Hence, this study was done to investigate the presence of CAstV in 50 broiler flocks from different parts of Kerala with clinical signs such as retarded growth, diarrhoea, and a mortality of 5 to 10 %. Out of the 50, five flocks were found positive for the virus by using the Reverse Transcriptase – Polymerase Chain Reaction (RT-PCR) method with the primers targeting the partial ORF1b gene of the viral nucleic acid. The viral presence was confirmed by isolation using embryonated chicken eggs (ECE), which produced notable alteration to the infected embryos. Nucleotide sequencing of the isolates revealed a high identity of up to 100 % with the other CAstV sequences retrieved from the NCBI database. The study confirms the first report of molecular detection and isolation of CAstV from the state of Kerala.