Saving and early discharge of a neonate with severe meconium aspiration syndrome

Surfactant is the treatment of choice in severe respiratory distress syndrome. Intubation, administration of surfactant, extubation (INSURE) is never reported to have been used for meconium aspiration syndrome (MAS) although it is used as the standard method of delivery of surfactant for respiratory distress syndrome. This is a case report of the use of INSURE technique for severe MAS. The baby was born at term gestational age to a primigravida mother by C-section for fetal distress. The baby was vigorous with chest retractions. Hence, the baby was supported with delivery room Continuous positive airway pressure and shifted to Neonatal Intensive Care Unit (NICU). In NICU, the baby was stabilized and given surfactant using the INSURE technique. Subsequently, a chest X-ray showed clearing of lung infiltrates and drastically reduced oxygen requirement of the baby and the baby was discharged early to home.

Clinical Profile of Interstitial Lung Disease in Indian Children.

Objective: To describe the clinical spectrum and factors associated with poor short-term outcomes in children with interstitial lung disease (ILD). Design: Retrospective chart review Setting: Pediatric Chest Clinic of a tertiary care hospital Methodology: We retrieved information regarding clinical course and laboratory features of all children diagnosed as ILD between January 1999 and February 2010. Disease severity was assessed using ILD score based on clinical features and SpO2 at the time of initial evaluation. Outcome was assessed after 3 months of initial diagnosis as improved or death/no improvement in symptoms. Results: 90 children (median age, 6.8 years; 62% boys) were diagnosed to have ILD during this period. 46 children were R E S E A R C H P A P E R classified as having ‘definite ILD’ while 44 had ‘possible ILD’. The commonest clinical features at presentation were cough (82.2%), dyspnea (80%), pallor (50%), and crackles (45.6%). 3 children (3.3%) died while 21 (23%) showed no improvement in clinical status on follow-up at 3 months. A higher ILD score (RR 3.72, 95% CI 1.4, 9.9) and lower alkaline phosphatase levels (median [IQR]: 205 [175.2] vs. 360 [245.7]; P=0.006) were found to be significantly associated with worse outcomes. Conclusion: The common clinical features of ILD in our study included breathlessness, cough and hypoxemia. A working diagnosis of ILD can be made with the help of imaging, bronchoscopy, or lung biopsy. A simple score based on clinical findings and pulse-oximetry might predict those children with poor short-term outcome.