Publications by authors named "Satinder Aneja"

133 Publications

Point Prevalence of Peripheral Neuropathy in Children and Adolescents with Type 1 Diabetes Mellitus.

Indian J Pediatr 2021 Jun 10. Epub 2021 Jun 10.

Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, 110001, India.

Objective: To assess the point prevalence of peripheral neuropathy (PN) in children with type 1 diabetes mellitus (T1DM) and to determine their predictors.

Methods: In this cross-sectional study, children aged 8-18 y with T1DM on insulin therapy for > 2 y and free from acute complications were enrolled. All participants were evaluated for symptoms of PN with diabetic neuropathy symptom (DNS) score and underwent a detailed neurological examination. Assessment of nerve dysfunction was done using nerve conduction studies (NCS). The disease-related factors that increase the risk of PN were determined.

Results: Fifty children (52% boys) were enrolled with mean age of 12.2 ± 2.8 y and duration of diabetes 5.1 ± 2.1 y. No subject had clinical evidence or DNS score suggestive of PN. Twenty-eight (56%) children demonstrated subclinical neuropathy on NCS. Proportion of children with pure motor, pure sensory, and mixed motor-sensory neuropathy was 40%, 2%, and 14%, respectively. The peroneal nerve was the most common motor nerve affected. Poor glycemic control (HbA1c > 9%) and longer duration of diabetes (> 5 y) were significantly associated with the risk of PN (p value < 0.05).

Conclusion: A large proportion of children with T1DM have subclinical PN. Poor glycemic control and longer duration of diabetes are risk factors for nerve dysfunction. Neurophysiological studies should be performed in these children to facilitate early detection.
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http://dx.doi.org/10.1007/s12098-021-03742-4DOI Listing
June 2021

Diagnostic Accuracy of Parents' Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones, and PEDS Combined in Indian Children Aged Less than 2 Years.

Indian J Pediatr 2021 Feb 23. Epub 2021 Feb 23.

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, Bangla Sahib Road, New Delhi, 110001, India.

Objective: To assess the diagnostic accuracy of Parent's Evaluation of Developmental Status (PEDS), PEDS Developmental Milestones (PEDS:DM) and PEDS Combined for developmental screening of Indian children aged less than 2 y.

Method: A hospital-based study of diagnostic accuracy was conducted over 17 mo. Children under 24 mo (n = 180) were enrolled after exclusion of severe illnesses or known neurodevelopment disorders. The index tools included standardized Hindi translations of PEDS and PEDS:DM. The reference tool was Developmental Assessment Scale for Indian Infants (DASII). Both were administered by blinded researchers. Parameters of diagnostic accuracy were computed.

Results: There were 13 (7.2%) failures in PEDS, 119 (66.1%) in PEDS:DM and 119 (66.1%) in PEDS Combined. DASII identified 3 children with developmental delay. Sensitivity (Sn) [95% CI] of PEDS was 33.3 [0.8-90.6] and Specificity (Sp) 93.2 [88.5-96.5]. The Sn and Sp of both PEDS:DM and PEDS Combined were 100 [29.2-100] and 34.5 [27.5-42.0], respectively.

Conclusions: Hindi translations of PEDS, PEDS:DM and PEDS Combined are not suitable for developmental screening of children less than 2 y due to suboptimal diagnostic accuracy.
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http://dx.doi.org/10.1007/s12098-020-03651-yDOI Listing
February 2021

Growth faltering in early infancy: highlights from a two-day scientific consultation.

BMC Proc 2020 15;14(Suppl 12):12. Epub 2020 Sep 15.

National Science Professor, Indian Institute of Technology, New Delhi, India.

Faltering of growth in early life has been recognized as a public health challenge among Indian babies. A two-day consultation on growth faltering in early infancy was organized to examine the data and evidence on identification and management of early growth failure and to identify knowledge gaps and future areas of research. The consultation was supported by the Biotechnology Industry Research Assistance Council (BIRAC), the Indian Academy of Pediatrics (Nutrition Chapter), Vardhman Mahavir Medical College and Safdarjung Hospital, and the Society for Applied Studies. It brought together researchers, clinicians, policy makers and program managers.
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http://dx.doi.org/10.1186/s12919-020-00195-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490870PMC
September 2020

Use of the International League Against Epilepsy (ILAE) 1989, 2010, and 2017 Classification of Epilepsy in children in a low-resource setting: A hospital-based cross-sectional study.

Epilepsia Open 2020 Sep 21;5(3):397-405. Epub 2020 Jun 21.

Department of Pediatrics Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital New Delhi India.

Objectives: This cross-sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource-limited setting in India.

Methods: Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II-epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme.

Results: Seven hundred and twenty-six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system ( = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes ( = .31) or the 2010 and 2017 schemes ( = .10).

Significance: The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.
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http://dx.doi.org/10.1002/epi4.12401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7469804PMC
September 2020

Duchenne Muscular Dystrophy: Journey from Histochemistry to Molecular Diagnosis.

Indian Pediatr 2020 08;57(8):741-743

Department of Pediatrics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India.

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August 2020

Presumptive Treatment of Acute Febrile Illness for Preventing Acute Encephalitis Syndrome: Does It Work?

Indian Pediatr 2020 07;57(7):607-608

Center for Disease Dynamics, Economics and Policy, New Delhi, India.

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July 2020

Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data.

Vaccine 2020 06 15;38(30):4717-4731. Epub 2020 May 15.

Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA. Electronic address:

This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.
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http://dx.doi.org/10.1016/j.vaccine.2020.05.019DOI Listing
June 2020

Clinical Profile and Short-term Outcome of Pediatric Status Epilepticus at a Tertiary-care Center in Northern India.

Indian Pediatr 2020 03;57(3):213-217

Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children Hospital, New Delhi, India.

Objective: To assess clinical profile and short term treatment outcomes of pediatric status epilepticus (SE) at a tertiary-care center in northern India.

Methods: Prospective cohort study enrolled children aged 1 month to 18 years presenting with SE to the emergency department. Enrolled children (109) were treated as per hospital protocols. Clinical features during hospitalization were noted. Pediatric overall performance category (POPC) scale was used for classification of outcome at the time of discharge.

Results: Acute symptomatic etiology was identified in 66 (60.6%) cases (CNS infections were predominant). Previous diagnosis of epilepsy was found in 32 (29.4%) children; and benzodiazepine responsive SE were seen in 65 (59.6%) children. Predictors of unfavorable outcome were acute symptomatic etiology (adjusted OR 4.50; 95% CI 1.49, 13.62) and no treatment administered prior to hospital (adjusted OR 3.97; 95% CI 1.06, 14.81).

Conclusions: Acute symptomatic etiology, mainly acute CNS infections, is the leading cause of SE in this region. Early and pre-hospital management with benzodiazepines may improve SE outcome.
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March 2020

Neuro-Developmental and Epilepsy Outcomes of Children with West Syndrome: A Cross-Sectional Study from North India.

Ann Indian Acad Neurol 2020 Mar-Apr;23(2):177-181. Epub 2020 Feb 25.

Department of Pediatric Neurology, Lady Harding Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Objectives: To assess the neurodevelopmental outcome of West syndrome (WS) in Indian children, who differ in their clinical profile from the western population.

Materials And Methods: This cross-sectional study enrolled children aged 2--5 years with prior diagnosis of WS between November 2013 and March 2015. They were assessed for epilepsy outcome and developmental outcome using developmental profile 3 (DP3) and vineland adaptive behavioral scale II (VABS II).

Results: Sixty-one children were enrolled. Perinatal asphyxia (40.9%), neonatal hypoglycemia (14.8%), and neonatal meningitis (9.8%) were predominant causes among the children with known etiology. Favorable epilepsy outcome (seizure freedom for >6 months) was observed in 29/61 patients (47.5%). Moderate to severe developmental delay was observed in 55/61 children (91.8%). Favorable developmental outcome (GDS by DP3 >70) was observed in just 5/61 (8%) patients.

Conclusions: This study highlights the high prevalence of developmental delay in this population of children with WS, with adverse perinatal events being the most common etiology.
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http://dx.doi.org/10.4103/aian.AIAN_503_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061506PMC
February 2020

Diagnostic Accuracy of Indian Scale for Assessment of Autism in Indian Children Aged 2-5 Years.

Indian Pediatr 2019 10;56(10):831-836

Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.

Objective: To determine the diagnostic accuracy of Indian Scale for Assessment of Autism (ISAA) in children aged between 2-5 years. Design: Setting:.

Study Design: Study of diagnostic accuracy.

Participants: A consecutive sample of 500 children with suspected Autism (delay or regression of developmental milestones, delay or regression in speech, age-inappropriate understanding, behaviour, play and/or social interaction) was recruited.

Setting: Tertiary level hospital, (November 2015 - November 2017).

Procedure: Each child underwent an expert comprehensive assessment of Autism (reference tool) that included history, observation, examination, diagnostic criteria for Autism Spectrum Disorder (ASD) of the Diagnostic and Statistical Manual of Mental Disorders', 5th edition, Childhood Autism Rating Scale-2 (CARS2), developmental status and adaptive function. This was followed by the administration of ISAA (test tool) in Hindi language. Parameters of diagnostic accuracy and Receiver Operating Characteristic curves were computed.

Main Outcome Measures: ASD based on (i) expert assessment, (ii) CARS-2, and (iii) ISAA.

Results: In children aged 2-3 years, sensitivity of ISAA was 100% (95% CI 98.2% -100%), specificity 28.9% (95% CI 17.7% to 43.4%), positive likelihood ratio 1.4 and negative likelihood ratio 0. In 3-5 year olds, sensitivity was 99.6% (95% CI 97.6% to 99.6%), specificity 33.3% (95% CI 15.1% to 58.3%), positive likelihood ration 1.5 and negative likelihood ratio 0.01. The degrees of autism based on the existing cut off values were inaccurate.

Conclusions: ISAA has sub-optimal performance in diagnosing and assessing severity in 2-5 year old children.
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October 2019

Incidence of vincristine induced neurotoxicity in children with acute lymphoblastic leukemia and its correlation with nutritional deficiencies.

Pediatr Hematol Oncol 2019 Sep 13;36(6):344-351. Epub 2019 Sep 13.

Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital , New Delhi , India.

Injection vincristine is an important component of therapy for acute lymphoblastic leukemia (ALL). An important adverse effect of vincristine is neurotoxicity. The incidence of this adverse effect is well studied. The present was undertaken to determine the incidence of vincristine-induced neurotoxicity in children with ALL after the induction of remission phase of chemotherapy and to ascertain its correlation with undernutrition, vitamin B12, folate and iron deficiency. Thirty children (1-18 years) with ALL were enrolled at the commencement of chemotherapy. The electrophysiological evaluation was done at baseline and repeated after four doses of vincristine (1.5 mg/m/dose). Clinical evaluation was done regularly. Anthropometry and serum B12, folate and ferritin levels were assessed at baseline. Twelve children over a 4-week period of observation had peripheral neuropathy clinically. The autonomic system was most commonly involved followed by motor and sensory system respectively. On electrophysiological testing, half of the patients had evidence of neuropathy. Micronutrient deficiencies were present in a significant number of patients-63.3% had a B12 deficiency, 20% were deficient in folate and 43.3% in iron. The incidence of vincristine-induced neuropathy in patients with/without these micro-nutrient deficiencies was not statistically significantly different. Vincristine-induced neuropathy is common in Indian children with ALL. The present study did not find any correlation between the occurrences of vincristine-induced neuropathy and nutritional deficiencies. Larger studies are warranted to evaluate the contribution of micronutrient deficiencies to the development of peripheral neuropathy in childhood ALL.
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http://dx.doi.org/10.1080/08880018.2019.1637981DOI Listing
September 2019

Guillain-Barre syndrome in North Indian children: Clinical and serial electrophysiological features.

Neurol India 2019 May-Jun;67(3):724-727

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Background: Guillain-Barre syndrome (GBS) is a common acquired polyneuropathy in children.

Aim: To describe the clinical and serial electrophysiological features along with short-term outcomes of children with GBS in north India.

Setting And Design: This was a prospective study conducted at a tertiary care pediatric hospital in north India.

Materials And Methods: Consecutive children, aged 2 to 18 years, with GBS, presenting within 4-weeks of onset of weakness, diagnosed on clinical and/or electrophysiological grounds, were enrolled. The enrolled children underwent a detailed clinical-assessment followed by nerve conduction studies. Repeat nerve conduction studies were performed after 2-weeks of the first study to determine changes in the electrophysiological subtype. The patients were followed up for 3 months.

Results: Thirty-six children were studied. The mean age at presentation was 5.1 years [standard deviation (SD): 2.1]. The mean medical research council (MRC)-sum-score at admission was 24.1 (SD: 10.4). Thirty-three children (91%) had loss of ambulation, 24 (66%) had cranial nerve involvement, and 6 (16.6%) required ventilation. At presentation, 20 had acute motor axonal neuropathy (AMAN), 13 had acute inflammatory demyelinating polyneuropathy (AIDP), 2 had in-excitable nerves, and 1 had normal findings. Four children, initially diagnosed as AIDP, had AMAN with reversible conduction failure on the repeat study. The final classification was AMAN in 25 (69.4%; 95% confidence interval (CI), 51.9-83.7%) and AIDP in 9 children (25%; 95% CI, 12.1-42.2%). Only one patient was nonambulatory at a 3-month follow-up (n = 32). The Erasmus GBS outcome score was 2 in 2 (5.6%), 3 in 5 (13.9%), 4 in 26 (72.2%), and 5 in 3 (8.3%) patients.

Conclusions: The serial electrophysiological studies were helpful in establishing the final correct diagnosis.
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http://dx.doi.org/10.4103/0028-3886.263191DOI Listing
February 2020

Cerebral Palsy in North Indian Children: Clinico-etiological Profile and Comorbidities.

J Pediatr Neurosci 2019 Jan-Mar;14(1):30-35

Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India.

Aims And Objectives: Cerebral palsy (CP) is a common motor disability in children. This study aimed at elaborating various comorbidities and etiologies and also at correlating motor disability with other disabilities.

Material And Methods: This hospital-based study was conducted in the outpatient department of a tertiary care hospital in Delhi on 160 children with CP in the age group 2-15 years. A detailed history taking and examination were conducted for each patient and appropriate investigations were performed.

Results: Most patients, that is 64.4%, were younger than 5 years of age and 72.5% were males. Most common etiology was birth asphyxia (41.9%). Maximum patients were of bilateral spastic (spastic quadriplegic) CP accounting 43.1%. Intellectual disability was the most common comorbidity across all subtypes of CP followed by epilepsy. Comorbidities such as epilepsy and all visual problems except optic atrophy were more common in spastic quadriplegic CP. Hearing, speech impairment, and optic atrophy were more common in dyskinetic CP. Chewing, swallowing, and drooling problems were more common in spastic quadriplegic CP.

Conclusion: Most common risk factor of CP is birth asphyxia; thus, by improving health care facilities, its incidence can be reduced. CP affects not only motor functions but also other important functions of body as well, and the more severe the motor disabilities, the more are other comorbidities and their intensity also increases with that of the intensity of brain insult.
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http://dx.doi.org/10.4103/jpn.JPN_46_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6601115PMC
July 2019

Association of Child Neurology-Indian Epilepsy Society Consensus Document on Parental Counseling of Children with Epilepsy.

Indian J Pediatr 2019 07 8;86(7):608-616. Epub 2019 Jun 8.

Department of Pediatric Neurology, Madhukar Rainbow Children's Hospital, Malviya Nagar, Delhi, 110017, India.

When a child is diagnosed with epilepsy, counseling regarding the same is done by the treating doctor. Most parents are frightened and have poor knowledge about epilepsy. Therapeutic advice including drug dosage, administration and side effects takes up the major part of physician's time, thereby neglecting important issues like home seizure management, follow up and others. These lacunae in knowledge require systematic patient and family education. To address these issues, an expert group meeting of pediatric neurologists and epileptologists in India along with social workers/epilepsy educators, legal experts, parents, and teachers was held. The various aspects regarding parental counseling in children with epilepsy were discussed and a consensus document was formulated. Here authors present the group consensus statement on counseling parents and caregivers of children with epilepsy. This document is intended to help physicians and pediatricians counsel the families when a child is diagnosed with epilepsy.
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http://dx.doi.org/10.1007/s12098-019-02946-zDOI Listing
July 2019

Unusual Presentation of PMM2-Congenital Disorder of Glycosylation With Isolated Strokelike Episodes in a Young Girl.

J Child Neurol 2019 06 11;34(7):410-414. Epub 2019 Mar 11.

3 Neurology Division, Department of Pediatrics, Lady Hardinge Medical College (LHMC) and associated Kalawati Saran Children Hospital, New Delhi, India.

Congenital disorders of glycosylation (CDG) are multisystemic inherited metabolic disorders with marked phenotypic variability. The most frequent described type is PMM2-CDG (earlier known as CDG Type Ia) which presents either with pure neurologic features or with combined neurologic and systemic features. The classical presentation is characterized by varied combinations of developmental delay, hypotonia, ataxia, dysmorphism, inverted nipples, and abnormal fat distribution. Strokelike episodes and seizures are known acute complications that usually occur on a background of developmental delay, ataxia, or dysmorphism. We report here a developmentally normal young girl who presented with isolated strokelike episodes and was diagnosed to have CDG Type Ia. This condition should be kept in the differentials of unexplained strokelike episodes in children. The diagnosis has important therapeutic and prognostic implications.
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http://dx.doi.org/10.1177/0883073819833543DOI Listing
June 2019

Adverse Drug Reactions of Anti-Epileptic Drugs in Children with Epilepsy: A Cross-Sectional Study.

Curr Drug Saf 2019 ;14(3):217-224

Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Greater Noida, UP 201310, India.

Background: Adverse drug reactions (ADRs) due to antiepileptic drugs (AEDs) in children contribute to poorer patient outcomes. However, reliable data ragarding such ADRs is not available.

Objectives: Thus, the aim of the present study was to determine the incidence and patterns of ADRs of antiepileptic drugs in children aged 2-17 years presenting to a tertiary care teaching hospital.

Methods: An observational study was conducted in the Department of Pediatrics, Kalawati Saran Children's Hospital for a period of one year. Two hundred consecutive eligible patients (aged 2-17 yrs with epilepsy on AED) with consenting parents were enrolled. ADRs were noted using Paediatric Epilepsy Side Effect Questionnaire (PESQ) at clinic visits and any other ADRs reported by parents were also recorded. Causality, severity and avoidability assessments were done.

Results: The mean age was 10.5 ± 3.6 years. A total of 139 ADRs occurred in 97 patients. One hundred and nine ADRs were reported by use of PESQ, in addition, 30 ADRs were reported by parents. Poor school result (33.8%) was the commonest ADR. Valproate (61.9%) was the main drug causing ADRs. Valproate, when used in polytherapy, was associated with more number of children experiencing ADRs (72.2%). The most common add on drug was clobazam (42.3%). Children with poorly controlled epilepsy were associated with more ADRs. Causality assessment revealed that 91.3% of the ADRs were probable. Most (94.9%) ADRs were of 'mild' category and 95.7% were probably preventable. Treatment was discontinued only in 6 patients of phenytoin toxicity.

Conclusion: Cognitive and neurological problems were the most common ADRs seen in children with epilepsy. Polytherapy significantly increases the likelihood of ADRs in children.
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http://dx.doi.org/10.2174/1574886314666190311112710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875869PMC
February 2020

Integrated Management of Newborn and Childhood Illness (IMNCI) Strategy and its Implementation in Real Life Situation.

Authors:
Satinder Aneja

Indian J Pediatr 2019 07 18;86(7):622-627. Epub 2019 Feb 18.

Department of Pediatrics, School of Medical Sciences & Research, Sharda University, Greater Noida, UP, India.

To meet the sustainable development goals (SDG) target of reducing under-five mortality to 25 per 1000 live births, concerted efforts are required to end all preventable deaths of newborns and children under 5 y of age. There is evidence to support Integrated Management of Neonatal and Childhood Illness (IMNCI) as a cost- effective strategy which can improve child survival. IMNCI has 3 components- capacity building of health workers, health system strengthening and improving community and family practice. For best results, all three components of the IMNCI strategy should be implemented in a coordinated fashion. IMNCI implementation in india has been uneven. The main focus has been on capacity building and with little attention on system strengthening or improving community practices. Ill- sustained funding and poor monitoring and supervision system were additional factors which are major challenges. Since evidence based interventions remain same, IMNCI remains as relevant today as before. It would be appropriate to redesign it as per current needs and implement it with more planning with committed budget and inbuilt measures of quality improvement along with supportive supervision.
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http://dx.doi.org/10.1007/s12098-019-02870-2DOI Listing
July 2019

Effect of high dose vitamin d supplementation on vitamin d nutrition status of pre-pubertal children on anti-epileptic drugs - A randomized controlled trial.

Clin Nutr ESPEN 2019 02 23;29:36-40. Epub 2018 Nov 23.

Department of Internal Medicine, Maulana Azad Medical College, New Delhi, India.

Background And Aims: Patients on long term anti-epileptic drug therapy are prone for Vitamin D deficiency for a myriad of reasons. The aim of this research was to study the effect of high dose vitamin D supplementation on vitamin D nutrition status of children newly started on anti-epileptic drug therapy.

Materials: This randomized controlled trial was conducted in a tertiary care Children's Hospital at New Delhi from November 2011 to March 2013. Eighty three children in the age group 5-10 years newly started on anti-epileptic drugs (AED) were randomized into two groups; group A - the intervention group, to whom 60,000 IU vitamin D3 was given orally/month under direct supervision along with AED for a period of 6 months, and group B- the control group, to whom AED without vitamin D3 was given. Serum 25(OH)D, ionized calcium (iCa), total calcium (tCa), inorganic phosphate (iP), alkaline phosphatase (ALP) and parathyroid hormone (PTH) levels were assayed at baseline and at the end of 6 months and were compared within and between the two groups.

Results: The mean 25(OH)D in Group A was maintained at 6 months follow up [ 26 ng/ml, 95% CI 20-34 ng/ml] compared to baseline [25 ng/ml, 95% CI -19 to 33 ng/ml] [ p = 0.83]. In group B, there was a significant decrease in 25(OH)D levels at 6 months [13 ng/ml (95% CI 9 ng/ml-17 ng/ml)] compared to baseline [18 ng/ml (95% CI 13-24 ng/ml)] [p = 0.01]. At 6 months, mean serum 25(OH)D was significantly higher in group A as compared to group B (p = 0.005).

Conclusion: To conclude, oral administration of 60,000 IU vitamin D3/month is sufficient to maintain serum 25(OH)D level and prevent development of vitamin D deficiency in children newly started on AED over a period of 6 months. Non supplementation leads to the lowering of serum 25(OH)D in these children.

Trial Registration Number: CTRI/2017/08/009234.
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http://dx.doi.org/10.1016/j.clnesp.2018.11.007DOI Listing
February 2019

Diagnosis and Management of Acute Encephalitis in Children.

Indian J Pediatr 2019 Jan 19;86(1):70-75. Epub 2018 Sep 19.

Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.

Acute encephalitis is a common cause of death and neurodevelopmental problems in children. The causative agents are numerous including infectious agents such as viruses, bacteria, mycobacteria and protozoa; para-infectious and immune mediated disorders such as acute disseminated encephalomyelitis (ADEM) and autoimmune encephalitis, especially the recently described anti-NMDA receptor encephalitis. Also, many viral associated encephalopathies such as acute necrotizing encephalopathy can mimic the presentation of acute encephalitis. In this article, authors describe the approach to the diagnosis and management of acute encephalitis in children.
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http://dx.doi.org/10.1007/s12098-018-2775-0DOI Listing
January 2019

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

Vitamin B Deficiency in Children With Infantile Spasms: A Case-Control Study.

J Child Neurol 2018 10 22;33(12):767-771. Epub 2018 Jul 22.

2 Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.

There have been few case reports showing association of vitamin B deficiency with infantile spasms. We planned this study to see if there was an association of serum vitamin B deficiency in children with development of infantile spasms. Cases included children with infantile spasms of ages 6 months to 3 years. The controls were children in the same age group who had global developmental delay but no history of epileptic spasms. Mean serum vitamin B, serum homocysteine, and urinary methylmalonic acid levels were measured in both groups and compared. Children with infantile spasms had lower mean serum vitamin B levels (354.1 pg/mL; standard deviation 234.1 pg/mL) as compared to children with global developmental delay without spasms (466.7 pg/mL; standard deviation 285.5 pg/mL) ( P value < .05). Mean serum homocysteine level (13.9 vs 7.8 μmol/L, P = .02) and mean urinary methylmalonic acid level (68.1 mmol/mol of creatinine vs 26.1 mmol/mol of creatinine, P = .03) were elevated in children with infantile spasms than in controls. Fourteen children (35.0%) with infantile spasms were vitamin B deficient compared with 3 (7.50%) controls ( P = .005). Thus, vitamin B deficiency may have an association with infantile spasms. More studies are needed before recommending routine measurement of serum B levels in children with infantile spasms.
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http://dx.doi.org/10.1177/0883073818787062DOI Listing
October 2018

Causality assessment of serious and severe adverse events following immunization in India: a 4-year practical experience.

Expert Rev Vaccines 2018 06 11;17(6):555-562. Epub 2018 Jun 11.

b Department of Epidemiology, School of Public Health , University of Michigan , Ann Arbor , MI , USA.

Background: India has implemented the World Health Organization's revised Causality Assessment Protocol for adverse events following immunization (AEFI). We describe the number and types of serious/severe AEFIs, including deaths.

Research Design And Methods: Analysis of causality classification of reported serious/severe AEFIs from 1 January 2012 to 7 January 2016 was done. Classification includes (A) consistent with causal association to immunization; (B) indeterminate; (C) coincidental association; or (D) unclassifiable. We present descriptive statistics across each category.

Results: Analysis of causality assessment completed for 1037 reports of serious AEFIs: 499 (48%) were causally associated, 84 (8%) were indeterminate, 323 (31%) were coincidental, and 131 (13%) were unclassifiable. Of the 499 reports in the A category, the events were causally linked to vaccine product for 189 (18%), to immunization error for 135 (13%), and to immunization anxiety for 175 (17%). Among 279 reported deaths, more than half (55%; n = 153) were coincidental events and 37% were unclassifiable.

Conclusions: Causality assessment of AEFI cases is an important component of vaccination programs and post-marketing surveillance of vaccines. Field reporting and investigation of AEFIs can be improved for many severe or serious reports, most of which are not causally linked to the vaccination program.
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http://dx.doi.org/10.1080/14760584.2018.1484285DOI Listing
June 2018

Zika Virus Infection and Microcephaly in Infants: Is the Association Casual or Causal?: Public Health Viewpoint.

Authors:
Satinder Aneja

Indian Pediatr 2018 04;55(4):333-334

Department of Pediatrics, School of Medical Sciences and Research, Sharda University, India.

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April 2018

Addition of pyridoxine to prednisolone in the treatment of infantile spasms: A pilot, randomized controlled trial.

Neurol India 2018 Mar-Apr;66(2):385-390

Division of Pediatric Neurology, Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children's Hospital, New Delhi, India.

Background: West syndrome is a catastrophic epilepsy syndrome characterized by infantile spasms, hypsarrhythmia, and developmental arrest or regression.

Aim: The aim of this study was to explore the role of pyridoxine in the management of infantile spasms.

Setting And Design: This was a pilot, randomized, open-label trial conducted at a tertiary level hospital from November 2012 to March 2014.

Materials And Methods: Children aged 3 months to 3 years presenting with infantile spasms in clusters (at least 1 cluster/day) with hypsarrhythmia or its variants on electroencephalogram (EEG) were enrolled. The study participants were randomized to receive either oral prednisolone (4 mg/kg/day) alone or 30 mg/kg/day of pyridoxine with oral prednisolone. The primary outcome measure was the proportion of children who achieved spasm freedom for 48 h on day-14 after treatment initiation, as per parental reports, in both the groups. The adverse effects were also monitored. The study was registered with clinicaltrials.gov (ClinicalTrials.gov Identifier: NCT01828437).

Results: Sixty-two children were randomized into the two groups with comparable baseline characteristics. The proportion of children with spasm cessation on day-14 was similar in the two groups (39 vs. 37%, P = 0.98). The adverse effects were comparable in both the groups.

Conclusions: The combination of pyridoxine with oral prednisolone was not found to be a beneficial therapy as compared to prednisolone alone in the treatment of infantile spasms in this pilot study. However, high dose pyridoxine may be safe in children with infantile spasms.
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http://dx.doi.org/10.4103/0028-3886.227281DOI Listing
September 2019

Vaccine Safety and Surveillance for Adverse Events Following Immunization (AEFI) in India.

Indian J Pediatr 2018 02 23;85(2):139-148. Epub 2017 Nov 23.

The INCLEN Trust International, F-1/5, 2nd Floor, Okhla Industrial Area, Phase I, New Delhi, 110020, India.

Rationale: Assured quality vaccines and safe immunization practices are pre-requisite to successful immunization programs. All vaccines go through stringent safety checks during pre-licensure stage. Adverse Events Following Immunization (AEFI) Surveillance program is an integral part of routine immunization program in India to monitor the vaccine safety in the post licensure phase. Indian AEFI Program: National AEFI surveillance relies on passive surveillance and reporting by the health functionaries and practitioners. Vigorous strengthening of AEFI surveillance has resulted in manifold rise in absolute number of AEFI reports across several reporting units in the country in the last decade. Establishment of National AEFI Secretariat, National Technical Collaborating Centre, and development of risk communication strategy as well as quality management certification are some of the unique aspects of this public health program. All serious AEFI reports undergo a systematic causality assessment as per WHO-algorithm by trained committees. National AEFI surveillance system has forged formal linkages with national pharmacovigilance program, the regulators, and professional bodies. Challenges: The number of the reported serious AEFIs are still far less than the expected numbers. Although the AEFI committees at the district and state levels have been established, a large proportion are far from functional. Way forward: As the national immunization program introduces newer vaccines for different age groups and coverage improves, the issues of vaccine hesitancy and confidence are likely to be raised more often and the AEFI surveillance program will have to assume greater responsibility to comprehensively respond to the community concerns and sustain public confidence in vaccines.
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http://dx.doi.org/10.1007/s12098-017-2532-9DOI Listing
February 2018

Predictors of death in infants with probable serious bacterial infection.

Pediatr Res 2018 04 20;83(4):784-790. Epub 2017 Dec 20.

Pediatric Biology Center, Translational Health Science and Technology Institute, Gurgaon, India.

BackgroundBacterial infections account for a significant proportion of neonatal and infant mortality globally. We aimed to identify predictors of death in infants with probable serious bacterial infection (PSBI) defined as signs/symptoms of possible serious bacterial infection along with baseline C-reactive protein (CRP) ≥12 mg/l.MethodsWe did a secondary analysis using the data collected from 700 infants with PSBI who participated in a randomized controlled trial in India in which zinc or placebo was given in addition to the standard antibiotics. Logistic regression was used to estimate the associations between relevant variables and death within 21 days.ResultsThose infants who were fed cow's milk or formula before the illness episode had 3.7-fold (95% confidence interval (CI) 1.5-9.3) and 5.3-fold (95% CI 2.0-13.6) higher odds of death, respectively. Lethargy (odds ratio (OR) 2.4, 95% CI 1.1-5.4) and CRP (OR 1.9, 95% CI 1.1-3.3) were also independent predictors of death. In the model including only clinical features, female gender (OR 2.25, 95% CI 1.0-5.0), abdominal distention (3.7, 95% CI 1.1-12.3), and bulging fontanelle (5.8, 95% CI 1.1-30.5) were also independent predictors for death.ConclusionFormula or cow milk feeding prior to the illness, lethargy at the time of presentation, and high serum CRP levels predicted death in infants with PSBI.
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http://dx.doi.org/10.1038/pr.2017.299DOI Listing
April 2018

Changing pattern of prevalence, genetic diversity, and mixed infections of viruses associated with acute gastroenteritis in pediatric patients in New Delhi, India.

J Med Virol 2018 03 17;90(3):469-476. Epub 2017 Nov 17.

Department of Biotechnology, School of Chemical and Life Sciences, Jamia Hamdard University, New Delhi, India.

There are very few studies that have assessed multiple viral agents causing Acute-Gastroenteritis (AGE) in India. The present study compared the changing pattern of prevalence and genetic diversity of five enteric viruses associated with acute-diarrhea in Delhi children within a gap of 5 years. Fecal samples were collected from diarrheal children (<4 years) during two winter seasons: year 2009-2010 (n = 59) and year 2014-2015 (n = 85). Samples were individually tested for rotavirus-A, norovirus, astrovirus, adenovirus, and sapovirus using EIA/RT-PCR and genetically characterized by phylogenetic analysis. Rotavirus was the most predominant (54.9%) virus followed by norovirus (25.7%), astrovirus (8.3%), and adenovirus (4.9%) with rare detection of sapovirus (0.7%). While detection rate increased for both rotavirus (49.2-58.8%) and astrovirus (5.1-10.6%), norovirus detection rate decreased (30.5-22.4%) from 2009 to 2015. During the same time period, adenovirus detection remained low (4.7-5.1%). Interestingly, mixed infections increased from 8.5% to 16.5% after 5 years. G1P[8] rotavirus strain was found most predominant (40%). Both type-1 and 8 astroviruses were detected. Single sapovirus detected was of genotype GII.1. Both GI (GI.5, GI.3) and GII (GII.1, GII.4, GII.7, GII.21, GII.13) genogroups of norovirus were detected. Of particular significance was the first detection of other NoV genotypes (besides GII.4 and GI.3) in Delhi. This is also the first report of NoV GI.5 from India. A change in prevalence pattern and increased diversity from 2009 to 2015 emphasizes the need for continued enteric virus surveillance to help measure the impact of new diarrhea vaccine(s) introduced in India.
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http://dx.doi.org/10.1002/jmv.24980DOI Listing
March 2018

Pedigree Analysis of Familial Primary Concomitant Horizontal Strabismus in Northern India.

Strabismus 2017 12 10;25(4):200-213. Epub 2017 Aug 10.

b Department of Genetics , University of Delhi South Campus , New Delhi, India.

Purpose: Familial clustering of common forms of primary strabismus like esotropia (ET) and exotropia (XT) is observed in a proportion of the strabismus cohort. The genetic components of this remain unidentified. Linkage studies have demonstrated susceptibility locus for primary strabismus at the STBMS1 locus on 7p22.1 as well as other loci on 4q28.3 and 7q31.2. Recently next generation sequencing (NGS) technology has emerged as a powerful tool in discovery genomics and a large number of novel disease-causing variants are being reported. In this study, we recruited informative families for subsequent genetic analysis for disease-causing variant identification.

Methods: All consecutive families with two or more affected members with primary concomitant horizontal strabismus were prospectively recruited at the ophthalmic outpatients department (OPD) of Lady Hardinge Medical College, New Delhi, from August 2014 to February 2017. Detailed phenotypic evaluation and pedigree documentation was performed.

Results: Of the 39 recruited families of north Indian origin, 18 families each had affected family members demonstrating either ET or XT. 100% concordance of the phenotype in the affected family members was observed in these families. While vertical transmission was observed in 17/18 families with XT, 7 with ET had affected members across one generation, 2 demonstrated consanguineous pedigree, and 2 comprised identical twin families. In 3 families, a combination of ET and XT was noted. This comprised one family with the ET and XT patients being from 2 separate arms of the family related by marriage, one family where one sibling had XT and the other had ET, and another family where the maternal aunt of the affected proband with ET had XT.

Conclusions: Subjects with familial primary concomitant strabismus recruited in this study may provide a valuable resource to unravel the genetic determinants of this condition, which is a common disorder of early childhood with high ophthalmic morbidity.
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http://dx.doi.org/10.1080/09273972.2017.1350865DOI Listing
December 2017

Application of the revised WHO causality assessment protocol for adverse events following immunization in India.

Vaccine 2017 07 22;35(33):4197-4202. Epub 2017 Jun 22.

Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA. Electronic address:

Background: In 2013, the World Health Organization (WHO) and CIOMS introduced a revised Causality Assessment Protocol (CAP) for Adverse Events following Immunization (AEFI). India is one of the first countries to adopt the revised CAP. This study describes the application of the revised CAP in India.

Methods: We describe use of CAP by India's AEFI surveillance program to assess reported AEFIs. Using publicly available results of causality assessment for reported AEFIs, we describe the results by demographic characteristics and review the trends for the results of the causality assessment.

Results: A total of 771 reports of AEFI between January 2012 and January 2015, completed causality review by August 2016. The cases were reported as belonging to a cluster (54%; n=302), hospitalized or requiring hospitalization (41%; n=270), death (25%; n=195), or resulting in disability (0.4%; n=3). The most common combinations of vaccines leading to report of an AEFI were DTwP, Hepatitis B, and OPV (14%; n=106), followed by Pentavalent and OPV (13%; n=103), and JE vaccine (13%; n=101). Using the WHO Algorithm, most AEFI reports (89%, n=683) were classifiable. Classifiable AEFI reports included those with a consistent causal association (53%; n=407), an inconsistent causal association (29%; n=226) or were indeterminate causal association with implicated vaccine(s) or vaccination process (6.5%; n=50) (Fig. 1); 88 reports remained unclassifiable.

Conclusions: The revised CAP was informative and useful in classifying most of the reviewed AEFIs in India. Unclassifiable reports could be minimized with more complete information from health records. Improvements in causality assessment, and standardization in reporting between countries, can improve public confidence in vaccine system performance and identify important vaccine safety signals.
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http://dx.doi.org/10.1016/j.vaccine.2017.06.027DOI Listing
July 2017