Introduction: A substantial proportion of the Indian population comprises children under 15 years of age. The prevalence of psychosocial disorders in children is increasing, coinciding with a ...decrease in infection-related morbidities. Psychosocial disorders may not only have short-term effects but also have long-lasting effects on the child’s well-being. Aim: To assess the prevalence of psychosocial disorders in children aged 4-10 years and compare it before and after the COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted as an online survey originating from Rukmani Birla Hospital, a tertiary care centre in Jaipur, Rajasthan, India. A total of 171 children aged between 4-10 years were included in the study, from February 2021 to June 2021. A structured survey questionnaire was distributed using Google Forms. The Childhood Psychopathological Measurement Schedule (CPMS) was used to assess psychosocial problems in children. CPMS scoring was performed for both the pre-pandemic period (before March 2020) and the post-pandemic period (from March 2020 until the form was filled out) for the same children. The Chi-square test was used to compare the association of demographic variables with the CPMS score. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: The mean age of the children was 6.82±2.06 years, with 47.4% (81/171) being females. A majority of the children, 158 (92.4%), were from an urban setting. The average CPMS score significantly increased from 6.66±7.46 to 11.9±10.8 (p-value <0.05) after one year of the COVID-19 pandemic. Before the pandemic, 28 (16.37%) children had an abnormal CPMS score, while after the pandemic, 73 (42.69%) had an abnormal score. Prior to the pandemic, 96 (56.14%) children had a screen time of 1-2 hours per day, but after the pandemic, 94 (55%) had a screen time of more than four hours. Psychosocial problems were significantly higher in nuclear families before the pandemic (p-value <0.05) and significantly higher in children with increased screen time after the pandemic (p-value <0.01). Conclusion: The COVID-19 pandemic has led to an increase in psychosocial disorders among children. There is an urgent need to address these issues in children at an early stage so that early interventions can be implemented.
BackgroundThe overuse of antibiotics in newborns leads to increased mortality and morbidities. Implementation of a successful antibiotic stewardship programme (ASP) is necessary to decrease ...inappropriate use of antibiotics and its adverse effects.ProblemOur neonatal intensive care unit (NICU) is a tertiary referral centre of north India, consisting of all outborn babies mostly with sepsis caused by high rate of multidrug-resistant organisms (MDROs). So antibiotics are not only life-saving but also used excessively with a high antibiotic usage rate (AUR) of 574 per 1000 patient days.MethodA quality improvement (QI) study was conducted using the Plan–Do–Study–Act (PDSA) approach to reduce AUR by at least 20% from January 2019 to December 2020. Various strategies were made : such as making a unit protocol, education and awareness of NICU nurses and doctors, making check points for both starting and early stoppage of antibiotics, making specific protocol to start vancomycin, and reviewing yearly antibiotic policy as per antibiogram.ResultsThe total AUR, AUR (culture negative) and AUR (vancomycin) was reduced by 32%, 20% and 29%, respectively, (p<0.01). The proportion of newborns who never received antibiotics increased from 22% to 37% (p<0.045) and the proportion of culture-negative/screen-negative newborns where antibiotics were stopped within 48 hours increased from 16% to 54% (p<0.001). The compliance with the unit protocol in starting and upgrading antibiotic was 75% and 82%, respectively. In early 2020, there was a sudden upsurge in AUR due to central line-related bloodstream infection breakout. However, we were able to control it, and all the PDSA cycles were reinforced. Finally, we could reattain our goals, and also able to sustain it until next 1 year. There was no significant difference in overall necrotising enterocolitis and mortality rates.ConclusionIn a centre such as ours, where sepsis is a leading cause of neonatal deaths, restricting antibiotic use is a huge challenge. However, we have demonstrated implementation of an efficient ASP with the help of a dedicated team and effective PDSA cycles. Also, we have emphasised the importance of sustainability in success of any QI study.
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•Anti-NMDAR encephalitis is being increasingly recognized in children but its triggers and pathogenesis are unclear.•We present a young child with typhoid fever and Anti-NMDAR ...encephalitis occurring concurrently.•Possible triggering effect of Salmonella needs to be considered.
Disseminated neonatal herpes simplex virus (HSV) infection represents the most severe form of neonatal herpes, which is associated with high morbidity and mortality. It can be completely prevented ...and early antiviral treatment can significantly reduce its adverse outcomes. Its early recognition in the neonate can be difficult, since the clinical presentation often mimics bacterial sepsis especially in absence of cutaneous vesicles. We report a case of preterm (twin 1) baby who during the hospital stay developed disseminated neonatal HSV type 1 infection, possibly acquired during kangaroo mother care, as on examination mother was noticed to have herpes labialis. The other twin 2 baby also developed few macular papular rash and was immediately started on antiviral treatment. The purpose of this report is to alert healthcare providers to this potential route of transmission. Furthermore, it is essential to consider neonatal HSV infection in any sick infant who is not responding to standard empirical antibiotic management, even in the absence of herpetic lesions.
Factor X deficiency is a severe inherited coagulation disorder, which is characterized by severe systemic bleeding manifestations in affected individuals. It is a rare disorder with a frequency of ...around 1:1,000,000 in the general population. We present the case of an infant with factor X deficiency who presented with complex febrile seizure. Although febrile seizures are very common in children, a closer scrutiny leads to neuroimaging and finding of intracranial bleed. Hematologic and genetic investigations confirmed the diagnosis. A high index of suspicion should be maintained to diagnose uncommon bleeding disorders in children.
Laryngomalacia is the most common congenital anomaly of the larynx leading to stridor in newborns. However, laryngeal cyst, although rare, should also be considered in the differential diagnosis of ...stridor. Hence, every newborn with stridor should undergo flexible/rigid endoscopic evaluation of the airway so that these rare entities are not missed, as its early recognition and proper treatment are essential because it can cause life-threatening airway obstruction. We describe a newborn presenting to us with stridor and severe respiratory distress since birth, who was successfully treated with no recurrence, with transoral microscopic complete excision of the laryngeal saccular cyst. We emphasize the importance of a good clinical history along with endoscopic evaluation of the airway in every neonate presenting with stridor with an unexpected evolution to determine the causal lesion.
Antenatal diagnosis plays a major role in management of surgical problems of the fetus. Diagnostic testing in the antenatal period offers parents the option of avoiding the physical suffering and ...emotional trauma that may occur during the birth of a child with a severe, debilitating illness. Along with diagnosis, a good antenatal counseling reduces parents' stress and assists them to prepare for the hardship of a complicated pregnancy. Various medical and surgical anomalies involving wide range organ systems can be diagnosed antenatally. Antenatally diagnosed congenital surgical anomalies are usually first brought to the notice of the obstetrician who decides the fate of the fetus. Eighty percent of these fetuses are terminated at the level of the obstetrician. These include anencephaly, neural tube defects, polycystic kidneys, gastroschisis and omphalocele where the decision is unequivocal. On the contrary these also include few cases of minor anomalies like unilateral multicystic kidney, unilateral hydronephrosis and cleft lip where the decision of a pediatric surgeon would be to continue the pregnancy. There seems to be a huge scope for fetal therapy and this seems to be particularly possible in certain surgical conditions which are easily accessible with risk of fetal mortality being less (eg. abdominal wall defects). Antenatal diagnosis of various surgical conditions like abdominal wall defects and diaphragmatic abnormalities (eg. Congenital diaphragmatic hernia - CDH) allows early planning of management by a group of specialists including obstetricians, neonatologists, pediatric surgeons, and geneticists. This article discusses various aspects of antenatal diagnosis and counseling, focusing on the surgical aspects along with current status of fetal therapy for various surgical conditions.
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