International Journal of Contemporary Pediatrics
Permanent URI for this collection
Editor-in-Chief: Dr. Bhaven Kataria
ISSN: 2349-3283 (Print); 2349-3291 (Online)
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://www.ijpediatrics.com/
Browse
Recent Submissions
Item A prospective observational study of neutrophil CD64 as a diagnostic marker in neonatal sepsis(Medip Academy, 2024-11) Karmaker, P; Rahman, KMM; Rasel, M; Nasrin, UT; Afreen, S; Shabuj, MKH; Mannan, MA.Background: Neonatal sepsis is a major cause of mortality in the developing countries. With current investigations like septic screening and blood culture and sensitivity is not capable to early diagnosis of sepsis and have some limitations. Methods: This prospective observational study was conducted in the Department of Neonatology and Department of Microbiology and immunology, BSMMU after approval by Institutional review board over a one-year period from May 2021 to April 2022. During the study period, a total of 590 neonates were admitted in NICU of BSMMU. Among them 157 neonates with suspected neonatal sepsis were admitted. Among these 157 newborns, 64 were excluded. Finally, 93 patients were included and analysed in the study. Results: Total 157 patients with suspected sepsis were admitted during study period. Among them 64 newborns were excluded on basis of different exclusion criteria. Baseline characteristics of enrolled neonates 56(60.2%) were male. Mean gestational age 33.63�463 and mean birth weight 1863.23�3.202. Majority of the baby were inborn 68 (73.1%) and mode of delivery was LUCS. Maternal Risk factor for early onset sepsis like fever, UTI, PROM was not statistically significant. Hb and platelet significantly decreased in proven sepsis group. CRP significantly increased in proven sepsis group than clinical sepsis group. Mean nCD64 (%) was 83.62�.665 and 57�.277 in proven and clinical sepsis group respectively. It was significantly (P less than 0.001) increased in proven sepsis group. In ROC curve cut-off value for nCD64 in proven sepsis group was 71.5%. For sepsis diagnosis nCD64 showed sensitivity and specificity were 80% and 56% respectively. Calculating PPV and NPV were 71% and 74% respectively. nCD64 has an area under the curve (AUC) of 0.718. So, it is a moderately accurate marker for the diagnosis of neonatal sepsis. Conclusions: Flow cytometric assessment of neutrophil CD64 was found more in neonates with culture proven sepsis than clinical sepsis. nCD64 has a good sensitivity 80% and specificity 56% and PPV, NPV 71%,74% respectively in culture proven sepsis with a cut-off value 71.5%.Item What are the realms of pediatric weight reduction surgery and what is its influence on digestive wellbeing?(Medip Academy, 2024-10) Shankar Babu, SH; Atiq, S; Prasad, A; Yankov, I.The escalating prevalence of paediatric obesity poses profound health challenges, prompting a quest to foster effective weight loss strategies. Surgical interventions have emerged as pivotal tools to do so, with the most common of these being laparoscopic gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB), and adjustable gastric banding (AGB). This systematic review meticulously examines these surgical modalities alongside their outcomes in the short and long term and also, touches upon plausible alternatives to surgery in the event that surgery is contraindicated. Electronic search was conducted in PubMed, Science Direct and Cochrane Library and we sought out studies that specifically focused on pediatric patients. This yielded 30 sources, which were further shortlisted to 24 that were able to provide useful information suitable for this systematic review. Our findings suggest that there is ongoing debate on which specific surgical intervention prevails and positive and negative outcomes, alike, are associated with them all. We believe that it is agreeable that inspite of its shortcomings, bariatric surgical methods are able to offer enduring solutions and thus optimises health outcomes of pediatric patients, especially those with severe obesity.Item Acute disseminated encephalomyelitis in a five-year-old girl: a case report(Medip Academy, 2024-10) Ranabijuli, PK; Kamble, KB; Nazparveen, LA; Kumari, S.Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating central nervous system disorder with a predilection to early childhood. ADEM is generally considered a monophasic disease. However, recurrence has been described and defined as multiphasic disseminated encephalomyelitis (MDEM). ADEM often occurs after infection or immunization and is clinically defined as acute polyfocal neurological deficits, including encephalopathy. Many times, ADEM is a diagnosis of exclusion, and early diagnosis and treatment are the keys to favorable outcomes. Magnetic resonance imaging (MRI) typically demonstrates reversible, large, ill-defined white matter lesions of the brain and often also the spinal cord, along with frequent involvement of thalami and basal ganglia. CSF analysis may reveal mild pleocytosis and elevated protein but is generally negative for intrathecal oligoclonal bands. We report a case of five years six-month- old girl who presented with fever, vomiting, headache, and cough for seven days. She had one episode of involuntary passage of urine. The child was lethargic at presentation and was unable to stand or walk. Clinical features and investigations, including MRI brain and spine, were suggestive of ADEM. She was started on Inj. Methylprednisolone followed by oral prednisolone in tapering dose for four weeks. Clinical improvement was seen in the form of improvement in activity and power in limbs. The child improved with normal neurological function on day three of inj methylprednisolone. On follow-up for six months, the child did not have any relapse and had complete neurological and radiological recovery.Item Diagnostic accuracy of sputum gene xpert MTB /RIF and stool gene xpert-ultra in children with pulmonary tuberculosis in a resource constraint country(Medip Academy, 2024-11) Bhadra, S; Rahman, A; Alam, R; Mahbuba, S.Background: Diagnosis of tuberculosis in children remains a challenge especially in resource limited settings. This study aimed to determine the diagnostic accuracy of sputum Gene Xpert MTB/RIF and stool Xpert-Ultra for the diagnosis of PTB. Methods: This retrospective study was conducted in paediatric pulmonology ward of Bangabandhu Sheikh Mujib Medical University from March 2022 to December 2023.Consecuative 85 children aged 0-14 years with presumptive pulmonary tuberculosis (PTB) who provided both sputum and stool sample for GeneXpert and Xpert-Ultra respectively were included in the study. Diagnosis of PTB was confirmed by clinical, radiological, bacteriological or molecular evidence and taken as reference. Result: A total 119 children were enrolled; 85 of whom complete microbiological examination. PTB was diagnosed in 25 children. Of these 18(18/25) children was found positive in stool Xpert -Ultra and 6 children were tested positive by sputum /GA Gene Xpert MTB/RIF. All 6 positive sputum/GA samples were also positive on stool testing. The rate of concordance between stool and sputum was moderate with a kappa value of 0.441 (p<0.001). Overall sputum GeneXpert and stool Gene Xpert-Ultra showed Sensitivity of 24% and 72%, specificity of 100% and 100%, positive predicted value of 100% and 100%, negative predicted value of 75.95% and 89.55% and accuracy of 77.65% and 91.76% respectively. Conclusion: Stool gene xpert-ultra and sputum Gene Xpert both tests are highly specific for diagnosis of PTB. But sensitivity of stool Xpert-Ultra is more than the sputum Gene Xpert.Item Audit of compliance to recommended antibiotics prescription guidelines in the management of community-acquired pneumonia in a children's outpatient clinic, in Portharcourt, Nigeria(Medip Academy, 2024-11) Onubogu, UC; Amaewhule, OU; Amadi, IN; Leechi-Okere, CC.Background: The Paediatric Association of Nigeria produced a guideline for managing and diagnosing community-acquired pneumonia. This study aims to assess compliance with the recommended antibiotics prescriptions. Methods: A prospective review of the folders of children who presented with cough symptoms in the children's general outpatient clinic of Rivers State University Teaching Hospital. Their biodata, clinical examination findings, prior antibiotics exposure, and consult outcome were retrieved and analyzed. Results: A total 253 children with a median age of 3 years were studied from June to September 2022. No pneumonia was seen in 128 (50.6%), while 93 (36.8%) had various severity of Pneumonia. Antibiotics had been taken by 55 (21.7%) of the children before presentation. Antibiotics were prescribed in 210 (83.0%) of all the consultations for symptoms of cough. The antibiotic prescription rate for children with No pneumonia was 108 (84.4%), Pneumonia was 77 (88.5%) and severe pneumonia was 5 (83.3%). Cephalosporins were the most common type of antibiotics prescribed for Pneumonia and severe pneumonia at a rate of 52.6% and 57.1% respectively. The overall compliance rate with the PAN recommendations for antibiotic treatment guidelines was 42.5%. Children with No pneumonia significantly had higher odds of being managed with prescriptions that were not in line with the recommendation (OR;25.4, 95% CI:12.2,52.7, p<0.05). The highest type of Noncompliance was prescribing antibiotics where it was not indicated 109 (85.8%). Conclusions: Compliance with PAN recommendations for antibiotics treatment in community-acquired pneumonia is suboptimal. While the production of guidelines is excellent in standardizing health care, more work is needed to ensure these guidelines are utilized.Item Neuromyelitis optica in a paediatric patient: a case report(Medip Academy, 2024-10) Ranabijuli, PK; Sitaram, AP; Nazparveen, LA; Kumari, S.Neuromyelitis optica is a multifocal demyelinating disease of the central nervous system that predominantly affects the spinal cord and optic nerves, with variable clinical features including motor weakness in limbs, bowel and bladder affection and loss of vision. The disease is characterized by poor or no recovery. Magnetic resonance imaging (MRI) of spine with contrast shows hyperintense lesions involving contiguous segments with a normal MRI brain. CSF studies shows anti aquaporin 4 antibodies. Visual evoked potential of eyes shows marked reduction of optic nerve function. We report a case of eight year old girl who presented with diminished vision in eyes (right >left) and weakness in all four limbs. Clinical features and investigations were suggestive of NMO. She was treated with inj. methylprednisolone for 5 days followed by oral prednisolone in tapering dose for 6 weeks. The child improved of hemiparetic gait and power in the left side. Vision in the left eye did not deteriorate further. Repeat MRI showed the resolution of previous spinal lesions. Follow up of the child over seven years has multiple admissions due to relapses. In the third admission child was given again 5 days of inj. methylprednisolone followed by azathioprine for two months. On the seventh admission due to relapse, inj. rituximab 500 mg and inj. methylprednisolone 500 mg was given and repeated every 6 months. In the last follow up in June 2024, the child is clinically stable with improvement in gait and no further deterioration of vision and no bowel or bladder affection.Item Isolated congenital cleft mitral valve: a rare cause of mitral regurgitation presented as poor weight gain in children(Medip Academy, 2024-10) Singh, VK; Singh, SN; Singh, P.The anterior mitral leaflet cleft is very rare congenital lesion often encountered in association with other congenital heart defects. The isolated anterior leaflet cleft is a rare anomaly and is usually the cause of mitral valve regurgitation which is correctable. Children with poor feeding exhibit weight loss, growth retardation and sometimes heart failure. Clinically echocardiography is the first investigation of choice for evaluation of mitral valve disease providing useful information about valve anatomy and hemodynamic parameters. A case of 6-month-old male child with chief complaint of poor feeding and difficulty in breathing especially in early morning is being presented in this case report. A pan-systolic murmur of grade 4/6 heard on apex and back side of chest wall. Echocardiography revealed an isolated anterior mitral leaflet cleft producing moderate-severe mitral regurgitation. Isolated cleft of mitral valve is a very rare defect that has to be identified and diagnosed. All children presented with poor weight gain or failure to thrive should be screened with TTE to rule out congenital heart diseases.Item Five-year trends in antimicrobial susceptibility of uropathogens isolated from paediatric patients attending a tertiary care teaching hospital(Medip Academy, 2024-08) Surlu, VR; Krishnan, AR; Edavaloth, P; Mankarathodi, AJ; Neliyathodi, F; Jakribettu, RP.Background: Urinary tract infection (UTI) is a common bacterial infection encountered by paediatrician in their routine clinical practice, globally. To avoid complications, accurate diagnosis and initiation of appropriate antimicrobial therapy is very important. To reduce the treatment failure, the change in antimicrobial resistance (AMR) pattern is very essential. Aim was to study the trend of antimicrobial susceptibility of uropathogen in paediatric patients attending the tertiary care hospital. Methods: It was a retrospective study conducted in the department of microbiology, paediatrics and quality control, the records of paediatric patients i.e., between 1-16 years age, diagnosed with UTI between January 2017-December 2021 were collected. The age, gender, uropathogens and their antimicrobial susceptibility were noted. The data was analysed by frequency and percentage. Results: A total of 276 paediatric patients were diagnosed with UTI during the study period. The highest number of patients i.e., 109/276 (39.5%) belonged between 1-5 years of age with female predominance. E. coli (148/ 276, 53.62%) was the most common uropathogen isolated followed by Klebsiella spp. (57/276, 20.7%). Staphylococcus spp. and Enterococcus spp. were the common Gram-positive pathogens. Highest resistance was observed to ampicillin followed by 3rd generation cephalosporin (3GC), folate inhibitors among the E. coli and similarly in Klebsiella isolates. There was increasing rate of resistance seen in ampicillin, 3GC, nitrofurantoin, beta lactum-beta lactamase inhibitor combination. Conclusions: E. coli is the most common cause of UTI with changing resistance pattern over five years. So, the antibiogram needs to be closely monitored and the AMA for empirical therapy needs modified annually.Item Systemic lupus erythematosus presenting as toxic epidermal necrolysis: a case report(Medip Academy, 2024-10) Sandhu, JK; Rai, S; Sandhu, KK.Systemic lupus erythematosus is an autoimmune inflammatory disease with complex etiology. Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) represent a spectrum of skin lesions characterized by rashes, exfoliation, and sloughing usually following drug intake. Occasionally, TEN-like cutaneous manifestations have also been described with systemic lupus erythematosus. Recognition of lupus in a child presenting with TEN-like skin changes is clinically challenging and requires a high degree of suspicion. We present a case of a 9-year-old female with SJS/TEN like lesions following drug intake and on evaluation was found to have systemic lupus erythematosus.Item A case report on primary hyperoxaluria type 1 in an infant(Medip Academy, 2024-10) Bhatt, JV; Shah, KS; Desai, P; Paliya, P.An alanine-glyoxylate aminotransferase (AGT) deficiency causes elevated oxalate levels in primary hyperoxaluria type 1 (PH1), a rare genetic disorder that can cause renal complications. We report the case of a 3-month-old male infant with respiratory distress, decreased urine output, and metabolic acidosis who was born to consanguineous parents. Bilateral nephrocalcinosis and severe metabolic disturbances were found during further examinations. Prompt identification and genetic validation for therapeutic interventions guided by PH1, such as peritoneal dialysis. The severity of PH1 was highlighted by difficulties maintaining renal function even after an initial improvement. To lessen the severe effects of PH1, this case highlights the significance of early diagnosis, genetic evaluation, and multidisciplinary management.Item Fahr抯 syndrome presenting as focal seizures in an adolescent: a case report(Medip Academy, 2024-10) Sandhu, JK; Kaul, V; Sandhu, KK.Fahr抯 syndrome refers to a rare syndrome which is characterized by symmetrical and extensive intra-cranial calcification. It mostly presents in age group 30-40 years or in older adults, although few cases have also been reported in paediatrics. The usual presentation is in the form of movement disorders, cognitive impairment, neuro-psychiatric manifestations etc. Here we report a case of a 14-year-old adolescent male who came to us with complaints of chronic headache and recurrent episodes of focal seizures. His cranial radio-imaging revealed bilateral basal ganglia calcification. On metabolic workup, he was found to have hypocalcemia and secondary hyperparathyroidism, thus confirming the diagnosis of Fahr抯 syndrome.Item A rare case of total hip replacement in an 11-year-old female: rehabilitation goals and challenges - a case report(Medip Academy, 2024-10) Paranjape, SS; Lokwani, MD; Keswani, PP; Mohanty, SS.This case report describes a unique pediatric patient, the first and youngest in India, who underwent total hip replacement (THR) for right ankylosed hip. Patient presented with preoperative musculoskeletal deformities, posing challenges for postoperative rehabilitation. This 11-year-old female presented with non-traumatic insidious right hip pain, limping, right hip flexion and abduction deformity. Patient was diagnosed with idiopathic chondrolysis of the hip through exclusion and clinico-radiological findings. Patient underwent surgery for ceramic-on-ceramic THR. Fusion of triradiate cartilage and epiphysis and Risser抯 skeletal maturity staging were confirmed. Postoperative examination revealed right hip flexion and abduction deformity resulting in pelvic obliquity, which led to limb length discrepancy and functional scoliosis. There was increased anterior pelvic tilt, altering the gait pattern. Adhering to THR restrictions, rehabilitation strategies were tailored to restore normal pelvic orientation and address deformities through manual stretching of right hip abductor, tensor fascia latae, iliopsoas and rectus femoris. A left-sided shoe raise was also given. Lumbar segmental muscle activation, pelvic floor muscle training and gait training were crucial parts of the rehabilitation protocol. At ten-week, prodigious outcomes were achieved in the form of complete pain relief, complete correction of abduction and flexion deformity, normal pelvic alignment in the frontal plane and independent, stable full weight-bearing ambulation after two years of disabling ordeal suffering. However, minimal compensation of the anterior pelvic tilt persisted. Rehabilitation of this challenging patient with multiple deformities achieved excellent outcomes at ten-week post-rehabilitation. Thus, a tailored meticulous rehabilitation program can significantly improve quality of life.Item A unique and rare presentation of Henoch-Schonlein purpura: a case report(Medip Academy, 2024-10) Rahees, VK; Jimo, LN; Golmei, N; Sananganba, RK; Chettri, P.Henoch-Sch鰊lein purpura (HSP), or IgA vasculitis, is a common small vessel vasculitis in children, typically presenting with palpable purpura, abdominal pain, arthritis, and renal involvement. However, atypical presentations can delay diagnosis and management. A 12-year-old girl presented with multiple episodes of loose stools and abdominal pain. The initial diagnosis focused on acute gastroenteritis, and she was treated symptomatically. Subsequently, she developed urticarial rashes with breathing difficulty, complicating the diagnosis. Despite symptomatic treatment, she experienced severe abdominal pain, hematemesis and melena. Further investigations revealed antral gastritis, duodenitis, and cystitis. On the 14th day of admission, the patient developed characteristic palpable purpura on the lower limbs. Skin biopsy confirmed leukocytoclastic vasculitis with IgA deposits, consistent with HSP. The patient recovered with supportive care and remained symptom-free on follow-up. This case underscores the importance of considering HSP in pediatric patients with atypical presentations, such as gastrointestinal symptoms and urticaria without initial purpura. Early recognition and appropriate management are essential to prevent complications and ensure favourable outcomes. The variability in HSP presentations necessitates a high index of suspicion for timely diagnosis and treatment.Item Decoding the ovary-thyroid connection: a case report on intricacies of untreated hypothyroidism(Medip Academy, 2024-10) Jose, M; Madhavan, S; Menon, H.Precocious puberty may be a rare presentation of untreated hypothyroidism, while delayed puberty is its norm. Van Wyk-Grumbach syndrome (VWGS) refers to the development of isosexual precocious pseudo puberty and multicystic enlarged ovaries in the presence of hypothyroidism. Here we report a case of an eight-year-old girl child who required emergency surgical intervention attributable to the aforementioned syndrome.Item An unusual case of Anasarca-Rapunzel syndrome(Medip Academy, 2024-10) Chorya, M; Dave, D; Kacha, A.Rapunzel syndrome is a rare form of gastric trichobezoar extending into the intestine, often associated with malnutrition and protein-losing enteropathy. A 12-year-old female presented with epigastric abdominal pain, facial puffiness, bilateral lower limb swelling, and anorexia. She was a known case of sickle-thalassemia double heterozygous state but had never received a blood transfusion. Family history revealed parental separation and harsh paternal behavior. The patient was undernourished but otherwise developed normally. On examination, she was lethargic, exhibited generalized anasarca, severe anemia, signs of congestive cardiac failure, and patchy hair loss on the scalp. Abdominal examination revealed moderate ascites, hepatosplenomegaly, and a firm, mobile, non-tender epigastric mass (10�cm), suggestive of gastric bezoar. Laboratory findings showed microcytic hypochromic anemia with macro-ovalocytes in the context of sickle-thalassemia heterozygosity. The child required multiple blood and serum albumin transfusions for severe anemia and hypoproteinemia with anasarca. Hepatic and renal causes of anasarca were excluded. Cardiovascular and respiratory systems were normal. Contrast enhanced computed tomography (CECT) abdomen confirmed the gastric bezoar. After stabilization, exploratory laparotomy and trichobezoar evacuation were performed. Psychiatric counseling and diversion therapy were provided. The child was discharged in stable condition, with follow-up showing significant improvement in nutritional status, mood, and general well-being. This case highlights the unusual presentation of Rapunzel syndrome with generalized anasarca in a pediatric patient with underlying sickle-thalassemia, emphasizing the importance of multidisciplinary management and follow-up.Item Antenatal ileal perforation in preterm neonate-a rare presentation of spontaneous intestinal perforation(Medip Academy, 2024-10) Sharma, HV; Mahajan, V; Nazki, S.We report a case of 28 weeks gestational Age preterm neonate born via lower segment cesarian section who presented with gross pneumoperitoneum immediately after birth. Abdominal drain was inserted as a lifesaving procedure followed by laparotomy after stabilizing the child. Intraoperatively there was sealed ileal perforation which was managed surgically. Pneumoperitoneum secondary to antenatal ileal perforation is a rare manifestation of spontaneous intestinal perforation (SIP).Item Qualitative comparison of the different lung ultrasound scores in children with bronchiolitis: a systematic review(Medip Academy, 2024-10) Kogias, C; Prountzos, S; Alexopoulou, E; Douros, K.Description and qualitative comparison of the lung ultrasound (LUS) scores used to assess patients aged 0 to 2 years with bronchiolitis. A systematic literature review was carried out to find out the LUS scores used to assess patients aged 0 to 2 years with bronchiolitis, using Medline, Scopus and ScienceDirect databases from their inception to January 2024. A total of 23 studies matching our eligibility criteria were analysed for the purposes of this review and 1878 patients with bronchiolitis were included. Different LUS scores were described and analysed. This review summarises the different scoring systems used in LUS in literature and the potential effects they may have had in diagnosing or monitoring bronchiolitis.Item Role of bone marrow imprint smear cytology as a bridge between bone marrow aspiration and biopsy in children with pancytopenia(Medip Academy, 2024-08) Spoorthi, MS; Rudramurthy, P; Raghunathan, P; Saif, H; Lokanath, H.Background: Bone marrow aspiration cytology (BMA), bone marrow biopsy (BMB) and bone marrow Touch imprint smear cytology (BMI) are three important modalities helpful in arriving at a diagnosis in pancytopenia cases. BMA gives cytological picture; BMI plays a pivotal role in providing early diagnosis while awaiting BMB. Hence, the present study was undertaken to assess the role of BMI to bridge the gap between BMA and BMB. Methods: 40 children from one to eighteen years with pancytopenia to Indira Gandhi Institute of Child Health, Bengaluru, over a period of one year from September 2022 to August 2023 were enrolled. They were subjected to routine investigations, followed by BMA and BMB. Imprint smears were made from the biopsy core and examined. Results: BMA was useful in arriving at a diagnosis in 83.3% of cases, BMI smear examination and BMB were diagnostic in 91.6% and 95.8% of cases respectively. Most common entity in age group of 1-6 years was hemophagocytic lympho histiocytosis (HLH) followed by aplastic anaemia (AA) and megaloblastic anaemia (MA) in 6-12 years and 12-18 years age group children respectively. Conclusions: This study concludes that better results were yielded when all the three procedures were performed simultaneously. BMI was a useful diagnostic modality while awaiting biopsy. In cases where there was dry tap or hemodilution in BMA, the imprint smear cytology helped in rendering early diagnosis than BMB. Hence, this study emphasizes that BMI cytology should be implemented as a mandatory practice during bone marrow evaluation.Item Comparison of nasal masks or binasal prongs for delivering continuous positive airway pressure in preterm neonates of gestational age less than 32 weeks(Medip Academy, 2024-10) Ul Ayoub, T; Ur Nisa Quraishi, A.Background: Aim was to compare the efficacy and safety of continuous positive airway pressure (CPAP) delivered by nasal masks vs binasal prongs. Methods: This was observational trial where preterm infants less than 32 weeks of gestation with respiratory distress were enrolled after parental consent. Participants: 145 neonates less than 32 weeks gestation requiring nasal CPAP (NCPAP) as a primary mode for respiratory distress, who were treated with either nasal mask (n=45) or nasal prongs (n=99) as interface. Primary outcome: Was the incidence of CPAP failure (need for mechanical ventilation at less than 72 hours). Results: Failure rate in nasal mask group was 13% vs nasal prongs group was 39.4% and the difference was statistically significant. Secondary outcomes were mean FiO2 requirement at 6 hours, duration of CPAP therapy, hospital stay and nasal trauma. There was 3.7�78% reduction in oxygen requirement at 6 hours of CPAP initiation with nasal mask as compared to nasal prongs and the difference was statistically significant (p<0.05). the CPAP duration in nasal mask group was 3.4� 4.04 days vs nasal prongs group was 4.5�52 days and duration of hospital stay in nasal mask group was 15.4�.19 vs in nasal prongs group was 20.2�.86 and the both differences were also statistically significant(p<0.05). Nasal mask had no nasal injury (0%) as compared to infants on nasal prongs (23.2%) and the difference was statistically significant (p<0.05). Conclusions: NCPAP with mask as interface is as effective as prongs but causes less nasal trauma and less CPAP duration and hospital stay.Item Refractory dystonia with intracerebral hematoma after drowning(Medip Academy, 2024-10) Shah, BK; Kumari, N; Singh, AK.Drowning in children can have devastating consequences. The risk factors are inadequate supervision, seizure disorder, neurodevelopmental disorder, and cardiovascular disease. The duration of submersion is critical in determining outcomes. The lack of consensus guidelines on pediatric submersion injuries invites difficulty in managing the same. There is a lack of robust evidence on therapeutic hypothermia and, the use of pulmonary surfactants and barbiturates to improve clinical outcomes in such injuries. We present a case of a drowned child in cardiac arrest revived after resuscitation, developing sepsis, seizures, severe dystonia, and intracranial bleeding with hypoxic brain injury requiring vigorous management.