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Objective: To compare the performance of mid-upper arm circumference (MUAC) against weight-for-height Z-score (WHZ) for predicting inpatient deaths in children under 5 years of age. Design: Diagnostic test accuracy study. Setting: Paediatric emergency department of a tertiary care hospital catering to semi-urban and rural population in Delhi, India. Subjects: Hospitalized children (n 1663) aged 6 months to 5 years, for whom discharge outcome was available, were consecutively recruited over 14 months. MUAC (cm), weight (kg) height (cm), clinical details and the outcome were recorded. MUAC (index test) was compared with WHZ based on the WHO growth standards (reference test) for predicting the outcome. Results: One hundred and twenty-four (7 %) children died during hospital stay. Both MUAC < 11·5 cm (adjusted OR (95 % CI): 3·7 (2·43, 5·60), P < 0·001) and WHZ < −3 (2·0 (1·37, 2·99), P < 0·001) served as independent predictors of inpatient mortality. However, MUAC was a significantly better predictor of mortality compared with WHZ in terms of area under the receiver-operating characteristic curve (MUAC = 0·698, WHZ = 0·541, P < 0·001). MUAC < 11·5 cm had the best trade-off of sensitivity and specificity for predicting inpatient mortality. A combination of WHZ < −3 and/or MUAC < 11·5 cm did not significantly improve the predictive value over that of MUAC/ WHZ, assessed individually. Conclusion: MUAC < 11·5 cm is a better predictor of mortality in hospitalized under-5 children, as compared with WHZ < −3. It should be measured in all emergency settings to identify the children at higher risk of death. Keywords Child mortality Mid-upper arm circumferenceSevere acute malnutrition Weight-for-height Z-score Directly or indirectly, malnutrition contributes to nearly two-thirds of global mortality caused by pneumonia, diarrhoea, measles and other infections among children under 5 years of age (under-5s) (1,2) . In hospitalized Indian children, malnutrition has been shown to increase the risk of mortality up to six times in diarrhoea (3)(4)(5) and up to six times in acute respiratory tract infections (6,7) . To achieve the UN Millennium Development Goal 4, which aims to further reduce under-5 mortality (8) , it is imperative to curtail child deaths occurring as a consequence of malnutrition. The first step in this direction will be to identify and manage the set of malnourished children at risk for imminent death. The WHO has defined severe acute malnutrition (SAM) in 6-59-month-old children as a weight-for-height < −3 SD (severe wasting) of the reference population (9) . The selection of weight-for-height Z-score (WHZ) over other anthropometric criteria, namely weight-for-age Z-score (WAZ) or height-for-age Z-score (HAZ), is based on the fact that it has been shown to be an indicator of not only present nutritional status but also involves measurement of height that can be utilized to assess past nutritional status. However, the use of WHZ for identification of SAM is associated with some inherent pitfalls, especiall...

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Background : Outcome data of children with heart disease who acquired COVID-19 infection are limited. Aims : We sought to analyze outcome data and identify risk factors associated with mortality in children with heart disease and grown-ups with congenital heart disease (GUCH) who had a laboratory-confirmed COVID-19 infection. Settings and Design : This is a retrospective, multicentric, observational study. Materials and Methods : The study included children with heart disease and GUCH population, who presented with either symptomatic or asymptomatic COVID-19 infection to any of the participating centers. COVID-19-negative patients admitted to these centers constituted the control group. Results : From 24 pediatric cardiac centers across India, we included 94 patients with a median age of 12.5 (interquartile range 3–96) months and 49 (52.1%) patients were males. Majority (83 patients, 88.3%) were children. One-third of the patients (n = 31, 33.0%) had acyanotic congenital heart disease, and 41.5% (n = 39) were cyanotic, with > 80% of the patients being unoperated. Only 30 (31.9%) patients were symptomatic for COVID-19 infection, while the rest were incidentally detected positive on screening. A total of 13 patients died (case fatality rate: 13.8%). The in-hospital mortality rate among hospitalized patients was significantly higher among COVID-19-positive cases (13 of 48; 27.1%) as compared to COVID-negative admissions (9.2%) during the study period (P < 0.001). On multivariate analysis, the independent predictors of mortality among COVID-19-positive cases were severity of illness at admission (odds ratio [OR]: 535.7, 95% confidence interval [CI]: 6.9–41,605, P = 0.005) and lower socioeconomic class (OR: 29.5, 95% CI: 1.1–814.7, P = 0.046). Conclusions : Children with heart disease are at a higher risk of death when they acquire COVID-19 infection. Systematic preventive measures and management strategies are needed for improving the outcomes.