An open-label, pilot study to evaluate the benefits of using lyophilized human milk-derived nutritional product (NeoLact 70 – 1.55 g) as an immune-nutritional supplement in premature infants discharged from NICU

Background: Premature and low birth weight (LBW) infants are at increased risk of having inadequate growth in post-discharge periods. In this study, lyophilized human milk was used as an immune-nutrition supplement along with breastfeeding for a period of 1 month in preterm infants discharged from neonatal intensive care unit (NICU). Objectives: Primary objective was to assess the percentage change in serum immunoglobulins for the duration of supplementation, and secondary objectives were to correlate changes in immunoglobulins to number of episodes of infections including respiratory infections and diarrhea, requirement of antibiotics, weight gain, and episodes of feed intolerance during the study period. Methods: A total of 10 preterm and LBW infants were included in the study at the time of discharge from NICU after satisfying the inclusion and exclusion criteria. The serum immunoglobulins were estimated at baseline and at end of the study, other parameters such as episodes of infections, feed intolerance, and weight gain were recorded on the weekly follow-up visits. All the infants received supplementation with NeoLact 70 – 1.55 g on a TID frequency along with the regular breastfeeding for a period of 1-month post-discharge from NICU and were followed up on a weekly basis. Results: Ten infants completed the study, mean birth weight and gestational age were 1779.4±576 gm and 33.5±4.9 weeks, respectively. There was increase in immunoglobulins IgA, IgE, IgG, and IgM by 38.29%, 85.36%, 17.45%, and 48.25%, respectively, from baseline to end of study. None of the infants experienced feeding intolerance, diarrhea, abdominal distension, fever, respiratory infections, or rehospitalizations, none of the infants required antibiotics or probiotics during the study period. The average weight gain in the 1st, 2nd, 3rd, and 4th week of supplementation was 28.42 g/day, 31.57 g/day, 35.17 g/day, and 39.24 g/day, respectively, with a mean weight gain of 30.4 g/day achieved for the entire duration of the study. Conclusion: The immune-nutritional supplementation with lyophilized human milk (NeoLact 70 – 1.55 g) helps to ensure exclusive human milk diet post-discharge and reduce the risk of infections, diarrhea, and rehospitalization through the enhancement of immunoglobulins and ensuring optimal weight gain. However, these results should be confirmed through multicentric studies with larger sample size. Supplementation with NeoLact 70 – 1.55 g can clinically benefit premature and LBW infants post-discharge.

A study of serum zinc levels in children admitted with pneumonia in a tertiary care hospital in India

Background: Worldwide, pneumonia is a leading cause of morbidity and mortality in children under 5 years of age; especially, in developing countries. Objectives: The objective of the study is to investigate whether zinc deficiency and other nutritional factors are related to pneumonia in children between 6 months and 5 years old. Methodology: In this casecontrol study, a valid written consent was obtained from mothers of enrolled children. The cases included 75 children fulfilling the World Health Organization criteria for pneumonia, between the age group of 6 months and 5 years. They were interrogated for potential nutritional risk factors as per a predesigned proforma followed by a measurement of serum zinc levels. In the control group, 75 children of the same age group who were siblings of admitted children were included along with other children of the same age group admitted for non-respiratory complaints. A detailed case history was obtained and physical examination was done according to a predesigned proforma to elicit various potential risk factors. A semi-auto analyzer was used to measure the serum zinc levels through colorimetric methods using 5-bromo-PAS. Results: Significant nutritional risk factors identified were low serum zinc level, malnutrition, and anemia. Conclusion: The present study has identified various nutritional risk factors for pneumonia which can be tackled through effective education of the community and appropriate initiatives.

Severe COVID-19 illness in an Indian adolescent with autoimmune polyendocrinopathy syndrome-1

Autoimmune polyglandular syndrome-1 (APS-1)also known as autoimmune polyendocrinopathy candidiasis ectodermal dystrophy is a rare autosomal recessive disorder caused by mutation of AIRE gene on chromosome 21q22.3 with an overall prevalence of <1:100,000. Here, we present a 16-year-old male having clinical history of evolution of symptoms for oral candidiasis, hypoparathyroidism, and adrenal insufficiency (AI). He developed rare endocrine and non-endocrine manifestations such as type-1 diabetes (T1D) and autoimmune hepatitis, respectively. The patient while on hormone replacement therapy along with immunosuppressants developed liver cirrhosis and portal hypertension with esophageal varices and candidiasis. Subsequently, he was admitted for complaints of cough, cold and fever and was confirmed to be affected by SARS-CoV-2 by reverse transcription-polymerase chain reaction method. In his prolonged ICU stay of 26 days, he required oxygen therapy, intravenous glucocorticoids, remdesivir, low molecular weight heparin, and hemodynamic support with inotropes. His medical management with subcutaneous insulin therapy and azathioprine was continued. He was discharged after complete resolution of symptoms and negative tests for SARS-CoV-2 and was advised radiological and clinical follow-up. Reports suggest that risk of severe COVID does not increase in patients with AI or autoimmunity. However, our patient possibly developed severe COVID not only due to AI and autoimmunity but also associated rare manifestations like hyperglycemia due to T1D and cirrhosis. Thus, good glycemic control and well-tolerated modern immunosuppressant therapy may be useful in improving prognosis of severe COVID-19 illness in patients with APS-1.

Hypoxemia associated with lumbar puncture in neonates

Objectives: The objectives of the study were to study the effect of different stages of lumber puncture (LP) procedure on oxygen saturation (SpO2) in newborn baby. Materials and Methods: It was a 1-year, prospective observational study conducted in a tertiary care hospital. Forty neonates were included who fulfilled the inclusion criteria. SpO2 was measured during the different stages of LP in the recruited newborns and comparison was done between SpO2 changes in LP duration of <5 min and more than 5 min groups and the effect on SpO2 in preterm and term babies during LP. Results: Mean SpO2 during baseline, flexion, needle insertion, immediate repositioning, and 5 min after procedure were 94.5, 91.82, 88.92, 94.7, and 95.38, respectively. When compare to baseline, drop in SpO2 was found during flexion and needle insertion with p = 0.0025 and <0.0001, respectively. While comparing Mean SpO2 during different phases between duration of LP >5 min versus <5 min group, the saturation was less during flexion positioning with maximum fall at the time of needle insertion in LP duration >5 min. The regain of saturation during repositioning was more in LP <5 min versus duration >5 min group. Comparing between LP duration >5 min versus <5 min group, fall in SpO2 from baseline (5 min before LP procedure) was more in LP duration >5 min group during flexion and needle insertion phase. Hypoxemia is more in preterm than term neonates during flexion and during needle insertion, supine repositioning. Furthermore, hypoxia recovered after 5 min of supine repositioning more in term infants. Conclusions: Significant hypoxia was associated in newborn in flexion and needle insertion phase of lumbar puncture, especially in preterm newborns and those with prolonged duration of procedure.

Clinico-biochemical relation of Vitamin D3 with the severity of atopic dermatitis and response to supplementation of Vitamin D3: A randomized controlled trial

Background: Atopic dermatitis (AD), also known as eczema, is one of the most common skin disorders among children and adults, with a steep rise in diagnoses among children. Many studies have investigated the relationship between Vitamin D3 (Vit D3) and AD. Methods: A randomized controlled trial was conducted among 60 children at SCB Medical College, Cuttack from August 2014 to November 2016. Children were randomly assigned to an intervention group that received 60,000 IU of Vit. D3 every week for 6 weeks in addition to regular treatment for AD and a control group that received same treatment of AD except for Vit. D3. Both the groups were followed up at 4 weeks and 8 weeks. Results: In 60 cases of moderate to severe AD, 70% of the patients were male. About 81.7% of patients were from urban areas and 56.7% belonged to a middle socioeconomic class. In 76.6% of cases, family history of atopy was present. At baseline, mean SCORAD was 47.8±7.5 in the intervention group, and 49.2±10.3 in the control group. At baseline, serum Vitamin. D3 level (ng/ml) was 17.6±1.8 in intervention and 17.3±3.5 in control group. After Vitamin. D3 supplementation, the SCORAD improved to 12.8±5.1 (75% reduction) at 4 weeks, and 3.6±2.1 (92% reduction) at 8 weeks in the intervention group. In the control group, the mean SCORAD was 18.8±9.1 (61% reduction) at 4 weeks, and 7.3±4 (85% reduction) at 8 weeks. Discussion: The improvement of serum 25-hydroxy Vit. D3 was 134% and 366% in the intervention group compared to 78% and 121% in the observation group after 4 weeks and 8 weeks respectively. The p-values at both the time points were significant (<0.05) for the intervention group as compared to the control group. Conclusion: Short-term therapeutic supplementation of Vitamin. D3 in children with moderate to severe AD improves the clinical score. There is an inverse relationship between serum Vitamin. D3 level and severity of AD.

Association of maternal dietary patterns with child birth weight and size in India: Evidence from National Family Health Survey, 2005 to 2016

Background: Maternal dietary diversity during pregnancy is a major determinant of birth weight and birth size of infant. During pregnancy, mother diet is highly dependent on their topographical, cultural, and sociodemographic circumstances. Objective: The objective of the study was to assess the association between the maternal dietary intake with child birth weight and birth size along with the sociodemographic factors in India. Materials and Methods: The data for this study were drawn from the National Family Health Survey (NFHS), 2005 to 2006 and 2015 to 2016 held in India. Inferential statistical analysis Chi-square was built to test was used to examine the association between maternal dietary patterns, and logistic regression model was used to analyze the effect of mother’s dietary patterns on child birth weight and size by controlling the sociodemographic factors. Results: Mother’s daily intake of fish, meat, green leafy vegetables, and fruits was associated with higher birth weight or size and lower risk of intrauterine growth retardation. Women with ?2 dietary diversity categories had significantly higher proportion of low birth weight (LBW) and size of babies comparatively to those in the ?2 dietary diversity categories, there were lesser chance of LBW and small size of babies with women’s dietary diversity 3 (odds ranges from 1.09 to 1.44) or ?4 (odds ranges from 1.15 to 1.59). Furthermore, low birth order, mother’s underweight status, low maternal education, and wealth status significantly have positive association with the poor birth outcomes. Conclusion: The birth weight and size of newborns were found positively associated with the mother’s dietary intake. To meet the aim of maternal dietary diversity and to achieve the double bonus, the government should focus more on supplementation and food security programs during pregnancy that also include nutritional education as well as behavioral and social change interventions strategies.

Perspectives in preschool nutrition

Malnutrition is a grave global public health problem and needs serious attention. The prevalence of malnutrition in under 5 years children in India is high. Hence, there is an urgent need to recognize the nutrition and feeding concerns, the gaps in adequate nutrient intake and bridge them to ensure optimum nutritional care in early childhood. Twenty-eight Pediatricians were selected by purposive sampling from Telangana (n=12) and West Bengal (n=16) to form an advisory board. An advisory board meeting was conducted, which included a presentation on preschool nutrition in an Indian perspective. This was followed by a focused group discussion among the team of experts to gather their views on nutrition concerns of the preschoolers. They gave their opinion on how to address these concerns, role of healthy food drinks, the role of novel nutrients such as prebiotics and docosahexaenoic acid in preschoolers and the importance of nutrition education of mothers by healthcare professionals. Further, the board members pointed out the common micronutrient deficiencies such as iron, Vitamins-A and D, excessive intake of sugar and fat, and indicated a need for micronutrient supplementation, healthy alternatives for sugar and fat, views on healthy food drinks among the preschoolers. The advisory board members were unanimous in their belief that it is essential to create awareness and educate mothers about preschool nutrition and for doctors to include some nutrition counseling time for early childhood nutritional care. This would help to improve the nutritional intake which is essential to ensure optimum growth and development during the preschool age for a healthier future.

Atypical Kawasaki disease in an early infant, a diagnostic challenge: Case report

A 4.5-month-old girl presented to us with continuous fever for 10 days and loose stools for 2 days. She received short courses of multiple oral antibiotics during this period however, was not relieved. Initial investigations were suggestive of urinary tract infection for which broad spectrum antibiotics were started. However, fever persisted even after 72 h of antibiotics. Blood counts showed persistently high total leukocyte count and increasing platelet count, along with high C-reactive protein. Consequently, a diagnosis of Kawasaki disease (KD) was suspected, which was supported by echocardiographic findings. After she received intravenous immunoglobulins, her fever subsided and lab parameters showed significant improvement. This case highlights an unusual presentation of KD in an uncommonly young age group without much clinical pointers except for persistent fever.

Idiopathic dilated cardiomyopathy as cor bovinum in infancy: “A foggy road in winter”

Dilated cardiomyopathy, when diagnosed in infancy, poses an array of difficulties from reaching an etiological diagnosis to prognosticating the long-term outcome. Here, we report a case of idiopathic dilated cardiomyopathy in a 6-month-old child who responded well to beta-blocker (Carvedilol) in optimum dosage and revealed favorable cardiac remodeling over 6 months with substantial improvement in ejection fraction (EF) (EF of 22–44%) with significant amelioration of child’s symptoms. Our case has a unique message that while treating idiopathic dilated cardiomyopathy (DCM) in infancy, optimized use of the beta-blockers is most often the only way to clear the foggy road of idiopathic DCM and obtain a favorable outcome.

Cardiovascular manifestations and echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 (MIS-C): A retrospective study

Background: The multisystem inflammatory syndrome in children (MIS-C) has been described recently during COVID-19 pandemic. It is a delayed post-infectious response with a lag time of 4–6 weeks following the exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), involving multiple systems which is being increasingly reported worldwide. Aim: The study aims to investigate and report the cardiovascular manifestation and echocardiographic findings in pediatric patients diagnosed with MIS-C. Materials and Methods: The present study is a retrospective analysis of clinical data gathered from 40 admitted children diagnosed with MIS-C. The study was conducted for 1 year (from 1st June 2020 to 30th May 2021) at Cheluvamba Hospital, a tertiary care center attached to Mysore Medical College And Research Institute, Mysore, Karnataka. Results: Out of 40 children, 21 (52.5%) had manifestation of cardiovascular system in the form of shock, requiring ionotropic support and care at the Intensive Care Unit. Among them, 90% patients show elevated cardiac biomarker (Troponin T), 33.3% had two-dimensional echocardiographic (2D echo) findings in which 9.5% show coronary artery dilatation and 23.8% show left ventricular hypertrophy. Conclusion: MIS-C is a hyperinflammatory syndrome related to SARS-CoV-2 infection. Cardiac involvement is evidenced by perturbation of cardiac chamber size, function, coronary artery abnormalities, and elevated cardiac biomarker. Though, most of the patients responded to the initial treatment and recovered, there is scarcity of data regarding long-term cardiovascular complication.