AimChest X ray has been used in diagnosing RDS since long. Lung Ultrasound is an upcoming bedside, point of care modality with no radiation exposure to diagnose RDS. This study aims to compare lung ...ultrasound and traditional chest X ray for diagnosing respiratory distress syndrome.Material and MethodThis study was conducted in level III Neonatal Intensive Care Unit of a tertiary care Hospital. Preterm newborns (GA <34 weeks) with respiratory distress (Downe s greater than 4) within 2 hours of birth, and FiO2 >0.3% were included in this study. Chest X ray and Lung ultrasound were done within 2 hours of birth. Preterm Neonates with FiO2 requirement of >0.4% with RDS were given surfactant. Also neonates with septic shock, Chorioamnionitis, Meconium Aspiration Syndrome and antenatally diagnosed congenital lung disease were excluded from the study. Data was analysed using SPSS software. P Value of <0.5 was significant.ResultsOut of total 180 preterm newborns, We enrolled 70 cases. Mean gestational age was 30.17 + 2.90 weeks. Median Birth weight was 1387 grams (IQR 865 - 1850 grams). As per chest X Ray 72% cases were suggestive of Hyaline Membrane Disease. As per criteria (FiO2 > 40% and RDS) 45.7% (31 cases ) were given surfactant. Lung Ultrasound done within 2 hours of birth was suggestive of RDS in 53.7% cases. Area under Curve for Lung ultrasound was 0.89 and score of 8 was kept cut off.ConclusionsLung ultrasound along with FiO2 requirement has a predictive value to administer surfactant in preterm neonates.
Introduction: Healthcare workers (HCWs) are at higher risk of getting infected with COVID-19 infection due to their close proximity to COVID-19-positive patients. We studied the risk stratification ...and positivity rate in HCWs at risk of getting COVID-19 infection as well as the possible factors responsible for their being at risk of COVID-19 infection during the study period. Material and Methods: This prospective study was conducted after approval by the institutional ethics committee. The data regarding demographic variables, risk stratification, COVID-19 (reverse-transcription polymerase chain reaction) report, and possible sources of exposure for HCWs were recorded in a proforma by personal/telephonic interviews as well as from hospital records from March 2020 to June 2021. The data generated were entered into Microsoft Excel® software and analyzed using percentages, proportions, and Chi-square tests for qualitative variables. Results: COVID-19 infection's positivity rate was 19.5% among high-risk and 0.6% among low-risk HCW contacts. HCWs working in non-COVID-19 areas (67.9%) were more at risk than those working in COVID-19 areas (32.1%). In contrast, the COVID-19 positivity rate was significantly higher among high-risk contact HCWs from COVID-19 areas (34.2%) than in non-COVID-19 areas (12.6%). The maximum COVID-19 positivity rate was seen in high-risk contacts with body fluid exposure (21%), performing aerosol-generating procedures (20%), and close exposure in operation theaters (18%). Conclusions: Risk stratification is an important tool to contain infection among HCWs who had unprotected close contact with a COVID-19-positive case. With appropriate contact tracing, we were able to avoid over- and under-quarantine, save many man-hours as well as contain the spread of infection. HCWs should not only wear appropriate personal protective equipment (PPE) during work hours but should also practice mask-wearing and social distancing while they are in the community.
Abstract
Acute respiratory distress syndrome (ARDS) has high mortality and multiple therapeutic strategies have been used to improve the outcome. Inhaled nitric oxide (INO), a pulmonary vasodilator, ...is used to improve oxygenation. This study was conducted to determine the role of sildenafil, an oral vasodilator, to improve oxygenation and mortality in pediatric ARDS (PARDS). The prevalence of pulmonary hypertension in PARDS was studied as well. Inclusion criteria included children (1–18 years) with ARDS requiring invasive ventilation admitted to the pediatric intensive care unit of a teaching hospital in Northern India over a 1-year period of time. Thirty-five patients met the inclusion criteria. Pulmonary arterial pressure (PAP) was determined by echocardiogram. Patients with persistent hypoxemia were started on oral sildenafil. The majority of patients (77%) had a primary pulmonary etiology of PARDS. Elevated PAP (>25 mm Hg) was detected in 54.3% patients at admission. Sildenafil was given to 20 patients who had severe and persistent hypoxemia. Oxygenation improved in most patients after the first dose with statistically significant improvement in PaO
2
/FiO
2
ratios at both 12 and 24 hours following initiation of therapeutic dosing of sildenafil. Improvement in oxygenation occurred irrespective of initial PAP. Outcomes included a total of 57.1% patients discharged, 28.6% discharged against medical advice (DAMA), and a 14.3% mortality rate. Mortality was related to the severity of PARDS and not the use of sildenafil. This is the first study to determine the effect of sildenafil in PARDS. Sildenafil led to improvement in oxygenation in nearly all the cases without affecting mortality. Due to unavailability of INO in most centers of developing countries, sildenafil may be considered as an inexpensive alternative in cases of persistent hypoxemia in PARDS. We recommend additional randomized controlled trials to confirm the effect of sildenafil in PARDS as determined in this study.
Background: Acute kidney injury (AKI) is common in critically ill children and is associated with poor outcome.
Objective: To study the incidence, risk factors and outcome of AKI in children admitted ...to paediatric intensive care unit (PICU) of a developing country.
Materials and Methods: This prospective observational study was conducted in a tertiary care PICU over one-year period. Critically ill children aged from 2 months to 18 years were included. RIFLE criteria based on GFR, and urine output was used for categorisation.
Results: Of 380 children, 53 children (14%) had AKI (met any of the RIFLE criteria). The most common diagnoses underlying AKI were acute lower respiratory tract infection, CNS illness and severe dehydration. Subjects with AKI had a higher PRISM score (>10) at admission, longer duration of stay and high mortality. Significant risk factors for AKI following multivariate analysis were: age 1-5, PRISM score (>10) at admission, shock, infection, thrombocytopenia, hypo-albuminaemia and multi-organ dysfunction. Twenty-six of 53 subjects fulfilled the maximum RIFLE criteria within 72 h after admission and the mean (SD) time to first RIFLE attend was 1.6 (1.2) day. Subjects with AKI (RIFLE criteria) had 4.5 times higher mortality than those without AKI (36 vs 8%, P< etc).
Conclusion: A high incidence of AKI was noted in the PICU that was associated with high mortality. The RIFLE criterion is an effective tool which can be used not only for predicting the outcomes, but may help in the early identification of patients at risk for AKI.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Objectives: This study was done to determine the effect of malnutrition on mortality in Pediatric Intensive Care Unit (PICU) and on the pediatric risk of mortality (PRISM) scoring. Subjects and ...Methods: This was a prospective study done over 1 year. There were total 400 patients (1 month 14 years), who were divided into cases with weight for age <3 rd centile and controls with ≥3 rd centile of WHO charts. Cases were subdivided into mild/moderate (61-80% of expected weight for age) and severe malnutrition (<60%). Results: Out of total, 38.5% patients were underweight, and malnutrition was more in infancy, 61/104, i.e. 58.5% (P - 0.003). There was no significant difference in vitals at admission. Cases needed prolonged mechanical ventilation (P - 0.0063) and hospital stay (P - 0.0332) compared to controls. Mean and median PRISM scores were comparable in both the groups, but mortality was significantly higher in severely malnourished (P value 0.027). Conclusion: Severe malnutrition is independently associated with higher mortality even with similar PRISM score. There is need to give an additional score to children with weight for age <60% of expected.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This ...study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p < 0.001), with wide limits of agreement. NIBP significantly overestimated BP (p < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years (p < 0.001), with the maximum difference being in infants. It was insignificant in adolescents (p = 0.28) and underweight children (p = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.
Management of Poisonings in Children Puneet Aulakh Pooni; Vikas Bansal
Journal of pediatric critical care,
01/2016, Letnik:
3, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Acute poisoning in children is common problem worldwide, prevalent in rural as well as urban areas. Exposure of a child to such a substance is usually accidental and can cause symptoms and signs of ...organ dysfunction leading to injury or death. This review is intended to discuss general approach to various types of accidental poisoning based on altered physiology in general and history and a physical examination with intent to fit the clinical characteristics into a group of signs and symptoms associated with a particular substance. (also known as TOXIDROMES) Fortunately, very few patients require hospital admission and even fewer patients need treatment in a pediatric Intensive care unit. Most patients will need a period of observation in a monitored bed which could be located in the emergency ward or in a step down level of pediatric intensive care unit The ones who need admission to pediatric intensive care unit are usually critical if organ dysfunction sets in. The challenge to the pediatric Intensivist tends to be institution of supportive treatment promptly, as well as, to institute specific antedote therapy (if available) as soon as feasible. To the physician examining the patient a challenging issue is to determine which ingestions are potentially high risk and which are Inconsequential. Alluminium phosphide, organophosphorous compounds, kerosens oil ingestion can result in life threatening problems in affected children, are therefore reviewed in greater detail. Most poisonings can be managed by supportive treatment in the PICU.
This prospective study was carried out to evaluate the clinical and anthropometric profile of 71 children confirmed to have celiac disease on the basis of clinical features, duodenal biopsy and ...unequivocal improvement on gluten-free diet. Serological tests were performed in 35 cases. The patients were divided into three age groups <5 years, 5–10 years, and >10 years as per the age of presentation to the hospital. Mean age was 8.7 years with a slight female preponderance. Diarrhea was the commonest presentation in group I and failure to thrive in group III. All patients in group III, had weight for age (w/a) <3rd percentile and majority (83 per cent) had short stature, with delayed puberty in all. All children had significant improvement in symptoms and growth on gluten restriction. None of the patients had been suspected to have celiac disease before, which signifies that in spite of increasing incidence of celiac disease, this disease is grossly under-diagnosed in North India where wheat is the staple diet. It is essential to make an early diagnosis of celiac disease in children to prevent growth delay.
Aim
Paediatric intensive care is a fast‐growing specialty in India. There are studies on parental stress in paediatric intensive care unit (PICU) in developed countries, but limited data from ...developing countries, where many factors may be different, are available. This paper describes various stressors in Indian parents.
Method
One hundred parents were interviewed using the Parental Stress Scale (PSS: PICU), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful).
Results
The average parental stress score was 3.0. The main causes of extremely stressful situations were: the parents' child having breathing difficulty; their child suffering pain; their child being unresponsive; crises in other children in the PICU. Factors least associated with stress included: not being alone with baby; and the presence of monitors and equipment. Nearly all parents (99) felt that prayer was of help. The majority (67) felt stressed during procedures, and 59 parents felt stressed by the sights and sounds of the PICU. Factors significantly related to increased stress included: the severity of illness as measured by higher paediatric risk of mortality scoring (P = 0.0136); for mothers rather than fathers (P = 0.0054): for parents <30 years (P = 0.0114); and parents of a male child (P = 0.0482).
Conclusions
It is concluded that there is significant stress among parents of children admitted to an Indian PICU, and stress factors are different from studies done in developed countries. Mothers and young parents were more stressed. Type of family, income, education, number and age of children did not affect level of stress.
Aim
Paediatric intensive care is a fast‐growing specialty in
I
ndia. There are studies on parental stress in paediatric intensive care unit (
PICU
) in developed countries, but limited data from ...developing countries, where many factors may be different, are available. This paper describes various stressors in
I
ndian parents.
Method
One hundred parents were interviewed using the
P
arental
S
tress
S
cale (
PSS
:
PICU
), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful).
Results
The average parental stress score was 3.0. The main causes of extremely stressful situations were: the parents' child having breathing difficulty; their child suffering pain; their child being unresponsive; crises in other children in the
PICU
. Factors least associated with stress included: not being alone with baby; and the presence of monitors and equipment. Nearly all parents (99) felt that prayer was of help. The majority (67) felt stressed during procedures, and 59 parents felt stressed by the sights and sounds of the
PICU
. Factors significantly related to increased stress included: the severity of illness as measured by higher paediatric risk of mortality scoring (
P
= 0.0136); for mothers rather than fathers (
P
= 0.0054): for parents <30 years (
P
= 0.0114); and parents of a male child (
P
= 0.0482).
Conclusions
It is concluded that there is significant stress among parents of children admitted to an
I
ndian
PICU
, and stress factors are different from studies done in developed countries. Mothers and young parents were more stressed. Type of family, income, education, number and age of children did not affect level of stress.
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