Background: The addition of medium chain triglycerides is preferable as they are more easily digested and quickly absorb in bloodstream than long chain fat and provide ready supply of energy by increasing fatty acid bioavailability. Modular products like micro lipids and medium-chain triglyceride (MCT) oils are now focused as a fat supplementation. The rate of weight gain with MCT is not well known, and there is very less research done in Pakistan. Objective: To determine the effect of MCT oil supplemented human milk compared with un supplemented human milk fed to preterm infants on promoting weight gain. Study Design: Randomized controlled trial Study Setting: This study was conducted in Department of Neonatology, Children Hospital, PIMS, Islamabad, Pakistan from 20th August 2022 to 20th February 2023. Methodology: The study conducted after approval from institutional ethical committee. A total of 160 preterm infants fulfilling the inclusion criteria and enrolled in the study after informed consent from parents. The patients were receiving enteral feeding of human milk within neonatology department of hospital was included and they were randomly assigned to Group NF (receiving 20 ml of human milk without MCT oil), Group F (receiving 20ml of human milk with 1 ml of MCT oil fat). Primary outcomes were including growth in term of weight gain at measured at 1st ,5th and 10th day of MCT oil intake after hospital admission. Secondary outcome included feeding intolerance, diarrhoea, sepsis and necrotising enterocolitis. All the data was collected in the form of a questionnaire. The statistical analysis was done by using SPSS version 20. Results: One sixty very low birth weight infants were analyzed in this study. All infants were randomly divided into two groups: F and NF, the demographic details. The weight of infants was measured on first day, fifth day and tenth day and noted that the frequency of infants improved the weight gain after taking human milk without fat supplementation or human milk with fat supplementation. We found the gradually infants more increasing their weights in Group F as compared to Group NF. On tenth day 75% infants reaches between1400-1490 gm weight (p<0.001). The average daily gain in weight of Group F infants (g/kg). 12.2 Group A, 13.6 in group B were calculated on day first. The average daily weight was shifted in Group B from 13.6 to 14.9 on day fifth then it was further increased as 15.6 in Group C, and 15.8 in Group D. Practical Implication: The fat in the milk of humans is a significant source of energy. In an underdeveloped State like Pakistan that is short on resources, (MCT) oil can be a useful substitute for MCT due to its high MCT content. Few research studies have been conducted into this area thus far. Previous studies have had a low number of participants and produced contradictory findings. Therefore, this study was carried out to compare the efficacy of feeding preterm infants human milk supplemented with MCT oil to that of feeding them human milk without the supplement. Conclusion: Our study shows the average weight gain in those infants fed fat supplementation of MCT oil added in breast milk. The study provides data regarding the selection and use of fat supplemented human milk over non-supplemented human milk and this reduces the morbidity and mortality rate due to insufficiency of nutrients. Keyword: Fat supplementation, MCT oil, breast milk, preterm infants, weight gain rate.

Objective: To determine the frequency of common causes of severe anemia in children under 5 years of age admitted in children hospital, Lahore Design of the Study: Cross sectional study Study Settings: The study was conducted at Department of Pediatric Medicine, Children Hospital, Lahore from 5 Sep 2018 to 5 March 2019. Material and Methods: Patients were evaluated for the severity of anemia by the Hb level, baseline investigations, CBC with peripheral film and retics count, Hb electrophoresis, osmotic fragility test, G6PD assay, serum bilirubin, coomb’s test and bone marrow biopsy ,if required. The demographic characteristics of patients and WHO criteria for Hb level was noted on the specifically designed study proforma. A blood sample was drawn and was sent to hospital laboratory for analysis of related causes of severe anemia. The collected data was entered and analyzed using SPSS software version 17.0. Results of the Study: The mean age of patients was 30.41 ± 18.60 months with minimum and maximum age as 1 and 60 months. There were 169(46.3%) boys and 196(53.7%) girls with slightly higher female to male ratio. The mean Hb level was 5.15 ± 1.06 g/dL with minimum and maximum Hb as 3.40 and 6.90 g/dL. The common causes of anemia were assessed that showed 232(63.6%) patients had iron deficiency, 7(1.9%) cases had Sickle cell anemia, 37(10.1%) cases had Septicemia and 89(24.4%) cases had malaria Conclusion: According to the findings of current study, the common causes of severe anemia in local children are found to be, iron deficiency anemia in 232(63.6%) cases, Sickle cell anemia in7(1.9%) cases ,septicemia in 37(10.1% ) cases and malaria in 89(24.4%) cases. So during clinical evaluation of patients it must be kept in mind that these factors can contribute to severe anemia. So, preventive and therapeutic strategies must be ensured to minimize the risk of severe anemia in these children Keywords: Anemia, Prevalence, Nutritional status, Risk factors, malaria, iron deficiency, Septicemia, sickle cell anemia

Introduction: Iron is the most prevalent nutrient deficiency in infants and young children around the world despite its importance for healthy brain development. Infants who drink whole cow's milk or other animal milks are at a greater risk of developing iron deficiency anaemia. In our culture, cow's milk consumption is widespread. There were no local studies available on iron deficiency anemia in infants using different types of milk so need for the present study was felt. Objectives: The objectives of this study were to determine the frequency of exclusively breastfed and cow’s milk fed infants at 3 month of age and to compare the frequency of iron deficiency anemia in exclusively breastfed and cow’s milk fed infants. Study Design: It was a cross-sectional study. Setting and Duration: Research was conducted at the Medical Outpatient Department of The Children’s Hospital and The Institute of Child Health Lahore from 08/02/2022 to 07/08/2022. Material and Methods: This study involved 220 infants of both genders at 3 months of age presenting for vaccination. Outcome variables were frequency of exclusive breast feeding and iron deficiency anemia. All patients' guardians signed an informed consent form. Results: There were 115 (52.3%) male and 105 (47.7%) female patients in the study group. The Hb of the patients ranged from 7.6 g/dl to 14.5 g/dl with a mean of 11.00±1.98 g/dl while the serum iron level ranged from 41 µg/dl to 115 µg/dl with a mean of 67.94±22.99 µg/dl. Majority of the parents (56.4%) belonged to poor class and 46.4% mothers were illiterate. The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was higher among infants on cow’s milk (37.7% vs. 22.2%) as compared to those on exclusive breast feeding however the observed difference was statistically insignificant (p=0.051). Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Conclusion: The frequency of exclusive breastfed infants was 45 (20.5%). There was no significant difference in the frequency of exclusive breast feeding across gender (p=0.873), socioeconomic (p=0.900) and educational (p=0.858) status. 76 (34.5%) Infants had iron deficiency anemia. The frequency of iron deficiency anemia was insignificantly higher among infants on cow’s milk (37.7% vs. 22.2%; p=0.051) as compared to those on exclusive breast feeding. Similar insignificant difference was observed across gender, socioeconomic and educational status groups. Keywords: Exclusive Breast Feeding, Cow’s Milk Feeding, Iron Deficiency Anemia

Objective: To find frequency of Hypocalcemia in infants of diabetic mothers within 24 hours of life. Study Design: It was a cross-sectional study. Study Duration: The study was conducted at paediatric department of Ittifaq hospital Lahore from April 12, 2018 till Oct 12, 2019. Material and Methods: A total of 260 cases after getting approval of synopsis were taken from Neonatal ward after delivery from Ittifaq hospital Lahore. All neonates fulfilling / meeting inclusion criteria were assessed for hypocalcaemia. Their basic history like age (hours), gender, gestational age, birth weight and baseline calcium level were noted. Venous blood was taken for analysis of calcium level and hypocalcaemia was labeled as per operational definition. Results: The mean age of infants was 11.92 ± 6.66 hours with minimum and maximum age as 1 and 24 hours. There were 137(52.7%) male and 123(47.3%) female cases, with higher male to female ratio. The mean gestational age was 39.48 ± 1.68 weeks with minimum and maximum gestational age as 37 and 42 weeks. The mean birth weight was 3193.99 ± 404.12 g with minimum and maximum birth weight as 2500 and 3892 grams. A total of 67(25.8%) neonates had hypocalcaemia while 193(74.2%) neonates had normal calcium level. Practical implication: This study was done to determine the frequency of neonatal hypocalcemia among infants with maternal hypocalcemia due to the lack of data, especially at the local level. If diagnosed early, they can begin treatment right away, which could reduce their mortality and morbidity in our region of the world. Conclusion: Through the findings of this study, it is concluded that, almost a quarter i.e. 25.8% neonates had hypocalcaemia that is considerably high percentage. So, infants born to diabetic mothers should be screened for hypocalcaemia to minimize the risk of related complications like seizure and loss of consciousness etc. Keywords: Pregnancy, diabetes mellitus, gestational diabetes mellitus, calcium level, hypocalcaemia

Introduction: Acute gastroenteritis-related diarrhea is a major contributor to pediatric morbidity and mortality. Although the success of various oral rehydration formulations varies and the treatment of choice ultimately depends on the underlying reason, oral rehydration remains crucial for efficient early therapies. Objective: To compare outcome of Glucose ORS with and without rice based ORS in treatment of acute gastroenteritis from 6 month to 5 years in terms of mean stool frequency. Study Design: Randomized clinical trial Settings: The study will be done at department of Peads Ittifaq Hospital Lahore from 9 December 2018 to 19 June 2019. Sample Technique: Non probability consecutive sampling Methodology: Children of both sexes were included in this analysis of gastroenteritis cases between the ages of 6 months and 5 years. They divided into two separate groups. For 48 hours, group A was given G-ORS, whereas group B was given rice soup. Over the course of 48 hours, the typical individual needs to use the washroom. Results: Eighty people took part in the study (forty in each group). There were 25 males in Group A (40.02%), and 26 in Group B (50.98%). The average ages of those in Group A and Group B were very comparable (3.30±1.18 vs. 2.07±1.03 years, p=0.29). The baseline stool frequency of Group A was 4.11±2.33, while that of Group B was 5.01±2.81 (p= 0.51). Group A also had a higher mean weight, at 6.87±1.97, than Group B, at 6.28±2.01. Group A had an average of 2.15±0.77 bowel movements in 48 hours, while Group B had an average of 2.08±0.73 (p=0.91). The mean frequency was 2.170.78 for males, 2.14±0.69 for females, and 2.11±0.72 for both sexes combined (p=0.91). There were no statistically significant differences in age, BMI over 10, or baseline frequency. Practical implication: The purpose of this research was to more exactly explain the authentic benefit of rice-based ORS in comparison to glucose ORS and to evaluate whether or not there is significant differences. Conclusion: Both groups reduced the number of incidences of the confounding variable roughly at the same rate, and there was no statistically significant difference between them either in terms of that reduction or in terms of stratification of any of the study's other confounding variables. Keywords: G-ORS, Gastroenteritis, Stool frequency, Rice soup