Reintervention Before Bidirectional Cavopulmonary Shunt and Intermediate Outcomes in Children with Single Ventricle Who Underwent Main Pulmonary Artery Banding.

Unplanned reinterventions following pulmonary artery banding (PAB) in single ventricle patients are common before stage 2 palliation (S2P) but associated risk factors are unknown. We hypothesized that reintervention is more common when PAB is placed at younger age and with a looser band, reflected by lower PAB pressure gradient. Retrospective single center study of single ventricle patients undergoing PAB between Jan 2000 and Dec 2020. The association with reintervention and successful S2P was modeled using exploratory cause-specific hazard regression. A multivariable model was developed adjusting for clinical and statistically relevant predictors. The cumulative proportion of patients undergoing reintervention were summarized using a competing risk model. 77 patients underwent PAB at median (IQR) 47 (24-66) days and 3.73 (3.2-4.5) kg. Within18 months of PAB, 60 (78%) reached S2P, 9 (12%) died, 1 (1%) transplanted and 7 (9%) were alive without S2P. Within 18 months of PAB 10 (13%) patients underwent reintervention related to pulmonary blood flow modification: PAB adjustment (n = 6) and conversion to Damus-Kaye-Stansel/Blalock-Taussig-Thomas shunt (n = 4). 6/10 (60%) reached S2P following reintervention. A trend toward higher intervention in patients with a genetic syndrome (p-0.06) and weight < 3 kg (p-0.057) at time of PAB was noted. Only genetic syndrome was a risk factor associated with poor outcome (p-0.025). PAB has a reasonable outcome in SV patients with unobstructed systemic and pulmonary blood flow, but with a high reintervention rate. Only a quarter of patients with genetic syndromes reach S2P and further study is required to explore the benefits from an alternative palliative strategy.

Risk Factors of Central Line-Associated Bloodstream Infection (CLABSI): A Prospective Study From a Paediatric Intensive Care Unit in South India.

Background Central line-associated bloodstream infection (CLABSI) is the most common hospital-acquired infection. However, studies evaluating the factors associated with the risk of CLABSI in pediatric intensive care units (PICU) were limited in India. Objective The objective of our study is to evaluate the association of factors and the etiology causing CLABSI. Study design This is a hospital-based single-center prospective study conducted in the pediatric intensive care unit (PICU) of our tertiary care hospital spanning one year. Participants Children aged between two months to 15 years admitted in the PICU for more than 48 hours with central venous catheterization were included. Pearson's chi-squared test with Yates' continuity correction and logistic regression with odds ratio were calculated by R statistical software (R Foundation for Statistical Computing, Vienna, Austria) and a p-value less than 0.05 was considered statistically significant. Results Our analysis showed that factors such as young age (2-12 months), high pediatric risk of mortality (PRISM III) score (> 15), leukocytosis, neutrophilia, anemia, change of central venous catheter, duration of catheterization (>7 days), exposure to blood products, use of steroids, inotropes, and prophylactic antibiotics were significantly associated with increased risk of CLABSIs with an odds ratio of 4.53, 4.54, 2.91, 4.56, 4.76, 3.74, 2.49, 2.41, 7.22, 6.77 and 5.16 respectively (p<0.05). Further, factors such as older age (>12 months) and low PRISM III score (≤ 15) significantly reduce the risk of CLABSIs by 83.64% and 69.14% respectively (p<0.05). Conclusion In conclusion, our results revealed that factors such as young age, high PRISM III score, leukocytosis, neutrophilia, anemia, change of central venous catheter, duration of catheterization (> 7 days), exposure to blood products during the hospital stay, use of steroids, inotropes, and prophylactic antibiotics were identified as risk factors for CLABSI.

COVID-19 related multisystem inflammatory syndrome in children (MIS-C): a hospital-based prospective cohort study from Kerala, India.

Objectives: To study (1) epidemiological factors, clinical profile and outcomes of COVID-19 related multisystem inflammatory syndrome in children (MIS-C), (2) clinical profile across age groups, (3) medium-term outcomes and (4) parameters associated with disease severity. Design: Hospital-based prospective cohort study. Setting: Two tertiary care centres in Kerala, India. Participants: Diagnosed patients of MIS-C using the case definition of Centres for Disease Control and Prevention. Statistical analysis: Pearson χ2 test or Fisher's exact test was used to compare the categorical variables and independent sample t-test or Mann-Whitney test was used to compare the continuous variables between the subgroups categorised by the requirement of mechanical ventilation. Bonferroni's correction was used for multiple comparisons. Results: We report 41 patients with MIS-C, mean age was 6.2 (4.0) years, and 33 (80%) were previously healthy. Echocardiogram was abnormal in 23 (56%), and coronary abnormalities were noted in 15 (37%) patients. Immunomodulatory therapy was administered to 39 (95%), steroids and IVIg both were used in 35 (85%) and only steroids in 3 (7%) patients. Intensive care was required in 36 (88%), mechanical ventilation in 8 (20%), inotropic support in 21 (51%), and 2 (5%) patients died. Mechanical ventilation requirement in MIS-C was associated with hyperferritinaemia (p=0.001). Thirty-seven patients completed 3 months follow-up by April 2021, of whom 6 (16%) patients had some residual echocardiographic changes. Conclusions: Patients with MIS-C in our cohort had varied clinical manifestations ranging from fever with mild gastrointestinal and mucocutaneous involvement to fatal multiorgan dysfunction. Immediate and medium-term outcomes remain largely excellent except for the echocardiographic sequelae in a few patients which are also showing a resolving trend. Hyperferritinaemia was associated with the requirement of mechanical ventilation.

Neuromelioidosis Masquerading as Acute Demyelinating Encephalomyelitis.

BACKGROUND: Neuromelioidosis is a rare conduction, which is difficult to diagnose and treat. CASE CHARACTERISTICS: Preadolescent girl presenting with prolonged fever, acute ascending paralysis and encephalopathy. OUTCOME: Neuromelioidiosis was confirmed on brain biopsy culture. Patient improved with an intensive antibiotic regimen. MESSAGE: Neuromelioidosis can mimic acute demyelinating encephalomyelitis clinically and radiologically.