Asian Journal of Pediatric Research

Aim: Hypernatremia is a recognized complication of poorly constituted Oral Rehydration Solution (ORS) use that can cause neurological manifestations which require careful but often challenging management to prevent morbidity and mortality. Herein we report a case of symptomatic hypernatremia in a 2-year-old boy following ingestion of poorly constituted Oral Rehydration Solution (ORS) and highlight challenges in management. 

Presentation of Case: This is a case report of a 2-year-old male who presented with a four-day history of vomiting and fever. He received four litres of hyper-concentrated ORS (1 packet of ORS to 0.7 l of water) prior to presentation. At presentation, he was lethargic and subsequently lapsed into unconsciousness. He also developed focal and generalized seizures. Serial serum electrolytes testing showed hypernatremia which ranged from 157-161 mmol/L in the first 48 hours of admission for which appropriate intravenous fluids were given. Serum sodium levels gradually returned to normal (140-142 mmol/L) with treatment. He subsequently regained full consciousness after four days in a coma and was discharged home in satisfactory clinical condition.

Conclusion: This case is being reported to highlight the important role of proper history taking, careful fluid and electrolyte monitoring in the diagnosis and care of this condition and emphasise on adequate education of caregivers by clinicians and the mass media on appropriate preparation of ORS.

Introduction: Incidence of nephrotic syndrome (NS) and filariasis both is high in China, Japan & India. Studies have shown the association of filariasis in NS. In the coastal belt of Gujarat, Filariasis occurs as the mosquito responsible is still prevalent. Therefore, filariasis association may be causing persistence of oedema in NS relapse cases. After a 7^th relapse patient was treated successfully with diethylcarbamazine citrate (DEC), we decided to observe the effect of DEC on weight loss and urine protein, in relapse patients of NS.

Case Details: In relapse patients of NS, DEC was given by oral route in the dose of 72 mg/kg/cycle for 7 days. Weight record and urine protein were measured daily. Steroid as Tab prednisolone was administered at 2 mg/k/d.

Outcome: The 1^st case was a steroid-dependent nephrotic syndrome with the 7^th relapse; she had been on prednisolone and Levamisol for 3 years. DEC was started on day 3 of admission and response was seen on the 5^th day. Urinary protein became nil on day 10, and the patient has been relapse free for 1 year. In each of the other 4 cases with 1^st, 2^nd, 2^nd and 4^th relapse respectively, the response of DEC was seen within 2 days. Thus, after starting DEC weight and urine protein reduced within 2 days in 5 relapse cases. Filaria was not detected in blood film of any patient and Elisa tests done in 2 were negative.

Conclusion: Randomized studies with controls and better filarial detection methods are required for DEC to be considered as an add-on drug in relapse cases of NS in, Filarial endemic regions, as it is faster acting, effective, similar to Levamisol and safe.

Background and Objective: Hemodynamically significant patent ductus arteriosus (HsPDA) is a common cause of morbidity in preterm infants. Indomethacin and Ibuprofen, which are cyclo-oxygenase (COX) 1, 2 inhibitors are commonly used drugs for closure of HsPDA. As, Ibuprofen has several contraindications, we designed study using oral paracetamol (a peroxidase inhibitor) and compared with oral ibuprofen, for efficacy and safety in relation to closure of HsPDA in preterm infants.

Methods: 140 preterm infants (gestational age less than 32 weeks) with HsPDA (confirmed by 2D Echo) were randomly assigned in two groups and received first course of either oral paracetamol (70) or ibuprofen (70). The need for a second course was determined by 2D Echo evaluation. Parameters studied were rate of ductal closure, any adverse effects and discharge rate.

Results: Both groups were similar in term of ductal closure after first course (p=0.46) and second course (p=0.59). However, 22 from Ibuprofen group and only 2 from PCM group developed adverse effects (p<0.001). From paracetamol group 58 were discharged, and 12 died; while from ibuprofen group 46 discharged, 24 died (p=0.03).

Conclusion: Paracetamol for HsPDA in preterm neonates was associated with good efficacy and better safety; and less deaths, as compared to ibuprofen.

Background: Vitamin K deficiency can cause severe haemorrhage in the newborn and is an important cause of infant morbidity and mortality. HDN can be classified according to the time of presentation after birth into early (0–24 hours), classical (1–14 days) and late (2–12 weeks) HDN. Late HDN, which presents after the first week of life, mainly manifests as intracranial haemorrhage, depending upon the site and amount of bleeding, it either results in mortality or life long sequelae in the form of cerebral palsy and scar epilepsy with or without cognitive impairment.

Objective: To determine the frequency of ICH about vitamin K deficiency and outcome in infants aged 2 to 24 weeks.

Materials and Methods: From 1 September 2017 to 30 September 2019 we retrieved the retrospective data of 8 patients with late HDN admitted to Bapuji Child Health Institute and Chigateri Government General Hospital, Davangere.

Results: Six of eight cases with late HDN had an intracranial haemorrhage, of whom 5 patients died (62%), one ended up with neurological sequelae (12%) and 2 cases had an extracranial bleed. Out of these 8 cases, 5 had not received vitamin K at birth.

Conclusion: For neonates on strict breastfeeding, despite some with vitamin K prophylaxis, some patients still may suffer from intracranial and extracranial bleeding due to late HDN. Therefore, a change in strategy in the form of making the paediatricians and Anganwadi workers working in subcenters to give vitamin K, who have been vaccinating the babies after birth, would increase the vitamin K coverage.

Background and Objectives: There is no consensus over which drug best reduces symptoms in Bronchiolitis syndrome. The primary objective of our study is to establish comparative effect of adrenaline nebulisation alone and combination of adrenaline nebulisation plus injectable dexamethasone and adrenaline nebulisation plus fluticasone nebulisation in the treatment of clinical cases of bronchiolitis.

Methods: 100 patients diagnosed clinically as bronchiolitis were enrolled in study from 1 month to 24 months of age. Patients were enrolled by purposive sampling. Patients with respiratory distress assessment instrument score [RDAI] of 4 to 15 were chosen, randomized into three groups and treatment given till patient fullfilled discharge criteria. Group A (n=33) were given nebulised adrenaline alone, Group B (n=34) were given nebulised adrenaline plus injectable dexamethasone and Group C (n=33) were given nebulised adrenaline plus nebulised fluticasone.

Results: The mean reduction in clinical severity-RDAI score was 1.75 ±0.86 in Group A, 2.30 ± 0.68 in Group B and 1.42 ± 0.9 in Group C when measured in terms of difference in clinical scores between day 1 and 2 (p=0.0003).

Mean duration of hospital stay in the group A was (4.93±1.95 days), Group C (4.78±1.83) and Group B (3.91 ±1.37 days). The difference of stay between the Groups A and B was 1.02±0.58 days vs 0.87± 0.46 days in groups B and C (p-0.0048). Reduction in the length of hospital stay in group B was 22% compared to Group A & 19% compared to Group C (p-0.0048).

Side effects were tachycardia in six patients.

Conclusion: Combination of adrenaline nebulization and injectable dexamethasone was found significantly better as compared to nebulised adrenaline plus nebulised fluticasone and nebulised adrenaline alone in patients of clinical bronchiolitis in reducing severity of clinical symptoms and duration of hospitalization.