ABSTRACT
Background: Neonatal sepsis is a syndrome causing severe organ dysfunction triggered by a dysregulated host in response to an infection, affecting millions of neonates. In such situations, early identification and management in the initial hours dramatically improves the outcome. Hence, it was taken up to study the incidence, clinical profile and short-term outcomes of neonates with septic shock.Methods: Hospital based prospective observational study on 95 neonates admitted to neonatal intensive care unit in the department of Paediatrics at Acharya Vinobha Bhave rural hospital, Sawangi, Wardha from 1st August 2016 to 31st July 2018.Neonates diagnosed with septic refractory shock were enrolled after taking IEC approval and assent form and those with non-septic aetiology shock were excluded. Statistical analysis was done to establish correlation between neonatal variables and outcome.Results: 95 neonates fulfilled the inclusion criteria and were recruited. Out of these, 37 and 53 were outborn and inborn respectively. Maximum neonates were preterm and males. Neonates with birth weight 1000-1499 grams to those less than 1000 was 4.2:1. Normal vaginal delivery was more common as compared to lower segment caesarean section (LSCS). Blood culture positivity was in 44.2%. Age of presentation with shock ranged from 1 to 20 days and duration of shock ranged from 2 hours to 192 hours. Most infants were ventilated (84%) and it was more among those who died.Conclusions: Septic shock is the most common type, carrying high morbidity and mortality (more than 60%). Laboratory and clinical parameters (TLC, Platelet count, CRP, Blood culture, duration of shock, HR, RR, BP or arterial blood gas) (p>0.05) did not carry a prognostic value in predicting the outcome of such neonates. Early identification and intervention remains the key in managing such a challenging neonatal condition.
ABSTRACT
Introduction: Role of transcranial Doppler in prevention of stroke in sickle cell children has been well appreciated. Studies are being done to develop the protocol in children. Since we don’t find stroke very commonly in this part of the world, this study was done in order to see the prevalence of abnormal flow velocity in sickle children attending sickle cell clinic. The aims of this study were to measure mean flow velocity in different vessels in homozygous sickle cell patients using transcranial Doppler study, to compare the mean velocity in sickle children with age and sex matched controls and to correlate mean velocity with headache or stroke if any and also to correlate mean velocity with number of transfusions. Materials and Methods: The study was done in Paediatric wards. It was a prospective crosssectional comparative study. Twenty six children below 14yrs of age with homozygous sickle cell disease attending the Sickle cell clinic were selected as the cases. Forty cases of similar age and sex were recruited as normal control group. Transcranial Doppler was done in six different vessels in both the groups and mean flow velocity was measured. Mean flow velocity was correlated with symptoms and number of transfusions. Velocity was classified as normal (<170cm/sec), conditional (170-199cm/sec) or abnormal (>200cm/sec). Statistical analysis was done using SPSS 10 software. Results: In normal age and sex matched controls mean blood flow velocity was 50cm/sec where as in the cases of sickle cell disease was 180cm/sec. Maximum mean velocity was observed in middle and posterior cerebral artery. In two Sickle cell cases (8%) blood flow velocity was abnormal, these children had headache though received 5-10 transfusions/year. In only 4% sickle cell children flow velocity was normal and rest had conditional velocity. Among these children 39% received less than 5 and rest received 5-9 transfusions /yr and had no symptoms of stroke. Conclusions: Flow velocity measured by Transcranial Doppler is highest in middle cerebral artery and Posterior cerebral artery which appear to be the best arteries for this test in this region. Flow velocity was significantly high in children with sickle cell disease as compared to normal children. Prevalence of abnormal flow velocity in our children was 8% and children with abnormal mean flow velocity presented with headache.