Journal Issue: Volume: 30, No. 3 (2010)
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Volume
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Issue Date
2010
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Paediatric Day Care Inguinal Hernia Surgery in a General Hospital: A Prospective Study on Change in Practice
(Nepal Paediatric Society (JNPS), 2010) Shah, JN; Subedi, N
Abstract:
Introduction: This prospective study was undertaken to observe the prospects of daycare inguinal hernia surgery in general hospital setup in a developing country like Nepal and to assess the advantages, acceptability and safety of this approach.
Methodology: The study was carried out prospectively for one year from March 2009- Feb 2010. Before surgery, children were examined in surgical referral clinic (SRC). Parents were given verbal and written instructions for pre-operative fasting. Operations were carried out under intravenous anesthesia without intubation by experienced consultant general surgeon or by registrar under supervision. Children were observed in recovery area till conscious. Once awake, the children were handed over to parents for further observation till fully conscious and could tolerate liquid. Oral Paracetamol and homecare instructions were given to parents. Appointment slip was given for follow up visit in SRC within 3-5 days.
Results: There were 90 children, male 81 (89%), age 2 months to 13 years. Right inguinal hernias were 62 (70%). There were no major complications, mortality or readmission. Saving in terms of less disruption of routine work at home and office was more appreciated by parents.
Conclusion: We conclude that day care inguinal hernia surgery in children in our setup is safe, economic well accepted by child and parent's both.
Pleural Effusion in Children: How often do we suspect Tubercular origin?
(Nepal Paediatric Society (JNPS), 2010) Shrestha, PN; Rayamajhi, A
Abstract:
Introduction: Pleural effusion is a common problem in children; mostly due to common causes like pyogenic or tubercular infections. Different studies have showed that about 30%-60% of pleural effusion have resulted into formation of empyema.
Method: This was an observational study done in children aged 3 months to 14 years with a diagnosis of pleural effusion admitted at Kanti Children’s Hospital, Maharajgunj from August 2009 to March 2010. The aim of the study was done to find out different modalities of treatment for the same and their outcome. A detailed clinical history and physical examination, was done in all children. Chest x-ray, laboratory reports and treatment were recorded and all patients followed up until death or discharge. Any change of management was also noted. Pleural effusion caused by nephritic syndrome or congestive cardiac failure were excluded from the study.
Results: During the study period of eight months, 64 patients were admitted with the diagnosis of pleural effusion. Boys to girls ratio was 2:1. Right-sided pleural effusions were more common than left sided pleural effusions (53% vs. 37%). Most of patients improved with parental antibiotics along with chest tube drainage (62%). One in three patients (31%) received anti-tubercular drugs. Three patients (4.6%) were referred to surgeon for decortications and one patient (1.6%) died.
Conclusion: Though chest tube drainage with parental antibiotics was the mainstay of treatment of pleural effusion, however one-third of patients also received anti-tubercular drugs.
An Epidemiological Study of Snake Bite Cases in Children of Nepal
(Nepal Paediatric Society (JNPS), 2010) Joshi, DD
Abstract:
Introduction: Snakebite is common in the Terai region of Nepal. Injury and mortality of humans due to Snake envenomation is a serious pubic health problem in Southeast Asia and Nepal. It has been thought that at least 50,000 people in the region die of snake bites (this includes India, Bangladesh and Nepal and Pakistan) per year. There are abundant venomous snakes present in the region. Studies in Nepal have identified 4 species of snake responsible for the majority of fatal bites. These are the Indian cobra (Naja naja), common krait (Bungaris caeruleus) Russell's viper (Viper ressellii) and greenpit viper. The incidence of snakebite varies from 300-500 bites per 100,000 human populations in forested regions to 50-100 bites per 100,000 in Sahara.
Objective: To study the epidemiology of snakebite in the endemic regions of the terai, to analyse the morbidity and mortality data of snakebite cases in children for the year 2008.
Method: National Zoonoses and Food Hygiene Research Centre (NZFHRC) started collection of secondary and primary information on snakebite cases in children recorded and reported by different media and hospitals, health post in Nepal during the year 2008. The data had been compiled, tabulated and analysed. This is the regular surveillance study carried out on snakes in general and venomous snakebite human cases recorded in Nepal. The team visited in 6 mid, hill districts and 24 terai districts of Nepal.
Results: Total snakebite cases in children were 540 during the year 2008. Of which 10 cases were from six mid hill districts and 530 were from 24 terai and inner terai districts of Nepal. Total morbidity was 406 (75.19%) and mortality 134 (24.81%). Seasonal incidence of snakebite cases recorded in Bheri zonal hospital and medical college Banke district. Highest morbidity were recorded during the month of Jestha (May) to Aswin (August). Morbidity 12 (25%) and mortality 3 (20%) were recorded in the month of May/June 2008.
Conclusions: Snakebite cases in children and deaths were recorded and reported along with adult cases of snakebite. Total adult cases were 2190 of which children were 540 (24.66%) during the year 2008. This means that about 25% of all cases of snakebites were seen in children every year in the endemic areas of snakes. Mass awareness school education programme about snakebite especially in endemic area of terai and inner districts should be advocated regularly so that parents along with children will take necessary precautions.
Clinical Profile of Birth Asphyxia in Dhulikhel Hospital: A Retrospective Study
(Nepal Paediatric Society (JNPS), 2010) Dongol, S; Singh, J; Shrestha, S; Shakya, A
Abstract:
Introduction: Birth asphyxia is defined by the World Health Organization "the failure to initiate and sustain breathing at birth." The WHO has estimated that 4 million babies die during the neonatal period every year and 99% of these deaths occur in low-income and middle income countries. Three major causes account for over three quarters of these deaths, serious infection (28%) complication of preterm birth (26%) and birth asphyxia (23%). This estimation implies that birth asphyxia is the cause of around one million neonatal deaths each year. One of the present challenges is the lack of a gold standard for accurately defining birth asphyxia. Because of same reason the incidence of birth asphyxia is difficult to quantify.
Objective: The aim of this study was to assess the prevalence of birth asphyxia, identify the common obstetric and neonatal risk factors, and study the cause of death.
Methodology: All babies born in Dhulikhel Hospital (DH) from Jan 2007 to Oct 2009 with a diagnosis of birth asphyxia (5 min Apgar < 7 and those with no spontaneous respirations after birth) were included in the study (n=102). Clinical information was collected retrospectively from maternal records (maternal age, gravida, type of delivery, presence of meconium, induced or spontaneous labour, and pregnancy complications). The NICU records provided additional information about new born infant (birth asphyxia, stages of birth asphyxia, birth weight, sex and subsequent mortality).
Results: Among the 3784 live births there were 102 babies with birth asphyxia prevalence of 26.9/1000 live births. Babies with Hypoxic ischemic encephalopathy (HIE) Stage 1 had a very good outcome but HIE III was associated with a poor outcome. Males, primipara and pregnancies with complications were associated with a higher rate of birth asphyxia. Septicaemia, necrotizing enterocolitis, preterm delivery, convulsion and, pneumothorax were associated with higher mortality and morbidity.
Conclusion: Birth asphyxia was one of the commonest causes of admission and mortality in NICU. Babies with HIE Stage III had a very poor prognosis. Birth asphyxia combined with other morbidities was associated with a higher mortality. Sepsis is the commonest morbidity in cases of birth asphyxia. Maternal gravida, pregnancy complication with PROM, meconium, APH, emergency caesarean section, preterm and male sex were the risk factors for birth asphyxia.