Journal Issue: No 4, Issue 8, OCT-DEC, 2004
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Volume
Number
Issue Date
Journal Title
Journal ISSN
1812-2027
Journal Volume
Articles
HIV and AIDS: the global perspectives and the challenges for Nepal
(Kathmandu University, 2004) S, Sharma
NA
Technology transfer by faculty exchange between developed and developing countries
(Kathmandu University, 2004) DB, Karki
NA
One year follow up study of term babies born at Kathmandu medical college teaching hospital
(Kathmandu University, 2004) K, Manandhar; DS, Manandhar; MR, Baral
Objective: To study the mean, standard deviation and centiles for anthropometry and haemoglobin in healthy term
infants followed up to 12 months of age. Design: Cohort study Settings: Kathmandu Medical College Teaching
Hospital (KMCTH) in Kathmandu. Subject: Consecutive healthy term newborns Method: 100 consecutive healthy
term newborns were enrolled at birth.19 babies were lost in follow up. So, 81(45 male, 36 female) healthy, full term
infants were followed up from birth to 12 months of age. Anthropometry (weight, length, and head circumference)
and haemoglobin were measured at birth, 6 weeks, 6 months, 9 months and 12 months of age. Haemoglobin was
estimated by Hemocue microcuvette method. The data so obtained was subjected to statistical analysis by using
SPSS computer package.
Main outcomes: Mean, centile and standard deviation score values for weight (Kgs), infant length (cms), head
circumference (cms) and haemoglobin (gm/dl) at birth, 6 weeks, 6 months, 9 months and 12 months of age. Results:
Out of 100 babies enrolled, data presented here is for the remaining 81 babies. Among 81 babies, 76 were
appropriate for gestational age (AGA) and 3 were small for gestation (SFD). The mean, standard deviation and
percentile values are presented for anthropometry (weight, length and head circumference) and haemoglobin at
birth, 6 weeks, 6 months, 9 months and 12 months of age. The mean birth weight was 3.05 kg (SD 0.41). The mean
infant length and head circumference at birth were 49 cm (2.28) and 33.8 cm (SD1.4) respectively. The mean
haemoglobin at birth was 15.7 gm/dl (SD 2.29). At 12 months of age mean weight, length, head circumference and
haemoglobin were 9 kg (SD 0.81), 73.5 cm (SD 2.9), 45 cm (SD 1.2 ) and 11.1 gm/dl (SD 1.41) respectively.
Almost 50% of the babies at 6 weeks, 9 months and 12 months of age were found to be anaemic (Hb <11 gm/dl).
Among the babies, 49% were exclusively breast fed for 6 months of age. Other feeding practices seen were,
mother’s breast feed with water supplementation (25%), mother’s breast feeding with formula feed (16%) and
formula feeding only (5%). National and international comparisons of anthropometry and haemoglobin data are
shown in table.
Prognostic indicators in Haemolytic Uraemic Syndrome
(Kathmandu University, 2004) K, Malla; T, Malla; Md, Hanif
Objective: This study aims to review the clinical presentations of Haemolytic Uraemic Syndrome (HUS) and to
compare the poor prognostic indicators with mortality. Methods and Materials: Prospective study carried out in
Renal Dialysis ward of Dhaka Shishu Hospital, Bangladesh from September 2001- November 2003 for a period of
26 months. All children admitted to renal dialysis ward with oliguria or anuria with pallor was included in this study.
HUS was confirmed after laboratory investigations showing features of hemolytic anaemia, thrombocytopenia and
renal insufficiency. Various clinical presentations were reviewed. Then bad prognostic factors were compared with
mortality. Results: There were total 25 cases of HUS in 26 months.17 (68%) were males and 8(32%) females.21
(84%) children were <5 years. Only 4(16%) were >5 years. Before onset of HUS 40% children had bloody
diarrhoea, 36% had acute watery diarrhoea and 24% had others symptoms. The other presentations noted were fever
88%, respiratory distress and convulsion 52% and oliguria 40%, anuria 60%, reluctant to feed 40% and cough
28%. The main physical findings noted were irritability 40%, pallor 100%, dehydration 28%, puffy face with
oedema 32%, high blood pressure 16%, hepatomegaly 28%, jaundice, sclerema and petechial rashes 8%, lethargic
16%, acidotic breathing 48% and rectal prolapse 12%. 44% children died after HUS and 56% recovered from the
illness. Mortality was 66% when duration of illness before onset of HUS was >14 days. With duration of anuria <3
days there was no mortality but it was 91% and 100% with anuria >3-8days and >8 days respectively. Mortality was
78% when age was<18months and it was 75% when age was >5years.Diarrhoea associated HUS had 27% and non
diarrhoea associated HUS had 85% mortality. Mortality was 77% and 100% respectively when HUS was associated
with convulsion and hypertension. WBC >30,000 had mortality 100% and decreased platelet count <30,000 had
mortality 80%. With creatinine level >700μmol/L mortality was 80% and with Serum potassium level 5.6-
7.5mmol/L mortality was 67%.Conclusion: HUS comprised of varieties of presentations. Diarrhoea was the
commonest preceding illness before onset of HUS. The bad prognostic indicators carrying high mortality was
duration of illness before onset of HUS >14 days, anuria >3days, age < 18 months and >5 years, Non diarrhoea
associated HUS, HUS associated with convulsion and hypertension, WBC >30,000/cumm, platelets <30,000/cumm,
creatinine level >700μmol/L and serum potassium level 5.6-7.5mmol/L. Since bad prognostic factors may progress
rapidly to mortality, consultation with paediatrician and transfer to a tertiary care centre should be done when HUS
is diagnosed so that it can be managed appropriately in time.
Key words: Haemolytic Uraemic Syndrome-clinical presentation-mortality.