Thiamine Responsive Acute Infantile Encephalopathy.

This retrospective study was conducted to describe clinical and investigational findings and to determine the effect of thiamine treatment on mortality in patients admitted with acute non-infectious encephalopathy to a hospital in Sikkim between October 2019 and March 2021. Amongst 37 included patients the median age was 4 mo (IQR 3-5), 62.2% were males, 75% were exclusively breastfed infants, 67.6% and 89.2% patients had ophthalmologic and respiratory abnormalities respectively. Multisystem involvement was common. Bilateral basal ganglia involvement was noted in 75% of neuroimaging. Biochemical thiamine deficiency was confirmed in one infant. None of the 11 patients who received thiamine died whereas 20 among 26 patients who did not receive thiamine died [case fatality rate (CFR) 76.9%]. Thiamine treatment was significantly associated with reduced odds of mortality (aOR 0.046, 95% CI 0.0024-0.86, p 0.039). In patients with acute non-infectious encephalopathy and bilateral basal ganglia involvement thiamine use was associated with decreased mortality.

Demographic and Clinical Profile of Invasive Staphylococcal Infections in Children Admitted to Pediatric Intensive Care Unit: A Retrospective Study.

OBJECTIVE: Staphylococcal infections are common cause of morbidity and mortality in pediatric intensive care unit (PICU). The objective of this study was to describe the clinical and microbial features, and outcome of patients with invasive staphylococcal infection. MATERIALS AND METHODS: We conducted a retrospective chart review of the children admitted to PICU with invasive staphylococcal infections. Invasive staphylococcal infection was defined as clinical infection with isolation of Staphylococcus aureus from a normally sterile body site. RESULTS: A total of 50 children (1 month to 16 years) were identified with staphylococcal infections during the study period. There was male preponderance (75%) with high prevalence in school going children. Among these children, 36% (18) were coagulase-negative (CONS), which were excluded. Of the remaining, 64% (32) were coagulase-positive Staphylococcus aureus, 54% (27) were methicillin-resistant Staphylococcus aureus (MRSA), and 10% (5) were methicillin-susceptible Staphylococcus aureus (MSSA). Community-acquired staphylococcal infections were present in 24 children (CA-MRSA). Pneumonia with empyema was the most common 20 (62%) site of primary staphylococcal infection, followed by blood stream infection 9 (28%) and skin and soft tissue infection 3 (9%). Of the soft tissue infection, three were MRSA, with two had pyopericardium with infective endocarditis. Resistance in MSSA was found to be maximum to penicillin, erythromycin, and ciprofloxacin with no resistance with vancomycin. CONCLUSION: There is an increase incidence of MRSA among community-acquired staphylococcal infections requiring intensive care management. A larger study on clinical profile of Staphylococcus infection in pediatrics is urgently needed to define the exact magnitude of the problem. HOW TO CITE THIS ARTICLE: Lalitha AV, Rebello G, Chettri S, Reddy M. Demographic and Clinical Profile of Invasive Staphylococcal Infections in Children Admitted to Pediatric Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2020;24(9):890-891.

Current Concepts in the Management of Meconium Aspiration Syndrome.

In developing countries, meconium aspiration syndrome (MAS) is an important cause of morbidity and mortality among neonates. The concepts of pathophysiology and management of meconium stained amniotic fluid (MSAF) and meconium aspiration syndrome have undergone tremendous change in recent years. Routine intranatal and postnatal endotracheal suctioning of meconium in vigorous infants is no longer recommended. Recent studies have challenged its role even in non-vigorous infants. Supportive therapy like oxygen supplementation, mechanical ventilation and intravenous fluids are the cornerstone in the management of meconium aspiration syndrome. Availability of surfactant, inhaled nitric oxide, high frequency ventilators and extracorporeal membrane oxygenation has made it possible to salvage more infants with meconium aspiration syndrome. In this review the authors have discussed the current concepts in the pathophysiology and management of MAS. Drugs in trials and future therapeutic targets are also discussed briefly.

Endotracheal Suction for Nonvigorous Neonates Born through Meconium Stained Amniotic Fluid: A Randomized Controlled Trial.

OBJECTIVE: To assess whether endotracheal suctioning of nonvigorous infants born through meconium stained amniotic fluid (MSAF) reduces the risk and complications of meconium aspiration syndrome (MAS). STUDY DESIGN: Term, nonvigorous babies born through MSAF were randomized to endotracheal suction and no-suction groups (n=61 in each). Risk of MAS, complications of MAS and endotracheal suction, mortality, duration of neonatal intensive care unit stay, and neurodevelopmental outcome at 9 months were assessed. RESULTS: Maternal age, consistency of meconium, mode of delivery, birth weight, sex, and Apgar scores were similar in the groups. In total, 39 (32%) neonates developed MAS and 18 (14.8%) of them died. There were no significant differences in MAS, its severity and complications, mortality, and neurodevelopmental outcome for the 2 groups. One infant had a complication of endotracheal suctioning, which was mild and transient. CONCLUSIONS: The current practice of routine endotracheal suctioning for nonvigorous neonates born through MSAF should be further evaluated. TRIAL REGISTRATION: Clinical Trial Registry of India: CTRI/2013/03/003469.