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Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition mainly affecting children with a distinct clinico-radiologic pattern. Initially thought to be secondary to respiratory viral infections, there have been more insights to the pathogenesis of ANEC including genetics. We present a case of a girl who developed this condition with classical clinico-radiologic findings of ANEC secondary to severe dengue infection and could not survive. We report this case with the aim to raise awareness about this fatal complication of dengue infection as dengue has become a global health-care problem.

ObjectiveThe aim of this study was to describe the outcome of the use of interventional radiological procedures (IRP) (angioembolization) in critically injured children.MethodsA retrospective review of medical records of all children who underwent an IRP from January 2010 to December 2015 was done. Data were collected on a structured proforma and results are presented as mean with standard deviation and frequency with percentages.ResultEighteen patients were identified who underwent IRP during the study period. The mean age was 10.4 ± 4.3 years and 10 (55%) were males. Ten patients had a road traffic accident, four had a history of fall, one patient had glass cut pelvic injury, and two patients had blunt abdominal trauma, while one patient had bleeding secondary to hemipelvectomy. The genitourinary system was involved in five patients, liver in four, and spleen in two and pancreas in one patient. Bleeding was from branches of internal iliac artery in seven patients, hepatic artery in three patients, splenic artery in two patients, and middle colic artery in one patient, while one patient had blood oozing from the bone after hemi-pelvictomy. Four French vascular access sheath was placed under ultrasound guidance; this was followed by the placement of C1 catheter (Cordis, Miami, FL). After vessel identification, a 2.7F Progreat microcatheter (Terumo, Tokyo) was used for super-selective cannulation of the bleeding vessel. Intravascular coil, polyvinyl alcohol (PVA) particles, or gel foam was used for the embolization of bleeding vessels. No procedural complications were observed except minor oozing in one patient. One patient expired due to multiorgan dysfunction.ConclusionAngioembolization is a useful and relatively safe procedure in the management of vitally stable children with hemorrhagic abdominopelvic injuries. However, further studies may be needed to evaluate the efficacy and cost-effectiveness of this practice, especially in resource-constrained settings.

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To determine the relationship of hyperchloremia on development of Acute Kidney Injury (AKI), hyperchloremic metabolic acidosis, PICU length of stay and mortality in critically ill children. We did retrospective review of medical records of all children (aged 1 month to 16 years) admitted in our PICU from January to December 2015. Study population was divided into groups based on Chloride (Cl) level. Children with Cl level >110 meq/L were labelled as hyperchloremic groups and those with <110 as normochloremic group. Patients having acute kidney injury on admission and length of PICU stay <24 hours were excluded. A total 200 patients were identified, 100 in each group. Mean age was 55.59 ± 57.77 months with no difference between the two groups (p 0.66). 63% were males. Mechanical ventilation was needed in 50% patients, inotropes in 21.6 and renal replacement therapy in 14%. There was no significant difference between the two groups in development of AKI, length of PICU stay or survival (p value >0.05).