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Chakrabarti S, Singh P, Keepanasseril A, Mondal N. Growth Pattern of Preterm Neonates with Fetal Growth Restriction: A Prospective Cohort Study. Indian J Pediatr 2023:10.1007/s12098-023-04848-7. [PMID: 37747632 DOI: 10.1007/s12098-023-04848-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/16/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVES To compare the growth of preterm neonates with fetal growth restriction (FGR) and preterm neonates born appropriate-for-gestational-age (AGA) from birth to 12-18 mo of corrected age (CA). METHODS In this prospective cohort study, 85 preterm neonates with FGR and 85 gestation- and gender-matched AGA neonates were followed up from birth till 12-18 mo corrected age. Anthropometric indices were compared at specific time points and the risk factors for underweight status were analyzed. RESULTS Mean gestational age of the cohort was 32.8 ± 2.1 wk. Mean birth weight was 1414 ± 248 g in the FGR and 1806 ± 416 g in AGA neonates. At 12-18 mo of corrected age, a significantly greater proportion of FGR infants were wasted (24.3% vs. 7.2%, P = 0.005). A greater proportion of FGR infants were underweight (27% vs. 17.4%, P = 0.11), stunted (41.9% vs. 36.2%, P = 0.30), and microcephalic (27% vs. 23.1%, P = 0.36), although the differences were not statistically significant. Significant catch-up growth from 40 wk postmenstrual age (PMA) to 12-18 mo corrected age in weight (52.8% vs. 13.1%, P <0.001) and length (37.9% vs. 8.7%, P <0.001) was observed in the FGR neonates. The z-score of weight for age at 3 mo (adjusted OR 0.65, 95% CI: 0.52-0.8; P <0.001), the median time to full feeds (aOR: 1.10, 95% CI: 1.04-1.15; P = 0.001), and hypothyroidism (aOR 2.44, 95% CI: 1.46-4.08; P = 0.001), were independent predictors of underweight status at 12-18 mo. CONCLUSIONS At 12-18 mo of corrected age, a significantly greater proportion of preterm FGR neonates were wasted compared to AGA ones. The former also exhibited significantly greater catch-up growth than the latter.
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Affiliation(s)
- Sarthak Chakrabarti
- Department of Pediatrics, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
| | - Praachi Singh
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
| | - Anish Keepanasseril
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India
| | - Nivedita Mondal
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, 605006, India.
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Survival and Neurodevelopmental Outcome of Extremely-Low-Birth-Weight Infants at One Year of Age-A Prospective, Descriptive Study. Indian J Pediatr 2023; 90:233-239. [PMID: 35727530 DOI: 10.1007/s12098-022-04252-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/06/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To study the survival rates at discharge and neurodevelopmental outcome at 1 y of corrected age (CA) of extremely-low-birth-weight ELBW neonates. METHODS This prospective, descriptive study was conducted in a tertiary care level III extramural NICU of a teaching hospital. Forty-nine extremely-low-birth-weight (ELBW) neonates were enrolled in the study from July 2017 to June 2018. Baseline demographic data, morbidities during NICU stay, and survival at discharge for the enrolled neonates were recorded. The enrolled infants were followed up to 1 y of CA at three-monthly intervals. During the follow-up, anthropometry, developmental screening by Denver Developmental Screening Test (DDST), and tone assessment by Amiel-Tison scale were done. Developmental Assessment Scale for Indian Infants (DASII) was administered at CA of 12 mo. RESULTS Thirty-seven (75.5%) neonates survived to discharge. Survival rate of neonates with birth weight > 750 g and with gestational age ≥ 26 wk was 90.2% and 85.7%, respectively. Amongst those < 750 g or < 26 wk (n = 8), none survived. Abnormal developmental quotient (DQ < 70%) was seen in 6 infants out of 33 infants (18.1%) followed at 1 y of CA. CONCLUSION Overall, 3/4th of ELBW infants survived to discharge and 80% of those who were followed up at 1 y of CA had normal neurodevelopmental outcome. However, survival rates of neonates born at < 26 wk and/or with birth weight < 750 g were less and needs to be improved.
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Growth and Neurodevelopmental Outcomes of Very Low Birth Weight Infants From Southern India at Corrected Age of One Year. Indian Pediatr 2023. [DOI: 10.1007/s13312-023-2691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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4
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Short-term neurodevelopment and growth outcomes of very and moderate preterm Indian infants. J Perinatol 2022; 42:1489-1495. [PMID: 36184641 DOI: 10.1038/s41372-022-01519-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To study the growth and neurodevelopmental outcome of very and moderate preterm infants (VMPT) compared to term appropriate-for-age (term AGA) infants at 18-months corrected age. METHODS This prospective cohort study enrolled consecutively born 212 VMPT infants and 250 term AGA controls delivered during study period. OUTCOME MEASURES Major neurodevelopmental impairment (NDI) defined as any one of cerebral palsy, motor (MoDQ) or mental developmental quotient (MoDQ) <70 on Developmental Assessment Scale for Indian infants, visual or hearing impairment, or epilepsy, and growth outcomes. RESULTS Among 195 VMPT and 240 term AGA infants who completed follow-up, the frequency of major NDI was 12.8% and 2.5% respectively (RR 5.1; 95% CI [2.13-12.19]). Major NDI was higher among infants <28 weeks gestation (39%) and birthweight <1000 grams (27%). A quarter of VMPT infants exhibited wasting and 18% stunting than 7% each among controls. CONCLUSION VMPT infants had a higher frequency of major NDI and growth failure at 18-months.
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Tewari VV, Kumar A, Kurup A, Daryani H, Saxena A. Impact of Cerebral Oxygen Saturation Monitoring on Short-term Neurodevelopmental Outcomes in Neonates with Encephalopathy - A Prospective Cohort Study. Curr Pediatr Rev 2022; 18:301-317. [PMID: 35249496 DOI: 10.2174/1573396318666220304210653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/12/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Near-infrared spectroscopy (NIRS) has been used for monitoring cerebral oxygen saturation (rSO2) in neonates. There is a lack of data from low-middle income countries (LMIC) setting of cerebral rSO2 in neonates with encephalopathy of diverse etiologies. This study aimed to monitor cerebral rSO2 using NIRS in encephalopathic neonates to maintain the rSO2 between 55 to 85 % in the first 72 hours of admission to improve short-term neurodevelopmental outcomes (NDO). MATERIALS AND METHODS This prospective cohort study enrolled encephalopathic neonates with hypoxic- ischemic encephalopathy (HIE) and non-HIE etiologies into 8 clinical categories. The cerebral rSO2 was monitored and targeted to be between 55 to 85 %, with predefined actions and management alterations over 72 hours. The neurodevelopmental assessment was conducted at 3, 6, and 9-12 months corrected age. Moreover, the motor and mental developmental quotients (MoDQ) (MeDQ) were recorded and compared to historical control. RESULTS A total of 120 neonates were enrolled and assessed for NDO. The MoDQ (mean ± SD) was 92.55 ± 14.85, 93.80 ± 13.20, 91.02 ± 12.69 and MeDQ (mean ± SD) was 91.80 ± 12.98, 91.80 ± 13.69, 88.41 ± 11.60 at 3, 6 and 9-12 months. The MoDQ and MeDQ scores of the historic cohort at 12 months were 86.35 ± 20.34 and 86.58 ± 18.27. The mean difference [MD (95 %CI)] for MoDQ was - 4.670 (- 8.48 to - 0.85) (p=0.0165) and for MeDQ was - 1.83 (- 5.26 to 1.6) (p=0.29). There was a negative correlation between the composite developmental quotient (CoDQ) with mean rSO2 and a positive correlation with cerebral fractional tissue oxygen extraction (CFTOE). Neonates with HIE and neonatal encephalopathy (NE) (n=37/120) had the lowest motor and mental DQ on neurodevelopmental assessment. Clinical categories, neonatal meningitis (NM), and intraventricular hemorrhage (IVH) improved in DQ scores over the study period. CONCLUSION Monitoring and maintaining cerebral rSO2 between 55-85 % through appropriate management changes improved neurodevelopmental scores at the 12-month follow-up in neonates with encephalopathy caused by varied etiologies.
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Affiliation(s)
- Vishal Vishnu Tewari
- Department of Pediatrics, Command Hospital and Armed Forces Medical College, Pune, India
| | - Ashutosh Kumar
- Department of Pediatrics, Command Hospital, Lucknow, India
| | - Arjun Kurup
- Department of Pediatrics, Armed Forces Medical College, Pune, India
| | | | - Apoorv Saxena
- Department of Pediatrics, Armed Forces Medical College, Pune, India
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Chinnappan A, Sharma A, Agarwal R, Thukral A, Deorari A, Sankar MJ. Fortification of Breast Milk With Preterm Formula Powder vs Human Milk Fortifier in Preterm Neonates: A Randomized Noninferiority Trial. JAMA Pediatr 2021; 175:790-796. [PMID: 33970187 PMCID: PMC8111561 DOI: 10.1001/jamapediatrics.2021.0678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Fortification of expressed breast milk (EBM) using commercially available human milk fortifiers (HMF) increases short-term weight and length in preterm very low-birth-weight (VLBW) neonates. However, the high cost and increased risk of feed intolerance limit their widespread use. Preterm formula powder fortification (PTF) might be a better alternative in resource-limited settings. OBJECTIVE To demonstrate that fortification of EBM by preterm formula powder is noninferior to fortification by HMF, in terms of short-term weight gain, in VLBW neonates. DESIGN, SETTING, AND PARTICIPANTS Open-label, noninferiority, randomized trial conducted from December 2017 to June 2019 at a level 3 neonatal unit in India. The trial enrolled preterm (born at or before 34 weeks of gestation) VLBW neonates receiving at least 100 mL/kg/d of feeds and consuming 75% of milk or more as EBM. INTERVENTIONS Neonates were randomly assigned to receive fortification by either PTF or HMF. Calcium, phosphorus, iron, vitamin D, and multivitamins were supplemented in PTF and only vitamin D in the HMF group to meet the recommended dietary allowances. MAIN OUTCOMES AND MEASURES The primary outcome was the weight gain until discharge from the hospital or 40 weeks' postmenstrual age, whichever was earlier; the prespecified noninferiority margin was 2 g/kg/d. Secondary outcomes included morbidities such as necrotizing enterocolitis, feed intolerance, and extrauterine growth restriction (<10th percentile on the Fenton chart at 40 weeks' postmenstrual age). RESULTS Of the 123 neonates enrolled, 60 and 63 were randomized to the PTF and HMF groups, respectively. The mean gestation (30.5 vs 29.9 weeks) and birth weight (1161 vs 1119 g) were comparable between the groups. There was no difference in the mean (SD) weight gain between the PTF and HMF groups (15.7 [3.9] vs 16.3 [4.0] g/kg/d; mean difference, -0.5 g/kg/d; 95% CI, -1.9 to 0.7). The lower bound of 95% CI did not cross the noninferiority margin. The incidence of feed intolerance was lower in the PTF group (1.4 vs 6.8 per 1000 patient-days; incidence rate ratio 0.19; 95% CI, 0.04 to 0.95), and fewer neonates required withholding of fortification for 24 hours or more (5% vs 22%; risk ratio, 0.22; 95% CI, 0.07 to 0.75). The incidence of necrotizing enterocolitis stage II or more (0 vs 5%) and extrauterine growth restriction (73% vs 81%) was comparable between the groups. CONCLUSIONS AND RELEVANCE Fortification with preterm formula powder is not inferior to fortification with human milk fortifiers in preterm neonates. Given the possible reduction in feed intolerance and lower costs, preterm formula might be a better option for fortification, especially in resource-restricted settings. TRIAL REGISTRATION Clinical Trial Registry, India Identifier: CTRI/2017/11/010593.
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Affiliation(s)
- Arunambika Chinnappan
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Akash Sharma
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - M. Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Strobel KM, Romero T, Kramer K, Fernandez E, Rottkamp C, Uy C, Keller R, Moyer L, Poulain F, Kim JH, DeUgarte DA, Calkins KL. Growth Failure Prevalence in Neonates with Gastroschisis : A Statewide Cohort Study. J Pediatr 2021; 233:112-118.e3. [PMID: 33647253 PMCID: PMC8154735 DOI: 10.1016/j.jpeds.2021.02.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To perform a multicenter study to assess growth failure in hospitalized infants with gastroschisis. STUDY DESIGN This study included neonates with gastroschisis within sites in the University of California Fetal Consortium. The study's primary outcome was growth failure at hospital discharge, defined as a weight or length z score decrease >0.8 from birth. Regression analysis was performed to assess changes in z scores over time. RESULTS Among 125 infants with gastroschisis, the median gestational age was 37 weeks (IQR 35-37). Length of stay was 32 days (23-60); 55% developed weight or length growth failure at discharge (28% had weight growth failure, 42% had length growth failure, and 15% had both weight and length growth failure). Weight and length z scores at 14 days, 30 days, and discharge were less than birth (P < .01 for all). Weight and length z scores declined from birth to 30 days (-0.10 and -0.11 z score units/week, respectively, P < .001). Length growth failure at discharge was associated with weight and length z score changes over time (P < .05 for both). Lower gestational age was associated with weight growth failure (OR 0.70 for each gestational age week, 95% CI 0.55-0.89, P = .004). CONCLUSIONS Growth failure, in particular linear growth failure, is common in infants with gastroschisis. These data suggest the need to improve nutritional management in these infants.
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Affiliation(s)
- Katie M Strobel
- Division of Neonatology and Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA.
| | - Tahmineh Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine Statistics Core, University of California Los Angeles, Los Angeles, CA
| | - Katelin Kramer
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Erika Fernandez
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Catherine Rottkamp
- Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, CA
| | - Cherry Uy
- Division of Neonatal/Perinatal Medicine, Department of Pediatrics, University of California Irvine, Irvine, CA
| | - Roberta Keller
- Division of Neonatology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Laurel Moyer
- Division of Neonatology, Rady Children's Hospital, San Diego, CA
| | - Francis Poulain
- Division of Neonatology, Department of Pediatrics, University of California Davis, Davis, CA
| | - Jae H Kim
- Division of Neonatology, Department of Pediatrics, University of California San Diego, San Diego, CA
| | - Daniel A DeUgarte
- Division of Pediatric Surgery, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Kara L Calkins
- Division of Neonatology and Developmental Biology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA
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Risk factors for postdischarge growth retardation among very-low-birth-weight infants: A nationwide registry study in Taiwan. Pediatr Neonatol 2019; 60:641-647. [PMID: 30982695 DOI: 10.1016/j.pedneo.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Very-low-birth-weight (VLBW) infants have a high risk of postdischarge growth retardation (GR). Continued GR might exert negative long-term effects on their health. This study examined the prevalence and the risk factors for postdischarge GR among VLBW infants in Taiwan. METHODS Nationwide data from the Taiwan Premature Infant Follow-up Network between 2007 and 2011 were analyzed. Infants with a gestational age (GA) < 37 weeks and birth body weight (BBW) < 1500 g were enrolled. They were followed up after discharge at the corrected ages of 6, 12, and 24 months. Associations between postdischarge GR at the follow-ups and possible risk factors were analyzed. RESULTS The prevalence of postdischarge GR among 2124 VLBW infants was 17.3%, 19.4%, and 13.8% at the corrected age (CA) of 6, 12, and 24 months, respectively. The significant perinatal factors of postdischarge GR were being small for gestational age (SGA) and extremely low birth weight (ELBW). ELBW infant with extra-uterine growth retardation (EUGR) at discharge or longer length of hospital stay (LOS) had poorer growth outcomes. Among non-ELBW infants, EUGR at discharge and surgical necrotizing enterocolitis (NEC) were the main influencing factors of unfavorable growth outcomes. RDS with surfactant therapy had a positive effect of postdischarge growth outcomes in ELBW infants. CONCLUSION Postdischarge GR is still a serious problem in Taiwan. Being SGA and ELBW and EUGR were significant risk factors for postdischarge GR throughout the first two years of life in VLBW infants. An integrated and organized team for postdischarge care as well as scheduled follow-ups, detailed nutritional education, and thorough inspection are necessary.
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Oommen SP, Santhanam S, John H, Roshan R, Swathi TO, Padankatti C, Grace H, Beulah R, Jana AK, Kumar M, Thomas N, Yadav B. Neurodevelopmental Outcomes of Very Low Birth Weight Infants at 18-24 Months, Corrected Gestational Age in a Tertiary Health Centre: A Prospective Cohort Study. J Trop Pediatr 2019; 65:552-560. [PMID: 30793756 DOI: 10.1093/tropej/fmz006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine the prevalence and risk factors for poor neurodevelopmental outcome in a cohort of very low birth weight (VLBW) infants. SUBJECTS AND METHODS Four hundred and twenty-two infants of a total of 643 VLBW survivors from a teaching hospital in South India were followed up to assess their neurodevelopmental outcomes. RESULTS Among the 422 children who completed the assessment, results of 359 children whose assessments were done between 18 and 24 months were analysed. Thirty-seven children (10.31%) had poor neurodevelopmental outcome, six children [1.67%] had cerebral palsy, one child had visual impairment and another had hearing impairment. Poor post-natal growth was independently associated with poor neurodevelopmental outcomes in the multivariate analysis (p = 0.045). Neonatal complications were not associated with the developmental outcome. CONCLUSION Despite lower rates of neonatal complications compared with Western cohorts, significant proportion of VLBW infants had poor neurodevelopmental outcomes. Poor post-natal growth was an important determinant of the developmental outcome.
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Affiliation(s)
- Samuel P Oommen
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sridhar Santhanam
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hima John
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reeba Roshan
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - T O Swathi
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Caroline Padankatti
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Hannah Grace
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Rachel Beulah
- Developmental Pediatrics Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Atanu Kumar Jana
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manish Kumar
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Niranjan Thomas
- Department of Neonatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Bijesh Yadav
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India
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Kurniawati, Rustina Y, Budiati T. Peer Support Increases Maternal Confidence, Kangaroo Mother Care Implementation and Weight Gain in LBW Infants. Compr Child Adolesc Nurs 2019; 42:252-260. [PMID: 31192719 DOI: 10.1080/24694193.2019.1594457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kurniawati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Yeni Rustina
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
| | - Tri Budiati
- Faculty of Nursing, Universitas Indonesia, Depok, West Java, Indonesia
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Meyers JM, Tan S, Bell EF, Duncan AF, Guillet R, Stoll BJ, Angio CTD. Neurodevelopmental outcomes among extremely premature infants with linear growth restriction. J Perinatol 2019; 39:193-202. [PMID: 30353080 PMCID: PMC6351156 DOI: 10.1038/s41372-018-0259-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 08/29/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes in linear growth-restricted (LGR) infants born <29 weeks with and without weight gain out of proportion to linear growth. STUDY DESIGN We compared 2-year neurodevelopmental outcomes between infants with and without LGR and between LGR infants with and without weight gain out of proportion to linear growth. The outcomes were Bayley-III cognitive, motor, and language scores, cerebral palsy, Gross Motor Function Classification System (GMFCS) level ≥ 2, and neurodevelopmental impairment. RESULT In total, 1227 infants were analyzed. LGR infants were smaller and less mature at birth, had higher BMI, and had lower Bayley-III language scores (82.3 vs. 85.0, p < 0.05). Among infants with LGR, infants with high BMI had lower language scores compared with those with low-to-normal BMI (80.8 vs. 83.3, p < 0.05), and were more likely to have GMFCS level ≥2 and neurodevelopmental impairment. CONCLUSION Among infants with LGR, weight gain out of proportion to linear growth was associated with poorer neurodevelopmental outcomes.
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Affiliation(s)
- JM Meyers
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - S Tan
- Statistics and Epidemiology Unit, RTI International, Research Triangle Park, NC, USA
| | - EF Bell
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - AF Duncan
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA
| | - R Guillet
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - BJ Stoll
- Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA,Emory University School of Medicine, Department of Pediatrics, Children’s Healthcare of Atlanta, Atlanta, GA, USA
| | - CT D Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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12
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Upadhyay RP, Naik G, Choudhary TS, Chowdhury R, Taneja S, Bhandari N, Martines JC, Bahl R, Bhan MK. Cognitive and motor outcomes in children born low birth weight: a systematic review and meta-analysis of studies from South Asia. BMC Pediatr 2019; 19:35. [PMID: 30696415 PMCID: PMC6350290 DOI: 10.1186/s12887-019-1408-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/17/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND South Asia contributes substantially to global low birth weight population (i.e. those with birth weight < 2500 g). Synthesized evidence is lacking on magnitude of cognitive and motor deficits in low birth weight (LBW) children compared to those with normal birth weight (NBW) (i.e. birth weight ≥ 2500 g). The meta-analysis aimed to generate this essential evidence. METHODS Literature search was performed using PubMed and Google Scholar. Original research articles from south Asia that compared cognitive and/or motor scores among LBW and NBW individuals were included. Weighted mean differences (WMD) and pooled relative risks (RR) were calculated. All analyses were done using STATA 14 software. RESULTS Nineteen articles (n = 5999) were included in the analysis. Children < 10 years of age born LBW had lower cognitive (WMD -4.56; 95% CI: -6.38, - 2.74) and motor scores (WMD -4.16; 95% CI: -5.42, - 2.89) compared to children with NBW. Within LBW children, those with birth weight < 2000 g had much lower cognitive (WMD -7.23, 95% CI; - 9.20, - 5.26) and motor scores (WMD -6.45, 95% CI; - 9.64, - 3.27). CONCLUSIONS In south Asia, children born LBW, especially with < 2000 g birth weight, have substantial cognitive and motor impairment compared to children with NBW. Early child development interventions should lay emphasis to children born LBW.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
| | - Gitismita Naik
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Jose Carlos Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Maharaj Kishan Bhan
- Indian Institute of Technology (IIT), New Delhi, India.,Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
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Growth and Neurodevelopmental Outcome in Preterm LBW Infants with Sepsis in India: A Prospective Cohort. Int J Pediatr 2018; 2018:5735632. [PMID: 29681952 PMCID: PMC5841091 DOI: 10.1155/2018/5735632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 11/30/2017] [Accepted: 12/25/2017] [Indexed: 11/17/2022] Open
Abstract
Objective Neonatal sepsis is associated with abnormal neurodevelopmental outcomes but not with poor growth at 9 to 15 months of corrected age in LBW infants. Design Setting and Participants This is a prospective cohort study involving 128 eligible preterm low-birth-weight (LBW) infants admitted during the period of 2013-2014 to the Durgabai Deshmukh Hospital and Research Center. All patients were followed up in the outpatient Department of Pediatrics. They were divided into the sepsis and nonsepsis group. Results A total of 94 infants were evaluated (40 in sepsis and 54 in nonsepsis group). At the age of 9-15 months, low-birth-weight infants with neonatal sepsis had an increased risk of neurodevelopmental disorders (67.5 versus 20.3%; RR: 3.31 (1.87-5.85)). There is no statistically significant difference in the growth outcomes. Conclusion Neonatal infections are associated with the abnormal neurodevelopmental outcomes in LBW infants but there was no significant difference at growth outcome at 9 to 15 months of corrected age between both groups.
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Banupriya N, Bhat BV, Benet BD, Catherine C, Sridhar MG, Parija SC. Short Term Oral Zinc Supplementation among Babies with Neonatal Sepsis for Reducing Mortality and Improving Outcome - A Double-Blind Randomized Controlled Trial. Indian J Pediatr 2018; 85:5-9. [PMID: 28891027 DOI: 10.1007/s12098-017-2444-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 07/31/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the efficacy of short term zinc supplementation on the mortality rate and neurodevelopment outcome in neonates with sepsis at 12 mo corrected age. METHODS The clinical trial was undertaken in the neonatal intensive care unit of JIPMER during the time period from September 2013 through December 2016. Neonates with clinical manifestations of sepsis who exhibited two positive screening tests (microESR, C- reactive protein, band cell count) were included and randomized into no zinc and zinc group. The intervention was zinc sulfate monohydrate given at a dose of 3 mg/kg twice a day orally for 10 d along with standard antibiotics. The no zinc group was on antibiotic treatment. Blood samples from both groups were collected at baseline and after day 10. Babies were carefully discharged from the hospital. The babies were followed up till 12 mo corrected age using DASII (Development Assessment Scale for Indian Infants). RESULTS At the time of enrolment, patient characteristics were similar in both the groups. The mortality rate was significantly higher in no zinc compared to zinc group (5 vs. 13; P = 0.04). Although motor development quotient was similar, mental development quotient was significantly better among babies who received zinc supplementation. CONCLUSIONS Short term zinc supplementation of newborns with sepsis reduces mortality and improves mental development quotient at 12 mo of age.
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Affiliation(s)
- Newton Banupriya
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India
| | - Ballambattu Vishnu Bhat
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India.
| | - Bosco Dhas Benet
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India
| | - Christina Catherine
- Department of Neonatology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, 605006, India
| | - Magadi Gopalakrishna Sridhar
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
| | - Subhash Chandra Parija
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Pondicherry, India
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Ballot DE, Ramdin T, Rakotsoane D, Agaba F, Chirwa T, Davies VA, Cooper PA. Assessment of developmental outcome in very low birth weight infants in Southern Africa using the Bayley Scales of Infant Development (III). BMJ Paediatr Open 2017; 1:e000091. [PMID: 29637126 PMCID: PMC5862217 DOI: 10.1136/bmjpo-2017-000091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES The study aimed to compare the developmental outcome of very low birth weight infants with a group of normal-term controls in a tertiary hospital in sub-Saharan Africa. DESIGN A group of 105 very low birth weight infants were assessed at a mean age of 17.6 months (95% CI 16.7 to 18.6) using the Bayley Scales of Infant Development, Third Edition, and compared with a group of normal-term controls at the same mean age. RESULTS Seven of the study infants (7%) had developmental delay (a score below 70), compared with none in the control group (p=0.04). Three of the seven study infants were delayed on all three subscales, one of whom had cerebral palsy. A further 34% of the study infants were 'at risk' of developmental delay (a score below 85). There was no difference in the mean composite score between the study group and controls for the cognitive (p=0.56), motor (p=0.57) or language (p=0.66) subscales. There was no difference in mean composite scores on all subscales between infants who were appropriate for gestational age and those who were small for gestational age. Cognitive and motor scores remained stable in paired assessments of study infants before and after 1 year of age; language scores decreased significantly (p<0.001). Mechanical ventilation was the only risk factor significantly associated with a cognitive score below 85 in study infants. CONCLUSION Very low birth weight infants in sub-Saharan Africa are at risk of developmental delay and require long-term neurodevelopmental follow-up.
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Affiliation(s)
- Daynia Elizabeth Ballot
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanusha Ramdin
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - David Rakotsoane
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Faustine Agaba
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Victor Alan Davies
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Alan Cooper
- Division of Neonatology, Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
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Meyers JM, Bann CM, Stoll BJ, D’Angio CT, Bell EF, Duncan AF, Guillet R. Neurodevelopmental outcomes in postnatal growth-restricted preterm infants with postnatal head-sparing. J Perinatol 2016; 36:1116-1121. [PMID: 27629374 PMCID: PMC5130598 DOI: 10.1038/jp.2016.154] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/02/2016] [Accepted: 08/18/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare neurodevelopmental outcomes in postnatal growth-restricted infants born <29 weeks with and without postnatal head-sparing (PHS). STUDY DESIGN We analyzed developmental outcomes at 2 years of age among postnatally growth-restricted infants with and without head-sparing. The primary outcome was Bayley III cognitive composite score; secondary outcomes included Bayley III motor composite score, moderate/severe cerebral palsy, gross motor functional classification scale level⩾2, and presence or absence of neurodevelopmental impairment (NDI). RESULTS Of 1098 infants evaluated at 18 to 22 months, 658 were postnatally growth restricted, of whom 301 had head-sparing. In the multivariate model including independent risk factors for poor growth and poor developmental outcome, infants with head-sparing had higher adjusted motor composite scores (mean difference 4.65, P<0.01), but no differences in other neurodevelopmental outcomes. CONCLUSION PHS is associated with improved neurodevelopmental outcome in extremely preterm infants, specifically Bayley III motor scores, but whether beneficial effects of PHS persist later in life is unknown.
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Affiliation(s)
- Jeffrey M. Meyers
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
| | - Carla M. Bann
- Social, Statistical and Environmental Sciences Unit, RTI International
| | - Barbara J. Stoll
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta
| | - Carl T. D’Angio
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
| | | | - Andrea F. Duncan
- Department of Pediatrics, University of Texas Medical School at Houston
| | - Ronnie Guillet
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry
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Prediction of Neurodevelopmental Outcome of Preterm Babies Using Risk Stratification Score. Indian J Pediatr 2016; 83:640-4. [PMID: 26916889 DOI: 10.1007/s12098-016-2050-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To study the incidence of major neurodevelopmental disability (NDD) at 1 y age (corrected for prematurity) in a cohort of preterm Indian babies (≤33 wk) and to predict NDD based on perinatal risk factors. METHODS This prospective cohort study was conducted at a referral neonatal intensive care unit (NICU) with a developmental follow up clinic in private sector in Kerala, India. The study was conducted for 4.5 y - January 2005 to July 2009. All preterm babies ≤33 wk at birth, discharged from the NICU were included. Pre-defined perinatal and neonatal risk factors known to affect neurodevelopmental outcome were recorded prospectively, in a structured form. Babies were followed to 1 y of age, corrected for prematurity and classified as normal or as having major neurodevelopmental disability (NDD). Major NDD was defined as cerebral palsy or Development Assessment Scale for Indian Infants (DASII) motor /mental score <70 or blindness in one or both eyes or hearing impairment needing hearing aids. RESULTS The incidence of major NDD at 1 y age (corrected for prematurity) among the 225 preterm babies was 6.2 %. A clinical score was devised by combining 5 risk factors, gestation ≤28 wk, need for extensive resuscitation at birth, symptomatic hypoglycemia, invasive ventilation for >7 d and abnormal neurosonogram. Scores of 1 to 5 were associated with 4, 6, 10, 25, 100 % risk of major NDD respectively (p < 0.01). The authors could stratify 87.5 % of the babies into low risk (score of 1 or 2) for NDD and 12.5 % into high risk (score 3 or 4 or 5) for major NDD. CONCLUSIONS Majority of the preterm babies at lower risk of NDD need less intensive follow up, while those at higher risk (12.5 %) should be guided to more frequent structured follow up and early intervention program.
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Kiy AM, Rugolo LM, Luca AKD, Corrente JE. Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Growth of preterm low birth weight infants until 24 months corrected age: effect of maternal hypertension. J Pediatr (Rio J) 2015; 91:256-62. [PMID: 25431856 DOI: 10.1016/j.jped.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the growth pattern of low birth weight preterm infants born to hypertensive mothers, the occurrence of growth disorders, and risk factors for inadequate growth at 24 months of corrected age (CA). METHODS Cohort study of preterm low birth weight infants followed until 24 months CA, in a university hospital between January 2009 and December 2010. INCLUSION CRITERIA gestational age < 37 weeks and birth weight of 1,500-2,499 g. EXCLUSION CRITERIA multiple pregnancies, major congenital anomalies, and loss to follow up in the 2nd year of life. The following were evaluated: weight, length, and BMI. OUTCOMES growth failure and risk of overweight at 0, 12, and 24 months CA. Student's t-test, Repeated measures ANOVA (RM-ANOVA), and multiple logistic regression were used. RESULTS A total of 80 preterm low birth weight infants born to hypertensive mothers and 101 born to normotensive mothers were studied. There was a higher risk of overweight in children of hypertensive mothers at 24 months; however, maternal hypertension was not a risk factor for inadequate growth. Logistic regression showed that being born small for gestational age and inadequate growth in the first 12 months of life were associated with poorer growth at 24 months. CONCLUSION Preterm low birth weight born infants to hypertensive mothers have an increased risk of overweight at 24 months CA. Being born small for gestational age and inadequate growth in the 1st year of life are risk factors for growth disorders at 24 months CA.
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Mukhopadhyay K, Louis D, Mahajan G, Mahajan R. Longitudinal growth and post-discharge mortality and morbidity among extremely low birth weight neonates. Indian Pediatr 2014; 51:723-6. [DOI: 10.1007/s13312-014-0489-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Mukhopadhyay K, Balachandran B. Universal newborn screening - is it going to be a reality in India? Indian Pediatr 2014; 51:697-8. [PMID: 25228598 DOI: 10.1007/s13312-014-0484-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Arora R, Consul M, Saluja S, Modi M, Sanklecha M, Sundaresan S, Balasubramanian S, Ghosh JB, Hung PL. Correspondence. Indian Pediatr 2013. [DOI: 10.1007/s13312-013-0287-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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