Profile and outcomes of in-hospital cardiac arrest in a paediatric emergency department.

A retrospective study was conducted to determine the profile and outcome of patients who experienced in-hospital cardiac arrest (IHCA) in an emergency department (ED), from January to December 2017. Newborns of day one till children 14 years of age who suffered cardiac arrest during their stay in the ED of National Institute of Child Health, Karachi, Pakistan, were included in the study. The outcome variables were the return of spontaneous circulation and survival before final discharge from the ED. IHCA was observed in 935 (4.82%) out of the 19,385 children studied, while in 568 (61%) children spontaneous circulation was restored. Most of the patients who suffered IHCA were infants, i.e. 719 (77%). A significant association of return of spontaneous circulation and survival till final discharge from the ED was observed with age (p-value <0.001) and mode of arrival at the hospital (p-value <0.001). Thus, IHCA was reported in approximately five percent of patients and return of spontaneous circulation was reported in 61 percent.

Profile and outcomes of critically ill children in a lower middle-income country.

OBJECTIVE: To determine the clinical profile and outcome of critically ill children presenting to a paediatric ED in a lower middle-income country. METHODS: We performed a retrospective analysis of children (<14 years) presenting to the ED of the National Institute of Child Health, Karachi, between January and December 2014 who were assigned to acuity 1 (requiring immediate life-saving interventions) according to the Emergency Severity Index. Data included demographic variables, presenting complaints, interventions and outcomes in the ED. RESULTS: There were 172 162 visits during the year. Of these, 13 551 (8%) were level 1. 64% of level 1 patients were transported to the ED without ambulance service. Neonates (0-28 days) constituted 48% of level 1 children; their most frequent presenting complaints were respiratory symptoms, followed by fever and reluctance to feed. Above the neonatal age group, the most common presenting complaints were gastrointestinal symptoms (with signs of hypoperfusion), followed by seizures, reluctance to feed and respiratory symptoms. 64% of children of >28 days presenting were malnourished. Interventions included cardiopulmonary resuscitation, application of bubble continuous positive airway pressure and endotracheal intubation. Overall mortality was 13%; 63% of all deaths were in the neonatal age group. CONCLUSION: Children with the highest triage acuity represent 8% of all visits to a paediatric ED. In this group, neonates account for nearly half of all the children, and more than half of all the deaths among critically ill children came in ED. A large proportion of high-acuity children are malnourished.

Overcrowding and possible solutions for a busy paediatric emergency department.

OBJECTIVE: To quantify the extent of emergency department overcrowding in a tertiary care hospital and to identify possible solutions. METHODS: This retrospective study was conducted at the National Institute of Child Health, Karachi, and comprised data of all patients presenting to the emergency department from November 2014 to January 2015. Data was collected through the health management information system which generates daily report of patients. Patients who stayed at the emergency department for 4 or more hours were included. RESULTS: Of the 6,505 patients, 2,757(42.38%) were discharged straightaway while 2,555(39.27%) were admitted to different wards and subspecialties. Besides, 934(14.35%) patients left the department against medical advice, 147(2.25%) expired, 89(1.36%) were referred to other hospitals, 20(0.30%) were dead on arrival and 3(0.04%) left without being seen by a physician. Of those who were admitted, 1,049(41%) patients stayed for more than 10 hours before getting the main hospital bed. Mostly, the delays observed were due to delay in getting lab reports, already preoccupied ventilators and incubators in paediatric and neonatal intensive care units, not using checklist for proper re-assessment of patients and early discharge, overburdened by patients coming in just for nebulisation and intravenous or intramuscular medications, the admitting residents detain the unstable patient longer in emergency department before admission to wards. CONCLUSIONS: The emergency department of the hospital faced significant overcrowding which overwhelmed efficient standard care.

Pattern of relapse in paediatric acute lymphoblastic leukaemia in a tertiary care unit.

OBJECTIVE: To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors. METHODS: The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis. RESULTS: Of the 60 patients enrolled, 4(6.6%) expired and 1(1.7%) was lost to follow-up. Of the 55(91.6%) who comprised the study sample, 35(58%) were males and 25(42%) females. Mean age of relapse was 6.8±3.27 years. Mean time to relapse from diagnosis was 1.3±0.54 years; 12(20%) patients suffered relapse, and of them 5(14%) were boys. Central nervous system relapse in 8(67%) patients was the most common site, with 3(25%) bone-marrow relapses. Out of 12 patient with relapses, 9(75%) had white blood cell count less than 50,000/cm. CONCLUSIONS: Relapse in acute lymphoblastic leukaemia was common, although treatment modalities are improving day by day.

Nail as a foreign body in a neonate, an unusual presentation at an unusual age.

Children are prone to ingest substances due to their exploratory nature and tendency to put everything in the mouth. Commonly ingested foreign bodies are coins, batteries and buttons. Foreign body ingestion in neonates is a very rare presentation and always needs important consideration as it can be a part of child abuse and can lead to serious life threatening consequences.

Rota virus Diarrhea in Hospitalized Children.

OBJECTIVE: To determine the frequency and clinical features of Rota virus diarrhea in children presenting in a tertiary care hospital. STUDY DESIGN: A cross-sectional, observational study. PLACE AND DURATION OF STUDY: National Institute of Child Health, Karachi, from January to June 2007. METHODOLOGY: A total of three hundred children of either gender aged 1 month to 5 years, who presented with diarrhea of < 7 days as a primary illness were enrolled. Children with bloody diarrhea or nosocomial gastroenteritis acquired during hospitalization for other disease were not included. Detection of Rota virus in stool was done by enzyme linked immunoassay. RESULTS: Out of 300 children, 188 (63%) tested positive and 112 (37%) tested negative for Rota virus. Positive Rota virus cases in 7 - 12 months of age was (n = 34, 18.08%). Overall, 151 (80.3%) children with Rota virus were less than 3 years old. 182 (60.7%) had fever, 118 (39.3%) had vomiting and 156 (82.9%) children had both fever and vomiting. CONCLUSION: This study shows that Rota virus is a common organism causing diarrhea in children less than 3 years of age. There is a need to incorporate Rota virus vaccine in the national EPI program to decrease the disease burden as highlighted in this study.