Browsing by Author "Shrestha, Laxman"
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Publication Clinical Profile and Outcome of Mechanically Ventilated Neonates in a Tertiary Level Hospital Authors(Nepal Paediatric Society (JNPS), 2015) Shrestha, Prabina; Basnet, Srijana; Shrestha, LaxmanAbstract: Introduction: Many sick neonates admitted to neonatal intensive care unit (NICU) require mechanical ventilation but it is associated with various complications and the outcome of neonates is unpredictable. This study aims to identify the indications for mechanical ventilation, complications, co-morbid conditions and outcome of those neonates in terms of survival. Materials and Methods: Retrospective observational study of all neonates who underwent mechanical ventilation from 1 January 2014 to 31 December 2014 in NICU, Tribhuvan University Teaching Hospital. Medical records of the patients were retrieved from hospital record section to collect the relevant data. Results: One-third of admitted neonates in NICU required mechanical ventilation (MV). Commonest indication was severe respiratory distress (70%) followed by perinatal asphyxia (12%) and recurrent apnea (8%). Disease pattern were sepsis (37.2%), RDS of prematurity (17.6%), perinatal asphyxia (11.7%), meconium aspiration syndrome (9.8%), apnea of prematurity (7.8%) and congenital pneumonia (4%). Hospital acquired sepsis was a major complication occurring in 47% patients on mechanical ventilation. Survival rate among neonates on MV was 33%. Survival was better with increasing birth weight and gestational age. Survival was 100% in congenital pneumonia, 50% in perinatal asphyxia, 50% in recurrent apnea, 26% in sepsis, 20% in MAS and 0% in RDS of prematurity. Conclusion: Survival rate of neonates on mechanical ventilation in NICU was 33%. Sepsis was a major problem in NICU, which must be addressed to improve outcome.Publication Clinico-epidemiological Profile of Children with Diphtheria in Tertiary Care Hospital of Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Shrestha, Laxman; Bajracharya, LunaAbstract: Introduction: This study was conducted with the aim to describe the clinical presentation of diphtheria in children, relationship between clinical disease and immunization status, complications of the disease and adverse events due to anti diphtheria serum (ADS). Methods: All patients admitted at Tribhuvan University Teaching Hospital, Kathmandu from July 2016 to November 2018 with clinical diagnosis of diphtheria were included in this study. Results: There were total 12 children and age ranged from five to 15 years, out of which seven (58%) were males and five (42%) were females. All of them were immunized except one whose immunization status was unknown. All of them had tonsillopharyngeal diphtheria. Four patients (33%) also had nasal and five (42%) patients had additional laryngotracheal diphtheria. Seven patients had bull neck on presentation. Four patients had airway obstruction due to laryngotracheal diphtheria requiring tracheostomy. Throat swab for Corynebacterium Diphtheria by Albert stain and Gram stain were positive in 10 patients, and in nine, diagnosis was confirmed by culture. Six patients (50%) were given anti diphtheria serum (ADS) out of which four patients (66.66%) developed anaphylaxis. Myocarditis was the commonest complication seen in four patients (25%). All children with myocarditis developed complete heart block (CHB) and none of them survived. Conclusions: Tonsillopharyngeal diphtheria was the most common clinical presentation and myocarditis was highly fatal complication. This study emphasizes on the need for careful surveillance, early laboratory confirmation and careful administration of ADS in patients with clinical diagnosis of diphtheria.Publication Eosinophilic Meningitis and Intracranial Haemorrhage: Can it be Neuro-Gnathostomiasis?(Nepal Paediatric Society (JNPS), 2018) Basnet, Srijana; Shrestha, Laxman; Poudel, Daman RajAbstract: Peripheral eosinophilia is commonly encountered in our clinical practice. In this case report, we present a child who presented with hemorrhagic stroke and was finally diagnosed of eosinophilic meningitis. In this case report, we also propose probable etiologic agent.Publication Foetal and Neonatal Outcome in Pregnant Women with COVID-19(Nepal Paediatric Society (JNPS), 2020) Shrestha, Rupesh; Basnet, Srijana; Shrestha, LaxmanAbstract: Introduction: The pandemic caused by coronavirus disease 2019 has adversely affected the health of all individuals including pregnant women. The susceptibility of pregnant women and their foetuses to severe acute respiratory syndrome coronavirus 2 infection is not clearly known. The objective of this review is to summarise the available evidence on foetal and neonatal outcomes of pregnant women with confirmed coronavirus disease 2019. Methods: The review was conduced by searching the PubMed and MedRxiv databases for studies reporting outcome of pregnancy with confirmed coronavirus disease from December 2019 to April 2020 using combination of terms "pregnancy", "coronavirus disease 2019", "foetal outcome" and "neonatal outcome". Only peer reviewed articles reporting outcome of pregnancy with confirmed coronavirus disease 2019 were included in the review irrespective of language. Ongoing pregnancies, induced abortion, and pregnancies without outcome were excluded from analysis. Variables extracted and analysed included gestational age at delivery, mode of delivery, foetal and neonatal outcome. Results: In total, 21 studies consisting 230 pregnant women including three twin pregnancies were enrolled in the study. Fever and cough were the most common symptoms reported in pregnant women. One hundred and sixty-two (70.4%) pregnant women underwent cesarean section and there were 68 (29.6%) preterm deliveries. Eight babies tested positive out of 161 newborns that were tested for coronavirus infection. Among adverse outcomes reported, there were two miscarriages, two still births and only one neonatal death. Conclusions: Outcome of pregnancy with coronavirus disease 2019 in late trimester appears to be favourable. Occurrence of preterm delivery and cesarean section appear higher among infected pregnant women in comparison to general population. There was no conclusive evidence of vertical transmission.Publication Incidence, Outcome and Predictors of Mortality in Respiratory distress syndrome (RDS): A Prospective Cohort Study at Tertiary Care Hospital in Nepal(Nepal Paediatric Society (JNPS), 2022) Basnet, Srijana; Aryal, Surabhi; Shrestha, LaxmanAbstract Introduction: With advances in therapies during antenatal and perinatal period, there has been apparent decrease in incidence and mortality due to respiratory distress syndrome (RDS). However, there is paucity of data on exact incidence and outcome of RDS in resource limited setting. This study was conducted with the primary aim to describe the outcome of RDS and analyze the predictors for mortality. Methods: A prospective observational study was conducted in the Neonatal Intensive Care Unit (NICU) and Neonatal Unit of Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal from October 2019 to April 2021. Results: A total of 94 preterm newborns developed RDS giving prevalence of 20.5 per 1000 live birth cohort at TUTH. Incidence of RDS among preterm babies was 14.6%. The median duration of continuous positive airway pressure (CPAP) was 48 hours (Range 8 - 192 hours). Inhospital mortality rate was 15 (15.96%). Lower gestational age and premature rupture of membrane (PROM) were significantly associated with higher mortality whereas Normal Vaginal delivery (NVD) was associated with lower mortality. Logistic regression analysis for risk of dying for the cohort predicted that lower birth weight (AOR = 0.99; 95% CI = 0.99 - 0.99; P = 0:01), sepsis (AOR = 145.14; 95% CI = 5.04 - 4175.15; P = 0:004) are independently associated with increased risk of dying whereas increase duration of NICU stay decreased the risk (AOR = 0.71; 95% CI = 0.54 - 0.91; P = 0:01). Conclusions: The mortality rate decreases with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortalityPublication Kikuchi Fujimoto as an Initial Presentation of Systemic Lupus Erythromatosis(Nepal Paediatric Society (JNPS), 2021) Basnet, Srijana; Shrestha, Laxman; Shrestha, PrabinaAbstract: Kikuchi-Fujimoto Disease (KFD) is a rare benign, condition of necrotising histiocytic lymphadenitis. In this case report, we discuss a case of 10 year old male patient who presented with a fever, rash and generalised lymphadenopathy that was not attributable to the more common causes. Axillary lymph node biopsy confirmed the diagnosis of KFD. Treatment with prednisolone improved his symptoms but after six months he had recurrence of his symptoms. He was investigated again and finally met diagnostic criteria for SLE. This case report highlights importance of close follow up in a child with KFD.Publication Mortality and Morbidity Pattern of Preterm Babies at a Tertiary Level Hospital in Nepal(Nepal Paediatric Society (JNPS), 2013) Shrestha, Laxman; Shrestha, PrabinaAbstract: Introduction: Preterm birth is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. The objectives of this study were to find the demographic characteristics and clinical course of preterm babies admitted at Neonatal Unit of TU Teaching Hospital. Materials and Methods: A retrospective study was done by collecting data from labour room, NICU and by reviewing medical records of all preterm babies admitted to NICU in 2011. Results: There were total of 266 preterm deliveries in TUTH in the year 2011. About 45% of them required NICU admission. Ninety five babies were included in the study. Most common cause of premature delivery was maternal pregnancy induced hypertension (26%). Other causes were preterm premature rupture of membrane (24%) and in 25% of cases the cause was unknown. There were 10 (10.5%) severe preterm babies with mean weight 1.4 ± 0.3 kg, 27 (28.5 %) moderate preterm babies with mean weight 1.8 ± 0.4 kg and 58 (61%) late preterm babies with mean weight 2.2 ± 0.5 kg. Respiratory distress syndrome (RDS) was seen in 32% babies, hyperbilirubinemia in 40% babies, sepsis occurred in 37% and NEC in 4%. Hypothermia was seen in 10.5% and hypoglycemia in 5% babies. Apnea of prematurity was seen in 7% babies. Mechanical ventilation was required in 7% babies. The overall mortality was 12%. The main causes of death were respiratory distress syndrome and sepsis. The mean duration of stay was 10.2±8.8days. The survival rate of severe preterm babies was 80%, moderate preterm babies was 78% while that of late preterm was 95%. Conclusion: The main causes of morbidities in preterm babies were respiratory distress, hyperbilirubinemia and sepsis. Respiratory distress syndrome and sepsis were the predominant causes of mortality in these babies.Publication Neurodevelopmental Outcome of High Risk Babies at One Year of Age Born in a Tertiary Centre(Nepal Paediatric Society (JNPS), 2017) Shrestha, Merina; Bajracharya, Luna; Shrestha, LaxmanAbstract: Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age. Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study. Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.Publication Outcome of Improvised Bubble Continuous Positive Airway Pressure (bCPAP) in Respiratory Distress Syndrome (RDS) and Factors Associated with its Failure: A Prospective Observational Study(Nepal Paediatric Society (JNPS), 2023) Basnet, Srijana; Aryal, Surabhi; Poudel, Daman Raj; Shrestha, LaxmanAbstract: Introduction: Bubble CPAP (bCPAP) is the standard treatment for newborn with RDS but is challenged by availability of proper bCPAP delivery devices. The improvised bCPAP using modified nasal prong with expiratory limb immersed in water is commonly used to deliver pressurized air to the neonate’s lungs. The primary objective of the study was to evaluate effectiveness of improvised bCPAP in treating Respiratory distress syndrome (RDS) and to identify factors that may be associated with its failure. Methods: In this prospective observational study, all consecutively born preterm neonates delivered before 37 weeks of gestation, admitted to the neonatal intensive care unit (NICU) with diagnosis of RDS and needed bCPAP were included in the study. Early rescue surfactant was given according to NICU protocol of the hospital. Those neonates failed to improve despite treatment with Continuous Positive Airway Pressure (CPAP) and needed MV within 96 hours of life are considered as CPAP failure (CPAP-F). Results: 119 preterm newborn with mean gestational age was 31.95 ± 2.05 weeks and birth weight 1614.33 ± 454.32 gm were enrolled. bCPAP was successful in 22 (18.5%) preterm infants. The mean duration of Continuous Positive Airway Pressure (CPAP) was 61.21 ± 41.81 hours and NICU stay was 12.34 ± 8.12 days. Surfactant was given in 51 (42.9%) and mortality rate was 17 (14.29%). Multivariable logistic regression analysis showed gestational age less than 32 weeks 0.534 (95%CI: 0.340-0.839) and pneumothorax 22 (95%CI: 2.122 - 228.070) are independent risk factors associated with CPAP-F. Conclusions: Improvised bCPAP is effective in the management of respiratory distress syndrome (RDS). Pneumothorax and gestational age < 32 weeks are independent risk factor for its failure.Publication Prevalence of Bilateral Vocal Fold Palsy in Cases with Perinatal Hypoxia(Institute of Medicine, 2025) Gyawali, Bigyan Raj; Dutta, Heempali; Neupane, Yogesh; Pokhrel, Sishir; Guragain, Rajendra; Shrestha, Laxman; Basnet, Srijana; Balakrishnan, Karthik; Sidel, DouglasABSTRACT Introduction: There is a notable gap concerning the potential impact of perinatal hypoxia on laryngeal innervation and its role as a causative factor for bilateral vocal fold palsy (BVFP) in children. This study aims to assess the prevalence of BVFP in cases with perinatal hypoxia. Methods: This cross-sectional study took place at the Department of Ear, Nose, and Throat (ENT) and the Department of Pediatrics of Institute of Medicine, Kathmandu, Nepal. Institutional Review Board approval was obtained. From November 2019 to March 2023, all children under 2 years of age with documented perinatal hypoxia were included. Exclusion criteria comprised cases without parental consent, identification of another identifiable cause of BVFP, or the child being on oxygen support during examination, preventing laryngoscopy. Additionally, a retrospective cohort analysis included all BVFP patients at the department between January 2013 and November 2019 to validate our findings. Results: The study included 21 cases, and none of those with perinatal hypoxia exhibited BVFP. Furthermore, the retrospective cohort of BVFP cases presenting at our department did not reveal a significant history of perinatal hypoxia. Conclusion: Our study did not yield compelling evidence linking perinatal hypoxia with BVFP however, considering the constraints of our study, insights from existing literature and absence of prior research in this area, the hypothesis of perinatal hypoxia's impact on laryngeal innervation merits further, more comprehensive research in this area. Keywords: Hypoxic injury; perinatal hypoxia; vocal fold palsyPublication Trends in Neonatal Mortality at a Tertiary Level Teaching Hospital(Nepal Paediatric Society (JNPS), 2013) Basnet, Srijana; Shrestha, LaxmanAbstract: Introduction: Neonatal services at Tribhuvan University Teaching hospital (TUTH) was essentially up to level II till year 2008 and upgraded to level III care in later years. A 4 years retrospective study was carried out at TUTH, Kathmandu, Nepal to determine any change in the trend of neonatal mortality after the improvement in its services. Materials and Methods: Labor room record book, neonatal record book, perinatal audit data and neonatal record charts were used to collect the data. Results: During the study period, there were total of 15063 live births. The neonatal mortality ranges from 9.46 to 14.88 per 1000 live births per year. There was no significant fall in trend of neonatal mortality (x2 for linear trend=1.40, p=0.23). There was also no significant fall in trend in perinatal mortality rates over this period (x2 for linear trend=1.92, p=0.16).The number of neonates referred to other hospitals has been significantly reduced by 61%.(x2 for linear trend=33.18, p<0.001). Majority of the neonatal deaths (72%) occurred within first 7 days of life and more than a third (39%) died within the first 24 hours of life. Respiratory distress syndrome, perinatal asphyxia and neonatal sepsis were three major causes of death. Deaths due to respiratory distress and perinatal asphyxia has not changed significantly over the years (p=0.4 and 0.25 respectively). Incidence of low birth weight ranges from 10.8 – 16.1% of total live births. 63% of neonatal mortality occurred in low birth weight babies. This trend has not changed in over the years (x2=1.03, p=0.31). Conclusion: With the improvement in the services, though neonatal mortality remained unchanged, referral rates and mortality due to respiratory distress syndrome of prematurity has decreased.