Journal Issue: Volume: 34, No. 3 (2014)
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2014
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Antioxidants in Hypoxic Ischemic Encephalopathy
(Nepal Paediatric Society (JNPS), 2014) Rathee, AVS; Prasad, PL
Abstract:
Introduction: Perinatal asphyxia and related injuries are leading cause of morbidity and mortality in India. These babies are at risk to develop hypoxic ischemic encephalopathy (HIE) due to multiple organ including brain damage. The role of malondialdehyde (MDA) as a marker of free radical injury has been well established. Vitamin C and alpha Tocopherols have neutralizing effects on the free radicals. Considering these facts, it was decided to estimate serum MDA level in cases of HIE and the neutralizing effects of Vitamin C and Vitamin E.
Material and Methods: The study was conducted in a tertiary care teaching hospital. Neonates with an Apgar score of <6 at 5 minutes and birth weight >2500g were included in the study. They were randomized into two groups. One group was given Vit E and vitamin C and the other was not given any of the anti oxidants. Serum MDA level were measured in both groups.
Result: Serum MDA level was found to be increasing in both groups, but the increase was significantly higher in group II where antioxidants were not given. It was also found that serum MDA level was significantly low in antioxidants groups with HIE than those without antioxidants.
Conclusion: Antioxidants supplementation in cases of HIE is associated with lesser production of free radicals and their neutralization is affected by antioxidants resulting into lesser damage to brain.
Bacteriological Profile of Neonatal Sepsis in a Tertiary Level Hospital of Nepal
(Nepal Paediatric Society (JNPS), 2014) Khanal, R; Manandhar, S; Acharya, GP
Abstract:
Introduction: Neonatal sepsis is one of the most common reasons for admission to neonatal units in developing countries. It is also a major cause of mortality in both developed and developing countries. This study was done to determine the bacterial profile causing neonatal sepsis and to assess their susceptibility pattern to various antimicrobial agents.
Materials and Methods: A cross-sectional prospective study was conducted in Paropakar Maternity and Women’s Hospital, Kathmandu, Nepal among 340 neonates suspected of neonatal sepsis. Blood culture was performed and organisms were identified with Gram staining and conventional biochemical methods. Antimicrobial susceptibility testing was performed by Kirby-Bauer disk diffusion method according to the Clinical and Laboratory Standards Institute (CLSI).
Results: The prevalence rate of neonatal sepsis was 20.3%. Among 340 neonates, 52.17% were males and 47.82% were females. Gram positive cocci were the most predominant isolates (88.40%). Among Gram positive cocci Staphylococcus epidermidis was the most common isolates (72.46%) followed by Staphylococcus aureus (7.24%), Staphylococcus saprophyticus (4.34%) and Enterococcus fecalis (4.34%). Gram negative bacilli were found in 11.60% of the growth positive samples of which E.coli and Klebsiella spp were found in 10.14% and 1.44% respectively. Sensitivity to Amikacin was highest among all types of organisms isolated. Vancomycin and Gentamycin sensitivity was highest for Gram positive and Gram negative organisms respectively. Ampicillin resistance was highest among isolates. Among the 69 isolates 48 were Multiple drug resistant.
Conclusion: The predominance of Gram positive cocci particularly Coagulase negative Staphylococci is shown. Empirical antibiotic therapy should be reviewed for Multiple drug resistant strains.
Community Based Nutrition Education for Promoting Nutritional Status of Children under Three Years of Age in Rural Areas of Mahottari District of Nepal
(Nepal Paediatric Society (JNPS), 2014) Yadav, DK; Gupta, N; Shrestha, N; Kumar, A; Bose, DK
Abstract:
Introduction: Maternal and child mortality have declined significantly in Nepal to the extent that Nepal is on track to meet the Millennium Development Goals for maternal and child mortality. Similar improvements have not been seen in general nutrition status of them. Objective of this study was to evaluate a nutrition-education intervention designed to improve nutritional status (reduce stunting, wasting and underweight) of children.
Materials and Methods: It was an intervention with separate sample pretest posttest design. Two groups of Village Development Committee (VDC) from Mahottari district were recruited as interventional and control areas. The intervention was a 12-months nutrition education program and comprised of twelve times with 2-3 hour nutrition lectures and discussion classless conducted by the Female Community Health Volunteers (FCHVs).
Results: The Present study found that number of underweight children increased by 7.6% in control group while it decreased by 17.7% in intervention group from baseline to endline in both groups. So, intervention programme was able to decrease the number of underweight children significantly. Study shows that wasting status of children increased by 11.4% in control group from baseline to endline period. While in intervention group wasting status of children decreased by more than 5% from baseline to endline period.
Conclusion: Nutrition education intervention was effective to reduce wasting and underweight but did not reduce the stunting status of children. Stunting reflects failure to receive adequate nutrition over a long period of time and is affected by recurrent and chronic illness. Findings suggested that nutrition programme of longer duration should be implemented to control the stunting status of children.
Early Experience With Single-Stage Transanal Endorectal Pull Through For Rectosigmoid Hirschsprung’s Disease
(Nepal Paediatric Society (JNPS), 2014) Shrestha, MK; Sherchan, M; Dhoubhadel, BK; Basnet, RB
Abstract:
On 24th August 2015, the spelling of the third author's name was changed from Dhaubhadel TO Dhoubhadel - Editor.
Introduction: Recent trends in surgery for Hirschsprung’s disease (HD) have been towards earlier operation and fewer surgical stages. A single-stage transanal endorectal pull through (TEPT) is the latest development and minimally invasive technique for HD. This observational prospective study was designed to evaluate the safety and efficacy of single-stage TEPT technique in the management of rectosigmoid HD.
Materials and Methods: Infants and children with biopsy-proved aganglionosis and barium enema (BE) documented rectosigmoid HD were included for single stage TEPT. Twenty children aged 22 days to 7 years (17 boys and 3 girls) underwent one stage TEPT over 5 year period. Median follow up was 18 months (range 6-36 months). These patients were evaluated with regard to age, sex, intraoperative details, postoperative functional outcome and complications and need for secondary surgical procedure.
Results: The operating time was 105-180 minutes (mean 120 minutes). The length of resected bowel was 18-30 cm (mean 25 cm). Intraoperative blood loss was 5-40 ml, less in infants compared to older children. Blood transfusion was needed in none out of 12 infants and 2 out of 8 older children. Transient perianal excoriation occurred in 16 patients. Postoperative enterocolitis occurred in one patient. One patient developed constipation with encopresis following anastomotic stricture. None had adhesive obstruction and prolapse of pulled through colon, one required colostomy for anastomotic leakage and peritonitis while another had retained aganglionic segment and re-do pull through was required.
Conclusion: Single-stage TEPT can be performed successfully in all age of children. The technique is safe, easily learned and has good clinical results.
Is Iron Deficiency Anaemia, a risk Factor For Wheeze Associated Respiratory Tract Infection in Children?
(Nepal Paediatric Society (JNPS), 2014) Agrawal, A; Gupta, R; Sodhi, KD; Raghav, V
Abstract:
Introduction: Wheezing is the common in children with cumulative prevalence of almost 50% by the age of 6 yrs. Iron deficiency anaemia is an independent risk factor for lower respiratory tract infections (LRTI), however may also play an important role in wheeze associated respiratory tract infection. The present study aimed at finding a correlation between iron deficiency anaemia and wheeze associated respiratory tract infection.
Materials and Methods: This case control study was conducted at a multidisciplinary tertiary care hospital from Jul 2012 to Jun 2013 among children six months to five years and having ≥2 episodes of wheeze associated respiratory tract infections. The clinical presentation and laboratory profile were recorded on a predesigned performa. Iron deficiency anaemia was diagnosed by haemoglobin <11.0 gm%, serum ferritin<12ng/ml and RDW>15%. The statistical analysis was done using SPSS, Version 15.0.
Results: A total of 100 children were enrolled in the study, of which 50 cases and 50 matched controls. Majority of subjects in both groups were males (n=31;62%),with male to female ratio of 1.6:1. Proportion of cases with iron deficiency anaemia were higher among cases(32%) as compared to controls(24%) but the difference between two groups was not significant statistically (p=0.373) despite having higher risk(OR=1.49;95% CI=0.62-3.59). Mean monocyte, oeosinophil and absolute oeosinophil count was found to be significantly higher in cases as compared to controls (p<0.05).
Conclusion: The present study do not suggest a possible linkage between iron deficiency anemia and wheeze associated respiratory infection, however its role as causative factor needs to be explored through long-term prospective and intervention studies on a large population.