To the Editor: Coronavirus pandemic has not only impacted human life but also impacted medical education and residency training all over [1]. With principles of social distancing, all face to face classes were suspended due to the ongoing COVID 19 pandemic [2]. Considering its implications on our students, an online teaching session was conducted every day for 12 d. We used a free version of Zoom which allows maximum of 100 participants and for time period of 40 min. Students' perceptions were collected at the end of this lecture series.Feedback responses were obtained from 77 participants. Of these, 87% (67) were post-graduate students. Participants found the sessions to be relevant to their learning needs and clinical practice [n = 75 (97%)]. Majority of the participants perceived that the sessions were tailored to their level of learning [n = 76 (99%)] and found the sessions to be interesting and enjoyable [n = 72 (95%)]. All of the participants (n = 77) felt that each pediatric sub-specialty should start their classes for postgraduates, and that online classes should be made a part of the medical postgraduate curriculum.In the open comments, participants responded that these online sessions broke monotonous routine, were a good utilization of time and the material was easy to access. They felt motivated to read on those topics and it helped them not to think of COVID and sleep peacefully. Most frequent factors hindering learning were stated as limitation on the number of participants, time limitation of the sessions, and technical faults during the conduct of sessions. These shortcomings were addressed subsequently through buying advanced version of the software that allows more time, and better opportunity to interact with students.COVID pandemic made us realize the importance of online training for our pediatric postgraduate students. Students' satisfaction levels with online learning were comparable to the previous studies [3]. Apart from gain in knowledge, the present study revealed the impact of online learning on the morale of our students by creating a diversion from the ongoing pandemic situation. We conclude that online teaching is feasible, cheap and must be made a part of the postgraduate training in India beyond the prevailing lockdown.

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A descriptive study was conducted with an objective to determine the predictors of mortality among referred neonates and to ascertain their transport characteristics. A total of 300 consecutive neonates who were transferred to the centre were enrolled in the study. Following information were recorded: maternal details, birth details, interventions before transportation, details of transportation and neonatal condition at arrival. Detailed clinical assessment and management was done as per standard neonatal protocols. Birth weight <1 kg (OR 0.04; 95% CI: 0.006-0.295, P<0.01) and transportation time >1 hour (OR 5.58; 95% CI: 1.41-22.01, P=0.01) were found to be significant predictors for mortality among the transported neonate. Transport characteristics reflect road transport with limited utility of ambulances and lack of trained health personal. Hence to conclude, extreme low birth weight and prolonged transportation time were found to be significant predictors of neonatal mortality among the transported neonate.

Infant massage was first introduced in China in 2nd century BC. Massaging the newborn has been a tradition in India and other Asian countries since time immemorial. Various oil-based preparations have been used depending on the regional availability. There has been a recent surge in this ancient art particularly as a therapy among parents and professionals in the Western world. Evidence exists supporting the benefits of touch and massage therapy. We reviewed the literature to look at the various techniques of providing massage, its benefits, possible mechanism of action and adverse effects. The review suggests that massage has several positive effects in terms of weight gain, better sleep-wake pattern, enhanced neuromotor development, better emotional bonding, reduced rates of nosocomial infection and thereby, reduced mortality in the hospitalized patients. Many studies have described the technique and frequency of this procedure. Massage was found to be more useful when some kind of lubricant oil was used. Harmful effects like physical injury and increased risk of infection were encountered when performed inappropriately. The review also discusses the different hypotheses put forward regarding the mechanism of action. As of now there are very few studies describing the long term impact of neonatal massage.

This study highlights the developing country perspective of children with West syndrome, including delayed presentation, adverse perinatal events as the predominant etiology, and modest response to oral steroids.

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Background:Information regarding early predictive factors for mortality and morbidity in sepsis is limited from developing countries.Methods:A prospective observational study was conducted to determine the clinical outcome and predictors of mortality in children with sepsis, severe sepsis, and septic shock. Children aged 1 month to 14 years admitted to a tertiary care pediatric intensive care unit (PICU) with a diagnosis of sepsis, severe sepsis, or septic shock were enrolled in the study. Hemodynamic and laboratory parameters which discriminate survivors from nonsurvivors were evaluated.Results:A total of 50 patients (30 [60%] males) were enrolled in the study, of whom 21 (42%) were discharged (survivors) and rest 29 (58%) expired (nonsurvivor). Median (interquartile range) age of enrolled patients were 18 (6, 60) months. Mortality was not significantly predicted individually by any factor including age (odds ratio [OR] [95% confidence interval [CI]]: 0.96 [0.91-1.01], P = 0.17), duration of PICU stay (OR [95% CI]: 1.18 [0.99-1.25], P = 0.054), time lag to PICU transfer (OR [95% CI]: 1.02 [0.93-1.12], P = 0.63), Pediatric Risk of Mortality (PRISM) score at admission (OR [95% CI]: 0.71 [0.47-1.04], P = 0.07) and number of organ dysfunction (OR [95% CI]: 0.03 [0.01-1.53], P = 0.08).Conclusion:Mortality among children with sepsis, severe sepsis, and septic shock were not predicted by any individual factors including the time lag to PICU transfer, duration of PICU stay, presence of multiorgan dysfunction, and PRISM score at admission.

Plasmodium vivax is traditionally known to cause benign tertian malaria, although recent reports suggest that P. vivax can also cause severe life-threatening disease analogous to severe infection due to P. falciparum. There are limited published data on the clinical and epidemiological profiles of children suffering from ‘severe malaria’ in an urban setting of India. To assess the clinical and epidemiological profiles of children with severe malaria, a prospective study was carried out during June 2008–December 2008 in the Department of Pediatrics, Guru Teg Bahadur Hospital, a tertiary hospital located in East Delhi, India. Data on children aged ≤12 years, diagnosed with severe malaria, were analyzed for their demographic, clinical and laboratory parameters. All patients were categorized and treated as per the guidelines of the World Health Organization. In total, 1,680 children were screened for malaria at the paediatric outpatient and casualty facilities of the hospital. Thirty-eight children tested positive for malaria on peripheral smear examination (2.26% slide positivity rate). Of these, 27 (71%) were admitted and categorized as severe malaria as per the definition of the WHO while another 11 (29%) received treatment on outpatient basis. Most (24/27; 88.8%) cases of severe malaria (n=27) were infected with P. vivax. Among the cases of severe malaria caused by Plasmodium vivax (n=24), 12 (50%) presented with altered sensorium (cerebral malaria), seven (29.1%) had severe anaemia (haemoglobin <5 g/dL), and 17 (70.8%) had thrombocytopaenia, of which two had spontaneous bleeding (epistaxis). Cases of severe vivax malaria are clinically indistinguishable from severe falciparum malaria. Our study demonstrated that majority (88.8%) of severe malaria cases in children from Delhi and adjoining districts of Uttar Pradesh were due to P. vivax-associated infection. P. vivax should, thus, be regarded as an important causative agent for severe malaria in children.