Readmission to paediatric intensive care unit: frequency, causes and outcome

Readmission to intensive care units is considered to be an important quality indicator in ICU settings. This study was carried out at the paediatric intensive unit [PICU] and step down units of paediatric ward at the Aga Khan University Hospital, Karachi, Pakistan, to assess the frequency, common causes and outcome of patients readmitted in PICU within 48 hours after discharge from unit. During the study period, 1022 patients were admitted in PICU, out of which 24 [2.34%] patients required readmission. Male to female ratio was 1.2:1. The mean length of stay on paediatric floor before readmission was 24 hours. Fifteen [62%] patients were readmitted due to worsening of primary condition while 9 [38%] developed new problems. Respiratory problems accounted for 15 [62.5%] of readmissions, followed by cardiovascular 4 [16.5%] and sepsis related causes 3 [12.5%]. The mortality rate of readmitted patients was 21% [5/24] in this study as compared to overall PICU mortality of 122 [11.93%]

Frequency of cardiorenal syndrome type-I in hospitalized children with acute heart failure in a tertiary-care hospital

To determine the frequency of cardiorenal syndrome in hospitalized children with acute heart failure. Descriptive study. Paediatric Intensive Care Unit, The Aga Khan University Hospital, Karachi, from December 2010 to December 2011. Sixty eight [68] children with acute heart failure fulfilling the selection criteria were evaluated for worsening of renal function [WRF]. Serum creatinine was done at baseline and repeated at 72 hours to see the worsening of renal function. Estimated serum creatinine clearance was calculated by Schwartz formula. Mean age of patients was 43.6 +/- 55.2 months. There were 43 [63%] males, 70% were under 57 months of age. Mean weight on admission was 14.7 +/- 19.13 kg and mean height was 83 cm [ +/- 31.08 SD]. Mean serum creatinine on admission was 0.77 mg/dl [ +/- 1.18 SD]. Worsening renal function was noted in 55 [81%] of children, out of those, majority 36 [70.5%] were under 5 years of age. Worsening renal function was found in 81% of children admitted with the diagnosis of acute heart failure. Majority [70.5%] were under 5 years of age indicating a closer observation of renal status in younger age group to reduce, morbidity and mortality

Botulism in children: a diagnostic dilemma in developing countries

Botulism is a well-known disease of the neuromuscular junction. It is a rare but curable cause of paralysis in paediatric population. In addition to classical clinical signs and symptoms, the diagnosis of botulism requires laboratory confirmation of intoxication by various biological tests. These include demonstration of botulinum toxin in serum or isolation of the Clostridium botulinum from stool/gastric aspirates. However, it is not always possible to confirm intoxication due to unavailability of technical facilities, especially in resource limited countries like Pakistan. Under these circumstances, electrophysiological studies serve as an excellent diagnostic tool. These studies can provide quick diagnosis of botulism so that early administration of botulism immunoglobulin, if available, can reduce morbidity, mortality and length of stay in hospital. We report a case of botulism from Pakistan diagnosed on the basis of electrophysiological studies

Elective tracheostomy in mechanically ventilated children

Tracheostomy is an important procedure in children requiring prolonged mechanical ventilation. We conducted a retrospective study to assess the frequency, indications, postoperative course and short-term outcome of elective tracheostomy in a Paediatric Intensive Care Unit [PICU] of Pakistan. Twenty-five patients underwent tracheostomy in last 5 years [2.2% of all PICU admissions]. Mean age of patients was 6 years and 60% were male. The most common indication for tracheostomy was prolonged mechanical ventilation secondary to neurological disease [60%], followed by upper airway obstruction [40%]. Major complications included accidental decannulation [20%] and tube obstruction [20%]. Three patients [12%] developed ventilator-associated pneumonia after tracheostomy change while persistent bacterial colonization of trachea was observed in 8 patients [32%]. Decannulation was achieved in 40% [10/25]. There was no mortality related to tracheostomy in this series

Acute necrotizing encephalopathy of childhood: a fatal complication of swine flu

Acute necrotizing encephalopathy of childhood [ANEC] is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu [H1N1]. He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health care issue these days