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Accidental Olanzapine Consumption in Children
(Nepal Paediatric Society (JNPS), 2017) Kumar, Kalenahalli Jagadish; Samatha, Aleti; Marda, Srikanth; Chaudhary, Divya
Abstract: Olanzapine is commonly used an atypical antipsychotic drug. Overdose is characterized by agitation, deep coma, blurred vision, myosis, respiratory depression and cardiovascular effects. Cardiovascular toxicity includes alterations in blood pressure, conduction disturbances like prolongation of the QRS/ QT intervals or ventricular dysrhythmias. We report two children with Olanzapine poisoning who presented with altered consciousness and one of them had ECG abnormality. Both of them recovered and discharged.
Variations of Dermatological Findings in New-Borns of a Community Hospital in Nepal
(Nepal Paediatric Society (JNPS), 2017) Shrestha, Asim; Shrestha, Smriti
Abstract: Introduction: Skin manifestations are common in neonates. The prevalence of skin changes and their association with neonatal and maternal factors are not adequately documented in Nepal. It is important to differentiate common benign skin lesions from infrequent skin changes that cause morbidity, requiring medical management. The objectives of this study were to determine the pattern of skin lesions in new-borns and their association with maternal and neonatal variables. Material and Methods: This was a prospective, cross-sectional study conducted in obstetric unit of the hospital from December 2016 to May 2017. Outborn babies and babies shifted to NICU were excluded. Results: A total of 935 new-borns were examined. The commonest skin lesions were Mongolian spot (66.7%), Erythema toxicum (46.6%), Milia (44.4%), Epstein pearls (26.4%) and Salmon patch (11.9%). Mothers aged 35 years or older (63.6%) had statistically significant association with Erythema toxicum (p=0.01). Erythema toxicum was more in primiparity, term pregnancy and caesarean section delivery. Milia was associated with male babies. Salmon patch was seen more in term pregnancy. Congenital melanocytic nevus, haemangioma and port-wine stain were noted in three, two and one new-borns respectively, which alter morbidity and hence are important to diagnose in time. Conclusion: We found that 93.8% of neonates had at one or more skin lesions. The majority of skin lesions were benign and transient. Erythema toxicum was seen commonly in mothers aged 35 and more. Salmon patch was seen more in term pregnancy.
Study of Correlation of Neonatal Outcomes with Gross Abnormalities of Placenta and Umbilical Cord
(Nepal Paediatric Society (JNPS), 2017) Nair, Bindu T; Raju, Uma
Abstract: Introduction: Perinatal outcome of new-borns is greatly influenced by abnormalities of placenta and umbilical cord. In most of the deliveries, whether home or institutional, the placenta and umbilical cords are discarded without examination. Due to paucity of information on abnormalities of placenta and cord, there is hardly any correlation with foetal outcomes. The aim was to study the correlation between the foetal outcome and the different types of abnormalities of placenta and umbilical cord. Materials and Methods: A prospective, cross-sectional, descriptive, randomised study was conducted from January 2016 to December 2016 in a tertiary care hospital in North India. The study was carried out on 1000 term singleton newborns. The placenta and umbilical cords were obtained from both normal and caesarean section deliveries. A proforma was used to gather data from the patients and new-borns. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20 (SPSS Inc, Chicago, IL, IBM version) along with Microsoft Excel (2010 version). Results: One thousand placentae and umbilical cords were examined of which high placental weight/birth weight ratio, gross anomalies of placenta (infarctions, calcifications and retro placental haematoma), marginal (battledore and velamentous) umbilical cord insertions, long umbilical cords and single umbilical artery were associated with negative foetal outcomes. Conclusions: There was a high incidence of adverse foetal outcome with placental and umbilical cord abnormalities. Education of our health personnel dealing with deliveries on the importance of proper examination of the placenta and umbilical cords should be emphasised and instituted upon.
Study of Anaemia in Children with Severe Acute Malnutrition
(Nepal Paediatric Society (JNPS), 2017) Dwivedi, Deepak; Singh, Veerendra; Singh, Jyoti; Sharma, Sangita
Abstract: Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children. Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0. Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent. Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.
Status Disclosure in HIV Infected Children in Abakaliki, Ebonyi State, Southeast, Nigeria
(Nepal Paediatric Society (JNPS), 2017) Orji, Maria-Lauretta; Onyire, Nnamdi Benson; Onwe, Emeka Ogah
Abstract: Introduction: The emotional and psychosocial issues surrounding HIV infection make status disclosure herculean task. Many caregivers are unwilling to disclose because they are afraid of possible unpleasant outcome. The objective of this study were to determine the prevalence rate of HIV status disclosure and possible effect on ART adherence. Material and Methods: It was a cross sectional study that involved consecutive recruitment of 94 confirmed HIV infected children aged 5-17 years. Structured questionnaire was used to obtain information on socio-demographic, disclosure and adherence. Assessment of adherence was done in the clinic by direct questioning and pill count. Results: A total of 31 (33.0%) have received a form of information regarding their HIV status. The mean age of disclosure was 12.48± 2.46 years. Majority (95.5%) of the children that received full information about their HIV status were adolescents. Circumstantial disclosure was seen in 25 (80.6%) out of the 31 subjects. A total of 61.3% of HIV status disclosure was done in hospital setting by health workers and 81.8% of subjects that were given full information about HIV were from health workers in a hospital setting. There was however no relationship between adherence to ART and status disclosure (p= 0.832). Conclusion: Age of status disclosure was rather late in this study and majority of the disclosure were consequent to prevailing circumstances in the subjects’ life. A step-wise approach to disclosure that entailed giving age dependent information as from the age of seven years is therefore recommended
Observer Variability in Head Circumference Measurement Using Routine Versus Non-Stretchable Tapes in Children
(Nepal Paediatric Society (JNPS), 2017) Thakkar, Pareshkumar Amrutlal; Yagnik, Kinjal; Parmar, Niyati T; Das, Rashmi Ranjan; Thakkar, Ukti P
Abstract: Introduction: Observer variability is known in taking head circumference. Stretchable tapes do not provide accurate results after being used repeatedly. The aim of this study was to compare the intra-observer and inter-observer variability in measuring head circumference (HC) or occipito-frontal circumference (OFC) by using routine stretchable and non-stretchable tapes. Material and Methods: In this crosss-ectional study, all stable children in the age group of 1 month to 5 years attending the pediatric department of a tertiary care teaching hospital over six months period were included. The main outcome measures were: intra-observer & inter-observer variability in HC measurements by routinely used stretchable and non-stretchable tapes, and accuracy of readings of old stretchable tapes. Results: A total of 301 children were included. There was good correlation in the measurements taken by two observers (inter-observer), and three different readings of the same observer (intra-observer), correlation coefficient being > 0.99. With stretchable tape, 26% subjects had both intra-observer and inter-observer variability of ≥ 0.5 cm, which was 9.9% and 15.9% with the use of non-stretchable tape, respectively. Non-stretchable tape compared to stretchable tape had significantly less intra-observer (p < 0.001) and inter-observer variability (p=0.038). Conclusions: Observer variability was significantly less with the use of non-stretchable tapes compared to routinely used stretchable tapes. Old stretchable tapes used repeatedly over certain periods were not able to provide accurate readings.
Neonatal Mortality and Morbidity in a Tertiary Care Hospital of Coastal South India
(Nepal Paediatric Society (JNPS), 2017) Kannan, Raja; Rao, Suchetha; Mithra, Prasanna; Rajesh, SM; Unnikrishnan, Bhaskaran; Rekha, T
Abstract: Correction: On 13th June, Prasanna Mithra was added as an author of this paper. Introduction: Progress in new-born survival has been slow. There is a variation in neonatal death rates across states and geographical region of a country. Understanding the pattern of mortality is essential in improving new-born survival. This study was conducted to study the mortality and morbidity profile in Neonatal Intensive Care Unit (NICU) of a university teaching hospital. Material and Methods: This was a retrospective descriptive study including records of all neonates admitted in NICU from January 2015 to December 2016. Results 3623 neonates were admitted during the study period. Majority were preterm and low birth weight babies. Neonatal jaundice (41.4%) was the leading cause of admission. Major cause of morbidity was sepsis (26.2%). Average duration of stay were higher in out borns (8.4 days) compared to inborn (6.5 days) neonates. Among mortality a higher male predominance was seen. Neonatal sepsis (36.3%) was the single most common cause of mortality followed by respiratory distress syndrome (27.4%) and congenital malformations (18.6%). Out born neonates which were self-transported had higher mortality rate than transported by ambulance. Conclusion This study identifies sepsis, prematurity and low birth weight as the major causes of morbidity. Sepsis, respiratory distress syndrome and congenital malformations were the leading causes of mortality Understanding causes of neonatal mortality may help to implement interventions to promote new-born survival.
Fulminant Hepatitis A in Children, its Incidence, Presentation, Complications and Outcome: A Study from Eastern India
(Nepal Paediatric Society (JNPS), 2017) Mohanty, Niranjan; Shubhankar, Mishra; Sambedana, Panigrahi
Abstract: Introduction: Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. The disease is usually mild and self-limited, and complications are very rare. But sometimes hepatitis A can cause acute liver failure (ALF), a severe, life-threatening condition. The objective was to do clinicoepidemiological evaluation of hepatitis A patients who were admitted to the In patients department of our hospital along with analyze the complications seen in the disease. Materials and Methods: It was a prospective study, done in Department of paediatrics, Maharaja Krushna Chandra Gajapati from May 2014-April 2016. Total number of patients was 80. Patients having history or features of prodromal symptoms like fever, nausea, vomiting, anorexia, yellowish discoloration of urine and body, pain abdomen, change in mental status and coagulopathy with suspicion of acute hepatitis (within 8 wks) with positive IgM for hepatitis A were included in the group. Statistical analysis was done by SPSS software version 20. Results: Total number of patients was 80. Mean age of hospitalisation was 5.5 years. 90% children were having jaundice. 85% patients were having liver enzyme high. Most common complication was gallbladder wall thickening followed by ascitis, pleural effusion etc. Encephalopathy was observed in three patients. Total three patients died. Maximum death was seen in infancy with delay in hospitalisation. Conclusions: Viral hepatitis due to hepatitis A is a benign disease. But fulminant hepatic failure due to it is not uncommon. The lesser the age, presence of cardinal features like jaundice may not be apparent. So clinicians must be conscious of these lethal complications while managing a child of probable viral hepatitis. This study will raise the consciousness of urgency of vaccination for hepatitis A, which is thought to be sparingly optional for many parents as well as doctors.
Comparison of Oral Versus Normal and High-Dose Rectal Paracetamol in the Treatment of Fever in Children
(Nepal Paediatric Society (JNPS), 2017) Bastola, Ramchandra; Shrestha, Shree Krishna; Bastola, Bhawana Sigdel; Shrestha, Dhurba; Sharma, Yograj
Abstract: Correction: On 13th June 2018 the author Yog Raj Sharma was changed to Yograj Sharma Introduction: Paracetamol is the most commonly used drug in paediatrics with the standard dose (15 mg/kg) of oral and rectal paracetamol preparations interchangeably is used to treat fever in children, assuming they have equal antipyretic effect. We did a study to compare the effectiveness of two different rectal doses of paracetamol: 15 mg/kg and 30 mg/kg to that of a standard oral dose of 15 mg/kg. Material and Methods: This is a prospective, interventional, randomized controlled study done in Western Regional Hospital, Nepal in which 192 children with fever aged six months to six years. Study duration was August 2015 to October 2015. The sample included 63 in the oral normal dose group (15mg/kg), 59 in normal dose rectal group (15mg/kg) and 70 in high dose (30mg/kg) rectal paracetamol group. Temperature was recorded before and after the administration of paracetamol at an interval of 30, 60, 120, and 180 minutes by using a digital thermometer. Results: Total of 59 patients received 15 mg/kg rectal Paracetamol (group A), 70 received 30 mg/kg rectal Paracetamol (group B), and 63 received 15 mg/kg oral Paracetamol (group C). Mean temperature before giving medication in Group A, B and C respectively were 101.7° F, 101.9° F and 101.5° F. At 30 min temperature was 100.8° F, 100.8° F and 100.66° F, while at 60 minutes temperature was 99.9° F, 99.7° F, and 99.7° F respectively for Group A,B and C. But at 120 and 180 minutes temperature decreased significantly who got rectal 30 mg/kg of paracetamol. Conclusions: Rectal paracetamol in a dose of 30mg/kg is more effective than oral paracetamol in a dose of 15 mg/kg. However oral paracetamol given in a dose of 15 mg/ kg is more effective than rectal paracetamol in a same dose.
Combination of Alarm-intervention and Reboxetine in Therapy- Resistant Enuresis
(Nepal Paediatric Society (JNPS), 2017) Kosilov, Kirill; Kuzina, Irina; Gainullina, Yuliya; Kuznetsov, Vladimir; Kosilova, Liliya; Karashchuk, Elena Viktorovna; Prokofyeva, Alexandra; Loparev, Sergay
Abstract: Introduction: The first-line treatments of primary monosymptomatic night enuresis (PMNE) are alarm intervention and desmopressin. Some patients are resistant to these modes of treatment. Therefore Reboxetine has been used to treat PMNE in these scenarios in recent years and published in many studies. The aim of the study was to determine effectiveness and safety of combination of Alarm intervention and Reboxetine, to treat patients with therapyresistant enuresis. Material and Methods: Two hundred and nineteen children of both sexes were participated in the experiment (average age, 11.3 years). Participants were divided into three groups: Group A (71 patients, Alarm intervention), Group B (79 patients, Reboxetine as monotherapy), Group C (69 patients, Alarm intervention + Reboxetine). The duration of treatment was twelve weeks, followed by follow-up period of twelve weeks to see efficacy. Result: There was no significant change in number of enuresis episodes per week before and after treatment in a group B. The number of enuresis episodes per a week (weekly) in a group C reached: before treatment 5.3 (1.5), after treatment 1.0 (0.8), 3 three months after the end of treatment 0.7 (0.7). The percentage of patients with PMNE in a group C was significantly less immediately after the course of treatment (17.4%), and three months after treatment (24.6%). Conclusion: Combined treatment of therapy-resistant enuresis with use of Alarm Intervention and Reboxetine gives a high percentage of cured patients both immediately after therapy (82.6%) and three months after the end (75.4%).
Assessment of Nutritional Status of Children Attending Paediatrics OPD of a Tertiary Care Hospital in Eastern Nepal
(Nepal Paediatric Society (JNPS), 2017) Thakur, Jitendra; Bhatta, Nisha Keshary; Poudel, Prakash; Shah, Gouri Shankar; Singh, Rupa Rajbandari
Abstract: Introduction: Malnutrition is one of the major health problem worldwide, especially in developing world and so is in Nepal, the causes being numerous. The objectives of this study were to assess the nutritional status of children attending paediatric OPD of BPKIHS and to find relation of the nutritional status with different factors. Material and Methods: This descriptive cross sectional study was done by face to face interviews using semi-structured questionnaire and anthropometric variables were recorded. Data of total 192 children was analysed by descriptive statistics. p-value <0.05 was considered significant. Results: According to IAP classification 50.52% were malnourished [grade I 65.97%, grade II 26.8%, grade III 7.21%]. According to WHO classification 47.39% stuntedmoderate 89%, severe 11% and 9.89% wasted [moderate 94.73%, severe 5.26%]. Female sex, low education level in mother, low economic status, unavailability of exclusive breast feeding, low birth spacing and hospitalization were significantly associated with malnutrition. Conclusion: Malnutrition is common in children visiting paediatric OPD of BPKIHS. Female sex, maternal illiteracy, poverty, early weaning, birth spacing and hospitalization in past were major risk factors for malnutrition.
Right Coronary Artery Dominance in Cadaveric Human Hearts in Department of Anatomy of a Medical College: A Descriptive Cross-sectional Study
(Nepal Medical Association, 2022) Tiwari, Nripendra; Budhathoki, Deepesh
Abstract Introduction: Cardiac coronary dominance plays a significant role in different clinical conditions and diseases of the heart. As the people of developing and developed nations are having global coronary artery diseases, it is mandatory to have knowledge of coronary artery diseases including cardiac coronary dominance. The aim of this study is to find out the prevalence of the right coronary artery dominance in cadaveric human hearts in a medical college. Methods: A descriptive cross-sectional study was conducted among all 52 preserved hearts as well as the heart isolated from cadavers obtained from the teaching hospital. The study was conducted from 24th June, 2020 to 24th December, 2020 after obtaining ethical clearance from the Institutional Review Committee (Reference number: 2306202004). All cadaveric heart specimens were laelled with numbers and photographed for easy description of anatomical variation related to the coronary artery. Data were entered into Microsoft Excel 2007 and analysed using Statistical Package for the Social Sciences version 20.0. Point estimate at 90% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 52 undissected isolated cadaveric hearts, the right cardiac dominance was found in 42 (80.76%) (71.77-89.75 at 90% Confidence Interval). The mean diameter of the right coronary artery was found to be 4.06±0.55 mm. Conclusions: The prevalence of right cardiac dominance in isolated cadaveric hearts was similar to the studies done in a similar setting.
Scrub Typhus in Children Authors
(Nepal Paediatric Society (JNPS), 2018) Zainab, Madiha; Gupta, Atul Kumar; Guha, Suparna
Abstract: Introduction: Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli Orientia tsutsugamushi. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatment Material and Methods: Record files of all patients diagnosed with positive Weil felix (OXK>1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years. Results: Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever <1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline. Conclusion: So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.
Useful Daily Behaviour to Remove Asymptomatic Bacteriuria in an Eight Years Age Girl with Spina Bifida Occulta
(Nepal Paediatric Society (JNPS), 2018) Taniguchi, Kazuto; Nakashima, Takema; Ichiyama, Yasunobu; Yamamoto, Hirokazu; Uemichi, Kazuyasu
Abstract: Asymptomatic bacteriuria is occasionally found in healthy children. However, the fact that spina bifida occulta can be hidden in asymptomatic bacteriuria is not well known. We report an 8-year-old girl with asymptomatic bacteriuria. Spina bifida occulta was revealed by radiological examinations. Simple daily behavior, consisting of keeping the genitals clean, rehydrating regularly and not prolonging urination, was useful for removing asymptomatic bacteriuria in spina bifida occulta.
Salmonella Sepsis presenting as Early Onset Neonatal Sepsis
(Nepal Paediatric Society (JNPS), 2018) Shrestha, Nipun; Shrestha, Dhruba
Abstract: Neonatal sepsis is one of the feared cause of neonatal death in both term and preterm infants, leading up to 30% of neonatal death in developing countries. Salmonella sepsis is one of the uncommon causes of early onset neonatal sepsis. Here we present a case of early onset neonatal sepsis due to Salmonella species. Baby was delivered vaginally with good Apgar score. Within few hours of birth, baby developed respiratory distress and was admitted with empirical antibiotics. The blood culture showed the growth of Salmonella species. Child was treated with IV antibiotics and responded well to it and was discharged home without complication.
Unintentional Injuries among Under-Five Children in Mid-Western Development Region, Nepal: A Cross-Sectional Study
(Nepal Paediatric Society (JNPS), 2018) Kafle, Bharat; Yadav, Uday Narayan; Marahatta, Sujan Babu; Mishra, Durga; Pant, Narayan Dutt
Abstract: Introduction: Unintentional injury is the biggest threat to the survival of the under-five children, which impact is immeasurable to families and often entire communities. The objectives of this study were to assess the prevalence of unintentional injuries among under-five children and the factors associated with it. Material and Methods: A facility-based quantitative cross-sectional study was conducted from August 2016 to January 2017. Multistage time frame convenient sampling method was applied to collect the data from 259 mothers of under-five children in the selected district of Mid-Western Development region of Nepal. The data was collected from 10 rural health facilities and two from urban setting using a semi-structured questionnaire. An analysis was performed using SPSS ver.15. Results: The prevalence of unintentional injuries was found to be 33.20 % among the under-five children. The present study showed that ecological belt, the age of mothers, education of mothers, education of fathers, the occupation of mothers, the occupation of fathers, family income quintiles, household type, numbers of a sibling, age and gender of children were significant factors associated with unintentional injuries among under-five children. More than 70% of the respondents were not aware of how to provide first aid care to the children with respect to unintentional injury. Conclusion: This study highlights the burden of unintentional injuries among under-five children in mid-western development region of Nepal. Intervention targeting multifactorial issues in line with all type of fall injuries, burns and injuries with the use of sharp objects might be helpful to tackle the problems.
Subcutaneous Adiposity and Nutritional Status Among Children of Eastern-India
(Nepal Paediatric Society (JNPS), 2018) Debnath, Sampriti; Mondal, Nitish; Sen, Jaydip
Abstract: Introduction: Skinfold thickness is now considered to be an important indicator of body composition and nutritional status. Assessment of subcutaneous adiposity is becoming very important due to increasing trend of overweight and obesity. The objectives of the present study were to determine age-sex specific subcutaneous adiposity using skinfold thicknesses and its use in assessment of nutritional status among children of Eastern-India. Material and Methods: The investigation was carried out among 1262 children (619 boys; 643 girls) aged 5–12 years of Darjeeling district, West Bengal. Anthropometric measurements of skinfold thickness were recorded using standard procedures. Age-sex specific smooth percentile curves of skinfold thickness were derived using the L, M and S model. Results: Sexual dimorphism was observed in TSF, SSF, SISF, PBF, Σ2SKF and Σ4SKF measurements between sexes in children (p<0.05). Age-sex specific mean values of skinfold thicknesses of TSF, SSF, SISF and PBF of girls were observed to be significantly higher than boys (p<0.05). The age-sex specific mean values of BSF, TSF, SSF, SISF, Σ4SKF and PBF did not show any age-specific trend in children. Comparison with the NHANES-III data showed poor attainment of subcutaneous adiposity and nutritional status. Conclusion: Results of the present study showed the age-sex specific variations in subcutaneous adiposity pattern in children. The comparisons of skinfold thicknesses with references showed unsatisfactory nutritional status among children. These findings are important for future investigations in field, epidemiological and clinical settings.
Paediatric RIFLE and AKIN Classification for Detection and Outcome of Acute Kidney Injury in Critically Sick Children. Which is Better? A Prospective Cohort Study Authors
(Nepal Paediatric Society (JNPS), 2018) Thakkar, Pareshkumar A; Pandey, Neha; Shringarpure, Kalpita S
Abstract: Introduction: Acute Kidney Injury (AKI) is becoming increasingly common in both developed and developing countries with significant morbidity and mortality. However, the precise incidence of AKI in children is not well known due to lack of uniformity in various definitions of AKI. This study was carried out to compare incidence of AKI using two different definitions-pRIFLE and AKIN. Material and Methods: This was a prospective cohort study conducted in the paediatric ICU of a tertiary care government hospital attached to a Medical College of Central Gujarat, India. Total 115 critically ill paediatric patients aged one month to 12 years were included in the study. Serum Creatinine (SCr) levels were tested and Glomerular filtration rate (GFR) was calculated using the Schwartz formula at 0, 6, 12, 24 and 48 hours of admission. Patients were assessed for AKI using AKIN and pRIFLE classification. Results: Incidence of AKI was 80% and 66.9% in critically ill children, as classified by pRIFLE and AKIN classification respectively. Paediatric RIFLE labelled 15 more patients as AKI which were classified as non-AKI by AKIN criteria. There was moderate agreement in between the two classifications to diagnose stages of AKI (Kappa 0.474, CI- 0.359 to 0.589). With increasing grades of AKI, mortality was higher using pRIFLE staging; unlike the AKIN staging wherein this was not observed. Conclusion: The pRIFLE criteria detects a greater number of cases of AKI compared to AKIN criteria. Based on severity staging, pRIFLE is more consistent with adverse outcome of patients with AKI compared to AKIN classification. Overall mortality is significant high in patients with AKI compared to patients without AKI using any of the classifications.
Neuroimaging in Children with Cerebral Palsy: A Study Conducted at Tertiary Level Paediatric Hospital of Nepal
(Nepal Paediatric Society (JNPS), 2018) Manandhar, Bina Prajapati; Singh, Usha; Khatun, Najala
Abstract: Introduction: In Nepal, cerebral palsy (CP) is the common cause of severe motor disability. However, only few descriptive studies related to it have been conducted, but those did not incorporate neuroimaging in CP. Thus, the objective of this study is to identify clinical and radiological profile of children diagnosed with CP at a tertiary level paediatric hospital of Nepal. Material and Methods: This study was carried out at Kanti Children's Hospital and the study utilized data of children diagnosed with CP from September 2015- April 2017. Results: A total of 100 children were diagnosed with CP. Spastic CP was the most common in children (71%), followed by mixed (21%) and dyskinetic (8%). Majority of the children were male (74%), born at term (90%) and delivered at institution (80%). Neuroimaging abnormality was found in 66% of cases which included brain malformation (2%), periventricular white matter abnormalities (23%), cortical or deep grey matter lesions (37%) and miscellaneous (4%). The results of this study also showed significant association between variables such as birth weight and birth asphyxia with type of neuroimaging findings. Conclusion: Neuroimaging is helpful for diagnosis of CP and also useful for parents and physicians to understand children condition. Hence, further studies related to neuroimaging in CP are important to better understand it in detail.
Dietary Practices of Lactating Women and Nutritional Status of Children in Baglung District, Nepal Authors
(Nepal Paediatric Society (JNPS), 2018) Gautam, Usha; Yadav, Dipendra Kumar
Abstract: Introduction: Breastfeeding success depends on both mother and child. There is high energy requirement to produce breast milk, which is wholesome food for under 6 months children and then complementary foods are introduced to child. Inadequate feeding practices affect nutritional status of children. The main aim of this study was to measure the dietary practices of lactating women and nutritional status of their children. Material and Methods: A cross sectional study was conducted among 343 lactating women and under two years children of Baglung district. Random sampling technique was applied to select the participants. Face to face interview was conducted among women to collect the data and anthropometric measurement was performed among the children. Data were entered in EPI-DATA version 3.2 and exported to Statistical Package for Social Sciences (SPSS version 17.0) for further analysis. Results: Only 5.2% of mother had taken additional two meals per day and energy intake of 31.8% of women was met. Dietary practices of mothers were not associated with nutritional status of children. Breastfeeding practice was nearly universal (99.7%). Bulks (91.8%) of children were put into breast for breast feeding within first hour of birth. Exclusive breastfeeding rate was 34.5%. Bottle feeding was practiced by 15.6% of women. Less than half (40%) of 6-23 months children (n=174) had achieved satisfactory feeding practice (minimum meal frequency and minimum dietary diversity). The rate of wasting (n=180), stunting (n=180) and underweight (n=343) was 10%, 22.2% and 9.3% respectively. Feeding practice to children was associated with wasting and stunting. Conclusion: Dietary practice of women and feeding practice to their children was not satisfactory. Dietary practice of women was not associated with nutritional status of children but feeding practice was associated with their nutritional status. The rate of stunting, wasting and underweight was high.

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