Showing papers in "Journal of Nepal Paediatric Society in 2009"

Clinical and Bacteriological Profiles of Blood Culture Positive Sepsis in Newborns

Abstract: Neonatal infections currently cause about 1.6 million deaths annually in developing countries. Sepsis and meningitis is responsible for most of these deaths. This study was undertaken to determine the clinical presentations, bacteriological profiles and antibiotic sensitivity patterns of isolates from blood cultures of neonates admitted in a tertiary care hospital in Eastern Nepal. All blood culture reports (n=103) during January 2006 - February 2007 from newborns admitted in neonatal division at BP Koirala Institute of Health Sciences, Nepal were analyzed and antibiotic sensitivity patterns were studied. The positive blood culture was 20% (103/513). Most (97.1%) of the sepsis was caused by single organism, while polymicrobial aetiology was observed in 2.9% cases. Meningitis was documented in 9(8.7%) cases. Staphylococcus aureus (38.8%) and coagulase negative staphylococcus (CONS) (21.3%) are the commonest isolates in blood culture. Among gram-negative organisms, Klebsiella species (11.6%) and Enterobacter species (9.7%) were the leading cause of neonatal sepsis. Majority of newborns with neonatal sepsis presented with refusal to feeds (42.7%), fever (41.7%) and jaundice (41.7%). Most of the organisms showed sensitivity with amino glycosides (gentamicin and amikacin) and third generation cephalosporins. It is concluded that Staphylococcus aureus, CONS, and Klebsiella species remain the principal organisms causing neonatal sepsis and first line antibiotics like amino glycosides should be first choice of drugs. Key words: Blood culture, neonatal sepsis, antibiotic sensitivity. doi:10.3126/jnps.v27i2.1411 J. Nepal Paediatr. Soc. Vol.27(2) p.64-67

Is Low Hemoglobin Level a Risk Factor for Acute Lower Respiratory Tract Infections

Abstract: Objective: This prospective study was conducted to evaluate whether a low hemoglobin level, was a risk factor for Acute Lower Respiratory Tract Infections (ALRTI) in children. Methods : 150 Children of all age groups who came to the outpatient department and those admitted for ALRTI were included in the study. Age and sex-matched 140 children, not having any respiratory illness, were taken as control. The study period was from March 2006 - March 2007. Detailed clinical and laboratory evaluation of the enlisted patients was done. All were subjected to detail investigations. Results : Radiological evidence of pneumonia was present in 70 (50 %) children.Hyperinflated lungs were seen in 40 (29%) and was normal in 30 (21.4%) cases. Blood culture was positive in 14 (10%) children of study group and none among control group. Klebsiella was the commonest organism isolated 6 (4.2%) in blood culture positive cases. The mean Hemoglobin (Hb) level of study group was 9.88 gm% and it was 12 gm% in control group.96 (68.6%) of study group and 30 (21.42%) of control group had anemia. Of the anemic children, 79 (82.3%) in study group had iron deficiency, and 17 (17.7%) had normocytic normochromic anemia. These values were 18 (33.3%) and 36 (66.6%) respectively for control group. Low hemoglobin level was a risk factor (p<0.001) ALRTI. Conclusion: Anemic children were 3.2 times more susceptible to ALRTI compared to the control group and and iron deficiency anemia was predominating. Supplemental iron therapy may reduce the incidence of ALRTI. Prevention of anemia, due to whatever etiology is also essential. Key words: ALRTI, anemia, hemoglobin. DOI: 10.3126/jnps.v30i1.2453 Journal of Nepal Paediatric Society Vol.30(1) 2010 1-7

Epidemiology of Japanese Encephalitis in Nepal

Abstract: Introduction Japanese Encephalitis is acute encephalitis that can progress to paralysis, seizures, coma and death. Japanese encephalitis is the leading cause of viral encephalitis in Asia, with 30,000–50,000 cases reported annually.1 The Japanese encephalitis virus is a member from the family Flaviviridae.2 Human, cattle and horses are dead-end hosts and disease manifests as fatal encephalitis. Domestic pigs and wild birds are reservoirs of the virus; transmission to humans may cause severe symptoms. The natural host of the Japanese encephalitis virus is bird, not human, and the virus will therefore never be completely eliminated.3 One of the most important vectors of this disease is the mosquito Culex tritaeniorhynchus (Picture 1) and Culex gelidus. Culex tritaeniorhynchus is active during dusk and dawn and it is during this part of the day that it bites and infects individuals with Japanese Encephalitis. The vector’s presence has been confirmed in Nepal.

Profile of Asphyxiated Babies at Tribhuvan University Teaching Hospital

Abstract: Objective: To assess risk factors and outcome in the early neonatal period of babies who were asphyxiated at birth. Methodology: This was a retrospective study conducted at Tribhuvan University Teaching Hospital (TUTH) over a period of one year from 15th Feb 2007 to 14th Feb 2008. All the term babies who had Apgar score of less than < 6 at 1 minute of birth were included. Detailed maternal risk factors during pregnancy and labor were analyzed. The newborn babies who required admission in neonatal unit were again analyzed for development of hypoxic ischemic encephalopathy (HIE) and their outcome. Results: During the study period, out of 3594 term babies, 327 babies (9%) were asphyxiated. Of the total asphyxiated babies, 85% and 15% had moderate and severe asphyxia, respectively, at 1 minute of birth. Out of these asphyxiated babies, 51% and 7% had intrapartum and maternal risk factors, respectively. Intrapartum risk factors like meconium stained liquor, non-vertex presentation, and fetal heart rate abnormalities accounted for 4 fold risk of asphyxia. Of these babies, 26% required admission in nursery and 29% developed hypoxic ischemic encephalopathy. Among the admitted babies 6% expired, 2% left against medical advice and rest were discharged. Conclusion: Early identification and close monitoring of high risk mothers studies with maintaining partograph during labor will help to reduce neonatal asphyxia. Key words: Asphyxiated babies doi:10.3126/jnps.v29i1.1592 J. Nepal Paediatr. Soc. Vol.29(1) p.3-5

Maternal risk factors and morbidity pattern of very low birth weight infants: a NICU based study at Eastern Nepal.

Abstract: Background: Preterm deliveries of babies weighing less than 1500 grams (VLBW, very low birth weight) are of major concern because of maximum perinatal morbidity and mortality found in this group. VLBW babies overload the neonatal intensive care unit (NICU) and their mortality contributes significantly to neonatal and infant mortality. Objectives: To study the common maternal risk factors associated with VLBW births. To study the morbidity and mortality patterns of VLBW babies. Methods: This was a hospital based retrospective study done in NICU of BP Koirala Institute of Health Sciences. Data were collected from medical records of VLBW babies admitted in NICU over a period of three years (13 April 2005 to 12 April 2008). Data were analyzed with SPSS 10.0 software. Results: Data of 140 VLBW babies were analyzed. Mean birth weight was 1188.9 (±212.78), 10.7% were home deliveries, 24.3% were twins, 31.4% required active resuscitation at birth and 46.4% were exposed to antenatal steroid. Common maternal risk factors associated with premature deliveries were inadequate antenatal check up (ANC) visits (95.7%), twin pregnancy (24.3%), antepartum hemorrhage (APH, 28.6%), premature rupture of membrane (23.6%), pregnancy induced hypertension (12.9%), bad obstetric history (12.9%) and maternal age less than 20 years (8.6%). Common morbidities among VLBW babies were clinical sepsis (77.1%), non physiological hyperbilirubinemia (73.6%), apnea (48.6%), shock (42.9%), hypoglycemia(39.3%), anemia (29.3%), hyaline membrane disease (HMD, 21.4%), patent ductus arteriosus (15.0%), severe hypothermia (12.1%), culture proven sepsis (15.7%), retinopathy of prematurity (5.7%), and bronchopulmonary dysplasia (3.6%). Overall survival was 54.3% and major causes of death were HMD (51.0%) and sepsis (34.7%). Median durations of hospital stay were 17.5 days for survivors and five days for expired cases. Conclusion: Increasing the coverage of ANC visits, early diagnosis and treatment of APH and pregnancy induced hypertension, discouraging the childbirth at too young age, early diagnosis and treatment of acute infections and chronic medical diseases in mothers are important measures to decrease the burden of VLBW births. Common morbidities in VLBW babies are sepsis, HMD, apnea, hyperbilirubinemia, patent ductus arteriosus, shock, anemia, hypoglycemia, hypothermia and hypocalcemia. Common causes death of VLBW babies are HMD and sepsis. Overall survival of VLBW babies in our settings is less. More numbers of well equipped NICUs and services like surfactant therapy are needed to improve survival of VLBW infants in our set up. Key words: Maternal risk factors, Morbidity, Mortality, Very low birth weight. doi: 10.3126/jnps.v29i2.2040 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.59-66

Kangaroo Mother Care for Low Birth Weight Babies: A prospective Observational Study

Abstract: Introduction: Kangaroo Mother Care is the low cost, humane technique for caring low birth weight babies by direct skin to contact with the mother. Objective: The Prospective observational study was done to see the effect of KMC especially on weight gain on low birth weight babies weighing 2000 grams or less at Special Care Baby Unit of Paropakar Maternity and Women's hospital, Kathmandu. Method: The study was conducted in Special Care Baby Unit (SCBU) of Paropakar Maternity and Women's Hospital over 7 months period May 2007 to Nov. 2008 (from Baishakh 2064 to Kartik 2065). The method of care consisted of skin to skin contact between the mother and the infant. Result: It was observed that babies had good weight gain of average 30gms/day and had short duration of hospital stay of average 9 days. Babies had less morbidities like hypothermia, apnea, skin infections and oral thrush. 100% babies had exclusive breast feeding and KMC was acceptable to mothers. Conclusion: Kangaroo Mother Care shows early and good weight gain in low birth weight babies. It is simple, low cost technique and well acceptable by mother and family and can be continued at home. Key words: Kangaroo mother doi:10.3126/jnps.v29i1.1593 J. Nepal Paediatr. Soc. Vol.29(1) p.6-9

An Overview of Neonatal Admissions at College of Medical Sciences (COMS)

Abstract: mother 11.6568 Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Objective: To know the profile of newborn admissions and its outcome and the factors associated with neonatal mortality. Methods: The study included both intramural and extramural cases of 180 newborn babies admitted in nursery over a period of 6 months from 01/08/06 to 31/01/07. The relevant data were recorded on a pre-designed proforma meticulously. Results: There were 180 newborn babies during the study period. The mean birth was 2.7 kg.. Majority, 77.8 %( 140) of the babies weighed equal to or more than 2.5 kg. Low birth weight (LBW) was seen in 22.2 %( 40) babies. There were 80 %( 144) full term babies and 20 %( 36) preterm babies. Majority of the mothers in the age group between 20-30 years had incomplete antenatal check- ups. There were 86 %( 155) normal vaginal deliveries, 4.5 %( 8) forceps deliveries and 9.5 %( 17) caesarean sections. Birth/perinatal asphyxia 39(22%), prematurity 36(20%) and neonatal septicemia 30(17%) comprised of leading admissions. There were 27deaths (15%) in total.13 (7%), 8(5%) and 6(3%) babies died of severe perinatal asphyxia, neonatal septicemia and prematurity respectively. Most of the deaths occurred during the first 72 hours. Conclusions: The mean birth weight is good. The major causes of neonatal death are birth/perinatal asphyxia, prematurity and neonatal septicemia. The factors influencing neonatal mortality are low and poor antenatal care, meconium stained liquor, delay in coming to the hospital, PROM, eclampsia. The study emphasises the importance of regular antenatal care, timely referral of pregnant women with complications to appropriate centers and conducting delivery in a clean environment for lowering neonatal mortality. Key words: newborn, admission, neonatal outcome, asphyxia doi:10.3126/jnps.v27i2.1413 J. Nepal Paediatr. Soc. Vol.27(2) p.73-74

Infection of Cyclospora cayetanensis in Diarrhoeal Children of Nepal

Abstract: Introduction: Cyclospora cayetanensis is a coccidian parasite that causes recurrent gastroenteritis among children living under poor sanitary condition and adults from industrialized countries who lived or traveled in endemic developing countries. Methods: A total of 1842 stool specimens from gastroenteritis patients were examined between March 2006 to February 2007 and collected various types of faecal specimens from human, animals and samples of water and green leafy vegetables. Results: Of 1842 stool specimens collected from different areas of Nepal, 146 (7.9 %) were found to be positive for Cyclospora cayetanensis. with the majority were from children 2-9 years of age. The highest rate of infections was found in the month of June; (31.6%). Cyclospora cayetanensis were found to be contaminated in green vegetables including leaves of basil, mint leaves, water sources and feces of domestic animals and these findings were presented in the paper. Conclusion: Cyclospora-like oocysts were detected in vegetables leaves, feces of domestic animals and water sources. The results suggest that water, vegetables and domestic animals are possible sources of infection in Nepal. The study also obtained more information on Cyclospora cayetanensis a coccidian parasite that infect humans especially children and causes prolonged diarrhea and life threatening infestation.

Type II Vitamin D Dependent Rickets: A Case Report

Abstract: Vitamin D-dependent rickets Type II is a rare autosomal recessive disorder. Alopecia of the scalp or the body is seen in some families with Vitamin D-dependent rickets Type II. We report a child with this disease, and review the salient features of this disease with emphasis on the associated alopecia. Due to lack of facilities for estimation of 1, 25(OH)2 D and parathyroid hormone, alopecia remains the only clue to the diagnosis of this rare syndrome in association with resistant rickets. Key words: Rickets, Vitamin D metabolism DOI: 10.3126/jnps.v30i1.2460 Journal of Nepal Paediatric Society Vol.30(1) 2010 46-49

Japanese encephalitis in children admitted at Patan hospital.

Abstract: This is a hospital based retrospective study, which was done in Pediatric ward of Patan hospital. Study period was one and half year (from Srawan 2063 to 2064 poush).Data were taken from discharge book of Pediatric ward, from the record section of this hospital, and from JE surveillance office, WHO, Kathmandu. All children from 1 month to 14 years ,who were admitted in Pediatric ward with symptoms of Meningitis, Meningoencephalitis and Encephalitis were included in this study and patients more than 14 years of age and symptoms not suggestive of meningitis, meningoencephalitis or encephalitis were excluded from the study. Headache; vomiting and fever were the chief complaints of patients. Two patients died during study period. There were 16 patients with serologically confirmed Japanese encephalitis. Key words: Japanese encephalitis virus (JEV), arthropod borne disease, Acute encephalitis syndrome (AES). doi:10.3126/jnps.v29i1.1595 J. Nepal Paediatr. Soc. Vol.29(1) p.17-21

Fahr's Disease: A Case Report

Abstract: We report a case of Fahrs disease in a 15year old girl presented to us with focal seizure with secondary generalisation. Clinically there were no abnormal findings. The CT scan (brain) showed multiple symmetric and extensive calcifications in the basal ganglia, thalamus, and dentate nucleus, subcortical white matter of cerebral and cerebellar areas. Presently the child is under followup with good seizure control with carbamezpine. This rare case of idiopathic Fahr's disease in a child, which has never been reported in Indian literature has been brought out to highlight this unusual condition and its differentiation from the commoner Fahr's syndrome. Key words: Basal ganglia, calcification, Fahrs disease. DOI: 10.3126/jnps.v30i1.2459 Journal of Nepal Paediatric Society Vol.30(1) 2010 44-45

An Overview of Renal Diseases in Children in Pokhara

Abstract: mother 11.6568 Normal 0 false false false MicrosoftInternetExplorer4 st1\:*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Objective: To determine the current pattern and prevalence of renal diseases in childhood in this region of Nepal. Material and Methods: A retrospective study of the renal diseases in children attending the Pediatric OPD and those hospitalised in Manipal Teaching Hospital, Pokhara was done over a period of 6 years (September 2000- September 2006). A detailed clinical and laboratory evaluation was performed at baseline. The children were managed according to disease diagnosed. These cases are under follow up and some have undergone surgical treatment. Results: 228 children (123 boys & 105girls) were diagnosed to have renal disease. Among them 39.5% had urinary tract infection (UTI), 30.7 % were suffering from acute glomerulonephritis (AGN), 17.5% were cases of nephrotic syndrome (NS) and 12 % had some other problems for example, 6.14% had genetic defects, 2.63% had renal Stone, 2.2% had pre-renal acute renal failure, unexplained recurrent hematuria in 1.3%. All the cases of UTI underwent through investigation and were treated accordingly. All cases of AGN are planned for follow up for 1½ yrs and among them 3 required biopsy till date. All cases of NS are under regular follow-ups and 2 have undergone biopsy. Renal stone was operated successfully. All cases of acute and chronic renal failures had required dialysis. Out of 5 (2.5%) chronic renal failures, 2 with end stage renal disease expired after repeated hemodialysis and three are still requiring dialysis. Among the obstructive uropathies, 43 % had renal stone, 36 % had posterior urethral valve and 21% VUR. Conclusion: It can be concluded that renal disease is not uncommon in children. It can be completely cured with proper and adequate treatment. Sometimes it has a bad prognosis when it reaches end stage renal disease. Early recognition, timely treatment and regular follow up are mandatory in management of children with renal diseases. Key words: Renal disease pattern, UTI, AGN, NS, Obstructive Uropathy, Renal failure doi:10.3126/jnps.v27i2.1414 J. Nepal Paediatr. Soc. Vol.27(2) p.75-78

Knowledge about condoms among adolescents in Kathmandu Valley.

Abstract: Introduction: The issues of sexual and reproductive health (SRH) remain the leading cause of ill health among adolescents worldwide and are of growing concern in Nepal. The correct knowledge of condoms is integral part of SRH. The present study was carried out to assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Aim: To study, assess and compare the knowledge about condoms among adolescents in the Kathmandu valley of Nepal. Methods: The study was a cross-sectional questionnaire-based survey. The sample was derived through cluster sampling of the secondary schools in the Kathmandu valley. Schools were selected randomly and two hundred and fifty adolescents were taken from each government and non-government high schools. Result: Altogether 500 adolescents were recruited for this study. A total of 298 (53.0%) participants said that condoms reduced pleasure. Most women don't like to use condoms was agreed by 291 (55.6%) people and it was statistically significant ( p value < 0.05) when compared between males and females. Using condoms with new partner is a good idea was agreed upon by 448 (81.0%) participants. Women should ask their partners to use condoms was answered by 480 (88.1%) and discussing condom use with prospective partner is easy was agreed by 417(79.0%) and both the issues were also statistically significant ( p value < 0.05). Conclusion: It was found that the knowledge about condoms was not adequate and the knowledge among male participants was in general better than females. Key words : Adolescents, Condom, Sexual and reproductive Health DOI: 10.3126/jnps.v30i1.2455 Journal of Nepal Paediatric Society Vol.30(1) 2010 18-22

Bubble-CPAP in Neonatal Unit of TUTH

Abstract: Introduction: Nasal Continuous Positive Airway Pressure (CPAP) in newborn babies with respiratory distress reduces requirement for mechanical ventilation thereby decreasing referral to higher centre. In our neonatal unit prior to the use of this intervention, morbidity and mortality associated with respiratory distress was significant which has decreased after we started CPAP in Kartik 2065 (October 2008) including a decrease in referrals to higher centre for ventilator support.The objective of this study was to evaluate the outcome of bubbling CPAP in newborn babies who had respiratory distress. Methods: Observational study done in neonatal unit of TUTH over a period of 3 months i.e from Kartik to Poush 2065 B.S (mid of October to mid of January,2008) Results: 127 neonates were admitted, of whom 15 babies with respiratory distress (11.8% of total admissions) received CPAP. 11 babies improved, while 4 babies died. Among those attending follow up (8 babies) none had any features of chronic lung disease. Conclusion: In resource poor settings where level II neonatal care is already exists; CPAP can be easily applied for newborn babies with respiratory distress with promising results and it helps to decrease neonatal morbidity and mortality. Key words: CPAP, neonatal mortality, respitatory Distress. DOI: 10.3126/jnps.v30i1.2465 Journal of Nepal Paediatric Society Vol.30(1) 2010 64-68

A Study of Early Neonatal Deaths at Kathmandu Medical College Teaching Hospital

Abstract: Over 9 million deaths occur each year in the perinatal and neonatal periods globally. 98% of these deaths take place in the developing world. Nepal has a high neonatal mortality rate (NMR) of 38.6 per 1000 live births (2001). Two thirds of the newborn deaths usually occur in the first week of life (early neonatal death). Newborn survival has become an important issue to improve the overall health status and for achieving the millennium developmental goals of a developing country like Nepal. Aims and Objectives: This study was carried out to determine the causes of early neonatal deaths (ENND) at KMCTH in the two-year period from November 2003 to October2005 (Kartik 2060 B.S. to Ashoj 2062). Methodology: This is a prospective study of all the early neonatal deaths in KMCTH during the two-year study period. Details of each early neonatal death were filled in the standard perinatal death audit forms of the Department. Results: Out of the 1517 total births in the two-year period, there were 10 early neonatal deaths (ENND). Early neonatal death rate during the study period was 6.7 per 1000 live births and early neonatal death rate (excluding less than 1 kg) was 6.1 per 1000 live births The important causes of early neonatal deaths were extreme prematurity, birth asphyxia, congenital anomalies and septicaemia. During the study period, there was no survival of babies with a birth weight of less than 1 kg. Among the maternal characteristics, 80% of the mothers of early neonatal deaths were aged between 20-35 years. 50% of the mothers were primigravida. 50% of the mothers of ENNDs had delivered their babies by caesarean section. Discussion: Most of the early neonatal deaths were due to extreme prematurity. Birth asphyxia was the second most important cause of early neonatal deaths. 70% of ENNDs were among LBW babies. Prevention of premature delivery, proper management of very low birth weight babies and early detection and appropriate management of perinatal hypoxia have become important interventional strategies in reducing early neonatal deaths in KMCTH. Conclusion: Early neonatal mortality at KMCTH is fairly low. Good care during pregnancy, labour and after the birth of the baby has helped to achieve these results. Low cost locally made equipments were used to manage the sick newborns. Reduction of early neonatal deaths require more intensive care including use of ventilators, surfactant and parenteral nutrition and prevention of preterm births Key words: Early neonatal death (ENND), neonatal mortality doi:10.3126/jnps.v27i2.1584 J. Nepal Paediatr. Soc. Vol 27(2), p.79-82

Emperical Oral Antibiotic Therapy for Children with Low Risk Febrile Neutropenia during Cancer Chemotherapy

Abstract: Introduction : In patient with fever and neutropenia during cancer chemotherapy who have a low risk of complications, oral antibiotic may be an acceptable alternative to intravenous antibiotics. Methods : We conducted a prospective hospital based study to the patients who had fever and neutropenia during caner chemotherapy. Only low risk patients i.e. neutropenia of less than seven days, ANC >250/cmm, without any signs of shock were included in the study. All the patients were hospitalized and given oral antibiotics Ofloxacin and Amoxy-Clav and were closely observed until fever subsided for more than 48 hours and improved from neutropenia. Results : A total of 54 cases were enrolled in the study. Out of 54 patients two patients were lost, 8 needed IV antibiotics for different reasons and 44 patients (81%) improved well with oral antibiotics only. Conclusion : In hospitalized low risk patients who have fever and neutropenia, empirical therapy with oral ofloxacin and amoxy-clav may be a safe alternative to IV antibiotics. Key words: Febrile Neutropenia, Cancer Chemotherapy, ANC. doi:10.3126/jnps.v29i1.1596 J. Nepal Paediatr. Soc. Vol.29(1) p.22-25

Determinant of Early Initiation of Breastfeeding in a Tertiary Neonatal Unit

Abstract: Introduction: Initiation of breastfeeding within one hour of birth is an important determinant of successful breastfeeding. National Family and Health Survey -3(NFHS-3) reported that only 23.4% of children < 3 years were breastfed within one hour of birth. Objectives: the purpose of this study is to study the determinant of initiation of breastfeeding within one hour of birth. Setting: Tertiary -level neonatal unit. Material and Methods: All mothers admitted in the postnatal ward were eligible for inclusion; mothers of sick and /or preterm infants were excluded. Enrolled mothers were interviewed between 24 and 72 hours after delivery. Results: The proportion of mothers who initiated breast feeding within one hour of delivery was 32%, between 1-6 hrs were 47% and between 6 to 48 hrs were 21%. Maternal age, education, socioeconomic status, occupation and antenatal or labor room counseling did not influence the initiation of breast feeding within one hour of delivery in univariate analysis. On multivariate analysis, admission in the general ward and delivery by caesarean section were found to be significantly associated with not initiating breastfeeding within one hour (adjusted ORs: 8.79, 2.48 to 31.08, p =0.001 and 6.79, 4.07 to 22.02 p =0.001 respectively). Only about 13% of the infants received prelacteal feeds. Conclusion: Mothers delivering by caesarean section or admitted in the general ward were at high risk of not initiating breastfeeding within one hour. Innovative strategies are required to ensure timely ignition of breastfeeding. Key words: Breastfeeding, Caesarean section, prelacteal feeds, time of initiation. doi: 10.3126/jnps.v29i2.2042 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.74-78

A 14-year-old boy with Isolated Tuberculous Orchitis

Abstract: The genitourinary tract is the most common extrapulmonary site affected by tuberculosis. The male genital organs are involved in more than 50% of patients. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy. Key words: genitourinary tuberculosis, testis, USG, FNAC doi:10.3126/jnps.v29i1.1598 J. Nepal Paediatr. Soc. Vol.29(1) p.30-32

Clinico-Laboratory Profile and Immediate Outcomes of Hyperbilirubinemic Babies Admitted in Kanti Children Hospital

Abstract: Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis.

Glomerular Diseases in Children - A Review of 27 Cases Recorded at a Single Centre in Eastern Nepal

Abstract: Glomerular disease remains an important cause of renal disease in children. We retrospectively assessed the clinical features and histopathological diagnoses in kidney biopsy specimens in children (n=27). The medical records and histopathological diagnoses between 2003 and 2006 were reviewed. In each patient, clinical presentation, age at onset of disease, gender, presence of nephrotic range proteinuria, hematuria, hypertension and histopathological diagnoses were evaluated. SLE nephritis (n=8) and membranoproliferative glomerulonephritis (MPGN) (n=8) were the most frequent glomerular diseases and nephrotic syndrome (n=21) was the frequent clinical manifestation. Key words: Renal biopsy, Glomerular diseases doi:10.3126/jnps.v29i1.1597 J. Nepal Paediatr. Soc. Vol.29(1) p.26-29

Early Motherhood and Contraceptive Use among Adolescents: A Study from Rajshahi District of Bangladesh

Abstract: Introduction : This paper employs various statistical methods to identify the factors associated with age at first motherhood and contraception use among the adolescence mothers in Rajshahi district of Bangladesh. Methods: To meets the objectives this study utilizes information from 1000 married adolescents of Rajshahi district within the age span (15-19 years). Results: We have observed adolescents mean age at first marriage and birth to be 15.0 and 16.4 years. This study reveals that the education, place of residence, occupation of husband and religion played the greatest roles on adolescent's age at first motherhood. The analysis shows that, use of contraceptive among the adolescent's was still very low. Slightly 56.7 per cent of the married adolescents were currently using any method of contraception. Among the factors determining contraceptive use among adolescents, education, visits of family planning workers and place of residence appears to be the most significant and positively associated with contraceptive use. Conclusions: The results indicate several policy options: (1) government has to take initial steps to strictly prohibit the early marriage with the proper application of existing law that would directly or indirectly rise the age at first birth among the adolescence; (2) programmes that encourage postponement of first birth after marriage through adoption of temporary contraceptive methods should be considered seriously ; (3) provide adolescents with information on the availability of family planning methods and their effectiveness; (4) increase the number of visits by family planning workers and their counseling about family planning methods help to motivate adolescents to accept family planning methods and use them effectively and (5)emphasize adolescents education to make a lasting impact on overall health of the adolescent mothers. Key words: Adolescence, age specific live birth, contraception DOI: 10.3126/jnps.v30i1.2454 Journal of Nepal Paediatric Society Vol.30(1) 2010 8-17

A Perspective Study on the Etiology of Diarrhea in Children Less than 12 Years of age attending Kanti Children’s Hospital

Abstract: Introduction: Diarrhea is the most common illness among children causing highest number of mortality and morbidity in the developing countries. Objective: This study was conducted to determine the etiological agents of diarrhea in children less than 12 years of age. Methods: The study was carried out in Tribhuvan University Teaching Hospital, Health Research Laboratory and stool specimen were collected from Kanti Children's Hospital between February 2007 and August 2007. The specimens were processed by standard microbiological methods, serological diagnosis for the complete identification of bacterial isolate and use of Rotaclone for diagnosis for Rotavirus. Results: A total 500 specimen were processed and 312 (62.4%) cases were identified with enteropathogens. Out of 500, 165 (33%) showed significant bacterial growth, 110 (22%) single or multiple parasitic infestation, and 167 (21.4%) Rotavirus. Among the bacterial isolate, Escherichia. coli (20.2%) were highest in number, Entamoeba. histolytica (10%), among the protozoa and Ascaris lumbricoide (1.4%) among the helminth. Age group 0-2 years showed most number of cases. The prevalence of Rotavirus infection was more in Inpatient (65.4%) than Outpatient (34.6%) (P>0.05). Ethnicgroup wise distribution showed that Gurung/Magar/ Rai/Tamang were highly infected (34.6%) (P>0.05). Conclusion: The results showed that bacteria were the major etiological agents of diarrhea in children than parasites and Rotavirus. E. coli among the bacteria, E. histolytica among the parasite and Rotavirus constituted the major causative agents identified. The age group 0-2years was the most vulnerable group where most of the enteropathogens were detected. Key words: Bacteria, Children Diarrhea, Parasites, Rotavirus doi:10.3126/jnps.v29i1.1594 J. Nepal Paediatr. Soc. Vol.29(1) p.10-16

Role of Serum Alanine Aminotransferase Aspartate Aminotransferase and Alkaline Phosphatase in Early Detection of Protein Energy Malnutrition

Abstract: mother 11.6568 Normal 0 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} Objective: Although Protein Energy Malnutrition (PEM) has been studied extensively; the best criteria for its detection in early stages have not been established. This study was carried out to observe the change in transaminases, alkaline phosphatase levels when compared with control and also to see their relationships with various grades of PEM. Then to see if certain biochemical parameters could be used to detect malnutrition in early stage. Methods: Cross sectional study between Jan 1999-Dec 2000,124 children from 5 months to 5 years were included in the study. Out of 124 children 98 (79%) were cases and 26 (21%) normal age matched healthy controls. Cases were divided into groups as per Gomez classification (Group 1-Grade I PEM, 37;Group 2- Grade II PEM, 34; Group 3- Grade III PEM27; and Group 4 26 Healthy controls). Three serum enzymes, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Alkaline Phosphatase (ALP) was analyzed and for statistical analysis student's "t" test was used. Results: The mean serum values +SD of ALT (Grade I PEM-41.40 +13.25,Grade II PEM-31.53+10.6,GradeIIIPEM-33.77+12.45,Control-23.11+8.73) and Aspartate aminotransferase (Grade I PEM-42.8+11.06,Grade II PEM 31.47+8.32,GradeIII PEM 35.00+10.86, Control-25.42+8.77) in patients with PEM were significantly (p Conclusion: It can be concluded that abnormalities in blood levels of these enzymes occur in any form of PEM and these are related to the severity of the disease. Hence this may be helpful in early diagnosis of PEM where clinical features are equivocal. Key words: Protein Energy Malnutrition, Enzymes, Alanine Aminotransferase, Aspartate aminotransferase, Alkaline phosphatase doi:10.3126/jnps.v27i2.1412 J. Nepal Paediatr. Soc. Vol.27(2) p.68-72

Fetal Hydantoin Syndrome: A Case Report

Abstract: A term baby born to an epileptic mother who was treated with Phenytoin until 10weeks of pregnancy was born with multiple congenital anomalies and diagnosed to have Fetal Hydantoin Syndrome. Infants of mothers who have taken hydantoin during pregnancy have been found to have broad multisystem patterns of abnormalities, including mental retardation, craniofacial anomalies, nail and digital hypoplasia and prenatal onset of growth deficiency. The discussion aims to bring to attention the potential hazard of the use of hydantoin drug during reproductive age to all medical practitioners. Key words: Congenital anomalies, epilepsy, fetal hydantoin syndrome, phenytoin. DOI: 10.3126/jnps.v30i1.2463 Journal of Nepal Paediatric Society Vol.30(1) 2010 57-59

Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach

Abstract: Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 - 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided. Key words: Anterior sagittal anorectoplasty, anorectal malformations, perineal ectopic anus, vestibular fistula. DOI: 10.3126/jnps.v30i1.2458 Journal of Nepal Paediatric Society Vol.30(1) 2010 37-43

Apert Syndrome (Acrocephalosyndactyly): A Rare Syndromic Craniosynostosis

Abstract: We report a premature infant who had multisutural craniosynostosis with pointed head, syndactyly of 2nd, 3rd and 4th fingers of all four limbs and other findings that were consistent with Apert syndrome. This is perhaps the first case of Apert Syndrome reported from Nepal. Key words: Apert syndrome, craniosynostosis, syndactyly doi: 10.3126/jnps.v29i2.2046 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.92-93

Study of Visceral Leishmaniasis (Kala-azar) in Children of Nepal

Abstract: Introduction: Visceral leishmaniasis (VL) or Kala-azar is a potentially fatal vector-borne (sand fly phlebotomies spp) zoonotic disease caused by a protozoan parasite, Leishmania donovani In Nepal, the disease is restricted to the Eastern Terai region which lies adjacent to the Bihar state of India Although leishmaniasis is regarded as a significant health problem in Nepal by the Ministry of Health, there is no active case detection programme in the country Objective: Objectives of this study were to determine the up-to-date morbidity and mortality trend for VL in children of Nepal Method: The epidemiological surveillance team from the NZFHRC visited to eight zonal hospitals in Terai region during the month from September to December of each year 2003 to 2007 The morbidity and mortality data up to the year 2007 were collected every year The team has also collected 66 blood serum samples of which 18 samples from children were collected for the diagnosis Results: A total 25890 cases with 599 deaths were reported during the year 1980-2006 The case fatality rate (CFR) varied from 023% to 132% Districtwise analysis showed that, during 2003, highest incidence was in Mahottari district (184/100,000), followed by Sarlahi (100/100,000) and Sunsari (96/100,000) The highest CFR was in Dhanusha (29%) followed by Bara (24%) and Saptari (20%) Majority (709%) of persons affected by VL were aged 15 years and above, followed by 10-14 years (139%), 5-9 years (119%) and 1-4 years (33%) VL cases recorded from different district of Nepal for the year 2004, 2005, 2006 and 2007 are recorded CFR for the year 2004, 2005, 2006 and 2007 were 32%, 37%, 1667% and 1142% respectively Conclusions: There should be regular surveillance research work to be carried out in endemic area Mass public health education, to make the people aware about preventive aspects of the disease is important The possibility of the existence of animal reservoirs as zoonotic disease should also be considered This disease is very much serious in children below 15 years of age both in male and female, therefore it is essential to have paediatrician post at least in all VL six endemic districts Key words: Epidemiology, Leishmaniasis, Kala-azar, Sandfly doi: 103126/jnpsv29i22041 J Nepal Paediatr Soc Vol 29, No 2, pp67-73

Myelofibrosis in a Child with Tuberculosis: A Case Report

Abstract: Myelofibrosis (MF), or fibrosis of the bone marrow, is an uncommon condition in children. Fewer than 100 cases have been described in the medical literature. Most cases in children arise secondary to other disease processes. We present a case of Myelofibrosis in a 12-year-old girl. The purpose of reporting this case is that this child had a diagnostic dilemma and was sent home with poor prognosis but with proper diagnosis and treatment she improved and may have a complete cure, as the myelofibrosis was secondary to tuberculosis. Key words: myelofibrosis, tuberculosis, acute megakaryoblastic leukemia (AMKL) doi:10.3126/jnps.v27i2.1588 J. Nepal Paediatr. Soc. Vol.27(2) p.90-92

Parietal Epidural Dermoid Mimicking a Scalp Abscess in an Infant: Case Report

Abstract: Scalp masses that involve the scalp or the cranium especially over the parietal bone are uncommon presentation in infants. We report a case of an 8-week old female child who presented with a left parietal scalp mass which had been progressively increasing since birth. CT scan revealed the mass extending into the cranium with underlying bone defect over the parietal area, with medial extension till the sagittal suture. Intraoperatively there was presence of thick white infected flaky material with small tufts of hair which was removed completely till the bone edges and from the epidural space. There was no recurrence postoperatively and the baby was discharged after a week of antibiotics. This case provides an example that simple looking scalp masses in infants and children should be managed with caution to prevent further morbidity. Key words: Dermoid, Scalp abscess doi: 10.3126/jnps.v29i2.2048 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.98-100

Japanese Encephalitis Vaccination in Children Population of Nepal During the year 2005, 2006 and 2008

Abstract: Japanese Encephalitis (JE) is caused by a Flavivirus that, in a proportion of human cases, causes severe encephalitis leading to death or sometimes permanent disablement. It is a zoonotic disease, transferred from animals (commonly pigs or wild birds) by a mosquito vector to humans. In Southeast Asia it is thought to cause up to 50000 clinical cases and 10000 deaths per year. JE vaccination programme was carried out in high risk districts of Nepal. Japanese encephalitis vaccination was carried out during the years 2005, 2006, 2008 and 2009. The data collected from primary and secondary sources from the District Health Offices and other concerned central offices of the Department of Health Services, was tabulated and analysed. Thirty-five lakh of JE vaccine doses was procured by the Ministry of Health during the year 2006/2007. This vaccine was used in children under 15 years of age of 12 districts of JE risk and high-risk areas of Nepal. It was found that during the year 2005; 85% children in Banke and 81% in Kailali were vaccinated against JE. In Kailali and Banke districts it was found to be about 103% coverage in children population targeted, in Dang district it was 100% coverage, and in Bardiya district it was 73% coverege but in Rupandehi and Kanchanpur districts it was only about 40% and 41% respectively. JE vaccine coverage was very low in two Rupandehi and Kanchanpur districts during 2005 and 2006 and very high coverage during the year 2008. JE vaccination coverage results for the year 2009 have not been made available yet due to unavailability of data. This type of mass vaccination campaign needs regularlity, mass awareness and health education programme should be carried out before JE vaccination campaign in the children in the future. Key words: Japanese Encephalitis, flavivirus, zoonotic, vector borne, lyophilized vaccine. doi: 10.3126/jnps.v29i2.2045 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.85-91