Association between breastfeeding practices and anemia in children aged 6-60 months

Background: Anemia is one of the most common nutritional problems in India. Anemia is significantly influenced by dietary factors. Objective was to study the association between breast feeding practices and occurrence of moderate to severe anemia in children aged 6-60 months in relation to those without anemia, admitted to SAT Hospital.Methods: Case control study done at SAT Hospital. 85 moderates to severe anemic children and 85 non anemic children were enrolled in the study. Detailed history was taken including dietary history stressing infant and young child feeding practices. Physical examination was done including anthropometric measurements. Relevant haematological investigations were done.Results: Highest percentage of cases 76.4 % were from the age group 6 months to 24 months. Out of 85 cases 58.8% were with exclusive breastfeeding<6 months and among controls is 37.6%. Association of lack of exclusive breastfeeding for 6 months and anemia is statistically significant. Lack of timely introduction of complementary feeding, poor score for infant and young child feeding practices, male gender, lack of iron rich foods, small for gestational age babies were also significantly associated.Conclusions: Maximum number of anemic children were belonging to 6 months to 24 months, Lack of exclusive breastfeeding for 6 months was a major risk factor for developing anemia in children. Lack of timely introduction of complimentary feeding at 6 months and poor infant and young child feeding practices were significant risk factors for developing nutritional anemia.

Immune Reconstitution Inflammatory Syndrome in CNS Tuberculosis.

Background: Immune Reconstitution Inflammatory Syndrome (IRIS), an exaggerated inflammatory response with clinical worsening due to immune recovery during treatment, is rare in the immune-competent population. Case characteristics: A 5-½-year old immunecompetent girl with CNS tuberculosis without HIV who developed paradoxical IRIS. Outcome: Response to supportive care along with Anti-tuberculosis treatment. Message: IRIS can occur in tuberculosis, even in the immuno-competent.

Umbilical cord blood nutrients in low birth weight babies in relation to birth weight & gestational age.

BACKGROUND & OBJECTIVE: Low birth weight (LBW) babies are a vulnerable group and represent two outcomes--preterm birth (preterm LBW) and term with intrauterine growth retardation (term LBW). LBW babies are considered to have low nutrient reserve, but the extent of deficiency as compared to the normal babies and the differences between preterm LBW and term LBW are unclear. This study was carried out to look at key anthropometric, biochemical and clinical (ABC) parameters of LBW babies, both preterm and term, in comparison to a control group of term normal weight babies. METHODS: A group of 500 babies was selected at birth from a tertiary care teaching hospital and categorized into LBW (n = 251) with preterm LBW (n = 59), term LBW (n = 192) and term controls (n = 249). Two controls were dropped as tests could not be performed in the available cord blood sample. Key anthropometric and biochemical parameters were measured. Socio-economic status, age, parity, height and pre-delivery haemoglobin of the mothers were also recorded. RESULTS: The maternal characteristics were comparable in the three groups. Socio-economically, majority of them belonged to lower middle or upper lower class (Class III and IV) representing the non affluent. All the anthropometric measurements and nutrients measured namely total protein, albumin, cholesterol, triglycerides, calcium, magnesium, zinc and iron were significantly lower in LBW babies compared to term control babies. These values were lowest in preterm LBW followed by term LBW. Total iron binding capacity (TIBC) showed inverse association with iron. Some of the babies including control babies had protein, albumin, calcium and iron below the normal range and mean albumin, calcium and iron levels were below the normal range in all the three subsets. INTERPRETATION & CONCLUSION: Preterm and term LBW babies are born with significantly lower nutrient reserves at birth compared to term control babies. Normal weight babies from the non affluent sections also have low nutrients especially albumin, calcium and iron. As these levels are liable to be further lowered by recurrent infections and inappropriate feeding habits, nutritional surveillance, extra feeding and supplements like calcium and iron are recommended for such vulnerable babies to promote optimum growth and to prevent deficiencies. This is important as currently, there are no clear or uniform recommendations for extra feeding and nutrient supplements to LBW babies and no supplements other than exclusive breast feeding are recommended for term normal birth weight babies. Extra nutritional inputs for LBW and selected non affluent babies along with care of the prospective and prenatal mothers for ensuring adequate transfer of nutrients to the offspring seem necessary. Such interventions can be integrated with the existing health care programmes to reach all the beneficiaries.

Atypical relapsing course of Kawasaki disease with hemorrhagic serous effusions and hepatic dysfunction.

Kawasaki disease (KD) is a multisystem vasculitis of childhood with cardiac, renal, pulmonary and neurological complications. Hemorrhagic serous effusions, liver dysfunction and relapsing course in spite of treatment are rare. We report an atypical case of KD with a relapsing course, hemorrhagic effusions and hepatic dysfunction, that required two repeated courses of intravenous immunoglobulin (IVIG) and methylprednisolone.