Search

Introduction: Nearly 60-80% of the term and preterm neonates are affected due to rise in bilirubin levels during early postnatal days, and causes readmission of the neonate sometimes with severe jaundice, which can be reduced if neonatal hyperbilirubinemia can be predicted early. The study was conducted to evaluate the predictive values of cord blood albumin and bilirubin for neonatal hyperbilirubinemia and to evaluate the better predictor between them. Method: In this hospital based observational study, 152 healthy term newborns with birth weight more than 2.5 kg were included. Assessment of cord blood haemoglobin, blood group, albumin and bilirubin levels was done. Follow-up for first consecutive five days after birth was done and assessed daily to look for evidence of jaundice, sepsis or any other illness. Serum bilirubin was evaluated at 72-96 hours of life in all neonates and was done early, if clinically indicated. Receiver’s Operating Characteristics curves were used for calculating the cut-off values of cord blood albumin and bilirubin in relation to hyperbilirubinemia. Result: The cut-off values obtained for albumin and bilirubin of cord blood was < 2.56 mg/dL and >2.33 mg/dL respectively at optimum sensitivity and specificity. Cord blood bilirubin was found to be highly sensitive for early recognition of significant neonatal hyperbilirubinemia as compared to cord blood albumin and can be used for screening purpose. Conclusion: Cord blood albumin and bilirubin can be used for negating the development of NNHB, but for screening purpose, cord blood bilirubin is more predictive of neonatal hyperbilirubinemia.

Introduction: With the advancement in neonatal care over the last two decades, neonatal mortality is decreased but simultaneously there is an increase in the adverse outcomes including neurodevelopmental abnormalities in the high-risk neonates. Purpose: To evaluate the association between cranial ultrasound findings and the clinical neurodevelopmental outcome among high-risk neonates at 12 months (corrected gestational age in preterm infants) and to assess the various perinatal risk factors associated with neurodevelopmental outcome. Material and Methods: 123 high-risk neonates admitted in NICU were enrolled. Cranial ultrasound was performed and morphology was noted. The neurodevelopmental assessment was done using DDST Test II at 12 months age and these neonates were labeled as normal or abnormal based on the findings. Association between the two non-parametric variables was seen using the Pearson Chi-square test. Results: There was a statistically significant association between clinical neurodevelopmental outcome and gestational age at birth; birth weight; Apgar score 0.05). The sensitivity of CUS was 89.2%, specificity 47.3%, positive predictive value 89.2%, and negative predictive value 47.3%. Conclusions: The neurodevelopmental outcome in high-risk neonates was associated with gestational age at birth; birth weight; Apgar score at 5 minutes; neonatal seizures and abnormal cranial ultrasound findings. The current study recommend the use of cranial ultrasound for the prediction of neurodevelopmental abnormalities especially in neonates with above risk factors.

Background: Diarrhoea is one of themajorkillerin under five years children worldwide. But accurate knowledge and practices about diarrheal diseases and use of ORS as an important tool in the mothers remain low. This cross sectional study was conducted to find out the level of knowledge and practices about diarrhoea and ORS in the mothers of under five children. Material and Method: This cross-sectional study was conducted in 8 randomly selected colonies of semi urban and urban area of Indore district in the year 2017. Mothers who had at least one child under five years of age with one episode of diarrhoeain the past were included in the study. Results: Most of the mothers (61.4%) knew right description for diarrhoea. But very few mother had knowledge about causes (23.6%) of diarrhoea. Verysmall number (26.81%) knew about all danger signs. Majority (91.8%) of mothers knew of ORS though only half 54.5% of them knew correct method of ORS preparation. 81.7% mothers had some knowledge about use of home based fluid. About one third of mothers knew about Zinc tablets (34.6%) and Rotavirus vaccine (37.3%). 44.7% of mother used ORS while 73.4% used home based fluids. Post diarrheal episode only 26.36% of mothers gave extra meal to the children. Conclusion: A strong association is found between knowledge and practices regarding diarrhoea management. Hence health education should be used as a tool to promote knowledge and good practices and reduce morbidity and mortality related to acute diarrhoea.

Introduction: Breast milk is planned for nursing young ones and therefore considered as nature’s most precious gift to humankind. However, despite strong evidences in support of breastfeeding, its prevalence has remained low worldwide. Objective: The objective of this study is to explore the knowledge, attitude, and perception toward breastfeeding among primigravida mothers and factors determining them. Materials and Methods: The study was conducted over 18 months on primigravida mothers admitted in postnatal care ward of tertiary care center of a medical college. Questionnaires were filled by mothers of newborns about various domains such as initiation of feeding, latching, maternal position during breastfeeding, prelacteal, colostrum, exclusive breastfeeding (EBF), and feeding at public places. Results: A total of 260 women aged 21–25 years were included in the study. Most of them were the housewives (81.5%), Hindu (95.4%), living in joint family (55.8%), and living in urban area (73.8%). About 90.4% initiated breastfeeding immediately after delivery and mothers have good knowledge on breastfeeding (81.1%). Mothers living in joint family had significantly more knowledge about the EBF and importance of colostrum. The source of their knowledge regarding breastfeeding was mostly medical staff (95.4%). Conclusion: The present study found that mothers had satisfactory knowledge regarding breastfeeding. Proper counseling and all level of support should be given to primigravida mothers, and breastfeeding practices can be increased by strengthening the existing program through media support and by removing social taboo regarding breastfeeding.

Background: The early childhood development is most crucial and the mother’s care and attention is essential. The inevitable changes like women entering the work field have an effect on the child care and development. This study was done with an objective to study the health profile and its determinants in children of working women by interrogating the mother regarding common health problems of their children, breast feeding practices and immunization coverage of the children. Methods: The data was collected through questionnaires that were named as the mother’s schedule and the child schedule, which consisted of close-ended questions which were coded for an easy data entry. The mother’s schedule looked at the information regarding the mother, like the caretaker during the mother’s absence, the time which was spent with her child each day, etc. The Child schedule looked for information like whether the child was exclusively breast fed, its age in months when the weaning started, whether the government sponsored creche services were utilized, etc. It also included the anthropometrical measurements of the child like its current weight, current height and mid arm circumference, which were obtained by using standardized tools. For each schedule, a separate table was created in a relational basis in MS access, with suitable key fields to connect the information for the analysis. Results: According to our study the major determinants of health of the children of working mother were type of family, family size, working hours of mother, type of mother’s work and substitute care provider in the absence of mother. The prevalence of most of the diseases was also high in nuclear families, when substitute care was provided by elder siblings, very large and very small family size, long working hours of mother and when mother was working as non-skilled and semiskilled worker. Conclusions: There is an adverse effect on the health of children those mothers are working.

Agenesis of the lung is an extremely rare congenital anomaly representing failure of development of the primitive lung bud. Here we are presenting a case of left lung agenesis with bicuspid aortic valve in a 17 year old girl who came with the complaints of backache only. The diagnosis was made on the basis of CECT and 2D Echocardiography. DOI: http://dx.doi.org/10.3126/jnps.v34i2.8792 J Nepal Paediatr Soc 2014;34(2):147-149

Background: Brainstem gliomas account for approximately 25% of all posterior fossa tumors. In pediatric age group, it constitutes about 10% of all brain tumors. Brainstem glioma is an aggressive and lethal type of malignancy with poor outcome despite all treatments. Aim: We studied the incidence and treatment outcome in pediatric patients with brainstem glioma depending on their tumor volume presenting in our institution in last 5 years. Brain tumors comprised 2.95% of all cancers and brainstem gliomas were 8% of all brain tumors. Materials and Methods: Nine pediatric patients were included in this analysis, who were treated with localized external radiotherapy 54–59.4 Gy along with temozolomide 75 mg/m2 during the whole course of radiotherapy. Results: The median survival in all these patients was 20 months and the overall 2 years survival is 44.4% (4/9). The median survival of patients with primary disease volume

Osteosarcoma (OS), the most common type of primary malignant bone tumor, is defined by the presence of malignant mesenchymal cells producing osteoid or immature bone. The peak incidence of the most frequent type of OS, i.e., high-grade central OS, occurs in the second decade of life during the adolescent growth spurt. Most patients suffer from the pain and swelling in the involved region and, usually, seek medical attention. Diagnosis is carried out by conventional radiographs, computed tomography, and magnetic resonance image (MRI). In addition, three-phase bone scans, thallium scintigraphy, dynamic MRI, and positron emission spectroscopy are new innovative promising tools. OS can be treated with surgery, radiotherapy, and chemotherapy. There is a clear need for newer effective agents for patients with OS, especially for patients who afflicted with metastatic and recurrence tumor. Monoclonal antibodies directed against OS may prove useful as treatment, either for drug delivery or for radiopharmaceuticals.

Here we are describing a case of neurofibromatosis1(NF1) with facial plexiform neurofibroma presenting as bilateral orbital ptosis. The patient had cafe au lait spots, freckling and plexiform neurofibroma. To the best of our knowledge only one case was reported in literature with bilateral ptosis in plexiform neurofibroma without any systemic features of NF1 from Ireland. No case has been reported with similar condition from India. Introduction: Neurofibromatosis I (Van Recklinghausen disease) is an autosomal dominant disease with incomplete penetrance and variable expression.Its incidence is about 1:3000 live births. Diagnostic criteria include: 1) Six or more cafe-au-lait spots, >5 mm in size in prepubertal and > 15 mm in postpuberal age group; 2) Two or more neurofibromas of any type or one plexiform neurofibroma; 3) Freckling of the axillary or inguinal regions (Crowes sign), 4) Optic glioma; 5) Two or more Lisch nodules; 6) Osseous lesions such as sphenoid dysplasia or thinning of cortex of long bones (with or without pseudoarthrosis); 7) First-degree relative (parent, sibling, offspring) with neurofibromatosisI. Diagnosis is made if two or more criteria are present[1].Plexiform neurofibroma though among one of the criteria of NF1, is itself very significant because of its tendency to grow, turn malignant and producing cosmetic as well as functional problems[2]. Case: A 14 year old male child presented to us with bilateral ptosis and not able to open eyes leading to visual handicap. He was IUGR with birth weight of 1.5 kg and had one month NICU stay. Since then parents noticed swelling over left half of the face involving left upper and lower eyelids.This swelling was growing keeping pace with the growth of the child. There was also very small swelling over right upper eyelid. He also had global developmental delay with all milestones achieved one to one and half year later than normal child. Patient had no history of headache, convulsion and hearing impairment. No other family member was having NF1. Figure 1 A: Clinical picture of patient showing plexiform neurofibroma with bilateral ptosis B:Cafe au lait spots and freckling on the back of patient On examination at present the patient was malnourished and stunted with no sign of puberty. General examination shows swelling over left half of face along with both eyelids, freckling over groin, axilla and whole trunk. Four big Cafe au lait spots measuring 6x4, 3x1, 5x3,3x2 cm size and multiple small cafe au lait spots of 0.5 to 1 cm were present at various parts of the body. The swelling of face was extending from left half of nose medially to left pinna laterally, superiorly involving left upper and lower eyelids, right upper eyelid and upper lip, causing disfigurement. The margins of swelling were indistinct, consistency was soft like “bag of worms” as described in literature and overlying skin was hyperpigmented. There was also dimple in the left pinna. There was malocclusion of teeth and persistence of deciduous teeth. There were no neurofibromas, lisch nodules or any bone deformity. MRI of patient was done which revealed moderate supratentorial hydrocephalous. Rest of brain parenchyma was normal. Sella was enlarged with non-visualization of anterior clinoid processes. Bilateral optic nerves were vertically tortutous but no evidence of tumor was present. There was evidence of retinal detachment of right eye. Ipsilateral lens also appears deformed and displaced. Ill-defined soft tissue thickening was also noted involving bilateral upper eyelids (right side> left side), left cheek, nasal vestibule and upper lip. A relatively defined nodular thickening was also noted in left masticular space. Patient underwent ptosis-correction surgery in both the eyes, retinal detachment surgery and lensectomy of the right eye. Since parents were not concerned for asthesis and no major functional impairment was present, so further treatment was deffered and decision to keep patient under regular six monthly follow up was taken. Histopathology of right lid swelling showed a firm nodule measuring 2.5x1x0.5 cm. Hematoxylin and Eosin sections showed features of a plexiform neurofibroma. An epidermoid cyst with heavy infiltration by chronic inflammation was also seen in surrounding soft tissue. No evidence of malignancy seen in the sections studied. This patient fulfilled three criteria for NF1and probably developed disease due to spontaneous mutation.