Pakistan Pediatric Journal

Vitamin D deficiency in children with congenital adrenal hyperplasia (CAH): a cross-sectional study from tertiary health care center of Pakistan.

ABID ALI JAMALI — 2025-03-17

INTRODUCTION: Children with congenital adrenal hyperplasia (CAH) receive glucocorticoids from the time of diagnosis. Recent studies show that steroids enhance the inactivation of 25(OH)D by up-regulating 24-hydroxylase activity. We conducted this study to find out vitamin D deficiency (VDD) in children with CAH who were receiving steroids.

MATERIAL AND METHODS: Prospective descriptive cross-sectional study, conducted at the outpatient department of pediatric endocrinology at National Institute of Child Health (NICH) Karachi during 2017-2018. The sampling technique was non-probability consecutive sampling and the sample size was n= 150 CAH patients. All CAH patients meeting the inclusion criteria were enrolled in the study.

RESULTS: Fifty-four per cent of patients with CAH had VDD and 46% had a sufficient level of vitamin D. The mean age of our patients was 11.85±3.32 years. The mean duration of CAH and vitamin D levels were 11.85±3.32 years and 14.6±5.65 ng/dl, respectively. Forty-eight per cent of VDD patients were from low socioeconomic status and 68.67% of patients from the urban area were deficient in vitamin D status. VDD was found more in children with inadequate sun-exposure i.e. 65.62% of patients with inadequate sun exposure were VDD. More females with CAH were VDD as compared to males with a male to female ratio of 1:1.2.

CONCLUSION: The frequency of VDD in children with CAH is comparable to our general population. Adolescent girls, patients from lower socioeconomic status, patients from the urban areas and patients with inadequate sun exposure are more prone to VDD.

Efficacy of Phenytoin vs Levetiracetam in Status Epilepticus at Institute of Child Health, Faisalabad.

Zahid Mahmood Anjum — 2025-03-17

ABSTRACT

Background:

Status epilepticus is the second most common neurologic emergency in children. Morbidity and mortality are considerable, and thus, timely termination of convulsive status epilepticus is the primary goal of management to avoid these risks.

Objective:

To compare the efficacy of phenytoin and Levetiracetam in status epilepticus in children.

Study Design:

Randomized Controlled Trial (RCT).

Setting:

This study was conducted in pediatric emergency department of Children Hospital Faisalabad.

Duration of Study:

Six months period from: 1/8/2022 to 31/1/2023.

Methodology:

A total of 70 patients were randomly allocated to one of the group by computer generated random number table according to their admission in emergency. Children in group A were given levetiracetam. Children in group B were given I/V phenytoin. For both groups if seizures recurred after the first loading dose an additional 10mg/kg of the same drug was given over 10 minutes.

The patients were monitored to see whether there was any recurrence of seizure activity in subsequent 24 hours. Seizure control was defined as the absence of seizure within 24 hours after the initial loading of the drug.

Results:

Comparison of efficacy of phenytoin and levetiracetam in status epilepticus children shows that 32(91.4%) in Group A and 26(74.3%) in Group B were treated effectively, p-value=0.005.

Conclusion:

We concluded that the efficacy of levetiracetam is significantly higher than phenytoin in the treatment of status epilepticus in children.

Keywords:

Children, Status epilepticus, Phenytoin, Levetiracetam, Efficacy

Frequency and Associated Factors of Anemia among Children Age 6 To 59 Months of Age

Dr.waqas younus — 2025-03-17

Abstract:
Objectives: To determine the frequency and associated factors of anemia among children age 6 to 59 months of age.
Materials and Methods: This study was conducted in the Department of Pediatrics Unit-II Bolan medical college hospital Quetta. Detailed history and physical examination of children with suspected anemia was carried out. All participants with hemoglobin less than 11g/dl by haemocue were investigated for complete blood count using an automated machine MS 9- 5H or CELL DYN 3700. Mean corpuscular volume was also done in all children with anemia to detect iron deficiency. Also blood smear for malaria parasites was done using Giemsa stain and the number of asexual parasite/200WBC was counted. Stool analysis was done by microscopic examination to find out parasites, ova or other forms of intestinal helminthes. All the demographic details and study results were recorded on a predesigned data collection proforma.
Results: A total of 196 children with mean hemoglobin levels of 9.97 ± 2.20 g/dl were enrolled.
The prevalence of anemia in our study was found to be 63% respectively. Associated factors of all cases of anemia were evaluated on the basis of various factors that include nutritional, infectious and other causes like worm infestations. There was significant relationship found between anemia and iron deficiency anemia. However, no significant relationship was found between anemia with gender and other associated factors.
Conclusion: The prevalence of childhood anemia in our study is very alarming. Lack of parental education and poor socioeconomic status on the other hands signifies a massive treat that needs to be address. An integrated approach of provision of basic health care facilities, creating awareness among parents are the essentials steps that needs to be taken in order to reduce the prevalence of childhood anemia and improve the outcome of children especially in resource limited areas of our country.

Effect of gross motor function in children with cerebral palsy on parental depression

umar ibrahim — 2025-03-17

Background: Parents of CP children having many problems because CP children completely depend on their parents that can affect the parent’s behavior and mental level. Therefore, this study is to conduct to find correlation of gross motor function of CP children and stress anxiety and depression in their parents and after 6 months find out what change occur in level of stress anxiety and depression with change in gross motor function.

Objective: To investigate the association between gross motor function in children with cerebral palsy with levels of depression in their parents.

Methods: A cross-sectional survey was conducted at the Helping Hand Institute of Rehabilitation Sciences in Mansehra with 126 children (aged up to 18) with cerebral palsy and their parents. GMFM 88 examined gross motor function, whereas DASS 42 assessed parental depression. The statistical analysis in IBM SPSS 22 included mean, standard deviation, frequency, percentage, Spearman correlation, and linear regression.

Results: The mean age of children was 6.76±3.92 years, and parents were 33.21±7.06 years. Spastic CP was prevalent in 89.7% of children. Significant correlations were found between GMFCS levels and parental depression, with higher GMFCS levels associated with increased depression. Regression analysis supported a significant relationship, indicating the potential predictive value of gross motor function in parental depression. Female parents exhibited a higher rate of depression compared to male parents.

Conclusion: This study provides a significant association between the severities of gross motor function in children with CP.

Key words: Depression, cerebral palsy, gross motor function.

Seromolecular Detection of Cytomegalovirus Infection in Immunocompromised Versus Immunocompetent Pediatric Patients

Nashwa Naguib Omar — 2025-03-17

Objective: Study aimed to evaluate seromolecular assays in detecting cytomegalovirus in pediatrics versus PCR based on their immunocompetency. Study Design: Retrospective crosectional study. Place and Duration: From December 2019- December 2023 in a tertiary University hospital. Materials and Methods: 203 pediatric patient’s records were collected and divided into; Group 1: Immunocompromised and Group 2: Immunocompetent, whom underwent diagnostic tests by both PCR and Electrochemiluminescence Immunoassay. Results: Patients with positive CMV IgG were 82.3% in Group 1 and Group 2 presented 81.3%. Patients with positive CMV IgM and negative PCR were recorded in only (6.3%) of children from Group 1 and (3.7%) of Group 2. Patients with positive CMV PCR were divided into patients with positive CMV IgM representing 4/96 (4.2%) in Group 1, 4/107 (3.7%) in Group 2 and others with negative CMV IgM 6/96 (6.3%) in Group 1, 5/107 (4.7%) in Group 2 respectively. Regarding median viral load it was greater in Group 1 (1189.00 copies/ml) than in Group 2 (492 copies/ml). Total positive CMV by both PCR and IgM (ECLIA) were 11/96 (11.4%) patients in Group 1 giving a sensitivity of 27.2% and a specificity of 90.59% for (ECLIA) versus PCR in this group. Total positive CMV by both PCR and IgM was 9.3% in Group 2 giving a higher sensitivity of 40% and a specificity of 96.91% for (ECLIA) versus PCR in this group. Conclusion: Our study points out the limitations of relying solely on serology without PCR, especially in immunocompromised cases to avoid missing positive cases.

Keywords: CMV, immunocompetent, immunocompromised, PCR, Serology

Frequency and Antimicrobial Sensitivity Pattern of Urinary Tract Infections in Late Onset Sepsis among Neonates at Children’s Hospital Lahore

Wajiha Rizwan — 2025-03-17

ABSTRACT

Objective: This study aimed to investigate the frequency and antimicrobial sensitivity patterns of urinary tract infections (UTIs) in neonates with late-onset sepsis in order to guide clinical decision-making and develop effective strategies for prevention and management of UTIs.

Study design: A cross-sectional study utilizing non-probability consecutive sampling and included neonates aged 7-28 days diagnosed with late onset sepsis.

Place and duration of study: Conducted at the Children's Hospital, Lahore, over a period of six months from September 2022 to March 2023.

Material and methods: Sample size of 100 neonates was estimated. Data including demographic information, urine samples, and antibiotic sensitivity patterns were collected and analyzed using SPSS v. 25.0. Chi-square test was applied for analysis and a p-value ≤ 0.05 was considered as significant.

Results: A mean age of 27.25 ± 4.45 days among neonates, with a male predominance of 77% was found. E. coli was the most common organism causing UTIs (64.7%), followed by Klebsiella (17.64%) and Staphylococci (11.76%). Pseudomonas was least commonly isolated (5.88%). Antibiotic sensitivity patterns varied among organisms, with Amikacin and Cefotaxime showing high sensitivity rates against E. coli. There was no significant difference in the frequency of different organisms between male and female neonates.

Conclusion: E. coli is the most frequently isolated organism in neonatal UTIs, with varying resistance and sensitivity patterns to different antibiotics. Understanding these patterns is crucial for guiding treatment decisions for the prevention and management of UTIs in neonates with LOS.

Keywords:

E. coli, Neonatal sepsis, UTIs, Antimicrobial pattern

Efficacy of Intravenous Magnesium Sulphate in Neonates Suffering from Birth Asphyxia in a resource limited Country

salman arshad — 2025-03-17

Abstract:

OBJECTIVE: To determine the eﬀicacy of magnesium sulphate in reducing short-term morbidity and mortality among neonates suffering from birth asphyxia.

Study Design: Randomized Control trial.

Place and Period of Study: Neonatology Unit of Allama Iqbal Memorial Teaching Hospital, Sialkot from November 2022 to July 2023.

Methodology: Neonates with perinatal asphyxia, meeting the inclusion criteria were enrolled in Study (total of 128 with 64 in each Group). Asphyxia was classified according to criteria laid by Sarnat. After taking informed consent case group received Magnesium sulphate at the dose of 250mg/kg at 6 hour, 24 hour and at 48 hour of life. Rest of the management was similar for both groups. Data was collected on predesigned Performa. Distribution of perinatal factors and neonatal baseline characteristics were noted. Data was analyzed by using SPSS version 27, Chi-square test applied with P-value <0.05 taken significant.

Results: This study showed statistically significant difference (p-value<0.05) in short term outcomes in the form of decrease frequency and early control of seizures along with shorter duration of hospital stay. However, the difference in establishment of sucking reflex and neurological status at discharge was insignificant (p-value >0.05).

Conclusion: Magnesium sulphate is an effective drug for reducing the short term morbidities in asphyxia especially in resource limited institutes.

Keywords: Birth asphyxia, Magnesium sulphate, Morbidity, Mortality, Neonate, Outcome, Resource limited country, Term

Knowledge, Attitude and Practice (KAP) Study of Pediatricians on Infantile Spasms: An online survey from Pakistan.

iram_javed javed — 2025-03-17

Abstract

Objective: To determine Knowledge, Attitude and Practice of Pakistani Pediatricians regarding Infantile Spasms.

Study Design

Descriptive Cross-sectional study.

Place and Duration of Study

Online survey across Pakistan from January 2023 to March 2023.

Material and Methods

This descriptive study enrolled 117 pediatricians from January 2023-March 2023 through online survey. All the practicing pediatricians from Pakistan were invited to participate in the study by sharing the google form in WhatsApp group of pediatricians. Data of Knowledge, Attitude and Practices regarding Infantile Spasm was collected. Data analysis was performed by SPSS version 26 using descriptive statistics to determine the frequency and percentages for of Knowledge, Attitude and Practices towards Infantile Spasm.

Results

Majority of the pediatricians 109(93.2%) correctly identified infantile spasm as a type of seizure. Jerks occurring in clusters were recognized as pointers by 92(78.6%) subjects whereas Salaam Seizures by only 2 (1.7%) subjects. Atlesat 1 case per month was seen by 89(76%) participants. EEG & MRI were available to 84(82.9%) & & 74(63.2%) setups for diagnosis. Knowing etiology was considered Very Important by 64(54.7%) subjects. Most of the subjects had correct idea regarding first drug of choice. Regarding treatment response almost 60% of the subjects had understanding. Complete response was correctly identified as spasm cessation for 4 weeks by 33(28.2%) subjects only. Nelson's Textbook of Pediatrics was used as guideline by 89(76.1%).

Conclusion

Pediatricians are managing children with infantile spasm. They have some knowledge but to make is more precise there is dire need to improve knowledge, attitude and practices of pediatricians of Pakistan.

Key words

Infantile spasm, Pediatrician, West Syndrome, Knowledge, Attitude, practice

The Efficacy of Intramuscular Iron Therapy in Pediatric Patients with Severe Iron Deficiency Anemia: A Pilot Study

Dr Rizwan Gohar — 2025-03-17

Abstract:

Objective: To assess the efficacy of intramuscular iron therapy in pediatric patients with severe iron deficiency anemia (IDA) in a healthcare setting in Pakistan.

Study Design: Quasi-experimental pilot study

Place and Duration of Study: Department of Pediatrics, Lahore General Hospital, Pakistan; June to December 2023.

Methods: 45 children (ages 6 months to 5 years) diagnosed with severe IDA (hemoglobin <7 g/dL, serum ferritin <12 μg/L) were administered intramuscular iron isomaltoside 1000 (maximum dose 200 mg). Hemoglobin levels and body weight were evaluated at baseline and 4 weeks post-intervention.

Results: Following treatment, median hemoglobin increased from 6.5 g/dL to 10.9 g/dL, while median weight increased from 9.4 kg to 10.2 kg. Statistical analysis using the Wilcoxon Signed Ranks Test revealed significant improvements in both hemoglobin levels (Z=5.858, p<0.001) and weight (Z=5.848, p<0.001). The intervention was well-tolerated, with minor adverse events reported in 6.67% of participants.

Conclusion: This initial investigation provides promising evidence supporting the potential of intramuscular iron therapy as an efficient, safe, and tolerable treatment approach for children with severe IDA in resource-limited settings. These findings warrant further exploration through more extensive, randomized controlled studies.

Keywords: Iron deficiency anemia, children, Pakistan, intramuscular iron therapy

Outcome of Various Treatments for Functional Constipation in Children at a Tertiary Care Hospital: A Randomized Clinical Trial

Bareera Hurmat — 2025-03-17

Objective: To compare the efficacy of saline enema, polyethylene glycol (PEG), and their combination in children with functional constipation over an eight-week period.

Study design: Randomized clinical trial

Place and duration: Department of Pediatric Surgery Unit II, The Children’s Hospital Lahore, from October 2023 to July 2024.

Material and Methods: Ninety children diagnosed with functional constipation were randomly assigned to one of three groups: saline enema (Group 1), PEG (Group 2), and combined therapy (Group 3). Evaluations were conducted at baseline, and at the 2nd, 4th, and 8th weeks. Outcome measures included pain during defecation, number of bowel movements, fecal soiling, stool consistency and complications. Data were analyzed using SPSS version 25.

Results: Significant improvement in functional constipation were observed in the PEG and combined therapy groups compared to the saline enema group. Pain during defecation was eliminated in 100% of patients in the PEG and combined groups, whereas 33.3% of patients in the saline enema group continued to experience pain. Number of bowel movements increased notably in the PEG and combined groups, with most patients achieving 4 to 7 bowel movements per week. Fecal soiling was entirely resolved in the PEG and combined groups but persisted in 36.7% of the saline enema group. Stool consistency improved in the PEG and combined groups, with most patients achieving normal stool form (Bristol Stool Chart scores of 3 or 4).

Conclusion: PEG as sole or in combination with saline enema significantly more effective than saline enema in managing pediatric functional constipation.

A Comparison of PRISM-IV and PIM-III Scores in Predicting Mortality in the Paediatric Intensive Care UnitABSTRACT OBJECTIVES: To determine the sensitivity, specificity and diagnostic accuracy of PRISM-IV score and PIM-III score in predicting mortality in cr

Nabeera Hayat — 2025-03-17

ABSTRACT

OBJECTIVES: To determine the sensitivity, specificity and diagnostic accuracy of PRISM-IV score and PIM-III score in predicting mortality in critically ill children receiving critical care.

STUDY DESIGN: Cross-sectional validation study.

SETTING/DURATION OF STUDY: Department of Paediatrics, Combined Military Hospital, Lahore, Aug 2022 to Aug 2024.

METHODOLOGY: We studied 300 children admitted to the paediatric intensive care unit aged between the ages of 1 to 12 years. Patients who were diagnosed as suffering from severe malnutrition, or those suffering from chronic liver disease, nephrotic syndrome or had received blood product transfusions prior to admission to the PICU were excluded. All patients underwent scoring with PRISM-IV and PIM-III systems at the time of admission and were followed up till completion of twenty-eight days, or till the occurrence of mortality. A PRISM-IV score of >10 and a PIM-III score of >4 were considered to be high risk for the occurrence of mortality.

RESULTS: Patient age upon enrollment was 4.0 (IQR: 6.0) years, with a slight female majority of 158 (52.7%). Common indications for admission were pulmonary infections (n=93, 31.0%) acute exacerbations of bronchial asthma (n=73, 24.3%) and non-respiratory infections (n=57, 19.0%). PRISM-IV had a sensitivity of 92.86%, specificity 86.11% and diagnostic accuracy 88.00% in predicting mortality, while PIM-III had a sensitivity, specificity and diagnostic accuracy of 92.86%, 96.76% and 95.67%, respectively, for the same.

CONCLUSION: PIM-III and PRISM-IV have good diagnostic accuracy in predicting the occurrence of death in paediatric critical care.

Wasp sting envenomation:A clinical spectrum

momina Khan — 2025-03-17

It's about clinical spectrum of wasp sting veneomation in two young boys bitten by wasp while playing outside.

Hypertrophic Osteoarthropathy: A Case Report

Sikander Ikram — 2025-03-17

Abbreviations:

HOA= hypertrophic osteoarthropathy, PDP= pachydermoperiostosis, ECHO= Echocargiogram, TB=tuberculosis, LFT's= Liver function tests, ALT= alanine transaminase, AST= aspartate transaminase, ESR= erythrocyte sedimentation rate, CT= Computer Tomography, HRCT= High Resolution Computed Tomography, VEGF= Vascular Endothelial Growth Factor

Intrduction:

Hypertrophic Osteoarthropathy (HOA) is characterised by digital clubbing, periosteal new bone formation, polyarthiritis, hyperhidrosis and seborrhea. It has two types, primary HOA (or pachydermoperiostosis) and secondary HOA, the latter involving liver, heart and intestines and commonly predisposing to cancerous diseases like adenocarcinoma of the lung. [1]

Case:

A 7 year old presented with digital clubbing, multiple joint deformities, sweaty palms, with no secondary involvement of organ systems.

Clinical relevance:

This case is reported because it is a text book case of PDP/ Primary HOA. Whenever in clinical practise, isolated joint involvement with digital clubbing is seen, HOA should be considered as one of the differentials and excluded among other possibilities.

Laboratory values:

X-ray findings suggestive of periarticular, periosteal reaction over generalised osteopenia. ECHO, HRCT, LFT's and TB screening were all documented as normal.

Reference:

1. DOI: http://doi.org/10.1016/j.jaad.2016.02.226. Hypertrophic osteoarthropathy- a case report.

DENGUE ENCEPHALITIS IN CHILDREN; RARE PRESENTATION OF SEVERE DENGUE FEVER

Qurat Ul Ain — 2025-03-17

Dengue is one of the most commonly encountered arboviral diseases prevalent worldwide. Dengue encephalitis is a rare neurological complication of the dengue virus. Although dengue is viewed as a non-neurotropic virus, it should be considered a differential diagnosis in endemic areas.

This case report highlights the importance of keeping dengue encephalitis as one of the differentials and prompt treatment to prevent the progression of symptoms and long-term neurological sequelae. Moreover, it emphasizes the efficacy of steroid therapy in treating dengue encephalitis.

Double Trouble: Meckel's Diverticulum Coexisting with Exomphalos Minor in a Neonate - A Case Report

Ayeza Ali — 2025-03-17

Exomphalos, also known as omphalocele is a midline defect, in which abdominal contents are covered with peritoneal membrane and herniated into the umbilical cord. It is commonly associated with other developmental anomalies. In this case report we illustrate a case of an omphalocele in a neonate associated with Meckel’s diverticulum, which is a rare occurrence. To our knowledge, this is the first reported case of Meckel’s diverticulum in an exomphalos in Pakistan