LOS sepsis is an important risk factor for thrombocytopenia in the NICU. Fungal and gram- negative sepsis are frequently associated with a decreased platelet count. Sepsis-induced thrombocytopenia is more common among LBW babies and preterm babies. The mortality rate is significantly related to degree of thrombocytopenia.

Due to changing characteristics of infective endocarditis in the past two decades, we, retrospectively analysed 28 cases of infective endocarditis in children of age less than 15 years at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar from December, 1983 to November, 1993. The incidence of disease was observed as 1.5 cases/1000 children admitted with a M:F ratio of 2:1. Three patients were of age less than 2 years (group I) as 25 were above 2 years of age (group II). The two groups had significant difference in portal of entry of infection, infective microorganisms, echocardiography and prognosis. Congenital heart disease was the commonest underlying cardiac lesion in 24 (85.71%) patients. Portal of entry of infection was apparent in 35.71% only; dental route being more frequent in group II. Streptococcus viridans (in 9 cases) followed by staphylococcus aureus (in 4 cases) were the two common organisms isolated. Patients were treated, for a period of 4-6 weeks with a over all mortality rate of 25%. Factors associated with poor prognosis were age < 2 years, staphylococcal infection ad negative blood cultures. Heart failure resistant to medical therapy was a leading cause of death.

Renal dysfunction following cardiopulmonary bypass is a frequent complication of open heart surgery. Acute renal failure requiring dialysis occurs in approximately 1.5% of patients following cardiac surgery and remains a cause of major morbidity and mortality. Method: Sixty-five patients of either sex in the age group of 10-50 years scheduled to undergo various cardiac procedures were included in this study. All patients had normal preoperative levels of serum creatinine, blood urea nitrogen, blood glucose levels, urine analysis, 24 hour urinary protein < 200 mg, and normal 24 hour creatinine clearance. After surgery, patients were transferred to an intensive care unit for postoperative management and monitoring. Patients were shifted to cardiovascular and thoracic surgery ward as soon as their clinical condition permitted. Blood urea nitrogen, serum creatinine, 24 hour creatinine clearance was performed on day one and day seven of postoperative period. Result: Postoperative oliguric acute renal failure was 7.7% and overall mortality was 6.1%. We found no association between aortic cross clamp time and postoperative renal dysfunction. Conclusion: Optimisation of cardiac performance post cardiopulmonary bypass seems to be the most important factor in the prevention of postoperative renal dysfunction in patients requiring total cardiopulmonary bypass.

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Nosocomial infective endocarditis (IE) is a relatively uncommon but, a serious complication affecting critically ill hospitalized patients who are frequently exposed to life-saving invasive procedures. Immunosuppressive treatment in solid organ transplant recipients predisposes to infections, nevertheless, nonspecific symptoms of IE, such as fever, lassitude, weight loss, and signs of inflammation may often be misinterpreted as acute rejection episode or a common urinary tract infection. The case reported here was a recent renal transplant with methicillin-resistant Staphylococcus aureus IE. We believe the diagnoses of IE in her were missed at her first presentation due to her non-specific symptoms and lack of echocardiography and blood culture results. Septic procedure at insertion of central venous catheter (CVC) in the Intensive Care Unit with trauma to tricuspid valve (TV) at the time of CVC insertion was a possible source of infection for IE. The patient was managed effectively with intravenous antibiotics in spite of having hanging pedunculated vegetation on TV.