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Objetive: We sought to determine the association between maintenance intravenous solutions and the presence of hyponatremia in children in pediatric intensive care (PICU).Materials and Methods: An analytical observational study in children hospitalized in the PICU between January 2015 and December 2018. Patients who received maintenance fluids within the first 48 h after admission and who had at least two serum sodium levels drawn during this time were included.Measurements and Main Results: A total of 1,668 patients were admitted to the PICU during the study period, 503 of whom met the inclusion criteria. The median age was 24 months (IQR 8–96) and 50.9% were female. Altogether, 24.1% of the children developed hyponatremia; it was more frequent in those who received hypotonic solutions (63 vs. 37%; OR 1.41 95% CI 0.92, 2.15 p = 0.106), who also had a longer hospital stay (20 vs. 14 days, difference in means 8 days, 95% CI 2.67, 13.3, p = 0.001). Children who received loop diuretics and those who were post-operative had a greater risk of developing hyponatremia if they received hypotonic solutions (aOR 2.1 95% CI 1.41, 3.0, p = 0.000). Those with balanced isotonic solutions had a lower risk of developing hyponatremia (aOR 0.59 95% CI 0.35, 0.99, p = 0.004) and hyperchloremia (aOR 0.51 95% CI 0.34, 0.77, p = 0.000), adjusted for disease severity. A greater risk of death was found in the group with severe hyponatremia <130 mEq/L (aOR 9.75 95% CI 1.64–58.15; p = 0.01).Conclusions: Hyponatremia associated with the use of hypotonic maintenance solutions occurs in one out of four children in intensive care. The use of these solutions is associated with a longer hospital stay, and the main risk groups are post-operative patients and those who receive loop diuretics. Clinical studies are needed to determine which maintenance solutions have the greatest efficacy and safety in critically ill children.

Methods: Objectives: 1.To study time trend, geographic distribution by zone, cities and centres of COVID-19 infection in HD patients , 2.To study age and gender distribution of COVID patients, 3.To study outcome of COVID-19 infection Methods: From March 15, 2020 to November 15, 2020, consecutive MHD patients who acquired COVID-19 infection in a large dialysis network across India in 235 centres across 25 states were reviewed for date of infection, centre city and zone. Threshold for testing was locally determined and was mostly symptom based. The type of test was determined by state regulatory practices and was either RT-PCR or Antigen test. Incidence of infection zone wise and centre wise infection burden was reviewed. Age, gender and disposition of patients: hospitalisation or home-based care were noted. Survival status is reported. Results are described as numbers and percentage Results: n=883 (4.85%)/18200 patients tested positive for COVID-19

BackgroundAntibiotics are among the most commonly prescribed drugs and are considered a major determinant in the development of resistance. Regionally no regulation on antibiotics exists and resistance is an important and growing problem. Close vigilance to the use and indication of antibiotics prescription need to be reinforced in order to develop better guidelines for its management.MethodsA point prevalence study of the prescription of antibiotics from all inpatients in the Surgery Department (SD), Intensive Care Unit (ICU), Pediatric Intensive Care Unit (PICU) and Neonatal Intensive Care Unit (NICU) was performed in November 2016. Data were collected using standardized method.ResultsOf 231 patients, 193 (83.75%) received one or more antibiotics. The highest rate of prescription occurred in the PICU (96%, 24/25) and SD (90%; 114/127) and the lowest in the ICU (68%; 19/28). The parenteral route was used in 100%. Carbapenems were the most commonly prescribed antibiotic in critical care units (61.53%) and combination therapy with another broad-spectrum antibiotic was found in 50% of cases. Therapeutic prescription, with either clinical or microbiological diagnosis, was indicated in 81.81% of cases; 33.86% (64/189) of which were nosocomial. A positive bacterial culture was identified in 65.4% (151/231) of charts. The rates of identified microorganism through bacterial cultures per department were NICU 95% (35), PICU 79% (19), ICU 68% (13), SD 46% (53).ConclusionThese data indicates a high rate of antibiotic broad-spectrum use at the hospital. Considering that almost 20% of cases didn’t have an infectious disease diagnosis, antibiotics prescription seems to be strongly empirical. National antibiotic stewardship policies are required with a multifaceted strategy including education, regulation and greater financial support from the government to impact on antimicrobial resistance rates.Disclosures All authors: No reported disclosures.

BackgroundProven measures to prevent VAP include 35–45¡ inclination of the head, prompt extubation, hand hygiene prior to intubation, oral hygiene with clorhexidine, minimize secretion pooling above the endothraqueal tube cuff. Adherence to these methods remains an angular point in preventing VAP’s. Increasing rates of VAP in the pediatric critical care unit (PICU) of a reference teaching hospital in Guatemala, led the Hospital Infection Prevention and Control (HIPC) team to implement a bundle to control VAP’s.MethodsA daily active surveillance to identify cases of VAP according to the Center for Disease Control (CDC) definition was done for 10 months before the HIPC intervention. The HAI implemented a bundle defined as: (1) head elevation (35¡ degree inclination), (2) hand hygiene, (3) oral hygiene with clorhexidine, (4) minimize secretion pooling, (5) daily evaluation of extubation, (6) daily surveillance, (7) continuous education of personnel, (8) adequate supplies distribution analysis. After the intervention rates and trends of VAP where analyzed for 30 months.ResultsIn the pre-intervention observational period the rates of VAP increased from 18 (September 2014) to 28 cases per 1,000 ventilator-days (June 2015). The first month after the bundle implementation (July 2015) a 50% VAP rate decreased was evidenced. A constant decrease in VAP rates was reported in the 24 months after the implementation of the bundle, reaching the lowest rate in August 2017 (five cases per 1,000 ventilator-days). For administrative reasons adherence to oral hygiene with clorhexidine was sub-optimal due to a lack of supplies from August 2017 to December 2017 which coincided with an increase in VAP rates from five to 14 per cases 1,000 ventilator-days.ConclusionA notable and constant reduction of VAP rates in the PICU was achieved after the implementation of the bundle. Even though many of the measures included in the bundle were already protocoled in the PICU, a probable lack of adherence could explain the high rates observed pre-intervention. By adding the continuous education and supervision of the personnel by a member of the HIPC team, to previously proven methods, the VAP rates decreased in almost 80%. This makes a strong case for the idea that protocols without continuous enforcement might not be enough to control infections.Disclosures All authors: No reported disclosures.