Short-term Outcomes In Children Research Articles

Childhood haemorrhagic stroke: a 7-year single-centre experience

BackgroundIn recent years, there has been increasing research interest in improving diagnostic and management protocols in childhood arterial ischaemic stroke (AIS). However, childhood stroke comprises, in approximately equal parts, both...

Membrane-filtration based plasma exchanges for atypical hemolytic uremic syndrome: Audit of efficacy and safety.

While complement blockade with eculizumab is recommended as first-line therapy of atypical hemolytic uremic syndrome (aHUS), plasma exchanges (PEX) remain the chief option for anti-factor H (FH) antibody associated disease and when access to eculizumab is limited. We reviewed adverse events (AEs) and adverse outcomes (eGFR <30 mL/min/1.73 m2 or death), in all patients with aHUS managed with membrane-filtration based PEX at one tertiary care center over 5.5 years. During January 2013 to June 2018, 109 patients with aHUS (74 with antibodies to FH), aged median (range) 7.6 (0.5-18) year weighing 22.1 (6-90) kg, underwent 2024 sessions of PEX. AE, in 12.1% patients, were usually self-limiting and included chills (5.5%), vomiting/abdominal pain (3.3%), hypotension (1.6%), urticaria (1.5%), seizures (0.2%), hypocalcemia (0.2%), and hemorrhage (0.1%); plasma hypersensitivity and severe reactions were rare. Rate of catheter-related infections was 1.45/1000 catheter-days. Filter reuse (OR 1.69; 95% CI 1.26-2.26; P < .001) and >20 sessions of PEX/patient (OR 1.99; 95% CI 1.27-3.10; P = .002) were independently associated with adverse events; infusion of IV calcium gluconate during PEX was protective (OR 0.26; 95% CI 0.16-0.43; P < .001). Hematological remission was achieved in 96.3% patients after 6 (5-8) PEX sessions; 80.8% and 89.6% patients were dialysis independent by one and 3 months, respectively. PEX is safe and associated with satisfactory short-term outcomes in children with aHUS. Prolonged PEX and filter-reuse are associated with complications.

A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control.

The diagnosis of type 1 diabetes (T1D) brings significant medical, psychosocial, and educational challenges for the child, family, and medical team. We developed a structured certified diabetes educator (CDE) led program spanning the year after diagnosis with the goal of supporting families as their understanding of this chronic disease and its management evolves. The aim of this study was to determine the effect of this program upon hemoglobin A1c (HbA1c), and how this effect is mitigated by socioeconomic status (SES). Patients enrolled in the type 1 year 1 (T1Y1) program were assigned a CDE who provided intensive coaching, tailored to family lifestyle, and readiness to assume independence. We identified all patients diagnosed with T1D in the 2 years before (controls) and after (T1Y1 group) the start of the T1Y1 program on January 7, 2014. There were 675 patients diagnosed with T1D between July 2012 and June 2016 (284 controls, 391 T1Y1). HbA1c was significantly lower in the T1Y1 group at 6 (6.7% vs. 7.1%, P < 0.001), 12 (7.3% vs. 7.8%, P < 0.001) and 18 (7.6% vs. 7.9%, P = 0.01) months, but not 24 (7.8% vs. 8%, P = 0.14) months after diagnosis. This effect was not observed in patients with lower SES. Additional structured education and support in the year after diagnosis can improve short-term outcomes in children with T1D, but this effect may not persist after discontinuing intensive coaching. Families of lower SES did not benefit from this approach.

Ten-Year Experience in the Prevention of Post-Kasai Cholangitis.

Cholangitis is the most common complication after the Kasai procedure. It can be life-threatening and may affect long- and short-term outcomes of children with biliary atresia. We summarize our experiences in the prevention of early-onset cholangitis. From January 2002 to March 2013, children with biliary atresia (BA) who underwent the Kasai procedure in the General Surgical Department were included in a retrospective cohort study. These patients were divided into group A (therapy 1) and group B (therapy 2) depending on the infection prevention protocol and occurrences of cholangitis within the six months after surgery were recorded. Two hundred eighteen children were included in this cohort study. Seventy-six children (35 females and 41 males) were included in group A. One hundred forty-two children (65 females and 77 males) were included in group B. Therapy 1 was our primary protocol and included a third-generation cephalosporin, metronidazole, and human immunoglobulin. Therapy 2 was a modification of therapy 1 that involved imipenem-cilastatin and human immunoglobulin. Statistical analyses were performed. A p value below 0.05 was regarded as significant. In group A, 45 children developed cholangitis within the six months after the Kasai procedure. In group B, 14 of these children experienced post-operative cholangitis. A χ2 analysis was used to examine the difference in the incidence of cholangitis between groups A and B. There was a substantial difference in the morbidity of post-operative cholangitis between groups A and B (59.2% vs. 9.9%, p = 0.000). Cholangitis in the early period after a Kasai procedure can be prevented effectively with an advanced prophylactic protocol.

How Different is AMAN from AIDP in Childhood GBS? A Prospective Study from North India.

To compare the clinical profile and short-term outcome of children with axonal and demyelinating subtypes of childhood Guillain Barré syndrome (GBS). This is a prospective observational study conducted in a tertiary care teaching hospital in North India. Consecutive children with Guillain Barré syndrome were recruited to compare the clinical profile and short term outcome among the subtypes. Among 9847 children admitted to the emergency, 95 had acute flaccid paralysis; 57 of whom had GBS. Electrophysiological studies were completed in 57; of whom 20 had acute inflammatory demyelinating polyneuropathy (AIDP); 19 had acute motor axonal neuropathy (AMAN); 12 had non-reactive nerves; five were unclassifiable; 1 had acute motor sensory axonal neuropathy (AMSAN). More children in AMAN group had preceding gastroenteritis (4 vs. 2), while AIDP group had upper respiratory infections (12 vs. 7). Ataxia was only seen in AIDP subtype while wrist drop, foot drop and hyperreflexia were seen only with AMAN subtype. Respiratory muscle involvement (6 vs. 3) and artificial ventilation (5 vs. 2) was more in AMAN. At discharge, children with AIDP were less likely to be non-ambulant (12 vs. 6, p = 0.036). Mean disability scores at hospital discharge (4.9 ± 1.2 vs. 4 ± 0.9, p = 0.015) and at last follow-up (0.7 ± 1.01 vs. 0.05 ± 0.2, p = 0.016) were higher in AMAN. Children with AIDP were more likely to achieve normalcy on follow-up (19 vs. 12, p = 0.023). Children with AMAN appear to have a more severe clinical course; higher short-term morbidity; and slower recovery than those with AIDP.

Guillain-Barre syndrome in North Indian children: Clinical and serial electrophysiological features.

Guillain-Barre syndrome (GBS) is a common acquired polyneuropathy in children. To describe the clinical and serial electrophysiological features along with short-term outcomes of children with GBS in north India. This was a prospective study conducted at a tertiary care pediatric hospital in north India. Consecutive children, aged 2 to 18 years, with GBS, presenting within 4-weeks of onset of weakness, diagnosed on clinical and/or electrophysiological grounds, were enrolled. The enrolled children underwent a detailed clinical-assessment followed by nerve conduction studies. Repeat nerve conduction studies were performed after 2-weeks of the first study to determine changes in the electrophysiological subtype. The patients were followed up for 3 months. Thirty-six children were studied. The mean age at presentation was 5.1 years [standard deviation (SD): 2.1]. The mean medical research council (MRC)-sum-score at admission was 24.1 (SD: 10.4). Thirty-three children (91%) had loss of ambulation, 24 (66%) had cranial nerve involvement, and 6 (16.6%) required ventilation. At presentation, 20 had acute motor axonal neuropathy (AMAN), 13 had acute inflammatory demyelinating polyneuropathy (AIDP), 2 had in-excitable nerves, and 1 had normal findings. Four children, initially diagnosed as AIDP, had AMAN with reversible conduction failure on the repeat study. The final classification was AMAN in 25 (69.4%; 95% confidence interval (CI), 51.9-83.7%) and AIDP in 9 children (25%; 95% CI, 12.1-42.2%). Only one patient was nonambulatory at a 3-month follow-up (n = 32). The Erasmus GBS outcome score was 2 in 2 (5.6%), 3 in 5 (13.9%), 4 in 26 (72.2%), and 5 in 3 (8.3%) patients. The serial electrophysiological studies were helpful in establishing the final correct diagnosis.

Analysis of Presentations and Outcomes of Care of Children with Disorders of Sexual Development in a Nigerian Hospital.

To describe the presentation, diagnosis, management, and short-term outcome of children with disorders of sexual development (DSD) in the context of multidisciplinary team care. Prospective descriptive study. University Teaching Hospital. All children who presented with genital ambiguity. Records of all patients diagnosed and managed for DSD between January 2011 and December 2016 were reviewed. The care pathway included clinical, laboratory, internal genitalia evaluation, and panel (including parents) meeting. Fifteen children presented with DSD at a median age of 20months. Only 5/15 (33.3%) presented in the neonatal period. Ten of fifteen patients (66.7%) presented with genital ambiguity. Ovotesticular DSD was the most common diagnosis (9/15; 60%). Seven of the patients were genetically female (46, XX), 1 was genetically male (46, XY) and 1 without genetic diagnosis. Six patients were assigned male gender and they underwent male genitoplasty. Five of them had excision of Müllerian structures with gonadectomy. Three of fifteen patients (20%) were diagnosed as 46, XX DSD, at a median age of 7years. All of them were due to congenital adrenal hyperplasia and underwent female genitoplasty. Two patients were diagnosed as XY, DSD. They were both raised as female at presentation and were reassigned male sex. Both had urethroplasty done. Four patients had postoperative urethrocutaneous fistula and 1 had partial wound dehiscence. The median follow-up period was 21months (interquartile range, 2-26months). The frequency of ovotesticular DSD is high in our setting. The decision of sex assignment was finally made at a median age of 7.5months in most of our patients with satisfactory short-term surgical outcome.

Childhood-Onset Systemic Lupus Erythematosus: A Cohort Study.

To determine the clinical and immunological characteristics and short-term outcome of children with systemic lupus erythematosus (SLE). A descriptive cohort study. Paediatric Rheumatology Clinic, The Aga Khan University Hospital, Karachi, from January 2011 to December 2015. Clinical and immunological profile and short-term outcome of children less than 16 years of age admitted in the paediatric ward, with the diagnosis of SLE was studied. Demographic data, clinical presentation, laboratory findings, immunological profile and treatment regimens of these children were evaluated. Thirty-two children, satisfying the criteria of American College of Rheumatology (ACR) for SLE, were enrolled during the study period of five consecutive years. A female predominance was observed with 28 (87.5%) patients being female (F:M 7:1). Mean age at symptom onset was 10.5 +2.7 years; and 8.8 +2.1 years in females and males, respectively. The mean age at diagnosis was 11.3 +2.8 years in females and 9.4 +1.9 years in males. Prolonged fever was the most common non-specific symptom found in 27 (84%), followed by pallor in 13 (41%) patients. Twenty-two (69%) children were found to be anemic and 18 patients (56%) having signs of arthritis at presentation. Renal involvement was observed in 15 (47%) patients. The most common laboratory finding was anemia, found in 22 (69%) of cases. The most common immunological markers were serum anti-neutrophil antibodies (ANA), positive in 28 (88%) patients, followed by anti double-stranded DNA antibodies, raised in 26 (81%) of cases. Out of 32, 12 patients were lost to follow-up. Of the remaining 20 children who were followed for four years, ten (50%) went into remission. Childhood-onset SLE encompasses a wide variety of manifestations with a female preponderance. Fever, arthralgia and pallor are the most frequent clinical manifestations among the children. Hemolytic anemia (HA) is the most common laboratory abnormality, with ANA and anti ds-DNA antibodies positivity in the majority of padiatric patients.

Short-Term Outcome in Children and Adolescents with Orthostatic Intolerance and Postural Tachycardia Syndrome (P2.131)

Short-Term Outcome in Children and Adolescents with Orthostatic Intolerance and Postural Tachycardia Syndrome (P2.131)

Clinical Profile and Short-Term Outcome of Pediatric Hyperleukocytic Acute Leukemia from a Developing Country.

This study was conducted to determine the frequency, clinical profile, and short-term outcome of children with hyperleukocytosis at two pediatric oncology centers in Karachi. Of a total 1,045 patients, 13.97% (n=146) patients had hyperleukocytosis. Majority (61.7%, n=90) were under 10 years of age and 76% (n=146) were male. The symptom duration before diagnosis was more than 30 days in 49.3% (n=72). The median WBC count was 181 x109/L(IQR=130.45298.3) and extreme hyperleukocytosis (>200 x109/L) was observed in 44.5% (n=65) patients. Majority (94.5%, n=138) of patients were diagnosed with acute lymphoblastic leukemia. One or more complications developed in 78% (n=114) of cases. Clinical and laboratory tumor lysis syndrome (TLS) was observed in 17.1% (n=25) and 39% (n=57) patients, respectively. Pulmonary and neurological complications related to leukostasis were noted in 9.5% (n=14) and 27.3% (n=40) of cases, respectively. Infectious complications occurred in 23.2% (n=34) patients. The case-specific mortality was 20.5% (n=30). No mortality was related to early complications of hyperleukocytosis.

Short-term outcomes in children undergoing restorative proctocolectomy with ileal-pouch anal anastomosis

IntroductionPatients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC) commonly undergo restorative proctocolectomy with ileal-pouch anal anastomosis (RP-IPAA). We sought to describe patient characteristics and postoperative outcomes in this patient population. MethodsUsing the National Surgical Quality Improvement Program-Pediatric Participant Use Files from 2012 to 2015, children who were 6–18years old who underwent RP-IPAA for FAP or UC were identified. Postoperative morbidity, including reoperation and readmission were quantified. Associations between preoperative characteristics and postoperative outcomes were analyzed. ResultsA total of 260 children met the inclusion criteria, of which 56.2% had UC. Most cases were performed laparoscopically (58.1%), and the operative time was longer with a laparoscopic versus open approach (326 [257–408] versus 281 [216–391] minutes, p=0.02). The overall morbidity was 11.5%, and there were high reoperation and readmission rates (12.7% and 21.5%, respectively). On bivariate analysis, preoperative steroid use was associated with reoperation (22.5% versus 10.9%, p=0.04). On multivariable regression analysis, obesity was independently associated with reoperation (odds ratio: 3.34 [95% confidence intervals: 1.08–10.38], p=0.04). ConclusionsChildren who undergo RP-IPAA have high rates of overall morbidity, reoperation, and readmission. Obesity was independently associated with reoperation. This data can be used by practitioners in the preoperative setting to better counsel families and establish expectations for the postoperative setting. Type of StudyRetrospective Comparative Study. Level of EvidenceLevel III.

Dengue infection in children with thalassemia - is it different?

Background: Children with thalassemia are at equal risk of getting dengue. Atypical manifestations of dengue in children with thalassemia are highlighted in studies from South Asia. Burden of suboptimal transfusion and chelation in children with thalassemia prompted us to undertake this study Objectives: To study the clinical course and short term outcome of children with thalassemia affected by dengue, and compare them to dengue infection in children without chronic illness. Methods: Retrospective case note review of children with thalassemia, admitted with dengue from April 2013 to April 2018. Comparison group included children without chronic disease admitted with dengue from November 2012 to April 2014. Severity, complications, hematological/ biochemical parameters, treatment given were analysed. Management was according to ‘WHO 2009 Guideline on Dengue’ Results: 15 children with Thalassemia (n=207) had confirmed dengue (NSI positive/ Dengue IgM positive), M: F=1:1.1, median age 6 years (interquartile range IQR 3-11). Median duration of hospital stay 6 (IQR 4-6) days. WHO Group A, B and C had 5, 6 and 4 patients respectively. Clinical features included fever in 15 (100%), persistent vomiting in 9 (60%), abdominal pain in 4 (26.7%) and excessive fluid accumulation in 2 (13.3%). 12 (80%) had anemia at presentation, median Hb 83 (IQR 70-101) g/l, while 2 (13.3%) had hematocrit >36%. 14 (93%) patients had platelets </= 150,000/ cu.mm, 9 (60%) with severe thrombocytopenia (</= 50,000/cu.mm). TC </= 4000/cu.mm present in 7 (46.7%) patients. AST/ ALT elevated in 14 (93.3%) patients. 4 (26.7%) patients required intensive care. 10 (66.7%) children required red cell transfusion. There were no deaths.Comparing with other group, there was significant difference in number of patients with anemia (p=0.0001, 95% CI 5.6 to 3.8) and hemo-concentration (P=0.0001, (95% CI -15.3 to -9.7). Conclusion: Children with thalassemia and dengue infection present with anemia requiring red cell transfusion, hence HCT may not be a useful monitoring tool. In comparison to national statistics (INCLEN Study Group data 2014), the proportion of patients in Group B (40 vs 9.5%) and group C (26 vs 5.9%) appears to be higher in children with thalassemia. Such patients require in-patient care as they may be at greater risk of developing severe disease

The Influence of Mode of Delivery on the Neurodevelopment of Children and Adolescents

Background: Cesarean section is one of the most frequently performed surgical procedures in the world and its rates have been increasing worldwide over the past decades. Despite being a lifesaving procedure in emergent situations, it can be associated with a range of adverse maternal and childhood health outcomes. To date, there is a lack of consistent studies regarding the association between mode of delivery and a child’s neurodevelopment. Objective: The aim of this review is to highlight the possibility of neurocognitive outcomes during childhood and adolescence being affected by the child’s mode of delivery.Method: Literature review based on studies published between 2005 and 2018, available on PubMed. Results: Regarding uncomplicated pregnancies and deliveries most studies found no difference in neurodevelopment according to mode of delivery, apart from nonplanned cesarean, which usually correlates to worse outcomes. In breech presentation, shortterm outcomes of children born vaginally were poorer while long-term neurological outcomes were contradictory. Preterm infants were more commonly associated with adverse neurological outcomes and these varied according to the age at which children were assessed. Considering drug administration during delivery, the long-term neurological effects of children exposed to exogenous oxytocin are not known and transitory neonatal exposure to anaesthetic drugs during delivery probably won’t harmfully influence longterm neurodevelopment. Conclusions: Neurodevelopment is influenced by a vast number of genetic and environmental variables, becoming impracticable to account for all factors that may affect neurocognitive outcomes. Therefore, future investigation is necessary to enlighten if neurodevelopment is in fact associated with mode of delivery or if underlying causes are the real influencers. Thus, when considering mode of delivery, every obstetrical case should be individually analysed, maternal and neonatal risks and benefits should be balanced and common beliefs demystified to help mothers make an informed decision and promote their children’s healthy development.

Short-Term Outcomes in Children Undergoing Restorative Proctocolectomy with Ileal Pouch-Anal Anastomosis

Dukleska, Katerina MD; Teeple, Erin A. MD; Aka, Allison A. MD; Vinocur, Charles D. MD; Berman, Loren MD Author Information

Classic Swenson abdomino perineal pull through in the treatment of Hirschsprung’s Disease – 3 years experience in a tertiary care Paediatric Hospital in Bangladesh

Background : Hirschsprung disease (HD)is a common cause of intestinal obstruction. Definitive treatment is to excise aganglionic segment and anastomosis with anal remnant.Objective : The aim of the study was to analyze the short term outcome of children who have undergone the Classic swenson abdominoperineal pull through operation in the treatment of Hirschsprung’s disease.Methods : This Prospective study had been carried out in the department of paediatric surgery, Dhaka shishu (Children) Hospital during the period of January 2013 to January 2016. Total 50 patients with Hirschsprung’s disease with or without colostomy except total colonic aganglionosis were included in this study.We also excluded those patients with major co-morbidities and patients who did not agree to close stoma within 12 weeks of pull through. Consideration was given to postoperative complications(Cuff /anastomotic/pelvic abscess, wound infection, anastomotic leakage,fecal incontinence, urinary incontinence, mortatality), operation time and post operative hospital stay and as well as the short term outcome.Result : Among the study population 36 (72%) were male and 10(28 %) were female with a male female ratio of 2.5:1. Mean age at presentation was 17.96±12.05 months.Thirty eightpatients had diverting colostomy and underwent staged procedure.On the other hand 12 patients had no colostomy and underwent single stage procedure.Four patientsdeveloped anastomoticabcess, 3patients developed urinary incontinence,4 fecal incontinence and 2 patients developed post operative intestinal obstruction.The mean Operation time was114.14±13.02 minutes and mean hospital staywas 6.18±1.83 days.Thirty seven patients were discharged without any complications.Conclusion : The Classic Swenson’s procedure is an effective procedure in the treatment of HD .Northern International Medical College Journal Vol.8(1) July 2016: 185-188

Impact of gestational age at PPROM on the short-term outcome of children born after extreme and prolonged preterm prelabor rupture of membranes in an experienced care center

Introduction. Survival of infants born af-ter extreme PPROM (preterm prelabor rupture of membranes) has increased dra-matically in the past 20 years, up to 90% in some tertiary neonatal centres, due to the progress in neonatal cardiorespiratory management.Known risk factors of poor outcomes are lower gestational age at PPROM and pro-longed and severe oligohydramnios. Methods. We performed a retrospective study over a 6-year-period (2009-2015), including 14 pregnant women who expe-rienced PPROM, before 25 weeks of gesta-tion, with prolonged (>14 days) and severe oligohydramnios (amniotic fluid index 20 weeks (p < 0.01). In all infants requiring iNO, the oxygenation index improved dramatically and rap-idly with treatment. We found no difference in the rate of bron-chopulmonary dysplasia, necrotizing en-terocolitis, retinopathy of prematurity or intraventricular hemorrhage. Conclusion. PPROM before 20 weeks of gestation exposes the neonate to a high risk of refractory hypoxemia compared to PPROM after 20 weeks. The initial care management requires more aggressive treatment with administration of iNO in all of them. After the initial period, the evolution of all babies born after PPROM is comparable to that of their controls.

Children with Moderate Acute Malnutrition with No Access to Supplementary Feeding Programmes Experience High Rates of Deterioration and No Improvement: Results from a Prospective Cohort Study in Rural Ethiopia.

BackgroundChildren with moderate acute malnutrition (MAM) have an increased risk of mortality, infections and impaired physical and cognitive development compared to well-nourished children. In parts of Ethiopia not considered chronically food insecure there are no supplementary feeding programmes (SFPs) for treating MAM. The short-term outcomes of children who have MAM in such areas are not currently described, and there remains an urgent need for evidence-based policy recommendations.MethodsWe defined MAM as mid-upper arm circumference (MUAC) of ≥11.0cm and <12.5cm with no bilateral pitting oedema to include Ethiopian government and World Health Organisation cut-offs. We prospectively surveyed 884 children aged 6–59 months living with MAM in a rural area of Ethiopia not eligible for a supplementary feeding programme. Weekly home visits were made for seven months (28 weeks), covering the end of peak malnutrition through to the post-harvest period (the most food secure window), collecting anthropometric, socio-demographic and food security data.ResultsBy the end of the study follow up, 32.5% (287/884) remained with MAM, 9.3% (82/884) experienced at least one episode of SAM (MUAC <11cm and/or bilateral pitting oedema), and 0.9% (8/884) died. Only 54.2% of the children recovered with no episode of SAM by the end of the study. Of those who developed SAM half still had MAM at the end of the follow up period. The median (interquartile range) time to recovery was 9 (4–15) weeks. Children with the lowest MUAC at enrolment had a significantly higher risk of remaining with MAM and a lower chance of recovering.ConclusionsChildren with MAM during the post-harvest season in an area not eligible for SFP experience an extremely high incidence of SAM and a low recovery rate. Not having a targeted nutrition-specific intervention to address MAM in this context places children with MAM at excessive risk of adverse outcomes. Further preventive and curative approaches should urgently be considered.

Short-Term Outcome in Children and Adolescents with Orthostatic Intolerance (OI) and Postural Tachycardia Syndrome (POTS)

Short-Term Outcome in Children and Adolescents with Orthostatic Intolerance (OI) and Postural Tachycardia Syndrome (POTS)

Social context of preterm delivery in France in 2011 and impact on short-term health outcomes: the EPIPAGE 2 cohort study.

Low socio-economic context increases the risk of preterm delivery and may affect short-term outcomes in children born preterm. We described the social context of preterm delivery in France in 2011 and compared it with the general population of deliveries over the same period. We also studied how social context influenced pregnancy and delivery characteristics in the preterm population, and how it affected mortality and short-term morbidity in liveborn preterm children (<35 weeks). We created an individual socio-economic vulnerability index, derived from multiple correspondence analysis based on maternal social information in the French National Perinatal Survey (NPS-2010). Weighted coordinates were applied to families from the EPIPAGE 2 study, a population-based cohort of preterm infants born in 2011, to quantify the infant's exposure to socio-economic vulnerability. Multivariable logistic models were used to relate the socio-economic context to pregnancy and delivery characteristics, and to assess its impact on short-term outcomes of the infants. Among mothers of preterm infants, gestational age decreased as socio-economic conditions worsened. In the most deprived group, women had more irregular pregnancy care, a higher prevalence of infection during pregnancy, and a lower rate of antenatal corticosteroid administration. The most deprived group was associated with a higher risk of severe morbidity for the preterm neonates. Our results emphasise the need for a large population-based surveillance system to identify the most deprived mothers, and to propose appropriate follow-up and care to these women and their infants in order to enhance long-term health.

Impact of Comorbidity on Three Month Follow-up Outcome of Children with ADHD in a Child Guidance Clinic: Preliminary Report

Context:Attention deficit hyperactivity disorder (ADHD) is one of the common neurodevelopmental disorders.Aims:Study objective is to report impact of comorbidities on short-term outcome in children with ADHD followed in a child guidance clinic.Settings and Design:This was done in a child guidance clinic run jointly by the pediatric and psychiatry department at a tertiary teaching hospital. This is a 3 month prospective follow-up study to assess the outcome in ADHD children.Materials and Methods:Children attending pediatric department with behavioral problems or poor scholastic performance were screened for ADHD and further confirmation of diagnosis was done by semistructured interview of the child and parent. Children functional assessment and ADHD symptom profile was compared at baseline and at follow-up. We screened for and excluded those showing autistic spectrum disorder and having worse than mild mental retardation. Baseline variables were compared between improved and not improved subgroups and impact of these variables on outcome at 3-month follow-up was analyzed.Statistical Analysis:Descriptive statistics.Results:Of the 25 children completing the study, at the end of 3 months, 15 improved (not fulfilling criteria for ADHD) and 10 did not improve. Applying Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) for diagnosis of psychiatric comorbidities, six had associated psychiatric comorbidities. This was significantly higher in those who did not improve.Conclusions:Presence of comorbidities at baseline was found to affect outcome at 3 month assessment in this preliminary study. Future studies with larger sample and longer follow-up are needed for finding the predictors of outcome in ADHD children in developing nations.