Indian Pediatrics
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Item Congenital Heart Disease: Would It Be the Key Driver of Infant Survival During Amrit Kaal (2022-2047)?(Indian Academy of Pediatrics, 2023-02) Baranwal, Arun K; Prinja, Shankar; Kaur, NavpreetPost-independence, we made significant strides in childhood survival. However, there is an abysmal improvement in survival due to birth defects. Globally, India contributes the largest proportion of under-5 deaths, overall as well as due to birth defects. Congenital heart disease (CHD) is the single most common cause of birth-defect related deaths, and is the 7th most common cause of infant deaths. Scarcity of pediatric cardiac care professionals and pediatric cardiac centers has led to a huge demand-supply gap. Understanding the burden of CHD and taking imperative steps at primary, secondary and tertiary levels are essential during Amrit Kaal (2022-2047). Coverage of management of CHD under Janani Shishu Suraksha Karyakram, Rashtriya Bal Suraksha Karyakram and Ayushman Bharat programs offers a huge promise, as shown by the experience from Hridayam program in Kerala.Item Modified Pediatric Penile Perception Scale to Evaluate Cosmetic Outcome in Children With Hypospadias Repair(Indian Academy of Pediatrics, 2023-08) Ratan, Simmi K; Kumar, Parveen; Kishore, Jugal; Aggarwal, Satish KumarObjectives: To compare the interpretation for cosmesis post-hypospadias repair by child, parents and surgeons using modified Pediatric Penile Perception Scale (PPPS). Methods: This cross-sectional study involving 50 children (aged 2 to 17 years) with hypospadias was conducted at the pediatric surgery department of our public sector tertiary care hospital. Subjects were assessed 6 months after completion of all stages of hypospadias repair. Cosmetic assessment was done using modified PPPS. We clubbed together the variables ‘meatus’ and ‘glans’ as MG (meatus-glans) complex due to their extreme proximity (embedding), while cosmesis of phallus was considered independently. The modified PPPS scoring parameters included phallus, MG complex, shaft skin, and general appearance. Independent assessment by surgeon, patients and parents was compared, and analyzed using SAS 9.2 statistical software. Cosmetic results of single vs staged repair, and different repair types was compared. Results: Assessment using modified PPPS showed that MG complex cosmesis and skin scarring were the most heeded parameters by all three categories of observers. PPPS by surgeons remained least affected by phallic cosmesis and that of the patient by the overall phallic appearance. Tubularized incised plate urethroplasty (TIPU) scored better on cosmesis. Conclusion: Phallic cosmesis should be considered an independent variable for assessing cosmetic outcome of hypospadias, apart from MG cosmesis.Item USPSTF and ISPAD Guidelines on Screening for Prediabetes and Type 2 Diabetes in Children and Adolescents(Indian Academy of Pediatrics, 2023-07) Singh, Aaradhana; Dabas, AashimaThe rising trends of obesity, metabolic syndrome and diabetes in adults are worrisome globally. The majority of antecedents to adult noncommunicable diseases begin in childhood. Type 2 diabetes is recognized as one of the major diseases that contribute to the NCD burden in childhood. Recently, the US Preventive Services Task Force (USPSTF) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) released their guidelines on diagnosis and management of prediabetes and diabetes in children targeted screening for youth-onset type 2 diabetes is suggested in at-risk children (obese, positive family history of type 2 diabetes, etc.), while the role of screening asymptomatic children is not substantiated. Obesity and insulin resistance are important risk factors for type 2 diabetes. The cutoffs of fasting plasma glucose for the diagnosis of prediabetes and diabetes are >100 to 125 and ?126 mg/dL, respectively. This update briefly summarizes the recommendations on screening for youth-onset prediabetes and type 2 diabetes.Item Levetiracetam and Midazolam vs Midazolam Alone for First-Line Treatment of Children With Generalized Convulsive Status Epilepticus (Lev-Mid Study): A Randomized Controlled Trial(Indian Academy of Pediatrics, 2023-08) Elshater, Ahmed A; Sadek, Abdelrahim A; Abdelkreem, ElsayedBackground:Benzodiazepines are the first-line anti-seizure medication (ASM) for generalized convulsive status epilepticus (GCSE), but they fail to end seizures in a third of cases. Combining benzodiazepines with another ASM that acts by a different pathway could be a potential strategy for rapid control of GCSE. Objectives: To evaluate the efficacy of adding levetiracetam to midazolam in the initial treatment of pediatric GCSE. Design: Double-blind randomized controlled trial. Setting: Pediatric emergency room at Sohag University Hospital between June, 2021 and August, 2022. Participants: Children aged between 1 month and 16 years with GCSE lasting more than 5 min. Interventions: Intravenous levetiracetam (60 mg/kg over 5 min) and midazolam (Lev-Mid group) or placebo and midazolam (PlaMid group) as first-line anticonvulsive therapy. Outcome measures: Primary: cessation of clinical seizures at 20- min study time point. Secondary: cessation of clinical seizures at 40-min study time point, need for a second midazolam dose, seizure control at 24-hr, need for intubation, and adverse effects. Results: Cessation of clinical seizures at 20-min occurred in 55 children (76%) in Lev-Mid group compared with 50 (69%) in the PlaMid group [RR (95% CI) 1.1 (0.9-1.34); P=0.35]. No significant difference was found between the two groups regarding the need for a second midazolam dose [44.4% vs 55.6%; RR (95% CI) 0.8 (0.58- 1.11); P=0.18] as well as cessation of clinical seizures at 40-min [96% vs 92%; RR (95% CI)1.05 (0.96-1.14); P=0.49] and seizure control at 24-hr [85% vs 76%; RR (95% CI) 1.12 (0.94-1.3); P=0.21]. Intubation was required for three patients in the Lev-Mid group and six patients in the Pla-Mid group [RR (95%CI) 0.5 (0.13- 1.92); P=0.49]. No other adverse effects or mortality were observed during the 24-hour study timeframe. Conclusion: Combined levetiracetam and midazolam for initial management of pediatric GCSE presents no significant advantage over midazolam alone in cessation of clinical seizures at 20-min.Item Dyslipidemia Among Overweight and Obese Children in Jharkhand: A Hospital-Based Study(Indian Academy of Pediatrics, 2023-08) Sinha, Sumita; Tripathy, Saroj Kumar; Das, Sarthak; V, Vinayagamoorthy; Malik, Archana; NishiObjective: To study the prevalence of common dyslipidemia among overweight and obese children between 2-18 years in a tribal region. Methods: This cross-sectional study was carried out in 151 overweight and obese children aged 2-18 years, who visited the pediatric outpatient department of a tertiary care hospital in Jharkhand between 1 August and 30 November, 2022. Dyslipidemia was defined as anyone of the following: a total cholesterol level of 240 mg/dL, a triglyceride level of 150 mg/dL, a low-density lipoprotein cholesterol level (LDL-C) of 140 mg/dL, a high-density lipoprotein cholesterol level (HDL-C) of 40 mg/dL, or the use of a lipid-lowering drug [8]. Overweight and obesity were defined as per World Health Organization criteria. Result: The prevalence of dyslipidemia was 63.6%. The most common type of dyslipidemia was low HDL-C + high TG levels found in 32.5% (n=49) children. The most prevalent pattern of dyslipidemia in overweight children was low HDL-C (19, 32.3%); and in obese children low HDL-C and high TG levels (39, 42.3%). Conclusion: The prevalence rate of dyslipidemia was high among overweight and obese children in this region. There was a positive association between dyslipidemia and body mass index.Item Management of Hepatitis C in Children – A New Paradigm(Indian Academy of Pediatrics, 2023-01) Poddar, Ujjal; Reddy, DV UmeshIntroduction: With the advent of direct-acting antivirals (DAAs), the past decade has seen a paradigm shift in the management of hepatitis C (HCV) infection in children. In this review, we summarize the various treatment options for pediatric HCV infection, highlighting the recent changes in the management. Methods: A literature search was performed using the PubMed database with the relevant keywords. Filters included were human, ages 0-18 years, and the English language. Results: Initial phase of HCV treatment using conventional or pegylated interferon and ribavirin combination regimens yielded poor outcomes in children, especially in genotypes 1 and 4, with an overall sustained virologic response of 58%. Also, treatment with interferon and ribavirin combination was associated with significant side effects in up to 52% of those treated. Presently, various combinations of direct-acting antivirals (DAAs) have been approved in children above three years of age with documented evidence of high efficacy (SVR12 of 92% to 100%) and excellent safety, and the current standard of care. Conclusion: With various DAA regimens now being approved for children above three years of age, the treatment of active HCV infection (HCV-RNA positive) in children has become simple. Besides the effectiveness of DAA therapy, public awareness about HCV transmission, better screening, and making the DAAs available at a subsidized price in the public sectors are necessary to eliminate HCV infection in India.Item Clinico-Hematological Profile and Management of Children With Non-Transfusion Dependent Thalassemia (NTDT) at a Pediatric Center in Northern India(Indian Academy of Pediatrics, 2023-08) Parakh, Nupur; Khan, Afreen; Sharma, Sunita; Chandra, JagdishObjective: To study the clinico-hematological profile, complications, and management of children with non-transfusion dependent thalassemia (NTDT) in northern India. Method: We retrieved and analyzed the data of 69 children with NTDT diagnosed between January, 2006 to December, 2018, aged under 18 years from our unit’s records. Result: The participants mean (SD) age was 4.4 (3.1) years, and they presented with anemia (29%), jaundice (13%), hemolytic facies (13%), splenomegaly (87%), thromboembolism (2.9%) and pathological short stature (28.5%). The most common cause of NTDT was ?-thalassemia (45%), followed by either compound-heterozygous or homozygous for E?-thalassemia mutation. The most frequent single genotype observed was compound heterozygous for IVS1-5 (G>C) and codon 26 (G>A). The mean (SD) follow-up duration was 3.5 (2.4) years. On follow-up, 27 children (%) remained transfusion free, and 30 (%) needed occasional transfusions. 63% of patients initially presenting with pathological short stature showed improvement in growth. Amongst children older than 10 years (n=20), subclinical hypothyroidism was detected in 6 children and impaired glucose tolerance test in 1 child. Conclusion: Eß-thalassemia was the commonest cause of NTDT in this population.Item Treatment of Seizures in the Neonate: Special Report From the ILAE Task Force on Neonatal Seizures, 2022(Indian Academy of Pediatrics, 2023-08) Jajoo, Mamta; Anand, Pratima; Passi, Gouri RaoThe International League Against Epilepsy (ILAE) task force on neonatal seizures has recently published draft guidelines and consensusbased recommendations on the treatment of neonatal seizures. This update provides a summary of the recommendations and the changes in management compared to the previous WHO ILAE guidelines, published in 2011, with emphasis on practical decision making requirements for a pediatrician.Item MTHFR C677T Polymorphism, Plasma Homocysteine, and PDGF-AA Levels and Transcranial Doppler Velocity in Children With Sickle Cell Disease(Indian Academy of Pediatrics, 2023-08) Mahmoud, Asmaa A; Hady, Nahla MS Abd El; Rizk, Mohammed S; El-Hawwary, Ahmed M; Saleh, Nagwan YObjective: To evaluate the effect of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism on plasma homocysteine (tHcy) and platelet-derived growth factor (PDGF-AA) levels in children with sickle cell disease (SCD), and ascertain their role in predicting high transcranial doppler velocity (TCD). Methods: We estimated MTHFRC677T gene polymorphism, plasma tHyc and PDGF-AA in 44 SCD patients and 44 healthy children. Results: The prevalence of mutant homozygous MTHFR (C677TT) in SCD was 13.6%. Significantly higher plasma tHcy was observed in mutant homozygous MTHFRC677TT patients. Significantly higher plasma tHcy and PDGF-AA levels were observed in SCD patients than in controls. Median (IQR) PDGF-AA levels were significantly higher in conditional and high-risk TCD patients as compared to low-riskTCD patients [325 (93.1-368) and 368 (111-480) vs 111 (56-201) pg/mL, respectively; P<0.001]. Mean (SD) tHcy levels were significantly higher in high-risk TCD children than low-risk TCD children (12.9 (2.7) vs 9.9 (2.5) µmol/L; P=0.006). The receiver operating characteristic revealed that the area under the curve (AUC) of PDGF-AA for high TCD velocity was 0.934 (95% CI 0.845-1.00; P<0.001) and tHcy had an AUC of 0.675 (95% CI 0.517-0.833; P=0.04). Conclusion: PDGF-AA and tHcy levels could be used as predictive markers for stroke in SCD children. MTHFR Polymorphism contributes to elevated tHcy levels.Item The Efficacy of Different Triptans for the Treatment of Acute Headache in Pediatric Migraine: A Systematic Review(Indian Academy of Pediatrics, 2023-08) Chanchlani, Roshan; Agrawal, Amit; Janjua, Dalwinder; Hafsa, Shaik NidaBackground: Serotonin receptors 5-HT1B and 5-HT1D in the cerebral arteries are activated by the 5-hydroxytryptophan agonists (triptans) to relieve the discomfort associated with migraines. Even though triptans are often used to treat acute migraines, there is some debate over their effectiveness. Objective: Our systematic review aimed to evaluate the effectiveness of triptans for acute treatment of migraine in young individuals. Methods: Utilizing the databases of Google Scholar, Cochrane Library, and PubMed, a literature search was conducted, and all papers published till July 2022 were included. This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. In addition to the Boolean operators AND, OR, and NOT, the following descriptive terms were also used: “Triptans,” “Pediatric Migraine,” “Migraine disorders,” “Headache,” “Children,” and “Adolescent.” Results: A total of 1047 studies were identified, and 25 articles were finally included in the study. 17 of them were RCTs while the remaining were non-randomized trials. Most studies recruited participants aged between 12-17 years. Among 25 studies, 7 reported sumatriptan use, 3 assessed a combination of sumatriptan and naproxen, 4 were on almotriptan, 1 on eletriptan, 6 on rizatriptan, and 4 on zolmitriptan use. Conclusion: We found that rizatriptan (good tolerability profile with a dose of 5 mg) and sumatriptan (nasal spray, 10 mg and 20 mg) had higher efficiency as compared to other triptans. Regardless of type or dose, all triptans are generally well tolerated by patients, but a few adverse effects such as light-headedness (sumatriptan), nasopharyngitis, and, muscular spasms (sumatriptan/ naproxen), somnolence, and dry mouth (rizatriptan), and dizziness (zolmitriptan group) were reported with the triptans.Item Kasai Portoenterostomy at a Slightly Delayed Age and Native Liver Survival in Children With Biliary Atresia: Single Center Experience(Indian Academy of Pediatrics, 2023-08) Ramakrishna, Somashekara Hosaagrahara; Nayak, Samar Pratim; Rao, Sanjay; DCruz, Ashley Lucien Joseph; Garg, Mansi; Ramachandran, KalyaniObjectives: We studied the modifiable prognostic factors that extend native liver survival at 2 years after Kasai portoenterostomy (KPE). Methods: We reviewed hospital records of patients with neonatal cholestasis, with focus on infants diagnosed with biliary atresia in a tertiary care hospital between January, 2014 and May, 2021. We determined the association of outcome with clinical and laboratory variables. Results: Infants who underwent KPE at a median (IQR) age of 76 (72-79) days had best outcomes, with minimal severe post-KPE complications and 2- year survival rate of 84.6%, compared to other infants (younger and older age at KPE). The median (IQR) weight at KPE in this group was 4.66 (4.2, 5.0) kg. Conclusions: In contrast to traditional recommendations, babies with median age at KPE of 76 days had superior native liver survival (84.6%) and reduced post-KPE complications, as compared to earlier KPE age. Nutritional status and weight of infant at KPE could be associated with this survival difference. This observation needs confirmation through multicentric prospective studies in different settings.Item Warning Signs on Short Hammersmith Neonatal Neurological Examination and Correlation With Hammersmith Infant Neurological Examination Global Score in Preterm Infants: A Prospective Cohort Study(Indian Academy of Pediatrics, 2023-08) Bhandankar, Manisha; Metgud, DeepaObjective: To describe the findings of short Hammersmith Neonatal Neurologic examination (HNNE) in preterm small for gestational age (SGA) and appropriate for gestational age (AGA) infants at term equivalent age (TEA) and to correlate it with the global score of Hammersmith Infant Neurologic Examination (HINE) performed at 4-6 months of corrected age. Methods: This prospective cohort study was conducted at the high risk follow-up clinic of our center. 52 preterm infants born <35 weeks gestation were examined using HNNE at TEA and followedup till 4-6 months of corrected age to estimate HINE. Results: 20 infants (38.5%) had warning signs and 9 (17.3%) had abnormal signs on short HNNE. 12 (37.5%) AGA infants and 6 (30%) SGA infants had global score <65 at mean corrected age (SD) of 4.3 (0.7) weeks and 4.5 (0.8) weeks, respectively. Very preterm, birth weight <1000 g and SGA was significantly associated with global scores <65. Conclusion: Early identification of warning signs among SGA infants using Short HNNE screening at TEA can be useful to initiate early intervention. There was no statistically significant difference in global scores by HINE among AGA and SGA infants in early infancy.Item Sustainable Food Systems: The Way Forward in the Indian Context(Indian Academy of Pediatrics, 2023-08) Chaudhary, AbhishekCurrent Indian food system is not sustainable as it fails to fulfil its primary function of delivering adequate nutrition to its population while causing high environmental impacts along with widespread poverty among farmers. Here, we discuss how recent research has enabled quantification of a country’s current food system sustainability through multiple indicators across nutrition, environmental, and economic dimensions. This data can be used by policy makers, farmers, businesses, consumers, and other stakeholders to make scientific evidence-based informed decisions regarding which diets and food items to promote or discourage in near future to make progress towards sustainability. While several government initiatives are underway to transform Indian agri-food sector, the need of the hour is multi-sectoral collaboration across ministries along with dietary behavior changes by consumers, and innovations in agritech and food formulations by businesses to make farm production more efficient and products more nutrient dense.Item SCN1A Gene Mutations in Indian Children With Epilepsy: Single Center Experience(Indian Academy of Pediatrics, 2023-08) Maruthi, Goske; Dhayalan, Pavithra; Kumaran, Priyanka; Soundraoandiyan, Jagatheesh; Gambhir, PrakashObjective: To study prevalence of SCN1A gene mutations in complex seizure disorders. Methods: Retrospective laboratory based study on samples sent for molecular diagnosis in complex seizure disorders. Exome sequencing was performed. Phenotype- genotype correlation was done for patients showing variants in SCN1A gene. Results: 364 samples were evaluated; of which, 54% were of children below 5 years of age. SCN1A mutations were seen in 50 samples of patients with complex seizure disorders; 44 variants were identified. Types of seizure disorders commonly associated were Dravet syndrome and genetic epilepsy with febrile seizures. Conclusions: SCN1A mutations are common in complex seizure disorders, especially Dravet syndrome. Early identification of SCN1A gene in etiology is important for selection of correct antiepileptic and counselling.Item Antibiotic Susceptibility, Carrier State and Predictors of Outcome of Staphylococcus aureus Infections in Hospitalized Children(Indian Academy of Pediatrics, 2023-01) Kaur, Kiranpreet; Khalil, Sumaira; Singh, NP; Dewan, Pooja; Gupta, Piyush; Shah, DheerajObjectives: To evaluate the antibiotic resistance pattern, clinical profile and predictors for adverse outcomes in children hospitalized due to staphylococcal infection; and the frequency of nasal and axillary carrier states in these children. Methods: This descriptive study enrolled 100 symptomatic children (aged 1 month - 12 years) in whom S. aureus was isolated from cultures of blood, pus or cerebrospinal fluid. All samples were processed as per the Clinical and Laboratory Standards Institute (CLSI) standards. Antimicrobial susceptibility was tested using disc diffusion method; minimum inhibitory concentration (MIC) for vancomycin was measured using E strips. Predictors for poor recovery were determined by univariate and multivariable logistic regression analysis. Results: Skin and soft tissue infections were the most common (47%) followed by respiratory infections (37%). Methicillin-resistant Staphylococcus aureus (MRSA) was detected in 62%, out of which 63% (39/62) were multi-drug resistant. Carrier state was present in 49% (93% MRSA); 80% were axillary carriers. High MIC (>1 µg/mL) for vancomycin was seen in 65% of patients, and was the only factor associated with poor recovery [aOR (95%CI) 5.3 (1.6,18.5); P=0.008] on multivariable logistic regression analysis. Conclusion: MRSA is the predominant strain in severe staphylococcal infections requiring hospitalization, and majority of them are multidrug resistant. High MIC to vancomycin among S. aureus is an emerging concern.Item The Need for Food Fortification With Zinc in India: Is There Evidence for This?(Indian Academy of Pediatrics, 2023-07) Pullakhandam, Raghu; Kulkarni, Bharati; Kurpad, Anura V; Sachdev, Harshpal SThere has been recent advocacy for food fortification with zinc in India. However, there are three important conditions that should be established before fortifying food with any micronutrient, which requires that there should be i) Established high prevalence of biochemical or sub-clinical deficiency (?20%), ii) Low dietary intakes that increase the risk of deficiency, and iii) Evidence of efficacy of supplementation from clinical trials. For zinc, all three conditions are not satisfied. The prevalence of low serum zinc concentrations in Indian children is well below 20% (~6%), signifying that zinc deficiency is not a public health problem. There is no risk of dietary zinc inadequacy in Indian populations where intake has been measured. Finally, there is no robust evidence that zinc-fortified foods improve functional outcomes, even if the serum zinc concentration is increased. Thus, contemporary evidence does not justify the need for food fortification with zinc in India.Item Hemodynamic Responses to Recorded Maternal Voice Among Sedated Children in the Pediatric Intensive Care Unit: An Open-Label Randomized Controlled Trial(Indian Academy of Pediatrics, 2023-06) Mandal, Shreelata; Joshi, Poonam; Murry, Lumchio Levis; Lodha, RakeshObjective: To assess the effect of maternal audiotaped voice on clinical parameters of sedated children. Methods: A randomized controlled trial was conducted on 25 sedated critically ill children admitted to the pediatric intensive care unit. An audiotaped maternal voice was played to the children in the experimental group (n=13) via a headphone for 15 minutes, twice a day for 3 days. Children in the control group (n=12) received routine care without any additional auditory stimulation. Clinical and hemodynamic variables were recorded at 5 minutes interval three times. Results: Significant changes were observed in the mean (SD) heart rate (per minute) at 10 minutes [129.83 (19.14) vs 124.29 (14.90), P=0.051], respiratory rate at 5 minutes [44.38 (17.79) vs 34.65 (7.64), P=<0.001] and 10 minutes [42.79 (13.89) vs 35.44 (7.65) P=<0.001], systolic blood pressure at 5 minutes [95.24 (15.01) vs 101.02 (19.83) P=0.045], and mean blood pressure at 15 minutes [68.66 (13.61) vs 73.61 (17.59) P=0.051] mmHg between the experimental and the control group, respectively. Conclusion: Listening to recorded maternal voice had a positive effect on clinical parameters of sedated critically ill children.Item Assessment of QT Interval Abnormalities on Electrocardiogram in Children With Breath-Holding Spells(Indian Academy of Pediatrics, 2023-07) Kavthekar, Saiprasad Onkareshwar; Kavthekar, Swati Saiprasad; Bharati, Hemant Pralhad; Patil, Rahul Ravso; Kurane, Anil BapuraoObjective: To assess QT interval abnormalities among children with breath-holding spells. Methods: This case control study included 204 children (104 cases of breath-holding spells and 100 healthy children) younger than 3 years. Breath-holding spells were evaluated for age of onset, type (pallid/cyanotic), triggering factors, frequency and presence of family history. Twelve- lead surface electrocardiogram (ECG) was analyzed for QT interval (QT), corrected QT interval (QTc), QT dispersion (QTD) and QTc dispersion (QTcD) in milliseconds. Results: The mean (SD) QT, QTc, QTD and QTcD interval in milliseconds were 320 (0.05), 420 (0.07), 61.15 (16.20), 102.3 (17.24), respectively for breath-holding spells as compared to control group [300 (0.02), 370 (0.03), 38.6(14.28), 78.6 (14.28), respectively] (P<0.001). Similarly, pallid breathholding spells had prolonged mean (SD) QT, QTc, QTD and QTcD interval in milliseconds [380 (0.04), 520 (0.08), 78.88 (10.78), 123.33 (10.28), respectively] as compared to cyanotic spells [310 (0.04), 400 (0.04), 57.44 (14.64), 97.90 (15.03), respectively] (P<0.001). The mean QTc interval was 590 (0.03) and 400 (0.04) milliseconds in prolonged and non-prolonged QTc group, respectively (P<0.001). Conclusion: Abnormal QT, QTc, QTD and QTcD were observed among children with breath-holding spells. ECG should be strongly considered, especially in pallid, frequent spells occurring at younger age and having positive family history, to identify long QT syndrome.Item Effect of Clinician-directed Technical Specifications on Entrance Skin Doses in Neonates(Indian Academy of Pediatrics, 2023-07) Shrikant, Ketaki Nawlakhe; Pournami, Femitha; Panackal, Anila V; Prithvi, Ajai Kumar; Prabhakar, Jyothi; Jain, NaveenObjectives: To compare the entrance skin doses (ESD) before and after implementation of a radiation safety policy in neonates (RSN), which focused on clinician-directed technical specifications on the digital X-ray machine. Methods: Prospective observations included two sets of X-rays: Before (BRSN) and after (ARSN) implementation of RSN (documented indication for Xray/expected posttest findings, settings of 40 kVp, 0.5 mAs, film-focus distance 100 cm, gonadal-shield, optimal collimation, and post-shoot image-enhancement). Results: 33 and 32 X-rays were analyzed in respective groups. Mean (SD) of calculated and machine-quantified ESD (µGy/m2) was higher in BRSN group as compared to ARSN group (P <0.001). All ARSN X-rays were interpretable for expected post-test findings. Conclusion: Clinicians’ cognizance of ability to make consequential bedside technical specifications, can reduce ESD without affecting interpretability. These single observations could have a larger impact in sick neonates, where multiple X-rays are done.Item Overall and Event Free Survival of Childhood Cancer - Report From a Hospital-based Cancer Registry in Northern India, 2013-21(Indian Academy of Pediatrics, 2023-07) Arora, Ramandeep Singh; Kumari, Rashmi; Adhana, Arun; Tripathi, Rashi; Sachdev, Mansi; Jain, PrachiObjectives: Using data from a hospital-based cancer registry (HBCR) in the private sector in Northern India, we provide overall survival (OS) and event-free survival (EFS) for childhood cancer patients. Methods: All newly diagnosed childhood (age <18 years) cancer patients in our HBCR registered between March 1, 2013 till July 31, 2021 were eligible. 3-year and 5-year OS (death was an event), EFSc (death, progression/relapse was an event), and EFSa (death, progression/relapse, abandonment of treatment was an event) were calculated using the Kaplan-Meier method. Regression analysis was done to see their association with demographic, diagnostic and treatment variables. Results: 705 newly diagnosed children (36.2% female) with cancer were registered. Common cancers were leukemias (26%), CNS tumors (20%) and bone tumors (16%). 202 (28.6%) had experienced an event at median follow up of 1.95 years (range 0-8.14 years), which included 23 (3.3%) who abandoned treatment. The 3- year OS, EFSc, EFSa were 70.8%, 64.4% and 63.6%, respectively. Correspondingly, 5-year OS, EFSc, EFSa were 66%, 58.6% and 57.5%, respectively. There was no significant difference by age group, gender, nationality, and if cancer directed treatment initiated elsewhere. The OS, EFSa and EFSc by the main and the extended International Childhood Cancer Classification categories varied significantly (P<0.001). Conclusion: We add more recent registry-based OS data on childhood cancer in India and present the first estimates on EFS.