Hypernatremic dehydration is a neonatal morbidity commonly seen in exclusively breast-fed neonates due to inadequate breast milk intake. This problem is generally missed by native practitioners as the degree of dehydration can be underestimated due to fluid shifts. Neonates of primiparous mothers, neonates born via caesarean section and those who experience greater weight loss in the first week of life are at higher risk of developing hypernatremic dehydration. No consensus treatment guidelines exist till date. Complications of hypernatremic dehydration like cerebral edema usually occur during improper correction.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Ventilator-associated pneumonia (VAP) is one of the most frequent hospital-acquired infections occurring in intubated patients. Because VAP is associated with higher mortality, morbidity and healthcare costs, there is a need to solicit further research for effective preventive measures. VAP has been proposed as an indicator of quality of care. Clinical diagnosis has been criticized to have poor accuracy and reliability. Thus, the Centers for Disease Control and Prevention has introduced a new definition based upon objective and recordable data. The principal determinant of VAP development is the presence of the endotracheal tube (ETT). Contaminated oropharyngeal secretions pool over the ETT cuff and subsequently leak down to the lungs through a hydrostatic gradient. Lastly, biofilm develops on the inner ETT surface and acts as a reservoir for microorganism inoculum to the lungs. New preventive strategies are focused on the improvement of secretions drainage and prevention of bacterial colonization. The influence of gravity on mucus flow and body positioning can facilitate the clearance of distal airways, with decreased colonization of the respiratory tract. A different approach proposes ETT modifications to limit the leakage of oropharyngeal secretions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Scrub typhus is a mite-borne acute febrile illness caused by Orientia tsutsugamushi. Recently a surge in pediatric cases is noted across the country. This review focuses on the pathogenesis, clinical profile, diagnosis, management and critical care needs in children with scrub typhus.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction : Diabetic ketoacidosis (DKA),a common emergency encountered in children is characterized by deranged acid-base status and a myriad of electrolyte disturbances. Objective : This study was done with the objective of determining the effect of serum sodium and potassium levels on prognosis of children with DKA. Methods : This cross-sectional study was done in the pediatric intensive care unit of a tertiary care center, from January 2015 to September 2015. Children diagnosed with DKA were included in the study. Convenient sample size was adopted. In a structured proforma, demographic and medical history was noted. Serum sodium and potassium were determined by Ion Selective Electrode method at the time of diagnosis and 12 hourly, till resolution of acidosis. The clinical outcome of the child, the duration of insulin infusion and hospital stay were noted. Association between dependent and independent variables was determined by chi-square test and level of significance was fixed at 5%. Results : Thity three patients were included. The mortality rate was 13%. Twenty (60%) patients required insulin infusion for less than 24 hours and 18 (62%) stayed in hospital for less than 2 weeks. Hyperkalemia at presentation was significantly associated with mortality, hyponatremia at the time of admission was found to be significantly associated with prolonged hospital stay and abnormal sodium and potassium levels persisting at the end of 24 hours was significantly associated with need for prolonged insulin infusion. Conclusion : Presence of hyperkalemia and hyponatremia at admission and persistence of abnormal serum sodium and potassium levels beyond 24 hours are poor prognostic markers in children with DKA.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Super refractory status epilepticus was a term used first in the Third London-Innsbruck Colloquium on status epilepticus held in Oxford. It can be estimated that about 15% of all the cases with status epilepticus admitted to hospital become super-refractory. Neurologists and intensivists together manage such cases in close conjunction. Despite the high mortality rate, survival with meaningful functional and cognitive recovery is possible.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background : Pneumonia is one of the leading cause of death globally, among children younger than five years. South Asia has the highest incidence of pneumonia (0.36 episodes/child/year) in the world and bulk is in India. Of all cases of pneumonia in children in India, 65% were reported to be moderately severe or severely malnourished. In these children deficiency of micronutrients, particularly zinc has been shown to be associated with higher incidence and severity of pneumonia. Identification of modifiable risk factors of severe acute lower respiratory tract infection (ALRTI) like correction of protein energy malnutrition (PEM) and micronutrient deficiency may help in reducing the burden of disease with regard to both morbidity as well as mortality. Objective : Serum zinc level in children 2-60 months, hospitalized with WHO defined severe pneumonia, with the same age matched controls and its correlation with malnutrition. Methods : This was a hospital based prospective, observational cross-sectional study.150 children in the age group of 2-60 months were enrolled, out of which 75 cases had pneumonia. 43 cases were of the age group 2-12 and 32 were from 12-60 months age group. Children were divided in four groups: Group A had children with pneumonia who had grade I or grade II malnutrition; Group B had children with pneumonia who had no malnutrition, Group C had children with malnutrition who did not have pneumonia while group D had children with neither pneumonia nor malnutrition. Serum zinc levels were measured, analyzed and interpreted with regard to age, sex and nutritional status. Results : It was found that children with severe pneumonia and grade I/II malnutrition had low serum zinc levels (59.52+1.55 μg /dl), while serum zinc levels were within normal range ( >65 μg/ dl) in all other children. Thus, while serum zinc levels in children with grade I and grade II malnutrition with pneumonia were low, levels were normal in children with pneumonia who did not have malnutrition. Similarly, serum zinc levels were in normal range in well -nourished asymptomatic children as well as those with grade I and grade II malnutrition without any respiratory disease. Conclusion : Children with grade I or grade II malnutrition with lower serum zinc levels are either more prone to develop severe pneumonia or serum zinc levels decline due to poor intake in a sick malnourished child. Larger studies may help to decide whether reduced serum zinc is an independent factor or not for children with mild lower respiratory tract infection and whether zinc supplementation during treatment has any beneficial effects.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

A fourty eight day old baby boy presented with a history of unprovoked, left sided focal seizures commencing at the age of 21 days of life and had recurrent hospital admissions previously. He was referred to our tertiary care centre for further evaluation. Clinical assessment on the day of presentation in the Emergency Room revealed a GCS of 13/15, without any focal neurological deficits and an anterior fontanelle that was level, but pulsatile. He was also noted to have severe hypertension. Laboratory parameters revealed hypocalcemia, hypomagnesemia and significantly low 25- OH- vitamin D levels with normal complete blood counts, liver and renal functions. Further endocrinology evaluation revealed a normal PTH level with increased fractional excretion of magnesium in urine. Seizure control was achieved with intravenous calcium and magnesium administration along with antiepileptic drugs. Hypertensive urgency needed appropriate management with nifedipine and labetalol initially and blood pressures normalized only after correction of serum magnesium levels. At discharge, all antihypertensive drugs could be tapered and discontinued. This interesting case highlights the issue of hypomagnesemia manifesting as hypertension, even up to levels of a hypertensive urgency in infants and children.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Takayasu’s arteritis (TA) is a rarity in young children, with only less than 10 cases reported in infants worldwide, to date. Case characteristics: We report our experience with a 4-month-old girl who was diagnosed with Takayasu arteritis, presenting with myocarditis and heart failure. She had high inflammatory markers and coronary dilatation on echocardiography. She was initially treated with IVIG (intravenous immunoglobulin) and Aspirin. The persistence of high acute phase indices prompted further investigation, revealing narrowing of the major segments of the aorta, on CT angiography. Based on these angiographic findings diagnosis of TA was made. Outcome: She responded to immunosuppressive therapy. Conclusion : TA though rare, in infancy can present with unexplained myocarditis especially with elevated inflammatory markers and heart failure.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Hyperleukocytosis in pertussis has a correlation with disease severity. We describe a 5-week-old infant with severe pertussis and hyperleukocytosis requiring mechanical ventilation. Baby developed refractory hypoxemia. Two cycles of exchange transfusion were done on different occasions. Exchange transfusion resulted in significant improvement in oxygenation and hemodynamic parameters. Exchange transfusion is a viable treatment option in pertussis hyperleukocytosis complicated by refractory hypoxemia or persistent features of Systemic Inflammatory Response Syndrome.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]