In conclusion, the proportion of sepsis contributing to SIRS is high in a tertiary care hospital. Therefore rapid recognition of SIRS is essential. Goal directed treatment of sepsis is also important so that high mortality associated with severe sepsis and septic shock are prevented.

Background: Objective of current study was to study the spectrum of bone marrow aspiration results and their clinico-hematological profile in children. Methods: Design: Cross sectional descriptive study, conducted from 1 st April 2011 to 31 st March 2012. Setting: Referral care centre in Northern India. Participants: All hospitalized patients in the age group of 0-18 years requiring a bone marrow examination for various hematological disorders. Procedure: A total of 140 children underwent bone marrow examination during the study period. An aspirate smear was prepared and stained with Romanowsky's stain, Prussian blue stain was used for staining iron. Demography, history, examination and the investigations of patients who underwent bone marrow aspiration were noted in a preset proforma. Results: The most common hematological disorder encountered was Iron deficiency anemia accounting for 41.43% of all cases. Idiopathic thrombocytopenic purpura was the most common platelet disorder (12.85%). Acute lymphoblastic leukemia was the commonest hematological malignancy diagnosed (6.42%), followed by acute myeloblastic leukemia (4.28%), visceral leishmaniasis (1.43%), malaria (0.71%), lymphohistiocytosis (0.71%) and anemia of chronic disorder (0.71%). Conclusions: The most common condition encountered on bone marrow examination during our study was iron deficiency anemia. In absence of relevant etiological investigations in resource poor settings bone marrow aspiration is done in severe anemia to confirm nutritional deficiency anemia or to rule out hematological malignancies. The threshold of doing bone marrow was also low in patients of ITP as one contemplated putting a patient on steroids.

Ventilator-Associated Pneumonia (VAP) is defined as nosocomial pneumonia in mechanically ventilated patients that develop more than 48 hours after initiation of Mechanical Ventilation (MV). 1 In addition to its high mortality rate compared to other nosocomial infections, VAP is associated with prolonged hospitalisation and considerable medical costs. Intubation associated lesions of pharynx and trachea lead to bacterial colonization by decreasing ciliary function and swallowing reflex. It inhibits cough reflex and bypasses the body's humidified airways. Colonisation of upper respiratory tract occurs rapidly and 90% of infants have positive pharyngeal culture by 3 rd day. 2 However, bacterial colonisation does not always result in disease. Factors influencing which of the colonized infant will develop disease include prematurity, underlying illness, ABSTRACT Background: Objective of current study was to know the risk factors, pathological profile and outcome of ventilator associated pneumonia in the neonatal intensive care unit. Methods: Design: Prospective observational study. Settings: A teaching, referral, neonatal intensive care unit at Srinagar, Kashmir. Participants: All ventilated neonates who required mechanical ventilation for more than 48 hours between August 2011 to July 2012. Procedure: The diagnosis of VAP was made on the basis of criteria given by National Nosocomial Infection Surveillance System (1996), paediatric modification of the original guidelines given by Centre of Disease Control & prevention (CDC). Risk factors for VAP were assessed by bivariate and multivariate analysis. Semi-quantitative culture was done using blood agar, chocolate agar and McConkey's agar as plating media. Results: VAP developed in 32 of 96 ventilated neonates (33.34% VAP rate). Prematurity, very low birth weight, use of nasogastric tube, mean duration of mechanical ventilation, NICU stay in days and number of endotracheal tube changes were statistically significant risk factors associated with VAP. Multiple logistic regression analysis revealed that duration of mechanical ventilation (P = 0.006) and VLBW (<15000 grams) (P = 0.032) were only two single independent and statistically significant risk factors. Most common bacteria isolated from ETA was Klebsiella (37.5%). There were 9 (28.1%) mortalities in VAP group and 14 (21.8%) in non-VAP group, which was statistically insignificant. Conclusions: A number of measures is required to decrease the incidence of VAP based on the prevalent modifiable risk factors and etiological organisms in NICU. Daily assessments of readiness to wean and use of weaning protocols must be adhered to in NICUs.

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