Indian Journal of Trauma and Emergency Pediatrics

Neurofibromatosis type 1 (NF1) is an autosomal dominant disease with an incidence of about 1 in 2500– 3300. Neurological manifestations may be due to involvement of the cerebrum, spine, cranial nerves and peripheral nerves. The severity of NF1 depends on the area of the brain involved. In children they may present with features of failure to thrive, when the lesion involves the hypothalamic area. We are presenting a rare case of diencephalic syndrome with involvement of hypothalamus, chiasm, suprasellar region, midbrain and cerebellum.

Keywords: Neurofibromas Type 1; Diencephalic Syndrome; Failure to Thrive; Optic Nerve Glioma; Unidentified Bright Objects. 

Bone health is important to health and quality of life. It is important to optimize bone health throughout life cycle. Adolescence is a transitional journey from childhood to adult life along with physical development. This may be considered as physical, psychological and emotional rebirth. Nutrition in adolescence has preventive role related to diet causing chronic diseases like cardiovascular disease, cancer and osteoporosis. Diet and physical factors play a major role in promoting bone health, which begins in childhood and continues into old age. Calcium and protein in the diet with sunlight exposure and weight bearing exercises are important for building the peak bone mass in adolescents. Calcium as nutrient in adolescence is critical for prevention of osteoporosis and improving quality of life.

Keywords: Adolescence; Calcium; Vitamin D; Osteoporosis; Peak Bone Mass (PBM). 

Background: The highest mortality rates are observed in children under five years in developing countries. Shock is the result of various etiologies and the leading causes of shock in children younger than 5 years of age. More specifically, the outcome benefit of further optimizing metabolic parameters, namely ScvO2, directed therapy remains unknown. Even though current ACCM/PALS guidelines represent best practice, prospective randomized trials are lacking to confirm all components of these recommendations. Hence the present study was undertaken to assess the role of ScvO2 in management of fluid refractory. Methods: The study design was one year randomized controlled trial. Institutional Ethical Clearance was obtained for the study prior beginning of the study. Children fulfilling the selection criteria were selected After obtained written informed consent, demographic data was recorded and history was taken. Clinical examination was done for all patients and findings were recorded on predesigned and pretested proforma. Result: 31.37% children in group A and 27.45% in group B presented with fever. Majority of the children were hypotensives. 66.67% of patients in both the groups had ephedrine. Outcome among children with group B was significantly better (94.12%) compared to group A (80.39%) supporting the current ACCM/PALS guidelines. Conclusion: It may be concluded that, ScvO2 in management of fluid refractory and catecholamine resistant shock has reduced the mortality but did not influence the hospital stay.

Keywords: ScvO2; Shock; Fluid Refractory; Hospital Stay. 

Introduction: The rate of preterm birth is increasing worldwide primarily at the expense of late preterm newborns. Late preterm infants are the fastest growing sub group of neonates and constitute approximately75% of all preterm birth sin2009. The birth rate of late preterm new borns has increased by 25% from 1990 to 2005 in the United States. Methodology: Details regarding maternal risk factors were collected by detailed history taking and the medical records with them. The infants in the sample were followed throughout their stay in the SNCU and postnatal wards, up until hospital discharge. Data were collected from infants and mothers medical records and supplemented with additional information collected at discharge using a structured form covering the variables of interest. Results: Hyperbilirubinaemia, Sepsis, Birth asphyxia and respiratory distress constitute the major neonatal morbidities which accounts for 68%, 68%, 41% & 34% respectively. Conclusion: Rate of re hospitalization is high in late preterm neonates.

Keywords: Preterm; Hyperbilirubinaemia; Sepsis; Birth Asphyxia. 

Introduction: Surfactant replacement therapy is one of the best studied therapies in neonates. It has been shown in numerous clinical trials to be successful in ameliorating RDS. These trials have examined the effects of surfactant preparations delivered through the endo tracheal tube either within minutes of birth(prophylactic treatment) or after the symptoms and signs of RDS are present (selective or “rescue” treatment). Methodology: Details regarding maternal risk factors were collected by detailed history taking and the medical records with them. The infants in the sample were followed throughout their stay in the SNCU and postnatal wards, up until hospital discharge. Data were collected from infants and mothers medical records and supplemented with additional information collected at discharge using a structured form covering the variables of interest. Variables relating to the mothers and their infants were analyzed Results: Regarding respiratory morbidities, 34 neonates presented with respiratory distress secondary to pneumonia which accounts for 2%. 2 of the neonates presented as TTNB which accounts for about 2%. 62 neonates didn’t have any respiratory distress which accounts for about6 2%. Conclusion: Birth asphyxia constitutes the second most morbidity with 41 neonates affected which constitute about 41%. A large number of the infants in this study had respiratory distress 34%, followed by Pneumonia and TTN.

Keywords: Birth Asphyxia; Pneumonia; RDS. 

Introduction: Respiratory distress (RD) in neonates is one of the important clinical manifestations of a variety of disorders of the respiratory system and non-respiratory disorders. The high percentage of babies with respiratory distress is because babies have minimal respiratory reserve and they can encounter numerous problems in transition from intrauterine to extra-uterine life. Methodology: All the babies born at or referred to NICU of Hospital during the neonatal period of (0-28) days of birth and meeting the criteria for case definition were included in the study. Sample size 150 consecutive newborns with respiratory distress were considered as cases for this study. Results: None of the clinical features were significantly associated with outcome in neonates with pneumonia except respiratory rate  60/min. Conclusion: Chest retraction and tachypnea had high sensitivity. Grunting, lethargy, poor feeding & hypothermia had high specificity.

Keywords: Respiratory Distress; Neonatal Pneumonia; Poor Feeding & Hypothermia. 

Background: Blunt abdominal injury following trauma is quite common in childhood. It may be responsible for major mortality and morbidity depending upon the pattern and presentation of the injury. The aim of our research was to study the pattern, presentation and prognosis of visceral injuries in children afflicted with blunt abdominal trauma. Material and Methods: It was a prospective study conducted over a period of two-and-half years during which a total of 28 children with some form of intra abdominal injury following blunt trauma were studied. Detailed demographic and clinical profiles of the patients were noted. The mechanism of injury, type and grade of visceral injuries and their management were studied. Results: There were 24 males and 4 females children (M: F ratio of 6:1) with some form of intra-abdominal injury. The mean age was 6.8 years. The most common form of injury was motor vehicle accident (53.5%). Around 7% of children suffered polytrauma. Ultrasound detected only 57% of the injuries. The liver was the most commonly injured solid visceral organ in children. Non-operative management was successful in all the patients with solid visceral injury. Conclusions: Solid organ injury is much more common than hollow visceral injury with liver being the most commonly injured intra-abdominal organ. Road traffic accident is the most common mechanism of injury. Ultrasound examination in blunt trauma is neither very specific nor sensitive. CT scan gives the accurate details of visceral injury but carries risk of radiation. Nonoperative management is the mainstay of treatment even in high grade solid organ injuries while operative intervention is required for most of the bowel injury.

Keywords: Blunt Trauma; Children; Visceral Injuries.