Optic nerve sheath diameter as a non-invasive tool to detect clinically relevant raised intracranial pressure in children: an observational analytical study.

BACKGROUND: Raised intracranial pressure (ICP) contributes to approximately 20% of the admissions in the paediatric intensive care unit (PICU) in our setting. Timely identification and treatment of raised ICP is important to prevent brain herniation and death in such cases. The objective of this study was to examine the role of optic nerve sheath diameter (ONSD) in detecting clinically relevant raised ICP in children. METHODS: A hospital-based observational analytical study in a PICU of a tertiary care institute in India on children aged 2-14 years. ONSD was measured in all children on three time points that is, day 1, day 2 and between day 4 and 7 of admission. ONSD values were compared between children with and without clinical signs of raised ICP. RESULTS: Out of 137 paediatric patients recruited, 34 had signs of raised ICP. Mean ONSD on day 1 was higher in children with signs of raised ICP (4.99±0.57 vs 4.06±0.40; p<0.01). Mean ONSD on day 2 also was higher in raised ICP patients (4.94±0.55 vs 4.04±0.40; p<0.01). The third reading between days 4 and 7 of admission was less than the first 2 values but still higher in raised ICP patients (4.48±1.26 vs 3.99±0.57; p<0.001). The cut-off ONSD value for detecting raised ICP was 4.46 mm on the ROC curve with an area under curve 0.906 (95% CI 0.844 to 0.968), 85.3% sensitivity and 86.4% specificity. There was no difference in ONSD between the right and the left eyes at any time point irrespective of signs of raised ICP. CONCLUSION: We found that measurement of ONSD by transorbital ultrasound was able to detect clinically relevant raised ICP with an excellent discriminatory performance at the cut-off value of 4.46 mm.

Correlation of anthropometric measurements with body mass index and estimation of the proportion of metabolic syndrome among overweight and obese children: a hospital-based cross-sectional study.

BACKGROUND: Early identification of overweight and obesity with the help of simple anthropometric tests can prevent from development of metabolic complications in these children. Body mass index (BMI) is the most commonly used parameter but, measurements such as waist circumference (WC), waist-to-height ratio (WHtR) and wrist circumference (WrC) have also been studied and found to have a better correlation with visceral fat. OBJECTIVE: To correlate WC, WHtR and WrC with BMI among overweight and obese children. The secondary objective was to estimate the proportion of metabolic syndrome among obese and overweight children. METHODS: A single-centre, cross-sectional study involving 80 overweight and obese children aged 3-15 years. Anthropometric measures such as WC, WHtR and WrC of the study subjects were correlated with BMI and investigated for metabolic syndrome. RESULTS: Statistically significant and moderate positive correlation was found between BMI and WC, r (80)=0.45 and p<0.001 with WC explaining 20% of the variation of BMI. There was a statistically significant, moderate positive correlation between WHtR and BMI r (80)=0.34 and p<0.001 with 11% of the variation in BMI. There was a statistically significant strong positive correlation between WC and WrC (80)=0.61 and p<0.001, and WrC explains 37.2% of the variation in WC. However, there was no statistically significant correlation between BMI and WrC. Metabolic syndrome was found in 13 (16.25%) children. CONCLUSION: Alternative anthropometric measurements such as WC and WHtR have a significant correlation with BMI and may be of help in defining overweight and obesity in children. There was a statistically significant strong positive correlation between WC and WrC among obese children. Metabolic syndrome is common in these children.

Vertical transmission and clinical outcome of the neonates born to SARS-CoV-2-positive mothers: a tertiary care hospital-based observational study.

Background: Neonatal transmission of SARS-CoV-2 from positive mothers to their babies has been a real concern, opening the arena of research in this area. Objective: To detect the possibility of vertical transmission of SARS-CoV-2 from COVID-19-positive mothers to their neonates and the clinicopathological outcome in them. Design: A single-centre, prospective, observational study involving 47 COVID-19-positive mothers and their neonates. Setting: A tertiary care hospital in Eastern India. Participants: Neonates born to SARS-CoV-2-infected mothers. Main outcome measures: We investigated the SARS-CoV-2 positivity rate by real-time reverse transcriptase-PCR (RT-PCR) done twice (on admission and after 24 hours of admission) in neonates born to SARS-CoV-2-positive mothers, who tested RT-PCR positive for this virus in their nasopharyngeal swab. Clinical outcome was also assessed in these neonates during their hospital stay. Results: Out of 47 neonates born to SARS-CoV-2-positive mothers, four were SARS-CoV-2 positive by RT-PCR. All the neonates in our study were discharged home in stable condition after management of acute complications. None of them required readmission. Conclusion: Vertical transmission occurs in neonates born to COVID-19-positive mothers; however, the risk is small. Majority of the neonates remain asymptomatic with good clinical outcome.

Excretion of SARS-CoV-2 in breast milk: a single-centre observational study.

Background: Breast feeding by SARS-CoV-2-infected mothers has been a concern because of the possibility of excretion of virus in breast milk. Objective: To detect SARS-CoV-2 in expressed breast milk (EBM) of mothers infected with SARS-CoV-2 and clinical outcome of neonates delivered and breast fed by them. Design: A single-centre, prospective observational study involving 50 SARS-CoV-2-infected mothers and their 51 neonates. Setting: A tertiary care hospital in Eastern India. Participants: SARS-CoV-2-infected mothers and neonates delivered by them. Main outcome measures: We investigated the presence of SARS-CoV-2 in the breast milk of mothers, who tested positive for this virus in their nasopharyngeal swab (NPS). Clinical outcome was assessed in neonates breast fed by these mothers after 1 month of the postnatal period. Results: 50 SARS-CoV-2-positive expectant mothers were enrolled for the study. One out of 51 neonates, who delivered through lower segment caesarean section at term gestation and tested SARS-CoV-2 negative, died due to severe birth asphyxia. One sample of EBM was collected from each of the 49 mothers within 4 days of delivery. All EBM samples tested negative for SARS-CoV-2 through real-time reverse transcriptase-PCR (RT-PCR). All the newborns were screened twice for presence of SARS-CoV-2 RNA in their NPS, by RT-PCR. 2 of 51 neonates had COVID-19 infection after 24 hours of life. Caregivers of 37 of 50 alive neonates responded to follow-up via telephone. Except for minor feed intolerance in one (1 of 37) neonate, all neonates were reported well after 1 month of their age. Conclusion: All the samples of breast milk were negative for SARS-CoV-2. Most of the neonates remained asymptomatic on breast feeding, whose mothers had SARS-CoV-2 infection before delivery.

Risk factors for cerebral edema in diabetic ketoacidosis in a developing country: role of fluid refractory shock.

OBJECTIVES: To study the clinical profile and risk factors of cerebral edema in children with diabetic ketoacidosis with specific reference to fluid refractory shock. DESIGN: Retrospective review of medical records. SETTING: Twelve-bed pediatric intensive care unit of a teaching hospital. PATIENTS: Seventy-seven patients admitted to pediatric intensive care unit with a diagnosis of diabetic ketoacidosis over 5 yrs. INTERVENTION: Medical records were reviewed, and data with respect to patients' age, clinical features, biochemical profile (blood glucose, osmolality, electrolytes, urea, creatinine, arterial pH, PaCO(2), and HCO(3) at admission, 6-12 hrs, 24 hrs, and beyond 24 hrs), cerebral edema, presence of sepsis and shock, treatment details, and primary outcome in terms of survival or death were retrieved. Patients with and without cerebral edema were compared. Variables that were significant on univariate analysis were entered in a multiple logistic regression analysis to determine the predictors for cerebral edema. Odds ratio and 95% confidence interval were calculated using SPSS version 15. MEASUREMENTS AND MAIN RESULTS: Mean age of the patients was 5.6 (standard deviation, 3.8) years. Fifty-five (71.4%) patients had new-onset diabetes mellitus. Cerebral edema was seen in 20 patients (26%). Blood glucose, serum osmolality, and CO(2) values at admission and rate of decline in glucose and osmolality during the first 12 hrs were similar in the cerebral edema and noncerebral edema groups. On multiple logistic regression analysis, fluid refractory shock (odds ratio, 7.3; 95% confidence interval, 1.3-41; p = .025) and presence of azotemia (odds ratio, 4.3; 95% confidence interval, 1.1-16; p = .034) at admission were predictors for development of cerebral edema. Mortality in cerebral edema group was 25% as compared to 3% in the noncerebral edema group. CONCLUSIONS: Patients with fluid refractory shock and azotemia at admission had higher odds for development of cerebral edema. Initial blood glucose, effective osmolality, or decline in glucose and osmolality had no association with cerebral edema.