Browsing by Author "Mishra, Deepak"
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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 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 Role of Lumbar Puncture in Late Onset Neonatal Sepsis(Nepal Paediatric Society (JNPS), 2019) Das, Amit Kumar; Mishra, Deepak; Jha, Nitu Kumari; Mishra, Rakesh; Jha, SoniyaAbstract: Introduction: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. It is responsible for about 30-50% of the total neonatal deaths in developing countries. Neonatal sepsis can be divided into two sub-types depending upon whether the onset of symptoms within the first 72 hours of life (Early Onset Neonatal Sepsis) or after 72 hours of life (Late Onset Neonatal Sepsis ). Meningitis is an important complication of late onset neonatal sepsis. Method: This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Neonatal Intermediate Care Unit (NIMCU) and Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital from July 2016 to June 2017. The objective of this study was to evaluate the importance of performing LP in neonates with LONS. Results: 16.8% neonates with late onset neonatal sepsis were found to have meningitis. Among the neonates with meningitis CRP was positive 57.2% and negative in 42.8 %. Among the cases with abnormal CSF findings, blood culture was sterile in 85% cases and organism was isolated 15% cases. In 88.8% cases with positive blood culture, no meningitis was detected. Lumbar puncture was traumatic in 1 neonate (0.8%) in first attempt. Apart from this no other complication of performing lumbar puncture was noted. Conclusion: Lumbar puncture and CSF examination is mandatory in all cases with late-onset sepsis. Author Biographies Amit Kumar Das, Indira Gandhi Memorial Hospital, Male, Maldives Consultant Paediatrician, Department of Paediatrics Deepak Mishra, Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal Department of Paediatrics Nitu Kumari Jha, National Academy of Medical Sciences, Kathmandu, Nepal Department of Obstretics and Gynaecology Rakesh Mishra, NAMS, Kathmandu, Nepal Department of Orthopaedics Soniya Jha, Ramlal Golchha Eye Hospital, Morang, Nepal Medical Officer