Browsing by Author "Rayamajhi, Ajit"
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Publication Clinical Profile, Immediate Outcome and Predictors of Poor Outcome of Children in Pediatric Intensive Care Unit with Sepsis(Institute of Medicine, Tribhuvan University, 2024) Poudel, Bulu Wagley; Shrestha, Pun Narayan; Shrestha, Sanjeet Kumar; Malla, Sadikshya Shah; Rayamajhi, AjitAbstract: Introduction Sepsis remains a major cause of death in children with death rate ranging from 5% in developed countries to 35% in developing countries. However, data on the predictive factors for poor outcome particularly in developing countries, remain limited. So this study aims to evaluate the clinical profile, immediate outcome and factors associated with poor outcome of the children with sepsis. Methods This retrospective study was conducted in the Pediatric Intensive Care Unit (PICU) at Kanti Children Hospital, Kathmandu. Medical records of patients aged 30 days to 14 years, diagnosed with sepsis based on clinical and laboratory parameters and admitted to the PICU between April 2024 to September 2024 were analyzed. The clinical features, outcome in the form of discharge or death during the hospital stay and factors effecting the poor outcome were tabulated and the data analysis was done by SPSS version 21. Results The total number of patient enrolled in the study were 53. The mean age of the patient was (3.49±0.183) yrs. Among them 31/53(58 %) were male and 22/53(42%) were female. Among them 42/53(79.25%) were Hindus 5/53(9.43%) were Muslims 4/53(7.54%) Buddhist and 2/53 (3.77%) Christian. The most common presenting symptom was fever observed in 50/53(94.4%) of cases. The mortality rate for sepsis was (14/53)26.41% which is statistically significant. Predictors of poor outcome included were the need for dialysis (p=0.016), the presence of Central Nervous System disease (p=0.001), the use of mechanical ventilation (p=0.00), the use of ionotropic support (p=0.010) and elevated D-dimer levels (p=0.036). Conclusion Fever was the most common symptom of sepsis with a mortality rate of 26.41%. Key predictors of poor outcome included the need of dialysis, presence of CNS disease, mechanical ventilation, the use of ionotropic support and elevated D-dimer level.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.