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BackgroundThe Nurturing Care Framework (NCF) is a comprehensive approach that enhances early childhood development (ECD). Due to the paucity of personnel skilled in nurturing care for ECD (NC-ECD), Indian Academy of Pediatrics (IAP) developed IAP-NURTURE (NC-ECD) aimed at training paediatricians to incorporate nurturing care into office practice. A systems approach was employed: needs assessment; development of resources and training strategy; implementation of 200 workshops across India (2022–2024), and; impact evaluation. The study objectives were to (a) document the context of IAP NURTURE (NC-ECD); (b) assess trainee capacity enhancement and (c) identify challenges and suggestions for improvement.MethodsA triphasic mixed-methods study was conducted based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation- Maintenance) framework. The study population included organisers, trainers and trainees, recruited by purposive sampling. Phase 1 (qualitative) used key informant interviews (KIIs) of organisers to understand context. Phase 2 focused on participants’ training. In the quantitative component, workshop documents and online survey findings were reviewed. The qualitative component included in-depth interviews (IDIs) of trainees. Phase 3 (qualitative) employed focused group discussions (FGDs) of trainers. Data management included descriptive statistics (quantitative) and Braun and Clarke’s methodology for thematic analysis (qualitative). Data integration identified areas of convergence, complementarity and expansion.ResultsIAP NURTURE (NC-ECD) trained 7047 paediatricians. Data was retrieved from: 9 KII (phase 1); 4155 (58.9%) pretests, 2596 (36.8%) post-tests, 1506 (21.3%) feedback forms, 205 (5%) online survey respondents, and 18 (36.7%) IDIs (phase 2) and 15 FGDs (phase 3). Data integration indicates IAP NURTURE (NC-ECD) had a positive impact on the trainees: high satisfaction with training and resources provided; helpful in practice (skill enhancement, involving staff, using well-child visit schedule), and; receiving positive feedback from clientele. Challenges and solutions were identified.ConclusionsThe IAP NURTURE (NC - ECD) model (based on systems approach, NCF strategic actions and principles of adult learning) and lessons learnt from this study can guide development of similar capacity building initiatives.

Objectives: To assess the neurodevelopmental outcome of West syndrome (WS) in Indian children, who differ in their clinical profile from the western population. Materials and Methods: This cross-sectional study enrolled children aged 2--5 years with prior diagnosis of WS between November 2013 and March 2015. They were assessed for epilepsy outcome and developmental outcome using developmental profile 3 (DP3) and vineland adaptive behavioral scale II (VABS II). Results: Sixty-one children were enrolled. Perinatal asphyxia (40.9%), neonatal hypoglycemia (14.8%), and neonatal meningitis (9.8%) were predominant causes among the children with known etiology. Favorable epilepsy outcome (seizure freedom for >6 months) was observed in 29/61 patients (47.5%). Moderate to severe developmental delay was observed in 55/61 children (91.8%). Favorable developmental outcome (GDS by DP3 >70) was observed in just 5/61 (8%) patients. Conclusions: This study highlights the high prevalence of developmental delay in this population of children with WS, with adverse perinatal events being the most common etiology.

Objective To determine the diagnostic accuracy of MCHAT-R/F, RBSK-ASQ and TABC for screening children aged 16 to 30 months for autism spectrum disorder (ASD). Method Children aged 16 to 30 months were recruited from the pediatrics department. Those with known neurodevelopmental disorders, disabilities, severe medical illnesses, unavailable mothers, or lack of maternal understanding of Hindi, were excluded. The three index tools were translated into Hindi; each tool was piloted on 25 mothers and modified accordingly. The researcher was trained in administration, scoring and interpretation of the three tools. After enrollment the index tools and Developmental Profile (DP-3) were administered to each participant. The reference tool was a comprehensive assessment by experts that included clinical evaluation, computation of DP-3 scores, and application of diagnostic criteria of ASD; the final diagnosis being ASD or Non-ASD. Results Sensitivity and specificity of M-CHAT-R/F were 95.2% and 94.4%, of RBSK-ASQ were 100% and 93.9%, and of TABC were 100% and 94.4%, respectively. Convergent validity was high (Spearman’s correlation coefficient 0.98). Test-retest and inter-rater reliability of each tool was excellent (Intra-class correlation coefficient 1.00). Conclusion All three tools had acceptable psychometric properties, high convergent validity and excellent test-retest and inter-rater reliability.

Objectives This cross‐sectional study was designed to test the applicability of the 1989, 2010, and 2017 International League Against Epilepsy (ILAE) classification of epilepsy in children from a resource‐limited setting in India. Methods Classification of seizure types and syndromes was done through parental interviews and review of medical records in children with epilepsy aged one month to 18 years. Available investigations including EEG, MRI, and metabolic/genetic tests were used in classifying patients as per the 1989, 2010, and 2017 ILAE (level II‐epilepsy type) classification. We compared the proportion of children remaining unclassified by each scheme. Results Seven hundred and twenty‐six children (436 males, mean age 6.4 ± 4.6 years) were enrolled. Using the 1989 ILAE classification, we were able to classify 95.7%, and 82.6% children by the 2010 scheme. The 2017 ILAE classification could classify all 726 children at level I (seizure type), 664 (91.0%) children at level II (epilepsy type), and an electroclinical syndrome could be identified in 409 (56.1%) of the children. An etiology could be identified in 75%, perinatal brain injury being the most frequent. West syndrome was the most common electroclinical syndrome, identified in 22.7% patients. The 1989 ILAE classification system was superior to the 2010 system (P = .01) in epilepsy classification. There was no difference between the 1989 and 2017 schemes (P = .31) or the 2010 and 2017 schemes (P = .10). Significance The 2017 ILAE classification, being multidimensional, allowed classification of children who could not undergo extensive evaluation due to economic constraints and also provided room for overlapping etiologies.

Background: The modified Atkins diet (MAD) has been used predominantly in older children, adolescents, and adults. There is a paucity of data on the use of the MAD in refractory epilepsy in young children. Objectives: This study was planned to evaluate the efficacy and tolerability of the MAD in refractory epilepsy in young children. Methods: This study recruited children aged 9 months to 3 years with refractory seizures. Children received MAD for 6-month with the on-going anticonvulsant medications being continued unchanged. Reduction in seizure frequency was the primary outcome measure. Adverse effects were also studied. Results: Thirty-one children with daily seizures were studied with a median age of 18-month (range 9-30 months). West syndrome was the most common epilepsy syndrome (26, 86.6%). Twenty-one children remained on diet at 3 months and 13 at 6 months. The children who achieved >50% seizure reduction were 17 (54.8%) at 3 months and 9 (29%) at 6 months. Refusal to eat was a significant problem seen in eight children. Three children discontinued the diet due to adverse effects. Conclusion: The MAD was found to be feasible, effective, and well-tolerated.

The Autism Dysmorphology Measure is designed for non-expert clinicians. It uses an algorithm to assess 12 body regions and categorizes Autism on the number of dysmorphic regions identified; Essential (≤ 3), Equivocal (4–5) or Complex (≥ 6). We evaluated 200 Indian children with Autism (mean age 3.7 years) in a hospital-based cross-sectional study and compared inter-group profiles. We found 31% Essential, 49% Equivocal and 20% Complex Autism. On comparing results with existing literature, it appeared that genetic ancestry and age significantly influenced dysmorphism and hence categorization. No significant differences were observed between complex and essential autism in epilepsy, severity of autism or development, as reported earlier. These shortcomings make the present tool unsuitable for use in young Indian children with Autism.

Background Universal developmental screening is recommended at 9, 18, 24 and 36 months. The Government of India Mother and Child Protection (MCP) card is an immunization record that is used to monitor child development, and identify children requiring further evaluation. Objectives To determine the diagnostic accuracy of the MCP card for developmental screening, and perform its item analysis. Study design Mixed-method study (prospective study of diagnostic accuracy and qualitative study). Participants Mother-child dyads of children between 2–36 months of age were recruited from the outpatient department or wards of a tertiary level children’s hospital from November, 2019 to October, 2021. Children with confirmed neurodevelopmental disorders/disability, and mothers with less than 6 th standard education were excluded. Intervention Each mother was given a MCP card, and taught how to mark the items. This was followed by the researcher’s evaluation (index tool). The reference tool was a comprehensive clinical assessment (CCA) by the researcher and an expert. The CCA included clinical examination of hearing, vision, and neuro-development; and psychometric assessment of development and adaptive function. Each mother underwent an in-depth interview. Overall and group wise psychometric properties of diagnostic accuracy were computed. The interview transcripts were analyzed thematically. Outcomes The proportion of children with ‘fail’ and ‘delay’ by the evaluation of the researcher with the MCP card and the expert by the CCA, respectively. Results The study population included 213 children (40.4% females). Fifty-two (24.4%) children were identified as ‘Fail’ by the MCP card and 43 (20.2%) as ‘delay’ by the expert’s CCA. The overall sensitivity and specificity was 83.7% (95% CI 69.3–93.2) and 90.6% (95% CI 85.2–94.5), respectively. Acceptable diagnostic accuracy was found in the age-group 7–9 months, 13–18 months, and 25–36 months. Conclusions The MCP card may be used for developmental screening at 9, 18, and 36 months.

The bioactive compounds from Actinomycetes have antibacterial, anticancer, antioxidant, and antifungal properties. The antioxidant activity of ethyl acetate extract of Bacillus licheniformis was determined by carrying out several assays. Preparation of a bioactive feed encapsulated with sodium alginate and chitosan was carried out for treating the bacterial infection in Macrobrachium rosenbergii. An experimental trial with three different groups was conducted to determine the effect of crude extract of B. licheniformis against pathogenic bacteria, Aeromonas hydrophila in freshwater prawn, M. rosenbergii. The first group of prawns was given commercial diet. The second group of prawns challenged with A. hydrophila was given commercial feed. The third group of A. hydrophila challenged prawns was given the encapsulated B. licheniformis feed. The survival percentage of prawns was decreased in group 2 compared to the prawns of group 1 and group 3. The antioxidant properties were found to be significantly increased in case of group 3 prawns. Real time Reverse transcription - Polymerase chain reaction (RT-PCR) study of three different groups with three immune genes - Superoxide dismutase (SOD), Crustin and Prophenoloxidase was carried out and antioxidant enzymatic activity, and immunological parameters were recorded. Group 1 was designated as control, injected with saline. Group 2 was designated as infected, challenged with A. hydrophila and group 3 as treated, challenged with A. hydrophila and injected with crude extract of B. licheniformis. The results revealed that the SOD and Prophenoloxidase of gills and hemolymph showed highest gene expression in the case of treated group compared to the infected and control group. The data indicated that B. licheniformis showed enhanced antioxidant activities, immune response, disease resistance, and gene expression in M. rosenbergii challenged with A. hydrophila. Graphical abstract