Pub Date : 2022-11-27DOI: 10.3126/jnps.v42i1.39298
Rimjhim Sonowal, Ashok Kumar V
Introduction: Calcium physiology is in transitional state after birth and may be deranged by various neonatal disorders leading to hypocalcaemia. Coexisting hypocalcaemia can further worsen underlying condition and increase mortality. This prospective observational study was done to study the incidence, clinical correlates and outcome of early onset hypocalcaemia in sick newborns. Methods: A prospective observational study was done on 175 sick newborns. Ionized serum calcium levels were measured at six, 24, 48 and 72 hours of age by arterial blood gas analyzer. Maternal and neonatal characteristics, ionized calcium levels, clinical course and outcomes were recorded. Patient characteristics and neonatal morbidities were compared between hypercalcaemic group and normocalcaemic group by chi square test. Odds ratio was calculated to see correlation between hypocalcaemia with respiratory support and death. Results: Early onset hypocalcaemia occurred in 101 of 175 (57.7%) sick newborns. Early onset hypocalcaemia was higher in preterm babies (59.7%) than term babies (54.1%). Meconium stained amniotic fluid, obstructed labour and MAS were significantly associated with early onset hypocalcaemia. Newborns with MAS and HIE had high incidence of hypocalcaemia in both term and preterm groups. Newborns with hypocalcaemia were more likely to receive mechanical ventilation (OR 2.84; CI 1.28-6.30; p value 0.01) and had higher mortality (OR 2.10; CI 1.02-4.33; p value 0.04). Conclusions: Early onset hypocalcaemia is very common in sick newborns. Meconium aspiration syndrome was a significant risk factor for early onset hypocalcaemia. Early onset hypocalcaemia was associated with higher odds of receipt of mechanical ventilation and mortality
{"title":"Early Onset Hypocalcaemia in Sick Newborns: A Prospective Observational Study","authors":"Rimjhim Sonowal, Ashok Kumar V","doi":"10.3126/jnps.v42i1.39298","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.39298","url":null,"abstract":"Introduction: Calcium physiology is in transitional state after birth and may be deranged by various neonatal disorders leading to hypocalcaemia. Coexisting hypocalcaemia can further worsen underlying condition and increase mortality. This prospective observational study was done to study the incidence, clinical correlates and outcome of early onset hypocalcaemia in sick newborns.\u0000Methods: A prospective observational study was done on 175 sick newborns. Ionized serum calcium levels were measured at six, 24, 48 and 72 hours of age by arterial blood gas analyzer. Maternal and neonatal characteristics, ionized calcium levels, clinical course and outcomes were recorded. Patient characteristics and neonatal morbidities were compared between hypercalcaemic group and normocalcaemic group by chi square test. Odds ratio was calculated to see correlation between hypocalcaemia with respiratory support and death.\u0000Results: Early onset hypocalcaemia occurred in 101 of 175 (57.7%) sick newborns. Early onset hypocalcaemia was higher in preterm babies (59.7%) than term babies (54.1%). Meconium stained amniotic fluid, obstructed labour and MAS were significantly associated with early onset hypocalcaemia. Newborns with MAS and HIE had high incidence of hypocalcaemia in both term and preterm groups. Newborns with hypocalcaemia were more likely to receive mechanical ventilation (OR 2.84; CI 1.28-6.30; p value 0.01) and had higher mortality (OR 2.10; CI 1.02-4.33; p value 0.04).\u0000Conclusions: Early onset hypocalcaemia is very common in sick newborns. Meconium aspiration syndrome was a significant risk factor for early onset hypocalcaemia. Early onset hypocalcaemia was associated with higher odds of receipt of mechanical ventilation and mortality","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44146992","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 : 2022-11-27DOI: 10.3126/jnps.v42i1.42162
T. Shrestha, Archana Pandey Bista, S. Shrestha
Introduction: Parental satisfaction is one of the indicators of quality care. An understanding of the satisfying areas would help to identify and prioritize care and support areas for infants and parents. Therefore, this study was conducted to find out the parental satisfaction with care and support in neonatal care units (NCUs). Methods: Cross-sectional descriptive study was conducted in NCUs of five selected public hospitals. The study was conducted among 305 parents of preterm infants (PTIs). After obtaining ethical approval, in-person interviews were conducted with parents using a satisfaction questionnaire. Both descriptive and inferential statistics were used for data analysis. Results: Parents were moderately satisfied with care and support with a median score and interquartile range of 3.4 (3.1- 3.8). They were highly satisfied with the infant care and least satisfied with the attachment and care guidance support with median scores of 4.0 (3.5 - 4.0) and 3.1 (2.6 - 3.8) respectively. Parental satisfaction was significantly associated with parental age, gestational age at birth, and birth weight (P value < 0.05). Conclusions: Parents are moderately satisfied with the care and support received in the NCUs. Their satisfaction is lower with the support for attachment and care guidance. In addition to competent and affectionate care to PTIs, parental support for attachment, guidance, and involvement in care need to be considered by NCU personnel.
{"title":"Parental Satisfaction with Care and Support in Neonatal Care Units of Public Hospitals of Nepal","authors":"T. Shrestha, Archana Pandey Bista, S. Shrestha","doi":"10.3126/jnps.v42i1.42162","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.42162","url":null,"abstract":"Introduction: Parental satisfaction is one of the indicators of quality care. An understanding of the satisfying areas would help to identify and prioritize care and support areas for infants and parents. Therefore, this study was conducted to find out the parental satisfaction with care and support in neonatal care units (NCUs).\u0000Methods: Cross-sectional descriptive study was conducted in NCUs of five selected public hospitals. The study was conducted among 305 parents of preterm infants (PTIs). After obtaining ethical approval, in-person interviews were conducted with parents using a satisfaction questionnaire. Both descriptive and inferential statistics were used for data analysis.\u0000Results: Parents were moderately satisfied with care and support with a median score and interquartile range of 3.4 (3.1- 3.8). They were highly satisfied with the infant care and least satisfied with the attachment and care guidance support with median scores of 4.0 (3.5 - 4.0) and 3.1 (2.6 - 3.8) respectively. Parental satisfaction was significantly associated with parental age, gestational age at birth, and birth weight (P value < 0.05).\u0000Conclusions: Parents are moderately satisfied with the care and support received in the NCUs. Their satisfaction is lower with the support for attachment and care guidance. In addition to competent and affectionate care to PTIs, parental support for attachment, guidance, and involvement in care need to be considered by NCU personnel.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42403874","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 : 2022-11-27DOI: 10.3126/jnps.v42i1.37197
M. Shrestha, Anjuly Mandal, Sweta Kumari Gupta, M. Baidya
Introduction: Maternal smoking has been an important risk factor for low birth weight (LBW), preterm birth as well as small for gestational age. In this study, we try to analyze the association of maternal smoking during the different stages of pregnancy with outcome of birth weight. Methods: This is a cross-sectional hospital-based study, which was undertaken comprising of 1240 singleton live born baby in a Tertiary Care Teaching Hospital, Nepal. The enrollment occurred between June 2012 and May 2016 (Four years) among mothers who smoked any time during the current pregnancy. Based on the amount of smoking, the mothers with cigarette smoking were divided into four groups which includes: preconception, the first trimester, second trimester and third trimester. The data analyses were performed using Logistic regression and 95% confidence interval along with p-value. A p-value < 0.05 was considered statistically significant. Results: Of a total of 1240 singleton births, 328 (26.5%) were LBW. Among them, 149 (12.1%) of the mothers reported smoking during pregnancy. When compared with the nonsmoking groups, all the maternal smoking groups had higher incidences of LBW infants, especially when the mothers smoked > 10 cigarettes / day and during any stage of conception. Conclusions: Smoking during pregnancy is associated with an increased incidence of LBW among the infants. In addition, the newborns of mothers who smoked >10 cigarettes / day were most susceptible to having LBW, irrespective of the stage of pregnancy during which the mothers smoked.
{"title":"Maternal Smoking during Pregnancy and its Association with Low Birth Weight","authors":"M. Shrestha, Anjuly Mandal, Sweta Kumari Gupta, M. Baidya","doi":"10.3126/jnps.v42i1.37197","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.37197","url":null,"abstract":"Introduction: Maternal smoking has been an important risk factor for low birth weight (LBW), preterm birth as well as small for gestational age. In this study, we try to analyze the association of maternal smoking during the different stages of pregnancy with outcome of birth weight.\u0000Methods: This is a cross-sectional hospital-based study, which was undertaken comprising of 1240 singleton live born baby in a Tertiary Care Teaching Hospital, Nepal. The enrollment occurred between June 2012 and May 2016 (Four years) among mothers who smoked any time during the current pregnancy. Based on the amount of smoking, the mothers with cigarette smoking were divided into four groups which includes: preconception, the first trimester, second trimester and third trimester. The data analyses were performed using Logistic regression and 95% confidence interval along with p-value. A p-value < 0.05 was considered statistically significant.\u0000Results: Of a total of 1240 singleton births, 328 (26.5%) were LBW. Among them, 149 (12.1%) of the mothers reported smoking during pregnancy. When compared with the nonsmoking groups, all the maternal smoking groups had higher incidences of LBW infants, especially when the mothers smoked > 10 cigarettes / day and during any stage of conception.\u0000Conclusions: Smoking during pregnancy is associated with an increased incidence of LBW among the infants. In addition, the newborns of mothers who smoked >10 cigarettes / day were most susceptible to having LBW, irrespective of the stage of pregnancy during which the mothers smoked.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43934324","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}
Introduction: Prematurity is a major cause of admission in the NICU in most hospitals. Premature babies are likely to face complications. Understanding the factors contributing to preterm mortality is needed to identify interventions required to reduce neonatal mortality rate. This study aims to determine the causes of mortality in preterm babies. Methods: A retrospective study was carried out in Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal. All the preterm babies admitted in the sick newborn units were included. Descriptive statistics were performed using frequency and percentage. The bivariate and multivariate analyses were performed to determine the causes of mortality in preterm. Results: Total 205 (71.4%) admitted preterm babies had complications at the time of admission. LBW babies were three times more likely to have mortality among preterm admission (p – value < 0.0001). Co-morbidities such as sepsis (p - value < 0.05) and perinatal asphyxia (p – value < 0.0001) were significantly associated with preterm mortality. The duration of stay among preterm babies was higher compared to term babies. The mortality rate was higher among preterm admission compared to term admission (60% vs 40%). Conclusions: Preterm babies with LBW, neonatal sepsis and perinatal asphyxia are at greater risk of mortality. Improved antenatal and perinatal care, quality newborn care and appropriate infection prevention measures can help reduce preterm birth, prematurity related complications and mortality among these vulnerable group of newborns.
{"title":"Determinants of Mortality in Preterm Newborns Admitted in a Neonatal Intensive Care Unit: Findings from a Tertiary Level Maternity Hospital in Nepa","authors":"S. Karmacharya, Kalpana Upadhyaya Subedi, Sumit Agrawal, Noora Pradhan, Ritesh Barnwal, Prajwal Paudel","doi":"10.3126/jnps.v42i1.39957","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.39957","url":null,"abstract":"Introduction: Prematurity is a major cause of admission in the NICU in most hospitals. Premature babies are likely to face complications. Understanding the factors contributing to preterm mortality is needed to identify interventions required to reduce neonatal mortality rate. This study aims to determine the causes of mortality in preterm babies.\u0000Methods: A retrospective study was carried out in Paropakar Maternity and Women’s Hospital, Thapathali, Kathmandu, Nepal. All the preterm babies admitted in the sick newborn units were included. Descriptive statistics were performed using frequency and percentage. The bivariate and multivariate analyses were performed to determine the causes of mortality in preterm.\u0000Results: Total 205 (71.4%) admitted preterm babies had complications at the time of admission. LBW babies were three times more likely to have mortality among preterm admission (p – value < 0.0001). Co-morbidities such as sepsis (p - value < 0.05) and perinatal asphyxia (p – value < 0.0001) were significantly associated with preterm mortality. The duration of stay among preterm babies was higher compared to term babies. The mortality rate was higher among preterm admission compared to term admission (60% vs 40%).\u0000Conclusions: Preterm babies with LBW, neonatal sepsis and perinatal asphyxia are at greater risk of mortality. Improved antenatal and perinatal care, quality newborn care and appropriate infection prevention measures can help reduce preterm birth, prematurity related complications and mortality among these vulnerable group of newborns.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42892676","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 : 2022-11-27DOI: 10.3126/jnps.v42i1.39034
Kamal Parihar, Pradeep Kumar Gupta, Vandana Singh, Sanjay Sharma
Introduction: ROP is a challenge due to better premature survival. It has an increasing trend and is a preventable cause of vision loss. Its occurrence, severity and outcome in rural population is poorly studied. Methods: Ahospital based prospective observational longitudinal study was conducted on babies born at a tertiary care centre. Babies with gestation <32 weeks or birth weight < 1500 g were screened for ROP. Preterm babies of >32 weeks gestation with oxygen requirement, RDS, surfactant use, PDA, neonatal hyperbilirubinemia requiring phototherapy, septicemia, red cell transfusion due to anemia, need for inotropes were also included. Babies with ROP were assessed for severity as also need for intervention and were followed for12 months. Results: Of the 211 neonates screened, 51 had ROP. Frequency was inversely related to both birth weight and gestational age with no gender difference. Oxygen therapy (p 0.001), RDS (p 0.005), mechanical ventilation (p0.003) and septicemia (p 0.005) were main risk factors. Neonatal hyperbilirubinemia requiring phototherapy was found to be protective (p 0.0005). 15.68% cases required laser photocoagulation. During follow up, ROP regressed in all patients. Conclusions: Risk factors for ROP included oxygen usage, RDS, mechanical ventilation and septicemia. Blood products or inotropes use was not an independent factor. Neonatal hyperbilirubinemia was protective. When diagnosed early, outcome is good in ROP.
{"title":"Retinopathy of Prematurity: Incidence, Risk Factors & Outcome in North Indian Rural and Semi-urban population","authors":"Kamal Parihar, Pradeep Kumar Gupta, Vandana Singh, Sanjay Sharma","doi":"10.3126/jnps.v42i1.39034","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.39034","url":null,"abstract":"Introduction: ROP is a challenge due to better premature survival. It has an increasing trend and is a preventable cause of vision loss. Its occurrence, severity and outcome in rural population is poorly studied.\u0000Methods: Ahospital based prospective observational longitudinal study was conducted on babies born at a tertiary care centre. Babies with gestation <32 weeks or birth weight < 1500 g were screened for ROP. Preterm babies of >32 weeks gestation with oxygen requirement, RDS, surfactant use, PDA, neonatal hyperbilirubinemia requiring phototherapy, septicemia, red cell transfusion due to anemia, need for inotropes were also included. Babies with ROP were assessed for severity as also need for intervention and were followed for12 months.\u0000Results: Of the 211 neonates screened, 51 had ROP. Frequency was inversely related to both birth weight and gestational age with no gender difference. Oxygen therapy (p 0.001), RDS (p 0.005), mechanical ventilation (p0.003) and septicemia (p 0.005) were main risk factors. Neonatal hyperbilirubinemia requiring phototherapy was found to be protective (p 0.0005). 15.68% cases required laser photocoagulation. During follow up, ROP regressed in all patients.\u0000Conclusions: Risk factors for ROP included oxygen usage, RDS, mechanical ventilation and septicemia. Blood products or inotropes use was not an independent factor. Neonatal hyperbilirubinemia was protective. When diagnosed early, outcome is good in ROP.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47614336","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 : 2022-11-27DOI: 10.3126/jnps.v42i1.39003
A. Gupta, Deepa Shreyas, Ramya Nayak
Foreign body (FB) aspiration is a serious medical problem that can mimic other respiratory conditions. Isolated pleural effusion is a rare presentation of FB aspiration. We report herein a six years old boy presenting with fever and cough without history of choking and respiratory distress and X-ray chest suggestive of pleural effusion. Although, the child was initially misdiagnosed as pneumonia with sympneumonic effusion, the diagnosis was established only once he coughed out a piece of foreign body. The present case highlights that FB aspiration, even though rare, should be considered as one of the differential diagnosis of pleural effusion.
{"title":"Isolated Pleural Effusion- An Interesting Case Report of Foreign Body Aspiration-A Case Report","authors":"A. Gupta, Deepa Shreyas, Ramya Nayak","doi":"10.3126/jnps.v42i1.39003","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.39003","url":null,"abstract":"Foreign body (FB) aspiration is a serious medical problem that can mimic other respiratory conditions. Isolated pleural effusion is a rare presentation of FB aspiration. We report herein a six years old boy presenting with fever and cough without history of choking and respiratory distress and X-ray chest suggestive of pleural effusion. Although, the child was initially misdiagnosed as pneumonia with sympneumonic effusion, the diagnosis was established only once he coughed out a piece of foreign body. The present case highlights that FB aspiration, even though rare, should be considered as one of the differential diagnosis of pleural effusion.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45261840","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}
Immediate hypersensitivity to inhaled allergens is common in children. Although wheezing and urticaria are well known in immediate hypersensitivity, back pain is unknown. A nine year old boy with a history of asthma presented with back pain, but not wheezing or urticaria, while wiping the floor. The immuno-capsulated hydrophilic carrier polymer (ImmunoCAP) test revealed that dust mites and molds were the specific antigens causing the immediate hypersensitivity. Therefore, back pain can appear in immediate hypersensitivity. The ImmunoCAP test is useful for determining the allergens in atypical immediate hypersensitivity. Risk factors can be hidden in daily cleaning.
{"title":"Back Pain in Atypical Immediate Hypersensitivity Caused by Exposure to Dust Mites and Molds: A Case Report","authors":"Kazuto Taniguchi, Kazutaka Mizuta, Kazuyasu Uemichi","doi":"10.3126/jnps.v42i1.38141","DOIUrl":"https://doi.org/10.3126/jnps.v42i1.38141","url":null,"abstract":"Immediate hypersensitivity to inhaled allergens is common in children. Although wheezing and urticaria are well known in immediate hypersensitivity, back pain is unknown. A nine year old boy with a history of asthma presented with back pain, but not wheezing or urticaria, while wiping the floor. The immuno-capsulated hydrophilic carrier polymer (ImmunoCAP) test revealed that dust mites and molds were the specific antigens causing the immediate hypersensitivity. Therefore, back pain can appear in immediate hypersensitivity. The ImmunoCAP test is useful for determining the allergens in atypical immediate hypersensitivity. Risk factors can be hidden in daily cleaning.","PeriodicalId":39140,"journal":{"name":"Journal of Nepal Paediatric Society","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46340981","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.v41i3.35051
D. Shrestha, P. Amatya, A. Sharma, S. Shrestha, Yograj Sharma, S. Pathak, P. Pokharel, N. Shrestha, Santosh Pokhrel, Srijana Dongol, Ganendra Bhakta Raya, Amrit Ghimire, J. Koirala, S. Basnet
Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit
{"title":"Nepal Paediatric Society Guideline for use of Antibiotics in Critically ill Children in the Pediatric Intensive Care Unit","authors":"D. Shrestha, P. Amatya, A. Sharma, S. Shrestha, Yograj Sharma, S. Pathak, P. Pokharel, N. Shrestha, Santosh Pokhrel, Srijana Dongol, Ganendra Bhakta Raya, Amrit Ghimire, J. Koirala, S. Basnet","doi":"10.3126/jnps.v41i3.35051","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.35051","url":null,"abstract":"Justification: Overuse and administration of unnecessary and inappropriate antibiotics are the leading causes for the increased antimicrobial resistance worldwide. Judicious use of antimicrobials can prevent this phenomenon. \u0000Objective: Create a collaborative outline for the use of antibiotics in the paediatric intensive care unit for various infections, based on evidence, taking into consideration local antimicrobial susceptibility patterns. \u0000Process / Methods: Under the aegis of Nepal Paediatric Society, this guideline has been developed after several meetings of paediatricians working in various hospitals in different parts of Nepal, looking into the prevalent diseases and local sensitivity patterns of antibiotics. \u0000Recommendations: This guideline will help standardize the treatment protocol in paediatric intensive care units in Nepal and help paediatricians decide the appropriate use of antibiotics promptly while managing critically ill children. \u0000Keywords: Antibiotics; antibiotic sensitivity; antimicrobial resistance; critically ill child; Paediatric Intensive Care Unit ","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":"44938655","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.v41i3.32410
Anusha Patil, B. Vishwanath
Introduction: Patients with DKA generally present with a high anion gap metabolic acidosis (AG > 16) due to the presence of ketones but may also develop a narrow anion gap metabolic acidosis related to hyperchloremia. This study attempts to determine the incidence of hyperchloremic metabolic acidosis (before starting IV fluids) in children with DKA and to evaluate the impact of hyperchloremic metabolic acidosis on acute kidney injury and cerebral edema and inturn on mortality and duration of PICU stay. Methods: This was a prospective study conducted in the Department of Paediatrics, VIMS, Bellary between May 2016 to December 2017 and a total of 32 patients with DKA were enrolled in the study. Along with routine investigations, ABG and serum chloride levels were measured at the time of admission for categorization into normochloremic (high anion-gap) metabolic acidosis and hyperchloremic (normal anion-gap) metabolic acidosis. Incidence of hyperchloremic metabolic acidosis and its impact on the development of acute kidney injury and cerebral edema was taken as the primary outcome of the study. Mortality rate and duration of PICU stay were taken as a secondary outcome. Results: Hyperchloremic metabolic acidosis was observed in 18.8% of the study group. Acute kidney injury was seen in 38.4% of children who had normochloremic metabolic acidosis and in 83.3% of children with hyperchloremia. About 50% patients developed cerebral edema in the hyperchloremia group and only 3.8% developed cerebral edema in normochloremic group. These differences were statistically significant. Mortality rate in normochloremic and hyperchloremic metabolic acidosis was 3.8% and 50% respectively. Conclusions: Hyperchloremia at presentation in DKA is a risk factor for increased mortality. This fact should be born in mind while treating patients aggressively with chloride-containing fluids. Simple investigations like ABG and serum chloride levels can direct careful management of DKA and appropriate selection of IV fluids.
{"title":"Hyperchloremic Metabolic Acidosis in Diabetic Ketoacidosis – Boon or Bane in Paediatrics? Prospective Cohort Study","authors":"Anusha Patil, B. Vishwanath","doi":"10.3126/jnps.v41i3.32410","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.32410","url":null,"abstract":"Introduction: Patients with DKA generally present with a high anion gap metabolic acidosis (AG > 16) due to the presence of ketones but may also develop a narrow anion gap metabolic acidosis related to hyperchloremia. This study attempts to determine the incidence of hyperchloremic metabolic acidosis (before starting IV fluids) in children with DKA and to evaluate the impact of hyperchloremic metabolic acidosis on acute kidney injury and cerebral edema and inturn on mortality and duration of PICU stay. \u0000Methods: This was a prospective study conducted in the Department of Paediatrics, VIMS, Bellary between May 2016 to December 2017 and a total of 32 patients with DKA were enrolled in the study. Along with routine investigations, ABG and serum chloride levels were measured at the time of admission for categorization into normochloremic (high anion-gap) metabolic acidosis and hyperchloremic (normal anion-gap) metabolic acidosis. Incidence of hyperchloremic metabolic acidosis and its impact on the development of acute kidney injury and cerebral edema was taken as the primary outcome of the study. Mortality rate and duration of PICU stay were taken as a secondary outcome. \u0000Results: Hyperchloremic metabolic acidosis was observed in 18.8% of the study group. Acute kidney injury was seen in 38.4% of children who had normochloremic metabolic acidosis and in 83.3% of children with hyperchloremia. About 50% patients developed cerebral edema in the hyperchloremia group and only 3.8% developed cerebral edema in normochloremic group. These differences were statistically significant. Mortality rate in normochloremic and hyperchloremic metabolic acidosis was 3.8% and 50% respectively.\u0000Conclusions: Hyperchloremia at presentation in DKA is a risk factor for increased mortality. This fact should be born in mind while treating patients aggressively with chloride-containing fluids. Simple investigations like ABG and serum chloride levels can direct careful management of DKA and appropriate selection of IV fluids.","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":"42361486","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.v41i3.36601
.. Richa, Shashi Sharma, S. Madan, Sanasam Manimukta Singh, B. Yadav, Daksh Yadav
Introduction: Cleft lip and/ or cleft palate are the most common visible craniofacial anomalies. These patients often have feeding difficulties and recurrent infections leading to an altered immune system which can be assessed by the variations in hematological parameters. We intended to assess the clinical profile and the hematological parameters in patients with cleft lip and palate. Methods: This is a three-year cross-sectional study conducted at SGT Medical College, Gurugram, Haryana, India from January 2017 to December 2019 involving assessment of patients with cleft lip and palate who visited the paediatric unit for complete evaluation before surgery. Syndromic children or those with associated deformities were excluded .A total of 115 patients were enrolled in the study and the following information was recorded: Age, Gender and type of cleft (Cleft lip and alveolus, cleft lip, alveolus and palate, and isolated cleft palate). Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were evaluated and compared amongst the anatomical subtypes. Results: A total of 115 patients were included in the study, of which 66 (57.4%) were males and 49 (42.6%) were females. 57 (49.6%) had a cleft lip, alveolus, and palate, 36 (31.3%) had a cleft lip and alveolus and 22 (19.1%) had cleft palate only. Anaemia was present in 71.1% of cases. 83.4% cases of cleft lip and alveolus while81.8% of isolated cleft palate were anaemic. Microcytic hypochromic anaemia was present in 63.4% of cases while 36.6% had normocytic normochromic anaemia. The total leukocyte count was elevated in 60 children (52.2%) which was highest in cleft lip and alveolus (66%). Absolute neutrophil count was significantly high in the lip and alveolus groups.(13.9%) Absolute lymphocyte count was highest in lip and alveolus (30.56%). Absolute monocyte count and the absolute eosinophil count was low in the majority of cases. Conclusions: A large number of children with cleft lip and/ or palate are not exclusively breastfed due to anatomical deficits. They need supplemental iron to meet the demands. A standard policy to provide auxillary iron by health care professionals should be made at the first visit to the health centre because nutritional anaemia negatively affects the physical and cognitive development of a child. It also unnecessarily prolongs the date for optimum and safe surgery.
{"title":"Clinical and Hematological profile of Paediatric Patients with Cleft Lip and Palate in a Tertiary Care Hospital of Haryana, India","authors":".. Richa, Shashi Sharma, S. Madan, Sanasam Manimukta Singh, B. Yadav, Daksh Yadav","doi":"10.3126/jnps.v41i3.36601","DOIUrl":"https://doi.org/10.3126/jnps.v41i3.36601","url":null,"abstract":"Introduction: Cleft lip and/ or cleft palate are the most common visible craniofacial anomalies. These patients often have feeding difficulties and recurrent infections leading to an altered immune system which can be assessed by the variations in hematological parameters. We intended to assess the clinical profile and the hematological parameters in patients with cleft lip and palate.\u0000Methods: This is a three-year cross-sectional study conducted at SGT Medical College, Gurugram, Haryana, India from January 2017 to December 2019 involving assessment of patients with cleft lip and palate who visited the paediatric unit for complete evaluation before surgery. Syndromic children or those with associated deformities were excluded .A total of 115 patients were enrolled in the study and the following information was recorded: Age, Gender and type of cleft (Cleft lip and alveolus, cleft lip, alveolus and palate, and isolated cleft palate). Hematological parameters including hemoglobin, total leukocyte count, differential leukocyte count, absolute eosinophil count, and red cell indices were evaluated and compared amongst the anatomical subtypes.\u0000Results: A total of 115 patients were included in the study, of which 66 (57.4%) were males and 49 (42.6%) were females. 57 (49.6%) had a cleft lip, alveolus, and palate, 36 (31.3%) had a cleft lip and alveolus and 22 (19.1%) had cleft palate only. Anaemia was present in 71.1% of cases. 83.4% cases of cleft lip and alveolus while81.8% of isolated cleft palate were anaemic. Microcytic hypochromic anaemia was present in 63.4% of cases while 36.6% had normocytic normochromic anaemia. The total leukocyte count was elevated in 60 children (52.2%) which was highest in cleft lip and alveolus (66%). Absolute neutrophil count was significantly high in the lip and alveolus groups.(13.9%) Absolute lymphocyte count was highest in lip and alveolus (30.56%). Absolute monocyte count and the absolute eosinophil count was low in the majority of cases.\u0000Conclusions: A large number of children with cleft lip and/ or palate are not exclusively breastfed due to anatomical deficits. They need supplemental iron to meet the demands. A standard policy to provide auxillary iron by health care professionals should be made at the first visit to the health centre because nutritional anaemia negatively affects the physical and cognitive development of a child. It also unnecessarily prolongs the date for optimum and safe surgery. ","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":"45635144","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：