Browsing by Author "Shrestha, Rupesh"
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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 Rise of Haemoglobin after Blood Transfusion in Children Without Active Bleeding(Nepal Paediatric Society (JNPS), 2020) Shrestha, Rupesh; Basnet, Srijana; Gami, Fakir ChandraAbstract: Introduction: Blood transfusion is a common practice among children with severe anaemia. A common assumption among physician is that transfusion of 5 ml/kg packed red cell will increase the haemoglobin of the recipient by 1 gm/dl. This study was aimed at assessing the effect of volume of blood product and hematocrit of donor blood in the rise of haemoglobin concentration after transfusion in children without active bleeding. Methods: A prospective observational study was conducted in 32 children aged between one to 15 years without active bleeding who received blood transfusion in Paediatric ward and Paediatric Intensive Care Unit of a tertiary care hospital in Nepal from December 2013 to November 2014. Haemoglobin levels before and after transfusion were compared and any adverse reactions that occurred during transfusion were recorded. Hematocrit of each donor blood was measured. Results: The overall rise of haemoglobin after transfusion of blood product with hematocrit of 53 ± 8.9 % at the rate 14.5 ± 6.0 ml/kg was 2.7 ± 1.4 gm/dl. The rise of haemoglobin after transfusion of whole blood with hematocrit of 38.8 ± 4.4% at the rate 15.5 ± 6.9 ml/kg was 1.8 ± 1.2 gm/dl. The rise of haemoglobin after transfusion of packed cell with hematocrit 57.0 ± 4.8 % at the rate 14.2 ± 5.8 ml/kg was 2.9 ± 1.4 gm/dl. Conclusion: This study supports the general consensus of 1 gm/dl rise of haemoglobin after transfusion of packed red cell at 5 ml/kg.Publication Transient Abnormal Myelopoiesis in a Neonate without Down Syndrome(Nepal Paediatric Society (JNPS), 2017) Shrestha, RupeshAbstract: Transient abnormal myelopoiesis (TAM) also known as transient myeloproliferative disorder (TMD), a unique transient neonatal preleukaemic disorder characterized by clonal proliferation of megakaryoblasts, has been usually described to be associated with Down syndrome neonates. However, there are case reports of it occurring in neonates without Down phenotype, who are either mosaic for trisomy 21 or have trisomy 21 restricted to leukemic clone. This case report presents a case of TAM in a phenotypically normal neonate who presented in respiratory distress with features of tumour lysis syndrome (TLS) immediately after birth who was treated symptomatically and had spontaneous remission within three months.