Background Dengue fever prevalence is rising globally and it causes significant morbidity and mortality. Fluid extravasation during the critical phase of dengue haemorrhagic fever (DHF) leads to shock, multi-organ failure and death if not resuscitated appropriately with fluids. The mainstay of management is judicious fluid replacement using a guideline based, calculated fluid quota of maintenance (M) fluid plus 5% deficit (M +  5% deficit) to prevent organ hypoperfusion. Methods We conducted an observational follow-up study in Sri Lanka from January–July 2017 to identify the fluid requirements of DHF patients and to identify whether features of fluid overload are present in patients who exceeded the fluid quota. Patients who developed DHF following admission to the place of study, were recruited and the amount of fluid received during the critical phase was documented. Results A total of 115 DHF patients with a mean age of 30.3 (SD 12.2) years were recruited to the study. There were 65 (56.5%) males and the mean fluid requirement was 5279.7 ml (SD 735) over the 48 h. Majority of the study participants (n = 80, 69.6%) received fluid in excess of the recommended maintenance + 5% deficit and this group had higher body mass index (22.75 vs 20.76, p0.03) and a lower white cell count at the onset of the critical phase (3.22 × 103 vs 4.78 × 103, p < 0.001). The highest fluid requirement was seen within the first 12 and 24 h of the critical phase in patients requiring fluid M +  5%–7.5% deficit and ≥ M +  7.5% deficit respectively. Patients exceeding M + 5% deficit had narrow pulse pressure and hypotension compared to the rest. DHF grades III and IV were seen exclusively in patients exceeding the fluid quota indicating higher amount of fluid was given for resuscitation. Fluid overload was detected in 14 (12.1%) patients and diuretic therapy was required in 6 (5.2%) patients. Conclusions The majority of patients received fluid in excess of the recommended quota and this group represents patients with narrow pulse pressure and hypotension. Although, fluid overload was infrequent in the study population, clinicians should be cautious when administering fluid in excess of M +  7.5% deficit.

Objective: To describe early single-centre clinical experience with the Amplatzer Ductal Occluder II (ADO II).Method: Children with a haemodynamically significant patent ductus arteriosus (PDA) who underwent percutaneous trans-pulmonary closure with Amplatzer Ductal Occluder II (ADO2) were included. Data was collected from computer based patient records.Results: Trans-pulmonary PDA closures using ADO 2 were undertaken in 32 children (22 females) with a mean age of 1year 9 months (range 5 months to 10 years) and a mean weight of 8.2kg (range 4.2-25kg). Complete occlusion was noted pre-discharge in 31 (97%) patients. One (3%) had residual shunting after deployment followed by embolization to the left pulmonary artery on the third day of the procedure. One (3%) had mild flow acceleration in the left pulmonary artery and another (3%) had mild aortic flow obstruction following the procedure. At 7 and 30 days, echocardiography confirmed complete ductal occlusion without need for further intervention in all 31 (97%) successful cases.Conclusion: ADO II is highly effective in rapid occlusion of morphologically varied small to moderate-sized PDAs.

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Objective: To determine the age range, where juvenile T inversion pattern in right precordial leads (V1 to V4) in an ECG changes to the adult upright T wave pattern Method: A descriptive cross-sectional study was done in children aged 5 years and above referred to the paediatric cardiology clinic, Teaching Hospital Karapitiya from January 2012 to April 2013. Inclusion criteria were: children with no cardiac lesion or a haemodynamically insignificant cardiac lesion after a full cardiac evaluation.The cohort was divided into six age groups and the presence of juvenile and adult ECG patterns were evaluated. Results: A total number of 1039 children were enrolled. At the age of 13 years 50% depicted both juvenile and adult ECG patterns. At the age range of 13-15 years 78 (60%) of a total of 130 showed the adult ECG pattern compared to 99 (44.4%) of a total of 223 at 11-13 years (X 2 =8.0; p=0.005). Even after 13 years of age the juvenile ECG pattern persisted in 30-40% of children. Conclusions: Transition of the juvenile T inversion pattern in right precordial leads in an ECG to the adult upright T wave pattern occurs predominantly at the age range of 13-15 years. Presence of juvenile T inversion pattern in an ECG after 13-15 years can be a normal finding as well as may be a pre-symptomatic diagnosis of a cardiomyopathy. Although it is normal to have a juvenile ECG pattern above 13 years it is advisable to perform an echocardiographic evaluation on children above 13 years with juvenile T inversion pattern which may lead to early diagnosis of cardiomyopathy.