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Background: NICU in public hospitals in developing countries face immense challenges in the form of overcrowding, less manpower and lack of equipment. Patient care is the prime responsibility of the health care workers. Parental satisfaction although an important part of health care is not given its due importance. There are very few studies analysing parental satisfaction of NICU babies in the developing countries including India. The objective of this cross-sectional study was to 1. Assess satisfaction regarding medical treatment 2. To assess satisfaction regarding General environment. Take suggestions regarding improvement in services.Methods: A total of four hundred and fifty-nine parents were interviewed. They were parents of babies admitted in NICU, those coming for follow up in the well-baby clinic. Parents of babies who died or left against medical advice were interviewed at the time of leaving the hospital or telephonically later. Results were analysed statistically using the student chi square test.Results: 92.6% of the respondents were satisfied with the medical services and 96.6% were satisfied with the general environment. Reasons for lack of satisfaction were analysed. Nuclear families, urban background, adverse outcome of the baby were the Key factors. Parents gave pertinent suggestions like improvement in cleanliness, more beds, increase in medical staff, better availability of medicines and blood products.Conclusions: There is need to develop standardised protocols to analyse parental satisfaction. This will lead to better understanding of parental expectations and help to improve patient care.

Introduction: Septic shock is a common admission diagnosis in PICU. It is associated with high mortality. Aim: The current study aimed at determining the predictors of outcome in pediatric septic shock in patients admitted to the PICU of a tertiary care teaching hospital. Patients and Methods: It was a prospective, observational study done in a time period of 6 months (November 2018 to April 2019) during which patients of septic shock were evaluated. All cases were examined clinically and investigated with Complete Blood Count, Blood Culture and Sensitivity, urine routine examination, urine Culture and Sensitivity, tracheo-bronchial aspirate (in case of ventilated patients) and arterial blood gas analysis were done as a part of study protocol. The data so procured was analysed statistically and documented and the result was evaluated. Results: A total of 54 patients of septic shock were admitted to the PICU during the study period of whom 47 patients were finally included as per the study protocol. Of these 9 patients expired and the remaining were discharged. On evaluating the role of different demographic, clinical and laboratory parameters between survivors and non-survivors for their association with mortality, only delayed capillary refill time on admission (p=0.008) and low mean pH (p=0.008) showed a statistically significant association with mortality. Conclusion: A delayed capillary refill time on admission and a low mean pH were statistically significant predictors of mortality in this study.

Introduction: Pediatric Acute Respiratory Distress syndrome (PARDS) has been re-defined (2015) as per the final recommendations of the Pediatric Acute Lung Injury Consensus Conference. The use of high flow nasal cannula is a promising treatment but its efficacy compared with non invasive ventilation (NIV) is not known. Aims and Objectives:The current study was undertaken to study the efficacy of high flow nasal cannula compared with NIV in PARDS. Methods: This was a pilot randomized controlled trial done in the PICU of a tertiary care teaching hospital over 10 months (December 2017 -September 2018). All patients aged 1-18 years of age, who presented with or developed ARDS during their course of hospitalization, and who fulfilled the inclusion criteria, were randomized to receive HFNC and Continuous Positive Airway Pressure (NIV) as the initial respiratory support. Details were noted in a pre-designed standardized data collection form, entered into MS-EXCEL worksheet 2013 and analyzed using the Epi info software version 7.2.0.1. Results: A total of 40 patients were enrolled, 20 in each arm.Of these majority (25/40=62.5%) were boys. Majority of these patients were from rural or semi-urban areas (28/40=70.0%) and belonged to low socio-economic class (33/40= 82.5%) patients.Underlying diagnosis was sepsis in the majority (27/40=67.5%) patients.Twenty one (23/40=57.5%) patients had co-existent pneumonia. Development of hemodynamic instability approached statistical significance in being low in HFNC group compared with the CPAP group (p=0.07; OR 0.206, 95% CI 0.036-0.159). Subsequent requirement of invasive ventilation was also low in HFNC group compared with CPAP group and approached significance (p=0.09; OR 1.653, 95% CI 0.074-1.246). Total duration of respiratory support (p=0.62) was comparable in both the groups. Conclusion: HFNC is efficacious in managing PARDS. Subsequent requirement of invasive ventilation and hemodynamic deterioration was significantly low with HFNC compared with NIV (CPAP).

Haemophagocyticy lymyphohistiocytosis in the new-born is uncommon. Incidence is reported between 1 in 50,000 to 1,50,000 admissions. Usually it is primary or familial HLH in the first year of life. Secondary causes are due to viral, bacterial and fungal infections. A dysmorphic small for gestational age male neonate presented with sepsis and neonatal cholestasis. He also had associated HLH. Exom sequencing showed a 21q22.11q22.12 deletion. This has not known to have any association with familial HLH. He was managed with IVIG and steroids. The neonate made a recovery but succumbed later to an intercurrent illness.