Comparison of Non-Invasive Oscillometric and Intra-Arterial Blood Pressure Measurements in Children Admitted to the Pediatric Intensive Care Unit

Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p < 0.001), with wide limits of agreement. NIBP significantly overestimated BP (p < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years (p < 0.001), with the maximum difference being in infants. It was insignificant in adolescents (p = 0.28) and underweight children (p = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.

Role of montelukast in multitrigger wheezers attending chest clinic in Punjab, India

BACKGROUND

Wheeze is seen in 40% of preschool children, one-third of these may develop recurrent wheeze. Montelukast is an oral, once a day, easy to give therapy but there is no definite evidence to support its use in a recent meta-analysis. Present study was done to evaluate role of daily montelukast and various factors affecting the outcome after therapy in multitrigger wheeze (MTW).

METHODS

A prospective study conducted in Pediatric chest clinic over 18 months at DMCH, Ludhiana. Children from 6 months to 5 years, diagnosed cases of MTW were started on montelukast. Diagnosis based on symptoms of recurrent wheeze triggered by various allergens/precipitants was made by pediatrician in charge of chest clinic. Children were followed up at 1 and 3 months. They were labeled as controlled, partially controlled, or uncontrolled as per global initiative for asthma guidelines. Data were used to compare the outcome related to various factors.

RESULTS

Total 139 out of 150 children came for regular follow-up. At the end of 3 months, 94 (67.7%) were controlled, 8 (5.7%) partially controlled, and 37 (26.6%) children remained uncontrolled on montelukast. Factors associated with poor control were onset of symptoms at younger age (<6 months of age), family history of allergies, prior multiple visits or hospitalizations due to MTW, use of MDI in the past. No significant side effects were reported by parents.

CONCLUSION

Symptomatically two-third of children became better after starting montelukast. There were few factors which resulted in poorer control in subset of patients.

Head drop and flaccid weakness in infantile nephrotic syndrome

Dropped head syndrome (DHS) is a relatively rare condition, with a broad differential diagnosis. We report here a case of infantile nephrotic syndrome with DHS caused by severe hypokalemia. Electrocardiogram showed flat T- and U-waves. Multiple factors including recurrent diarrhea, prolonged diuretic and corticosteroid use, hypomagnesemia, poor intake, and malnutrition caused hypokalemia in the case. Head drop and flaccid weakness resolved completely after potassium and magnesium supplementation. Potassium levels should be monitored and corrected promptly in these settings.

Multidimensional impact on families of children with steroid-sensitive nephrotic syndrome

AIM

Children with nephrotic syndrome (NS) have prolonged disease course with relapses requiring frequent visits and prolonged steroid therapy with their long-term concerns. All these factors affect the child and their families in many domains of functioning. The objective of this study was to assess multidimensional impact on families of children with nephrotic syndrome using (PedsQL) Family Impact Module (FIM).

METHODS

This cross-sectional study was conducted in a paediatric nephrology clinic of a tertiary care hospital. Fifty cases of steroid-sensitive nephrotic syndrome between age group of 2-18 years were included, and equal age-sex matched healthy children were taken as controls. Baseline demographic factors including age, gender and education status, modified Kuppuswamy's socio-economic status were collected and clinical variables of NS cases were recorded. FIM is a parent-reported instrument that measures the impact of paediatric chronic health conditions on care giver's HRQOL and their family function. Mean FIM scores were compared among the cases and controls, and different predictive factors affecting family impact (FI) were analysed.

RESULTS

The FI total score showed significantly lower scores in cases (mean score: 60.76 ± 15.66) as compared to controls (mean 100). Among the individual groups, lowest scores were found in two domains, namely 'worry' and 'emotional function' with mean scores of 46.20 ± 20.66 and 46.80 ± 24.61, respectively, although other domains were also significantly affected.

CONCLUSION

FI score should be evaluated in all cases of NS as parenting such children may significantly affect all domains of family functioning.

Outcome of children with acute disseminated encephalomyelitis in a tertiary care center in India

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated disease of the brain that follows viral infection or vaccination, or even appears spontaneously. The objective of the study was to evaluate the clinical, neuroimaging and laboratory profiles of children with ADEM. Seventeen children admitted to the Pediatric Department of Dayanand Medical College and Hospital, Ludhiana, whose cases were consistent with the diagnosis of ADEM, were included. Their clinical and neuroimaging profiles and outcomes were studied. The most common presenting features were fever (71%), altered sensorium (59%) and headache and convulsions (41%). Brain MRI identified lesions in subcortical white matter (75%) and periventricular white matter (38%). Most patients were treated with corticosteroids. A favorable outcome was seen in 88% of patients. Although 59% of patients had neurologic sequelae at discharge, only one patient had a major neurological deficit at follow-up. Prognosis for survival and outcome was good in the majority of patients. Neurological sequelae at discharge do not predict poor outcome.

Pulmonary functions in normal school children in the age group of 6-15 years in north India

OBJECTIVE

Lung function tests have become an integral part of assessment of pulmonary disease. As few studies on pulmonary function tests have been carried out in young children in India, the study was carried out in normal urban and rural school children in Ludhiana district of North India to determine pulmonary functions in the age group 6-15 years and to find its correlation with regards to age, sex, height and weight.

METHODS

The study group included 600 normal children between 6-15 years age from different urban and rural schools in the region. A preformed questionnaire was interviewed and detailed general physical and systemic examination was done. Pulmonary function tests were measured by using Micromedical Gold standard fully computerized portable auto spirometer (Superspiro Cat No. SU 6000).

FINDINGS

The present study shows, all the three independent variables (age, weight and height) have linear positive correlation with lung function parameters, both for boys and girls. Lung function values in boys were significantly higher as compared to that of girls. Urban children had higher lung function parameters than rural children except IRV, FEF(25%). Among all anthropometric parameters, height was the most independent variable with maximum coefficient of correlation.

CONCLUSION

Equations derived from the present study for estimation of the expected values of lung function will help to interpret the observed lung function values in children of North India.