INTRODUCTIONStress hyperglycemia(SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. [1][2][3][4] It is often discovered incidentally when routine blood sugar measurements reveal an elevated blood glucose. It is estimated that 49-70% of children with stress hyperglycemia have BG concentrates >150 mg/dl, 20-35% of children have BG > 200 mg/dl. 1-4However the occurrence of blood glucose more than 150 ABSTRACT Background: Stress hyperglycemia (SH) occurs commonly during critical illness in children with previously normal glucose homeostasis. Objective of present study was to study the clinical presentation, underlying illness and the outcome of stress hyperglycemia among critically ill children. Methods: Children attending the outpatient department and the casualty were admitted to Emergency department based on the triage guidelines. Children with blood glucose above 200 mg/dl on admission to the emergency department were considered to have hyperglycemia and were shifted to the Paediatric intensive care unit or the paediatric wards for further management. Data was collected as per the proforma. The blood sugar values were followed up in these children until restoration of normoglycemia. All the children were followed up till discharge or death in case of mortality. Associated risk factors were analysed between the survivors and nonsurvivors. Results: Among 102 children included in the study group from1 month to 12 yrs, 55 were infants, 37 in the age group of 1-5 yrs and 10 were more than 5 yrs. 60 were males and 42 were females. Family history of diabetes was encountered in 10 children. Out of 102 children, 60 recovered to hospital discharge. Sepsis, seizures, bronchopneumonia and CNS infections were the common illness among children with stress hyperglycemia. Age less than 1year, breathlessness, fever, shock, seizures and altered sensorium were identified to be significantly associated with mortality in children with stress hyperglycemia by univariate analysis in this study. Regression analysis revealed age less than one year, presence of lung infiltrates, longer duration of hyperglycemia, and need for Paediatric Intensive Care Unit (PICU) admission to be significantly associated with mortality. Non survivors had persistent hyperglycemia up to 48 hours in comparison to survivors. Overall mortality in the study group was 41%. Conclusions: Incidence of stress hyperglycemia is high in infants. Infections were the common underlying diagnosis in stress hyperglycemia. Being an infant, prolonged hyperglycemia for 48 hrs and need for PICU care were significantly associated with mortality. Overall mortality in children with stress hyperglycemia is 41%.

Accurate data collection is difficult in Vanuatu. There is the risk of under-ascertainment however, the figure of 27/1000 represents the current best possible estimate of perinatal mortality at VCH over the last 20 years. VCH is Vanuatu's premier hospital and it is likely that the national figure for perinatal mortality is higher, probably in the range of 37-39/1000. This places Vanuatu's perinatal mortality at a level 30 years or more behind Australia. These figures represent the largest account of hospital based perinatal data collected from any Pacific island nation.

Background: Bubble continuous positive airway pressure (bCPAP), a non-invasive respiratory device provides continuous pressure that helps recruitment of more alveoli, increases the lungs, functional residual capacity and decreases the work of breathing in newborns admitted with respiratory distress. Bubble continuous positive airway pressure (bCPAP) is the most important respiratory support in different types of respiratory conditions in level III. In this observational study, author reported this research using bCPAP therapy as the primary respiratory support in level III unit in tertiary care centre in Chengalpattu, Tamil Nadu, India. Despite reporting their indications, duration of use and adverse effects we tried to search for further improvement in other areas of CPAP therapy in level III newborn unit.Methods: This prospective observational study included 250 babies delivered in obstetric unit and admitted with respiratory distress within 6 hours of birth at level III care. They were treated according to level III newborn unit protocol. Those data were collected and entered in the proforma. Newborns were followed up till discharge.Results: A total of 250 babies satisfying the inclusion criteria delivered in Chengalpattu Medical College Hospital, Tamil Nadu, India (mean gestational age 36±2 weeks, mean birth weight 2.5±1.2 kg were included. All newborns were given bCPAP as the primary support. The most common underlying cause of respiratory distress was transient tachypnea of newborn (44%), followed by respiratory distress syndrome (24%) and prolonged respiratory transition (18%). The therapy success rate was 86%. Only 35 newborns failed to respond to CPAP. The most common adverse effect was eye puffiness (19%).Conclusions: Bubble continuous positive airway pressure (b CPAP) therapy use is being well established in level III unit for various respiratory conditions with minimal failure and adverse effects. Its use in extreme preterms and initiation after 6 hours is controversial.