International Journal of Contemporary Pediatrics

Figaro crowns- brings a smile or a frown?

Anushka Das, Neeraja R., Ila Srinivasan, Yuthi Milit — Mon, 27 Mar 2023 00:00:00 +0000

Initially, the treatment option for grossly decayed teeth was extraction, but due to advancements in paediatric dentistry, it has now shifted to restoration. Earlier, only full-coverage stainless steel crowns were in use, but they have a disadvantage for aesthetic restorations. Following this many crowns have been introduced into paediatric dentistry to preserve the tooth for function and aesthetics. Investigators have argued that certain restorations are superior to others, yet the hunt for the ideal aesthetic restoration goes on. This case series aims to check the efficacy, aesthetics and ease of placement of the newly introduced Figaro crowns. This case series reports 4 cases in which Figaro Crowns were used for aesthetic full coronal restorations in children aged between 3- 6 years. Figaro crowns are time efficient, advantageous in uncooperative placement and can be done with minimal tooth structure reduction. Figaro crowns appear to be the alternative to zirconia crowns and strip crowns as they have superior aesthetics and minimal reduction of tooth structure, making them more time-saving compared to zirconia crowns.

Congenital hand anomalies and rare syndromes in children

Deepa Shetty, Paras Patel, Rohan Shetty, Sanjay Vansh — Mon, 27 Mar 2023 00:00:00 +0000

Congenital hand anomalies and associated rare syndromes in children are commonly seen in clinical practice and require complete clinical, radiological and genetic evaluation. The purpose of this case series is to describe four rare syndromic children with varied hand anomalies and differences. Three of the children are female and one is a male. Distal limb defects from simple polydactyly, clinodactyly to cleft hand were identified including preaxial anomalies. Significant clinical problems noted were chiefly cosmetic and altered self-image was also noted in one child. The orofacial clefting noted in the child with ectrodactyly ectodermal dysplasia (EEC) syndrome required repeated surgery though the child had minimal feeding difficulty and significant speech delay. Multidisciplinary management is necessary with the early involvement of clinical geneticist.

Effect of yoga on bio-physiological parameters among overweight and obese adolescents: a case series study

Saritha G., Anita David, P. Stalin, J. Julius Xavier Scott — Mon, 27 Mar 2023 00:00:00 +0000

The number of overweight and obese children in India was 19.3% (NFHS-5), which was a big jump from the previous number of 6.3% (NFHS-4). A school-based case-series design was conducted to assess the effect of yoga on biophysiological parameters among overweight and obese adolescents (11-13 years) at selected schools in Puducherry. The census method was used to screen 286 adolescents, aged 11 to 13, for height and weight. The study included 18 overweight boys and girls. Bio-physiological parameters were measured at baseline, three months, and six months after yoga practice. The results of the study showed that a significant difference was found after yoga practice. The mean difference in weight reduction was 4.0, the BMI was 1.7, the waist circumference was 4.6, the hip circumference was 6.2, the triceps skin fold thickness was 4.9, and the sub capsular skin fold thickness was 5.7. The mean difference in pulse reduction was 8.8, the systolic blood pressure was 11.0, and the diastolic pressure was 6.9. In terms of body composition, the decrease in fat (%) was 3.4, water (%) was 2.4, extracellular volume (ECW) (%) was 1.1, intracellular volume (ICW) (%) was 2.0, and the body fat mass index (BFMI) was 1.7. The study concluded that yoga is effective in managing obesity and building healthy citizens in future adolescents.

Bibliometric analysis of published research on pediatric health disparities

Jennifer W. Glusman, Kathryn Doherty, Kacie E. Johannes, Allison W. Willis — Mon, 27 Mar 2023 00:00:00 +0000

This study aimed to examine the current evidence in the medical literature on health disparities in the pediatric population. A bibliometric analysis of published research focused on health disparities in pediatric patients was conducted to analyze publication trends. A search of the Scopus database was conducted using keywords that were determined to be appropriate by the authors. This analysis helps determine which pediatric subspecialties may be lacking in health disparity research. A total of 2,380 publications from 1979 to 2021 met the inclusion criteria using the keywords “pediatric health disparities.” The number of articles published increased over the observation period, with 679 published between 2020-2021. When grouped by subspecialty, the majority of articles were associated with general pediatrics, followed by oncology, cardiology, nephrology, endocrinology, gastroenterology, neurology, pulmonology, and urology. When organized by health disparity risk factor or population, socioeconomics was the most common followed by race, urban, gender, rural, mental disability, physical disability, gender identity, religion and sexual orientation. The United States published more articles than any other country. The National Institute of Health has funded the majority of pediatric health disparities research. Pediatrics was found to be the leading journal of pediatric health disparity research. Research on pediatric health disparities is most frequently published in the United States, and is most focused on socioeconomics in a primary care setting. There is a large gap of research conducted in pediatric subspecialties, and on health disparities such as religion, sexual orientation, gender, and gender identity.

Donation of women's milk to the neonatology department at the Androva hospital in Mahajanga

Mon, 27 Mar 2023 00:00:00 +0000

Background: The functioning of a milk bank begins with the donation of milk from women donors. The objective of our study was to describe the demographic profile of mothers who donate milk and their practice of donating milk in the neonatology department at the hospital Center Androva Mahajanga.

Methods: This is a prospective, descriptive study over a 7-month period, from August 2019 to February 2020. Were included all healthy breastfeeding women who agreed to donate excess breast milk.

Results: The participation rate of breastfeeding women in milk donation was 6.6%. Vaginal delivery was the most common (85.9%). The majority had no knowledge about milk donation (83.8%). Manual breast pumping was the most used (43.8%). The average total amount of milk collected by a mother from the beginning to the end of the donation was 613 ml. The average duration of donation by a mother was 6.4 days.

Conclusions: The participation and knowledge of mothers on the donation of women's milk was low, although it can improve the survival of newborns.

Events that occur in premature babies before death during their hospital stay

Rowshan Jahan Akhter, Kanta Chowdhury, Nishat Jahan, M. Mahbubul Hoque — Mon, 27 Mar 2023 00:00:00 +0000

Background: Globally, more than 80% of newborn babies die due to LBW. PT/LBW babies usually die because of complications from prematurity rather than the prematurity itself. Due to prematurity, they face several problems during their early life, like temperature control, feeding problem, poor immunity, respiratory insufficiency etc. and especially during SCANU and NICU stay they develop sepsis, NEC leading to their death. The aim of this study was to find out the events that occur before the death of premature neonates admitted in the NICU.

Methods: A retrospective study conducted in the NICU of Department of neonatology of Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh during the period from January, 2021 to December, 2021. During this period preterm babies who died were analyzed.

Result: During study period total 95 preterm babies died. Their mean± SD of birth weight was 1228.26±115.60. Majority (40%) of neonates were 28-31 weeks old and majority (59%) neonates were male. We found 27.3% had PNA, 12% had PDA, 19% had RDS and 33.6% had only prematurity during admissions. Among all neonates, 51.58% developed sepsis, 40% pneumonia, 34% pulmonary hemorrhage 20% intra ventricular hemorrhage, 25% NEC, 13.6% BPD and 12% PDA respectively and finally died.

Conclusion: In our study, 32 (33.6%) babies admitted with only prematurity and rest were admitted with other diagnosis like PNA (27.3%), RDS (19%,) PDA (12%) and CHD (9.4%). However, they finally died of Sepsis 49 (51%), Pneumonia 38 (40%), IVH 19 (20%), NEC 24 (25.2%), BPD 13 (13.6%), Pulmonary Hemorrhage 33 (34.7%).

Study of electroencephalogram characteristics in neurological conditions in pediatric tertiary care hospital

Mon, 27 Mar 2023 00:00:00 +0000

Background: Electroencephalogram (EEG) remains a veritable tool in the diagnostic workup of seizures and childhood epileptic syndromes. EEG has a significant role in substantiating the clinical suspicion of epilepsy, the classification of seizures, and the management of childhood epilepsy.

Methods: This study was retrospective descriptive with convenience sampling where two-years EEG recordings were included and the reporting were reviewed. The desired variables were encrypted and descriptive analysis made via statistical software SPSS version 20.

Results: There was 499 EEG done in a two-year time period where the female children were (n=205, 41.1%) and mean age was 66 months. There were (n=317, 63.5%) children from out of Kathmandu valley. The most common indication for EEG recommendation was seizure without impaired consciousness (69.7%) and least common indication was seizure with impaired consciousness (8.4%). The rate of detection of EEG abnormalities in seizure without impaired consciousness was 43.9% while that in seizure with impaired consciousness was 38.1%. Among the most common EEG abnormality, abnormal sleep EEG record suggestive of generalized epilepsy most of the children had a history of seizure without impaired consciousness (71.4%) and least presented with seizure with impaired consciousness.

Conclusions: The abnormality detection rate of epilepsy was higher in chance if done in early ages. The possibility of findings in EEG are higher with the history of seizures and the perinatal insult as well as birth asphyxia. EEG should be carried out to support the diagnosis of epilepsy in children, and a normal EEG won't be totally excluding epilepsy.

Routine fetal echocardiography for detection of congenital heart disease-mandatory or an optional tool?

Sat, 04 Mar 2023 00:00:00 +0000

Background: Aim of the study was to assess the role of fetal echocardiography in identification of antenatal cardiac defects in a tertiary care centre in North India.

Methods: Prospective study done in a tertiary care centre in North India on female patients presenting to a tertiary care centre with pregnancy over a period of two years. All routine investigations were done and specific examination in the form of a screening fetal echocardiography was done in the selected two groups of patients, high and low risk.

Results: A sample size of 250 patients with intrauterine pregnancy of 18-28 weeks of gestation was analyzed. A detailed history, examination and fetal echocardiography was performed in all the patients. In group I-105 patients with elevated risk factors (for congenital heart disease) (CHD) were included whereas in group II-145 patients with low risk factors were taken. The various demographic parameters among the two groups were almost similar. The outcome was also similar in two groups with nil neonatal mortality. Except for the NICU admission between the two groups, rest all the parameters whether maternal or neonatal were not statistically significant.

Conclusions: In the present study, we tried to find out role of fetal echocardiography for detection of CHD in high and low risk cases. The results were almost similar in both high and low risk group. Indications of referral for fetal echocardiography cannot be listed as it was found that almost similar percentage of heart defects are seen in both groups I and II.

Perinatal outcome of neonates born to COVID SARS-CoV-2 positive mothers: a comparative study

Thu, 16 Mar 2023 00:00:00 +0000

Background: The entire world is experiencing a difficult scenario because of COVID-19 infection caused by severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). It is imperative to have comprehensive information on how COVID-19 affects pregnancy-related outcomes when compared to outcomes in uninfected pregnant women.

Methods: Neonates born to SARS-CoV-2 positive mothers were included in the case group (n=127) and neonates born to SARS-CoV-2 negative mothers were included in the control group (n=127) in this prospective comparative study. In both groups, the mothers were matched for age, body mass index (BMI), morbidities, and parity. Neonatal morbidity and mortality in both groups were examined after neonates were monitored for 7 days after delivery.

Results: Neonatal morbidity was more among neonates born to COVID positive mothers (p<0.05) but mortality did not show any significant difference. There was statistically significant difference in gestation and birth weight among cases and controls. No neonate born to COVID positive mother was tested positive for COVID by reverse transcriptase-polymerase chain reaction (RT-PCR). Mean APGAR score at 1min was less among neonates born to COVID positive mothers but at 5 minutes it was almost similar among both groups.

Conclusions: According to the study's findings, maternal COVID-19 infection significantly affects perinatal outcomes, neonatal morbidity, birth weight, and neonate gestational age.

Accuracy of Shukla’s formula for depth of insertion of umbilical venous catheter

Fri, 17 Mar 2023 00:00:00 +0000

Background: The use of umbilical venous catheter (UVC) is an essential part of neonatal care allowing delivery of intravenous fluids, nutrition, and medication. It is important to know the position of the UVC tip accurately at the first attempt to prevent complications and minimize handling. We aimed to determine the precision and accuracy of Shukla’s formula developed to guide UVC placement and to evaluate the probability of UVC placement at desired radiological markings using weight-based Shukla’s formula.

Methods: This study was carried out at NICU in NRI medical college, a tertiary care center in Chinakakani, Andhra Pradesh, India. A prospective observational study was done from December of 2021 to September 2022. With an aim to study the accuracy of Shukla's formula in assessing the depth of insertion of UVC, depth was calculated and position of the tip of the catheter confirmed by x-ray.

Results: We have taken 138 neonates in our NICU unit with mean gestational age of 33.91 wks. and with mean birth weight of 1.91 kg. Out of 138 infants 99 had a successful ideal UVC placement using Shukla's formula. In reference to gestational age out 83 newborns in gestational age between 32-36 weeks 62 had ideal placement of UVC. In reference to birth weight ideal position of the UVC was seen in 73% of newborns.

Conclusions: Shukla’s formula provided a reasonably accurate probability of achieving ideal UVC position in most of our babies: accurate in 72%.

Effect of perinatal factors on cord blood thyroid stimulating hormone levels

Vikram A. Pawar, Swati Jain, Vaibhav Pustake, Poonam Pawar — Mon, 27 Mar 2023 00:00:00 +0000

Background: Screening for congenital hypothyroidism (CH) is a routine practice in most developed countries of the world. This can be done by measuring cord blood thyroid stimulating hormone (CBTSH). Apart from foetal thyroid status and iodine nutrition status of the population, many perinatal factors may also affect CBTSH. The influence of these perinatal factors may affect the sensitivity of CBTSH as a screening tool for CH. The present study was carried out to study the influence of various perinatal factors on CBTSH level.

Methods: It was a cross sectional study conducted in tertiary care centre in North Maharashtra. 793 new-borns were included in study. Effects of perinatal factors like maternal age, parity, gender of the baby, birth weight, mode of delivery, gestational age, birth asphyxia on CBTSH was analysed with appropriate scientific method.

Results: The mean TSH level in the study group was 7.56±3.9 mIU/l. Among the associated factors vaginal delivery, low gestational age, low birth weight and birth asphyxia were significantly associated with elevated CBTSH values. Hence, any rise in cord blood TSH should be seen in the light of these factors.

Conclusions: Among all the associated factors, primi-parity, vaginal delivery, low gestational age, low birth weight and birth asphyxia were significantly associated with elevated CBTSH values. However, no association was observed between CBTSH values and gender of the baby and maternal age.

Renal involvement and outcome in children with COVID-19 infection

Neha Pandey, Alpana Ohri, Amish Udani, Chintan Shah — Mon, 27 Mar 2023 00:00:00 +0000

Background: COVID-19 infection is known for multi-organ involvement of which Kidney injury predominates. AKI is associated with raised mortality in intensive care setting worldwide. Due to scarcity of data of renal involvement in pediatric COVID-19 population, we aimed to study its incidence in pediatric population requiring admission for COVID 19.

Methods: This was a single centred observational study where all the indoored COVID-19 infected children were looked for any form of renal involvement. We divided the study population into subgroups of those having any underlying renal ailment and the other without any underlying illness.

Results: 342 patients with COVID-19 infection were enrolled. Renal involvement was seen in 38 (11%) subjects. Of them 31 subjects developed AKI. Maximum number of population had severe/ stage III AKI (as per KDIGO criteria). Among the AKI subgroup (N=31), 41.9% (n= 13) required acute RRT of which 6 subjects were successfully discharged. 20/31 (64.5%) subjects of AKI subgroup were discharged with complete renal recovery and 11/31 (35.4%) had expired. Among the 7 subjects who did not develop AKI, all were discharged successfully.

Conclusions: AKI occurred in significant proportion of study population with SARS-Co-V2 infection. AKI subgroup reports higher mortality rate which is proportional to the stage of AKI.

Hypoglycemia in breastfed neonates: a hospital-based study

Abhishek Chakraborty, Monika Deb — Mon, 27 Mar 2023 00:00:00 +0000

Background: Neonates has well-coordinated adaptation system which maintains the blood sugar at certain safe level in extra uterine life. However certain intrauterine risk factors alter this adaptation system leading to hypoglycemia in early post-natal period. Most of the time hypoglycemic episodes are transient but sometimes there may be recurrent or prolonged hypoglycemia leading to permanent insult in brain and neurological deficit in post-natal life. Aims and objective of the study was to find out incidence of hypoglycemia in exclusively breastfeed neonates and the risk factors associated with this in the post-natal ward of a tertiary care centre in North-East India.

Methods: This is a prospective study conducted for a period of six month, where 112 exclusively breastfeed neonates who were shifted immediately to post-natal ward were included. Capillary blood sugar was checked at 1, 3, 6, 12, 24, 48 and 72 hours of life. Neonates with capillary blood glucose less than 40 were considered hypoglycemic. All the hypoglycemic babies were extensively evaluated for different intrauterine and post-natal risk factors.

Results: Incidence of hypoglycemia was 16% (18 out of 112 babies). Significant numbers (30.5%) of LBW babies had hypoglycemia, where as 6.5% of normal birth weight babies had hypoglycemia. 38.8% of preterm babies had hypoglycemia where as 11.95% of term babies had hypoglycemic episodes. 71.4% (5 out of 7 babies) of neonates born from diabetic mother. All the large for date infants of diabetic mother had hypoglycemia.

Conclusions: Our study came to a conclusion that incidence of hypoglycemia is not very uncommon finding in exclusively breastfeed neonates especially those with risk factors. Routine capillary blood glucose screening is utmost important to pick up the babies with hypoglycemia to prevent immediate and long-term complication.

Kawasaki like illness in COVID versus Kawasaki disease in pre-COVID era

Aijaz Ahmad Bhat, Amber Bashir, Muzafar Jan, Khurshid Ahmad Wani — Mon, 27 Mar 2023 00:00:00 +0000

Background: In children and adolescents, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is mostly responsible for mild respiratory symptoms, in contrast with severe forms reported in adults. An association between the disease caused by SARS-CoV-2, coronavirus disease 2019 (COVID-19), and late manifestations of vasculitis has been increasingly suspected.

Method: All children and adolescents (aged ≤18 years) who were diagnosed with Kawasaki disease (KD) and KD shock syndrome (KDSS) as per AHA and Kanegaye et al criteria. From each patient we obtained at least two nasopharyngeal swabs to test for SARS-CoV-2 using reverse transcription- polymerase chain reaction (RT-PCR). We also took blood samples to test for IgG antibodies against SARS-CoV-2.

Results: Leucocytosis was found in majority with median leucocyte count of 10100 predominant neutrophila. Inflammatory markers D dimer, serum ferritin and fibrinogen level were raised. The 43% patients had coronary artery aneurysm. The 75% patient had some form of Left ventricular systolic dysfunction. All patients received IVIG while 13 patients received both IVIG and methyl predinisolone. Ionotropes were used in 68%. Two patients received tocluzumab.

Conclusions: In this study we found increased incidence of Kawasaki like illness temporally associated with COVID-19. Older age of presentation with more atypical presentation.

Assessment of gestational age using anthropometric parameters in newborns

Bharathi Asokan, Saravanan S. — Mon, 27 Mar 2023 00:00:00 +0000

Background: Estimation of gestational age was needed for the measurement of intrauterine growth and associated conditions, such as whether infants with a low birth weight are preterm or growth-retarded, and identifying high-risk status for developmental delay. Menstrual history was unreliable in most of the cases and ultrasound was not feasible in low resource area, so in this study we were used anthropometric measurements as a simple tool for assessment of gestational age.

Methods: This study was a cross sectional observational study conducted in 380 babies born in January 2020-December 2022 in department of pediatrics, Rajah Muthiah Medical College and Hospital. The data were collected using semi-structured questionnaire and anthropometric assessment. The Epi info 7 software was used to analyse the data.

Results: The mean gestational age among neonates studied was 37.06±2.32 weeks, the mean head circumference was 33.48±1.01 cm and majority of them 141 babies had head circumference 33 cm, the mean chest circumference was 30.69±1.08 cm. and majority of the babies, had chest circumference of 30 cm, the mean foot length was 7.64±0.24 cm, the mean length of the babies was 47.9±1.26 cm.

Conclusions: Our study conclude that anthropometeric parameters in combination (head, chest circumference, length, foot length, birth weight) and as single parameters (foot length) was a simple and easy tool for assessing gestational age in low resource setting where we can make quick referral.

Epidemiology and clinical course of bronchiolitis in hospitalized children in tertiary care hospital in Kashmir

Mohammad Imran Malik, Khurshid Ahmad Wani, Ruhail Ahmad Baba, Irshad Ahmad Kumar — Mon, 27 Mar 2023 00:00:00 +0000

Background: Bronchiolitis is the commonest lower respiratory tract infection in children < 2 years of age and is responsible for the majority of their pediatrician visits and hospital admission during the winter season. The aim of this study was to describe the epidemiological data, seasonal trends, clinical characteristics, and outcomes of children admitted with bronchiolitis in pediatric hospital GMC Srinagar.

Methods: This was a retrospective observational study in children less than 2 years of age admitted in department of pediatrics in GMC Srinagar. Data were collected through review of the medical records of patients with a diagnosis of bronchiolitis on discharge and analyzed through SPSS 20.

Results: A total of 228 infants were enrolled in the study. The majority were males (60.08%). The median age on admission was 5.5 months, exclusive breastfeeding was the mode of feeding in majority and 8.77% were ex-preterm. Respiratory syncytial virus (RSV) was identified in majority (103) and admission peak was from October to March. Most of the patients presented on day 3 of the illness. Most patients 45.17% were having feeding difficulties and chest auscultation was normal in about 22% of the children. Oxygen supplementation was administered to 85.52% of the children. The 32 children (14.03%) required admission to PICU. Mechanical ventilation was required in 6 children (18.75%). No death occurred in infants while in the hospital.

Conclusions: RSV has been found to be the main responsible virus. Management of bronchiolitis is usually symptomatic as recommended by most of the guidelines.

Physical activity during COVID-19 pandemic and its impact on glycemic control in children with type 1 diabetes mellitus

Rubi Zined, Rimple Sharma, Smita Das, Rajni Sharma — Mon, 27 Mar 2023 00:00:00 +0000

Background: Physical activity is one of the important factors affecting glycemic control in type 1 diabetes mellitus (T1DM). During COVID-19 pandemic the government imposed restrictions to prevent the spread of COVID and physical activity of children was curtailed. We assessed the physical activity during COVID-19 pandemic restrictions (from September 2020 to September 2021) and its association with their glycemic control.

Methods: 48 children with T1DM receiving treatment in paediatric endocrinology outpatient department (OPD), AIIMS, New Delhi were enrolled. Socio-clinical data were collected using pre-validated and tested self-structured tool, physical activity was assessed using global physical activity questionnaire and glycemic control was assessed by glycated haemoglobin (HbA1C) and compared to baseline level before the onset of pandemic.

Results: Among 48 children (11.2±3.7 years, 25 M: 23 F), 79.2% fulfilled the 60 minutes’ requirement of physical activity/day. Moderate negative correlation was found in recommended physical activity duration and HbA1c during COVID-19 pandemic. However, there was a significant increase in the HbA1C level from 7.6±1.5 to 8.5±1.8 during COVID-19 pandemic.

Conclusions: There was a moderate negative correlation between duration of physical activity and HbA1c of children. In spite of restrictions imposed by the government, children who were physically active were able to maintain good glycemic control. Although there was significant increase in the mean HbA1c of children during COVID-19 pandemic but the percentage of hyperglycemic events was significantly lower among the children who had walked/rode bicycle for going from one place to another and who had more rooms to play at home had good glycemic control.

Bacteriological profile and antibiotic susceptibility pattern of neonatal septicaemia-a prospective study

Deepali Jaybhaye, Shruti Chandra, Sukhmeen Johar, Abhijit Sanjay Nagre — Mon, 27 Mar 2023 00:00:00 +0000

Background: Neonatal sepsis is one of the major cause of mortality and morbidity Globally, objective of this prospective study was to evaluate the microorganisms profile involved in neonatal septicemia and their antibiotic susceptibility.

Methods: This prospective study conducted in neonate admitted to Mahatma Gandhi Mission Medical College and Hospital Aurangabad Maharashtra in NICU, from June 2021 to May 31, 2022. Data was analysed by percentages of each antibiotic used. And which organism was responsible for neonatal sepsis.

Results: In this study we have found that high bacterial prevalence of Klebsiella at 36%, Enterococci at 23.5 and staph aureus at 19.8% in neonatal sepsis. While the antibiotics most used was Piperacillin and tazobactam, meropenam, colistin, cefotaxime, amikacin. In our setting we found that bacteria are still sensitive to third generation cephlosporings.

Conclusions: From our study we can conclude that, in our tertiary care hospital Klebsiella is major cause of neonatal sepsis, along with-it sensitivity with effectiveness of cephalosporin.

A randomized controlled trial to compare the success rates and efficacy of high flow nasal cannulae versus nasal continuous positive airway pressure in post extubation period in neonates

Srinivas C. Awanti, Ramesh R. Pol, Arun B. Katti — Mon, 27 Mar 2023 00:00:00 +0000

Background: Nasal continuous positive airway pressure (nCPAP) is the mainstay for non-invasive respiratory support for all respiratory distress neonates. Recent advances in Heated humidified high flow nasal cannula (HHHFNC) usage with enhanced humidity, and improved comfort factors have led to its widespread use, at times replacing nCPAP in many neonatal settings. The present study was to assess the efficacy and safety of HHHFNC compared with nCPAP for non-invasive respiratory support in post-extubation period.

Methods: A hospital based randomized controlled trial was conducted in neonatal intensive care unit (NICU) of S. Nijalingappa Medical College and HSK Hospital, Bagalkot from January 2019 to June 2020. 140 post-extubated neonates were enrolled for the study after obtaining informed consent from parents, and those who were directly extubated to no support and with major congenital anomalies were excluded from the study. Randomization was done by computer generated random number allocation method.

Results: Of the140 babies, 60% were males and 40% were females. Out of 84 male neonates, 47 (67.1%) were on nCPAP and 37 (32.9%) on HHHFNC and out of 56 female neonates 23 (32.9%) were on nCPAP and 33 (47.1%) on HFNC. In this study, 4 babies on nCPAP required re-intubation within 72 hours. 5 babies on HHHFNC, 3 babies required re-intubation within 72 hours and 2 babies within 5 days. The incidence of nasal trauma, hospital stay and duration of NIV support were less in HHHFNC group as compared to nCPAP group.

Conclusions: HHHFNC therapy is as effective as nCPAP therapy for the facilitation of extubation in neonates.

Evaluation and assessment of clinical and demographic profile, aetiology and outcome of status epilepticus in paediatric patients

Nirav Z. Garasiya, Priyanshi P. Patel — Mon, 27 Mar 2023 00:00:00 +0000

Background: Status epilepticus (SE) is one of the most frequent neurological emergencies that require prompt diagnosis and treatment. If not managed promptly, it may result in significant neurological morbidity and mortality.

Methods: It is prospective observational study. Study for clinical and demographic profile, aetiology, outcome in patient of status epilepticus.

Results: Occurrence of SE is in indoor paediatric patients was 2.05%. Male and female M: F ratio is 1.3:1. Fever was common associated symptoms in SE. The commonest type of seizure was generalised tonic-clonic seizure (GTCS). Infective etiology was most common amongst patients with SE. secondary epilepsy with CP was second most common cause followed by complex febrile seizure and primary epilepsy. In infants, metabolic etiology was the most common cause for SE. Majority of seizures were controlled only by benzodiazepines. Requirement of midazolam infusion was only in few patients and requirement of anesthetic agent was rare. Mechanical ventilation was frequently required in patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). Mortality was almost same in all age groups with SE. Mortality was directly proportional to duration of the SE and was highest in patient having >30 minutes of duration of seizure.

Conclusions: SE was more commonly associated with male gender and age <5 years. By improving hygiene, nutritional and vaccination status, overcrowding and education, we can reduce occurrence of SE, by reducing infections. Mortality can be reduced by immediate control of seizure and improving intensive care facilities.

Comparative evaluation of high flow oxygen therapy versus low flow oxygen therapy in the management of acute moderate bronchiolitis

Pragalatha Kumar A., Sujata Sajjanar — Mon, 27 Mar 2023 00:00:00 +0000

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence, no consensus exists on management. Hence the present study was conducted to find out the efficacy of high flow oxygen therapy (HFNC) versus low flow oxygen therapy in the management of acute moderate bronchiolitis.

Methods: Prospective randomized controlled study of 100 children aged between 2 months to 24 months with signs and symptoms of acute moderate bronchiolitis were admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2018 to June 2019 formed the study group, they were randomised into 2 groups, group A received high flow oxygen therapy and group B received low flow oxygen therapy.

Results: Out of 100 children enrolled in the study, 50 children (group A) received high flow oxygen therapy and 50 children (group B) received low flow oxygen therapy. At 24 hours the mean severity score for group A was 0.46±077 and group B was 1.86±0.86 (p<0.001). Maximum improvement in O₂ saturation was observed in group A compared to group B. The duration of hospital stay was shorter (2-3 days) in group A with a mean of 2.20 days and was longer (4-5 days) in group B with a mean value of 3.84 days which was statistically significant (p<0.001).

Conclusions: Children with acute bronchiolitis treated with heated humidified high flow oxygen (HFNC) had early improvement in the clinical severity score, reduced duration of oxygen requirement and decrease in the length of hospital stay. Hence heated humidified high flow oxygen (HFNC) is an effective and safe modality of treatment for children with acute moderate bronchiolitis compared to low flow oxygen therapy (p<0.0001).

A hospital-based cross-sectional study on health problems and the factors affecting the health of adolescent girls in rural population

Sreekavya P., Channabasavanna N., K. B. Mahendrappa, G. M. Kumar — Mon, 27 Mar 2023 00:00:00 +0000

Background: Many adolescent girls die prematurely due to various preventable or treatable reasons, and many more suffer from chronic ill-health and disability. The objective of this study was to assess the nutritional status, gynaecological problems, and psychological problems of adolescent girls attending the Paediatric OPD and ward. The aim was to study the prevalence of malnutrition in adolescent girls attending paediatric OPD and ward.

Methods: A cross-sectional hospital-based study was conducted on adolescent girls attending Paediatric OPD and ward of Adichunchanagiri institute of medical sciences and research centre, B. G. Nagara from November 2019 to November 2020. A total of 374 adolescent girls (10-17 years) were enrolled. Clinical examination was done after recording their weight and height. Body Mass Index was computed.

Results: Mean age of the study participants was 13.05 years, and majority of them were from low socioeconomic status. Around 41.2% of the fathers had semi-skilled jobs, and 19.3% of the mothers had clerical jobs, shop owners, or farmers. About 71.1% of the adolescents attained menarche with a mean age of 13.2 ± 0.11 years. 62% had normal BMI, followed by 25.1% with underweight, overweight in 9.4%, and obese in 3.5% of the adolescents. Around 62% of the adolescents were normally nourished, and 38% were malnourished.

Conclusions: Socioeconomic status, occupation of mothers, family types and diet of the adolescents had a significant association with poor nutritional status. It is important to understand the need for evaluation of malnourished adolescent females and their causes to prevent chronic illness and death among them.

Immediate outcome of meconium aspiration syndrome with respect to neonatal maturity and birth weight

Nazeer Ahmed, Rajesh Ashok Bavalatti, Achyut N. Thobbi — Mon, 27 Mar 2023 00:00:00 +0000

Background: About 13% of live births result in MSAF, and as gestational age at birth increases, this percentage increases as well. About 5% of babies born with MSAF develop MAS (meconium aspiration syndrome). The mortality rate from MAS is still as high as 3-5 percent, even with modern NICU care.

Methods: This study was a hospital-based a prospective observational study over an 18-months period, and all babies were admitted to the NICU who satisfied the MAS criteria were added in the study. The babies were monitored for their immediate outcome.

Results: MAS was more prevalent among mother who had a history of pregnancy-induced hypertension and in neonates who were in fetal distress. With a mean gestational age of 38-40 weeks and a mean birth weight of 2.76 kg, it is more common in term newborns and babies born by caesarean section. The most frequent cause of death, birth asphyxia, which accounted for 30.7% of cases of MAS, was most frequently associated with neonates who were depressed at birth.

Conclusions: Term and post-term neonates with weight >2.5 kg at birth are frequently associated with MAS. When meconium was present below the vocal cords, a low APGAR score at 1 minute and thick meconium were associated with a higher mortality rate. Non-vigorous babies require early and effective management, and early assisted ventilator support may be necessary when there is evidence of thick meconium. Asphyxiated babies should be carefully monitored. effective intrapartum suctioning, neonatal care, an accurate diagnosis and prompt treatment can significantly lessen the complications, morbidity and mortality in meconium aspiration syndrome.

Study of tuberculosis and other infections among children (age 2 to 18 years) with multitransfused thalassemia major

Gunjan V. Ramani, Namrata K. Makwana, Bhadresh Vyas, Mahesh Jani — Mon, 27 Mar 2023 00:00:00 +0000

Background: In India, beta thalassemia is prevalent across the country, with an average frequency of carriers being 3-4%. Infection is the major cause of morbidity and mortality in thalassemia, so regular screening is required for this disease.

Methods: Ethical clearance taken from institutional ethical committee. 150 thalassemia patients were enrolled in study after informed written consent. The medical histories were obtained from the patients and their files. Clinical examination was done including anthropometry, general examination, and systemic examination. MT and chest X-ray (CXR) were done for screening of tuberculosis infection. Blood samples were taken for S. ferritin, S. creatinine, serum glutamic pyruvic transaminase (SGPT), human immunodeficiency virus (HIV), and hepatitis B surface antigen (HBsAg) tests. Transfusion and other detail were taken like iron chelator, folic acid (FA) and calcium supplements.

Results: In this study, out of 150 patients, 4 patients were RVD positive and 34 patients were HCV positive. No Patients found HBsAg positive. No patient had Montoux test reactive and chest X-ray positive finding.

Conclusions: : Increase frequency of transfusion-related infection (hepatitis C, B, and HIV) in multi-transfused thalassemia. No correlation was found between tuberculosis infection and thalassemia patients in this screening study.

Safety and efficacy of combination of oral iron chelators in thalassemia major patients

Justin Thomas, Pramod Sharma, Manish Parakh, Deepshikha Mandloi — Mon, 27 Mar 2023 00:00:00 +0000

Background: To assess the safety and efficacy of combination of oral iron chelation therapy in transfusion dependent thalassemia patients and to compare it with other regimes.

Method: 150 transfusion dependent thalassemia patients with iron overload were recruited for a prospective, case control study. They were divided into 4 groups based on their chelation regime. The drugs used were deferasirox (DFX) alone, deferiprone (DFP) alone, DFP+DFX in combination, parenteral desferrioxamine (DFO) with either DFX or DFP with 50, 15, 70 and 15 in each group respectively. Doses used were DFX-30 mg/kg, DFP- 75 mg/kg/day, DFP+DFX-50 +30 mg/kg/day, DFO+DFP-25 mg/kg/d+50 mg/kg/day and DFO+DFX-25 mg/kg/d +30 mg/kg/d daily. Base line haematological, hepatic and renal profile and S. ferritin samples were collected and analyzed. Patients were monitored monthly for compliance and side effects. 30 patients were excluded during the course of study. Tests were repeated after 18 months period and the results of 120 patients were compared between the groups and statistically analyzed.

Results: There was statistically significant reduction of S. ferritin in both groups taking oral combination therapy and parenteral therapy (p<0.0001). There were no serious hematological, renal/hepatic side effects in any groups.

Conclusions: The oral combination therapy of iron chelators is safer and was well tolerated by all the patients and is similarly efficacious to the parenteral therapy in lowering S. ferritin.

The role of melatonin in regulating sleep wake disorders in children attending the developmental pediatrics outpatient service of a tertiary care hospital in South India

Megha Thampy, M. C. Mathew, Anna Mathew, Liya Grace Kurien, John Michael Raj — Mon, 27 Mar 2023 00:00:00 +0000

Background: We have observed that 75% of children with neurodevelopmental challenges visiting the Developmental Pediatrics department of this institution have sleep wake disorders. Disturbed sleep has a negative effect on learning and behavior. In this study we assessed the effectiveness of melatonin in improving sleep wake disorders in children with developmental compromise from this south Indian state.

Methods: Children with developmental challenges having sleep wake disorders confirmed by the pediatric insomnia severity index PISI, who were prescribed a daily dose of 3mg of melatonin participated in this prospective, observational, longitudinal study if the parents gave written informed consent. Parents were educated in the practice of sleep hygiene. The sleep disturbance scale for children (SDSC) was used to assess the overall pattern of sleep and six common disorders before and three weeks after starting melatonin.

Results: Based on the PISI scores, 13, 58 and 20 children had mild, moderate and severe insomnia respectively. Melatonin improved sleep latency, increased duration of sleep, decreased night awakenings, crying spells, dreams and daytime drowsiness. There was a significant improvement in the sleep pattern as indicated by better scores in the total SDSC score as well the scores for the six sleep disorders (p<0.001).

Conclusions: Melatonin has a significant role to play in regulating duration and quality of sleep and improving sleep pattern in developmentally challenged children with sleep-wake disorders.

Thiamine deficiency in exclusive breastfed infants with encephalopathy attending Govind Ballabh Panth children hospital, Srinagar

Younus Ramzan Khan, Junaid Mehraj, Kaiser Ahmad — Mon, 27 Mar 2023 00:00:00 +0000

Background: Thiamine deficiency (TD) has historically affected countries and populations consuming milled white rice. TD in infants can have an acute presentation of encephalopathy with shock with severe metabolic acidosis and death sometimes, if not promptly treated with an intravenous dose of thiamine. Aim was to study the biochemical deficiency of thiamine in exclusively breastfed infants presenting with encephalopathy and compare them with age-matched controls and to study their clinical course and short-term outcome (till discharge).

Methods: After dividing infants into four groups based on age in days: (31-60 days; 13 in cases and 8 in controls; 61-90; 4 in cases and 3 in controls; 91-120 days; 2 in cases and none in controls; and >120 days 4 each in cases and controls. This study primarily included the selection of case/control subjects. Two case-control analyses were conducted. In the first one, blood thiamine levels were compared between infants with encephalopathy and without encephalopathy. In the second one, breast milk thiamine levels were compared between infants with encephalopathy and without encephalopathy. Student's independent t test was used for statistical analysis.

Results: Out of 38 infants, 23 had presented with encephalopathy, and 15 were healthy taken as controls. The mean blood levels of thiamine in infants with encephalopathy in cases were 17.29 nmol/l with a standard deviation of 8.86: the levels ranged between 13.47 and 21.13. The mean value of controls was 51.31, with a standard deviation of 25.52 ranging between 23.25 and 124.7. The p<0.001 and was considered statistically significant. The ROC analysis of the data obtained from thiamine levels obtained in the study 'patient's blood compared with the control group.

Conclusions: TD can be clinically and biochemically attributed to presentation of infants with acute encephalopathy.

Indoxacarb poisoning induced methemoglobinemia-a rare presentation in paediatric age group

Mon, 27 Mar 2023 00:00:00 +0000

Indoxacarb, an oxadiazine insecticide, has high insecticidal and low mammalian toxicity. The insecticidal activity of indoxacarb is attributed to its ability to block sodium channels in the insect nervous system. Several cases of indoxacarb-induced methemoglobinemia have been reported in adults, but presentation in paediatric age group is rare. Methaemoglobinaemia occurs after indoxacarb ingestion because its aromatic metabolites are biotransformed to active intermediates that produce methaemoglobin. The case involved is an adolescent girl who presented to the PICU 3 hours after suicidal ingestion of 10-15 ml of indoxacarb. After 15 min of consumption of poison she developed pain abdomen and vomiting. At PICU, she complained of nausea, vomiting and dizziness. Her vital signs were heart rate 96/min, BP 110/80 mmHg, oxygen saturation 78% on room air and GCS 15/15. Despite receiving 10L/ min of oxygen via NRBM mask. Her ECG showed normal sinus rhythm without ischaemic change, and CXR showed no specific abnormality. Initial arterial blood gas analysis revealed pH-7.413, pO₂-123.6 mmHg, pCO₂-37.7 mmHg, HCO₃ 23.5 mmol/L. Other laboratory results were normal. Methaemoglobinemia is a rare clinical presentation of indoxacarb poisoning. The treatment plan includes timely administration of injection methylene blue.

A case report of a pediatric patient with Hirschsprung’s disease

Mon, 27 Mar 2023 00:00:00 +0000

The objective is to describe an uncommon case of Hirschsprung's disease (HD), also called congenital megacolon. The lack of neuronal ganglion cells from the submucosal and muscular nerve plexuses throughout a segment of varied length characterizes HD. Approx 94% of HD cases are diagnosed below the age of 5 years. A 3 years old male patient was admitted to the male surgery ward under a pediatric surgeon with the chief complaints of chronic constipation since birth with a history of delayed passage of meconium. The patient was diagnosed with a case of HD at the age of 1 year for which he was operated on colostomy was performed with multiple biopsies from narrowed rectosigmoid, from the transitional zone, and from colostomy stoma which confirmed the decision to make colostomy at the ganglionated segment of the colon based on the clinical picture during surgery. Biopsy report of narrowed rectosigmoid segment showed the absence of ganglion cells, while colostomy stoma and dilated proximal colon showed the presence of ganglion cells. The patient underwent a surgical procedure named pull-through surgery for HD, a martin's modification of the Duhamel operation.

Light emitting diode bulb aspiration in children: a rare entity

Mon, 27 Mar 2023 00:00:00 +0000

Foreign body aspiration is a life threatening emergency in children. Different types of foreign bodies are aspirated and reported in literature but light emitting diode (LED) bulb is an unusual cause of foreign body aspiration. Rigid bronchoscopy is gold standard for treatment of foreign body aspiration. We wish to present a case of 9 years old male child with LED bulb aspiration which was retrieved with rigid bronchoscopy.

Adrenal haemorrhage in new born presenting as severe neonatal jaundice

Sushil Singla, Yaswanth Chowdhary Raavi, Harmeet Kaur Sodhi, Vishal Sreenivasan — Mon, 27 Mar 2023 00:00:00 +0000

Neonatal adrenal haemorrhage is a relatively uncommon. Most often associated with difficult labour, birth trauma, hypoxia, sepsis. Clinical manifestations may vary from asymptomatic to life threatening Addisonian crisis. We present a case of right subacute adrenal hematoma confirmed on MRI abdomen. Risk factor being birth asphyxia. He presented with neonatal jaundice and was managed successfully by conservative methods. Treatment depends on the clinical features and severity. Most of the cases are asymptomatic and managed conservatively. Infants with acute haemorrhage might need urgent blood transfusion. Laparotomy is indicated when haemorrhage seems to be continuing, especially when the exact site of haemorrhage is in doubt. Adrenal haemorrhage usually takes 3 weeks to 6 months to resolve completely. Our case was clinically and hemodynamically stable, so he was managed conservatively and discharged after a week. This case emphasizes the importance high degree of suspicion in evaluation of neonate presented with late onset jaundice and importance of ultrasonography in diagnosis and conservative management.

Early neonatal presentation of methylmalonic aciduria: a case report from rural central India

Sneha Barahate, Anuragsingh Chandel, Swapnil Kolhe, Varsha Chauhan, Manish Jain — Mon, 27 Mar 2023 00:00:00 +0000

Methylmalonic aciduria (MMA) is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. They are characterized by impaired conversion of methymalonyl CoA to succinyl CoA by the enzyme methylmalonyl CoA mutase resulting in accumulation of metabolites of branched chain amino acid catabolism. MMA has a wide clinical spectrum, ranging from a benign condition to fatal neonatal disease. Its onset ranges from the neonatal period to adulthood. We report a case of a day 4 old male child who presented with the complaints of respiratory distress, poor feeding, and excessive crying. Mother had a history of previous neonatal loss on day 3 of life. Diagnosis of MMA was made with the help of clinical presentation and laboratory investigations. At present universal newborn screening for metabolic disorders is not done routinely in India. Diagnosing and managing IEM in India and other developing countries is a challenge since most of the classic metabolic test are not routinely available. Many cases are asymptomatic and undetected and hence we report this case to stress the importance of including MMA in newborn screening programme for early detection and intervention.

A rare case report: an unusual fusion of mesiodens and incisors, supernumerary canine and missing mandibular lateral incisors

Rina G. Mehta, Kamlesh B. Rami, Disha Bhatt, Kunal Thakkar, Niyati Thakkar — Mon, 27 Mar 2023 00:00:00 +0000

Supernumerary teeth are commonly encountered dental anomalies that affect the primary and early mixed dentition. They can lead to a range of pathological disturbances in the developing permanent dentition. Consequently, the patient has poor dental and facial aesthetics. The erupted or unerupted extra tooth located at the maxillary midline, between the central incisors is known as mesiodens. When diagnosed early, it can be treated properly with an excellent prognosis. The objective of this case report is to share knowledge about mesiodens and their management.

Ignorance: the root of misfortune. Early childhood dental trauma to upper central incisor- consequences and its management-a case report

Pragya Singhal, Prachi Mital, Deepak Raisingani, Ashwini B. Prasad — Mon, 27 Mar 2023 00:00:00 +0000

The successful treatment of early childhood dental trauma is influenced by the child’s age, the child’s cooperation, and the time-lapse between the trauma and seeking dental care. Delayed emergency care raises the risk of complications, making vital tooth survival and/or a favourable prognosis less predictable. As a result, prompt treatment and follow-up are critical to reducing the risk of both short and long-term negative outcomes. This case report describes an early childhood trauma to the upper central incisor which was left untreated. It subsequently developed discoloration, pulpal necrosis, thin dentinal walls, and a wide-open apex. An absorbable collagen barrier was placed against which MTA was condensed and filled up to the cementoenamel junction. A subsequent assessment revealed clinical and radiographic success.

An interesting manifestation of COVID-19 in children: case report and review on multisystem inflammatory syndrome in pediatric patients

Sharmila Pendyala, Maryam Maqsood, Vamsi Krishna Kaza — Mon, 27 Mar 2023 00:00:00 +0000

Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 or PIMS-TS (pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection) has been presenting itself in children in connection to the SARS-CoV-2 infection. Along with a brief review of global data on MIS-C, we present two case reports of critically ill pediatric patients (aged 16 and 14 years), presenting with features of MIS-C from May 2020 to March 2021, to a tertiary-care hospital in Telangana, India. The patients with MIS-C were healthy prior to testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Clinical presentations were similar, with fever, abdominal pain, gastrointestinal complaints, or maculopapular rash. The diagnostic parameters revealed elevated levels of C-reactive protein, D-dimer, and NtProBNP. Other infectious aetiologies were ruled out. Both patients required ionotropic support, and intravenous immunoglobulin (IVIG), and were also given empiric antibiotics. Both were hemodynamically stable upon discharge. As knowledge of the various COVID-19 manifestations in children increases, reporting is essential to better-educating healthcare professionals in clarifying and streamlining the variety of symptoms connected to MIS-C and assessing the associated risk factors that predispose the pediatric population to develop severe disease.

A case report on anti-epileptic drugs associated cerebral palsy and rickets

Sunil K. Behera, Divya Amaravadi, Gurnoor Suman, N. Shri Hala, Arvini Shreya — Mon, 27 Mar 2023 00:00:00 +0000

Seizures are incredibly widespread all around the world, today. A seizure is often described as a transient alteration in the electrical activity of the brain. This required the treatment with antiepileptic drugs (AEDs). The majority of AEDs lower vitamin D levels. Vitamin D is found to be crucial for intestinal absorption of calcium, magnesium, and phosphate which helps to build and mineralize bones. Vitamin D deficiency has been seen to be a causative reason for cerebral palsy which is a neurological illness that affects movement and muscle coordination, permanently. It has been observed to manifest in infancy or early childhood due to vitamin D deficiency due to long term use of AEDs making it severe due to malnourishment. This case reports the use of antiepileptic drugs leading to cerebral palsy due to vitamin D deficiency. Therefore, by this case report we want to alert the readers and healthcare professionals about the possible adverse effects of AEDs and to be aware of them.

Pyogenic granuloma in a 6-year-old boy - a rare case report

Divya Gera, Anshul Tanwar, Anant G. Nigam, Shradha Jain, Vipul Sharma — Mon, 27 Mar 2023 00:00:00 +0000

The gingiva, also known as the gums, is the pink-coloured keratinized mucosa that surrounds and protects the teeth. Gingival enlargement or gingival overgrowth, a common trait of gingival disease, is characterized by an increase in the size of gingiva. Irritation fibroma is an exophytic soft tissue mass in the oral mucosa. Indeed, it is not a real neoplasm, but a focal hyperplasia of fibrous connective tissue induced by local trauma or chronic irritation. Pyogenic granuloma is one of the inflammatory hyperplasia seen in the oral cavity, majority are found on the marginal gingiva with only 15% of the tumours on the alveolar part. It predominantly occurs in the second decade of life in young females, male to female ratio is 1:99, and size of lesion varies in diameter from few millimetres to several centimetres. This article presents a case of pyogenic granuloma in an 6year old boy who presented with a gingival overgrowth in his mandibular left buccal surface region i.r.t 31 including marginal and attached gingiva. He had discomfort during mastication, interferes with occlusion there was episode of bleeding during brushing. The lesion was excised and histopathological report confirmed the diagnosis. Case was followed up for six months and no recurrence of the lesion. Etiological factors, clinical features, differential diagnosis and different treatment options are discussed based on the review of current literature available.

Fibromatosis colli: a rare case report

Nitish Kumar, Tanya Singh, Avinash Rastogi — Mon, 27 Mar 2023 00:00:00 +0000

Fibromatosis colli, a rare benign congenital mass of the sternocleidomastoid muscle, is mainly found in the neonatal age group, often at the age of 2 to 4 weeks of life. Also known as a pseudo tumour, its aetiology is still unknown and may occur due to injury of the sternocleidomastoid muscle in the last trimester of intrauterine life or during delivery. Frequently manifests as restriction of neck movement and enlarging neck mass at around 14-28 days after birth. Ultrasonography (USG) neck is the preferred diagnostic modality. Treatment is mainly conservative consisting of observation and stretching exercises. Surgical intervention is required in <10% of cases and consists of a tenotomy of the sternocleidomastoid muscle. We present a case report of fibromatosis colli in a 15-day-old female neonate with a history of birth trauma presented with a right neck mass and torticollis, diagnosed using high-frequency ultrasound. This condition regressed in the next few months while the patient was instituted only conservative treatment. Thus, signifying the importance of clinical diagnosis and differentiation from other causes of neck masses to prevent unnecessary investigation and overtreatment.