Journal Issue: Volume: 41, No. 2 (2021)
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2021
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Nepal Pediatric Society Guidelines for the Safe Transport of Critically Ill Children in Nepal
(Nepal Paediatric Society (JNPS), 2021) Amatya, Puja; Shrestha, Dhruba; Joshi, Suchita; Sharma, Arun; Shrestha, Shrijana; Basnet, Sangita
Abstract:
Transport of critically ill children is associated with increased risk of morbidity and mortality in developing countries due to the lack of adequate resources and skilled personnel. Transport of the sick child remains a major challenge in Nepal as well. The main objective of this article is to describe the importance of safe transport, and be a resource and guide for health care personnel during inter-facility transport of sick children in Nepal. This guideline is based on consensus statement of Nepal Pediatric Critical Care Working Group (NPCCWG) under the aegis of the Nepal Pediatric Society (NEPAS). It includes different components of transport, namely essential equipment, patient preparation, communications, medications, and transport checklist, that are required during transport of sick children, taking into consideration the current resources available in our health care facilities.
A Prospective Case-Control Study to Compare the Clinical Outcomes and Metabolic Profile in Neonates Born to Diabetic Mothers in a Tertiary Care Armed Forces Hospital, India
(Nepal Paediatric Society (JNPS), 2021) Singh Dhillon, Harpreet; KN, Kushvanth; Kaur Dhillon, Gurpreet; Sasidharan, Shibu; Singh, Vijay
Abstract:
Introduction: The prevalence of gestational diabetes mellitus (GDM) is on the rise especially in women of Asian ethnicity. GDM carries with it a multitude of foeto-maternal complications, the management of which is still a challenge, especially in developing countries.
Methods: This was a hospital based prospective case control study conducted on 100 neonates to compare clinical outcomes and metabolic profiles in neonates of diabetic mothers and neonates of non-diabetic mothers over a period of two years.
Results: The mothers in GDM group had 66% emergency lower segment caesarean section (LSCS) compared to 32% in non- GDM group (p = 0.001). The infants of diabetic mothers (IDM) had statistically significant higher percentage of preterm births, NICU admission, hyperbilirubinemia, hypoglycaemia and polycythemia. The anthropometric and cord blood parameters (Haemoglobin, haematocrit, platelet, calcium and bilirubin) were comparable in both the groups.
Conclusions: GDM poses significant risks to both mother and neonate, however optimal glycemic control and meticulous monitoring and treatment protocols can reduce the incidence of certain known complications.
C-Reactive Protein With Procalcitonin as a Marker of Occult Bacterial Infection in Fever Without a Focus
(Nepal Paediatric Society (JNPS), 2021) Hiremath, Pooja M; D, Narayanappa; H S, Rajani
Abstract:
Introduction: Fever without a focus constitutes a major problem in children in the age group of three months to 36 months. Majority have viral infections but around 1.6 - 2% can have occult serious bacterial infection which needs early identification and treatment. The study was done to evaluate combination of CRP with Procalcitonin (PCT) as a marker of SBI in children (Three months - 36 months) with fever without focus in comparison with only PCT or CRP done separately.
Methods: In this hospital based explorative study, 31 children between three months to 36 months of age with fever without any localising signs were enrolled. Relevant investigations were done to diagnose or rule out serious bacterial infection. Cut off of > 10 mg/dl for CRP and > 0.5 ng/ml for PCT was considered. Appropriate statistical analysis was done.
Results: Among 31 recruited cases, 14 had occult serious bacterial infection with urinary tract infection being the most common cause. The combination PCT with CRP had sensitivity of 78.5%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 85%. Diagnostic accuracy was 90.32% which did not have any statistically significant difference compared to PCT alone but significant compared to CRP alone.
Conclusions: Combining CRP with procalcitonin did not have any added advantage over procalcitonin alone but combination of CRP and PCT and PCT alone is useful in detecting occult serious bacterial infections in children with fever without focus compared to CRP alone.
Characteristics of Hearing Impairment in Children Aged Six Months to Two Years with Global Developmental Delay
(Nepal Paediatric Society (JNPS), 2021) Bhat Y, Ramesh; Kashyap, Harish; Kini, Pushpa; Hebbar, Shrikiran
Abstract
Introduction: Children with global developmental delay (GDD) are at greater risk to have hearing impairments. These impairments interfere with developmental progress or rehabilitation effects. Hearing impairments may be correctable and if so, may improve developmental outcomes. We aimed to study the incidence, characteristics and probable risk factors of hearing impairment in children aged six months to two years with GDD.
Methods: In this prospective study, an auditory evaluation was carried out by a trained audiologist in children with GDD. Transient evoked otoacoustic emissions (TEOAE) and brainstem auditory evoked response (BERA) were assessed in these children. Hearing loss was classified based on Goodmann's classification.
Results: Of 113 children with GDD assessed, hearing impairment was identified in 35 (30.9%) children. Of 35 children, 22 (62.8%) had isolated sensorineural hearing loss (SNHL). Conductive hearing loss was identified in four (11.5%) and combined hearing loss in nine (25.7%). Of 31 children with SNHL, hearing loss was bilateral in 25 (80.6%). In SNHL, hearing loss was profound in one (3.2%), severe in 14 (45%), moderately severe in three (9.6%), and moderate in five (16.2%). Hearing impairment was associated with 31.7% (20/63) children with cerebral palsy. Kernicterus was another predominant risk factor associated with SNHL. Metabolic disorders, otitis media, tuberous sclerosis, and metachromatic leukodystrophy were other conditions associated with hearing impairment.
Conclusions: Hearing impairment is accompanied by about a third of children with GDD. The hearing impairment in children with GDD tends to severe SNHL type in about 45% and bilateral in about 80%.
Clinico - Epidemiological Profile of Diabetic Ketoacidosis in Hospitalised Children at a Tertiary Health Care Centre
(Nepal Paediatric Society (JNPS), 2021) Mali, Vijay Tukaram; Kavthekar, Saiprasad Onkareshwar; Verma, Sachin; Kurane, Anil Bapurao; Patil, Nivedita Balasaheb; Kulkarni, Suhas Panditrao
Abstract:
Introduction: Diabetic Ketoacidosis (DKA) presents with spectrum of clinical manifestations and awareness regarding this amongst physicians is crucial. The study aimed to chronicle the clinical profile of DKA in type 1 diabetes mellitus (T1DM) children.
Methods: The study was conducted at a tertiary care hospital including patients with signs and symptoms of DKA with either debut or established T1DM (n = 38). Detailed clinical history, examination and laboratory investigations were carried out. Differences in frequency distribution concerning demographics and clinical data were analysed in R-studio software (v.1.2.5001).
Results: Kussmaul breathing (49.97%) was the commonest presentation. Infection (39.46%) and poor compliance due to inadvertent omission of insulin therapy (50%) were the commonest precipitating factors. Mild, moderate and severe dehydration was present in 44.74%, 39.47% and 15.79% respectively. Forty-five percent patients had moderate while 34.21% and 21.05% had mild and severe DKA respectively. Seventy-five percent and 52% patients were below 3rd percentile for height and weight respectively. High number of patients had past history of viral infections, were diagnosed in winter, belonged to 2nd or 3rd birth order and from lower middle class. Patients with poor compliance to insulin belonged to lower middle (40%), upper lower (53.33%) and lower class (6.67%).
Conclusions: DKA can be diagnosed early by identifying dehydration, Kussmaul breathing, polyuria and altered sensorium. Infection and poor compliance due to omission of insulin therapy were the commonest and preventable precipitating factor for DKA. Poor compliance to insulin can be attributed to lower socioeconomic class. Awareness among physicians concerning clinical profile of DKA is crucial.