Background: Pakistan has the highest prevalence of Β-Thalassemia major in children and Chronic Hepatitis C (HCV) infection is a common transfusion transmitted infection. After the emergence of new generations of Antiviral drugs labelled as Direct Acting Antivirals (DAAs), substantial eradication of HCV has been reported as 90–95% with fewer side effects as compared to older regimen of Peginterferon with or without Ribavirin. The main objective of this study was to assess the Rapid virological response (RVR) at 4th week, End of treatment response (ETR) at 12th week and sustained viral response (SVR) at 24th week achieved by using direct acting antiviral and to assess their safety. Methods: Retrospective descriptive study was conducted from July 2018 to July 2020 at National Institute of Child Health. All β-thalassemia major paediatric patients with HCV infection and age between 3–14 years were included. Demographic data, liver function test, HCV PCR, and response of antiviral therapy was recorded and analyzed. Safety was determined by adverse effects reported in records and efficacy was documented by clearance of HCV-RNA to see ETR and SVR. Results: Total 21 patients were treated. Mean age was 7.67±3yr and 12 (57%) were male. Mean weight was 19.3±3.2kg. RVR and ETR was achieved in all (100%) and SVR was achieved in 20/21 (95%) patients. Headache in 2(9.5%) and generalized body ache was found in 1 (4.25%) patient. Conclusion: Combined Sofosbuvir and Daclatasvir were found to be effective and safe for treating HCV in Thalassaemia Major Children.

Objective: To determine the frequency of common indications of exchange transfusion in neonates with jaundice presenting to a tertiary care health facility. Study Design: A descriptive cross-sectional study. Place and Duration: Department of Paediatrics, National Institute of Child Health, Karachi Pakistan, from January 2022 to June 2022. Methodology: All neonates up to 28 days of either gender presenting with jaundice were included. Details about gender, ethnicity, blood group, feeding practices and indications of exchange transfusion were noted. Results: The mean age of the patients was 10.71±9.68 days. There were 66 (50.4%) males and 65 (49.6%) females. The Mean weight and gestational age were found to be 3.39±0.37 kg and 39.34±1.07 weeks respectively. Feeding practice among majority (n=78, 59.5%) of the mother was mixed (n=78, 59.5%). ABO incompatibility was observed in 31 (23.7%), Rh incompatibility in 24 (18.3%) and unidentified cause in 11 (8.4%) neonates. Practical Implications: For hyperbilirubinemia in neonates, ABO incompatibility was found to be the most frequent causative factor behind exchange transfusion. Conclusion: ABO incompatibility was found to be the most common indications of exchange transfusion followed by Rh incompatibility in neonates with jaundice presenting to tertiary care facility. Keywords: ABO incompatibility, exchange transfusion, jaundice, Rh incompatibility, neonates.

Objective: To determine the frequency of hypoalbuminemia in critically ill children, and to assess the association of low serum albumin with clinical deterioration and outcome. Method: The prospective, descriptive study was conducted from September 1, 2020, to October 31, 2021, at the National Institute of Child Health, Karachi, and comprised critically ill children of either gender aged between 3 months and 16 years admitted to the paediatric intensive care unit. Serum albumin values were documented at 2 hours post-admission and at 24 hours. Paediatric Index of Mortality 2 score, Vasoactive Inotropic Score, and Paediatric Sequential Organ Failure Assessment scores were calculated. Hypoalbuminemia was defined as serum albumin 3.3gdl. Data was analysed using SPSS 27. Results: Of the 110 patients, 70(63.6%) were boys and 40(36.4%) were girls. The overall mean age was 46.72±43.28 months. Hypoalbuminemia at 24 hours was found in 74(67.3%) subjects compared to 60(54.5%) at 2 hours, and mean serum albumin was lower at 24 hours compared to 2 hours post-admission (p<0.05). Patients with hypoalbuminemia had significant relation with Paediatric Index of Mortality 2 score, Vasoactive Inotropic Score, Paediatric Sequential Organ Failure Assessment score, and outcome (p<0.05). The risk of mortality was 4.1 times higher in patients with hypoalbuminemia (p=0.001). Conclusion: The incidence of hypoalbuminemia was found to be higher in children in intensive care settings, and hypoalbuminemia was a significant independent predictor of mortality in a critically ill child. Key Words: Hypoalbuminemia, Serum albumin, Critically ill, Children, PICU, Prognosis.

Objective: To determine the frequency of outcomes among children who are mechanically ventilated in PICU. Study Design: Prospective Observational study. Setting: National Institute of Child Health (NICH). Period: January 2020 to June 2020. Material & Methods: All children who fulfill the sample inclusion criteria were registered for research and prior consent was taken from parents or guardian by primary researcher. The primary investigator followed the patient till discharge from PICU. The patient information was obtained through medical record, patients’ charts, and directly by following the patients prospectively. Data was analyzed by employing SPSS version 25. In the test, significance was determined by P value of less than 0.05. Results: Mean age of patients was 6.73±3.90 years. There was 55.7% male and 44.3% female patients. Mean weight, duration of stay in PICU, mechanical ventilation days, PEEP, PIP, Pressure Support and FIO2 was 21.92±10.29 kg, 6.73±5.46 days, 5.78±4.43 days, 5.36±0.55, 16.87±1.03, 9.63±0.78 and 55.05±19.47 respectively. In our study, mortality rate was 37%. We found significant association of age group, cardiogenic shock and Sepsis with outcome. Conclusion: Mortality rate among mechanically ventilated patients was 37% while outcome was significantly associated with age group, cardiogenic shock and sepsis.

Objective: To determine the spectrum and outcome of intra-abdominal tumors in children less than five years admitted in the critical care unit of a tertiary care center of Pakistan. Methodology: This retrospective study included children less than five years with malignant abdominal mass admitted in the pediatric critical care unit of the tertiary care center of Pakistan from July 2015 to June 2019. Undiagnosed patients or with relapsed or benign abdominal tumors managed in an outpatient or admitted in the critical care for post-operative care only were excluded from the study. Data was entered and analyzed by using SPSS version 21.0. Result: Total 55 patients were included with 69% boys and median age three years (IQR – 2 years). Abdominal distention was the commonest complain (100%). Only 42% children survived (n=23/55). High grade mature Bcell Non Hodgkin Lymphoma was the most common (45%) diagnosis. Advance Stage III/IV was seen in 94%. Combined multiple site metastasis was most common (45.4%). Sepsis (OR-5.30, 95% CI-1.24-22.65, p-0.024), inotropic use (OR-9.00, 95% CI-1.33-60.92, p-0.024) and malnutrition (OR-4.85, 95% CI-1.08-21.63, p-0.039) were identified as the most significant prognostic factors related to high mortality. Conclusion: B-cell Non-Hodgkin Lymphoma was the most common histopathological diagnosis, while sepsis was the commonest reason for admission in critical care unit. Majority presented with advanced stages (stage III/IV) with poor outcome(58% mortality). Sepsis, malnutrition and need of inotropes were found to be the independent risk factors contributing to this high mortality. We recommend for early recognition of abdominal distention as an important sign of cancer with prompt referral to pediatric oncology unit which would definitely decrease the upfront critical care requirement and improve survival.