Journal Issue: Volume: 37, No. 3 (2017)
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2017
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Assessment of Nutritional Status of Children Attending Paediatrics OPD of a Tertiary Care Hospital in Eastern Nepal
(Nepal Paediatric Society (JNPS), 2017) Thakur, Jitendra; Bhatta, Nisha Keshary; Poudel, Prakash; Shah, Gouri Shankar; Singh, Rupa Rajbandari
Abstract:
Introduction: Malnutrition is one of the major health problem worldwide, especially in developing world and so is in Nepal, the causes being numerous. The objectives of this study were to assess the nutritional status of children attending paediatric OPD of BPKIHS and to find relation of the nutritional status with different factors.
Material and Methods: This descriptive cross sectional study was done by face to face interviews using semi-structured questionnaire and anthropometric variables were recorded. Data of total 192 children was analysed by descriptive statistics. p-value <0.05 was considered significant.
Results: According to IAP classification 50.52% were malnourished [grade I 65.97%, grade II 26.8%, grade III 7.21%]. According to WHO classification 47.39% stuntedmoderate 89%, severe 11% and 9.89% wasted [moderate 94.73%, severe 5.26%]. Female sex, low education level in mother, low economic status, unavailability of exclusive breast feeding, low birth spacing and hospitalization were significantly associated with malnutrition.
Conclusion: Malnutrition is common in children visiting paediatric OPD of BPKIHS. Female sex, maternal illiteracy, poverty, early weaning, birth spacing and hospitalization in past were major risk factors for malnutrition.
Combination of Alarm-intervention and Reboxetine in Therapy- Resistant Enuresis
(Nepal Paediatric Society (JNPS), 2017) Kosilov, Kirill; Kuzina, Irina; Gainullina, Yuliya; Kuznetsov, Vladimir; Kosilova, Liliya; Karashchuk, Elena Viktorovna; Prokofyeva, Alexandra; Loparev, Sergay
Abstract:
Introduction: The first-line treatments of primary monosymptomatic night enuresis (PMNE) are alarm intervention and desmopressin. Some patients are resistant to these modes of treatment. Therefore Reboxetine has been used to treat PMNE in these scenarios in recent years and published in many studies. The aim of the study was to determine effectiveness and safety of combination of Alarm intervention and Reboxetine, to treat patients with therapyresistant enuresis.
Material and Methods: Two hundred and nineteen children of both sexes were participated in the experiment (average age, 11.3 years). Participants were divided into three groups: Group A (71 patients, Alarm intervention), Group B (79 patients, Reboxetine as monotherapy), Group C (69 patients, Alarm intervention + Reboxetine). The duration of treatment was twelve weeks, followed by follow-up period of twelve weeks to see efficacy.
Result: There was no significant change in number of enuresis episodes per week before and after treatment in a group B. The number of enuresis episodes per a week (weekly) in a group C reached: before treatment 5.3 (1.5), after treatment 1.0 (0.8), 3 three months after the end of treatment 0.7 (0.7). The percentage of patients with PMNE in a group C was significantly less immediately after the course of treatment (17.4%), and three months after treatment (24.6%).
Conclusion: Combined treatment of therapy-resistant enuresis with use of Alarm Intervention and Reboxetine gives a high percentage of cured patients both immediately after therapy (82.6%) and three months after the end (75.4%).
Comparison of Oral Versus Normal and High-Dose Rectal Paracetamol in the Treatment of Fever in Children
(Nepal Paediatric Society (JNPS), 2017) Bastola, Ramchandra; Shrestha, Shree Krishna; Bastola, Bhawana Sigdel; Shrestha, Dhurba; Sharma, Yograj
Abstract:
Correction: On 13th June 2018 the author Yog Raj Sharma was changed to Yograj Sharma
Introduction: Paracetamol is the most commonly used drug in paediatrics with the standard dose (15 mg/kg) of oral and rectal paracetamol preparations interchangeably is used to treat fever in children, assuming they have equal antipyretic effect. We did a study to compare the effectiveness of two different rectal doses of paracetamol: 15 mg/kg and 30 mg/kg to that of a standard oral dose of 15 mg/kg.
Material and Methods: This is a prospective, interventional, randomized controlled study done in Western Regional Hospital, Nepal in which 192 children with fever aged six months to six years. Study duration was August 2015 to October 2015. The sample included 63 in the oral normal dose group (15mg/kg), 59 in normal dose rectal group (15mg/kg) and 70 in high dose (30mg/kg) rectal paracetamol group. Temperature was recorded before and after the administration of paracetamol at an interval of 30, 60, 120, and 180 minutes by using a digital thermometer.
Results: Total of 59 patients received 15 mg/kg rectal Paracetamol (group A), 70 received 30 mg/kg rectal Paracetamol (group B), and 63 received 15 mg/kg oral Paracetamol (group C). Mean temperature before giving medication in Group A, B and C respectively were 101.7° F, 101.9° F and 101.5° F. At 30 min temperature was 100.8° F, 100.8° F and 100.66° F, while at 60 minutes temperature was 99.9° F, 99.7° F, and 99.7° F respectively for Group A,B and C. But at 120 and 180 minutes temperature decreased significantly who got rectal 30 mg/kg of paracetamol.
Conclusions: Rectal paracetamol in a dose of 30mg/kg is more effective than oral paracetamol in a dose of 15 mg/kg. However oral paracetamol given in a dose of 15 mg/ kg is more effective than rectal paracetamol in a same dose.
Fulminant Hepatitis A in Children, its Incidence, Presentation, Complications and Outcome: A Study from Eastern India
(Nepal Paediatric Society (JNPS), 2017) Mohanty, Niranjan; Shubhankar, Mishra; Sambedana, Panigrahi
Abstract:
Introduction: Hepatitis A is one of the most frequent infectious liver diseases affecting children worldwide. The disease is usually mild and self-limited, and complications are very rare. But sometimes hepatitis A can cause acute liver failure (ALF), a severe, life-threatening condition. The objective was to do clinicoepidemiological evaluation of hepatitis A patients who were admitted to the In patients department of our hospital along with analyze the complications seen in the disease.
Materials and Methods: It was a prospective study, done in Department of paediatrics, Maharaja Krushna Chandra Gajapati from May 2014-April 2016. Total number of patients was 80. Patients having history or features of prodromal symptoms like fever, nausea, vomiting, anorexia, yellowish discoloration of urine and body, pain abdomen, change in mental status and coagulopathy with suspicion of acute hepatitis (within 8 wks) with positive IgM for hepatitis A were included in the group. Statistical analysis was done by SPSS software version 20.
Results: Total number of patients was 80. Mean age of hospitalisation was 5.5 years. 90% children were having jaundice. 85% patients were having liver enzyme high. Most common complication was gallbladder wall thickening followed by ascitis, pleural effusion etc. Encephalopathy was observed in three patients. Total three patients died. Maximum death was seen in infancy with delay in hospitalisation.
Conclusions: Viral hepatitis due to hepatitis A is a benign disease. But fulminant hepatic failure due to it is not uncommon. The lesser the age, presence of cardinal features like jaundice may not be apparent. So clinicians must be conscious of these lethal complications while managing a child of probable viral hepatitis. This study will raise the consciousness of urgency of vaccination for hepatitis A, which is thought to be sparingly optional for many parents as well as doctors.
Neonatal Mortality and Morbidity in a Tertiary Care Hospital of Coastal South India
(Nepal Paediatric Society (JNPS), 2017) Kannan, Raja; Rao, Suchetha; Mithra, Prasanna; Rajesh, SM; Unnikrishnan, Bhaskaran; Rekha, T
Abstract:
Correction: On 13th June, Prasanna Mithra was added as an author of this paper.
Introduction: Progress in new-born survival has been slow. There is a variation in neonatal death rates across states and geographical region of a country. Understanding the pattern of mortality is essential in improving new-born survival. This study was conducted to study the mortality and morbidity profile in Neonatal Intensive Care Unit (NICU) of a university teaching hospital.
Material and Methods: This was a retrospective descriptive study including records of all neonates admitted in NICU from January 2015 to December 2016.
Results 3623 neonates were admitted during the study period. Majority were preterm and low birth weight babies. Neonatal jaundice (41.4%) was the leading cause of admission. Major cause of morbidity was sepsis (26.2%). Average duration of stay were higher in out borns (8.4 days) compared to inborn (6.5 days) neonates. Among mortality a higher male predominance was seen. Neonatal sepsis (36.3%) was the single most common cause of mortality followed by respiratory distress syndrome (27.4%) and congenital malformations (18.6%). Out born neonates which were self-transported had higher mortality rate than transported by ambulance.
Conclusion This study identifies sepsis, prematurity and low birth weight as the major causes of morbidity. Sepsis, respiratory distress syndrome and congenital malformations were the leading causes of mortality Understanding causes of neonatal mortality may help to implement interventions to promote new-born survival.