Clinical spectrum and short-term outcomes of multisystem inflammatory syndrome in children in a south Indian hospital

Background: The aims of the study were to determine the incidence of hyponatremia associated with pneumonia and to assess its utility as an indicator of morbidity in children hospitalized with community acquired pneumonia between 2 months and 5 years of age.Methods: This was a prospective study of children aged 2 months to 5 years hospitalized with community acquired pneumonia. 120 children aged 2 months to 5 years with symptoms of lower respiratory tract infection and had radiological evidence of pneumonia were recruited into the study. Children with chronic diseases, previously treated with intravenous fluids and those with chronic drug intake were excluded from study.Results: Of the 120 children, 40.8% (49/120) had hyponatremia at admission. The relationship of hyponatremia to different clinical and laboratory parameters was analyzed. Sixty-one percent (31/51) of children under 1 year and 26% (18/69) of children between 1 to 5 years of age had hyponatremia (p=0.001). Hyponatremia was seen more commonly in children with severe pneumonia, with initial high temperature(p=0.001), with tachycardia (p=0.001), leukocytosis (p=0.001), increased neutrophils (p=0.001) and reactive thrombocytosis (p<0.001) and in children who had hemodynamic instability on admission (p<0.001). All 11(9.2%) children who required mechanical ventilation had hyponatremia (p<0.001). Consolidation was significantly associated with hyponatremia (p<0.001). Hyponatremia also showed a significant association with prolonged hospital stay (p<0.001).Conclusion: The incidence of hyponatremia in children hospitalised with pneumonia is 40.8%. This study concludes that the hyponatremia shows a significant association with the morbidity of the disease like requirement of intensive care and mechanical ventilation, hemodynamic instability and prolonged hospital stay. Hence the presence of hyponatremia at admission can be used as an indicator of morbidity.

Background: The aims of the study were to estimate the incidence of reactive thrombocytosis(RT) among febrile children aged 2 months to 12 years and to identify any differences in age group and gender in mounting thrombocytosis as a response to infection, to identify if thrombocytosis occurred preferentially in any particular group of serious bacterial infections(SBI), to compare thrombocytosis with other parameters like total white cell count, C-reactive protein(CRP), cultures etc. and to assess the utility of platelet count as a potential predictor of serious bacterial infection.Methods: This was a prospective study done in Institute of Child Health and Hospital for children, Madras Medical College from September 2015 to July 2016. Inclusion criteria: Children aged 2 months to 12 years with symptoms of fever less than 6 days admitted in the paediatric wards and those seen at the outpatient department. Exclusion criteria: Children having received parenteral antibiotics.Results: Of the 500 children, 142 (28.4%) had reactive thrombocytosis. RT was mild in 120 children (24%), moderate in 16 children (3.2%), severe in 4(0.8%) and extreme in two children (0.4%). This study showed that 36.48% (85 / 233) of children under 1 year had RT (p = 0.0002).There was no significant sex related difference in mounting RT. Out of 500 children included in the study, serious bacterial infection was diagnosed among 171 children (34.2%).Pneumonia (n=100) was the most common SBI followed by urinary tract infections (n=33), meningitis (n=23), sepsis (n=15). This study showed that RT has a moderate ability to predict serious bacterial infections (AUC=0.78; PPV-75.35%).Conclusions: Incidence of reactive thrombocytosis in febrile children aged 2 months to 12 years is 28.4%. It occurs more frequently in infants and without any sex predilection. RT is associated with leucocytosis, positive CRP, positive Chest X ray findings, positive urine culture and positive CSF findings. This shows that RT has a moderate ability in predicting SBI in children.

Objective: To compare the diagnostic accuracy of various transcutaneous bilirubin (TcB) nomograms for predischarge screening. Methods: The paired total serum bilirubin (TSB) and TcB measurements collected in neonates ≥35 weeks and ≥2000 g birth weight were analyzed. BiliCare™ bilirubinometer was used for TcB measurement. We chose the following nomograms for the study: Bhutani nomogram, Maisel's nomogram, Agarwal nomogram, Thakkar nomogram, American Academy of Pediatrics (AAP) nomogram within 3 mg/dl of phototherapy cutoff, AAP nomogram >70% of phototherapy cutoff and if TcB value is above 13 mg/dl. The diagnostic accuracy of these nomograms for TcB was compared with TSB plotted in the Bhutani nomogram. Results: TcB showed a positive correlation with TSB (Pearson correlation coefficient = 0.783). Bhutani nomogram, Maisel's nomogram and AAP (using within 3 mg/dL cutoff) nomogram showed good sensitivity and low false-negative rate while avoiding blood draws in most neonates. Conclusion: Bhutani nomogram, Maisel's nomogram, and AAP (using within 3 mg/dL of phototherapy cutoff) nomograms have comparable diagnostic accuracy for predischarge bilirubin screening in neonates.