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Background: Malaria remains a significant public health in India and a major cause of under 5 mortality. Clinical manifestations of malaria in children may differ significantly from adults and there is wide variation in manifestation depending on endemicity. We conducted this study to find the clinical presentation and features which would predict mortality in children with severe malaria. Methods: a prospective observational study was conducted at Pediatric units of SCB Medical College, Cuttack. Children below 14 years of age with confirmed diagnosis of malaria and satisfying the WHO criteria for severe malaria were included in the study. Baseline demographic data collected and clinical features during the course of illness were documented. Logistic regression analysis was used to find the predicting factors for mortality. Result: out of 557 cases with malaria over a period of 20 months, 130 patients (23.3%) satisfied the WHO criteria for severe malaria. Case fatality rate was 8.5%. Apart from fever, anemia and prostration were most commonly associated complications. Presence of respiratory distress, CNS involvement, shock and renal failure were found to be the major predictor of death. Risk of mortality increased significantly with the presence of multiple organ dysfunction. About 12.3% of the patients were G6PD deficient. A higher incidence of hemoglobinuria and a lower incidence of cerebral malaria was observed in G6PD deficient patients. Conclusion:Complications associated with severe malaria in pediatric populations in India differ from African countries. Multiple organ dysfunction is not uncommon in the pediatric population and it significantly increases the chances of adverse outcome.

Background: Respiratory distress continues to be a significant cause of admission to the NICU. It also contributes significantly to morbidity and adverse outcome during the clinical course of the disease. Advances in the field of neonatal care like the use of antenatal corticosteroids, CPAP and noninvasive Ventilation, surfactant, gentle mechanical ventilation, a better understanding of the disease process and early enteral nutrition have resulted in improved survival of premature neonates. Methods: This was a prospective observational study done between January 2015 and September 2016 in a tertiary care NICU which included 209 preterm neonates between 26 weeks to 34 weeks of gestation with respiratory distress. The demographic, clinical, treatment profile and outcome were documented till discharge or death. Result: Out of 209, nearly 61% of the admitted neonates received any course of antenatal corticosteroid. About 43% of the infants had one of the antenatal risk factors for early-onset sepsis. Overall survival was 72.7%. CPAP was used as the primary mode of respiratory support in 88% of cases and the incidence of CPAP failure within 7 days was 29.6%. Almost 56% of neonates required surfactant therapy. INSURE method was used for surfactant administration in 80% cases. The failure rate of the INSURE method of surfactant administration was 27.1% and 37.5% at 72 hours and 7 days of life respectively. Sepsis was the commonest complication and accounted for nearly two-thirds of the mortality. The most common morbidity was sepsis (64.6%) followed by hemodynamically significant patent Ductus Arteriosus (25.8%). The culture positivity rate was 9.6% and Klebsiella was the most common organism isolated (45%). Nearly 11.5% of all cases developed any grade of IVH and 5.7% cases had severe IVH (IVH grade ≥ 3). About 11.5% of the cases had NEC of any stage and nearly one-third of these cases had NEC stage ≥ 2. Retinopathy of prematurity was identified in 6.2% of all cases and nearly 47% of these infants required therapy. Only 7.2% of the cases required oxygen therapy beyond 36 weeks PMA. Conclusion: Nasal continuous positive airway pressure is a safe and effective mode of respiratory support in preterm neonates with respiratory distress with a failure rate of around 30%. Nearly onethird of neonates who receive INSURE method of surfactant administration may subsequently require mechanical ventilation.

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