Introduction: Urinary tract infection is one of the commonest causes of childhood morbidity. Earlydiagnosis and appropriate choice of antimicrobials is essential. Hence, this study aims to identify theprevalence of Escherichia coli in childhood urinary tract infections. Methods: This was a hospital based descriptive cross-sectional study conducted in Nobel MedicalCollege, Biratnagar over a period of one year. A total of 163 cases aged 1-15 years were included andclinical profile, laboratory reports including bacterial isolates in urine cultures and their sensitivitypatterns were documented. Results: The prevalence of Escherichia coli is 45 (53.57%) C.I. Escherichia coli was the most commonorganism isolated in bacterial cultures followed by Klebsiella 12 (14.29%), Enterococcus 10 (11.90%).Urinary tract infection was common among females with male: female ratio of 1:2.3. Fever 152(93.2%) and abdominal pain 113 (69.3%) were the most common presenting symptoms. Escherichiacoli was found most sensitive to Nitrofurantoin 43 (95.5%) followed by Ciprofloxacin 41 (91.1%) andAmikacin 40 (88.8%). Conclusions: Urinary tract infections in childhood require prompt attention and treatment to preventsignificant morbidity and mortality. From this study it can be concluded that Escherichia coli is oneof the most common isolates in urine culture and Aminoglycosides and Fluoroquinolones can beaccepted as empirical treatment regimens for childhood Urinary tract infections.

Introduction: Thrombocytopenia is a clinical condition characterized by decrease in number of platelets below the normal range. It is associated with bleeding tendency, hemodynamic instability, impaired inflammatory process and thus affecting host defence mechanism. There has been only few studies published till date in pediatric intensive care units suggesting thrombocytopenia is associated with increased mortality. Objectives: To determine the prevalence of thrombocytopenia in the critically ill children and its relationship with mortality in Pediatric intensive care unit (PICU) admitted children. Methodology: A prospective observational study was performed over a period of 12 months on 102 critically ill children admitted in PICU who fulfilled the criteria. Two patients left the study due to financial problems and as outcome could not be assessed on them, they were excluded from the study. Platelet count was noted at the time of admission and consecutively for the initial four days at PICU. Thrombocytopenia was defined as platelet count less than 150/nL. Mortality in PICU was recorded as primary outcome. Results: The prevalence of thrombocytopenia during consecutive 4 days was 34% (n=34) and at the time of admission in PICU was 16% (n=16) among 100 children analysed in the study. The mortality in the PICU was 27% (n=27). Mortality among thrombocytopenic children was 61.7% (n=21) as compared to 7.6% (n=5) in non-thrombocytopenic children (p=<0.001). Mortality was 18 times more for those who were thrombocytopenic at the time of admission as compared to those who subsequently developed thrombocytopenia during course of stay in PICU. Conclusion: Thrombocytopenia has significant association with increased mortality. Thrombocytopenic children at the time of admission have more likelihood of mortality than nonthrombocytopenic children in intensive care units.

Background: Bronchiolitis is an acute, highly communicable lower respiratory tract infection. A variety of agents ranging from nebulised racemic epinephrine, salbutamol and routinely available levoepinephrine have been tried. The Present study was aimed at comparing the effectiveness of adrenaline and salbutamol in acute bronchiolitis in children aged 2 months to 2 years. Materials and Methods: The Present study was conducted at Nobel medical College Teaching Hospital over the period of one year from Feb 2018 to Jan 2019. Two different cohorts were identified in which clinically diagnosed cases and were grouped into Group A and Group B to receive the different drugs as per the study protocol. Respiratory Distress Assessment Instrument (RDAI) Scores was used for clinical assessment. Results: The age of the patients ranged from 2 months to 24 months with a median of 8 months. The males constituting about 57.42% of the study population of 155 patients. On comparing the prenebulisation variables with 10 and 30 minutes post nebulisation values, it was found that Both adrenaline and salbutamol caused overall significant improvement in RR (p-value <0.00001 in both groups) except in the age group of 19-24 months. Adrenaline was seen to be superior to salbutamol in decreasing the RR (p<0.0001) except for children in the age group of 19-24months. Adrenaline also caused greater rise in heart rate in comparison to salbutamol in all age groups. Conclusion: This study concludes that Adrenaline was seen to be superior to salbutamol in decreasing the RR and RDAI, although it showed variance with age.

Background: Tuberculosis which is caused by Mycobacterium tuberculosis a chronic infectious disease is considered the second most common infectious cause of mortality and morbidity in children around the world. This study was carried out to test the validity of Crofton, Horne and Miller scoring system for the diagnosis of children suffering from tuberculosis. Materials and Methods: It was done in an inpatient ward of a pediatric tertiary referral centre, from Feb 2018 to Jan 2019as a prospective case control study, including 92 children aged 2 years to 12 years admitted with clinical differential diagnosis of tuberculosis. Among them 46 children meeting the case definition were taken as cases and 46 were age, sex and disease presentation matched controls. Results: Sensitivity of the score was low (50%) but the specificity was high (95%) with 92% positive predictive value and a negative predictive value of 65.67%. Contact with an adult suffering from tuberculosis, positive Mantoux test (>10mm in duration) were found to be the most important indicators of TB in children. Males were found to be affected twice as much as the females. Conclusion: From the findings of the study, it can be concluded that the Crofton, Horne, Miller score chart is a simple and cost-effective tool, which can be applied to improve the diagnosis of TB in children due to financial constraints faced by patients in resource limited countries like Nepal.

Introduction: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality especially in developing countries. The clinical signs and symptoms of neonatal sepsis are non specific and blood culture report is considered gold standard for confirmation of neonatal sepsis. Organisms and their sensitivity pattern vary from place to place. The confirmation of diagnosis and management of neonatal sepsis is challenging and time consuming.Objective: The aim of this study was to find incidence of blood culture proven sepsis in suspected early onset neonatal sepsis, find out sensitivity pattern of isolated organism and to find association of risk factors and clinical signs and symptoms with blood culture proven sepsis.Methodology: Prospective study was conducted in Nobel Medical College, Biratnagar from November 2016 to November 2017. Sample size was calculated to be 300 and blood culture was sent of each neonates admitted with suspected early onset neonatal sepsis before giving neonates with first dose of antibiotics and report of 72 hours was taken into consideration.Results: Out of 300 cases of suspected early onset neonatal sepsis 70.3% presented with lethargy, followed by other symptoms like poor feeding, respiratory distress, fever, hypothermia, feeding intolerance, abnormal body movement and abdominal distension. Low birth weight neonates, preterm neonates, prolonged duration of per vaginal leaking and low platelets count were significantly associated with blood culture proven sepsis in this study. Incidence of blood culture positive sepsis in suspected early onset neonatal sepsis was 27%. Coagulase negative Staphylococcus aureus(21%) was predominant organism isolated followed by Klebsiella Pneumonia, Pseudomonas, Escherichia coli. All of the isolated Klebsiella and Pseudomonas and 86% of Escherichia coli were found to be resistant to ampicillin. All isolated Coagulase negative Staphylococcus aureus were sensitive to vancomycin.Conclusion: Coagulase negative Staphyloccus aureus was predominant organism detected but majority of organisms were gram negative organisms. High resistance to ampicillin was found and cefotaxime was also less sensitive to isolated organism. Vancomycin was found to be sensitive to all isolated Staphylococcus aureus and coagulase negative Staphylococcus aureus. Amikacin was highly sensitive among causative organisms isolated. BJHS 2018;3(1)5 : 370-376

Background: Pneumonia is the main cause of death among children under five years of age particularly in developing countries. According to the WHO, there are more than 15 million cases representing 7-13% of pneumonia cases annually which necessitate hospital admission due to their severity. There is paucity of data regarding the clinical spectrum and the epidemiology of severe pneumonia from eastern part of Nepal. It is important to understand the clinical spectrum and the epidemiology of severe pneumonia at local level to better define problem and to draw inferences for management and policy formulation. Material and Methods: A hospital based retrospective observational study conducted at Department of Pediatrics and Neonatology, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal. One hundred and forty four cases with a diagnosis of severe pneumonia were studied over a period of one year. All the cases from 1 month to 5 years of age fulfilling the standard WHO case definition of severe pneumonia were included in the study. A pre-designed semi-structured questionnaire was used to obtain the clinical profile and investigations. Results: A total of 144 cases were studied and analyzed. The age range was from 1 month to 5 years. The mean age of the cases was 13.56 months. Majority of the cases belonged to age group of 1-6 months 40.27% (n=58). There was a male preponderance in our study comprising 58.3% (n=84) of males and 41.7% (n=60) of females. Fever and cough were the most common symptoms present in all cases, fever being present in 95.8% (n=136) cases and cough was present in 98.6% (n=142) cases. The most common radiological finding in our study was bronchopneumonia in 27.8% (n=40) cases followed by lobar pneumonia in 24.3% (n=35) cases and interstitial pneumonia in 18.8% (n=27) cases. Complications were present in 6.9% (n=10) cases and 22.2% (n=32) of the cases had no radiological abnormalities. Among the studied symptoms and signs of severe pneumonia, hurried breathing (p<0.001), wheeze (p=0.016), refusal of feeds (p=0.001), altered sensorium (p=0.006) and previous history of acute respiratory infections showed significant association with radiological abnormalities. Conclusion: Children of severe pneumonia presenting with fast breathing, wheeze, altered sensorium, refusal of feeding and past history of acute respiratory infections showed significant association with abnormal chest radiographs.

Introduction: Tuberculosis infection is very common, and it continues to be the major public health problem in Nepal. Published data about the epidemiology of TB in children is scarce in Nepal, though it is considered one of the most common causes of childhood morbidity in the country. Aims and objectives: To calculate the prevalence of tuberculosis in children aged 0-15 years and to study their clinico-laboratory profile. Methodology: This is a hospital based study conducted in Nobel Medical College Teaching Hospital, Biratnagar over a period of one year. We analyzed 289 children aged 0-15 years suspected of having tuberculosis on clinical grounds and subjected to further screening tests. Results: Majority of the children were males and most of the children were 5-15 years of age. 15 of the cases were diagnosed as tuberculosis out of which one case was bacteriologically confirmed pulmonary tuberculosis and be 5.2 %. Fever and cough were the most common clinical presentations and mantoux test and chest X-ray were most suggestive in majority of the cases. Conclusions: This study supports the use of history and thorough clinical examination and high index of clinical suspicion for diagnosis of childhood tuberculosis.