Browsing by Author "Nepal, Deepeshwara"
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Publication A Typical Case of Child Abuse: A Case Report Authors(Nepal Paediatric Society (JNPS), 2010) Nepal, Deepeshwara; Dhakal, Ajaya Kumar; Banstola, Dinesh; Mahaseth, ChandeshwarAbstract: Child abuse is common but still unnoticed, undiagnosed, neglected childhood problem in Nepal. Child abuse has diverse clinical manifestation ranging from minor injury to severe head trauma to simulating severe medical problem. The true incidence of intentional head injury in children remains uncertain in Nepal. We are reporting a case of child abuse with blunt head trauma with intracranial hemorrhage presenting as a loss of consciousness simulating as a diabetic ketoacidosis (DKA)Publication Clinico-Laboratory Profile and Immediate Outcomes of Hyperbilirubinemic Babies Admitted in Kanti Children Hospital(Nepal Paediatric Society (JNPS), 2010) Nepal, Deepeshwara; Banstola, Dinesh; Khakal, Ajaya Kumar; Mishra, Udbhabhat; Maheseth, ChandeshawarAbstract: Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis.Publication Determinant of Early Initiation of Breastfeeding in a Tertiary Neonatal Unit(Nepal Paediatric Society (JNPS), 2009) Nepal, Deepeshwara; Jeeva, Sankar M; Misra, Satish M; Paul, Vinod KAbstract: Introduction: Initiation of breastfeeding within one hour of birth is an important determinant of successful breastfeeding. National Family and Health Survey -3(NFHS-3) reported that only 23.4% of children < 3 years were breastfed within one hour of birth. Objectives: the purpose of this study is to study the determinant of initiation of breastfeeding within one hour of birth. Setting: Tertiary -level neonatal unit. Material and Methods: All mothers admitted in the postnatal ward were eligible for inclusion; mothers of sick and /or preterm infants were excluded. Enrolled mothers were interviewed between 24 and 72 hours after delivery. Results: The proportion of mothers who initiated breast feeding within one hour of delivery was 32%, between 1-6 hrs were 47% and between 6 to 48 hrs were 21%. Maternal age, education, socioeconomic status, occupation and antenatal or labor room counseling did not influence the initiation of breast feeding within one hour of delivery in univariate analysis. On multivariate analysis, admission in the general ward and delivery by caesarean section were found to be significantly associated with not initiating breastfeeding within one hour (adjusted ORs: 8.79, 2.48 to 31.08, p=0.001 and 6.79, 4.07 to 22.02 p=0.001 respectively). Only about 13% of the infants received prelacteal feeds. Conclusion: Mothers delivering by caesarean section or admitted in the general ward were at high risk of not initiating breastfeeding within one hour. Innovative strategies are required to ensure timely ignition of breastfeeding.Publication Morbidity Pattern and Hospital Outcome of Neonates Admitted in Tertiary Care Hospital, Nepal(Nepal Paediatric Society (JNPS), 2020) Nepal, Deepeshwara; Agrawal, Sumit; Shrestha, Sushan; Rayamajhi, AjitAbstract: Introduction: The first 28 days of life, neonatal period is crucial as neonates are susceptible to sepsis, birth asphyxia, hypoxic injuries and its consequences which may lead to lifelong morbidity. Knowing the causes of morbidity and mortality is an essential step to improve neonatal health. The aim of this study is to describe the pattern and causes of neonatal admission, immediate hospital outcome in the form of improved, died or left against medical advice and factors associated with its outcome. Methods: This was a retrospective hospital based study carried out in Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital, Kathmandu, Nepal over a period of six months (February 2019 to July 2019 AD). Neonatal details including age, sex, gestational age, birth weight, and maternal age and parity, mode of delivery, place of delivery, neonatal morbidities and neonatal outcomes were recorded in a predesigned performa. Results were expressed as mean, percentage and p value. P- value was calculated by using chi-square test. Results: A total of 163 neonates were admitted during the study period, among which 106 (65%) were males. The mean birth weight was 2483.96 ± 812.63 gm. Among admitted newborns 130 (79.8%) had good outcome, babies born to young mothers (< 20 years of age) had poor outcome which is statistically significant with p value of 0.002. Neonates whose birth weight were < 1000 gram had significantly poor outcome (0.001). Conclusion: Common causes of NICU admission were neonatal sepsis, neonatal hyperbilirubinemia, prematurity and perinatal asphyxia. Babies born to young primipara mothers, extremely low birth weight, extremely premature babies and babies undergoing mechanical ventilation had poor outcome.Publication Relationship Between Gross Motor Function and Nutritional Status in Children with Cerebral Palsy attending a Tertiary Children’s Hospital of Nepal(Nepal Paediatric Society (JNPS), 2022) Dhaubhadel, Suraj; Prajapati, Bina; Nepal, DeepeshwaraAbstract: Introduction: Malnutrition is a common problem in children with cerebral palsy and their management outcome is not satisfactory unless we address their nutritional aspect. The present study aims to find the relationship between gross motor function and nutritional status in these children by comparing the proportion of stunting, wasting and under-weight between the various levels of gross motor function. Methods: Our study was across- sectional study conducted on 82 cases of cerebral palsy between one to five years of age visiting Kanti Children’s Hospital, Kathmandu, Nepal from May 2017 to September 2018. Their level of gross motor function was ascertained by applying the Gross Motor Function Classification System (GMFCS) and anthropometry was done using standard methods. On the basis of their motor function, the children were divided into two categories: those with poorer motor function who had poor self-mobility even with assistance (GMFCS level 4 and 5) and those with better motor function who had self-mobility with various degrees of assistance (GMFCS level 1, 2 and 3). Wasting, stunting and under-weight were compared between the two categories and odds ratio with 95% confidence interval was estimated for malnutrition. Results: The children belonging to poorer motor function were more likely to be underweight (Odds ratio 3.41; CI 1.36-8.52; p-value 0.008) and stunted (Odds ratio 3.9; CI 1.47-10.53; p-value 0.048) than those with better motor function. Conclusions: Children with poorer motor function are more likely to develop malnutrition (Specially stunting) than those with better motor function indicating that chronic form of malnutrition is more common in these children.