Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit

Objective : To study the profile and outcome of children admitted to a tertiary level pediatric intensive care unit (PICU) in India.Methods : Prospective study of patient demographics, PRISM III scores, diagnoses, treatment, morbidity and mortality of all PICU admissions.Results : 948 children were admitted to the PICU. Mean age was 41.48 months. Male to female ratio was 2.95:1. Mean PRISM III score on admission was 18.50. Diagnoses included respiratory (19.7%), cardiac (9.7%), neurological (17.9%), infectious (12.5%), trauma (11.7%), other surgical (8.8%).196 children (20.68%) required mechanical ventilation. Average duration of ventilation was 6.39 days. 27 children (30.7 children /1000 admissions) had acute respiratory distress syndrome. Gross mortality was 6.7% (59 patients). PRISMIII adjusted mortality was directly proportional to PRISMIII scores. 49.5% of nonsurvivors had multiorgan failure. Average length of PICU stay was 4.52 +/−2.6 days. Complications commonly encountered Were atelectasis (6.37%), accidental extubation (2%), and pneumothorax (0.9%). Incidence of nosocomial infections was 16.86%.Conclusion : Our data appears to be similar with regards to PRISMIII scores and adjusted mortality, length of the PICU stay, and duration of ventilation, to previously published western data. Multiorgan failure remains a major cause of death. As expected, Dengue and malaria were common. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. Clearly more studies are required to assess the overall outcomes of critically ill children in India     

Zespół hemolityczno-mocznicowy u dzieci w latach 1971–2010; doświadczenia jednego ośrodka dializ dla dzieci

Hemolytic uremic syndrome (HUS) is thrombotic microangiopathy witch recognized by hemolytic anemia, thrombocytopenia and acute renal failure. In 90% of children HUS is a consequence of enteral infection caused by, most commonly verotoxin, producing Escerichia coli. In remaining 10% of cases not preceded by diarrhea atypical HUS is recognized.AimAim of the study was to assess the frequency and clinical course of HUS in 140 children hospitalized in years 1971–2010 in the Department of Pediatrics and Nephrology, Medical University of Warsaw.Material and MethodsThe patients were analyzed in 2 groups: hospitalized in years 1971–1992 (group I; n=94) and 1993–2010 (group II; n=46). The division was based on the change of mode of therapy, because since 1993 plasmaphereses have been used in the treatment of atypical and severe cases of HUS.ResultsAge of children was significantly higher in group II compared to group I (4.48±4.46 vs 1.43±1.97 year, p<0.0001). In this group also atypical HUS was diagnosed more commonly (26% vs 6.38%; p<0.02). In both groups the incidence of atypical HUS was significantly higher in winter. In treatment red blood cell transfusions and plasma infusions were used. 87% of children from group I and 56% from group II required renal replacement therapy. The result of the treatment of acute phase of the disease was recovery of normal renal function in 65.7% of children from group I and 95.6% from group II. 6.6% of children from group I and 2.2% from group II required chronic dialysis. Unfavourable outcome (death) was observed in 27.7% from group I and 2.2% from group II.ConclusionThe treatment with plasmaphereses and plasma infusions improved outcome and decreased the requirement for chronic renal replacement therapy in children hospitalized with HUS in years 1993–2010.     

Maximal expiratory pressure in residential and non-residential school children

Objective :Maximal Expiratory Pressure (MEP) is a powerful indicator for respiratory muscle strength, which reflects the ability of a person to cough effectively.Methods: The present study was designed on healthy respiratory symptom free children of a Residential – Sainik (50) and Non-Residential (44) school children (aged 12-14 yrs) of Bijapur, to evaluate MEP in relation to their physical anthropometry. MEP (mm Hg) was determined by using a modified Black’s apparatus, which is significantly higher in Residential-Sainik school children in comparison to Non-Residential school children (p<0.01).Results: In both groups, MEP showed positive correlation with height (Residential, r=0.72, p<0.001; Non-Residential, r=0.73, p<0.001); weight (Residential, r=0.73, p<0.001; Non-Residential, r=0.69, p<0.001), BSA (Residential, r=0.79, p<0.001; Non-Residential, r=0.72, p<0.001) and BMI (Residential, r = 0.48, p<0.01; Non-Residential,r=0.34, p<0.05), and also revealed a higher MEP in children with greater chest expansion.Conclusion: Possibly, routine physical exercise in residential Sainik school children attribute to their better respiratory muscle strength.     

Clinical implications of Golgi protein 73 and granulocyte colony-stimulating factor and their related factors in children with bronchopneumonia

ObjectiveTo investigate the clinical implications of Golgi glycoprotein 73 (GP73) and granulocyte colony-stimulating factor (G-CSF) in children with bronchopneumonia (BP).MethodsSeventy-two children with BP (observation group) and 81 healthy children (control group) consecutively brought to the present study's hospital between June 2019 and October 2020 were enrolled. GP73 and G-CSF levels were determined to analyze their diagnostic value for pediatric BP. High-sensitivity C-reactive protein (hs-CRP) was also measured. The clinical implications of GP73 and G-CSF in pediatric BP complicated with respiratory failure and their connections with the inflammatory response were discussed.ResultsGP73 and G-CSF levels were remarkably higher in the observation group (p < 0.05). The sensitivity and specificity of combined detection (GP73+G-CSF) in predicting pediatric BP were 72.22% and 86.42%, respectively (p < 0.001). GP73 and G-CSF, which are closely related to X-ray classification and complications in the observation group, decreased after treatment and were positively correlated with hs-CRP (p < 0.05), especially in children complicated with respiratory failure. Regression analysis identified the independence of the course of the disease, hs-CRP, X-ray classification, GP73, and G-CSF as influencing factors of respiratory failure in children with BP (p < 0.05).ConclusionGP73 and G-CSF, with elevated levels in children with BP, are strongly linked to disease progression and are independent influencing factors of respiratory failure, which may be the key to diagnosing and treating pediatric BP in the future.     

Severe falciparum malaria

Falciparum malaria affect all ages with multiple-systemic complications which varies in different age group. We studied 242 children with complicated Falciparum malaria with a median age of 6.5 years to look for occurrence of different complications in younger and older age groups and overall mortality picture. Unarousable coma (40.5%), severe anemia (26.03%). repeated seizures (46.2%) and hepatopathy (32.2%) were commonest complications. Under five children had higher risk of development of cerebral malaria (P<0.01), severe anemia (P<0.05) and seizures (P<0.001); whereas above five children had higher risk of acute renal failure (P<0.05) and malarial hepatopathy (P<0.02). Over all mortality was 9.9%, cerebral malaria being the commonest cause (6.6%). Multi-system involvement was seen in 58.4% cases of death. Children having pulmonary edema, shock and cerebral malaria had high case fatality rate.     

Non traumatic coma

Objective: To study the etiology and clinical profile of non-traumatic coma in children and to determine the clinical signs predictive of outcome.Methods: 100 consecutive cases of nontraumatic coma between 2 months to 12 years. Clinical signs studied were temperature, pulse, heart rate, blood pressure, coma severity by Glasgow coma scale (GCS), respiratory pattern, pupillary and corneal reflex, extra ocular movements, motor patterns, seizure types and fundus picture. These were recoded at admission and after 48 hours of hospital stay. Etiology of coma was determined on basis of clinical history, examination and relevant laboratory investigations by the treating physician. The outcome was recorded as survived or died, and among those who survived as normal, mild, moderate, or severe disability. Chi-square test and logistic regression analysis were done to determine predictors of outcome.Results: Etiology of coma in 60% cases was CNS infection (tubercular meningitis19, encephalitis18, bacterial meningitis16, others7); other causes were toxic-metabolic conditions (19%), status epilepticus (10%), intracranial bleed (7%), and miscellaneous (4%). 65 children survived, 11 were normal, 14 had mild disability, 21 had moderate disability and 14 were severely disabled and dependent. Survival was significantly better in patients with CNS infection (63%) as compared to those with toxic-metabolic causes (27%) and intracranial bleed (43%, P < 0.05). On bivariate analysis age <-3 years, poor pulse volume, abnormal respiratory pattern and apnoea, abnormal pupillary size and reaction, abnormal extra ocular movements, absent corneal reflex, abnormal motor muscle tone at admission or 48 hours correlated significantly with mortality. Survival was better with increasing GCS (Spearman rho =. 32, P < 0.001). On logistic regression age < 3 years, poor pulse volume, absent extraocular movements and papilloedema at admission and 48 hours after admission were independent significant predictors of death.Conclusion: CNS infections were the most common cause of non-traumatic coma in childhood. Simple clinical signs were good predictors of outcome     

Outcome of teenage pregnancy

Objective The objective of the study was to evaluate the obstetric, fetal and neonatal outcomes of teenage pregnancy in a tertiary care teaching hospital. Methods A retrospective case control study was performed over a period of 5 years. Data were retrieved from hospital records. All teenage mothers (aged 13–19 completed years at delivery) delivering in the University Hospital were taken as cases. Next 3 consecutive deliveries in the age group of 20–30 year were selected as controls for each case. For statistical analysis the cases were further subdivided into 2 groups, ≤17 years (Group A) and 18–19 years (Group B). Groups were compared for obstetric complications and neonatal outcome. Statistical analysis was done by software package SPSS 10. Results The incidence of teenage deliveries in hospital over last 5 years was 4.1%. Majority of the teenagers were primigravida (83.2% vs. 41.4%, p<0.01). Complications like pregnancy induced hypertension (PIH) (11.4% vs 2.2%, p<0.01), pre-eclamptic toxemia (PET) (4.3% vs 0.6%, p<0.01) eclampsia (4.9% vs 0.6%, p<0.01) and premature onset of labor (26.1% vs 14.6%, p<0.01) occurred more commonly in teenagers compared to controls. Teenage mothers also had increased incidence of low birth weight (LBW) (50.4% vs 32.3%, p<0.01), premature delivery (51.8% vs 17.5%, p<0.01) and neonatal morbidities like perinatal asphyxia (11.7% vs 1.9%, p<0.01), jaundice (5.7% vs 1.2%, p<0.01) and respiratory distress syndrome (1.9% vs 0.3%, p<0.05). Teenage pregnancy was also associated with higher fetal (1.9% vs 0.3%, p<0.05) and neonatal mortality (3.8% vs 0.5%, p<0.05). Conclusion Teenage pregnancy was associated with a significantly higher risk of PIH, PET, eclampsia, premature onset of labor, fetal deaths and premature delivery. Increased neonatal morbidity and mortality were also seen in babies delivered to teenage mothers. Younger teenager group (≤17 years) was most vulnerable to adverse obstetric and neonatal outcomes.     

Pediatric presentations of leptospirosis

Objective : Leptospirosis in children is an often under diagnosed condition due to the non specificity of the presentations except for the classical Weil’s disease.Methods : Children presenting with symptoms and signs suggestive of Leptospirosis were included in the study. Diagnostic criteria were fever, myalgia, conjunctival suffusion, Jaundice, headache, altered sensorium, seizures, bleeding manifestation and oliguria. Their clinical profile, lab parameters (general and specific), response to treatment and outcome were analysed.Result : One hundred and thirty nine cases were diagnosed during a 4-year period. The commonest symptoms were fever 133 (96%), headache and myalgia 34 (24%). Jaundice was present in only 25 (18%) of cases with renal failure in 2 cases. The frequently encountered clinical signs were hepatomegaly in 100 (72%), myalgia in 34 (24%) with icterus in 25 (18%),12 (9%) of children presented with shock and 10 (7%) had meningitis. CPK estimated was a useful index of myositis. The diagnosis was confirmed by Dark field microscopy and paired or single high serological tests (MAT, ELISA IgM). Overlapping infections such as culture positive Salmonella typhi with leptospirosis (Serology positive) or Dengue Hemorrhagic fever with Leptospirosis presented with complications such as a myocarditis, shock and ARDS.Conclusion : Presentation of non-icteric forms of Leptospirosis are often non-specific and may be missed unless there is a high index of suspicion. This study emphasizes the myositis and meningitis forms of leptospirosis. Delayed diagnosis leads to increased mortality and morbidity.     

Quantification of coronary risk score

Objective : To quantify the coronary risk score in children and/or grandchildren of patients with coronary artery diseae (CAD).Methods : One hundred and fifty children with positive family history of CAD (cases) and age and sex matched children with no such history (controls) were enrolled in the study. Fasting blood sugar, serum cholesterol and triglycerides were estimated on all children and a risk score was calculated using Nora’s scheme.Result : The cases and controls were similar with respect to mean age, six distribution, mean weight and mean height. None of the child was hypertensive. Mean serum levels of triglycerides were 164.7 m/dl and 105.7 mg% respectively in cases and controls (p<0.005). Prevalence of hypertriglyceridemia was three times more in cases (p<0.001). Cases had a significantly higher risk scores (p<0.00001) and this was mainly attributable to higher biochemical risk (P<0.0006).Conclusion : Children and grand children with a positive family history of CAD had significantly higher risk scores for future CAD. The increased risk was mainly due to biochemical derangements.     

Team: A National,Multicentric, Retrospective Analysis of Outcomes in Nocturnal Enuretic Children Treated with an Antidiuretic in Two Different Modes

PurposeSeveral monocentre authors described an improvement in outcome of desmopressin treatment when not terminated abruptly but instead tapered out. This national multicentre retrospective survey was designed to test whether structured withdrawal of desmopressin can improve outcome.Material and Methods487 enuretic patients from 181 centres were enrolled. The study was conducted on out-patients with typical age and gender distribution. 267 patients were pre-treated. At outset, 41% showed 7 wet nights/week, 45% showed 3-6 and 14% <3. All patients were treated with desmopressin. Response to therapy was subdivided into response (wet nights reduction >90%), partial response (50-90%) and minor reduction (<50%). After 4-26 weeks treatment was either abruptly terminated or tapered. Relief of bedwetting was defined as <2 wet nights/month.ResultsThe group with abrupt termination (173 children) showed 51% response, 27% partial response and 22% minor reduction. The tapering group (314 children) had 72% response, 24% partial response and 4% minor reduction (p<0.0001). Enuresis frequency with abrupt termination decreased from 20.53 wet nights/month before treatment to 5.8. The tapering group had 21 wet nights/months before and 1.86 after (p<0.0001). One month follow up showed <2 wet nights/month in 57% with abrupt termination and in 80% with tapering (p<0.0001). Pre-treatment had no influence. No severe side effects occurred.ConclusionsThis national multicentre retrospective analysis proves that antidiuretic treatment followed by a structured withdrawal program is superior to regular treatment in enuretic children and therefore should be the mainstay of treatment. It is also superior to published outcomes of alarm treatment.     

Postasphyxiai Encephalopathy in Preterm Neonates

Objective : Perinatal asphyxia is an important determinant of infant neurological outcome. There are very few studies looking exclusively at postasphyxial encephalopathy in preterm neonates.Methods : We studied the neurologic and sonographic abnormalities in 40 preterm babies with severe birth asphyxia during their hospital stay and till 3 months corrected age.Result : 87.5 % of the asphyxiated preterm babies had neonatal neurologic abnormality, compared to only 17% of the control babies (p < 0.0001). Generalised hypotonia and reduced activity were the commonest abnormalities (observed in 85% of asphyxiated babies) while depressed sensorium (60%) and seizures (35%) were seen in more severe cases. White matter disease (WMD-including periventricular flare, cerebral edema and periventricular leucomalacia) was significantly more frequent in the study cases (34.5% in study casesvs 7.5% in controls, p < 0.0001) as was grade 3/4 intraventricular hemorrhage(IVH) (25% in study cases vs 2.5% in controls, p < 0.0001). There was 11 fold higher mortality among the asphyxiated babies (23 deaths in study casesvs 2 in controls, p < 0.0001).Conclusion :The survivors had a significantly higher incidence of both mild and severe neurological abnormalities at corrected age of 3 months among the asphyxiated babies. There was a good correlation between the severity of the neonatal encephalopathy as well as the sonographic findings and the outcome.     

儿童重症监护室儿童慢性危重症的病因组成及预后分析北大核心CSCD

目的探讨儿童重症监护室儿童慢性危重症(pediatric chronic critical illness,PCCI)的病因组成和转归。方法以2017年1月—2022年12月在广东医科大学附属东莞儿童医院儿童重症监护室住院并达到PCCI诊断标准的患儿为研究对象。根据患儿的病历资料及出院诊断,对其病因进行分类。收集并分析其住院期间相关临床资料。结果2017年1月—2022年12月儿童重症监护室3955例住院患儿中,有321例(8.12%)符合PCCI诊断标准。321例PCCI患儿中,最常见的病因为感染(71.3%,229例),其次为意外伤害(12.8%,41例)、手术后(5.9%,19例)、肿瘤/免疫系统疾病(5.0%,16例)、遗传/染色体疾病(5.0%,16例)。321例PCCI患儿中,好转出院249例(77.6%),家属要求出院37例(11.5%),在院死亡35例(10.9%)。死亡病例中,感染占74%(26/35),意外伤害占17%(6/35),肿瘤/免疫系统疾病占6%(2/35),遗传/染色体疾病占3%(1/35)。2017—2022年PCCI在儿童重症监护室疾病中的占比呈逐年上升的趋势(P<0.05)。321例PCCI患儿中,婴幼儿148例(46.1%),学龄前儿童57例(17.8%),学龄期儿童54例(16.8%),青春期儿童62例(19.3%),其中婴幼儿组占比最高(P<0.05)。以上4个年龄组在院病死率分别为14.9%(22/148)、8.8%(5/57)、5.6%(3/54)、8.1%(5/62),其中婴幼儿组病死率最高,但4个组比较差异无统计学意义(P>0.05)。结论PCCI在儿童重症监护室疾病中的占比越来越高,其主要病因为感染及意外伤害,引起PCCI患儿死亡最常见的病因为感染。PCCI患病人群以婴幼儿为主,婴幼儿患者在院病死率相对较高。     

Oral midazolam and oral butorphanol premedication

Objective: To evaluate the efficacy of oral midazolam and oral butorphanol for their sedative analgesic effects in children.Methods: Sixty children, aged 2 to 10 yrs, of ASA physical status I and II, scheduled for surgical procedures of 1 to 2 hrs duration were randomized to one of the two groups. Group I : children received midazolam 0.5mg/kg orally and Group II : children received butorphanol 0.2mg/kg orally. Score of the children was assessed every 5 minutes till the induction of anesthesia. Intraoperative and postoperative analgesic requirement was recorded alongwith postoperative recovery and complications.Results: The groups were identical regarding the patient’s characteristics, hemodynamic variables, duration of surgery and awakening time. Less time was required for the onset and time of maximum sedation in the butorphanol group (p<0.05). Sedation scores were similar among the groups at all time intervals, while the scores were higher in the butorphanol group at the time of induction (p<0.05). Less number of children required intraoperative and postoperative rescue analgesia in the butorphanol group (p<0.05). Statistically significant difference was found among the groups in respect to complete amnesia (50% in group Ivs 80% I group II, p<0.05) and recollection (40% in group Ivs 10% in group II, p<0.05).Conclusion: Oral butorphhanol is comparable to oral midazolam in children but analgesia alongwith sedation is an additional advantage which makes it better than midazolam without a significant increase in side effects.     

Outcome of parapneumonic empyema

Objective: Empyema thoracis is known to have variable age group affection, causative agents and controversy regarding primary mode of management. To look into current demography, bacteriology and treatment outcome.Methods: Prospective study made on admitted cases of parapneumonic empyema from July 2001 to June 2003. All cases were treated with chest tube drainage, parenteral antibiotics or thoracotomy in multiloculated or non-improving cases.Results: 0.8% (C.I. 0.6–1.0) of total pediatric admission had empyema, who were more likely to be females (P<0.05), under-weight (P<0.05) compared to children admitted for other reasons.Staphylococcus aureus is still the commonest isolate (13.2%). All cases received antibiotics prior to hospitalisation. Majority of cases (90.5%) could be successfully managed with antibiotics and chest tube drainage alone. 9.4% cases needed thoracotomy. 5.8% cases needed salvage thoracotomy following non-improvement with chest tube drainage. Fever remission time and duration of hospital stay were comparable in both groups. Thoracotomy cases required antibiotics for shorter period (P=0.04). Two cases died due to reasons other than mode of management. Radiological and lung function recovery was excellent in most of the cases.Conclusion: Chest tube drainage is a safe, efficacious primary method of empyema management.     

Necrotising pneumonitis in children

We retrospectively analysed the clinical features and outcome of children under 17 years of age with necrotising pneumonitis (NP). The radiographs and CT scans of the chest of children under 17 years of age between July 1995 and March 1999 who had complicating community-acquired pneumonia were reviewed. CT scans were obtained for persistent fever, respiratory distress and sepsis despite empiric antibiotic therapy and closed tube drainage. A total of 21 children had the radiographic features of NP of whom 11 (52%) patients were successfully managed using antibiotic therapy with or without closed tube drainage. Ten patients required thoracoscopic decortications and/or lysis of pleural adhesions or debridement of empyema due to refractory pleural sepsis, failure of pulmonary re-expansion and persistent air-leaks. The most common pathogens identified were Streptococcus pneumoniae (n=3),Staphylococcus aureus (n=2), and Haemophilus influenzae type b (n=2). The days of hospital stay, duration of fever and days of C-reactive protein return to normal were significantly less for the medically versus the surgically treated children (P < 0.05). Conclusion The clinical course of necrotising pneumonitis in children following complicated pneumonia is often prolonged despite adequate antibiotic therapy. Necrotising pneumonitis with co-existing multiple loculations, pneumothorax/bronchopleural fistula in the empyema and extensive pleural peel are poor prognostic factors for medical therapy. Thoracoscopic removal of loculated empyema, lysis of adhesions and/or decortication are effective in relieving tachypnoea, chest pain, and controlling fever and improve the outcome, especially in children with empyema. Received: 6 November 1999 and in revised form: 8 February and 12 March 2000 Accepted: 27 March 2000     

Profile of acute renal failure in children in Kashmir

We report on the etiology and the short term outcome (3 month) of children with acute renal failure (ARF) at a tertiary care centre in north India. Acute tubular necrosis was the commonest cause of ARF (33%) especially in children <5 years of age; while in children >10 years, glomerulonephritis was the commonest cause. The overall mortality rate was 20%.The outcome at 3 months showed normal renal function in 72 patients and CKD in 5 patients. Three patients were lost to follow-up.     

The profile and outcome of patients admitted to a pediatric intensive care unit

The records of all admissions to a 6-bed pediatric intensive care unit (PICU) over a period of 6 years were reviewed. The age, diagnosis, clinical service provided, duration of stay and outcome were recorded. Of the 3025 children admitted, 2092 (69.2%) were males. Neonates constituted 13.1% (400) and infants 57.1% (1727) of total admissions. The duration of stay ranged from 6 hours to 46 days, and 61 patients stayed for longer than 13 days (long-stay patients). The most common cause for admission was septicemia, seen in 459 patients (14.8%); 418 (13.8%) children had congenital heart disease, 407 (13.5%) lower respiratory tract infections (LRTI) and 261 (8.6%) meningitis. The most common conditions necessitating long-stay in the PICU were meningitis (20%), Landry-Guillain-Barre syndrome (16.6%), acute renal failure (20%), and septicemia (16.6%). There were 721 deaths giving a mortality of 23.5%. Of these 134 (18.6%) were due to septicemia, 103 (14.2%) due to congential heart disease, 77 (10.6%) due to meningitis and 55 (7.6%) due to LRTI. The highest case fatality rate was seen with encephalitis (52.6%), followed by hepatic coma (51.3%), malignancies (43.2%), septicemia (29.1%) and meningitis (29.5%). The mortality was lower (9.8%) in long-stay patients than in short-stay patients (24.6%). There was gradual increase in proportion of cases requiring interventions including artificial ventilation (1% to 35%), peritoneal dialysis (1.5% to 11%), insertion of central venous pressure lines (0 to 10%), over the last 6 years. The comparison of case fatality rates before and after the PICU was made a functionally independent unit eleven months ago, reveals a declining trend for certain diseases including LGB syndrome (22.5% to 0%) (p<0.02), dengue hemorrhagic fever (44% to 9%) (p<0.02), meningitis (34% to 20%). renal failure (17% to 10%), encephalitis (55% to 26%). The ventilator survival increased from 22% to 42% (p<0.001).     

Amnioinfusion in thick meconium

Objective : There are conflicting reports regarding the results of amnioinfusion in the management of meconium passagein utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour.Methods : 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Transcervical amnioinfusion of one liter saline infused over 30–45 minutes. End points were relief of decelerations, incidence of vaginal delivery, presence of meconium below the neonatal cords, and X-ray evidence of meconium aspiration.Results : Amnioinfusion resulted in relief of decelerations in 75% of cases as compared to 7% in the control group. Eighty-eight percent of patients delivered vaginally as compared to 58% in the control group (p<0.001). Neonatal outcome was significantly better in the infusion group. The incidence of meconium below the vocal cords was reduced from 48% to 17% (p<0.004) using amnioinfusion with positive X-rays for meconium aspiration in only 12.5% versus 26% (p<0.5).Conclusions : We concluded that transcervical intrapartum amnioinfusion is a safe, simple and inexpensive technique that reduces operative intervention and improves neonatal outcome, and is of tremendous relevance in developing countries.     

The Efficacy of Dihydrotestosterone Transdermal Gel Pretreatment in Primary Hypospadias Surgery: A Prospective,Controlled Randomized Study

PurposeEfficacy evaluation of transdermal dihydrotestosterone (DHT) treatment based on the results of hypospadias repair in children with primary hypospadias.Material and MethodsBetween September 2004 and April 2006, a randomized total of 75 children with primary hypospadias with a mean age of 33.4±3.7 months were evaluated. While 37 children (Group 1) were treated with a daily application of 2.5% DHT transdermal gel for 3 months, 38 children of group 2 did not receive DHT before operation. All children underwent hypospadias repair using tubularized incised plate urethroplasty. Postoperative complications of the children were analysed using the Mann-Whitney U test with respect to fistula, urethral strictures, meatal stenosis, glandular dehiscence and scar formation.Results4 patients (10.5%) of group 2 developed urethrocutaneous fistulae compared to group 1 in which only one fistula was found (2.7% p>0.05). While 3 patients (7.8%) in group 2 had glandular dehiscence, no patients in the DHT group had one (p<0.05). There were 2 cases with meatal stenosis in group 2 (5.2%), but no patient with meatal stenosis in group 1 (p>0.05). There were 16 cases (42.1%) with moderate to severe scar formation in group 2, whereas only two children (5.4%) had scar formation in the DHT group (p<0.05). There was a significant difference between the overall re-operation rates of group 2 (23.8%, 9 patients) and group 1 (2.7%, one patient) (p<0.05).ConclusionsPretreatment with DHT transdermal gel was found to be effective in decreasing the complications and improving the cosmetic results after hypospadias repair.