Abstract: Assisted ventilation has become an indispensable part of the neonatal intensive care. It is helpful to reduce the high mortality in this group of neonates and identification of risk factors is important. Objectives: To assess the current status of neonatal ventilation in a tertiary care neonatal unit in a rural hospital in central India, to identify the common indications for ventilation, analyze the complications that arise, and evaluate the short term outcome as measured by survival. Design: Hospital based prospective observational study Setting and participants: conducted on neonates who required mechanical ventilation over period of 2 years (1st September 2015 — 31^st August 2017). Materials and methods: Neonates requiring mechanical ventilation during the study period of 2 years (1st September 2015 — 31^st August 2017) were enrolled in the study. Neonates who received mechanical ventilation for minimum of 6 hours during the study period were included in the study after written informed consent from parents. Babies who expired within 6 hours of life, neonates with birth weight < 500 grams, abrupt termination of ventilator support for any reason and gestational age <26 weeks were excluded. Results: 206 neonates were included in the study. Males comprised of 56.8% of ventilated neonates. The most common indication of ventilation was birth asphyxia, in 29.1% neonates, followed by neonatal sepsis (22.3%), respiratory distress syndrome (18.4%), and meconium aspiration syndrome (13.1%). Complications were seen in 35.9% neonates, the most common complication was ventilator associated pneumonia (50%), sepsis (40.5%), pneumothorax (16.2%). Survival rate among the ventilated neonates was 45.6%o. Conclusion: Neonates with birth asphyxia and sepsis were the major problems in NICU, which must be addressed to improve outcome.

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Objective: To find the nature of cough associated symptoms and conditions, medication preference in Indian children visiting pediatric outpatient services, with cough as the chief complaint. Material and methods: The survey was conducted in six cities across Indian winter months from October to December 2017. The target population for the survey consisted of 1998 children, involving200 pediatricians across the country. Data was collected on children having cough, categorized under 6 groups ranging from age 1-2 years to 11-12 years, visiting pediatric OPD / clinics with cough as the chief complaint. Parameters evaluated included duration of presenting cough, history of similar episodes, nature, intensity and frequency of cough, associated symptoms, presence of risk factors, drugs used for treatment of cough, concomitant medications and self-medication, if any. Results: Data on 1998 children having cough, aged between 1 to 12 years (58% males; 42% females), wascapturedin this survey in 6 cities(Bangalore - 350, Ahmedabad - 249, Delhi - 403, Hyderabad - 298, Lucknow - 397 and Mumbai— 301). Over69% children presented with cough since5 days prior to OPD visit while only 3% had symptoms lasting over 10 days. Almost half of the children reported 4 to 6 similar episodes of cough in preceding 12 months. 25% of the children were having dry cough whereas 61% had wet cough with no or scanty expectoration. Fever was present as associated symptom in 62.9%o cases. Majority (77%) of children had no family history of asthma, allergic rhinitis or tuberculosis. None of them were diagnosed either as pneumonia or tuberculosis on further investigation. First and second generation antihistaminics were prescribed in 76%o and 78% children respectively. Antibiotics (50%) and nutritional supplements (12%) were also prescribed besides mucolytics (62%) and expectorants (63%). 83% of children preferred oral medicine. More than half of the children had more than 6 bouts of cough per day. Use of self- medication was however low. Conclusion: Acute onset and recurrent cough is common in children. Exposures to modifiable risk factors such as environmental pollutants are commonly seen to be associated with pediatric cough. Fever is a common accompanying symptom. Due caution need be observed while prescribing multiple and multi-combination preparations so that same molecule is not present in different preparations, thus avoiding overdosing. Decongestants, antitussives, mucolytics, expectorants and first and second generation antihistamines were commonly prescribed in management of pediatric cough with a view to decrease mucosal oedema, secretions and allergy.

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Turner syndrome is a comparatively commonly encountered chromosomal disease with well known congenital malformations involving the cardiovascular and renal system in addition to its typical phenotypic characteristics. Liver involvement in Turners syndrome is seldom reported .We describe a case of a 9-year old girl with Turner syndrome, presenting with massive upper gastrointestinal bleed from Grade-III esophageal varices and portal hypertension due to a rare vascular anomaly involving the hepatic vasculature.

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Abstract:Background: Jaundice is one of the most common conditions requiring medical attention in newborn babies. Exchange transfusion is standard method of therapy for immediate treatment of severe hyperbilirubinemia and prevention of kernicterus. As bilirubin is removed from plasma, extra vascular bilirubin equilibrates and binds to albumin in exchanged blood. Within half hour of exchange transfusion bilirubin level returns to 60% ofpre exchange level. Guidelines for the implementation ofphototherapy and exchange transfusion rely on evidence-based estimates of when the benefit of these interventions exceeded their risks and costs. Material and methods: The following study is a prospective study carried out in Hospital for Children and Upgraded Department of Paediatrics, PMCH, Patna. Neonates who underwent exchange transfusion for neonatal hyperbilirubinemia from August 2011 to September 2012 in NICU were included in study. Result: In this study most common cause of hyperbilirubinemia requiring exchange transfusion was ABO incompatibility i.e 42.86%, (n=15). Rh incompatibility constituted 22.85% of cases (n=8). In remaining 34.29%% cases (n=12) no specific cause could be found. Immediate complications were seen in 7 out of 35 cases (20%). all cases were followed till age of 12 months, at 6 months follow up, out of 34 cases 4(11.76%) showed gross motor and fine motor delay while language and social personal delay was seen in 2(5.88%) and 3(8.82%) respectively. At 12 months follow up out of remaining 32 cases (3 were lost to follow up) 4 cases (12.5%) showed delay in developmental milestones. Conclusion: Two most common cause for hyperbilirubinemia needing exchange transfusion are ABO incompatibility (42.86%) and Rh incompatibility (22.85%). In about 34.29%o of cases exact cause could not be found out. Pre exchange bilirubin values strongly correlated with persistent BERA changes (p value< 0.005).

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Objective of study was to assess the hand hygiene compliance in health care personnel before and after hand hygiene education and effect of change in hand hygiene compliance on rate of hospital acquired infections. It is an_observational analytical study. Study was carried out on medical and paramedical staff working or visiting to PICU over a period of 4 months from March 2015 to June 2015. Surveillance was done by CCTV camera recordings. Two weekly classes on hand hygiene and its importance in PICU were taken by the principal investigator Total opportunities for HH observed during video surveillance were 10519, out of which 5953 opportunities were used with total compliance of 56%. Hand hygiene compliance in the same period i.e. Mar 2014 to June 2014 was 33%.This is a pre intervention data Hence we can see that compliance improved from 33% to 56% which is significant with p- value < 0.01.Ventilator associated pneumonia (VAP) rate between march 2014 - June 2014 was 22.3/1000 ventilation days. Central line associated blood stream infection ( CLABSI) during the same period was 10.06/ 1000 catheter days( unpublished data). In intervention phase i.e. march 2015 to June 2015, there was significant fall in VAP rate which was 13.42/ 1000 ventilator days, and CLABSI rate which was 2.78/1000 catheter days. There was significant fall in a rate of HAI. It can be concluded that rate of hand hygiene compliance can be increased significantly by reinforcing its importance repeatedly to medical staff working in I.C.U.s. Only increase in hand hygiene compliance can decrease the number of rate of hospital acquired infections.

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Objective: To determine the antibiotic sensitivity pattern of bacterial isolates from septic neonates so as to identify the most suitable policy for use of empirical antibiotics.Design: Retrospective cross-sectional study Participants: 126 infants admitted between 1^st September 2015 and 30^th August 2016, for treatment of suspected sepsisMethod: Reports of blood culture done by BacT/Alert® system and other relevant data pertaining to suspectedcases of neonatal sepsis were collected from the case records and retrospectively analyzed. Results and outcome measures:Commonest organism was E.coli. Resistance to ampicillin, gentamicin and cefotaxime was significant. Overall, 73% of all organisms were susceptible to either carbapenems or glycopeptides while 63%% were susceptible to either piperacillin/tazobactam or an aminoglycoside (preferably netilmicin). Conclusion: Carbapenems and Glycopeptides rotated with Piperacillin/tazobactam and an Aminoglycoside (preferably netilmicin) may have to be empirically used in units with similar flora and sensitivity patterns.

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