Paediatric inpatient morbidity patterns and drug usage in a teaching hospital serving an underdeveloped area.

Morbidity patterns and drug usage in hospitalized children in a developing area were prospectively studied. The study group consisted of 347 children (age 0-12 yrs) representing all admissions to a paediatric unit over a six month period. Respiratory tract diseases (30.5%) and infectious diseases (26.1%) were the most common reasons for hospitalization. Tuberculosis was the most common infectious disease seen among the hospitalized children. Antimicrobials (60.8%), iron preparations (45.5%), vitamins (43.2%) and antipyretics (29.9%) were the most frequently prescribed groups of drugs. Ampicillin was the most commonly used antimicrobial. Adverse drug reactions were seen in 1.7% of the children. The overall mortality was 9.2%. The mean length of stay was 7.9 days and the mean number of drugs used was 3.4 per patient. More than 4 drugs were prescribed in 54.4% of children. Approximately two thirds received parenteral therapy.

Acute renal failure in children requiring dialysis therapy.

A prospective study over two and a half years analysed 48 children of acute renal failure requiring dialysis therapy. The mean age was 3 years 9 months and M:F ratio was 1.8:1. Renal causes predominated, accounting for 65%, with prerenal and postrenal causes responsible for 19% and 16%. Acute glomerulonephritis was seen in 13 cases, hypovolemia secondary to gastroenteritis in 9, tubular necrosis in 6, and hemolytic uremic syndrome in 5. A delay in seeking medical attention was present in as many as 48%, and was especially common with female children. All had oligo-anuria, with fluid overload present in 18.7%, hypertension in 23%, hypotension in 16.6%, neuropsychiatric manifestations in 20%, and infections in 47%. Peritoneal dialysis was carried out in 95%, and hemodialysis in 6.2%. Urine output and renal function returned to normal within 1.5 to 16 days (mean 5.9) in the survivors. Of the 28 who survived, 19 were followed up regularly for a mean of 4.25 months and all except one had normal renal function. Factors associated with a poor prognosis included female sex, age < 1 year, neurological manifestations, and hypotension, though these were not statistically significant. Mortality in our series was 41.5%. While etiological factors have shown changing trends, mortality still remains high inspite of dialysis.

Difficult to control epilepsy in childhood--a long term study of 123 cases.

One hundred and twenty three children with difficult to control epilepsy (DCE) were studied. Etiological factors which predominated included an age of onset less than 2 years (71.5%), male sex (69%), mixed, secondarily generalized, or complex partial seizures (77%), mental retardation (64%) and neurological abnormalities (52%). Static neurological disease was seen in 63%, with only 17% having idiopathic disease. Identifiable epileptic syndromes were noted in less than half the children. The surface EEG was abnormal in 84%, and correlated with the clinical seizure type in 81%. CT and MRI were helpful in diagnosis in only 38 and 48%, respectively, and even less so in therapy decisions, 7 and 16%, respectively. Prior therapy revealed the use of polytherapy in 61% and suboptimal dosages in 78%. In the 100 patients with adequate follow up, 67% showed a good response, i.e., 35% complete and 32% more than 50% reduction in seizures. Only 11% were total nonresponders, and most were severely retarded. Major treatment strategies employed included switching to monotherapy, supranormal dosages and avoidance of sedative anticonvulsants. Side effects were noted in 41% with 8 cases being life threatening. Overall mortality was 4%. We concluded that risk factors for DCE included early age of onset, mental retardation and certain seizure types. EEG was more helpful than neuroimaging. Treatment responses were favorable, especially in those with normal intellect and the use of normal or high dose monotherapy.

Prevalence of bacteriuria in febrile infants.

Urine samples from 129 admitted febrile infants were collected using the suprapubic aspiration technique, and subjected to routine urinalysis, culture, and antibiotic sensitivity testing. Most of the infants suffered from respiratory tract infections (n = 80) and gastroenteritis (n = 25). Sixty nine patients were male and sixty female. In all, 7 patients had positive cultures (5.4%), indicating a high yield (> 5%). Six of these were female and occurred in patients with gastroenteritis (p < 0.05 for both by chi 2 and Z test). Four patients showed pus cells and organisms on smear, and all of them were culture positive. Another three had only pus cells, but were also culture positive. One patient each, who had pus cells only or organisms only on smear had no growth on culture. E. coli was grown in 6 of these cases, and Klebsiella in one. All cultures were sensitive to ciprofloxacin. Variable sensitivity was seen with gentamicin, streptomycin, and furadantin. The organisms were uniformly resistant to ampicillin and chloramphenicol. The procedure of suprapubic aspiration was safe with no complications. Our findings indicate that bacteriuria is not uncommon in febrile infants even with clinical evidence of other illnesses and that female children, especially those with gastroenteritis, are at most risk. Routine urine cultures in such patients would appear justified.

von Willebrand's disease with gastrointestinal telangiectasia.

A 30-year old woman presented with recurrent and massive bleeding from gastrointestinal tract. Her coagulation profile revealed von Willebrand's disease and her endoscopic examination showed extensive telangiectasia localized to the gastrointestinal tract. The association of Von Willebrand's Disease and telangiectasia is extremely rare and hence the report.

Adverse drug reactions in pediatrics with a study of in-hospital intensive surveillance.

A two-part prospective study of adverse drug reactions (ADRs) in Indian children was carried out at a teaching general hospital. Using an in-hospital intensive surveillance scheme (IISS) for the detection of ADRs, indoor patients of one of the two units in the pediatric ward were monitored daily for 6 months, with the other unit serving as a control group. A total of 347 patients were monitored, 2781 daily orders written and 24,474 doses of 96 different drugs given. Six patients suffered from ADRs (1.73%), and 1 reaction proved fatal (0.29%), while the control group reported only 1 ADR in the same time period. The frequency of ADRs (p < 0.001) and their resultant mortality in Indian children was less than that in a western prototype study. Though IISS showed a marked increase in ADR reporting, it was too cumbersome for routine use in our country. In the second part of the study, 40 cases of ADRs seen over 2 years were analyzed. Antimicrobials, especially sulphonamides, accounted for a high percentage of cases mostly as skin rashes and fairly severe reactions were common. Patients on anti-tuberculous and anti-convulsant drugs required prolonged supervision for late onset reactions.