Background: A spontaneous breathing trial (SBT) is often used to decide about extubation readiness in mechanically ventilated patients. Studies done to identify the best method of SBT have shown variable results. As there was no published data comparing continuous positive airway pressure (CPAP) and T piece, this study was conducted to compare CPAP and T piece as method of SBT for postextubation outcomes. Subjects and Methods: This study was a pilot randomized controlled trial conducted at a tertiary care pediatric intensive care unit (PICU) from November 2018 to October 2019. Criteria for starting SBT and to identify trial as failure were predefined. Sixty patients were included in the study and randomly assigned to CPAP and T-piece group, of 30 each. Demographic data, diagnosis, duration of mechanical ventilation (MV), endotracheal tube size, need of inotropes, vasopressors, and sedation were all recorded. The primary outcome of the study was extubation failure within 48 h. The secondary outcomes studied were mortality, need of respiratory support, duration of oxygen requirement, and length of PICU (LOPICU) stay after extubation. Results: Age, gender, indication of intubation, duration of MV, and number of SBT attempts were similar in both the groups. There was no statistically significant difference in extubation failure within 48 h between the two groups. Four patients were reintubated in both the groups and two patients died in T piece group and one patient in CPAP group. Postextubation respiratory support, duration of oxygen therapy, LOPICU stay, and mortality were not significant different between the two groups. Conclusion: There was no significant difference in extubation outcomes when CPAP and T piece were used as methods of SBT.

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Background: Plasmalyte A, a balanced solution is reported to be associated with a reduced incidence of hyperchloremia and metabolic acidosis when compared with 0.9% NaCl among adults. Considering the paucity of evidence in the pediatric population, the present study was conducted with an objective to compare the efficacy and safety of plasmalyte and normal saline as intravenous fluid bolus therapy in children with shock in terms of Electrolytes and Acid-base balance at admission and at 6 h. Subjects and Methods: This double-blinded, randomized controlled trial was conducted in the pediatric emergency department (ED) of a tertiary care hospital among children aged 1 month to 14 years who presented to the ED with shock. A total of 400 children were randomized to receive either plasmalyte or 0.9% saline solution as intravenous fluid bolus therapy. Changes in laboratory parameters including pH, serum bicarbonate levels, serum lactate level, and serum electrolytes-sodium, potassium, chloride levels from baseline (hour 0) to hour 6 were compared in both groups. Secondary outcomes included the need for vasopressors, duration of hospital stay, and in-hospital mortality. Results: The two groups were similar in terms of baseline clinical characteristics. Patients receiving plasmalyte demonstrated significantly greater improvement in the pH (P = 0.001), bicarbonate (P = 0.001) and lactate levels (P = 0.03) compared with patients receiving normal saline. In addition, normal saline group patients had a higher rise in sodium (P = 0.11) and chloride levels (P = 0.02) as compared to the plasmalyte group. The children who received plasmalyte had a significantly lesser need for vasopressors (P = 0.04), shorter mean duration of hospital stay (P = 0.01), and lower mortality (P = 0.03). Conclusion: Plasmalyte was superior to Normal saline when used as a resuscitation fluid in children with shock, in terms of better improvement of acid-base balance after fluid bolus therapy, a lower rise in serum chloride level at 6 h from baseline, shorter hospital stay, lesser need for vasoactive drugs and lower mortality.

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We describe radioclinical findings in a 4-year-old male child with enteric encephalopathy. Magnetic resonance imaging brain showed lesions in the corpus callosum with restricted diffusion in the white matter of bilateral cerebral hemisphere. Mild encephalopathy with reversible splenial lesion has been described in children and adults due to various causes, although very few have been reported due to enteric fever.

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Plastic bronchitis, a rare but serious clinical condition, is commonly seen after Fontan surgeries in children. It may be a manifestation of suboptimal adaptation to the diversion of systemic blood flow directly into the pulmonary circulation, thereby leading to unfavorable hemodynamics, which causes the formation of bronchial casts. We hereby report a child who had not responded to conventional medical management of the bronchial casts. He was then subjected to cardiac catheterization where balloon dilatation of the Fontan fenestration was done, following which he remained asymptomatic for 3 months of follow-up.

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Atypical hemolytic–uremic syndrome (aHUS) is a form of thrombotic microangiopathy that occurs due to dysregulation of alternate pathway of complement system, which progressively causes systemic complications, end-stage renal disease, and death. As prognosis is poor compared to typical hemolytic–uremic syndrome, early diagnosis and treatment is crucial for favorable outcome. We came across seven patients of aHUS in our pediatric intensive care unit in the last 5 years. Plasma exchange (PE) along with immunosupressives was used for treatment. First child who did not receive PE died. Rest six patients underwent PE and attained hematological remission; however, one later on progressed to chronic kidney disease and expired. All others are on regular follow-up and doing well. A high index of suspicion is required to diagnose aHUS. Early PE can give a better prognosis.

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The availability of anti-staphylococcal antibiotics today has revolutionized the treatment strategies to fight Staphylococcus aureus. However, its virulent nature still remains a major cause of morbidity and mortality, especially in the pediatric age group. It presents with a wide spectrum of illnesses ranging from minor skin and soft-tissue infections to fatal necrotizing pneumonia and disseminated disease. However, its presentation as meningitis with septic venous sinus thrombosis in pediatrics remains a rare complication till date. We present the case of an 8-month-old girl child with disseminated staphylococcal disease (DSD) caused by community-acquired methicillin-sensitive S. aureus and complicated by acute mastoiditis, meningitis, and cerebral venous sinus thrombosis. This rare and severe manifestation of DSD was managed successfully with intravenous antibiotics and systemic anticoagulation.

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Individual genetic disorders are rare but cumulative prevalence of these disorders is high. Genetic diagnostic armamentarium has expanded with introduction of next generation sequencing techniques. A qualified geneticist can be of invaluable help in applying suitable genetic test and analyzing the results. We present 3 cases highlighting how involving qualified geneticist in daily round can help in detecting rare disorder even when clinical picture is not suggestive of a genetic disorder.

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The concept of neonatal and pediatric airway team is somewhat new in India. : In Western countries, though this concept has been established recently, it remains only limited to children's hospitals. We report the case of a 15-month-old girl with failure to thrive and critical life-threatening severe subglottic stenosis. She was managed in a comprehensive manner by multidisciplinary pediatric airway team at a tertiary-level children's hospital.

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Respiratory illnesses and failure are common in pediatric population compared to adults due to anatomical and physiological differences in respiratory system. Respiratory acidosis is commonly seen in intensive care settings and needs immediate attention. Treatment depends on underlying pathology and mechanical ventilation. Respiratory alkalosis is least common only mainly iatrogenic or child is hyperventilating.

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Background: For any research, it is important to ensure that an establish instrument conforms to the culture of the population in focus. The objectives of this study include translation of the Parental Stressor Scale: Pediatric Intensive Care Unit (PSS: PICU) questionnaire into Malayalam and the analysis of its psychometric properties. Subjects and Methods: This was a cross-sectional study of 201 parents of children admitted to the PICU. The PSS: PICU questionnaire was first translated into Malayalam language using the standard “Forward-Backward” procedure. Following consent, parents completed the demographic sheet and the Malayalam version of PSS: PICU scale within 30 min. Results: Analysis showed good psychometric properties for the Malayalam PSS: PICU questionnaire when compared to the original English version. The principal component factor analysis with Varimax rotation was used to assess the validity and was found to favor the conceptual dimensions of the original English questionnaire. The Cronbach's alpha coefficient used to assess reliability was 0.865 for the entire scale reflecting good internal consistency. Conclusion: The PSS: PICU questionnaire was translated to Malayalam and the psychometric properties of the Malayalam version were found to be adequate, albeit requires further exploration before extensive use.

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