Journal Issue: Volume: 41, No. 1 (2021)
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2021
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal
(Nepal Paediatric Society (JNPS), 2021) Basnet, Sangita; Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Bajracharya, Binod Lal; Shrestha, Anil; Shrestha, Sudeep; Rajchal, Pramila; Kafle, Raju; Shrestha, Devendra; Puri, Sangeeta; Bhatta, Anwesh; Pathak, Om Krishna; Shrestha, Shrijana
Abstract:
Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal.
Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources.
Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources.
Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.
Association of Tri-Ponderal Mass Index vs Body Mass Index With Mid-Upper Arm Circumference Among Adolescent Girls
(Nepal Paediatric Society (JNPS), 2021) Roy, Shreyasi; Sen, Jaydip
Abstract:
Introduction: Since 2017, number of studies involving nutritional status of adolescents using a novel parameter named tri-ponderal mass index (TMI) is soaring high. The concept of TMI was formulated to substitute body mass index (BMI) in case of adolescent population. The present study aims to find TMI values of school-going adolescent girls (aged 10 to 19 years). It also aims to compare the association of TMI and BMI with mid-upper arm circumference (MUAC) of the subjects.
Methods: Height, weight and MUAC were measured using standard procedures. The BMI and TMI were accordingly calculated. The data obtained was tabulated to elucidate age-wise descriptive statistics. Quadratic polynomial regression was employed to yield a general conclusion regarding association of TMI and BMI with MUAC of the subjects. Receiver operating characteristic (ROC) curve was plotted to check which of the two indices, BMI or TMI, has better ability to predict higher MUAC of the subjects.
Results: The ROC-area under curve (AUC) was 0.867 and 0.955 for TMI and BMI respectively.
Conclusion: BMI has better association with MUAC. In comparison to TMI, BMI has superior ability in predicting higher MUAC of the subjects.
Better Prediction of Neuro - Developmental Outcome in Babies Using Combined Vojta’s Neurokinesiological Examination, Amiel Tison Angles and Head Holding Grades
(Nepal Paediatric Society (JNPS), 2021) Jain, Ashish; Veerabhadrappa, H; Shrikant, SW; Kumari, Nisha
Abstract:
Introduction: With the advances in medical technology, the survival rate has increased amongst the high-risk neonates. Changes occurring in the neuro-motor function during the first year of life are closely related to the maturation of the central nervous system of babies and the presence or absence of injury to brain. These should be detected as early as possible, so that intervention programmes can be started.
Methods: A prospective study was done in NICU of a teaching hospital, to find the predictive value of combined assessment by three neuro-developmental examinations Viz. Vojta’s Neurokinesiological examination, Amiel-Tison angles and head holding grades. Total 375 babies with various high risk category were included, out of which only 114 infants completed one-year follow-up. On the first visit a detailed neurological examination was performed using Vojtas Neurokinesological postures, Amiel- Tison angles and head holding grades based on Trivandrum Developmental Screening Chart (TDSC). At one year, the milestones attained were plotted against the BSID percentiles and babies assigned as developmentally delayed, if it was below 97% pass level. Sensitivity and specificity were calculated and propositions evaluated by chi-square test.
Results: 23% babies had developmental delay at one year. The important high risk factors were maternal risk factors 39%, HIE with MAS, HIE stage-III, complications during NICU stay.
Conclusions: Vojta’s Neurokinesiological examination is an effective screening test that can be applied to all high-risk neonates. The predictive value could be enhanced to 100%, by using other simple tests, like Amiel-Tison Angles and Head holding grades by TDSC.
Clinical and Demographic Profiles of Children Presenting with Acetaminophen Induced Acute Liver Failure in a Tertiary Paediatric Intensive Care Unit of South India
(Nepal Paediatric Society (JNPS), 2021) Amatya, Puja; Kapalavai, Sudeep Kumar; Krupanandan, Ravi Kumar; Sadasivam, Kalaimaran; Sankaranarayanan, Srinivas; Ramachandran, Bala
Abstract:
Introduction: Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Although hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. There is very sparse data regarding APAP induced paediatric acute liver failure in our settings, hence this study was done to know the clinical and demographic profiles as well as outcome of children with APAP induced acute liver failure.
Methods: This was a retrospective study done in children aged 0 - 18 years admitted with the diagnosis of acetaminophen induced acute liver failure in a tertiary paediatric intensive care unit of South India from January 2014 to December 2018. The clinical, demographic profiles and outcome of these patients were reviewed and analysed.
Results: A total of 26 children had acetaminophen induced acute liver failure. Out of 26 patients, 53.8% were males and 46.1% were females. Among these, 24 (92.3%) survived and two (7.7%) died. The average dose of acetaminophen ingested was 168.5 mg/ kg/d. The mean serum acetaminophen level was 52.3 mg/dl. The presence of low pH, hypotension and international normalised ratio (INR) value of > 4 showed bad outcome in children with acetaminophen induced acute liver failure.
Conclusion: Paracetamol induced acute liver failure is rare but fatal presentation in children. Children with acidosis, shock and INR value of > 4 had poor prognosis. Hence, judicious use of different preparations as well as counselling to parents regarding use of appropriate doses in children should be done while prescribing this medicine.
Clinical Profile, Outcome and Risk Factors for Mortality of Neonates Requiring Mechanical Ventilation at Tertiary Care Centre of Central Gujarat, India
(Nepal Paediatric Society (JNPS), 2021) Thakkar, Pareshkumar A; Pansuriya, Himanshu G; Bharani, Sheela; Taneja, Khushboo Kamal
Abstract:
Introduction: Mechanical ventilation is an important factor contributing to the reduced neonatal mortality in NICU. However, many ventilated babies are left with detrimental sequelae. This study was undertaken to know the prognostic predictors and survival outcome in the ventilated neonates. We assessed the clinical profile, outcome of mechanical ventilation and analysed the risk factors for mortality and complications resulting from mechanical ventilation.
Methods: A prospective study was conducted at the NICU of a tertiary care hospital in India. The study period was from May 2015 to April 2016. Neonates who underwent mechanical ventilation and met the inclusion criteria were enrolled in the study. Their demographic profile, outcomes and risk factors were documented and analysed using appropriate statistical methods.
Results: 285 neonates required mechanical ventilation during the study period. Among them, 190 were included in the study. Overall mortality was 99 out of the 190 enrolled (52%). The most common indications for mechanical ventilation were Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS) and apnea. Risk factors contributing significantly to higher mortality of ventilated neonates were very low birth weight (VLBW), gestation of less than 32 weeks, shock, ventilator- associated complications like pneumothorax and pulmonary haemorrhage. In multiple regression analysis, very low birth weight, circulatory disturbances, pneumothorax, pulmonary haemorrhage, and higher initial FiO2 requirement were found to be independent risk factors of mortality.
Conclusions: The commonest indications for mechanical ventilation were RDS and MAS. Significantly higher mortality was seen amongst VLBW, preterm neonates. Co-morbidities like circulatory disturbance, and complications like pneumothorax and pulmonary haemorrhage contributed to adverse outcomes.