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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
Role of Lumbar Puncture in Late Onset Neonatal Sepsis
(Nepal Paediatric Society (JNPS), 2019) Das, Amit Kumar; Mishra, Deepak; Jha, Nitu Kumari; Mishra, Rakesh; Jha, Soniya
Abstract: Introduction: Neonatal sepsis is a clinical syndrome characterized by signs and symptoms of infection with or without accompanying bacteremia in the first month of life. It is responsible for about 30-50% of the total neonatal deaths in developing countries. Neonatal sepsis can be divided into two sub-types depending upon whether the onset of symptoms within the first 72 hours of life (Early Onset Neonatal Sepsis) or after 72 hours of life (Late Onset Neonatal Sepsis ). Meningitis is an important complication of late onset neonatal sepsis. Method: This was hospital based prospective observational study conducted among the neonates admitted with diagnosis of late onset neonatal sepsis in Neonatal Intermediate Care Unit (NIMCU) and Neonatal Intensive Care Unit (NICU) of Kanti Children’s Hospital from July 2016 to June 2017. The objective of this study was to evaluate the importance of performing LP in neonates with LONS. Results: 16.8% neonates with late onset neonatal sepsis were found to have meningitis. Among the neonates with meningitis CRP was positive 57.2% and negative in 42.8 %. Among the cases with abnormal CSF findings, blood culture was sterile in 85% cases and organism was isolated 15% cases. In 88.8% cases with positive blood culture, no meningitis was detected. Lumbar puncture was traumatic in 1 neonate (0.8%) in first attempt. Apart from this no other complication of performing lumbar puncture was noted. Conclusion: Lumbar puncture and CSF examination is mandatory in all cases with late-onset sepsis. Author Biographies Amit Kumar Das, Indira Gandhi Memorial Hospital, Male, Maldives Consultant Paediatrician, Department of Paediatrics Deepak Mishra, Kanti Children’s Hospital, Maharajgunj, Kathmandu, Nepal Department of Paediatrics Nitu Kumari Jha, National Academy of Medical Sciences, Kathmandu, Nepal Department of Obstretics and Gynaecology Rakesh Mishra, NAMS, Kathmandu, Nepal Department of Orthopaedics Soniya Jha, Ramlal Golchha Eye Hospital, Morang, Nepal Medical Officer
Patient Awareness of Cost of Treatment at a Government Sponsored Hospital in India
(Nepal Paediatric Society (JNPS), 2019) Ritesh; Singh, Harsh Mohinder; Singh, Bikram Jit
Abstract: Introduction: To evaluate the awareness amongst the beneficiary about the costs of medical services in a hospital which provides all services at no cost and also to analyse whether education level of the beneficiary client, number of days stayed in hospital and their prior exposure of being treated on payment in other hospital has some bearing on cost estimation by the participants. Method: It was a cross sectional questionnaire based survey study. A total of 130 beneficiary clientele of a government hospital were interviewed. Two sample ‘t’ test and ANOVA were used for statistical analysis. Multivariate regression analysis was used to study effect of more than one independent variable on cost estimation. Scatter plot and box plots were used to study standard deviation. Results: It revealed poor awareness of people in cost estimation of medical expenses. A significant ‘p’ value of < 0.05 was observed with respect to length of stay (p = 0.003), treatment modality (p = 0.000) and multivariate variable (treatment technique along with exposure to treatment in paid hospital, p = 0.008). Conclusion: The beneficiary clientele in a hospital with free treatment generally not aware about the exuberant costs of treatment born by the state. Author Biographies . Ritesh, ITFH Tajikistan Department of Pediatrics Bikram Jit Singh, Maharishi Markandeshwar, Deemed to be University, Mullana, India Department of Mechanical Engineering
Coexistence of Allergic Rhinitis in Children Attending Paediatric Asthma Clinic
(Nepal Paediatric Society (JNPS), 2019) Singh, Rajesh Kumar; Simalti, Ashish Kumar
Abstract Introduction: Asthma and allergic rhinitis are considered manifestations of the chronic inflammatory respiratory syndrome of the common airways or united airways disease. We conducted a prospective epidemiological study to evaluate the prevalence of allergic rhinitis among children already diagnosed as having asthma. Methods: A prospective epidemiological study was carried out during 2015 to 2016 at a tertiary care centre in North India. The severity of asthma was classified according to the Global Initiative for Asthma (GINA) report & allergic rhinitis according to Allergic Rhinitis and Its Impact on Asthma (ARIA). Results: A total of 64 children were screened. After excluding five subjects (7.8%), 59 subjects with asthma were analysed. We could not find any definitive correlation between severity of asthma to severity of allergic rhinitis (p > 0.05). The prevalence of co morbidity of asthma and allergic rhinitis was maximum when onset of asthma was between three to six years (70%), was 40% for < three years and 50% when age of onset was six to nine years. The age of onset of asthma in children having asthma only was five years and that of children with both asthma and allergic rhinitis was 5.5 years. This difference was not significant (p > 0.05). Conclusion: There was a high prevalence of co morbidity (50.84%) of allergic rhinitis among patients with asthma. A positive correlation was found between duration and severity of asthma, but this was not observed for allergic rhinitis. In most cases asthma preceded or started with AR. Author Biographies Rajesh Kumar Singh, Command Hospital (Eastern Command) Kolkata, India Department of Paediatrics Ashish Kumar Simalti, Army Hospital Research and Referral, New Delhi, India Department of Paediatrics
A Five Years Study of Occurrence and Associated Risk Factors for Birth Defects in a Tertiary Care Hospital in Central Nepal
(Nepal Paediatric Society (JNPS), 2019) Basaula, Yuba Nidhi; Paudel, Radha Kumari; Chapagain, Ram Hari
Abstract Introduction: Congenital anomalies account for 7.0% of neonatal deaths in Nepal. The present study was carried out to determine the overall rate of congenital malformations, incidence and prevalence in live births, still birth and incidence affecting various organ systems, at Bharatpur Hospital, Nepal. Methods: All the intramural deliveries between Jan 2015 to Dec 2019 were included in the study. All the newborns were looked for congenital malformations after birth within seven days. Antenatal ultrasonography findings were noted. 2D echocardiography was also used for all congenital heart diseases, along with routine X-ray chest. A total of 131 babies with congenital problem were studied and the information was recorded in WHO NBBD Proforma. Data were recorded in MS Excel and SPSS 16 version was used for analysis. Results: Out of the total 60160 deliveries, 131 (0.21% of total birth) were with congenital malformations, sex wise distribution was 65 (49.5%) females and 63 (48.7%) males and three (1.8%) were ambiguous. Oro-facial malformation (49, 37.4%) was the commonest form of malformation followed by the musculoskeletal system (31, 23.6 %), centre nervous system (31, 23.6%) and congenital malformations of genital organs (8, 6.0%). Conclusions: The incidence of congenital malformation in this study was 0.21%. Females were more common than males and oro-facial malformation was the commonest type of malformation. Lack of antenatal visit, lack of folic acid during pre-conception period and low socioeconomic status were the commonest risk factors. Author Biographies Yuba Nidhi Basaula, Bharatpur Hospital, Bharatpur, Chitwan, Nepal Department of Paediatrics Radha Kumari Paudel, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal Faculty of Nursing Ram Hari Chapagain, National Academy of Medical Sciences / Kanti Children’s Hospital, Kathmandu, Nepal Department of Paediatrics
Response to: Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador: Correspondence
(Nepal Paediatric Society (JNPS), 2020) Garrido, David Israel
Abstract: Dear editor, This letter is in response to Chaudhary, Shrestha, and Pathak, who highlighted various aspects of our previous manuscript "Prevalence of Anaemia in Children Diagnosed with Pneumonia in a Tertiary Hospital in Quito, Ecuador." I want to respond to each point referred to in a similar extension as used by the authors. We agreed on the fact that it is prompt to conclude in nutritional deficiencies as a risk factor to suffer pneumonia in Ecuadorian children that is why we express this conclusion as a possibility. Nevertheless, as evidenced in the meta-analysis presented by Jackson et al., the Odds Ratio (OR) meta-estimate for under nutrition as a risk factor for acute lower respiratory infections was 4.5 (95% CI 2.1-9.5)1. To add, in the same paper, the OR meta-estimate for anaemia, vitamin D deficiency, and zinc supplementation, was 3.9 (95% CI 2.4-6.3), 7.3 (95% CI 2.5 to 21.5), and 0.5 (95% CI 0.3 to 0.9), respectively 1. Moreover, in a study conducted in Malawi including 9 533 children, severe malnutrition and moderate malnutrition were associated not only with a pneumonia risk but with an increased risk of inpatient mortality, with Odds Ratios (OR) of 4.63 (3.08, 6.97) and 1.73 (1.21, 2.48) respectively. Therefore, there is supporting evidence globally of the suggested risk 2. I am glad that the authors in the letter bring to the table a discussion of pneumonia diagnosis. In our study, the evaluation of pneumonia started with the clinical assessment including parameters with an acceptable sensitivity (Sen%) or specificity (Spe%), such as; fever on examination (Sen% 47, Spe% 68), history of fever (Sen% 92, Spe% 21), tachypnoea (Sen% 13, Spe% 95), rhonchi (Sen% 26, Spe% 98), crackles (Sen% 43, Spe% 73), wheezing (Sen% 4, Spe% 98) (3). However, as referred to in the original paper, the evaluation was not limited to these factors "Hypoxemia, defined as a sustained saturation of peripheral oxygen (SpO2) <90 %, was used as criteria for hospitalization, along with criteria for respiratory distress, which includes: tachypnoea, dyspnoea, retractions (suprasternal, intercostal, or subcostal), grunting, nasal flaring, apnoea and altered mental status. Furthermore, CBC, acute-phase reactants and chest radiography were performed" (4). Nonetheless, I should remark two factors; firstly, pneumonia severity assessment is based on clinical parameters as presented in the New South Wales Government guideline (5). So, minimizing the utility of the clinical evaluation may be a mistake, especially in institutions without prompt access to the radiologic test. Secondly, even we knew that the patients included in this study were evaluated in other differential diagnoses like bronchiolitis, asthma or cardiac diseases which can mimic pneumonia, this was a cross-sectional study using retrospective data collection. Regarding the exclusion criteria, concomitant conditions that could affect anthropometric measurements include any congenital disease, which compromises a normal growth independently of the nutritional intake (Examples; Down syndrome, achondroplasia). Conditions that could affect the haemoglobin measurement or other parameters in the complete blood count include haematological, infectious or any disease which physiopathology may influence the interpretation of these results in the context of our study (Examples; Sickle cell disease, thalassemia, haemolytic anaemia, solid tumour cancers, haematological neoplasm, paludism), and conditions that could predispose to pneumonia include diseases which may produce an increased risk of infections (Examples; haematological neoplasm, inherited and acquired immunodeficiencies, immunosuppressive therapy) It is true that without specific evaluation of iron profile is not possible to establish with a high certainty iron deficiency. However, in our study are some relevant considerations; we excluded patients with a current diagnosis of other types of anaemia (haemolytic anaemia), chronic inflammatory conditions, cancer, and haematological neoplasms. All these factors reduce the possible causes of anaemia, and in the light that nutritional anaemia is the most frequent type in Latin America, it is reasonable to think that iron deficiency may be the leading cause in our patients. When we think about microcytic anaemia, as this was the most frequent type in our study, and as we excluded thalassemia, chronic inflammatory disease, and was no evidence of lead poisoning or newly diagnosed thalassemia in our patients, the possibility of iron deficiency increases. Although, at the end of our paper, we recommend the use of iron profile in new studies. I should highlight that we did not report cases of macrocytic anaemia. The question regarding the use of nutritional supplements is interesting, especially considering that in Ecuador, the governmental normative of micronutrients supplementation with the product "Chis Paz" consider children between 6 and 24 months of age. In our study, there was no possibility to know if the patients receive any supplementation. But, it would be useful to include this variable in prospective studies. Subclinical infections and iron deficiency anaemia have been described extensively in subclinical malaria, in other types of subclinical infections and even acute infections, there are still debate.
Vitamin B12 Deficiency Presenting as Pancytopenia with Hepatosplenomegaly in an Infant Authors
(Nepal Paediatric Society (JNPS), 2020) Gauchan, Prerana; Giri, Bishnu Rath; Bhatta, Uma
Abstract: Deficiency of vitamin B12 due to nutritional insufficiency is common in developing part of world. Serum vitamin B12 level in infants is determined by the foetal storage during pregnancy. Therefore, evaluation on vitamin B12 level during pregnancy is essential for prevention of vitamin B12 deficiency in infancy. Here we report a vitamin B12 deficient infant who presented with hepatosplenomegaly with pancytopenia including normocytic anaemia and circulating atypical cells. It is also a reminder to clinicians about the uncommon manifestation of vitamin B12 deficiency which mimics haematological malignancy.
Seizure as a Presentation of Permanent Neonatal Diabetes Mellitus due to Mutation in KCNJ11 Gene: A Case Report
(Nepal Paediatric Society (JNPS), 2020) Patnaik, Sibabratta; Sahoo, Bandya; Jain, Mukesh Kumar; Mishra, Reshmi; Behera, Jyotiranjan
Abstract: Diabetes Mellitus in first six months of life is usually monogenic and is referred to as neonatal diabetes mellitus. The incidence of neonatal diabetes is extremely rare and varies from 1:89000 to 1:400000 live births. We report a two months old baby presenting with repeated seizures; on evaluation found to have diabetic ketoacidosis and initially managed with IV insulin infusion. Genetic study revealed heterozygous mutation, p. Valin 252 Leu in KCNJ 11 gene. This mutation suggests responsiveness to oral glibenclamide. The baby has responded to therapy. Seizure as a presenting feature for hyperglycemia is a rare entity
Parvovirus Encephalitis: Looking Through the Eyes
(Nepal Paediatric Society (JNPS), 2020) Maity, Debasis; Biswas, Arnab; Mitra, Sonali
Abstract: Parvovirus B19 usually causes less severe symptomatic infections. Its severity depends upon the affected cells of a particular organ system. Whereas diseases affecting the skin and haematological systems tend to be milder, affection of CNS may turn serious. Direct invasion or NS1 toxicity of Parvo virus B19 has been postulated behind CNS tropism. Here we depict Parvovirus B19 causing acute encephalitis and ophthalmoplegia in an immunocompetent male child, taking an eventful course, responded with IVIG & steroids, reversed the symptoms except some VEP abnormalities. This explores the need for timely intervention with immunotherapy in such cases to prevent permanent sequelae.
Community-Acquired Pseudomonas Aeruginosa Wrist Joint Arthritis in a Child - A Case Report
(Nepal Paediatric Society (JNPS), 2020) Jangid, Manoj Kumar; Selim, Mohamad Ahmed
Abstract: Pseudomonas aeruginosa is a rare cause of bone and joint infection in an immunocompetent child. Rapid diagnosis and prompt therapy are required to prevent serious joint damage. We hereby present our experience with a case of septic arthritis involving distal radioulnar joint with associated distal radius osteomyelitis in a previously healthy six years old girl who presented with fever, swelling and pain of the right lower forearm. Pseudomonas aeruginosa was isolated from both joint fluid and blood. The child was successfully treated with a combination of surgical debridement and two weeks of intravenous and four weeks of oral antibiotic therapy.
The Economic burden of Neonatal Intensive Care Unit Admission at a Community Hospital of Central Nepal
(Nepal Paediatric Society (JNPS), 2020) Sharma, Samana; Chapagain, Ram Hari; Pathak, Om Krishna; Gupta, Arun; Rai, Kavi Raj; Karn, Shruti; Sah, Sandeep Kumar
Abstract: Introduction: Neonatal sepsis is the commonest cause of neonatal morbidity and mortality and remains a major public health problem especially in developing countries. It is one of the most common causes for admission to neonatal units. The objective of this study was to evaluate the cost of care of neonates admitted in Neonatal Intensive Care Unit. It also compared the cost of care of neonates with sepsis and those with non-sepsis along with the duration of hospital stay and its correlation. Method: A hospital based prospective cross-sectional observational study was carried out over a period of one year. All the neonates admitted at NICU and fulfilling the inclusion criteria formed the study population. Total cost was calculated as the summation of direct and indirect cost. Normally distributed data was analyzed using the Student’s t-test, non-normally distributed data using Mann-Whitney U test. P-value < 0.05 was taken to be statistically significant. Result: Direct cost comprises more than two third of the cost. The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The cost for the ones with sepsis was USD 226.30 (Range 172.19-291.34) and 174.02 (Range 99.67-221.96) in non-sepsis. The mean duration of stay in NICU of the ones having sepsis was 6.6 days and 4.4 days in non-sepsis. Conclusion: The median total cost of care of neonates admitted in NICU was USD 222.66 (Range 169.52-280.03). The duration of stay and the total cost of treatment with sepsis are higher than those with non-sepsis.
Study on Association of Serum Ferritin With Thyroid Profile And Oral Glucose Tolerance Test in Thalassemia Major Children
(Nepal Paediatric Society (JNPS), 2020) Khan, Sudip; Saha, Sudip; Pal, Partha Pratim; Bera, Aparajita; Birua, Shyama
Abstract: Introduction: The free iron and haemosiderosis-induced damage of the endocrine glands cause endocrinopathies such as abnormal glucose tolerance and hypothyroidism in transfusion - dependent beta-thalassemia major patients. Our objective was to study the association of serum ferritin level with thyroid dysfunctions; abnormal blood glucose tolerance and to see if they appear in the earlier period of life. Methods: This cross-sectional study was done among thalassemia major children of two to 12 years in a tertiary care hospital, Kolkata, India. A pre-designed proforma was filled. Serum ferritin, fT4, TSH level, and oral glucose tolerance test (OGTT) were measured at presentation and noted in proforma. Results: A total of 80 thalassemic children were studied. Fiftieth percentile cut off value (1414 ng/ml) of serum ferritin was found to be significant with associated variables like normal fT4, TSH, and OGTT. Out of all study subjects, 39 (51.3%) of normal fT4, 39 (54.9%) of normal TSH and 39 (52.0%) of normal OGTT had ferritin < 50th percentile (P < 0.05). Nine (11.3%) children had abnormal thyroid profiles and five (6.3%) children had abnormal OGTT having ferritin > 2000 ng/ml. At a cut off value of ferritin level > 1414 ng/ml, fT4, TSH and OGTT showed significant abnormality (p < 0.05 with df 1). Conclusions: Ferritin is a good indirect marker to assess the risk of endocrine abnormality in thalassemic children. Frequent monitoring should be done once ferritin level crosses 1000 ng/ml. This will help in early detection and timely management of thalassemia related endocrinopathies.
Morbidity and Mortality Pattern of Patients Admitted into Paediatric Intensive Care Unit of Tertiary Level Hospital of Nepal
(Nepal Paediatric Society (JNPS), 2020) Shrestha, Anil Kumar; Bhattarai, Susan; Paudel, Prajwal; Basel, Prem Lal
Abstract: Introduction: The paediatric intensive care unit (PICU) takes care of critically ill paediatric patients. Regular evaluation of the outcomes of patients admitted to PICU is important to assess the effectiveness of various interventions. This study aimed to find the morbidity and mortality pattern of patients admitted to PICU of tertiary level Paediatric hospital of Nepal. Methods: We conducted a retrospective, cross sectional observational study using the records of all the patients admitted to PICU of a tertiary level hospital from January 2017 to August 2017. We collected data on age, sex, geographical distribution, duration of PICU stay and the morbidity and mortality outcomes. Outcome is classified as transfer to ward, leave against medical advice (LAMA) and death. Data were analysed descriptively using SPSS version 23. Results: Out of 358 patients admitted to PICU, the mean age was 1.83 years. Majority were infants (54.5%) with male:female ratio of 1.8:1. The major causes of PICU admission were respiratory disease (27.7%) followed by CNS disease (19.6%) and infections (17.3%). The average length of stay was 6.27 days. Overall mortality was 22.7%. Conclusion: Respiratory infections were the primary cause of PICU admission and overall mortality rate was high at 22.7%. However, mortality rate was even worse for patients with multi-system involvement. We need prospective studies to examine the underlying reasons for mortality among patients with multi-system involvement.
Effectiveness of Glycerin Magnesium Sulphate Versus Heparin Benzyl Nicotinate Application Among Children with Phlebitis
(Nepal Paediatric Society (JNPS), 2020) Dahal, Akriti Shree; Tuitui, Roshani; Shrestha, Purna Devi; Sharma, Bharati; Acharya, Sharada; Dahal, Priyanka
Abstract: Introduction: Phlebitis is the most common complication of intravenous infusion therapy. Incidence of phlebitis in children receiving intravenous therapy has been reported to be as high as 71.25%. The study was done to find out the effectiveness of glycerin magnesium sulphate versus heparin benzyl nicotinate application in children with phlebitis. Methods: A pre-post control group design was used. A total of 43 subjects were randomly assigned into two groups [22 in experimental (glycerin magnesium sulphate application) and 21 in control (heparin benzyl nicotinate application) group] by lottery method. Data was collected using Modified Visual Infusion Phlebitis (VIP) Score. Results: The comparison between VIP score was based on observations made before the interventions and at 12, 24, 36 and 48 hours after the intervention. Independent t tests showed significant difference in reduction of VIP score in experimental and control group after 12 hours and 24 hours of intervention. The study demonstrated that there is no statistically significant difference in reduction of VIP score among the subjects in experimental and control group at 12 hours (p = 0.219), 24 hours (p = 0.349), 36 hours (p = 0.695) and 48 hours (p = 0.424) after the intervention. Conclusion: The study concludes that both glycerin magnesium sulphate and heparin benzyl nicotinate can be used effectively among children with phlebitis. However, after 24 hours of phlebitis, an alternative intervention needs to be used.
Clinical and Immunological Spectrum of Systemic Lupus Erythematosus in Children
(Nepal Paediatric Society (JNPS), 2020) Kini, Sandesh; Y, Ramesh Bhat; Thunga, Chennakeshava; Shashidhara, Sowmya; Anand, Akshatha
Abstract: Introduction: Systemic Lupus Erythematosus (SLE) is an auto immune disorder affecting mainly adolescent females and young women of reproductive age. The disease is characterised by widespread inflammation of blood vessels and connective tissues due to the presence of anti-nuclear antibodies (ANA). There are limited number of studies from South India on paediatric lupus. Our objectives were to study the clinical and immunological features of childhood SLE along with treatment modalities and its outcome at the end of one year follow up. The correlation between various auto-antibodies and systemic involvement was also assessed. Methods: This was a retrospective observational study carried out in paediatric unit at a tertiary care centre in South India. Data was obtained through patient’s medical records. From April 2003 to April 2019, 32 children were diagnosed to have SLE as per the American college of Rheumatology 1997 criteria. Results: The study population included 32 children fulfilling the criteria. Female to male ratio was 4.3:1. The mean age at diagnosis was 11.52 years. The most common clinical manifestations were renal (87.5%) followed by haematological (81.3%), musculoskeletal (59.4%), mucocutaneous (53.1%) and nervous system (31.3%) involvement. All patients were positive for anti-nuclear antibodies. Anti-double stranded DNA (78.1%) was the most common auto-antibody profile followed by anti-ribosomal p protein (37.5%) and anti-nucleosome antibody (37.5%). During the follow up, 13 (40.6%) children attained complete remission, 10 (31.2%) went into partial remission and nine (28.1%) had persisting active disease. Conclusion: The clinical spectrum and outcome of paediatric SLE depends upon the age of presentation and number of organ systems involved at the time of diagnosis. Our study throws light on various aspects of SLE in children from developing countries like India.
Breastfeeding Pattern and its Associated Factors Among Mothers Working at Two Hospitals in Kathmandu
(Nepal Paediatric Society (JNPS), 2020) Basnet, Srijana; Shrestha, Merina; Adhikari, Tulashi; Shakya, Aarati
Abstract: Introduction: Breastfeeding practices of women working at the hospital are likely to be modified by the facilities and support that they receive at the hospital. This study was done to evaluate the breast feeding practices and to analyse important factors that are associated with exclusive breast feeding till six months among women working at hospitals in Kathmandu, Nepal Methods: A total of 110 women, with a young child between the ages of six months and two years were recruited from two hospitals in Kathmandu. A predesigned structured, interviewer-administered questionnaire was used for data collection. Results: The mean age of the mothers was 29.85 ± 3.68 years. Ninety seven (88.2%) women were aware about initiation of breastfeeding within first hour of birth but only 64 (58.2%) women could practice it. Most women 100 (90.9%) were aware about exclusive breastfeeding but only 18 (16.3%) could practice exclusive breastfeeding till six months. Mean duration of exclusive breastfeeding was 2.86 ± 2.00 months and 20 (18.2%) mothers practiced mixed feeding since birth. The participants whose babies had prelacteal feeding had significantly shorter duration of mean exclusive breast feed {1.92 ± 2.18 (S.D)} compared to those who did not have prelacteal feed {3.33 ± 1.74 (S.D)} (p = 0.001). Those who delivered by normal vaginal delivery, initiated breastfeeding within first hour of delivery, expressed breast milk and got feeding breaks were associated with longer duration of mean exclusive breast feed. Conclusion: The breast feeding practices among working women at hospital is quite low compared to national statistics on IYCF. Breast milk expression and feeding breaks for lactating working women could improve feeding practices.
A Cross Sectional Study to Assess Peak Expiratory Flow Rate in Healthy School Children for Establishment of Normative Data
(Nepal Paediatric Society (JNPS), 2020) Sharma, Rajeev; Kaur, Avneet; Gupta, Manish; Kaur, Amarpreet; Arora, Hobinder; Singh, Sukhpal
Abstract: Introduction: Peak Expiratory Flow Rate (PEFR) can be measured by cheap and portable instrument, peak flowmeter which is useful in detecting early asthmatic changes and monitoring the treatment response. Methods: This study was conducted on 1000 normal healthy children of nine to 14 years of age of either sex from various schools of Faridkot district in South West Punjab, India. Anthropometry was done and PEFR was measured using Mini Bell Peak Flow Meter. Linear regression analysis was done and normograms were constructed. Results: Linear regression equations were derived for PEFR with height, weight, BSA and BMI in boys and girls. The most significant correlation was seen with height (r = 0.527 in boys, r = 0.410 in girls) followed by body surface area (r = 0.506 in boys, r = 0.296 in girls). Body mass index had negative correlation (r = -0.200) with PEFR in girls. Nomograms were constructed on basis of linear regression equations of PEFR with height (-46.67 + 2.02 x height for boys, -12.64 + 1.50 x height for girls) and BSA (82.02 + 137.2 x BSA for boys, 96.61 + 88.11 x BSA for girls) Conclusion: There is need for nomogram for each region so that personal value of PEFR can be compared to normal reference population and also with predicted value from regression equation as PEFR varies from region to region. The nomograms and regression equations derived from this study can be useful for predicting normal values of PEFR of children of South West Punjab.

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