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Association of Vitamin D Deficiency with Acute Lower Respiratory Infection in Toddlers Authors
(Nepal Paediatric Society (JNPS), 2016) Narang, Gursharan Singh; Arora, Sunita; Kukreja, Sahiba; Shifali, Dr
Abstract: Introduction: Pneumonia remains a significant health problem in India with significant morbidity and mortality. Objectives of this study were to identifying an effective nutritional agent that reduces the need for antibiotics, duration of pneumonia and length of hospitalization would be highly cost-beneficial. Material and Methods: This was a hospital-based case-control study: A total of 100 children including 50 cases and 50 controls, aged 2–60 months, were enrolled. Case definition of severe ALRI as given by the World Health Organization was used for cases. Controls were healthy children attending outpatients’ service for immunization or admitted for minor ailments other than ALRTI. Results: Mean 25(OH)D concentrations in children of the study group were lower than those of the control group (20.431 ng/mL vs. 27.67 ng/mL; p = 0.035). Factors significantly associated with decreased risk of ALRTI in univariate analysis were: exclusive breastfeeding in the first 6 months (cases 13/50 (26%), controls 42/50 (84%); p=0.000); adequate exposure to sunlight (cases 14/50 (28%), controls 42/50 (84%); P=0.000); and serum 25OHD3 <20 ng/ml (cases 28/50 (56%), controls 0/50 (0%); p=.000). Multivariate logistic model indicated that severe vitamin D deficiency (OR=NA), exclusive breast feeding (OR=.174); 95% CI (.061- .521; p=.002) and adequate sunlight exposure (OR=.179) ;95%CI (.062-.519); p=.002) were significant independent predictive risk factors for ALRTI among the children between 2 months – 5 years of age (all p<0.05). Conclusion: Severe vitamin D deficiency (<20ng/ml), nonexclusive breastfeeding in the first six months of life, inadequate sun exposure were significant risk factors for ALRTI in Indian children.
Additional Use of Alarm Systems in Wakefulness in the Treatment of Mono-Symptomatic Nocturnal Enuresis
(Nepal Paediatric Society (JNPS), 2016) Kosilov, Kirill Vladimirovich; Loparev, Sergey Alexandrovich; Kuzina, Irina Gennadyevna; Shakirova, Olga Victorovna; Zhuravskaya, Natalia Serveevna; Lobodenko, Alexandra
Abstract: Introduction: There are many factors associated with nocturnal enuresis in children and can be very challenging as regards its management. Consequently, misunderstanding could arise explaining the state when a child for years urinates in bed. The aim of this study was to investigate possibilities of increase of efficiency of alarm systems and decrease of time of result achievement in case of usage of such modernized therapy algorithm. Materials and methods: 452 children (307 boys and 145 girls) took part in the study. All patients were randomly divided into two groups prior to alarm systems therapy. Group А patients (206) were offered to use alarm system (Wet Stop/ BYE-WET by PALCO LABS, Inc (USA) in normal mode. Group В patients (246) were using alarm system in wakefulness – urinated on device catching sensor. Alarm intervention was carried out within 12 weeks, total period of observation over the patients– 5 months. Results: We found out that number of patients with urination in sleep after 3 months of therapy was reliably less in this group than in control (23.5 against 40.3 percent, p < 0.05). Conclusion: Usage of alarm systems in patient’s wakefulness in addition to standard treatment regimen was improved the efficiency of Alarm-therapy up to 76.5 percent. Day training with the usage of alarm systems reliably increased the number of dry nights and self-wakening in case of desire to urinate. Usage of alarm systems in wakefulness was safe and did not result in additional refusal from treatment.
Averting the Legacy of Kidney Disease; Focus on Childhood
(Nepal Paediatric Society (JNPS), 2016) Ingelfinger, Julie R; Kalantar-Zadeh, Kamyar; Schaefer, Franz
Abstract: World Kidney Day 2016 focuses on kidney disease in childhood and the antecedents of adult kidney disease that can begin in earliest childhood. Chronic kidney disease (CKD) in childhood differs from that in adults, as the largest diagnostic group among children includes congenital anomalies and inherited disorders, with glomerulopathies and kidney disease in the setting of diabetes being relatively uncommon. In addition, many children with acute kidney injury will ultimately develop sequelae that may lead to hypertension and CKD in later childhood or in adult life. Children born early or who are small-for date newborns have relatively increased risk for the development of CKD later in life. Persons with a high-risk birth and early childhood history should be watched closely in order to help detect early signs of kidney disease in time to provide effective prevention or treatment. Successful therapy is feasible for advanced CKD in childhood; there is evidence that children fare better than adults, if they receive kidney replacement therapy including dialysis and transplantation, while only a minority of children may require this ultimate intervention Because there are disparities in access to care, effort is needed so that those children with kidney disease, wherever they live, may be treated effectively, irrespective of their geographic or economic circumstances. Our hope is that World Kidney Day will inform the general public, policy makers and caregivers about the needs and possibilities surrounding kidney disease in childhood.
White Cerebellum Sign
(Nepal Paediatric Society (JNPS), 2016) Gopalakrishnan, Shridhar; Uddandam, Rajesh; Sodhi, Kirandeep
Abstract: The white cerebellum sign is an unusual but striking radiological sign of global hypoxia ischemia of the brain. Recognition helps in diagnosis and prognosis as this sign is usually associated with a uniformly poor outcome.
Mild to Severe Anemia of Undiagnosed Etiology Diagnosed by Genetic Study
(Nepal Paediatric Society (JNPS), 2016) Bose, Kalliol; Siddique, Md Abu Bakkar; Ghorai, Sudipta; Kundu, Chanchal; Saha, Sudip
Abstract: We report a case of a child with beta thalassemia major, whose mother is a carrier of beta thalassemia and father is having hereditary persistence of fetal hemoglobin. Gene study revealed compound heterozygous for codon 8/9+G and IVS-1-5 G>C point mutation. Another four cases of anemia not responding to iron diagnosed to have alpha thalassemia carrier are also reported here.
Incomplete Kawasaki Disease: A Rising Trend
(Nepal Paediatric Society (JNPS), 2016) Zainab, Madiha; Guha, Suparna
Abstract: Kawasaki Disease is the most common cause of acquired heart disease in the developed countries. The diagnosis of typical Kawasaki Disease (KD)is not much of a problem. However incomplete Kawasaki Disease where only two to three clinical features are present, poses a diagnostic dilemma. Here we report our experience with the disease in the paediatric department of Vivekananda Institute of Medical Sciences (VIMS). In one year retrospective study from Jan 2015 to Jan 2016, 20 cases were diagnosed as KD, of which five were complete and 15 incomplete. Fifty percent of cases were less than one year’s age and there was male preponderance. More than 90% showed echo changes and all except one responded to IVIG and aspirin who succumbed due to aneurysm rupture. So we conclude that high index of suspicion for diagnosing KD must be there and early treatment to prevent echocardiographic changes.
Neonatal Bartter Syndrome
(Nepal Paediatric Society (JNPS), 2016) Roy, Amrita; Chakraborty, Debalina Sarkar; Dogra, Shivani; Sengupta, Sudip
Abstract: The neonatal form of Bartter syndrome is characterized by intrauterine onset of polyuria leading to severe polyhydramnios. We report a case of a 31 weeks, male baby was born by emergency Caesarean Section due to severe polyhydramnios (AFI 54). Postnatally, baby had polyuria, dehydration, hyponatremia, hypokalemia and hypochloremic metabolic alkalosis. Possibility of neonatal Bartter syndrome was supported by high serum renin and aldosterone levels. Correction of electrolytes and dehydration along with indomethacin constituted the treatment. This syndrome is reported to make paediatricians aware about the severe neonatal form of the disease.
Necrotizing Enterocolitis with Perforation in an Extreme Preterm, Extremely Low Birth Weight Neonate
(Nepal Paediatric Society (JNPS), 2016) Gopalakrishnan, Shridhar; Singh, Shailendra; Sodhi, Kirandeep; Arora, Manu
Abstract: Necrotizing enterocolitis (NEC) remains the most common and serious surgical condition among preterm, very low birth weight neonates with a mortality of 40% to 50% in those requiring surgery. We report perforation secondary to NEC in an extreme preterm, extremely low birth weight neonate with a good outcome due to aggressive surgical management and intensive care.
Gastrointestinal Mucormycosis: A Rare but Lethal Mimicker of Necrotising Enterocolitis
(Nepal Paediatric Society (JNPS), 2016) Radhakrishna, Veerbhadra; Govindarajan, Krishna Kumar; Balachandar, Bharathi; Plakkal, Nishad; Jinkala, Sree Rekha
Abstract: Neonatal Gastrointestinal mucormycosis is a rare fungal infection carrying high morbidity and mortality. Clinically, it is not easily distinguishable from the more common necrotizing enterocolitis. Diagnosis is made by histopathology of the involved bowel. We report a neonate with gastrointestinal mucormycosis, bringing to notice the fatality of this infection.
Hypervitaminosis D Following Overdose in a Patient with SLE
(Nepal Paediatric Society (JNPS), 2016) Roy, Kakali; Basu, Surupa; Kundu, Ritabrata; Das, Joydeep
Abstract: Vitamin D supplementation has come under lime light and is being prescribed randomly. Often physicians prescribe high doses of Vitamin D. Overdosing may be dangerous if not supervised or followed up. We are presenting one child with all features of hypercalcemia due to hypervitaminosis D following overdose. Doctors should be cautious during prescribing high dose of Vitamin D.
Hemophagocytic Syndrome in a Four Year Old Male Child with Plasmodium Vivax Infection
(Nepal Paediatric Society (JNPS), 2016) Bhatia, Ravi; Bhatia, Gunjan
Abstract: In Hyper endemic zones Malaria is known to present with unusual complications. Haemophagocytic syndrome is a disorder of mononuclear phagocytic syndrome. There are many published reports of haemophagocytic syndrome due to P. falciparum infection but haemophagocytic syndrome due to P. vivax infection is quite rare.
Ellis Van-Creveld Syndrome in an Ethnic Group in Nepal: Case Report with Review of Literature
(Nepal Paediatric Society (JNPS), 2016) Gauchan, Eva; Sharma, Prakash
Abstract: Ellis van-Creveld syndrome is a rare autosomal recessive disorder characterized by acromesomelic dwarfism, postaxial polydactyly, oro-dental abnormalities and congenital heart disease. We are reporting three cases in two families of the same ethnic group from Western Nepal. Genetic testing should be done in this population in order to identify the mutation in the gene causing the syndrome.
Ectopia Cordis
(Nepal Paediatric Society (JNPS), 2016) Rahman, Md Hamidur; Hassan, Mahmuda; Chowdhury, Kona; Quddus, Abdul
Abstract: Ectopia Cordis is a rare congenital anomaly characterized by partial or complete displacement of the heart outside the thoracic cavity. Usually ectopiacordis is associated with other multiple anomalies and intra cardiac defects. The five main ectopic positions are adjacent to the thorax approximately 60%, abdominal is 15-30%, thoraco-abdominal is 7-18%, cervical is about 3% and least is the cervicothoracic. We are reporting a case of ectopiacordis of abdominal type. This is the first reported abdominal ectopia cordis case in Bangladesh.
Update on Changing Terminologies in Sepsis
(Nepal Paediatric Society (JNPS), 2016) Simalti, Ashish Kumar; Ghuliani, Ranjit; Nair, Bindu T.
Abstract: Definitions of sepsis and septic shock were last revised in 2001. Since then there have been considerable advances in our understanding of pathophysiology, management, and epidemiology of sepsis, suggesting the need for reexamination. The European Society of Intensive Care Medicine and the Society of Critical Care Medicine convened a task force in January 2014 with objective to evaluate and, as needed, update definitions for sepsis and septic shock. Recommendations of this task force were published recently as “The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)”. The aim of this article is to generate awareness and discussion regarding this new important development.
Developmental Outcome in Children with Malnutrition
(Nepal Paediatric Society (JNPS), 2016) Chattopadhyay, Nandita; Saumitra, Masani
Abstract: Background: Developmental challenges and malnutrition are two major childhood health problems in the developing world and malnutrition is a major risk factor for poor development, which can, ultimately, lead to developmental challenges with life-long implications, affecting the individual, the family and the society at-large. Materials and Methods: We searched PUBMED & COCHRANE REVIEW databases, published documents from WHO, UNICEF, UNDP and the World Bank and citations thereof, for relevant literature on brain development and malnutrition, dietary supplementation and brain development. Results: Effect of nutrition on the developing brain has been thoroughly studied and established. Undernutrition, particularly during fetal and 1st two years of postnatal life, is a major risk factor for poor neuro-development, leading to motor, cognitive and speech delay, as well as behavioral problems and learning disabilities. Macro and micro-nutrients, like proteins, Iron, Iodine, Zinc, vitamins-B, C and D, choline and essential fatty acids are essential for proper brain development. Supplementation of pregnant and lactating mothers, infants and toddlers with multiple micronutrient, specially Iron, Iodine, Vitamins B12 and Folate and choline has been found beneficial, particularly among the vulnerable population. Conclusion: Dietary supplementation for pregnant and lactating mothers, infants and toddlers along with a congenial socio-emotional environment and cognitive stimulation from an early age can go a long way to help the child at-risk attain his developmental potential.
The Use of PELOD Score in Predicting Acute Kidney Injury in Critically Ill Children
(Nepal Paediatric Society (JNPS), 2016) Prasetyo, Risky Vitria; Saraswati, Putu Dian; Kurniawan, Muhammad Riza; Kushartono, Hari; Soemyarso, Ninik Asmaningsih; Azis, Abdul Latief; Noer, Mohammad Sjaifullah
Abstract: Introduction: Acute kidney injury (AKI) significantly increases morbidity and mortality in critically ill children. Prognostic indicators such as Pediatric Logistic Organ Dysfunction (PELOD) score is associated with factors related to renal dysfunction. The aim of this study was to study the AKI incidence and correlate the PELOD score with AKI in critically ill children admitted to PICU at Dr. Soetomo Hospital Surabaya Indonesia. Material and Methods: A prospective study was conducted to all children admitted to PICU during 15 January-14 April 2014. Demographic data (age, sex, PICU indications, PELOD scores, AKI staging by pRIFLE at admission) and outcome after 7 days at PICU were recorded. All data were analyzed descriptively (p<0.05). Results: A total of 56 (47.1%) out of 119 children were studied. The rest was excluded for being <3 months old, had end-stage kidney disease or complex cardiac problem, and cardiac catheterization. Mean age of subjects was 49.7 (SD 46.2) months, male-to-female ratio of 1.2:1. PICU indication was dominated by shock (35.7%), followed by CNS dysfunction in 13 (23.2%) and respiratory failure in 12 (21.4%) children. AKI was noted in 15 (26.8%) children, mostly (10.7%) in Injury stage with 5 (8.9%) in Risk and 4 (7.1%) in Failure stages. PELOD scores at admission ranged from 0 to 20 (mean 4.34, SD 5.87), higher scores in AKI group (7.8±6.64 vs 3.1±5.09, P=0.013). Twelve (21.4%) children died, 7 (58.3%) had AKI with 3 (25.0%) each in Risk and Failure while 1(8.3%) in Injury (p<0.05). Conclusion: PELOD score can be used as a predictor for AKI in critically ill children.
Reference Ranges for Hematological Values in Umbilical Cord Blood in Pokhara, Nepal
(Nepal Paediatric Society (JNPS), 2016) Basnet, Sahisnuta; Singh, Sandip Kumar; Sathian, Brijesh; Mishra, Rajnish
Abstract: Correction: Due to an error in loading the metadata, the author Sahisnuta Basnet was omitted. Sahisnuta Basnet was therefore added to the metadata on 9th January 2017. The PDF was correct. Introduction: Reference hematological values in newborns are informative in evaluation of newborns to determine state of health or disease. For a given population, reference values may differ in accordance with various factors such as age, sex, race, diet, drug intake, altitude, socio-economic status and also the method employed for determination of the values. The aim of this study was to establish reference ranges of complete blood count using umbilical cord blood of normal, healthy, full term neonates born in Manipal Teaching Hospital (MTH), Pokhara, Nepal. Material and Method: The study was conducted in 210 full term, healthy newborns delivered in MTH between Jan 2014 to Feb 2015. Cord blood was collected and a complete blood count was obtained using an automated hematology analyzer. Result: Mean hemoglobin was 15.24 ± 1.96 gm/dl and mean red blood cell count was 4.30 ± 0.63 (range 3.05 – 6.36) X 1012/L. Mean white blood cell count was 14.93 ± 4.44 (range 6.10 ± 31.7) X 109/L and platelet count was 226.88 ± 61.28 (range 105 ± 392) X 109/L. There was no significant difference found in hemoglobin, red cell, white cell and platelet counts between males and females in this study. Conclusion: The values obtained from our study provide ranges for some hematological values in healthy newborns of Pokhara Nepal. However, the hematological reference values for Nepalese cord blood needs to be confirmed by larger numbers of samples from different centers of Nepal.
Prevalence of Wasting, Thinness, Stunting and Under-weight among Paediatric AIDS Patients in a Tertiary Centre
(Nepal Paediatric Society (JNPS), 2016) Anyanwu, Onyinye Uchenna; Onyire, Benson Nnamdi; Daniyan, Faith W.
Abstract: Introduction: Malnutrition is a common occurrence in HIV positive children. Its presence reflects the level of care the child receives as well as affects the outcome of their infection. The objective of this study was to determine the prevalence of various forms of malnutrition among HIV positive children. This was a Hospital based Cross-sectional study in HIV-positive children receiving care in FETHA. Material and Methods: using the WHO reference standards, we determined the prevalence of wasting, thinness, stunting and underweight in HIV-positive children receiving care in FETHA. Height and weight measurements of 89 HIV-positive children aged 0-18year old were taken. Socioeconomic stratification was done by Olusanya’s criteria. Results: The prevalence of wasting, thinness, stunting and underweight in HIV- positive children were 31(34.8%), 22(24.7%), 30(33.7%), and 33(37.1%) respectively. Age group and socioeconomic status were significantly associated with the various forms of malnutrition while gender and clinical stage of disease were not. Conclusion: There is still a high prevalence of acute and chronic malnutrition amongst paediatric-AIDS patients which is significantly more amongst adolescents and the lower socioeconomic class.
Prevalence of Stunting and Thinness Among Adolescent Girls Belonging to the Rajbanshi Population of West Bengal, India
(Nepal Paediatric Society (JNPS), 2016) Roy, Susmita; Barman, Sweeta; Mondal, Nitish; Sen, Jaydip
Abstract: Introduction: In India majority of the individuals remain undernourished. The primary causes of undernutrition are its large population, socio-economic differences and inadequate access to health facilities. Assessment of nutritional status among adolescents is very important as they are the future parents and constitute a potentially vulnerable segment of the population. The present school-based cross-sectional study evaluates the prevalence of stunting and thinness among adolescent girls from North Bengal. Materials and Methods: The present study was carried out among 500 Rajbanshi adolescent girls aged 9 to 18 years and residing in the districts of Darjeeling and Jalpaiguri in West Bengal, India. Anthropometric measurements of height and weight were recorded and body mass index (BMI) calculated. The prevalence of undernutrition was assessed using recommended anthropometric indices of stunting (low height-for-age) and thinness (low BMI-for-age), along with a comparison with the WHO reference population. Results: The overall prevalence of stunting and thinness was observed to be 39.60% and 26.00% respectively. The prevalence of age-specific stunting was higher and lower among girls aged 17 years (70.21%) and 10 years (24.00%), respectively. The age-specific prevalence of thinness was observed to be higher among those aged 10 years (66.00%) and lower among those aged 17 years (8.51%). Conclusion: There is a need for appropriate nutritional intervention programmes to address their nutritional needs. The results of the present study will also help policy makers to formulate various developmental and health care programmes.
Paediatric Constipation;Think Beyond Thyroid Causes
(Nepal Paediatric Society (JNPS), 2016) Debnath, Ekta Malik; Datta, Rashmi Rasi; Debnath, Pinaki Ranjan; Jain, Anju
Abstract: Introduction: This study was designed to evaluate the importance of proper detailed history and examination of the patient as well as to determine the prevalence of unrecognized hypothyroidism among the paediatric patients with constipation attending the outpatient paediatric units in our hospital. Material and Methods: A retrospective review of medical records of paediatric patients ordered for thyroid function tests between July 2014 and June 2015 was performed. Total of 2210 paediatric patients were included in the study. A complete review of the medical records of these patients were performed which included indications for ordering thyroid tests, medical history, drug history, radiologic evaluation, other laboratory tests and subspeciality consultation.The samples were analyzed in the hormone unit of the Clinical Biochemistry Laboratory by a fully automated analyzer (Cobas e411, Roche). Data analysis was done using SPSS statistical software. Clinical diagnosis was made according to the paediatric reference ranges used in our clinical laboratory. Results: Out of all patients, 149 had history of constipation and 11 patients out of 149 had abnormal thyroid function. Repeat measurements after three months showed normal results for nine, while only two patients had results suggestive of hypothyroidism. Conclusion: Functional constipation is a condition which is to be diagnosed only by history or clinical examination. Thyroid profile where necessary is to be done after proper examination, to reduce the burden of cost to laboratory and society as well as exposing the pediatric patient to trauma.

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