Browsing by Author "Aryal, Surabhi"
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Publication Acute Poisoning among Children Admitted in a Tertiary Care Hospital: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Aryal, Surabhi; Karki, Susmin; Lamichhane, MachhindraAbstract Introduction: Acute poisoning is one of the critical causes of hospital admission in children worldwide. Understanding the clinico-demographic profile of childhood poisoning will help in developing targeted prevention strategies. This study aimed to find the prevalence of acute poisoning cases among children admitted to a tertiary care hospital. Methods: A descriptive cross-sectional study was done among 4972 children admitted in the pediatric ward, High Dependency Care Unit, and Pediatric Intensive Care Unit of a tertiary care hospital in Nepal. The data were collected from the hospital records from over three years between 1 January 2020 and 31 December 2022 after receiving ethical approval from the Institutional Review Committee. A convenience sampling method was used. Data related to the clinical and demographic data were collected from the patients with acute poisoning and analyzed. Point estimate at 95% Confidence Interval was calculated. Results: Out of 4972 paediatric cases admitted to the hospital, acute poisoning was seen in 57 (1.14%) (0.81-1.39, 95% Confidence Interval) patients. Out of these acute poisoning cases, 31 (54.39%) were accidental. The mean age was 10.10±5.40 years with 35 (61.40%) patients from the adolescent age group. Conclusions: This study conducted in a Nepalese tertiary care hospital identifies acute poisoning as a notable concern among pediatric admissions.Publication Hemangioblastoma: An Uncommon Cause of Polycythemia in a Child(Nepal Health Research Council, 2023) Aryal, Surabhi; Sharma, Arun KumarAbstract Polycythemia is a rare condition in children. Myeloproliferative neoplasms, including polycythemia vera although rare, is an important cause of childhood primary polycythemia. Secondary polycythemia is more common in children due to conditions causing hypoxia or due to pathologic erythropoietin production in malignancies like renal cell carcinoma, Wilms tumor or Hepatocellular carcinoma. Central nervous system hemangioblastoma is one of the rare causes of polycythemia. We report a 13-year-old girl with primarily neurological symptoms identified to be polycythemic during routine evaluation. Clinical examination and neuroimaging subsequently confirmed an intracranial space occupying lesion which was excised. Hemoglobin level normalized after tumor excision. This case report emphasizes the need for thorough systemic evaluation including central nervous system examination in children identified to be polycythemic. Keywords: CNS tumor; hemangioblastoma; polycythemiaPublication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract: Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Outcome of Improvised Bubble Continuous Positive Airway Pressure (bCPAP) in Respiratory Distress Syndrome (RDS) and Factors Associated with its Failure: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2023) Basnet, Srijana; Aryal, Surabhi; Poudel, Daman Raj; Shrestha, LaxmanAbstract: Introduction: Bubble CPAP (bCPAP) is the standard treatment for newborn with RDS but is challenged by availability of proper bCPAP delivery devices. The improvised bCPAP using modified nasal prong with expiratory limb immersed in water is commonly used to deliver pressurized air to the neonate’s lungs. The primary objective of the study was to evaluate effectiveness of improvised bCPAP in treating Respiratory distress syndrome (RDS) and to identify factors that may be associated with its failure. Methods: In this prospective observational study, all consecutively born preterm neonates delivered before 37 weeks of gestation, admitted to the neonatal intensive care unit (NICU) with diagnosis of RDS and needed bCPAP were included in the study. Early rescue surfactant was given according to NICU protocol of the hospital. Those neonates failed to improve despite treatment with Continuous Positive Airway Pressure (CPAP) and needed MV within 96 hours of life are considered as CPAP failure (CPAP-F). Results: 119 preterm newborn with mean gestational age was 31.95 ± 2.05 weeks and birth weight 1614.33 ± 454.32 gm were enrolled. bCPAP was successful in 22 (18.5%) preterm infants. The mean duration of Continuous Positive Airway Pressure (CPAP) was 61.21 ± 41.81 hours and NICU stay was 12.34 ± 8.12 days. Surfactant was given in 51 (42.9%) and mortality rate was 17 (14.29%). Multivariable logistic regression analysis showed gestational age less than 32 weeks 0.534 (95%CI: 0.340-0.839) and pneumothorax 22 (95%CI: 2.122 - 228.070) are independent risk factors associated with CPAP-F. Conclusions: Improvised bCPAP is effective in the management of respiratory distress syndrome (RDS). Pneumothorax and gestational age < 32 weeks are independent risk factor for its failure.