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BACKGROUND Hearing loss is a chronic condition, and many cases can be detected in the neonatal period. Recognizing it early is of crucial importance as early auditory rehabilitation would help in child’s comprehensive development. We wanted to assess the prevalence of hearing impairment among high risk newborns admitted to inborn unit of tertiary care centre in Central Kerala and screen for the associated risk factors in these newborns. METHODS Thousand consecutive inborn neonates from Neonatal ICU, Department of Paediatrics, tertiary care centre in Thrissur, Kerala, detected as high risk by Joint Committee on Infant Hearing (JCIH) criteria were enrolled for the study from December 2011 to November 2012 after the approval by Institute’s Ethics Review Board. Risk factor assessment was done before enrolment. A qualified audiologist conducted the test on babies in soundproof chamber. DPOAEs (Distortion Product Otoacoustic Emissions) were used for initial testing after checking ears for debris. Those who failed in the first test were asked to come for a retest after 2 weeks. Those who failed in the retest were asked to report for Brainstem Evoked Response Audiometry (BERA). Those who were diagnosed as having hearing impairment were advised auditory rehabilitation as well as auditory verbal therapy. RESULTS Of the 1000 eligible neonates born in our hospital during the study period (December 2011 to November 2012) 69 were lost to follow up. Among the remaining 931 babies the frequency of hearing impairment was 0.8 %. Among the 931 neonates, 130 had absent response with the first OAE test contributing to 13.9 %. Twenty-one neonates had absent response to second OAE test out of 130 contributing to 16.1 %. The failure rate for second test is 2.2 % of the total population of 931 newborns. Eight of the 21 neonates who were subjected to BERA had severe hearing loss. The prevalence of hearing impairment was 8 per 1000. CONCLUSIONS The prevalence (percentage) of hearing impairment by two staged screening protocol is 0.8 %. Risk factors which were present in these babies were prematurity, low birth weight, low Apgar score, history of exanthematous fever in mother, neonatal jaundice, ototoxic medication history, craniofacial anomalies, and family history of deafness, meningitis and mechanical ventilation. KEYWORDS Otoacoustic Emissions, Brain Stem Evoked Response Audiometry, Risk Factors, Hearing Impairment, Neonates

Dengue fever is a common viral infection in the tropical areas, especially in India. However, dengue infection presenting as hemorrhagic encephalitis is rare. A 10-year-old girl presented with fever, headache, vomiting, and seizures followed by altered sensorium. Her blood serum was positive for antidengue immunoglobulin M enzyme-linked immunosorbent assay (ELISA) and NS1Ag, and cerebrospinal fluid study showed lymphocytic pleocytosis. Magnetic resonance imaging T2-weighted and fluid-attenuated inversion recovery (FLAIR) images showed hyperintensities involving the bilateral thalami, pons, and midbrain with patchy hemorrhage. Despite all supportive measures, she expired 3 days after admission. Our case highlights that dengue encephalitis may present even in the absence of other classical signs.

Background: The effects of obesity on asthma severity, diagnosis and control are increasingly recognized. Primary objective of our study was to find out the relationship between BMI and severity of asthma in children. Secondary objectives were to study associated co-morbid conditions viz., atopic eczema and allergic rhinitis in children with asthma and the relationship between family history of asthma, atopy and allergic rhinitis with severity of asthma.Methods: This cross-sectional study was done in the tertiary care centre in Thrissur, Kerala. Children of age 6 to 14 years diagnosed as asthma according to Global Initiative for Asthma (GINA) guidelines were included. One hundred children qualified for the study during the stipulated time period. Children with symptoms and signs of asthma, were classified to intermittent and persistent based on GINA guidelines. BMI was calculated in all. Preliminary details and details on the risk factors were collected.Results: Mean age of the study population is 8.8 years. The study group had male predominance (57%). 39% had mild intermittent, 33% had mild persistent, 22% had moderate persistent and 6% had severe persistent asthma. Intermittent, mild persistent and moderate persistent were grouped as non-severe. 50% children had normal BMI, 28% were overweight and 22% underweight. Family history of asthma and atopic dermatitis was 47% and 38% respectively. Maximum children belonged to low socioeconomic status.Conclusion: Did not find any statistically significant association between severity and duration of asthma with obesity or overweight in children with asthma (p>0.05).

Background: Neonatal sepsis related mortality is preventable with timely recognition, rational antimicrobial therapy and aggressive supportive care. The objective of this study was to study the maternal and neonatal risk factors in new-borns with early onset sepsis and to ascertain commonest pathogen responsible.Methods: This study was done in the neonatal intensive care unit tertiary care hospital, Thrissur. Data collected after clinical examination and from the records of new-borns diagnosed with early onset sepsis were analyzed. All neonates suspected to have sepsis had a septic screen to corroborate the diagnosis. Blood culture was performed in all cases of suspected sepsis prior to starting antibiotics. The risk factors for sepsis, both maternal and neonatal were analysed. Their clinical features and bacteriological profile were studied. Data analysis was done using their mean±standard deviation (SD), percentage analysis, chi-square test or fischer’s test.Results: Fifty newborns with diagnosed early onset sepsis (EOS) were studied. Results suggest that maternal screening is prudent, interventions like vaginal examination were causative of sepsis than meconium stained liquor or prolonged rupture of membranes. A coincidental finding suggests that sepsis is more common in males and term babies. Blood culture showed predominant pathogen to be Klebsiella.Conclusions: Among the maternal factors, increased frequency of vaginal examination was most prevalent in the study group. Prematurity and asphyxia were not strong pre-runners for sepsis. EOS cases presenting with respiratory distress were 50%. Fever and tachycardia were the next common clinical features. The cases yielded blood culture positive were 20% and Klebsiella pneumonia (40%) was the commonest organism isolated.

Background: Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few hours or a few days and can also affect other organs such as brain, heart and the lungs. Hence early diagnosis and intervention is needed to improve the outcome of the children. In these studies this objective was to determine if cystatin C is an early marker indicative of renal dysfunction in critically ill children and to determine if Cystatin C can detect Acute kidney injury earlier than serum creatinine.Methods: This prospective cohort study was undertaken in PICU at Jubilee Mission Medical College from December 2016- May 2018. Blood samples were collected from 34 critically ill children for serum creatinine estimation at 0,24 and 48 hours of admission and serum and urine were collected for cystatin C estimation at admission. Children were categorized into AKI and NON-AKI based on pRIFLE criteria. Comparison of cystatin C values with serum creatinine was performed and Statistical analysis was done using IBM SPSS version 20.Results: A total of 34 critically ill children were enrolled in this study, out of which 12 children progressed to AKI during the course of illness according to modified Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE) criteria. We found a strong positive correlation between cystatin C at 0 hours and serum creatinine at 48 hours among AKI groups.Conclusions: Serum and Urine cystatin C are early markers to diagnose AKI in critically ill children. Serum cystatin C is more sensitive than urine cystatin C for the diagnosis of AKI.

We present a report of three cases with vesicles containing opalescent fluid grouped over the face and scattered on the trunk and limbs. Culture of the fluid aspirated from the vesicles grew Staphylococcus aureus in two of the three cases. The observation of vesicles grouped on the face in a sick febrile child should prompt the diagnosis of a severe staphylococcal septicemia.

familial chylomicronemia syndrome is a very rare condition with an incidence of one in one million. we report such a condition detected incidentally in a cleft child.