ABSTRACT
BACKGROUND: There is limited literature in children on efficacy of different routes of vitamin B12 administration for vitamin B12 deficiency macrocytic-megaloblastic anemia. OBJECTIVE: To compare parenteral with oral vitamin B12 therapy in children with macrocytic-megaloblastic anemia. STUDY DESIGN: Single-center, open-label randomized controlled trial. PARTICIPANT: 80 children aged 2 month-18 year with clinical and laboratory features of nutritional macrocytic anemia. INTERVENTION: All children received an initial single parenteral dose of 1000 µg vitamin B12 followed by randomization to either parenteral or oral vitamin B12 for subsequent doses. Group A was given 1000 µg intramuscular (IM) vitamin B12 (3 doses on alternate days for those aged <10 year, five doses for age >10 year), followed by monthly 1000 µg IM for the subsequent two doses. Group B was given daily oral vitamin B12 1500 µg (500 µg in <2 years age) for three months. Folic acid and iron supple-mentation, and relevant dietary advice were given to both groups in a similar fashion. OUTCOME: Improvement in serum vitamin B12 levels and total hemoglobin was compared three months post-treatment. RESULT: The median(IQR) increase in serum vitamin B12 level was significantly higher in group A [600 (389,775) vs 399 (313, 606) pg/mL; P= 0.016]. The median (IQR) rise of hemoglobin was also more in group A [2.7 (0.4,4.6) vs 0.5 (-0.1,1.2) g/dL; P=0.001]. CONCLUSION: Increase in serum vitamin B12 levels and hemoglobin was better in children with nutritional macrocytic anemia receiving parenteral as compared to oral vitamin B12.
Subject(s)
Anemia, Macrocytic , Anemia, Megaloblastic , Vitamin B 12 Deficiency , Anemia, Macrocytic/drug therapy , Anemia, Megaloblastic/drug therapy , Child , Folic Acid/therapeutic use , Hemoglobins/analysis , Hemoglobins/therapeutic use , Humans , Vitamin B 12/therapeutic use , Vitamin B 12 Deficiency/drug therapyABSTRACT
Effective communication with parents is a very important skill for pediatricians especially in a neonatal setup. The authors analyzed non-verbal communication of medical caregivers during counseling sessions. Recorded videos of counseling sessions from the months of March-April 2016 were audited. Counseling episodes were scored using Non-verbal Immediacy Scale Observer Report (NIS-O). A total of 150 videos of counseling sessions were audited. The mean (SD) total score on (NIS-O) was 78.96(7.07). Female counseled sessions had significantly higher proportion of low scores (p < 0.001). No video revealed high score. Overall 67(44.67%) sessions revealed low total score. This reflects an urgent need to develop strategies to improve communication skills in a neonatal unit. This study lays down a template on which other Neonatal intensive care units (NICUs) can carry out gap defining audits.
