Surfactant therapy in premature babies: SurE or InSurE.

BACKGROUND: Preterm infants with respiratory distress syndrome (RDS) requiring surfactant therapy have been traditionally receiving surfactant by intubation surfactant and extubation technique (InSurE), which comprises of tracheal intubation, surfactant administration, and extubation. However, more recently noninvasive methods like least invasive surfactant therapy or minimally invasive surfactant therapy have been reported to be successful. These methods, avoid intubation thus minimize airway trauma and avoid barotrauma. The primary aim of this randomized trial was to compare the need for mechanical ventilation (MV) between the administration of surfactant via a thin catheter during spontaneous breathing and the InSurE technique. METHODS: Preterm infant's ≤34 weeks with RDS requiring continuous positive airway pressure (CPAP) within 6 hours of life were prospectively randomized to receive early surfactant either by SurE (surfactant without endotracheal tube intubation) or InSurE technique. The need for MV within the first 72 hours and other related outcomes were analyzed between the two groups. RESULTS: One hundred seventy-five infants in each group were analyzed. The need for MV in the first 72 hours of life was significantly lower in the SurE group compared to the InSurE group (19% vs 40%, P < .01). Similarly, duration of oxygen therapy and hospital stay were significantly shorter in the SurE group. Furthermore, bronchopulmonary dysplasia (BPD) rate was significantly lower among the infants administered surfactant by the SurE technique. CONCLUSION: In preterm neonates with RDS who are stabilized on CPAP, the SurE technique for surfactant delivery results in the reduced need for MV and also may decrease the rate of BPD in some vulnerable subpopulations.

Multidimensional impact on families of children with steroid-sensitive nephrotic syndrome.

AIM: Children with nephrotic syndrome (NS) have prolonged disease course with relapses requiring frequent visits and prolonged steroid therapy with their long-term concerns. All these factors affect the child and their families in many domains of functioning. The objective of this study was to assess multidimensional impact on families of children with nephrotic syndrome using (PedsQL) Family Impact Module (FIM). METHODS: This cross-sectional study was conducted in a paediatric nephrology clinic of a tertiary care hospital. Fifty cases of steroid-sensitive nephrotic syndrome between age group of 2-18 years were included, and equal age-sex matched healthy children were taken as controls. Baseline demographic factors including age, gender and education status, modified Kuppuswamy's socio-economic status were collected and clinical variables of NS cases were recorded. FIM is a parent-reported instrument that measures the impact of paediatric chronic health conditions on care giver's HRQOL and their family function. Mean FIM scores were compared among the cases and controls, and different predictive factors affecting family impact (FI) were analysed. RESULTS: The FI total score showed significantly lower scores in cases (mean score: 60.76 ± 15.66) as compared to controls (mean 100). Among the individual groups, lowest scores were found in two domains, namely 'worry' and 'emotional function' with mean scores of 46.20 ± 20.66 and 46.80 ± 24.61, respectively, although other domains were also significantly affected. CONCLUSION: FI score should be evaluated in all cases of NS as parenting such children may significantly affect all domains of family functioning.

Outcome of children with acute disseminated encephalomyelitis in a tertiary care center in India.

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated disease of the brain that follows viral infection or vaccination, or even appears spontaneously. The objective of the study was to evaluate the clinical, neuroimaging and laboratory profiles of children with ADEM. Seventeen children admitted to the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, whose cases were consistent with the diagnosis of ADEM, were included. Their clinical and neuroimaging profiles and outcomes were studied. The most common presenting features were fever (71%), altered sensorium (59%) and headache and convulsions (41%). Brain MRI identified lesions in subcortical white matter (75%) and periventricular white matter (38%). Most patients were treated with corticosteroids. A favorable outcome was seen in 88% of patients. Although 59% of patients had neurologic sequelae at discharge, only one patient had a major neurological deficit at follow-up. Prognosis for survival and outcome was good in the majority of patients. Neurological sequelae at discharge do not predict poor outcome.

Parental stress in a paediatric intensive care unit in Punjab, India.

AIM: Paediatric intensive care is a fast-growing specialty in India. There are studies on parental stress in paediatric intensive care unit (PICU) in developed countries, but limited data from developing countries, where many factors may be different, are available. This paper describes various stressors in Indian parents. METHOD: One hundred parents were interviewed using the Parental Stress Scale (PSS: PICU), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful). RESULTS: The average parental stress score was 3.0. The main causes of extremely stressful situations were: the parents' child having breathing difficulty; their child suffering pain; their child being unresponsive; crises in other children in the PICU. Factors least associated with stress included: not being alone with baby; and the presence of monitors and equipment. Nearly all parents (99) felt that prayer was of help. The majority (67) felt stressed during procedures, and 59 parents felt stressed by the sights and sounds of the PICU. Factors significantly related to increased stress included: the severity of illness as measured by higher paediatric risk of mortality scoring (P = 0.0136); for mothers rather than fathers (P = 0.0054): for parents <30 years (P = 0.0114); and parents of a male child (P = 0.0482). CONCLUSIONS: It is concluded that there is significant stress among parents of children admitted to an Indian PICU, and stress factors are different from studies done in developed countries. Mothers and young parents were more stressed. Type of family, income, education, number and age of children did not affect level of stress.

A Simple Clinical Score "TOPRS" to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India.

OBJECTIVE: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department. METHODS: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of 'toprs' score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded. Variables were categorized as normal (score zero) or abnormal (score 1) based on systemic inflammatory response syndrome (SIRS) criteria and criteria mentioned in advanced pediatric life support (APLS) and the total scores were computed for each child. The outcome (death/discharge) was correlated with the study variables and total score. The predictive ability of score was calculated using receiver operating characteristic (ROC) curve analysis. FINDINGS: Of the six variables, temperature, oxygen saturation and respiratory rate were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5. CONCLUSION: For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death.