Journal of Nepal Paediatric Society

Cerebral Venous Sinus Thrombosis in a Child with Iron Deficiency Anaemia

2023-09-10T04:51:57+00:00

Children who have cerebral venous sinus thrombosis (CVST) are at risk for both emergency and long-term neurological effects. Non-specific symptoms like fever, altered mental status, and localized neurological abnormalities define it. Infection, trauma, prothrombotic diseases and, most critically, iron deficiency anaemia (IDA) are etiologic factors. IDA, which is frequently brought on by excessive cow milk consumption in newborns and toddlers, is a preventable risk factor for CVST. We discuss the case of a 32-month-old female who presented with lethargy and hemiparesis, and was diagnosed with CVST in the context of IDA.

Hyperpigmented Macules in an Indian boy: is it EDP or LPP ? - A Case Report

2023-09-10T04:51:55+00:00

Erythema dyschromicum perstans (EDP) and Lichen planus pigmentosus (LPP) are both inflammatory disorders of pigmentation with unknown etiology and are difficult to differentiate clinically and histologicaly. There is no consensus on whether both entities are separate or belong to the same spectrum of cutaneous disorders. We present a 13 year old boy with mostly asymptomatic hyperpigmented lesions over body. The lesions were subsequently diagnosed as EDP after detailed examination and histopatholgical examination.

Mild Encephalopathy with Reversible Splenic Lesions in an Infant with COVID-19

2023-09-10T04:51:53+00:00

There have been few reports of mild encephalopathy with reversible splenic lesions (MERS) associated with COVID-19 in infants. Here, we present a case of MERS in a 23-month-old infant with COVID-19 in Japan during the Omicron variant epidemic. The increase in COVID-19 acute encephalopathy in infants, including those with MERS, should be considered in the future due to the prevalence of the Omicron variant strain. Meanwhile, whether the cause is COVID-19, acute encephalopathy with a lesion localized in the splenium of the corpus callosum can be treated with temporary anticonvulsant therapy, as is generally the case with MERS.

Peutz-Jeghers Syndrome Causing Gastroduodenal Intussusception : A Rare Case Report

2023-09-10T04:51:51+00:00

Peutz-Jeghers syndrome (PJS) is a rare disease characterized by melanotic macular lesions over the pulp of fingers, in oral cavity mucosa, lips, and hamartomatous gastric and intestinal polyps. They usually present with intestinal intussusception or intestinal bleeding; gastroduodenal intussusception is an infrequent presentation. Endoscopic resection or complete surgical excision of the polyp is the treatment of choice. We here present a case of a seven year male with multiple gastric polyps presenting as gastric outlet obstruction.

Retrieval of Broken Umbilical Venous Catheter Fragment in a VLBW Neonate

2023-09-10T04:51:47+00:00

Fracture of umbilical venous catheters is a serious uncommon complication. We are reporting a 31+4 week male neonate weighing 1390 gm with a broken umbilical venous catheter and successful retrieval of the catheter by an open surgical technique.

Assessment of Bacterial Profile and Antimicrobial Susceptibility Pattern of Bacterial Isolates from Blood Culture in Tertiary Level Paediatric Hospital of Nepal

2023-09-10T04:52:50+00:00

Introduction: Bloodstream infection is a major cause of morbidity and mortality which requires antibiotic treatment. Antimicrobial resistance is an emerging serious public health threat in both developed and developing countries. Children are more susceptible to infections requiring an appropriate choice of antibiotic based on blood culture. This study aims to investigate the bacteriological profile and antibiotic sensitivity pattern of blood culture isolates and compare the yield of bacterial growth between Brain Heart Infusion Broth (BHIB) or BD BACTEC culture media.

Methods: A total of 12,795 blood samples were sent for bacteriological culture either for BHIB or BACTEC techniques, 10994 and 1801 samples respectively. Chi-square test was used for showing association between BACTEC and BHIB among isolates.

Results: The findings showed that the BACTEC method detected more positive isolates than the BHIB method. The rate of isolation was found highest among children under five years. The most common pathogens isolated were Staphylococcus species (28.1%), Staphylococcus aureus (25.6%), Acinetobacter species (12%), Pseudomonas species (8.2%), Klebsiella species (6.6%), CONS (4.4%), Escherichia coli (4.4%), Salmonella Typhi (3.5%), Enterobacter species (3.2%) and Streptococcus species (0.3%).

Conclusions: Staphylococcus aureus was the commonest isolate identified in the current study. BACTEC culture method detected the higher percentage of isolates than BHIB method.

Behavioural Profile, Linguistic skills, Adaptive Behaviours and Intellectual Functioning of School aged Children with History of Early Language Delay

2023-09-10T04:52:46+00:00

Introduction: Language is a fundamental skill and a foundation stone for multiple cognitive and socio-emotional aspects of development. Considering that well-developed language abilities enable children to negotiate the social-relational demands of school life and provide the foundational knowledge upon which academic skills are built, there is a higher chance of scholastic difficulties, social and, behavioural and emotional maladjustments resulting in poor mental health in those who have language delay.

Methods: An ambispective study conducted at a tertiary centre after taking ethical approval from the institutional review board. Children with isolated early language delay were reassessed at school age for intelligence quotient, language development, adaptive behaviours and behavioural issues.

Results: out of 57 children, persistence of poor language skills was seen in 65%, mean IQ score was 90 ( ± 17. 067) and mean VABS score was 94 ( ± 15). 61.4% children had significant behavioural issues. On interview, most worrisome issue reported by children was ‘being teased by friends’ due to poor language skills. Additionally, lower social competence level was noted in children who had poor language skills.

Conclusions: persistence of language, cognitive and behavioural dysfunctions in children with seemingly benign ‘speech and language delay’ at an early age, emphasizes the importance of comprehensive reassessment of these children at school age for early recognition and management.

Diagnostic Accuracy of Haematological Scoring System in Paired cord Blood and Peripheral Venous Blood for early Detection of Neonatal Sepsis – A Prospective Analytical Study

2023-09-10T04:52:43+00:00

Introduction: Sepsis is one of the major causes of neonatal morbidity and mortality. Early recognition and diagnosis of early onset neonatal sepsis (EONS) is difficult. Hence, there is a need for early predictive screening method for EONS, for which Haematological Scoring System (HSS) is used. It comprises of total leucocyte count, immature / total neutrophil ratio, total PMN count, immature PMN count, degenerative changes in PMN and platelet count.

Methods: 100 inborn neonates with two or more risk factors for EONS, chosen by sequential sampling method were included in this prospective analytical study. Blood samples were collected from umbilical cord and peripheral vein and analysed for haematological parameters. Blood cultures were performed as gold standard for diagnosing neonatal sepsis and sepsis screen was done to corroborate the diagnosis of EONS.

Results: Out of 100 neonates, 21 had sepsis, 14 had probable sepsis and 65 had no sepsis. Among the variables of HSS it was observed that elevated I:T ratio, thrombocytopenia, elevated I:M ratio and elevated immature neutrophil count have shown significant correlation with EONS with statistically significant p values (p value < 0.05), with raised I:T ratio being highly sensitive in identifying neonatal sepsis and degenerative changes in neutrophils being highly specific.

Conclusions: The HSS was found to be satisfactory in identifying EONS. It can be used as a simple, quick, cost effective and readily available screening test with decent sensitivity and high specificity, for detection of EONS.

Effectiveness of Video-Assisted Distraction Technique in Reduction of Pain Among Preschool Children Undergoing Vein Puncture

2023-09-10T04:52:37+00:00

Introduction: Vein puncture is an invasive but common procedure for children, often accompanied by pain, fear and anxiety and refuse to cooperate. Distraction technique is one of the non-pharmacological methods of controlling pain. The objective of this study was to find the effectiveness of video assisted distraction technique in reduction of pain among preschooler children.

Methods: Quasi experimental study was conducted in Bharatpur Hospital, Chitwan, Nepal. 108 preschooler children consisting of 54 children in each experimental and control group selected by non-probability purposive sampling technique were enrolled in the study. Structured pain scale was used to collect data in both groups. Animated cartoon video was shown only to experimental group five minutes prior to until the vein puncture was over. Data analysis was done using descriptive statistics and inferential statistical tests.

Results: In experimental group, 59.2% had moderate pain whereas 68.5% in control group had severe pain. The pain score of experimental group was significantly lower than that of control group at p = 0.05 with the mean value of experimental and control group 6.85 ± 0.79 and 7.25 ± 0.87 respectively.

Conclusions: Distraction is an effective technique for children undergoing vein puncture in order to alleviate pain level during vein puncture

Factors Associated with Exclusive Breastfeeding among Working Mothers Attending Maternal and Child Health Clinic

2023-09-10T04:52:34+00:00

Introduction: Breast milk is a natural and perfect food that protects against illness and death by acting as the baby’s first immunization. The employment of the mother is considered to be one of the most important barriers to exclusive breastfeeding (EBF).

Methods: A hospital-based descriptive cross-sectional study was done to find out the associated factors with EBF among working mothers. A total of 150 working mothers having children six to 24 months were selected. Self-developed semi-structured interview schedule was used. Pre-testing was done on 15 (10%) of the total sample and necessary modifications were done. Data were analyzed by using descriptive (Frequency, percentage) and inferential statistics (Chi-square and odds ratio).

Results: A total of 52 (34.66%) working mothers reported to have practice of EBF for six months. Majority (80%) of the working mothers fed colostrum. Majority (92.85%) of the working mothers gave powdered milk due to inadequate milk secretion. Regarding Expressed Breast Milk (EBM) storage, more than 50% had no idea about EBM and 47 (31.33%) of the mothers had a breastfeeding room at their workplace. 80 (53.33%) mothers had allowed children in their workplace while 47 (88.0%) had family support. EBF was associated with mode of delivery (OR = 0.440, 95% CI: 0.214 - 0.903), child hospitalization in the past (OR = 0.139, 95% CI: 0.031 - 0.618), facility of express breastmilk (OR = 4.087, 95% CI: 0.978 - 17.079) and flexible working environment (OR = 4.2, 95% CI: 1.789 - 9.863).

Conclusions: About only one-third of working mothers had given EBF to their child. Vaginal delivery, child hospitalization in the past, a facility of EBM at home, and a flexible working environment were associated factors with EBF among working mothers.

Feasibility of Telemedicine for Follow up of Children with Established Seizure Disorder- A Tertiary Care Center Prospective Study

2023-09-10T04:52:30+00:00

Introduction: Medical information exchanged via electronic communications to improve a patient’s clinical health status by a physician without in-patient visit is telemedicine. Control of seizures with antiepileptic drugs, reassurance for compliance to drugs, regular monitoring of adverse effects of drugs in patient with established seizure can be possible through telemedicine. The main objective of this study was to evaluate feasibility of telemedicine for follow up of children with established seizure disorder.

Methods: This study was conducted among children of age one to 16 years with an established seizure due to any cause presenting to the Paediatric Neurodevelopmental OPD of Tribhuvan University Teaching Hospital (TUTH) between October 1, 2018 and September 30, 2020. Mobile phone as a modality of telemedicine was used to inquire about seizure every month for 12 months and whenever necessary.

Results: When parameters as seizure control, total cost and time spent per hospital visit, distance to TUTH were analyzed, more than 75% caregivers were satisfied with telemedicine. Greater age, appropriate development, focal onset of seizure, normal electroencephalogram and seizure adequately controlled by single antiepileptic drug were the favorable factors in better seizure control in children using telemedicine.

Conclusions: Telemedicine for follow up of children with established seizure disorder seems to be a feasible and satisfactory option when implemented with caution and proper patient selection as it decreases unnecessary high expenses and time to hospital visit

Hand Washing – its Awareness and Practices Among School Children and Facilities Available in Rural Government Schools of District Rohtak, Haryana

2023-09-10T04:52:26+00:00

Introduction: Hand washing with soap (HWWS) is one of the single most cost-effective public health interventions. HWWS is effective in reducing diarrhea and can reduce its risk up to 48% and acute respiratory infections by more than 20%. Government of India launched Swachh Bharat Swachh Vidyalaya program, which also provided guidelines for hand washing i.e., availability of soap at hand washing stations, hand washing to be done before mid-day meal and also after use of toilet or urinal. The objective of the study was to assess knowledge and practices of hand washing among school children along with adequacy of available hand washing facilities and contributors responsible for it.

Methods: A descriptive cross-sectional study was carried out in all Government schools of Lakhan Majra block, Rohtak, Haryana, India. Thirty-Eight schools for provision of facilities and 613 students for assessing knowledge, practice and behavior change were included in the study employing stratified random sampling technique. Semi-structured interview schedule was used for data collection.

Results: All schools had hand washing facilities. Soap was available in 63.2% and 97.2% students knew benefits of hand washing while 88.9% of them were promoting it also. Less than one fifth of the students could demonstrate the correct steps of hand washing.

Conclusions: Majority of students were aware of washing hands before and after critical times. Soap availability in schools was inadequate

Impact of Quality Improvement (QI) Initiatives on Neonatal Mortality in NICU: A Retrospective Analysis in Tertiary Care Centre in Western India

2023-09-10T04:52:22+00:00

Introduction: The global “under-five mortality” has dropped 60% from 93 deaths per 1,000 live births in 1990 to 37 in 2020 in the last three decades. It is vital to adopt proven quality improvement initiatives to provide quality care to improve neonatal mortality and morbidity. Aim of the study was to assess the impact of the quality improvement interventions and strategies in reducing the neonatal mortality statistics.

Methods: The study was conducted in a 500 bedded Government Hospital in India. The management implemented various tactics, such as enhancing the existing infrastructure, upgrading equipment, augmenting the workforce, and implementing established clinical protocols, to enhance the quality of intensive care services provided in the NICU. The QI points were identified based on the shortcomings that were identified and shortlisted based on the working of NICU pre QI implementation. The outcome was measured as neonatal mortality indicators and the data was compared between pre and post implementation period.

Results: After implementing quality improvement measures, there were notable enhancements in the total floor area, availability of skilled personnel, and equipment. The number of total admissions to the NICU increased by 79%, and mortality reduced from 20.93% to 7.82%. There was a statistically significant decrease in disease-specific neonatal mortality rates, with a p-value of less than 0.001.

Conclusions: This study concludes that implementation of proper and comprehensive QI interventions and strategies in NICUs can help in decreasing the neonatal mortality.

Incidence of Acute Kidney Injury in 1 - 14 years old Critically ill Children in a Tertiary care Center

2023-09-10T04:52:19+00:00

Introduction:Acute Kidney injury (AKI) is associated with poor outcomes in critically ill hospitalized children. There are very few studies on incidence of AKI based on urine output criteria of KDIGO (Kidney Disease: Improving Global Outcome) and time lag between the fall in urine output and rise in serum creatinine. This study was therefore aimed at determining the same.

Methods: A prospective study was conducted in the Department of Paediatrics of a tertiary care hospital. 171 critically ill children between one to 14 years who were admitted in PICU were enrolled. Hourly urine output and eight hourly serum creatinine levels were measured and incidence of AKI was calculated along with lag time between fall in urine output and rise in serum creatinine. Outcome of children with AKI was also studied. Data analysis was done using SPSS software version 25.0 and Microsoft excel 2007.

Results: The mean age + SD of children in the study was 5.5 years ± 3.76 with a range of one to 14 years, with 62.6 % of them being boys. The incidence of AKI in the study population was 14.62%. The mean lag time between fall in urine output and rise in serum creatinine was found to be 13.21 hours. AKI had a significant association with mortality, use of nephrotoxic drugs, inotropes and mechanical ventilation.

Conclusions: A significant number of critically ill children develop AKI and its occurrence portends a poor outcome. Utilization of the KDIGO reduced urine output criteria as a marker of AKI allows for early detection and intervention

Modified Sick Neonatal Score (MSNS) in Predicting the Outcome of Neonates in Tertiary Care Hospital

2023-09-10T04:52:16+00:00

Introduction: Neonatal disease severity scoring systems are widely used to predict severity of illness. Existing scoring systems contain variables like pH, PO2 / FiO2 ratio, and base excess, which are difficult to obtain in resource-limited settings. Modified sick neonatal score (MSNS) is based on eight clinical variables which are easy to calculate and are also accurate enough at the same time. This study was done to evaluate MSNS for predicting the outcome of neonates in our settings.

Methods: This was prospective observational study done at neonatal intensive care unit (NICU) of tertiary care hospital in Nepal from February 2021 to January 2022. The parameters required for the score were recorded at admission. Total score was calculated and outcome was noted. Data collected was analyzed using SPSS Statistics for Windows, v21.0. Chi square test, Mann-Whitney U test and ROC analysis were used for statistical analysis.

Results: Total of 195 neonates were discharged and 37 expired. The mean MSNS score among expired was 8.16 ± 1.625 and discharged was 10.99 ± 1.753. For a cutoff score of ≤ 10, sensitivity and specificity; Positive and negative predictive value were 89.2% and 60.5%; 30.7% and 98.3% respectively. The area under the curve (AUC) of MSNS was 0.875 (CI 95%; 0.817 - 0.934). Lower MSNS score was also associated with requirement of iontrope and ventilator support.

Conclusions: MSNS can be used as an important clinical tool for predicting the severity of disease in neonates in resource limited settings.

Parental Satisfaction with the Care of Admitted Children in a Tertiary Level Hospital

2023-09-10T04:52:13+00:00

Introduction: The quality care is an essential aspect of hospital service in improving health outcomes. Quality of children’s care can be assessed by measuring the parental satisfaction.

Methods: A descriptive cross-sectional design was used. Non-probability purposive sampling was used to select 167 parents of children who were admitted in Kanti Children Hospital. Data were collected by interviewing either the father or mother as roomed-in by using the Pediatric family satisfaction questionnaire (PFSQ) containing three domains as modified to suit to local context. Data were entered, cleaned and analyzed in statistical package for the social sciences SPSS version 22. Chi-square test and Spearman rank correlation coefficient were used to analyze the data.

Results: Findings revealed that the overall satisfaction among majority (59.9%) of the respondents was low. However, domain wise, almost all (94.6%) respondents were satisfied in medical care followed by 89.2% in nursing care and lowest proportion (42.5%) was satisfied with hospital services and accommodation. Parental overall satisfaction was significantly higher among those admitted in surgical unit (p = 0.00) and among those with days of hospitalization as more than 6 days (p = 0.01). Findings also showed a moderate correlation between the satisfaction with nursing care and medical care (r = 0.64).

Conclusions: Parents tend to have low satisfaction with the care provided to the admitted children whereas domain wise satisfaction is high in medical and nursing care and low in hospital services. Therefore, in order to increases the parental satisfaction, more focus should be given to improve the quality of hospital services and accommodation.

Prevalence and Associated Factors of Malnutrition in Under Five Children in Eastern Nepal: A Hospital Based Study

2023-09-10T04:52:09+00:00

Introduction: Malnutrition among children remains one of the most important causes of morbidity and mortality in the developing countries like Nepal. Multiple interrelated determinants are involved in causing malnutrition that needs to be catered. This study aims to assess the prevalence and associated factors of malnutrition among under-five children in eastern Nepal.

Methods: This is a hospital-based correctional study. The enrolment occurred between Jan 2018 and Dec 2019 among children who visited nutrition clinic in our hospital. The data analyses were performed using Logistic regression and 95% confidence interval along with p-value. A p-value < 0.05 was considered statistically significant.

Results: A total of 310 children were analyzed for malnutrition. Among them, the prevalence of underweight, stunting and wasting was 34.10, 32.45, 17.54 % respectively. Among them, majority of the mother belonged to young age group between 18- 25 years, 216 (69.68%) were females and 120 (38.71%) and Majority of malnutrition fell in the age group of 12 – 23 months. Mother’s age, mother’s education, family size, economic status, child’s age and sex, exclusive breast, ethnicity, mother’s occupation and total family size were found to be significantly associated with malnutrition.

Conclusions: This study highlights serious concern of malnutrition among under five years old children in eastern part of Nepal. Multiple hierarchically interrelated determinants associated with child, mother and the social environmental factors were found significant in malnutrition among the children.

Spectrum of Paediatric Dermatoses in a Private Medical College

2023-09-10T04:52:05+00:00

Introduction: Dermatoses in children puts a huge burden on the parents as well as their development. Severity of these dermatoses vary from location to location. Environment plays an important role, especially in children and presentation of these dermatoses maybe quite different than those in adults.

Methods: This is a six months prospective study. All children who presented to the Paediatrics / Dermatology OPD with any skin ailment were included. Diagnosis was done clinically, investigations if required were done. Based on age, cases were divided into six groups. Skin disorders were categorized into 17 groups. The demographic data and other clinical details were recorded on a pre-designed performa.

Results: 206 children were included in our study. Males were 136 (66.01%) and females were 70 (33.98%) with M:F ratio 1.94:1. The spectrum of skin diseases were infections and exanthems (40.29%), eczematous diseases (19.41%), disorders of sebaceous and sweat glands (13.10%), papulosquamous diseases (6.31%), hypersensitivity syndromes (5.82%), disorders of pigmentation (5.33%), disorders of hair and nail (3.39%), cutaneous tumor and tumor syndromes (1.94%), vascular disorders (1.45%), disorders of cornification (0.97%), photo-dermatoses(0.97%), histiocytosis and malignant skin tumors (0.48%), and miscellaneous (0.48%). Dermatoses according to age were neonatal (0.97%), infant (4.36%), toddlers (9.70%), preschool (18.44%), school-age-children (30.58%), and adolescents (35.92%).

Conclusions: Skin infections and infestations being the majority explains the status of developing countries like India. This study can help identify (or diagnosing) and treating common dermatological conditions in children and this would also sensitize our fellow paediatricians to this common but often neglected aspect of childcare.

Stretched Penile Length in Boys - A Cross-sectional Single Centre Study

2023-09-10T04:52:02+00:00

Introduction: Stretched penile length is the most relevant measurement to define the size of the penis, which varies in various ages, geographical regions and ethnicities. Thus, a population specific normative data on stretched penile length helps in early diagnosis of penile abnormalities and endocrine disorders in children.

Methods: A cross sectional study was done in 501 healthy boys from neonatal period till 12 years of age. Boys with abnormalities of external genitalia, suspected endocrine disorders, suspected syndromes, chronic diseases were excluded from the study. Stretched penile length was measured with a transparent ruler from the pubic ramus till the tip of the glans penis excluding the foreskin. Height and weight of the boys were also recorded. Spearman’s rank correlation coefficient test was used to find the correlation of stretched penile length vs height and weight of the boys. P < 0.05 was considered significant.

Results: The median, 5th, 95th percentiles of stretched penile length were calculated. The median stretched penile length of the boys ranged from 3.01 (2.32, 3.06) cm in infancy to 6.33 (6.04, 6.62) cm by 12 years. The correlation of stretched penile length vs height and weight showed a statistically significant positive correlation. (rs = 0.979, p < 0.001; rs = 0.971, P < 0.001 respectively).

Conclusions: Our study provides normative data on stretched penile length from neonatal period till 12 years of age. There was a significant positive correlation between stretched penile length and height and weight of the boys.

Validation of the Paediatric Asthma Score (PAS) in Evaluation of Acute Exacerbation of Asthma in Children

2023-09-10T04:51:59+00:00

Introduction: Assessing the severity of acute asthma objectively is important to guide treatment. Peak Expiratory Flow Rate (PEFR) is used for this. Paediatric Asthma Score (PAS) is a user-friendly asthma score in children. Our aim was to validate the efficacy of PAS in comparison with PEFR for assessing severity of acute asthma.

Methods: The study included 32 children in the age group of five to 14 years, with mild to moderate asthma exacerbation. The PEFR and the PAS were measured before treatment, 15 min, 30 min, and one hour after treatment, and at discharge. Paired t-test was used to establish construct validity by comparing pre-and post-treatment PEFR and PAS. The criterion validity was calculated by correlating pre-and post-treatment PASs with PEFRs.

Results: The mean predicted PEFR improved with treatment by 22.35% (p < 0.001) by one hour. Pre- and post-treatment PASs significantly correlated with PEFRs. The correlation of pre-treatment PEFR and PAS was r = -0.491 (p = 0.004), that for post-treatment at 1hour was r = -0.505 (p = 0.003).

Conclusions: The study validities the PAS as a measure of severity of asthma. The PAS is thus a simple alternative to the PEFR to estimate airway obstruction in children within the age group to five to 14 years with acute asthma exacerbations.