Acute lower respiratory infection (ALRI), primarily pneumonia and bronchiolitis, is a substantial cause of morbidity and mortality in children younger than 5 years of age, particularly in developing countries. Worldwide, 20% mortality among children aged less than 5 years is attributed to respiratory tract infections (predominantly pneumonia associated). With neonatal pneumonia inclusive, 35-40% mortality among children aged less than 5 years account for 2.04 million deaths/year. Southeast Asia stands first in number for ARI incidence accounting for more than 80% of all incidences together with sub Saharan African countries. 1,2 In India, more than ABSTRACT Background: Acute lower respiratory infection (ALRI), primarily pneumonia and bronchiolitis, is a substantial cause of morbidity and mortality in children <5 years of age, particularly in developing countries. Vitamin D deficiency is a significant risk factor for severe ALRI in Indian infants and children <5 years of age. This study was done to determine the relationship, if any, between respiratory illnesses and serum vitamin D status. Methods: This study included 40 (22 boys and 18 girls) hospitalized children of 6 months to 5 years of age with ALRI as cases and 40 (25 boys and 15 girls) age and sex matched children with no respiratory illness and no clinical manifestation of vitamin D deficiency as controls. Sociodemographic profile, feeding history, immunization history, sun exposure, drug history, causes of admission were taken by interviewing the child's mother or guardian. Serum vitamin D was estimated using commercially available kit by chemiluminiscence technique. General physical and systemic examination with emphasis on respiratory system was performed. ALRI diagnosis was made by clinical, radiographic and biochemical findings. Results: Among vitamin D deficient and insufficient children, 71% and 74% were adequately exposed to sunlight respectively. 50% vitamin D deficient children were diagnosed of bronchial asthma and 33% of bronchopneumonia. Among vitamin D insufficient, 48% had acute bronchiolitis and 35% had bronchopneumonia. Among sufficient Vitamin D, bronchopneumonia and acute bronchiolitis were 36% each i.e. most of the cases of bronchial asthma (60%) had vitamin D deficiency whereas majority of acute bronchiolitis cases (73%) had vitamin D insufficiency. Statistically significant difference was seen between cases and control among vitamin D sufficient, insufficient and deficient groups with higher number of sufficient vitamin D controls. Low vitamin D levels were significantly correlated with ALRI. Conclusions: Subclinical vitamin D deficiency is significant risk factors for severe ALRI in Indian children of less than 5 years of age.

Background: Thrombocytopenia (platelet count <1,50,000/µL) is one of the most common haematological problems in neonatal intensive care units. In contrast, only 2% of the normal neonates are thrombocytopenic at birth with severe thrombocytopenia (platelet count <50,000/µL) occurring in less than 3/1000 term infants. Multiple disease processes can cause thrombocytopenia in neonates. The important causes of thrombocytopenia in neonates are sepsis, birth asphyxia, prematurity, intra-uterine growth retardation, hyperbilirubinemia, respiratory distress syndrome, meconium aspiration syndrome and low birth weight. Apart from platelet count, bleeding manifestations depend on underlying ailments. The aims and objective were to study the clinical profile, etiology and outcome of neonatal thrombocytopenia in a tertiary care hospital.Methods: Prospective study involving 100 neonates with or developed neonatal thrombocytopenia in NICU.Results: In present study, 100 new-borns with thrombocytopenia 46% were mild, 35% were moderate and 19% were severe thrombocytopenia. 51 (51%) had early onset neonatal thrombocytopenia and 49 (49%) babies had late onset neonatal thrombocytopenia. Anaemia was the dominant maternal predisposing risk factor. Sepsis was the most common cause of neonatal thrombocytopenia. Most common symptom was apnoea. Sepsis, RDS and NEC had significantly contributed to mortality. Most common cause of death was sepsis followed by RDS and NEC.Conclusions: Neonatal thrombocytopenia is a treatable and reversible condition. Hence, it is important to identify neonates at risk and initiate transfusion therapy to prevent severe bleeding and potentially significant morbidity. Anaemia and PROM were the commonest maternal risk factors. Therefore, author recommended that babies born to mothers with these risk factors should be closely monitored for thrombocytopenia.

Background: Retinopathy of prematurity (ROP) is a complex disease of the developing retinal vasculature in premature infant. The challenge in India is that a large number of neonatal intensive care units (NICUs) don't have an effective ROP screening strategy. Objective: To measure the incidence of ROP in neonates with gestational age (≤32 weeks) or weighing <2000 g with risk factors and evaluation of risk factor associated with ROP. Materials and Methods: This prospective study was conducted in the Department of Pediatrics and Ophthalmology from January to July 2016. Neonates with gestational age ≤32 weeks, birth weight (BW) ≤1500 g, and selected preterm infants with a BW between 1501 and 2000 g with risk factors admitted in NICU/special newborn care unit were included in the study and screened for ROP by trained ophthalmologist under supervision of the pediatrician. All data were analyzed using SPSS or MedCalc. Univariate and multivariate logistic regression was done to determine the risk factors for the development of any ROP. Result: The incidence of ROP in our study was 19%. 4% of the neonates have severe (early treatment for ROP [ETROP] Type 1) ROP while 15% have non-severe (ETROP Type 2) ROP. 8 neonates developed Stage 1 ROP (42.11%), 7 developed Stage 2 (36.84%), and 4 neonates developed Stage 3 ROP (21.05%). Conclusion: The current study revealed that the incidence of ROP in sick neonates was 19%. Significant risk factors were found to be low BW, low gestational age, supplemental oxygen, and mechanical ventilation, culture proven sepsis, anemia, apnea, and respiratory distress syndrome (RDS).

Background: Immunization remains an important public health intervention. On one side morbidity and mortality caused by vaccine-preventable diseases are still high in developing countries, on the other side immunization coverage is still low. Present study aims to assess immunization status of under-five children in relation to various demographic variables of their mothers.Methods: A total of 530 mothers with children under 5 years attending OPD, immunization clinic or admitted in paediatric ward were included in the study. Maternal demographic variables like age, religion, education, socio economic status, residence, parity and occupation were compared with immunization status of their children.Results: Most of mothers were housewives (73.77%), primary educated (33.58%), belonged to Hindu religion (47.54%), were of 21-30 years age group (52.64%), residing in urban areas (62.07%) and belonged to middle socio economic status (45.84%). Out of total 530 children 161 (30.37%) were completely immunized as compared to 21.32% who were unimmunized. Boys were marginally more unimmunized (37.32%) than girls (23.04%). Mothers’ education, occupation, parity, religion, residence and socio-economic status significantly influenced immunization status of their children (p<0.05).Conclusions: Therefore, it is recommended that any strategy formulated to improve vaccination coverage in children of our country should focus to strengthen above mentioned weak links.

Introduction: Many newborns die every year due to various congenital anomalies and those who survive, suffer from long-term morbidity. To deal with birth defects, a large proportion of health resources and workforce is required. Among the various congenital anomalies, neurological birth defects are the leading type. Objective: The objective of the study was to document the epidemiological features and prevalence of congenital neurological anomalies in rural areas. Materials and Methods: This retrospective study was conducted in the department of pediatric of a medical college of Rajasthan. The study population included live births born in our institution between 1990 and 2018. A register was maintained after delivery to document the particulars of neonates with a congenital birth defect and their mothers. We had taken neonatal record from this register and analyzed the data of the past 28 years, retrospectively. Results: Of 241,848 live births, 6623 cases were identified with a primary diagnosis of one or more congenital anomalies giving a prevalence rate of 274/10,000 live births (95% confidence interval [CI]: 262.2–285.8). Anomalies of the nervous system were the second common defects, accounting for 19.95% of the birth defects just after the heart disease anomalies (21.65%). Neurological anomalies were diagnosed in 1321 neonates. The prevalence of neurological anomalies was 54.62/10,000 live births (95% CI: 49.75–59.49). The most common neurological anomaly was myelomeningocele/meningocele (spina bifida cystic) found in 64.87% of cases followed by Chiari malformation (7.72%), encephalocele (6.89%), microcephaly (6.88%), hydrocephalous (1.43%), and spina bifida occulta (1.43%). Conclusion: Neurological anomalies were among common congenital anomalies and considerable cause of mortality and morbidity. Myelomeningocele/meningocele (spina bifida cystic) was the most common neurological anomaly.