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Introduction: With the advancement in neonatal care over the last two decades, neonatal mortality is decreased but simultaneously there is an increase in the adverse outcomes including neurodevelopmental abnormalities in the high-risk neonates. Purpose: To evaluate the association between cranial ultrasound findings and the clinical neurodevelopmental outcome among high-risk neonates at 12 months (corrected gestational age in preterm infants) and to assess the various perinatal risk factors associated with neurodevelopmental outcome. Material and Methods: 123 high-risk neonates admitted in NICU were enrolled. Cranial ultrasound was performed and morphology was noted. The neurodevelopmental assessment was done using DDST Test II at 12 months age and these neonates were labeled as normal or abnormal based on the findings. Association between the two non-parametric variables was seen using the Pearson Chi-square test. Results: There was a statistically significant association between clinical neurodevelopmental outcome and gestational age at birth; birth weight; Apgar score <5 at 5 minutes; neonatal seizures; and abnormal cranial ultrasound findings (p<0.05), while the association with all other studied parameters were found to be statistically not significant (p>0.05). Conclusions: The neurodevelopmental outcome in high-risk neonates was associated with gestational age at birth; birth weight; Apgar score at 5 minutes; neonatal seizures and abnormal cranial ultrasound findings. The current study recommend the use of cranial ultrasound for the prediction of neurodevelopmental abnormalities especially in neonates with above risk factors.

Parvovirus B19 has rarely been associated with acute liver failure (ALF), which has a high mortality. Plasma exchange that usually acts as a bridge to liver transplantation removes toxins, antibodies, cytokines, and can correct coagulopathy while maintaining a euvolemic state. Pediatric data regarding its use are scarce. We report a case of 16-year-old girl with acute liver failure in stage 4 encephalopathy with coagulopathy due to parvovirus B19 who was successfully managed with high-volume therapeutic plasma exchange (TPE). We tried to use it as a treatment modality due to nonavailability of in-hospital transplant facilities. Parvovirus B19 may be an underdiagnosed cause of acute viral hepatitis. Therapeutic plasma exchange can act as a bridge to liver transplant (LT) or bridge to recovery especially in self-limiting illnesses such as viral hepatitis. How to cite this article Singh DP, Agarwal S, Singh R, Nandan D, Gupta A. Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure. Indian J Crit Care Med 2020;24(5):361–362.

BACKGROUNDCarcinoma of gallbladder is uncommon but is a highly fatal malignancy due to late presentation. However, it is the most common malignancy of biliary tract and represents 80-90% of the biliary tract complications. The northern parts of India has high incidence of gallbladder stone disease with a rising trend in gallbladder malignancy.