Short-term Outcomes In Children Research Articles

Clinical characteristics and short-term outcomes of children with severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome treated with methylprednisolone and/or intravenous immunoglobulin

In this case series, we evaluated the clinical profiles and short-term outcomes of four pediatric patients diagnosed with SARS-CoV-2-associated multisystem inflammatory syndrome (MIS-C), treated with Methylprednisolone and/or intravenous immunoglobulin (IVIg). All cases were managed at a tertiary care hospital in the Rohilkhand region and met the WHO diagnostic criteria for MIS-C. The study period spanned from May to December 2021, with the primary outcome being the resolution of fever. Secondary outcomes included the length of hospital stay, mortality, duration of respiratory or inotropic support (if applicable), and the time to normalization of inflammatory markers. The four cases presented with varying degrees of MIS-C involvement: two patients had significant cardiac involvement, one displayed neurological symptom, and another had systemic inflammatory manifestations. All patients received IVIg (2 g/kg) and Methylprednisolone (2 mg/kg/day). Fever resolved within 3-5 days of treatment, and inflammatory markers normalized within a median of 5 days. Two cases required inotropic support for shock, and one required high-flow nasal cannula (HFNC) oxygen for respiratory distress. No mortality was observed in this cohort. In conclusion, treatment with IVIg and Methylprednisolone was associated with favorable outcomes in these MIS-C cases.

Pediatric arterial ischemic stroke; Risk factors, clinical presentation and short-term outcome of patients presenting at a tertiary care hospital.

Objective: To determine the risk factors, clinical presentation and short term outcome in children presenting with arterial ischemic stroke at a tertiary care hospital. Study Design: Prospective Observational study. Setting: Medical Units of National Institute of Child Health, Karachi, Pakistan. Period: November 2022 October 2023. Methods: Children of either gender aged between 1 month to 12 years and admitted with the diagnosis of pediatric arterial ischemic stroke during the study duration were analyzed. Detailed medical and neurological examinations were performed. Routine work up and laboratory investigations were done. Modified Rankin Scale (MRS) scores at the time of enrollment, discharge and after 3 month follow-up were recorded. Results: In a total of 35 children, 21 (60.0%) were boys the mean age was 6.89±3.63 years. The most frequent presenting clinical features were focal neurological deficits noted in 29 (82.9%) children whereas fever, and fits were reported in 26 (74.3%), and 22 (62.9%) children, respectively. Right hemiplegia was observed in 15 (42.9%) children. Stroke was secondary to moyamoya 8 (22.9%), infections in 6 (17.1%) children. Mortality was reported among 3 (8.6%) children while 3 others lost during the follow ups. Comparison of mean mRS scores at the time of admission, discharge and after 3 months showed significant reduction (p<0.001). Conclusion: Focal neurological deficits were the predominant clinical features, with a significant incidence of associated fever and seizures. Moyamoya and infections emerged as primary causative factors. Despite a mortality rate of 8.6%, there was an overall improvement in outcomes, as evidenced by a significant reduction in Modified Rankin Scale scores at admission, discharge, and after three months.

Short-Term Outcomes in Children with multisystem inflammatory syndrome associated with SARS-COV2 Infection

Short-Term Outcomes in Children with multisystem inflammatory syndrome associated with SARS-COV2 Infection

Utility of Early Magnetic Resonance Imaging to Enhance Outcome Prediction in Critically Ill Children with Severe Traumatic Brain Injury.

Many children with severe traumatic brain injury (TBI) receive magnetic resonance imaging (MRI) during hospitalization. There are insufficient data on how different patterns of injury on early MRI inform outcomes. Children (3-17years) admitted in 2010-2021 for severe TBI (Glasgow Coma Scale [GCS] score < 9) were identified using our site's trauma registry. We used multivariable modeling to determine whether the hemorrhagic diffuse axonal injury (DAI) grade and the number of regions with restricted diffusion (subcortical white matter, corpus callosum, deep gray matter, and brainstem) on MRI obtained within 7days of injury were independently associated with time to follow commands and with Functional Independence Measure for Children (WeeFIM) scores at the time of discharge from inpatient rehabilitation. We controlled for the clinical variables age, preadmission cardiopulmonary resuscitation, pupil reactivity, motor GCS score, and fever (> 38°C) in the first 12h. Of 260 patients, 136 (52%) underwent MRI within 7days of injury at a median of 3days (interquartile range [IQR] 2-4). Patients with early MRI were a median age of 11years (IQR 7-14), 8 (6%) patients received cardiopulmonary resuscitation, 19 (14%) patients had bilateral unreactive pupils, the median motor GCS score was 1 (IQR 1-4), and 82 (60%) patients had fever. Grade 3 DAI was present in 46 (34%) patients, and restricted diffusion was noted in the corpus callosum in 75 (55%) patients, deep gray matter in 29 (21%) patients, subcortical white matter in 23 (17%) patients, and the brainstem in 20 (15%) patients. After controlling for clinical variables, an increased number of regions with restricted diffusion, but not hemorrhagic DAI grade, was independently associated with longer time to follow commands (hazard ratio 0.68, 95% confidence interval 0.53-0.89) and worse WeeFIM scores (estimate β - 4.67, 95% confidence interval - 8.33 to - 1.01). Regional restricted diffusion on early MRI is independently associated with short-term outcomes in children with severe TBI. Multicenter cohort studies are needed to validate these findings and elucidate the association of early MRI features with long-term outcomes in children with severe TBI.

Respiratory culture growth and 3-years lung health outcomes in children with bronchopulmonary dysplasia and tracheostomies.

While bacteria identification on respiratory cultures is associated with poor short-term outcomes in children with bronchopulmonary dysplasia (BPD) and tracheostomies, the influence on longer-term respiratory support needs remains unknown. To determine if respiratory culture growth of pathogenic organisms is associated with ongoing need for respiratory support, decannulation, and death at 3 years posttracheostomy placement in children with BPD and tracheostomies. This single center, retrospective cohort study included infants and children with BPD and tracheostomies placed 2010-2018 and ≥1 respiratory culture obtained in 36 months posttracheostomy. Primary predictor was any pathogen identified on respiratory culture. Additional predictors were any Pseudomonas aeruginosa and chronic P. aeruginosa identification. Outcomes included continued use of respiratory support (e.g., oxygen, positive pressure), decannulation, and death at 3 years posttracheostomy. We used Poisson regression models to examine the relationship between respiratory organisms and outcomes, controlling for patient-level covariates and within-patient clustering. Among 170 children, 59.4% had a pathogen identified, 28.8% ever had P. aeruginosa, and 3.5% had chronic P. aeruginosa. At 3 years, 33.1% of alive children required ongoing respiratory support and 24.8% achieved decannulation; 18.9% were deceased. In adjusted analysis, any pathogen and P. aeruginosa were not associated with ongoing respiratory support or mortality. However, P. aeruginosa was associated with decreased decannulation probability (adjusted risk ratio 0.48, 95% CI 0.23-0.98). Chronic P. aeruginosa was associated with lower survival probability. Our findings suggest that respiratory pathogens including P. aeruginosa may not promote long-term respiratory dysfunction, but identification of P. aeruginosa may delay decannulation.

Impact of patent foramen ovale on short-term outcomes in children with biliary atresia undergoing living donor liver transplantation: a retrospective cohort study

ObjectiveTo investigate the impact of patent foramen ovale (PFO) on the short-term outcomes of living donor liver transplantation (LDLT) in children with biliary atresia.MethodsWith the approval of the hospital ethics committee, 304 children with biliary atresia who underwent LDLT in our center from January 2020 to December 2021 were enrolled. According to the results of echocardiography before the operation, the subjects were divided into the PFO group (n = 73) and the NoPFO group (n = 231). The baseline characteristics; intraoperative recipient-related data and donor-related data; incidence of postreperfusion syndrome (PRS); postoperative mechanical ventilation time; ICU stay duration; postoperative hospital stay duration; liver function index; incidences of postoperative complications including acute renal injury (AKI), graft dysfunction, hepatic artery thrombosis (HAT) and portal vein thrombosis (PVT); and one-year survival rate were compared between the two groups.ResultsThe median age in the PFO group was 6 months and that in the NoPFO group was 9 months (P < 0.001), and the median height (65 cm) and weight (6.5 kg) in the PFO group were significantly lower than those in the NoPFO group (68 cm, 8.0 kg) (P < 0.001). The preoperative total bilirubin level (247 vs. 202 umol/L, P = 0.007) and pediatric end-stage liver disease (PELD) score (21 vs. 16, P = 0.001) in the PFO group were higher than those in the NoPFO group. There were no significant differences in the intraoperative PRS incidence (46.6% vs. 42.4%, P = 0.533 ), postoperative mechanical ventilation time (184 vs. 220 min, P = 0.533), ICU stay duration (3.0 vs. 2.5 d, P = 0.267), postoperative hospital stay duration (22 vs. 21 d, P = 0.138), AKI incidence (19.2% vs. 24.7%, P = 0.333), graft dysfunction incidence (11.0% vs. 12.6%, P = 0.716), HAT incidence (5.5% vs. 4.8%, P = 0.762), PVT incidence (2.7% vs. 2.2%, P = 0.675) or one-year survival rate (94.5% vs. 95.7%, P = 0.929) between the two groups.ConclusionThe presence of PFO has no negative impact on short-term outcomes in children with biliary atresia after LDLT.

Short-term outcomes of South African children with multisystem inflammatory syndrome in children: a prospective cohort study

BackgroundDespite the life-threatening presentation of multisystem inflammatory syndrome in children (MIS-C), the overall prognosis is favourable in centres with access to appropriate supportive care. In this study, we investigate the...

Treatment Response and Short-term Outcomes in Children Admitted as Multisystem Inflammatory Syndrome in Children

Background:Multisystem inflammatory syndrome in children (MIS-C) is a postviral complication that has been described among children after 2–6 weeks of exposure to the COVID-19 virus from various parts of the world. Published literature regarding MIS-C in children is limited. The aim of this study was to investigate the disease management and clinical outcomes of a larger group of children from North India presenting with features of MIS-C.Materials and Methods:This is an observational study of children with MIS-C, admitted to the pediatric intensive care unit (PICU) between March 1, 2021, and August 31, 2021, during the second wave of SARS-CoV-2 infection in India.Results:Out of the 37 children presenting with MIS-C, 62% of patients were male and 37% were female patients. Vasoactive medications were required in 14 patients. Eighteen patients required respiratory support, of which 17 received noninvasive ventilation and only one patient required invasive mechanical ventilation. Methylprednisolone and intravenous immunoglobulin (IVIG) were used in the majority of patients. No patient required remdesivir. Thirty-six patients were discharged home with a median duration of 4 days in PICU and a hospital stay of 10 days, only 1 (2.7%) patient died during the treatment. Thirty-five (94.5%) patients received IVIG alone, and five patients (13.5%) received IVIG along with methylprednisolone. Patients who received a combination of steroids and IVIG had greater severity of illness, deranged laboratory parameters, highly raised inflammatory markers, requiring higher inotropes, respiratory support, PICU requirement, and length of stay in hospital.Conclusions:The decision to treat MIS-C patients with IVIG plus methylprednisolone or IVIG alone must be reviewed on an individual basis. IVIG in conjunction with methylprednisolone should be considered for patients with severe MIS-C and hypotension who have been admitted to the PICU.

PRISM III Score Predicts Short-Term Outcome in Children with ARDS on Conventional and High-Frequency Oscillatory Ventilation.

Therapeutic recommendations for pediatric acute respiratory distress syndrome (PARDS) include conventional (CMV) and rescue high-frequency oscillatory mode (HFOV) of mechanical ventilation (MV). The pediatric risk of mortality (PRISM) is a frequently used mortality score for critically ill patients. In search of methods to recognize those patients, we analyzed the PRISM III score as a potential predictor of the short-term outcome in MV subjects with PARDS. A retrospective five-year study of PARDS in children on MV was conducted in the Pediatric ICU. Seventy patients were divided into two groups (age group &lt;1 year and age group 1-7 years). The PRISM III score was used to assess the 28-day outcome and possible development of complications. The most common causes of PARDS were pneumonia and sepsis. Male sex, malnourishment, sepsis, and shock were significant indicators of poor outcome. The PRISM III score values were significantly higher in those who died, as well as in subjects requiring HFOV. The score had a significant prognostic value for short-term mortality. There was no significant difference in outcome based on the comparison of two modes of ventilation. A significantly higher score was noted in subjects who developed sepsis and cardiovascular insufficiency. The PRISM III score is a fair outcome predictor during the 28-day follow-up in MV subjects with PARDS, regardless of the ventilation mode.

Association of Attention-Deficit/Hyperactivity Disorder Diagnosis With Adolescent Quality of Life

Appropriate diagnosis of attention-deficit/hyperactivity disorder (ADHD) can improve some short-term outcomes in children and adolescents, but little is known about the association of a diagnosis with their quality of life (QOL). To compare QOL in adolescents with and without an ADHD diagnosis. This cohort study followed an emulated target trial design using prospective, observational data from the Longitudinal Study of Australian Children, a representative, population-based prospective cohort study with biennial data collection from 2006 to 2018 with 8 years of follow-up (ages 6-7 to 14-15 years). Propensity score matching was used to ensure children with and without ADHD diagnosis were well matched on a wide range of variables, including hyperactive/inattentive (H/I) behaviors. Eligible children were born in 1999 to 2000 or 2003 to 2004 and did not have a previous ADHD diagnosis. All incident ADHD cases were matched with controls. Data were analyzed from July 2021 to January 2022. Incident parent-reported ADHD diagnosis at age 6 to 7, 8 to 9, 10 to 11, 12 to 13, or 14 to 15. Quality of life at age 14 to 15 was measured with Child Health Utility 9D (CHU9D) and 8 other prespecified, self-reported measures mapped to the World Health Organization's QOL domains. Pooled regression models were fitted for each outcome, with 95% CIs and P values calculated using bootstrapping to account for matching and repeat observations. Of 8643 eligible children, a total of 393 adolescents had an ADHD diagnosis (284 [72.2%] boys; mean [SD] age, 10.03 [0.30] years; mean [SD] H/I Strengths and Difficulties Questionnaire score, 5.05 [2.29]) and were age-, sex-, and H/I score-matched with 393 adolescents without ADHD diagnosis at time zero. Compared with adolescents without diagnosis, those with an ADHD diagnosis reported similar QOL on CHU9D (mean difference, -0.03; 95% CI, -0.07 to 0.01; P = .10), general health (mean difference, 0.11; 95% CI, -0.04 to 0.27; P = .15), happiness (mean difference, -0.18; 95% CI, -0.37 to 0.00; P = .05), and peer trust (mean difference, 0.65; 95% CI, 0.00 to 1.30; P = .05). Diagnosed adolescents had worse psychological sense of school membership (mean difference, -2.58; 95% CI, -1.13 to -4.06; P < .001), academic self-concept (mean difference, -0.14; 95% CI, -0.02 to -0.26; P = .02), and self-efficacy (mean difference, -0.20; 95% CI, -0.05 to -0.33; P = .007); displayed more negative social behaviors (mean difference, 1.56; 95% CI, 0.55 to 2.66; P = .002); and were more likely to harm themselves (odds ratio, 2.53; 95% CI, 1.49 to 4.37; P < .001) than adolescents without diagnosis. In this cohort study, ADHD diagnosis was not associated with any self-reported improvements in adolescents' QOL compared with adolescents with similar levels of H/I behaviors but no ADHD diagnosis. ADHD diagnosis was associated with worse scores in some outcomes, including significantly increased risk of self-harm. A large, randomized clinical trial with long-term follow-up is needed.

Invasive fungal infections in a paediatric intensive care unit in a low-to middle-income country.

Background Paediatric intensive care units (PICUs) are high-risk settings for healthcare-associated infections. Invasive fungal infection (IFI) is one of the common causes of healthcare-associated infections. Objectives To describe the prevalence and short-term outcomes of children with IFI, and to offer a basis for the efficient prevention and treatment of IFI. Methods A retrospective study was conducted in children under the age of 12 years over a two-year period. Participants were categorised according to pre-defined microbiology criteria into IFI if they had a positive culture from blood or other sterile sites. Data collected included demographics, invasive procedures, length of stay and mortality. Results One thousand and forty-two children were admitted during the study period. Of the total, 56.8% (n=592) were male. Median length of stay was 18 days (mean±SE 18.6±8.9). IFI was identified in 35 cases per 1 000 admissions, with 77.7% of these infants under the age of one year. The mean length of stay was 18.6 days compared with 7.5 days for children with bacterial infections. The in-hospital mortality for invasive fungal infection was 36% compared with 16% for all admissions. Findings confirmed that colonisation was more prevalent than IFI. Conclusion IFIs are common among infants, and these patients have a higher mortality rate and prolonged hospital stay. Therefore we recommend early diagnosis and timely treatment with high-performance antifungal drugs to improve the prognosis in children with IFI.

Children with Guillain-Barre Syndrome: A Comparison between AIDP and AMAN variants among Patients admitted in a Tertiary Care Hospital

Background: Guillain-Barre syndrome (GBS) is the leading cause of acute flaccid paralysis in children. This study was aimed to compare the clinical spectrum and shortterm outcome of children with acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) subtypes of GBS in children. Methods: The study was a prospective cohort study done in a tertiary neurology hospital for 3 years. Children under 18 years of age fulfilling the Brighton diagnostic criteria for GBS were enrolled in the study. Based on the nerve conduction study, patients were subclassified as AIDP, AMAN, AMSAN, and others. Finally, a comparison was done in children with AIDP and AMAN subtypes. Results: A total of 102 children have fulfilled the Brighton diagnostic criteria of GBS during that study period. Among them, 83 children were included in the final analysis as NCS findings suggestive of AIDP and AMAN were found in 29(28.43%) and 54(52.94%) of cases respectively. No patient died in this cohort and follow-up was done at 3 months after discharge. A comparison of clinical data between the two groups revealed similar clinical features in most of the cases. The mean age difference between the two groups was statistically significant and AIDP was found to be more frequent in the 1-5 years age group. There was a significant association between gastroenteritis and AMAN subtypes. On symptom analysis, pain and tingling sensation were found predominantly in AMAN subtypes. Children having AMAN variants developed respiratory distress more than AIDP. Assisted ventilation were needed in 14.45% of cases and the majority of them were from the AMAN group. The mean duration of hospital stay and the mean disability scores at three months after discharge were significantly higher in the AMAN group. Conclusions: AMAN was the commonest GBS subtypes in children. AIDP was more frequent in the younger age group. Children with AMAN appeared to have higher short-term morbidity and slower recovery than those with AIDP. Bang. J Neurosurgery 2022; 11(2): 94-100

Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 InfectionDuring the First and Second Waves of the Pandemic.

ObjectivesTo compare the clinical profile and short-term outcome of children admitted with acute SARS-CoV-2 infection during the first and second waves of the Coronavirus Disease (COVID-19).MethodsThis retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confirmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay.ResultsOne thousand and twenty-four children were recruited, 592 of the first wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR = 3.38) and neurological manifestations (OR = 4.61). There was a higher requirement of intensive care (OR = 4.2) and invasive mechanical ventilation (OR = 4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the difference was not statistically significant. Children with neurological comorbidities (OR = 8.73), malnutrition (OR = 3.01), and preterm babies (OR = 6.8) were associated with severe COVID.ConclusionThe clinical profile of the second wave of COVID-19 in children was different from the first wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a significant increase in the incidence of severe infections requiring ICU care was observed.

Patterns and Short Term Outcome of Children with Major Congenital Anterior Abdominal Wall Defects Admitted At Mbarara Regional Referral Hospital, South Western Uganda, from September 2019 to June 2020.

Background: Omphalocele and gastroschisis are the most common major congenital abdominal wall defects (CAWDs) globally. Mortality among neonates major CAWDs is higher in low-income countries than in high-income countries. This study described the patterns and short-term clinical outcomes of infants with gastroschisis and omphalocele at a regional referral hospital in southwestern Uganda.&#x0D; Methods: A case series was conducted at Mbarara Regional Referral Hospital ten months. Children born with CAWD during the study period 54 samples size were consecutively recruited into the study. Data were entered, cleaned, and analyzed using Stata version 15. Descriptive statistics were performed where continuous variables were summarized using median and interquartile ranges, while categorical variables were summarized using frequencies and proportions. Time to mortality was assessed using Kaplan–Meier survival analysis.&#x0D; Results: A total of 54 newborns were recruited into the study, of which 40 (70.04%) had Gastroschisis and 14(25.93%) had omphalocele. The median age of the infants was 9 days with an interquartile range of 4 to 21days. Of the 54 newborns, 30(69.2%) were male within the age group of 1-10 days. Mortality was higher in babies with complex gastroschisis (22) than simple gastroschisis (10). Not administering antibiotics and low birth weight were the factors associated with mortality among infants diagnosed with gastroschisis and omphalocele in the neonatal period.&#x0D; Conclusion: The most common observed defect was gastroschisis, Mortality was generally high among children presenting with gastroschisis. Complex gastroschisis has a poorer prognosis than simple gastroschisis over 30 days follow up period. Non-use of antibiotics before referral to a health facility and low birth weight were the factors associated with mortality among infants diagnosed with gastroschisis and omphalocele in the neonatal period.&#x0D; Recommendation: The most common pattern observed was Gastroschisis. The majority of children presenting with Omphalocele were more likely to survive for 30 days. There is a need for timely referral for babies born with congenital anterior abdominal wall defects.

Endoscopic third ventriculostomy success score in predicting short-term outcome in children with hydro-cephalus

Endoscopic third ventriculostomy success score in predicting short-term outcome in children with hydro-cephalus

Etiology, Clinical Profile, and Short-Term Outcome of Children With Acute Kidney Injury.

Background: Acute kidney injury (AKI) is a common clinical syndrome in hospitalized children and it imposes heavy burden of mortality and morbidity. In resource-constraint settings, management of AKI is very challenging and associated with adverse outcomes. The aim of this study was to determine the clinico-etiological profile and outcome of AKI.Methodology: This prospective observational study was done at the department of pediatric nephrology and pediatric intensive care unit, National Institute of Child Health, Karachi, Pakistan from December 2020 to May 2021. A total of 130 children aged 1 month to 15 years, diagnosed with AKI irrespective of the underlying cause were included. Detailed medical information of each child including medical history, examination, and baseline investigations were obtained. Clinical and etiological profile of patients was noted. The patients were followed up to three months and the outcome was noted.Results: In a total of 130 children, 82 (63.1%) were male. The mean age was 5.5±4.4 years (ranging between 1 month and 15 years). There were 117 (90.0%) children who were referred from other centers for either dialysis or surgical treatment. Prerenal cause of AKI was found in 66 (50.8%) children, followed by renal 53 (40.8%) and postrenal in 11 (8.5%) cases. Fever and shortness of breath were the most common clinical presenting symptoms in 102 (78.5%) and 100 (76%) cases, respectively. There were 45 (34.6%) cases who were managed conservatively, 80 (61.5%) needed dialysis, while three children were managed with plasmapheresis and two required surgical intervention in the emergency department. At three-month follow-up period, 64 (49.2%) children recovered (including nine with partial recovery), 46 (36.1%) expired, 9 (6.9%) developed end-stage renal disease, while 11 (8.5%) had chronic kidney disease.Conclusion: Sepsis, nephrotoxic drugs, and acute glomerulonephritis were the major causes of AKI at our center. Mortality was high among children presenting with AKI. A relatively high proportion of children with younger age, septic AKI, and presentation in critical condition could be the reasons for this high mortality.

Factors Predicting Short Term Outcome in Children With Idiopathic Nephrotic Syndrome: A Prospective Cohort Study.

ObjectiveThe objective of the article is to determine the risk factors associated with relapses in children with idiopathic nephrotic syndrome (INS).Material and methodsFifty-seven children with the first episode of INS were included and followed up prospectively for a minimum period of one year to identify the risk factors related to relapses. The study subjects were divided into early (less than eight days) and late (equal to or more than eight days) responder groups and were compared in terms of the number of days to achieve complete remission, time to first relapse, and the pattern of relapse at the last follow-up.ResultsOf the 57 children, 32 (56%) were male and 25 (44%) female. The mean age of the study cohort was 5.3 ± 3 years. Sixteen (55%) children with ages ranging from one to four years had a higher propensity to develop relapse, although the p-value (p=0.11) was not significant. Gender analysis did not reveal any significant correlation (p=0.32); however, a higher proportion of males (n=17; 63%) responded within eight days of starting steroids than female counterparts (n=10; 37%). Microscopic hematuria at the disease onset was seen in 12 (21%) children, and out of them, five (41.6%) remained in complete remission. The mean time to achieve complete remission was 8.1 ± 3.5 days, while the early responder group had delayed time to first relapse as compared to the late responders (3.1 ± 5.2 vs. 1.6± 3.8; p=0.21). Among all the study participants, a significant number of children (n=20; 51%) were in complete remission at their last follow-up visit. Baseline serum albumin, cholesterol, body mass index (BMI), and serum creatinine had no significant difference.ConclusionThe delayed response to steroids and younger age at presentation can predict the time to first relapse and number of relapses in children with INS, respectively.

Clinical Profile and Short Term Outcome of Acute Encephalitis Syndrome in Children: An Observational Study from a Tertiary Care Centre, Tripura, India

Introduction: Acute Encephalitis Syndrome (AES) is a group of neurologic manifestation caused by wide range of microbes, chemicals and toxins. Japanese Encephalitis Virus (JEV) is the major cause of AES in India. Isolation of aetiological agent in AES cases presents a fundamental challenge to prevention and management. Lack of study on AES in the paediatric population of Tripura prompted the authors to take up this study. Aim: To determine the clinical profile and short term outcome of children with AES from Tripura, India. Materials and Methods: This hospital-based cross-sectional observational study was conducted from November 2017 to April 2019 in the Department of Paediatrics at Agartala Government Medical College (AGMC), Tripura, India. Total 100 children, from 1 month to 12 years of age, fulfilling definition of AES were enrolled in the study. All the cases were managed as per institutional treatment protocol and were followed-up at 1 and 3 months following discharge. Case record, patient profile records and reports of investigations were the study tools. Chi-square test and Fisher’s-exact test were used as per applicability to test the significance of difference of proportions using Statistical Package for the Social Sciences (SPSS) version 15.0. The difference was considered significant for a p-value &lt;0.05. Results: Out of total, 30 patients (30%) were in 9-12 years age group, with slight male preponderance (1.1:1). Total 72 cases (72%) were from rural area. Common clinical features were fever, altered sensorium, seizures, irritability, abnormal movement, pallor, papilloedema, and lethargy. Abnormal laboratory parameters included leucocytosis (62%), anaemia (27%), hyponatremia (35%), and hypoglycaemia (16%) and elevated liver enzymes (15%). IgM serology was positive for JEV (19%), scrub typhus (6%), herpes simplex virus (2%), dengue (2%), measles (1%), and enterovirus (1%). Magnetic resonance imaging brain was normal in 37% of the cases. About 54% of the cases recovered completely, 20% of the cases died and remaining 26% survived with sequelae. Conclusion: AES is common among older male children from the rural area. Serologically JEV is most common cause. Total 54% cases recovered completely. Proportion of death and residual sequelae were higher in the JEV category. The observations of the study indicate need of extensive studies and scaling up of JE vaccination.

Functional Short-Term Outcomes and Mortality in Children with Severe Traumatic Brain Injury: Comparing Decompressive Craniectomy and Medical Management.

The effect of decompressive craniectomy (DC) on functional outcomes and mortality in children after severe head trauma is strongly debated. The lack of high-quality evidence poses a serious challenge to neurosurgeons' and pediatric intensive care physicians' decision making in critically ill children after head trauma. This study was conducted to compare DC and medical management in severely head-injured children with respect to short-term outcomes and mortality. Data on patients <18 years of age treated in Germany, Austria, and Switzerland during a 10-year period were extracted from TraumaRegister DGU®, forming a retrospective multi-center cohort study. Descriptive and multi-variable analyses were performed to compare outcomes and mortality after DC and medical management. Of 2507 patients, 402 (16.0%) received DC. Mortality was 20.6% after DC and 13.7% after medical management. Poor outcome (death or vegetative state) occurred in 27.6% after DC and in 16.1% after medical management. After risk adjustment by logistic regression modeling, the odds ratio was 1.56 (95% confidence interval 1.01-2.40) for poor outcome at intensive care unit discharge and 1.20 (0.74-1.95) for mortality after DC. In summary, DC was associated with increased odds for poor short-term outcomes in children with severe head trauma. This finding should temper enthusiasm for DC in children until a large randomized controlled trial has answered more precisely if DC in children is beneficial or increases rates of vegetative state.

Association Between the Rate of Treatment Response and Short-Term Outcomes in Childhood Guillain-Barré Syndrome.

Introduction: Few studies have examined the association between the rate of treatment response and the outcome of pediatric Guillain-Barré syndrome (GBS). Therefore, our study aimed to identify treatment response in relation to the short-term outcomes of GBS. Further, we investigated its potential predictive value for prognosis.Methods: Our retrospective study included children diagnosed with GBS in the Pediatric Neurology Department of the Children's Hospital of Hebei Province from 2016 to 2020. According to the rate of response from the standard intravenous immunoglobulin (IVIg) treatment, patients were divided into two groups: rapid-response GBS (initial response within 7 days) and slow-response (initial response within 8–30 days). The GBS disability score (Hughes Functional Grading Scale) was used to assess the children's functional disability at nadir, 1 month, and 6 months after onset.Results: Among the 36 children included in the study, 18 (50%) and 18 (50%) were rapid and slow responders, respectively. Time from IVIg treatment to the initial response was significantly shorter in the rapid-response group (5 [3–6.25] days vs. 10.5[8.75–15] days in slow-response GBS, p < 0.001). Hughes score at 1 month was worse than the rapid responders (Fisher's exact test, p = 0.006). Survival analysis (Kaplan–Meier) with respect to regaining the ability to walk independently (Hughes Functional Grading Scale of 2) within 1 month after onset was significantly different among the two groups (log-rank test for trend, p = 0.024). The abnormal levels of cerebral spinal fluid proteins and autonomic dysfunction were more frequent in the slow-response group than those in the rapid group (p < 0.05).Conclusion: The rate of response to IVIg treatment was correlated with short-term outcomes in children with GBS and had predictive value for prognosis. The role of patient's initial responses to treatment could be significantly valuable in developing more effective and efficient treatment options.