Care Beyond Newborn Survival Including Child Health and Early Childhood Development; Mental and Psychological Health.

Last couple of decades have witnessed a substantial decline in child mortality. Now, the need of the hour is to ensure the quality survival of children beyond infancy. Adverse events in the first few years of life have a long-lasting effect on child's development, behavior and personality; and effective interventions during this time have maximum impact to prevent these consequences. Nurturing Care for Early Childhood Development (NC-ECD) is a concept adapted worldwide by health agencies to improve the level of optimum care to children in the first 1000 days as promotion of Early Childhood Development (ECD) is integral for overall social and financial progress of the country and its population. The five components of NC-ECD include good health, adequate nutrition, responsive caregiving, safety and security, and opportunities for early learning. This five-pillar approach emphasizes upon providing quality care by catering to needs like responsive caregiving, safe and secure environment and better learning opportunities apart from health and nutrition, which are already addressed by various health programs. Taking care of mental health of child as well as caregiver is another important aspect of providing optimum care to these children. To accomplish these goals, there is a need to integrate ECD with existing public health programmes with additional focus on elements of early learning opportunities, safety and security, and responsive caregiving.

COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study.

BACKGROUND: Multisystem inflammatory syndrome in children (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new entity affecting a small percentage of children during the COVID-19 pandemic. MATERIALS AND METHODS: Demography, clinical, and laboratory variables of children admitted from April to September 2020 with MIS-C were studied retrospectively at eight hospitals in Delhi, India. RESULTS: We identified 120 patients [median age: 7 years (interquartile range (IQR): 4-10)] with male-to-female ratio of 2.3:1. Overall, 73 out of 120 children (60.8%) presented with shock, 63 (52.5%) required inopressor support, and 51 (43%) required respiratory support. We categorized the cohort into three observed clinical phenotypes: MIS-C with shock (n = 63), MIS-C with Kawasaki disease (KD) (n = 23), and MIS-C without shock and KD (n = 34). Atypical presentations were hypothermia, orchitis, meningoencephalitis, demyelination, polyneuropathy, pancreatitis, and appendicitis. Ninety-four percent had laboratory evidence of SARS-CoV-2 (78.3%, seropositive and 15.8%, RT-PCR positive). The median C-reactive protein (CRP) was 136 mg/L (IQR, 63.5-212.5) and ferritin was 543 ng/mL (IQR, 225-1,127). More than 90% received immunomodulatory therapy (intravenous immunoglobulins and/or steroids) with an excellent outcome (96% survived). CRP and absolute neutrophil count (ANC) were correlated statistically with severity. CONCLUSION: MIS-C data from Delhi are presented. Rising CRP and ANC predict the severe MIS-C. HOW TO CITE THIS ARTICLE: Mehra B, Pandey M, Gupta D, Oberoi T, Jerath N, Sharma R, et al. COVID-19-associated Multisystem Inflammatory Syndrome in Children: A Multicentric Retrospective Cohort Study. Indian J Crit Care Med 2021;25(10):1176-1182.

Prophylactic Vitamin D Supplementation Practices for Infants: A Survey of Pediatricians From Delhi.

This survey was conducted among 125 pediatricians working in public and private child care facilities of Delhi. Prescription rates of routine vitamin D supplementation varied between 70-100% for various groups of infants, despite non-availability of government guidelines. Pediatricians in private practice more frequently prescribed vitamin D supplementation to term healthy infants as compared to government pediatrician (91.4% vs 71.6%; P=0.005).

Content of Food Advertising for Young Adolescents on Television.

BACKGROUND: Food related advertisements on television may have a major influence on the dietary habits and obesity among young adolescents. OBJECTIVE: To evaluate the frequency and typology of food advertisements on most popular television channels, watched by school-going young adolescents in Delhi. METHODOLOGY: Biphasic study to (a) identify the three television channels most frequently watched by administering a questionnaire to 400 school going young adolescents; and (b) view each of these channels for 2 hours per day for 6 days each, and observe the content of advertisements related to foods, beverages, and food outlets. RESULTS: Four hundred and three food related advertisements were viewed over 36 hour on Discovery, MTV and Disney Channels. Among 235 food related advertisements 163 (69.3%) pertained to candies, chocolates and confectionary and 35 (14.8%) to salty snacks. Sugar sweetened soft drinks contributed 90 of 106 (85%) of beverage advertisements. Of 62 advertisements related to food outlets, 59 were of fast food joints. CONCLUSION: Majority of food advertising content on television most commonly watched by young adolescents is related to unhealthy foods and beverages, igh in energy and low in micronutrient content.

Organochlorine pesticide exposure in mothers and neural tube defects in offsprings.

We explored the association between maternal exposure to organochlorine pesticides and neural tube defects (NTDs) in the offspring. Blood was collected from 35 mothers and their offsprings with NTDs (case group) and from 35 mothers-neonate dyads without congenital anomalies (control group). The median blood levels of DDE, t-HCH and endosulphan in mothers in the case group and of dichlorodiphenyltrichloroethane (DDT), dichlorodiphenyldichloroethylene (DDE), total hexachlorocyclohexane (t-HCH) and endosulfan in the neonates with NTDs were significantly higher. Neonates with NTDs had 3.6 times more chances of having blood levels of endosulfan above the median level of the control group. Mothers delivering offsprings with NTDs had 11.3 times greater chances of having DDE levels above the median concentration in the control group. We recommend a restrained use of organochlorine pesticides like DDT, DDE, and endosulfan, while monitoring the expectant mothers closely for birth defects like NTDs.

Caffeine Intake Among Adolescents in Delhi.

BACKGROUND: Availability and advertising of caffeinated drinks is on the rise in Indian market. Excess caffeine intake may have deleterious effects on health. OBJECTIVE: To estimate the daily consumption of caffeine among urban school-going adolescents from Delhi. MATERIALS AND METHODS: A school-based survey was conducted to determine the amount and pattern of caffeine consumption among students of classes 9-12, using a self-administered questionnaire. RESULTS: Of 300 participants (median age 15 year, 174 boys), 291 (97%) were consuming caffeine [mean (SD): 121.0 (98.2) mg/day]. Nineteen (6%) students were consuming more than 300 mg of caffeine per day. Tea/coffee contributed to more than 50% of the caffeine intake. The rest was derived from cola beverages, chocolates, and energy drinks. CONCLUSION: Average caffeine consumption among school-going adolescents from Delhi is high. The findings of this preliminary survey need to be confirmed in larger data sets.

Effect of Carbamazepine and Valproate Monotherapy on Cardiovascular Risks in Epileptic Children.

OBJECTIVE: We determined the effects of carbamazepine and valproic acid on the serum lipids and apolipoprotein A and B in epileptic children on long-term monotherapy and 3 months after drug discontinuation. METHOD: Thirty-three epileptic children (17 boys, 16 girls, mean age 9.79 ± 2.5 years) were evaluated for serum lipids and lipoprotein results at the initiation of antiepileptic drug tapering and 3 months after cessation of antiepileptic therapy. RESULTS: In the carbamazepine group (n = 13), there was no significant difference in the lipid profile at the end of therapy or at 3 months after the discontinuation, whereas in the valproate group (n = 20), triglycerides and apoprotein B and high-density lipoprotein cholesterol increased significantly 3 months after discontinuation. The ratios of total cholesterol:high-density lipoprotein improved but low-density lipoprotein:high-density lipoprotein and apolipoprotein:apolipoprotein remained unchanged. CONCLUSION: Because these ratios are better predictor of atherosclerosis risk than the absolute values, the overall risk is not increased by the long-term use of carbamazepine and valproate.

Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls.

OBJECTIVE: To measure levels of micronutrients in children with cerebral palsy and compare them with neurologically normal children of similar nutritional status. METHODS: Fifty children with cerebral palsy (2-12 y) and 50 age and sex matched controls of similar nutritional status were enrolled. Detailed dietary history was recorded and nutritional status assessed. Venous blood (3 ml) was drawn for analysis. Micronutrient levels were measured as per standard technique. RESULTS: Serum iron was 12.6 ± 5.9 and 20.9 ± 3.3 µmol/L in CP and controls respectively (P < 0.001). Mean copper levels were 106.2 ± 38.3 µg/dl in CP and 128.8 ± 20.2 µg/dl in controls (P < 0.001); magnesium levels were 1.97 ± 0.4 and 2.2 ± 0.3 mg/dl (P = 0.003). Zinc levels were similar in CP and controls (P = 0.979). The mean energy intake was significantly less in CP (P = 0.016). Mean protein intake did not vary significantly (P = 0.847). No correlation was found between energy intake and serum levels of micronutrients (P > 0.05). There was no difference in micronutrient levels with respect to gross motor functional classification system (GMFCS) grades and limb involvement (P > 0.05). CONCLUSIONS: The serum levels of iron, copper and magnesium are significantly less in children with cerebral palsy, hence the need for supplementation.