Objectives: To obtain cut-off values of PEWS scores that can predict need for PICU transfer at admission. To obtain cut-off values of PEWS scores that can predict unanticipated worsening (PICU transfer from ward after admission) Materials and methods: This was a prospective 12 month observational study of patients aged 1month to12 years admitted in our Emergency department. Approximately 738 patients were included in our study and all were subjected to PEWS score individually by the nurses and the pediatric trainee. Interrater reliability between nurses and pediatric trainee was evaluated. PEWS score was measured at initial assessment (S0) by pediatric trainee and staff nurse in emergency and after one hour (S1) by pediatric trainee alone. Patients were stratified into 3 outcome groups: those admitted to PICU either from ED, transferred from the ward, or those directly admitted to ward from ED. PEWS score was calculated and compared among the groups. Results: Among 1525 patients, 738(48%) were admitted, 252(34.12%) to PICU and 486(65.85%) to ward. AUC for predicting overall admission was 0.69 (95%CI: 0.68–0.77), for PICU 0.86 (95%CI:0.96–1) and for ward 0.75 (95%CI: 0.66-0.75). The sensitivity and specificity in predicting overall admission with cut off of PEWS≥ 1.5 was 76% and 64%, for PICU admission with cut off PEWS ≥ 3 was 100% and 90%, for ward admission with cut off PEWS ≥1.5 was 79% and 61% respectively. Interrater reliability was excellent . Conclusions: The study found elevated PEWS serve as excellent screening tool for prediction to PICU admission and transfer from ward to PICU

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Objectives: Neonatal sepsis accounts for early-half of all neonatal deaths in India. Although the gold standard for diagnosis is by blood culture, there is a need for a test that is cheap, accurate and easily performed with quick availability of reports. In this study we have analysed the diagnostic value of nucleated red blood cells to correctly predict neonatal sepsis. Materials and Methods: A time bound, prospective comparative study was done on neonates with suspected neonatal sepsis for a 2 year period. Neonates were then analysed in three groups depending on their blood culture and septic parameter results as no sepsis, probable sepsis and proven sepsis. Nucleated red blood cells were analysed in all three groups with a cutoff value of 40cells/cumm. Results: 245 neonates were included in the study. The mean value of NRBC was 38.84, 26.45 and 5.06 in proven sepsis, probable sepsis and clinical sepsis group respectively. Nucleated RBCs had a sensitivity of 33.3%, Specificity of 95.6%, Positive predictive value of 75% and a negative predictive value of 78.5% in detecting sepsis. Conclusion: NRBC is a simple and cost effective test in early diagnosis of neonatal sepsis. It will help the clinicians in early diagnosis and treatment thereby reducing the neonatal morbidity and mortality.

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Objectives: To compare the efficacy of dexmedetomidine and midazolam for sedation of mechanically ventilated children admitted to PICU. Secondary objectives were to compare the top up doses of fentanyl and paralytic agents, length of mechanical ventilation, ICU stay and hospital stay, and adverse events. Materials and methods: An open label, non inferiority RCT was done from August 2016 to April 2018 in PICU of a tertiary care hospital in India. Sedation level was assessed using Penn State Children Hospital sedation algorithm and the targeted sedation was 4 or 5 score. Maximum dose of midazolam was 4 mcg/kg/min and of dexmedetomidine was 0.75 mcg/kg/hr. Sum of the periods (in hours) the patient was monitored for sedation, the time periods (in hours) where the patient was at level of sedation 4 or 5 were calculated. Percentage of time spent in level 4 or 5 was calculated. Results: 49 children were randomized (24 in midazolam and 25 in dexmedetomidine). There was no difference in the percentage of time spent in the targeted sedation between the groups [midazolam 67.3 (18.8) vs dexmedetomidine 56.3(28.6); p=0.12]. The absolute difference in the percentage of time spent between the groups was -10.94% [(SE=7.05); 95% CI: -25.15 to 3.25]. The lower end of 95% CI for this difference breached the non-inferiority limit of -20%. Number of fentanyl boluses, duration of mechanical ventilation, ICU stay and hospital stay were similar between the groups. Four (17.4%) children in dexmedetomidine group developed persistent bradycardia, while none in midazolam group (p=0.05). Conclusion: Our study could not establish the non-inferiority of dexmedetomidine compared to midazolam for sedation in children on mechanical ventilation.

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Objectives: To determine the prognostic ability of urinary biomarkers in paediatric sepsis with or without AKI. Methodology: A single-center pilot prospective observational study was conducted in the 12-bedded multidisciplinary PICU of a tertiary referral and teaching hospital in South India over a period of 18 months. Children aged 1 month to 18 years admitted to PICU with diagnosis of sepsis were considered for inclusion. We excluded those with chronic kidney disease, anuria or brain death at admission and hospital stay < 24 hours. Demographic and clinical details, severity of illness, organ dysfunctions, details of PICU interventions and outcomes were recorded. Urine samples were collected within 24 hours of admission to test for 7 biomarkers (α1 microglobulin, FABP-1, MMP-8, NGAL, KIM-1, IGFBP-7, IL-18). All patients were followed up for 14 days and categorized into two groups: sepsis associated AKI (SA-AKI) and sepsis without AKI (Sepsis non-AKI, SN-AKI) using AKIN criteria. Results: Total of 45 children were enrolled, of which 25 had AKI (SA-AKI) and 20 did not (SN-AKI). Among SA-AKI patients, 9 had Stage 1 AKI, while rest had stage 3 AKI. Twenty patients with AKI required mechanical ventilation and 16 required renal replacement therapy. PRISM III, PELOD and SOFA score at admission were similar among SA-AKI and SN-AKI, however, PELOD and SOFA scores on day 3 were significantly higher among SA-AKI children (p<0.05). Median urinary concentrations of the 7 biomarkers tested were higher in SA-AKI group compared to SN-AKI group, but only KIM-1 and IGFBP-7 were statistically significant (p=0.0003 and p=0.0024 respectively). KIM-1 ≥18.18 pg/ml had area under receiver operating characteristics curve (AUC-ROC) of 0.85±0.07(CI0.70-0.95) with 83.3% sensitivity and 88.8% specificity, while IGFBP-7 ≥98pg/ml had AUC-ROC of 0.80±0.08(CI0.64-0.92) with 72.2% sensitivity and 83.3% specificity. None of the biomarkers showed significant correlation with AKI stage. In SA-AKI group, α1 microglobulin was significantly higher in those who died compared to those who survived (p=0.035). Overall mortality was more in SA-AKI group compared to SN-AKI group (44% vs 5.4%, p=0.003), there was no significant difference in length of PICU stay. Conclusion: SA-AKI is associated with high morbidity and mortality. Specific urinary biomarkers (KIM-1, IGFBP-7) were significantly elevated in the sepsis patients who developed AKI compared to those who did not. α1 microglobulin can predict survival in SA-AKI.

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Objective: To evaluate the value of lung ultrasound in the diagnosis of respiratory distress syndrome (RDS) in newborn infants Methods: From October 2017 to October 2018, 54 newborn infants were divided into two groups: RDS group (27 cases) and control group (27 cases) According to the findings of chest x-ray, there were 18 cases of grade II RDS,7 grade III cases, and 2 grade IV cases in RDS group. Lung ultrasound was performed at bedside by a single expert. The ultrasound indexes observed in this study included pleural line, A-line, B-line, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, lung pulse etc. Findings: In all of the infants with RDS, lung ultrasound consistently showed compact B lines, bilateral white lung or interstitial syndrome, pleural line abnormalities, A-line disappearance, The simultaneous demonstration of lung consolidation, pleural line abnormalities and bilateral white lung, or lung consolidation, pleural line abnormalities and A-line disappearance co-exists with a sensitivity 100 % and specificity 90 % for the diagnosis of neonatal RDS for studied sample size *Total sample size being 40 cases & 40 control Conclusion: This study indicates that using an ultrasound to diagnose neonatal RDS can be reliable tool. A lung ultrasound has many advantages over other techniques. Ultrasound is non-ionizing, lowcost, easy to operate, and can be performed at bedside, making this technique ideal for use in NICU *Complete Statistical analysis to follow once the sample size is completed

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Objective: To assess the prognostic value of rise in NLR and PLR in pediatric intensive care as markers of mortality. Materials and methods: A retrospective study based on 2 year data from HIMS and G-HEALTH data systems of AJ Institute of Medical Science, of all patients admitted to PICU after excluding those in whom all the study parameters were not retrievable. NLR and PLR ratios were determined and compared to PELOD 2 using SPSS version 17.0 Results: The demographic data was matched, the median NLR rise was 0.175 (IQR 1.714) while for PLR rise was 4.623 (IQR 85.533). PELOD 2 predicted mortality in 72.2% of the patients, while NLR increase predicted in 64.11% and PLR increase in 77.77%. A decreasing trend in NLR and PLR were both closely related to lesser length of stay in hospital and better survival. Conclusion: The study gives an insight into the fact that simple and inexpensive markers such as rise in NLR and PLR helps in predicting the mortality in the pediatric intensive care which is comparable to PELOD scoring.

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Objective: To study the clinical profile, intensive care needs and predictors of in hospital mortality in children with Spontaneous Intracranial Hemorrhage (SICH). Material and methods: Retrospective observational study in a tertiary care pediatric intensive care unit (PICU) of a teaching and referral hospital where 105 children aged > 1 month to 12 years with SICH admitted between January 2009 and May 2018 were assessed for in-hospital mortality as primary outcome. Survivors and non-survivors were compared to determine predictors of outcome. Results: The median (IQR) age of study subjects was 6 (2.25, 70) months, with 76 (72.4%) boys. Altered sensorium (n=87, 82.9%) and seizures (n=73, 69.5%), and pallor (n=66, 62.9%) and bulging anterior fontanelle (n=52, 49.5) were common presenting symptoms and signs respectively. Median (IQR) Glasgow Coma Scale (GCS) at admission was 10 (6,13) with features of herniation in 27 (25.7%). Arteriovenous malformation was the commonest cause of bleed among older children whereas late hemorrhagic disease of newborn was predominant cause among infants. Commonest site of bleed was intracerebral (n=47, 44.8%) followed by subdural (n=26; 24.8%). Sixteen (15.2%) children died during hospital stay. On univariate analysis, GCS<8, higher PRISM-III (>20), need for intubation at admission, development of shock and Acute kidney injury (AKI) during hospital stay and refractory status epilepticus requiring thiopentone coma were found to be significant predictors of mortality. Focal seizures were however associated with better survival [OR 0.12; 95% CI:0.03-0.47; p-0.002]. Age, site or etiology of bleed did not affect outcome. On multivariable analysis, progression to AKI [OR 5.86; 95% CI:1.53-22.4; p-0.01] predicted poor outcome. Conclusions: Etiology of SICH varies with age. Age or site of bleed did not predict outcome. Refractory status requiring thiopentone and development of MODS (shock, AKI) were associated with poor outcome.

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Objectives: To compare and analyse the relationship between Pao2/Fio2 (P/F) ratio and Spo2 /Fio2 (S/F) ratio in critically ill children requiring respiratory support. Materials and Methods: Our study was done over a period of 7 months (February 2016-August 2016) in the Paediatric Intensive care Unit (PICU), in a Tertiary care Hospital. All Children admitted in PICU, who require respiratory support (Noninvasive/Invasive) are recruited in the study. Children with congenital heart disease, chronic lung disease, abnormal haemoglobin, etc., are excluded from the study. Children for whom the definitive Fio2 delivery is not known (eg: face mask, Head box etc.) are also excluded. S/F ratio and P/F ratio was calculated twice for each participant, once at the time of recruitment and again at the time of deterioration (requiring escalation in the respiratory support) or 24 hours after recruitment, whichever is the earliest. Results: We obtained a total of 250 samples from 125 participants. Among 125 children, 112 (89.5%) required invasive ventilation, 5 (4%) required face mask Non-invasive ventilation, 1 (0.8%) required nasopharyngeal CPAP and 7 (5.7%) required high flow nasal cannula therapy. In our study, 27 (21.6%) had ARDS. Our study showed, S/F ratio of less than 180 corresponds well with P/F ratio <200, with sensitivity and specificity of 90% and 59% respectively (AUROC-0.8). In other words, any child who require Fio2 of 50% or more to maintain a saturation of 90% (S/F ratio<180) are likely to have ARDS (P/F <200). Conclusion: Our study showed a strong correlation between S/F ratio and P/F ratio. S/F ratio (<180) helps in early identification of children at risk of ARDS, especially in Paediatric Emergency and in secondary level settings where arterial blood gas are not available.

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Objectives: To assess long term health related quality of life in all PICU survivors with acute respiratory illness requiring invasive respiratory support, three to eight years after discharge Materials and Methods: All premorbidly well children between 1month to 15years of age who were ventilated for more than 48 hours for acute respiratory illness between March 2008- February 2014 and who were survived and discharged were included in our study. Neonates, children with acute neurological dysfunction, premorbidly unwell children, readmission to PICU were excluded.Data was collected from medical records. Those who were non contactable were written a postal letter. Quality of life assessment was done with the help of the Health Utility Index 2 which has 6 domains; sensation, mobility, emotion, cognition, self care and pain. Functioning within each attribute is represented by four or five levels. The assessment was done either by telephone questionnaire or by objective assessment in PICU office/Out patient department(OPD) by using HUI2 index. By using this,the outcome is classified as NORMAL(Score>0.99),FAIR(0.89-0.99) and POOR(Score<0.89). Results: In our study we had total 259 children who were admitted with acute respiratory illness requiring invasive ventilation in PICU for more than 48 hours during our study period. Out of these, 67 children (26%) died during PICU stay due to various complications and 46 (18%) were discharged against medical advice. Among 146 children, we were able to contact 66 children and the remaining 74 children could not be contacted through telephone or postal service. In the study group, six children died after discharge due to various causes . HUI2 questionnaire details were obtained either through personal interview (n=24) or by telephonic interview (n=42). HUI2 assesment was done for 66 children (Mean age 7.8± 2.6 years). Mean HUI2 score was 0.94±0.062. Majority of children are having good quality of life (84%) and 16% having poor quality of life who were affected in more than one domain. Of these 66 children, only one child was having learning disability and was affected badly in 4 domains(Score of 0.69) of quality of life. He needs spectacles to see and can walk with some limitation and often anxious and studies less compared to peer groups. Most common affected domain in our study group is ‘Cognition’. 23(35%) children are able to learn and remember school work less than their peer groups at school otherwise there were normal in all other domains. This is based on their parents perspective. Second most common affected domain is ‘Emotion’. 12(19%) children in our study group (66) are occasionally irritable, angry, depressed, anxious due to various reasons. Third most common affected domain is ‘Sensation’. Eleven(17%) children among our study group required either spectacles or hearing aid. In the ‘Pain’ domain, only 7 children (11%) out of 66 has occasional pain and discomfort. In the ‘selfcare’ domain, only 5 children (8%) out of 66 children are affected. These children have some difficulty to handle their day to day activities. Least commonly affected domain is ‘Mobility’(1.5%) where only one child was affected who needs some assistance while walking. In our study, duration of PICU stay, complications of ventilation (VAP, Pneumothorax, Pneumo-mediastinum) and multiorgan dysfunction (ARF,ALF,DIC-9) had influence on the long term outcome but it is not statistically significant (P value 0.128, 0.206 and 0.638 respectively). This may be due to the decrease in effect of acute illness in long term quality of life. In our study there was no correlation noted between maternal and paternal education and quality of life. Majority of PICU survivors(84%) have a good long term Quality of life (HUI mean score 0.94+/0.06). Even though, factors (Duration of PICU stay, complications of ventilation and multiorgan dysfunction) influencing long term quality of life were present more in the Poor outcome group, they are not statistically significant. This may be due to the decrease in effect of acute illness in long term quality of life.

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Objectives: To document ultrasound appearance of lungs in mechanically ventilated patients with (ventilator associated pneumonia) VAP. Methods: This was a prospective observational cohort, single centre study conducted in PICU of a university affiliated tertiary care hospital. A total of 28 patients of age 1 year to 14 years who were receiving invasive mechanical ventilation for reasons other than pneumonia and other lung diseases were selected by consecutive sampling technique. The lung ultrasound (LUS) was performed whenever there was a suspicion of VAP and these were diagnosed as per CDC criteria. LUS was performed with Aloka SSD-90 machine with both 5MHz linear and 7.5MHz linear transducer. Each lung was divided into six areas (superior and inferior of anterior, lateral and posterior zones). Anterior axillary line divided anterior from lateral and posterior axillary line divided lateral from posterior area. The probe orientation was perpendicular to the ribs. Results: A total of 28 patients (18 males) were enrolled. Median age was 6.5 years ranging from 1-13 years Dynamic linear/arborescent air-bronchograms were seen in all 100% cases. Shred sign was seen in 28% cases. Partial loss of aeration was seen in 68% while total loss of aeration was seen in 32% cases. Hepatisation was noticed in 21 % patients. Thickened pleural line heterogenous echotexture were also noticed. Pleural effusion was seen in two patients. Conclusion: LUS is feasible in mechanically ventilated children and Specific LUS findings are seen in VAP which can be used to diagnose it rapidly at bedside.

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Objectives: To compare neutral and lowered shoulder position on successful right subclavian vein Catheterisation in children. Materials and Methods: A randomized control trial was conducted on 40 children aged upto 14 years of age in whom central vein catheterization was planned. Patients were randomized using computer generated random numbers into two groups either neutral or lowered shoulder position during subclavian vein puncture and guide wire insertion. Block randomisation was used for allocation into groups. Sequentially numbered opaque sealed envelops were used for allocation concealment. Data on number of attempts, successful catheterization and complications were collected. Results: Both the groups were similar w.r.t age, weight, hight and gender distribution. Rate of successful subclavian catheterization were similar in both the groups [(neutral-90s% versus lowered-95%) with a nonsignificant p-value 0.46].The complication rates were also similar with a p value of 0.18. Conclusion: Both the shoulder positions were associated with similar success rates of subclavian catheterization and complications.

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Objective: To study the baseline cytokine levels and their correlation with severity of illness and mortality in critically ill children with severe sepsis. Design: Subgroup analysis of a randomized, doubleblind, placebo-controlled trial. Setting: Pediatric intensive care unit of a tertiary care teaching hospital in North India. Patients: Fifty children, 3 months-12 years, with severe sepsis. Material and Methods: Blood was collected at admission for estimation of pro-inflammatory (IL-6, IL-12p70, IL-17, and TNF-α) and anti-inflammatory (IL-10 and TGF-β1) cytokines. Primary outcome: To find out correlation between cytokine levels with severity of illness (PRISM III score). Secondary outcomes: To compare cytokine levels among survivors and non-survivors. Results: Baseline pro-inflammatory cytokine levels [median (IQR)] were IL-6: 189 (35-285) pg/ml, IL-12p: 48 (28-98) pg/ml, IL-17: 240 (133-345) pg/ml, and TNF-α: 296 (198-430) pg/ml; anti-inflammatory cytokine levels were IL-10: 185 (62-395) pg/ml, and TGF-β1: 204 (92-290) ng/ml. The median (IQR) PRISM III score was 15 (12-20). Pro-inflammatory cytokines showed positive correlation with PRISM III score: IL-6 (Spearman's correlation coefficient, ρ=0.273, p=0.06), IL-12 (ρ=0.367, p=0.01), IL-17 (ρ=0.197, p=0.17), and TNF-α (ρ=0.284, p=0.05); and anti-inflammatory cytokines showed negative correlation: IL-10 (ρ= -0.257, p=0.09), and TGF-β (ρ= -0.238, p=0.11). The mortality was 10% (n=5). Among non-survivors, the levels of pro-inflammatory cytokines were significantly higher as compared to survivors [IL-6: 359 (251-499) vs. 157 (97-223) pg/ml, p=0.000; IL-12p70: 167 (133-196) vs. 66 (30-100), p=0.000; IL-17: 400 (333-563) vs. 237 (122-318), p=0.009; and TNF-α: 409 (355-503) vs. 330 (198-415), p=0.002, respectively]. Conclusion: In critically ill children with severe sepsis, pro-inflammatory cytokines showed a positive correlation with severity of illness and were significantly higher among non-survivors.

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Objectives: Primary: To estimate prevalence of acute gut injury (AGI) in critically ill children during first week. Secondary: To estimate impact of AGI on mortality in critically ill children. Material and Methods: Current study is a part of larger prospective cohort study which includes all children aged between 1 month to 18 years admitted to pediatric intensive care unit. Current study analyzed children admitted during December 2017 to April 2018. Children with chronic gastrointestinal symptoms were excluded. European Society of Intensive Care Medicine classification was used to classify for AGI into four categories. Clinical details and outcome parameters were recorded. Results: Thirty-one children were included in the analysis. Median (IQR) age of the children was 32.5 (7.5-96) months; 32% of patients were male. Thirteen (42%) children died. Prevalence of AGI, gut dysfunction (AGI≥2), and gut failure (AGI≥3) was 64.5%, 41.9% and 22.6% respectively. Mortality was significantly increased in patients with AGI, gut dysfunction and gut failure (18% vs 82%, p = 0.047; 22.5% vs 77.8%, p= 0.009 and 29.1% vs 70.9%, p=0.008 respectively). Area under curve of receiver operating curve (AUC-ROC) for prediction of mortality of worst AGI and worst PELOD-2 score in first week were not significantly different (76.4 % and 81.3% respectively, p=0.67). Conclusion: Acute gut injury and gut dysfunction are significant among critically ill children and are associated with increased mortality. With new objective AGI classification, gut dysfunction should be included as measure of organ dysfunction among pediatric organ dysfunction scores.

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Objective: Acute kidney injury shown to be commonest complication in critically ill children admitted to the PICU. KDIGO classification and definition now used universally. We undertook prospective observational study to study the etiology and maximum stage of AKI as defined by KDIGO, its complications and outcomes. Materials and Methods: All children admitted to the PICU were included in the study. The diagnosis of sepsis and MODS was made according to the standard International guidelines. The patients were followed up till discharge/death. All children were screened for AKI at admission and subsequently using serum creatinine measured by modified Jaffe's method and urine output measurement. Results: 197 children were admitted to PICU. 38 (19.28%) developed AKI and 6 (15.78%) developed stage III AKI. Malignancies, serious neurological and renal disorders and post complex surgeries accounted for most of the cases with AKI. Six were admitted with primary renal condition. Sepsis with or without MODS was seen in 12 patients with AKI and in 8 without AKI.21 children with AKI and 3 children were exposed to nephrotoxic drugs. 23 Children with AKI required inotropic support. Children with AKI had ALOS in PICU of 9.86 days while ALOS in children without AKI was 6.23 days.18 children with AKI died (47.36%) while 36 (21.38%) with no AKI expired. Conclusions: AKI in children in the PICUs of referral hospitals in the armed forces have varied etiologies and presentations. These children require early identification and management with close monitoring to prevent long term renal morbidity and mortality.

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Objective: To study the clinical profile, intensive care needs and predictors of mortality in critical pertussis. Material and methods: Case records of 36 children >1 month to 5 years old with probable critical pertussis admitted to a tertiary care PICU of a teaching and referral hospital between January 2016 and May 2018 were analyzed retrospectively. Clinical, laboratory and treatment variables between survivors and nonsurvivors were compared to determine predictors of mortality. Results: Subjects included 21(58.5%) boys and 15 (41.7%) girls. The median (IQR) age was 3.5 (1.5,7) months. Typical paroxysmal cough 31 (86.1%), apnea 15 (41.7%) and seizures 17 (47.2%) were presenting symptoms. Twenty-one (58.3%) children were unimmunized for pertussis. Twenty-three were pertussis PCR positive. Respiratory failure (n=35, 97.2%), and hyperleukocytosis (n= 22, 61.1%) were major complications. Intensive care needs included mechanical ventilation (n=11, 30.6%), vasoactive support (n=7, 19.4%) and exchange transfusion (n=3, 8.3%). Pulmonary arterial hypertension (PAH) was detected in 5 out of 15 (33.3%) children who underwent echocardiography. Eight (22.2%) children died during PICU stay. Median (IQR) length of PICU stay in survivors was 4 (3, 5) days. On univariate analysis, female sex, apnea, hyperleukocytosis, encephalopathy (GCS<14), need for vasoactive support and mechanical ventilation predicted mortality. Conclusions: There is a resurgence of pertussis. Infants before starting or completion of their primary immunization schedule are at high risk for critical pertussis. Hyperleukocytosis, need for vasoactive support and mechanical ventilation were predictors of poor outcome.

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Objective: To evaluate functional outcomes in children with severe sepsis and septic shock admitted to the PICU using Pediatric Overall Performance Category Scale (POPC) and Pediatric Cerebral Performance Category (PCPC) scales at discharge/death as compared to baseline scores. Methods: We conducted this prospective observational study from October 2017 to June 2018. Children aged 2 months to 17 years admitted to PICU with severe sepsis and septic shock were enrolled. Data collection included demographic and clinical details and POPC and PCPC scores. Data was analyzed using stata 11. Results: A total of 96 children were enrolled. Sixty nine % had septic shock and 31% had severe sepsis. Twenty four (25%) died. The Median (IQR) POPC and PCPC scores at admission were – 3 (1 to 4). The POPC and PCPC scores at discharge/death were 2 (1 to 5) and 2 ( 1 to 6) respectively. At admission 49% had a baseline POPC and PCPC score of ≥ ≥ 2 and at discharge/death 59 (61%) had a POPC and PCPC score of ≥ ≥2. Conclusion: The functional outcomes of children admitted to the PICU with severe sepsis and septic shock were poor with more than half having mild to severe disability or death.

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Objective: To study the clinical profile of children admitted with meningitis Design: Prospective observational study Setting: Study was conducted in PICU of tertiary health care centre in Chennai Participants: All children less than 18 years of age with a diagnosis of meningitis for a two years period between 2017- 2018 were included in the study Methods: All children with suspected meningitis admitted in pediatric intensive care unit of the Institution from January 2017 to December 2018 were studied. The variables included were age, sex, religion, residence, nutritional status, etiology of meningitis, duration of hospital stay, requirement of mechanical ventilation. The status of the child at the time of presentation, presence of shock, bleeding manifestations, raised intra cranial tension, was noted. The presence of sequelae and treatment and follow up was also noted. The collected data were analyzed with suitable statistical methods. Statistical analysis: Data was entered into Microsoft excel data sheet and was analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi-square test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation .p value of <0.05 was considered as statistically significant. Results: A total of 4237 children were admitted in the hospital out of which 13 meningitis cases in the age group below eighteen years comprised the study population. 3 (23%) were infants, 4 (30.7%) were between 1- 3 years of age, remaining 6 were more than3 years of age. Among the cases, 5 (38.4%) children were male and 8 (61.5%) were female. Among them, majority were Hindu (75.42%) by religion and urban (58.11%) by residence. Majority were due to bacteria while 3 (23.07%) each were due to viral and tubercular meningitis. Out of them 1 (8%) child was undernourished who had tuberculous meningitis. Out of the 13 children who were admitted, only 7 (53.88%) children were completely immunized. The duration of hospital stay was more than 2 weeks for 6 (46.1%) children, out of whom 2 had tubercular meningitis. Antibiotics were given for all of them while 8 (61.5%) children were given steroids. 4 (30.7%) had features of raised Intra cranial tension, while none had features of shock or bleeding manifestation or thrombosis.2 (15.38%) children required mechanical ventilation. Out of the children,2 (15.38%) had sequelae in the form of hydrocephalus,2 (15.38%) had subdural abcess,1 (7.3%) facial nerve palsy and hydrocephalus and 1 (7.3%) had hemiparesis. CSF analysis was done for all of the children with meningitis, out of whom CSF PCR showed hemophilus influenza b for 3 (23.7%) children, Escherichia shigella for 1(7.3%) child, Pneumococcus species for 1(7.6%) child candida for 1 (8.3%) child, enterovirus and streptococcus bovis for 1 (8.3%) child each. Conclusion: Acute bacterial meningitis still remains a major cause of mortality and morbidity in children. Hemophilus influenza remains the main cause in pediatric age group.

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Objective: To study the practices and outcomes of initiation of inotropes in relation to resuscitation fluids boluses used in children with septic shock. Material and Methods: It was a Prospective observational study carried out from November 2014 to April 2016 at Pediatric emergency and PICU, LHMC and KSCH, New Delhi. Children aged 1 to 18 years with septic shock were included. Primary outcome was to look at various practices of initiation of inotropes; accordingly patients were categorized into 3 groups; N1 received inotropes after completion of first(20mL/kg),N2 after second(40mL/kg) and N3 after third (60mL/kg) bolus. Secondary outcome was to compare time taken, amount of fluid required to achieve hemodynamic stability, total fluid required and complications in first 24 hours of treatment. Study was approved by IEC. Results: Total 100 patients enrolled were grouped into N1(46), N2(10) and N3(44). Mean volume of fluid required to achieve hemodynamic stability in N1(40±10 mL/Kg) was significantly less than N2(70±10 mL/Kg) and N3(70±20mL/Kg);p=0.019. Mean time taken to achieve hemodynamic stability was significantly less in N1(115±45 minutes) than N2(196±32minutes) and N3(212±44minutes); p=0.021.Complications were lower in N1 (32%) than N2(40%) and N3(47%); p=0.036. Mean volume of Intravenous fluid required in first 24 hours of treatment in N1,N2 and N3 group was 122.4 ±22mL/kg, 151±31mL/kg and 145±24mL/kg respectively. Mortality difference in N1(17%), N2(30%) and N3(27%) was not significant. Conclusion: Early initiation of inotropes resulted in less total fluid volume, lesser time to achieve hemodynamic stability, less fluid boluses, and lesser complications in first 24 hours.

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