Browsing by Author "Kabra, Sushil K"
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Item Clinical Profile and Outcome of Swine Flu in Indian Children.(2011-05) Das, Rashmi Ranjan; Sami, Abdus; Lodha, Rakesh; Jain, Richa; Broor, S; Kaushik, S; Singh, B B; Ahmed, M; Seth, Rachna; Kabra, Sushil KObjective: To describe the clinical characteristics and outcome of Indian children infected with 2009 H1N1 influenza virus. Study design: Retrospective chart review. Setting: Outpatient department and hospitalized patients in a tertiary care hospital. Methods: Clinical details of 85 children (positive for the 2009 H1N1 virus infection tested by real-time reversetranscriptase– polymerase-chain-reaction assay) were analyzed from medical charts. Results: Of the 85 (55 boys) children positive for 2009 H1N1 virus infection, 64.7% were between 5 years to 16 years, and 35.3% were below 5 years age. The mean age of these children was 7.5±3.5 yr. Contact history was positive only in 22 (26%) cases. High grade fever was the most common symptom, followed by cough and rhinorrhea. Twenty-nine (34%) patients had an underlying co-morbid condition. Of the 34 patients who underwent chest radiography during evaluation, 18 children (52.9%) had findings consistent with lower respiratory tract infection. Antiviral therapy was initiated in 76 patients. Hospitalization was required in 30 (35.3%) children. Risk factors for hospitalization included underlying co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph. Mean length of hospitalization was 131+76 hours, irrespective of underlying disease. Three children developed Acute Respiratory Distress Syndrome and died. Conclusions: Clinical features and routine laboratory investigations in children with swine origin influenza were non-specific. Children with co-morbid condition, respiratory distress, vomiting, wheezing, diarrhea, hypotension and infiltrates/consolidation on chest radiograph were at higher risk of hospitalization.Item Clinical Profile of Interstitial Lung Disease in Indian Children.(2013-01) Sankar, Jhuma; Pillai, Mrinal S; Sankar, M Jeeva; Lodha, Rakesh; Kabra, Sushil KObjective: To describe the clinical spectrum and factors associated with poor short-term outcomes in children with interstitial lung disease (ILD). Design: Retrospective chart review Setting: Pediatric Chest Clinic of a tertiary care hospital Methodology: We retrieved information regarding clinical course and laboratory features of all children diagnosed as ILD between January 1999 and February 2010. Disease severity was assessed using ILD score based on clinical features and SpO2 at the time of initial evaluation. Outcome was assessed after 3 months of initial diagnosis as improved or death/no improvement in symptoms. Results: 90 children (median age, 6.8 years; 62% boys) were diagnosed to have ILD during this period. 46 children were R E S E A R C H P A P E R classified as having ‘definite ILD’ while 44 had ‘possible ILD’. The commonest clinical features at presentation were cough (82.2%), dyspnea (80%), pallor (50%), and crackles (45.6%). 3 children (3.3%) died while 21 (23%) showed no improvement in clinical status on follow-up at 3 months. A higher ILD score (RR 3.72, 95% CI 1.4, 9.9) and lower alkaline phosphatase levels (median [IQR]: 205 [175.2] vs. 360 [245.7]; P=0.006) were found to be significantly associated with worse outcomes. Conclusion: The common clinical features of ILD in our study included breathlessness, cough and hypoxemia. A working diagnosis of ILD can be made with the help of imaging, bronchoscopy, or lung biopsy. A simple score based on clinical findings and pulse-oximetry might predict those children with poor short-term outcome.Item Incidence of Acute Kidney Injury in Hospitalized Children.(2012-07) Mehta, Poonam; Sinha, Aditi; Sami, Abdus; Hari, Pankaj; Kalaivani, Mani; Gulati, Ashima; Kabra, Madhulika; Kabra, Sushil K; Lodha, Rakesh; Bagga, ArvindObjective: To determine the incidence and outcome of acute kidney injury (AKI) in hospitalized patients. Design: Prospective, observational. Setting: Tertiary care center in North India. Participants/patients: Inpatients, 1 month to 18-yr-old. Intervention: None. Main Outcome Measures: Incidence of AKI based on the serum creatinine criteria proposed by the AKI Network. Results: During February to September 2008, thirty nine of 108 (36.1%) critically ill patients and 34 of 378 (9.0%) patients who were not critically ill developed AKI (P <0.001); the respective incidence densities were 45.1 and 11.7 cases/1000 patient days, respectively. The maximal stage of AKI was stage 1 in 48 (65.8%) patients, stage 2 in 13 (17.8%) and stage 3 in 12 (16.4%) patients; 11 (15.1%) required dialysis. Patients with AKI had a significantly longer duration of hospital stay (9 days vs 7 days, P<0.02) and higher mortality (37% vs 8.7%; hazard ratio, HR 2.73; 95% CI 1.64, 4.54). Independent risk factors for AKI were young age (HR 0.89; 95% CI 0.83, 0.95), shock (HR 2.65; 95% CI 1.32, 5.31), sepsis (HR 3.64; 95% CI 2.20, 6.01), and need for mechanical ventilation (2.18; 95% CI 1.12, 4.26). Compared to patients without AKI, the mortality was higher for AKI stage 2 (HR 5.18; 95% CI 2.59, 10.38) and stage 3 (HR 4.34; 95% CI 2.06, 9.16). Shock was an independent risk factor for mortality (HR 10.7; 95% CI 4.96, 22.98). Conclusions: AKI is common in critically ill children, especially younger patients with septicemia and shock, and results in increased hospital stay and high mortality.Item Infant Pulmonary Function Tests in Children with Airway Anomalies and Correlation with Bronchoscopy Findings(The Indian Academy of Pediatrics, 2024-05) Pathania, Amit; Jat, Kana Ram; Sankar, Jhuma; Lodha, Rakesh; Kabra, Sushil KObjectives: To evaluate the role infant pulmonary function tests (Tidal Breathing Flow Volume Loops, TBFVL) in children with airway anomalies and to correlate the TBFVL so obtained with bronchoscopy findings. Methods: In this prospective cohort study, we enrolled children aged 0-2 years with airway anomalies and performed TBFVL and bronchoscopy. The primary outcome measure was graphic pattern of TBFVL in laryngomalacia. Secondary outcome measures were types of TBFVL results in various airway anomalies and controls. Results: Out of 53 children enrolled, 28 (52.3%) had laryngomalacia. Pattern 3 (fluttering of inspiratory limb) was commonest TBFVL pattern in laryngomalacia. Among TBFVL parameters, the ratio of inspiratory time to expiratory time (Ti/Te) and tPTEF/tE was significantly high in children with isolated laryngomalacia compared to controls. At six months of follow-up, TBFVL pattern 1 (normal) became the commonest pattern. Conclusion: A particular type of airway anomaly may have a characteristic graphic pattern in TBFVL and TBFVL pattern may indicate improvement in airway anomalies in follow-up.Item Management of Status Asthmaticus in Children.(2010-12) Saharan, Sunil; Lodha, Rakesh; Kabra, Sushil KAsthma is a common chronic inflammatory disorder of the airways characterized by recurrent wheezing, breathlessness, and coughing. Acute exacerbations of asthma can be life-threatening; annual worldwide estimated mortality is 250,000 and most of these deaths are preventable. While most of the acute exacerbations can be managed successfully in the emergency room, few children have severe exacerbations requiring intensive care. Mainstay of treatment for status asthmaticus are inhaled β2 agonist and anticholinergic agents, oxygen along with corticosteroids. Children who do not respond well to initial treatment require parenteral β2 agonist and magnesium. Rarely, sick children need parenteral aminophylline infusion and mechanical ventilation. Guidelines for diagnosis, treatment, ventilator management and supportive care for status asthmaticus in children are discussed in the protocol.Item Mobile Direct Observed Therapy (MDOT) for Inhaler Therapy in Children With Newly Diagnosed Asthma: A Pilot Study(The Indian Academy of Pediatrics, 2024-12) Pathania, Amit; Jat, Kana Ram; Pathania, Meenakshi; Lodha, Rakesh; Kabra, Sushil KObjectives: We aimed to assess the acceptability of Mobile Direct Observed Therapy (MDOT) amongst the parents/caregivers of children with asthma. Methods: This open-label pilot randomized controlled trial enrolled newly diagnosed children aged 5-15 years with asthma, who were followed up telephonically for six weeks. Parents of children in the intervention arm were requested to record a video of the metered dose inhaler with spacer (MDI-S) technique of their child on a mobile phone and share it through WhatsApp with investigator who then provided corrective measures as required by a text/video message. The children in the control arm continued follow-up telephonically without exchange of any videos for six weeks. The primary outcome measures were the acceptability of MDOT and the effect of such interaction on the correctness of the MDI-S technique. Secondary outcome measures were the level of asthma control as per GINA guidelines and the caregivers’ perception and feedback about MDOT. Result: A total of 30 children were enrolled, 15 in each arm. Thirteen (86%) parents uploaded good-quality videos. The average number of incorrect steps decreased from 2.64 in the first video to 0.18 after the fourth video and nil after the fifth video in the MDOT group. At six weeks of follow-up, the average number of incorrect steps was significantly lower in the MDOT group compared to the control group (0 vs 2.9; P < 0.001). The proportion of children having controlled asthma was better in the MDOT group compared to controls (85% vs 70%) (P = 0.39). All parents liked MDOT.Item Normative Data of Infant Pulmonary Function Testing: A Prospective Birth Cohort Study from India(Indian Academy of Pediatrics, 2020-01) Kumar, Prawin; Mukherjee, Aparna; Randev, Shivani; Jat, Kana Ram; Lodha, Rakesh; Kabra, Sushil KObjective: To develop a normal reference range of Infantpulmonary function test (IPFT) indices for Indian children.Design: Prospective birth cohort study.Setting: Division of Pediatric Pulmonology of a tertiary-careinstitute in India from August 2012 to March 2017.Participants: All neonates born at the institute during the studyperiod were screened for eligibility.Measurement: IPFT at baseline and every 6-month until 36-months of age.Main Outcome Measure(s): Tidal breathing flow-volume loop(TBFVL), Rapid thoracoabdominal compression (RTC), andRaised volume RTC (RVRTC) indices at baseline and follow-up.Results: 310 newborns were enrolled in the cohort; 281 of them(169 male) had completed 36-months of follow-up at the end ofthe study period. There was no influence of gender on thebaseline IPFT indices. Tidal volume per unit body weight (VT/kg)significantly increased from baseline to 36 months of age(P<0.001) while the peak ratio (tPTEF/tE) initially decreased in first18-months of age (P<0.001), after that returned to the baselinevalue by 36 months of age. RTC indices did not changesignificantly from baseline values. In RVRTC, the ratio of forcedexpiratory volume in 0.5s to forced vital capacity (FEV0.5/FVC)was significantly decreased from baseline to 36 months of age(P=0.002).Conclusions: Normal values for various IPFT indices for TBFVL,RTC, and RVRTC from neonates to the age of 36-month areprovided. These data may be used as normative data for healthyneonates and children of Indian originItem Oral Antibiotics for Community–acquired Pneumonia with Chest- indrawing in Children Aged Below Five Years: A Systematic Review.(2016-06) Lodha, Rakesh; Randev, Shivani; Kabra, Sushil KObjectives: To determine the efficacy of oral antibiotics in under-five children with pneumonia and chest indrawing. Methods: We included controlled clinical trials (randomized or quasi randomized) that compared the efficacy of oral antibiotics versus parenteral antibiotics for treatment of community- acquired pneumonia with chest-indrawing (severe pneumonia as defined by the World Health Organization’s guidelines) in children below 60 months of age. Data were extracted and managed using RevMan software. Main outcome variables were: treatment failure rate, relapse rate, death rate, need for hospitalization, and severe adverse effects. Results: We identified four randomized controlled trials involving 4400 children who were diagnosed to have severe pneumonia but were feeding well and not hypoxic. Baseline characteristics of children in the two treatment arms (oral and parenteral antibiotics) were similar. In two studies, oral antibiotics were administered on an ambulatory basis, while in two, oral antibiotics were used in hospitalized children. Failure rate in children receiving oral antibiotics was 13% (288/2208) while that in children receiving parenteral antibiotics was 13.8% (302/2183) (OR 0.93; 95% CI 0.78, 1.11). Failure rates were not affected by the type of oral antibiotic, or presence of wheeze. Relapse rates, hospitalization or serious adverse events were similar in the two groups. Conclusion: Children with tachypnea with chest-indrawing without signs/symptoms of very severe pneumonia may be treated with oral antibiotics.Item Predictors of Malnutrition in Children with Cystic Fibrosis(Indian Academy of Pediatrics, 2019-10) Dhochak, Nitin; Jat, Kana Ram; Sankar, Jhuma; Lodha, Rakesh; Kabra, Sushil KObjective: To determine occurrence of malnutrition in childrenwith cystic fibrosis and identify predictors of malnutrition at time ofenrolment and after 2 years of follow up.Design: Retrospective chart review.Setting: Pediatric chest clinic at a tertiary-care center in northernIndia.Patients: Cystic fibrosis patients enrolled between 2009-2015with at least 3 years follow-up.Procedure: Weight and height were noted at enrolment, and after1 year and 2 years of follow-up. Clinical details, medications, andpulmonary exacerbations during second year were recorded.Main outcome measure: Occurrence of malnutrition i.e. weightfor age Z-score < -2.Results: 61 medical records were reviewed. Occurrence ofmalnutrition at baseline, and 1- and 2-year follow-up was 65.5%,54.1% and 57.3%, respectively. Weight for age Z-score atenrolment significantly correlated with time to diagnosis fromonset r=0.015, P=0.029). Weight for age Z-score at 2-year follow-up was significantly associated with steatorrhea (P=0.03),increased frequency of stools (P<0.01) and pulmonaryexacerbation (P=0.03) during second year. Linear regressionshowed significant association between weight for age Z-score at2 years with steatorrhea and pulmonary exacerbations [r=-0.795(-1.527, -0.062)] and [r=-0.261 (-0.493, -0.028)]. Pulmonaryexacerbations during second and third year had significantcorrelation with weight for age Z-score at the beginning ofrespective years (r = -0.219, P=0.015).Conclusion: Occurrence of malnutrition is high in children withcystic fibrosis in this region, with uncontrolled fat malabsorptionand recurrent respiratory infections being significant risk factors.Item Transfusion of Blood and Components in Critically Ill Children.(2010-12) Uppal, Preena; Lodha, Rakesh; Kabra, Sushil KThe physicians prescribing transfusions must have a thorough understanding of the various blood products, their indications and contraindications, and requirements for modification of the blood products to prevent probable adverse effects. Decision to give an RBC transfusion should not be based solely on Hb concentration, it should take in account high severity of illness; active bleeding; emergency surgery; etc. Using restrictive transfusion strategy of transfusion RBCs can decrease transfusion requirements without increasing adverse outcomes. In most circumstances, platelets should be maintained greater than 10×109/L. Platelet counts greater than 20×109/L are indicated for invasive procedures and greater than 50× 109/L for major surgeries or invasive procedures with risk of bleeding. Whenever possible, ABO-compatible platelets should be administered. Fresh frozen plasma should be transfused in multiple coagulation factor deficiencies, DIC with bleeding, replacement of rare single congenital factor deficiencies when specific concentrates are not available (e.g., protein C or factor II, V, X, XI, or XIII deficiency). During transfusion child should be monitored carefully.Item Wheezing in Preschool Children and Total IgE Levels: A Birth Cohort Study(Indian Academy of Pediatrics, 2020-03) Jat, Kana Ram; Kumar, Prawin; Mukherjee, Aparna; Shivani, Randev; Bipin, Jose; M, Kalaivani; Lodha, Rakesh; Kabra, Sushil KObjectives: To evaluate association between total IgE levels and wheezing in preschoolchildren from India. Methods: Datawere collected in a prospective birth cohort study relatedto wheezing till three years of age. Total IgE was measured at enrolment, at one year and twoyears of age and correlated with wheezing episodes. Results: A total of310 (167 boys)children were enrolled. Total IgE levels increased with age (P<0.001). Overall, 101 (32.6%)children had 182 episodes of wheezing. The median (IQR) total IgE levels in children withwheezing and without wheezing were similar at one year [42.1 (12.7, 93.5) vs 41.9 (17.1,96.7) kU/L; P=0.39] and two years of age [62.8 (32.4, 212.0) vs 75 (25.8, 173.0) kU/L,P=0.92). Conclusion: Total IgE levels increased with age and were not different in preschoolchildren with and without wheezing.