Utility of lung ultrasound in childhood pneumonia in a tertiary care center

Background: Pneumonia is a major cause of childhood mortality and morbidity worldwide. Chest radiography has been used as a modality for diagnosing but has the disadvantage of radiation exposure and inter-observer variability. Hence studies have explored the possibility of using lung ultrasound in the diagnosis of pneumonia. To assess lung ultrasound (LUS) findings in childhood pneumonia and to correlate lung ultrasound findings with clinical findings.Methods: 210 children between 2 months to 5 years admitted in the hospital with diagnosis of pneumonia were enrolled in the study. They underwent LUS within 24 hours of admission and the results were analysed.Results: Out of the 210 patients enrolled in the study, 41 (19.5%) had positive LUS findings. However, LUS findings correlated well with clinical findings in cases with very severe pneumonia.Conclusions: This study showed that lung ultrasound cannot be used a sole diagnostic tool in childhood pneumonia, but it has a valuable role in detection of complications. Lung ultrasound will require more training for detection of early indicators of pneumonia.

Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

Clinicopathological profile of rickettsial fever in tertiary healthcare centre: a prospective case study

Background: Rickettsia are obligate intracellular proteobacteria spread by eukaryotic vectors like ticks, mites, fleas and lice. Rickettsial infections are generally incapacitating and difficult to diagnose; Case fatality rates up to 45 percent is seen in cases with multiple organ dysfunction. The disease continues to be under diagnosed and treated. Objective of this study was to study the clinicopathological profile and outcome of children admitted with rickettsial fever. To study the correlation between Rathi-Goodman-Aghai score and Weil-Felix test. To study the response of rickettsial fever to Doxycycline.''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''Methods: This study is a prospective observational study conducted from December 2017 to April 2019 at a tertiary health care center in South India, involving patients admitted between 2 months to 18 years of age with a diagnosis of Rickettsial fever. Clinical data and investigations were collected and analysed. The response to doxycycline was recorded.'''''''''''''''''''''''''''''''''''''''''''''''' '''''''''Results: Total of 49 patients were enrolled in the study. Most common age group affected was between 1 to 5 years accounting for 32.7% of the cases. 78% of the patients hailed from rural background. Most common presentation being fever, present in 100% of the cases. 81.6% of patients had significant Rathi-Goodman-Aghai score of >14. Weil felix showed significant titres (1:80) in 97.9% out of which serology suggestive of scrub typhus was found in 79.6% patients. There was no statistical significance between rickettsial score and Weil-Felix test (p value= 0.736). 26.5% of the cases required respiratory support and 2% cases required dialysis. 10.2% cases succumbed and 89.8% cases improved.Conclusions: Rickettsial infection is re-emerging with propensity for life threatening complications. There is no statistical significant correlation between Rickettsial score and Weil Felix test. Early treatment has better outcome.

A randomised control trial comparing the efficacy of cord milking over the delayed cord clamping on serum ferritin level in preterm neonates at 6 weeks of age

Background: Perinatal iron deficiency has received little attention in the past. Umbilical cord milking is a type of placental transfusion, they serve to potentially enhance neonatal blood volume and consequently the iron stores after birth. Among the neonates, the preterm infants are sick and vulnerable babies who are already deprived of iron stores. The aim of this study was to evaluate the effect of cord milking on ferritin values amongst preterm neonates.Methods: This is a hospital based randomized control trial which included the babies born at 29-36 weeks of gestation. The babies were randomized to two intervention groups; cord milking and delayed cord clamping group. Detailed clinical history taken, including details of labour and clinical examination. Blood samples were analysed for ferritin as required at 6 weeks of post-natal age.Results: Neonates under cord milking group had higher ferritin values (249.04'21.93 ng/mL) as compared to those neonates under delayed cord clamping group (179.66'32.94 ng/mL) and this was statistically very significant (p= <0.001).Conclusions: In preterm neonates, umbilical cord milking results in improved iron status as shown by higher ferritin values at 6 weeks of life. UCM can be a used as placental transfusion strategy in preterm neonates for improving iron status and preventing anemia of prematurity.

Study of changes noted in the platelet count in cord blood of neonates born to hypertensive mothers in a tertiary care hospital, Bangalore, India

Background: Hypertensive disorders of pregnancy pose several problems to both mother and newborn. Complications in new-born like intrauterine death (IUD), intrauterine growth retardation (IUGR), perinatal asphyxia, neonatal sepsis and bleeding disorders are associated with toxemia of pregnancy. To decrease the perinatal morbidity and mortality, babies of hypertensive mothers should be carefully monitored and managed. Aim of this study was to establish the changes in total platelet count in umbilical cord blood.Methods: This is a hospital based prospective observational study which included the babies born to mothers having hypertensive disorders of pregnancy, total cases accounting about 158. Detailed clinical history taken including details of labour and clinical examination done.' In all the subjects, 2 ml of umbilical cord blood anticoagulated with EDTA was collected and haematological tests for total platelet count (TPC) count was done.Results: This study shows that the incidence of neonatal thrombocytopenia is 43.67%. The incidence of sepsis among thrombocytopenia group accounts for about 60% in gestational hypertension, 64.2% in pre-eclampsia and 50% in eclampsia group.Conclusions: With respectively, these findings it can be concluded that the incidence of Neonatal Thrombocytopenia is significantly higher in babies born to HDP mothers and it can be taken as a marker to evaluate Sepsis in such a situation in resource limited setting. As less number of studies is available in this area of interest, this study supports the cause.

Severe haemoptysis in a 5 year old child with Kartagener's syndrome: case report

Kartagener`s syndrome, a rare autosomal recessive disorder is a type of Primary Ciliary Dyskinesia (PCD) associated situs inversus, bronchiectasis, sinusitis and male infertility. We present a case of a 5-year-old girl who came with features of bilateral glue ear, recurrent sinusitis, recurrent hemoptysis and dextrocardia. She was diagnosed to have Kartagener`s syndrome and was evaluated for recurrent hemoptysis.

Acquired generalized lipodystrophy type 2-lawrence syndrome: a rare case report

Lawrence syndrome (Acquired Generalized Lipodystrophy) is a rare disorder, characterized by various dermatological and systemic manifestations such as lipodystrophy, hypertriglyceridemia, hepatomegaly, acanthosis nigricans and acromegaloid features. Because of its rare occurrence we are reporting a case with similar manifestations in a 10 years old child.

Study to correlate sepsis markers and blood culture in neonatal sepsis

Background: Neonatal sepsis forms the second most common cause of neonatal mortality resulting in more than one million neonatal deaths per year. Neonatal sepsis, pneumonia and meningitis together result in one- fourth of all newborn deaths. Objectives of the study was to correlate sepsis markers with blood culture in neonatal sepsis.Methods: A cross sectional study was carried out in the NICU unit under department of Pediatrics, between November 2017 and May 2019. Sample size was 50. Babies admitted to NICU with clinical suspicion of sepsis were included in the study. Blood samples from these babies were collected under aseptic precautions and subjected to rapid diagnostic tests- sepsis markers and blood culture.Results: Male were predominant (64%). Important risk factors were preterm and low birth weight. Blood culture positivity was 20% (E. coli being most commonly isolated organism). CRP had a high sensitivity of 90% and low specificity of 47%. Procalcitonin had highest sensitivity of 100% and low specificity of 47.5%.Conclusions: CRP and PCT were found to be statistically significant (p=0.036 and 0.01), can be used as a diagnostic tool in neonatal sepsis.

Clinical profile of hypernatremia in exclusively breast-fed neonates

Background: Neonatal hypernatremia is a potentially lethal condition. This study was planned to find out the predisposing factors and outcome of hypernatremia in breast feed late preterm and term neonates.Methods: In defined study period, neonates with serum sodium level >145mmol/L, who satisfies all the inclusion criteria are included in the study.' The data was collected using a proforma which included clinical symptoms, risk factors for neonatal hypernatremia in addition to laboratory data.Results: The results demonstrated hypernatremia in 63 neonates with mean age of presentation being 4.5 days, mean sodium level of 154.2 and average weight loss was 13.2%. Neonates admitted at older age >7days had higher sodium concentration with mean of 162.5mmol/L. Serum sodium levels correlates positively with percentage of weight loss and correlates negatively with birth weight and was statistically significant with p value <0.05. 41(65%) of mothers were primipara, 37(58%) had delivered by LSCS and 39(62%) had lactation issues postnatally. Most common presenting symptom was jaundice in 44(71%), followed by fever in 38(61%).Conclusions: Hypernatremic dehydration can be prevented by counselling about importance of breast feeding for the mothers starting from antenatal period, early initiation of breast feeding, addressing lactation issues and monitoring daily weight.