Journal of Nepal Paediatric Society <p>Official journal of the Nepal Paediatric Society (NEPAS). Articles available in full text. From Vol.30, the journal will be published three times a year.</p><p>Journal of Nepal Paediatric Society is included on <a href="" target="_blank">DOAJ</a> and <a title="Scimago" href=";tip=sid&amp;clean=0" target="_blank">Scimago</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>). Accuracy of Transcutaneous Bilirubinometry in Neonates Receiving Phototherapy <p><strong>Introduction</strong>: Phototherapy remains mainstay of treating neonatal hyperbilirubinemia across gestational age spectrum. Neonates under phototherapy (PTx) require frequent estimation of serum bilirubin (TSB) to monitor disease progression. Transcutaneous bilirubinometer (TcB) is widely used for estimation of TSB with limited data for neonates receiving PTx. The aim of study was to assess the diagnostic accuracy of TcB as compared to TSB in preterm and term infants receiving phototherapy.</p><p><strong>Methods: </strong>This prospective study analyzed 385 paired TcB-TSB samples from 234 hemodynamically stable preterm (89) and term (145) neonates receiving in-hospital PTx. Indigenous photo-opaque patch was applied to sternum before starting PTx. TcB was measured from patched area of skin using Dräger JM-103 device at 12 and 24 hours during phototherapy within 5 minutes of blood collection for TSB. Linear regression and Bland-Altman plots were used to compare TcB with TSB.</p><p><strong>Results</strong>: The mean (SD) gestational age and birth weight were 35.8 (2.43) weeks and 2250 (560) grams. Difference of mean of TcB and TSB was ranging between 0.7-1 mg/dl with TcB underestimating TSB. At 12 hours and 24 hours of PTx, the correlation coefficient were (r = 0.84 and 0.81, <em>p</em>&lt;0.01) among preterm and (r = 0.76 and 0.79, <em>p</em>&lt;0.01) among term infants. Bland–Altman plot showed significant agreement between TcB from patched site and TSB in both preterm and term neonates.</p><p><strong>Conclusion</strong>: TcB demonstrated significant accuracy in predicting TSB in both term and preterm neonates receiving PTx with slight underestimation of TSB. The study showed marginally higher correlation for preterm infants.<strong> </strong> <strong></strong></p> Pallavi Parag Dagli Snehal Vasava ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 1 7 10.3126/jnps.v38i1.17138 Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia <p><strong>Introduction</strong><br />Pneumonia is a widespread and commonest infectious lung disease that causes inflammation which lead to reduced oxygenation. Indeed, it is the leading cause of child death in the world. The study was carried out to fine out the demographic, clinical characteristics and radiologic resolution of Pneumonia in children between 2 months to 16 years of age.</p><p><strong>Material and Methods</strong><br />A prospective study done in 121 cases over 18 month period in patients admitted in pediatric department of Dhulikhel hospital. Demography, clinical profile, diagnosis, Down’s scoring at presentation, response of treatment and risk factor for fetal Community acquired pneumonia were analyzed using descriptive statics. Chest radiography was done on admission and every 2 weeks until its complete resolution occurred.</p><p><strong>Results</strong><br />A total of 121 patients with community acquired pneumonia were enrolled. The male and female ratio was 1.69:1. Among all age group it was most significantly common in children less than 1 year (p=.022).The common symptoms of Community acquired pneumonia observed in this study were cough (80%), fever (66%) and shortness of breath (38.8%). On chest roentgenogram right middle zone(47.9%) was most frequently involved. The total leukocyte count had low degree of association with pneumonia. More than half of patients (54.08%) with community acquired pneumonia had radiographic resolution at 2 weeks. The respiratory distress was significantly high (p&lt;0.0001) in children who delayed to seek medical treatment in a health facility by three days.Anemia, lymphopenia, thrombocytopenia, sepsis and hemorrhagic pleural effusion were the clinical characteristics associated withfatal   Community acquired pneumonia</p><p><strong>Conclusion</strong><br />Clinical presentations variesin Community acquired pneumonia with different age groups. Chest radiography is still best investigation for the diagnosis of pneumonia and most of the radiological clearance occurs in 2 weeks.</p> Srijana Dongol Singh Narayan Charan Shrestha Anish Joshi ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 8 13 10.3126/jnps.v38i1.18854 Demographic Profile and Outcome of Mechanically Ventilated Children in a Tertiary Care Hospital of a Developing Country <p><strong>Introduction: </strong>The need for mechanical ventilation (MV) is an absolute indication for admission to Paediatric intensive care unit (PICU). Management of children requiring invasive ventilation in resource limited developing countries is challenging. Scare data is available from Asian countries regarding use of MV in PICUs. The objectives of this study were to determine the clinical profile, characteristics, common causes for ventilation, ventilation related complications and final outcome of these patients.</p><p><strong>Material and Methods: </strong>A retrospective study of children requiring ventilator support in PICU of Kalinga Institute of Medical Sciences from January 2014 to December 2016 was done. Data collected included epidemiological trends, indications for ventilation, complications, length of stay on ventilator and outcome.</p><p><strong>Results: </strong>A total of 1172 patients were admitted to PICU, 101 (8.6%) patients required MV. 42% of the mechanically ventilated patients were infants and 75% were males. Impending respiratory failure (34.6%) and low Glasgow coma scale (17.8%) were the commonest indication for ventilation in this study. The median length of MV was 2.1 days. The mortality rate of these children was 38.6%. We report the epidemiological trends, frequency, indications and outcomes of children requiring ventilator support in PICU. Analysis of this data can be helpful in improving outcome in future by planning better treatment strategies.</p><p><strong>Conclusion</strong>: The frequency of MV in our PICU is low. Respiratory failure was the most common reason for mechanical ventilation.  </p> Bandya Sahoo Mukesh Kumar Jain Bhaskar Thakur Reshmi Mishra Sibabratta Patnaik ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 14 18 10.3126/jnps.v38i1.18879 Dietary Practices of Lactating Women and Nutritional Status of Children in Baglung District, Nepal <p><strong>Introduction: </strong>Breastfeeding success depends on both mother and child. There is high energy requirement to produce breast milk, which is wholesome food for under 6 months children and then complementary foods are introduced to child. Inadequate feeding practices affect nutritional status of children. The main aim of this study was to measure the dietary practices of lactating women and nutritional status of their children.</p><p><strong>Material and Methods: </strong>A cross sectional study was conducted among 343 lactating women and under two years children of Baglung district. Random sampling technique was applied to select the participants. Face to face interview was conducted among women to collect the data and anthropometric measurement was performed among the children. Data were entered in EPI-DATA version 3.2 and exported to Statistical Package for Social Sciences (SPSS version 17.0) for further analysis.</p><p><strong>Results: </strong>Only 5.2% of mother had taken additional two meals per day and energy intake of 31.8% of women was met. Dietary practices of mothers were not associated with nutritional status of children. Breastfeeding practice was nearly universal (99.7%). Bulks (91.8%) of children were put into breast for breast feeding within first hour of birth. Exclusive breastfeeding rate was 34.5%. Bottle feeding was practiced by 15.6% of women. Less than half (40%) of 6-23 months children (n=174) had achieved satisfactory feeding practice (minimum meal frequency and minimum dietary diversity). The rate of wasting (n=180), stunting (n=180) and underweight (n=343) was 10%, 22.2% and 9.3% respectively. Feeding practice to children was associated with wasting and stunting.</p><p><strong>Conclusion: </strong>Dietary practice of women and feeding practice to their children was not satisfactory. Dietary practice of women was not associated with nutritional status of children but feeding practice was associated with their nutritional status. The rate of stunting, wasting and underweight was high.  </p> Usha Gautam Dipendra Kumar Yadav ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 19 24 10.3126/jnps.v38i1.19513 Neuroimaging in Children with Cerebral Palsy: A Study Conducted at Tertiary Level Paediatric Hospital of Nepal <p><strong>I</strong></p><p><strong>Introduction: </strong>In Nepal, cerebral palsy (CP) is the common cause of severe motor disability. However, only few descriptive studies related to it have been conducted, but those did not incorporate neuroimaging in CP. Thus, the objective of this study is to identify clinical and radiological profile of children diagnosed with CP at a tertiary level paediatric hospital of Nepal.</p><p><strong>Material and Methods: </strong>This study was carried out at Kanti Children's Hospital and the study utilized data of children diagnosed with CP from September 2015- April 2017.</p><p><strong>Results: </strong>A total of 100 children were diagnosed with CP. Spastic CP was the most common in children (71%), followed by mixed (21%) and dyskinetic (8%). Majority of the children were male (74%), born at term (90%) and delivered at institution (80%). Neuroimaging abnormality was found in 66% of cases which included brain malformation (2%), periventricular white matter abnormalities (23%), cortical or deep grey matter lesions (37%) and miscellaneous (4%). The results of this study also showed significant association between variables such as birth weight and birth asphyxia with type of neuroimaging findings.</p><p><strong>Conclusion: </strong>Neuroimaging is helpful for diagnosis of CP and also useful for parents and physicians to understand children condition. Hence, further studies related to neuroimaging in CP are important to better understand it in detail.</p> Bina Prajapati Manandhar Usha Singh Najala Khatun ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 25 30 10.3126/jnps.v38i1.19330 Paediatric RIFLE and AKIN Classification for Detection and Outcome of Acute Kidney Injury in Critically Sick Children. Which is Better? A Prospective Cohort Study <p><strong>Introduction: </strong>Acute Kidney Injury (AKI) is becoming increasingly common in both developed and developing countries with significant morbidity and mortality. However, the precise incidence of AKI in children is not well known due to lack of uniformity in various definitions of AKI. This study was carried out to compare incidence of AKI using two different definitions-pRIFLE and AKIN.</p><p><strong>Material and Methods: </strong>This was a prospective cohort study conducted in the paediatric ICU of a tertiary care government hospital attached to a Medical College of Central Gujarat, India. Total 115 critically ill paediatric patients aged one month to 12 years were included in the study. Serum Creatinine (SCr) levels were tested and Glomerular filtration rate (GFR) was calculated using the Schwartz formula at 0, 6, 12, 24 and 48 hours of admission. Patients were assessed for AKI using AKIN and pRIFLE classification.</p><p><strong>Results: </strong>Incidence of AKI was 80% and 66.9% in critically ill children, as classified by pRIFLE and AKIN classification respectively. Paediatric RIFLE labelled 15 more patients as AKI which were classified as non-AKI by AKIN criteria. There was moderate agreement in between the two classifications to diagnose stages of AKI (Kappa 0.474, CI- 0.359 to 0.589). With increasing grades of AKI, mortality was higher using pRIFLE staging; unlike the AKIN staging wherein this was not observed.</p><p><strong>Conclusion</strong>: The pRIFLE criteria detects a greater number of cases of AKI compared to AKIN criteria. Based on severity staging, pRIFLE is more consistent with adverse outcome of patients with AKI compared to AKIN classification. Overall mortality is significant high in patients with AKI compared to patients without AKI using any of the classifications.  </p> Pareshkumar A Thakkar Neha Pandey Kalpita S Shringarpure ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 31 37 10.3126/jnps.v38i1.19767 Subcutaneous Adiposity and Nutritional Status Among Children of Eastern-India <p><strong>Introduction: </strong>Skinfold thickness is now considered to be an important indicator of body composition and nutritional status. Assessment of subcutaneous adiposity is becoming very important due to increasing trend of overweight and obesity. The objectives of the present study were to determine age-sex specific subcutaneous adiposity using skinfold thicknesses and its use in assessment of nutritional status among children of Eastern-India.</p><p><strong>Material and Methods: </strong>The investigation was carried out among 1262 children (619 boys; 643 girls) aged 5–12 years of Darjeeling district, West Bengal. Anthropometric measurements of skinfold thickness were recorded using standard procedures. Age-sex specific smooth percentile curves of skinfold thickness were derived using the L, M and S model.</p><p><strong>Results: </strong>Sexual dimorphism was observed in TSF, SSF, SISF, PBF, Σ2SKF and Σ4SKF measurements between sexes in children (p&lt;0.05). Age-sex specific mean values of skinfold thicknesses of TSF, SSF, SISF and PBF of girls were observed to be significantly higher than boys (p&lt;0.05). The age-sex specific mean values of BSF, TSF, SSF, SISF, Σ4SKF and PBF did not show any age-specific trend in children. Comparison with the NHANES-III data showed poor attainment of subcutaneous adiposity and nutritional status.</p><p><strong>Conclusion: </strong>Results of the present study showed the age-sex specific variations in subcutaneous adiposity pattern in children. The comparisons of skinfold thicknesses with references showed unsatisfactory nutritional status among children. These findings are important for future investigations in field, epidemiological and clinical settings.</p> Sampriti Debnath Nitish Mondal Jaydip Sen ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 38 45 10.3126/jnps.v38i1.18750 Unintentional Injuries among Under-Five Children in Mid- Western Nepal <p><strong>Introduction: </strong>Unintentional injury is the biggest threat to the survival of the under-five children, which impact is immeasurable to families and often entire communities. The objectives of this study were to assess the prevalence of unintentional injuries among under-five children and the factors associated with it.</p><p><strong>Material and Methods: </strong>A facility-based quantitative cross-sectional study was conducted from August 2016 to January 2017. Multistage time frame convenient sampling method was applied to collect the data from 259 mothers of under-five children in the selected district of Mid-Western Development region of Nepal. The data was collected from 10 rural health facilities and two from urban setting using a semi-structured questionnaire. An analysis was performed using SPSS ver.15.</p><p><strong>Results: </strong>The prevalence of unintentional injuries was found to be 33.20 % among the under-five children. The present study showed that ecological belt, the age of mothers, education of mothers, education of fathers, the occupation of mothers, the occupation of fathers, family income quintiles, household type, numbers of a sibling, age and gender of children were significant factors associated with unintentional injuries among under-five children. More than 70% of the respondents were not aware of how to provide first aid care to the children with respect to unintentional injury.</p><p><strong>Conclusion: </strong>This study highlights the burden of unintentional injuries among under-five children in mid-western development region of Nepal. Intervention targeting multifactorial issues in line with all type of fall injuries, burns and injuries with the use of sharp objects might be helpful to tackle the problems.</p> Bharat Kafle Uday Narayan Yadav Sujan Babu Marahatta Durga Mishra Narayan Dutt Pant ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 46 52 10.3126/jnps.v38i1.18250 Salmonella Sepsis presenting as Early Onset Neonatal Sepsis <p>Neonatal sepsis is one of the feared cause of neonatal death in both term and preterm infants, leading up to 30% of neonatal death in developing countries. Salmonella sepsis is one of the uncommon causes of early onset neonatal sepsis. Here we present a case of early onset neonatal sepsis due to Salmonella species. Baby was delivered vaginally with good Apgar score. Within few hours of birth, baby developed respiratory distress and was admitted with empirical antibiotics. The blood culture showed the growth of Salmonella species. Child was treated with IV antibiotics and responded well to it and was discharged home without complication.</p> Nipun Shrestha Dhruba Shrestha ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 53 55 10.3126/jnps.v38i1.20052 Useful Daily Behaviour to Remove Asymptomatic Bacteriuria in an Eight Years Age Girl with Spina Bifida Occulta <p align="left">Asymptomatic bacteriuria is occasionally found in healthy children. However, the fact that spina bifida occulta can be hidden in asymptomatic bacteriuria is not well known. We report an 8-year-old girl with asymptomatic bacteriuria. Spina bifida occulta was revealed by radiological examinations. Simple daily behavior, consisting of keeping the genitals clean, rehydrating regularly and not prolonging urination, was useful for removing asymptomatic bacteriuria in spina bifida occulta.</p> Kazuto Taniguchi Takema Nakashima Yasunobu Ichiyama Hirokazu Yamamoto Kazuyasu Uemichi ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 56 58 10.3126/jnps.v38i1.19904 Scrub Typhus in Children <p><strong>Introduction: </strong>Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli <em>Orientia tsutsugamushi</em>. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatment</p><p><strong>Material and Methods: </strong>Record files of all patients diagnosed with positive Weil felix (OXK&gt;1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years.</p><p><strong>Results: </strong>Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever &lt;1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline.</p><p><strong>Conclusion: </strong>So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.</p> Madiha Zainab Atul Kumar Gupta Suparna Guha ##submission.copyrightStatement## 2018-11-19 2018-11-19 38 1 59 62 10.3126/jnps.v38i1.18659