Clinical profile and outcome of dengue in children admitted in pediatric intensive care unit in a tertiary center in South India

Background: As dengue being a tropical infection presenting with varying degrees of severity of illness in Indian children, present study is aimed at studying the clinical profile, outcome, predictors for mortality of moderate and severe dengue cases admitted to PICU in a tertiary care center in South India. Methods: It is a retrospective observational study. All patients admitted in PICU from April 2016 to March 2017 were included in the study. Patients were classified based on National Vector Borne Disease Control Program (NVBDP). Clinical characteristics, laboratory parameters, complications, outcome and predictors for mortality were studied. Results: All 58 seropositive dengue cases admitted were included. Most common presenting symptoms were fever in 58 (100%), vomiting in 33 (56.8%) and abdomen pain in 19 (32.7%). Among severe dengue, expanded dengue syndrome was present in 10 (30%), expanded dengue syndrome with shock was present in 10 (30%), significant hemorrhage with shock in 2 (6%), hemorrhage without shock in 1(3%) and combination of expanded dengue syndrome with hemorrhage and shock in 10 (30%).Pleural effusion was present in 38 (65.5%) and ascites in 18(31%) children. Among severe dengue,12(36.3%) received invasive mechanical ventilation,8(24%) received inotropes,19(57.5%) received steroids and 7 (21%) had abdomen compartment syndrome requiring drainage of ascites. Conclusion: Significantly more number of children who died received ventilator support and inotropes. Commonest cause of death is catecholamine resistant shock. There is no major adverse effect of steroids when used in severe dengue.