Background: With advances in neuroimaging, acute necrotizing encephalopathy of childhood (ANEC) is being recognized as an acute encephalopathy with a characteristic rapidly deteriorating neurological course with poor neuro-developmental outcomes with high mortality and morbidity rates. Indian data of ANEC is primitive and hence this study was planned. The objective of the study was to evaluate the clinical, radiological characteristics and its outcomes in children with ANEC.Methods: Retrospective review of 10 infants and children with ANEC at Department of Paediatrics, S.N. Medical College and HSK Hospital, Bagalkot from January 2013 to December 2019. ANEC was suspected based on clinical and radiological characteristics and diagnosis was made based on diagnostic criteria proposed by Mizuguchi et al. Clinical and radiological (Magnetic resonance imaging (MRI) brain characteristics) findings and response to early pulse dose steroid therapy and supportive treatment were assessed in all cases. All cases were followed for evaluation of neurodevelopmental outcome and response to physiotherapy was noted in all the cases.Results: Total 10 cases were analysed (age ranged from 6 months to 11 years). Sex distribution male to female was 3:7. All cases had precedent viral illnesses and had fever, coryza, diarrhoea. The initial neurological symptoms included seizures and status epilepticus (n=7), altered sensorium (n=3), focal neurological signs , gait disturbances (n=2) and diplopia (n=1). MRI brain revealed characteristic thalamus involvement with varied involvement of midbrain, pons, medulla (n=10). Other findings were cavitation (n=5), haemorrhage (n=4), minimal residual lesions (n=4), cerebral atrophy (n=1), normal brain study (n=5) on follow-up. 9 out of 10 cases survived, responded to early physiotherapy and rehabilitation. 6 children had complete recovery with minimal disability in 3 cases.Conclusions: ANEC is a clinico-radiological syndrome. Early detection and appropriate treatment improves outcome in ANEC.

INTRODUCTIONBirth asphyxia refers to condition of hypoxemia, hypercapnia and insufficient blood perfusion of new born during labour and birth. NNPD defines moderate birth asphyxia as APGAR score of 4-6 at 1minute and severe birth asphyxia as APGAR score of <3 at 1 minute.1 AAP defines it as APGAR score of less than 3 at 5minutes associated with cord pH of less than 7.0, presence of neurologic dysfunction and evidence of multiorgan dysfunction. 2Perinatal Asphyxia (PA) is a major public health problem. As per the latest estimates, PA accounts for 9% (i.e. 0·8 million) of total under-5 mortality (i.e. 8.8 millions) worldwide, being one of the three most common causes of neonatal deaths along with prematurity and bacterial infections. Of a total of 2.7 million stillbirths globally, approximately 1.2 million occur during intrapartum period, largely owing to asphyxia.3 As per NNPD, 9.5% of babies require some form of resuscitation. Manifestations of Hypoxic Ischaemic Encephalopathy (HIE) were seen in approximately 1.4% of all babies. PA was responsible for 28.8% of all neonatal deaths. Apart from neonatal deaths, asphyxia is responsible for life-long neuromotor disability in a large number of children. 1 ABSTRACTBackground: Objectives of current study was to study the incidence of multiorgan dysfunction in babies with perinatal asphyxia and its effect on the outcome. Methods: All term babies admitted to NICU of S. Nijalingappa Medical College and Hanagal Shri Kumareshwara Hospital, Bagalkot in the period January 2013 to December 2013 with perinatal asphyxia and HIE were included in the study. Detailed history and thorough examination was done using predesigned and prestructured proforma. Necessary investigations were done as indicated to identify organ dysfunction. Results: 80.8% of babies with perinatal asphyxia had evidence of multiorgan dysfunction with HIE alone seen in 19.2% of cases. Respiratory failure was the most common organ dysfunction after CNS seen in 63.1% of cases. CVS involvement was seen in 54.3% (31) of babies, out of which the mortality was seen in 22.5% (7 cases), renal involvement was seen in 29.8% (17) of babies, out of which the mortality was seen in 29.4% (5 cases). Increased mortality in babies who had cardiovascular dysfunction and in babies with renal dysfunction was statistically significant. Mortality was higher in babies with multiorgan dysfunction which increased proportionately with increase in number of organs involved. Conclusions: Multiorgan dysfunction is common in babies with perinatal asphyxia. Cardiovascular involvement and renal involvement are associated with poor outcome. Mortality is directly proportional to the number of organs involved.

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Background: Mucocutaneous diseases are more common children with HIV infection than normal population. These develop a wide variety of infectious and inflammatory diseases of the skin. In some cases, disorders of the skin or mucous membrane may provide an early clue to the presence of HIV infection. Objective: To determine the prevalence and pattern of mucocutaneous manifestation in HIV infected children. Methods: All serologically positive children admitted in paediatric ward of S. Nijalingappa Medical College, Bagalkot, between the age group of 18 months to 14 years were studied from October 2010 to March 2012 (18 months period). Clinical information was collected using standard questionnaire. Results: 85 children who fulfilled inclusion criteria were enrolled in the study. 57 children had mucocutaneous manifestation and most of them were aged more than 5 years. The most prevalent mucocutaneous disorders were infectious dermatosis. Most of them were seen with WHO stage III and IV, and with moderate and severe immunosuppresion. Two or more mucocutaneous disorders were found in moderate and severe immunosuppresion. Conclusions: The prevalence of mucocutaneous disorders is high in HIV infected children with varied pattern. Advanced immunosuppresion is highly associated with a wide spectrum of mucocutaneous disorders.