ABSTRACT
Objectives: To evaluate the prognostic ability of serum ferritin when estimated within 5 days of onset of illness in children with severe sepsis admitted to a pediatric intensive care unit. Methods: This observational study enrolled children aged 1 month to 12 years with severe sepsis. Hemoglobin, serum ferritin and C-reactive protein levels were measured within five days of illness. Final outcomes were recorded in all enrolled children. Results: 70 children with median (IQR) age of 27 (8,108) months were enrolled during the study period (July, 2019 to August, 2021). 28 (40%) of these had poor outcome (nonsurvival). The median (IQR) level of serum ferritin was 1369 (558-5607) ng/mL in nonsurvivors and 282 (129-680) ng/mL in survivors (P<0.05). A significant correlation was seen between serum ferritin and Pediatric Risk of Mortality III (PRISM III) score (r=0.364 P=0.002) and pediatric Sequential Organ Failure Assessment (pSOFA) score (r=0.246 P=0.04) at 48 hours of admission. 54 (77.1%) children were anemic. Serum ferritin levels in children with anemia also had a good predictive ability for poor outcome [AUC: 0.764, 95% CI: 0.634, 0.894]. Conclusions: Serum ferritin levels, within five days of onset of illness, predicted poor outcome in critically ill children with severe sepsis and in children with microcytic anemia.
ABSTRACT
Concerns have been raised in the media that ‘the third wave’ will severely afect children. Here, an experience of SARSCoV-2 infection in children is reported. Of the 8,626 SARS-CoV-2 RT-PCR tests performed in children (0–17 y) from March 2020 to July 2021 at the authors' institute, 1470 (17%) were positive, [711/4821 (14.7%) during the frst wave (July 2020 to January 2021), and 759/3583 (21.2%) during the second wave (February 2021 to July 2021)]. The children in both waves were similar in presentation (74.1% mildly symptomatic versus 80.2% mildly symptomatic; rest asymptomatic). None of them had COVID pneumonia. Five children died (0.3%), all of a serious primary non-COVID disease. Seventy-three cases of MIS-C during August 2020 to July 2021, with low mortality (2.7%) were also identifed. The similarity in COVID-19 infection in children between the frst and the second waves seems to suggest that the likelihood of the ‘third wave’ hitting children hard is low.
ABSTRACT
Objectives: To evaluate the incidence of aminoglycoside-related nephrotoxicity and ascertain drug causality and its risk factors. Methods: This prospective study was conducted from January, 2019 to January, 2021, and recruited 110 consecutively admitted children aged 1 month to 12 years, receiving aminoglycosides for ?4 days. Drug causality was assessed using Liverpool adverse drug reaction causality assessment tool. Results: 42 (38.2%) children developed acute kidney injury (AKI), with 71 (64.5%) having composite nephrotoxicity (AKI and/or tubular-dysfunction). Only 17 (15.5%) had AKI definitively attributable to aminoglycosides. Hypotension [OR 0.016 (95% CI 0.01-0.71), P=0.03], PRISM-III score 20-29% [OR 55.48 (95% CI 3.66-840.53), P=0.004] and post-surgery patients [OR 3.2 (95% CI 1.01-10.1), P=0.047] were independent predictors of AKI. Conclusions: Only a small proportion of children receiving aminoglycosides had AKI definitively attributable to the drug.
ABSTRACT
To study the clinical profile of and complications in children with scrub typhus. Prospective observational study. Tertiary care hospital. Children up to 12 years of age who had a fever for more than five days without an identifiable infection were included. All children who were suspected of having rickettsial infections were defined as having scrub typhus if they had a positive Weil-Felix test result [OX-K 1:80 or more] and one or more of the following clinical features [after exclusion of other diagnoses]: rash, edema, hepatosplenomegaly, lymphadenopathy, an eschar, and a tick bite or tick exposure. Thirty-five children were diagnosed with scrub typhus between February 2010 and February 2011. The age of the patients ranged from 1.5 to 12 years. Edema, crackles/rhonchi, hepatomegaly and hypotension were encountered in 60%, 23%, 91% and 34% of patients, respectively. An eschar was observed in 11% of the cases. Complications included myocarditis with cardiogenic shock in 34% of the cases and acute kidney injury in 20% of the cases. Anicteric hepatitis and thrombocytopenia were observed in 31% and 61% of cases, respectively. One patient died. High incidences of myocarditis and acute kidney injury were observed, which indicates that the children were treated at a late stage of the disease. Clinicians should be cognizant that myocarditis and acute kidney injury are serious manifestations of pediatric scrub typhus. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved