IX NATIONAL CONFERENCE OF PEDIATRIC INFECTIOUS DISEASES, CHENNAI, OCT 2006

Dr. Sripradha, Dr. Janani Sankar, Mrs. Sowmya Krishnakumar
Department of Pediatrics and Hematology, Kanchi Kamakoti Childs Trust Hospital

The response of hematological system to various stressful events is a well known entity. Transient stress leucocytosis also known as TSL which occurs following a stressful event like acute hypoxia, seizures, etc is characterized by increase in Absolute Neutrophil Count (ANC) and Platelet count with no difference in hemoglobin levels. The return of these parameters to normal 24-48 hours after the stressful event has also been documented in the literature. There is also a documented increase in the absolute numbers of T (CD4, CD8, CD56) B (CD20) and Natural killer cells.

Aims and objectives: To study the effect of stress on CBC & ANC before and after stressful events in children like acute hypoxia or seizures.

Nature and period of study: Prospective study 2 years (March 2004 - March 2006).

Place and duration of study: Department of Pediatrics & Hematology - Kanchi Kamakoti Childs Trust Hospital.

Inclusion criteria: All children who were previously well and who get admitted with an acute stressful even - vomiting, respiratory distress, seizures, trauma, etc.

• Children on longterm medications (antibiotics, anticonvulsants, chemotherapeutic drugs, anti failure drugs, steroids and anti psychotic drugs).
  
• Children who have already received antibiotic for the present illness.
  
• Children who require immediate commencement of antibiotics and or steroids for the present illness.
  

Detailed history leading to the stressful event including past illness, drug intake etc is recorded and blood samples are collected on admission and 24 hours after admission for total count, Absolute Neutrophil count and examination of the peripheral smear to look for band forms.

A total of 856 children were admitted with stressful events in the last 2 years. However only 276 children satisfied our inclusion criteria and hence they were alone included. Vomiting was the stressful event in 143 children, seizures in 72, hypoxia secondary to acute wheeze or bronchiolitis in 30 and trauma following a road traffic accident or fall from a height in 31. Mean total count at admission was 23,500 and mean ANC was 8256. Mean total count after 24 hours was 9650 with the mean ANC being 1560. Peripheral smear study showed an increase in band forms following the stressful event and a decrease or absent band forms after 24 hours. There was no other clinical or laboratory evidence of bacterial infection warranting antibiotic therapy in any of these children.

The purpose of this study is to demonstrate the effect of stress on the rise and fall of blood counts which will indirectly limit the initiation of antibiotic therapy. This will eventually reduce the duration of hospital stay and hence would be cost effective for the patient. It will also eliminate the spread of resistance of organisms to antibiotics especially with the surge of ESBL organisms.

NCPID 2006 - Conference Abstracts. Pediatric Oncall [serial online] 2007 [cited 15 April 2007(Supplement 4)];4. Available from:
http://www.pediatriconcall.com/fordoctor/Conference_abstracts/
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