Jayashree Muralidharan

Scimitar Syndrome : An Uncommon Cause of Wheezing

Scimitar syndrome is a rare congenital anomaly characterized by total or partial anomalous venous drainage of the right lung to the inferior vena cava. The infantile form presents with congestive heart failure and respiratory distress in early months of life. We report here the case of a 6-month-old male child who presented with second episode of respiratory distress and wheeze. Poor response to bronchodilators led to fibreoptic bronchoscopy and computed tomographic scan that revealed bronchial anomalies with aberrant drainage of right lung into the inferior vena cava by scimitar vein. The case illustrates that one of the rare causes of wheezing in an infant could be scimitar syndrome.

Status Dystonicus in a Child with Familial Idiopathic Hypoparathyroidism

Hypoparathyroidism leading to status dystonicus is rarely reported in literature. The authors present an 8-y-old girl with idiopathic familial hypoparathyroidism who presented with status dystonicus. She was managed successfully with midazolam infusion, calcium and vitamin D supplementation, and oral anti-dystonia drugs.

15 Conventional vs. Restrictive Maintenance Fluid Regime in Children with Septic Shock after Initial Resuscitation: A Randomized Open Label Controlled Trial

Background Initial aggressive fluid resuscitation is of proven benefit in septic shock. Optimal post resuscitation fluid management is not known. Aims To compare restrictive vs. conventional post-resuscitation fluid protocols in children with septic shock. Methods We performed prospective randomized trial involving children (3 to144 months) with septic shock admitted to our PICU. After initial resuscitation, patients were randomly assigned to restrictive (A) or conventional (B) fluid protocol. The primary end point was length of PICU stay. Secondary end points included: all cause mortality, organ failure free days, ventilator-free days, measures of lung physiology and incidence of AKI. All analyses were performed on intention-to-treat basis. Intergroup differences were tested with Students’ t test, Chi-square and Mann Whitney U test as appropriate and ANOVA for repeated measures. Time to event data was analyzed with Kaplan-Meier method and Mantel-Cox log rank test. Results In 12 months period, total of 101 children were enrolled. The baseline characteristics of both groups were similar. The mean (±SD) cumulative fluid balance in initial ten days was - 42.6±82.6 ml (group A) and 339±117 ml (group B) (P<0.001). As compared to Group B, group A showed significantly more PICU free days [17.2±9vs.12.7 ±9.5days; p=0.015], lesser number of organ failures [p=0.001], higher proportion of patients recovering from organ failure [92.5vs.75%; p=0.005], improved oxygenation index and plateau pressure [p=0.001], lesser duration of ventilation [6.3±5.8 vs.9.9±5.2days; p=0.012], early recovery from shock [92.5±68.8 vs.123±87 hours; p=0.05]. Mortality was similar [18.5vs.23.4%; p=0.54]. Conclusions Restrictive fluid strategy improved lung function; shortened ventilation and ICU stay without aggravating the hemodynamic instability.

Abstract P-265: ENERGY BALANCE IN CHILDREN WITH SEVERE SEPSIS USING INDIRECT CALORIMETRY – A PROSPECTIVE COHORT STUDY

Single center, prospective cohort study of children aged 5 -12 years admitted with severe sepsis to tertiary care pediatric ICU from May 2016 to June 2017. Patients with active air leak, ventilator circuit leak >10%, on FiO2>60% or on high frequency oscillatory ventilation were excluded. Demographic, anthropometric and nutritional data were collected. Resting energy expenditure (mREE) was measured once daily with portable metabolic cart (Quark RMR, COSMED®) till 7 days or PICU discharge whichever was earlier.

Survival and neurological outcome following in-hospital paediatric cardiopulmonary resuscitation in North India

Background:: Data on outcome of children undergoing in-hospital cardiopulmonary resuscitation (CPR) in low- and middle-income countries are scarce. Aims:: To describe the clinical profile and outcome of children undergoing in-hospital CPR. Methods:: This prospective observational study was undertaken in the Advanced Pediatric Center, PGIMER, Chandigarh. All patients aged 1 month to 12 years who underwent in-hospital CPR between July 2010 and March 2011 were included. Data were recorded using the ‘Utstein style’. Outcome variables included ‘sustained return of spontaneous circulation’ (ROSC), survival at discharge and neurological outcome at 1 year. Results:: The incidence of in-hospital CPR in all hospital admissions (n = 4654) was 6.7% (n = 314). 64.6% (n = 203) achieved ROSC, 14% (n = 44) survived to hospital discharge and 11.1% (n = 35) survived at 1 year. Three-quarters of survivors had a good neurological outcome at 1-year follow-up. Sixty per cent of patients were malnourished. The Median Pediatric Risk of Mortality-III (PRISM-III) score was 16 (IQR 9–25). Sepsis (71%), respiratory (39.5%) and neurological (31.5%) illness were the most common diagnoses. The most common initial arrhythmia was bradycardia (52.2%). On multivariate logistic regression, duration of CPR, diagnosis of sepsis and requirement for vasoactive support prior to arrest were independent predictors of decreased hospital survival. Conclusions:: The requirement for in-hospital CPR is common in PGIMER. ROSC was achieved in two-thirds of children, but mortality was higher than in high-income countries because of delayed presentation, malnutrition and severity of illness. CPR >15 min was associated with death. Survivors had good long-term neurological outcome, demonstrating the value of timely CPR.