Avoid common mistakes on your manuscript.
To the Editor: Achieving child’s co-operation is the first step in pediatric echocardiography. While swaddling/ breast-feeding easily soothes infants, sedation is indispensable in toddlers since it is challenging to achieve their co-operation. Ataxia, dizziness, obtundation and hyperactivity have been reported with pediatric sedation [1]. Waiting-period for the sedative to take effect and the need for monitoring post-echo, until child regains consciousness, adds to the cost and man-power burden on health-care resources. Non-pharmacologic alternatives to sedation, if effective, can enable safer, cheaper and faster pediatric echo.
Cartoons have been successful pacifiers obviating the need for sedation [2, 3]. But if doctors use cartoons, parents may follow suit to win child’s cooperation at home adding to the burgeoning screen-time [4]. To evaluate if cartoons, minus visuals, (audio-component alone) are effective as stand-alone pacifiers for pediatric echo, ethics committee (JIP/IEC/2022/043) and clinical trials registry (CTRI/2022/09/045289) approvals were obtained. Toddlers (aged 2–5 y) requiring echocardiography preceding non-cardiac surgeries were randomised into group-1, audio-alone or group-2 audio plus video (n = 36 in each group). Sedated-children and those with congenital heart diseases were excluded. A wall-mounted television played the same cartoon (language varied based on child’s mother tongue) in both the groups with or without video (group 2 and 1 respectively).
Non-inferiority was pre-defined as difference in procedural duration of < 3 min between the two-arms. Study completeness score (SCS) (maximum of 6- based on the number of views-sub-xiphoid-2/PLAX/PSAX/A4C & A5C/Supra-sternal) and visual analogue scale (VAS) were used to describe study completeness and child’s anxiety during echo respectively.
Mean duration of echocardiography [263 s vs. 240 s (p value 0.07)], average SCS (5.9 in both groups) and VAS [0.56 vs. 0.92 (p value 0.45)] were not statistically different between the two groups.
By pre-specified criteria, audio-group was non-inferior to the video + audio group. Cartoons’ audio-content alone, in suitable languages, is an effective pacifier to achieve toddler-echocardiography.
References
Jain P, Sharma S, Sharma A, Goel S, Jose A, Aneja S. Efficacy and safety of oral triclofos as sedative for children undergoing sleep electroencephalogram: An observational study. J Pediatr Neurosci. 2016;11:105–8.
Stevenson JG, French JW, Tenckhoff L, Maeda H, Wright S, Zamberlin K. Video viewing as an alternative to sedation for young subjects who have cardiac ultrasound examinations. J Am Soc Echocardiogr. 1990;3:488–90.
Ferrer FS, Murcia MDG, Lopez-Pineda A, et al. Effects of watching cartoons during an echocardiography on infants and preschool children. A prospective randomized study. Front Pediatr. 2019;7:184.
Pandya A, Lodha P. Social connectedness, excessive screen time during COVID-19 and mental health: A review of current evidence. Front Hum Dyn. 2021;3. https://doi.org/10.3389/fhumd.2021.684137.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
None.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sangwani, R., Parale, C., Lallawmkima, I. et al. Audio vs. Video as a Pacifier for Pediatric Echocardiography- A Randomized Controlled Trial. Indian J Pediatr 90, 526 (2023). https://doi.org/10.1007/s12098-023-04516-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-023-04516-w