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.

Background: Neonatal sepsis, a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life is a major cause of morbidity and mortality in newborn inborn. Early diagnosis is critical, as sepsis can progress more rapidly in neonates than in adults. An attempt was made to establish correlation between early neonatal sepsis screening & blood culture in neonates presenting with features of sepsis. The aim of this study is to assess the usefulness of sepsis screen in early diagnosis of neonatal septicemia. Materials and Methods:The study was done in Kist medical college and hospital, Nepal from October 2015 to October 2016. Statistical correlation between early indicators of sepsis screen & blood culture (considered as gold standard) was established in clinically suspicious cases of neonatal sepsis. Results: Out of 150 cases studied, 72 were culture positive. CRP (77.8%) and immature: total neutrophils ratio (73%) showed highest sensitivity. CRP (66.7%), I/T ratio (61.5%) and micro ESR (60.2%) showed highest specificity. Positive predictive value was highest for CRP (68.2%) followed by I/T ratio (63.8%) and corrected total leukocyte count (56.2%). Conclusion:Serum CRP is the most sensitive marker of sepsis. Use of peripheral smear study and CRP can be implicated effectively as a sepsis screen for early diagnosis of neonatal sepsis. The combination of parameters yielded better results than single tests and proved to be an invaluable tool for early diagnosis of neonatal sepsis.

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: Acute poisoning is one of the common cause of emergency visits and hospital admissions and is a potentially preventable cause of childhood mortality and morbidity. The objectives of this study were to identify the common type of poisoning in children, to determine types of poisoning according to age and to find out the the common age group in which the incidence of poisoning was high. Materials and Methods: It was a descriptive observational study done in a teaching hospital in Lalitpur, Nepal in patients aged 1 month to 18 years who visited the emergency department and were admitted to hospital with history of alleged poisoning from Results: Fifty patients were included. Drugs, kerosene and organophosphorus were most common cause of poisoning. Drugs and kerosene below 10 years of age and organophosphorus and drugs above 10 years of age were common types of poisoning. Maximum numbers (50%) of children with poisoning cases were below five year of age. Mean duration of hospital stay was 2.1 days and mean age of poisoning was 7.8 years with a male (54%) predominance. Majority of poisoning occurred at home (84%) and 68% of patients were symptomatic at presentation to hospital with 84% of patients presenting to hospital within six hours. Conclusion: This study showed that drugs, kerosene and organophosphorus were most common forms of poisoning. While young children were most vulnerable for acute poisoning.

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.

Introduction: Lower respiratory tract infection is a major cause of death in children in a developing country and anemia is found to be one of the commonest associated cofactors. This study was aimed to determine association of anemia in children with lower respiratory tract infections.Materials and Methods: The retrospective study was done over a one-year period for children under 5 years of age, admitted in Pediatric Ward of a tertiary Hospital in Lalitpur. The study included 100 diagnosed cases of lower respiratory tract infections as per WHO criteria and 100 age and sex matched patients who did not have respiratory complaints as controls, excluding prematurity, chronic diseases, malnutrition and severe systemic illness. Appropriate clinical history, examination routine investigations like hemoglobin, peripheral smear, and Chest X-ray were included.Results: The age distribution maximum children were in the age group of 3 months to 23 months with significant association with prevalence of both pneumonia (p value 0.005) and anemia (p value 0.002). Anemia was found to be a significant risk factor for LRTI (p value < 0.001) with odds ratio of 2.68 and 95% CI (1.51 – 4.75).Conclusions: Anemia was significantly found to be associated with lower respiratory tract infections and these children were found to be 2.68 times more susceptible to lower respiratory tract infections. Early diagnosis and prevention of anemia is thus important to reduce the incidence of lower respiratory tract infections in children.Nepalese Medical Journal. vol.1, No. 1, 2018, page: 5-8

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.