Category Archives: Pediatrics

A serious outburst in tropical countries

Protect Your Child from Dengue3

What is Dengue?

Dengue is a viral infection spread by mosquitoes. It’s widespread in many parts of the world

These mosquitoes bite most often early in the morning or in the early evening. You can get it again if you’ve had it before, as you’ll only be immune to one variant of the virus.

How it effects?

Infected mainly through a bite from Aedes aegypti mosquito

This mosquito feeds and breeds in small man-made articles that contain water, rests inside buildings. 4

Dengue is caused by any one of four types of dengue viruses. When a mosquito bites a person infected with a dengue virus, the virus enters the mosquito. When the infected mosquito bites another person, the virus now enters healthy person’s bloodstream

Symptoms5

A common symptom in more severe cases is loss of platelets. In most people the infection is mild without causing any lasting problems. But in rare cases it can be potentially life threatening.

Why loss of platelets?

The virus infects cells of the human immune system, leading to symptoms that include liver damage and loss of white blood cells.

This is because of the following:

Dengue suppresses bone marrow which is the platelet-producing area, leading to decreased platelet count. Blood cells affected by dengue virus damage platelets, leading to their drastic fall in numbers. Antibodies produced in dengue also lead to massive destruction of platelets.6

Treatments

There’s no specific treatment or widely available vaccine for dengue. Treatment is rest, plenty of fluids and paracetamol for pain. Dengue usually resolves in one to two weeks. Especially in babies and young children, dengue may progress to dengue haemorrhagic fever.7

Best Foods to Recover from Dengue Fever

Papaya- Papaya leaves are the best option to go for

Broccoli -Excellent source of Vitamin K which helps to regenerate blood platelets.

Pomegranate- rich in essential nutrients and minerals that provides the body with required energy.

Can papaya leaves cure dengue?

Many health experts suggest papaya leaf juice as an effective remedy to treat dengue fever. The leaf extract increases platelet counts in the patients suffering from dengue.8

Acetogenin is a compound found in Papaya leaves have strong anti-malarial properties, making them best to cure dengue fever and malaria and Dengue

Don’t forget Chikungunya and Zika

Dengue, Zika, and Chikungunya are all carried by the pesky Aedes aegypti mosquito.

Is there any vaccine available for Dengue?

In 2016 a partially effective vaccine for dengue fever (Dengvaxia) became commercially available in 11 countries: Mexico, the Philippines, Indonesia, Brazil, El Salvador, Costa Rica, Paraguay, Guatemala, Peru, Thailand, and Singapore.

Sanofi’s vaccine designed to coax the body’s immune system into making antibodies against all the four forms of dengue.

How can we keep safe from dengue?

  • Personal protection and the environmental management of mosquitoes
  • Apply mosquito repellent, ideally one containing DEET
  • Cover your arms and legs by wearing long-sleeves and long pants
  • Use mosquito nets while sleeping

Over and over, nature shows that it’s a tough adversary. That’s why it’s important that we invest in laboratories, disease detectives, research, mosquito control, the public health system around the world to find, stop, track, prevent health threats.

Find more research advances in the diseases of children in our Pediatrics Diseases Session

On November 12-13 by our Honourable guests at Radisson Blu, Dubai Deira Creek

Explore Advancements in Pediatrics, Neonatal and Child Care

 

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How safe is the birth control pill: What’s Right for You?

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Birth control pills are believed to be one of the most effective birth control methods. Wikipedia states that over 100 million women worldwide, nearly 12 million women in the United States alone use birth control pills.

So what happens when taking oral contraceptives?

Will pills have any negative effect on your developing baby?

Is it best to stop your birth control pill immediately after finding out that you are pregnant?P n 2

Birth control pills are combination pills and progestin-only pills (the minipill).

Combination pills contain two kinds of hormones: Estrogen and progestin. These pills makes cervical mucus to thicken and the uterus lining to thin which keeps sperm from meeting with and fertilizing an egg.

Progestin-only pills work the same way as combination pills keeping sperm from reaching an egg.

Is it safe to take the pill while breastfeeding?pn 3

Combination pills may reduce the amount and quality of your breast milk in the first 3 weeks of breastfeeding.

Progestin-only pills are safe to use while you’re breastfeeding. Because they don’t effect on how much milk you produce.

Effective birth control methods:

Condoms

Diaphragm, Cervical Cap

Hormonal Methods

Oral Contraceptives

The Intrauterine Device (IUD)

Fertility Awareness Method

Lactational Amenorrhea Method

Vasectomy

After reading this blog on the birth control pill and its affects you may want to rethink taking it.

Meet the top Gynaecologists in PEDIATRICS NEONATAL CARE 2018 and get insights into this broader topic.

 

 

Blindness in Born Babies

PBlindness is one of the major problems in born babies. This can be caused by many different regions. Those are abnormalities in the developing of the eye, developing problems in eye structures, like prematurity related retinopathy, infections in eye, development problems or injury to parts of the brain responsible for vision.

Some of the factors:

  • Untimely, born in low weight, needing to be treated with oxygen at birth, or bleeding in the brain
  • retinoblastoma, congenital cataracts, or metabolic or genetic disease in family history
  • Infection of mother during pregnancy such as rubella, toxoplasmosis, cytomegalovirus, and some sexually transmitted infections including herpes, and  chlamydia
  • Problems in the central nervous system such as development are delay, cerebral palsy, seizures, or hydrocephalus.

They are many causes to vision loss but one is the most common condition is known as retinopathy of prematurity

Retinopathy of prematurity:

It is main eye problem in born babies born in before 31 weeks of pregnancy. Above 90% of all young child with retinopathy of prematurity are in the milder category and do not need treatment. Born children with more several diseases can develop impaired vision or blindness. About 1, 100-1500 born babies annually develop ROP that is requiring to surgical treatment. Some other reasons that cause vision loss at time of born babies.

Some other conditions:

Defects or abnormalities in the eye itself (coloboma, glaucoma, cataracts)

  • Infections, such as cytomegalovirus (CMV)
  • Neurological Visual Impairment (NVI)

What Would Cause Sudden Weight Gain in Children?

Some children are prone to gain weight gain easily so it’s important to follow physical fitness and healthy diet. When child goes from slim to suddenly overweight, it’s a cause for concern. Before you panic about weight gain, you should understand that there is a wide array when it comes to a child’s weight. One of the usual suspects is puberty. If your child has recently has been experiencing other signs of puberty, her weight gain could be another facet of her changing body. Several factors account for weight gain like changes in level of activity, friends or mood. In some cases, if your child is taking a certain medication, like an anti-psychotic drug, weight gain is often a side effect.

We know that sudden weight gain could be the sign of serious conditions. Overweight children are at a higher risk for health problems, including high blood pressure, elevated levels of cholesterol and type 2 diabetes.

If child has gained weight and we think his food habits could be the problem then there is a serious concern to create healthy diet.p

In some cases, medical treatment may be necessary; especially if the rapid weight gain is a side effect or symptom of another condition. Kids are developing weight-related health problems previously it is seen only in adults.

Genes aren’t the only things that family members may share.The eating and exercise habits of people in the same household. If parents eat a lot of high-calorie foods their kids tend to do the same.

So it’s not a specific number on the scale that’s important. It’s making sure that kids stay healthy — inside and out.

What new skill are you working on with your child this week? Please post in the comments. This should be a great way to strengthen your baby’s metabolism!

Get more recent posts and updates in Pediatrics @Pediatrics Neonatal Care 2018

Vision Reality for Children with Diabetes

Now a day’s diabetes is a common problem. Diabetes is Causes to Eye diseases in Children. Diabetes mellitus is a disorder caused by a decreased production of insulin or by the body’s inability to use insulin. Insulin is produced by the pancreas and is necessary for the body’s control of blood sugar. Fluctuations in blood sugar can be harmful to the body, including the eyes. Diabetes can occur at any age, in present diabetes is affected inborn babies, but most commonly is diagnosed from early childhood to the late 30s.In this type of diabeticdiabetes, a person’s glucagon products little or no insulin. Children with diabetes are at risk of developing eye disease that can affect their vision. Diabetic eye disease refers to a group of eye problems that affect those with diabetes.

Diabetic eye disease may include:

Diabetic retinopathy: Diabetic retinopathy is most in American adults. It causes blindness in young children, it is caused by damage to the small blood vessels of the retina.it is seeing the layer of the eye.

Diabetic macular edema (DME): Diabetes is the leading cause of new blindness, with DME contributing greatly to this vision loss. It may affect up to 10% of people with diabetes. Diabetic macular edema is a complication of diabetes caused by fluid accumulation in the macula that can affect the fovea. Vision loss from DME can advance over a period of months and make it impossible to focus clearly.

Cataract: It is a clouding of the eye lens, which blocks to the passage of light into the eye. The lens of the eye is located the pupil and the eye coloured iris and is normally transparent. The cause of cataract, your vision may become blurry or dim because cataracts stop light from properly passing through to your retina.

Glaucoma: Glaucoma is an important, lifelong eye disease. It can lead to vision loss not controlled, but now a day’s glaucoma is controllable with modern treatment.

Symptoms of the disease:

  • Blurred vision
  • Extreme hunger accompanied by weight loss
  • Excessive thirst
  • Frequent urination
  • Fatigue
  • Loss of feeling or tingles in the extremities
  • Frequent infections of the bladder, skin, or gums
  • Dry mouth
  • Slow healing of cuts and scrapes
  • Excessive or unusual infections

Treatment: The first step in any treatment for diabetic eye disease is to maintain Diabetic percentage in blood, blood glucose, blood pressure, and blood cholesterol levels as close to normal as possible. In modern days treatment for diabetic eye diseases in three options.

  • laser treatment
  • Avastin, Lucentis, or Eylea injection
  • intravitreal steroids: Kenalog, Ozurdex, and Iluvien

How parents can recognize Autism early?

AutismAutism is a Neurodevelopmental condition which has become more prevalent these days which includes impairments in social interaction and developmental language and communication skills combined with rigid, repetitive behaviors. It has been found that 1 in 68 children could have a diagnosis of autism.

Signs of Autism:

  • Avoidance of eye contact
  • Persistent preference for solitude
  • Resistance to minor changes in routine or surroundings
  • Restricted interests
  • Difficulty understanding other people’s feelings
  • Delayed language development
  • Persistent repetition of words or phrases (echolalia)
  • Repetitive behaviors (flapping, rocking, spinning, etc.)

Causes of Autism:

Most scientists have believed that it has caused mostly by genetic factors. There is reason that genes play a major role in the development of autism and it has been found that identical twins are more likely to both be affected than twins who are fraternal (not genetically identical).

When a pregnant woman is in habituated intake of drugs or chemicals, her child is more likely to be autistic. Research suggests that it may arise due to the abnormalities in parts of the brain that interpret sensory input and process language.

Autistic behavior is caused by:

  • Tuberous sclerosis
  • Encephalitis
  • Rubella (German measles) in the pregnant mother
  • Untreated phenylketonuria (PKU)
  • Fragile X syndrome

Some of the potential causes of autism are environmental toxins, pesticides and heavy metals such as mercury. Heavy metals are certainly more commonly observed in the environment now than they were in the past.

Treatment for Autism:

There are no “cures” for autism, but therapies and other treatment can feel them to be better from their symptoms

Many treatment approaches involve therapies such as:

  • speech therapy
  • behavioral therapy
  • physical therapy
  • occupational therapy
  • play therapy

Diet to be focused:

An autism diet may instead focus on whole foods, such as:

  • fresh fruits and vegetables
  • fish
  • lots of water
  • unsaturated fats
  • lean poultry

Some studies have suggested that diet can help to improve symptoms of attention-deficit hyperactivity disorder (ADHD), a condition like autism.

 Join the talk on Autism with our child Neurologist, child Psychiatrist, a pediatrician at 28th World Neonatal, Pediatric and Family Medicine Conference.

CONGENITAL ZIKA VIRUS INFECTION: Clinical Features, Evaluation, and Management of the Neonate

Zika virus is an arthropod-borne flavivirus transmitted by mosquitoes. Congenital Zika virus infection is associated with severe congenital anomalies. This topic will discuss issues related to newborns congenitally infected with Zika virus. Zika virus infection in pregnant women and other issues related to Zika virus infection, including epidemiology, travel advisories, and infection in older children and adults are reviewed separately.

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Zika virus is a neurotropic virus that particularly targets neural progenitor cells. Murine and human placental studies support the hypothesis that maternal infection leads to placental infection and injury, followed by transmission of the virus to the fetal brain, where it kills neuronal progenitor cells and disrupts neuronal proliferation, migration, and differentiation, which slows brain growth and reduces the viability of neural cells. Zika virus is also associated with a higher rate of fetal loss throughout pregnancy, including stillbirths. Placental insufficiency is the mechanism postulated to induce fetal loss later in pregnancy.

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A series from cases described histopathological findings in tissue from two new-borns with microcephaly and severe arthrogryposis who died shortly after birth and tissue from a microcephalic infant who died at age two months. In all cases, the mothers had symptoms consistent with Zika virus infection in the first trimester. The infants were born at 36, 38, and 38 weeks of gestation. Multiple congenital malformations were noted, including a wide range of brain abnormalities, craniofacial malformations, craniosynostosis, pulmonary hypoplasia, and multiple congenital contractures, consistent with fetal akinesia deformation sequence or severe arthrogryposis. In these cases, there was immunohistochemical and molecular evidence of virus persistence in the brain. The range of neuropathology included ventriculomegaly, lissencephaly (which commonly aligns with microcephaly), and cerebellar hypoplasia, all of which have been observed in other cases studied. Brains also showed evidence of tissue destruction, including calcifications, gliosis, and necrosis. The presence of necrosis suggests ongoing cellular injury, consistent with the demonstrated continued viral presence. Thus, the patterns of injury are likely to follow from both cellular injuries at the time of infection as well as subsequent damage as the brain develops. Evidence from cell culture systems places the neuronal precursor cell as a crucial target for Zika virus infection resulting in cell death. Loss of these cells early in development has been reported to substantially reduce the number of neurons generated and result in small brains without cortical gyration.

Neurodevelopmental outcomes of the tiniest babies

Care of preterm infants with extremely low birth weight (BW) and having intact survival is still a challenge for Neonatologists. In this issue, a study reported the survival rate and the outcome of preterm infants with a BW of ≤500 g in a single institute during a 10-year period. Their strategy regarding the timing of delivery of live or stillborn infants with a BW of ≤500 g is to deliver cases where continued pregnancy would compromise maternal health or where non-reassuring fetal status is identified.

The survival rate was 80% among live births, and the results of developmental assessments of 3-year-old children were 29% normal, 43% mild disability, and 29% severe disability.  All the tiniest babies were also the most immature ones, and they would die if they did not receive any resuscitation or life support after birth. The approach regarding the care of the most immature babies varies around the world.  In Japan, the limit of viability as defined in the law is 22 completed weeks of gestation. Preterm babies with a gestational age of ≥22 weeks will be resuscitated and admitted to the intensive care unit.  The differences in the approaches related to the most immature babies result in the variation in survival rates in different countries and regions.

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When counseling with parents, both survival rate and long-term neurodevelopmental outcomes are important for decision-making in the management of the most immature or the tiniest babies. A systematic review and meta-analysis focusing on neurodevelopmental outcomes of the most immature babies demonstrated that the most commonly observed neurodevelopmental disability is cognitive impairment, followed by cerebral palsy.  Vision and hearing deficits occur less frequently.  In Japan, the new Kyoto Scale of Psychological Development (KSPD) test was used for neurodevelopmental evaluation. A study reported that 43% (3/7) of survived patients had the mild neurodevelopmental disability. One patient was diagnosed with autism spectrum disorder with a normal DQ at the age of 3 years. In addition, 42% of the survived patients had either visual or hearing impairment. Hence, concerns remain regarding the neurodevelopmental outcomes of preterm infants with a BW of ≤500 g.

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Improving the survival rate of very tiny preterm infants and preventing the adverse neurodevelopmental outcomes are of utmost importance. One of the important therapies for the tiny preterm infants is the administration of antenatal corticosteroids (ANCS). Among the live births with a BW of ≤500 g, there was only one mother who received ANCS in the study. The administration of ANCS for an impending preterm delivery before 25 weeks of gestation is a controversial issue. A recent meta-analysis study showed reduced mortality and intraventricular hemorrhage (IVH) or periventricular leukomalacia in neonates born at <25 weeks and exposed to ANCS. There was no difference in the occurrence of stage II or more of necrotizing enterocolitis (NEC), and the incidence of chronic lung disease (CLD) was higher in the group that was administered ANCS. Composite outcomes of death or major morbidities (severe IVH, NEC, or CLD) were improved after exposure to ANCS. With the improvement of perinatal care, the survival rate of the most immature and the tiniest babies has increased. Further larger and additional long-term follow-up studies, as well as further research on the management of the tiniest babies, are needed to guide decision-making and to prevent major morbidities and disabilities.

Solar urticaria in infancy : Affects 2% of children who are exposed to the sun

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Solar urticaria is triggered by sun exposure resulting on exposed skin. Most cases are reported in the adult population. However, cases do occur in children. Solar urticaria in infancy has been rarely reported.

How common is sun allergy?

Solar urticaria is a rare allergy that occurs around the world. It can affect you at any age. It can even affect infants.

Solar urticaria is a rare photodermatosis characterized by pruritus, stinging, erythema, and wheal formation after a brief period of exposure to natural sunlight or an artificial light source emitting the appropriate wavelength. Photosensitivity disorders in children include a wide array of conditions, many of which are unique to this age group. A dermatologist’s consultation is essential in such cases for specific instructions and counselling of parents regarding photo protection in these children. This intervention may improve the quality of life by reducing the morbidity and chances of early mortality.

Treatment of solar Urticaria

  • Use of antihistamines and sun protection with appropriate clothing and sunscreen. A minority of patients would not respond to these measures.
  • Solar urticaria may present at the first year of life. Accurate diagnosis is crucial to avoid unnecessary testing and to manage patients appropriately. If diagnosed properly such patients can be adequately treated and continue to enjoy activities outside. Sometimes it will disappear on its own.2

    How can you help prevent solar urticaria flare-ups?

    There are some things you can do to prevent or reduce risk for solar urticaria:

    Limit sun exposure

    Consider phasing in during outdoor time

    Wearing closely woven clothes with maximum coverage

    Wearing clothing with UPF protection factor greater than 403

Intussusception in a Preterm New-born

Intussusception, the second most common abdominal emergency in childhood, is three times more common in men, and the peak age is before 2 years. The incidence in neonates is 0.3–1.3 per 6000 cases. Most of the cases were misdiagnosed as necrotizing enterocolitis (NEC), causing a delay in treatment. Diagnosis of intussusception requires high suspicion in premature infants. Clinical symptomatology alone is not reliable. These symptoms in premature neonates when constellate with abdominal distension are very suggestive of NEC, the most common acquired gastrointestinal emergency in the NICU.

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This leads to a delay in treatment of patients. Most of the reported cases were diagnosed preoperatively or at autopsy. The most crucial step during the neonatal period is the timing of surgery. As time passes, the probability of developing ischemia and necrosis increases. Premature neonates are at an increased risk of developing intestinal hypoperfusion causing intestinal stasis and dysmotility, which would be a reasonable explanation for intussusceptions and rapid deterioration. The case presented here differs from those reported in the literature is not only being diagnosed preoperatively, but it is also the earliest diagnosed and the only one in which the intussusception was manually reduced.

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Several patients were misdiagnosed with NEC, causing a delay in the operation. The abdominal plain film is not usually helpful in the diagnosis of neonatal intussusception. Although abdominal ultrasonography is the key modality in diagnosis, it has been mostly performed to exclude congenital anomalies, thus underutilizing its usefulness. The decision for performing an operation could be taken after a severe clinical deterioration of the patient or in the presence of free air in abdominal graphs. Rectal contrast enema should not be used, despite its usefulness for the diagnosis and treatment of intussusception, due to the vulnerability of the intestines to perforation. Prompt diagnosis and shorter operation time enabled faster improvement and shorter postoperative period in contrast to its counterparts in the literature in which resection of intestines was required.  Open surgery should be the treatment of choice due to the possibility of congenital anomalies. Late diagnosis might result in extended surgery, longer hospital stays, and death, mostly due to sepsis or perforation.

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NEC itself may lead to intussusception. The etiology of three patients in the literature has been reported as strictures due to NEC. However, most of the remaining were due to intestinal atresia, while some others were due to Meckel diverticula, duplication cysts, or hematomas. The patient presented here did not have any lead point. The subtle clinical and radiologic features of intussusception in premature neonates are difficult to distinguish from those of early NEC. The application of ultrasound is a feasible method in the early detection of intussusception, facilitating prompt surgical intervention and improving the outcome after surgery.