Browsing by Author "Paudeal, Subash"
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Publication Implementation of Delayed Cord Clamping in a Tertiary care Hospital: A Quality Improvement Project(Nepal Paediatric Society (JNPS), 2023) Twanabasu, Sajal; Paudeal, Subash; Sharma Chalise, Shiva Prasad; Devkota, Sunita; Pokhrel, Yushu; Sharma, SubashAbstract: Introduction: Delayed cord clamping (DCC) is defined as the delay in the clamping of the umbilical cord for more than 60 seconds or when the umbilical cord pulsations have stopped. It has numerous benefits to the infants like increased circulating volume, increased hemoglobin / haematocrit levels, elevated iron stores, and decreased need for red blood cell transfusions. Despite evidence-based recommendation, delayed cord clamping is not practiced routine in some medical settings. Methods: This quality improvement project (QI Project) was conducted to implement delayed cord clamping in one of the tertiary care hospital through Plan-Do-Study-Act (PDSA) cycles. We wanted to improve practice of delayed cord clamping from baseline to 70% in babies delivered by Cesarean section in a tertiary care hospital at Lalitpur. We included term and preterm vigorous newborns delivered by uncomplicated lower segment cesarean section (LSCS). After orientation to the Department of Paediatrics and Obstetrics, project was carried out between August 2021 to October 2021. Data was compiled every two weeks and obstacles and shortcomings were discussed and multiple interventions were done accordingly. Results: Out of 916 deliveries via LSCS, after exclusion 805 eligible cases were assessed in three months. The percentage of Delayed cord clamping (DCC) among uncomplicated LSCS increased to 70% in the month of October. Conclusions: QI project was helpful in improving the compliance of Delayed cord clamping (DCC) in the clinical practice by addressing the problems encountered among the study population.Publication Postnatal Growth Pattern of VLBW Infants Admitted at Patan Hospital - A Prospective Observational Study(Perinatal Society of Nepal (PESON), 2024) Paudeal, Subash; Ojha, Anil Raj; Chalise, Shiva Prasad Sharma; Twanabasu, Sajal; Sharma, SubasAbstract: Introduction: Very low birth weight (VLBW) infants (birth weight < 1500 g) comprise about one-third of neonatal deaths. Regular growth monitoring of these infants helps in assessing their nutritional status and identifies those with inadequate weight gain. Studies on postnatal growth velocities in VLBW infants have not been published so far in Nepal. Hence, this study aimed to describe postnatal growth pattern of VLBW infants admitted at Patan Hospital. Methods: It is a prospective observational study on VLBW infants admitted at Patan Hospital between March 17, 2021 and March 16, 2022. Weight, length, and head circumference (HC) were recorded and plotted on Fenton growth chart regularly until discharge. Data was entered into Microsoft Excel and analysed with SPSS version 25. Results: Seventy-two VLBW infants were admitted during the study period. Fiftyseven infants survived till they regained their birth weights and were included in final analyses. The mean weight gain velocity calculated from birth until discharge was 10.72 ± 2.98 g / kg / d and that after regaining birth weight was 17.33 ± 4.67 g / kg / d. These infants gained their length and HC on an average of 1.21 cm / week and 0.79 cm / week respectively. The incidence of postnatal growth failure at the time of discharge was 61.40%. Conclusions: The growth velocities in our VLBW infants is comparable to the standard recommended intrauterine rates. A large multi-centre prospective study is recommended to validate findings of this study