Journal Issue: Volume: 38, No. 1 (2018)
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Volume
Number
Issue Date
2018
Journal Title
Journal ISSN
ISSN 1990-7974 eISSN 1990-7982
Journal Volume
Articles
Accuracy of Transcutaneous Bilirubinometry in Neonates Receiving Phototherapy
(Nepal Paediatric Society (JNPS), 2018) Dagli, Pallavi Parag; Vasava, Snehal
Abstract:
Introduction: Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy.
Methods: This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB.
Results: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, p<0.01) among preterm and (r = 0.76 and 0.79, p<0.01) among term infants. Bland–Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates.
Conclusion: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants.
Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia
(Nepal Paediatric Society (JNPS), 2018) Singh, Srijana Dongol; Shrestha, Narayan Charan; Joshi, Anish
Abstract:
Introduction
Pneumonia is a widespread and commonest infectious lung disease that causes inflammation which lead to reduced oxygenation. Indeed, it is the leading cause of child death in the world. The study was carried out to fine out the demographic, clinical characteristics and radiologic resolution of Pneumonia in children between 2 months to 16 years of age.
Material and Methods
A prospective study done in 121 cases over 18 month period in patients admitted in pediatric department of Dhulikhel hospital. Demography, clinical profile, diagnosis, Down’s scoring at presentation, response of treatment and risk factor for fetal Community acquired pneumonia were analyzed using descriptive statics. Chest radiography was done on admission and every 2 weeks until its complete resolution occurred.
Results
A total of 121 patients with community acquired pneumonia were enrolled. The male and female ratio was 1.69:1. Among all age group it was most significantly common in children less than 1 year (p=.022).The common symptoms of Community acquired pneumonia observed in this study were cough (80%), fever (66%) and shortness of breath (38.8%). On chest roentgenogram right middle zone(47.9%) was most frequently involved. The total leukocyte count had low degree of association with pneumonia. More than half of patients (54.08%) with community acquired pneumonia had radiographic resolution at 2 weeks. The respiratory distress was significantly high (p<0.0001) in children who delayed to seek medical treatment in a health facility by three days.Anemia, lymphopenia, thrombocytopenia, sepsis and hemorrhagic pleural effusion were the clinical characteristics associated withfatal Community acquired pneumonia
Conclusion
Clinical presentations variesin Community acquired pneumonia with different age groups. Chest radiography is still best investigation for the diagnosis of pneumonia and most of the radiological clearance occurs in 2 weeks.
Demographic Profile and Outcome of Mechanically Ventilated Children in a Tertiary Care Hospital of a Developing Country
(Nepal Paediatric Society (JNPS), 2018) Sahoo, Bandya; Jain, Mukesh Kumar; Thakur, Bhaskar; Mishra, Reshmi; Patnaik, Sibabratta
Abstract:
Introduction: The need for mechanical ventilation (MV) is an absolute indication for admission to Paediatric intensive care unit (PICU). Management of children requiring invasive ventilation in resource limited developing countries is challenging. Scare data is available from Asian countries regarding use of MV in PICUs. The objectives of this study were to determine the clinical profile, characteristics, common causes for ventilation, ventilation related complications and final outcome of these patients.
Material and Methods: A retrospective study of children requiring ventilator support in PICU of Kalinga Institute of Medical Sciences from January 2014 to December 2016 was done. Data collected included epidemiological trends, indications for ventilation, complications, length of stay on ventilator and outcome.
Results: A total of 1172 patients were admitted to PICU, 101 (8.6%) patients required MV. 42% of the mechanically ventilated patients were infants and 75% were males. Impending respiratory failure (34.6%) and low Glasgow coma scale (17.8%) were the commonest indication for ventilation in this study. The median length of MV was 2.1 days. The mortality rate of these children was 38.6%. We report the epidemiological trends, frequency, indications and outcomes of children requiring ventilator support in PICU. Analysis of this data can be helpful in improving outcome in future by planning better treatment strategies.
Conclusion: The frequency of MV in our PICU is low. Respiratory failure was the most common reason for mechanical ventilation.
Dietary Practices of Lactating Women and Nutritional Status of Children in Baglung District, Nepal Authors
(Nepal Paediatric Society (JNPS), 2018) Gautam, Usha; Yadav, Dipendra Kumar
Abstract:
Introduction: Breastfeeding success depends on both mother and child. There is high energy requirement to produce breast milk, which is wholesome food for under 6 months children and then complementary foods are introduced to child. Inadequate feeding practices affect nutritional status of children. The main aim of this study was to measure the dietary practices of lactating women and nutritional status of their children.
Material and Methods: A cross sectional study was conducted among 343 lactating women and under two years children of Baglung district. Random sampling technique was applied to select the participants. Face to face interview was conducted among women to collect the data and anthropometric measurement was performed among the children. Data were entered in EPI-DATA version 3.2 and exported to Statistical Package for Social Sciences (SPSS version 17.0) for further analysis.
Results: Only 5.2% of mother had taken additional two meals per day and energy intake of 31.8% of women was met. Dietary practices of mothers were not associated with nutritional status of children. Breastfeeding practice was nearly universal (99.7%). Bulks (91.8%) of children were put into breast for breast feeding within first hour of birth. Exclusive breastfeeding rate was 34.5%. Bottle feeding was practiced by 15.6% of women. Less than half (40%) of 6-23 months children (n=174) had achieved satisfactory feeding practice (minimum meal frequency and minimum dietary diversity). The rate of wasting (n=180), stunting (n=180) and underweight (n=343) was 10%, 22.2% and 9.3% respectively. Feeding practice to children was associated with wasting and stunting.
Conclusion: Dietary practice of women and feeding practice to their children was not satisfactory. Dietary practice of women was not associated with nutritional status of children but feeding practice was associated with their nutritional status. The rate of stunting, wasting and underweight was high.
Neuroimaging in Children with Cerebral Palsy: A Study Conducted at Tertiary Level Paediatric Hospital of Nepal
(Nepal Paediatric Society (JNPS), 2018) Manandhar, Bina Prajapati; Singh, Usha; Khatun, Najala
Abstract:
Introduction: In Nepal, cerebral palsy (CP) is the common cause of severe motor disability. However, only few descriptive studies related to it have been conducted, but those did not incorporate neuroimaging in CP. Thus, the objective of this study is to identify clinical and radiological profile of children diagnosed with CP at a tertiary level paediatric hospital of Nepal.
Material and Methods: This study was carried out at Kanti Children's Hospital and the study utilized data of children diagnosed with CP from September 2015- April 2017.
Results: A total of 100 children were diagnosed with CP. Spastic CP was the most common in children (71%), followed by mixed (21%) and dyskinetic (8%). Majority of the children were male (74%), born at term (90%) and delivered at institution (80%). Neuroimaging abnormality was found in 66% of cases which included brain malformation (2%), periventricular white matter abnormalities (23%), cortical or deep grey matter lesions (37%) and miscellaneous (4%). The results of this study also showed significant association between variables such as birth weight and birth asphyxia with type of neuroimaging findings.
Conclusion: Neuroimaging is helpful for diagnosis of CP and also useful for parents and physicians to understand children condition. Hence, further studies related to neuroimaging in CP are important to better understand it in detail.