PCR-based DNA sequencing is a rapid and reliable diagnostic tool to identify the aetiological agents of neonatal sepsis. This is the first case series of emerging Rickettsial neonatal sepsis in India .
IntroductionG rowth is an essential feature of childhood. It depends on genetic, nutritional, social and emotional factors. It is affected by chronic systemic disease. Growth follows a sigma shaped curve with a high velocity in the early postnatal period and during puberty, but a steady rate during mid-childhood. Nephrotic syndrome occurs most commonly in the age group of 2-8 years when the growth rate is at a steady state. Patients having frequent relapses and requiring repeated courses of steroids often develop steroid toxicity, including growth retardation [1]. It is known that daily, supraphysiologic doses of glucocorticoids inhibit growth by multiple mechanisms including impaired release of growth hormone and decreased activity of insulin-like growth factor-1 (IGF-1) in growing bones. However their effect in Indian children with steroid sensitive nephrotic syndrome (SSNS) has not been described. This study correlates the growth rate with the cumulative dose of steroids in children with steroid sensitive nephrotic syndrome.
Material and MethodsThe data of 35 children with SSNS on regular follow-up for a minimum period of one year at the nephrology clinic of a tertiary level hospital was analyzed retrospectively. These children were divided into two groups. Groups 1 received prednisolone in the standard dose for the initial episode at 2 mg/kg/day for six weeks followed by 1.5mg/kg on alternate days for six weeks and relapses were treated with 2 mg/kg/ day till remission followed by 1.5 mg/kg/day for four weeks as per the guidelines of the Indian Academy of Pediatrics [2]. Group II consisted of children who in addition to the steroids had received steroid sparing agents like levamisole and or cyclophosphamide during the year of study.The height was measured using a stadiometer on at least two occasions, first at the time of inclusion in the study and second time a year later. The height was converted into an SD (standard deviation) score (Z score) using the software "CDC EPI Info 2002" which requires age and height for calculation. The change in SD scores over one year was noted as Δ SD score. The cumulative dose of steroids received during the year was calculated for each patient and recorded as mg/kg/year. Correlation of the growth rate as a change in the SD score over one year was done with the cumulative dose of steroids using the Pearson's correlation and its significance noted. Children with steroid resistance or those with a poor follow-up during the study period were excluded from the study.
ResultsRecords of 35 children with SSNS were analysed. There were 24 (68.6 %) boys and 11 (31.4 %) girls with the M: F ratio
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