Background and Objective: The treatment of ventilator-associated pneumonia (VAP) caused by multidrug resistant organisms is challenging even with appropriate intravenous antibiotics. The study was conducted to evaluate the efficacy and safety of nebulised Colistimethate sodium (CS) in the treatment of Gram negative VAP. Methods: For this prospective, interventional, open label, intention-to-treat, randomized trial, 40 consecutive patients were enrolled on the suspicion of VAP. After exclusion, 13 patients in CS nebulisation group and 15 patients in normal saline (NS) nebulisation group were randomized and completed the study. All patients were on systemic antibiotics. The clinical cure was the primary outcome and secondary outcomes included were microbiological cure, durations of mechanical ventilation and stay in PICU and adverse events related with nebulization therapy. Results: Two study groups had comparable clinical characteristics. Clinical and microbiological cures occurred in all patients of CS nebulisation group (100%) but in 11 out of 15 (73.3%) patients in NS nebulisation group (p-0.06). The total duration of mechanical ventilation and PICU stay were not significantly different in two groups. No statistically significant differences were observed with regard to adverse events. Conclusion: Aerosolized CS seems to be safe with no major adverse effects and with no clinical and microbiological benefits. There is need for adequately powered, multicentre study.

Objectives: To determine the discriminative ability of PRISM III scoring system in predicting mortality in children admitted to PICU. Methods: Prospective observational study in all children 1 month to 12 years of age admitted to PICU during July2017 to June2018. Result: Out of 250 patients admitted in the PICU, 133 were male & 117 were female. In the age group of 1 month to 12 months, 30(22.22%) expired while in 12 months to 12 years,18(11.65%) expired. Due to respiratory system involvement, mortality was 24(16.43%), due to central nervous system 8(17.39%) and septicemia 12(46.15%) . At 12 hours of admission, 214 patients had PRISM score 0 to 4, out of which 14 expired. 17 patients had score of 5 to 9, out of which 15 expired.19 patients had score >10 having 100% mortality. PRISM 24 score was taken 12 hours after the 1st score. 216 patients had PRISM score between 0 to 4, out of which 14 expired. 8 patients had score of 5 to 9 & 26 patients had score >10, out of which all expired. Conclusion: Since mortality rises with increase in PRISM 3 score at the time of admission, PRISM III score can be taken as an indicator of the initial severity of illness. PRISM III can help in selecting sick children for PICU admission and optimum utilization of limited PICU resources.

Orbital cellulitis is a potentially life-threatening and an uncommon emergency condition in children. There are little published data from incidence and prevalence in the developing country. This study was done to identify incidence, etiology and management of orbital cellulitis in children from two service hospitals in east and west coast of India. Methods : The two multispecialty service hospitals cater tertiary level care to dependant population with 80700 children between ages 1 month to 12 years. This study was a 2 years retrospective observational study using hospital based electronic information system and electronic case records from Jan 2017 to Dec 2018 between ages of 1 month to 12 years. Results : A total of 15 children with orbital cellulitis were included in the study giving incidence of 9.29 per 100000 in children <12 years age in our dependant population. The gender ratio was 2;1. 60% children had a preceding upper respiratory tract infection, 20% had furunculosis on face and 13 % had previous trauma to the face. Only in 3(20%) children, organisms were isolated and all grew Methicillin sensitive staphylococcus aureus(MSSA). All children were started on intravenous antibiotics as per unit policy. 6(40%) children required admission to Pediatric Intensive Care Unit (PICU) and surgical treatment was required in 2 (13%). All patients recovered with good outcome. Conclusion: The annual incidence of orbital cellulitis in our dependant population was 9.29 per 100000 per year. In children, it commonly follows upper respiratory infection or furunculosis of the face. Intravenous antibiotics and surgical management yields optimum result.

Injuries are one of the commonest causes of disability and death worldwide. They affect all populations in all geographic regions. Injuries are amongst the commonest causes of mortality in the pediatric population, after infections, congenital and neonatal complications. Children have considerable variations in their anatomy and physiology when compared to adults, which change with advancing age. A similar mechanism of trauma leads to different injuries with unique management and treatment strategies in pediatric patients. This review focuses on these aspects and management of pediatric trauma.

Scorpion sting is a major health problem in tropical and subtropical countries.^[1] A total of 113 species are available in India^[2]; of these Mesobuthus tumulus or Indian Red Scorpion is the most lethal.^[1] Like many other neglected tropical diseases, due to gross under-reporting, reliable statistics of scorpion envenomation are not available. Even more concerning is the lack of awareness amongst pediatricians regarding the spectrum of manifestations of scorpion envenomation in children and its management in both primary and advanced care settings. We are reporting a series of 3 cases exemplifying the myriad manifestations of scorpion envenomation along with emphasizing the role of prazosin and supportive intensive care monitoring and management. This article also focusses on role of treatment options such as amiodarone and glucose-insulin infusion in management of scorpion envenomation induced myocardial dysfunction, refractory to first line inotropes.

Intensive care unit is specialised unit providing care to critically ill patients. Level of intensive care unit depends on the requirement of the particular hospital. Outcome is always better if care is provided, the team specially trained in emergency and critical care. Equipment requirement is also different to some extent for children being developmentally and anatomically different at earlier age. Requirement for number of equipment is also slightly different.

Chylothorax, an accumulation of chyle in pleural cavity is a rare complication of pediatric blunt trauma. It could result from damage to or obstruction of thoracic duct. Though rare in incidence chylothorax can lead to significant morbidity and mortality. We report a case of traumatic high output chylothorax following blunt chest trauma in an eleven-year-old boy with h/o fall of ceiling at school. On admission GCS 7/15 with decompensated shock and bilateral hydropneumothorax for which child was intubated, started on inotropes and bilateral ICD placed. On further evaluation was found to have pulmonary contusions, bilateral multiple rib fractures, t4 & t5 vertebral fracture with grade 3 liver laceration. On day 3 child developed high output drain (>1L per day) and was confirmed as chyle on biochemical analysis, which was managed conservatively. The chest tube was removed after drain was completely stopped, he made a full recovery. Initial management of high output chylothorax is thoracic duct ligation or embolization which is typically needed early often within the first few days after diagnosis since conservative strategies are more likely to fail but our case shows that pediatric traumatic high output chylothorax can be successfully managed conservatively.

Thyroid storm is an uncommon but potentially lethal medical emergency. Thyroid hormone is present in excess leading to a hyper-metabolic state characterized by high grade fever, excessive sweating, palpitations which can rapidly progress into delirium, coma, and death. Precipitating events include trauma, infection, radioactive iodine treatment, or surgery.

Peptic ulcer disease (PUD) in children remains rare and difficult to diagnose before the onset of complications. We describe a 3-year-old child with perforated duodenal ulcer, associated with lower respiratory tract infection and hyperthyroidism. Upper GI endoscopy revealed three clean based ulcers in the first part of duodenum, erect chest x-ray showed bilateral gas under diaphragm and CT scan confirmed massive pneumoperitoneum. Emergency exploratory laparotomy detected perforation in the anterior wall of duodenum, managed with simple sutural closure. PUD in children is rare and high index of suspicion is required to prevent complications.

A 6 year old girl presented with a history of fever for 3 weeks, headache and multifocal seizures for 4 days with altered sensorium. Clinical assessment was consistent with hypotensive shock and encephalopathy. Her IgM and IgG Typhidot test was positive. Laboratory evaluation revealed deranged renal and liver functions with coagulopathy, anemia and thrombocytopenia. She did not respond to broad spectrum intravenous antibiotics, vaso-active infusions, corticosteroids and had refractory status epilepticus. She progressed rapidly to refractory septic shock and multiple organ dysfunction with AKI and ARDS. She succumbed to her illness despite antibiotics and other adjunctive therapies. This case highlights a rare and catastrophic presentation of typhoid fever.

Fluid and electrolytes management is key to pediatric critical care. These disorders may be primary or secondary to illness, drugs, iatrogenic, or as a result of medical error. The electrolyte disturbances are seen frequently and require aggressive monitoring and management. It is essential to understand normal water and electrolyte physiology and their distribution in human body for the management.