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Transfusion-Transmitted Malaria (TTM) in a Neonate - A Case Report
(Nepal Paediatric Society (JNPS), 2019) Tamaria, Kailash Chand; Matlani, Monika; Meena, Shyam S.
Abstract: Transfusion-transmitted malaria in neonates is uncommon entity. Here we report a case of severe malaria in a term neonate after exchange transfusion successfully treated with intravenous artesunate.
Super Refractory Status Epilepticus in a Case of Post Mumps Autoimmune Encephalitis: A Rare Case Report
(Nepal Paediatric Society (JNPS), 2019) Giri, Satabdi; Agrawal, Priyanka; Kumari, Mamta; Dash, Dillip Kumar
Abstract: Seizure is a common problem in many paediatric patients. When seizures persist even after 24 hrs of anaesthetic treatment it is known as Super Refractory Status Epilepticus (SRSE). We report a 10 years old girl admitted with fever, altered sensorium and GTCS with a provisional diagnosis of viral encephalitis. In the line of SRSE infusion thiopental was also started after giving first line antiepileptic as per guidelines. Seizures persisted despite six anti-epileptic drugs, steroids and infusion anaesthetic. MRI brain was suggestive of T2W Flair hyperintensity in B/L hippocampal and Para-hippocampal gyrus and CSF and blood positive for Mumps IgM. This was suggestive of Mesial temporal sclerosis (MTS) which is the scarring and loss of neurons in the deepest portion of the temporal lobe due to oxygen starvation to the brain, head trauma, brain infection or without any apparent cause. Dramatic response was seen after 36-48 hours of IVIG administration.
Recurrent Unilateral Nasal Obstruction: A Cause Lying Deep Inside
(Nepal Paediatric Society (JNPS), 2019) Biswas, Soumyadeep; Sarkar, Shatanik; Bandyopadhyay, Debasish; Patra, Chaitali
Abstract: Recurrent nasal obstruction, a common symptom in pediatric practice, can lead to some unusual diagnosis rarely. Non- response to standard treatment warrants further delineation of local anatomy, particularly if symptoms occur unilaterally. Here, we report a case of recurrent unilateral nasal obstruction in a 16 years old girl not amenable to conventional treatment with medicines, which on subsequent investigations revealed an impacted intranasal tooth.
Bone Tuberculosis: Rare Condition Among Infants
(Nepal Paediatric Society (JNPS), 2019) Bastola, Ramchandra; Adhikari, Neelam; Shrestha, Dhruba; Sigdel, Bhawana; Shrestha, Shree Krishna
Abstract: Bone tuberculosis in infancy has become rare these days. Here we report a case of 12 months old male infant who had presented with complaints of fever and skin rash for one month, along with protuberance of toe joint for 15 days. He was being treated with antibiotics, vitamin D and calcium without improvement. Further investigations led to mycobacterium positivity in bone biopsy. He was treated with anti-tubercular therapy and he responded to the treatment dramatically. So, though rare, it is important to consider bone tuberculosis when there are bony issues even in infancy, especially in endemic regions like ours.
Autoimmune Haemolytic Anaemia Following Influenza A Pandemic H1N1 Infection: A Case Report Authors
(Nepal Paediatric Society (JNPS), 2019) Bandyopadhyay, Pritam; Biswas, Tamoghna; Lahiri, Mahuya
Abstract: Autoimmune haemolytic anaemia has been rarely reported in association with influenza virus. Here, we report a 16 months old girl with warm autoimmune haemolytic anaemia following influenza A Pandemic H1N1 infection, which improved with oral corticosteroids and intravenous immunoglobulin.
Prevalence of Acute Kidney Injury in Patients with Perinatal Asphyxia in Tertiary Hospital
(Nepal Paediatric Society (JNPS), 2019) Shrestha, Nisha Jyoti; Upadhaya, Subedi, Kalpana; Shakya, Shristi; Saroja, Adhikari
Abstract: Introduction: Perinatal asphyxia has multisystem involvement, kidneys are most frequently affected. This study was conducted to determine the relation between severity of Hypoxic Ischaemic Encephalopathy (HIE) with acute kidney injury in term neonates. Methods: Retrospective study was done over a period of six months (Sept 2016 to Feb 2017) at Department of Neonatology of a tertiary level maternity hospital. Total 98 cases of Perinatal asphyxia cases which were diagnosed with certain degree of HIE were evaluated for its relation with renal involvement in different stage of HIE. Results: Out of 98 cases of perinatal asphyxia, HIE I was 21%, HIE II was 69% and HIE III was 10%, among which 72% cases had some degree of renal problem. seventy two cases had renal problem, oliguric cases were 41 (57%) among which 33% case had persistent symptoms and associated renal function deterioration. Among 42 cases of deranged RFTs, 40% of cases has persistently deranged RFTs. In comparison to HIE II in HIE III, 22% of cases had one time derangement of RFTs and 33% cases had at least one observation of oliguria, while remaining 45% cases had persistent deterioration of RFTs and urine output, suggesting that progression in HIE stage has significant association with renal dysfunction (p < 0.05). More than half of the cases of HIE III had mortality while 20.3% of HIE II cases had mortality, indicating that the mortality is highly significant with higher HIE grade (p < 0.05). Conclusions: Renal involvement is very common in cases of perinatal asphyxia, and severity of renal involvement increases as the HIE grading increases.
Prevalence and Risk Factors of Perinatal Asphyxia in a Tertiary Care Level Hospital, Harari Regional State, Ethiopia
(Nepal Paediatric Society (JNPS), 2019) Jamie, Arif Hussen; Abdosh, Mohammed Z
Abstract: Introduction: Globally birth asphyxia continues to present a major clinical problem. It is one of the common and leading causes of perinatal and neonatal mortality and morbidity especially in developing countries. Methods: A cross-sectional study was conducted among newborns in a tertiary level hospital, Ethiopia from February to July 2019. Systematic random sampling technique was used to select the study subjects. Multivariate logistic regression analysis was used to identify factors associated with the perinatal asphyxia among newborns. Results: Of the newborns, 32% had perinatal asphyxia and factors significantly associated were anaemia during pregnancy (adjusted OR = 2.99, 95% CI: 1.07 – 8.35), chronic hypertension (adjusted OR = 4.89, 95% CI: 1.16 – 20.72) and low birth weight newborns (adjusted OR = 3.31, 95% CI: 1.308 – 8.37). Conclusions: Maternal anaemia during pregnancy, chronic hypertension and low birth weight were significantly associated with perinatal asphyxia. Therefore, early screening and appropriate intervention during pregnancy and intra-partum might reduce perinatal asphyxia among newborns.
Impact of Kangaroo Mother Care on Outcome of Very Low Birthweight Preterm Newborns in a Tertiary Hospital in Abakaliki, Nigeria Authors
(Nepal Paediatric Society (JNPS), 2019) Ezeanosike, Obumneme; Daniyan, Olapeju; Anyanwu, Onyinye Uchenna; Asiegbu, Uzoma; Ezeonu, Chinonyelum; Onwe-Ogah, Emeka; Onyire, Onyire
Abstract: Introduction: KMC was developed for care of preterm and low birth weight babies due to shortage of staff and inadequate incubator care enabling early discharge from the hospital for close follow-up at home. It is essential in resource-limited countries where there is epileptic power supply. Therefore, strengthening the evidence for KMC becomes imperative in these resource-limited and adverse cultural regions. Methods: The KMC register of the Newborn Special Care Baby Unit of a tertiary hospital was used to analyse records from January 2016 to February 2018. A total of 55 preterm babies enrolled into KMC were studied. The age and parity of the mother, sex, birth weight, admission and discharge temperatures and weights, duration of KMC per day was retrieved from the KMC register. Results: The mothers’ ages ranged from 18 to 40 years (mean 28.6 ± 6.2 years) with 34% being inexperienced first-time mothers and 10% grand multipara. The birth weights of the babies ranged from 0.9 kg to 2.5 kg. Primiparous women were more likely to do KMC for longer durations. A linear regression model showed that the duration of KMC was related to parity. (R2 = 0.12, p = 0.02). On average there was significant weight gain on discharge with a paired t-test (t = 5.881, df = 44) comparing the discharge and commencement weights showing a mean difference of 0.123 kg (CI 0.081 kg, 0.165 kg, p < 0.001). Conclusions: KMC impacts positively on all parameters of the extremely LBW and premature babies and the duration of KMC is positively associated with better outcome.
Hypertension and its Determinants Among School Going Adolescents: A Cross Sectional Study in Nepal
(Nepal Paediatric Society (JNPS), 2019) Shakya, Sujata; Bajracharya, Shanti
Abstract: Introduction: Hypertension is a chronic life threatening non- communicable disease. It increases the risk for cardiovascular diseases even leading to premature death. Almost half of the adults with hypertension had elevated blood pressure during childhood. With globalisation and lifestyle changes, adolescents are exposed to various risk factors. However, diagnosis in this population is difficult due to absence of symptoms. Thus, regular blood pressure screening is essential in these groups. This study aimed to find out the prevalence of hypertension and its determinants among the school going adolescents of Kathmandu, Nepal. Methods: This was a descriptive cross sectional study which included five private secondary schools of Kathmandu, Nepal. The adolescent students studying in classes VIII, IX and X were the study subjects. Two stage cluster random sampling technique was used to select 356 participants. Data collection was done by doing anthropometric measurements, blood pressure measurement and through self administered questionnaire. Results: The study depicted that the prevalence of elevated blood pressure was 12.4%, stage 1 hypertension 32.3% and stage 2 hypertension 9.8%. Similarly, 13.8% were overweight and 1.4% were obese. Bivariate analysis depicted significant association of prevalence of hypertension with gender, religion and obesity (p < 0.05). The multivariate analysis shows that the significant predictors of elevated blood pressure and/or hypertension were gender and obesity. Males were six times more likely to have elevated blood pressure (AOR = 6.058, CI = 2.571 - 14.274) and 2.8 times more likely to be hypertensive (AOR = 2.838, CI = 1.688 - 4.773) compared to females. Similarly, compared to obese/ overweight students, thin and normally built ones have less likelihood of having elevated blood pressure and hypertension. Conclusions: Hypertension has been prevalent among adolescents, due to various behavioural risk factors. This is really challenging and of public health significance. Regular screening of adolescents is essential for early detection and management of hypertension.
External Environment, Enabling Factors and Predisposing Characteristics of Fully Immunised Children in Nepal
(Nepal Paediatric Society (JNPS), 2019) Thapa, Kanchan; Suwal, Bhim Raj; Adhikary, Pratik
Abstract: Introduction: Immunisation is a cost-effective public health intervention worldwide responsible for the reduction of infant and child morbidity and mortality. Full immunisation is a state of obtaining all vaccination according to the Immunisation schedule of Nepal. Methods: The secondary data of Nepal was downloaded from the DHS Program. A total of 1709 children aged 16-23 months were analysed for descriptive statistics. All the analyses were weighted by its sampling weight. The full immunisation status indicates those who completed 1 dose of BCG, 3 doses of Polio, 3 doses of DPT and 1 dose of Measles. The independent variables are further subdivided into enabling, predisposing and external environmental factors. Results: Over half of children (52.6%) were from Terai, nearly a quarter (23.0%) from province 2. More males (53.5%) and the majority of (86.1%) children with birth order one to three were immunised. Mother aged < 20 years (62%), working father (96.1%), working mother (59.7%), educated father (87.3%) and educated mother (70.7%) had children with complete immunisation. Non-smoker mother (94.6%) had fully immunised children. Nearly three quarters (73.5%) from a middle and rich family, those with PNC within 3 days (35.9%), delivered at a health facility (64.2%), and had PNC check from the skilled provider (12.1%) had completely immunised their children. Conclusions: Significant differences based on external environment, enabling factors and predisposing factors for full immunisation status was observed. Specific interventions based on these factors are recommended.
Clinico-Demographic Profile of Febrile Seizure and Its Association With Iron Deficiency
(Nepal Paediatric Society (JNPS), 2019) Birua, Shyama; Sarkar, Suman; Bera, Aparajita; Khan, Kalimuddin
Abstract: Introduction: Febrile seizure (FS) is recognised as the most frequent type of seizure in children (age six months to five years). This observational study was conducted in our hospital to assess any possible association of febrile convulsion with iron deficiency anaemia (IDA) and to see the incidence of iron deficiency in six months to five years old children. Methods: Eighty eight Simple febrile seizure patients of age six months to five years fulfilled the inclusion criteria and were enrolled between April 2018–March 2019. A pre-designed proforma including detailed history, physical examinations, systemic examinations and relevant investigations were filled-up. Results: Eighty eight subjects with FS were studied. Occurrence of IDA was 67.04% among them. Age was significantly associated with haemoglobin (Hb%) (p-value = 0.000), severity of anaemia (p-value = 0.000), mean corpuscular volume (MCV) (p-value = 0.000), mean corpuscular haemoglobin (MCH) (p-value = 0.000), mean corpuscular haemoglobin concentration (MCHC) (p-value = 0.000) and serum ferritin (p-value = 0.000). However, no significant association between Hb% and gender was found (p-value = 0.890). Conclusions: Considering the clinico-demographic context of the present study and extent of anxiety and worries of parents of FS children, it is imperative to initiate FS prevention and control programme. Nearly two-third of study subjects had significant low serum ferritin indicating association of simple febrile seizure with IDA. However, prevalence of IDA as a risk factor for FS needs to be studied on adequate and representative sample so that iron supplementation could be started as an inbuilt strategy of simple febrile seizure management.
Childhood Neurocysticersosis: A Rural Teaching Hospital Experience
(Nepal Paediatric Society (JNPS), 2019) Bhalla, Arjun Sakha; Maini, Baljeet; Gaur, Bablu Kumar
Abstract: Introduction: Neurocysticercosis (NCC) is caused by the larval stage of Taenia Solium. Neurocysticercosis is the most common cause of acquired epilepsy in developing countries. In India NCC has been identified as a significant cause of seizures. Methods: This prospective observational study was conducted on 150 children of NCC up to 18 years of age in a tertiary care hospital. The diagnosis was based on clinical and laboratory/ radiological evaluation of the patients. Socio-clinical, radiological and serological data of the patients were analysed. Results: A total of 150 children were enrolled in this study. The commonest age group of the cases in this study was six to 10 years. Male to female ratio was 1.8:1. The largest percentage of cases belonged to upper lower class (56%) and lowest was 4% in upper class. Sixty percent subjects were non vegetarian. Seizures were the most common presentation (96%). Headache was present in 44% cases. Single lesion was commonest type of lesion on radiological examination with frontal cortex as most commonly involved area of brain. Stage II NCC was commonest type of lesion on MRI. EEG was abnormal in 38% cases. Serum ELISA for cysticercosis was positive in 10% cases. Number of lesions was not associated with age group, type of seizure or any particular area of brain. Conclusion: Stage II NCC the commonest type of NCC. Single lesion NCC was more common than multiple lesions. All cases with atypical presentation and positive ELISA had multiple lesions. Frontal portion of cortex was most commonly involved.
SVT and Gram Negative Sepsis in Neonates
(Nepal Paediatric Society (JNPS), 2019) Pathak, Om Krishna; Singh, Yengkhom Rameshwor; Sunil Purswani,; Suryawanshi, Pradeep
Abstract: 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.
Stevens-Johnson Syndrome in a Child on Phenytoin, Exacerbated with Cefixime
(Nepal Paediatric Society (JNPS), 2019) Roka, Yam Bahadur; Shrestha, Sabrina; Roka, Narayani; Karki, Mohan
Abstract: Steven Johnson syndrome and toxic epidermal necrolysis are rare but potentially life threatening muco-cutaneous disorders. Their incidence ranges from 1.2 to six per million patient-years for Steven Johnson syndrome and 0.4 to 1.2 per million patient-years for toxic epidermal necrolysis. Drugs are the primary cause for these syndromes in majority cases. They might also be due to infections with Mycoplasma Pneumoniae or Herpes Simplex. The mortality ranges from five to 40% in these cases. We report a 10-year old girl who presented with history of multiple skin eruptions involving whole body and oral ulceration for five days. She was a known case of seizure disorder on phenytoin and had been prescribed Cefexime for fever. She was managed with intravenous fluids, corticosteroids, opiates, antacids and topical antibiotics. We want to highlight the possibility of Steven Johnson syndrome following the combination of these two drugs. Author Biographies Yam Bahadur Roka, Neuro Cardio and Multispecialty Hospital, Biratnagar, Nepal Department of Neurosurgery Sabrina Shrestha, Birat Medical College, Biratnagar, Nepal Department of Dermatology Narayani Roka, Neuro Cardio and Multispecialty Hospital, Biratnagar, Nepal Department of Ophthalmology Mohan Karki, Neuro Cardio and Multispecialty Hospital, Biratnagar, Nepal Department of Neurosurgery
Isoniazid Induced Psychosis: A Case Report Authors
(Nepal Paediatric Society (JNPS), 2019) Kaur, Taranjeet; Kaur, Kanwalpreet; Malhotra, Preeti
Abstract: Psychosis is a state of altered behaviour and mentation and it is not common in children. Isoniazid is a commonly used drug in the treatment and prophylaxis of tuberculosis. It may cause psychosis if overdosed but rarely with usual recommended doses. We report a case of drug induced psychosis secondary to isoniazid intake in a seven years old boy, who exhibited psychotic features about 10 days after the commencement of anti-TB combination drugs (Directly Observed Treatment Shortcourse) containing Isoniazid. This patient had no past medical or family history of mental illness. Drug induced psychosis was a possibility, and the responsible drug (isoniazid) was stopped. He improved following the withdrawal of isoniazid. Isoniazid psychosis is a major complication as iatrogenic psychiatric complications can greatly impact the patients’ quality of life, which if recognised early can be effectively treated. Author Biographies Taranjeet Kaur, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India Department of Paediatrics Kanwalpreet Kaur, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India Department of Paediatrics Preeti Malhotra, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India Department of Paediatrics
Hypothyroidism Causing Precocious Puberty and Ovarian Torsion
(Nepal Paediatric Society (JNPS), 2019) Kini, Sandesh; Y, Ramesh Bhat; Kousika, Phalguna; Thunga, Chennakeshava; Handattu, Koushik; Karegowda, Lakshmikanth Halegubbi
Abstract: Hypothyroidism in children causes delayed puberty. However longstanding untreated hypothyroidism can lead to precocious puberty which may be secondary to hyperprolactinemia or increased levels of thyroid stimulating hormone (TSH), enhancing the sensitivity of ovaries to circulating gonadotropins. Here we report a seven and half years old girl with hypothyroidism presenting with precocious puberty and multicystic ovaries which responded well to thyroid hormone supplementation but subsequently developed left ovarian torsion requiring surgical intervention.
A Girl Who is Smiling for no Reason: Gelastic Seizure- A Case Report
(Nepal Paediatric Society (JNPS), 2019) Paudel, Subodh Sharma; Agrawal, Nikhil
Abstract: Being a rare disorder, Gelastic seizure primarily presents as episodes of sudden occurrence of emotions usually associated with laugh or giggle due to facial contractions. A child presented with abnormal body movement in the form of smiling and uprolling of eyes, which was clinically diagnosed as gelastic seizure, a rare form of a very common presentation, epilepsy. The case is presented to highlight abnormal posturing and smiling episodes in a child can be a form of seizure episode, which generally presents with a diagnostic dilemma and therapeutic nightmare to the clinician.
Weekly versus Daily Iron Supplementation for Preventing Iron deficiency Anaemia Amongst Children Between Six to 24 Months: A Randomised Control Trial Authors
(Nepal Paediatric Society (JNPS), 2019) Kaushik, Sneha; Yadav, Anita; Debata, Pradeep Kumar; Aggarwal, Kailash Chandra
Abstract: Introduction: Iron deficiency anaemia is common in developing nations and starting iron supplementation from infancy is an important measure for its prevention. There is still not enough evidence, whether giving iron twice weekly as compared to daily, is enough to prevent the same. Methods: This open-labeled randomised control trial was conducted at a tertiary care facility over a period of 1.5 years. After informed consent from parents, a total of 125 non-anaemic healthy infants in age group six to 24 months; with birth weight > 2500 grams, born singleton at term gestation and predominantly breastfed in the first six months of life; were randomised using computer generated sequence to two groups. Control group received daily elemental iron supplementation of 1 mg/kg/day and the intervention group received twice weekly 2 mg/kg/day. Haemoglobin, serum ferritin were measured at enrolment and at the end of 100 days. Primary outcome was anaemia defined as haemoglobin less than 11 mg/dl. Secondary outcome measures were weight gain, increase in length and occipito-frontal circumference. Results: Baseline characteristics were similar in the two groups. This study showed significantly higher mean haemoglobin (mg/dl) (mean ± SD 11.882 ± 0.3237, 11.683 ± 0.4264, p = 0.009) and mean serum ferritin (ng/ml) (mean ± SD 101.704 ± 23.0263, 62.149 ± 24.2079, p = 0.000) at end of 100 days in the control group than the intervention group. There was no difference in any of the secondary outcomes. Conclusions: Biweekly iron supplementation can also prevent iron deficiency anaemia in children between six to 24 months of age but daily is better in respect to the increase in haemoglobin. Author Biographies Sneha Kaushik, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Postgraduate student, Department of Pediatrics Anita Yadav, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Associate Professor of Pediatrics Pradeep Kumar Debata, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Department of Paediatrics Kailash Chandra Aggarwal, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India Professor of Pediatrics
The Determinants of Early Initiation of Breastfeeding Practice among Mothers Attending a Tertiary Hospital, Kathmandu
(Nepal Paediatric Society (JNPS), 2019) Acharya, Sharada; Khanal, Chitra; Dahal, Akriti Shree; Maharjan, Mankeshari; Bhandari, Bhagawati
Abstract: Introduction: Breastfeeding is the best way of providing ideal food for the optimal growth and development of an infant. Early initiation of breastfeeding (EIBF) within one hour of birth is one of the cost effective strategies to reduce neonatal mortality. The aim of the study was to find out the determinants of breastfeeding practice. Methods: This was a descriptive cross-sectional study conducted among 207 mothers who have child from birth to 12 months in Maternal and Child Health (MCH) Clinic of tertiary care referral hospital. The mothers for the study were selected using probability sampling technique. Variables were analysed using a multivariate logistic regression model to identify the determinants of EIBF. Results: The prevalence of EIBF in the study population was 47.3%. Caesarean delivery (AOR: 3.449, CI: 1.224-9.719, p = 0.019), mothers who have done more than one postnatal visit (AOR: 2.824, CI: 1.126-7.079, p = 0.027) and low birth weight babies (AOR: 7.973, CI: 1.571-40.465, p = 0.027) were more likely to delay initiation of breastfeeding. Conclusions: Less than half newborn receive breast milk within the first hour of birth. Mothers delivered by caesarean section, who have done more than two postnatal visit and low birth weight babies were more likely to delay initiation of breastfeeding. These are the major determinants of initiation of breastfeeding. Existing breastfeeding promotion program should be strengthened within the existing health care system.
Safety of Early Rescue Surfactant Replacement Therapy for Preterm Neonates with Respiratory Distress Syndrome at Neonatal Intensive Care Unit of a Tertiary Hospital
(Nepal Paediatric Society (JNPS), 2019) Yadav, Sunil Kumar; Giri, Arun
Abstract: Introduction: Respiratory distress syndrome (RDS) is an acute disease of preterm neonates and is caused by the deficiency of pulmonary surfactant. Surfactant deficiency can lead to alveolar collapse, atelectasis, impaired gas exchange, severe hypoxia and acidosis. Surfactant replacement therapy (SRT) is an integral part of management of preterm neonates with respiratory distress syndrome. The objective of the study was to evaluate the safety of early rescue surfactant replacement therapy in RDS. Methods: This was a prospective observational study conducted in a 17 bedded teaching and referral NICU of Eastern Nepal over a period of seven months. All preterm neonates with clinical and radiological features of RDS were enrolled in the study. The safety of early rescue SRT was evaluated by measuring the outcomes: incidence of pulmonary haemorrhage, apnea, hypoxia and cardiac arrest. All data were entered into the worksheet of SPSS software version (19.0) and descriptive statistics including percentages and frequencies was analysed. The level of statistical significance adopted was p-value < 0.05. Results: The survival rate of preterm babies with SRT was 64.7% (22 babies). The incidence / prevalence of pulmonary haemorrhage, apnea, hypoxia, and cardiac arrest during or immediately after SRT was 14.7%, 5.9%, 5.9% and 2.9% respectively. Conclusions: This study suggests that SRT is an effective, safe and feasible intervention in level-3 neonatal units and has the potential to reduce neonatal mortality. The study also emphasises on the fact that SRT should be provided in settings where there is adequate manpower, professional skills and desired infrastructure to administer surfactant. Author Biographies Sunil Kumar Yadav, Nobel Medical College Teaching Hospital, Biratnagar, Nepal Department of Paediatrics and Neonatology Arun Giri, Nobel Medical College Teaching Hospital, Biratnagar, Nepal Department of Paediatrics and Neonatology

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