Background: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved. Objectives:This study was conducted to analyze the spectrum of diseases and outcomes at a level two NICU at a tertiary care teaching hospital. Methods: A descriptive observational study conducted at the neonatal care unit in the Department of Paediatrics at KIST Medical College, Lalitpur, Nepal over one year from 14th of April 2013 to 13th April 2014. Data on age at admission, gender, gestational age, birth weight, initial presenting symptoms at admission, fi nal diagnosis and outcome were collected from in patient records at the hospital record section and analyzed using SPSS 17.0. Results: A total of 279 neonates were studied. The commonest causes of admission were infection (45.9%), followed by respiratory conditions (14.7%), neonatal jaundice (12.5%), perinatal asphyxia (9.3%) and prematurity/ small for gestational age (SGA) (6.5 %). Most of the admissions (62%) were during the fi rst 24 hours of life. The majorities, 89.2%, were term gestation and 10.8% were preterm. Most of the preterm babies were late preterms with gestational ages between 35-36 weeks (73% of preterms were late preterms). Total of four mortalities (1.4%) occurred, three of which were due to perinatal asphyxia and one was a Down's syndrome with overwhelming sepsis. Conclusion: In this study, infections followed by respiratory conditions were the leading causes of admission. Most of the admissions occurred during the fi rst 24 hours of life. This emphasizes the fact that attentiveness during the fi rst day of life, simple measure to prevent infection and early detection and treatment may go a long way in improving neonatal outcome.

BackgroundSystemic lupus erythematosus (SLE) is known to present with a wide variety of clinical manifestations. Lymphadenopathy is frequently observed in children with SLE and may occasionally be the presenting feature. SLE presenting with granulomatous changes in lymph node biopsy is rare. These features may also cause diagnostic confusion with other causes of granulomatous lymphadenopathy.Case presentationWe report 12 year-old female who presented with generalized lymphadenopathy associated with intermittent fever as well as weight loss for three years. She also had developed anasarca two years prior to presentation. On presentation, she had growth failure and delayed puberty. Lymph node biopsy revealed granulomatous features. She developed a malar rash, arthritis and positive ANA antibodies over the course of next two months and showed WHO class II lupus nephritis on renal biopsy, which confirmed the final diagnosis of SLE. She was started on oral prednisolone and hydroxychloroquine with which her clinical condition improved, and she is currently much better under regular follow up.ConclusionGeneralized lymphadenopathy may be the presenting feature of SLE and it may preceed the other symptoms of SLE by many years as illustrated by this patient. Granulomatous changes may rarely be seen in lupus lymphadenitis. Although uncommon, in children who present with generalized lymphadenopathy along with prolonged fever and constitutional symptoms, non-infectious causes like SLE should also be considered as a diagnostic possibility.

Hepatitis A virus infection is a common public health problem in developing countries primarily due to poor hygiene and sanitation. The clinical features of hepatitis A virus are mostly related to the derangement of liver function with occasional extrahepatic complications. Herein, a 2.5-year-old girl presented with abdominal pain and decreased appetite for 4 days, high-colored urine for 3 days, and yellowish discoloration of the eyes for 2 days. On presentation, there was icterus along with hepatomegaly and diminished breath sounds on the right side were noted 1 day after admission. Chest X-ray revealed right sided pleural effusion; however, ultrasonography of chest and abdomen displayed bilateral pleural effusion (right more than left) and minimal ascites with thickened gall bladder wall. Immunoglobulin M anti-hepatitis-A virus serology was positive. The pleural effusion in this child resolved spontaneously in 10 days. We report this case to highlight that hepatitis A infection should be considered in the differential diagnosis of pleural effusion in a patient with features of acute hepatitis. However, other common causes of pleural effusion such as tuberculosis and parapneumonic effusions that may coexist with hepatitis, especially in developing world, need to be excluded.

Introduction: Sleep is an integral part in a child's health and development. During different stages of development, there are aberrations in normal physiology of sleep which make children more susceptible to various types of sleep problems. This study was conducted to identify sleep pattern and sleep problems in Nepalese children using Nepali translation of Brief Infant Sleep Questionnaire (BISQ) screening tool. Materials and Methods: This was a descriptive cross-sectional study. Data were collected from parents of children aged 6 to 36 months attending paediatric out-patient clinic for general health check-up from July 2013 to December 2013. Nepali translation of the BISQ was used as a screening tool for sleep problems in this study. Results: The study included 553 children (52.4% boys). Mothers completed the questionnaire in 92% of children. Mean total duration of sleep in 24 hours was 11.7 ±1.7 hours. Respondents reported sleep problem in 16.9% of children whereas 20.3% of children had sleep problems according to BISQ criteria. As per this criteria, 2.7% of children had total sleep duration less than 9 hours, 5.9% of children had total night awakening duration of more than one hour, 13.9% of children had night waking >3 times. These BISQ sleep parameters differed significantly in children with and without sleep problems (p<0.001). In addition, children with sleep problem took longer time to sleep than children without sleep problems (p<0.001). Conclusion: Sleep problems are common in Nepalese infants and toddlers according to the BISQ. Screening for sleep problems is highly recommended during health care visits given the prevalence of sleep problems identified by this study to reduce their potential adverse impact.

Background: Sleep problems are common in children and various questionnaires have been devised to screen these problems. Brief Infant Sleep Questionnaire (BISQ) is one of the sleep screening tools which is simple, reliable and valid tool and is being used for screening of sleep problems in infants and toddlers in various countries. Objectives: The objective of this study was to translate English version of Brief Infant Sleep Questionnaire to Nepali language using a standard technique so that Nepali version could be used to screen sleep problems in Nepalese infants and toddlers. Methods: This article describes the process of translation of original BISQ questionnaire into Nepali language in a standard method. Four bilingual paediatricians translated English BISQ to Nepali language which was then tested among few parents for understanding, clarity and uniformity of expected response. A draft version was fi nalized after consensus of translators, two expert paediatricians and original author. This version was then translated back into English by two independent medical professionals and compared with original BISQ for content and meaning. The fi nal version of Nepali translation was approved after consensus agreement. Results: The translated Nepali BISQ was then tested among 15 parents who had a child below three years of age. These parents did not fi nd diffi culty in understanding and responses were uniform and as expected from the original questionnaire. Conclusion:The Nepali version of BISQ could be applicable as a screening tool to assess sleep in infants and toddlers in clinical setup as well as research studies.