Antimicrobial Justification form for Restricting Antibiotic Use in a Pediatric Intensive Care Unit.

Objective: To study whether introduction of an ‘antimicrobial justification form’ deters clinicians from prescribing restricted antimicrobials and results in de-escalation of these antimicrobials. Methods: Clinicians were asked to fill a justification form if prescribing an antimicrobial from the pre-identified restricted group. Antimicrobial usage pattern over next year was compared with that in the one year preceding the introduction of justification form. Results: Significant overall decrease in antimicrobial usage (40.5% vs 34.6%) was noted in the post-intervention group along with a significant increase in the de-escalation of antibiotics. Conclusion: Introduction of a justification form before prescribing antimicrobials or at the time of deferring de-escalation can be useful in restricting usage of antimicrobials

Papaverine for Ischemia Following Peripheral Arterial Catheterization in Neonates.

11 Extremely low birth weight neonates who developed skin discoloration after peripheral arterial catheterization were given intra-arterial papaverine before the removal of arterial line. The skin color turned normal in all these neonates and none developed residual damage. In 3 neonates who could not receive papaverine, one developed gangrene of fingers.

Safety and Efficacy of Intravenous Colistin in Children.

Objective: To observe the safety and efficacy of Colistimethate sodium in children infected with gram-negative bacteria, susceptible only to colistimethate sodium. Methods: This prospective observational study done over 2 years observed children who received colistin for >48 h, for renal failure as defined by p-RIFLE criteria. Results: Out of 68 children, 52 (76.5%) survived. There were three children with evidence of acute kidney injury and none had neurotoxicity. Serum creatinine significantly decreased at 48 h and at end of treatment, from that at beginning of therapy (P=0.007). Conclusion: Colistimethate sodium is effective against carbapenem-resistant Gram-negative bacteria, and is safe in children.

ATP-binding Cassette Transporter A3 (ABCA3) Mutation in a Late Preterm with Respiratory Distress Syndrome.

Background: Surfactant protein abnormalities are rare causes of respiratory distress syndrome. Case characteristics: A late preterm (36 wks) who presented with respiratory distress syndrome.Observation: He was found to be a homozygous for a G to T transversion at the first base in intron 24, of ABCA3 gene which is necessary for lamellar body formation and surfactant production. Outcome: He died of severe respiratory failure even after multiple doses of surfactants and ventilation. Message: Surfactant deficiency with ABCA3 gene mutation needs to be suspected in late preterms who present with respiratory distress syndrome.

Respiratory Flutter Syndrome in a Neonate.

Respiratory flutter or diaphragmatic flutter is a rare disorder characterized by involuntary, high frequency contractions of the diaphragm. Only 7 cases are reported in infants till date. The present case presented with life threatening respiratory distress immediately after birth. In view of high respiratory rate of 120-154 per minute, clinical and fluoroscopic evidence of diaphragmatic contraction and absence of any obvious CNS, cardiovascular and respiratory pathology, respiratory flutter was diagnosed. It was also associated with dysphagia and laryngomalacia. The patient was managed with prolonged continuous positive airway pressures (CPAP) with partial success, but symptoms improved with use of chlorpromazine.

Rescue High Frequency Oscillation in Neonates with Acute Respiratory Failure.

The aim was to study the efficacy of rescue High Frequency Oscillatory Ventilation (HFOV) in improving the oxygenation and ventilation in neonates with acute respiratory failure after failing Conventional Mechanical Ventilation (CMV). Primary outcome was short term oxygenation, lung recruitment, and ventilation and secondary outcome studied was survival. 675 babies were ventilated and 97 of them received HFOV. HFOV significantly improved oxygenation index, alveolararterial oxygen gradient, pH, PCO2, PO2 and caused better lung recruitment within 2 hours. Fifty seven babies (58.77%) survived and the mortality was more in <28 weeks, babies with pulmonary hemorrhage, sepsis and CDH.

Prolonged neonatal interhospital transport on road: Relevance for developing countries.

Objective. To compare prolonged inter hospital long distance transports on road undertaken by a qualified transport team vs those done by the same team from shorter distances and time. Methods. Retrospective descriptive comparative study of the neonatal transports done during a period of 48 mo. All neonates transferred on road to a tertiary level pediatric hospital from various maternity and pediatric centers. The biochemical characteristics, adverse effects during transport and 24 hr survival after the transport in both the groups were compared. Results. The babies were comparable in their gestational age and ventilatory requirements (46% vs 39%). The biochemical and metabolic characteristics and 24 hr mortality rates for babies who were transported for longer times and distances were comparable (p value =0.75) to those transported for shorter times. Conclusion. Long distance neonatal transport on road is feasible and with a qualified team results can be comparable to those transported from shorter distances.

Long distance neonatal transport--the need of the hour.

This study compares the inter hospital long distance transports undertaken by a qualified transport team versus those done by other means. This was a retrospective descriptive comparative study of the neonatal transports done during a period of 33 months from various maternity and pediatric centers to a pediatric tertiary referral centre. We found that biochemical and temperature disturbances are more common in babies transported on their own and a specialized neonatal transport service could improve the survival of these babies. Survival was 96.2% (154/160) and 89% (114/128) in the two groups, respectively (P=0.03).