Indian Journal of Trauma and Emergency Pediatrics

Pediatric Acute Respiratory Distress Syndrome (PARDS) remains one of the most significant causes of respiratory failure, morbidity, and mortality in pediatric intensive care units worldwide. The first Pediatric Acute Lung Injury Consensus Conference (PALICC-1) in 2015 provided the inaugural pediatric-specific ARDS definition, addressing limitations of adult criteria. Since then, advances in pediatric respiratory support, especially high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), and lung-protective invasive ventilation have necessitated updated clinical recommendations. The Second International Guidelines (PALICC-2), released in 2023, represent a comprehensive revision of PARDS definitions, diagnostic thresholds, severity classification, monitoring protocols, and management strategies. This article synthesizes these updates by integrating the PALICC-2 Executive Summary and contemporary review published in 2023. The review explores revised diagnostic criteria incorporating noninvasive modalities, introduction of “possible PARDS” and “at-risk for PARDS” categories, restructured severity classification, and updated management practices spanning oxygen therapy, NIV, lung-protective mechanical ventilation, monitoring, sedation, fluid balance, nutrition, ancillary therapies, and ECMO. Emphasis is also placed on special populations, resource-limited settings, implementation challenges, and long-term outcomes. PARDS 2.0, as articulated through PALICC-2, offers a more inclusive, pragmatic, and physiologically relevant framework designed to improve early recognition, standardization of care, equity, research continuity, and global applicability.

Central venous catheterization (CVC) via the subclavian vein is commonly performed for fluid resuscitation, hemodynamic monitoring, total parenteral nutrition, and the administration of vasoactive medications. Although considered safe when performed by experienced clinicians, complications such as malpositioning can occur. We report a case of right subclavian CVC malposition in which the catheter tip was found to course retrogradely into the right internal jugular vein (IJV). This case emphasizes the importance of imaging and ultrasound guidance in preventing and detecting such complications.

We report a term small-for-gestational-age male infant who presented with antenatal suspicion of congenital heart disease and fetal growth restriction. Postnatal echocardiography confirmed complex congenital heart disease (CHD) with admixture physiology, common atrium, small PDA, and pulmonary hypertension. The neonate exhibited persistent bradycardia (70–90 bpm) throughout the NICU stay, an unusual but clinically relevant finding in the context of complex CHD. Despite stable perfusion and acceptable systemic oxygenation, bradycardia persisted, prompting referral to a tertiary pediatric cardiac intervention center. This case highlights the challenges in correlating antenatal and postnatal diagnostic findings and emphasizes the importance of early specialized referral in complex CHD with conduction abnormalities.

Hydatid cyst is a parasitic infection caused by Echinococcus granulosus. Intracranial hydatid cysts are rare and remain asymptomatic for prolonged periods. Complete & intact excision of cyst (to prevent anaphylactic shock) is mainstay of treatment. Pre & post-operative albendazole plays an important role along with oral steroids. We report an eleven-years-old girl presenting with headache, vomiting and weakness of right upper & lower limb. MRI brain revealed a well-defined cystic lesion in left fronto parietal lobe with significant midline shift (hydatid cyst). Patient was treated with albendazole and oral steroids. Complete excision of the cyst was performed. Albendazole was continued post-operatively for 3 months.