Publications by authors named "Monica Juneja"

68 Publications

Clinical profile and short-term course of post-traumatic headache in children with mild traumatic brain injury: a prospective cohort study.

Childs Nerv Syst 2021 Jan 6. Epub 2021 Jan 6.

Department of Pediatrics, Maulana Azad Medical College (University of Delhi) and associated Lok Nayak Hospital, Delhi 110002, India.

Objective: To study the clinical profile and factors associated with post-traumatic headache (PTH) in children with mild traumatic brain injury (mTBI) attending an urban public hospital.

Methods: We enrolled 130 consecutive children aged 6-12 years with mTBI (as per the International Classification of Headache Disorders-III criteria), and followed them up for 7 days. Those who developed PTH were further followed up monthly for 3 months.

Results: Thirty (23.1%) children developed PTH; 25 (19.2%) children had acute PTH (duration 7 days to 3 months) and the remaining 5 (3.8%) developed persistent PTH (> 3 months). Majority (50%) had bilateral headache and squeezing quality (50%). Forty percent of those with PTH met the criteria for migraine. Obesity (P = 0.84), female gender (P = 0.26), family history of headache (P = 0.93), and prior history of concussion (P = 0.70) were not associated with risk of PTH. Children who developed PTH had higher rate of nausea (RR (95% CI) = 2.42 (1.06, 5.5); P = 0.03) and vomiting (RR (95% CI) = 3.76 (1.64, 8.5); P = 0.001) after mTBI. Headache resolved within 1 month in 63.3% of children.

Conclusion: PTH was found to be common after mTBI in children. Protocolized follow-up and directed history taking for PTH in all children with mTBI, who are frequently discharge from the emergency department after first aid, will lead to appropriate diagnosis and management of this problem.
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http://dx.doi.org/10.1007/s00381-020-05032-4DOI Listing
January 2021

Managing Children with Special Needs in COVID-19 Times.

Indian Pediatr 2020 Oct 24;57(10):971. Epub 2020 Jul 24.

Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605476PMC
October 2020

Effectiveness of different parenting interventions on oral hygiene of cerebral palsy children: A randomized controlled trial.

Spec Care Dentist 2020 Jul 2;40(4):335-343. Epub 2020 Jun 2.

Department of Public Health Dentistry, Maulana Azad Institute of Dental Sciences, New Delhi, India.

Aim: To assess the effectiveness of different parenting interventions for improving oral hygiene of cerebral palsy (CP) children aged 4-12 years.

Methodology And Results: A randomized controlled trial was done among 60 CP children and parents visiting a tertiary care center in New Delhi. The study population was randomly assigned to experimental or control group (30 in each group). Parents/caregivers in the experimental group (Group 1) received video-based dental health education (DHE) and the control group (Group 2) received conventional DHE. Each group also received two telephonic reinforcements at fourth and eighth week after the first intervention at baseline. The groups were assessed for sociodemographic, familial factors, medical history, oral hygiene practices, and oral hygiene status. At 3-month follow-up, the mean reduction in simplified oral hygiene index (OHI-S), plaque index (PI), and gingival index (GI) scores was 0.27, 0.17, and 0.09, respectively, in Group 1 (P-value < .05). The mean reductions seen in Group 2 were 0.03 in OHI-S, 0.14 in PI, and 0.04 in GI index (P-value < .05, except for GI score: P-value = .6).

Conclusion: Video-based DHE is effective and brings about significant improvement in oral hygiene status and oral health among CP children.
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http://dx.doi.org/10.1111/scd.12481DOI Listing
July 2020

Paracetamol versus Ibuprofen for the Acute Treatment of Migraine Headache in Children: A Blinded Randomized Controlled Trial.

Indian J Pediatr 2020 Oct 26;87(10):781-786. Epub 2020 May 26.

Neurology Clinic, Department of Pediatrics, Maulana Azad Medical College (University of Delhi) and associated Lok Nayak Hospital, 2, BSZ Marg, Delhi, 110002, India.

Objective: To compare the efficacy of oral paracetamol and oral ibuprofen for the management of acute headache in children with migraine without aura.

Methods: This randomized-controlled trial was done at the Pediatric department of a public hospital in India between 20 May, 2017 and 22 March, 2018, and enrolled children (aged 6-12 y) with Migraine without aura as per International Classification for Headache Disorders, 3rd edition (ICHD-3) criteria. The 50 patients (21 females, mean age 9.9 y) consecutively enrolled were randomized by block randomization to two study groups, with one group (n = 25) receiving oral paracetamol (15 mg/kg/dose) and the other group (n = 25) oral ibuprofen (10 mg/kg/dose), at home, during a single episode of acute migraine headache. The study drugs were dispensed in a blinded fashion. Pain-freedom (score of zero in a 0-10 Visual analogue pain scale) and Pain-relief (≥2-point reduction from the baseline) two-hours after the study drug intake were the primary outcomes. Side-effects to the study drugs were actively solicited. Non-parametric tests for paired data were used.

Results: The two groups were similar at baseline. Forty-three children (22 paracetamol group and 21 ibuprofen group) completed the study. Both pain-freedom (32% vs. 28%, P = 0.77) and pain-relief (80% vs. 80%, P = 0.86) were not significantly different between the Paracetamol and Ibuprofen groups, respectively. Ten (23.2%) children had a side-effect due to the study drug, with no significant difference between the groups (13.6% vs. 33.3%; P = 0.11).

Conclusions: Both paracetamol and ibuprofen are effective and safe for the treatment of acute migraine attacks in children.
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http://dx.doi.org/10.1007/s12098-020-03315-xDOI Listing
October 2020

Promoting family integrated early child development (during first 1000 days) in urban slums of India (fine child 3-3-1000): Study protocol.

J Adv Nurs 2020 Jul 7;76(7):1823-1830. Epub 2020 May 7.

The INCLEN Trust International, New Delhi, India.

Aims: This project tests a novel, targeted home visitation programme for child development targeted behaviour change during the first 1,000 days for families in Delhi urban slums.

Background: The first 1,000 days have highest brain development potential and is dependent on the available nutrition, health, social and cognitive stimulus. Over 1.3 million children are born annually in the slums of India and are at risk of limited development potential. The children in urban slums at multiplicity of adversities at family, society and environmental levels. No tools are available for the community health functionaries to support the families to promote child development.

Design: This cohort study targets provision of behaviour change interventions targeted at three groups (pregnant women, infants and children in year 2) to document the impact on child development.

Methods: This implementation project delivers nutrition, health and child stimulation integrated services for the families through existing government community health workers and nurses. These workers shall train the families using audio-visual messages in tablets and demonstration kits for practice through quarterly home visits. Data on health, nutrition and child development shall be collected at baseline, midterm and after one year. The data from these participants shall be compared with data from recently delivered women, children aged 13 months and 25 months without intervention to document the impact.

Discussion: The successful implementation of the project has potential for future integration of the child development components into the existing programme at scale. The learning from this project shall be useful for India and other developing countries.

Impact: The first 1,000 days are critical period in human brain development and cognitive function acquisition potential, which is dependent on the available nutrition, health, social and cognitive stimulus. The development potential in children born and living in the slums, who are exposed to various adversities, can be mitigated through appropriate family-level practices with support from the community health workers and Nurses. This study is documenting the feasibility and impact of home visit linked coaching of families for improving child development status during the first 1,000 days in three sums of Delhi, India.
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http://dx.doi.org/10.1111/jan.14384DOI Listing
July 2020

Status Dystonicus: A Rare Manifestation of Cerebral Palsy.

Indian J Pediatr 2020 07 8;87(7):563. Epub 2020 Feb 8.

Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.1007/s12098-020-03206-1DOI Listing
July 2020

Children's Color Trail Test for Objective Assessment of Attention in Children with Attention Deficit Hyperactivity Disorder: A Diagnostic Accuracy Study.

Indian Pediatr 2019 12;56(12):1025-1028

Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Devendra Mishra, Professor, Department of Pediatrics, Maulana Azad Medical College, New Delhi 110 002, India.

Objective: To compare the Children's Color Trail Test scores in children with and without Attention Deficit Hyperactivity Disorder to assess its diagnostic performance in assessing attention-deficit.

Methods: 50 children with Attention Deficit Hyperactivity Disorder (diagnosed as per Diagnostic and Statistical Manual, 5th edition) and 50 age- and sex-matched children underwent Test 1 and Test 2 of the Children's Color Trail Test. A Receiver Operating Characteristics curve was constructed for the diagnostic accuracy of Children's Color Trail Test in Attention Deficit Hyperactivity Disorder.

Results: The Receiver Operating Characteristics curve showed a score ≤32 for Children's Color Trail Test 1 [AUC: 0.8 (0.71 to 0.87); P<0.001] and score ≤40 for Children's Color Trail Test 2 [AUC: 0.85 (0.77 to 0.92); P<0.001] as the best cut-off for diagnosing Attention Deficit Hyperactivity Disorder.

Conclusions: Children's Color Trail Test is a promising tool for diagnosing attention deficit, and could be used in settings where parent or teacher reports are not available.
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December 2019

HbE-Beta Thalassemia with Moyamoya Syndrome: A Rare Association.

Indian J Pediatr 2020 06 20;87(6):476-477. Epub 2019 Dec 20.

Department of Pediatrics, Maulana Azad Medical College, New Delhi, 110002, India.

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http://dx.doi.org/10.1007/s12098-019-03143-8DOI Listing
June 2020

Factors Associated with Transient Neonatal Hyperthyrotropinemia.

Indian J Pediatr 2020 06 8;87(6):482-483. Epub 2019 Nov 8.

Division of Genetics & Metabolism, Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College, New Delhi, India.

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http://dx.doi.org/10.1007/s12098-019-03095-zDOI Listing
June 2020

Clinico-Etiological Profile of Pediatric Refractory Status Epilepticus at a Public Hospital in India.

J Epilepsy Res 2019 Jun 30;9(1):36-41. Epub 2019 Jun 30.

Department of Pediatrics, Maulana Azad Medical College, Delhi, India.

Background And Purpose: Refractory status epilepticus (RSE) has been infrequently studied in Indian children. This research was conducted to study the clinico-etiological profiles and short-term outcomes of children aged 1 month to 12 years with convulsive RSE, at a public hospital.

Methods: The study was conducted between 1st April 2016 and 28th February 2017 after receiving clearance from an Institutional Ethics Committee. All children (aged 1 month to 12 years) who presented to the pediatrics department of a tertiary-care public hospital with convulsive status epilepticus (SE), or who developed SE during their hospital stay, were enrolled. All patients were investigated and managed according to a standard protocol. Outcomes were assessed based on the Glasgow Outcome Scale. Details of children who progressed to RSE were compared to those without RSE.

Results: Fifty children (28 males) with CSE were enrolled, of which 20 (40%) progressed to RSE. Central nervous system (CNS) infection was the most common etiology (53% in SE and 55% in RSE, > 0.05). Non-compliance with anti-epileptic drugs was the second most common etiology. The overall mortality rate was 38%, and although the odds of death in RSE (50%) were higher than in SE (30%), this difference was not statistically significant ( = 0.15). The odds of having a poor outcome was six times higher in children with RSE as compared to those with SE (odds ratio, 6.0; 95% confidence interval, 1.6-22.3; = 0.005).

Conclusions: When managing CNS infections, pediatricians need to be aware of the high risk of developing RSE. In addition, the possibility of RSE should be considered and managed promptly in an intensive-care setting, to reduce the mortality and morbidity of this severe neurological condition.
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http://dx.doi.org/10.14581/jer.19004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6706643PMC
June 2019

Prevalence of Epilepsy and Inter-Ictal Epileptiform Discharges in Children with Autism and Attention-Deficit Hyperactivity Disorder.

Indian J Pediatr 2019 10 24;86(10):897-902. Epub 2019 May 24.

Department of Pediatrics, GR Medical College, Gwalior, 474001, India.

Objective: To study the prevalence of epilepsy and Inter-ictal epileptiform discharges (IED) in children with Autism spectrum disorder (ASD) and Attention-deficit hyperactivity disorder (ADHD), and the factors associated with occurrence of epilepsy in these children.

Methods: Children between 6 and 12 y attending the Child Development Centre of a tertiary-care institute in India were evaluated for ASD and ADHD as per Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Childhood Autism Rating Scale was used to assess ASD severity, and Conner's Rating Scales were used to sub-classify children with ADHD. Intelligence quotient was assessed if not assessed in the previous 1 y. History of seizures was taken, and electroencephalography was done in all children. Epilepsy was diagnosed and classified according to International League Against Epilepsy.

Results: Of the 130 children enrolled (90 ASD, 40 ADHD), 56 (43%) had epilepsy and 55 (42.3%) had IED. The proportion of both epilepsy and IED was higher among ASD (both 45.5%) as compared to ADHD (37.5% and 35%), although not statistically significant. Among children with ASD, epilepsy was common in those with severe ASD (P < 0.001), and IED were more common in those with IQ <80 (P = 0.047). There were no significant differences between occurrence of epilepsy/IED and subtypes of ADHD.

Conclusions: The high prevalence of epilepsy and IED among children with ASD and ADHD emphasizes the need for guidelines for identifying and diagnosing epilepsy in this group. This will ensure appropriate management and improve patient outcomes.
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http://dx.doi.org/10.1007/s12098-019-02977-6DOI Listing
October 2019

Clinico-etiological Profile and Developmental Status of Infants Aged 1-24 months with Epilepsy.

Indian J Pediatr 2019 08 12;86(8):681-685. Epub 2019 Apr 12.

Department of Pediatrics, Lok Nayak Hospital and Maulana Azad Medical College (University of Delhi), 2, Bahadur Shah Zafar Marg, New Delhi, 110 002, India.

Objective: To study the clinico-etiological profile of epilepsy in children aged 1-24 mo attending a tertiary-care public hospital.

Methods: All infants aged 1-24 mo with epilepsy (as per International League Against Epilepsy, 2014) presenting between April 2016 and March 2017 were enrolled. Detailed history and examination were done in all children, and developmental assessment was done using Developmental Assessment Scale for Indian Infants (DASII). Electroencephalography and neuroimaging (CT/MRI) were done for all subjects.

Results: Sixty children (39 males) were consecutively enrolled after informed written consent. The mean (SD) age at seizure onset was 4.3 (4.14) mo. Perinatal asphyxia (45%) and malformations of cortical development (18.3%) were the commonest etiologies. Neurological examination was abnormal in 68.3%, and a neuroimaging abnormality was present in 76% of children. Fifteen patients (25%) had West syndrome, which was symptomatic in the majority (73.3%). Developmental delay (DQ < 70) was the commonest co-morbidity (81.7%); 28.3% had profound delay. Odds of having developmental delay were 13-times higher in those with an abnormal neurological examination [OR 13.5 (2.82-64.67), P = 0.001], and nearly 9-times higher with abnormal neuroimaging [OR 8.9 (2.11-37.9), P = 0.003].

Conclusions: Epilepsy in children <2 y is symptomatic in the majority, with sequelae of birth asphyxia as the commonest etiology. High prevalence of co-morbid developmental delay underscores the need for routine evaluation and early intervention in all high-risk infants.
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http://dx.doi.org/10.1007/s12098-019-02943-2DOI Listing
August 2019

Drug-resistant epilepsy in Indian children at a tertiary-care public hospital.

Childs Nerv Syst 2019 05 13;35(5):775-778. Epub 2019 Feb 13.

Department of Pediatrics, Lok Nayak Hospital, Maulana Azad Medical College, University of Delhi, 2, BSZ Marg, New Delhi, Delhi, 110002, India.

Background: Drug-resistant epilepsy (DRE), a condition in which seizures persist and seizure freedom is unlikely to be attained with further manipulation of anti-epileptic drugs, occurs in around 20% of children with epilepsy. This study was conducted with the aim to study the profile of Indian children with resistant epilepsy, using the new consensus definition of DRE.

Methods: All children who had been attending the Pediatric Neurology Clinic regularly for at least 6 months were reviewed between April and September 2015. Children fulfilling the ILAE Commission on Therapeutic Strategies Consensus Proposal definition of DRE were enrolled for the study. After informed consent, the records were reviewed and disease-related data was entered in the study form. The data were analyzed to determine etiological factors and treatment gaps in children with DRE.

Results: Fifty children (12 females) with median (range) age of 90 (11-159) months and follow-up of 17.9 (8.5-20) months were enrolled. The mean (standard deviation) age at seizure onset and start of anti-epileptic drugs (AED) were 1.8 (2.11) and 2.1 (2.09) years, respectively. The median (range) number of anti-epileptic drugs that had been tried in these children was 5 (2-9), with drug side effects leading to discontinuation in 8 (16%) patients. Only two patients had tried ketogenic diet; vagal nerve stimulation and epilepsy surgery had not been tried by any family, despite recommendation by the physicians in 7 children.

Conclusions: Majority of Indian children with DRE have onset of epilepsy in early infancy, and are infrequently provided access to newer non-pharmacological measures.
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http://dx.doi.org/10.1007/s00381-019-04084-5DOI Listing
May 2019

Autism Spectrum Disorders and Celiac Disease: Is there an Association?

Indian Pediatr 2018 10;55(10):912-914

Child Development Center, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi, India.

We included 150 children aged 2-12 years with Autism Spectrum Disorders and normal serum total IgA levels, and screened them for celiac disease using anti-tissue transglutaminase IgA levels. All the children were screen negative, suggesting lack of positive association between Autism Spectrum Disorders and Celiac disease.
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October 2018

Sleep Problems and Their Correlates in Children with Autism Spectrum Disorder: An Indian Study.

J Autism Dev Disord 2019 Mar;49(3):1169-1181

Maulana Azad Medical College, Bahadur Shah Zafar Marg, New delhi, 110002, India.

Sleep problems were studied in both typically developing (TD) children and those with autism spectrum disorder (ASD) using the Sleep Disturbance Scale for Children. Factors associated with these problems were also studied in children with ASD. Seventy-three children with ASD and their age and sex matched TD controls in age group of 3-12 years were enrolled in the study. Higher sleep problems were found in children with ASD than TD children. Most common sleep problem reported in children with ASD was Sleep Wake Transition Disorders, followed by Disorder of Initiation and Maintenance; while in TD controls, it was Sleep Breathing Disorders. Apart from severity of Autism; hyperactivity, sensory issues and poor motor skills were significantly associated with sleep problems, which may be important targets for intervention in children with sleep problems.
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http://dx.doi.org/10.1007/s10803-018-3820-6DOI Listing
March 2019

Prevalence of Unrecognized Autism Spectrum Disorders in Epilepsy: A Clinic-Based Study.

J Pediatr Neurosci 2018 Jul-Sep;13(3):308-312

Department of Paediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

Objective: To assess prevalence of unrecognized autism spectrum disorders (ASDs) in children with epilepsy using Diagnostic and Statistical Manual IV (DSM-IV) criteria and to evaluate factors affecting it in this population. It was a cross-sectional study conducted at a teaching hospital. It included randomly selected 106 children in the age 4-12 years with epilepsy, and without any structural anomaly identifiable on computed tomography/magnetic resonance imaging. Children already diagnosed with ASD were excluded.

Materials And Methods: Detailed clinical evaluation was carried out. Intelligence quotient (IQ) was assessed using Development Profile-II for all and Binet and Kulshrestha test, wherever possible. Participants were screened using Social Communication Questionnaire (SCQ). Those with SCQ score of ≥15 were evaluated for ASD using DSM-IV criteria. Childhood Autism Rating Scale was administered to assess the severity of autism. Data were analyzed with univariate and logistic regression analyses.

Results: A total of nine children were screened positive, of them, eight were diagnosed with ASD using DSM-IV criteria. The prevalence of unrecognized ASD was 7.5/100. On univariate analysis, intellectual disability ( < 0.01) and young age of onset of epilepsy ( = 0.03) were significantly associated with ASD. On multivariable analysis, only intellectual disability was significantly associated with ASD ( < 0.01). There was no significant association with gender, seizure type, frequency of seizures, intractability of epilepsy, or the number of antiepileptic drugs used.

Conclusion: ASDs are more prevalent in children with epilepsy than in general population. In cases with associated intellectual disability, co-occurrence of ASD is further increased. All children with epilepsy, particularly those with IQ ≤ 50, irrespective of age of onset of epilepsy, seizure type, frequency of seizures, or intractability of epilepsy, should be screened for ASD.
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http://dx.doi.org/10.4103/JPN.JPN_136_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6144604PMC
October 2018

Neurodevelopmental disorders in children aged 2-9 years: Population-based burden estimates across five regions in India.

PLoS Med 2018 07 24;15(7):e1002615. Epub 2018 Jul 24.

Department of Neurology, Paras Hospital, Gurugram, Haryana, India.

Background: Neurodevelopmental 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 Findings: We 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.

Conclusions: The study identifies NDDs in children aged 2-9 years as a significant public health burden for India. HI was higher than and ASD prevalence comparable to the published global literature. Most risk factors of NDDs were modifiable and amenable to public health interventions.
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http://dx.doi.org/10.1371/journal.pmed.1002615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6057634PMC
July 2018

Diagnostic Accuracy of International Epidemiology Network (INCLEN) Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) in Comparison with Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).

Indian Pediatr 2018 06;55(6):482-484

Child Development Center, Department of Pediatrics, Maulana Azad Medical College (University of Delhi), New Delhi, India.

Objective: To compare the diagnostic accuracy of INCLEN Diagnostic Tool for Autism Spectrum Disorder (INDT-ASD) against Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-5) for the diagnosis of Autism Spectrum Disorder (ASD).

Methods: 118 children aged 2-9 years with symptoms suggestive of ASD were assessed by INDT-ASD and DSM-V by trained personnel. ASD diagnosis by INDT-ASD was compared against the expert's DSM-5 diagnosis.

Results: INDT-ASD had a sensitivity and specificity of 100% and 75%, respectively against DSM-5 for the diagnosis of ASD; specificity for Autistic Disorder was 87%.

Conclusion: The INDT-ASD has a good sensitivity and specificity against DSM-5, and can continue to be used for the diagnosis of ASD even after the adoption of DSM-5 criteria.
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June 2018

Longitudinally Extensive Transverse Myelitis.

Indian J Pediatr 2019 01 4;86(1):91-92. Epub 2018 Jun 4.

Department of Pediatrics, Maulana Azad Medical College, Lok Nayak Hospital, Delhi, 110002, India.

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http://dx.doi.org/10.1007/s12098-018-2702-4DOI Listing
January 2019

Effect of multilevel lower-limb botulinum injections & intensive physical therapy on children with cerebral palsy.

Indian J Med Res 2017 Nov;146(Supplement):S8-S14

Child Development Center, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India.

Background & Objectives: Botulinum toxin is considered as an effective treatment for spasticity in children with cerebral palsy (CP). However, there are only a few long-term studies, and the effects on motor function have been inconclusive. Moreover, due to its high cost and need for intensive post-injection therapy, utility in context of developing nations has not been established. This retrospective study was undertaken to assess the long term effects of botulinum toxin-A with physical therapy in children with CP.

Methods: This retrospective study was conducted at a tertiary care centre in India, where a limited supply of botulinum toxin was introduced in the year 2009. It was used in a selective group of patients with CP along with intensive physical therapies. All children who received lower-limb botulinum injections over a 42-month period were analyzed. For evaluation of treatment effect, the measurement at 1 pre-injection assessment and the last measurements, i.e. 12 wk after last injection received by that child were compared.

Results: Twenty nine patients (20 males, median age 51 months) received 69 sessions of botulinum toxin injections in the lower limbs over a 42-month period. Thirteen patients were diplegic, 10 were quadriplegic, five were triplegic and one was hemiplegic. There was a significant improvement in pre- and post-injection scores on Observational Gait Scale (right side 7.1±3.6 to 10.7±3.7, left side 6.7±3.5 to 9.9±3.4), Gross Motor Function Measure Scale (47.9±17.7 to 67.6±17.2), Modified Ashworth Scale, passive range of motion and Gross Motor Function Classification System. Most of the patients showed gain in motor milestones as well.

Interpretation & Conclusions: Our results showed that judicious use of botulinum injections along with intensive physio/occupational therapies could yield good results in children with CP.
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http://dx.doi.org/10.4103/ijmr.IJMR_1223_15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5890601PMC
November 2017

A novel mutation in SLC39A14 causing hypermanganesemia associated with infantile onset dystonia.

J Gene Med 2018 04 23;20(4):e3012. Epub 2018 Mar 23.

Genomics and Molecular Medicine, CSIR-Institute of Genomics and Integrative Biology, New Delhi, India.

Background: Mutations in SLC39A14 cause a recessive disorder of manganese (Mn) metabolism that manifests as childhood onset progressive neurodegeneration characterized by parkinsonism and dystonia.

Methods: The present study genetically investigated a case of hypermanganesemia. We describe a family where an affected child with a history of progressive neurodegeneration showed symptoms of dystonia with increased levels of blood Mn and altered signal intensities in globus pallidus and dentate nucleus. Whole exome sequencing was conducted to genetically investigate the pathology in the child, which allowed us to identify a novel homozygous causal mutation in SLC39A14.

Results: Insilico modeling of the novel homozygous causal mutation in SLC39A14 predicted that it was deleterious, affecting Mn binding and transportation of metal by transmembrane instability of the protein structure. The clinical features of other reported mutations in SLC39A14 were also reviewed and the clinical spectrum in our case conforms to the described neurological abnormalities.

Conclusions: We conclude that the mutation identified in SLC39A14 in our case is a novel variation linked to recessive disorders of hypermaganesemia and dystonia.
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http://dx.doi.org/10.1002/jgm.3012DOI Listing
April 2018

Designing and Validation of a Hindi-language Parent Self-report Developmental Screening Tool.

Indian Pediatr 2017 Jul;54(7):550-555

Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony; and *Child Development Center, Maulana Azad Medical College and associated Lok Nayak Hospital, Bahadur Shah Zafar Marg; New Delhi, India. Correspondence: Dr. Rahul Jain, 61-A, DDA Flats, Phase 1, Qutab Enclave, New Delhi 110 016, India.

Aim: To design and validate Hindi-language parent self-report developmental screening questionnaires for 9-month and 18-month-old Indian children.

Design: Cross-sectional study.

Setting: Tertiary-care pediatric hospital from April 2014 to March 2016.

Participants: In each age group (9-month and 18-month), 45 children were enrolled for designing of questionnaires (30 for obtaining parental observations of current development and 15 for pre-testing). For validation of tool, 100 children (60 low risk and 40 high risk) were enrolled in each age group.

Methods: For designing, observations regarding current developmental milestones were obtained from parents and a list of all enumerated milestones was prepared. After detailed discussion by a team of developmental pediatricians, pediatric resident, clinical psychologist and language specialist, milestones were chosen for drafting of questionnaires. In each age group, drafts were pre-tested and required modifications were done. The final questionnaires contained 20 items each to be scored on a Likert scale (total score ranging from 20 to 60, a lower score indicating a higher risk of developmental delay). These questionnaires were validated against Developmental Assessment Scale for Indian Infants (DASII), a gold standard instrument.

Results: On ROC analysis, the 9-month and 18-month screening tool had area under curve of 0.988 and 0.953, respectively, for detecting developmental delay. Score ≤50 on the 9-months questionnaire had sensitivity of 100% and specificity of 87.2%. Score ≤49 on the 18-months questionnaire had sensitivity of 91.4% and specificity of 88.7%.

Conclusion: The new questionnaires have a promising role in developmental screening of children at the time of routine immunizations in our country.
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http://dx.doi.org/10.1007/s13312-017-1066-6DOI Listing
July 2017

Etiology and Short-term Outcome of First Seizure in Hospitalized Infants.

Indian Pediatr 2016 Oct;53(10):924-926

Departments of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, and #Chacha Nehru Hospital; Delhi, India.

We enrolled 75 consecutive infants presenting with history of first seizure at a tertiary care hospital in New Delhi, India. Clinical and biochemical work-up for etiology, and electroencephalography were performed in all infants. Developmental assessment was done 3-month after discharge. 72% had generalized seizures, and fever was the commonest co-morbidity (57.3%). 68% had provoked seizures, mainly due to hypocalcemia (34.3%) or neuro-infections (29.3%). Seven (9.3%) infants died during hospital stay; mostly those with neuro-infections. 13 (20.3%) infants had developmental delay.
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October 2016

Prevalence of Autism Spectrum Disorders in Siblings of Indian Children With Autism Spectrum Disorders.

J Child Neurol 2016 06 5;31(7):873-8. Epub 2016 Jan 5.

Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India.

This study determined the prevalence of autism spectrum disorders in 201 siblings of children with autism spectrum disorders. Siblings were screened using Modified Checklist for Autism in Toddlers and Social Responsiveness Scale, parent version. Screen-positive siblings were assessed using Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. The risk of autism spectrum disorder in siblings was correlated with various familial and disease characteristics of the index case. Prevalence of autism spectrum disorder in siblings was 4.97%. There was a significant effect of the presence of aggressive behavior, externalizing problems and total problems in the proband, assessed using Childhood Behavior Checklist, and the young age of the father at conception on sibling risk of autism spectrum disorder. Results of our study are in line with previous studies reporting similar prevalence but have also brought up the association with behavioral problems as a possible risk factor. Siblings of children with autism spectrum disorder should be routinely screened, and genetic counseling for this increased risk should be explained to the family.
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http://dx.doi.org/10.1177/0883073815624764DOI Listing
June 2016

Neurodevelopmental Status of Children Aged 6-30 Months With Congenital Heart Disease.

Indian Pediatr 2015 Nov;52(11):957-60

Department of Pediatrics, Lok Nayak Hospital; and *Department of Cardiology, GB Pant Hospital; Maulana Azad Medical College, New Delhi, India. Correspondence to: Dr Devendra Mishra, Departments of Pediatrics, Maulana Azad Medical College, New Delhi, India.

Background: Children with congenital heart diseases (CHD) are considered to be at high-risk for neurodevelopmental delay, but scant Indian data are available.

Objective: To evaluate the neurodevelopmental status of children with CHD.

Methods: We enrolled consecutive children aged 6-30 months with echocardiographically-confirmed CHD between June 2013 and January 2014. Children with clinically recognizable genetic syndromes or disorders; visual and/or hearing deficits, and microcephaly; and post-cardiac surgery children were excluded. Development was assessed by Developmental Assessment Scale for Indian Infants (DASII) and Developmental delay defined as Development Quotient (DQ) <70 in either the mental or motor scale.

Results: 75 children (53 males) with CHD were enrolled. Acyanotic CHD was seen in 51 children (VSD in 47%), and Tetralogy of Fallot was the commonest cyanotic CHD (25%). Developmental delay was seen in 25% of these children, more in the motor domain (48%) than in mental (12%). Mean motor and mental DQ in acyanotic CHD was 77 and 84, respectively; and 65 and 85, respectively in cyanotic CHD. Mean motor DQ was significantly less than mental DQ in both acyanotic and cyanotic CHD children (P=0.048).

Conclusion: Children with CHD are at an increased risk for developmental delay. Periodic surveillance, screening and evaluation should be instituted in them for early identification and appropriate interventions to enhance later academic, behavioral, psycho-social and adaptive function.
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http://dx.doi.org/10.1007/s13312-015-0752-5DOI Listing
November 2015

Visceral leishmaniasis with Roth spots.

Oxf Med Case Reports 2014 Sep 16;2014(6):110-1. Epub 2014 Sep 16.

Department of Pediatrics , Maulana Azad Medical College and attached Lok Nayak Hospital , New Delhi , India.

Visceral leishmaniasis (VL) is caused by the protozoan parasite Leishmania donovani and transmitted by the bite of infected sandfly Phlebotomus argentipes. The protozoa is obliged intracellularly and causes a wide spectrum of clinical syndromes: VL ('kala azar'), cutaneous leishmaniasis and mucocutaneous leishmaniasis (espundia). Kala azar is the most aggressive form and if untreated causes high mortality. Here, we describe a case of VL that presented to us with high-grade fever and found to have Roth spots that were resolved after 15 days of therapy.
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http://dx.doi.org/10.1093/omcr/omu043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369990PMC
September 2014

Ophelia syndrome: Hodgkin lymphoma with limbic encephalitis.

Indian Pediatr 2015 Apr;52(4):335-6

Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak hospital; and *Department of Pediatric Hemato-Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini; New Delhi, India. Correspondence to: Dr Satnam Kaur, Assistant Professor, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi 110 002, India.

Background: Limbic encephalitis, an immune-mediated encephalitis, results from inflammation in the medial temporal lobes. The paraneoplastic form is rare in pediatric population, and frequently precedes tumor diagnosis.

Case Characteristics: A 9-year-old boy receiving chemotherapy for Hodgkin lymphoma, developed headache, temporal lobe seizures, anxiety, hallucinations, short-term memory loss and autonomic disturbances. Magnetic resonance imaging of brain showed features suggestive of limbic encephalitis. Electro-encephalography showed diffuse slowing with no epileptiform discharges.

Outcome: We diagnosed paraneoplastic form of limbic encephalitis. Treatment with steroids and intravenous immunoglobulin failed, and the child died 4 weeks after onset of symptoms.

Message: Limbic encephalitis should be kept as differential diagnosis in a child with sub-acutely evolving neuropsychiatric symptoms.
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April 2015

Diffuse cystic lung disease in a child.

Lung India 2015 Mar-Apr;32(2):186-7

Department of Pediatrics, Maulana Azad Medical College, Delhi, India.

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http://dx.doi.org/10.4103/0970-2113.152653DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4372880PMC
March 2015

Benign infantile seizures.

Indian Pediatr 2015 Feb;52(2):151-2

Departments of Pediatrics, Lok Nayak Hospital and *Chacha Nehru Bal Chikitsalaya, Maulana Azad Medical College, Delhi, India. Correspondence to: Dr Devendra Mishra, Department of Pediatrics, Maulana Azad Medical College and associated Lok Nayak Hospital, Delhi 110 002, India.

Background: Benign infantile seizures are a common form of idiopathic seizures in infants, but infrequently reported.

Case Characteristics: Four cases identified over a 9-month period.

Observation: All had a cluster of focal seizures, normal development and no abnormality on hematological and biochemical work-up.

Outcome: No recurrence of seizures over a follow-up of 5 to 9 months.

Message: Identification of this syndrome has important therapeutic and prognostic implications.
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http://dx.doi.org/10.1007/s13312-015-0592-3DOI Listing
February 2015

Kocher-Debre-Semelaigne syndrome.

J Pediatr Neurosci 2014 Sep-Dec;9(3):289-90

Department of Pediatrics, Division of Pediatric Neurology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.

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http://dx.doi.org/10.4103/1817-1745.147570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302559PMC
January 2015