Indian Journal of Trauma and Emergency Pediatrics

Severe sepsis and septic shock are the leading causes of death in children admitted to any intensive care unit of a developing country. The most important reason for unfavorable outcomes in these children is the severity of illness at presentation which makes these children refractory to any goal directed measures undertaken thereafter. Apart from the agent and host related factors, environmental factors such as delay in seeking timely and appropriate healthcare and use of inappropriate modes of transport may be equally responsible in adding to the disease severity in these children. In this article we shall briefly review the importance of early recognition and treatment and the probable reasons for delay in our set up.  

Key word: Sepsis; Septic shock; Transport; Resuscitation; Golden hours; Early goal directed therapy. 

Hypotension in neonates, particularly preterm, is a matter of debate in all its aspects (definition, monitoring and treatment).The neonate is uniquely at risk of hypotension and low systemic blood flow states due to failure or delay in the normal transition of circulatory processes.While managing the hypotensive neonate, it is not clear whether the issue to be addressed is low blood pressure or low flow states. With the development of newer technologies to assess this issue; the subject becomes more challenging and interesting.Most of the neonatal units use a stepwise approach for managing hypotension in neonates. Although the understanding of cellular mechanisms of action of inotropes is well founded, there is little information on their clinically relevant long-term benefits in the neonatal patient population. Also data regarding their safety and efficacy are lacking. The current clinical query tries to answer the issue of use of dopamine versus dobutamine as first line inotrope of choice in this group of neonates. This would hopefully help the clinician to apply the evidence based practice for management of hypotension in preterm neonate and would provide insight for future well designed studies.  

Keywords: Hypotension; Preterm; Dopamine; Dobutamine. 

The T2 weighted MRI image of a school going child with parvovirus B-19 infection is described here.Parvovirus B19 infection is associated with a variety of neurologic manifestations of which encephalopathy and/or encephalitis are most commonly reported. However, bilateral basal ganglia lesions due to parvovirus B-19 infection have never been previously reported. We chose to report this image to highlight this uncommon association of human parvovirus B-19 infection in man.

Key words: Basal ganglia; Parvovirus B19; B19; Virchow- Robin spaces; Bilateral basal ganglia lesions. 

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Thermal care of newborn represents the basic care provided to the neonate. In the developed world, thermal protection of the neonate has resulted in improved survival of the newborns, but this issue still needs to be addressed in developing world. Hypothermia in neonates is an important contributor to neonatal morbidity and mortality; with premature and low birth weight (<1500 gm) infants at greatest risk of hypothermic injury.Hypothermia is regarded as one of the major causes of neonatal death in developing world. It does not require a special equipment to keep the neonate warm but requires knowledge of importance of thermal care and methods to keep the neonate warm. In this review we would be discussing, why newborns are at risk of hypothermia,basic mechanisms of thermoregulation and treatment of any grade of hypothermia, particularly severe hypothermia, as a neonatal emergency. The small but important interventions to protect newborn from hypothermia would not only reduce the individual mortality but also reduce the global burden of neonatal mortality. 

Keywords: Hypothermia; Low birth weight; Neonate; Prematurity; Thermal care; Thermoregulation.  

Objective: Our objective was to compare the effects of combination of vasopressin and epinephrine with epinephrine alone on rates of return of spontaneous circulation (ROSC) and mortality in children with in- ospital cardiopulmonary arrest (CPA). Methods: This was a retrospective chart review of children with cardiac arrest admitted to the Pediatric intensive care unit (ICU) of a tertiary care hospital in North India between May and July 2012. The study period was divided into two intervals- period 1 where only epinephrine was used and period 2 where a single dose of vasopressin was used at a dose of 0.8u/kg in addition to epinephrine. Children were resuscitated as per the 2010 AHA guidelines for cardiopulmonary resuscitation (CPR) during both time periods. Data regarding baseline characteristics, clinical course and predetermined clinical outcomeswere recorded in a pre-structured proforma. Data was entered into Microsoft excel and analyzed using Stata 11. Results: A total of 28 case records of children with CPA were retrieved during the study period. Of these only 6 (21%) children survived to hospital discharge while the remaining children (n= 22, 19%) succumbed to their illnesses. A total of 14 children each were enrolled during the two time periods. The most common reasons for ICU admission as well as mortality were severe sepsis and septic shock seen in almost all (n=14) the children in period 1 and 85% (n=12) of the children in period 2. Compared to period 1 children from period 2 were sicker at admission with higher mortality risk scores(p=0.03) higher incidence of tachyarrhythmia and of refractory shock. Almost 50% (n=7) of the children receiving vasopressin as the second drug had ROSCimmediately after the arrest in comparison to 43% (n=6) of children receiving epinephrine alone. At 24 hours however, only 5(35%) and 4 (28.6%) of these children from period 2 and period 1 respectively were found to be surviving. Ultimately only 2 children (14%) from period 2 and 4 children (28.6) from period 1 survived to hospital discharge. The differences between the two time periods with respect to all of these primary outcomes were statistically insignificant (p>0.05). Conclusion: Use of vasopressin as an add-on drug during CPR did not seem to affect the clinical outcomes of children with in-hospital cardiac arrest in comparison to the standard practice of using epinephrine alone. 

Key words: CPR; Cardiopulmonary resuscitation; Vasopressin; Epinephrine, In- ospital cardiac arrest.