Indian Journal of Trauma and Emergency Pediatrics

 Adolescence is transitional journey from childhood to adult life along with pubertal development and sexual maturation. This may be considered as physical, psychological and emotional rebirth. Dysmenorrhea is the common menstrual disorder in adolescent girls. Primary dysmenorrhea is menstrual pain not associated with pelvic pathology. Conditions associated with secondary dysmenorrhea include :Genital tract infections, Endometriosis, Mullerian anomalies, ovarian neoplasm.

Keywords: Adolescence; Dysmenorrhea; Endometriosis; Mullerian Anomalies.

 Avian influenza (AI), commonly called bird flu, is a viral infectious disease of birds. Most avian influenza viruses do not infect humans; however, some, such as A (H5NI) and A (H7N9), have caused serious infections in people. Outbreaks of AI in poultry may raise global public health concerns due to their effects on poultry populations, their potential to cause serious disease in people, and their pandemic potential. Reports of highly pathogenic epidemics in poultry, such as A (H5NI), can seriously impact local and global economics and international trade. Currently, the best way to prevent infection with avian influenza A virus is to avoid sources of exposure whenever possible. World Health Organization says that H5NI virus circulation in poultry is vital to reduce the risk of human becoming infected. Research regarding the background and transmission is ongoing. Data related to human infections with seasonal, pandemic and highly pathogenic avian influenza A (H5NI) viruses indicate that the earlier antiviral treatment is initiated the greater the clinical benefit as there is no vaccine at present.

Keywords: Avian Influenza; Pandemic; Poultry.

 Aim: To Study and Analyze the Effect of Perinatal Asphyxia on Blood Gas Analysis of Newborns. Background: Perinatal asphyxia, neonatal asphyxia, or birth asphyxia is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. Hypoxic damage can occur to most of the infant’s organs (heart, lungs, liver, gut, kidneys), but brain damage is of most concern and perhaps the least likely to quickly or completely heal. Materials and Methods: This was a tertiary care teaching hospital based, prospective case control study conducted on normal full term and full term asphyxiated neonates delivered and admitted in the Neonatal Intensive Care Unit at Adichunchanagiri Institute of Medical Sciences, B.G. Nagara from December 2012 to May 2014. Results : In cord blood, the values for pH, base excess, and PO2 means were lower and the values for PCO2 were higher in the group of asphyxiated newborns as expected. All the differences were statistically significant. Conclusion: . Within the 18­24 hours of life, there were no differences between the two groups in terms of the values obtained through gas analysis, except for PO2, and base excess which was lower in the group of asphyxiated newborns.

Keywords: NewBorn; Blood Gas; Asphyxia; Umbilical Blood

 Introduction: Acute scrotum is a surgical emergency in children. There are many differential diagnoses of which testicular torsion is the most critical. Materials and Methods: This is a prospective study of retrospective data of 20 boys below 12 years with acute scrotum. Data analysis was done with respect to age, duration of presentation, clinical signs and symptoms, blood count and urine analysis, Doppler USG, management and complications. Results: 4 patients underwent orchiectomy for nonviable testis following testicular torsion. Patients with epididymo­orchitis responded to management with intravenous antibiotics. Conclusion: Early referral and prompt diagnosis and intervention in patients with acute scrotum is necessary for testicular salvage.

Keywords: Acute Scrotum; Children; Testicular Torsion

 Background: In paediatric age­group, blunt abdominal trauma is more common and associated with multisystem involvement. Missed or delayed diagnosis can be fatal. Conservative management has been the gold standard for management of solid organ injury in clinically stable paediatric patients. Materials and Methods: Twenty­four patients less than 12 year age who were admitted between August 2012 and July 2016 with solid organ injury following Blunt Abdominal Trauma were analyzed on the basis of age, sex, mode of trauma, presenting symptoms and signs, investigation findings, organ involved, grade of injury, management and outcome. Results: The average age at presentation was 6.6 years. There were 17 males (70.8%) and 7 females (29.16%). Road traffic accident was the most common mode of injury. Eight patients (40%) had liver trauma of which seven had trauma of grade III­IV. Seven patients (35%) had splenic trauma of which six had trauma of grade II­IV. One patient had splenic artery pseudoaneurysm with multiple collaterals associated with traumatic pancreatitis. She was managed by DSA and splenic artery coiling. Eight patients (40%) had renal trauma – three had grade II trauma, one had grade I and one had grade V trauma. Three patients had urinary extravasation requiring USG guided nephrostomy drain to relieve abdominal distention. All had underlying occult urinary obstruction and underwent interval AndersonHynes dismembered pyeloplasty for the obstruction. Three patients had injuries involving 2 organs. Three patients had pancreatic injury. All patients had ileus secondary to haemoperitoneum for 48 to 72 hours. The haemoperitoneum resolved completely in all patients on USG by 3 to 5 days. All patients were conservatively managed. Six patients required image guided intervention. Two patients required ERCP and three patients underwent ultrasound­guided pigtail insertion to relieve the urinoma. One patient required DSA with coiling of splenic artery pseudoaneurysm. All patients responded successfully to conservative management. There was no mortality in this study. Conclusion: Conservative management of solid organ injuries is an accepted mode of management of BAT in children with good outcome and fewer complications.

Keywords: Solid Organ Trauma; Blunt Abdominal Trauma; Paediatric Age Group

 Objective: To identify neonatal risk factors for cerebral palsy among very preterm babies and in particular the associations independent of the coexistence of antenatal and intrapartum factors. Design: Case­control study. Subjects: Singleton babies born between January 2015 to December 2015 at less than 32 weeks’ gestation who survived to discharge from hospital: 59 with cerebral palsy and 234 randomly selected controls without cerebral palsy. Main outcome Measures: Adverse neonatal factors expressed as odds ratios and 95% confidence intervals. Results: Factors associated with an increased risk of cerebral palsy after adjustment for gestational age and the presence of previously identified antenatal and intrapartum risk factors were patent ductus arteriosus (odds ratio 2.3; 95% confidence interval 1.2 to 4.5), hypotension (2.3; 1.3 to 4.7), blood transfusion (4.8; 2.5 to 9.3), prolonged ventilation (4.8; 2.5 to 9.0), pneumothorax (3.5; 1.6 to 7.6), sepsis (3.6; 1.8 to 7.4), hyponatraemia (7.9; 2.1 to 29.6) and total parenteral nutrition (5.5; 2.8 to 10.5). Seizures were associated with an increased risk of cerebral palsy (10.0; 4.1 to 24.7), as were parenchymal damage (32; 12.4 to 84.4) and appreciable ventricular dilatation (5.4; 3.0 to 9.8) detected by cerebral ultrasound. Conclusion: A reduction in the rate of cerebral palsy in very preterm babies requires an integrated approach to management throughout the antenatal, intrapartum, and neonatal periods.

Keywords: Cerebral Palsy; Very Preterm Babies; Risk Factors; Management.

 One of the commonest seizures of childhood is febrile seizures. The presentation of these seizures is either simple or complex. Seizures in children aged 6 months to 6 years who previously were normal neurologically/developmentally fit to the diagnosis of febrile seizures. However, seizures remain a common presentation in children with neuro infections. A retrospective study of CSF pleocytosis inthe cases with first episode of complex febrile seizures admitted to a tertiary care rural hospital although gave a low yield for ABM, the yield was significantly higher in children aged <1 year. Thus it becomes imperative to evaluate children <1yr having the first episode of complex febrile seizures with lumbar puncture to rule out neuro infections.

Keywords: Complex Febrile Seizure; Acute Bacterial Meningitis; CSF Pleocytosis; Neuro Infections.

 Aim: Parenteral stress in pediatric intensive care unit is different in mothers when compared to fathers. The main focus of this study is to compare maternal stress to that of paternal stress and the effect of counseling on parenteral stress. Method: One hundred parents are interviewed (mother and father separately) using parenteral stress scale, which rates 15 factors on a scale from 1 to 4. Results: The average maternal stress score was 3 and paternal stress score was 2.6.After counseling maternal stress came down to 1.6 were as paternal stress was found to be 2. Stress among ventilated cases 3.4.Among male children was 3 and neurological cases was 3.2. Conclusion: The stress among mothers in pediatric intensive care is higher than stress in fathers. Parenteral stress was found to be highest in male children and ventilated cases. On counseling the relief in maternal population was statistically significant than the paternal population.

Keywords: Maternal Stress; Paternal Stress; Stress Scoring.

 Aim: To assess the microbiological profile of respiratory tract secretions obtained by BAL of patients admitted to PICU in NMCH&RC with severe pneumonia. Methods: The patients admitted in PICU of NMCH&RC, Raichur, with severe pneumonia in the age group of 1 month ­5 years were evaluated and started on first line of respiratory antibiotics after obtaining samples for relevant investigations, treatment was started as per the respiratory protocol. Among them who failed to respond for the same within 48­72 hours were subjected to BAL. During the period of October­2015 to March­2016 a total of 36 cases underwent BAL. The secretions collected through aseptic method were subjected to gram staining, ZN staining, culture and sensitivity. Results: Bacteriological study of the above 36 patients showed­ No. of cases 1) Gram positive organisms 39% (14) 2) Gram negative organisms 22% ( 8) 3) Fungi 14% ( 5) 4) Pseudomonas 11% ( 4) 5) Acino bacter baumannii 2% ( 1) 6) No yield 11% ( 4) Out 36 cases 26 were ventilated. Out of which Gram positive is more predominant than gram negative. In that 1 was Acino bacter baumannii and 4 were pseudomonas. Remaining 10 cases were managed conservatively. Out which 80% were gram negative and remaining 20% were gram negative. Antibiogram­ Gram positive ­ Linazolide, Amoxiclav Gram negative ­ Meropenem, Amikacin, Colistine Fungi ­ Fluconazole, Amphotericin­B Pseudomonas ­ Colistine + Meropenem Acino bacter baumannii ­ Piperacillin + Tazobactum No yield. Conclusion: The microbiological yield was significantly high (89%). Among that gram positive organisms were high and thus helped in preventing mortality. The yield is good when secretions obtained through BAL. The outcome is good in ventilated patients. Thus we conclude appropriate management of acute severe pneumonia the outcome is excellent.

Keywords: BAL; Antibiogram.

 Background & Objective: Dengue fever is an acute febrile illness caused by 4 closely related viral serotypes of the genus Flavivirus. Dengue has a broad range of clinical manifestations. So this study has been done to see the wide range of clinical presentation of dengue fever in a resource limited country like India. Materials & Methods: It is a retrospective study done in tertiary care teaching and referral hospital over the period of 8 months. Study was done by collecting the previous records from hospital record section. There were 48 cases of serologically confirmed cases of dengue which satisfied the inclusion & exclusion criteria were included in the study. Results: In our study there were 52% of the cases of dengue fever, 16.6% of cases of dengue fever with warning signs & remaining 31.4 % of patients were belong to severe dengue. The common Clinical symptoms at admission were fever (100%), vomiting (77%), respiratory distress(56.25%), generalised weakness (54.1%) & pain abdomen (33.3%). Less common symptoms were loose stools (6.25%), periorbital puffiness (6.25%), altered sensorium (4.1%), oliguria (2%) & bleeding manifestations (2%). Conclusion: In our study atypical presentations like respiratory distress, loose stools, meningeal signs were commonly noted & bleeding manifestation at admission was rare in our  study. Be aware of atypical presentation of dengue & early diagnosis & initiation of treatment for better outcome. 

Keywords: Dengue Fever; Clinical Profile; Atypical Presentation; Warning Signs