Background: Over the past decades, the indications for tracheostomy in children and the routine posttracheostomy course have changed significantly. The purpose of this study was to identify the indications, complications, and outcomes of pediatric tracheostomy. Subjects and Methods: This prospective observational study was conducted involving all children admitted to the pediatric intensive care unit (PICU) requiring tracheostomy from January 2018 to June 2019. A pre-structured proforma was used. The data regarding indications of tracheostomy, complications, and outcomes were analyzed. Patients were followed up till decannulation during the study period. Results: Out of 73 patients included in the study, 68.5% (n = 53) were males and 31.5% (n = 20) were females, with a mean age of 5.4 years. The most common primary indication for tracheostomy was neurological impairment (56.2%, n = 41) and airway obstruction (19.2%, n = 14). The average duration of PICU stay at the time of tracheostomy was 15.4 days. Prolonged mechanical ventilation was required in 62.3% of patients. Elective tracheostomy was done in 84.9% of patients. Complications due to tracheostomy were noted in 43.8% (n = 32) of cases, of which suprastomal granulations were the most common. The average length of PICU stay after tracheostomy was 21.8 days. The rate of successful decannulation was 69.9%. The most common cause for decannulation failure was subglottic stenosis. Conclusions: Neurological impairment requiring prolonged mechanical ventilation was the most common indication for tracheostomy. Suprastomal granulations were the most common complication and subglottic stenosis being the most common cause for decannulation failure.

Zygomycosis is a rare life threatening fungal infection in an immunocompromised child. The clinical manifestations of zygomycosis mainly are rhino cerebral, pulmonary, cutaneous, gastrointestinal, and cardiac disease. The diagnosis of zygomycosis is confirmed by direct examinations of clinical specimens and histopathological examination of tissue. The characteristic feature of Zygomycetes in tissue is, the formation of wide, ribbon-like, hyaline, aseptate or sparsely septated hyphae with wide-angle (approximately 90°) branching. The current report describes a case of sino-orbital zygomycosis in a 16-month-old immunocompetent child with atypical presentation. Histopathological examination (HPE) of the tissue confirmed the diagnosis of Zygomycetes.

Vanishing white matter (VWM) disease is a rare leukoencephalopathy. Normal development in early childhood with regression of milestones after trauma or infection is typical clinical presentation. We are reporting a child with atypical VWM disease. A 1.5-year-old female child presented with fever followed by altered sensorium and convulsions following first booster dose of diphtheria pertussis tetanus vaccination. Her development was normal till 1 yr of age. Her weight and head size were below 3 standard deviations. She had hepatosplenomegaly. Her routine investigations including cerebrospinal fluid examination were normal. Magnetic resonance imaging (MRI) of brain shows diffuse white matter signals changes (hyperintensity on T2-weighted and hypointensity on T1-weighted images) involving the subcortical ?U? fibers sparing basal ganglia. MRI shows diffuse white matter hyperintensity on T2-weighted images with areas of low signal on fluid-attenuated inversion recovery, close to the signal of cerebrospinal fluid. Based on MRI findings we diagnosed as VWM disease.