Journal of Nepal Paediatric Society最新文献

{"title":"Utility of Sequential Organ Failure Assessment Score in Prognosticating sick Children in Paediatric Intensive care Unit","authors":"Raju Kafle, Shah Sanjeev, Gupta Binod Kumar","doi":"10.3126/jnps.v42i1.41178","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.41178","url":null,"abstract":"Introduction: There are number of scoring systems to assess the morbidity and mortality of sick children in intensive care unit. Out of these scoring systems our study was designed to look for the utility of Sequential Organ Failure Assessment (SOFA) score which is less time consuming and simple to apply as a predictor of mortality in sick children admitted in Paediatric Intensive Care Unit (PICU).\u0000Methods: This was a prospective observational study done in PICU of Universal College of Medical Sciences, Bhairahawa, Nepal. Recruited patients were all critically sick children above one year who stayed in hospital above 72 hours and underwent all necessary evaluation, and were followed up until they were discharged or deceased. Initial SOFA score was calculated within 24 hours of admission (SOFA T0) and again calculated after 72 hours (SOFA T72). Delta SOFA score was calculated as the change in SOFA scores over 72 hours (SOFA T0 - SOFA T72). The primary outcome was in-hospital mortality.\u0000Results: When compared to outcome, the non survivors had high mean initial SOFA (T0) 11.51 ± ences ec ing 3.001 (P < 0.001), mean SOFA after 72 hours (T72) was 15.51 ± 4.026 (P < 0.001) and mean delta SOFA (T0-T72) was 4.58 ± 2.59 (P = 0.166) as compared to survivors. Delta SOFA was not significantly associated with outcome (P = 0.166). The initial SOFA score T0 > / = 11 predicted a mortality of 70.90% and SOFA T72 score of >/=15 predicted a mortality of 81.60% but delta sofa >/= 4 predicts a mortality of only 43.60%. Area under receiver operating characteristic (ROC) curve for SOFA TO was 0.769, for SOFA T72 was 0.890 and for delta SOFA was 0.604 and thus, showing excellent discriminative power for SOFA 72 for predicting mortality.\u0000Conclusions: The SOFA score demonstrated fair to good accuracy for predicting mortality when applied to sick children > 1 year admitted in PICU. Our study showed both initial SOFA T0 and SOFA at 72 hours predict mortality with good accuracy but SOFA at 72 hours is a better predictor of mortality as compared to initial and delta SOFA scores.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43539207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-epidemiological Profile of Children with Diphtheria in Tertiary Care Hospital of Nepal","authors":"S. Basnet, L. Shrestha, L. Bajracharya","doi":"10.3126/jnps.v42i1.40546","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.40546","url":null,"abstract":"Introduction: This study was conducted with the aim to describe the clinical presentation of diphtheria in children, relationship between clinical disease and immunization status, complications of the disease and adverse events due to anti diphtheria serum (ADS).\u0000Methods: All patients admitted at Tribhuvan University Teaching Hospital, Kathmandu from July 2016 to November 2018 with clinical diagnosis of diphtheria were included in this study.\u0000Results: There were total 12 children and age ranged from five to 15 years, out of which seven (58%) were males and five (42%) were females. All of them were immunized except one whose immunization status was unknown. All of them had tonsillopharyngeal diphtheria. Four patients (33%) also had nasal and five (42%) patients had additional laryngotracheal diphtheria. Seven patients had bull neck on presentation. Four patients had airway obstruction due to laryngotracheal diphtheria requiring tracheostomy. Throat swab for Corynebacterium Diphtheria by Albert stain and Gram stain were positive in 10 patients, and in nine, diagnosis was confirmed by culture. Six patients (50%) were given anti diphtheria serum (ADS) out of which four patients (66.66%) developed anaphylaxis. Myocarditis was the commonest complication seen in four patients (25%). All children with myocarditis developed complete heart block (CHB) and none of them survived.\u0000Conclusions: Tonsillopharyngeal diphtheria was the most common clinical presentation and myocarditis was highly fatal complication. This study emphasizes on the need for careful surveillance, early laboratory confirmation and careful administration of ADS in patients with clinical diagnosis of diphtheria.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46756292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Efficacy and Safety of Once Daily versus Twice Daily Dosing of Caffeine Citrate in Apnea of prematurity: a Randomised Control Tria","authors":"Farooq Syed, Sandesh Kini, Abdul Majeed","doi":"10.3126/jnps.v42i1.37173","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.37173","url":null,"abstract":"Introduction: Caffeine citrate is widely used for prevention of apnea of prematurity and helps in successful extubation from mechanical ventilation. The optimum caffeine dose in preterm infants with apnea of prematurity has been extensively investigated with varied results. The objective of our study was to compare the efficacy and safety of once versus twice daily maintenance dose of caffeine citrate in premature infants with apnea.\u0000Methods: In this study, preterm neonates with gestational age of 28 to 34 weeks, with evidence of apnea of prematurity were included. Both groups received a 20 mg / kg loading dose of caffeine citrate followed by a maintenance dose of 2.5 mg / kg every 12-hour-interval in group 1 and 5 mg / kg every 24-hour-interval in group 2, either orally or by intravenous infusion. Response to treatment, duration to achieve full feeds, possible adverse reactions were evaluated and compared among the two groups.\u0000Results: Among two groups, group 1 had early reduction in number of apneic episodes on five consecutive days after loading dose, which was statistically significant. Time taken to establish full feeds following treatment initiation was lower in group 1 compared to group 2 (median: Two vs four days) which was statistically significant.\u0000Conclusions: In this study, neonates who received twice daily maintenance dose of caffeine citrate had better outcomes in terms of early reduction in number of apneic episodes and early feed establishment when co","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45620445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Gross Motor Function and Nutritional Status in Children with Cerebral Palsy attending a Tertiary Children’s Hospital of Nepal","authors":"Suraj Dhaubhadel, Bina Prajapati, D. Nepal","doi":"10.3126/jnps.v42i1.38130","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38130","url":null,"abstract":"Introduction: Malnutrition is a common problem in children with cerebral palsy and their management outcome is not satisfactory unless we address their nutritional aspect. The present study aims to find the relationship between gross motor function and nutritional status in these children by comparing the proportion of stunting, wasting and under-weight between the various levels of gross motor function.\u0000Methods: Our study was across- sectional study conducted on 82 cases of cerebral palsy between one to five years of age visiting Kanti Children’s Hospital, Kathmandu, Nepal from May 2017 to September 2018. Their level of gross motor function was ascertained by applying the Gross Motor Function Classification System (GMFCS) and anthropometry was done using standard methods. On the basis of their motor function, the children were divided into two categories: those with poorer motor function who had poor self-mobility even with assistance (GMFCS level 4 and 5) and those with better motor function who had self-mobility with various degrees of assistance (GMFCS level 1, 2 and 3). Wasting, stunting and under-weight were compared between the two categories and odds ratio with 95% confidence interval was estimated for malnutrition.\u0000Results: The children belonging to poorer motor function were more likely to be underweight (Odds ratio 3.41; CI 1.36-8.52; p-value 0.008) and stunted (Odds ratio 3.9; CI 1.47-10.53; p-value 0.048) than those with better motor function.\u0000Conclusions: Children with poorer motor function are more likely to develop malnutrition (Specially stunting) than those with better motor function indicating that chronic form of malnutrition is more common in these children.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47086872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extrauterine Growth Restriction among Very Low Birth Weight Neonate using Intergrowth 21st in a Neonatal Intensive Care Unit: A Retrospective Study","authors":"S. Panda, B. Meher, Pravati Jena, D. Pradhan, S. Priyadarshini","doi":"10.3126/jnps.v42i1.41526","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.41526","url":null,"abstract":"Introduction: Extrauterine growth restriction (EUGR) is a universal problem but its prevalence using recent reference growth charts and morbidities associated with it are lacking. The study aims at estimating EUGR prevalence in very low birth weight (VLBW) neonates and its associated morbidities.\u0000Methods: All VLBW neonates admitted to NICU between Jan 2018 to June 2019 were analysed. Neonatal anthropometries were recorded on Intergrowth 21st gender based postnatal growth chart. EUGR was defined by weight below 10th percentile at discharge. Demographic profile and neonatal morbidities were compared between EUGR and non-EUGR by using unpaired t test and Chi-square test. Regression was used for identification of the risk factors.\u0000Results: Out of 148 VLBW neonates, 92 (62.1%) were male, 26 (17.56%) were below 1000 gm, 102 (68%) were EUGR at discharge. Mean (SD) birth weight and gestational age were 1202 (221) gms and 30.89 (2.77) wks respectively. Caesarean delivery, higher gestational age, lower birth weight, SGA at birth and prolonged duration to achieve full enteral feeding were significantly associated with EUGR (P < 0.05). Sepsis was significantly associated with EUGR (36.28% vs. 17.4%; P 0.022). EUGR babies needed longer hospital duration (24.56% vs. 16.78%; P 0.005) with a higher mean PMA at discharge (38.07 wks vs. 35.11 wks; P < 0.001). In regression model SGA at birth and delay in achieving full feeding were independent predictor of EUGR.\u0000 Conclusions: In VLBW neonate, prevalence of EUGR at discharge was 68%. Sepsis was significantly associated with EUGR. SGA and delay in achieving full feeding were independent predictors of EUGR.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46556153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Bilirubin Measurement as a Predictor of Significant Neonatal Hyperbilirubinemia in Low Birth Weight Neonates","authors":"Suchetha S Rao, Karthik Chellaganapathy, N. Kamath","doi":"10.3126/jnps.v42i1.38236","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38236","url":null,"abstract":"Introduction: Early recognition of neonatal hyperbilirubinemia is essential to prevent bilirubin encephalopathy. Transcutaneous bilirubin (TCB) measurement is a simple and easy method to predict neonatal hyperbilirubinemia. We aimed to study the efficacy of TCB as a predictor of subsequent significant neonatal hyperbilirubinemia in low birth neonates and compared the forehead and sternal sites for TCB measurement.\u0000Methods: A prospective study was conducted from August to October 2018 at a teaching hospital in South India including term and late preterm neonates weighing < 2.5 kg. The TCB values were obtained from the forehead (TCB-FH) and sternum (TCB-S) by a non-Invasive Bilirubin Analyser. The average of TCB (TCB- AV) was determined for each baby with TCB-FH and TCB –S values. Neonates were followed up subsequently till discharge for the development of significant hyperbilirubinemia. Receiver operating characteristic (ROC) curve was generated and the best cut-off value for 24-hour TCB as a predictor of significant hyperbilirubinemia was established.\u0000Results: The study included 88 neonates, of which 39 (44.3%) were late preterm and 49 (55.7%) term small for gestation age. Mean values of TCB –AV 6.25 ± 1.58, TCB – FH 6.24 ± 1.57391, and TCB – S 6.27 ± 1.56 were noted. The cut off value for TCB – AV was found to be 6.85 as a predictor for subsequent neonatal hyperbilirubinemia. TCB – AV was a better predictor than TCB - FH or TCB – S.\u0000Conclusions: TCB measurement is an easy and reliable predictor for subsequent significant hyperbilirubinemia in low birth weight neonates. The average of TCB forehead and sternum was a better predictor of significant hyperbilirubinemia.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48981713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chylolymphatic Cyst - Presenting as Acute Intestinal Obstruction – A Case Report","authors":"Sunita Arora, T. Kaur, Harwinder Singh Rana","doi":"10.3126/jnps.v42i1.38679","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38679","url":null,"abstract":"Chylolymphatic cyst is one of the rare variants of mesenteric cysts. These cysts are present within mesentery and contain chylous or lymphatic fluid. Chylolymphatic cysts are rare in paediatric age group. We present a case of a four years old boy who presented with features of acute intestinal obstruction. CECT abdomen revealed a hypodense cystic mass in the peritoneal cavity. Exploratory laparotomy of the abdomen revealed a solitary cyst measuring 10.7 cm x 9.4 cm x 10.5 cm which was adherent to the loops of small intestine and right kidney. Complete excision of cyst along with resection of the adjacent gut and end to end anastomosis was done. Histopathology of the excised cyst was suggestive of chylolymphatic cyst. It has been highlighted that chylolymphatic cyst can be a rare cause of intestinal obstruction in children.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48006750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of Surfactant replacement therapy for respiratory distress syndrome in preterm babies","authors":"P. Kansakar, Narottam Shrestha, Alisha Prajapati, Shiva Prasad Chalise, Santosh Kumar Mishra","doi":"10.3126/jnps.v42i1.38218","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38218","url":null,"abstract":"Introduction: Surfactant is an important treatment modality in preterm babies with respiratory distress syndrome leading to decrease in mortality, morbidity and cost of treatment. Experiences on surfactant therapy in Nepal are scarce. This study was conceptualised to find the use and immediate outcome of surfactant therapy in preterm babies in a tertiary care hospital in Nepal.\u0000Methods: A cross-sectional study was done in preterm babies who received surfactant over period of five years at neonatal / pediatric intensive care unit at Patan Hospital, Lalitpur, Nepal. After approval from Institutional review committee, information on gestational age, sex, birth weight, doses of dexamethasone, doses and time surfactant delivery, complications and immediate outcome was retrieved from the files. Comparison between early and late rescue group was done. Data was analysed using SPSS 16.\u0000Results: Twelve babies (11.2%) needed a repeat dose of surfactant. Only 12 (11.2%) babies received early rescue surfactant. About 53 (49.5%) babies developed complications with hypotension being the most common seen in 38 (35.5%) babies. Complications were 75% and 46% in the early and late rescue group respectively (p - 0.22). The mortality was inversely proportional to the gestational age (p - 0.002) and birth weight (p < 0.05). Mortality was 16% in both the groups but the deaths related to complications of surfactant was all in the late rescue group.\u0000Conclusions: Complications were more in early rescue group and mortality was similar in both the groups, but mortality related to complications of surfactant was all in the late rescue group. Complications of surfactant therapy and mortality were inversely proportional to the gestational age and birth weight.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46741299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperbaric Oxygen Therapy : A new Evolving Future Perspective for Management of Mucormycosis and COVID 19 in Children in Developing Countries","authors":"M. Lakra, A. Taksande, B. Lakhkar, Sachin Damke, Ashwini Lakra","doi":"10.3126/jnps.v42i1.42443","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.42443","url":null,"abstract":"The SARS COVID-19 virus has arisen as a major hazard to mankind, posing harm to the whole world population. During the second COVID wave, mucormycosis has emerged as one of the deadliest and most devastating illnesses. Mucormycosis is strongly associated with diabetes, prolonged use of steroids, prolonged hospitalisation and immunocompromised states. Children have also been affected by this badly. Hyperbaric oxygen therapy is a non-invasive, cost-effective and painless therapy where 100% oxygen is given to patients under high atmospheric pressure in small tents or chambers. It helps in tissue regeneration and angiogenesis. Hyperbaric oxygen has proved to be effective in the treatment of oculo-rhino-cerebral mucormycosis. Various studies have proved its role in the management of mucormycosis and acute respiratory distress syndrome associated with COVID-19 infection. The advantages of hyperbaric oxygen are same in children as in adults with minimum side effects. Hyperbaric oxygen therapy can be one of the good adjunctive therapies in the management of mucormycosis. It is found to be safe in the treatment of COVID-19 infection, but data is still limited on its use and further studies are needed. This article is all about its use, its efficacy, and future perspectives in the management of mucormycosis and COVID-19 in view of the arrival of the third COVID wave in developing countries like India.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43407304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Risk Factors Association for Ventilator Associated Pneumonia in Neontal Intensive Care Unit","authors":"Naresh Kumar, P. Malhotra, Amanjeet Kaur Bagga, Gagandeep Kaur","doi":"10.3126/jnps.v42i1.38603","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38603","url":null,"abstract":"Introduction: Ventilator Associated Pneumonia (VAP), the nosocomial pneumonia developing in mechanically ventilated patients after 48 hours of mechanical ventilation, is the second commonest nosocomial infection in the neonatal intensive care unit (NICU). VAP occurring within 96 hours of initiation of mechanical ventilation is termed as early VAP and later than that is known as late VAP. The aim of this study was to determine the incidence rate and risk factors of early and late ventilator associated pneumonia in NICU.\u0000Methods: The study was conducted from December 2015 to November 2017 in which 40 neonates were ventilated for more than 48 hours of which those who developed VAP as per CDC criteria were enrolled in the study. Birth weight, gestation age, reintubation if needed and number of days of ventilation were noted. Statistical associations were further evaluated between various parameters of VAP and time of development of VAP.\u0000Results: Incidence of Early VAP was 12.5% and that of Late VAP was 87.5%. 93.95% neonates who were reintubated developed VAP. Duration of mechanical ventilation and re-intubation were significantly associated with the time of development of VAP. Birth weight and gestation age were statistically insignificant factors in determining VAP.\u0000Conclusions: Re-intubation and duration of mechanical ventilation are a significant risk factor for development of late VAP. Gestation age and birth weight have been identified as additional risk factors. Early diagnosis is necessary for appropriate treatment and decreased hospital stay.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42807257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}