Browsing by Author "Bhatta, Nisha Keshary"
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Publication Assessment of Nutritional Status of Children Attending Paediatrics OPD of a Tertiary Care Hospital in Eastern Nepal(Nepal Paediatric Society (JNPS), 2017) Thakur, Jitendra; Bhatta, Nisha Keshary; Poudel, Prakash; Shah, Gouri Shankar; Singh, Rupa RajbandariAbstract: Introduction: Malnutrition is one of the major health problem worldwide, especially in developing world and so is in Nepal, the causes being numerous. The objectives of this study were to assess the nutritional status of children attending paediatric OPD of BPKIHS and to find relation of the nutritional status with different factors. Material and Methods: This descriptive cross sectional study was done by face to face interviews using semi-structured questionnaire and anthropometric variables were recorded. Data of total 192 children was analysed by descriptive statistics. p-value <0.05 was considered significant. Results: According to IAP classification 50.52% were malnourished [grade I 65.97%, grade II 26.8%, grade III 7.21%]. According to WHO classification 47.39% stuntedmoderate 89%, severe 11% and 9.89% wasted [moderate 94.73%, severe 5.26%]. Female sex, low education level in mother, low economic status, unavailability of exclusive breast feeding, low birth spacing and hospitalization were significantly associated with malnutrition. Conclusion: Malnutrition is common in children visiting paediatric OPD of BPKIHS. Female sex, maternal illiteracy, poverty, early weaning, birth spacing and hospitalization in past were major risk factors for malnutrition.Publication Clinical Study of Cutaneous Manifestations in Neonates in A Tertiary Care Center in Eastern Nepal: A Descriptive Cross-sectional Study(Nepal Medical Association, 2024) Timilsina, Anil; Bhatta, Nisha Keshary; Shah, NidhiAbstract Introduction: In the neonatal period, a variety of cutaneous symptoms are frequent. To minimize unneeded therapy and to reduce parents' stress, it's important to distinguish between transient and pathological newborn dermatoses. The purpose of this study is to describe the clinical pattern of cutaneous lesions in neonates. Methods: In this cross-sectional descriptive study , we enrolled 512 neonates born and admitted in maternal child health care ward and Post Natal ward of a tertiary health care center irrespective of cutaneous manifestations. Convenience sampling technique was used. They were examined till their stay in hospital and followed up weekly via telephone for development of dermatological manifestations. Results: Out of 512 neonates examined, 415 (81.05%) of neonate had at least one cutaneous manifestation, 393 (94.69%) had physiological skin lesions, 22 (5.31%) had pathological skin lesions. The most common physiological skin manifestations were sebaceous gland hyperplasia, mongolian spot, ETN, milia and epstein pearl. The pathological cutaneous manifestations though least common comprised of cradle cap, napkin dermatitis and bacterial infections. Most of the lesions were present within 24 hours of birth and many of them were physiological transient lesion. Conclusions: In conclusion, our study highlights the high prevalence of cutaneous manifestations in neonates, with the majority being physiological in nature. Medical personnel must be well versed in the skin changes of neonates which will further help prevent unnecessary treatment and identify life threatening situations that require additional attention.Publication Clinico-Epidemiological Study of Acute Flaccid Paralysis at a Tertiary Centre(Nepal Paediatric Society (JNPS), 2014) Chaudhary, Shipra; Bhatta, Nisha Keshary; Khanal, Basudha; Bhandari, Rabin; Singh, Rupa RajbhandariAbstract: Objectives: To study the clinico-epidemiological profile of different causes of Acute Flaccid Paralysis (AFP) including Acute Encephalitis Syndrome (AES) and their associated co-morbidities. Methodology: A prospective hospital-based study was carried out including all cases fulfilling AFP case definition. History, clinical examination, necessary investigations were performed and required treatment given. Regular follow-ups were done and final classification made alongwith AFP surveillance team. Results: Out of 43 children included in the study, 18 expired and 25 completed follow-up. Final classification showed 53.5% AES, 9.3% Guillain Barre Syndrome (GBS), 9.3% dyselectrolytemia, 9.3%, peripheral neuritis, 7% Non-Polio Entero Virus (NPEV) and 11.6% others. Fever, altered sensorium and convulsions were present in 79.1%, 65.1% and 58.1% respectively. Eighty-four percent had asymmetrical paralysis with quadriparesis in 72%. Cerebrospinal fluid was abnormal in 34.9%. Japanese encephalitis serology was positive in 4.7%. The mean GCS was 9.53±4.27 with a significant difference between survivors and non-survivors (p=0.02). Almost half (52.2%) required ICU care, of which 14 expired (p=0.005). Seventeen children needed mechanical ventilation, of which 13 died (p<0.001). Requirement of inotropes and complications like respiratory failure and autonomic failure were significantly related to death. Conclusion: AES, being one of the commonest causes of AFP, should be included in AFP surveillance. Poor GCS, requirement of inotropes, complications like respiratory failure and autonomic failure are related with poor prognosis. This study also helped in national surveillance of AFP cases in the eastern region and the target to achieve polio eradication in our country.Publication Congenital Hypothyroidism among Infants Undergoing Thyroid Function Test in a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2022) Mishra, Bijaya; Bhatta, Nisha Keshary; Regmi, Mohan Chandra; Das, Binod Kumar Lal; Khan, Seraj Ahmed; Gelal, Basanta; Niraula, Apeksha; Lamsal, MadhabAbstract Introduction: Congenital hypothyroidism is the most preventable and treatable cause of mental retardation in newborns and infants. Screening for congenital hypothyroidism in newborns and infants is not a routine practice in our part of the world. This study aimed to find out the prevalence of congenital hypothyroidism among infants undergoing thyroid function test in a tertiary care centre. Methods: A descriptive cross-sectional study was done in the Department of Biochemistry, from laboratory records starting 14th April, 2013 to 13th April, 2020 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 1502/019). Data of infants whose thyroid function tests were performed were obtained using convenience sampling. Thyroid-stimulating hormone was categorised per the European Society of Paediatric Endocrinology guidelines. Data were entered and analysed using Microsoft Excel 2011 and the Statistical Package for the Social Sciences version 11.5. Point estimate at a 95% Confidence Interval was calculated along with frequency and percentages for binary data. Results: Among 1243 infants, 56 (4.50%) (3.35-5.65 at 95% Confidence Interval) infants were diagnosed with congenital hypothyroidism. Conclusions: The prevalence of congenital hypothyroidism was higher than other studies done in similar settings. An unexpected finding of treatment-induced hyperthyroidism was observed, indicating a lack of regular and timely follow-up of infants diagnosed with congenital hypothyroidism.Publication Correlation Between Transcutaneous Bilirubin and Total Serum Bilirubin Before Initiation of Phototherapy in Neonates of Tertiary Care Centre of Nepal(Nepal Paediatric Society (JNPS), 2023) Mishra, Deepak; Yadav, Arabindra; Bhatta, Nisha Keshary; Shah, Lokraj; Pradhan, Shikhar; Soni, Prakash KumarAbstract: Introduction: Jaundice is the predominant health issue within the initial week of an infant’s life, impacting 60% of full-term and 80% of preterm newborns. Blood sampling for serum bilirubin measurement not only induces pain but also carries the potential for long-term consequences on neurodevelopment due to pain. Noninvasive transcutaneous bilirubin (TcB) devices, which serve as pointof-care instruments, not only save time but are also more cost-effective. This study’s primary objective is to explore the correlation between Delta MBJ20 transcutaneous bilirubinometer measurements and TSB levels determined through the Diazo method. Methods: This prospective observational research was conducted on newborn infants who received routine TSB tests during their care in the NICU, nursery, and neonatal ward at BPKIHS. TcB measurements were taken on both the sternum and forehead of neonates within a 30-minute window around the time of blood collection for the TSB assay, before phototherapy was initiated. The study involved analyzing a linear regression plot between the mean TcB readings from the forehead and sternum in relation to the mean TSB levels. Results: Ordinary Least Squares (OLS) linear regression analysis for TSB and forehead TcB indicates a significant positive strong linear relationship between the two measurements (r = 0.722, R2 = 0.52, P < 0.001). A similar pattern of linear relationship was observed between the sternum TcB and TSB (r = 0.771, R2 = 0.59, P < 0.001). Conclusion: TcB measurements from the forehead or sternum prove to be valuable non-invasive screening tools for non-severe hyperbilirubinemia in neonates.Publication Intrauterine Meconium Peritonitis: An Unusual Case of Foetal Ascites(Nepal Paediatric Society (JNPS), 2021) Paudel, Rajan; Bhatta, Nisha Keshary; Shah, Rajesh; Shah, Lokraj; Poudel, AnshuAbstract Meconium peritonitis is defined as aseptic chemical inflammation caused by an intrauterine bowel perforation. Its incidence is 1 in 35,000 live births. We present a case of meconium peritonitis presented at second day of postnatal life with isolated gross fetal ascites. Exploratory laprotomy was performed, suggestive of gross ascites with fecal contamination and perforation at terminal ileum for which ileal resection with double barrel ileostomy had been done. Postoperatively patient condition had improved and discharged. We would like to highlight this rare presentation of meconium peritonitis following intrauterine bowel perforation in fetus.Publication Morbidities, Complications and Outcomes at Discharge in Newborns Admitted with Respiratory Distress at a Tertiary Care Hospital ofNepal: A Descriptive Cross-Sectional Study(Nepal APF Hospital, 2026) Shah, Prakash Man; Bhatta, Nisha Keshary; K. C., Subash; Sah, Sukrita; K. C., Sri Ram; Karki, Rajani; Pokharel, SamikshyaAbstract: Introduction: Neonatal respiratory disorders are among the leading causes of admissions to neonatal intensive care units due to respiratory distress in the early neonatal period. However, studies on their spectrum and outcomes among Nepalese neonates are limited. This study aimed to find out the proportion and types of respiratory disorders among admitted newborns, along with associated complications and outcomes. Methods: This descriptive cross-sectional study was conducted in the Neonatology Unit of a tertiary care hospital from July 1, 2023 to June 30, 2024, among all inborn neonates meeting the inclusion criteria. Convenience sampling was applied, and the sample size taken was 150. Ethical approval was obtained from the Institutional Review Committee (Ref no 241/080/081-IRC). Data were entered in Microsoft Excel 2007 and analyzed using Statistical Package for the Social Sciences version 11.5. Results: Among 150 newborns, the most prevalent morbidity was Transient Tachypnoea of Newborn 56 (37.30%), followed by Meconium Aspiration Syndrome 46 (30.70%). Similarly, 27 (18%) had complications, and 123 (82%) had no complications. Likewise, 134 (89.30%) babies recovered and were discharged, and 7 (4.70%) died during the course of treatment. Conclusions: This study concluded that the most common morbidity was Transient Tachypnea of the Newborn, followed by Meconium Aspiration Syndrome. This study emphasizes early identification of different types of respiratory disorders and common complications among neonates with respiratory distress which will help in early recognition and treatment thereby minimizing complications and mortality.Publication Nucleated Red Blood Cell in Cord Blood as a Marker of Perinatal Asphyxia(Nepal Paediatric Society (JNPS), 2015) Kanodia, Piush; Bhatta, Nisha Keshary; Singh, Rupa Rajbhandari; Shah, Gauri Shankar; Yadav, Shankar Prasad; Yadav, Sunil KumarAbstract: Introduction: Perinatal asphyxia is a common problem with the incidence varying from 0.5 –2% of live births. According to World Health Organization, approximately 4 million babies die each year before they reach the age of one month. The number of NRBC/100 WBC is variable but is rarely greater than 10 in normal neonates. This simple test can be helpful in the rapid assessment of perinatal asphyxia. Material and Methods: This prospective case-control study and there were 82 newborns in Case and 82 newborns in Controls comprising of asphyxiated and nonasphyxiated neonates, respectively, over a period of 12 months. Results: Out of the 82 neonates in case group, fifty nine (59) neonates were found to have NRBC level ≥10/100WBC, out of which 58 (70.7%) were cases and 1(1.2%) was a control. NRBCs count of ≥10/100WBC were seen more in the newborn who had low 5 min Apgar score and in the newborn with severe HIE, these association were statistically significant (P value <0.001). The cut-off NRBC value of ≥10/100WBC also found to have a sensitivity of 70.30% with a specificity of 98.78%. NRBC has a positive predictive value of 98.31% with a negative predictive value of 77.14%. Significance and sensitive area for ROC curve was 0.875. The ROC curve was calculated with cut-off NRBC value of ≥10/100WBC. Conclusions: NRBC counts can be very useful to differentiate HIE newborns from non-HIE newborns which will help in appropriate management and better outcome of these newborns.Publication pH Prodigy: Predicting early Neonatal Destiny in Perinatal Asphyxia through cord Blood’s Crystal ball(Nepal Paediatric Society (JNPS), 2024) Mishra, Deepak; Bhatta, Nisha Keshary; Yadav, Arabindra; Shah, Lokraj; Pradhan, Shikhar; Soni, Prakash KumarAbstract: Introduction: Perinatal asphyxia, a condition affecting blood flow or gas exchange during birth, is a major contributor to neonatal morbidity and mortality. It adversely impacts various body systems, including renal, CNS, cardiac, and pulmonary functions. Common assessment methods, like Apgar scores, have limitations in subjectivity and sensitivity. Advanced technologies like aEEG and MRI, while more predictive, may lack universal accessibility. Studies exploring cord blood gas analysis as a link to short-term outcomes show promise in addressing perinatal asphyxia-related morbidity and mortality, particularly in resource-constrained settings such as ours. Methods: This one-year prospective cohort study at B.P. Koirala Institute of Health Sciences, Dharan, Nepal included 150 inborn newborns of 37 weeks or more who exhibited either an Apgar score of less than 7 at 5 minutes of life. They were subjected for estimation of umbilical cord blood pH, APGAR score, and outcome looked were NICU admission, seizure incidence, hypoxic ischemic encephalopathy assessment by Sarnat and Sarnat score, neurological status, duration of hospital stay, and final outcome (Discharge, LAMA, death). Results: Neonates with lower pH values have a higher likelihood of NICU admission, seizures, and hypoxic ischemic encephalopathy, extended hospital stays and increased mortality rates. A strong negative correlation between pH and hypoxic ischemic encephalopathy was observed, with a correlation coefficient of - 0.8112 (p < 0.001). Notably, pH emerged as the most significant independent predictor for hypoxic ischemic encephalopathy and abnormal neurologic examination (hypotonia). Conclusion: Umbilical cord blood pH is valuable predictor of early neonatal outcome in perinatal asphyxia.Publication Prevalence of Tuberculosis in Severe Acute Malnutrition: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2022) Thakur, Jitendra; Thakur, Ranjana; Bhatta, Nisha Keshary; Yadav, Shankar Prasad; Khanal, Basudha; Bhattarai, Narayan RajAbstract: Introduction: Tuberculosis (TB) and malnutrition are important causes of morbidity and mortality in children in the developing world. This study was done to determine the prevalence of tuberculosis in severe acute malnutrition (SAM) cases and to observe different presentations of SAM. Method: This prospective observational study was carried out in the Department of Paediatrics and Adolescent Medicine at a tertiary care center in Nepal for a duration of one year from December 2018 to November 2019. All cases of SAM meeting the inclusion criteria were evaluated with Mantoux test, chest X-ray, gastric aspirate / sputum analysis and gene-Xpert for diagnosis of TB. Other relevant investigations for diagnosis of TB were also sent as per the clinical scenario. Data were entered and analyzed using Microsoft excel. Descriptive statistics was used for analysis of data. Results: Total 107 SAM cases were analyzed. The hospital prevalence of wasting and severe wasting was 11.98% and 0.73% respectively. The prevalence of TB in SAM was 4.67%, commonest being pulmonary TB (60%). Among TB cases, 40% were without any systemic complaints. Only 19.6% cases presented with nutritional complaint. Conclusions: This study found that a significant percentage of cases with SAM had TB and hence adds on the importance of screening for TB (Pulmonary TB) in every case of SAM, irrespective of symptoms.Publication Rickets with Alopecia Signals Vitamin D Dependent Rickets Type II(Nepal Paediatric Society (JNPS), 2015) Yadav, Shankar Prasad; Bhatta, Nisha KesharyAbstract: Vitamin D-dependent rickets type II is a rare autosomal recessive disorder. We report 27 months female child with classical rachitic changes, very high level of 25-hydroxy Vitamin D, 1,25 (OH)2D and markedly elevated serum Alkaline phosphatase. Very high dose of oral calcium and vitamin D3 was prescribed with minor improvement in skeletal features and alopecia. This case report hints the physician to diagnose and manage Vitamin D-dependent rickets type II, when rachitic changes are associated with alopecia.Publication Thoracic Ectopia Cordis(Nepal Paediatric Society (JNPS), 2017) Muktan, Dipak; Singh, Rupa R; Bhatta, Nisha KesharyAbstract: Ectopia Cordis is a rare congenital anomaly characterized by partial or complete displacement of the heart outside the thoracic cavity with an estimated incidence of 5 to 8 per million live births We report a case of a 22-year-old primigravida, unbooked and immunized woman, with no relevant family or personal history, in which the prenatal fetal ultrasound, performed at 34 weeks of gestation, revealed a defect of the anterior chest wall with exteriorization of the heart. Baby was Pre-term 34 week by date but term by modified Ballard scoring, male weighing 2.4 kg delivered by lower segment caesarean section. Baby had complete thoracic ectopia cordis with large defect in anterior wall of chest and sternum was absent.