ObjectiveMIS-C is a novel disease entity. We aimed to outline the clinical features and laboratory parameters of children with moderate to severe MIS-C and to study predictors of more severe disease. MethodsIn this prospective longitudinal study, all children less than 15 years of age requiring admission to the Paediatric Intensive Care Unit (PICU) or High Dependency Unit (HDU) with three or more days of fever were screened for MIS-C according to the WHO case definition. Children with alternative diagnoses were excluded. Those included were tested for active or past infection with SARS-COV2 using RTPCR or antibody testing. Severe MIS-C was defined as presence of ventricular dysfunction, coronary dilatation, need for respiratory support, inotropes or invasive ventilation. Clinical features, laboratory parameters and risk factors for severe disease was studied.Results60 children were included in the study. Median age group was 5yrs(IQR 2.175,9)The median duration of PICU/HDU stay was 4 days(IQR 2,5.75). Two children died of the illness. Gastrointestinal symptoms were most common(73%) followed by muco-cutaneous(56%), respiratory(46%) and cardiovascular system(41%) involvement. Majority showed neutrophilia(73%), leucopenia(53%) and raised inflammatory markers including ESR,CRP, D-dimer, ferritin and NT-proBNP which showed significant association with need for respiratory support, inotropes, cardiac dysfunction and prolonged ICU stay. Gastrointestinal symptoms, respiratory distress, reduced urine output at admission, platelet counts less than 1.5 lakhs, D-dimer >2000ng/mL, CRP >70mg/L, NT-proBNP>500pg/mL, ferritin >250mcg/L were markers of severe MIS-C.ConclusionClinical features and laboratory parameters aid in early recognition of severe MIS-C resulting in greater probability of survival.
Ventilation-induced diaphragm dysfunction can delay weaning from mechanical ventilation. Identifying the optimal time for extubation has always been a challenge for intensivists. Diaphragm ultrasound is gaining immense popularity as a surrogate to measure diaphragm function. We attempted to assess the utility of diaphragm function in predicting extubation success using point-of-care ultrasound examination. We conducted a prospective observational study in a single-center tertiary care pediatric intensive care unit (PICU). All children aged between 1 month and 16 years admitted to the PICU and who underwent invasive mechanical ventilation for more than 24 hours were included in the study. Children who died during mechanical ventilation and those with conditions affecting diaphragm function like neuromuscular disorders, pneumothorax, chronic respiratory diseases, and intraabdominal hypertension were excluded from the study. Diaphragm thickening fraction (DTf) was measured during spontaneous breathing trial and correlated to predict extubation success. We found that DTf is an independent predictor of extubation success. DTf more than or equal to 20% was associated with extubation success with a positive predictive value of 85%. The area under the curve for DTf showed good accuracy.
Objectives: The objectives of the study were to evaluate the efficacy and the adverse effects of intranasal midazolam compared to intravenous (IV) midazolam for procedural sedation in children between 6 months and 12 years of age using the University of Michigan sedation scale. Design: Prospective open-label randomized controlled trial. Setting: Children requiring sedation for any invasive or non-invasive procedure in the Department of Paediatrics, between June 2012 and May 2014. Participants: A total of 246 children aged between 6 months and 12 years of age were enrolled and sequentially allocated into the study by computer-generated block randomization. Intervention: As per randomization, participants were administered intranasal or IV midazolam before the procedure. Procedure was done 5 min after IV and 15 min after intranasal administration. Main outcome measures: Sedation score was rated using the University of Michigan Sedation Score. The ease of performance, numbers of successfully completed procedures, and adverse effects were noted. Results: Intranasal midazolam provided better sedation scores (p<0.001) and ease of procedure scores (p=0.026) compared to IV, especially in the age group from 6 months to 6 years. Both groups gave comparable successful procedure completion rates. The most commonly encountered side effect with intranasal was nasal irritation (p<0.001). Conclusion: Intranasal midazolam provided significantly better sedation and ease of procedure scores when compared to IV, with fewer adverse effects. Hence, it can be put to use in resource-limited settings.
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