Journal Issue: Volume: 34 No. 1 (2014)
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2014
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ISSN 1990-7974 eISSN 1990-7982
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Articles
Acute Lymphoblastic Leukemia: Fourteen Years Experience of a Single Institution
(Nepal Paediatric Society (JNPS), 2014) Sah, KP; Shrestha, PN
Abstract:
Introduction: Leukemia commonly known as blood cancer is the most common malignant neoplasm in childhood accounting for about 41 % of all malignancies that occur in children younger than 15 year of age. The objectives of this study were to find out the clinico-laboratory features and survival of children with acute lymphoblastic leukemia (ALL) during fourteen years in pediatric oncology unit of a tertiary care hospital.
Materials and Methods: This was a retrospective study conducted at Kanti Children’s Hospital (KCH) from March 1998 to March 2012. Bone marrow aspiration showing ≥25 % blast cells was the criteria for diagnosis of ALL.
Results: Out of 755 childhood cancers reported in this hospital during study period, total number of Acute leukemia patients were 375 (49.7%). Among acute leukemia, patients with ALL were 300, which was 80.0 % among all leukemias and 39.7% of all cases of cancers. Among cases of ALL, L1, L2 and L3 constituted 163 (54.3%), 131 (43.7%) and 6 (2%) respectively. The age of the children with acute leukemia ranged from six months to fourteen years, with a mean age of 7.3 years. The majority of children (61.7 %) with ALL fell into the age group of 2-9 years. Males: Female ratio was (M:F=1.3:1 ). The most common presenting features in ALL were fever (89.2 %), followed by splenomegaly (89.1%), hepatomegaly (69.2%) and lymphadenopathy (58.4 %). Among all patients, remission rate was 28.3% at ≥ 5 years, 17.7% were on maintenance, 30.3% abandoned treatment and 23.7 % died.
Conclusion: This study showed that the patients on remission at ≥ 5 years in this centre were 28.3%.
Adverse Events of Exchange Transfusion in Neonatal Hyperbilirubinemia
(Nepal Paediatric Society (JNPS), 2014) Chitlangia, M; Shah, GS; Poudel, P; Mishra, OP
Abstract:
Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia.
Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary- care centre between September 2010 to March 2012, requiring ET were enrolled.
Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre- ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events.
Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.
An Assessment of Drawing Age in Pre-School Children Using 'Draw-A-Man' Test
(Nepal Paediatric Society (JNPS), 2014) Raja, S; John, BM
Abstract:
Introduction: Goodenough-Harris ‘Draw-a-Man’ Test has been traditionally used as a simple tool to measure mental development in a child. There have very few studies looking at utility of ‘Draw a man’ test in the Indian subcontinent in the recent past. We carried out an assessment of correlation of drawing age with chronological age in pre-school children by the ‘Draw- a- man test’ and looked for any associations with respect to a deviation (delay or advancement) in the calculated drawing age.
Materials and Methods: A cross-sectional descriptive study was conducted on 100 neurologically normal pre-school children between 36 to 72 months. The data was then analyzed with Pearson correlation and Chi square test on SPSS version 14.0
Result: There was a low positive correlation between drawing age and chronological age (Pearson correlation: r=+0.31, p=0.002).There were more boys (p=0.004) and more children with prematurity (p=0.012) in the group with low or equal drawing age compared to chronological age.
Conclusion: In view of the low positive correlation found in our study, further studies with a larger sample need to be conducted to establish the ‘Draw-a-man’ test as a screening tool for mental age assessment in our subcontinent. We did find a significant association of deviation of drawing age from chronological age with respect to gender and prematurity.
Randomized Control Trial of Kangaroo Mother Care in Low Birth Weight Babies at a Tertiary Level Hospital
(Nepal Paediatric Society (JNPS), 2014) Acharya, N; Singh, RR; Bhatta, NK; Poudel, P
Abstract:
Introduction: This study was conducted to compare the effect of Kangaroo Mother Care (KMC) and conventional methods of care on weight gain, occurrence of hypothermia and apnea and duration of hospital stay among Low Birth Weight (LBW) babies.
Materials and Methods: It was a randomized control trial conducted at a tertiary level hospital for a period of one year from June 2009 to May 2010. Total 126 stable LBW babies weighing less than 2000 gm and fulfilling inclusion criteria were included in the study. Neonates enrolled for the study were allocated to either KMC or control group using random number table. KMC group was subjected to Kangaroo mother care of at least six hours per day in not more than four sittings. In control group, babies were adequately clothed, covered and kept with their mother and if required were kept under radiant warmer. Recording of temperature in KMC group was done before, during and after KMC. In control group temperature was taken every 4 hours. Weighing of baby was done twice daily on electronic weighing scale.
Results: Median daily weight gain (IQR) was 10 (6- 20) gm in KMC group as compared to 7 (0-10) gm in control group (p<0.001). Mean weight gain was 12.11±9.04 gm in KMC group as compared to 3.29±15.81 gm in control group (p<0.001). Incidence of hypothermia was more in control group (12.6%) as compared to KMC group (3.1%) (p=0.048). Duration of hospital stay was less in control group as compared to KMC group (p=0.015).
Conclusion: LBW babies less than 2000 gm who receive KMC show better weight gain and have less incidence of hypothermia than those who do not receive KMC.