Evaluation of glomerular and tubular renal function in neonates with birth asphyxia.

BACKGROUND: Acute kidney injury (AKI) is one of the commonest manifestations of end-organ damage associated with birth asphyxia. OBJECTIVE: To evaluate glomerular and tubular dysfunction in neonates with moderate to severe birth asphyxia. DESIGN: Prospective cohort study. SETTING: Neonatal unit of a teaching hospital. METHODS: Subjects were inborn neonates of ≥34 completed weeks of gestation with an APGAR score <7 at 1 min after birth. Renal function tests including serum electrolytes were measured daily until 96 hrs of life along with urinary output. Fractional excretion of sodium (FeNa), renal failure index (RFI), urinary myoglobin and creatinine clearance (CrCl) were calculated using timed urine collection. Staging of AKI was undertaken using Acute Kidney Injury Network criteria (AKIN). PRIMARY OUTCOME MEASUREMENT: Recovery of glomerular function. RESULTS: A total of 2196 neonates were born during the study period (September 2006 to April 2007), 44 of whom met the inclusion criteria. Data from 36 neonates were available for final analysis. AKI developed in 9·1% (1/11) infants with moderate asphyxia and 56·0% (12/25) infants with severe asphyxia, making a total incidence of 41·7%. AKI persisted in 16·6% neonates at 96 hours of life. Ten neonates (27·7%) had serum creatinine levels >1·5 mg/dl. In neonates with AKI, tubular function (Fe Na, RFI, urinary myoglobin) was significantly deranged until 72-96 hrs of life. One infant died and one who was critically ill was discharged against medical advice; both had AKI. CONCLUSION: It is feasible to use AKIN staging for evaluating AKI in neonates with birth asphyxia.

Unusual fatal multiple-organ dysfunction and pancreatitis induced by a single wasp sting

Acute onset of multiple organ dysfunction syndrome (MODS) is a well-known complication following multiple wasp stings. However, MODS after a single wasp sting has been rarely reported in children and acute pancreatitis have probably never been observed before. Herein we describe the case of a 12-year-old boy who had urticaria and abdominal pain after a single wasp sting. The child gradually developed MODS while his abdominal complaints were worsening. Despite aggressive supportive management, the child did not survive. Afterward, the cause of the acute abdomen was finally diagnosed as acute pancreatitis. Both MODS and pancreatitis following a single wasp sting are very unusual. Thus, although pancreatitis is rarely manifested, it should be suspected after a wasp sting if there are predominant abdominal symptoms.(AU)

Drug use pattern in children at a teaching hospital.

This study aimed to evaluate drug utilization in pediatric out-patient department of a tertiary care teaching hospital. The patient and drug information of 254 patients was analyzed for WHO recommended prescribing indicators. The average number of drugs per prescription was 2.31 and 45% of medicines were prescribed from National List of Essential Medicines. The use of injectibles was low (1.18%) while an antibiotic was prescribed in 29.1%. Only 5.8% medicines were prescribed by generic name. Interventions are required to improve prescribing by generic name so as to further rationalize drug use in pediatric population.

Ventricular tachycardia in congenital adrenal hyperplasia.

Severe hyperkalaemia in patients with congenital adrenal hyperplasia in association with aggravating factors such as acidosis and hypocalcaemia can cause life-threatening ventricular arrhythmias. Treatment of the underlying cause may be the only modality required in such cases. We report a 20-day-old male presenting with ventricular tachycardia due to electrolyte abnormalities in salt-losing congenital adrenal hyperplasia. Sudden cardiac deaths reported earlier in such cases thus gain credence.

An unusual case of neonatal brain abscess following Klebsiella pneumoniae septicemia.

A case of solitary brain abscess in a term neonate caused by Kiebsiella pneumoniae is described. K. pneumoniae, although a common cause of neonatal septicemia, is rarely implicated as an etiological agent for cerebral abscess in this age-group. The interest of this case lies in the rarity of the causative organism and atypical features. In the absence of predisposing factors in the neonate, we suspect that the infection was transmitted vertically from the mother before or at the time of delivery since there was evidence of asymtomatic urinary tract infection in the antenatal period.