Factor Affecting Duration of Exclusive Breast Feeding in Preterm Infants With Gestational Age ? 34 Weeks

Objectives: To study the factors influencing the duration of exclusive breastfeeding (EBF) in preterm (?34 weeks) infants. Methods: This study was done in 113 preterm infants with gestational age ?34 weeks who were attending the well-baby clinic at the corrected age (CA) of 6 month. The birth details were noted from hospital records and feeding details were collected through a personal interview. Results: The mean (SD) duration of EBF was 3.61 (2.3) months, and 35.3% babies had received EBF till CA of 6 month. Operative delivery [aOR (95% CI): 3.8 (1.0, 13.4) P=0.037], delay in initiating tube feeding, [aOR; 1.5 (1.0, 2.1); P=0.017], and delay in establishment of oral feeds [aOR1 (1.0, 1.08) P=0.016] were associated with a shorter duration of EBF. Conclusion: The prevalence of EBF till 6 months CA in preterm ?34 weeks was 35.3%. Earlier initiation and establishment of full oral feeds may help in improving the duration of EBF

Indian Academy of Pediatrics Guidelines on Screen Time and Digital Wellness in Infants, Children and Adolescents

Justification: Screen-based media have become an important part of human lifestyle. In view of their easy availability and increasing use in Indian children, and their excessive use being linked to physical, developmental and emotional problems, there is a need to develop guidelines related to ensure digital wellness and regulate screen time in infants, children, and adolescents. Objectives: To review the evidence related to effects of screen-based media and excessive screen time on children’s health; and to formulate recommendations for limiting screen time and ensuring digital wellness in Indian infants, children and adolescents. Process: An Expert Committee constituted by the Indian Academy of Pediatrics (IAP), consisting of various stakeholders in private and public sector, reviewed the literature and existing guidelines. A detailed review document was circulated to the members, and the National consultative meet was held online on 26th March 2021 for a day-long deliberation on framing the guidelines. The consensus review and recommendations formulated by the Group were circulated to the participants and the guidelines were finalized. Conclusions: Very early exposure to screen-based media and excessive screen time (>1-2h/d) seems to be widely prevalent in Indian children. The Group recommends that children below 2 years age should not be exposed to any type of screen, whereas exposure should be limited to a maximum of one hour of supervised screen time per day for children 24-59 months age, and less than two hours per day for children 5-10 years age. Screen time must not replace other activities such as outdoor physical activities, sleep, family and peer interaction, studies, and skill development, which are necessary for overall health and development of the children and adolescents. Families should ensure a warm, nurturing, supportive, fun filled and secure environment at home, and monitor their children’s screen use to ensure that the content being watched is educational, ageappropriate and non-violent. Families, schools and pediatricians should be educated regarding the importance of recording screen exposure and digital wellness as a part of routine child health assessment, and detect any signs of cyberbullying or media addiction; and tackle it timely with expert consultation if needed.

Association of other congenital anomalies in children with cleft lip and palate: a prospective hospital based observational study

Background: Cleft lip and palate is a common congenital anomaly affecting approximately 1 in 700 live births in south Asia. It is often associated with syndromes and other malformations but the exact incidence of these in Asians is not known. The present study was carried out to determine the association of other congenital anomalies in children with cleft.Methods: The study was carried out in the patients attending the Cleft centre of our Hospital. They were examined for other major external congenital malformations and syndrome association.' Where ever relevant, appropriate investigations were done.Results: Of the total of 2367 children examined, 262 (11.06%) had congenital malformations.' Among the non-syndromic children, 9% had associated malformations.' The commonest was congenital heart disease (1.4%) following by genitourinary and skeletal anomalies.' The highest number of anomalies was seen in patients with cleft palate alone (24.89%). 1.4% patients had identifiable syndromes.Conclusions: The study emphasizes the need for a thorough examination of all children with cleft.' The overall lower incidence of syndromic clefts and associated anomalies in present study suggests that other etiological factors may be involved in our country.

Vitamin D Deficiency as a Factor Influencing Asthma Control in Children

Objective: To study the association between asthma control and serum 25OH Vitamin Dlevels in children with moderate persistent asthma on preventer therapy. Methods:Children aged 6-18 years, with moderate persistent asthma, on preventer therapy for ?2months were included. Control was categorized as good, partial or poor as per GINAguidelines. Serum 25 (OH) Vitamin D levels were measured and their relationship with thelevel of control was studied. Results: Out of 50 children enrolled, 22 had well-controlledasthma, and 21 had partially controlled asthma. Vitamin D was deficient in 30 children andinsufficient in 18 children. Children with vitamin D deficiency had significantly less well-controlled asthma as compared to those with insufficient or sufficient levels of 25 (OH)vitamin D (13.3% vs 88.9 % vs 100%). Conclusion: Vitamin D deficiency is associated withsuboptimal asthma control.

Fatty acid oxidation disorder as a cause of sudden infant death syndrome (SIDS)--a case report.

Although the cause of sudden infant death syndrome (SIDS) remains unknown, extensive studies over the last 10 years have begun to shed some light on this family tragedy. 5% of all cases of SIDS are caused by fatty acid oxidation disorders. We report a case of fatty acid oxidation disorder causing SIDS.

Congenital tuberculosis.

A 29 day old male infant presented with a history of fever, cough, increasing respiratory distress and abdominal distension from the 10th day of life. Examination revealed failure to thrive, marked tachypnea, pallor, hepatosplenomegaly and harsh vesicular breath sounds. Chest skiagram showed extensive broncho-pneumonic changes. As the infant did not respond to antibiotics, he was investigated for tuberculosis. The gastric aspirate smear showed plenty of acid fast bacilli (AFB) and culture showed M. tuberculosis growth. Endometrial biopsy of the mother showed tuberculous granuloma and acid fast bacilli and culture of the aspirate from endometrium grew M. tuberculosis. The need for endometrial biopsy of mothers of infants with congenital tuberculosis is highlighted.