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Causes of readmission after operation for congenital heart disease

Saharan, Sunil; Legg, Arthur T; Armsby, Laurie B; Zubair, M Mujeeb; Reed, Richard D; Langley, Stephen M
BACKGROUND: Readmission after operations for congenital heart conditions has significant implications for patient care. Readmission rates vary between 8.7% and 15%. The aim of this study was to determine the incidence, causes, and risk factors associated with readmission. METHODS: 811 consecutive patients undergoing operations for congenital heart conditions were analyzed. Readmission was defined as admission to any hospital within 30 days of discharge for any cause. Demographic, preoperative, operative, and postoperative variables were evaluated. Univariate comparisons were made between the nonreadmission and readmission groups, and multivariate logistic regression analysis was made to determine independent risk factors for readmission. RESULTS: There were a total of 92 readmissions in 79 patients (9.7%). The reasons included cardiac (36, 39%), pulmonary (20, 22%), gastrointestinal (13, 14%), infectious (20, 22%), and other adverse events (2, 2%). Patients with either single-ventricle palliation or nasogastric feeding accounted for 40 (50%) readmissions. On univariate analysis, there were significant differences between readmitted and nonreadmitted patients in relation to patient age, chromosomal abnormality, mortality risk score, duration of mechanical ventilation, postoperative length of stay, single-ventricle physiology, and nasogastric feeding at discharge (p < 0.05). On multivariate analysis, significant risk factors for readmission were single-ventricle physiology (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.28 to 4.47; p=0.005), preoperative arrhythmia (OR 2.59; 95% CI 1.02 to 6.59; p=0.04), longer postoperative length of stay (OR 2.2; 95% CI 1.22 to 3.99; p=0.008), and nasogastric tube feeding at discharge (OR 2.2; 95% CI 1.15 to 4.19; p=0.01). CONCLUSIONS: The incidence of readmission after operations for congenital cardiac conditions remains high. Efforts focusing on patients with single-ventricle palliation and those with preoperative arrhythmia, prolonged postoperative length of stay and nasogastric tube feeding at discharge may be particularly beneficial.
PMID: 25130076
ISSN: 1552-6259
CID: 1790562

Supportive care of a critically ill child

Saharan, Sunil; Lodha, Rakesh; Kabra, Sushil K
The goal of pediatric intensive care is early identification, severity assessment and resuscitation of critical patients by utilizing standardized protocols. The primary or precipitating disorder should be the focus of attention and specific intervention. But in order to provide holistic care to a patient, due attention should also be rendered to supportive care. Monitoring of sick children in PICU is an essential part of management. Various monitoring technologies add to the clinical monitoring but cannot replace clinical monitoring. The treating team should follow a checklist to ensure all aspects of supportive care are taken care of in every patient. Due attention should be paid to glucose control, skin and eye care, oral hygiene, prevention of stress ulcer, care of various lines and catheters and prevention of nosocomial infections.
PMID: 21193972
ISSN: 0973-7693
CID: 1790572

Management of status asthmaticus in children

Saharan, Sunil; Lodha, Rakesh; Kabra, Sushil K
Asthma is a common chronic inflammatory disorder of the airways characterized by recurrent wheezing, breathlessness, and coughing. Acute exacerbations of asthma can be life-threatening; annual worldwide estimated mortality is 250,000 and most of these deaths are preventable. While most of the acute exacerbations can be managed successfully in the emergency room, few children have severe exacerbations requiring intensive care. Mainstay of treatment for status asthmaticus are inhaled beta2 agonist and anticholinergic agents, oxygen along with corticosteroids. Children who do not respond well to initial treatment require parenteral beta2 agonist and magnesium. Rarely, sick children need parenteral aminophylline infusion and mechanical ventilation. Guidelines for diagnosis, treatment, ventilator management and supportive care for status asthmaticus in children are discussed in the protocol.
PMID: 20824393
ISSN: 0973-7693
CID: 1790582

Management of acute lung injury/ARDS

Saharan, Sunil; Lodha, Rakesh; Kabra, Sushil Kumar
Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are disorders of pulmonary inflammation characterized by hypoxemia and respiratory failure. Children have varying incidence of ALI/ARDS from 2.2 to 16 per 100,000 pediatric population associated with high morbidity, mortality, and financial burden. The diagnostic criteria include: acute onset, severe arterial hypoxemia resistant to oxygen therapy alone (PaO(2)/FIO(2) ratio
PMID: 20820950
ISSN: 0973-7693
CID: 1790592

Langerhans cell histiocytosis presenting as recurrent air leaks in young children [Case Report]

Saharan, S; Jose, B; Seth, R; Iyer, V K; Kabra, S K
PMID: 20064140
ISSN: 1651-2227
CID: 2394432

Association of Mycoplasma pneumoniae and asthma among Indian children

Varshney, Avanish K; Chaudhry, Rama; Saharan, Sunil; Kabra, Sushil Kumar; Dhawan, Benu; Dar, Lalit; Malhotra, Pawan
The role of Mycoplasma pneumoniae infection as a trigger for asthma exacerbations is well supported in previous studies. This study was designed to investigate the role of M. pneumoniae infection in acute exacerbation of asthma in children. A total of 150 patients (110 males, 40 females) were studied and immunoglobulin M (IgM) antibodies to M. pneumoniae were detected by enzyme-linked immunosorbent assay (ELISA), and PCR amplification was performed for the P1 gene to associate M. pneumoniae infection with asthma. As compared with 33 children with asthma, only two of the control subjects had positive IgM titers for M. pneumoniae, which was statistically significant (P=0.002). A total of 15 children with asthma were positive by PCR for the P1 gene while none of the controls had a positive PCR. Of these positive cases, 24 cases were positive only by ELISA, six were positive only by PCR and nine patients were found to be positive by both ELISA and PCR. All the clinical characteristics of the patients at baseline were comparable between the moderate and the severe group of patients statistically, except for the peak expiratory flow rate. Mycoplasma pneumoniae infection was found to have a significant association with acute exacerbation in the moderate group of asthma patients by PCR (P=0.01). These data suggest that M. pneumoniae infection may contribute to asthma exacerbation.
PMID: 19239491
ISSN: 1574-695x
CID: 1790602

Thrombotic microangiopathy associated with Plasmodium vivax malaria [Letter]

Saharan, Sunil; Kohli, Utkarsh; Lodha, Rakesh; Sharma, Alok; Bagga, Arvind
PMID: 18688654
ISSN: 0931-041x
CID: 1790612

Perinatal HIV

Saharan, Sunil; Lodha, Rakesh; Agarwal, Ramesh; Deorari, Ashok K; Paul, Vinod K
HIV pandemic is one of the most serious health crises the world faces today. Approximately 5-10% of all cases of HIV are children. Majority of children acquire infection through mother-to-child transmission either during pregnancy, delivery, or by breast-feeding. MTCT can be reduced to <2% by antiretroviral prophylaxis to women during pregnancy and labour and to the infant in the first weeks of life, obstetrical interventions including elective cesarean delivery and complete avoidance of breastfeeding. Guidelines for postnatal diagnosis of HIV infection, feeding, immunization and administration of cotrimoxazole prophylaxis have been described in the protocol.
PMID: 18536891
ISSN: 0973-7693
CID: 1790622

Persistent thrombocytopenia following dengue shock syndrome [Case Report]

Kohli, Utkarsh; Saharan, Sunil; Lodha, Rakesh; Kabra, S K
Though thrombocytopenia is one of the hallmarks of dengue hemorrhagic fever/ dengue shock syndrome, persistence of the same is rare. We report an 11 year-old child with dengue shock syndrome, who developed persistent thrombocytopenia. The possible mechanisms are discussed.
PMID: 18245943
ISSN: 0973-7693
CID: 1790632