BackgroundNeurodevelopmental disorders (NDDs) compromise the development and attainment of full social and economic potential at individual, family, community, and country levels. Paucity of data on NDDs slows down policy and programmatic action in most developing countries despite perceived high burden.Methods and findingsWe assessed 3,964 children (with almost equal number of boys and girls distributed in 2–<6 and 6–9 year age categories) identified from five geographically diverse populations in India using cluster sampling technique (probability proportionate to population size). These were from the North-Central, i.e., Palwal (N = 998; all rural, 16.4% non-Hindu, 25.3% from scheduled caste/tribe [SC-ST] [these are considered underserved communities who are eligible for affirmative action]); North, i.e., Kangra (N = 997; 91.6% rural, 3.7% non-Hindu, 25.3% SC-ST); East, i.e., Dhenkanal (N = 981; 89.8% rural, 1.2% non-Hindu, 38.0% SC-ST); South, i.e., Hyderabad (N = 495; all urban, 25.7% non-Hindu, 27.3% SC-ST) and West, i.e., North Goa (N = 493; 68.0% rural, 11.4% non-Hindu, 18.5% SC-ST). All children were assessed for vision impairment (VI), epilepsy (Epi), neuromotor impairments including cerebral palsy (NMI-CP), hearing impairment (HI), speech and language disorders, autism spectrum disorders (ASDs), and intellectual disability (ID). Furthermore, 6–9-year-old children were also assessed for attention deficit hyperactivity disorder (ADHD) and learning disorders (LDs). We standardized sample characteristics as per Census of India 2011 to arrive at district level and all-sites-pooled estimates. Site-specific prevalence of any of seven NDDs in 2–<6 year olds ranged from 2.9% (95% CI 1.6–5.5) to 18.7% (95% CI 14.7–23.6), and for any of nine NDDs in the 6–9-year-old children, from 6.5% (95% CI 4.6–9.1) to 18.5% (95% CI 15.3–22.3). Two or more NDDs were present in 0.4% (95% CI 0.1–1.7) to 4.3% (95% CI 2.2–8.2) in the younger age category and 0.7% (95% CI 0.2–2.0) to 5.3% (95% CI 3.3–8.2) in the older age category. All-site-pooled estimates for NDDs were 9.2% (95% CI 7.5–11.2) and 13.6% (95% CI 11.3–16.2) in children of 2–<6 and 6–9 year age categories, respectively, without significant difference according to gender, rural/urban residence, or religion; almost one-fifth of these children had more than one NDD. The pooled estimates for prevalence increased by up to three percentage points when these were adjusted for national rates of stunting or low birth weight (LBW). HI, ID, speech and language disorders, Epi, and LDs were the common NDDs across sites. Upon risk modelling, noninstitutional delivery, history of perinatal asphyxia, neonatal illness, postnatal neurological/brain infections, stunting, LBW/prematurity, and older age category (6–9 year) were significantly associated with NDDs. The study sample was underrepresentative of stunting and LBW and had a 15.6% refusal. These factors could be contributing to underestimation of the true NDD burden in our population.ConclusionsThe study identifies NDDs in childre...
Even with the advances in molecular or automated methods for detection of red blood cells of interest (such as reticulocytes or parasitized cells), light microscopy continues to be the gold standard especially in laboratories with limited resources. The conventional method for determination of parasitemia and reticulocytemia uses a Miller reticle, a grid with squares of different sizes. However, this method is prone to errors if not used correctly and counts become inaccurate and highly time-consuming at low frequencies of target cells. In this report, we outline the correct guidelines to follow when using a reticle for counting, and present a new counting protocol that is a modified version of the conventional method for increased accuracy in the counting of low parasitemias and reticulocytemias.
Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity (ROP) from a tertiary care center in the western Indian state of Goa, India.Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for a period of 18 months. Babies born at < 34 weeks’ gestation and having a birth weight of <1500gm were screened for ROP and laser photocoagulation was done for those who developed threshold ROP. Group differences between any ROP and threshold ROP were analysed using the chi-square test.Results: Out of the 244 preterm neonates screened, 37 developed ROP (15.16%), and 14 out of them (5.73%) developed threshold ROP requiring laser photocoagulation. Very low birth weight, prematurity, apnea, anemia, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, blood transfusions, exchange transfusions and days taken to reach full enteral feeds and regain birth weight were significantly associated with the development of ROP.Conclusions: This is the first report of ROP from Goa where less than 1 in 5 babies developed ROP. This is similar to that reported across the rest of the country. Judicious oxygen use, ventilation strategies, transfusions guidelines, control of sepsis, early enteral feeds and adequate nutrition may help prevent the development of ROP in the future.
Background: The hyperinflammatory state of multisystem inflammatory syndrome in children (MIS-C) predisposes to thromboembolic complications. We report a neonate with multiple cavitary lesions in lung, which we suspect could be a manifestation of multisystem inflammatory syndrome in neonate (MIS-N) following maternal COVID-19 infection during pregnancy.Case Report: Eight-day-old neonate was referred with fever and fast breathing.Mother was positive for COVID-19 in 29th week. COVID-19 reverse-transcription polymerase chain reaction was negative, however, antibodies were positive. He had increased leucocyte count, and elevated levels of C-reactive protein (CRP), procalcitonin, ferritin, lactate dehydrogenase, and D-dimer along with bilateral reticulonodular opacities on chest radiograph and multiple nodules with evidence of cavitation in both lungs on chest tomography. All cultures were negative. A possible diagnosis of MIS was made. Infant was treated with intravenous immunoglobulin (IVIG) which he responded to with resolution of symptoms. Conclusion:Neonates exposed to COVID-19 should be evaluated for thromboembolic complications and IVIG can be one of the treatment modalities.
Objective: To study if continuous temperature monitoring helps to prevent excessive postnatal weight loss in healthy newborns during hospital stay. Design: Prospective randomised controlled trial Setting: Postnatal ward of a tertiary level hospital in south-west India, between July 2018 and October 2018. Participants: 515 healthy newborns born in the hospital during the study. Intervention: Mothers were given the BEMPU device within 24 hours of delivery and taught to recognize alarms and take measures to treat hypothermia when the device alarmed till the baby was discharged from the hospital. All healthy newborns born in the hospital were included in the study and random allocation was done to either the intervention or control group. Babies who were sick and admitted in NICU and babies with congenital anomalies were excluded. IEC approval was obtained prior to the study. Outcome measures: postnatal weight loss. Results: 515 babies were included in the analysis. For vaginal deliveries; 163 babies were in the intervention group and 168 were in the control group. The mean lowest weight was higher and the mean weight loss was lower for the intervention group. For caesarean deliveries, 91 babies were in the intervention and 93 were in the control groups. The mean lowest weight was higher and the mean weight loss was lower for the intervention group for cesarean deliveries as well. Conclusions: Continuous monitoring of the temperature helps to prevent excessive postnatal weight loss in healthy babies born by spontaneous vaginal deliveries. Keywords: Hypothermia, Newborn, Temperature, Weight loss
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