Diagnostic Accuracy of the Government of India Mother and Child Protection Card for Developmental Screening of Indian Children Aged 2-36 Months: A Hospital-based Mixed Method Study

Background: Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives: To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design: Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants: Mother-child dyads of children between 2-36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6th standard education were excluded. Intervention: Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neurodevelopment; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes: The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results: The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3-93.2) and 90.6% (95% CI 85.2-94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7-9 months, 13-18 months, and 25-36 months. Conclusions: The MCP card may be used for developmental screening at 9, 18, and 36 months.

Clinical Profile of COVID-19 Illness in Children—Experience from a Tertiary Care Hospital

Objective To detail clinical profle and outcome in children infected with SARS-CoV-2. Methods This retrospective study was undertaken at a tertiary care pediatric teaching hospital in Northern India. The data on clinical characteristics and outcome of children (<18 y) with COVID-19 illness from April 2020–October 2020 were reviewed and analyzed. Results A total of 2919 children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) illness were tested for novel COVID-19 virus in the fu emergency (n=1744), severe acute respiratory infection (SARI) ward (n=825), and non-COVID area (n=350) of the hospital. 8.73% (255/2919) children tested positive for SARS-CoV-2 infection. Of the 255 positive cases, 144 (56.47%) were managed on an outpatient basis and 100 (59 boys) required admission in COVID ward. The mortality rate of patients with SARS-CoV-2 was 11.4% (29/255). Majority of children admitted with COVID-19 had severe to critical illness due to the presence of malnutrition and underlying comorbidities. Conclusions Children of all age groups were susceptible to COVID-19 illness with a slight male preponderance. Amongst infected, two-third were asymptomatic or had mild symptoms that required outpatient management and home isolation. The adverse outcomes were more commonly seen in infants and children>10 y of age with malnutrition and comorbid illness.

Providing Expressed Breast Milk to Preterm Neonates Admitted in an Extramural Neonatal Intensive Care Unit: Where do we stand?

Provision of expressed breast milk (EBM) to premature neonatesposes a great challenge in extramural Neonatal Intensive CareUnits (NICUs). We conducted a questionnaire-based survey toidentify the various challenges faced by the parents to provideEBM to their hospitalized premature infant. 40 preterm neonates(<34 wk gestation and <1500 g weight) planned to be started onEBM were included in the study. The median (range) durationafter which EBM was received in NICU after the time it was askedfor was 34.5 (13 to 40) hours, and it was received in a clean, sterileand covered container in only 8 (20%) cases. There were multiplehurdles in ensuring early availability of EBM in optimal condition.Sensitization and motivation of families regarding the importanceof ensuring early administration of EBM to their prematurelydelivered neonate may lead to substantial improvement inoutcome of these neonates.