IC/01(P) PREDICTION OF OUTCOME IN PATIENTS ADMITTED IN PICU BY
APPLICATION OF SEVERITY OF ILLNESS SCORE (PRISM-III SCORE –
PEDIATRIC RISK OF MORTALITY)
Sachin Pawar, Prameela Joji, Neetu Gupta
Ground Floor, Reji Tower, Near Subramanyam Temple, Poonthi Road, Kumarpuram, Medical
College P.O, Thiruvananthapuram
drsachinpawar@gmail.com
Background of the study: There are very few studies in India for Prediction of mortality in sick
patients by using PRISM-III score. Objectives: Prediction of short term outcomes in patients
admitted in PICU by application of a severity of illness score (PRISM-III score). Design:
Prospective, observational study. Settings: Tertiary care referral hospital Study period: 12
months (June 2009 to May2010) Participants: All sick children aged 1 month to 12 year
admitted in PICU fulfilling the following criteria, post-op patients excluded. Study protocol: All
patients consecutively admitted to the PICU. The PRISM-III score was calculated within the first
24 hours of intensive care unit stay to obtain the PRISM-III score and then the patients hospital
course was followed to determine the early outcome of his/her acute sickness (as dead or
survived). We used the most abnormal value for PRISM-III. Main outcome measures:
Prediction of mortality- death or survival in patients admitted in PICU by application of PRISMIII score.Results: A total of 150 babies, 101 babies were enrolled (49were excluded).Mean Age
was 3.5 ± 3.8Years and Mean PRISM Score was 9.80 ± 6.5. The predicted probability of ICU
mortality from our data showed that a PRISM – III score of above 15 yielded 32% probability of
death in ICU. The predicted probability of ICU mortality showed, that a child with PRISM score
of 5 had 1.6% chance of dying in ICU and a child with a score of 30 had 98.6% probability of
dying in the ICU. The results on goodness of the prediction model as seen by the HosmerLemeshow goodness of fit chi-square showed that the model of PRISM-III designed in this study
has been well fit for prediction of mortality rate in our PICU with p value of 0.617 for total
studied patients. The capacity of PRISM-III scoring system for discrimination between survived
and expired patients in our PICU as analyzed by Receiver Operating Characteristic (ROC) curve
showed a strong predictive power for the PRISM-III (under curve surface area = 0.924), i.e 92%
of the subjects could be predicted correctly and this was found to be extremely good.
Conclusions: PRISM-III score has good predictive value in assessing the probability of mortality
in relation to children admitted to PICU under Indian circumstances.
IC/02(P) CLINICO-BACTERIOLOGICAL STUDY OF NOSOCOMIAL INFECTIONS
IN THE PEDIATRIC INTENSIVE CARE UNIT (PICU)
Rajeev Awasthi, Sudhir Mishra
Departments of Pediatrics, Tata Main Hospital, Jamshedpur.
rajeev_gsvm@live.in
This study was conducted in PICU of Tata Main Hospital, 900 bedded multidisciplinary
industrial hospital, to estimate the incidence of nosocomial infections, to study pattern of NIs, to
establish the clinical and bacteriological profile and to evaluate risk factor for nosocomial
infection in PICU. 74 suspected cases of nosocomial infections were studied prospectively,
identified as per the guidelines laid down by CDC. Incidence of NI was 29 % ( N=255). Blood
stream infections was the most common NI observed in present study (43.24%, 32/74) followed
by Urinary Tract Infections (32.43%, 24/74), Nosocomial pneumonia (16.21%, 12/74), and SSI
(6.75%, 5/74).There were two patients with more than one NI.BSI was the common NI in child
with NP and SSI. The risk of nosocomial infection was directly related to the duration of stay in
the PICU and duration of placement of indwelling catheters /tubes. Age and sex were the
important independent risk factors for causing NIs as incidence of NIs was more in neonatal age
group and BSI occurring more commonly in male and UTI in female. Other risk factor like
malnutrition and immunocompromised status and underlying illness were also associated with
NIs. Most common organism from various samples sent was E –Coli (sensitive to Amikacin)
followed by Kleibsiella, maximum sensitivity to piperacillin and tazobactum combination
preparation. Length of stay in PICU almost increased to twice in children with nosocomial UTI,
VAP and SSI. For BSI with peripheral catheter, avg.duration of stay was 7.53 vs.4.65 days in
those without BSI and it was 7.62 vs 6 for BSI with central catheter .There was no association
between mortality due to NIs and mortality in children without NIs statistically.
IC/03(P) FEEDING IN VERY LOW BIRTH WEIGHT (VLBW) BABIES
K.K.Locham, Manpreet sodhi, Ashwani Kumar
Deptt. Of Pediatrics & Biochemistry, Govt. Medical College/ Rajindra Hospital,Patiala-147001
kklocham@hotmail.com
Aims & Objective:To study feeding pattern in VLBW babies. Material and Methods:The study
was conducted on 8 VLBW babies admitted to Neonatalogy Section of Department of
Pediatrics, Govt. Medical College, Patiala.Sex, gestation, antenatal risk factors, apgar score,
mode of delivery, disease pattern were recorded on a pretested proforma.The feed was started
when baby was hemodynamically stable.Babies were given trophic feeds for 1st 2 days(5
ml/kg/day), if gestation was < 34 weeks, then feeding was started at 15 ml/kg/day and increment
was given at 15 ml/kg/day. Results:5 babies were between 34-36 week and 2 babies were
between 32-34 week,only one baby was < 32 weeks.Pregnancy induced hypertension was
present in 6 cases.Only one baby had asphyxia that was mild (apgar score 6 at one minute).7
were SGA and one was AGA.2 babies had respiratory distress syndrome and one baby had
urinary tract infection .In 6 babies feeding was started with expressed breast milk within 3 days,
in rest 2,it was started on 6th and 7th day respectively.All but 2 babies tolerated increments well,
only one baby had abdominal distension.The case who remained on follow up, transfer was
done from Tube feed to Spoon/Breast feed on 2nd week.
Conclusion:In majority of babies,feeding was started within 3 days of life and transfer from tube
to spoon / breast feed was done in 2nd week.
IC/04(P) SIADH IN BIRTH ASPHYXIA
K.K.Locham, Gurdeep Kaur Bedi, Manpreet Sodhi, Harshvardhan, Neeraj Arora.
Deptt. Of Pediatrics & Biochemistry, Govt. Medical College/ Rajindra Hospital,Patiala-147001
kklocham@hotmail.com
Aims and Objectives: To evaluate SIADH in birth asphyxia and to compare it in different grades
of asphyxia and to find its correlation to gestation and birth weight. Material and Methods: The
study was conducted on 50 asphyxiated newborns admitted to Neonatology Section of
Department of Pediatrics, Government Medical College, Patiala. 30 normal newborns served as
controls. Birth asphyxia was labeled as mild, moderate and severe depending on Apgar score of
5-7, 3-4, 0-2 at 1minute respectively. Serum sodium and urine specific gravity were estimated
within 48 hours of birth. SIADH was defined when serum sodium was <130 meq/L and specific
gravity of urine was>1010with normal renal function. Results: SIADH was present in 22% cases
of birth asphyxia .Maximum incidence was observed in moderate asphyxia (44.4%) followed by
severe (35.7%) and mild (7.4%) asphyxia. In preterm as well as low birth weight babies, there
was no difference in incidence of SIADH between different grades of asphyxia. In term as well
as normal birth weight babies, a significant difference was observed when mild asphyxia was
compared with moderate and severe groups respectively. In AGA (Appropriate for Gestation
Age) babies, the difference in the SIADH was observed when mild group was compared with
moderate, however in SGA (Small for Gestation Age) babies, there was no difference of
incidence between different grades of asphyxia. Conclusion: SIADH was present in 22% cases of
birth asphyxia.
IC/05(P) 0.45 NORMAL SALINE VERSUS 0.18 NORMAL SALINE AS SHORT
DURATION INTRAVENOUS MAINTENANCE FLUID IN SICK CHILDREN: DOES IT
MATTER?
Maj Harsh Mohinder Singh, Wg Cdr V Venkateshwar
Resident Pediatrics, Armed Forces Medical College, Pune-40
hms.9791@gmail.com
Introduction: Hyponatremia has been reported following traditional hypotonic maintenance
fluids in sick children. Fluids with increased tonicity have been recommended but no single
consensus has been reached. Aims & Objectives: To compare the change in serum sodium levels
over a 6 hour period after infusion of N/5 saline (0.18 NS) versus N/2 saline (0.45 NS) as
maintenance fluids in sick children. Material & Methods: An open label randomized control trial,
done in a tertiary care centre. 100 normonatremic sick children aged 1-12 years requiring IV
maintenance fluids were included. They were randomized into two groups of 50 each to receive
0.18 and 0.45 NS as maintenance fluids respectively. Venous blood sample were taken prior and
6 hours after initiation of fluid therapy. The change in serum sodium levels was observed and
compared between the two groups. Statistical analysis was done by student t test. Result:
Baseline serum sodium levels in the two groups were comparable. After six hours of
maintenance fluid therapy a mean decrease of serum sodium level of 2.6 in 0.18 N group and 3.9
in 0.45 N group was observed. However there was no significant difference between the decrease
in serum sodium levels between the two groups (p=0.1). Conclusions: There is a small but
clinically insignificant decrease in serum sodium levels following short duration maintenance
fluids over 6 hours using either 0.18 or 0.45 N saline. There was no difference between the two
fluids. While using short duration IV maintenance fluids the choice between 0.18 and 0.45 N
saline does not matter.
IC/06(P) RESPIRATORY SUPPORT AND SHORT TERM NEURO-DEVELOPMENTAL
OUTCOME IN VLBW & ELBW NEONATES
Ashank Airan, Gp Capt Daljit Singh, Col R Ghuliani
Resident Pediatrics, Dept of Pediatrics, AFMC, Pune
drashank@yahoo.com
Introduction: Very Low Birth Weight (VLBW) & Extremely Low Birth Weight (ELBW)
neonates most often require respiratory support after birth which has for long been thought to be
associated with a poor neuro-developmntal outcome. Objectives: To ascertain the need of
respiratory support and to evaluate the short term neuro-developmental outcome in (VLBW) &
(ELBW) neonates. Material & Method: Short term neuro-developmental outcome was assessed
during follow up on basis of 04 criteria: - Cerebral palsy (assessed by tone and posture
abnormality during follow up), Blindness (assessed by ophthalmic evaluation for visual acuity),
Hearing impairment (assessed by OAE and/or BERA) and developmental delay (assessed by
Denver Development Scale Testing). Results: Records of 100 neonates (92 VLBW & 08 ELBW)
delivered from May 2007 to Feb 2010 in a tertiary care centre were reviewed. Overall only 32%
neonates required respiratory support in form of CPAP (20%) and mechanical ventilation
(12%).Neuro-developmental outcome at 1.5months, 03months and 06 months was assessed.
Among infants requiring respiratory support, the ones requiring CPAP had a good neurodevelopmental outcome in 75 %, 78 % & 75 % cases respectively. Those requiring mechanical
ventilation had a good neuro-developmental outcome in 66 %, 50 % & 50 % cases respectively.
In the infants who did not require respiratory support, 76 %, 74 % & 77 % cases respectively had
a good neuro-developmental outcome. Conclusion: CPAP is a good means of respiratory support
in VLBW neonates as it leads to a survival with good neuro-developmental outcome.
IC/07(P) SHORTENED COURSE OF ANTIBIOTIC TREATMENT FOR NEONATAL
SEPSIS (INDIVIDUALIZED APPROACH)
Biju.M, Abey Mathew, Naveen Jain
C/o. Dr Naveen Jain, House No 171, Kavaloor Lane, Vattiyoor Kavu PO, Trivandrum, 695013.
naveen_19572@hotmail.com; drbijuknr@yahoo.co.in
Objectives: To study the safety of an individualized approach to shortened course of antibiotics
in neonates initiated on IV antibiotics. Type of study : Prospective analytic study Setting:
Referral NICU with good microbiology lab Study period: prospective study 5 months-1st March
to 31st July 2010 (and retrospective audit of 4 years unit data) Methods: Retrospective audit: The
unit has practiced short course antibiotics for 4 years. A retrospective audit for re-sepsis &
mortality in the month following short course therapy was conducted (appendix) Prospective
trial: All babies (> 32 weeks and > 1500 grams) started on IV antibiotics in the first month of life
were eligible. Antibiotics were stopped if babies were asymptomatic for 2 days and repeat CRP
and blood culture were negative. Babies were followed for 2 days in hospital and at home for any
new symptoms of sepsis in the month following stop of therapy. Primary outcome Resepsis –
blood or urine culture positive or CRP positive with clinical signs warranting treatment with
antibiotics Secondary outcome Mortality Results: Of the 91 babies were enrolled, I0 babies were
excluded (meningitis, congenital anomalies and death while on treatment). Among 3 babies with
culture proven sepsis, in 2 babies we could stop antibiotics on day7 and in one on day 8. In 12
/15 (80%) babies with probable sepsis (positive CRP, negative culture), antibiotics were stopped
on day7. Out of 63 babies with blood c/s sterile & CRP negative, in 36 (57 %) babies we could
stop antibiotic on day 3 and in the rest, in ≤ 7days. In the month following stop of therapy, there
were no cases of re-sepsis or death. Conclusions: Shortened course of antibiotic treatment in
neonatal sepsis was not associated with re-sepsis or death. Babies who were asymptomatic for 2
days before stop of therapy and CRP negative had no re-sepsis.
IC/08(P) SEVERE THROMBOCYTOPENIA IN THE NICU
Debasis Panigrahi,Sumantra Raut,Niranjan Mohanty
SCB Medical College, Cuttack, Orissa
debasispeds@gmail.com
Objective: Severe thrombocytopenia (platelets 50000/µL) in a NICU patient can have
significant consequences. Methods: We identified all patients with severe thrombocytopenia who
were cared for in the In NICU of svpgip cuttackfrom april 2008 to. march 2010. Results: Among
1560 NICU admissions, severe thrombocytopenia was identified in 50 (3.2%). Just over 30% of
these presented in the first three days of life. . The prevalence was inversely related to birth
weight. Cutaneous bleeding was more common in patients with platelet counts of <30000/µL;
however, no statistically significant correlation was found between platelet counts and
pulmonary, gastrointestinal, or intraventricular bleeding. The most common explanations for
severe thrombocytopenia were acquired varieties of consumptive thrombocytopenia. Platelet
transfusions (median 5) were administered to 86% of the patients. 3 death were recorded 2 due to
pulmonary , 1 due to intraventricular bleeding. The mortality rate did not correlate with the
lowest platelet count. Conclusion: The prevalence of severe thrombocytopenia in the NICU is
inversely proportional to birth weight and most cases are acquired consumptive
thrombocytopenias. We speculate that very low platelet counts are a causal factor in cutaneous
bleeding, but pulmonary, gastrointestinal, and intraventricular bleeding are less influenced by the
platelet count and occur primarily from causes other than severe thrombocytopenia. The lowest
platelet count does not predict the mortality rate .
IC/09(P) ADVERSE EVENTS ASSOCIATED WITH EXCHANGE TRANSFUSION
Jainy NJ, Manish K, Sridhar S, Niranjan T, Jana AK, Kuruvilla KA
Neonatology Unit, CMC Hospital, Vellore 632004, Tamil Nadu.
anilkdj@hotmail.com
Exchange transfusion (ET) is widely used for the treatment of hyperbilirubinemia however its
complications have rarely been described recently. Aim: To study the profile of neonates
undergoing double volume ET in a tertiary care hospital and the associated complications.
Methods: All neonates who underwent ET for hyperbilirubinemia from 2006–09 in CMC,
Vellore. Results: 96 babies underwent 101 ET during the study period. Sex ratio was almost
equal, mean birth weight was 2573.59 (+/- 581) g and mean gestational age was 37.4 (+/- 3.0)
weeks. Most babies were outborn (62.5%), and pre-existing morbidities were present in 42.7%.
ABO (40.7%) incompatibility contributed to maximum number of cases for ET; most were done
using umbilical artery and vein (65.6%). 43.5% infants had complications after ET; 12% were
serious (apnea, bradycardia, respiratory distress, cardiac arrest). Seizures occurred in 5 (8.4%),
and 13 babies (22.4%) had infection; One baby had NEC. Hypocalcemia was usually
asymptomatic; no hypoglycemia was recorded. All babies with hydrops fetalis (8) had
complications. Babies with Rh incompatibility and babies with pre-existing illnesses had a
statistically significant higher incidence of complications after ET than other infants (p=0.000);
duration and method of ET were not significantly associated with risk of complications. There
were 4 deaths (3 hydrops, 1 had microvillous inclusion disease). Conclusions: Adverse events
occurred in 44.7% of ET performed; most were lab abnormalities. Infection-related
complications were 22%. Mortality rate was 4.1%. Hydrops fetalis, Rh incompatibility and preexisting illness were significantly associated with complications.
IC/10(P) STUDY OF ETIOLOGY AND OUTCOME OF VENTILATOR ASSOCIATED
PNEUMONIA (VAP) IN CHILDREN
Diwakar prasad BM , Prahalad kumar , Basavaraj GV ,Ramesh R L ,Shivananda
Dept. of Pediatrics, Indira Gandhi Institute of Child Health, Bangalore
diwakarpanu@gmail.com
Objectives :1} To find out the incidence of VAP in ventilated children in PICU
2}To study the etiology of VAP 3}To study predisposing factors for VAP Design: Prospective
study in IGICH from 1/7/2009 to 30/6/2010 for 12 months Setting : Picu At Igich Materials And
Methods : Source Of Data: Inclusion criteria: Those children admitted to PICU with ventilator
support formed the study group .These children at the time of admission and on ventilator were
after detailed history and clinical examination were subjected to routine investigation and chest
X-ray was on D1 of ventilation and subsequently if suspected to have ventilator associated
pneumonia .Those fulfilling clinical and radiological criteria of VAP(as per CDC criteria)and
apart from routine investigations were subjected for blood culture and ET-tube culture and
sensitivity. [CDC criteria for the diagnosis of VAP :A-Appearance of new X-ray infiltrate ,or
progression and persistence of infiltration,consolidation ,cavity or pneumatocele B-Fever
(>38.4deg or <37deg ),leucocytosis(<4000 or>15000) C- New onset purulent sputum -Change in
the character of sputum -increased respiratory secretions -increased suction requirements -new
onset cough ,dyspnea ,tachypnea ,rales ,bronchial breathing -worsening gas ex-change ,PaO2
/Fio2 <240 -increased O2 requirements -increased pressure requirements] The etiological
agent,the clinical response and the outcome were analysed Results : Out of the 120 children
ventilated 25 children fulfilled the criteria of VAP .The following were the results 1.The most
common age group of ventilation was 5.5 yrs, with male female ratio of 1.85:1(78:42).The most
common age group for VAP was 6.5 yrs with male female ratio of 1.7:1(16:9).2. Indication for
ventilator support were as follows a) Respiratory distress –70(58%) b) Encephalopathy-36
(30%) c) Seizures/status epileptic us –8(6%) d) Sepsis and shock –2 (1.42%) e) Poisoning-2
(1.42%) f) Snake bite- 2(1.42%) 3. Total number of children diagnosed as VAP was 25(21%),
by applying the CDC criteria for VAP. Of them respiratory cases were 11(9%), and nonrespiratory cases were 14(11%). The outcomes of children with VAP were, 4 of them (20%)died,
21(80%) of them recovered . A-Appearance of new X-ray infiltrate ,or progression and
persistence of infiltration,consolidation ,cavity or pneumatocele –25(100%) B-Fever (>38.4deg
or <37deg ),leucocytosis(<4000 or>15000)-25(100%) C- New onset purulent sputum-10(40%) Change in the character of sputum 12(48%) -increased respiratory secretions 6(24%) -increased
suction requirements 10(40%) -new onset cough ,dyspnea ,tachypnea ,rales ,bronchial breathing6(24%) -worsening gas ex-change ,PaO2 /Fio2 <240 –5(20%) -increased O2 requirements
4(16%) -increased pressure requirements 4(16%) 4. Blood cultures : Among the ventilated
patients 15(12.5%) blood cultures were positive with majority of them showing G neg
organisms. Of the VAP patients 4(16%) were blood culture positive sepsis5 ET tube cultures
:Were sent in all cases both study group and VAP group 21(17.5%) showed growth of organisms
in study group 15 (60%) showed growth of organisms in VAP group 4(16%)were
NFGNB,3(12%)were G+ cocci ,2(8%)were Ecoli,2(8%)were acenitobacter ,2(8%)were
Klebseilla and 2(8%)were Pseudomonas 2(8%) cases grew NFGNB both in blood and ET tube
,2(8%) cases grew Pseudomonas in blood and ET tube 5 Sensitivity :12 (80%)of the organisms
grown were G –ve organisms and was resistant to most of the antibiotics showing only
intermittent sensitivity to Ofloxacin,Netilmicin,and Amikacin (resistant to all other antibiotics)
3(20%)Gram positive cocci was intermediately sensitive to Vancomycin, and Ceftriaxone
(resistant to all other antibiotics) 6. Duration and VAP:Average duration of illness before
ventilation in the study group was 5.76 days, and average duration of a child on ventilation was
4.31 days Average duration of illness before ventilation in VAP group was 7.5 days and average
duration of child on ventilation was 7.35 days 7 Other factors Host factors: Malnutrition (mean
weight for age in study group was 88%and mean weight for age in VAP group was 76%)
Anemia (mean Hb% in study group was 11g and mean Hb% in VAP group was 8.5g) Impaired
consciousness (mean GCS was 11/15 in study group and 9/15 in VAP group) Conclusions: VAP
is a preventable condition in mechanically ventilated children. Avoidance of predisposing factors
will prevent the development of VAP Early recognition, prompt and effective treatment will
result in good out come In our study VAP was found to be present in 21% of the total ventilated
cases .It was a very important cause for prolongation of ventilation and was associated to be a
factor for development of multiorgan dysfunction and death in a significant number of cases with
VAP (20%)
IC/11(P) ACUTE KIDNEY INJURY IN CRITICALLY ILL NEONATES – INCIDENCE
AND OUTCOME
M.R.Savitha, G.M.Kumar, Sharath Chandra N
Department of Pediatrics, Mysore Medical College and Research Institute, Mysore
drsavithamr@yahoo.com
Introduction: Critically ill neonates are at risk of having Acute Kidney Injury(AKI) as they are
commonly exposed to nephrotoxic medications and have frequent infections which lead to
multiorgan failure. Aims And Objectives: To study the incidence, etiology and outcome of AKI
amongst the neonates admitted to neonatal intensive care unit To identify poor prognostic factors
for mortality Materials And Methods: This study was conducted from January 2010 to
September 2010. AKI was diagnosed when serum creatinine was elevated 2 SD above the mean
for gestational age or raising creatinine>0.3 mg/dl/day. Such neonates were studied according to
a predesigned proforma. Results: There were 54 cases (male:female=2.85:1) of AKI with an
incidence of 2.99%. The most common causes for AKI were birth asphyxia in 34 cases(62.96%)
and sepsis in 27 cases(50%). The other causes were meconium aspiration syndrome(20.4%),
acute diarrhea(11.11%), necrotizing enterocolitis(5.5%) and miscellaneous causes.
Majority(64.81%) were diagnosed at less than 5 days of age. All cases had oliguria. 16 cases had
hyperkalemia, 10 cases hyponatremia and 5 cases hypernatremia. The mean duration of AKI was
5.24 days. Peritoneal dialysis was done in 6 cases of which 4 recovered and 2 cases died. Over
all there were 7 deaths(12.96%), 38 cases recovered(70.36%) and 9 cases discharged against
medical advice. Risk factors for mortality were sepsis(85.71%), hyperkalemia(42.85%),
ventilator support, shock and low birth weight. Conclusions: 1. Neonates with birth asphyxia and
sepsis should be screened for AKI 2. Effective management of shock, hyperkalemia in AKI help
in reducing mortality.
IC/12(O) ELECTROLYTE CHANGES IN NEONATES ≥35 WEEKS GESTATION
RECIEVING PHOTOTHERAPY FOR NEONATAL JAUNDICE
Ch.Suman, N.Ranveer,P.nagasree, Abani kanta Sahu, P.Sudarsini
Departnent of Paediatrics, ASRAM Medical College,Eluru,AP
dr_abani@rediffmail.com
Background: Few studies currently available that depicts the adverse effects of phototherapy on
serum electrolytes. Objective: In this study, we evaluate the effect of phototherapy on serum
electrolytes of the babies born at >35 weeks of gestation developing
neonatal
hyperbilirubenemia. Setting & Study Period: ASRAM Medical College, a tertiary care hospital
at eluru, west Godavari district. Study was conducted from January 2009 to august 2010.
Method: A Prospective Case Control Study Subject And Intervention: Study was conducted on
150 neonates, 100 were study group & 50 were in control group. Inclusion criteria : neonates of
≥35 weeks gestation receiving illness in newborn & no history of hypothyroidism, diabetes in
mother & prolonged difficult labour. Phototherapy was started & given as per standard AAP
guidelines. Controls group were age, sex, and weight matched normal newborns without
significant jaundice. Serum electrolytes were estimated on pre and post phototherapy, which
included serum calcium, sodium, potassium. Results: Average duration of phototherapy was 50
hrs. The overall incidence of hypocalcaemia was seen in 9% of babies in study group and was
higher in 35-37 wks gestation group (14.6%) than in >37 wks gestation group (5.8%).Serum
calcium values were significantly decreased (p<0.001) after phototherapy in study group. The
overall incidences of hyponatremia was 6% in study group and a significant fall in serum sodium
was observed from pre phototherapy level to a post phototherapy level (p<0.001). However
serum potassium did not revealed any significant variation in both groups. Conclusion: During
phototherapy, estimation of serum calcium, & serum sodium should be checked regularly to
detect the Hypocalcaemia & Hyponatremia early and should be managed accordingly.
IC/13(P) PATTERN OF SEPSIS IN A NEONATAL UNIT
Ashwani Sood, Mangla Sood.
Department of Pediatrics, Indira Gandhi Medical College, Shimla
drkumarashw@hotmail.com
Objective: To study the pattern of neonatal sepsis in a neonatal unit during 1 year period and
assess the relationship between maternal risk factors and early onset sepsis (EOS). Methodology:
The study reported here was a retrospective analysis of 209 episodes of septicemia and 5
episodes of bacterial meningitis in 198 newborn infants, 22 (11.1) of whom died. Eighty-one
(38.8) infants had EOS (<=72 h) and 117 infants had late onset sepsis (LOS >72 h). All infants
had clinical evidence of sepsis, a perinatal score for sepsis of 4 or greater, and either treatment
with antibiotics for 7 days or more. The organisms causing neonatal sepsis were analyzed
according to the day of onset, gestational age, and birth weight. Results: Sepsis occurred in 5.6
per 1000 live births and 3.8% of neonatal admissions. There were 81 episodes of EOS and 128 of
LOS. Coagulase negative staphylococci (CONS) 38.8%, Staphylococcus aureus 20.1% , and
Gram-negative bacilli (GNB) 20.1% were the common isolates. Candida was isolated in 10
(5%) and one patient had polymicrobes.The mean gestational age and birthweight were higher
in babies with EOS compared with LOS. The higher likelihood of probable rather than definite
infection in infants with EOS was related to more mothers in the EOS group receiving
intrapartum antibiotics,with GNB infections being more common. Conclusions: Neonatal sepsis
is still a major contributer towards early neonatal mortality.Staph aureus and CONS were the
most common causes of EOS and LOS, respectively. The use of maternal intrapartum antibiotics
interferes with neonatal blood culture results. Because blood cultures are not always positive in
neonatal septicaemia, a combination of clinical, haematological and other microbiological
evidence should be used when suspecting and treating neonatal septicaemia.
IC/14(O) PROCALCITONIN AND INTERLEUKIN 6 ARE GOOD EARLY MARKERS
OF SEPSIS IN CHILDREN WITH FEBRILE NEUTROPENIA
Kharya G, Dinand V, Sachdeva A, Yadav S P
Pediatric Hematology Oncology Unit, Center for Child Health, Sir Ganga Ram Hospital, Delhi,
110060
gauravkharya@rediffmail.com
Introduction: Children with febrile neutropenia (FN) are at high risk of contracting lifethreatening infections. Blood culture (BC), the gold standard for sepsis, is often negative. Thus
other specific markers i.e. interleukin 6 (IL6) and procalcitonin (PCT) are needed to predict the
risk of sepsis. Aims and objectives: To test IL6 and PCT as markers of sepsis in FN patients.
Methods: This prospective study assesses the serum concentrations of IL6 and PCT along with
BC obtained from 62 consecutive episodes of FN (Test Group:TG) at admission. Cut-off values
were deduced using ROC curves. These values were further tested for prediction of sepsis in the
next 67 consecutive FN episodes (Validation Group:VG). Results: There were 15 episodes of
culture-proven sepsis in TG and 10 in VG. In the TG, mean IL6 and PCT levels were higher in
bacteremic (BE) and non-bacteremic (NBE) episodes (IL6: 457±393pg/ml vs. 181±291pg/ml,
P=0.021; PCT: 25±35ng/ml vs. 16±49ng/ml, P=0.44). IL6 was 67% sensitive(se) and 75%
specific(sp) in predicting sepsis at a cutoff level of 137pg/ml, while PCT was 66% se and 80% sp
at a cutoff level of 3.3ng/ml. In VG, mean IL6 in BE and NBE were 441±419pg/ml and
185±322pg/ml respectively (P=0.03). Similarly mean PCT values in BE and NBE were
16±16ng/ml and 5±16ng/ml (P=0.04). In this group, at the previously set cutoff values, IL 6 was
60% se and 77 % sp and PCT was 80% se and 85% sp for predicting risk of sepsis. Conclusion:
PCT and IL6 levels at onset of FN are good markers to predict the risk of sepsis.
IC/15(P) STUDY OF ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT
Anand S Vasudev, Anita S Bakshi, Shilpi Jain, R N Srivastava
Deptt.of Pediatrics, Apollo Indraprastha Hospital, New Delhi -110076.
drshilpyjain@yahoo.co.in
Objectives: To study the etiology and outcome of acute kidney injury (AKI ) in pediatric
intensive care unit(PICU) Methods: We performed a retrospective cohort study, in PICU of a
single tertiary care academic centre, on 36 patients admitted over last 5 years.
Results: Acute kidney injury is well recognized for its impact on the outcome of patients
admitted to the PICU. Our review showed that the mean age of patients was 4.6 years (range 2
months to 15 years). There were 21 boys and 15 girls. The causes of AKI were septicemia
(36%), HUS (14%), cardiac surgery (14%), primary renal disease (14%): ( glomerulonephritis -2
, polyangiitis -1 , nephrotic syndrome-2 ), multiorgan failure (MOF) (11%) and tumor lysis
syndrome and rhabdomyolysis (1 case each). Acute Kidney Injury Network criteria were used to
classify the patients.31 patients had AKI stage 3 while 5 had stage 1 and 2. Out of the 31 patients
with Renal failure, 19 patients (58%) had AKI stage 3 at presentation while others had mild renal
dysfunction and developed renal failure subsequently. Dialysis was performed in 31(87%)
patients.20 patients (64%) underwent a peritoneal dialysis (PD) and 11(23%) were started on a
hemodialysis (HD). 4 patients initially started on PD were shifted to HD. The average duration
of PD was 6.3 days (range 1 day to 28 days). Peritonitis developed in 2 cases. The overall
mortality rate was 30%, ascribed to MOF in 3 patients and underlying primary condition in rest
(cardiomyopathy-2, HUS-1, head injury-1, sepsis-3, tumor lysis syndrome -1). 3 patients
eventually developed ESRD and were put on maintenance HD (HUS -2, polyangiitis-1).
Conclusions: Children with severe AKI needing dialysis have diverse etiologies. Those with
acute tubular necrosis due to a reversible cause fully recover. AKI following sepsis and
multiorgan failure is associated with poor outcome.
IC/16(P) PRISM III SCORE AS A PREDICTOR OF MORTALITY IN VENTILATED
CHILDREN
Bharath Kumar Reddy K.R., Basavaraja G.V., Nijaguna, Prahlad Kumar A, Shivananda
Indira Gandhi Institute of Child Health, Bangalore
bharathreddykr@yahoo.co.in
Introduction: The need for ventilation is one of the primary reasons for referral to a tertiary care
center. It is important for a primary care physician to assess objectively the need for ventilation
and thereafter its outcome. The PRISM III score is one such score which may reflect the severity
of illness initially at the time of presentation. Other western studies done previously have shown
that pre ICU PRISM score to be a good measure of illness severity and that it provides an
estimate of hospital mortality. Objectives: To study the outcome of ventilation of children in a
tertiary care center To evaluate the predictors of poor outcome in a ventilated child and cause for
mortality among them. Study Design: Retrospective study Study duration: 6 months – January
2010 to June 2010 Study Subjects: All children aged between 1 month to 18 years, admitted and
ventilated in the PICU of Indira Gandhi Institute of Child Health. Results: In a period of 6
months, 70 children were ventilated. This included 60% (42) males and 40% (28) female
subjects with a 41.4% urban and 58.6% rural representation The mortality among ventilated
children was found to be 48.5 %. Higher PRISM III score was seen at admission in the ventilated
children who expired, hence indicating late referral for ventilation. (p = 0.004) 37.14% of all
ventilated children were for central nervous system causes of which status epilepticus was the
most common cause – 24% Poor outcome indicators in CNS cases included – A higher PRISM
III score (average = 36) with p = 0.0034 Poor GCS (< 8) – p = 0.004 Metabolic Acidosis; p =
0.054 Hyponatremia; p = 0.0045 Of the ventilated children 34.2% were due to respiratory
etiology of which 66.6% were suffering from very severe pneumonia. PRISM III score done in
these children revealed a significantly higher score (average 32) in those who expired (p =
0.048). Arterial Blood gas analysis showing respiratory acidosis at the time of admission was
associated with significantly higher mortality. (p = 0.006) 50 % of children with very severe
pneumonia were ventilated for ARDS. ARDS was an independent predictor of mortality. Other
predictors of poor outcome included – spO2 at admission (p = 0.04), Hypoxemia on ABG (p =
0.046), associated metabolic acidosis (p = 0.03). In children with Chronic Lung Disease,
hypoxemia was an indication for ventilation. Conclusion: PRISM III score was an important and
useful predictor of mortality in ventilated children. A High PRISM score at the time of
admission indicated that children reached the hospital at a later stage of disease and delay in
referral. There was no significant delay in ventilating a child in the hospital who required the
same. Hypoxemia being an important cause of mortality should be corrected as early as possible.
Children presenting with a poorer GCS at admission were associated with poorer outcome, hence
children should be brought as early as possible for treatment for the same. Other co-morbid
conditions such as hyponatremia and anemia could contribute to the poor outcome and need to
corrected in a ventilated child.
IC/17(P) THE PROFILE AND OUTCOME OF PATIENTS IN PAEDIATRIC
INTENSIVE CARE UNIT
Bhanu Kumar Bansal, Riddhi Janjikhel, G C Bothra, Rajiv Kumar Bansal, Sunita Ojha, Pooja
Agrawal, Charu Kalra, Rajkumar, Gargi Mathur
Santokba Durlabhji Memorial Hospital cum Medical Research Institute, Jaipur
bhanu_bansal2001@yahoo.co.in
Introduction: Seriously ill child needs ICU care. Concept of early intervention and approach to
sick patient is mandatory. Aims and Objectives: Analyze clinical profile, management and
outcome of patients in PICU. Materials and Methods: 452 patients admitted in PICU over one
year, studied and analyzed for clinical profile, management and outcome. Results: CNS
involvement was most common 156 (33.84%). 124 (27%) patients required ventilation, out of
then 82 (66%) survived. Mortality in ventilated patients was 34%. Rigid bronchoscopy done in
all 72 patients of foreign body aspiration and all had successful outcome. Overall mortality of
our PICU was 11.28%. Maximum mortality was in children between 1-5 years of age 18
(35.29%). Maximum number of deaths were seen in encephalitis cases 14 (27.45%) followed by
septicemia 8 (15.68%), intracranial hemorrhage 6 (11.76%) and bronchopneumonia 5 (9.8%)
patients. Conclusion: 1-5 years age group needed ICU care most, reflecting age related
vulnerability. CNS diseases were often the cause for PICU admissions. Most common cause of
death was encephalitis. Timely rigid bronchoscopy in foreign body aspiration cases was
rewarding.
IC/18(O)
24-H
PRETREATMENT
VS
6-H
PRETREATMENT
WITH
DEXAMETHASONE FOR PREVENTION OF POSTEXTUBATION AIRWAY
OBSTRUCTION IN CHILDREN: A RANDOMIZED DOUBLE-BLIND TRIAL
Meena JP, Baranwal AK, Singhi SC, Jayashree M
Postgraduate Institute of Medical Education and Research, Chandigarh-160012
drjpmeena@yahoo.com
Introduction: Post-extubation airway obstruction (PEAO) is common in pediatric crtical care
practice. Multi-dose steroid reduces its incidence among adults, controversy however continues
among children.
Aims & Objectives: To evaluate effect of 24h pretreatment with
dexamethasone (24hPD) on incidence of PEAO and reintubation in children intubated for >48h
compared to 6h pretreatment (24hPD).Material & Methods: In a prospective, randomized,
controlled, double-blind trial, 124 childen (3 mo-12 yrs) intubated for >48h and anticipated to
have their first planned extubation during next 24h were randomized to receive 24hPD
(0.5mg/Kg/dose, q 6h, total of 6 doses; n=66) or 6hPD (total of 3 doses; n=58). Patients with preexistent upper airway conditions, chronic respiratory diseases, steroid therapy in last 7 days, GI
bleeding, hypertension, hyperglycemia and those with poor airway reflexes were excluded.
Results: Two groups had similar baseline characteristics. 24hPD significantly reduced incidence
of PEAO (43/66 vs 48/58; p=0.027) with absolute risk reduction of 17%. It also reduced
incidence of reintubation by half, however it was statistically not significant (5/61 vs 9/58; RR,
1.09; 95%CI; 0.96-1.25). Time to recovery from PEAO among non-reintubated patients was
significantly lesser among 24hPD patients (Log-rank test, p=0.016). No adverse event was noted
with dexamethasone use. Intubation duration >7 days and cuffed tracheal tubes were found to be
independent-risk factors for PEAO (OR, 6 and 3.12 respectively). Conclusions: 24h
pretreatment with mult-dose dexamethasone had reduced incidence of PEAO, as well as time to
recover from it. 24hPD should be considered for high risk children intubated for >48h. Further
studies on larger sample size is desirable to validate these findings.
IC/19(P) ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) IN PEDIATRIC
INTENSIVE CARE UNIT
L.Das, B.Patnaik , N.Mohanty, S.S.Beriha
Department of Pediatrics, Sardar Vallabh Patel Post Graduate Institute of Pediatrics ,Cuttack
leena_das@yahoo.com
Introduction:Acute respiratory distress syndrome (ARDS) is a devastating inflammatory lung
condition with high mortality. This syndrome was first described in adults and now is being
increasingly recognised in children. There is scant clinical data about ARDS in children from our
country. Aim & Objective: To report causes, clinical features, and factors contributing to
better outcome of children with ARDS in Odisha. Methods and materials: This prospective study
was conducted in P.I.C.U. of our hospital(tertiary care centre) from September 2009-10.The
American European Consensus Conference Committee criteria were used to diagnose ARDS :
acute onset, bilateral infiltrates on chest radiography, arterial oxygen tension/fraction of O 2 in
inspired gases ratio <200,and absence of clinical evidence of left atrial hypertension. Results: A
total of 19 children were diagnosed as ARDS during study period giving an incidence of
15.8/1000 admissions. The mean age was 65.95 mo.(range 1-156mo).Incidence in males were
higher(57.9%)and also in rural children (68.4%).Malaria contributed to a 5(26.3%) cases, sepsis
4(21%)cases,
H1N1
flu
4(21%),pneumonia2(10.5%),chemical
poisoning1(.05%),
drowning1(.05%)cases. The overall mortality was 15 (78.9%).The associated complications were
Shock(42.1%),Sepsis(21%),Pneumothorax(15.7%) & DIC(.05%).Maximum PIP required was
26.4 and PEEP 8.3 cm of H2O.Early ventilator support had better outcome in 21% cases.1 case
of H1N1 flu survived. Conclusion: Early supportive measures in PICU has better outcome
signifying early identification and referral. Vaccination against H1N1 flu may reduce its
incidence.
IC/20(O) UTILISATION AND UNEXPECTED HOSPTALISATION RATES OF 23HOUR OBSERVATION UNIT IN A PEDIATRIC EMERGENCY DEPARTMENT OF
NORTH INDIA
Vidushi Mahajan, Sumant Arora, Vijaywant Brar, Vishal Guglani
Department of Pediatrics, Government Medical College and Hospital, Chandigarh
vidushimahajan2003@yahoo.co.in
Objective: The 23-hr observation unit (OU) is a novel and effective means to tackle
overcrowding in busy pediatric emergency departments (PED) worldwide. However, unexpected
hospitalizations from OU involve transfer of care and reduce the efficiency of OU. Hence, we
aimed to study the presenting diagnosis responsible for unexpected hospitalizations from a 23hour OU. Methods: Design: Prospective cohort study Setting: PED at a tertiary care teaching
hospital Duration: 15th Feb-15th March 2010 Protocol: Consecutive children were triaged, at
presentation to PED, according to WHO pediatric emergency triage algorithm. Those transferred
to 23-hour OU, were further followed up for duration of stay, hospital course, and outcome
(discharge/hospitalization). Results: We enrolled 300 (228 males, 72 females) consecutive
children attending PED over one month. All children at presentation were triaged by two medical
interns posted in PED, which was crosschecked by PED consultant. Majority (55%, n=165) of
children were triaged as non-urgent, 32% (n=97) as priority and 13% (n=38) as emergent. Out of
300 children, 175(58.3%) were transferred to 23-hour OU. Of these, 16 (9.1%) required
unexpected hospitalization. The children who required hospitalization were bronchiolitis (4),
bronchopneumonia (4), seizure (2), viral hepatitis (2), high fever (1), bronchial asthma (1),
severe anemia (1), and urticaria (1). Mean duration of stay in OU was 19 hours for those who
needed hospitalization against 13 hours for those who were discharged from OU. Conclusion:
Children with respiratory complaints (bronchiolitis and bronchopneumonia) need frequent
monitoring in 23-hour OU as they have high hospitalization rates from OU.
IC/21(P) INCIDENCE AND PATTERN OF FUNGAL SEPSIS IN NEONATAL ICU.
Shridhar Sushant, Kulkarni Anjali, Gupta Vidya, Kaul Sushma, Balan Saroja
Division of neonatology, Apollo Centre for Advanced Paediatrics, Indraprastha Apollo hospital,
New Delhi.
dr.sush@yahoo.co.in
Introduction: Fungal infections have become an increasingly frequent problem in NICUs
especially with increasing use of broad spectrum antibiotics. Objective: To study the incidence
and patterns of Fungal Blood stream infections in a tertiary level NICU. Material and Methods:
All neonates admitted in NICU for more than 48 hrs from july2009 –july2010 were included in
study. . Neonates admitted only for neonatal hyperbilirubinemia were excluded. A retrospective
database search was made to identify all neonates with fungal blood stream infections (BSI)
based on positive blood culture. Species identification of the fungal isolate along with its
antifungal sensitivity was studied. The association between a number of factors and progression
to invasive fungal infection was evaluated. Results: Total no of study subjects was 351. Fungal
BSI was identified in a total of 20 neonates(5.6%). The incidence of fungal BSI was similar
among inborn[2 of 38 (5.2%)] and outborn neonates[18 of 313 (5.7%)]. The most frequent
isolates in our study were Candida Tropicalis(40%) followed by Candida Pelliculosa(30%). All
isolates were sensitive to Amphoterecin B and Voriconazole. Two isolates were resistant to
fluconazole. Factors namely low gestation, bacterial sepsis, Use of carbepenems, ET intubation
and CV catheters were associated with an increased risk of progression to invasive fungal
infection. Conclusion: Almost all infections in our study were caused by non albicans candida.
Risk factors for invasive fungal infection were similar to those reported by other authors.
Resistance to fluconazole may reflect its indiscriminate use as a prophylactic antifungal agent.
IC/22(P) SPECTRUM OF NEURAL TUBE DEFECTS IN A TERTIARY CARE NICU
Sushma Malik, Charusheela Warke, Nisha Iyer, Alpana Somale, Yogini Bhaisare.
Pediatric Resident, Department of Pediatrics, 1st Floor, College Building, TNMC & BYL Nair
Hospital, Mumbai Central, Mumbai-400008
nishaiyer17784@gmail.com
Introduction: Neural tube defects (NTD) are the most common congenital anomalies, second
only to cardiac defects and contribute substantially to perinatal morbidity and mortality. The
incidence varies from 1/100-1/5000 live births and its etiology is multifactorial with genetic,
environmental and nutritional factors playing a role. Study: Amongst a total of 4715 deliveries at
our tertiary care hospital, over 20 months (January 2009-August 2010), we encountered 12
NTD’s in our NICU, ranging from anencephaly, raschicisis, meningomyelocele, Arnold chiari
malformations, occipital encephalocele to dermal sinus. The most common being
meningomyelocele with hydrocephalous followed by anencephaly. Included, are 2 rare
associations, one being Arnold chiari with vesico-vaginal fistula with skeletal dysplasia and
another, meningomyelocele with congenital diaphragmatic hernia. Our study also revealed that
most mothers had not received folate supplements and were unaware of its importance.
Discussion: NTD’s occur because of a defect in the neurulation process and are classified, into
open or closed NTD’s. The common cranial presentations include anencephaly, encephalocele
and dermal sinus. The spinal presentations include spina bifida aperta (cystic) and
meningomyelocele. Diagnosis of NTD’s include ante-natal USG and serum alpha-fetoprotein
and acetylcholine levels. Management strategies include termination of lethal conditions like
anencephaly to surgical & medical treatment of those with guarded outcomes. Early postnatal
detection and management of hydrocephalous, urinary and bowel dysfunction, infections helps
improve quality of life. Additionally, prevention of NTD is an integral part of management. This
can be done by increasing the awareness of peri-conceptional folate supplementation, food
fortification etc. Conclusion: Knowledge and awareness of folic acid supplementation must be
emphasized and practiced in all child bearing females to reduce the incidence of preventable
neural tube defects. Early referral to a tertiary care centre is imperative for optimal management
of the child with NTD.
IC/23(O) CLINICAL PROFILE OF PEDIATRIC H1N1 PATIENTS REQUIRING
INTENSIVE CARE UNIT ADMISSION: EXPERIENCE OF A REFERRAL UNIT IN
NORTHERN INDIA IN 2009
M. Kori, A.S. Bakshi, N. Jerath
Pediatric ICU, Apollo Center for Advanced Pediatrics, Indraprastha Apollo Hospitals, New
Delhi
dr_njerath@yahoo.com
Objectives: We present our experience of pediatric H1N1 cases requiring ICU during the first
outbreak of the disease in 2009. Methods: The records of all pediatric H1N1 cases admitted in
the isolation intensive care unit during October 2009 to February 2010 were reviewed. Results:
There were 18 pediatric admissions (10 boys) to the ICU during this period with H1N1 infection.
Only 4 had a definite history of contact with H1N1 infected person. The clinical features of
fever, cough and respiratory distress were common to all. Other symptoms were sore throat
(n=7), abdominal pain (n=3), myalgia (n=3) and blood mixed stools (n=1). Two had a history of
reactive airway disease and one was a known case of thalassemia. Nine of the 18 needed
advanced respiratory support in the form of invasive (n=5) and non-invasive (n=4) ventilation.
Two were ventilated elsewhere prior to transfer. All children had hypoxemia. Of the 5 children
requiring invasive ventilation three developed bilateral pneumothoraces needing tube drainage
and two developed massive subcutaneous emphysema as well. Ventilation was needed for a
mean of 6.4 days (1.2 to 46 days). Two developed ventilator associated pneumonia, both being
Acinetobacter spp. We did not use early steroids in ARDS management of these patients. Four
of the 5 children needing invasive ventilation expired of refractory hypoxemia, overall mortality
of 22%. None were put on ECMO support. Conclusions: H1N1 infection in children in 2009 was
characterized by severe respiratory involvement and a high mortality rate. Severe hypoxemia
refractory to usual measures was characteristic.
IC/25(P) DEVELOPING A MANAGED CLINICAL NETWORK FOR NEONATAL
INTENSIVE CARE UNITS IN NORTHERN IRELAND, UK
Bali S
Antrim Hospital, 45 Bush Road, Antrim, Northern Ireland, United Kingdom BT412RL
sanjeev.bali@northerntrust.hscni.net
Introduction: Formalised clinical networking nationally and internationally in various specialities
including neonatology has shown improved clinical outcomes for patients and improved
efficiencies. Northern Ireland has 7 neonatal units which work together informally, with separate
leadership, management and budgetary structures. Aims and objectives: To review existing
models of neonatal networks To propose a model for Northern Ireland To test the applicability of
the model Materials and methods: Qualitative study of views/ opinions of the proposed model
Leadership / managerial control Accountability for performance / outcomes / risk management
Financial / budgetary aspects Research methods included (a) Questionnaire study and (b) Focus
group meeting. Sample respondents chosen represented - All hospitals providing neonatal
services in Northern Ireland– Administrative managers, Consultant neonatologists, neonatal
nurse managers from all hospitals providing neonatal services in Northern Ireland - Senior
management team from the Northern Ireland neonatal transport service- Department of Health
(DHSSPNI) Northern Ireland Results: Majority of sample respondents were in favour a managed
clinical networking with clear leadership and accountability arrangements (60-81%). However,
there was an equal split in respondents between central Departmental control versus local
hospital control of budgets and incident reporting/action. Conclusion: The study is the first of its
kind in Northern Ireland. It shows a clear collective will from various senior managers and
clinical leaders for managed clinical networking as per the model proposed. Aspects of
managerial control, budgetary control and interface arrangements with other specialities, and
cross boundary work between hospitals needs further analysis.
IC/26(P) STUDY OF BASELINE NUTRITIONALCHARECTERSTIC AND TO
COMPARE TWO NUTRITIONAL PROTOCOLS IN PATIENTS WITH SYSTEMIC
INFLAMMATORY RESPONSE SYNDROME: A PROSPECTIVE RANDOMIZED
OPEN-LABELED CONTROLLED TRIAL
Babu Madarkar, Arun Baranwal, Sunit Singhi, Savita Attri.
Department of Pediatrics Advanced Pediatric Centre, Postgraduate Institute of Medical and
Education and Research, Chandigarh
babumadarkar@yahoo.co.in
Introduction The metabolic response in critically ill children elevates the resting energy
expenditure. But the optimal amount of non-protein calorie and protein required for the critically
ill children is not known, especially in those who are malnourished and constitute about 2/3 of
our PICU patients. Aims: To study the baseline nutritional characteristics and to compare the
outcome,tolerability and complications of following two nutritional protocols in critically ill
children Material And Methods: 140 patients Patients admitted in PICU, PGIMER, Chandigarh
over a period of one and half years were studied.A male preponderance (71%)was noted in
admission.With respect the weight, height there were 28.5% and 43% respectively suffering
from malnutrition.51.4% had hypoalbuminemia. Hypocupremia was observed in 10%.About
20% and 25 % had hypoferremia and low retinol levels respectively. One fifth of our patients
were suffering from hypokalemia and as many from hyperkalemia.13.7% were suffering from
hypomagnesemia.CNS infection(43.2%) was the most prevalent illness
followed by
Intrathoracic infections (39.2%), sepsis without focus(24.4%). Severity of illness was inversely
proportional to amount of calorie that can be delivered. Out come: 26(17.2%) died during the
study.11 of them died before 5 days.Large percentage of patients(43%) in lowest calorie group
died .Average mean duration of ventilation was 8 to 11 days amongst the four groups.