Background

Diabetic ketoacidosis(DKA) is a common acute complication of type 1 diabetes mellitus. Cardiac arrhythmias have not been recognised as a common complication of DKA in young adolescent diabetic patients. The possible causes of the arrhytmias metabolic acidosis itself, the dehydration and the electrolyte imbalance. Diabetic ketoacidosis can produce hypophosphataemia, and hypomagnesaemia, both of these electrolyte imbalances have been implicated in tachyarrhythmias including Supraventricula tachicardia(SVT).

Objectives

A case report of a patient with SVT with diabetic ketoacidosis was presented.

Methods

A 15-year-old female patient, who was previously known to be healthy, was referred from our hospital with a preliminary diagnosis of diabetic ketoacidosis. SVT was developed at the 6th hour of follow-up. Adenosine was given in repeated doses in accordance with the protocol. When no response was obtained, amiodarone treatment was started. This treatment response was obtained and the patient came out of the SVT after the 12th hour of hospitalization. During the SVT, the patient's PH value increased from 6.8 to 7.01. Potassium,magnesium and phosphorus values that were normal at the beginning of treatment were measured at low levels during the course of SVT.

Results

Metabolic acidosis and impaired ion values may affect cardiac muscle contractility and conduction system and cause cardiac dysfunction and arrhythmia. In the present case, SVT was considered to be a disorder that developed on the basis of acidosis due to the decrease in potassium, magnesium and phosphorus in spite of the precautions taken in the course of treatment.

Background

Milk delivered to Human milk bank should be pasteurized and stored at -20℃ in order to inactivate the microbial agents that may be present.

Objectives

We analyzed the change of macronutritional components of donated human breast milk going through Holder pasteurization (HoP) and storage by quantification.

Methods

A total of 30 breast milk samples from 17 healthy lactating mothers were collected at different time point after delivery and the samples were classified at 1 month interval after delivery to 6 months. We measured carbohydrate, protein, fat, and calory before and after HoP. After HoP, milks were stored at -20℃ and the nutrients were measured repeatedly 1 week, 2 weeks, and 4 weeks after the start of storage.

Results

Although slight decrease in fat content in breast milk for 6 months postpartum, there was no significant difference overall nutrients. The mean values of carbohydrates, protein, and fat in donor milk pre-HoP were 8.2, 1.3, and 3.8 g/dl compared with post-HoP values 8.2, 1.1, and 3.0 g/dl, respectively. Although HoP reduced protein and fat energy content of donor milk by 15.4% and 21.1%, respectively, carbohydrates were not reduced. There was no significant decrease in all the macronutrient contents following the storage up to 4 weeks.

Conclusion

The storage period did not affect nutrients, but the HoP affects several human milk components. Donor human milk after HoP may need fortification for normal infant growth.

Background

Post-delivery birth weight loss (PDBWL) is a natural process with poorly defined predictors in premature population. Copeptin (CTproAVP), released in stoichiometric amount equal to vasopressin, is regarded as a promising, stabile marker of fluid volume, potentially applicable in the monitoring of fluid therapy.

Objectives

Hypothetically PDBWL is expected to correlate with CTproAVP in the first week of life and may help in decision making regarding fluid therapy.

Methods

155 preterm newborns 30+0-36+6 GA were enrolled and observed up to the 7^th day of life(DOL). CTproAVP measurement was performed up to the 2^nd and between 4^th-7^thDOL. The results were compared with body weight and PDBWL, laboratory measurements, and selected maternal and neonatal clinical data.

Results

Mean PDBWL_max was 9.3 ± 1.8% (4.9 ± 3.6 and 4.4 ± 5.1% in first and second measurements, respectively). Median CTproAVP was 157 (1-3Q: 104-273) and 173 (115-277) pmol/ml. There was no correlation between CTproAVP and PDBWL, except the 1’CTproAVP value and the 2’PDBWL (R=0.165, p<0.05). Similar CTproAVP concentrations were found regardless of distinguished PDBWL ranges (<8, 8.0-9.9 and ≥10%). CTproAVP values were not affected by selected demographic and clinical data, except: 1’ and 5’Apgar evaluations, haematocrit and fluid administration up to 2^nd DOL.

Conclusion

Serum CTproAVP concentration does not predict post-delivery birth weight loss in clinically stable preterm newborns treated according to routine medical management. This observation may be restricted to limited ranges of hydration disturbances, without significant pathology.

Background

Three main central venous access strategies are available in neonates: umbilical venous catheter (UVC), epicutaneo-caval catheter (ECC), and centrally inserted central catheter (CICC) via ultrasound cannulation of brachio-cephalic vein

Objectives

To help decision making in central line placement

Methods

Methods: We developed an algorithm for a rational approach to this decision (see figure), based on the features of each central line: (1) UVCs - applicable only in the first 24hours of life - are high performance lines, but they have limited duration being associated with a high risk of infection, thrombosis and dislocation; (2) ECCs are low-performance lines, with limited duration and relevant incidence of complications; (3) CICCs – though requiring specific skills of ultrasound insertion – are high performance lines, with low complications and extended duration, so that they are ideal in severe/unstable clinical conditions (haemodynamic instability requiring inotropes and monitoring; major congenital malformations; indication to surgery; severe bronchopulmonary dysplasia requiring ventilation and IV infusion; no superficial vein available for cannulation; etc.).

Results

Our algorithm has been adopted for the last two years in more than 800 neonates admitted to our NICU, reducing the variability due to the clinician’s preference or experience, and improving the appropriateness of choice

Conclusion

To our knowledge, this is the very first algorithm in this area: we think it is a right move towards a more rational approach to venous access in the newborn.

Background

The majority of children admitted to PICU are infants with 46% ≤ 1 year of age with an average length of stay (LOS) of 3.6 days. Nutritional management of young critically ill children is often challenging, particularly with respect to minimising the effects of starvation associated with suboptimal nutrition delivery.

Objectives

The aim of this PINS3 sub-group analysis by three centres was to evaluate variation in nutrient practices and associated differences in protein and energy delivery.

Methods

3 members British-Dietetic-Association-Paediatric-Special-Interest-Group:Paediatric Cardiology/Intensive Care, combined dataset. Children were prospectively enrolled for up to 10 days. Inclusion criteria: 1-month-18 years of age, requiring mechanical ventilation, PICU-LOS stay of ≥3 days. Statistical significance p-value <0.05.

Results

n=63 children;44% male. Mean age was 47.8±55.5 months and severity of injury score 6.3±11. Overall, day-2 kcal/kg was 36.5±28.3 and 0.7±0.7g/kg protein, by Day 6 40.5±31 kcal/kg and 1.1±0.8g/kg protein and day 10 59.3±21.4kcal/kg and 1.50±0.5g/kg protein. Significant differences were seen between centres; Southampton-day 2 significant higher kcal/kg compared to Bristol 41.9±25 vs.11.7±14.6kcal/kg (p<0.001) and protein 1.3±1vs 0.3±0.5 (p<0.001); GOSH and Bristol 34.9±38 vs.11.7±14.6kcal/kg 0.7±0.7vs.0.3±0.5g/kg protein (p<0.001). The same pattern for energy intake for Bristol vs.Southampton/GOSH seen on day-6, but not for protein. The effect was not present on day-10.

Conclusion

All centres used similar methods to calculate nutritional requirements with an algorithm to guide nutritional support although variation in practice occurred. Future work should focus on developing evidence-based nutritional pathways considering the acute, stable and rehabilitation phase of critical illness with the aim of improving outcomes for young PICU survivors.

Background

Background:

Glucose-6-phosphate dehydrogenase (G-6PD) deficiency is an X-linked recessive condition with increased risk of severe neonatal jaundice. Prevalence of G6PD deficiency in Singapore is 2.5%. Currently G-6PD deficient babies are monitored inpatient for 7days in our unit. Recent national neonatal jaundice guidelines were revised with a higher threshold criterion for phototherapy.

Objectives

Objectives:

Evaluate outcomes of G6PD deficiency among neonates (> 35wks) and assess safety of an early discharge criteria based on the new guidelines.

Methods

Methods:

Retrospective study over 6 years from Sep 2012 to Sep 2018. All babies >35wks with G6PD deficiency born at Singapore General Hospital were included. Relevant data was extracted from the electronic medical database and analyzed using SPSS.

Results

Results:

Demographics are tabulated below.

Phototherapy was never required in 27.6% babies. Remaining 72.4% had neonatal jaundice requiring phototherapy with 93.5% needing it before 96hrs (Day 4) of life. Only 7.1% (n=9) babies needed phototherapy for rebound jaundice.

Presence of maternal haemolytic antibodies had a significantly higher requirement for phototherapy (p=0.021). More than 50% babies needing phototherapy will not require phototherapy as per new guidelines (p<0.001).

Conclusion

Conclusion:

One-quarter of G6PD deficient babies >35wks in our cohort never required phototherapy. Most babies with significant neonatal jaundice were identified before D4 of life. It is therefore safe to discharge well G6PD deficient babies not needing phototherapy on day 4 of life. This will decrease the length of hospital stay and promote mother infant bonding and successful breastfeeding.

Background

Iron deficiency anemia is the commonest cause of anemia in children in developing countries. According to WHO,it affects 1.62 billion people globally, with the highest prevalence among infants and preschool age children.Recently, Micro-dispersed iron or lactoferrin are used in treatment

Objectives

The aim of work is to compare efficacy and compliance to two iron formulations: Micro-dispersed iron and lactoferrin in the treatment of iron deficiency anemia in children aged 2-6 years.

Methods

The study was a randomized clinical trial including 100 children with iron deficiency anemia attended Alexandria University Children’s Hospital; where 50 children were given a combination of micro-dispersed iron containing 6 mg elemental iron with micro-dispersed Zinc 2.5 mg, vitamin B complex vitamin C and vitamin E 7.5 cm in the form of liquid chocolate twice daily for six weeks (MDI group), and the other 50 children were given Lactoferrin 100mg twice daily for six weeks (lactoferrin group). Hemoglobin (Hb), serum iron, serum ferritin were assessed before and after six weeks of treatment. A questionaire is done for assessing tolerability and compliance

Results

There was a statistically significant difference concerning the rise in Hb, serum iron and serum ferritin between micro-dispersed iron group and lactoferrin group where the rise in there levels was more in the first group, with less side effects

Conclusion

Iron deficiency anemia in children needs effective treatment modalities to be adopted. Compliance plays an important role in this easily treatable problem. Micro-dispersed iron is superior over lactoferrin in treatment of iron deficiency anemia where rise in hemoglobin was considered.

Background

Asparagine synthetase(ASNS) deficiency is a neurometabolic disorder first described in 2013. There are 21 cases known until now. Here we present an ASNS deficiency case who presented with microcephaly and apneic seizure and whose cranial screening was normal at admission. However, massive ventriculomegaly and brain atropy developed in just one month.

Objectives

A microcephalic 40 days old female born to consanguinous parents presented with apnea and seizure. She was intubated and admitted to our PICU. On examination, her anterior fontanel was closed, deep tendon reflexes were brisk and she had clonus. Hyperexplexia was also detected and there was no spinal defect. CBC and biochemical markers were within normal range. Cranial CT showed neither structural anomaly nor hemorrhage (fig1). CSF examination was not compatible with infection. Toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus serologies were negative. Metabolic screening was negative. The patient had a prominent clonus, and did not have any active seizure. Due to inability to extubate cranial screening was repeated. Here was a major cerebral and cerebellar atrophy and massive ventriculomegaly. Pons was atrophic as well. (fig2). A homozygous c.1394G>A p. (Arg 465G1n) mutation was detected on ASNS gene, as a result of whole exon analysis.

Methods

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Results

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Conclusion

ASNS exists in many cells', tissues' and organs' structure however, it shows as neurological impairment when it malfunctions. It is characterised by congenital microcephaly, progressive brain atrophy,severe neurodevelopmental delay,persistent seizures. Other features include axial hypotonia, appendicular hypertonia, hyperreflexia. Cranial MRI findings include thin cerebral cortex, cerebral volume loss, flattening of the gyri, volume loss in the pons.