Journal Issue: Volume. 40, No. 3 (2020)
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Volume
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2020
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Journal ISSN
ISSN 1990-7974 eISSN 1990-7982
Journal Volume
Articles
Foetal and Neonatal Outcome in Pregnant Women with COVID-19
(Nepal Paediatric Society (JNPS), 2020) Shrestha, Rupesh; Basnet, Srijana; Shrestha, Laxman
Abstract:
Introduction: The pandemic caused by coronavirus disease 2019 has adversely affected the health of all individuals including pregnant women. The susceptibility of pregnant women and their foetuses to severe acute respiratory syndrome coronavirus 2 infection is not clearly known. The objective of this review is to summarise the available evidence on foetal and neonatal outcomes of pregnant women with confirmed coronavirus disease 2019.
Methods: The review was conduced by searching the PubMed and MedRxiv databases for studies reporting outcome of pregnancy with confirmed coronavirus disease from December 2019 to April 2020 using combination of terms "pregnancy", "coronavirus disease 2019", "foetal outcome" and "neonatal outcome". Only peer reviewed articles reporting outcome of pregnancy with confirmed coronavirus disease 2019 were included in the review irrespective of language. Ongoing pregnancies, induced abortion, and pregnancies without outcome were excluded from analysis. Variables extracted and analysed included gestational age at delivery, mode of delivery, foetal and neonatal outcome.
Results: In total, 21 studies consisting 230 pregnant women including three twin pregnancies were enrolled in the study. Fever and cough were the most common symptoms reported in pregnant women. One hundred and sixty-two (70.4%) pregnant women underwent cesarean section and there were 68 (29.6%) preterm deliveries. Eight babies tested positive out of 161 newborns that were tested for coronavirus infection. Among adverse outcomes reported, there were two miscarriages, two still births and only one neonatal death.
Conclusions: Outcome of pregnancy with coronavirus disease 2019 in late trimester appears to be favourable. Occurrence of preterm delivery and cesarean section appear higher among infected pregnant women in comparison to general population. There was no conclusive evidence of vertical transmission.
A Crossover Comparative Study to Assess Efficacy of 5% vs. 20% Albumin in the Treatment of Anasarca in Children with Idiopathic Nephrotic Syndrome
(Nepal Paediatric Society (JNPS), 2020) Garg, Ajoy Kumar; Kalra, Suprita; Kumar, Ashutosh; Kanitkar, Madhuri
Abstract:
Introduction: Co-administration of albumin and furosemide has shown better response than furosemide alone in managing anasarca among children with nephrotic syndrome. There are different concentrations of albumin available. The aim of this study was to compare diuretic response to co-administration of either 5% or 20% albumin with furosemide in these children.
Methods: It was a crossover randomised trial conducted on children with nephrotic syndrome with moderate to severe oedema at a tertiary care centre. They were randomised to two groups; Group A (n = 14) received 5% albumin along with furosemide in midway followed by 20% albumin after washout period of 48 hrs and group B (n = 10) received albumin vice versa. Baseline and post therapy vitals, fluid intake, urine output and biochemistry were noted. Primary outcomes were increase in urine output and reduction in weight following co-administration of albumin with furosemide. For analysis of primary outcomes, two interventional arms were formed; group I (5% Albumin co-administered with furosemide) and group II (20% albumin co-administered with furosemide).
Results: Total children were 24 in each arm i.e. group I and II. Eighteen (75%) were males. Mean (range) age at enrolment and duration of illness were 55.3 (15 - 144) and 18.6 (1 - 120) months respectively. Mean difference (SD) in urine output were 1.52 (1.11) and 1.66 (0.95) ml/kg/hr (p = 0.12) and mean percentage weight loss were 2.25% (2.12) and 3.68% (3.84) in group I and II respectively (p = 0.64). On further comparing, urine output was significantly better when 5% albumin was co-administered with furosemide during first period than in second period.
Conclusions: Co-administration of either 5% or 20% albumin with furosemide is equally safe and effective in increasing urine output in children with anasarca.
A Sonographic Study of Kidney Dimensions Among Nepalese Children
(Nepal Paediatric Society (JNPS), 2020) Mansur, Dil Islam; Karki, Subindra; Shrestha, Pragya; Maskey, Sunima
Abstract:
Introduction: Any variations in shape or size of either one or both kidneys may indicate sign of its pathology. The study was aimed to determine normal values for renal dimensions among Nepalese children.
Methods: This was a cross-sectional study of the renal dimensions among 211 children. The length, breadth and thickness of kidneys were measured by computerised in built calliper in centimetre by using ultrasound and volume of the kidney was calculated.
Results: The mean values of length, breadth, thickness and volume were 7.05 ± 1.80 cm, 2.95 ± 0.48 cm, 1.35 ± 0.15 cm and 15.09 ± 5.91 cc for right kidneys respectively; and 7.36 ± 1.89 cm, 2.98 ± 1.89 cm, 1.35 ± 0.18 cm and 15.98 ± 6.44 cc for left kidneys respectively. The mean values for length, breadth, thickness and volume of right kidney was 7.57 ± 1.99 cm, 3.11 ± 0.46 cm, 1.38 ± 0.14 cm and 17.38 ± 6.20 cc among boys respectively; and 6.50 ± 1.39 cm, 2.78 ± 0.44 cm, 1.31 ± 0.17 cm and 12.69 ± 4.43 cc among girls respectively. Similarly, these values for length, breadth, thickness and volume of left kidneys were 7.91 ± 2.04 cm, 3.13 ± 0.49 cm, 1.39 ± 0.18 cm and 18.46 ± 6.89 cc among boys respectively; and 6.78 ± 1.52 cm, 2.83 ± 0.45 cm, 1.31 ± 0.17 cm and 13.38 ± 4.73 cc among girls respectively.
Conclusions: It was concluded that mean values for renal length and volume was found to be higher on left side than right side in all age groups. These values for renal breadth and thickness were observed almost same on both sides in all age groups. All measurements of renal dimensions were found significantly higher among boys than girls on both sides. This study has provided the reference values for renal sizes among Nepalese children.
A Study on Home Safety Practices to Prevent Childhood Injuries Among Mothers
(Nepal Paediatric Society (JNPS), 2020) Kadke, Shreedhara Avabratha; Chunduri, Sujatha; Kudpi, Varadaraj Shenoy
Abstract:
Introduction: Most unintentional injuries in children occur at home and many are preventable. Mothers and family’s role in injury prevention is very important. We intended to study the role of home safety practices in prevention of childhood injuries.
Methods: This descriptive cross-sectional study was done using a questionnaire. Mothers of children aged one to five years were assessed about home safety practices to prevent childhood injuries. Questionnaire included personal data about the participants such as age, occupation, education, family size and number of children. Safety practices followed by mothers to prevent six types of injuries namely burn, cut, fall, drowning, poisoning and choking were noted.
Results: Of the 150 mothers interviewed, 104 were aged below 30 years, 88 were educated up to high school and 130 were housewives. Thirty mothers reported some kind of injury sustained by their children, of which twenty-one were falls. Among precautionary measures mother – behaviour safety initiatives e.g. checking the hot water temperature (88%) or not leaving child alone (92%) got better responses than passive or environmental modifications e.g. using electrical – outlet protection (44%), staircase gates (52%). Overall safety practices were reasonably good with the majority scoring above 50%. Age, education, number of children, occupation of the mother, child age and history of injury did not correlate with the level of safety practices.
Conclusions: Mothers’ home safety practices to prevent childhood injuries were relatively better in majority of the study population. Mother’s age, educational level, occupation, number of children, child’s age and history of injury did not affect how mother and her family practiced safety measures.
Comparison Between Alvarado Score and Paediatric Appendicitis Score in Diagnosing Acute Appendicitis in Children
(Nepal Paediatric Society (JNPS), 2020) Rajbhandari, Bikesh; Dahal, Geha Raj; Pokharel, Rameshwar Prasad
Abstract:
Introduction: Acute appendicitis is the most common atraumatic surgical emergency in childhood. The accurate diagnosis of acute appendicitis is not always easy. Alvarado score (AS) and paediatric appendicitis score (PAS) are commonly used tools to assist diagnosis. This study compares the diagnostic accuracy between AS and PAS.
Methods: A prospective study was conducted from September 2016 to September 2017 in Paediatric Surgery Unit of Tribhuvan University Teaching Hospital. All eligible patients (children up to 16 years) who were operated for acute appendicitis were included. AS and PAS were calculated for all patients preoperatively. Final diagnosis of acute appendicitis was based on histopathological examination and labeled as ‘appendicitis’ or ‘no appendicitis’. A cut off score of 7 for AS and 6 for PAS was compared with ‘appendicitis’ or ‘no appendicitis’ group.
Results: A total of 70 patients were included in the study. Sixty five (93%) were histologically proven acute appendicitis and five (7%) were no appendicitis. The sensitivity, specificity, PPV, NPV and accuracy of AS were 89%, 40%, 95%, 22% and 85% respectively. For PAS, sensitivity, specificity, PPV, NPV and accuracy was 97%, 40%, 95.5%, 50% and 92% respectively. On Receiver Operating Characteristic curve, ‘area under curve’ of AS was 0.64 and that of PAS was 0.84. It was not statistically significant (p = 0.152).
Conclusions: There was no statistical significant difference between AS and PAS for diagnosing acute appendicitis.