Journal of Nepal Paediatric Society <p>Journal of Nepal Paediatric Society is the official journal of Nepal Paediatric Society. It is a peer reviewed, open access, paediatric journal and follows the general principles of scientific publications. It is a paediatric journal which publishes articles related to all aspects of health care in neonates, children and adolescents.&nbsp;</p> <p>Journal of Nepal Paediatric Society is included on <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a>.</p> Nepal Paediatric Society (NEPAS) en-US Journal of Nepal Paediatric Society 1990-7974 <p>Authors who publish with this journal agree to the following terms:</p><p>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a title="CC-BY" href="" target="_blank">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</p><p>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</p>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>). Nepal Paediatric Society Guideline for use of Antibiotics in Critically ill Children in the Pediatric Intensive Care Unit <p class="p1"><strong>Justification</strong>: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon.<span class="Apple-converted-space"> </span></p> <p class="p2"><strong>Objective</strong>: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns.<span class="Apple-converted-space"> </span></p> <p class="p2"><strong>Process / Methods: </strong>Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. <span class="Apple-converted-space"> </span></p> <p class="p2"><strong>Recommendations:</strong> This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children.<span class="Apple-converted-space"> </span></p> <p class="p2"><strong>Keywords: </strong>Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit<span class="Apple-converted-space"> </span></p> Dhruba Shrestha Puja Amatya Arun Sharma Shrijana Shrestha Yograj Sharma Santosh Pathak Prakash Jyoti Pokharel Nipun Shrestha Santosh Pokhrel Srijana Dongol Ganendra Bhakta Raya Amrit Ghimire Janak Koirala Sangita Basnet Copyright (c) 2021 Dhruba Shrestha, Puja Amatya, Arun Sharma, Shrijana Shrestha, Yograj Sharma, Santosh Pathak, Prakash Jyoti Pokharel, Nipun Shrestha, Santosh Pokhrel, Srijana Dongol, Ganendra Bhakta Raya, Amrit Ghimire, Janak Koirala, Sangita Basnet 2021-12-31 2021-12-31 41 3 307 314 10.3126/jnps.v41i3.35051 A Comparative Study of Diazo Test and Blood Culture in Children With Clinically Compatible Typhoid Fever <p class="p1"><strong>Introduction:</strong> Typhoid fever causes a clinically indistinguishable disease with a wide range of clinical severity. This study was done to compare the Diazo test with blood culture.</p> <p class="p1"><strong>Methods</strong>: A cross-sectional comparative study was done for one year with a sample size of 100 children up to the age of 15 years in the Department of Paediatrics, Sree Balaji Medical College and Hospital, Tamilnadu, India. Diazo test and blood culture were done in enrolled children who had clinical symptoms and signs suggestive of typhoid fever.</p> <p class="p1"><strong>Results</strong>: Blood culture-positive cases were 26% and diazo-positive cases were 34%. Out of 26 blood culture-positive cases, 19 cases showed positive results and seven had a negative result by Diazo test and this was statistically significant. Diazo test had sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value of 73.08%, 79.73%, 3.61, 0.34, 55.8%, 89.4% respectively. The measure of agreement Kappa value was found to be 0.480 which is considered to be a significant moderate agreement between the Diazo test and blood culture.</p> <p class="p1"><strong>Conclusions</strong>: Diazo test is a simple bedside test with a comparable degree of sensitivity and specificity and can be utilized for the diagnosis of typhoid fever in children in areas of scarce resources and thereby reducing the complications.</p> <p class="p1"><strong>Key words:</strong> Diazo test; Sensitivity; Specificity</p> Ramya Ramanathan Pooja Pradeep Shafath Ahmed Copyright (c) 2021 Ramya Ramanathan, Pooja Pradeep, Shafath Ahmed 2021-12-31 2021-12-31 41 3 315 319 10.3126/jnps.v41i3.36213 Assessment of Foetal Malnutrition Using CAN Score and its Comparison With Various Anthropometric Parameters and Proportionality Indices <p class="p1"><strong>Introduction: </strong>Nutritional status at birth is assessed by using various anthropometric parameters and proportionality indices. Present study aims to assess the utility of CAN score in identifying fetal malnutrition (FM) which would have been missed by using anthropometry alone. We also aim at re-evaluating the cut-off value of CAN score for our population.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods:</strong> Nutritional status of 411 neonates was assessed using anthropometric parameters, proportionality indices and CAN score. Effectiveness of each parameter in detecting FM was assessed and compared with CAN score cutoff &lt; 25 as well as new found cut-off &lt; 27 using appropriate statistical tools.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Result:</strong> Mean (SD) of all anthropometric parameters were significantly less in FM group (p &lt; 0.001). CAN score identified FM in 18.5% (76 / 411) babies whereas weight for GA identified 8.8% (36 / 411) babies as SGA and 91.2% as AGA (375 / 411); 12.3% (46 / 375) babies identified as AGA, were found to be malnourished by CAN score. Similar trend is seen with other parameters too. ROC curves show that AUC for birth weight, mid arm circumference, body mass index, Ponderal index, length and MAC / HC for determining FM was 0.891, 0.855, 0.837, 0.761, 0.749 and 0.714 in decreasing order. Birth weight with cut-off 2300 grams in a term newborn has maximum AUC making it the best marker for predicting FM. Present study identifies more FM by using modified CAN score cut off &lt; 27 instead of &lt; 25, 32.11% (132 / 411) and 18.5% (76 / 411) respectively.</p> <p class="p1"><strong>Conclusion:</strong> CAN score is a simple method to assess FM which does not require any sophisticated equipment or time-consuming calculations.<span class="Apple-converted-space"> </span></p> Anju Kapoor Sukarn Awasthi Ankit Yadav Shraddha Tiwari Copyright (c) 2021 Anju Kapoor, Sukarn Awasthi, Ankit Yadav, Shraddha Tiwari 2021-12-31 2021-12-31 41 3 320 326 10.3126/jnps.v41i3.35535 Birth Interval and its Association with adverse Childhood Nutritional outcomes among under-Five Children in Bangladesh: A Longitudinal Study <p><strong>Introduction:</strong> Short birth spacing is reported to have health consequences for both mother and child. This study aims is to examine the effect of short birth interval on nutritional outcomes of under-five children in Bangladesh.</p> <p><strong>Methods:</strong>We used data from the latest five rounds of Bangladesh Demographic and Health Surveys conducted from 2004 to 2017-18. The short birth interval is defined as birth spacing of &lt;24 months and 24-35 months between two subsequent births. The outcomes of interest are stunting and underweight. Both bivariate and multivariate statistical analyses were employed. Results of the multivariate analysis are shown by odds ratios (ORs) with 95% confidence intervals (CIs). Data were analyzed by Stata 15/IC.</p> <p><strong>Results:</strong> A total of 16,100 under-five children of second and higher-order births were included for analysis. Of the children, 12% were born at a space of &lt;24 months, and 19% were born with a space of 24-35 months. The proportion of children with short birth interval was found decreasing. Results of the logistic regression analysis show thatcompared to the birth interval of 36-59 months children born to women with birth interval &lt;24 months were significantly (<em>P</em>&lt;0.001) at higher risk of being stunted (OR = 1.44, 95% CI: 1.27, 1.57) and underweight (OR = 1.42, 95% CI: 1.27, 1.58). A similar result was obtained for the birth interval of 24-35 months.</p> <p><strong>Conclusion: </strong>Short birth interval remains a problem of childhood nutrition in Bangladesh. Research to explore causal pathways and programs to lengthen space between inter-pregnancy should be intensified.</p> <p><strong>Keywords:</strong> Birth interval, childhood nutrition, stunting, underweight, logistic regression</p> SM Mostafa Kamal Md Moniruzzaman Copyright (c) 2021 SM Mostafa Kamal, Md Moniruzzaman 2021-12-31 2021-12-31 41 3 327 335 10.3126/jnps.v41i3.33562 Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates <p><strong>Introduction: </strong>Low birth weight (LBW) neonates comprising of preterm and small for gestational age (SGA) are at risk of hypoglycemia. Hypoglycemia as such in LBW neonates is not well characterized. We aimed to study the blood glucose levels of these neonates and characterise the hypoglycemia.</p> <p><strong>Methods: </strong>Blood glucose levels in singleton neonates with birth weight between 1500 gm and 2499 gm were studied prospectively. Glucose levels were assessed at six hour intervals in the first 48 hours of life and extended if indicated. Glucose level ≤ 45 mg/dL in the first 24 hours and &lt; 50 mg/dL thereafter was considered hypoglycaemia.</p> <p><strong>Results: </strong>A total of 320 among 3822 neonates satisfied inclusion criteria; 104 had at least one low glucose reading with an incidence of hypoglycaemia of 32.5%. Preterm neonates constituted 158 (49.4%) and SGA 76 (23.8%). Mean blood glucose values were lowest in the first hour of life (60.1 ± 17.2 mg/dL). Incidence of hypoglycemia was highest within one hour of life followed by day two of life (16.3% and 11.6% respectively). About 86 (82.6%) neonates were asymptomatic. Overall, 75% of neonates had a single episode of hypoglycemia and 25% had a recurrence. Hypoglycaemia was noted in 31.8% of neonates born to diabetic mothers, mostly in the first hour (57.1%). Other risk factors for hypoglycemia included intrapartum fluids, birth weight &lt; 2000 g and polycythemia.</p> <p><strong>Conclusions: </strong>About a third of LBW neonates had hypoglycemia; mostly on the first hour and day one of life. Asymptomatic nature of hypoglycaemia in the large majority and recurrent hypoglycemia in 25% cases warrants glucose monitoring in this subgroup.</p> Ramesh Bhat Y Juanitha George Leslie Lewis Jayashree Purkayastha Copyright (c) 2021 Ramesh Bhat Y, Juanitha George, Leslie Lewis, Jayashree Purkayastha 2021-12-31 2021-12-31 41 3 336 345 10.3126/jnps.v41i3.32758 Causes of Mortality in Low Birth Weight Babies at a Tertiary Care Hospital <p class="p1"><strong>Introduction:</strong> Decreasing the neonatal mortality has been a major concern to decrease under five mortality rate. Low birth weight (LBW) and prematurity related deaths account to significant percentage of all neonatal deaths worldwide. Causes of mortality in LBW babies are not well documented. Hence this study aims to determine the causes of neonatal mortality among the LBW babies at Patan Hospital, Nepal. <span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Method: </strong>It was a retrospective observational study done at the Department of Paediatrics, Patan Hospital, Lalitpur, Nepal. The study period was three years from April 2017 to March 2020. All LBW babies born within the study period were included. Perinatal audit and case records were reviewed and necessary data was extracted. Results were analyzed using appropriate tools.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>Total LBW babies were 3028 which was 13% of all live births. Deaths among LBW were 83 comprising mortality rate of 26.7 per thousand live births. Among all neonatal deaths 76% of the deaths were LBW babies. Sixty very LBW babies died which contributed to 55% of total neonatal deaths.<span class="Apple-converted-space"> </span>Mean birth weight was 1185 grams, median 1045 with standard deviation 571 with range of 500 to 2484 grams. Respiratory distress syndrome (35%), sepsis (29%), congenital anomalies (23%) and birth asphyxia (12%) were the most common causes of mortality.</p> <p class="p1"><strong>Conclusions: </strong>Respiratory distress syndrome and sepsis were the most common causes of neonatal mortality among LBW babies. Improved neonatal care with special focus to very and extremely LBW babies might help reduce neonatal mortality.</p> Shiva Prasad Sharma Chalise Santosh Kumar Mishra Prerana Kasakar Md Firoz Anjum Copyright (c) 2021 Shiva Prasad Sharma Chalise, Santosh Kumar Mishra, Prerana Kasakar, Md Firoz Anjum 2021-12-31 2021-12-31 41 3 346 352 10.3126/jnps.v41i3.37154 Cerebral Hemodyanamics in Stable Preterm Infants Before and After Packed Cell Transfusion <p class="p1"><strong>Introduction:</strong> In a year, around 3.5 million preterm deliveries occur in India alone. Some of these babies will require packed cell volume (PCV) transfusion. There is a paucity of robust data on effect of blood transfusions on the cerebral hemodynamic from India. This study was done to see the effect of PCV transfusion on blood flow velocities and resistive index (RI) of anterior cerebral artery (ACA) in stable preterm infants.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods:</strong> A prospective observational study was conducted in a tertiary care hospital in Pune, India. All stable preterm infants (&lt; 37 weeks) receiving PCV transfusion were enrolled. USG Doppler study of ACA was done before and after PCV transfusion. Peak<span class="s2"> systolic velocity (PSV), end-diastolic velocity (EDV) and RI were </span>measured pre and post PCV transfusion.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>Thirty infants were included in the study, with median gestation age of 28.8 {interquartile range (IQR), 27-30.55} weeks and median birth weight of 970 {interquartile range (IQR), 869.5 - 1190} grams. There was a significant decrease in PSV pre and post PCV transfusion - 58.46 (± 18.44) cm / sec and 46.34 (± 13.93) cm / sec respectively (p value &lt; 0.001). Changes in RI and EDV were non-significant.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Conclusions: </strong>PCV transfusion significantly decreased PSV, reflecting improved cerebral oxygenation, and decreased cardiac output after correction of anaemia. Laboratory threshold for PCV transfusion in stable preterm infants are not known. USG Doppler study has the potential to provide one of the objective criteria for PCV transfusion in these infants though large scale randomized controlled trials are needed to prove its efficacy.</p> Chinmay Chetan Nyein Nyein Zaw Pradeep Suryawanshi Nishant Banait Prince Pareek Sujata Deshpande Bhvya Gupta Reema Garegrat Copyright (c) 2021 Chinmay Chetan, Nyein Nyein Zaw, Pradeep Suryawanshi, Nishant Banait, Prince Pareek, Sujata Deshpande, Bhvya Gupta, Reema Garegrat 2021-12-31 2021-12-31 41 3 353 357 10.3126/jnps.v41i3.36444 Changing Pattern of Bacteriological Profile, Antimicrobial Resistance and Mortality in Neonatal Sepsis in a Developing Country: A Retrospective Study <p class="p1"><strong>Introduction:</strong> Neonatal sepsis is one of the major contributors of mortality and morbidity among neonates. Irrational and overuse of antibiotics have led to an increase in antimicrobial resistance. This study was undertaken to investigate the bacteriological profile, antimicrobial resistance and predictors of mortality among blood culture-positive cases of neonatal sepsis<strong>. <span class="Apple-converted-space"> </span></strong></p> <p class="p1"><strong>Methods: </strong>Demographic and bacteriological data were collected from electronic and manual case records. Automated BACTEC 9050 system using Peds Plus Vial was used for blood culture. Multidrug resistance was defined as a resistance to any three of five antibiotic classes like aminoglycoside, carbapenem, extended spectrum cephalosporins, fluoroquinolones and piperacillin.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>Among 7180 admitted neonates, 433 (6.03%) were blood culture positive with early onset sepsis (EOS) in 50.1% of cases. Gram negative bacteria was the causative organism in 371 (85.7%) babies with klebsiella being the commonest pathogen (43.6%). The pathogen mix of early onset and late onset sepsis was similar and 90% of gram negative isolates were resistant to penicillin group. Multi drug resistance (MDR) was found in 51.2% of the gram negative organisms. EOS (Odds ratio 1.99; 95% confidence interval, 1.29-3.05) and MDR (Odds ratio 2.07; 95% confidence interval, 1.77-4.12) were independently associated with neonatal death due to sepsis.</p> <p class="p1"><strong>Conclusions: </strong>Gram-negative pathogens, specifically klebsiella accounted for a huge burden of neonatal sepsis. EOS and MDR were found to be independent predictors of death due to such sepsis. This study calls for multicentric studies on early onset neonatal infection and its relationship with pathogenic maternal flora. <span class="Apple-converted-space"> </span></p> Anindya Kumar Saha Abhishek Kumar Tiwari Pinaki Chattopadhyay Suchandra Mukherjee Bijan Saha Copyright (c) 2021 Anindya Kumar Saha, Abhishek Kumar Tiwari, Pinaki Chattopadhyay, Suchandra Mukherjee, Bijan Saha 2021-12-31 2021-12-31 41 3 358 366 10.3126/jnps.v41i3.33267 Clinical and Hematological profile of Paediatric Patients with Cleft Lip and Palate in a Tertiary Care Hospital of Haryana, India <p><strong>Introduction: </strong>Cleft lip and/ or cleft palate are the most common visible craniofacial anomalies. These patients often have feeding difficulties and recurrent infections leading to an altered immune system which can be assessed by the variations in hematological parameters. We intended to assess the clinical profile and the hematological parameters in patients with cleft lip and palate.</p> <p><strong>Methods</strong>: This is a three-year cross-sectional study conducted at SGT Medical College, Gurugram, Haryana, India from January 2017 to December 2019 involving assessment of patients with cleft lip and palate who visited the paediatric unit for complete evaluation before surgery. Syndromic children or those with associated deformities were excluded .A total of 115 patients were enrolled in the study and the following information was recorded: Age, Gender and type of cleft (Cleft lip and alveolus, cleft lip, alveolus and palate, and isolated cleft palate). Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were evaluated and compared amongst the anatomical subtypes.</p> <p><strong>Results</strong>: A total of 115 patients were included in the study, of which 66 (57.4%) were males and 49 (42.6%) were females. 57 (49.6%) had a cleft lip, alveolus, and palate, 36 (31.3%) had a cleft lip and alveolus and 22 (19.1%) had cleft palate only. Anaemia was present in 71.1% of cases. 83.4% cases of cleft lip and alveolus while81.8% of isolated cleft palate were anaemic. Microcytic hypochromic anaemia was present in 63.4% of cases while 36.6% had normocytic normochromic anaemia. The total leukocyte count was elevated in 60 children (52.2%) which was highest in cleft lip and alveolus (66%). Absolute neutrophil count was significantly high in the lip and alveolus groups.(13.9%) Absolute lymphocyte count was highest in lip and alveolus (30.56%). Absolute monocyte count and the absolute eosinophil count was low in the majority of cases.</p> <p><strong>Conclusions</strong>: A large number of children with cleft lip and/ or palate are not exclusively breastfed due to anatomical deficits. They need supplemental iron to meet the demands. A standard policy to provide auxillary iron by health care professionals should be made at the first visit to the health centre because nutritional anaemia negatively affects the physical and cognitive development of a child. It also unnecessarily prolongs the date for optimum and safe surgery. </p> - Richa Shashi Sharma Sakshee Madan Sanasam Manimukta Singh Bharti Yadav Daksh Yadav Copyright (c) 2021 Richa, Shashi Sharma, Sakshee Madan, Sanasam Manimukta Singh, Bharti Yadav, Daksh Yadav 2021-12-31 2021-12-31 41 3 367 373 10.3126/jnps.v41i3.36601 Clinical Profile and Socio-Demographic Characteristics of Children with Severe Acute Malnutrition (SAM) in Southern Odisha <p class="p1"><strong>Introduction:</strong> Severe acute Malnutrition (SAM) is an important contributor to morbidity and mortality amongst less than five years of age. In the National Family health Survey (NFHS), it was seen that 10% of children with SAM would require hospital admission. Even with establishment of nationwide Nutritional Rehabilitation centres (NRC) and standard guidelines, the problem of SAM is high in Odisha. The present study was undertaken to look at the clinical profile of the children with SAM in southern Odisha.</p> <p class="p1"><strong>Methods</strong>: A prospective observational study was conducted from one month to 60 months of age with SAM who were admitted to a tertiary teaching hospital. Demographics, clinical features, laboratory tests were recorded and tabulated.</p> <p class="p1"><strong>Results</strong>: We enrolled 70 SAM children (screened = 3288) for our study who were primarily nutritional. Exclusive breast feeding till six months was present in 26%, and all had inadequate complementary feeding. The major clinical presentations of SAM were diarrhea (36%), fever (34%) and poor weight gain (29%).<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Conclusions</strong>: Majority of SAM had low birth weight, and had poor rates of exclusive breast feeding, inadequate complementary feeding, and recurrent infections.</p> Shine Merin Mathew T V Ram Kumar Mohanty Niranjan Copyright (c) 2021 Shine Merin Mathew, T V Ram Kumar, Mohanty Niranjan 2021-12-31 2021-12-31 41 3 374 379 10.3126/jnps.v41i3.33371 Determination of Gestational Age by Fetal Kidney Length Measurement After the 20th Week in Healthy Women With Uncomplicated Pregnancy in Tertiary Care Centre <p class="p1"><strong>Introduction: </strong>Various organs are measured to estimate the gestational age of fetus. Sonographically derived parameters used to date pregnancy include crown rump length, biparietal diameter, head circumference, femoral length <span class="s4">and</span> abdominal circumference. Fetal kidney length, transcerebellar diameter and placental thickness are emerging as new parameters and are claiming to be more accurate in certain situations. In Nepalese context fetal kidney length has not been studied yet so this study was done to fill this need.</p> <p class="p1"><strong>Methods: </strong>Obstetric sonography was performed in 108 pregnant women with uncomplicated pregnancy to evaluate the efficacy of FKL as a measure to calculate the predicted gestational age. Gestational age ranged from 20 weeks to term. Only patient with known LMP and previous history of normal menstrual cycle were included in the study.</p> <p class="p1"><strong>Results: </strong>The study showed mean fetal kidney length at 20 - 24, 25 - 29, 30 - 34 and 35 - 37 weeks gestation as<span class="Apple-converted-space"> </span>22.5 ± 0.5, 26.9 ± 0.7, 32.32 ± 0.7 and 36.3 ± 0.6 respectively. Overall in combined second and third trimester, fetal kidney length showed strong linear correlation with gestation age with highest significant Pearson correlation coefficient of 0.989 as compared to other parameters (BPD = 0.986, HC = 0.976, AC = 0.971, FL = 0.984).</p> <p class="p1"><strong>Conclusions: </strong>Fetal kidney showed strongest linear correlation with clinical gestational age and it also demonstrated positive correlation with biparietal diameter, head circumference, abdominal circumference and femur length. Therefore fetal kidney length can be used as a reliable parameter for determination of gestational age.</p> Birendra Raj Joshi Akash Kumar Chaurasia Umesh Prasad Khanal Copyright (c) 2021 Birendra Raj Joshi, Akash Kumar Chaurasia, Umesh Prasad Khanal 2021-12-31 2021-12-31 41 3 380 386 10.3126/jnps.v41i3.35604 Epidemiology, Clinical Pattern and Management Outcome of Paediatric Burn Injuries in Nepal <p class="p1"><strong>Introduction: </strong>Burn injuries are third commonest type of injury in Nepal and 61% of burn victims are children. This represents a significant morbidity and mortality burden for patients and families. This study was carried out to describe epidemiology, clinical pattern and therapeutic outcome of children with burn.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods: </strong>It is a retrospective observational study of routinely collected data of children up to 14 years admitted to the Burns Ward at Kanti Children’s Hospital, Kathmandu, Nepal, from July 2016 to July 2019. Statistical analysis was done on the collected data<strong>.<span class="Apple-converted-space"> </span></strong></p> <p class="p1"><strong>Results</strong>: Total 935 patients were admitted with an average of 311.7 per year, among which 63% were males and 83.0% were aged five years or under. Patients travelled from all over Nepal for treatment at this hospital. 50.6% of patients presented with fresh burns &lt; 24 hours after injury. Scald burn was the commonest (82.6%). Children under five were more likely to have scald burns, whereas older children more likely to have flame or electric burns. Majority of cases (70%) were of mild burns &lt; 10% TBSA and only 3.2% TBSA &gt; 30%. 68.5% were managed conservatively and 18.4% required debridement and skin grafting. Mean length of stay was 15 days. Overall mortality was 1.0%. In children with &gt; 30% burns mortality was 12.9%.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Conclusions: </strong>Scald burn was the commonest while proportion of flame burn increases with age. Majority of burns occur in male under five years of age. Most cases presented with &lt; 10% TBSA and were managed conservatively.<span class="Apple-converted-space"> </span></p> Bijay Thapa Ram Hari Chapagain Anju Kayastha Copyright (c) 2021 Bijay Thapa, Ram Hari Chapagain, Anju Kayastha 2021-12-31 2021-12-31 41 3 387 394 10.3126/jnps.v41i3.30828 Gallbladder Wall Thickness to Predict Severe Dengue in Children <p class="p1"><strong>Introduction: </strong>Significant increase in plasma leakage is characteristic of severe dengue. This results in collection of fluid in serous cavities. Gall bladder wall thickening (GBWT) often precedes the development of pleural effusion and ascites. Early detection of plasma leakage and management is shown to reduce mortality in dengue illness. Ultrasonography is a point of care investigation to identify GBWT. The aim of this study was to determine the cut-off value of GBWT to predict severe dengue in the early phase of the illness.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods</strong>: This was a prospective study done on 310 children with dengue illness. Abdomen and chest ultrasound was done in all these children between third and sixth day of illness. GBWT of more than 3.5 mm was taken as a thickened gall bladder wall. Maximum severity of the illness was considered for categorising the severity of dengue.</p> <p class="p1"><strong>Results</strong>: Out of 310 children, 160 (51.6%) were categorized as dengue fever, 91 (29.4%) as dengue with warning signs and 59 (19%) as severe dengue. The incidence of thickened gall bladder wall was 27.5% in DF (Dengue fever), 68% in DF with warning signs and 96.6% in severe dengue. The odds of finding thickened gall bladder wall in severe dengue are 3.5 times that of dengue fever. GBWT increases as the severity of the illness increases. GBWT of 5 mm has sensitivity of 93.7% and specificity of 70% to predict progress to severe dengue. There was a fair correlation of 46% between thickened gall bladder wall and thrombocytopenia. Gall bladder wall thickness of 2.5 mm had sensitivity of 86.3% and specificity of 80% for ascites. GBWT of 3.5 mm had a sensitivity of 77.6% and specificity of 85% for pleural effusion.</p> <p class="p1"><strong>Conclusions</strong>: GBWT assessment by ultrasonography in early phase of illness can be used as a point of care modality to predict severe dengue. The sensitivity and specificity to predict the progression to severe dengue is 93.7% &amp; 70% respectively for the cut-off value of five mm of GBWT.</p> S N Prashanth Harshita Jagwani Sudha Kiran Das Jagadish Kumar Srinivasa Murthy Copyright (c) 2021 S N Prashanth, Harshita Jagwani, Sudha Kiran Das, Jagadish Kumar, Srinivasa Murthy 2021-12-31 2021-12-31 41 3 395 401 10.3126/jnps.v41i3.35384 Hyperchloremic Metabolic Acidosis in Diabetic Ketoacidosis – Boon or Bane in Paediatrics? Prospective Cohort Study <p class="p1"><strong>Introduction: </strong>Patients with DKA generally present with a high anion gap metabolic acidosis (AG &gt; 16) due to the presence of ketones but may also develop a narrow anion gap metabolic acidosis related to hyperchloremia. This study attempts to determine the incidence of hyperchloremic metabolic acidosis (before starting IV fluids) in children with DKA and to evaluate the impact of hyperchloremic metabolic acidosis on acute kidney injury and cerebral edema and inturn on mortality and duration of PICU stay.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods: </strong>This was a prospective study conducted in the Department of Paediatrics, VIMS, Bellary between May 2016 to December 2017 and a total of 32 patients with DKA were enrolled in the study. Along with routine investigations, ABG and serum chloride levels were measured at the time of admission for categorization into normochloremic (high anion-gap) metabolic acidosis and hyperchloremic (normal anion-gap) metabolic acidosis. Incidence of hyperchloremic metabolic acidosis and its impact on the development of acute kidney injury and cerebral edema was taken as the primary outcome of the study. Mortality rate and duration of PICU stay were taken as a secondary outcome.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>Hyperchloremic metabolic acidosis was observed in 18.8% of the study group. Acute kidney injury was seen in 38.4% of children who had normochloremic metabolic acidosis and in 83.3% of children with hyperchloremia. About 50% patients developed cerebral edema in the hyperchloremia group and only 3.8% developed cerebral edema in normochloremic group. These differences were statistically significant. Mortality rate in normochloremic and hyperchloremic metabolic acidosis was 3.8% and 50% respectively.</p> <p class="p1"><strong>Conclusions:</strong> Hyperchloremia at presentation in DKA is a risk factor for increased mortality. This fact should be born in mind while treating patients aggressively with chloride-containing fluids. Simple investigations like ABG and serum chloride levels can direct careful management of DKA and appropriate selection of IV fluids.</p> Anusha Kalagoud Patil B Vishwanath Copyright (c) 2021 Anusha Kalagoud Patil, Vishwanath B 2021-12-31 2021-12-31 41 3 402 407 10.3126/jnps.v41i3.32410 Neonatal Screening for Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency in Eastern India <p class="p1"><strong>Introduction: </strong>The overall magnitude of the frequency of G6PD deficiency ranges between 0 to 10 percent in the Indian population. This prospective study was planned to estimate the prevalence of G6PD deficiency in newborn population born in a tertiary care centre in Eastern India.</p> <p class="p1"><strong>Methods</strong>: This prospective observational study was undertaken among all consecutively delivered neonates born in a tertiary care teaching hospital of Eastern India, between Apr 2016 and Oct 2017. Prematurity less than 32 weeks and perinatal asphyxia requiring extensive resuscitation were excluded from the study. Umbilical cord blood samples were collected in a EDTA containers, drawn from the placental side of the umbilical cord incised while severing it at the time of birth. The G6PD levels were estimated quantitatively based on ultraviolet (UV) method by quantitative sphectrophotometric assay using ILab 650 fully automated analyzer. All babies wherein the cord blood G6PD levels was less than 6.95 mU/g of Hb was taken as deficient.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>Mean (SD) of G6PD at birth was 12.56 (3.45) mU/g of Hb. Out of 1037 neonates, five were found to be G6PD deficient. There was increased incidence of neonatal jaundice requiring phototherapy in G6 PD deficient neonates, and it was statistically significant.</p> <p class="p1"><strong>Conclusion:</strong> The prevalence of G6PD deficiency was 0.48% in term and late preterm neonates as assessed quantitatively in cord blood</p> Sweta Mukherjee Ashish Mallige Anupama Chowdhry Amit Devgan Brajesh Singh Bhasker Mukherjee Subhash Chandra Shaw Copyright (c) 2021 Sweta Mukherjee, Ashish Mallige, Anupama Chowdhry, Amit Devgan, Brajesh Singh, Bhasker Mukherjee, Subhash Chandra Shaw 2021-12-31 2021-12-31 41 3 408 412 10.3126/jnps.v41i3.37153 Nutritional Status of Children (5 - 18 Years) by Using Anthropometric Indices: A Cross-Sectional Study Among the Sartang and Miji, Lesser Known Tribes of Arunachal Pradesh, India <p class="p1"><strong>Introduction: </strong>In this era of globalization, planners often fail to understand the importance of community specific nutritional intervention among children due to dearth of study specifically among the lesser known communities in tribal dominated Indian state like Arunachal Pradesh. In order to find out the present condition of nutritional status in such lesser known tribal groups in the state, this present cross-sectional study was conceptualized to assess the nutritional status by using anthropometric indices in the Sartang and Miji tribal children in Arunachal Pradesh, India.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods: </strong>A total of 452 children aged five to 18 years living in rural areas of West Kameng district of Arunachal Pradesh, India were considered for the present analysis. The international standards were used to collect height and weight data and height for age and BMI for age percentile were calculated.</p> <p class="p1"><strong>Results: </strong>The results revealed that the prevalence of stunting (&lt; - 2 SD height for age) was higher among the Sartang male (34.0%) and female (46.3%) compared to Miji male (26.7%) and female (23.1%), respectively. Conversely the prevalence of overweight (percentile of BMI for age &gt; 85) was also higher among the Sartang male (19.1%) and female (27.8%) compared to Miji children. It may be due to the alteration of traditional food habits, consumption of regular fast food and increasing less socio-economic equity and higher inequality in both the communities.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Conclusions: </strong>Therefore, undernutrition as well as over nutrition are prevalent among studied children perhaps correlated with rapid change in their food habits and lifestyle in the early age.</p> Md. Ashgar Radhe Amung Suman Chakrabarty Copyright (c) 2021 Md. Ashgar, Radhe Amung, Suman Chakrabarty 2021-12-31 2021-12-31 41 3 413 418 10.3126/jnps.v41i3.37123 Profile of Nosocomial Sepsis in a Neonatal Intensive Care Unit of Tertiary Care Hospital in Eastern Part of Nepal <p class="p1"><strong>Introduction:</strong> Nosocomial sepsis constitutes a global health problem. They lead to significant morbidity and mortality in both developed and resource-limited countries. The objective of the study was to describe the profile of nosocomial sepsis in neonatal intensive care unit (NICU).<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods: </strong>This was a prospective descriptive study conducted in a teaching and referral NICU. All neonates in NICU who did not have any sign of infection at admission and remained hospitalized for at least 48 hours were observed. Profile of nosocomial infection was analyzed with descriptive statistics. P value of &lt; 0.05 was considered significant wherever applicable.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Results: </strong>The incidence rate and density of nosocomial sepsis were 47.3% and 39.3 infections per 1000 patient-days respectively. Blood stream infection was the commonest nosocomial infection. Pseudomonas aeruginosa was the most commonly isolated agent in blood cultures of patients with nosocomial sepsis.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Conclusions</strong>: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.</p> Sunil Kumar Yadav Niraj Niroula Arun Giri Copyright (c) 2021 Sunil Kumar Yadav, Niraj Niroula, Arun Giri 2021-12-31 2021-12-31 41 3 419 424 10.3126/jnps.v41i3.37162 Relationship Between Microalbuminuria and Risk Factors for Cardiovascular Diseases Among Secondary School Student in Ilorin, Nigeria <p class="p1"><strong>Introduction: </strong>Globally, cardiovascular diseases (CVDs) are the leading causes of deaths with more than half due to coronary heart disease linked with the development of atherosclerosis. Hypertension (HTN) and obesity are leading risk factors for atherosclerotic CVDs, presence of which is predicted by microalbuminuria (MA). We wanted to evaluate the relationship between microalbuminuria and risk factors for CVDs (obesity, overweight, pre-hypertension and hypertension) among secondary school students in Ilorin, North central Nigeria.<span class="Apple-converted-space"> </span></p> <p class="p1"><strong>Methods: </strong>We conducted a descriptive, cross-sectional study from December 2017 to March 2018 among secondary school students. We recruited 584 students, aged 10 to 18 years from 14 schools across the three Local Government Areas (LGAs) in Ilorin. We measured their blood pressure and anthropometrics following standard protocols and determined microalbuminuria in their early morning urine using Microalbumin 2-1 Combo strip and spot urinary albumin - creatinine ratio.</p> <p class="p1"><strong>Results:</strong> The prevalence of MA was 30.1%. MA was more common in obese and hypertensive adolescents (p &lt; 0.001 and p &lt; 0.01 respectively). Occurrence of MA correlated strongly with subject’s weight (r = 0.790, p = 0.004, p &lt; 0.01<strong>); </strong>systolic blood pressure (r = 0.884, p = 0.001, p &lt; 0.01) and body mass index<strong> (</strong>r = 0.710, p = 0.001, p &lt; 0.01<strong>).</strong> Independent predictors of MA were obesity, adjusted odds ratio (aOR) 4.9, (95% CI 1.124, 20.913), overweight (aOR 3.6, 95% CI 1.184, 10.174), older age (aOR 1.1, 95% CI 1.007, 1.219) and presence of systolic hypertension (aOR 3.1, 95% CI 1.903, 5.042).</p> <p class="p1"><strong>Conclusion</strong>s: This study shows a high prevalence of MA among the adolescents. CVDs risk factors predictive of MA are overweight, obesity, systolic hypertension and older age.<span class="Apple-converted-space"> </span></p> Kayode Olusegun Alabi Titilayo Funmilayo Kayode-Alabi Rasheed Olayinka Ibrahim Hamdalat Issa Mohammed Baba Abdulkadir Samuel Kolade Ernest Ayodele Isaac Ojuawo Copyright (c) 2021 Kayode Olusegun Alabi, Titilayo Funmilayo Kayode-Alabi, Rasheed Olayinka Ibrahim, Hamdalat Issa, Mohammed Baba Abdulkadir, Samuel Kolade Ernest, Ayodele Isaac Ojuawo 2021-12-31 2021-12-31 41 3 425 431 10.3126/jnps.v41i3.36244 The Effectiveness of Handicrafts on Anxiety Reduction among Hospitalised Children in Paediatric Ward of Dhulikhel Hospital <p class="p1"><strong>Introduction: </strong>Disease and hospitalization can be the first crisis which a child encounters. It can cause acute anxiety to them which may sequel their uncooperative behavior to the treatment procedures. Furthermore, high level of anxiety if persisted for longer period can affect their physiological and psychological health. So, in order to deal this anxiety beforehand, handicraft has become an effective play intervention in the hospital. Hence, we conducted this study to investigate the effectiveness of handicrafts on anxiety reduction among hospitalized children.</p> <p class="p1"><strong>Method: </strong>This is a pre-experimental study administered to 30 admitted children in Paediatric Ward of Dhulikhel Hospital who were selected using consecutive sampling technique. Anxiety levels before and after intervening handicraft were assessed via interview using State-Trait Inventory of Cognitive and Somatic Anxiety - Child Version (STICSA-C) tool where intervention was making handicrafts with colorful paper as per children’s capacity and preference for total six times in two consecutive days at four hours interval.</p> <p class="p1"><strong>Results: </strong>The study showed significant difference between anxiety score before and after intervening handicraft (42.70 ± 10.60 Vs. 33.30 ± 8.70, p = &lt; 0.001). While, anxiety level before intervening handicraft was not significantly associated with the selected demographic and clinical variables of children.</p> <p class="p1"><strong>Conclusions: </strong>In the study, handicraft was an effective play material in reducing anxiety among hospitalized children. But it is necessary to perform further studies that will take into account greater methodological stringency.</p> Binita Ranamagar Sita Karki Copyright (c) 2021 Binita Ranamagar, Sita Karki 2021-12-31 2021-12-31 41 3 432 438 10.3126/jnps.v41i3.36115 Utilization and Effectiveness of Free Newborn Care Service Package in Inpatient Care of Sick Newborns –A Time For its Revision to Ensure Sustainability: Evidences From a Tertiary Level Public Hospital in Nepal <p class="p1"><strong>Introduction: </strong>Free Newborn Care (FNC) service has been implemented to address the financial barriers to access sick newborn care in Nepal. This study was designed to evaluate the effectiveness of FNC package in terms of its adequacy to support a facility financially and the factors to be considered for reimbursement schemes in the FNC guideline.</p> <p class="p1"><strong>Methods: </strong>This is a cross sectional retrospective study where 2907 newborns who received FNC service from 2019 Mar 15 to 2021 Jan 14 over 20 months were included.<span class="s1"> Descriptive statistics </span>using frequency and percentages were used to describe the package received. Pearson’s Chi squared test was used to determine if the various factors receiving different newborn packages were statistically significant or not.</p> <p class="p1"><strong>Results: </strong>Amount reimbursed by FNC package for 20 months fell short by NRs 1355541. Majority of preterm (58%), LBW (52.3%) and MAS (55.3%) received package C. Babies who received package C with single morbidity was 576 (37.3%) with two to three morbidities was 380 (48.7%) and with more than three morbidities was 301 (70.2%). Those newborns who stayed for four to seven days, majority 654 (53.4%) received package B, whereas those who stayed for eight to 14 days, 15 - 21 days and &gt; 21 days, the majority 490 (38.4%), 66 (5.2%), 32 (2.5%) received package C respectively. There was an association between receiving package C mortality among cases (P<span class="Apple-converted-space"> </span>&lt; 0.001).</p> <p class="p1"><strong>Conclusions: </strong>Inpatient quality newborn care can save lives of many vulnerable newborns. FNC service has provided opportune context in care of sick newborns with promising results. However, revising the reimbursing schemes by focusing on length of stay, mortality and disease severity can better strengthen sick newborn care.</p> Prajwal Paudel Kalpana Upadhyaya Subedi Shailendra Bir Karmacharya Sarita Shrestha Anil Kumar Shrestha Pratikshya Subedi Sunil Kumar Sah Megha Mishra Asia Tamrakar Nisha Khati Astha Singh Kirtipal Subedi Avinash K Sunny Sangeeta Kaushal Mishra Copyright (c) 2021 Prajwal Paudel; Kalpana Upadhyaya Subedi, Shailendra Bir Karmacharya, Sarita Shrestha, Anil Kumar Shrestha, Pratikshya Subedi, Sunil Kumar Sah, Megha Mishra, Asia Tamrakar, Nisha Khati, Astha Singh, Kirtipal Subedi, Avinash K Sunny, Sangeeta Kaushal Mishra 2021-12-31 2021-12-31 41 3 439 446 10.3126/jnps.v41i3.37654 Grebe Syndrome - Case Report With Review of Literature <p class="p1">Grebe syndrome is a rare genetic condition characterized by short limb dwarfism. It is transmitted by autosomal mode of inheritance. There are no associated anomalies and the affected child has normal intelligence and normal life span. This syndrome has a very low incidence and needs to be differentiated from other forms of short limb dwarfism since treatment options may vary. We have described here a severely affected case of the same with review of literature.</p> Rashmi Nagaraj HS Kiran Copyright (c) 2021 Rashmi Nagaraj, HS Kiran 2021-12-31 2021-12-31 41 3 447 450 10.3126/jnps.v41i3.31170 Levothyroxine Overdose in a Toddler – A Case Report <p class="p1">Levothyroxine tablet overdose, can happen in children, because of unique physical nature of the tablet. Although it has a benign course, systemic symptoms of overdose may manifest in few children. This cannot be predicted based on dose consumed or by thyroid function tests. Propranolol and steroid can be used for systemic autonomic symptoms. Delayed manifestation of overdose may occur, which needs follow up. In this report, we present a toddler who had levothyroxine overdose and was managed with monitoring and follow up. Her hyperactivity was managed with oral triclofos. We would also like to emphasize that serial thyroid function tests are not needed in these children.</p> Radha Thiyagarajan Thasma Santhanakrishnan Arunprasath Copyright (c) 2021 Radha Thiyagarajan, Thasma Santhanakrishnan Arunprasath 2021-12-31 2021-12-31 41 3 451 453 10.3126/jnps.v41i3.40478 Neonatal Adenoviral Myocarditis – A Case Report and Review of Literature <p class="p1">Adenoviruses are DNA viruses that typically cause mild self-limited disease mostly involving the respiratory tract, gastrointestinal tract or conjunctiva. Typical respiratory symptoms include fever, pharyngitis, tonsillitis, cough, and sore throat but rare associations with severe disease such as myocarditis have been reported. Current treatment options are limited to usage of intravenous immunoglobulins (IVIGs) or antiviral agent Cidofovir, however usage of the latter is limited due to reports on drug induced adverse reactions. In this case report we describe an infant with severe myocarditis in whom Adenovirus was revealed to be the identifiable cause. The infant was treated with IVIG which is believed to act as an immunomodulatory agent. The infant recovered completely. Our conclusion is that patients with myocarditis caused by adenovirus are likely to benefit from early treatment with IVIGs.</p> Amrita Roy Labanya Chowdhury Debadatta Mukhopadhyay Alokananda Das Dutta Copyright (c) 2021 Amrita Roy, Labanya Chowdhury, Debadatta Mukhopadhyay, Alokananda Das Dutta 2021-12-31 2021-12-31 41 3 454 457 10.3126/jnps.v41i3.38138 Undiagnosed hypothyroidism presenting as recurrent bilateral large ovarian cyst in an early adolescent girl. A rare case report. <p>Hypothyroidism may manifest as large ovarian cyst formation with precocious puberty in young prepubertal girls, which frequently regress upon starting thyroxin suplemntation. We present a case report of 10 year old girl who had undergone unnecessary laparoscopic cystectomy for bilateral large ovarian cyst as the diagnosis of hypothyroidism was missed. She again had recurrence of bilateral ovarian cyst which regressed upon thyroxin supplementation.</p> Jyoti Agrawal Ajay Agrawal Copyright (c) 2021 Jyoti Agrawal, Ajay Agrawal 2021-12-31 2021-12-31 41 3 458 461 10.3126/jnps.v41i3.37206