Iron Profile in Term Small for Gestational Age Infants at 10 Weeks of Age and Correlation With Maternal Iron Profile : A Prospective Cohort Study

Background: Term small for gestational age (SGA) babies are at risk for developing iron deficiency anemia. The association between maternal and infant iron stores is not clear. Objective: To assess proportion of term SGA neonates developing iron deficiency anemia by 10 weeks of age, and measure correlation between iron profile and hepcidin of babies at birth and at 10 weeks of age with maternal iron profile. Design: Prospective cohort study conducted from November, 2018 to April, 2020. Participants: 120 term SGA babies and their mothers. Intervention: Hemogram, iron profile and serum hepcidin (every fourth case) estimated in mother, cord blood and baby at 10 weeks. Babies developing anemia at 6 weeks detected by hemogram and ferritin were started on iron supplementation and excluded from the study. Outcome: Proportion of babies developing iron deficiency anemia at 10 weeks of age. Results: 35 (29.2%) of 120 term SGA babies developed anemia (hemoglobin <9 g/dL) at 6 weeks. Proportion of infants who developed iron deficiency anemia (hemoglobin <9 g/dL and serum ferritin <40 µ/dL) at 6 and 10 weeks of age was 14.2% and 23.3%, respectively. No significant correlation was found bet-ween hemoglobin, iron and hepcidin of the baby in cord blood and at 10 weeks of age with that of mothers. Serum hepcidin in babies at birth (137.5 ng/mL) were higher than maternal values (128 ng/mL). Conclusion: A significant proportion of term SGA infants developed anemia during early infancy, irrespective of maternal iron status.

Management of Infants with Congenital Adrenal Hyperplasia

Treatment of congenital adrenal hyperplasia (CAH) requires lifelong replacement of glucocorticoids with regular follow up to manageassociated morbidities. The current review focuses on follow-up and management of infants diagnosed with classical CAH pertinent toIndian context. Early initiation of oral hydrocortisone in divided doses is recommended after diagnosis in newborn period, infancy andchildhood. Fludrocortisone is recommended for all infants with classical CAH. All infants should be monitored as per protocol fordisease and treatment related complications. The role of prenatal steroids to pregnant women with previous history of CAH affectedinfant for prevention of virilization of female fetus is controversial.

Newborn Screening and Diagnosis of Infants with Congenital Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH) is an autosomal recessive endocrine disorder which can manifest after birth with ambiguousgenitalia and salt-wasting crisis. However, genital ambiguity is not seen in male babies and may be mild in female babies, leading to amissed diagnosis of classical CAH at birth. In this review, we provide a standard operating protocol for routine newborn screening forCAH in Indian settings. A standardization of first tier screening tests with a single consistent set of cut-off values stratified by gestationalage is also suggested. The protocol also recommends a two-tier protocol of initial immunoassay/time resolved fluoroimmunoassayfollowed by liquid chromatography tandem mass spectrometry for confirmation of screen positive babies, wherever feasible. Routinemolecular and genetic testing is not essential for establishing the diagnosis in all screen positive babies, but has significant utility inprenatal diagnosis and genetic counseling for future pregnancy.

Effect of Gastric Lavage on Meconium?Aspiration Syndrome and Feed Intolerance in Vigorous? Infants Born with Meconium Stained Amniotic Fluid – A?Randomized Control Trial

Objective: To compare the incidence of meconium aspirationsyndrome and feed intolerance in infants born through meconiumstained amniotic fluid with or without gastric lavage performed atbirth.Setting: Neonatal unit of a teaching hospital in New Delhi, India.Design: Parallel group unmasked randomized controlled trial.Participants: 700 vigorous infants of gestational age ?34 weeksfrom through meconium stained amniotic fluid.Intervention: Gastric lavage in the labor room with normal salineat 10 mL per kg body weight (n=350) or no gastric lavage (n=350).Meconiumcrit was measured and expressed as ?30% and >30%.Outcome Measures: Meconium aspiration syndrome, feedintolerance and procedure-related complications during 72 h ofobservation.Results: 5 (1.4%) infants in lavage group and 8 (2.2%) in nolavage group developed meconium aspiration syndrome (RR0.63, 95% CI 0.21, 1.89). Feed intolerance was observed in 37(10.5%) and 53 infants (15.1%) in lavage and no lavage groups,respectively (RR 0.70, 95% CI 0.47, 1.03). None of the infants ineither group developed apnea, bradycardia or cyanosis during theprocedure.Conclusion: Gastric lavage performed in the labor room does notseem to reduce either meconium aspiration syndrome or feedintolerance in vigorous infants born through meconium stainedamniotic fluid.Keywords: Neonate, Prevention, Respiratory distress, Riskfactors, Vomiting.

Noise as a Health Hazard for Children: Time to Make a Noise about it.

Noise, a modern day curse of advancing infrastructure and technology, has emerged as an important public health problem. Exposure to noise during pregnancy may result in high-frequency hearing loss in newborns, growth retardation, cochlear damage, prematurity and birth defects. Newborns exposed to sound above 45 decibels may experience increase in blood pressure, heart rate, respiratory rate; decreased oxygen saturation; and increased caloric consumption. Noise exposure in older children may result in learning disabilities, attention difficulties, insulin resistance, hypertension, stress ulcers and cardiovascular diseases. Sudden exposure to loud noise can lead to rupture of eardrum. The damaging effects of noise pollution are more noticeable in large metropolitan cities, the hubs of urban settlements and industrial growth. Another concern is noise pollution inside the hospitals (particularly intensive care areas) that can lead to serious health consequences both for caregivers and for children. The issue needs to be addressed by both researchers and policy makers on an urgent basis.

The 2015 Academic College of Emergency Experts in India’s INDO-US Joint Working Group White Paper on Establishing an Academic Department and Training Pediatric Emergency Medicine Specialists in India.

PRASHANT MAHAJAN, PRERNA BATRA1, BINITA R SHAH2, ABHIJEET SAHA3, SAGAR GALWANKAR4, PRAVEEN AGGRAWAL5, AMEER HASSOUN2, BIPIN BATRA6, SANJEEV BHOI5, OM PRAKASH KALRA7 AND DHEERAJ SHAH1 From Department of Pediatrics and Emergency Medicine, Wayne State School of Medicine, Michigan, 2Department of Emergency Medicine, SUNY Downstate Medical Center, New York, 4University of Florida, Department of Emergency Medicine, Jacksonville, Florida, USA; Departments of 1Pediatrics and 7Medicine, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, 3Department of Pediatrics, Post Graduate Institute of Medical Education and Research and Ram Manohar Lohia Hospital, 5Department of Emergency Medicine, All India Institute of Medical Sciences, and 6National Board of Examinations, New Delhi, India. Correspondence to: Dr Prerna Batra, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi 110 095, India. drprernabatra@yahoo.com W H I T E P A P E R The concept of pediatric emergency medicine (PEM) is virtually nonexistent in India. Suboptimally organized prehospital services substantially hinder the evaluation, management, and subsequent transport of the acutely ill and/or injured child to an appropriate facility. Furthermore, the management of the ill child at the hospital level is often provided by overburdened providers who, by virtue of their training, lack experience in the skills required to effectively manage pediatric emergencies. Finally, the care of the traumatized child often requires the involvement of providers trained in different specialities, which further impedes timely access to appropriate care. The recent recognition of Doctor of Medicine (MD) in Emergency Medicine (EM) as an approved discipline of study as per the Indian Medical Council Act provides an unprecedented opportunity to introduce PEM as a formal academic program in India. PEM has to be developed as a 3- year superspeciality course (in PEM) after completion of MD/Diplomate of National Board (DNB) Pediatrics or MD/DNB in EM. The National Board of Examinations (NBE) that accredits and administers postgraduate and postdoctoral programs in India also needs to develop an academic program – DNB in PEM. The goals of such a program would be to impart theoretical knowledge, training in the appropriate skills and procedures, development of communication and counseling techniques, and research. In this paper, the Joint Working Group of the Academic College of Emergency Experts in India (JWG-ACEE-India) gives its recommendations for starting 3-year DM/DNB in PEM, including the curriculum, infrastructure, staffing, and training in India. This is an attempt to provide an uniform framework and a set of guiding principles to start PEM as a structured superspeciality to enhance emergency care for Indian children.

Assessment of Quality of Life during Treatment of Pediatric Oncology Patients.

Background: The objective of this study was to assess health-related quality of life (HRQOL) of pediatric cancer patients and their parents in North India. Materials and Methods: Seventy-fi ve cancer children were assessed for HRQOL, using Lansky play performance scale and health utility index-2 (HUI-2). Fifty-seven patients were followedup after 4 months after therapy and reassessed. Their parents were also assessed using World Health Organisation (WHO) QOL BREF. Seventy fi ve controls were also assessed and compared. Results: Lansky and HUI-2 scores of patients, as well as WHO QOL BREF of parents were signifi cantly poor in cancer patients when compared to controls. There was signifi cant improvement after therapy in patients with lymphomas and miscellaneous tumors. Pain and self-care were found to be maximally affected domains on HUI-2. Conclusions: Large prospective multicenter studies may be undertaken and hence that need based interventions can be planned.

Organic Foods for Children: Health or Hype.

Organic foods are promoted as superior and safer options for today’s health-conscious consumer. Manufacturers of organic food claim it to be pesticide-free and better in terms of micronutrients. Consumers have to pay heavily for these products – and they are willing to – provided they are assured of the claimed advantages. Scientific data proving the health benefits of organic foods, especially in children, are lacking. Indian Government has developed strict guidelines and certification procedures to keep a check on manufacturers in this financially attractive market. American Academy of Pediatrics, in its recently issued guidelines, did not recommend organic foods over conventional food for children. Indian Academy of Pediatrics has not opined on this issue till date. In this perspective, we present a critical review of production and marketing of organic foods, and scientific evidence pertaining to their merits and demerits, with special reference to pediatric population.

OEIS complex with major cardiac malformation: a case report.

OEIS Complex is a rare congenital multisystem defect that consists of omphalocele, exstrophy, imperforate anus and spinal defects. We report a case of such complex with additional major cardiac and other multisystem anomalies which are rarely described in literature. The authors give a review of literature on this infrequent complex along with a discussion on its pathogenesis, differential diagnosis and prenatal diagnosis.