Journal Issue: Volume: 43, No. 3 (2023)
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Volume
Number
Issue Date
2023
Journal Title
Journal ISSN
ISSN 1990-7974 eISSN 1990-7982
Journal Volume
Articles
Added Utility of Diaphragm and lung Ultrasound Indices along with Rapid Shallow Breathing Index in Predicting Extubation Success in Children
(Nepal Paediatric Society (JNPS), 2023) Habeeb, Sameen; Beig, Farzana; Ali, Mohd. Kashif
Abstract:
Introduction: Prolonged mechanical ventilation leads to diaphragm atrophy and impaired functions. An accurate assessment of its function by bedside ultrasonography during spontaneous breathing trial can add to predictive value of respiratory scores like RSBI. Lung and diaphragm ultrasound are bedside non-invasive techniques which can be used to assess the weaning readiness in children.
Methods: This study involved 50 children; newborn to 14 years of age, admitted to PICU and mechanically ventilated, during a period from November 2020 to November 2022. All patients were candidates for weaning and have been given a chance for spontaneous breathing trial (SBT), during which diaphragmatic and lung ultrasound indices were assessed. The diaphragm thickening fraction (DTF), diaphragmatic excursion (DE) and lung Ultrasound score (LUS) that included 4 US aeration forms, were assessed. Values satisfying any of the below variables were considered weaning failure; rapid shallow breathing index ≥ 8 breaths / min / ml / kg, Diaphragm thickness fraction ≤ 20%, Diaphragm excursion: ≤ 6 mm, Lung ultrasound score: ≥ 12. Sensitivity, specificity, PPV and NPV of each ultrasound parameters was calculated and compared.
Results: Statistically significant differences were found between patients with failed weaning and those with successful weaning regarding RSBI, DTF and LUSG. RSBI was found to be good predictor of weaning success. RSBI along with DTF and LUSG increased the specificity to predict weaning success rather than RSBI alone.
Conclusion: Rapid shallow breathing index of ≤ 8 is a sensitive predictor of weaning success. Lung and diaphragm ultrasound increase the specificity of RSBI to predict weaning success in critically ill children.
Analysis of Risk Factor Specific Mortality to Improve Neonatal Mortality Rate in a Special Newborn Care Unit: A Cross Sectional Descriptive Study
(Nepal Paediatric Society (JNPS), 2023) Kundu, Tapan Kumar; Chatterjee, Abhilash; Bera, Mitali; Chowdhury, Aditi; Guchhait, Riya
Abstract
Introduction: The proposed Sustainable Development Goal (SDG) target aims to reduce preventable deaths of newborn and reduce neonatal mortality to as low as 12 per 1000 live births by 2030. The study aimed to identify the newborns who died, why and when they died, if death was possibly preventable or probably unpreventable and identify the areas where neonatal mortality rate (NMR) reduction is possible.
Methods: A cross sectional, retrospective, descriptive study was conducted on inborn newborns at a Special Newborn Care Unit of a medical college hospital in eastern India from January 1, 2021 to December 31, 2021. Admission and mortality data regarding gender, social category, gestational age, birth weight, cause of death and age at death were collected and analysed.
Results: Live births in the institution were 14525 with 1423 sick newborns admitted to the SNCU and 309 deaths (54.37% males). Highest number of deaths occurred in birth weight ≤ 999 grams (88.75%) and gestational age < 28 weeks (79.66%). The cause of death was perinatal asphyxia in 29.13%, prematurity < 28 weeks gestation and IUGR with birth weight (≤ 999 grams) in 22.98% and sepsis in 22.65%. First day deaths were 15.21%, first 2 days 33.98% and first 7 days 74.11%.
Conclusion: Mortality in the sick newborns was 21.71%. Increased mortality was observed in female gender, scheduled tribe, < 28 weeks gestation, birth weight ≤ 999 grams. The possibly preventable deaths are most of the cases of perinatal asphyxia, sepsis and prematurity contributing to 74.76% of all deaths. To reduce NMR, interventions should target these areas.
An Exploratory Mixed Methods Study on Caregiver’s Knowledge on Nutritional Requirement of Children Aged Six Months to Two Years
(Nepal Paediatric Society (JNPS), 2023) M, Rajalakshmi; Abiharini, Subramoniam
Abstract:
Introduction: Giving healthy balanced diet to children ensures that they are getting all the essential vitamins, minerals and other nutrients. Majority of the mortality and morbidity among children occur in the under 5 age group and one of the major causes of death is the malnutrition. Focussing on overall nutritional value of food given is more important than on any one nutrient or some of them. Hence the study was done to assess the mother’s or direct care giver’s knowledge on nutritional requirement of children aged six months to two years.
Methods: It was an exploratory mixed method design where qualitative (Using in-depth interview) method was followed by the quantitative (Using communitybased cross sectional study design). A questionnaire was developed with items exploring the knowledge of caretakers of under 2-year children with the help of “In depth interview” technique among caretakers of a representative population. Questionnaire was also had details on socio-demographic variables and details on obstetrics and other health care seeking behavior of mothers.
Results: In-depth interview explored that caretakers and health care workers perspective on nutritional requirement for children aged 6 months to 2 years were mother’s educational status, family income and number of family members / children and various customs and belief. In the quantitative phase, 58.9% caregivers of children received information on feeding from health staffs and about 83.3% of them introduced complementary feeding after six months of age. The knowledge on practice food diversity was also found to be adequate.
Conclusion: Health education to caretakers regarding importance of balanced diet with efficient use of complimentary feeding and use of diverse food items to generate interest of child is important.
A Five Year Profile of Clinical, Epidemiological and Radiological Characteristics of H1N1 Influenza in Children Admitted to Tertiary Care Center in South India
(Nepal Paediatric Society (JNPS), 2023) Kumar, Sandeep; Athota, Mahesh Choudary; Kini, Pushpa; Aroor, Shrikiran; Mundkur, Suneel; Bhat Y, Ramesh; Moras, Karen Janice
Abstract:
Introduction: Influenza viruses are common etiological agents of acute respiratory illness in children. Clinical presentation varies from flu like illness to severe respiratory and multi organ involvement. This study is done to describe the clinical profile and outcome of hospitalized children diagnosed with H1N1 influenza.
Methods: A retrospective descriptive study was done at a tertiary care hospital in South India. It included children with swine flu diagnosed by RT-PCR assay of nasopharyngeal swab during the study period of five years. Data included clinical features, radiological findings, laboratory parameters, clinical course, complications and outcome.
Results: There were 118 children with H1N1 Influenza. Median age was 4.35 years (IQR 0.8 - 10.7) with male:female ratio of 0.8:1. Fever was the commonest symptom present in 113 children (95.7%) followed by cough in 103 (87.2%) and nasal discharge (39.8%). Lower respiratory tract signs were present in 38 (27.9%) of the children. Co-morbid illness included malnutrition (33%), pre-existing wheeze (9.3%) and anaemia (6.8%). Anaemia was the common laboratory (36%) followed by thrombocytopenia (21.2%) and leucopenia (18.6%). Interstitial pattern was the commonest radiological finding (27.9%). Complications included secondary bacterial infection (27.1%), severe respiratory distress (16.2%), septic shock and MODS (5.9%), pleural effusion (3.4%), ARDS (2.5%), pneumothorax (1.7%) and PAH (1.7%). Mortality was observed in 5 (4.2%) children.
Conclusion: The presence of co-morbid illness is a risk factor for severity of illness. Malnutrition and anaemia were risk factors for hospitalization and mortality.
A Study on Knowledge, Attitude and Practices Regarding Dengue Fever Among Parents from a Tertiary care Center in Mangalore, India
(Nepal Paediatric Society (JNPS), 2023) Shifa, Fathima; K, Shreedhara Avabratha
Abstract:
Introduction: Dengue fever has emerged as an endemic threat in many parts of South India. Therefore, awareness among parents regarding the preventive measures and early identification of symptoms of the disease in children is of prime importance. The present study was conducted to assess the level of awareness among parents regarding various aspects of dengue.
Methods: Questionnaire based descriptive study was conducted in both out-patient and in-patient basis in a Medical College Hospital in Mangalore, Karnataka. Data analysis was done by calculation of the percentage of correct responses and p value to determine the correlation between knowledge, attitude and practice score.
Results: Total of 94 parents were interviewed. Majority were below 30 years of age (45.7%) and had a family income of 10,000 to 50,000 per month (62.8%). Majority of parents (89.4%) had good knowledge about dengue fever. 90.4% of parents had a positive attitude and 89.4% received a good score in practice assessment. Statistically significant association was observed between knowledge and the attitude (p value = 0.005) and between the knowledge and dengue preventive practices (p value = 0.002). Demographic factors like age, sex, family income did not show any significant association with knowledge, attitude and practices while health education had.
Conclusion: Significant association was noted between knowledge and dengue preventive practices. Education had significant association with dengue knowledge, attitude and practices.