Background: Shock accounts for 2% of children admitted to Paediatric casualty worldwide as per most western literature and in Nelson text book of Paediatrics. About 10 million children die of shock every year in the world. Highest mortality is observed in under 5 children in developing countries. Clinical manifestations are due to decreased perfusion to tissues, the compensatory mechanisms that are triggered by the decreased perfusion and the inadequate removal of metabolic wastes. This study was carried out to assess the prevalence of paediatric shock in children admitted to Paediatric ICU, to identify possible aetiology and the response to treatment and outcome in patients admitted with shock in Paediatrics Department of Government Mohan Kumaramangalam Medical College, Hospital, and Salem.Methods: All sick children admitted to Paediatric intensive care unit of Government Mohankumaramangalam Medical College Hospital, Salem with the suspicion of shock are assessed by using the rapid cardiopulmonary assessment and diagnosed suffering from shock. Possible etiology, type and severity of shock would be arrived at using a targeted history, clinical examination and relevant laboratory investigations.Results: All children who had unstable airway or bradypnea, were having decompensated shock and except one among them all expired despite prompt airway management. Respiratory distress noticed in 23 (40.4%) of children and all of them had either cardiogenic, septic shock or a combination of both. Capillary refill time was prolonged in 52 (91.2%) of children and the remainder 5 (8.8%) had flash refill and managed as warm septic shock. Decompensated shock as evidenced by low blood pressure was seen in 57.9% children. All of them had altered mental status. Urinary output was monitored in 38 children of which 31 (81.6%) had oliguria.Conclusions: Septic shock accounts for majority of decompensated shock and poor outcome to management. Infancy decompensated shock, septic shock and those requiring ventilator support were the factors influencing the outcome of management.

In most of these new-born babies, the ineffective transport system results in hypoglycemia, hypothermia, cyanosis and other complications. These complications further increase the mortality among these sick neonates. ABSTRACT Background:In the past decade, great advancements in Neonatal care contributed to a fall in IMR. A further fall in IMR can only be achieved by improving the neonatal transport facilities. Hence to assess the current status of neonatal transport we undertook this study. Methods: This is a cross-sectional study of 75 neonates transported to our NICU. For all the babies, data regarding the place of birth, mode of delivery, mode of transport, etc. were collected. On admission parameters like blood glucose, temperature, CRT, SPO2, the presence of cyanosis, shock was assessed. Results: In the present study 64% of neonates came to our NICU on their conveyance. 67% of referrals from PHCs did not utilize ambulance facility. 30% of neonates had hypothermia on arrival. 35%had hypoglycemia on arrival. 15% had a low oxygen saturation on arrival. 15% had prolonged CRT on arrival. Only 8% of neonates received prior treatment. 11% babies did not have any referral slip. Only a very few had complete and proper referral advice. Conclusions: To further reduce the neonatal mortality rate, the neonatal transport facilities should be upgraded. A standard protocol should be formulated for interfacility transport. A separate fleet of neonatal ambulances well equipped and manned by trained personnel is the need of the hour.

Introduction: Kangaroo Mother Care (KMC) is a simple method of caring Low Birth Weight (LBW) babies with a birth weight below 2500 grams. The grandmothers play a key role in child rearing in the Indian society. Aim: To estimate the level of knowledge about the KMC in the grandmothers and to compare it with that of the mothers. Materials and Methods: The cross-sectional study was conducted in the neonatal follow-up clinic of a tertiary care hospital with a convenience sampling of all the mother (Group 1) and grandmother (Group 2) dyads. The mothers and grandmothers were interviewed separately using a pre-validated questionnaire with 15 open ended questions to assess the knowledge about the KMC. Mann-Whitney U test and Fischer’s- exact test were used for statistical analysis. Results: There were 390 mother- grandmother dyads in the study group. The mean age of the mothers and grandmothers were 24.69±1.54 years and 53.89±1.80 years, respectively. For all the 15 questions the grandmothers had a significantly lower score when compared to the mothers (p<0.001). The grandmothers (mean score: 8.48±2.00) had a significantly lower overall knowledge scores than the mothers (mean score: 23.10±1.55). On comparison of the mean knowledge scores of the mothers with their age, educational status and socio- economic class, it was found to be independent of these factors (p-value=0.209, 0.691 and 0.731, respectively). Conclusion: This study had demonstrated that the grandmothers have a significantly lower knowledge about KMC. There is an urgent need to empower them with the knowledge about KMC for the successful continuation KMC in the home.

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