Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.37162
S. Yadav, Nirajan Niroula, A. Giri
Introduction: 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). Methods: 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 < 0.05 was considered significant wherever applicable. Results: 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. Conclusions: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.
{"title":"Profile of Nosocomial Sepsis in a Neonatal Intensive Care Unit of Tertiary Care Hospital in Eastern Part of Nepal","authors":"S. Yadav, Nirajan Niroula, A. Giri","doi":"10.3126/jnps.v41i3.37162","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.37162","url":null,"abstract":"Introduction: 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). \u0000Methods: 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 < 0.05 was considered significant wherever applicable. \u0000Results: 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. \u0000Conclusions: This study revealed a high incidence of nosocomial sepsis. Hence, there is urgent need to adopt policies to prevent these infections.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41760271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Levothyroxine Overdose in a Toddler – A Case Report","authors":"Radha Thiyagarajan, Thasma Santhanakrishnan Arunprasath","doi":"10.3126/jnps.v41i3.40478","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.40478","url":null,"abstract":"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.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48390447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.33267
A. Saha, A. Tiwari, P. Chattopadhyay, S. Mukherjee, Bijan Saha
Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.
{"title":"Changing Pattern of Bacteriological Profile, Antimicrobial Resistance and Mortality in Neonatal Sepsis in a Developing Country: A Retrospective Study","authors":"A. Saha, A. Tiwari, P. Chattopadhyay, S. Mukherjee, Bijan Saha","doi":"10.3126/jnps.v41i3.33267","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.33267","url":null,"abstract":"Introduction: 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. \u0000Methods: 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. \u0000Results: 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.\u0000Conclusions: 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. ","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47925871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.33371
S. Mathew, T. Kumar, Mohanty Niranjan
Introduction: 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. Methods: 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. Results: 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%). Conclusions: Majority of SAM had low birth weight, and had poor rates of exclusive breast feeding, inadequate complementary feeding, and recurrent infections.
{"title":"Clinical Profile and Socio-Demographic Characteristics of Children with Severe Acute Malnutrition (SAM) in Southern Odisha","authors":"S. Mathew, T. Kumar, Mohanty Niranjan","doi":"10.3126/jnps.v41i3.33371","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.33371","url":null,"abstract":"Introduction: 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.\u0000Methods: 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.\u0000Results: 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%). \u0000Conclusions: Majority of SAM had low birth weight, and had poor rates of exclusive breast feeding, inadequate complementary feeding, and recurrent infections.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46266722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.36244
K. Alabi, Titilayo Funmilayo Kayode-Alabi, Rasheed Olayinka Ibrahim, Hamdalat Issa, M. Abdulkadir, S. Ernest, A. Ojuawo
Introduction: 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. Methods: 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. Results: The prevalence of MA was 30.1%. MA was more common in obese and hypertensive adolescents (p < 0.001 and p < 0.01 respectively). Occurrence of MA correlated strongly with subject’s weight (r = 0.790, p = 0.004, p < 0.01); systolic blood pressure (r = 0.884, p = 0.001, p < 0.01) and body mass index (r = 0.710, p = 0.001, p < 0.01). 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). Conclusions: 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.
{"title":"Relationship Between Microalbuminuria and Risk Factors for Cardiovascular Diseases Among Secondary School Student in Ilorin, Nigeria","authors":"K. Alabi, Titilayo Funmilayo Kayode-Alabi, Rasheed Olayinka Ibrahim, Hamdalat Issa, M. Abdulkadir, S. Ernest, A. Ojuawo","doi":"10.3126/jnps.v41i3.36244","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.36244","url":null,"abstract":"Introduction: 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. \u0000Methods: 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.\u0000Results: The prevalence of MA was 30.1%. MA was more common in obese and hypertensive adolescents (p < 0.001 and p < 0.01 respectively). Occurrence of MA correlated strongly with subject’s weight (r = 0.790, p = 0.004, p < 0.01); systolic blood pressure (r = 0.884, p = 0.001, p < 0.01) and body mass index (r = 0.710, p = 0.001, p < 0.01). 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).\u0000Conclusions: 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. ","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44704641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.37154
S. Chalise, S. Mishra, Prerana Kasakar, Md. Firoz Anjum
Introduction: 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. Method: 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. Results: 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. 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. Conclusions: 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.
{"title":"Causes of Mortality in Low Birth Weight Babies at a Tertiary Care Hospital","authors":"S. Chalise, S. Mishra, Prerana Kasakar, Md. Firoz Anjum","doi":"10.3126/jnps.v41i3.37154","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.37154","url":null,"abstract":"Introduction: 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. \u0000Method: 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. \u0000Results: 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. 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.\u0000Conclusions: 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.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48556477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.37654
Prajwal Paudel, K. Subedi, S. Karmacharya, Sarita Shrestha, A. Shrestha, Pratikshya Subedi, S. Sah, Megha Mishra, Asia Tamrakar, Nisha Khati, Astha Singh, Kirtipal Subedi, Avinash K. Sunny, S. Mishra
Introduction: 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. Methods: 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. Descriptive statistics 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. Results: 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 > 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 < 0.001). Conclusions: 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.
{"title":"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","authors":"Prajwal Paudel, K. Subedi, S. Karmacharya, Sarita Shrestha, A. Shrestha, Pratikshya Subedi, S. Sah, Megha Mishra, Asia Tamrakar, Nisha Khati, Astha Singh, Kirtipal Subedi, Avinash K. Sunny, S. Mishra","doi":"10.3126/jnps.v41i3.37654","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.37654","url":null,"abstract":"Introduction: 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.\u0000Methods: 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. Descriptive statistics 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.\u0000Results: 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 > 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 < 0.001).\u0000Conclusions: 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.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69306477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.36213
R. Ramanathan, P. Pradeep, Shafath Ahmed
Introduction: 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. Methods: 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. Results: 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. Conclusions: 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. Key words: Diazo test; Sensitivity; Specificity
{"title":"A Comparative Study of Diazo Test and Blood Culture in Children With Clinically Compatible Typhoid Fever","authors":"R. Ramanathan, P. Pradeep, Shafath Ahmed","doi":"10.3126/jnps.v41i3.36213","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.36213","url":null,"abstract":"Introduction: 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.\u0000Methods: 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.\u0000Results: 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.\u0000Conclusions: 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.\u0000Key words: Diazo test; Sensitivity; Specificity","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44386446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.32758
R. Y., Juanitha George, L. Lewis, Jayashree Purkayastha
Introduction: 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. Methods: 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 < 50 mg/dL thereafter was considered hypoglycaemia. Results: 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 < 2000 g and polycythemia. Conclusions: 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.
{"title":"Blood Glucose Levels and Characteristics of Hypoglycemia in Low Birth Weight Neonates","authors":"R. Y., Juanitha George, L. Lewis, Jayashree Purkayastha","doi":"10.3126/jnps.v41i3.32758","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.32758","url":null,"abstract":"Introduction: 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.\u0000Methods: 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 < 50 mg/dL thereafter was considered hypoglycaemia.\u0000Results: 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 < 2000 g and polycythemia.\u0000Conclusions: 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.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47941543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-12-31DOI: 10.3126/jnps.v41i3.37206
J. Agrawal, A. Agrawal
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.
{"title":"Undiagnosed hypothyroidism presenting as recurrent bilateral large ovarian cyst in an early adolescent girl. A rare case report.","authors":"J. Agrawal, A. Agrawal","doi":"10.3126/jnps.v41i3.37206","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.37206","url":null,"abstract":"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.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48901308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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