Sridevi A Naaraayan | Institute of Child Health (original) (raw)

Papers by Sridevi A Naaraayan

Research paper thumbnail of Effect of COVID-19 Pandemic on Awareness on Prevention of Spread of Infective Respiratory Secretions among Resident Doctors

Journal of Clinical and Diagnostic Research, 2023

Introduction: Respiratory infections including Coronavirus Disease-2019 (COVID-19) infection spre... more Introduction: Respiratory infections including Coronavirus Disease-2019 (COVID-19) infection spread through droplet infections. Hence standard precautionary measures like handwashing and use of masks are essential to prevent transmission of these infections in healthcare setting. Aim: To determine the effect of COVID-19 pandemic on awareness level of resident doctors on prevention of spread of infective respiratory secretions. Materials and Methods: This cross-sectional study was conducted among two subsequent batches (year 2019-20 and 2020-21) of resident doctors at a medical college hospital, from February 2020 to September 2020. The 2019-2020 batch of resident doctors worked as residents from March 2019 to March 2020 and were considered as pre-COVID-19 batch. The 2020-2021 batch of resident doctors had their training period from April 2020 to April 2021 and were considered the COVID-19 batch. A pretested semi-structured questionnaire consisting of 14 questions to evaluate the awareness on prevention of spread of infective respiratory secretions was administered. The responses were evaluated, marks awarded and summated. Results: The response rate of pre-COVID-19 batch was 85% and that of COVID-19 batch was 86%. The mean (standard deviation) score obtained by the COVID-19 batch was 9.91±3.42 which was significant higher than that obtained by the pre-COVID-19 batch which was 7.1±1.83. The score obtained by COVID-19 batch for 11/14 questions was significantly higher compared to the pre-COVID-19 batch. Conclusion: A significant improvement was seen in the knowledge level in prevention of spread of infective respiratory secretions among resident doctors after the onset of the COVID-19 pandemic.

Research paper thumbnail of Physical Growth of Low Birth Weight Infants in First Six Months of Life: A Prospective Cohort Study

INDIAN JOURNAL OF NEONATAL MEDICINE AND RESEARCH

Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. G... more Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. Growth is the single most important predictor of morbidity and mortality in a LBW infant. LBW babies show a pattern of growth, different from normal weighing babies. Aim: To assess the growth pattern of LBW infants in first six months of life. Materials and Methods: This prospective cohort study was done in Department of Paediatrics, of Kilpauk Medical College and Hospital, a tertiary care hospital in Southern India, from September 2019 to August 2020. Total 310 LBW infants, of which 200 were term and rest preterm were included and followed-up at the ages of three and six months. Clinical details including gender, gestational age, order of birth, length of stay in nursery, maternal and neonatal morbidities, type of feeding and intercurrent illness were noted. The weight, length and head circumference of the infants were measured by standard methods and interpreted using appropriate charts...

Research paper thumbnail of Diabetes that is difficult to treat

Indian Journal of Practical Pediatrics, 2019

Research paper thumbnail of Comorbidities in children hospitalized with severe acute malnutrition

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the s... more Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute ...

Research paper thumbnail of Effect of family factors on juvenile delinquency

International Journal of Contemporary Pediatrics, 2017

Background: Juvenile delinquency is multifactorial with risk factors operating at multiple levels... more Background: Juvenile delinquency is multifactorial with risk factors operating at multiple levels namely individual, micro environment and macro environment levels. The objective of this study was to determine the effect of family factors on juvenile delinquency.Methods: This was a case control study done from January 2009 to December 2009. Adolescents present in the Government run Special observation home were cases, while boys of 10, 11, and 12 standards in a government school served as controls. Data on demographic details, offence committed and family factors were collected using a structured proforma. Univariate and multivariate analyses were performed to determine which of the factors acted as risk factors for juvenile delinquency.Results: Totally sixty juveniles and an equal number of school students were interviewed. Paternal age above 50 years, paternal smoking, alcohol intake, substance abuse and involvement in crime, maternal education and employment, being born as a sing...

Research paper thumbnail of Free Style Libre Pro (FSLP) Flash Glucose Monitor (FGM) - A Novel Monitoring Tool for Children with Type 1 Diabetes Mellitus

Indian pediatrics, 2018

Flash glucose monitoring using Free Style Libre Pro (FSLP) was undertaken among fifteen diabetic ... more Flash glucose monitoring using Free Style Libre Pro (FSLP) was undertaken among fifteen diabetic children. Data revealed high glycaemic variability, Time in Target Range (TIR) to be 27% and 12% of time in hypoglycaemia. Sensor insertion and retention were problematic in 33%. Though user friendly, sensors may need an additional adhesive plaster for retention.

Research paper thumbnail of Autoimmunity in south Indian children with recently diagnosed type 1 diabetes mellitus

Background: Type 1 diabetes mellitus is known to be associated with autoimmunity and hence autoan... more Background: Type 1 diabetes mellitus is known to be associated with autoimmunity and hence autoantibodies. The primary objective of this study was to determine the prevalence of glutamic acid decarboxylase 65 (GAD) antibody in patients with newly diagnosed type 1 diabetes mellitus. Materials and Methods: This cross-sectional study was done in a government-run pediatric tertiary care center in South India from 2015 to 2017 and included 125 patients with newly diagnosed type 1 diabetes mellitus. Demographic and clinical data were captured and GAD antibody was detected by the ELISA technique and a titer of above 1.0 IU/mL was considered positive. Results: The prevalence (95% confidence interval) of GAD 65 antibody was found to be 79.2% (71%–86%). Glycated hemoglobin level was significantly higher in GAD negative when compared to GAD positive patients (P < 0.05). Conclusion: Type 1 diabetes mellitus is associated with high prevalence of autoantibodies in the current era.

Research paper thumbnail of Effect of Personal and School Factors on Juvenile Delinquency

The Indian Journal of Pediatrics, 2017

Research paper thumbnail of Risk factors of severe dengue in children: A nested case-control study

Journal of Pediatric Critical Care, 2021

Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferen... more Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferentiated fever to severe fatal form. The objectives of this study were to determine the prevalence and risk factors of severe dengue. Subjects and Methods: This nested case–control study was done in a medical college hospital in South India from October 2019 to January 2020. Children between 1 month and 12 years of age who presented with fever without focus and tested positive for dengue serology were included. Demographic data, anthropometry, clinical features, and laboratory parameters were noted down from all children. Severity of illness was classified according to the World Health Organization dengue guidelines 2009. Prevalence of severe dengue was expressed in proportion with 95% confidence interval (CI). Bivariate analysis was performed using Chi-square test, Fisher's test, and Student's t-test, and a P < 0.05 was considered statistically significant. Results: Out of 370 children, 192 (51.9%) had dengue without warning signs, 168 (45.4%) had dengue with warning signs, and 10 had severe dengue. The prevalence (95% CI) of severe dengue was 2.7% (1.3%–4.9%). Abdominal pain/tenderness (odd's ratio [OR] - 7.429), facial puffiness (OR - 4.333), hepatomegaly (OR - 3.857), and pleural effusion (OR - 13.222) were the significant risk factors for severe dengue. Conclusions: The significant risk factors for severe dengue were abdominal pain/tenderness, facial puffiness, hepatomegaly, and pleural effusion.

Research paper thumbnail of Assessment of risk of intussusception after pilot rollout of rotavirus vaccine in the Indian public health system

Vaccine, 2020

Background: Pre-licensure trials of ROTAVAC Ò were not adequately powered to assess risk of intus... more Background: Pre-licensure trials of ROTAVAC Ò were not adequately powered to assess risk of intussusception, a rare adverse event associated with other rotavirus vaccines in some settings. We examined the risk of intussusception after ROTAVAC Ò vaccination among Indian infants during pilot rollout of the vaccine in the public health system in three states-Himachal Pradesh, Maharashtra and Tamil Nadu. Methods: Passive surveillance for intussusception was set up in 35 sentinel health facilities covering 26.3 million population in the three states under monitoring of an Interministerial-Interagency Steering Committee. Clinical and immunization data were collected by independent teams. An expert committee blinded to vaccination status, classified intussusception cases using Brighton criteria. The self-controlled case-series method was used to estimate risk of intussusception (Brighton Level 1) after ROTAVAC Ò vaccination. Results: 151 intussusception cases were included in the analysis. The relative incidence (incidence during the risk period compared to the control period) 1-21 days after doses 1 and 2 combined was 1.56 (95% CI, 0.0-5.28) and that for three doses combined was 1.88 (95% CI, 0.76-4.30). Attributable risk 1-21 days after doses 1 and 2 combined was 0.11 (95% CI, 0.0-0.25) and that for 3 doses combined was 0.42 (95% CI, 0.0-0.70) per 100,000 doses. Conclusions: No increased risk of intussusception within 21 days of receipt of the first two doses combined or all 3 doses combined of ROTAVAC Ò was detected.

Research paper thumbnail of Socioeconomic Determinants of Breastfeeding Practices in South India - a Hospital-Based Cross-Sectional Study

Indian Journal of Child Health, 2018

This cross-sectional study was done in pediatric wards of a tertiary care teaching institution fr... more This cross-sectional study was done in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. The study was commenced after obtaining approval from the ABSTRACT Background: Breastfeeding is an unparalleled universally recommended intervention for the promotion of health and nutrition of children and reduction of mortality. In spite of the WHO recommendations and baby-friendly hospital initiative, breastfeeding practices are inappropriate due to maternal, infant, socioeconomic, and cultural factors. Objective: The objective of this study was to determine the socioeconomic factors associated with inappropriate breastfeeding practices. Secondary objective was to determine the knowledge level of mothers on ideal breastfeeding recommendations. Materials and Methods: This cross-sectional study was conducted in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. Mothers having children aged 7-60 months were included in the study. A sample size of one thousand was planned. After obtaining informed consent from mother, detailed feeding history including the timing of initiation of breastfeeding following childbirth, duration of exclusive breastfeeding, and age at which breastfeeding was discontinued was noted. Possible determinants considered were gender of the child, place of residence, maternal age, maternal education, maternal employment, number of children at home, type of family, whether mother was counseled during antenatal period, mode of delivery, and hospitalization in newborn period. Knowledge of mother on breastfeeding was probed and the response recorded. Univariate analysis followed by regression was performed to determine the significant factors. Results: 59% (95% confidence interval 55.9-62.1) of mothers initiated breastfeeding within 1 h of childbirth. 70.2% (95% CI-67.3-73) exclusively breastfed their babies for 6 months and above. 43.6% (95% CI-39.2-48.1) of mothers with children of age 25-60 months breastfed their babies up to 2 years and beyond. On univariate analysis, female gender, maternal employment, operative delivery, and hospitalization in the newborn period were identified as risk factors for inappropriate breastfeeding practices, which were confirmed by regression. Overall, only 26.6% (95% CI-23.9-29.5) of mothers had appropriate knowledge about ideal breastfeeding recommendations. Conclusion: Female gender, maternal employment, operative delivery, and hospitalization in newborn period are significant independent risk factors for inappropriate breastfeeding practices. Only a quarter of mothers had adequate knowledge of breastfeeding recommendations.

Research paper thumbnail of Comorbidities in Children Hospitalized with Severe Acute Malnutrition

Indian Journal of Child Health, 2018

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the s... more Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11-21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. Conclusion: Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes.

Research paper thumbnail of Comparison of Various Body Fat Indices in Early and Mid-Adolescents of South India: School-Based Cross-Sectional Study

Indian Journal of Child Health, 2018

besity is accumulation of excess body fat to the extent that it may have an adverse effect on hea... more besity is accumulation of excess body fat to the extent that it may have an adverse effect on health [1]. Obese children are more likely to become obese adults, and the biological changes that lead to obesity-related cardiometabolic disease start developing in childhood [2]. Hence, childhood obesity is considered the most serious public health challenge of this century [3]. A first and most important roadblock in the management of obesity is the lack of a gold standard measuring tool [4]. Body mass index (BMI) is the most commonly used index to identify obesity [5]. Although other indices such as waist circumference and skinfold thickness are more specific in measuring fatness, they are cumbersome and require periodic training of health personnel [6]. From skinfold measured in multiple sites (three/five/seven), Jackson and Pollock formula can be applied to calculate percentage of body fat [7]. Dual-energy X-ray absorptiometry (DEXA) is frequently used as the reference standard to assess the body composition in children [8], but its complexity and cost limit its use in daily clinical practice, and hence it still remains a tool confined to research. It is now well established that Asian adults, adolescents, and children have different body composition compared to Europeans. The objective of this study was to compare the extent of agreement between BMI, waist circumference, and triceps skinfold thickness against body fat percentage calculated using 7-site skinfold thickness in South Indian early and mid-adolescents. MATERIALS AND METHODS This cross-sectional study was performed in selected government schools in Chennai, which come under school health program of the institution, from May 2016 to October 2016. The study was commenced after approval from the Institutional Ethics Committee. Permission was obtained from school authorities concerned. Written informed consent was obtained from parents and assent from children. Schoolchildren aged 10-16 years, who assented,

Research paper thumbnail of Determinants of Immunization Status of Children Aged 1-5 Years Attending a Tertiary Health Care Facility: A Cross-Sectional Study

Indian Journal of Child Health, 2016

I mproving child survival by reduction of under-five mortality is one of the millennium developme... more I mproving child survival by reduction of under-five mortality is one of the millennium development goals (MDG). Among the four main strategies suggested by WHO for achieving this MDG target, immunization is of utmost importance [1]. Globally, under-five mortality has fallen steadily over the past decades because of increased use of key health interventions such as immunization [2]. According to guidelines developed by the WHO, children are considered fully immunized if they have received vaccination against tuberculosis (Bacillus Calmette-Guerin [BCG]), 3 doses of diphtheria, whooping cough (pertussis) and tetanus (diphtheria, tetanus, and pertussis [DPT]) vaccine, 3 doses of oral poliomyelitis vaccine (OPV), and 1 dose of measles vaccine by the age of 12 months [3]. According to UNICEF immunization coverage evaluation survey 2009, 61% of Indian children were completely immunized, while the corresponding figure for the state of Tamil Nadu was 77.3% [4]. National Family Health Survey 3 (NFHS-3) conducted, in 2005, documented an immunization coverage rate of 80.9% in the state [5]. The recent NFHS-4 conducted, in 2015, shows a decline in the rate from 80.9% to 69.7% [6]. There are a number of reasons why India lags behind its many less developed neighbors in vaccination rates [7]. Identification of factors determining immunization coverage is the crucial and first step to improve the immunization coverage rates and to decrease the under-five mortality.

Research paper thumbnail of Research Letters

Research paper thumbnail of Intussusception hospitalizations before rotavirus vaccine introduction: Retrospective data from two referral hospitals in Tamil Nadu, India

Vaccine, Jan 30, 2017

The indigenous oral rotavirus vaccine Rotavac® was introduced into the public immunization system... more The indigenous oral rotavirus vaccine Rotavac® was introduced into the public immunization system in India in 2016 and will be expanded in phases. This data will describe the epidemiology of intussusception in India in absence of rotavirus vaccination and will help in setting up or designing a safety monitoring system. Medical records of intussusception cases between 2013 and 2016 in two major referral hospitals in Tamil Nadu, India were reviewed, and data on clinical presentation and management and outcome were collated. A total of 284 cases of intussusception were diagnosed and managed at the two centers of which 280/284 could be classified as level 1 by the Brighton criteria. Median age at presentation was 8 months (Inter Quartile Range, IQR 6-17.2) with a male to female ratio of 2.1:1. Over half (57.7%) required surgical intervention while the rest underwent non-surgical or conservative management. Retrospective data from referral hospitals is sufficient to classify cases of int...

Research paper thumbnail of Diagnostic accuracy of digital thermometer compared to mercury in glass thermometer for measuring temperature in children

International Journal of Contemporary Pediatrics, 2017

Background: A wide variety of devices are available to record temperature from skin, oral or rect... more Background: A wide variety of devices are available to record temperature from skin, oral or rectal mucosa and the tympanic membrane. The accuracy of different devices is varied and the primary objective of this study is to compare the diagnostic accuracy of digital thermometer against mercury in glass thermometer in children. The secondary objective was to determine the average time taken by the digital thermometer to record the temperature.Methods: This descriptive study was conducted in a pediatric ward at Institute of Child Health and Hospital for Children, Egmore, Chennai. In all 92 febrile children aged 1 month to 12 years admitted in the ward, temperature was measured at the time of admission using both digital and mercury in glass thermometers placed in each axilla after obtaining informed consent. Concordance and discordance of both measurements were determined using Pearson Correlation coefficient and Bland altman plot. Average time taken by digital thermometer to record t...

Research paper thumbnail of Clinical Profile and Outcome of Scorpion Sting Envenomation in Children Admitted in a Tertiary Care Hospital

Journal of Evolution of Medical and Dental Sciences, 2016

BACKGROUND Scorpion sting envenomation is life threatening and a common public health problem in ... more BACKGROUND Scorpion sting envenomation is life threatening and a common public health problem in children. OBJECTIVES The primary objective was to characterize the epidemiological and clinical features of scorpion sting envenomation in children. The secondary objective was to determine the factors affecting duration of hospital stay. METHODS This retrospective descriptive study included children less than 12 years admitted in the paediatric ward with history of scorpion sting from Jan 2015 to Dec 2015. Epidemiological and clinical data such as age, sex, time and site of bite, pain, paraesthesia, swelling, sweating, vomiting, pre-hospital treatment, heart rate, blood pressure, X-ray, ECG findings, time and number of doses of prazosin administration, duration of hospital stay were collected. Parameters were expressed as percentage. Factors were analysed using Univariate and multivariate analyses. RESULTS Among 159 children the observations made were common age group 2-6 years (44.5%), males (63%), nocturnal bites (53.8%), lower limb bites (52.2%), pain (33.8%), admission within 2 hours (81.25%), pre-hospital treatment (28.7%) class I symptoms (43%) and ECG changes in (11.3%); 89.3% received prazosin. Univariate analysis identified abnormal heart rate, S3 gallop, cold extremities, weak pulse, prolonged capillary refill time, abnormal systolic blood pressure and ECG changes as significant risk factors for prolonged hospital stay, whereas cold extremities and ECG changes were significant risk factors in multivariate analysis. CONCLUSION Demographic parameters and clinical profile are described. Cold extremities and ECG abnormalities were significantly associated with prolonged hospital stay.

Research paper thumbnail of Neonatal Diabetes-From Insulin to Oral Hypoglycemic Agent: Case Report

Diabetes Case Reports, 2017

Patient Duration of follow up Present glibenclamide dose HbA 1 c Growth Development Before transf... more Patient Duration of follow up Present glibenclamide dose HbA 1 c Growth Development Before transfer After transfer Case 1 22 months 0.18 6 5.1 Severe Acute Malnutrition Global developmental delay Case 2 14 months 0.3

Research paper thumbnail of Self-medication pattern among children attending a tertiary hospital in South India: a cross-sectional study

International Journal of Contemporary Pediatrics, 2016

The main problem with self-medication with antibiotics is the emergence of resistance. 4 Economic... more The main problem with self-medication with antibiotics is the emergence of resistance. 4 Economic, political and cultural factors have contributed to the growth and spread of self-medication worldwide. These include greater availability of drugs, irresponsible publicity, pressure to convert prescription only drugs to ABSTRACT Background: Administration of medications by care-givers to children without medical consultation is termed selfmedication. Published literature on self-medication pattern in Indian children is scanty. Primary objective of the study was to study the prevalence of self-medication. Secondary objectives were to study its characteristics and the relation between demographic characteristics and self-medication. Methods: This descriptive study was performed in the outpatient department of Institute of child health and hospital for children. All children between 1 month and 12 years of age who attended the outpatient department during a particular time of the day on particular days of week were included in the study. After noting down the demographic characteristics, history of self-medication was elicited. For children who self-medicated, inciting illness, name of drug, source, reason and adverse events were noted down. Prevalence of self-medication was expressed as proportion with 95% confidence interval. Relation between demographic factors and self-medication was determined using chisquare test. Results: Prevalence of self-medication was 32% (95% confidence interval 28-35%). Common illnesses leading to self-medication were fever, cough and cold. Commonly used drugs were paracetamol, anticold medications and antibiotics. Most of them used previous prescription to procure the drugs and previous experience on efficacy was the most common reason cited. Older children were more commonly self-medicated than the younger (p = 0.001). Conclusions: Self-medication is encountered in 32% of children attending the outpatient department of the hospital and is more common in older children.

Research paper thumbnail of Effect of COVID-19 Pandemic on Awareness on Prevention of Spread of Infective Respiratory Secretions among Resident Doctors

Journal of Clinical and Diagnostic Research, 2023

Introduction: Respiratory infections including Coronavirus Disease-2019 (COVID-19) infection spre... more Introduction: Respiratory infections including Coronavirus Disease-2019 (COVID-19) infection spread through droplet infections. Hence standard precautionary measures like handwashing and use of masks are essential to prevent transmission of these infections in healthcare setting. Aim: To determine the effect of COVID-19 pandemic on awareness level of resident doctors on prevention of spread of infective respiratory secretions. Materials and Methods: This cross-sectional study was conducted among two subsequent batches (year 2019-20 and 2020-21) of resident doctors at a medical college hospital, from February 2020 to September 2020. The 2019-2020 batch of resident doctors worked as residents from March 2019 to March 2020 and were considered as pre-COVID-19 batch. The 2020-2021 batch of resident doctors had their training period from April 2020 to April 2021 and were considered the COVID-19 batch. A pretested semi-structured questionnaire consisting of 14 questions to evaluate the awareness on prevention of spread of infective respiratory secretions was administered. The responses were evaluated, marks awarded and summated. Results: The response rate of pre-COVID-19 batch was 85% and that of COVID-19 batch was 86%. The mean (standard deviation) score obtained by the COVID-19 batch was 9.91±3.42 which was significant higher than that obtained by the pre-COVID-19 batch which was 7.1±1.83. The score obtained by COVID-19 batch for 11/14 questions was significantly higher compared to the pre-COVID-19 batch. Conclusion: A significant improvement was seen in the knowledge level in prevention of spread of infective respiratory secretions among resident doctors after the onset of the COVID-19 pandemic.

Research paper thumbnail of Physical Growth of Low Birth Weight Infants in First Six Months of Life: A Prospective Cohort Study

INDIAN JOURNAL OF NEONATAL MEDICINE AND RESEARCH

Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. G... more Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. Growth is the single most important predictor of morbidity and mortality in a LBW infant. LBW babies show a pattern of growth, different from normal weighing babies. Aim: To assess the growth pattern of LBW infants in first six months of life. Materials and Methods: This prospective cohort study was done in Department of Paediatrics, of Kilpauk Medical College and Hospital, a tertiary care hospital in Southern India, from September 2019 to August 2020. Total 310 LBW infants, of which 200 were term and rest preterm were included and followed-up at the ages of three and six months. Clinical details including gender, gestational age, order of birth, length of stay in nursery, maternal and neonatal morbidities, type of feeding and intercurrent illness were noted. The weight, length and head circumference of the infants were measured by standard methods and interpreted using appropriate charts...

Research paper thumbnail of Diabetes that is difficult to treat

Indian Journal of Practical Pediatrics, 2019

Research paper thumbnail of Comorbidities in children hospitalized with severe acute malnutrition

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the s... more Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11–21.75) months; there were 93 (46.5%) boys. Acute ...

Research paper thumbnail of Effect of family factors on juvenile delinquency

International Journal of Contemporary Pediatrics, 2017

Background: Juvenile delinquency is multifactorial with risk factors operating at multiple levels... more Background: Juvenile delinquency is multifactorial with risk factors operating at multiple levels namely individual, micro environment and macro environment levels. The objective of this study was to determine the effect of family factors on juvenile delinquency.Methods: This was a case control study done from January 2009 to December 2009. Adolescents present in the Government run Special observation home were cases, while boys of 10, 11, and 12 standards in a government school served as controls. Data on demographic details, offence committed and family factors were collected using a structured proforma. Univariate and multivariate analyses were performed to determine which of the factors acted as risk factors for juvenile delinquency.Results: Totally sixty juveniles and an equal number of school students were interviewed. Paternal age above 50 years, paternal smoking, alcohol intake, substance abuse and involvement in crime, maternal education and employment, being born as a sing...

Research paper thumbnail of Free Style Libre Pro (FSLP) Flash Glucose Monitor (FGM) - A Novel Monitoring Tool for Children with Type 1 Diabetes Mellitus

Indian pediatrics, 2018

Flash glucose monitoring using Free Style Libre Pro (FSLP) was undertaken among fifteen diabetic ... more Flash glucose monitoring using Free Style Libre Pro (FSLP) was undertaken among fifteen diabetic children. Data revealed high glycaemic variability, Time in Target Range (TIR) to be 27% and 12% of time in hypoglycaemia. Sensor insertion and retention were problematic in 33%. Though user friendly, sensors may need an additional adhesive plaster for retention.

Research paper thumbnail of Autoimmunity in south Indian children with recently diagnosed type 1 diabetes mellitus

Background: Type 1 diabetes mellitus is known to be associated with autoimmunity and hence autoan... more Background: Type 1 diabetes mellitus is known to be associated with autoimmunity and hence autoantibodies. The primary objective of this study was to determine the prevalence of glutamic acid decarboxylase 65 (GAD) antibody in patients with newly diagnosed type 1 diabetes mellitus. Materials and Methods: This cross-sectional study was done in a government-run pediatric tertiary care center in South India from 2015 to 2017 and included 125 patients with newly diagnosed type 1 diabetes mellitus. Demographic and clinical data were captured and GAD antibody was detected by the ELISA technique and a titer of above 1.0 IU/mL was considered positive. Results: The prevalence (95% confidence interval) of GAD 65 antibody was found to be 79.2% (71%–86%). Glycated hemoglobin level was significantly higher in GAD negative when compared to GAD positive patients (P < 0.05). Conclusion: Type 1 diabetes mellitus is associated with high prevalence of autoantibodies in the current era.

Research paper thumbnail of Effect of Personal and School Factors on Juvenile Delinquency

The Indian Journal of Pediatrics, 2017

Research paper thumbnail of Risk factors of severe dengue in children: A nested case-control study

Journal of Pediatric Critical Care, 2021

Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferen... more Background: Dengue is a mosquito-borne viral disease whose severity varies from a mild undifferentiated fever to severe fatal form. The objectives of this study were to determine the prevalence and risk factors of severe dengue. Subjects and Methods: This nested case–control study was done in a medical college hospital in South India from October 2019 to January 2020. Children between 1 month and 12 years of age who presented with fever without focus and tested positive for dengue serology were included. Demographic data, anthropometry, clinical features, and laboratory parameters were noted down from all children. Severity of illness was classified according to the World Health Organization dengue guidelines 2009. Prevalence of severe dengue was expressed in proportion with 95% confidence interval (CI). Bivariate analysis was performed using Chi-square test, Fisher's test, and Student's t-test, and a P < 0.05 was considered statistically significant. Results: Out of 370 children, 192 (51.9%) had dengue without warning signs, 168 (45.4%) had dengue with warning signs, and 10 had severe dengue. The prevalence (95% CI) of severe dengue was 2.7% (1.3%–4.9%). Abdominal pain/tenderness (odd's ratio [OR] - 7.429), facial puffiness (OR - 4.333), hepatomegaly (OR - 3.857), and pleural effusion (OR - 13.222) were the significant risk factors for severe dengue. Conclusions: The significant risk factors for severe dengue were abdominal pain/tenderness, facial puffiness, hepatomegaly, and pleural effusion.

Research paper thumbnail of Assessment of risk of intussusception after pilot rollout of rotavirus vaccine in the Indian public health system

Vaccine, 2020

Background: Pre-licensure trials of ROTAVAC Ò were not adequately powered to assess risk of intus... more Background: Pre-licensure trials of ROTAVAC Ò were not adequately powered to assess risk of intussusception, a rare adverse event associated with other rotavirus vaccines in some settings. We examined the risk of intussusception after ROTAVAC Ò vaccination among Indian infants during pilot rollout of the vaccine in the public health system in three states-Himachal Pradesh, Maharashtra and Tamil Nadu. Methods: Passive surveillance for intussusception was set up in 35 sentinel health facilities covering 26.3 million population in the three states under monitoring of an Interministerial-Interagency Steering Committee. Clinical and immunization data were collected by independent teams. An expert committee blinded to vaccination status, classified intussusception cases using Brighton criteria. The self-controlled case-series method was used to estimate risk of intussusception (Brighton Level 1) after ROTAVAC Ò vaccination. Results: 151 intussusception cases were included in the analysis. The relative incidence (incidence during the risk period compared to the control period) 1-21 days after doses 1 and 2 combined was 1.56 (95% CI, 0.0-5.28) and that for three doses combined was 1.88 (95% CI, 0.76-4.30). Attributable risk 1-21 days after doses 1 and 2 combined was 0.11 (95% CI, 0.0-0.25) and that for 3 doses combined was 0.42 (95% CI, 0.0-0.70) per 100,000 doses. Conclusions: No increased risk of intussusception within 21 days of receipt of the first two doses combined or all 3 doses combined of ROTAVAC Ò was detected.

Research paper thumbnail of Socioeconomic Determinants of Breastfeeding Practices in South India - a Hospital-Based Cross-Sectional Study

Indian Journal of Child Health, 2018

This cross-sectional study was done in pediatric wards of a tertiary care teaching institution fr... more This cross-sectional study was done in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. The study was commenced after obtaining approval from the ABSTRACT Background: Breastfeeding is an unparalleled universally recommended intervention for the promotion of health and nutrition of children and reduction of mortality. In spite of the WHO recommendations and baby-friendly hospital initiative, breastfeeding practices are inappropriate due to maternal, infant, socioeconomic, and cultural factors. Objective: The objective of this study was to determine the socioeconomic factors associated with inappropriate breastfeeding practices. Secondary objective was to determine the knowledge level of mothers on ideal breastfeeding recommendations. Materials and Methods: This cross-sectional study was conducted in pediatric wards of a tertiary care teaching institution from January 2017 to July 2017. Mothers having children aged 7-60 months were included in the study. A sample size of one thousand was planned. After obtaining informed consent from mother, detailed feeding history including the timing of initiation of breastfeeding following childbirth, duration of exclusive breastfeeding, and age at which breastfeeding was discontinued was noted. Possible determinants considered were gender of the child, place of residence, maternal age, maternal education, maternal employment, number of children at home, type of family, whether mother was counseled during antenatal period, mode of delivery, and hospitalization in newborn period. Knowledge of mother on breastfeeding was probed and the response recorded. Univariate analysis followed by regression was performed to determine the significant factors. Results: 59% (95% confidence interval 55.9-62.1) of mothers initiated breastfeeding within 1 h of childbirth. 70.2% (95% CI-67.3-73) exclusively breastfed their babies for 6 months and above. 43.6% (95% CI-39.2-48.1) of mothers with children of age 25-60 months breastfed their babies up to 2 years and beyond. On univariate analysis, female gender, maternal employment, operative delivery, and hospitalization in the newborn period were identified as risk factors for inappropriate breastfeeding practices, which were confirmed by regression. Overall, only 26.6% (95% CI-23.9-29.5) of mothers had appropriate knowledge about ideal breastfeeding recommendations. Conclusion: Female gender, maternal employment, operative delivery, and hospitalization in newborn period are significant independent risk factors for inappropriate breastfeeding practices. Only a quarter of mothers had adequate knowledge of breastfeeding recommendations.

Research paper thumbnail of Comorbidities in Children Hospitalized with Severe Acute Malnutrition

Indian Journal of Child Health, 2018

Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the s... more Background: As per the National Family Health Survey-4 data, 7.9% of under-five children in the state of Tamil Nadu are severely wasted. The outcome of hospitalized severe acute malnutrition (SAM) children is dependent on the comorbidities present. Objective: The objective of this study is to describe the comorbid conditions in SAM children hospitalized in a tertiary care center. Methodology: This study was a hospital-based descriptive study, conducted from July 2015 to June 2016. A total number of 200 children, who were admitted with SAM as per the World Health Organization criteria, were included in the study. Systemic illness, anemia, vitamin deficiencies, sepsis, retroviral infection, tuberculosis, pneumonia, acute gastroenteritis, urinary tract infection (UTI), measles, skin infections, and worm infestations were the comorbidities considered. Results: Among 200 hospitalized SAM children, the median (interquartile) age was 15 (11-21.75) months; there were 93 (46.5%) boys. Acute gastroenteritis (57.5%) was the most common comorbidity, followed by pneumonia (44.5%), anemia (27%), systemic illness (17%), worm infestation (13.5%), UTI (13.5%), sepsis (13%), skin infection (8%), measles (6%), vitamin deficiency (4%), retroviral infections (3.5%), and tuberculosis (1%). The case fatality rate was 10.5%. Conclusion: Prompt identification of comorbidities is crucial in hospitalized SAM children, which will pave way for their treatment, resulting in better outcomes.

Research paper thumbnail of Comparison of Various Body Fat Indices in Early and Mid-Adolescents of South India: School-Based Cross-Sectional Study

Indian Journal of Child Health, 2018

besity is accumulation of excess body fat to the extent that it may have an adverse effect on hea... more besity is accumulation of excess body fat to the extent that it may have an adverse effect on health [1]. Obese children are more likely to become obese adults, and the biological changes that lead to obesity-related cardiometabolic disease start developing in childhood [2]. Hence, childhood obesity is considered the most serious public health challenge of this century [3]. A first and most important roadblock in the management of obesity is the lack of a gold standard measuring tool [4]. Body mass index (BMI) is the most commonly used index to identify obesity [5]. Although other indices such as waist circumference and skinfold thickness are more specific in measuring fatness, they are cumbersome and require periodic training of health personnel [6]. From skinfold measured in multiple sites (three/five/seven), Jackson and Pollock formula can be applied to calculate percentage of body fat [7]. Dual-energy X-ray absorptiometry (DEXA) is frequently used as the reference standard to assess the body composition in children [8], but its complexity and cost limit its use in daily clinical practice, and hence it still remains a tool confined to research. It is now well established that Asian adults, adolescents, and children have different body composition compared to Europeans. The objective of this study was to compare the extent of agreement between BMI, waist circumference, and triceps skinfold thickness against body fat percentage calculated using 7-site skinfold thickness in South Indian early and mid-adolescents. MATERIALS AND METHODS This cross-sectional study was performed in selected government schools in Chennai, which come under school health program of the institution, from May 2016 to October 2016. The study was commenced after approval from the Institutional Ethics Committee. Permission was obtained from school authorities concerned. Written informed consent was obtained from parents and assent from children. Schoolchildren aged 10-16 years, who assented,

Research paper thumbnail of Determinants of Immunization Status of Children Aged 1-5 Years Attending a Tertiary Health Care Facility: A Cross-Sectional Study

Indian Journal of Child Health, 2016

I mproving child survival by reduction of under-five mortality is one of the millennium developme... more I mproving child survival by reduction of under-five mortality is one of the millennium development goals (MDG). Among the four main strategies suggested by WHO for achieving this MDG target, immunization is of utmost importance [1]. Globally, under-five mortality has fallen steadily over the past decades because of increased use of key health interventions such as immunization [2]. According to guidelines developed by the WHO, children are considered fully immunized if they have received vaccination against tuberculosis (Bacillus Calmette-Guerin [BCG]), 3 doses of diphtheria, whooping cough (pertussis) and tetanus (diphtheria, tetanus, and pertussis [DPT]) vaccine, 3 doses of oral poliomyelitis vaccine (OPV), and 1 dose of measles vaccine by the age of 12 months [3]. According to UNICEF immunization coverage evaluation survey 2009, 61% of Indian children were completely immunized, while the corresponding figure for the state of Tamil Nadu was 77.3% [4]. National Family Health Survey 3 (NFHS-3) conducted, in 2005, documented an immunization coverage rate of 80.9% in the state [5]. The recent NFHS-4 conducted, in 2015, shows a decline in the rate from 80.9% to 69.7% [6]. There are a number of reasons why India lags behind its many less developed neighbors in vaccination rates [7]. Identification of factors determining immunization coverage is the crucial and first step to improve the immunization coverage rates and to decrease the under-five mortality.

Research paper thumbnail of Research Letters

Research paper thumbnail of Intussusception hospitalizations before rotavirus vaccine introduction: Retrospective data from two referral hospitals in Tamil Nadu, India

Vaccine, Jan 30, 2017

The indigenous oral rotavirus vaccine Rotavac® was introduced into the public immunization system... more The indigenous oral rotavirus vaccine Rotavac® was introduced into the public immunization system in India in 2016 and will be expanded in phases. This data will describe the epidemiology of intussusception in India in absence of rotavirus vaccination and will help in setting up or designing a safety monitoring system. Medical records of intussusception cases between 2013 and 2016 in two major referral hospitals in Tamil Nadu, India were reviewed, and data on clinical presentation and management and outcome were collated. A total of 284 cases of intussusception were diagnosed and managed at the two centers of which 280/284 could be classified as level 1 by the Brighton criteria. Median age at presentation was 8 months (Inter Quartile Range, IQR 6-17.2) with a male to female ratio of 2.1:1. Over half (57.7%) required surgical intervention while the rest underwent non-surgical or conservative management. Retrospective data from referral hospitals is sufficient to classify cases of int...

Research paper thumbnail of Diagnostic accuracy of digital thermometer compared to mercury in glass thermometer for measuring temperature in children

International Journal of Contemporary Pediatrics, 2017

Background: A wide variety of devices are available to record temperature from skin, oral or rect... more Background: A wide variety of devices are available to record temperature from skin, oral or rectal mucosa and the tympanic membrane. The accuracy of different devices is varied and the primary objective of this study is to compare the diagnostic accuracy of digital thermometer against mercury in glass thermometer in children. The secondary objective was to determine the average time taken by the digital thermometer to record the temperature.Methods: This descriptive study was conducted in a pediatric ward at Institute of Child Health and Hospital for Children, Egmore, Chennai. In all 92 febrile children aged 1 month to 12 years admitted in the ward, temperature was measured at the time of admission using both digital and mercury in glass thermometers placed in each axilla after obtaining informed consent. Concordance and discordance of both measurements were determined using Pearson Correlation coefficient and Bland altman plot. Average time taken by digital thermometer to record t...

Research paper thumbnail of Clinical Profile and Outcome of Scorpion Sting Envenomation in Children Admitted in a Tertiary Care Hospital

Journal of Evolution of Medical and Dental Sciences, 2016

BACKGROUND Scorpion sting envenomation is life threatening and a common public health problem in ... more BACKGROUND Scorpion sting envenomation is life threatening and a common public health problem in children. OBJECTIVES The primary objective was to characterize the epidemiological and clinical features of scorpion sting envenomation in children. The secondary objective was to determine the factors affecting duration of hospital stay. METHODS This retrospective descriptive study included children less than 12 years admitted in the paediatric ward with history of scorpion sting from Jan 2015 to Dec 2015. Epidemiological and clinical data such as age, sex, time and site of bite, pain, paraesthesia, swelling, sweating, vomiting, pre-hospital treatment, heart rate, blood pressure, X-ray, ECG findings, time and number of doses of prazosin administration, duration of hospital stay were collected. Parameters were expressed as percentage. Factors were analysed using Univariate and multivariate analyses. RESULTS Among 159 children the observations made were common age group 2-6 years (44.5%), males (63%), nocturnal bites (53.8%), lower limb bites (52.2%), pain (33.8%), admission within 2 hours (81.25%), pre-hospital treatment (28.7%) class I symptoms (43%) and ECG changes in (11.3%); 89.3% received prazosin. Univariate analysis identified abnormal heart rate, S3 gallop, cold extremities, weak pulse, prolonged capillary refill time, abnormal systolic blood pressure and ECG changes as significant risk factors for prolonged hospital stay, whereas cold extremities and ECG changes were significant risk factors in multivariate analysis. CONCLUSION Demographic parameters and clinical profile are described. Cold extremities and ECG abnormalities were significantly associated with prolonged hospital stay.

Research paper thumbnail of Neonatal Diabetes-From Insulin to Oral Hypoglycemic Agent: Case Report

Diabetes Case Reports, 2017

Patient Duration of follow up Present glibenclamide dose HbA 1 c Growth Development Before transf... more Patient Duration of follow up Present glibenclamide dose HbA 1 c Growth Development Before transfer After transfer Case 1 22 months 0.18 6 5.1 Severe Acute Malnutrition Global developmental delay Case 2 14 months 0.3

Research paper thumbnail of Self-medication pattern among children attending a tertiary hospital in South India: a cross-sectional study

International Journal of Contemporary Pediatrics, 2016

The main problem with self-medication with antibiotics is the emergence of resistance. 4 Economic... more The main problem with self-medication with antibiotics is the emergence of resistance. 4 Economic, political and cultural factors have contributed to the growth and spread of self-medication worldwide. These include greater availability of drugs, irresponsible publicity, pressure to convert prescription only drugs to ABSTRACT Background: Administration of medications by care-givers to children without medical consultation is termed selfmedication. Published literature on self-medication pattern in Indian children is scanty. Primary objective of the study was to study the prevalence of self-medication. Secondary objectives were to study its characteristics and the relation between demographic characteristics and self-medication. Methods: This descriptive study was performed in the outpatient department of Institute of child health and hospital for children. All children between 1 month and 12 years of age who attended the outpatient department during a particular time of the day on particular days of week were included in the study. After noting down the demographic characteristics, history of self-medication was elicited. For children who self-medicated, inciting illness, name of drug, source, reason and adverse events were noted down. Prevalence of self-medication was expressed as proportion with 95% confidence interval. Relation between demographic factors and self-medication was determined using chisquare test. Results: Prevalence of self-medication was 32% (95% confidence interval 28-35%). Common illnesses leading to self-medication were fever, cough and cold. Commonly used drugs were paracetamol, anticold medications and antibiotics. Most of them used previous prescription to procure the drugs and previous experience on efficacy was the most common reason cited. Older children were more commonly self-medicated than the younger (p = 0.001). Conclusions: Self-medication is encountered in 32% of children attending the outpatient department of the hospital and is more common in older children.