Introduction: Jaundice is an important problem during neonatal period. When total serum bilirubin (TSB) level exceeds a critical limit, it crosses the blood brain barrier and results into bilirubin encephalopathy. The main aim of therapy for neonatal hyperbilirubinemia is prevention of bilirubin encephalopathy by phototherapy and/or exchange transfusion. The aims of this study were to evaluate the efficacy of exchange transfusion (ET) and observe the adverse events during and following three days of ET in neonates with hyperbilirubinemia. Materials and Method: Hospital based cross-sectional descriptive study. All neonates admitted to neonatal intensive care unit and /or paediatric wards of a tertiary-care centre between September 2010 to March 2012, requiring ET were enrolled. Results: A total of 139 ETs were performed in 120 neonates. The common causes were ABO incompatibility (30.8%), prematurity (30.8%), idiopathic (27.5%), Rh isoimmunization (6.7%) and cephalhematoma (4.2%). Mean pre-ET total serum bilirubin (TSB) was 24.2 mg% dL. There was 58% reduction in TSB in post ET and 31% net reduction in 6 hr post ET. Term and preterm neonates showed equal percentage of TSB reduction. Respiratory distress (10.8%) and bradycardia (6.7%) were the common adverse events during, and hypocalcemia (98.3%) and thrombocytopenia (34.2%) in 3 days following ET. The sick neonates had significantly higher incidence of thrombocytopenia (p= 0.031), respiratory distress (p=0.009), apnea (p<0.001) and cardiorespiratory arrest (p<0.001). Overall mortality was 4.2%, and non-survivors were mostly low birth weight, born outside the present hospital and had higher incidence of adverse events. Conclusion: Exchange transfusion is an effective intervention in reducing the serum bilirubin level. However, these neonates require monitoring of ionised calcium and thrombocytopenia. Sick neonates had higher incidence of adverse events than healthy and close clinical monitoring is needed to improve the outcome.

Introduction: Acute respiratory infection is a leading cause of morbidity and mortality in under 5 children in developing countries. There are various modifiable risk factors associated with Acute Respiratory Tract Infection (ARI). Hence, identification of associated risk factors for ARI may be helpful to reduce the burden of disease. The aims of this study were to study the risk factors for ARI in under five hospitalized children and to correlate risk factors with ARI related morbidity. It was a hospital-based prospective study. Materials and Methods: Children of less than 5 years admitted in ward with diagnosis of ARI were enrolled in the study as cases. Control included children under 5 years of age attending to Well Baby Clinic, Immunization Clinic and siblings or relatives under 5 years who came with patients in the Paediatric outpatient department of the same institution during the same period. Various risk factors, demographic and clinical data of each child were recorded in a pre-designed proforma of both groups. Results: A total of 200 cases and 200 controls were enrolled. The various risk factors associated with ARI on stepwise logistic regression were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition. The statistically insignificant risk factors were infancy, economic status, illiterate parents, cooking fuel other than LPG, low birth weight, prematurity, lack of exclusive breast feeding, vitamin A deficiency and incomplete immunization. Conclusion: The various risk factors for ARI identified in this study were male gender, rural residency, overcrowding, history of ARI in any family member within two weeks and undernutrition.

Objectives: The present study was undertaken to study the incidence, etiological factor, and days of onset, clinical types and biochemical abnormalities in babies having neonatal seizures. Materials and Methods: This is a retrospective, observational hospital based study. Ninety neonates, who developed seizures before 28 days of life and admitted to neonatal intensive care unit and nursery with neonatal seizure, were evaluated for incidence, etiological factor, clinical types and biochemical abnormalities found in neonatal seizure. The variables were analysed using Chi-Square and student t-test. Results: The incidence of neonatal seizure was 10.3/ 1000 live births. The seizures were common in male babies. 65 (72.2%) neonates were born to multiparous women while 35 (38%) were born to primigravidas. In birth asphyxia (n= 40), the most common type of seizure observed was subtle seizure 20 (50%), followed by focal clonic 10 (25%) and multifocal clonic 5 (12.5%). Tonic type of seizure was observed in 3 (7.5%) and myoclonic in 2 (5%). Meningitis and septicaemia was the second most common cause of neonatal seizure observed in our study. Among metabolic abnormalities hypoglycaemia was found in 20 (22%) and hypocalcaemia in 10 (11%). Conclusion: The commonest cause of seizure was birth asphyxia presenting within 72 hours of life. Among infection septicaemia and meningitis was the most common cause leading to neonatal seizure. Among biochemical abnormalities the most common cause of seizure observed in our study was hypoglycaemia and hypocalcaemia. Subtle seizures were the commonest type of seizure observed in this study.

Background: Tobacco use as a habit by females and during pregnancy not only affects the maternal health but has negative impact on fetal health as well, but so far there has been few studies related to this issue in Nepal. No study of such type has been done in the Eastern Development region of Nepal. Objectives: This study was designed with the objectives to measure the proportion of women using tobacco during pregnancy among the patients enrolled and to compare the pregnancy course and socio-demographic variables between tobacco users and non users. Methods: Appropriate sample of 234 women selected from postnatal wards of Dhankuta and Sunsari district hospitals and Teaching Hospital of B P Koirala Institute of Health Sciences (BPKIHS) in the eastern Nepal from July 2009 to June 2010. They were interviewed and the data analyzed on SPSS 17 version. Results: The study revealed that the prevalence of tobacco use during pregnancy was 19.2 percent. Maximum number of the tobacco users was found in the age group of 20-29 years during their pregnancy. More than 73% of tobacco users were below the poverty line. Conclusion: No significant association was seen between the use of tobacco during pregnancy and events during pregnancy like abortion, pre term delivery, peri-natal mortality, low birth weight etc. And also, no significant difference was observed in health problem among the participants in between the groups. Health Renaissance, January-April 2013; Vol. 11 No.1; 157-161 DOI: http://dx.doi.org/10.3126/hren.v11i2.8225

Background: Adequate nutrition early in life has an important role in determining infants' growth and development, and in preventing many adult diseases. Over 2/3 rd of under-5 child deaths in the world is associated with inappropriate feeding practices and occurs during infancy. Yet, only 1/3 rd of world's infants are optimally fed. Objectives: To investigate breast feeding patterns and its relation to sociodemographic factors; and to identify factors associated with initiation, continuation, and maintenance of breast-feeding. Methods: Cross-sectional, semistructured questionnaire based study. 508 mothers of infants attending health center were interviewed about feeding patterns and socioeconomic variables. Data were analyzed using appropriate statistical methods. Results: 55.9% infants were breastfed within first hour of life and 90% within the first day. Rapid decline in exclusive-breastfeeding was seen with infant's age (78.6% at 1 month, 37.3% at 1-3 months, 35.4% at 3-6 months). Factors significantly associated with exclusive breast-feeding were maternal age and education, family income and type. 17.9% infants were given pre-lacteals where as 92.9% received Colostrum. Major factors associated with early initiation of breast-feeding were maternal age and education, family type and mode of delivery. Conclusion: The results show that national guidelines, public messages, and educational campaigns need to be strengthened to achieve desired goals regarding breast feeding.

A two month old male child presented to emergency of B. P. Koirala Institute of Health Sciences (BPKIHS), Dharan and was admitted to Paediatric ward with history of fever, cough and respiratory distress. On examination the breathing was rapid and shallow. The child was small for age with an upper to lower segment ratio of 1.9. The anteroposterior diameter of thorax was reduced. We report a very rare case of achondroplasia which was recognized in a two month age child who presented with severe pneumonia. Usually the clinically features of achondroplasia is more prominent when the child is growing in height but we diagnosed it in a two months child after performing the skeletal survey.