Introduction: Diarrhea is a leading cause of mortality in children in developing countries and the condition is worse in slums. In order to provide effective preventive and management strategies, it is important to identify factors associated with the disease. This study was carried out to investigate the risk factors of diarrhea in  children under five years of age in urban slums.   Methods: Parents of all children under five years from the urban slums of Tansen municipality, Palpa, Nepal were interviewed using a standardized pretested questionnaire and proforma. Parental variables, environmental factors, and presence of diarrhea in those children in past three months were collected by trained enumerators and the data were analyzed with statistical software SPSS-10.   Results: A total of 450 under five years children were enrolled in the study. There were 216 (48%) male and 234 (52%) female children with F:M ratio of 1.08:1. Occurrence of diarrhea was lower if the children were breast-fed for more than six months, well-nourished, used fountain water for drinking, or used boiled or treated water. Similarly, diarrhea prevalence was lower if father had a regular job, daily income in the family was more than one US dollar, there was a toilet in the house, practice of hand washing was followed before feeding or preparing food, or there was no child suffering from diarrhea in the neighborhood.   Conclusion: There are a few variables that are significantly related to diarrhea in children under five years of age. In order to decrease the diarrheal episodes in children in the slums of the developing countries, priority could be given in the improvement of those variables.

Introduction: When more than two fetuses simultaneously develop in the uterus, it is called higher order multiple pregnancy. The incidence of such pregnancies ranges from 0.01% to 0.07%.   Case report: We report a case of 26-year-old G2P1L0D2 with previous history of preterm vaginal twin delivery, diagnosed to have quadruplet pregnancy. She was admitted at 28 weeks of gestation for safe confinement. At 33 weeks of gestation, emergency cesarean section was conducted with outcome of two female and two male babies with quadriamniotic and quadrichorionic placenta, without any intra and post-operative complications.   Conclusion: A multidisciplinary approach with good neonatal care facilities is warranted for a better outcome in higher order multiple pregnancies.

ABSTRACT:Introduction: Perinatal asphyxia, a major topic in neonatology, is a severe condition which has a high impact on neonatal mortality and morbidity and neurological and intellectual development of the infant. It is defined by WHO as"failure to initiate and sustain breathing at birth". It is estimated that around four million babies are born asphyxiated and among those one million die and an equal number of babies develop serious neurological consequences ranging from cerebral palsy and mental retardation to epilepsy. This study was done to identify the occurrence, clinical profile and, immediate outcome of perinatal asphyxia in Lumbini Medical College Teaching Hospital. Methods: It was a retrospective study where 82 cases who fulfilled the inclusion criteria were included between December 2014 to November 2015. Inclusion criteria included newborns with: a) APGAR score equal to or less than six at five minutes, b) requirement of more than one minute of positive pressure ventilation, c) signs of fetal distress (heart rate of less than 100 beats per minute, late decelerations). Results: Out of total 425 neonatal intensive care unit (NICU) admissions, 82 (19.3%) cases were of asphyxia among which 56 were inborn and 26 were referred from outside. Of those 82 cases, 47 (57.3%) cases developed hypoxic ischemic encephalopathy (HIE); HIE stage I had good outcome with survival rate of 95% and HIE stage III had poor outcome with survival rate of only 25%. Conclusion: Despite advances in management of neonates, perinatal asphyxia is still the leading cause of neonatal intensive care unit admission and mortality and morbidity in neonates.

Introduction: Respiratory distress in newborns is a very common reason for admission in Neonatal Intensive Care Unit which may be transient or pathological; morbidity is high if not prompted for early diagnosis and treatment. The present study is undertaken to find out the clinical profile of neonates with respiratory distress in infants in a tertiary care hospital in western Nepal. Methods: A descriptive cross-sectional study was carried out in a tertiary care hospital in the western region of Nepal from April 2017 to March 2018 after approval from the institutional review committee. Sample size was calculated and consecutive sampling was done to reach the sample size. Data were collected from the study population after taking consent and entered in a predesigned proforma. It was then entered in a Statistical Package for Social Sciences, data analysis was done to find frequency and proportion for binary data. Results: Tachypnea was the most common presentation 77 (69.36%). Out of 1694 live deliveries during the study period, the prevalence of respiratory distress was 6.55 % in the total live deliveries while 30.83 % in admitted cases in Neonatal Intensive Care Unit. Survival rate was 95.50% while mortality rate accounted for 4.50%. Conclusions: Perinatal asphyxia accounted for the commonest cause of respiratory distress. To lessen the morbidity and mortality of the neonates with respiratory distress it is advocated that we practice proper and timely neonatal resuscitation, recognize the risk factors as early as possible so that perinatal asphyxia can be minimized.    

Background: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality in developing countries like Nepal. In order to lower the morbidity and mortality of newborns in Neonatal Intensive Care Unit (NICU), it is essential to study the bacteriological profile and antibiotic sensitivity. Objective: This study aims to study the common bacteriological profile and their antibiotics susceptibility pattern in the NICU of medical college of western Nepal. Methodology: A descriptive cross-sectional study was conducted in NICU of Devdaha Medical College and Research Institute, Nepal among all blood culture positive neonates admitted between April 2020 to September 2020. Convenient sampling was done. All clinically suspected neonates were identified and laboratory data including bacteriological profile and antibiotic sensitivity were recorded and analyzed using Statistical Package for the Social Sciences (SPSS) version 20. Results: Among 215 neonates admitted in the NICU, 45 (20.9%) had culture positive sepsis. Most isolates were early onset sepsis (62.22%) and low birth weight (57.78%). The majority of isolates were Gram positive, predominantly Staphylococcus aureus (37.78%). Staphylococcus aureus showed higher resistance to Cloxacillin (57.1%) and had higher sensitivity to Vancomycin and Linezolid (100%). Similarly, Gram negative isolates, Escherichia coli and Klebsiella sps, showed higher resistance to Ceftriaxone (100%) and Cefoperazone and were highly sensitive to Imipenem (100%) and Colistin (100%). Conclusion: Staphylococcus aureus was the most common organism causing neonatal sepsis in current study with increasing resistance to commonly used Cloxacillin and Ampicillin and highly sensitive to Vancomycin and Linezolid. There is higher risk of emergence of antibiotic resistance. Thus, rational use of empirical antibiotics is necessary to prevent drug resistant sepsis.