Publications by authors named "Veena Raghunathan"

15 Publications

  • Page 1 of 1

Miller Fisher Syndrome Associated With COVID-19 Infection.

Pediatr Neurol 2021 10 23;123:40. Epub 2021 Jul 23.

Chairman, Division of Pediatrics, Medanta, the Medicity, Gurugram, Haryana, India.

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http://dx.doi.org/10.1016/j.pediatrneurol.2021.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299212PMC
October 2021

Wilms tumor with Mulibrey Nanism: A case report and review of literature.

Cancer Rep (Hoboken) 2021 Jul 26:e1512. Epub 2021 Jul 26.

Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Cancer Institute, Medanta The Medicity Hospital, Gurgaon, Haryana, India.

Background: Mulibrey-Nanism (Muscle-liver-brain-eye Nanism = dwarfism; MUL) is a rare genetic syndrome. The underlying TRIM37 mutation predisposes these children to develop tumors frequently. In the largest published series of MUL, 8% patients were reported to develop Wilms tumor (WT). The published literature lacks data regarding the best treatment protocol and outcome of this cohort of children with WT and MUL. We report here a 2-year-old boy with WT and MUL and present a review of literature on WT in MUL.

Case: Our patient had associated cardiac problems of atrial septal defect, atrial flutter and an episode of sudden cardiac arrest. We managed him successfully with chemotherapy, surgery and multi-speciality care. He is alive and in remission at follow-up of 6 months.

Conclusion: A total of 14 cases (including present case) of WT have been reported in MUL and treatment details were available for six cases. They were managed primarily with surgery, chemotherapy with/without radiotherapy, and all achieved remission. The outcome data is available only for two cases, one has been followed up till 15 years post treatment for WT and other is our patient.
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http://dx.doi.org/10.1002/cnr2.1512DOI Listing
July 2021

Pediatric ABO-incompatible Living Related Donor Liver Transplantation: Experience from Indian Subcontinent.

Indian Pediatr 2021 03;58(3):281-282

Department of Surgery, Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Haryana, India.

We present our experience with pediatric ABO-incompatible liver transplantation in India. Data of patients <18 years of age undergoing ABO-incompatible liver transplantation our hospital between January, 2011 and November, 2018 were analyzed. Plasmapheresis was done pre-transplant till antibody titer was <16 units. Rituximab/Intravenous immunoglobulin was used for immunosuppression, in addition to standard drugs (mycophenolate mofetil, steroids, and tacrolimus). Out of 203 patients that underwent liver transplant during this period, 8 underwent ABO-incompatible liver transplantation; 4 (3 boys) had blood group O+ve. Median (range) age was 28 (7-91) mo, PELD score was 24.5 (14-42), and pre-transplant antibody titer range was 1:32-1024. Number of plasmapheresis sessions required ranged from 1-6. Post-operatively two patients had rise in antibody titer >64 requiring plasmapheresis. All 8 patients survived without rejection/biliary issues. Mean (range) of post-transplant hospital stay was 19.1 (13-22) d and follow-up period was 38.1 (7.1-84.4) mo. Pediatric ABO-incompatible liver transplantation can be successfully performed using plasmapheresis with optimal immune-suppression and vigilant post-op monitoring.
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March 2021

Successful use of blind bronchial aspiration and hyperinflation to treat postoperative right lung atelectasis in infants.

Pediatr Pulmonol 2021 06 1;56(6):1800-1802. Epub 2021 Mar 1.

Department of Pediatric Critical Care, Medanta, The Medicity, Gurgaon, India.

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http://dx.doi.org/10.1002/ppul.25326DOI Listing
June 2021

Pediatric liver transplantation in severe hepatopulmonary syndrome and use of inhaled nitric oxide for post-transplant hypoxemia-a single center experience.

Pediatr Transplant 2020 11 3;24(7):e13792. Epub 2020 Sep 3.

Institute of Liver Transplant & Regenerative Medicine, Medanta The Medicity, Gurgaon, India.

Data on pediatric patients with HPS undergoing LT are limited. Our aim was to study the spectrum and outcomes of pediatric patients with HPS undergoing LDLT. The role ofiNO for post-LDLT refractory hypoxemia was also assessed. Patients (aged < 18 years) undergoing LT were retrospectively studied. HPS was diagnosed based on European Respiratory Society Taskforce 2004 criteria. HPS was graded based on oxygenation criteria and contrast-enhanced echocardiogram. Post-operative course was studied. Refractory post-operative hypoxemia was treated with iNO by institutionally developed protocol. 23/150 pediatric patients undergoing LDLT had HPS. BA was the most common underlying cause (52.2%). By oxygenation criteria, 6 (26.1%) had VS-HPS. VS-HPS was associated with longer LOS (p = .031) and prolonged oxygen requirement (p = .001) compared with other HPS patients. 4/6 patients with VS-HPS had pO2 < 45 mm Hg. Among these, 2 developed ICH post-operatively and 1 died. 3 developed refractory post-operative hypoxemia, successfully treated with iNO. Mean duration of iNO was 26.3 days. In the group of patients with HPS, the incidence of HAT and portal vein thrombosis was 17.3% and 4.3%, respectively. One year post-LDLT survival of patients with HPS was similar to non-HPS patients (86.9% vs 94.4%; p = .88). We concluded that, pediatric patients with VS-HPS, especially those with pre-operative pO2 < 45 mm Hg, have long and difficult post-LT course. Refractory postoperative hypoxemia can be successfully overcome with strategic use of iNO. Vigilant monitoring and good intensive care support are essential.
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http://dx.doi.org/10.1111/petr.13792DOI Listing
November 2020

Intestinal mucormycosis complicated by iliac artery aneurysm and ureteric rupture in a child with new-onset type 1 diabetes mellitus.

J Paediatr Child Health 2021 07 20;57(7):1117-1119. Epub 2020 Aug 20.

Division of Endocrinology and Diabetes, Medanta Medicity Hospital, Gurugram, India.

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http://dx.doi.org/10.1111/jpc.15126DOI Listing
July 2021

Fluid Overload and Renal Angina Index at Admission Are Associated With Worse Outcomes in Critically Ill Children.

Front Pediatr 2018 1;6:118. Epub 2018 May 1.

Department of Pediatric Nephrology, Akron Children Hospital, Akron, OH, United States.

We investigated the association of fluid overload and oxygenation in critically sick children, and their correlation with various outcomes (duration of ventilation, ICU stay, and mortality). We also assessed whether renal angina index (RAI) at admission can predict mortality or acute kidney injury (AKI) on day 3 after admission. Prospective study, pediatric intensive care in a tertiary hospital. June 2013-June 2014. Patients were included if they needed invasive mechanical ventilation for >24 h and had an indwelling arterial catheter. Patients with congenital heart disease or those who received renal replacement therapy (RRT) were excluded. Oxygenation index, fluid overload percent (daily, cumulative), RAI at admission and pediatric logistic organ dysfunction (PELOD) score were obtained in all critically ill children. KDIGO classification was used to define AKI, using both creatinine and urine output criteria. Admission data for determination of RAI included the use of vasopressors, invasive mechanical ventilation, percent fluid overload, and change in kidney function (estimated creatinine clearance). Univariable and multivariable approaches were used to assess the relations between fluid overload, oxygenation index and clinical outcomes. An RAI cutoff >8 was used to predict AKI on day 3 of admission and mortality. One hundred and two patients were recruited. Fluid overload predicted oxygenation index in all patients, independent of age, gender and PELOD score ( < 0.05). Fluid overload was associated with longer duration of ventilation ( < 0.05), controlled for age, gender, and PELOD score. Day-3 AKI rates were higher in patients with a RAI of 8 or more, and higher areas under the RAI curve had better prediction rates for Day-3 AKI. An RAI <8 had high negative predictive values (80-95%) for Day-3 AKI. RAI was better than traditional markers of pediatric severity of illness (PELOD) score for prediction of AKI on day 3. This study emphasizes that positive fluid balance adversely affects intensive care in critically ill children. Further, the RAI prediction model may help optimize treatment and improve clinical prediction of AKI.
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http://dx.doi.org/10.3389/fped.2018.00118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938374PMC
May 2018

Heparin free dialysis in critically sick children using sustained low efficiency dialysis (SLEDD-f): A new hybrid therapy for dialysis in developing world.

PLoS One 2018 26;13(4):e0195536. Epub 2018 Apr 26.

Pediatric Nephrology, Akron Children's Hospital, Akron, Ohio, United States of America.

Background: In critically sick adults, sustained low efficiency dialysis [SLED] appears to be better tolerated hemodynamically and outcomes seem to be comparable to CRRT. However, there is paucity of data in critically sick children. In children, two recent studies from Taiwan (n = 11) and India (n = 68) showed benefits of SLED in critically sick children.

Aims And Objectives: The objective of the study was to look at the feasibility and tolerability of sustained low efficiency daily dialysis-filtration [SLEDD-f] in critically sick pediatric patients.

Material And Methods: Design: Retrospective study Inclusion criteria: All pediatric patients who had undergone heparin free SLEDD-f from January 2012 to October 2017. Measurements: Data collected included demographic details, vital signs, PRISM III at admission, ventilator parameters (where applicable), number of inotropes, blood gas and electrolytes before, during, and on conclusion of SLED therapy. Technical information was gathered regarding SLEDD-f prescription and complications.

Results: Between 2012-2017, a total of 242 sessions of SLEDD-f were performed on 70 patients, out of which 40 children survived. The median age of patients in years was 12 (range 0.8-17 years), and the median weight was 39 kg (range 8.5-66 kg). The mean PRISM score at admission was 8.77±7.22. SLEDD-f sessions were well tolerated, with marked improvement in fluid status and acidosis. Premature terminations had to be done in 23 (9.5%) of the sessions. There were 21 sessions (8.6%) terminated due to hypotension and 2 sessions (0.8%) terminated due to circuit clotting. Post- SLEDD-f hypocalcemia occurred in 15 sessions (6.2%), post- SLEDD-f hypophosphatemia occurred in 1 session (0.4%), and post- SLEDD-f hypokalemia occurred in 17 sessions (7.0%).

Conclusions: This study is the largest compiled data on pediatric SLEDD-f use in critically ill patients. Our study confirms the feasibility of heparin free SLEDD-f in a larger pediatric population, and even in children weighing <20 kg on inotropic support.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0195536PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5919674PMC
July 2018

A young child with fever and unexplained acute kidney injury: Answers.

Pediatr Nephrol 2018 10 26;33(10):1691-1693. Epub 2018 Feb 26.

Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, 122001, India.

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http://dx.doi.org/10.1007/s00467-018-3911-9DOI Listing
October 2018

A young child with fever and unexplained acute kidney injury: Questions.

Pediatr Nephrol 2018 10 26;33(10):1689-1690. Epub 2018 Feb 26.

Kidney Institute, Medanta, The Medicity, Gurgaon, Haryana, 122001, India.

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http://dx.doi.org/10.1007/s00467-018-3884-8DOI Listing
October 2018

Pediatric ABO-incompatible kidney transplantation: Evolving with the advancing apheresis technology: A single-center experience.

Pediatr Transplant 2018 05 30;22(3):e13138. Epub 2018 Jan 30.

Kidney and Renal Transplant Institute, Medanta, The Medicity Hospital, Gurgaon, India.

Recent literature has endorsed favorable outcomes following ABOi kidney transplantation in pediatric population. Nevertheless, reluctance to pursue an ABOi still remains pervasive. This could be ascribed to various legitimate reasons, namely less extensive pediatric ABOi data, technical difficulties encountered during PP, cost restraints, and concerns regarding higher rates of antibody-mediated rejection, infectious complications, and post-transplant lymphoproliferative disorder as compared to adults. However, given the similar excellent outcomes of both ABOi and ABOc kidney transplantation, clinicians should consider this option sooner if a compatible donor or swap is not available. Here, we describe the outcomes of three pediatric ABOi performed at our institute in India (from 2014 till now), wherein distinct apheresis modalities had been employed in each desensitization protocol, and our techniques evolved with advancing science in apheresis. This case series includes India's first published pediatric ABO-incompatible transplant (Case 2) and the youngest child to undergo ABO-incompatible renal transplant in SAARC nations (Case 3).
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http://dx.doi.org/10.1111/petr.13138DOI Listing
May 2018

Feasibility of sustained low efficiency dialysis in critically sick pediatric patients: A multicentric retrospective study.

Hemodial Int 2018 04 3;22(2):228-234. Epub 2017 Oct 3.

Pediatric Nephrology, Akron Children's Hospital, Akron, Cleveland, Ohio, USA.

Introduction: Sustained low-efficiency dialysis (SLED) has emerged as a cost effective alternative to Continuous Renal Replacement Therapy in the management of hemodynamically unstable adult patients with acute kidney injury. The objective of the study was to document the SLED practices in these centers, and to look at the feasibility, and tolerability of SLED in critically sick pediatric patients.

Methods: It was a retrospective record review from January 2010 to June 2016 done in four tertiary pediatric nephrology centers in India. All pediatric patients undergoing SLED in the collaborating centers were included in the study. Basic demographic data, prescription parameters and outcomes of patients were recorded.

Findings: During the study period a total of 68 children received 211 sessions of SLED. PRISM score at admission in patients was 13.33 ± 9.15. Fifty-seven patients were ventilated (84%). Most of the patients had one or more organ system involved in addition to renal (n = 64; 94%). Heparin free sessions were achievable in 153 sessions (72%). Out of 211 sessions, 148 sessions were on at least one inotrope (70.1%). Overall premature terminations had to be done in 27 sessions (13% of all sessions), out of which 7 sessions had to be terminated due to circuit clotting (3.3%). Intradialytic hypotension or need for inotrope escalation was seen in 31 (15%) sessions but termination of the session for drop in BP was required in only 20 (9%) sessions.

Conclusion: SLED is a feasible method of providing renal replacement in critically ill pediatric patients.
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http://dx.doi.org/10.1111/hdi.12605DOI Listing
April 2018

Outcome of 200 Pediatric Living Donor Liver Transplantations in India.

Indian Pediatr 2017 Nov 24;54(11):913-918. Epub 2017 Aug 24.

Department of Pediatric Gastroenterology, Hepatology and Liver transplant, *Pediatric Intensive Care Unit, #Institute of Liver Transplant and Regenerative Medicine, and $Department of Radiology; Medanta -The Medicity, Gurgaon, Haryana, India. Correspondence to: Neelam Mohan, Department of Pediatric astroenterology, Hepatology and Liver transplant, Medanta - The Medicity, Gurgaon, Haryana, India.

Objective: To describe our experience of pediatric living donor liver transplantation from India over a period of 12 years.

Materials And Methods: A retrospective analysis of 200 living donor liver transplantation in children (18 years or younger) was done for demographic features, indications, donor and graft profile and outcome.

Results: Between September 2004 and July 2016, 200 liver transplants were performed on 197 children. Fifty transplants were done in initial 6 years and 150 in next 6 years. All donors (51% mothers) were discharged with a mean stay of 7 days. The leading indications of liver transplants were cholestatic liver disease (46%) followed by metabolic liver disease (33%) and acute liver failure/acute on chronic liver failure (28.5%). Biliary leakage (8.5%), biliary stricture (9%), hepatic artery thrombosis (4.5%) and portal vein thrombosis (4%) were the most common surgical complications; all could be managed by surgical or interventional radiological measures, except in one child who died. Sepsis, acute rejection and CMV hepatitis in first 6 months were seen in 14.5%, 25% and 17% cases, respectively. Post-transplant lymphoproliferative disease was seen in only 1.5%. Re-transplant rate was 1.5%. The overall 1 year survival rate was 94% and 5 year actuarial survival was 87% with no statistically significant difference between children weight <10 kg vs. >10 kg. Outcome in acute liver failure did not differ significantly between those with acute on chronic liver failure vs. those with chronic liver disease.

Conclusions: Advances in medical and surgical techniques associated with multidisciplinary teams including skilled pediatric liver transplant surgeons, anesthetists, dedicated pediatric hepatologists, pediatric intensivists, interventional radiologists and pathologists resulted in an excellent outcome of living related liver transplants in children. Low age and weight of the baby does not seem to be a contraindication for liver transplantation as outcome were comparable in our experience.
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http://dx.doi.org/10.1007/s13312-017-1181-4DOI Listing
November 2017

From cerebral salt wasting to diabetes insipidus with adipsia: case report of a child with craniopharyngioma.

J Pediatr Endocrinol Metab 2015 Mar;28(3-4):323-6

Unlabelled: Craniopharyngioma is associated with a wide and interesting variety of sodium states both by itself and following surgical resection. These are often challenging to diagnose, especially given their dynamic nature during the perioperative course. We present the case of a boy with craniopharyngioma who had hyponatremia due to cerebral salt wasting preoperatively, developed diabetes insipidus (DI) intraoperatively and proceeded to develop hypernatremia with adipsic DI.

Conclusion: Cerebral salt wasting is a rare presenting feature of craniopharyngioma. Postoperative DI can be associated with thirst abnormalities including adipsia due to hypothalamic damage; careful monitoring and a high index of suspicion are required for its detection. Adipsic DI is a difficult condition to manage; hence a conservative surgical approach is suggested.
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http://dx.doi.org/10.1515/jpem-2014-0224DOI Listing
March 2015

Diagnosis of bacterial ventilator-associated pneumonia in children: reproducibility of blind bronchial sampling.

Pediatr Crit Care Med 2013 Jan;14(1):e1-7

Department of Pediatrics, Sir Ganga Ram Hospital, New Delhi, Delhi, India.

Objective: To evaluate the reproducibility of blind bronchial sampling in patients with suspected diagnosis of bacterial ventilator-associated pneumonia.

Design: Prospective study.

Setting: Pediatric intensive care unit of a tertiary care, multidisciplinary, teaching hospital in Northern India.

Patients: All consecutive patients on mechanical ventilation for >48 hrs were evaluated clinically for ventilator-associated pneumonia.

Interventions: Children with clinical ventilator-associated pneumonia were subjected to blind bronchial sampling twice.

Measurements And Main Results: Sixty-eight blind bronchial sampling samples from 34 patients were analyzed for polymorphonuclear cells, the presence, type, and number of bacteria. Acinetobacter baumannii was the most common organism grown from distal respiratory secretions. For polymorphonuclear cells, the concordance between two blind bronchial samples was 85.3% and kappa coefficient was 0.65. The concordance for the presence and type of bacteria in Gram staining in two samples was 85.3% and kappa coefficient was 0.68. The intraclass coefficients for bacterial index and predominant species index were 0.82 (95% confidence interval 0.65-0.91) and 0.89 (95% confidence interval 0.78-0.94), respectively. The use of prior antibiotics did not adversely affect the reproducibility of blind bronchial sampling. No major complications were recorded during the procedure.

Conclusions: Blind bronchial sampling of lower respiratory tract secretions in mechanically ventilated patients generates reproducible results of quantitative and qualitative cultures. We suggest that blind bronchial sampling may provide valuable clue to the bacterial etiology in ventilated child with suspected clinical ventilator-associated pneumonia.
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http://dx.doi.org/10.1097/PCC.0b013e318260129dDOI Listing
January 2013
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