Asian Journal of Pediatric Research

The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Adult and Infant Mask Ventilation Quality Evaluation from Various Viewpoints by Non-medical Personnel: Randomized Simulation Trial”. No formal abstract is available. Readers are requested to read the full article.

Rat-bite fever (RBF) is a systemic infectious disease. It is due to Streptobacillus moniliformis, a commensal bacterium of the nasopharyngeal mucosa of small rodents, in particular rats. This anthropozoonosis is rare in urban areas. The first clinical sign of infection is a fever, followed by polyarthritis and a rash. It can only start with skin signs, as in our observation. We report the case of a 41-day-old female infant who was the victim of a rat bite at one month of life in the upper nasal and labial areas. A rabies vaccine with local care has been made. The clinical course at 3 days after the bite was marked by a non-pruritic papulopustular rash, the vesiculo-bullous lesions in the bilateral and symmetrical legs evolved into inflammatory ulcerative necrotizing lesions in a geographic map of the lower 1/3 of the lower limbs with gangrenous lesions in the toes, an erythematous base on the face, hands and feet and discreet oral erosions, associated with generalized purpuric spots and fevers at 40°C. The biological assessment was carried out objectifying an inflammatory syndrome made of a leukocytosis at 26770/mm³, with neutrophils at 10842/mm³, CRP = 215 mg/L. The diagnosis of RBF was made by the isolation of a Gram-negative bacillus in a blood culture. The final identification of the germ was carried out by molecular biology (PCR of 16S rRNA). The lumbar puncture was negative and the cardiac ultrasound was without abnormality. Arterial and venous Doppler ultrasound of the lower limbs was normal. The diagnosis of rat bite fever having been retained. The infant was put on cefpodoxime IV for 3 weeks and metronidazole IV for 10 days. The clinical course at 3 months later, spontaneous amputation of gangrenous toes with residual skin scars was noted.

Aims: To study the anthropometric measurements of the neonates between 28 to 42 weeks of gestational age. To express them as smoothed percentiles and obtain their correlation with the constant.  Comparing the data trend with the Shah Study conducted twelve years ago in the same institute.

Study Design: Cross-sectional observational study of 500 (selected out of 1223 by convenience sampling) live new-borns, 28 to 42 weeks gestational age (confirmed by Ballard score) was conducted in NICU and post-natal ward, Sir-T hospital, Bhavnagar. Infantometer and non-stretchable measuring tape were used for measurements.

 Results: Demographic data- female, male: [247 (49.4%), 253 (50.6%)]. The newborns weighing < 2.499 kg were n= 193(38.6%), 2.500- 3.00 kg n=247(49.4%) and > 3.00 kg n= 60(12%). 244 newborns were <37 weeks old (48.8%) and 256 were 37- 42 weeks old (51.2%), with 37 weeks old contributing n=167(33.4%). The male newborn had higher anthropometric variable than female: Weight, Crown Heel Length, Head Circumference, Chest Circumference, Ponderal Index, Thigh Circumference, Mid Arm Circumference, Foot Length were 2.500, 46.73, 31.65, 29.69, 2.38, 12.06, 8.4, 6.79 of female and 2.595, 47.43, 32.08, 29.95, 2.39, 12.19, 8.2, 7.13 of male respectively, except in MAC.

By comparing the mean of the parameters of 34 to 38 week newborns, the mean of TC and MAC of the present study was found to be increased than in Shah Study. Similarly, the mean of weight in 34, 36, 37 and 38, CHL in 36 and 38, the HC  in 36, 37 and 38, the CC in 34, 35, 36 and 37, the FL in 35 and 37, and the Ponderal Index in 34, 35 and 38 week newborns, of present study was increased, as compared to Shah Study. By Pearson’s correlation, the maximum association was found with TC (r 0.934), followed by PI (0.868) and HC (0.844) in the present study and with TC (0.966) in Shah Study. The intrauterine growth curves were constructed by plotting percentile values of each anthropometric parameter against gestational age in weeks.

Conclusion: The nutrition has improved in the near term and full-term neonates. The percentile charts constructed in accordance with current data trends thus can be utilised regionally.

Introduction: Obesity is an emerging epidemic worldwide causing serious public health concern. The upper part of the body as Neck circumference (NC) can be used as a simple and time saving screening tool to evaluate it.

Materials and Methods: From January 2018 to June 2019, this school-based prospective observational study was conducted in schools of rural and urban areas near Jaipur taking 1000 children between age group of 6 to14 years. Children with conditions likely to interfere with neck circumference measurement were excluded. All anthropometric measurements were taken with standard techniques, and children were divided as normal, overweight or obese.

Results: Out of 1000 subjects, 364 males and 428 females were normal weight, 44 males and 68 females were overweight and 41 males and 19 females were found obese.

Intra group comparison of neck circumference in male & females showed significant correlation between normal, overweight & obese children. There was a good positive correlation between BMI and NC for all children.

Conclusion: Neck circumference can be used with great reliability to screen overweight and obesity in children.

Objective: Electrolyte dysregulations particularly hypophosphatemia and hypokalemia following feeds in a starved person is known as refeeding syndrome, which may lead to life-threatening conditions like arrhythmias, heart failure, respiratory and neuromuscular compromise. To evaluate electrolyte dyscrasias following enteral or parenteral feeding, among intrauterine growth retardation (IUGR) neonates ie those who were starved in-utero, compared to non-IUGR neonates this study was planned.

Methodology: From March to August 2015, 60 IUGR and non-IUGR neonates who were admitted at birth before starting of nutrition, either by breast milk or electrolyte-free intravenous fluid. An infant was classified as IUGR when his birth weight was <10^th percentile according to Fenton or Lubchenco growth charts. Venous blood was collected from intramural babies at zero hours of life or just before starting feeds to determine the basal level of serum electrolytes – phosphorus, magnesium and potassium, and was repeated in the following 48 and 72 hours.

Results: There was no significant difference between the two groups based on sex, history of maternal pre-eclampsia and oligohydramnios. At 72 hours after the start of feeding, Hypophosphatemia was significantly more prevalent, in 33.33% of IUGR vs. 2% of the non-IUGR group, [RR-5, p = 0.010]. Hypokalemia 20% IUGR; 1% non-IUGR group, [RR-6, p = 0.103]. Hypomagnesemia 3% IUGR; 2% non-IUGR group, [RR-1.5, p = 0.640]. Combined electrolyte– hypophosphatemia with hypokalemia (6.6%) and hypophosphatemia with Hypomagnesemia (13.3%), were present only in the IUGR group. Hyperglycemia was not present in any neonate.     

Conclusions: IUGR neonates are more likely to develop Refeeding syndrome when compared to non-IUGR babies, manifesting as decreased phosphorus, potassium and magnesium levels. Phosphorous should be a part of feeding nutrition in IUGR babies.