Journal Issue: Volume: 44, No. 2 (2024)
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ISSN 1990-7974 eISSN 1990-7982
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Acute Kidney Injury in Neonates with Perinatal Asphyxia: A Descriptive Analysis
(Perinatal Society of Nepal (PESON), 2024) Bhat, Ramesh; Martha, Sathiskumar
Abstract:
Introduction: Although acute kidney injury (AKI) is one of the complications of perinatal asphyxia, it is not well recognized morbidity in neonates. AKI based on serum creatinine and urine output assessments vary widely. We aimed to study the prevalence and characteristics of AKI among perinatally asphyxiated near term and term neonates. We also evaluated oliguric and non-oliguric AKI on day 3 of life and relationship of AKI to hypoxic-ischemic encephalopathy (HIE) stages. Further we compared mortality among asphyxiated neonates with and without AKI as well as mortality among oliguric AKI and non-oliguric AKI neonates.
Methods: Neonates with gestation ≥ 35 weeks fulfilling the criteria of perinatal asphyxia were included in the study. The serum creatinine, electrolytes, urine output, presence of HIE and duration of hospital stay were studied.
Results: A total of 67 perinatally asphyxiated neonates were studied. Oliguria was found in nine (13.4%) neonates on day 2. Among them, six (66.6%) neonates had normal urine output and three (33.4%) continued to have oliguria by day 3. On day 3, AKI was found in 32 (47.8%) neonates which was oliguric in three (9.4%) and non-oliguric in 29 (90.6%). AKI was observed in 23 (44.2%) of 52 neonates with HIE, 60% of HIE stage I, 41% of HIE stage II and 33.3% of HIE stage III. Mortality among neonates with AKI was 6.3 (95% CI-0.7 to 57.1) times greater compared to neonates without AKI. A higher percentage of oliguric AKI neonates expired (2/3; 66.6%) compared to non-oliguric AKI neonates (3/29; 13.8%).
Conclusions: Among asphyxiated neonates, AKI was observed in 48% on day 3. AKI was mostly non-oliguric. AKI especially the oliguric type in asphyxiated neonates contributes to higher mortality.
Awareness Regarding Learning Disabilities Among Basic Level Teachers in Selected Schools of Pokhara, Nepal
(Perinatal Society of Nepal (PESON), 2024) Poudel, Dipika; Lamichhane, Sabina
Abstract:
Introduction: Learning disabilities are the disorders that affect the ability to understand or use spoken or written language, do mathematical calculations, coordinate movements or direct attention. It is a developmental disorder seen in children usually recognized in school age. A learning disability may not be curable, but with the right support and intervention, children with learning disabilities can succeed in school and go on to successful, often distinguished careers later in life. The study’s objective is to assess the awareness level regarding learning disability among basic level teachers in selected schools of Pokhara.
Methods: A cross-sectional study design was adopted among 128 basic level teachers in schools of Pokhara. A structured knowledge questionnaire was developed focusing on learning disabilities. About four Government school were selected by purposive sampling technique and basic level teachers were selected by total enumeration technique. Collected data were analyzed using the SPSS software version 23. Descriptive (mean, frequency, percentage, standard deviation) and inferential statistics (chi-square) test as per the nature of data.
Results: The present study revealed that slightly more (50.8%) of the respondents had overall low awareness whereas (49.25%) of the respondents had overall high awareness regarding learning disability. There was a statistically significant association between family history, source of information (friend) and level of awareness at the p-value < 0.05.
Conclusion: The result of the present study revealed that the level of awareness about learning disability among basic level teachers is low as none of them had adequate awareness on concept and definition of learning disability. Appropriate training should be provided to the teachers regarding identification, diagnosing and managing the child with learning problems so that child can succeed in school and go on successful careers later in life.
Benefit of Oral Nutrition Supplement for Children with Acute Malnutrition at Hospital Outpatient
(Perinatal Society of Nepal (PESON), 2024) Sidiartha, Gusti Lanang; Pratiwi, Gusti Ayu Putu Eka; Subanada, Ida Bagus; Sidiartha, Gusti Ayu Dian Noviyani; Iswari, Made Dwitia Ayu
Abstract:
Introduction: Acute malnutrition in children is still high in our country. It needs optimal nutrition support during and after discharge from the hospital. We evaluated the benefit of oral nutrition supplements (ONS) in improving acute malnutrition in children in a hospital outpatient setting.
Methods: A retrospective cohort study was conducted among 124 children under five with acute malnutrition (weight-for-height < -2SD, according to the WHO growth standard). All the children were followed during six months of treatment. At the end, the change of nutritional status was calculated and associated factors were studied.
Results: Among 124 children, 70 (56.5%) were males and 54 (43.5%) were females with a median age of nine months. On recruitment, 41 children (33.1%) had severe acute malnutrition (SAM) and 83 children (66.9%) had moderate acute malnutrition (MAM). In the end, five children (4.1%) improved from SAM to well-nourished, 22 children (17.7%) improved from MAM to well-nourished, and 13 children (10.5%) improved from SAM to MAM, respectively. Initial SAM status and frequent visits were significantly associated with the improvement in nutritional status.
Conclusions: Treatment with ONS for six months in children under five with acute malnutrition improved their nutritional status by approximately 32.3%, in which 21.8% had complete improvement. Independent factors for improvement were initial SAM status and frequent visits to the outpatient clinic.
Elucidating Acute Kidney Injury in Pediatric Critical Care: Comparative Insights from pRIFLE and KDIGO criteria
(Perinatal Society of Nepal (PESON), 2024) Vinoy, Gloria; SR, Shalini
Abstract:
Introduction: This study aims to investigate the incidence, etiology, risk factors, course, and outcomes of Acute Kidney Injury (AKI) in the Paediatric Intensive Care Unit (PICU). It also seeks to compare the pRIFLE (Paediatric Risk, Injury, Failure, Loss, and End-stage renal disease) and KDIGO (Kidney Disease: Improving Global Outcomes) criteria in terms of incidence and staging, and assess the relative diagnostic abilities of oliguria and serum creatinine as determinants.
Methods: This was a cross-sectional study with AKI screening according to pRIFLE and KDIGO. All patients admitted to PICU for more than 24 hours were included. Relevant history, examination findings, and lab investigations were recorded after informed consent. Differences between AKI and non-AKI groups were analyzed using the independent t-test.
Results: AKI incidence varied between 13.5% (pRIFLE) and 12.5% (KDIGO). The difference was statistically insignificant. Risk factors included nephrotoxic drugs, mechanical ventilation, and inotropes (p = 0.031, < 0.001, < 0.001). Mortality risk was 6.4 times higher in AKI. PICU stay was longer for AKI group (6.8 ± 3.9 days) compared to non-AKI (4.2 ± 2.6 days, p < 0.001). Urine output criteria identified AKI in 8.3% of patients not meeting serum creatinine criteria, while 23.3% had AKI based on serum creatinine only with normal urine output.
Conclusions: AKI significantly increases mortality risk in PICU patients, with mechanical ventilation, nephrotoxic drugs, and inotropic support being key risk factors. Incidence rates vary by definition used, and there is poor congruence between serum creatinine and urine output in diagnosing AKI.
Feasibility of Pulse Oximetry as a Screening Tool for Early-Onset Neonatal Sepsis at Tertiary Care Teaching Hospital, India
(Perinatal Society of Nepal (PESON), 2024) Singh, Silky; Bijapure, Hidaytullah R; Patil, Mallanagouda M; Charaki, Siddu; SS, Kalyanshettar; Patil, SV
Abstract:
Introduction: Sepsis is a serious infection in neonates. It usually presents with non-specific symptoms, making early diagnosis difficult. In India, with an incidence of sepsis 30 per 1,000 live births, early detection is very important. Hypoxia is a one of the important findings seen in sepsis. Pulse oximetry is a simple, reliable way to measure oxygen saturation. The primary objective of this study was to assess the feasibility of utilizing pulse oximetry as a means of detecting hypoxia in asymptomatic neonates with early-onset neonatal sepsis (EONS).
Methods: A prospective observational study was conducted among 282 asymptomatic neonates. Pulse oximetry was performed thrice: within six hours, within 24 hours of life and one to two hours before discharge. Newborns with oxygen saturation below 90% within six hours or with readings between 90 - 94% within 24 hours on repeat screening were considered as test-positive. Full sepsis screening including blood cultures, chest X-ray was performed in test positive asymptomatic neonates. Echocardiography was also performed to exclude any cardiac problems. Neonates who tested negative were observed until they were discharged from the hospital to detect any possible development of sepsis.
Results: Out of 282 neonates, five (1.8%) tested positive by pulse oximetry. All of them were confirmed to have probable EONS. All those neonates who tested-negative by pulse oximetry, remained free of EONS during follow-up.
Conclusion: Pulse oximetry can be a useful screening tool for detecting EONS.