Arun Kumar Baranwal

Postgraduate Institute of Medical Education and Research | PGIMER · High Dependency Facility (HDF) Unit, Advanced Pediatrics Center

Objectives: To analyze the clinical features associated with the need for mechanical ventilation (MV) in children with Guillain-Barré syndrome (GBS). Design: Retrospective cohort study, 2010–2019. Setting: PICU. Patients: All children, 1 month to 12 years old, diagnosed with GBS in our single-center PICU. Intervention: Retrospective c...

Objective: To determine the efficacy and safety of intravenous (IV) labetalol in the management of hypertensive crisis in children. Methods: A retrospective chart review of 56 consecutive children (age > 1 mo to ≤ 12 y) with hypertensive crisis admitted to a pediatric intensive care unit (PICU) from July 2009 to 2019. Results: The proportion o...

Objective Multi‐dose dexamethasone pretreatment reduces risk of post‐extubation airway obstruction (PEAO). However, its optimal dose is not known. We planned to compare 24h pretreatment with low‐dose dexamethasone (LDD) (0.25 mg/kg/dose) versus high‐dose dexamethasone (HDD) (0.5 mg/kg/dose) in reducing risk of PEAO. Design Stratified (for age and...

Background Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. In low middle-income countries, out of pocket expenditure (OOP) constitutes a major portion of the total expenditure. This makes it important to gain insights into the cost of pediatric intensive care. We undertook this study to calculate the health...

Objective To describe the etiology of childhood arterial-ischemic stroke from a developing country and assess short-term neurologic outcome. Methods Prospective observational study. Consecutive children between the age of >28 days to <12 years, admitted with the diagnosis of arterial-ischemic stroke were enrolled during the study period from Janua...

Acute myocarditis in children is associated with high morbidity and mortality, with limited data on intravenous immunoglobulin (IVIG) treatment and outcome. Our goal was to describe clinical, treatment profile, and predictors of outcome in children with acute fulminant myocarditis (AFM) receiving intensive care. Case records of 120 children with cl...

There is lack of data on iron metabolism in critically ill sepsis children from population with high prevalence of iron deficiency (ID). The study was designed to study impact of sepsis on iron parameters in children with ID. Sepsis patients (age 6–59 months) and their apparently healthy sibling/cousin as controls were enrolled in this case–control...

Objective Mitochondrial dysfunction is central to sepsis-induced multi-organ dysfunction. Thiamine deficiency may contribute to mitochondrial dysfunction and thus high mortality. Study was planned to assess thiamine status in children with septic shock in comparison to healthy controls from a developing country and to study the effect of thiamine l...

Aims and objectives: Reporting ventilator-free days (VFDs) with time frame of 28 days is a popular composite outcome measure (COM) in trials. However, early deaths and shorter pediatric intensive care unit (PICU) stay predominate in low- and middle-income countries (LMICs). A shorter time frame may reduce sample size required. We planned to comput...

Objectives: To describe the clinical profile, intensive care needs, outcome, and predictors of mortality in critically ill children with hemophagocytic lymphohistiocytosis. Design: Retrospective case series. Setting: PICU of a tertiary care teaching hospital in North India. Patients: Children 2 months to 12 years old with the diagnosis of hemoph...

Objectives: To describe the clinical profile, intensive care needs, outcome, and predictors of mortality in critically ill children with hemophagocytic lymphohistiocytosis. Design: Retrospective case series. Setting: PICU of a tertiary care teaching hospital in North India. Patients: Children 2 months to 12 years old with the diagnosis of hemoph...

Background: Globally, Pediatric Intensive Care Unit (PICU) admissions are amongst the most expensive. This makes it important to gain insights into the cost of pediatric intensive care units. We undertook this study to calculate the health system cost and out of pocket expenditure incurred per patient during Pediatric Intensive Care Unit (PICU) sta...

Objective Post-extubation airway obstruction (PEAO) is common and difficult to predict in children. We hypothesised that Intracricoid Peritubal Free Space (IPFS) obtained by deducting the outer diameter of the endotracheal tube in situ (ODTT - provided by the manufacturer) from the ultrasonographically measured internal transverse cricoid diameter...

Background Toxic epidermal necrolysis (TEN) is a life‐threatening severe cutaneous adverse reaction. Data on pediatric TEN is limited. Methods Case records of 44 children, 1 month–12 years with a diagnosis of TEN (>30% body surface area [%BSA] detachment) admitted to a tertiary pediatric intensive care unit (PICU) between 2009 and 2018 were analyz...

Spinal muscular atrophy (SMA) encompasses a group of disorders with loss of spinal motor neurons.The report describes the neuropathological findings including brain and spinal cord at autopsy in a five-and-half-month-old boy with suspected type 1 SMA. The anterior motor neurons, Clarke's column at all the levels of spinal cord showed neuronal loss...

The focus of national governments and the medical profession on the pandemic of coronavirus disease 2019 (COVID-19) has resulted in neglect of care for children with new onset illnesses. Type 1 diabetes (T1D), the most common endocrine disorder in children, is prone to rapid deterioration if not diagnosed in time. We recently encountered a child wh...

Purpose: To study the clinical profile and predictors of outcome in children undergoing decompressive craniectomy (DC) for non-traumatic intracranial hypertension (ICH). Materials and methods: Mixed observational study of children, aged 1 month-12 years, who underwent DC for non-traumatic ICH in a tertiary care pediatric intensive care unit from 20...

Background: Sepsis-induced myocardial dysfunction has implications on outcome. For lack of echocardiography in resource-limited settings, myocardial biomarkers may be an alternative monitoring tool. Objective: This study was planned to explore the longitudinal behavior of creatine phosphokinase-MB (CPK-MB) in children with sepsis with and withou...

Objective: Snake envenomation has been poorly studied in developing countries. 'Early morning neuroparalytic syndrome' (EMNS), the classical clinical constellation caused by krait bites, refers to nighttime, indoor bites where nonspecific symptoms progress to neuroparalysis. Literature regarding EMNS in children is scarce. This study was planned t...

Objectives Hydrocarbons are a common cause of accidental poisoning in children, with kerosene being the most implicated agent in rural parts of India. However, lately, liquid mosquito repellent ingestion is emerging as an important cause of hydrocarbon (kerosene) poisoning in urban households. Methods This is a retrospective case series over a 5-y...

Objective: Drowning is a leading cause of unintentional injury-related death in low- and middle-income countries (LMICs). This study was undertaken to know the epidemiology, intensive care needs and predictors of outcome of children with drowning. Methods: Records of children below 12 years admitted with drowning to the emergency room and/or pae...

Purpose: Spontaneous intracranial haemorrhage (SICH) in children, although uncommon, is associated with significant mortality and morbidity. Paediatric data is however limited. Material and methods: Case records of 105 children with SICH, > 1 month to 12 years, admitted to a tertiary level PICU of a teaching and referral hospital between January 2...

Scrub typhus is a mite-borne acute febrile illness caused by Orientia tsutsugamushi. Recently a surge in pediatric cases is noted across the country. This review focuses on the pathogenesis, clinical profile, diagnosis, management and critical care needs in children with scrub typhus.

Intracranial infection due to Salmonella is uncommon in children. Subdural empyema (SDE) is described with Salmonella typhi as a complication of meningitis. We report a 6-month-old infant with SDE secondary to Salmonella paratyphi B who had presented with prolonged fever and enlarging head. A literature review of Salmonella SDE in infants with resp...

Aims & Objectives: Post-extubation airway obstruction (PEAO) is common in children. We hypothesized that Intracricoid Peritubal Free Space (IPFS) between inner circumference of cricoid and outer circumference of tracheal tube (TT) may inversely correlate to cricoid edema, and thus development of PEAO. Methods • Design: Prospective observational st...

Objectives: Hyperferritinemia is being suggested to identify patients with sepsis-induced macrophage activation syndrome for early intervention. However, data among iron-deficient children are scarce. This study was planned to explore the biological behavior of plasma ferritin in children from communities with a high frequency of iron deficiency w...

Objective: To study the clinical profile, intensive care needs and predictors of in hospital mortality in children with Spontaneous Intracranial Hemorrhage (SICH). Material and methods: Retrospective observational study in a tertiary care pediatric intensive care unit (PICU) of a teaching and referral hospital where 105 children aged > 1 month to 1...

Objective: To study the clinical profile, intensive care needs and predictors of mortality in critical pertussis. Material and methods: Case records of 36 children >1 month to 5 years old with probable critical pertussis admitted to a tertiary care PICU of a teaching and referral hospital between January 2016 and May 2018 were analyzed retrospectiv...

Incidence of allergic disorders in children has increased significantly over time due to environmental and life-style changes. These include allergic rhinitis, atopic dermatitis, allergic conjunctivitis, food allergies, bronchial asthma, drug allergies, insect bites and anaphylaxis; most being IgE-mediated type 1 hypersensitivity reactions to commo...

Hospitalized children often experience pain and anxiety, which can dramatically affect their well-being and often delay healing. This can result in long term effects such as post-traumatic stress disorder, often causing decreased intellectual and social capacities and decreased immune function. Health care providers spend a large part of their live...

Management of hepatic encephalopathy in children remains supportive. Use of N acetyle cystine (NAC) is recommended in case of drug induced liver failure and some other conditions. We could not fi nd any study supporting or refuting role of NAC in hepatic encephalopathy due to Wilsons disease.

Objective: To evaluate efficacy of high-dose oral ambroxol in acute respiratory distress syndrome (ARDS) with respect to ventilator-free days (VFD). Design: Prospective, randomized, placebo-controlled, blinded pilot trial. Patients: Sixty-six mechanically ventilated patients (1 month to 12 years) with ARDS who were hand-ventilated for <24 hr before...

Dear Editor,I am grateful to Dr. Grunwell [1] for pointing out typographical and statistical errors in the relative risk calculations in the index study [2]. On reviewing the original master chart and the original draft manuscript, I found that data from all 124 patients (including 66 in the 24hPD group) were included in the per-protocol analysis,...

Context: There is a paucity of data evaluating serum albumin levels and outcome of critically ill-children admitted to intensive care unit (ICU). Aims: The aim was to study frequency of hypoalbuminemia and examine association between hypoalbuminemia and outcome in critically ill-children. Settings and design: Retrospective review of medical re...

Purpose: Multidose steroid pretreatment is effective in preventing postextubation airway obstruction (PEAO) in adults, however controversy continues for children. This study was designed as a randomized, placebo-controlled, double-blind trial to compare the effect of 24-h pretreatment with dexamethasone (24hPD) versus 6-h pretreatment (6hPD) on PE...

The World Health Organization recommends oxygen therapy for children under 5 years of age with pneumonia and lower chest indrawing. In patients with severe pneumonia who are initially normoxaemic, there is little information on the risk of subsequently developing hypoxaemia and the benefit of routine oxygen therapy. To study the incidence of subseq...