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Infantile Seborrheic Dermatitis
(Nepal Paediatric Society (JNPS), 2015) Pandita, Aakash; Sharma, Deepak; Murki, Srinivas; Pratap, Tejo
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Comparison of Feeding Behaviours in Term Infants and Preterm Infants (30 To 34 Weeks) at Six Months Corrected Age
(Nepal Paediatric Society (JNPS), 2015) Philip, Abhishek Koshy; Kumar, KV Vijay
Abstract: Feeding is explained as the placement, manipulation and mastication of food in the oral cavity prior to initiation of the swallow. In infants, feeding is considered as innate behaviour. Literature provides evidences connecting successful feeding as a predictor for normal communication. This study aimed at comparing the feeding behaviours of term and preterm infants (30 to 34 weeks) at six months corrected age. A questionnaire was developed based on milestones on feeding development. This consisted information on mode of feeding, difficulties in feeding and feeding behaviour. The questionnaire was administered on parents of 50 infants (25 term and 25 preterm infants). Significant difference in feeding behaviour was observed between the term and preterm infants at six months of age. This long term feeding difficulty may be pronounced during the transitional feeding. Hence the need for Speech Language Pathologist to evaluate feeding behaviour at transitional period for preterm infants becomes necessary.
Rickets with Alopecia Signals Vitamin D Dependent Rickets Type II
(Nepal Paediatric Society (JNPS), 2015) Yadav, Shankar Prasad; Bhatta, Nisha Keshary
Abstract: Vitamin D-dependent rickets type II is a rare autosomal recessive disorder. We report 27 months female child with classical rachitic changes, very high level of 25-hydroxy Vitamin D, 1,25 (OH)2D and markedly elevated serum Alkaline phosphatase. Very high dose of oral calcium and vitamin D3 was prescribed with minor improvement in skeletal features and alopecia. This case report hints the physician to diagnose and manage Vitamin D-dependent rickets type II, when rachitic changes are associated with alopecia.
Rare Association of Bilateral Anotia with Congenital Facial Palsy
(Nepal Paediatric Society (JNPS), 2015) Bhatnagar, Ruchika; Prasad, Prem Lochan
Abstract: Anotia is a birth defect and is associated with facial palsy and congenital heart defect as various presentation of cardiofacial syndrome. Herein we report a case of bilateral anotia and unilateral congenital facial palsy without congenital heart disease. It may occur due to single gene abnormality, teratogenic effect of maternal ingestion of thalidomide, retinoic acid, misoprostol or maternal diabetes, dietary lack of carbohydrates and folate.
Protein S Deficiency - An Uncommon Cause with Common Presentation
(Nepal Paediatric Society (JNPS), 2015) Kora, Nabanita; Das, Rajib; Som, Sabyasachi; Laha, Sumanta; Bannerji, Nayan; Rana, Kriti S
Abstract: Correction: The correct PDF for this article was loaded on 9th March 2017. We offer our sincere apologies for having the wrong PDF loaded for this article. Stroke in child poses a major health problem. Thrombophilic factors have been implicated in 4-8% of young stroke worldwide. Protein S deficiency is a very rare cause of stroke. A few cases have been reported in literature. We are reporting a rare case of protein S deficiency causing stroke in a two year old child.
Propranolol Therapy for an Abdominal Giant Haemangioma in a Neonate
(Nepal Paediatric Society (JNPS), 2015) Docx, Martine Karine Francine; Vandenberghe, P; Broek, Dr Van De; Govaert, P
Abstract: A one day old Moroccan boy was admitted to our neonatal unit with a giant tuberous right abdominal haemangioma. The clinical examination revealed no other vascular tumours. There was no evidence of heart failure. Ultrasound and MRA documented a giant vascular structure suggestive of haemangioma. The tumor responded well to propranolol treatment.
Neurological Worsening in a Child of Miliary Tuberculosis with Neuro-Tuberculosis on Anti Tubercular Treatment
(Nepal Paediatric Society (JNPS), 2015) Arora, Sunita; Narang, Gursharan Singh; Dhillon, Prabhjot Kaur
Abstract: A seven and half year old male child presenting with pyrexia of unknown origin was diagnosed to be a case of miliary tuberculosis. Neuroimaging revealed multiple discrete ring as well as nodular enhancing lesions indicative of tuberculomas. After the initial response to ATT along with systemic steroids the child again presented with severe headache along with vomiting towards the end of intensive phase. Repeat neuroimaging showed appearance of new lesions with perilesional edema. Child was started again on systemic steroids and Streptomycin was added to the anti tubercular regimen, to which the child responded well.
Neonate with Severe Complications of Epidermolysis Bullosa and Bilateral Clubfoot: An Unusual Case Presentation and Treatment
(Nepal Paediatric Society (JNPS), 2015) Krasniqi-Daka, Afërdita; Sejdiu-Hasbahta, Teuta; Gërçari, Antigona; Vuniqi-Krasniqi, Merita; Daka, Qëndresë
Abstract: Epidermolysis bullosa is a term for a heterogeneous group of rare disorders, characterized by extensive blistering of the skin and mucous membranes as the most prominent features. So far association of the disease with extra-cutaneous manifestations and complications has been pointed out. We present an unusual case of a neonate with severe complications of epidermolysis bullosa, associated with bilateral clubfoot.
Menkes Disease- A Rare Neurodegenerative Disorder
(Nepal Paediatric Society (JNPS), 2015) Choudhary, Richa; Choudhary, Anita; Sitaraman, S
Abstract: Menkes Disease is a rare neurological disorder of impaired copper transport, characterized by progressive neurodegeneration, refractory epilepsy and characteristic hair abnormalities. Here, we report a 5 month old child with developmental delay, refractory seizures, and hypopigmented short, sparse hair with microscopic pili torti; low serum copper and ceruloplasmin and neuroimaging revealing white matter hyperintensities and tortuous vessels.
Isolated unilateral left upper lobe agenesis causing recurrent pneumonia: A case report
(Nepal Paediatric Society (JNPS), 2015) Agrawal, Jyoti; Gupta, Mukesh
Abstract: Lung agensis is a rare developmental anomaly. It can range from total bronchial and parechymal agensis to mild pulmonary parenchymal hypoplasia of one or both lungs. A case of lobar agenesis of the left upper lung in a three month old girl causing recurrent chest infection is presented.
Calcaneal Apophysitis (Sever's Disease): MRI Findings
(Nepal Paediatric Society (JNPS), 2015) Dogan, Mehmet S; Doganay, Selim; Koc, Gonca; Gorkem, Sureyya B; Ciraci, Saliha; Coskun, Abdulhakim
Abstract: Calcaneal apophysitis (Sever’s disease), is the most frequent cause of the heel pain in growing children. The diagnosisis generally made with a typical history and clinical examination. Imaging modalities including radiography and magnetic resonance imaging can help establish the diagnosis. In this case we report imaging findings of an 11-year-old boy diagnosed as Sever’s disease.
Adams – Oliver Syndrome
(Nepal Paediatric Society (JNPS), 2015) Joshi, Avadhesh; Karnawat, Bhag Singh; Jangid, Manoj Kumar
Abstract: Aplasia cutis congenita is characterized by congenital absence of portion of skin over a localized or widespread area. Adams- Oliver syndrome (subtype-II of ACC) is associated with distal limb reduction anomalies. We describe an infant with this uncommon disease associated with multiple midline lesions, which is a rare occurrence.
Developmental Screening Tools for Motor Developmental Delay in High Risk Preterm Infants
(Nepal Paediatric Society (JNPS), 2015) Ramachandran, Selvam; Dutta, Sudip
Abstract: The preterm very low birth weight infants are at high risk of motor developmental delays. The developmental screening tools used by health professionals in pediatric practice serves several purposes viz. as a discriminative screening tool to identify the developmental delay in such high risk infants; as an evaluation tool to quantify the levels of functional skills achieved; as a prognostic tool to quantify the changes in levels of functional skills following specific developmental care interventions and as a predictive tool to predict the quantum of existing or impending neuro-developmental disability in high risk infants. Thus developmental screening tools serves as an integral part of early intervention programs. Such screening tools also serve as program evaluation strategy in quantifying the efficacy of early developmental care intervention programs. This review is aimed at describing the properties of developmental screening tools for motor developmental delay in preterm infants.
Upper Arm Composition as an Indicator of Body Composition and Nutritional Status of Adolescent Boys Aged 10-18 Years
(Nepal Paediatric Society (JNPS), 2015) Sen, Jaydip; Mondal, Nitish; Ghosh, Partha
Abstract: Introduction: The upper arm composition is usually assessed based on total upper arm area (TUA), upper arm muscle area (UMA), upper arm fat area (UFA) and arm fat index (AFI). It is closely associated with assessment of body composition and nutritional status. The present study aims to determine the age specific variations in upper arm composition and its usefulness in the assessment of body composition and nutritional status among adolescent boys. Materials and Methods: The study was conducted among 964 boys (aged 10 – 18 years) and belonging to the indigenous Rajbanshi population of West Bengal, India. The boys were selected from five different sub-urban government secondary schools located under Siliguri subdivision of Darjeeling district, West Bengal, India. The anthropometric measurements of height, weight, MUAC and TSF were recorded and upper arm composition was estimated based on TUA, UMA, UFA and AFI using standard procedures. The overall body composition was evaluated using body mass index (BMI). Results: There appears to be existence of significant age-specific variations in BMI, UMA and UFA as the boys approached higher ages. The age specific means of TUA, UMA and UFA increased with age. The adolescent boys were observed to be well below the 50th percentiles of the reference population in BMI, TUA, UMA, UFA and AFI. Age and sex-specific smooth percentile curves were derived for height, weight, TSF, BMI, UMA and UFA using the L, M and S modelling approach for further evaluation of body composition. Conclusion: The present study recommends the assessment of body composition and nutritional status to improve screening of nutritional status using upper arm composition, especially in community settings so as to accurately identify the risk of lower or greater adiposity and muscularity, and thereby proposing a major opportunity to improve health through proper intervention programmes.
Study of Role of Iron Deficiency Anaemia in Febrile Seizures in Children in a Tertiary Care Centre
(Nepal Paediatric Society (JNPS), 2015) Sreenivasa, Bheema Naik; Kumar, Gowripura Visweswaraiah; Manjunatha, Bheema Naik
Abstract: Introduction: The world health organization estimates that anaemia largely caused by iron deficiency, affecting between 500 million and two billion people worldwide. Considering the age prevalence of iron deficiency anaemia and febrile convulsion which are the same, the role of iron in the metabolism of neurotransmitter and some enzymes, the function of hemoglobin in conveying oxygen to the brain and since fever can exacerbate symptoms that result from anaemia, a relationship between iron deficiency anaemia and febrile convulsions is probable. Some studies have suggested iron deficiency as a predisposing factor for febrile seizures. We designed this case control study to evaluate the relationship between iron deficiency anaemia and febrile convulsions. The objective of this study was to study the role of iron deficiency as a risk factor for febrile seizures. Materials and Methods: Hundred cases and 100 controls were included in the study. Cases were children of age group six months to six years presenting with febrile seizures. Controls were children of same age group presenting with febrile illness but without any seizures. After informed consent, detailed history was taken and clinical examination done in both cases and controls and blood investigations were done to diagnose iron deficiency anemia. Two groups were matched for age and sex. In all children hemoglobin (Hb) level, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW) and plasma ferritin (PF) were determined and the data collected were analyzed statistically. Results: The mean PF was significantly lower in cases compared to controls (p=0.000) and RDW was significantly higher in cases compared to controls (p=0.00). The mean Hb%, MCV, MCH are lower in cases compared to controls but it was statistically not significant. Concluson: Iron deficiency is a significant risk factor for febrile seizures in children of age group six months to six years. Early detection and timely correction of iron deficiency may be helpful for prevention of febrile seizures in children.
Relationship Between Non-Invasive Blood Pressure (NIBP), on First Day of Life with Birth Weight
(Nepal Paediatric Society (JNPS), 2015) Chawla, Garima; Maini, Baljeet; Bhardwaj, Anand Kumar
Abstract: Introduction: India faces lot of neonatal morbidity. Non-invasive blood pressure (NIBP) monitoring is being used for monitoring sick new borns as a safe and cost effective method of blood pressure monitoring. But there is no available information on normal values of NIBP for neonates in India. With more stress of government (and advancement) in new born care, establishing normative data of NIBP in Indian newborns should be high priority. Material and Methods: This was an observational cohort study done in a level III neonatal intensive care unit. 164 clinically stable babies on day 1 of life were included. Blood pressure was measured by the Oscillometric method. Results: Progressive increase of blood pressure was seen with increasing birth weight. 10th, 50th, 75th, 95th Centile curves were drawn from available data. For very low birth weight babies (< 1500grams), the values of systolic, diastolic and mean BP (±2standard deviations (S.D.)) were found to be 53.7 ± 1.7, 29.1 ± 1.7 and 41 ± 1.1 mm Hg respectively. For low birth weight babies, i.e. with birth weight 1500-2499 grams, the values for systolic, diastolic and mean BP(±2 S.D.) were 62.2 ± 2.5, 34.8 ± 2.4 and 46.6 ± 2.4 mm Hg respectively. For normal weight babies (more than 2499 grams), the systolic, diastolic and mean BP (±2 S.D.) were 72.8 ± 4.2, 43 ± 4 and 55.3± 4 mm Hg respectively. The rise in systolic blood pressure with rising birth weight was highly significant (p <0.001). Similar were the results for diastolic and mean BPs, (p<0.001 for both), Conclusion: Blood pressure on day 1 of life appears to be directly related to birth weight. The effect is seen in all (i.e. systolic, diastolic and mean) blood pressure values.
Profile of Macrosomic Babies at a Tertiary Level Hospital
(Nepal Paediatric Society (JNPS), 2015) Shah, Subhash Chandra; Shrestha, Devendra; Dhakal, Ajaya Kumar; Shakya, Arati; Shakya, Henish; Pradhan, Amita
Abstract: Introduction: Macrosomia is known to be associated with adverse neonatal outcomes. The aim of this study was to estimate the incidence of macrosomia in a tertiary teaching hospital of Nepal based on local intrauterine foetal growth percentile curve according to gestational age, risk factors for morbidity and mortality and neonatal outcome of macrosomia. Materials and Methods: This was a descriptive observational study done on live term macrosomic babies delivered during the study period at KIST Medical College Teaching Hospital, Lalitpur Nepal. The maternal and neonatal records of macrosomic babies were reviewed. All the macrosomic babies were followed up till discharge. Macrosomic babies needing admission into the neonatal care unit were considered as ones with complication. Maternal and neonatal risk factors associated with neonatal complications were analysed. Results: Among total of 2922 live singleton deliveries, 342 (11.7%) babies were macrosomic. The neonatal complications associated with macrosomia were seen in 19.6%. The risk factors significantly associated with neonatal complications were mode of delivery via caesarean section, instrumental delivery and 1 min low Apgar score. Maternal diabetes leading to macrosomia however was seen in only one case. The most common neonatal complications were neonatal sepsis (11.4%), significant hyperbilirubinaemia (2%) and transient tachypnoea of newborn (1.6%). Conclusions: Neonatal sepsis was the major cause of morbidity even in the macrosomic babies. Importance of early interventions for prevention and management of macrosomic babies with neonatal sepsis needs to be emphasized.
Prevalence of Underweight, Stunting and Thinness Among Adolescent Girls in Kavre District
(Nepal Paediatric Society (JNPS), 2015) Mansur, Dil Islam; Haque, Mohammad Khurshidul; Sharma, Kalpana; Mehta, Dilip Kumar; Shakya, Rojina
Abstract: Introduction: Poor nutritional status during adolescence is an important determinant of health outcome. The adolescents have different needs and have diverse problems. Nutritional assessments among adolescents are important as they are the future parents and constitute a potentially susceptible group. The present study is an attempt to evaluate the prevalence of underweight, stunting and thinness including overweight among adolescent girls from rural community. Material and Methods: A cross-sectional study was conducted among school going adolescent girls, 9-16 years studying in various schools in rural area of Kavre district, Nepal during 15thMarch to 15th September 2014. The weight and height were recorded from each participant in kilogram and centimetre respectively, and nutritional status of the adolescent girls was assessed through the Z-scores of underweight (weight for age), stunting (height for age) and thinness (BMI for age) according to WHO criteria. Data was entered and analyzed by using SPSS 19.0. Results: The overall prevalence of underweight, stunting and thinness was 31.98%, 21.08% and 14.94% respectively. It was concluded that highest (49.5%) prevalence of underweight was among 11 years of adolescent girls and the lowest (20.7%) was found in the age group of 13 years. Stunting was highest in age group of 9 years (37.34%) and the lowest prevalence of stunting was 10.7% in the age group of 14 years. The highest prevalence (24.2%) of thinness was found in 9 years and lowest prevalence (11.0%) was found in 10 years adolescent girls. Conclusion: It is concluded that there is a high prevalence of under nutrition among studied adolescent girls in the rural areas of Kavre district. Health education and nutrition interventions are needed on priority basis.
Findings of Paediatric Upper Gastrointestinal Endoscopy at a Tertiary Care Centre
(Nepal Paediatric Society (JNPS), 2015) Thapa, Surya Bahadur; Sharma, Arun Kumar
Abstract: Introduction: Endoscopy is an important diagnostic tool for gastrointestinal disorders in children. Practitioners still debate the need and utility of endoscopy in children and this important evaluation is potentially underutilized. There is a paucity of paediatric endoscopy data in Nepal. This report describes an initial three-year experience on profile of upper gastrointestinal endoscopy at Tribhuvan University Teaching Hospital (TUTH). Material and Methods: This retrospective study was conducted by reviewing hospital records for children undergoing endoscopy for various indications at TUTH during November 2011 to October 2014 (3 years). Results: We performed 362 endoscopies during this period. Mean age of patients was 9.49 years (range 2 months to 18 years) and 199 (54.9%) patients were under 10 years of age. Common indications were upper gastrointestinal bleeding (27.6%), recurrent abdominal pain (26.2%), acute abdominal pain (24.6%), recurrent vomiting (5.2%), and caustic ingestion (3.6%). An abnormality was detected in 159 (42.2%) patients. Varices (16.6%), gastritis/duodenitis (14.9%), ulcer (3.3%), oesophagitis (1.9%) were common diagnoses. Etiology of upper gastrointestinal bleed was identified in 65% of patients. Majority of patients with recurrent abdominal pain had negative results (80%). Failure to thrive constituted a very small proportion of children (0.2%) evaluated. All children received sedation/ analgesia and tolerated the procedure well. Conclusion: Paediatric upper gastrointestinal endoscopy can be safely performed across wide age range with proper sedation/ analgesia. Endoscopic diagnosis may improve management and children requiring such evaluation should be timely referred. Paediatricians should be encouraged to refer patients with growth failure early to ensure proper management.
Comparison of Intranasal Midazolam and Rectal Diazepam as Anticonvulsant in Children
(Nepal Paediatric Society (JNPS), 2015) Gunawan, Prastiya Indra; Rulian, Fadil; Saharso, Darto
Abstract: Introduction: Rectal diazepam is reputed as the gold-standard management of childhood seizures. Otherwise, intranasal (IN) midazolam has no first-pass metabolism and faster onset of action. The effectiveness and easier route of these drugs are important choices for faster seizure cessation. The aim of this study was to clarify the effectiveness of intranasal midazolam compared with rectal diazepam for seizure termination. Material and Methods: The children, one month until 18 years of age, presented with acute seizures. Patients were randomly classified into two groups with either received intranasal midazolam or rectal diazepam for seizure termination. Interval time of drug administration to cease seizure was compared. The log-rank analysis was used for statistical analysis. Side effect of both drugs were evaluated. Results: There were 60 patients enrolled the study, 30 in each group. The median time interval for seizures cessation with intranasal midazolam was 42 seconds, otherwise in rectal diazepam group was 180 seconds. There was statistically significant difference interval time between two groups (p<0.01). None of the both groups had any significant side effects statistically. Conclusion: Intranasal midazolam is effective to terminate a seizure in children. It can be used as an alternative treatment for seizures in patients with intravenous or rectal route difficulties.

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