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Severe Dengue in Pediatric ICU: Experience from a Tertiary Care Referral Center

Milind S. Tullu , Vinod C. Ingale* , Milind S. Tullu** , C.T. Deshmukh*** , Veerla Swathi* , Preetham Philip Tauro****

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Indian Journal of Trauma and Emergency Pediatrics 8(2):p 71-75, May-August 2016. | DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.8216.5

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Abstract

 Background: Severe Dengue is associated with varied organ involvement and high mortality. Aims and Objectives: To study clinical profile and outcome of Severe Dengue in a tertiary care Pediatric ICU. Materials and Methods: Consecutive patients diagnosed as Severe Dengue were enrolled retrospectively over 6 months period (1st June 2015 to 30th November 2015). All patients were NS1 and/ or IgM positive for Dengue infection. The clinical presentation, laboratory parameters and patient outcomes were studied. Results: A total of 33 patients with Severe Dengue were included in the study (19 females, 57.5%). The common clinical presentations were with­ fever (100%), vomiting (51.51%), abdominal pain (45.45%) and bleeding (45.45%). Central nervous system (CNS) features included ­ altered sensorium (33.33%) and seizures (24.24%). On admission, hypotension (96.96%), tachycardia (90.90%) and respiratory distress (63.63%) were seen. 63.63% cases had hepatomegaly, 48.48% had pleural effusion and 39.39% had ascites. Common laboratory findings included­ thrombocytopenia (< 1 lakh/cumm) in 72.72%, hematocrit > 40 in 33.33% and SGPT > 150 IU/L in 44% of cases. Complications included­ acute respiratory distress syndrome (ARDS­ 18.18%) and disseminated intravascular coagulation (DIC­ 21.21%). Colloids were used in 81.81% and ionotropes in 93.93% of patients. All the patients underwent mechanical ventilation. Packed red cells and platelets were given in 30.3% and 33.3% of cases. Case fatality was 42.42%. Altered sensorium (p = 0.024), seizures (p = 0.0473), DIC (p = 0.026) and ARDS (p = 0.0027) were significant predictors of mortality. Conclusions: Mortality in Severe Dengue was high in our study (probably due to late referrals and more severe illness). Altered sensorium, seizures, DIC and ARDS were predictors of mortality. CNS presentation was seen in about one third of cases. Hepatomegaly, raised liver enzymes and thrombocytopenia were seen in most of the cases.

Keywords: ARDS; Critical; Dengue; Intensive; Liver; Seizures; Shock; Ventilation.

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DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.8216.5

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