Browsing by Author "Pathak, Om Krishna"
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Publication Cranial Ultrasound in Moderate and Late Preterm Neonates: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2021) Pathak, Om Krishna; Singh, Yengkhom Rameshwor; Mugurkar, Rahul; Suryawanshi, PradeepAbstract Introduction: Preterm infants’ brain is vulnerable to ischemic and hemorrhagic injuries due to structural and molecular immaturities as well as associated co-morbidities, which is usually detected by bedside cranial ultrasound. Cranial ultrasound findings are common in preterm infants’ of < 32 weeks, so cranial ultrasound is routinely recommended in them but there is no such recommendation regarding moderate and late preterm infants. The objective of this study is to find the cranial ultrasound abnormalities in moderate and late preterm infants. Methods: This prospective observational study was conducted in a tertiary level neonatal care unit. Hundred moderate and late preterm neonates delivered or admitted within seventh day of life were included in the study. Cranial ultrasound scan was performed between third and seventh day of life and before discharge and ultrasound findings were noted. Data were collected in predesigned case record form and analysed using Fischer Exact test. Results: Out of 100 neonates, 47 (47%) were males and 53 (53%) females. There were 43 (43%) moderately preterm and 57 (57%) late preterm infants. Mean day of life for performing first and second cranial ultrasound was 4.17 (3 - 7) days and 13.24 (3 - 40) days respectively. Cranial abnormalities were noted in 26% neonates. Intra-ventricular haemorrhage grade 1 or 2 was the commonest abnormality noted. Choroid plexus cyst (4%), cerebral edema (3%), periventricular hyperechogenicity (3%) and hydrocephalus (1%) were the other abnormalities noted. Neonates having APGAR < 6 at one minute, mechanically ventilated and having co-morbidities had significantly higher incidence of abnormal findings. Conclusions: It is reasonable to perform screening cranial ultrasound in high risk moderate and late preterm infants having low APGAR score, mechanically ventilated and having co-morbidities.Publication Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal(Nepal Paediatric Society (JNPS), 2021) Basnet, Sangita; Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Bajracharya, Binod Lal; Shrestha, Anil; Shrestha, Sudeep; Rajchal, Pramila; Kafle, Raju; Shrestha, Devendra; Puri, Sangeeta; Bhatta, Anwesh; Pathak, Om Krishna; Shrestha, ShrijanaAbstract: Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.Publication Preterm Neonates Admitted in the Neonatal Intensive Care Unit at a Tertiary Care Centre: A Descriptive Cross-sectional Study(Nepal Medical Association, 2023) Sharma, Yograj; Pathak, Om Krishna; Poudel, Bipin; Sharma, Asmita; Sapkota, Ram Prasad; Devkota, KiranAbstract Introduction: Preterm birth, one of the leading causes of admissions to the Neonatal intensive care unit, is a major contributor to neonatal morbidity and mortality in developing countries. This study aimed to find out the prevalence of premature neonates admitted to the Neonatal Intensive Care Unit of a tertiary care centre. Methods: This descriptive cross-sectional study was conducted from clinical records of preterm neonates (born before 37 completed weeks of gestation) admitted in the Neonatal Intensive Care Unit from 16 July 2020 to 14 July 2021. Following ethical approval from the Institutional Review Committee (Reference number: 077/78-018), the patient’s clinical characteristics and systemic morbidities were recorded. Convenience sampling was done. Point estimate and 95% Confidence Interval were calculated. Results: Among 646 admissions, the prevalence of preterm neonates was found to be 147 (22.75%) (19.52-25.98, 95% Confidence Interval). The male: female ratio was 1.53:1. The median gestational age and birth weight were 33 weeks (Range: 24–36 weeks) and 1680 g respectively. A total of 73 (49.65%) delivery was followed by premature rupture of membrane. The morbidity due to respiratory problems was highest at 127 (86.39%), followed by metabolic at 104 (70.74%) and sepsis at 91 (61.90%). The renal system was the least affected 5 (3.40%). Conclusions: The prevalence of preterm neonates in the neonatal intensive care unit was higher than in other studies done in similar settings.Publication SVT and Gram Negative Sepsis in Neonates(Nepal Paediatric Society (JNPS), 2019) Pathak, Om Krishna; Singh, Yengkhom Rameshwor; Sunil Purswani,; Suryawanshi, PradeepAbstract: Supraventricular tachycardia is the most common tachyarrhythmia seen in fetuses, neonates and infants. Sustained SVT may lead to congestive cardiac failure. Neonatal supraventricular tachycardia is more commonly associated with other cardiorespiratory and congenital problems and is uncommon in an otherwise healthy infant. Supraventricular tachycardia is also caused by neonatal sepsis but has rarely been reported. Here, we report two cases of SVT (Supraventricular tachycardia) induced by neonatal sepsis. Two neonates, one male and another female, both born to Indian mother had tachycardia with heart rate > 220 beats/minute along with poor perfusion, tachypnoea, fever and deranged coagulation profile. Both the babies had culture positive gram negative sepsis with normal echocardiography and supraventricular tachycardia on electrocardiograms which were treated with anti arrhythmic drugs and treatment of sepsis. This case report gives further insight into one more presentation and complication of neonatal sepsis.Publication The Economic burden of Neonatal Intensive Care Unit Admission at a Community Hospital of Central Nepal(Nepal Paediatric Society (JNPS), 2020) Sharma, Samana; Chapagain, Ram Hari; Pathak, Om Krishna; Gupta, Arun; Rai, Kavi Raj; Karn, Shruti; Sah, Sandeep KumarAbstract: Introduction: Neonatal sepsis is the commonest cause of neonatal morbidity and mortality and remains a major public health problem especially in developing countries. It is one of the most common causes for admission to neonatal units. The objective of this study was to evaluate the cost of care of neonates admitted in Neonatal Intensive Care Unit. It also compared the cost of care of neonates with sepsis and those with non-sepsis along with the duration of hospital stay and its correlation. Method: A hospital based prospective cross-sectional observational study was carried out over a period of one year. All the neonates admitted at NICU and fulfilling the inclusion criteria formed the study population. Total cost was calculated as the summation of direct and indirect cost. Normally distributed data was analyzed using the Student’s t-test, non-normally distributed data using Mann-Whitney U test. P-value < 0.05 was taken to be statistically significant. Result: Direct cost comprises more than two third of the cost. The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The cost for the ones with sepsis was USD 226.30 (Range 172.19-291.34) and 174.02 (Range 99.67-221.96) in non-sepsis. The mean duration of stay in NICU of the ones having sepsis was 6.6 days and 4.4 days in non-sepsis. Conclusion: The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The duration of stay and the total cost of treatment with sepsis are higher than those with non-sepsis.