Kamaldeep Arora

Incidence, risk factors and outcome of acute kidney injury in critically ill children – a developing country perspective

Background: Acute kidney injury (AKI) is common in critically ill children and is associated with poor outcome. Objective: To study the incidence, risk factors and outcome of AKI in children admitted to paediatric intensive care unit (PICU) of a developing country. Materials and Methods: This prospective observational study was conducted in a tertiary care PICU over one-year period. Critically ill children aged from 2 months to 18 years were included. RIFLE criteria based on GFR, and urine output was used for categorisation. Results: Of 380 children, 53 children (14%) had AKI (met any of the RIFLE criteria). The most common diagnoses underlying AKI were acute lower respiratory tract infection, CNS illness and severe dehydration. Subjects with AKI had a higher PRISM score (>10) at admission, longer duration of stay and high mortality. Significant risk factors for AKI following multivariate analysis were: age 1–5, PRISM score (>10) at admission, shock, infection, thrombocytopenia, hypo-albuminaemia and multi-organ dysfunction. Twenty-six of 53 subjects fulfilled the maximum RIFLE criteria within 72 h after admission and the mean (SD) time to first RIFLE attend was 1.6 (1.2) day. Subjects with AKI (RIFLE criteria) had 4.5 times higher mortality than those without AKI (36 vs 8%, P< etc). Conclusion: A high incidence of AKI was noted in the PICU that was associated with high mortality. The RIFLE criterion is an effective tool which can be used not only for predicting the outcomes, but may help in the early identification of patients at risk for AKI.

Efficacy and safety of paracetamol versus ibuprofen for treating patent ductus arteriosus in preterm infants: A meta-analysis

Objectives: The objective was to review the available evidence comparing oral paracetamol versus oral ibuprofen for the closure of patent ductus arteriosus (PDA) in preterm infants. Methods: We searched all the major databases (Medline via Ovid and PubMed) till April 2014. Randomized trials were included. Primary outcome measure was the primary closure rate of PDA after the first course of the drug. Review manager (version 5.2) was used for all the analyses. GRADE criteria were used to rate the quality of evidence. Results: Of 38 full-text articles assessed for eligibility, two trials (n = 240) were included in the final analysis. There was no significant difference between the two groups except for the following parameters, which favored the paracetamol group: Shorter mean days needed for PDA closure (mean difference, −0.49 [95% confidence interval [CI], −0.54 to − 0.44], P < 0.00001), a lower risk of gastro-intestinal bleeding (odds ratio [OR], 0.25 [95% CI, 0.06-1.02], P = 0.05) as well as hyperbilirubinemia (OR, 0.46 (95% CI, 0.23-0.95), P = 0.04). The GRADE evidence was found to be of low quality. Conclusions: There is not enough evidence to judge about the efficacy or safety of ibuprofen versus paracetamol for treating the PDA in preterm infants. Randomized trials with low risk of bias and adequate sample size including different subgroups of preterm infants are needed before any firm recommendation can be made.

Fryns Syndrome: A Lethal Birth Defect with Variable Phenotypic Expressions in Siblings

Fryns syndrome (FS) is a multiple congenital anomaly syndrome, inherited as an autosomal recessive defect with variable expression. The authors report a newborn with FS, whose mother had two previous affected pregnancies with the infants having variable phenotypic expression. FS is characterized by craniofacial dysmorphism, diaphragmatic hernia and distal limb hypoplasia. This is the first published report from India describing a case of FS with familial recurrence, which would serve further to illustrate the clinical variability of this disorder.

Postnatal Maturation of Amplitude Integrated Electroencephalography (aEEG) in Preterm Small for Gestational Age Neonates

ObjectiveThe primary objective was to evaluate the postnatal maturation pattern on aEEG during first two weeks of life in clinically stable and neurologically normal preterm small for gestational age (PSGA) and gestation matched (1 week) preterm appropriate for gestational age (PAGA) neonates born between 300/7 and 346/7 weeks of gestation.MethodsSerial aEEG tracings were recorded on 3rd, 7th and 14th day of life. The primary outcome was total aEEG maturation score. Three blinded assessors assigned the scores.ResultsWe analyzed a total of 117 aEEG recordings in 40 (19 PSGA and 21 PAGA) neonates. The baseline characteristics were comparable except for birthweight [1186 (263) vs 1666 (230) g]. There was no difference in the mean (SD) total scores on day 3 (9.0 (1.8) vs. 9.5 (1.1), P=0.32) and day 14 of life, but was lower in PSGA infants on day 7 (8.6 (2.4) vs. 10.1 (1.1), P=0.02). On multivariate analysis, maturation of PSGA neonates was found to be significantly delayed at any point of life from day 3 to day 14 (mean difference, -0.8, 95 % CI: -1.6 to -0.02, P=0.04).ConclusionLower aEEG maturation score on day 7 possibly indicates delayed maturation in PSGA neonates in the first week of life.

Visual and Refractive Outcomes of Children After Early Secondary Cataract Extraction Following Wound Repair for Penetrating Ocular Trauma

PURPOSE To evaluate the visual and refractive outcomes in children 8 years of age or younger with corneal laceration and cataract following penetrating ocular injuries who underwent primary corneal tear repair followed within 1 to 8 weeks by early secondary cataract extraction. METHODS This retrospective, non-comparative case series reviewed the admission and operative charts of children 8 years of age or younger (range: 3 to 8 years) who underwent corneal wound repair as the primary surgical procedure followed within 1 to 8 weeks by cataract extraction with intraocular lens implantation, with a minimum follow-up period of 6 months. The main outcome measures were best corrected visual acuity (BCVA) and refractive error as the spherical equivalent at the final follow-up visit. RESULTS A total of 47 children (33 boys, 14 girls) were included. The mean age at the time of injury was 5.9 ± 2.2 years (range: 3 to 8 years). Follow-up periods ranged from 6 months to 3 years (median: 18 months). The mean time gap between the wound repair and cataract extraction was 5 weeks (range: 1 to 8 weeks). Approximately 36 (77%) eyes obtained BCVA better than 6/18. All but one eye achieved BCVA better than 6/60. The deviation from emmetropia was less than 1.00 diopter (D) in 23 (54%) eyes, 1.00 to 3.00 D in 15 (35%) eyes, and more than 3.00 D in 5 (12%) eyes. CONCLUSIONS Early removal of cataract with intraocular lens implantation 1 to 8 weeks after the primary wound repair in young children with penetrating corneal injuries can result in excellent visual and refractive outcomes with early intervention and aggressive amblyopia treatment. [J Pediatr Ophthalmol Strabismus. 2018;55(2):122-127.].

Fetomaternal outcome in high-risk parturients receiving epidural analgesia using fentanyl with ropivacaine versus iv tramadol: a comparative study

Pain during labour is one of the worst experiences in the life of a woman, and its relief is an important issue. Most women request for some forms of analgesia (pharmacological/non-pharmacological) to get rid of this excruciating pain. Few women also opt for caesarean section to avoid the bad experience of painful labour and/or episiotomy. Painful labour also reduces uteroplacental blood flow. To counter all these, effective analgesia is needed to eliminate/attenuate pain in labour. Various pain-relieving methods are available since long time that include: systemic administration of medications, inhalational medications, transcutaneous nerve stimulation (TENS), neuro-axial blockade, and epidural analgesia. Of them, epidural analgesia is the most accepted method as it has been found to be both safe (both for the mother and the neonate), and effective. However, there is some doubt regarding its effect on the duration of labour (some think that it may increase the ABSTRACT

A study of the prevalence and risk factors of asthma in urban schools of Ludhiana, Punjab

Background: Asthma is the most common chronic childhood disease being increasingly diagnosed in recent years. A review estimating the prevalence of bronchial asthma in the Indian children concluded the burden to be high than previously understood. There is paucity of data from Punjab, and no study from Ludhiana has estimated the true prevalence of asthma in urban area. Objective: To determine the prevalence and risk factors for childhood asthma using questionnaires and pulmonary function tests. Material and Methods: This was a questionnaire based cross-sectional study over a period of 1.5 year in the age group of 5-15 years studying in three schools of urban Ludhiana. The data were analyzed b STATA Software (version 16, college station Tx, USA). P Results: The retrieval of questionnaire I was possible in 80% of the 2500 distributed. The prevalence of asthma was calculated as 7.5% (95% confidence interval, 5.2-10.5). The mean age of the children with asthma was 8.67 ΁ 2.62 years. The most common symptoms reported by the cases were wheezing and seasonal allergy. No predilection for sex, socioeconomic status, and pet at home was noted. The family history of asthma and allergy, family history of smoking were emerged as significant risk factors. Conclusions: The prevalence of asthma in the urban schools of Ludhiana was found to be 7.5% which was much higher than previously reported. Age groups 5-8 years were commonly affected. Family history of asthma or allergy, and smoking history were found to be significant risk factors for development of asthma.

Benign skin lesion in a neonate.

Dr Shasanka Shekhar Panda Dr Rashmi Ranjan Das Dr Kamaldeep Arora MCh, Senior Research Associate (Pool Officer), Departments of Paediatric Surgery, All India Institute of Medical Sciences (AIIMS), New Delhi, India MD, Assistant Professor, Department of Paediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India DM, Assistant Professor, Department of Paediatrics, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Teaching NeuroImages: Fused brain Does face predict the brain?

A term male infant born by normal vaginal delivery was diagnosed to have holoprosencephaly on antenatal ultrasound, which was confirmed by postnatal MRI as alobar holoprosencephaly (figure). Clinical examination revealed no microcephaly or dysmorphism, except flat nasal bridge.

Green pigmented teeth

A male child born with rhesus-isoimmunisation was treated with double volume exchange transfusion followed by phototherapy for 96 hours. On day 10, he was found to have conjugated hyperbilirubinemia which gradually progressed (maximum value, 42 mg/dL; conjugated fraction, 32 mg/dL on day 30). Hepatobiliaryiminodiacetic-acid (HIDA) scan showed delayed clearance. He received phenobarbitone for five days, keeping the possibility of inspissated bile plug syndrome. Gradually the bilirubin level decreased to 6mg/dl by 2 months of age. The baby had eruption of deciduous teeth at 7 months of age which were green-to-black stained. At current age of 18 months, all the teeth are green-to-black stained (Fig. 1).