G. V. Basavaraja

Objective To develop evidence-based guidelines for the prevention, identification, and management of growth failure in infants under 6 months (U6M), ensuring early detection and intervention to improve health outcomes. Justification Growth failure in the first 6 months of life significantly increases the risk of acute malnutrition and stunting in later childhood. Unlike older children, management in this age group prioritizes establishing exclusive breastfeeding and addressing feeding challenges. There are no standardized guidelines for identifying and managing growth failure in this vulnerable population. Process A national consultative committee of experts was convened to formulate these guidelines. The committee conducted extensive discussions, dividing key areas among six working groups. The process included four virtual and one in-person meeting between August and October 2024. A draft guideline was developed, reviewed, and approved by all committee members. Recommendations Early growth failure is a significant public health concern. Timely identification of at-risk infants through mother-infant dyad assessments during routine health visits is essential. Weight-for-age is the most reliable anthropometric indicator for recognizing at-risk infants U6M. The term “infant at risk of poor growth and development” is recommended to identify at-risk infants needing intensified support. Community-based interventions should support at-risk infants without medical complications, while those with complications need facility-based care with skilled lactation support. Severely wasted infants require close monitoring for hypothermia, hypoglycemia, and sepsis. Establishing exclusive breastfeeding should be prioritized in all cases, and when not feasible, F-100D (Catch-up D) should be used to ensure safe nutritional rehabilitation while minimizing renal solute load.

Objective To study the profile of neurological manifestation of rickettsial disease in children. Methods Review of hospital records was done in a tertiary care hospital for the period from January to December, 2020. Data of all the children fulfilling the inclusion criteria i.e., clinical criteria and serology were retrieved from the hospital records. Results Of the total 7974 children admitted over this period, 178 were diagnosed with rickettsial disease wherein 54 (33.3%) had neurological involvement. Convulsions (59%), altered sensorium (56%), headache (44%), meningeal signs (37%), ataxia, (11%), lateral rectus palsy (7.5%) and stroke (7.5%) were the major neurological manifestations. Cerebrospinal fluid (CSF) analysis done in 30 (55%) children showed pleocytosis [median (IQR) cells 15 (3.75, 50)] with lymphocyte predominance [median (IQR) lymphocytes 11.5 (3, 38.75)] and elevated proteins [median IQR 41.5 (29.75,61)]. Neuroimaging abnormalities noticed were cerebral edema (n=7), cerebellar hyperintensities (n=5), basal ganglia infarcts (n=2) and hippocampal hyperintensities (n=1). Conclusion Early recognition of rickettsial infection as a cause of neurological manifestation would facilitate early specific management.