No abstract

The prevalence of metabolic disorders in Nepal is yet unknown, although many case reports occur in literature. Heel-prick blood samples from newborns were collected on Dried Blood Spot (DBS) collection cards and tested through Tandem Mass Spectroscopy and fluorescence assays for disorders included in the Swiss neonatal screening program; two cases of hypothyroidism and one case of cystic fibrosis were identified. Thyroid stimulating hormone (TSH), immuoreactive trypsinogen (IRT), hydroxyprogesterone (OHP), tyrosine (Tyr), and octanoylcarnitine (C8) showed significant differences with gestation age. Most of the parameters were positively correlated with each other except galactose, galactose 1 phosphate uridyl transferase (GALT), and biotinidase. First and ninety-ninth percentiles in the Nepalese newborns were found to be different when compared with the Swiss newborns. Congenital hypothyroidism and cystic fibrosis are candidates to be considered for a newborn screening program in Nepal. Differences between the Nepalese and Swiss newborns in parametric values that change with gestation age can be attributed to a higher survival rate of pre-term babies in Switzerland. Others could be explained in part by early and exclusive breastfeeding in Nepalese newborns.

Objective?The objective of this study was to determine the diagnostic validity of digital chest auscultation to improve the differentiation of chest sounds associated with pneumonia in children. Methods?This is a prospective case?control study at two hospitals in Nepal. Cases had World Health Organization-defined pneumonia and were classified as radiologically confirmed or nonconfirmed based on radiographic findings. Controls had no respiratory complaints. The presence of crepitations in recorded lung sounds defined pneumonia. Radiologically confirmed pneumonia was the reference standard. Results?Sensitivity and specificity of digital auscultation were 56% (95% confidence interval [CI], 40?70%) and 73% (95% CI, 70?76%), respectively. Conclusion?Digital auscultation in conjunction with standardized grading of digital lung sounds has the potential to improve the specificity of pneumonia diagnosis, but further development of objective interpretation of lung sounds is needed.

Introductions:In most children aged 1-36 months, the cause of a febrile illness is a self limiting viral infection. It is very difficult to distinguish these from serious bacterial infection. Objective of this study is to assess the efficacy of the Yale Observation Scale (YOS) to detect serious bacterial infection in febrile children aged 1-36 months.

Introduction: Neonatal sepsis is one of the leading causes of mortality worldwide. Knowing the association of thrombocytopenia to the specific organism can help to choose the correct antibiotic before a culture sensitivity report becomes available. Hence, this study was planned to find out if thrombocytopenia is associated with any specific type of organism in neonatal sepsis and higher mortality. Method: It was a retrospective observational study done at the neonatal intensive care unit at Patan Hospital. The samples were taken over three years, from April 2018 to March 2021. All culture-positive sepsis within the study period were included. The cases whose files were missing were excluded. Neonatal sepsis was defined as cases where a blood culture was positive for the organism. The data was analyzed using SPSS 16. Result: There were 51 cases whose analysis was done. Klebsiella 25(49.02%) and Acinetobacter 11(21.57%) were the most common organisms. Fifty-nine percent of cases had thrombocytopenia among which 5(10%), 6(12%), and 19(37%) had mild, moderate, and severe thrombocytopenia, respectively. Klebsiella sepsis was significantly associated with thrombocytopenia (p-value 0.001). The sensitivity of Klebsiella to Meropenem and Colistin was 70% and 100% respectively. Mortality was not associated with thrombocytopenia. Conclusion: In the study, thrombocytopenia was associated with Klebsiella sepsis in neonates. Hence, in thrombocytopenic patients with clinical suspicion of sepsis, proper antibiotics to cover Klebsiella should be started empirically till a blood culture report becomes available.

Introduction: Nepal is one of the countries which has been hit hard by the COVID-19 pandemic and has resulted in high morbidity and mortality across all age groups including neonates. There has been a paucity of studies regarding maternal to neonatal COVID-19 transmission and the published studies also have a poor sample size to reach any definite conclusion. Hence this study was carried out to see the clinical profiles of neonates born to COVID-19 mothers. Methods: It was a descriptive cross-sectional study. The study was conducted at a tertiary care centre over the period of one year from April 2020 to March 2021 after taking ethical clearance from the Institutional Review Committee with reference number drs2105211526. Convenient sampling was done. All neonates born to COVID-19 positive mothers who were diagnosed by a real-time polymerase chain reaction of the nasopharyngeal swab during the time of delivery were included in the study. Data analysis was done using Statistical Package for Social Sciences 20 using appropriate tools. Results: A total of 105 babies born to COVID-19 positive mothers who were tested for COVID-19 infection were included in the study. Ten (9.5%) (3.89-15.10 at 95% Confidence Interval) of neonates born to COVID-19 positive mothers were positive for the COVID-19 virus. All the neonates born to COVID-19 positive mothers were discharged home except one case who had other comorbidities. Fever was present in four (40%) of COVID-19 positive neonates. Conclusions: There is a possibility of vertical transmission of coronavirus in neonates although the outcome is favourable.

Introduction: Paediatric surgical cases has been operated by general surgeon due to lack of paediatric surgeons. Complex cases in neonates and infants is being referred to other centres with paediatric surgical services. This study aims to compare the spectrum of paediatric surgical cases and their outcome before and after availability of paediatric surgeon. Method: This is the Retrospective study conducted at Patan Academy of Health Sciences over a period of 4 years. Group 1 included surgeries during 1st 2 y before and Group 2 during 2nd 2 y period after the availability of paediatric surgeon. Ethical approval was obtained. Patient age, sex, diagnosis, operative procedure, type of surgery and outcome data were collected from operative theater register and patients file from medical record section. Data analysis was done using SPSS 16. Result: Among 1157 cases, 369 cases were in group 1 and 788 in group 2. Male to female ratio was 2.8:1. Laparotomy 270(23.2%) was the most performed inpatient surgery and hernitomy 221(19.1%) in day care. There was total 52(4.5%) neonates, 2(4%) in group 1 and 50(96%) neonates in group 2. Among total cases mortality rate was 8(0.7%) in group 2, due to preterm birth, delayed presentation and septicemia. Conclusion: Lower GI tract and skin and soft tissue were most common system involved. Laparotomy and incision and drainage were most performed surgery before and after availability of paediatric surgeon. There was 96% increment in neonatal cases (50 v/s 2) after availability of paediatric surgeon. Mortality was 8(0.7%) in group-2 due to delayed presentation and septicemia.

Introduction: Children present with different renal diseases with variations according to different geographic locations. This study aims to determine the trend of pediatric renal disease presenting. Method: This retrospective study from pediatric nephrology clinic register during 2008 to May 2018 at Patan Hospital, Patan Academy of Health Sciences, Nepal to analyze the changing pattern of renal disease. The prevalence and characteristic of renal diseases were compared between the 1st and 2nd 5-y period, the age at presentation and gender was analyzed. Mean age at presentation was analyzed by independent t-test,  a p-value <0.05 was considered significant. The study was approved by the ethical committee. Result: A total of 352 children visited the nephrology clinic, male:female ratio 1.42:1,  mean age 6.25±4.5 y, the majority in 0-5 y. Congenital anomalies of the kidney and urinary tracts (CAKUT) were 39%, mostly vesicoureteral reflux. Acute glomerulonephritis and the nephrotic syndrome were seen in 32.7% and 23.6%. Children <5 y of age presented with CAKUT while ≥5 y with acute glomerulonephritis. The mean age at presentation for CAKUT was 2.9±3 y and acquired diseases 8.46±3.91 y, p-value<0.05; and for glomerulonephritis 9.8±2.91 y and nephrotic syndrome 6.91±4.08 y, p-value<0.05. Conclusion: There was a decrease in the number of children visiting the nephrology clinic. Children <5 y presented with CAKUT while ≥5 y had acquired conditions. Children with acute glomerulonephritis were of a higher age than children with nephrotic syndrome.