Coronavirus disease 2019 associated stroke in a toddler – A case report

Background: Stroke, an infrequent entity in children, usually presents with headache, reduced cognition, and seizures as frequent findings. The association of paediatric stroke with Coronavirus disease 2019 (COVID-19) is unknown with only a hand full of postulated hypotheses till date. Clinical Description: A 2-year-old child with sudden onset focal neurological deficits and high COVID antibody titters has been reported soon after a brief episode of cough and cold. Magnetic resonance imaging brain suggested infarct in posterior cerebral circulation. All other inflammatory markers and prothrombotic work-up were normal pointing toward a territorial affliction. Management: Child responded well to anticoagulants (low molecular weight heparin and aspirin) with complete neurological recovery. Conclusion: Possibility of COVID-19 associated regional endotheliitis is very high in the aforesaid toddler. Our case is the youngest reported case of paediatric stroke with a possible association with COVID-19.

Salmonella typhimurium meningitis in an exclusively breast fed infant: A case report

Salmonella-related meningitis brings greater morbidity and mortality than that caused by other bacteria. We report a case of Salmonella typhimurium meningitis in a male child aged 5½ months who presented with fever, poor feeding, and irritability. Anterior fontanelle was bulged. S. typhimurium was isolated from cerebrospinal fluid. Child was treated with intravenous antibiotics for 4 weeks and he recovered completely.

An observational study of salivary C-reactive protein as a potential novel non-invasive biomarker of neonatal sepsis

Objectives: Serial C-reactive protein (CRP) monitoring helps to rule out and prognosticate sepsis. Small blood volumes in neonates make it difficult for repeated blood draws for serial CRP monitoring. Hence, the need of the hour is a non-invasive method such as CRP estimation in saliva. This study aims to correlate salivary CRP with serum CRP levels and establish the potential clinical utility of salivary CRP in diagnosing neonatal sepsis. Materials and Methods: Twenty-three consecutive neonates diagnosed with clinically suspected sepsis and admitted to the NICU were the study subjects. Demographics such as gestational age and weight at birth, sex and detailed clinical features, and comorbidities were noted. Blood samples for CRP estimation and blood culture were collected as soon as clinical suspicion of sepsis arose. Saliva samples were collected for CRP estimation within 1 h of blood sample collection. The saliva was collected in a 2 mL syringe using low suction. Salivary and serum CRP were estimated by the particle enhanced immunoturbidimetric assay. Results: In our study, the CRP levels in saliva correlated moderately well with CRP levels in serum (Spearman correlation coefficient r = 0.582, P = 0.004). The sensitivity and specificity of salivary CRP to predict a serum level of ≥10 mg/L were observed to be 0.75 and 0.93, respectively. Conclusion: Our study shows the promise of salivary CRP as a potential clinically meaningful biomarker of neonatal sepsis and warrants the need for larger studies to validate the utility of salivary CRP to serially monitor neonatal sepsis.

An unusual deep seated haemangioma successfully treated with propranolol

Infantile hemangiomas (IH) are most common vascular tumors. It usually resolves on its own, treatment becomes necessary if there is disease progression. Oral propranolol is a medical therapeutic option for complicated IH with impressive efficacy and generally good tolerance. We report a case of deep seated IH of the cheek in a 4 month old successfully treated with propranolol.

Systemic toxicity in a child after topical cyclopentolate eye drops application

An 8-year-old girl was seen in our ophthalmology OPD who had come with complaints of mild pain in both eyes for 1 month. Her unaided vision in both eyes was 6/6. Her weight was 20 kg. Cyclopentolate 1% eye drops was administered twice to the child at 5 min interval in both eyes. The child became restless after 30 min of installation of eye drops installation. She started behaving abnormally and was not allowing to do retinoscopic examination. She had altered behavior, visual hallucination, and difficulty in walking. She was disoriented with slurred speech. She had ataxia and frequent tightening of limbs with jerky movements and was plucking her hair. Her pulse rate was 90/min and blood pressure was 120/90 mm of Hg. Her oxygen saturation was 94% in room air. The child was shifted to nearby hospital where a paediatrician and anesthesiologist were available and was kept under observation. Child’s pulse, blood pressure, and oxygen saturation were monitored for the next 5 hours. The child recovered completely over the next 8 hours.

Profile of paediatric sleep patients and polysomnography findings: Experience from an exclusive paediatric sleep clinic in India

Objectives: The objectives of the study were to describe the profile of patients attending an exclusive paediatric sleep clinic in India. Materials and Methods: Children aged 1 month–18 years, attending an exclusive paediatric sleep clinic, were assessed using standardized questionnaires. Children underwent sleep coaching, were treated medically, or underwent polysomnography based on the decision of the paediatric pulmonologist. Level 1 polysomnography was conducted by trained personnel. Results: Of 186 children, 36.5% were for infant sleep issues, 24.7% suspected obstructive sleep apnea (OSA), 18.2% neuromuscular diseases with sleep problems, 15.6% genetic disorders with sleep problems, 4.3% parasomnias, and 0.5% abnormal movements during sleep. Of the 85 paediatric polysomnographies conducted, 9.4% were normal studies, 87% had OSA, 1.1% restless leg syndrome, and 2.3% were inadequate studies. Conclusion: Sleep disorders in children are not uncommon and paediatricians need to be aware and identify them early. More number of exclusive paediatric sleep clinics need to be established in India.