Early Lung Ultrasound Scores in Neonates With Respiratory Distress - A Cross-Sectional Study From South India.

OBJECTIVE: To estimate the lung ultrasound (LUS0) scores within 6 hours of birth in neonates with respiratory distress (RD) and assess its ability to predict the severity of RD. METHODS: This single-center cross-sectional study included all neonates admitted with RD during the study period for whom a LUS was performed within 6h of birth. LUS0 scoring was done by dividing the lung fields into 3 fields on either side and a score from 0 to 3 per field (maximum score 18). We excluded neonates with congenital heart disease, congenital anomalies of chest/lung, chromosomal anomalies and if the operator for LUS0 was not available. ROC curves were constructed for estimating the cut-off LUS0 score for the severity of RD in terms of the following six outcomes: fraction of inspired oxygen (FiO2) requirement >50% during first 3 days of life, need for invasive ventilation on day 3 of life, Silverman-Anderson score >7, surfactant requirement, radiological grades of RDS, and death. RESULTS: The median (IQR) LUS0 scores were significantly higher in neonates with greater severity of RD in terms of FiO2 requirement >50% during first 3 days of life [12.0, (5.0, 14.0)], need for invasive ventilation on day 3 of life [12.0 (7.5, 12.5)], Silverman-Anderson score ≥ 7 in preterm [9.5, (6.0, 12.0)], surfactant requirement [11.5, (4.0, 12.5)], radiological grades of RDS [10.0, (4.0, 12.0)], and death [12.0, (7.0, 15.0)]. In logistic regression analysis, with continuous LUS0 scores as covariates, the odds ratio significantly increased for every unit increase in LUS0 score. CONCLUSION: Early LUS0 scores can predict the prognosis and severity of neonatal RD.

The Out-of-pocket Expenditures Incurred during Neonatal Hospitalization in a Public Hospital in Tamil Nadu - A Cross-Sectional Study.

Background: For effective policy making, it is important to understand out of pocket costs incurred in neonatal admissions in public hospitals. This cross sectional study was conducted with an objective to estimate out of pocket expenses expended on neonates and attenders during neonatal hospitalizations in a tertiary care referral hospital. Material and Methods: The data were collected using a pretested and semi structured questionnaire in 298 neonates during July'2022. Expenditures were reported as median values with interquartile range (IQR) and compared using the Kruskal Wallis test. Result: On analyzing the results, there were no direct medical costs. The median cost spent on food per day, transport during the stay, non medical expenses per day, and total expenses per day were Rs. 300 (IQR 200, 500), Rs. 1000 (500, 1500), Rs. 500 (333, 896), and Rs. 1080 (800, 1533), respectively. Higher expenses were associated with preterm, low birth weight, neonatal seizures, and longer stay (P values <0.001, 0.028, <0.001, and <0.001, respectively). About 9.39% and 1% of the families were found to be catastrophic health expenditures at 10% and 25% threshold levels, respectively. Conclusion: To conclude, all the direct medical costs were borne by the caregiver. However, some non medical and indirect costs are associated with neonatal hospitalizations in public hospitals and cash benefit schemes can offset them.

Sociodemographic and Clinical Characteristics of Child Sexual Abuse Reported to an Urban Public Hospital in Southern India, 2019-22.

OBJECTIVES: To describe the profile of child sexual abuse (CSA) reported to a tertiary care hospital. METHODS: A retrospective analysis of CSA reported in children aged below 18 years from January, 2019 to June, 2022. RESULTS: Out of the 231 cases of sexual abuse reported, 115 (49.8%) were children below 18 years. Most of the victims were children from 10 to 15 years (37.4%), and there were only two male victims. In 89.6%, the perpetrator was known to the victim. Revictimization was seen in 31%. The reported perpetrators were friends (27%), neighbors (34.8%), strangers (10.4%), or fathers (7.8%). Penetrative abuse was seen in 58.3% of reports. External injuries were seen in 6.96%. Eight victims were pregnant and HIV screening was positive in one victim. CONCLUSION: Early identification of CSA is important to prevent revictimization. Children from all age groups can be victims of CSA. Perpetrators can hail from all walks of life of the children.

Premature Atherosclerosis in Children With Transfusion-Dependent Thalassemia: A Twin-Center Cross-Sectional Study.

OBJECTIVE: Objective To analyze the risk of premature atherosclerosis in children with transfusion-dependent thalassemia (TDT) compared to controls by measuring carotid intima-media thickness (CIMT) and correlating it with clinical and biochemical parameters. METHODS: Case-control study among children aged 2 to 15 years. RESULTS: Significantly higher CIMT values were observed across all age groups. Mean (SD) CIMT in controls were 0.27(0.07) mm, 0.39 (0.03) mm, and 0.46 (0.05) mm in 2 to 5 years, 6 to 10 years, and 11 to 15 years age groups respectively, as against 0.43 (0.08) mm, 0.55 (0.07) mm and 0.63 (0.08) mm in cases in similar age groups (P<0.001). Mean triglycerides and liver enzymes were significantly elevated in cases. Logistic regression analysis demonstrated that older age group and higher serum ferritin levels, but not dyslipidemia, were significantly associated with high CIMT. CONCLUSION: Children with TDT are at increased risk for premature atherosclerosis.