Browsing by Author "Bhatta, Nisha Keshary"
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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 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 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.