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 Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal <div class="page" title="Page 2"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Justification:</strong> Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal.</p> <p><strong>Objective:</strong> Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources.</p> <p><strong>Process / Methods:</strong> Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources.</p> <p><strong>Recommendations:</strong> Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.</p> </div> </div> </div> </div> Sangita Basnet Dhruba Shrestha Puja Amatya Arun Sharma Binod Lal Bajracharya Anil Shrestha Sudeep Shrestha Pramila Rajchal Raju Kafle Devendra Shrestha Sangeeta Puri Anwesh Bhatta Om Krishna Pathak Shrijana Shrestha Copyright (c) 2021 Sangita Basnet, Dhruba Shrestha, MD, Puja Amatya, MD, Om Krishna Pathak, MD, Arun s, MD, Raju Kafle, MD, Binod Lal Bajracharya, MD, Sudeep Shrestha, MD, Anil Shrestha, MD, Pramila Rajchal, MD, Devendra Shrestha, MD, Sangeeta Puri, MD, Anwesh Bhatta, MD, Shrijana Shrestha, MD 2021-04-24 2021-04-24 41 1 1 10 10.3126/jnps.v41i1.35075 Kikuchi Fujimoto as an Initial Presentation of Systemic Lupus Erythromatosis <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Kikuchi-Fujimoto Disease (KFD) is a rare benign, condition of necrotising histiocytic lymphadenitis. In this case report, we discuss a case of 10 year old male patient who presented with a fever, rash and generalised lymphadenopathy that was not attributable to the more common causes. Axillary lymph node biopsy confirmed the diagnosis of KFD. Treatment with prednisolone improved his symptoms but after six months he had recurrence of his symptoms. He was investigated again and finally met diagnostic criteria for SLE. This case report highlights importance of close follow up in a child with KFD.</p> </div> </div> </div> </div> Srijana Basnet Laxman Shrestha Prabina Shrestha Copyright (c) 2021 Srijana Basnet, Laxman Shrestha, Prabina Shrestha 2021-04-24 2021-04-24 41 1 99 102 10.3126/jnps.v41i1.29519 Patent Vitello - Intestinal Duct: A Case Report <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>A wide variety of anomalies may occur as a result of the vitello- intestinal duct (VID) failing to obliterate completely. These anomalies occur in approximately 2% of the population and may remain silent throughout life or may present incidentally with an intra-abdominal complication. Complete patency of vitello-intestinal duct is the rarest of all the anomalies of VID. We report a case of 27 day old female presenting with pinkish umbilical mass since birth referred to us by a paediatrician as umbilical granuloma, which turned out to be patent vitello- intestinal duct.</p> </div> </div> </div> </div> Bijay Thapa Anupama Thapa Anju Kayasthya Copyright (c) 2021 Bijay Thapa, Anupama Thapa, Anju Kayasthya 2021-04-24 2021-04-24 41 1 103 106 10.3126/jnps.v41i1.30184 Persistent Hyperinsulinemic Hypoglycemia in Infancy-A Case Report <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Persistent hyperinsulinemic hypoglycemia of infancy (PHHI) is one of the commonest reasons for severe, intractable hypoglycemia in neonates. Dysregulated insulin secretion is the major underlying pathogenesis which results in hyperinsulinemia, hypoketonemia and hypofatty acidemia. The management is extremely complicated. Early diagnosis and aggressive management of hyperinsulinemic hypoglycemia is essential for prevention of hypoglycemia induced neuronal injury. Here we describe a baby diagnosed as PHHI who was unresponsive to medical management with diazoxide and underwent near total pancreatectomy. Genetic work up revealed a homozygous termination mutation in ABCC8 gene at amino acid position 1452 with heterozygosity in both parents.</p> </div> </div> </div> </div> Nishanth Rajan Jamuna Kalpana Sundaramoorthy Gopi Vishwanathan Mohan Venkatesan Radha Lalitha Krishnan Copyright (c) 2021 Nishanth Rajan, Jamuna Kalpana, Sundaramoorthy Gopi, Vishwanathan Mohan, Venkatesan Radha, Lalitha Krishnan 2021-04-24 2021-04-24 41 1 107 110 10.3126/jnps.v41i1.30806 Recurrent Respiratory Tract Infection in an infant: Early Diagnosis by Clinical and Radiological Pearls <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Recurrent respiratory tract infections, a cause of concern for both parents and paediatricians, can have various etiologies entitled to different organ systems. Diagnosing the exact cause warrants both clinical acumen and timely investigations. Here, we are reporting an infant with recurrent respiratory tract infections, where adequate clinical examination prompted us to diagnose the extra-respiratory cause with simple investigations.</p> </div> </div> </div> </div> Shatanik Sarkar Chaitali Patra Shibani Pal Arkapriya Pramanik Copyright (c) 2021 Shatanik Sarkar, Chaitali Patra, Shibani Pal, Arkapriya Pramanik 2021-04-24 2021-04-24 41 1 111 114 10.3126/jnps.v41i1.30250 Reddish Diarrhoea Caused by Excessive Ingestion of Watermelon: Mimicker of Bacterial Colitis <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p>Bloody diarrhoea in children is indicative of serious diseases. Although bloody diarrhoea following bacterial colitis is well known, reddish diarrhoea caused by excessive ingestion of watermelon is unknown. A two year old girl who excessively ingested watermelon presented with repeated reddish diarrhoea. A kit for fecal occult blood testing revealed that the reddish diarrhoea did not contain blood. Reddish diarrhoea caused by excessive ingestion of watermelon can be a mimicker of bacterial colitis. The kit for fecal occult blood testing was useful for differential diagnosis. We should be aware that this pitfall can be hidden in daily nutrition.</p> </div> </div> </div> </div> Kazuto Taniguchi Toshihiro Nonaka Kazuyasu Uemichi Copyright (c) 2021 Kazuto Taniguchi, Toshihiro Nonaka, Kazuyasu Uemichi 2021-04-24 2021-04-24 41 1 115 118 10.3126/jnps.v41i1.32932 Association of Tri-Ponderal Mass Index vs Body Mass Index With Mid-Upper Arm Circumference Among Adolescent Girls <div class="page" title="Page 11"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Since 2017, number of studies involving nutritional status of adolescents using a novel parameter named tri-ponderal mass index (TMI) is soaring high. The concept of TMI was formulated to substitute body mass index (BMI) in case of adolescent population. The present study aims to find TMI values of school-going adolescent girls (aged 10 to 19 years). It also aims to compare the association of TMI and BMI with mid-upper arm circumference (MUAC) of the subjects.</p> <p><strong>Methods:</strong> Height, weight and MUAC were measured using standard procedures. The BMI and TMI were accordingly calculated. The data obtained was tabulated to elucidate age-wise descriptive statistics. Quadratic polynomial regression was employed to yield a general conclusion regarding association of TMI and BMI with MUAC of the subjects. Receiver operating characteristic (ROC) curve was plotted to check which of the two indices, BMI or TMI, has better ability to predict higher MUAC of the subjects.</p> <p><strong>Results:</strong> The ROC-area under curve (AUC) was 0.867 and 0.955 for TMI and BMI respectively.</p> <p><strong>Conclusion:</strong> BMI has better association with MUAC. In comparison to TMI, BMI has superior ability in predicting higher MUAC of the subjects.</p> </div> </div> </div> </div> Shreyasi Roy Jaydip Sen Copyright (c) 2021-04-24 2021-04-24 41 1 11 16 10.3126/jnps.v41i1.29573 Better Prediction of Neuro - Developmental Outcome in Babies Using Combined Vojta’s Neurokinesiological Examination, Amiel Tison Angles and Head Holding Grades <div class="page" title="Page 17"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> With the advances in medical technology, the survival rate has increased amongst the high-risk neonates. Changes occurring in the neuro-motor function during the first year of life are closely related to the maturation of the central nervous system of babies and the presence or absence of injury to brain. These should be detected as early as possible, so that intervention programmes can be started.</p> <p><strong>Methods:</strong> A prospective study was done in NICU of a teaching hospital, to find the predictive value of combined assessment by three neuro-developmental examinations Viz. Vojta’s Neurokinesiological examination, Amiel-Tison angles and head holding grades. Total 375 babies with various high risk category were included, out of which only 114 infants completed one-year follow-up. On the first visit a detailed neurological examination was performed using Vojtas Neurokinesological postures, Amiel- Tison angles and head holding grades based on Trivandrum Developmental Screening Chart (TDSC). At one year, the milestones attained were plotted against the BSID percentiles and babies assigned as developmentally delayed, if it was below 97% pass level. Sensitivity and specificity were calculated and propositions evaluated by chi-square test.</p> <p><strong>Results:</strong> 23% babies had developmental delay at one year. The important high risk factors were maternal risk factors 39%, HIE with MAS, HIE stage-III, complications during NICU stay.</p> <p><strong>Conclusions:</strong> Vojta’s Neurokinesiological examination is an effective screening test that can be applied to all high-risk neonates. The predictive value could be enhanced to 100%, by using other simple tests, like Amiel-Tison Angles and Head holding grades by TDSC.</p> </div> </div> </div> </div> Ashish Jain H Veerabhadrappa SW Shrikant Nisha Kumari Copyright (c) 2021 Ashish Jain, H Veerabhadrappa, SW Shrikant and Nisha Kumari 2021-04-24 2021-04-24 41 1 17 22 10.3126/jnps.v41i1.29993 Clinical and Demographic Profiles of Children Presenting with Acetaminophen Induced Acute Liver Failure in a Tertiary Paediatric Intensive Care Unit of South India <div class="page" title="Page 23"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Acetaminophen (APAP) is the most widely used over-the-counter antipyretic and analgesic medicine in children. Although hepatic failure and death is rare in paediatric population, it is one of the most important and dangerous presentation of acetaminophen induced toxicity in children. There is very sparse data regarding APAP induced paediatric acute liver failure in our settings, hence this study was done to know the clinical and demographic profiles as well as outcome of children with APAP induced acute liver failure.</p> <p><strong>Methods:</strong> This was a retrospective study done in children aged 0 - 18 years admitted with the diagnosis of acetaminophen induced acute liver failure in a tertiary paediatric intensive care unit of South India from January 2014 to December 2018. The clinical, demographic profiles and outcome of these patients were reviewed and analysed.</p> <p><strong>Results:</strong> A total of 26 children had acetaminophen induced acute liver failure. Out of 26 patients, 53.8% were males and 46.1% were females. Among these, 24 (92.3%) survived and two (7.7%) died. The average dose of acetaminophen ingested was 168.5 mg/ kg/d. The mean serum acetaminophen level was 52.3 mg/dl. The presence of low pH, hypotension and international normalised ratio (INR) value of &gt; 4 showed bad outcome in children with acetaminophen induced acute liver failure.</p> <p><strong>Conclusion:</strong> Paracetamol induced acute liver failure is rare but fatal presentation in children. Children with acidosis, shock and INR value of &gt; 4 had poor prognosis. Hence, judicious use of different preparations as well as counselling to parents regarding use of appropriate doses in children should be done while prescribing this medicine.</p> </div> </div> </div> </div> Puja Amatya Sudeep Kumar Kapalavai Ravi Kumar Krupanandan Kalaimaran Sadasivam Srinivas Sankaranarayanan Bala Ramachandran Copyright (c) 2021 Puja Amatya, Sudeep Kumar Kapalavai, Ravi Kumar Krupanandan, Kalaimaran Sadasivam, Srinivas Sankaranarayanan, Bala Ramachandran 2021-04-24 2021-04-24 41 1 23 28 10.3126/jnps.v41i1.30616 Clinical Profile, Outcome and Risk Factors for Mortality of Neonates Requiring Mechanical Ventilation at Tertiary Care Centre of Central Gujarat, India <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Mechanical ventilation is an important factor contributing to the reduced neonatal mortality in NICU. However, many ventilated babies are left with detrimental sequelae. This study was undertaken to know the prognostic predictors and survival outcome in the ventilated neonates. We assessed the clinical profile, outcome of mechanical ventilation and analysed the risk factors for mortality and complications resulting from mechanical ventilation.</p> <p><strong>Methods:</strong> A prospective study was conducted at the NICU of a tertiary care hospital in India. The study period was from May 2015 to April 2016. Neonates who underwent mechanical ventilation and met the inclusion criteria were enrolled in the study. Their demographic profile, outcomes and risk factors were documented and analysed using appropriate statistical methods.</p> <p><strong>Results:</strong> 285 neonates required mechanical ventilation during the study period. Among them, 190 were included in the study. Overall mortality was 99 out of the 190 enrolled (52%). The most common indications for mechanical ventilation were Respiratory Distress Syndrome (RDS), Meconium Aspiration Syndrome (MAS) and apnea. Risk factors contributing significantly to higher mortality of ventilated neonates were very low birth weight (VLBW), gestation of less than 32 weeks, shock, ventilator- associated complications like pneumothorax and pulmonary haemorrhage. In multiple regression analysis, very low birth weight, circulatory disturbances, pneumothorax, pulmonary haemorrhage, and higher initial FiO2 requirement were found to be independent risk factors of mortality.</p> <p><strong>Conclusions:</strong> The commonest indications for mechanical ventilation were RDS and MAS. Significantly higher mortality was seen amongst VLBW, preterm neonates. Co-morbidities like circulatory disturbance, and complications like pneumothorax and pulmonary haemorrhage contributed to adverse outcomes.</p> </div> </div> </div> </div> Pareshkumar A Thakkar Himanshu G Pansuriya Sheela Bharani Khushboo Kamal Taneja Copyright (c) 2021 Pareshkumar A Thakkar, Himanshu G Pansuriya, Sheela Bharani, Khushboo Kamal Taneja 2021-04-24 2021-04-24 41 1 29 34 10.3126/jnps.v41i1.30630 Comparison of Efficacy of First Haemodialysis Session for Correction of Metabolic Disturbances in Acute Kidney Injury and Chronic Kidney Disease in Children <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Acute kidney injury and chronic kidney disease present with various complications like electrolyte disturbances, metabolic acidosis and fluid overload in children. The objective of the study was to compare the efficacy of the first session of haemodialysis in children with acute kidney injury stage 3 and chronic kidney disease G5 treated by dialysis for immediate recovery of renal functions in terms of reduction in the level of azotemia, correction of fluid and electrolyte imbalances, metabolic acidosis, and improvement in clinical status.</p> <p><strong>Methods:</strong> This was a cross-sectional comparative observational study conducted on 13 patients of acute kidney injury stage 3 and 46 patients with chronic kidney disease G5, who required haemodialysis. Their clinical assessment, fluid status, renal function tests, electrolyte, bicarbonate were done at admission and completion of the first session of heamodialysis.</p> <p><strong>Results:</strong> The age group of children was six to 16 years (median 11.4 years). There were six males (46%) and seven females (54%) in the acute kidney injury group and 29 (63%) males and 17 (37%) females in chronic kidney disease G5 groups. Sepsis (31%) and glomerulonephritis (31%) were common etiologies detected for acute kidney injury while in chronic kidney disease G5, congenital anomalies of the kidney and the urinary tract were the commonest (50%). There were significant reductions in the levels of serum urea and creatinine and a rise in blood pH, bicarbonate level, and base excess following the first session of haemodialysis in comparison to pre-dialysis values in both AKI and CKD.</p> <p><strong>Conclusions:</strong> The study demonstrated improvement in the clinical parameters and biochemical parameters equally after the first dialysis sessions in both groups. This is one of the effective renal replacement therapy and should be instituted wherever indicated to improve the immediate outcome of the patients.</p> </div> </div> </div> </div> Shubham Verma Abhinay Abhishek Om Prakash Mishra Ankur Singh Rajniti Prasad Copyright (c) 2021 Shubham Verma, Abhinay Abhishek, Om Prakash Mishra, Ankur Singh, Rajniti Prasad 2021-04-24 2021-04-24 41 1 35 41 10.3126/jnps.v41i1.30825 Cranial Ultrasound in Moderate and Late Preterm Neonates: A Prospective Observational Study <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Preterm infants’ brain is vulnerable to ischemic and hemorrhagic injuries due to structural and molecular immaturities as well as associated co-morbidities, which is usually detected by bedside cranial ultrasound. Cranial ultrasound findings are common in preterm infants’ of &lt; 32 weeks, so cranial ultrasound is routinely recommended in them but there is no such recommendation regarding moderate and late preterm infants. The objective of this study is to find the cranial ultrasound abnormalities in moderate and late preterm infants.</p> <p><strong>Methods:</strong> This prospective observational study was conducted in a tertiary level neonatal care unit. Hundred moderate and late preterm neonates delivered or admitted within seventh day of life were included in the study. Cranial ultrasound scan was performed between third and seventh day of life and before discharge and ultrasound findings were noted. Data were collected in predesigned case record form and analysed using Fischer Exact test.</p> <p><strong>Results:</strong> Out of 100 neonates, 47 (47%) were males and 53 (53%) females. There were 43 (43%) moderately preterm and 57 (57%) late preterm infants. Mean day of life for performing first and second cranial ultrasound was 4.17 (3 - 7) days and 13.24 (3 - 40) days respectively. Cranial abnormalities were noted in 26% neonates. Intra-ventricular haemorrhage grade 1 or 2 was the commonest abnormality noted. Choroid plexus cyst (4%), cerebral edema (3%), periventricular hyperechogenicity (3%) and hydrocephalus (1%) were the other abnormalities noted. Neonates having APGAR &lt; 6 at one minute, mechanically ventilated and having co-morbidities had significantly higher incidence of abnormal findings.</p> <p><strong>Conclusions:</strong> It is reasonable to perform screening cranial ultrasound in high risk moderate and late preterm infants having low APGAR score, mechanically ventilated and having co-morbidities.</p> </div> </div> </div> </div> Om Krishna Pathak Yengkhom Rameshwor Singh Rahul Mugurkar Pradeep Suryawanshi Copyright (c) 2021 Om Krishna Pathak, Yengkhom Rameshwor Singh, Rahul Mugurkar, Pradeep Suryawanshi 2021-04-24 2021-04-24 41 1 42 47 10.3126/jnps.v41i1.31024 Efficacy of Heel Warming on Pain Response to Heel Stick in Neonates <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Heel prick is one of the commonest procedures carried out in the hospitalised newborns. Pain is a subjective experience for which the neonates, infants and children respond with behavioural reactions. Applying hot pack to the skin surface causes proximal blood vessels to dilate due to the raised temperature which may decrease the pain perception in neonates. We intended to study the effect of heel warming during heel prick in perception of pain in neonates.</p> <p><strong>Method:</strong> An experimental study was conducted among neonates admitted in paediatric wards of BPKIHS. Total 92 participants undergoing heel prick/stick were selected by consecutive sampling technique and allocated randomly to experimental group and control group. Warmer was applied to the heel of the baby for three to five minutes which provided the baby’s heel with the warmth of 38°C to 40°C prior to heel stick in experimental group only. Newborn’s pain level was assessed in both experimental and control group through The Neonatal Infant Pain Scale (NIPS). Mann Whitney test was used to compare means of pain score between experimental and control groups.</p> <p><strong>Results:</strong> The mean pain score among experimental group was 1.39 and in control group was 2.20. Experimental group showed significantly lower pain (p &lt; 0.001) compared to the control group. Application of warmth before heel stick caused reduction in pain.</p> <p><strong>Conclusions:</strong> The findings suggest that heat application prior to heel stick is effective in reducing pain in newborns.</p> </div> </div> </div> </div> Pratima Sharma Sapkota Sunita Shah Bhandari Basanta Kumar Karn Upendra Yadhav Copyright (c) 2021 Pratima Sharma Sapkota, Sunita Shah Bhandari, Basanta Kumar Karn, Upendra Yadhav 2021-04-24 2021-04-24 41 1 48 53 10.3126/jnps.v41i1.30786 Etiological Trends and Epidemiological Profile of Tropical Fever in Children Presenting with Acute Undifferentiated Fever at a Tertiary Care Centre in North India <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> The objective of this study was to determine the etiology of acute undifferentiated fevers (AUF) in hospitalised children with in a tertiary care centre in North India. The various causes of acute undifferentiated fevers included dengue, malaria, scrub typhus, enteric fever, leptospirosis and Chikungunya. The clinical spectrum and therapeutic outcome of these cases was also studied.</p> <p><strong>Methods:</strong> This retrospective study was conducted over a period of 6 months from June 2019 to December 2019. The clinical information of 126 children who tested positive for any of the causes of AUF namely dengue, malaria, scrub typhus, enteric fever, chikungunya and leptospirosis was obtained from the Paediatrics Department. The information was recorded in a predesigned proforma. Various tests performed for the diagnosis of these illnesses were noted. They included dengue NS1 antigen ELISA and IgM ELISA, peripheral blood smear (PBS) for malarial parasite and rapid malarial antigen detection test (RMAT), scrub typhus IgM ELISA, leptospira IgM ELISA, and Chikungunya IgM ELISA.</p> <p><strong>Results:</strong> The diagnosis of AUF were dengue (55.5%; 70/126), malaria (19%; 24/126) and scrub typhus (19%; 24/126), enteric fever (4.7%;6/126) and Chikungunya (1.5%; 2/126). The most common presenting symptom was fever or pyrexia followed by myalgia, generalised aches and pains in the body and vomiting. Commonly observed complications included thrombocytopenia, hepatitis and shock.</p> <p><strong>Conclusions:</strong> Dengue, malaria and scrub typhus are the major causes of AUF in the hospitalised children with dengue being the most prevalent infection. The study further emphasises the need to develop a systematic approach to the diagnosis of AUFs. This should be using a combination of clinical, epidemiological and laboratory parameters, which will be very useful for developing a relevant action plan for treatment and prevention of such fevers in any hospital setup.</p> </div> </div> </div> </div> Monika Matlani Pramod Kumar Shyam S Meena Mohan Vashistha Vinita Dogra Copyright (c) 2021 Monika Matlani, Pramod Kumar, Shyam S Meena, Mohan Vashistha, Vinita Dogra 2021-04-24 2021-04-24 41 1 54 60 10.3126/jnps.v41i1.29595 Evaluation of Ischaemia Modified Albumin as a Marker of Oxidative Stress in Beta Thalassemia Major Children <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Iron overload in thalassemia catalyses the production of a variety of reactive oxygen species leading to cumulative cell damage. Ischemia modified albumin (IMA) is an end product of oxidative stress. It is imperative to pick up oxidative stress early in order to prevent the organ damage in thalassemia. Therefore this study was undertaken to estimate IMA levels and to see the correlation between ferritin and IMA to establish whether ferritin can be a proxy marker for oxidative stress.</p> <p><strong>Methods:</strong> A total of 76 children were included in the study out of which 46 were diagnosed cases of β- Thalassemia major and 30 formed the healthy controls. Pre transfusion haemoglobin, AST, ALT, ferritin and IMA levels were estimated and compared with healthy control children. Correlation was drawn between haemoglobin, AST, ALT, ferritin with IMA.</p> <p><strong>Results:</strong> There is significant elevation in the level of IMA and ferritin in children with Thalassemia major as compared to the healthy controls (p = &lt; 0.001). There was a significant positive correlation between ferritin and IMA and a significant negative correlation between haemoglobin % and IMA. Regression relationship between ferritin and IMA established that IMA (ng/ mL) = 246.118 + 0.829 (Ferritin ng/dL).</p> <p><strong>Conclusions:</strong> IMA levels were significantly elevated in β- thalassemia major children and correlated positively with ferritin levels. By establishing a regression relationship between ferritin and IMA levels, we can fairly estimate the levels of IMA. Hence, we can utilise ferritin as a proxy marker of oxidative stress instead of IMA.</p> </div> </div> </div> </div> K Jagadish Kumar Smriti Bhagiratha Prashanth Vishwanath Copyright (c) 2021 K Jagadish Kumar, Smriti Bhagiratha, Prashanth Vishwanath 2021-04-24 2021-04-24 41 1 61 66 10.3126/jnps.v41i1.29931 Evaluation of Risk Factors for Exchange Range Hyperbilirubinemia in Neonates from Eastern Part of Nepal <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Neonatal hyperbilirubinemia continues to be the commonest cause of nursery and NICU admissions and readmissions in the neonatal period worldwide. Although most cases are physiological, toxic levels of un-conjugated bilirubin can lead to acute and chronic bilirubin encephalopathy. Hence, this study aimed to study the risk factors for exchange range hyperbilirubinemia in neonates.</p> <p><strong>Methods:</strong> This was a hospital-based prospective observational study conducted in a teaching and referral NICU over a period of one year from July 2019 to August 2020. All neonates with diagnosis of hyperbilirubinemia requiring double volume exchange transfusion were included in the study. Risk factors for significant hyperbilirubinemia were analysed with descriptive statistics. P-value of &lt; 0.05 was considered significant wherever applicable.</p> <p><strong>Results:</strong> The mean gestational age and birth weight were 38.06 ± 2.13wks and 2611.72 ± 389.39 gm respectively. Fifteen percent of the babies (162) developed hyperbilirubinemia and 28 (17.3%) required double volume exchange transfusion. Among neonates requiring exchange transfusion, 17 were females and 11 were males. Among 28 babies who required DVET, 20 (71.4%) were SGA. ABO incompatibility was present in 14 (50.0%) neonates and Rh incompatibility in 13 (46.4%) neonates. ABO along with Rh incompatibility was present in eight (28.6%) neonates. DCT was positive in six neonates with ABO incompatibility and nine neonates in Rh incompatibility. G6PD deficiency was present in four (14.3%) neonates.</p> <p><strong>Conclusions:</strong> The most important risk factors identified were small for gestational age, ABO and Rh incompatibility followed by oxytocin use and sibling treated for jaundice.</p> </div> </div> </div> </div> Sunil Kumar Yadav Arun Giri Bbita Khanal Copyright (c) 2021 Sunil Kumar Yadav, Arun Giri, Bbita Khanal 2021-04-24 2021-04-24 41 1 67 72 10.3126/jnps.v41i1.31040 Impact of Anaemia on the Severity of Acute Bronchiolitis in Infants <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Although anaemia is a predisposing factor in the occurrence of lower respiratory tract infections, there is limited data about the relationship between anaemia and acute bronchiolitis in infants. The aim of this study is to determine whether anaemia is an independent clinical condition increasing the severity of acute bronchiolitis in infants.</p> <p><strong>Methods:</strong> This retrospective study was conducted on 163 infants (101 acute bronchiolitis and age and sex matched 62 controls), aged between one month to two years. According to the clinical severity of the disease, patients were divided as having mild, moderate and severe acute bronchiolitis. Haemoglobin (Hb) level was considered low when below 11 gm/dL, which is less than 2 standard deviation (SD).</p> <p><strong>Results:</strong> Median Hb and mean cell haemoglobin concentration (MCHC) levels were significantly lower in acute bronchiolitis patients than controls {10.1 gm/dL (9.6 - 10.6 gm/dL) vs. 11.2 gm/dL (10.6 - 12.1 gm/dL); p &lt; 0.001)}, and {33.6 (32.5 - 34.1 gm/dL) vs. 34 gm/dL (33.1 - 34.5 gm/dL) p = 0.012}. Conversely, median red cell distribution width (RDW) was higher {14.4% (13.5 - 15.6%) vs. 14.1% (13.1-15%)}. When evaluated by logistic regression analysis, the risk of severe bronchiolitis increased 10 times in acute bronchiolitis patients with a Hb value ≤ 10 gm/dL. Also, there was a significant negative correlation between Hb level and bronchiolitis severity (r :- 0.423, p &lt; 0.001). Furthermore, the patients who had Hb value under 9.95 gm/dL had risk of more severe bronchiolitis with 73.7% sensitivity and 83.3% specificity than other patients.</p> <p><strong>Conclusions:</strong> Anaemic infants are more susceptible to acute bronchiolits and as the degree of anaemia increases, they are more severely affected.</p> </div> </div> </div> </div> Elif Çelik Serkan Fazlı Çelik Şükrü Güngör Adem Dursun Copyright (c) 2021 Elif Çelik, Serkan Fazlı Çelik, Şükrü Güngör, Adem Dursun 2021-04-24 2021-04-24 41 1 73 79 10.3126/jnps.v41i1.30704 Incidence and Outcome of Acute Kidney Injury in Hospitalised Children <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Acute kidney injury (AKI) is common in hospitalised children with adverse short and long term outcomes. Detection of the incidence, etiological profile and outcome of AKI is important for starting preventive and therapeutic modalities. This study aimed to determine the incidence, etiology and short term outcome of AKI at a tertiary centre in Eastern Nepal.</p> <p><strong>Methods:</strong> A prospective observational study was conducted in children from two months to 14 years of age admitted in paediatric wards and paediatric intensive care unit (PICU) of a tertiary centre of Eastern Nepal. AKI was defined according to pRIFLE criteria.</p> <p><strong>Results:</strong> From May 2015 to March 2016, 942 patients enrolled in Paediatric wards and PICU were evaluated. The overall incidence of AKI was found to be 5.9% and 18.23% in patients admitted in PICU. AKI was commonest among cases having infectious etiology compromising 73.2% (n = 41), 17.85% (n = 10) due to primary renal disease, 5.35% (n = 3) secondary to congenital heart disease, and 3.57% due to other causes. Among AKI patients, 55.4% (n = 31) required inotropic support, 33.9% (n = 19) required mechanical ventilation while 5.36% (n = 3) underwent dialysis. Out of 56 AKI patients 71.4% (n = 40) had improved clinical outcome and 28.6% (n = 16) expired. Patient with AKI had significant longer duration of hospital stay as compared to non AKI (Seven days vs. three days, p &lt; 0.001). Mortality was high among AKI patients on injury and failure stage (p = 0.003) and those requiring mechanical ventilation and inotropic support (p &lt; 0.001).</p> <p><strong>Conclusions:</strong> The incidence of AKI was found to be high in paediatric patients. Presence of AKI increased the duration of hospital stay and mortality in hospitalised children often requiring mechanical ventilation and inotropic support.</p> </div> </div> </div> </div> Rajan Paudel Gauri Shankar Shah Shipra Chaudhary Dinesh Dharel Anuradha Timilsina Copyright (c) 2021 Rajan Paudel, Gauri Shankar Shah, Shipra Chaudhary, Dinesh Dharel, Anuradha Timilsina 2021-04-24 2021-04-24 41 1 80 86 10.3126/jnps.v41i1.30138 Referrals from Paediatric Department with Respiratory Symptoms having Skin Lesions <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Paediatric patients with respiratory symptoms having skin lesions are often referred from Paediatric to Dermatology Department. Knowledge about skin and respiratory manifestations will lead to early diagnosis and proper management by the doctors of both the specialties. These dermatological conditions may or may not be related to respiratory illness or may hence be part of total disease process or may be completely separate entity. The aim of this study was to find out skin manifestations of various respiratory diseases and analyse dermatological disorders in children referred from Paediatric Department having respiratory symptoms.</p> <p><strong>Methods:</strong> An observational cross sectional hospital based study involving inpatients and outpatients referred from Paediatrics to Dermatology Department having respiratory illness and skin lesions was undertaken between January 2019 to December 2020. Details of skin disease were recorded. The descriptive statistical analysis was expressed in frequency and percentage and Chi square test was applied to determine significance among variables.</p> <p><strong>Results:</strong> Total 437 patients were included in the study. The most common diagnosis made by Paediatric {160 (36.6%)} and Dermatology Departments {246 (56.2%) was viral exanthema followed by atopic dermatitis {77 (17.6%)}. Out of total 65 patients who suffered from bronchial asthma, 59 (90.7%) patients had atopic dermatitis.</p> <p><strong>Conclusions:</strong> Significant paediatric patients with respiratory illnesses have concomitant skin lesions. There is very high percentage of patients having atopic dermatitis among those who had asthma and hence clearly depicts relation between the two diseases.</p> </div> </div> </div> </div> Sagar Mani Jha Lee Budhathoki Nabin Bhakta Shakya Sunil Shakya Kumar Roka Copyright (c) 2021 Sagar Mani Jha, Lee Budhathoki, Nabin Bhakta Shakya, Sunil Shakya, Kumar Roka 2021-04-24 2021-04-24 41 1 87 92 10.3126/jnps.v41i1.35184 Validity of Bilirubin Measured by Biliscan (Smartphone Application) in Neonatal Jaundice – An Observational study <div class="page" title="Page 1"> <div class="section"> <div class="layoutArea"> <div class="column"> <p><strong>Introduction:</strong> Bilirubin is a frequently ordered investigation in neonatal intensive care units and out-patient practice during follow- up. The gold standard for its estimation is serum bilirubin which is invasive resulting in parenteral apprehension, pain, discomfort and iatrogenic anaemia in a neonate, while the non-invasive measurement by transcutaneous bilirubinometer is not available in all the centres because of its cost. Biliscan is a smartphone application that uses a phone’s inbuilt camera and a colour calibration card to detect neonatal jaundice. We compared bilirubin measured by Biliscan with reference to serum bilirubin among neonates admitted to a tertiary care centre.</p> <p><strong>Methods:</strong> We conducted an observational study from June-2019 to September-2019 at a tertiary care centre in Hyderabad, India. Inborn neonates (greater than &gt; 35 weeks gestational age at birth, and less than a week old) who required bilirubin estimation, underwent both invasive serum sampling and non-invasive estimation by Biliscan. Photograph of the baby’s chest was captured using the colour calibration card of the Biliscan application. Bilirubin values derived from the Biliscan application were compared to those derived from blood samples.</p> <p><strong>Results:</strong> A total of 143 neonates were enrolled. The mean bilirubin value estimated by serum sampling was 11.9 g/dl against 13.1 g/dl of that derived from smartphone application. Biliscan and serum bilirubin showed moderate agreement with a correlation coefficient of 0.6. Bland- Altman plot constructed showed bias of 1.1 with the limits of agreement ranging from -3 to +5.3. Biliscan had a good sensitivity of 90% in identifying high levels of serum bilirubin (&gt; 95th percentile on Bhutani nomogram).</p> <p><strong>Conclusion:</strong> Biliscan application is a non-invasive, real-time, inexpensive and an easily available method that cannot replace serum bilirubin, however can complement and has the potential to help in screening neonates thus facilitating recognition of jaundice early and minimising the number of invasive pricks.</p> </div> </div> </div> </div> Swapna Lingaldinna Kalyan Chakravarthy Konda Narahari Bapanpally Madireddy Alimelu Himabindu Singh Meghna Ramaraju Copyright (c) 2021 Swapna Lingaldinna, Kalyan Chakravarthy Konda, Narahari Bapanpally, Madireddy Alimelu, Himabindu Singh, Meghna Ramaraju 2021-04-24 2021-04-24 41 1 93 98 10.3126/jnps.v40i3.29412