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Papers by nandita chattopadhyay

Journal of family medicine and primary care, May 1, 2024

Journal of family medicine and primary care, 2024

Background: Sepsis, the second most common cause of neonatal mortality, causes more than one mill... more Background: Sepsis, the second most common cause of neonatal mortality, causes more than one million deaths annually. India has the highest incidence of clinical sepsis (17000/100000 live birth). Objective: This study aimed to determine the risk factors and organisms of early-onset neonatal sepsis (EONS) in a tertiary care hospital in Northeast India. Materials and Methods: It was a case-control study conducted in the neonatal unit of MGM Medical College, Kishanganj, Bihar, from January 2022 to April 2023. All neonates admitted to the neonatal intensive care unit (NICU) within 72 hours of life constituted the study population. Neonates diagnosed as EONS by clinical and laboratory parameters were considered as cases and those not diagnosed for EONS as controls. Maternal and newborn information and laboratory parameters were collected and analyzed. For risk factor identification, the bivariate logistic regression was used. Result: An equal number of cases (78) and control (78) were enrolled in the study. Maternal age >30 years (adjusted odds ratio [aOR] = 3.017, confidence interval [CI]: 1.238 to 7.352; P < 0.015), maternal urinary tract infection (UTI) in the third trimester (aOR = 5.435, CI: 2.647 to 11.158; P < 0.0001), and premature rupture of membranes (PROM) (aOR = 2.918, CI: 4.61 to 33.73, P < 0.004) were significant predictors of EONS. Pseudomonas (41.02%), Klebsiella (16.66%), and coagulase-negative Staphylococcus aureus (20.51%) were commonly isolated organisms, which were highly resistant to cephalosporin, meropenem, aminoglycosides, and quinolones. Conclusion: Proper and adequate antenatal screening for diagnosis and treatment of maternal infection and high-risk pregnancies for perinatal management of newborn is recommended to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics may minimize the hazard of antibiotic resistance.

F1000Research, Nov 11, 2022

Background As a post-COVID complication in children, multisystem inflammatory syndrome in childre... more Background As a post-COVID complication in children, multisystem inflammatory syndrome in children (MIS-C) is important because of its varied and life-threatening manifestations. With this background, this study attempts to focus on MIS-C cases in an underprivileged rural setting in northeastern India, with most patients being treated with methylprednisolone rather than intravenous immunoglobulin due to financial constraints. Methods In this prospective longitudinal cohort study at MGM Medical College, 27 MIS-C cases diagnosed following WHO criteria were included. Laboratory and radiological investigations, including echocardiography, were performed as required for diagnosis and to assess prognosis. Most patients were treated with methylprednisolone. A follow-up assessment was done six weeks after discharge for any residual impairment. Results The most frequently affected age group was 5-10 years (59.28%), while respiratory (48.14%) and cardiac (40.74%) were the most commonly involved systems. Logistic regression studies established a significant association between serum ferritin level and prolonged hospital stay (coefficient 0.0674, p=0.0041), possibly due to greater complications in cases with high ferritin levels. Organ impairment was found to increase the need for inotrope use (coefficient 3.8797, p=0.00584). Most cases were treated with methylprednisolone alone (85.18%) with a favourable response and no death occurred. Conclusion The favourable response in cases treated with methylprednisolone Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Indian Pediatrics Case Reports

Indian Pediatrics Case Reports

Introduction: Early childhood is the period of most rapid brain development. Early childhood deve... more Introduction: Early childhood is the period of most rapid brain development. Early childhood development (ECD) is considered a prime investment for future prosperity in all dimensions, and the nurturing care framework provides a roadmap for promoting ECD. The deliverables for nurturing care (NC) are simple and affordable but require a robust delivery system with multi-stakeholder involvement to reach all caregivers, who are the ultimate implementing agents. Determining how to develop an effective ECD-NC delivery system can be a perplexing primary healthcare issue, unique to each country and community. Objectives To devise a cost-effective and sustainable program through the mediation of trained ECD activists from the community and to promote ECD-NC in remote, rural India by motivating and empowering mothers to implement nurturing care. Method In a rural community with an estimated 8,000 children between the ages of zero and six, eight local women were trained on ECD and NC delivery ...

Research and Humanities in Medical Education, Dec 31, 2014

The author uses the metaphor of the Indian sweet, rasgulla, to unravel the details of how to cond... more The author uses the metaphor of the Indian sweet, rasgulla, to unravel the details of how to conduct a literature search, and demonstrates thereby, how to structure a review of literature. The process also illustrates that a scientific temperament can be beneficial in any walk of life.

Global Pediatric Health

Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B... more Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B gene leading to decreased secretion of serum ceruloplasmin in blood and decrease biliary excretion of copper leading to toxic level accumulation in the liver, brain, kidney, and cornea, resulting in development of characteristic liver disease and neuropsychiatric symptoms. Our case presented with mainly clumsiness and gait abnormality without any psychiatric component and any history of liver disease. A 13-year old male, born out of non-consanguineous marriage, presented with clumsy walking and slurring of speech. The child also complained of poor handwriting and slipping of slipper from foot, without any history of abnormal behavior and poor scholastic performance. On examination gait was abnormal with sidewise swaying, increased muscle tone with rigidity and bilateral flexor plantar reflex. Slit lamp examination of eyes revealed bilateral Kayser-Fleischer rings. Serum ceruloplasmin wa...

Cureus

Although infantile tremor syndrome is considered a rare entity, we present a typical case of this... more Although infantile tremor syndrome is considered a rare entity, we present a typical case of this disorder. This case reinforces the association of infantile tremor syndrome with exclusive breastfeeding in infants and the absence of proper complementary feeding. A nine-month-old, irritable, listless, exclusively breastfed female presented with grade 2 malnutrition, tremors, hyperpigmentation, scarce scalp hair, and delayed developmental milestones. Laboratory investigations revealed macrocytic anemia and a low serum vitamin B12 value of 205 pg/dL. Cerebral and mild cerebellar atrophy were noted on the MRI brain scan. Accordingly, the patient was diagnosed with infantile tremor syndrome and treated with vitamin B12 and nutrient supplementation with zinc, magnesium, folic acid, and iron. The tremors improved and the child became responsive and interested in her surroundings. It is essential to recognize this condition at the earliest and initiate treatment. Basic interventions such as the promotion of proper nutrition, timely introduction of complementary feeding, and weaning practices are key factors in decreasing the incidence of this condition.

Indian Pediatrics

JUSTIFICATION Global developmental delay (GDD) is a relatively common neurodevelopmental disorder... more JUSTIFICATION Global developmental delay (GDD) is a relatively common neurodevelopmental disorder, however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. PROCESS Seven subcommittees of subject experts and members of Indian Academy of Pediatrics (IAP) chapter of neurodevelopmental Pediatrics and Neurology chapter, comprising of writing and expert group from among members of Indian Academy of Pediatrics and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of Indian Academy of Pediatrics (IAP). GUIDELINES GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.

Journal of the Indian Medical Association, 2011

Neonatal cutaneous mastocytosis is rare infiltrative disorder of the skin. Though often asymptoma... more Neonatal cutaneous mastocytosis is rare infiltrative disorder of the skin. Though often asymptomatic, systemic features may be associated with any clinical pattern of the disorder at any age group. We present our experience with a 3 1/2 months old female child. She presented with recurrent eruption of tense bullae preceded by flushing, irritability since day 3 of life. Darier sign and dermatographism were present. Skin biopsy confirmed the case as urticaria pigmentosa which is the most common form of cutaneous mastocytosis. Investigation revealed deranged liver function. Child was given H1 antihistaminics and topical glucocorticoid. Family counselled about chance of anaphylaxis to various toxins and drugs and risk of development of systemic mastocytosis.

Journal of Nepal Paediatric Society, 2014

2 month old baby presented with huge hepato-splenomegaly, ascites & pallor, , born to a mother su... more 2 month old baby presented with huge hepato-splenomegaly, ascites & pallor, , born to a mother suffering from fever and backache since last 4 months. Hypo-echoic shadows in liver, spleen and abdominal lymph nodes on USG & CT-scan and acute-on-chronic inflammation of liver by FNAC suggested Congenital Tuberculosis. Investigations in mother revealed Pulmonary Tuberculosis & Caries Spine, confirming the diagnosis of Congenital Tuberculosis in the baby. DOI: http://dx.doi.org/10.3126/jnps.v34i2.10910 J Nepal Paediatr Soc 2014;34(2):144-146

Indian pediatrics, 2005

This study was conducted to find normative values for thyroid stimulating hormone (TSH) in 1200 c... more This study was conducted to find normative values for thyroid stimulating hormone (TSH) in 1200 cord blood samples of term babies whose mothers were not on any thyroid medications. TSH was estimated within 24 hrs by enzyme immunoassay. A full thyroid profile, viz, T3, T4, TSH, fT3 and fT4 was done at 7-10 days of age in all babies with cord TSH >20 mIU/L. The mean, median and standard deviation for the TSH values for the cohort were 6.13 mIU/L, 5.8 mIU/L and 4.523 respectively. 22 babies with TSH values >20 mIU/L were given repeat tests. Hypothyroidism was confirmed in two of these babies. We conclude that a cut off value of TSH >20 mIU/L is adequate for neonatal thyroid screening in Indian settings.

Behavioral Problems in Children and Adolescents, 2014

Indian Pediatrics

Early childhood development (ECD) provides building blocks for future educational achievement, em... more Early childhood development (ECD) provides building blocks for future educational achievement, emotional and moral development; the early years of life provide a critical window of opportunity for intervention. Experts across the world are emphasizing on promotion of ECD through the 5-pronged Nurturing Care Framework (NCF). The Sustainable Development Goals have focussed on optimum development for all children by 2030. For India, with 164.5 million population of children between 0-6 years, the magnitude of the problem is huge. We have been focusing on ECD since the launching of the Integrated Child Development Scheme (ICDS) in 1976. Many national policies and programs have evolved since then to promote ECD. Inspite of all efforts, the overall picture of early childhood development in India is still not optimal, due to multiple factors. All five components of nurturing care framework have not been included comprehensively in the services offered. If India focuses on these areas and comes up with a convergent ECD delivery system through a single portal that can be provided with equity at the grassroot level, coupled with proper documentation, we may proceed towards our goals at a better pace. Multiple stakeholders (the government, public and private health care providers, non-government organizations, professional bodies) need to work in synergy to enable us to reach the 2030 goals

Indian Pediatrics

Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and ... more Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently, they have started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF)

Journal of family medicine and primary care, May 1, 2024

Journal of family medicine and primary care, 2024

Background: Sepsis, the second most common cause of neonatal mortality, causes more than one mill... more Background: Sepsis, the second most common cause of neonatal mortality, causes more than one million deaths annually. India has the highest incidence of clinical sepsis (17000/100000 live birth). Objective: This study aimed to determine the risk factors and organisms of early-onset neonatal sepsis (EONS) in a tertiary care hospital in Northeast India. Materials and Methods: It was a case-control study conducted in the neonatal unit of MGM Medical College, Kishanganj, Bihar, from January 2022 to April 2023. All neonates admitted to the neonatal intensive care unit (NICU) within 72 hours of life constituted the study population. Neonates diagnosed as EONS by clinical and laboratory parameters were considered as cases and those not diagnosed for EONS as controls. Maternal and newborn information and laboratory parameters were collected and analyzed. For risk factor identification, the bivariate logistic regression was used. Result: An equal number of cases (78) and control (78) were enrolled in the study. Maternal age >30 years (adjusted odds ratio [aOR] = 3.017, confidence interval [CI]: 1.238 to 7.352; P < 0.015), maternal urinary tract infection (UTI) in the third trimester (aOR = 5.435, CI: 2.647 to 11.158; P < 0.0001), and premature rupture of membranes (PROM) (aOR = 2.918, CI: 4.61 to 33.73, P < 0.004) were significant predictors of EONS. Pseudomonas (41.02%), Klebsiella (16.66%), and coagulase-negative Staphylococcus aureus (20.51%) were commonly isolated organisms, which were highly resistant to cephalosporin, meropenem, aminoglycosides, and quinolones. Conclusion: Proper and adequate antenatal screening for diagnosis and treatment of maternal infection and high-risk pregnancies for perinatal management of newborn is recommended to prevent neonatal sepsis-related morbidity and mortality. Rational use of antibiotics may minimize the hazard of antibiotic resistance.

F1000Research, Nov 11, 2022

Background As a post-COVID complication in children, multisystem inflammatory syndrome in childre... more Background As a post-COVID complication in children, multisystem inflammatory syndrome in children (MIS-C) is important because of its varied and life-threatening manifestations. With this background, this study attempts to focus on MIS-C cases in an underprivileged rural setting in northeastern India, with most patients being treated with methylprednisolone rather than intravenous immunoglobulin due to financial constraints. Methods In this prospective longitudinal cohort study at MGM Medical College, 27 MIS-C cases diagnosed following WHO criteria were included. Laboratory and radiological investigations, including echocardiography, were performed as required for diagnosis and to assess prognosis. Most patients were treated with methylprednisolone. A follow-up assessment was done six weeks after discharge for any residual impairment. Results The most frequently affected age group was 5-10 years (59.28%), while respiratory (48.14%) and cardiac (40.74%) were the most commonly involved systems. Logistic regression studies established a significant association between serum ferritin level and prolonged hospital stay (coefficient 0.0674, p=0.0041), possibly due to greater complications in cases with high ferritin levels. Organ impairment was found to increase the need for inotrope use (coefficient 3.8797, p=0.00584). Most cases were treated with methylprednisolone alone (85.18%) with a favourable response and no death occurred. Conclusion The favourable response in cases treated with methylprednisolone Open Peer Review Approval Status AWAITING PEER REVIEW Any reports and responses or comments on the article can be found at the end of the article.

Indian Pediatrics Case Reports

Indian Pediatrics Case Reports

Introduction: Early childhood is the period of most rapid brain development. Early childhood deve... more Introduction: Early childhood is the period of most rapid brain development. Early childhood development (ECD) is considered a prime investment for future prosperity in all dimensions, and the nurturing care framework provides a roadmap for promoting ECD. The deliverables for nurturing care (NC) are simple and affordable but require a robust delivery system with multi-stakeholder involvement to reach all caregivers, who are the ultimate implementing agents. Determining how to develop an effective ECD-NC delivery system can be a perplexing primary healthcare issue, unique to each country and community. Objectives To devise a cost-effective and sustainable program through the mediation of trained ECD activists from the community and to promote ECD-NC in remote, rural India by motivating and empowering mothers to implement nurturing care. Method In a rural community with an estimated 8,000 children between the ages of zero and six, eight local women were trained on ECD and NC delivery ...

Research and Humanities in Medical Education, Dec 31, 2014

The author uses the metaphor of the Indian sweet, rasgulla, to unravel the details of how to cond... more The author uses the metaphor of the Indian sweet, rasgulla, to unravel the details of how to conduct a literature search, and demonstrates thereby, how to structure a review of literature. The process also illustrates that a scientific temperament can be beneficial in any walk of life.

Global Pediatric Health

Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B... more Wilson disease is a rare autosomal recessive genetic disease, caused by the mutation of the ATP7B gene leading to decreased secretion of serum ceruloplasmin in blood and decrease biliary excretion of copper leading to toxic level accumulation in the liver, brain, kidney, and cornea, resulting in development of characteristic liver disease and neuropsychiatric symptoms. Our case presented with mainly clumsiness and gait abnormality without any psychiatric component and any history of liver disease. A 13-year old male, born out of non-consanguineous marriage, presented with clumsy walking and slurring of speech. The child also complained of poor handwriting and slipping of slipper from foot, without any history of abnormal behavior and poor scholastic performance. On examination gait was abnormal with sidewise swaying, increased muscle tone with rigidity and bilateral flexor plantar reflex. Slit lamp examination of eyes revealed bilateral Kayser-Fleischer rings. Serum ceruloplasmin wa...

Cureus

Although infantile tremor syndrome is considered a rare entity, we present a typical case of this... more Although infantile tremor syndrome is considered a rare entity, we present a typical case of this disorder. This case reinforces the association of infantile tremor syndrome with exclusive breastfeeding in infants and the absence of proper complementary feeding. A nine-month-old, irritable, listless, exclusively breastfed female presented with grade 2 malnutrition, tremors, hyperpigmentation, scarce scalp hair, and delayed developmental milestones. Laboratory investigations revealed macrocytic anemia and a low serum vitamin B12 value of 205 pg/dL. Cerebral and mild cerebellar atrophy were noted on the MRI brain scan. Accordingly, the patient was diagnosed with infantile tremor syndrome and treated with vitamin B12 and nutrient supplementation with zinc, magnesium, folic acid, and iron. The tremors improved and the child became responsive and interested in her surroundings. It is essential to recognize this condition at the earliest and initiate treatment. Basic interventions such as the promotion of proper nutrition, timely introduction of complementary feeding, and weaning practices are key factors in decreasing the incidence of this condition.

Indian Pediatrics

JUSTIFICATION Global developmental delay (GDD) is a relatively common neurodevelopmental disorder... more JUSTIFICATION Global developmental delay (GDD) is a relatively common neurodevelopmental disorder, however, paucity of published literature and absence of uniform guidelines increases the complexity of clinical management of this condition. Hence, there is a need of practical guidelines for the pediatrician on the diagnosis and management of GDD, summarizing the available evidence, and filling in the gaps in existing knowledge and practices. PROCESS Seven subcommittees of subject experts and members of Indian Academy of Pediatrics (IAP) chapter of neurodevelopmental Pediatrics and Neurology chapter, comprising of writing and expert group from among members of Indian Academy of Pediatrics and its chapters of Neurology, Neurodevelopment Pediatrics and Growth Development and Behavioral Pediatrics were constituted, who reviewed literature, developed key questions and prepared the first draft on guidelines after multiple rounds of discussion. The guidelines were then discussed by the whole group in an online meeting. The points of contention were discussed and a general consensus was arrived at, after which final guidelines were drafted by the writing group and approved by all contributors. The guidelines were then approved by the Executive Board of Indian Academy of Pediatrics (IAP). GUIDELINES GDD is defined as significant delay (at least 2 standard deviations below the mean with standardized developmental tests) in at least two developmental domains in children under 5 years of age; however, children whose delay can be explained primarily by motor issues or severe uncorrected visual/hearing impairment are excluded. Severity of GDD can be classified as mild, moderate, severe and profound on adaptive functioning. For all children, in addition to routine surveillance, developmental screening using standardized tools should be done at 9-12 months,18-24 months, and at school entry; whereas, for high risk infants, it should be done 6-monthly till 24 months and yearly till 5 years of age; in addition to once at school entry. All children, especially those diagnosed with GDD, should be screened for ASD at 18-24 months, and if screen negative, again at 3 years of age. It is recommended that investigations should always follow a careful history and examination to plan targeted testing and, vision and hearing screening should be done in all cases prior to standardized tests of development. Neuroimaging, preferably magnetic resonance imaging of the brain, should be obtained when specific clinical indicators are present. Biochemical and metabolic investigations should be targeted towards identifying treatable conditions and genetic tests are recommended in presence of clinical suspicion of a genetic syndrome and/or in the absence of a clear etiology. Multidisciplinary intervention should be initiated soon after the delay is recognized even before a formal diagnosis is made, and early intervention for high risk infants should start in the nursery with developmentally supportive care. Detailed structured counselling of family regarding the diagnosis, etiology, comorbidities, investigations, management, prognosis and follow-up is recommended. Regular targeted follow-up should be done, preferably in consultation with a team of experts led by a developmental pediatrician/ pediatric neurologist.

Journal of the Indian Medical Association, 2011

Neonatal cutaneous mastocytosis is rare infiltrative disorder of the skin. Though often asymptoma... more Neonatal cutaneous mastocytosis is rare infiltrative disorder of the skin. Though often asymptomatic, systemic features may be associated with any clinical pattern of the disorder at any age group. We present our experience with a 3 1/2 months old female child. She presented with recurrent eruption of tense bullae preceded by flushing, irritability since day 3 of life. Darier sign and dermatographism were present. Skin biopsy confirmed the case as urticaria pigmentosa which is the most common form of cutaneous mastocytosis. Investigation revealed deranged liver function. Child was given H1 antihistaminics and topical glucocorticoid. Family counselled about chance of anaphylaxis to various toxins and drugs and risk of development of systemic mastocytosis.

Journal of Nepal Paediatric Society, 2014

2 month old baby presented with huge hepato-splenomegaly, ascites & pallor, , born to a mother su... more 2 month old baby presented with huge hepato-splenomegaly, ascites & pallor, , born to a mother suffering from fever and backache since last 4 months. Hypo-echoic shadows in liver, spleen and abdominal lymph nodes on USG & CT-scan and acute-on-chronic inflammation of liver by FNAC suggested Congenital Tuberculosis. Investigations in mother revealed Pulmonary Tuberculosis & Caries Spine, confirming the diagnosis of Congenital Tuberculosis in the baby. DOI: http://dx.doi.org/10.3126/jnps.v34i2.10910 J Nepal Paediatr Soc 2014;34(2):144-146

Indian pediatrics, 2005

This study was conducted to find normative values for thyroid stimulating hormone (TSH) in 1200 c... more This study was conducted to find normative values for thyroid stimulating hormone (TSH) in 1200 cord blood samples of term babies whose mothers were not on any thyroid medications. TSH was estimated within 24 hrs by enzyme immunoassay. A full thyroid profile, viz, T3, T4, TSH, fT3 and fT4 was done at 7-10 days of age in all babies with cord TSH >20 mIU/L. The mean, median and standard deviation for the TSH values for the cohort were 6.13 mIU/L, 5.8 mIU/L and 4.523 respectively. 22 babies with TSH values >20 mIU/L were given repeat tests. Hypothyroidism was confirmed in two of these babies. We conclude that a cut off value of TSH >20 mIU/L is adequate for neonatal thyroid screening in Indian settings.

Behavioral Problems in Children and Adolescents, 2014

Indian Pediatrics

Early childhood development (ECD) provides building blocks for future educational achievement, em... more Early childhood development (ECD) provides building blocks for future educational achievement, emotional and moral development; the early years of life provide a critical window of opportunity for intervention. Experts across the world are emphasizing on promotion of ECD through the 5-pronged Nurturing Care Framework (NCF). The Sustainable Development Goals have focussed on optimum development for all children by 2030. For India, with 164.5 million population of children between 0-6 years, the magnitude of the problem is huge. We have been focusing on ECD since the launching of the Integrated Child Development Scheme (ICDS) in 1976. Many national policies and programs have evolved since then to promote ECD. Inspite of all efforts, the overall picture of early childhood development in India is still not optimal, due to multiple factors. All five components of nurturing care framework have not been included comprehensively in the services offered. If India focuses on these areas and comes up with a convergent ECD delivery system through a single portal that can be provided with equity at the grassroot level, coupled with proper documentation, we may proceed towards our goals at a better pace. Multiple stakeholders (the government, public and private health care providers, non-government organizations, professional bodies) need to work in synergy to enable us to reach the 2030 goals

Indian Pediatrics

Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and ... more Early childhood development (ECD) refers to the physical, motor, socio-emotional, cognitive, and linguistic development of a young child. The 'Countdown to 2030' global distribution of 'children at risk of poor development' indicates the need for urgent action and investment in ECD. Nurturing care enhances ECD, even in the presence of adversities. Strategic actions should exist at multiple levels: the family, community, health care providers and government. Previously, child health related policies and programs of the Government of India functioned in isolation, but have recently, they have started demonstrating multi-sectoral collaboration. Nonetheless, the status of ECD in India is far from optimal. There is strong evidence that parenting programs improve outcomes related to ECD. This is dependent on key programmatic areas (timing, duration, frequency, intensity, modality, content, etc.), in addition to political will, funding, partnership, and plans for scaling up. Each country must implement its unique ECD program that is need-based and customized to their stakeholder community. Barriers like inadequate sensitization of the community and low competency of health care providers need to be overcome. IAP firmly believes that responsive parenting interventions revolving around nurturing care should be incorporated in office practice. This paper outlines IAP's position on ECD, and its recommendations for pediatricians and policy makers. It also presents the roadmap in partnership with other stakeholders in maternal, neonatal, and child health; Federation of Obstetric and Gynaecological Societies of India (FOGSI), National Neonatology Forum (NNF), World Health Organization (WHO), and United Nation Children Fund (UNICEF)