Revista de neurología y medicina pediátrica

Vitamin B12 deficiency has been associated with neurodevelopmental disorders in infants. Role of maternal and infant diet and other epidemiological features have not been reported from India.

Objective: To compute the prevalence of vitamin B12 deficiency in hospitalized children 2 months to 2 years of age and compare demographic, clinical, dietary and developmental status between those found deficient and sufficient.

Methods: The first 3 children aged 2 months to 2 years hospitalized to the Pediatric Medicine wards of King George’s Medical University Hospital, Lucknow on a predecided weekday were enrolled for study and subjected to a proforma driven work up. Those with history of vitamin supplements were excluded. Vitamin B12 and folate levels were measured by chemiluminiscence method. Vitamin B12 cut off value below 200 pg/ml and folic acid cut off value of <3 ng/ml were considered deficient. Neurodevelopmental status was assessed by Vineland Social Maturity Scale. Demographic data, dietary history of mother and child, anthropometry, clinical features and neurodevelopmental status were compared between the 2 groups.

Results: A total of 91 children [mean age 9.64+/- 4.42 months; 57.1% male] were enrolled, of which 17 [18.7%; 95% CI 11.3-28.2] were vitamin B12 deficient. No child was folic acid deficient. Vitamin B12 deficient children were significantly more likely to belong to lower socioeconomic status, be exclusively breast fed infants of vegetarian mothers with higher mean corpuscular volume and mean corpuscular hemoglobin concentration but lower mean platelet count. They also had higher odds of having a developmental quotient [DQ]<70 [OR=7.8; 95% CI 2.4-24.8; p=0.000] and significantly lower mean DQ [p=0.018].

Conclusion: Clear association of vitamin B12 deficiency with maternal and infant diet and impaired neurodevelopmental status was found which has important implications for millions of children in this country.

Growth of post taumatic intradiploic leptomeningeal cyst following head trauma is one of the rare complications of skull fractures seen mainly in infancy and toddlers. It is characterized by progressive diastatic enlargement of the fracture line with progressively increasing pulsatile cystic mass filled with cerebrospinal fluid in diploic space. Herein, we report a case of 2 year old boy presented with huge soft, non-tender pulsatile growing mass on the frontal aspect 9 months after sustaining head injury. CT imaging delineated it as a post traumatic intradiploic leptomeningeal cyst in frontal bone secondary to superior sagittal suture diastasis. Cyst was meticulously excised from superior sagittal sinus followed by durocranioplasty.

Aim: This study’s purpose is to determine what themes patients with Cerebral Palsy (CP) rate most highly for importance in their quality of life. Additionally, we aim to determine and compare the parent’s perception of quality of life measures for their child with CP.

Methods: Thirty one patients with CP and their guardians were administered a 50 item questionnaire.

Results: When comparing the quality of life ratings of patients with CP to parents, five measures were statistically significant. Patients thought that playing video games (p=0.039), using the TV (p=0.004) and how their physical disability affects their appearance in comparison to their peers (p=0.018) were more important than their parents did. Parents thought their child’s future financial independence (p=0.017) and access to healthcare (p=0.008) were more important than their adolescent children did.

Interpretation: Parents can accurately predict a few of the quality of life measures important to their child such as eating and drinking independently and going to school. However, disparities exist in many psycho-social domains. A better understanding of the importance of quality of life themes for patients with CP is important because it helps to direct care that can both take advantage of and improve what our patients feel is most important.

Background: Unlike Western countries, Africa is marked by a very high infant-juvenile mortality rate. The main causes of these deaths were previously infectious diseases and malnutrition. The early 21st century is marked by an epidemiological transition, highlighting non-communicable diseases amongst which children’s heart diseases. This raises another problem: the management of patients, including surgical treatment. We publish here the experience of our center showing the difficulties of surgical management.

Method: A retrospective and descriptive study was carried out on children younger than 16, diagnosed with cardiac condition between January 1st 2006 to June 30th 2015, at the Mother and Child Centre of the Chantal Biya Foundation in Yaounde. We collected data on socio-demographic background, the types of heart disease, clinical and therapeutical characteristics from registers, patient’s files as well as the electronic database of echocardiographic records.

Results: Out of 17280 patients consulting in our cardiac unit during the study period, 1761 (%) were diagnosed of cardiopathies. Patients were generally from poor settings. Congenital cardiopathies (cardiac diseases) concerned 1315 (74.7%) patients with ventricular septal defect as the main type, 439 (24.9%) patients suffered from acquired cardiopathies, rheumatic valvulopathies been the main figure. Both congenital and acquired cardiopathies were associated in 7 (0.4%) children. An indication for surgery was given in 1019 patients. Only 72 (7.1%) could effectively benefit from surgery. The procedure took place abroad for 46 (63.9%) patients and locally for the 26 (36.1%) others. 2/3 (76%) of management fees were paid by occidental nongovernmental organisations, 21% by families, 3% by insurances and no case by the government.

Conclusion: The treatment, especially surgery in heart diseases of children is a challenge in Africa’s poverty context. However, better organization of the health financing system could help to find a partial solution.

Background: Informed consent is an ethical practice that should be guaranteed before a child is involved in a research. The position of the child in research has also become a subject of debate with regards to ethics. Though many countries may have unique provisions for conducting research with children, it is the goal of every regulatory mechanism to guarantee the autonomy, rights and protection of children in research.

Discussion: The form in which the information about a research is presented to a child can either weaken or strengthen the capacity of child to provide informed consent. The Medical Research Council suggests that many children would be competent to give consent if the information about the study is provided in an appropriate form and they are helped through the process of decision-making.

It is ethically unacceptable to exclude children with cognitive challenges or learning disabilities from research based on their condition. Any research with children should be designed to integrate children with these forms of condition, except it is vital to exclude them.

Even when the capacity of a child to provide informed consent is apparent, it is good ethical practice to involve the parents of the child in the decision making process especially for a research that carries any form of risk or discomfort. Notwithstanding this position, researchers always face challenges with obtaining active parental consent. Parental consent waiver is one of the options for dealing with the challenges associated with obtaining active parental consent. Most times parental waiver is a decision reached at recruitment points where a child with capacity to give informed consent insists that his or her parents should not be informed if he or she would participate in the research.

Summary: It is now clear that researchers must seek to position a child as one who can make informed choices. These emerging perspectives should support the selection of design, methodology and intervention for children with a goal to strengthen their capacity and autonomy to give informed consent.

Congenital diaphragmatic hernia (CDH) is characterized by the absence of all or part of a diaphragmatic dome. It represents 8% of all congenital malformations, with an incidence of 1 in 2500 births in the United States. While many cases are discovered prenatally or during the immediate postnatal period, 5 to 25% of CDH can be late diagnosed. It is associated with varying degrees of pulmonary and pulmonary arterial hypertension leading to a significant cause of morbidity and mortality. CDH has been rarely reported in Africa and never in Cameroon where there is a profound lack of appropriate infrastructures to help manage these children. We are reporting the case of 24 days newborn presenting with severe respiratory distress and hemodynamic compromise diagnosed with a left diaphragmatic hernia with subsequent emergent surgical repair.