Journal Issue: Volume: 40, No. 2 (2020)
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2020
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ISSN 1990-7974 eISSN 1990-7982
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Articles
A Prospective Observational Study of Hypomagnesemia in Critically Ill Paediatric Patients
(Nepal Paediatric Society (JNPS), 2020) Chandrashekhar, Channanayaka; Pillai, Reshmi; Vasudev, Prajwala Hassan; Babu, Tirin; Panachiyil, George Mathew
Abstract:
Introduction: Magnesium deficiency, a common finding in critically ill patients, is associated with increased need for respiratory support, increased duration of ICU stay and mortality. The primary objective of our study is to assess the prevalence of hypomagnesaemia in critically ill children (requiring inotropic support, respiratory support, and fluid resuscitation) on admission in the Paediatric Intensive Care Unit (PICU). The secondary objective is to evaluate its relationship with the length of hospital stay and mortality.
Methods: This prospective observational study was conducted in the PICU of a tertiary care hospital. In this study, serum magnesium levels at admission were measured along with other laboratory tests, after informed consent. Serum magnesium levels were assayed in our laboratory. The normal range of serum magnesium in our lab is 1.7-2.7 mg/dl. During admission in PICU, there was follow-up for ionotrope administration, need for mechanical ventilation, APACHE II score, PICU length of stay and mortality.
Results: In this study, 350 critically ill children requiring hemodynamic / respiratory support were chosen. However, 83 children were excluded from study as they were discharged against medical advice. The prevalence of hypomagnesemia in this study was 43.4%. There was no significant association between hypomagnesemia, duration of hospital stay and mortality.
Conclusion: Hypomagnesaemia is a common finding in critically ill paediatric patients, however there is no significant association noted in regards to length of hospital stay, duration of mechanical ventilation, inotropic support and mortality.
Burden of Care Among Mothers Having Children with Congenital Heart Diseases
(Nepal Paediatric Society (JNPS), 2020) Sharma, Nita; Sharma, Pratima; Mishra, Tulashi Adhikari
Abstract:
Introduction: Congenital Heart Disease (CHD) is a problem with structure and function of the heart that is present at birth. Children with CHD require special care, treatment and follow up for a number of common conditions which may be quite straining to the care givers. The objective of the study was to find out the burden of care among mothers having children with CHD.
Methods: This descriptive cross-sectional study was carried out in a cardiac centre of Nepal. A total of 95 mothers having children with CHD attending outpatient department of our institute were selected as the sample for the study using non-probability purposive sampling technique. A semi structured interview questionnaire consisting of the Modified Caregiver Strain Index was used to assess the burden of care among mothers having children with CHD. Frequency and percent were used to describe the variables and chi- square test at 0.05 significance level was used to analyse associations.
Results: Most (77.9%) of the mothers were regularly strained to find that their children’s health condition was deteriorating due to CHD. Nearly half (44.2%) of the mothers always had financial constrain while giving care to the child, nearly half (40%) of the mothers had done emotional adjustments to take care of their children with CHD, another two-fifths (28.4%) of the mothers sometimes had disturbed sleep and almost half (46.3%) of the mothers were always upset due to some behaviour of their child with CHD. Half (50.5%) of the mothers had high level of burden of care. Statistically significant association were found between age of the mother and level of burden of care (p value = 0.05). Similarly, the type of family (p value = 0.005), age of the children (p value = 0.000) and type of CHD (p value = 0.002) were significantly associated with the level of burden of care among the mothers.
Conclusion: The study concluded that mothers tend to feel less burden of care as the child grows older, mothers having children with cyanotic heart disease tend to experience more burden of care. Mothers of less than thirty years of age and living in a joint family also experience more burden of care.
Comparative Study about Impact of Inadequate Psychomotor Stimulation on Neuro-Development in Pre-School Children in Rural India
(Nepal Paediatric Society (JNPS), 2020) Chatterjee, Nandita; Basu, Swati
Abstract:
Introduction: In a rural, underprivileged community, multiple factors including poverty, non-stimulating home environment and lack of parental awareness about early childhood development and early intervention lead to inadequate ‘nurturing care’ for young children, who with genetic predisposition for typical brain development may not reach their developmental potential. The present study attempts to compare and study the developmental differences between children who had adequate stimulation and those who did not during preschool period.
Methods: Developmental assessment of 51 healthy children, aged 3.5 - 4.5 years with poor psychomotor stimulation (study group) and an age-matched group of 27 children attending pre-school (control group) from the same community was conducted and compared. Developmental screening was done using the DDST II screening tool.
Results: The incidence of developmental delay in the study group was significantly higher; deficits were most marked in personal-social and language domain. Concept of colours, counting objects and drawing were conspicuously absent in most children.
Conclusion: Improving home environment, provision of learning opportunity with available resources, and generation of awareness among parents regarding early child development and early intervention are simple, low-cost measures to improve the developmental trajectory in these children.
Diagnostic Yield of Upper Gastrointestinal Endoscopy in Children: A Three Years Experience
(Nepal Paediatric Society (JNPS), 2020) Joshi, Binita Gurubacharya; Ghimire, Madhu
Abstract:
Introduction: Gastrointestinal disorders are very common in paediatric population. Upper Gastrointestinal Endoscopy procedures have increased dramatically worldwide and have contributed in identification of various gastrointestinal disorders along with therapeutic benefits. However, it is recently being established in paediatric population in Nepal and proper data is scarce. This study was aimed to assess upper gastrointestinal endoscopy with respect to its indications and diagnostic yield at a tertiary centre over a three years period.
Methods: This is a retrospective observational study where data of all paediatric patients between the age group 0 - 15 years having various gastrointestinal problems who underwent upper gastrointestinal endoscopy from March 2013 - Feb 2016 in our centre were analysed.
Results: Among 270 patients, males comprised 60% and females comprised 40%. Age range was 0 - 15 years and majority were from the age group between 10 to 15 years (66.2%). Most common indications for endoscopy were chronic abdominal pain (58.8%), acute epigastric pain (18.5%), followed by failure to thrive (7%). Abnormal findings were detected in 250 patients (92.5%); gastroduodenitis (28.14%), antral gastritis (18.51%), erosive gastritis (15.92%), duodenitis (9.25%), hiatus hernia (7.4%), varices (5.5%) were common findings. Histopathologically, chronic gastritis and duodenitis (72%) were common findings followed by acute gastritis and giardiasis. Among 80 patients who underwent RUT, 50% each had positive and negative results.
Conclusion: Chronic abdominal pain remains common gastrointestinal problem in children. With the advent of upper gastrointestinal endoscopy various gastrointestinal problems can be identified and managed accordingly. Along with the facility of histopathology, diagnostic yield and outcome is further enhanced.
Differentiating Scrub Typhus, Dengue Fever and Typhoid Fever in Indian Children Presenting with Acute Febrile Illness
(Nepal Paediatric Society (JNPS), 2020) Chatterjee, Saheli Misra; Mondal, Suman; Mukhopadhyay, Kaushik; Das, Niloy Kumar
Abstract:
Introduction: The disease spectrum of dengue, scrub typhus and typhoid presenting as acute febrile illness is often a diagnostic dilemma to the clinician. The purpose of this study is to compare the clinical features and laboratory parameters of children suffering from typhoid, dengue and scrub typhus and use these parameters in early identification of scrub typhus before conclusion is made from serological diagnosis.
Methods: A retrospective observational analytical study was conducted among children presenting with acute febrile illness in a tertiary care level hospital. Over the period of one year 113 cases were identified of which 39 were dengue, 44 were typhoid and 30 were scrub typhus.
Results: The mean age of the children was 7.45 ± 2.98 years, median was eight with an interquartile range of six to ten years. The male to female ratio was 1.3:1. Symptoms of vomiting (61.54%), headache (46.15%) and hepatomegaly (47.37%) were significantly higher among children with dengue fever. A significantly higher number of children with scrub typhus fever had temperature above 40°C. The incidence of low haemoglobin, raised C reactive protein, raised ALT and low albumin levels were significantly higher in them. Children with acute febrile illness having temperature > 40°C, absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to suffer from scrub typhus with relative probability ratio (RPR) of 25.68 and 10.57 respectively (p < 0.001). Children with WBC < 5000/mm3 were more likely to be suffering from dengue with RPR of 10.60 (p < 0.001).
Conclusion: Children with acute febrile illness with temperature > 40°C and absolute neutrophil/lymphocyte ratio > 2 early in the illness were more likely to be suffering from scrub typhus.