Journal of Nepal Paediatric Society
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694
(FIVE YEARS 122)

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6
(FIVE YEARS 1)

Published By Nepal Journals Online

1990-7982, 1990-7974

2021 ◽  
Vol 41 (1) ◽  
pp. 103-106
Author(s):  
Bijay Thapa ◽  
Anupama Thapa ◽  
Anju Kayasthya

A wide variety of anomalies may occur as a result of the vitello- intestinal duct (VID) failing to obliterate completely. These anomalies occur in approximately 2% of the population and may remain silent throughout life or may present incidentally with an intra-abdominal complication. Complete patency of vitello-intestinal duct is the rarest of all the anomalies of VID. We report a case of 27 day old female presenting with pinkish umbilical mass since birth referred to us by a paediatrician as umbilical granuloma, which turned out to be patent vitello- intestinal duct.


2021 ◽  
Vol 41 (1) ◽  
pp. 111-114
Author(s):  
Shatanik Sarkar ◽  
Chaitali Patra ◽  
Shibani Pal ◽  
Arkapriya Pramanik

Recurrent respiratory tract infections, a cause of concern for both parents and paediatricians, can have various etiologies entitled to different organ systems. Diagnosing the exact cause warrants both clinical acumen and timely investigations. Here, we are reporting an infant with recurrent respiratory tract infections, where adequate clinical examination prompted us to diagnose the extra-respiratory cause with simple investigations.


2021 ◽  
Vol 41 (1) ◽  
pp. 61-66
Author(s):  
K Jagadish Kumar ◽  
Smriti Bhagiratha ◽  
Prashanth Vishwanath

Introduction: Iron overload in thalassemia catalyses the production of a variety of reactive oxygen species leading to cumulative cell damage. Ischemia modified albumin (IMA) is an end product of oxidative stress. It is imperative to pick up oxidative stress early in order to prevent the organ damage in thalassemia. Therefore this study was undertaken to estimate IMA levels and to see the correlation between ferritin and IMA to establish whether ferritin can be a proxy marker for oxidative stress. Methods: A total of 76 children were included in the study out of which 46 were diagnosed cases of β- Thalassemia major and 30 formed the healthy controls. Pre transfusion haemoglobin, AST, ALT, ferritin and IMA levels were estimated and compared with healthy control children. Correlation was drawn between haemoglobin, AST, ALT, ferritin with IMA. Results: There is significant elevation in the level of IMA and ferritin in children with Thalassemia major as compared to the healthy controls (p = < 0.001). There was a significant positive correlation between ferritin and IMA and a significant negative correlation between haemoglobin % and IMA. Regression relationship between ferritin and IMA established that IMA (ng/ mL) = 246.118 + 0.829 (Ferritin ng/dL). Conclusions: IMA levels were significantly elevated in β- thalassemia major children and correlated positively with ferritin levels. By establishing a regression relationship between ferritin and IMA levels, we can fairly estimate the levels of IMA. Hence, we can utilise ferritin as a proxy marker of oxidative stress instead of IMA.


2021 ◽  
Vol 41 (1) ◽  
pp. 1-10
Author(s):  
Sangita Basnet ◽  
Dhruba Shrestha ◽  
Puja Amatya ◽  
Arun Sharma ◽  
Binod Lal Bajracharya ◽  
...  

Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.


2021 ◽  
Vol 41 (1) ◽  
pp. 87-92
Author(s):  
Sagar Mani Jha ◽  
Lee Budhathoki ◽  
Nabin Bhakta Shakya ◽  
Sunil Shakya ◽  
Kumar Roka

Introduction: Paediatric patients with respiratory symptoms having skin lesions are often referred from Paediatric to Dermatology Department. Knowledge about skin and respiratory manifestations will lead to early diagnosis and proper management by the doctors of both the specialties. These dermatological conditions may or may not be related to respiratory illness or may hence be part of total disease process or may be completely separate entity. The aim of this study was to find out skin manifestations of various respiratory diseases and analyse dermatological disorders in children referred from Paediatric Department having respiratory symptoms. Methods: An observational cross sectional hospital based study involving inpatients and outpatients referred from Paediatrics to Dermatology Department having respiratory illness and skin lesions was undertaken between January 2019 to December 2020. Details of skin disease were recorded. The descriptive statistical analysis was expressed in frequency and percentage and Chi square test was applied to determine significance among variables. Results: Total 437 patients were included in the study. The most common diagnosis made by Paediatric {160 (36.6%)} and Dermatology Departments {246 (56.2%) was viral exanthema followed by atopic dermatitis {77 (17.6%)}. Out of total 65 patients who suffered from bronchial asthma, 59 (90.7%) patients had atopic dermatitis. Conclusions: Significant paediatric patients with respiratory illnesses have concomitant skin lesions. There is very high percentage of patients having atopic dermatitis among those who had asthma and hence clearly depicts relation between the two diseases.


2021 ◽  
Vol 41 (1) ◽  
pp. 42-47
Author(s):  
Om Krishna Pathak ◽  
Yengkhom Rameshwor Singh ◽  
Rahul Mugurkar ◽  
Pradeep Suryawanshi

Introduction: Preterm infants’ brain is vulnerable to ischemic and hemorrhagic injuries due to structural and molecular immaturities as well as associated co-morbidities, which is usually detected by bedside cranial ultrasound. Cranial ultrasound findings are common in preterm infants’ of < 32 weeks, so cranial ultrasound is routinely recommended in them but there is no such recommendation regarding moderate and late preterm infants. The objective of this study is to find the cranial ultrasound abnormalities in moderate and late preterm infants. Methods: This prospective observational study was conducted in a tertiary level neonatal care unit. Hundred moderate and late preterm neonates delivered or admitted within seventh day of life were included in the study. Cranial ultrasound scan was performed between third and seventh day of life and before discharge and ultrasound findings were noted. Data were collected in predesigned case record form and analysed using Fischer Exact test. Results: Out of 100 neonates, 47 (47%) were males and 53 (53%) females. There were 43 (43%) moderately preterm and 57 (57%) late preterm infants. Mean day of life for performing first and second cranial ultrasound was 4.17 (3 - 7) days and 13.24 (3 - 40) days respectively. Cranial abnormalities were noted in 26% neonates. Intra-ventricular haemorrhage grade 1 or 2 was the commonest abnormality noted. Choroid plexus cyst (4%), cerebral edema (3%), periventricular hyperechogenicity (3%) and hydrocephalus (1%) were the other abnormalities noted. Neonates having APGAR < 6 at one minute, mechanically ventilated and having co-morbidities had significantly higher incidence of abnormal findings. Conclusions: It is reasonable to perform screening cranial ultrasound in high risk moderate and late preterm infants having low APGAR score, mechanically ventilated and having co-morbidities.


2021 ◽  
Vol 41 (1) ◽  
pp. 73-79
Author(s):  
Elif Çelik ◽  
Serkan Fazlı Çelik ◽  
Şükrü Güngör ◽  
Adem Dursun

Introduction: Although anaemia is a predisposing factor in the occurrence of lower respiratory tract infections, there is limited data about the relationship between anaemia and acute bronchiolitis in infants. The aim of this study is to determine whether anaemia is an independent clinical condition increasing the severity of acute bronchiolitis in infants. Methods: This retrospective study was conducted on 163 infants (101 acute bronchiolitis and age and sex matched 62 controls), aged between one month to two years. According to the clinical severity of the disease, patients were divided as having mild, moderate and severe acute bronchiolitis. Haemoglobin (Hb) level was considered low when below 11 gm/dL, which is less than 2 standard deviation (SD). Results: Median Hb and mean cell haemoglobin concentration (MCHC) levels were significantly lower in acute bronchiolitis patients than controls {10.1 gm/dL (9.6 - 10.6 gm/dL) vs. 11.2 gm/dL (10.6 - 12.1 gm/dL); p < 0.001)}, and {33.6 (32.5 - 34.1 gm/dL) vs. 34 gm/dL (33.1 - 34.5 gm/dL) p = 0.012}. Conversely, median red cell distribution width (RDW) was higher {14.4% (13.5 - 15.6%) vs. 14.1% (13.1-15%)}. When evaluated by logistic regression analysis, the risk of severe bronchiolitis increased 10 times in acute bronchiolitis patients with a Hb value ≤ 10 gm/dL. Also, there was a significant negative correlation between Hb level and bronchiolitis severity (r :- 0.423, p < 0.001). Furthermore, the patients who had Hb value under 9.95 gm/dL had risk of more severe bronchiolitis with 73.7% sensitivity and 83.3% specificity than other patients. Conclusions: Anaemic infants are more susceptible to acute bronchiolits and as the degree of anaemia increases, they are more severely affected.


2021 ◽  
Vol 41 (1) ◽  
pp. 29-34
Author(s):  
Pareshkumar A Thakkar ◽  
Himanshu G Pansuriya ◽  
Sheela Bharani ◽  
Khushboo Kamal Taneja

Introduction: Mechanical ventilation is an important factor contributing to the reduced neonatal mortality in NICU. However, many ventilated babies are left with detrimental sequelae. This study was undertaken to know the prognostic predictors and survival outcome in the ventilated neonates. We assessed the clinical profile, outcome of mechanical ventilation and analysed the risk factors for mortality and complications resulting from mechanical ventilation. Methods: A prospective study was conducted at the NICU of a tertiary care hospital in India. The study period was from May 2015 to April 2016. Neonates who underwent mechanical ventilation and met the inclusion criteria were enrolled in the study. Their demographic profile, outcomes and risk factors were documented and analysed using appropriate statistical methods. Results: 285 neonates required mechanical ventilation during the study period. Among them, 190 were included in the study. Overall mortality was 99 out of the 190 enrolled (52%). The most common indications for mechanical ventilation were Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS) and apnea. Risk factors contributing significantly to higher mortality of ventilated neonates were very low birth weight (VLBW), gestation of less than 32 weeks, shock, ventilator- associated complications like pneumothorax and pulmonary haemorrhage. In multiple regression analysis, very low birth weight, circulatory disturbances, pneumothorax, pulmonary haemorrhage, and higher initial FiO2 requirement were found to be independent risk factors of mortality. Conclusions: The commonest indications for mechanical ventilation were RDS and MAS. Significantly higher mortality was seen amongst VLBW, preterm neonates. Co-morbidities like circulatory disturbance, and complications like pneumothorax and pulmonary haemorrhage contributed to adverse outcomes.


2021 ◽  
Vol 41 (1) ◽  
pp. 23-28
Author(s):  
Puja Amatya ◽  
Sudeep Kumar Kapalavai ◽  
Ravi Kumar Krupanandan ◽  
Kalaimaran Sadasivam ◽  
Srinivas Sankaranarayanan ◽  
...  

Introduction: Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Although hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. There is very sparse data regarding APAP induced paediatric acute liver failure in our settings, hence this study was done to know the clinical and demographic profiles as well as outcome of children with APAP induced acute liver failure. Methods: This was a retrospective study done in children aged 0 - 18 years admitted with the diagnosis of acetaminophen induced acute liver failure in a tertiary paediatric intensive care unit of South India from January 2014 to December 2018. The clinical, demographic profiles and outcome of these patients were reviewed and analysed. Results: A total of 26 children had acetaminophen induced acute liver failure. Out of 26 patients, 53.8% were males and 46.1% were females. Among these, 24 (92.3%) survived and two (7.7%) died. The average dose of acetaminophen ingested was 168.5 mg/ kg/d. The mean serum acetaminophen level was 52.3 mg/dl. The presence of low pH, hypotension and international normalised ratio (INR) value of > 4 showed bad outcome in children with acetaminophen induced acute liver failure. Conclusion: Paracetamol induced acute liver failure is rare but fatal presentation in children. Children with acidosis, shock and INR value of > 4 had poor prognosis. Hence, judicious use of different preparations as well as counselling to parents regarding use of appropriate doses in children should be done while prescribing this medicine.


2021 ◽  
Vol 41 (1) ◽  
pp. 48-53
Author(s):  
Pratima Sharma Sapkota ◽  
Sunita Shah Bhandari ◽  
Basanta Kumar Karn ◽  
Upendra Yadhav

Introduction: Heel prick is one of the commonest procedures carried out in the hospitalised newborns. Pain is a subjective experience for which the neonates, infants and children respond with behavioural reactions. Applying hot pack to the skin surface causes proximal blood vessels to dilate due to the raised temperature which may decrease the pain perception in neonates. We intended to study the effect of heel warming during heel prick in perception of pain in neonates. Method: An experimental study was conducted among neonates admitted in paediatric wards of BPKIHS. Total 92 participants undergoing heel prick/stick were selected by consecutive sampling technique and allocated randomly to experimental group and control group. Warmer was applied to the heel of the baby for three to five minutes which provided the baby’s heel with the warmth of 38°C to 40°C prior to heel stick in experimental group only. Newborn’s pain level was assessed in both experimental and control group through The Neonatal Infant Pain Scale (NIPS). Mann Whitney test was used to compare means of pain score between experimental and control groups. Results: The mean pain score among experimental group was 1.39 and in control group was 2.20. Experimental group showed significantly lower pain (p < 0.001) compared to the control group. Application of warmth before heel stick caused reduction in pain. Conclusions: The findings suggest that heat application prior to heel stick is effective in reducing pain in newborns.


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